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    Clinical Trial Results:
    Safety and efficacy of Abatacept in patients with treatment-resistant sarcoidosis

    Summary
    EudraCT number
    2016-003360-39
    Trial protocol
    DE  
    Global end of trial date
    15 Feb 2021

    Results information
    Results version number
    v1(current)
    This version publication date
    03 Jun 2022
    First version publication date
    03 Jun 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    P001382
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    DRKS00011660: Deutsches Register Klinischer Studien
    Sponsors
    Sponsor organisation name
    Medical Center - University of Freiburg
    Sponsor organisation address
    Hugstetter Straße 55, Freiburg, Germany, 79106
    Public contact
    Leiter der Klinischen Prüfung, Universitätsklinikum Freiburg, +49 761270 37060, joachim.mueller-quernheim@uniklinik-freiburg.de
    Scientific contact
    Leiter der Klinischen Prüfung, Universitätsklinikum Freiburg, +49 761270 37060, joachim.mueller-quernheim@uniklinik-freiburg.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    31 Jan 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    15 Feb 2021
    Global end of trial reached?
    Yes
    Global end of trial date
    15 Feb 2021
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the safety of Abatacept in patients with treatment-resistant sarcoidosis, measured as number of infectious complications during treatment period.
    Protection of trial subjects
    A Data Monitoring Committee (DMC) was established to review safety data of part I of the study in order to monitor overall patient safety and to give a recommendation regarding the frequency of study visits for patients in part II of the study. A patient was able to withdraw from the study at any time, at his or her own request, for any reason (specified or unspecified) and without penalty or loss of benefits to which the patient is otherwise entitled.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    21 Feb 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 30
    Worldwide total number of subjects
    30
    EEA total number of subjects
    30
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    23
    From 65 to 84 years
    7
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Part I: included 6 patients monitored for therapy-associated complications. A Data Monitoring Committee decided on the frequency of study visits for part II patients based on safety data from part I patients. 1st meeting after visit 1(week 6) of last Patient part I. Part II study: another 24 patients: focus on efficacy and safety.

    Period 1
    Period 1 title
    Overall (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Abatacept
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Abatacept
    Investigational medicinal product code
    Other name
    Orencia
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Proprietary name: Orencia, Name of substance: Abatacept, Manufacturer: Bristol-Myers Squibb, Strength: 125 mg/syringe, Dose: 1x125 mg weekly, Dosage Form: Solution for injection: pre-filled syringe with a passive needle safety guard

    Number of subjects in period 1
    Abatacept
    Started
    30
    Completed
    24
    Not completed
    6
         Adverse event, serious fatal
    1
         Disease progression
    1
         Wish of patient
    2
         Stay in hospital due to ureterolithiasis
    1
         Lost contact
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall
    Reporting group description
    -

    Reporting group values
    Overall Total
    Number of subjects
    30 30
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    23 23
        From 65-84 years
    7 7
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    9 9
        Male
    21 21

    End points

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    End points reporting groups
    Reporting group title
    Abatacept
    Reporting group description
    -

    Primary: Severe infections

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    End point title
    Severe infections [1]
    End point description
    End point type
    Primary
    End point timeframe
    During observation period
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Single-arm trial. The primary analysis was performed in terms of an annual incidence rate, calculated as the number of infectious complications related to the duration of observation, both measures cumulated for all patients.
    End point values
    Abatacept
    Number of subjects analysed
    30
    Units: Number of severe infections
    1
    No statistical analyses for this end point

    Primary: Severe infections

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    End point title
    Severe infections [2]
    End point description
    End point type
    Primary
    End point timeframe
    During observation period
    Notes
    [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Single-arm trial. The primary analysis was performed in terms of an annual incidence rate, calculated as the number of infectious complications related to the duration of observation, both measures cumulated for all patients.
    End point values
    Abatacept
    Number of subjects analysed
    30
    Units: Incidence rate
        number (confidence interval 95%)
    0.0352 (0.0009 to 0.1959)
    No statistical analyses for this end point

    Secondary: Non-severe infections

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    End point title
    Non-severe infections
    End point description
    Number of patients who experienced non-severe infections under abatacept treatment.
    End point type
    Secondary
    End point timeframe
    During observation period
    End point values
    Abatacept
    Number of subjects analysed
    30
    Units: Number of patients
        0 infections
    8
        1 infection
    10
        2 infections
    5
        3 infections
    5
        4 infections
    2
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Complete study
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    22
    Reporting groups
    Reporting group title
    Abatacept
    Reporting group description
    Abatacept 125 mg

    Serious adverse events
    Abatacept
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 30 (20.00%)
         number of deaths (all causes)
    1
         number of deaths resulting from adverse events
    0
    Injury, poisoning and procedural complications
    Lower limb fracture
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Post procedural fever
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Ventricular fibrillation
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Trigeminal nerve disorder
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Ureterolithiasis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Abatacept
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    30 / 30 (100.00%)
    Vascular disorders
    Flushing
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Hot flush
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Surgical and medical procedures
    Inguinal hernia repair
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Fatigue
         subjects affected / exposed
    4 / 30 (13.33%)
         occurrences all number
    4
    Oedema peripheral
         subjects affected / exposed
    3 / 30 (10.00%)
         occurrences all number
    3
    Pain
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Pyrexia
         subjects affected / exposed
    4 / 30 (13.33%)
         occurrences all number
    4
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Dyspnoea exertional
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Oropharyngeal pain
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Pharyngeal erythema
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Rales
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Investigations
    C-reactive protein increased
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Hepatic enzyme increased
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Injury, poisoning and procedural complications
    Animal scratch
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Hand fracture
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Infusion related reaction
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Limb injury
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Rib fracture
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Cardiac disorders
    Cardiovascular disorder
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Diastolic dysfunction
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Tachycardia
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    2
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    3 / 30 (10.00%)
         occurrences all number
    3
    Headache
         subjects affected / exposed
    3 / 30 (10.00%)
         occurrences all number
    3
    Paraesthesia
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Syncope
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Ear and labyrinth disorders
    Ear pain
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Eye disorders
    Cataract
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Erythema of eyelid
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Gastrointestinal disorders
    Abdominal pain upper
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Aerophagia
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Constipation
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Diarrhoea
         subjects affected / exposed
    5 / 30 (16.67%)
         occurrences all number
    5
    Diarrhoea haemorrhagic
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Faeces soft
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Melaena
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Oral mucosal erythema
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Toothache
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Vomiting
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Acne
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Hand dermatitis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Rash
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    3 / 30 (10.00%)
         occurrences all number
    3
    Arthropathy
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Costochondritis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Intervertebral disc protrusion
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Musculoskeletal chest pain
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Osteoarthritis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Osteoporotic fracture
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Tenosynovitis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    6 / 30 (20.00%)
         occurrences all number
    7
    Cystitis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Influenza
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Nasopharyngitis
         subjects affected / exposed
    6 / 30 (20.00%)
         occurrences all number
    7
    Oral candidiasis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    2
    Oral herpes
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Periodontitis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Pulpitis dental
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Respiratory tract infection
         subjects affected / exposed
    4 / 30 (13.33%)
         occurrences all number
    5
    Scarlet fever
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Tonsillitis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences all number
    1
    Upper respiratory tract infection
         subjects affected / exposed
    7 / 30 (23.33%)
         occurrences all number
    10
    Urinary tract infection
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    5

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    13 Oct 2017
    Amendment was done to adapt the total amount of blood taken for laboratory testing, and to harmonize the protocol and the patient informed consent form (PIC) in this regard.
    17 Dec 2018
    Amendment was done primarily to clarify two inclusion criteria. With regard to pre-existing immunosuppressive treatment (inclusion criterion no. 5), it was specified that patients with (exactly) 5 mg prednisolone equivalent per day can also be included (“greater than” was replaced by “greater than or equal”), and that in case of additional immunosuppressive therapy, patients can be included irrespective of steroid dose. In inclusion criterion no. 6, the KSQ module was specified, as there is no total or generic KSQ score. Furthermore, disease progression was added as criterion for premature termination.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/32551397
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