E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Macrophage activation syndrome / Secondary hemophagocytic lymphohistiocytosis (MAS/sHLH) in patients with Systemic Juvenile Idiopathic Arthritis (sJIA) or Adult-onset Still's Disease (AOSD) |
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E.1.1.1 | Medical condition in easily understood language |
A rare, life-threatening condition, characterized by uncontrolled hyper-inflammation on the background of a rheumatologic disease. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10053867 |
E.1.2 | Term | Macrophage activation syndrome |
E.1.2 | System Organ Class | 100000004870 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
• To describe the pharmacokinetic profile of emapalumab
•To confirm the proposed dosing regimen of emapalumab
•To evaluate the safety and tolerability profile of intravenous administrations of emapalumab
•To preliminary assess the efficacy of emapalumab
•To assess the levels of relevant pharmacodynamic biomarkers
•To assess other potential disease markers
•To assess the immunogenicity of emapalumab |
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
•Patients of both genders.
•Confirmed sJIA or high presumption of sJIA for patients presenting with MAS in the context of the onset of sJIA.
•AOSD patients: confirmed AOSD diagnosis as per Yamaguchi criteria
•Diagnosis of active MAS confirmed by the treating rheumatologist
•Patient presenting an inadequate response to high dose i.v. glucocorticoid treatment
•Tocilizumab, TNF inhibators and canakinumab, if administered, have to be discontinued before emapalumab initiation
•Informed consent provided by the patient (as required by local law), or by the patient’s legally authorized representative(s) with the assent of patients who are legally capable of providing it, as applicable. |
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E.4 | Principal exclusion criteria |
•Diagnosis of suspected or confirmed primary HLH or HLH consequent to a neoplastic disease.
•Active mycobacteria (typical and atypical), Histoplasma Capsulatum, Shigella, Salmonella, Campylobacter and Leishmania infections.
•Clinical suspicion of latent tuberculosis.
•Positive serology for HIV antibodies.
•Presence of malignancy.
•Receipt of a BCG vaccine within 12 weeks prior to screening.
•Receipt of live or attenuated live vaccines (other than BCG) within 6 weeks prior to screening. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Safety and tolerability:
•Incidence, severity, causality and outcomes of AEs (serious and non-serious), with particular attention being paid to infections.
•Evolution of laboratory parameters, in particular CBC, LFTs, inflammatory markers (ferritin and CRP) and coagulation parameters.
•Number of patients withdrawn from the study due to safety reasons.
Pharmacokinetics and pharmacodynamics:
•PK profile of emapalumab.
•Levels of circulating free IFNγ at predose, and total IFNγ after initiation of emapalumab.
•Levels of the main IFNγ-induced chemokines and other potential disease biomarkers.
•Levels (if any) of circulating antibodies against emapalumab to determine immunogenicity. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At multiple timepoints over 8 weeks |
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E.5.2 | Secondary end point(s) |
Efficacy:
•Number of patients achieving MAS remission by Week 8 after initiation of emapalumab treatment.
•Time to MAS remission.
•Number of patients for whom at any time during the study glucocorticoids can be tapered i) to the same (or lower) dose being administered before the occurrence of MAS ((in those patients who are already treated for the underlying condition) or ii) by 50% (or less) of the dose administered at emapalumab treatment start (in those patients who present with MAS at disease onset).
•Time to glucocorticoids tapering (as above described).
•Survival time.
•Number of patients withdrawn from the study due to lack of efficacy. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
At multiple timepoints over 8 weeks |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 6 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Canada |
France |
Italy |
Netherlands |
Spain |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 2 |