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    Clinical Trial Results:
    A Randomized, Double-Blind, Placebo-Controlled Phase 2a Study to Evaluate the Efficacy and Safety of Tildrakizumab in Subjects with Active Ankylosing Spondylitis or Non-Radiographic Axial Spondyloarthritis

    Summary
    EudraCT number
    2016-003936-19
    Trial protocol
    HU   ES  
    Global end of trial date
    03 Sep 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    19 Dec 2020
    First version publication date
    19 Dec 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CLR_16_22
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Sun Pharma Global FZE
    Sponsor organisation address
    #43, Block Y, SAIF Zone, Sharjah, United Arab Emirates, 122304
    Public contact
    Shravanti Bhowmik, MD, Sun Pharmaceuticals Advanced Research Company Limited, +91 22 6645 5645, shravanti.bhowmik@sparcmail.com
    Scientific contact
    Shravanti Bhowmik, MD, Sun Pharmaceuticals Advanced Research Company Limited, +91 22 6645 5645, shravanti.bhowmik@sparcmail.com
    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
    03 Sep 2019
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    21 Feb 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    03 Sep 2019
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    Primary Efficacy Objective (Part 1) - To evaluate the efficacy of tildrakizumab in subjects with AS or nr-axSpA, as measured by the proportion of subjects achieving Assessment of SpondyloArthritis international Society (ASAS) criteria defined as ≥ 20% improvement in 3 of 4 assessment domains (ASAS20) response criteria at Week 24. Primary Safety Objective (Parts 1 and 2) - To assess the safety/tolerability and immunogenicity of multiple-dose administration of tildrakizumab in subjects with AS or nr-axSpA.
    Protection of trial subjects
    The trial and site activities were monitored according to the ICH-GCP guidelines considering every aspect of the trial, ensuring that the rights, safety and well-being of patients are protected and consistent with the Declaration of Helsinki.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    07 Feb 2017
    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
    Poland: 87
    Country: Number of subjects enrolled
    Spain: 5
    Country: Number of subjects enrolled
    Hungary: 4
    Country: Number of subjects enrolled
    United States: 5
    Worldwide total number of subjects
    101
    EEA total number of subjects
    96
    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)
    101
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    101 subjects with active AS were enrolled and randomized.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Investigator, Subject

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    SUNPG1622 I
    Arm description
    SUNPG1622 I dose: Injection
    Arm type
    Experimental

    Investigational medicinal product name
    SUNPG1622 I
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    SUNPG1622 I administered by Subcutaneous injections, every 4 weeks

    Arm title
    Placebo
    Arm description
    Placebo: Injection
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Placebo administered SC injection every 4 weeks

    Number of subjects in period 1
    SUNPG1622 I Placebo
    Started
    50
    51
    Completed
    42
    40
    Not completed
    8
    11
         Consent withdrawn by subject
    -
    1
         Adverse event, non-fatal
    -
    1
         Withdrawal by Subject
    6
    9
         Lost to follow-up
    2
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Study (overall period)
    Reporting group description
    -

    Reporting group values
    Overall Study (overall period) Total
    Number of subjects
    101 101
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    39.5 ( 10.10 ) -
    Gender categorical
    Units: Subjects
        Female
    24 24
        Male
    77 77

    End points

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    End points reporting groups
    Reporting group title
    SUNPG1622 I
    Reporting group description
    SUNPG1622 I dose: Injection

    Reporting group title
    Placebo
    Reporting group description
    Placebo: Injection

    Primary: Assessment of SpondyloArthritis International Society 20 Response Rates at Week 24

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    End point title
    Assessment of SpondyloArthritis International Society 20 Response Rates at Week 24
    End point description
    End point type
    Primary
    End point timeframe
    Week 24
    End point values
    SUNPG1622 I Placebo
    Number of subjects analysed
    50
    51
    Units: Number
        number (confidence interval 95%)
    74.00 (61.84 to 86.16)
    83.67 (73.32 to 94.02)
    Statistical analysis title
    Cochran-Mantel-Haenszel Analysis-ASAS20 Response
    Comparison groups
    SUNPG1622 I v Placebo
    Number of subjects included in analysis
    101
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.4439
    Method
    Cochran-Mantel-Haenszel
    Parameter type
    Difference (%)
    Point estimate
    -6.31
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -22.34
         upper limit
    9.71
    Variability estimate
    Standard error of the mean

    Secondary: Assessment of SpondyloArthritis International Society 20 Response Rates up to Week 24

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    End point title
    Assessment of SpondyloArthritis International Society 20 Response Rates up to Week 24
    End point description
    End point type
    Secondary
    End point timeframe
    Week 24
    End point values
    SUNPG1622 I Placebo
    Number of subjects analysed
    50
    49
    Units: Number
        number (confidence interval 95%)
    74.00 (61.84 to 86.16)
    83.67 (73.32 to 94.02)
    No statistical analyses for this end point

    Secondary: Assessment of SpondyloArthritis International Society 20 Response Rates

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    End point title
    Assessment of SpondyloArthritis International Society 20 Response Rates
    End point description
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    SUNPG1622 I Placebo
    Number of subjects analysed
    36
    47
    Units: number
        number (confidence interval 95%)
    88.89 (78.62 to 99.15)
    76.60 (64.49 to 88.70)
    No statistical analyses for this end point

    Secondary: The percentage of subjects who required adjustment of background therapy at Week 16 for the FAS

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    End point title
    The percentage of subjects who required adjustment of background therapy at Week 16 for the FAS
    End point description
    End point type
    Secondary
    End point timeframe
    Week 16
    End point values
    SUNPG1622 I Placebo
    Number of subjects analysed
    50
    51
    Units: number
        number (confidence interval 95%)
    2 (0.00 to 9.43)
    0 (0.00 to 9.43)
    No statistical analyses for this end point

    Secondary: The percentage of subjects who required adjustment of background therapy for the PPAS

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    End point title
    The percentage of subjects who required adjustment of background therapy for the PPAS
    End point description
    End point type
    Secondary
    End point timeframe
    Week 16
    End point values
    SUNPG1622 I Placebo
    Number of subjects analysed
    48
    44
    Units: number
        number (confidence interval 95%)
    1 (0.00 to 6.12)
    0 (0.00 to 6.12)
    No statistical analyses for this end point

    Other pre-specified: Assessment of SpondyloArthritis International Society 70 Response Rates at Measured Time Points

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    End point title
    Assessment of SpondyloArthritis International Society 70 Response Rates at Measured Time Points
    End point description
    End point type
    Other pre-specified
    End point timeframe
    Week 72
    End point values
    SUNPG1622 I Placebo
    Number of subjects analysed
    50
    51
    Units: number
        number (confidence interval 95%)
    33.33 (19.08 to 47.59)
    31.71 (17.46 to 45.95)
    No statistical analyses for this end point

    Other pre-specified: Assessment of SpondyloArthritis International Society Response Rates 5/6 at Measured Time Points

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    End point title
    Assessment of SpondyloArthritis International Society Response Rates 5/6 at Measured Time Points
    End point description
    End point type
    Other pre-specified
    End point timeframe
    Week 72
    End point values
    SUNPG1622 I Placebo
    Number of subjects analysed
    42
    41
    Units: numbeer
        number (confidence interval 95%)
    52.38 (37.28 to 67.49)
    39.02 (24.09 to 53.96)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Week 72
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20.1
    Reporting groups
    Reporting group title
    Part 1: SUNPG1622 or Placebo
    Reporting group description
    -

    Reporting group title
    Part 2: Treatment Follow-up (SUNPG16221 Dose Injection)
    Reporting group description
    -

    Reporting group title
    Part 3: Washout
    Reporting group description
    -

    Serious adverse events
    Part 1: SUNPG1622 or Placebo Part 2: Treatment Follow-up (SUNPG16221 Dose Injection) Part 3: Washout
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    1 / 101 (0.99%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Fibroadenoma of breast
         subjects affected / exposed
    0 / 101 (0.00%)
    0 / 101 (0.00%)
    1 / 101 (0.99%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pancreatic carcinoma metastatic
         subjects affected / exposed
    0 / 101 (0.00%)
    0 / 101 (0.00%)
    1 / 101 (0.99%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Crohn's disease
         subjects affected / exposed
    0 / 101 (0.00%)
    0 / 101 (0.00%)
    1 / 101 (0.99%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hyperplasia
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0.5%
    Non-serious adverse events
    Part 1: SUNPG1622 or Placebo Part 2: Treatment Follow-up (SUNPG16221 Dose Injection) Part 3: Washout
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    12 / 101 (11.88%)
    10 / 101 (9.90%)
    0 / 101 (0.00%)
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Blood creatine phosphokinase increased
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Weight increased
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    0
    1
    0
    Cardiac disorders
    Blood pressure increased
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    0
    1
    0
    General disorders and administration site conditions
    Hyperplasia
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    0
    1
    0
    Injection site erythema
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    0
    1
    0
    Injection site joint erythema
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    0
    1
    0
    Skin and subcutaneous tissue disorders
    Dermatitis allergic
         subjects affected / exposed
    1 / 101 (0.99%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    1
    1
    0
    Erythema
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Endocrine disorders
    Glucose tolerance impaired
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    0
    1
    0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    0
    1
    0
    Herpes simplex
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Pyrexia
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Sinusitis
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Upper respiratory tract infection
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Vaginal infection
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Metabolism and nutrition disorders
    Blood glucose increased
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    0
    1
    0
    Dyslipidaemia
         subjects affected / exposed
    1 / 101 (0.99%)
    0 / 101 (0.00%)
    0 / 101 (0.00%)
         occurrences all number
    1
    0
    0
    Hypercholesterolaemia
         subjects affected / exposed
    0 / 101 (0.00%)
    1 / 101 (0.99%)
    0 / 101 (0.00%)
         occurrences all number
    0
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    14 Jun 2017
    1. Allowance of subjects who failed to meet minimal response criteria at Week 16 to continue in Part 1 and 2 of the study, with the possibility for adjustment of background therapy at Week 16. 2. Amendment of primary and secondary endpoints to improve characteristics for the power of the study. 3. Revision of ASAS20, ASAS40, and ASAS70 definitions for clarification. 4. Addition of exclusion criteria regarding bilateral sacroiliac joint fusion and fused discovertebral units. 5. Addition of definition of stable dose for NSAIDs. 7. Addition of 2 stages to study to prioritize the development program for AS and nr-axSpA. 8. Addition of requirement that any non-drug therapy was stable for 4 weeks prior to IMP initiation.
    19 Mar 2018
    1. Added reference to LTE study throughout. 2. Correction of text describing the definition of minimal response. 3. Addition of text describing requirements for subjects taking low-potency opioids. 4. Clarification that measurement of height was only required once, at Screening. 5. Addition of high sensitivity CRP collection at Screening for subjects with non-radiographic axial spondyloarthritis. 6. Editorial and administrative changes implemented throughout the document.

    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
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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