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    Summary
    EudraCT Number:2017-000322-35
    Sponsor's Protocol Code Number:ACE-536-MF-001
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-01-20
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2017-000322-35
    A.3Full title of the trial
    A Phase 2, Multicenter, Open-Label Study to Evaluate the Efficacy and Safety of Luspatercept (ACE-536) in Subjects With Myeloproliferative Neoplasm-Associated Myelofibrosis and Anemia With and Without Red Blood Cell-Transfusion Dependence
    Studio di fase 2 per determinare l¿efficacia e la sicurezza di Luspatercept in soggetti con neoplasia mieloproliferativa associata a mielofibrosi e anemia con e senza dipendenza da trasfusioni di globuli rossi
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to evaluate the benefit and safety of Luspatercept (ACE-536) in adults with myeloproliferative neoplasm-associated myelofibrosis and anemia with and without red blood cell-transfusion dependence
    Studio per valutare il beneficio e la sicurezza di luspatercept (ACE-536) negli adulti affetti da mielofibrosi associata a neoplasia mieloproliferativa e anemia con o senza dipendenza da trasfusione di globuli rossi
    A.3.2Name or abbreviated title of the trial where available
    -
    -
    A.4.1Sponsor's protocol code numberACE-536-MF-001
    A.5.1ISRCTN (International Standard Randomised Controlled Trial) NumberISRCTN00000000
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT03194542
    A.5.3WHO Universal Trial Reference Number (UTRN)U1111-1197-1202
    A.5.4Other Identifiers
    Name:-Number:-
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorCELGENE CORPORATION
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportCelgene Corporation
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPPD
    B.5.2Functional name of contact pointPPD Project Manager
    B.5.3 Address:
    B.5.3.1Street AddressTorre Nozar, c/Tit¿n, 15, Mendez Alvaro
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28045
    B.5.3.4CountrySpain
    B.5.4Telephone number0034963314057
    B.5.5Fax number000000
    B.5.6E-mailrosa.ballester@ppdi.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLuspatercept
    D.3.2Product code [ACE-536]
    D.3.4Pharmaceutical form Lyophilisate for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLuspatercept
    D.3.9.1CAS number 1373715-00-4
    D.3.9.2Current sponsor codeACE-536
    D.3.9.3Other descriptive nameLUSPATERCEPT
    D.3.9.4EV Substance CodeSUB179621
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typenot less then
    D.3.10.3Concentration number37
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLuspatercept
    D.3.2Product code [ACE-536]
    D.3.4Pharmaceutical form Lyophilisate for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLuspatercept
    D.3.9.1CAS number 1373715-00-4
    D.3.9.2Current sponsor codeACE-536
    D.3.9.3Other descriptive nameLUSPATERCEPT
    D.3.9.4EV Substance CodeSUB179621
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typenot less then
    D.3.10.3Concentration number87
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Anemia associated with myeloproliferative neoplasm (MPN)-associated myelofibrosis
    Anemia associata a mielofibrosi associata a neoplasia mieloproliferativa (NMP)
    E.1.1.1Medical condition in easily understood language
    Anemia due to a bone marrow disorder resulting in abnormal production of blood cells
    Anemia causata da una malattia del midollo osseo che porta a una produzione anomala di globuli rossi
    E.1.1.2Therapeutic area Diseases [C] - Blood and lymphatic diseases [C15]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10028537
    E.1.2Term Myelofibrosis
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10074691
    E.1.2Term Post polycythaemia vera myelofibrosis
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10074689
    E.1.2Term Post polycythemia vera myelofibrosis
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10074690
    E.1.2Term Post essential thrombocythemia myelofibrosis
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10074692
    E.1.2Term Post essential thrombocythaemia myelofibrosis
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the efficacy and safety of luspatercept for the treatment of anemia in subjects with MPN-associated myelofibrosis with and without RBC-transfusion dependence.
    Valutare l'efficacia e la sicurezza di luspatercept nel trattamento di anemia in soggetti affetti da mielofibrosi associata a NMP con e senza dipendenza da trasfusione di RBC.
    E.2.2Secondary objectives of the trial
    - To evaluate the safety of luspatercept in MPN-associated myelofibrosis
    - To evaluate the effect of luspatercept in MPN-associated myelofibrosis:
    -- on the time to and duration of anemia response
    -- on frequency of RBC transfusions and transfusion dependence
    -- on symptom response improvement via the Myelofibrosis Symptom Assessment Form (MF-SAF) v4
    -- on health-related quality of life (HRQoL) via the EQ-5D-5L and Functional Assessment of Cancer Therapy - Anemia (FACT-An) questionnaires
    --on the changes in hemoglobin and mean hemoglobin increase
    --To evaluate population pharmacokinetics of luspatercept in subjects with MPN-associated myelofibrosis with and without RBC-transfusion dependence
    - Valutare la sicurezza di luspatercept nella mielofibrosi associata a NMP
    - Valutare l'effetto di luspatercept nella mielofibrosi associata a NMP:
    --sul tempo alla e sulla durata della risposta all¿anemia
    -- sulla frequenza delle trasfusioni di RBC e della dipendenza da trasfusione
    -- sul miglioramento della risposta dei sintomi attraverso il modulo di valutazione dei sintomi della mielofibrosi (MF-SAF) v4
    -- sulla qualità di vita correlata allo stato di salute (HRQoL) attraverso il questionario EQ-5D-5L e quello sulla valutazione funzionale della terapia tumorale - Anemia (FACT-An)
    --sulle variazioni dell'emoglobina e l'aumento medio dell'emoglobina
    - -Valutare la farmacocinetica di popolazione di luspatercept nei soggetti affetti da mielofibrosi associata a NMP con o senza dipendenza da trasfusione di RBC
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Subject is =18 years of age at the time of signing the informed consent form (ICF).
    2. Subject has MPN-associated myelofibrosis (PMF, post-PV MF, and/or post-ET MF) as confirmed from the local pathology report.
    3. Subject has anemia defined as:
    a. Cohorts 1 and 3A
    i. Obtain = 3 Hgb levels of = 9.5 g/dL recorded on = 3 different days,
    including the day of dosing, in the 84-day period immediately up to the C1D1 date. No subjects with an interval = 42 days between hemoglobin
    measurements will be enrolled.
    ii. There must not be any RBC transfusions within the 84-day period immediately up to the C1D1 date.
    b. Cohorts 2 and 3B
    i. Average RBC-transfusion frequency: 4 to 12 RBC units/84 days over at least the 84 days immediately up to the C1D1 date. There must be no interval > 56 days without = 1 RBC-transfusion.
    ii. Subjects must have a Hgb value of < 13 g/dL on C1D1 prior to luspatercept administration.
    iii. Only RBC transfusions given when the Hgb = 9.5 g/dL are scored in determining eligibility.
    iv. RBC transfusions given because of bleeding, infection, or chemotherapy-induced anemia are not scored in determining eligibility.
    4. Subject has an Eastern Cooperative Oncology Group (ECOG) performance score of = 2.
    5. Subject is not anticipated during the 6 months from the C1D1 date to receive a hematopoietic cell transplant.
    6. A female of childbearing potential (FCBP) for this study is defined as a female who: 1) has achieved menarche at some point, 2) has not undergone a
    hysterectomy or bilateral oophorectomy or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out
    childbearing potential) for at least 24 consecutive months (ie, has had menses at any time in the preceding 24 consecutive months). FCBP
    participating in the study must:
    a. Have 2 negative pregnancy tests as verified by the Investigator prior to starting study therapy. She must agree to ongoing pregnancy testing
    during the course of the study, and after end of study treatment. This applies even if the subject practices true abstinence from heterosexual
    contact.
    b. Either commit to true abstinence from heterosexual contact (which must be reviewed on a monthly basis and source documented) or agree
    to use, and be able to comply with, effective contraception without interruption, 28 days prior to starting investigational product, during the
    study therapy (including dose interruptions), and for 12 weeks (approximately 5 times the mean terminal halflife of luspatercept based on multiple-dose pharmacokinetics [PK] data) after discontinuation of study therapy.
    7. Male subjects must: a. Practice true abstinence (which must be reviewed on a monthly basis)
    or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential** while participating in the study, during dose interruptions and for at least 12 weeks (approximately 5 times the mean terminal half-life of luspatercept based on multiple-dose PK data) following investigational product discontinuation, even if he has undergone a successful vasectomy
    8. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted.
    9. Subject is willing and able to adhere to the study visit schedule and other protocol requirements.
    1. Il soggetto ha = 18 anni al momento della sottoscrizione del modulo di consenso informato (ICF).
    2. Il soggetto è affetto da mielofibrosi associata a NMP (PMF, MF post-PV, e/o MF post-ET) come confermato dal referto del laboratorio di patologia locale.
    3. Il soggetto è affetto da anemia definita come:
    a. Coorti 1 e 3A
    i. Raggiungimento di = 3 livelli di Hgb di = 9,5 g/dl registrati in = 3 giorni diversi, incluso il giorno di somministrazione, nel periodo di 84 giorni immediatamente successivo fino alla data di C1G1. Non sarà arruolato nessun soggetto con un intervallo = 42 giorni tra le misurazioni di emoglobina.
    ii. Non deve essere effettuata nessuna trasfusione di RBC entro il periodo di 84 giorni immediatamente successivo fino alla data di C1G1.
    b. Coorti 2 e 3B
    i. Frequenza media delle trasfusioni di RBC: da 4 a 12 unità di RBC/84 giorni per almeno 84 giorni immediatamente successivi fino alla data di C1G1. Non deve esserci nessun intervallo > 56 giorni senza = 1 trasfusione di RBC.
    ii. I soggetti devono presentare un valore di Hgb di < 13 g/dl il C1G1 prima della somministrazione di luspatercept.
    iii. Soltanto le trasfusioni di RBC effettuate nel momento in cui l’Hgb risulta = 9,5 g/dl vengono prese in considerazione ai fini della determinazione dell’eleggibilità.
    iv. Le trasfusioni di RBC effettuate a causa di sanguinamento, infezione o anemia indotta da chemioterapia non vengono prese in considerazione ai fini della determinazione dell’eleggibilità.
    4. Il Soggetto presenta uno stato di performance ECOG (Eastern Cooperative Oncology Group) di =2.
    5. Durante i 6 mesi dalla data di C1G1, non è previsto per il soggetto alcun trapianto di cellule ematopoietiche.
    6. Una donna in età fertile (FCBP) per il presente studio è definita come una donna che: 1) ha raggiunto il menarca in un dato momento, 2) non è stata sottoposta a isterectomia o a ooforectomia bilaterale oppure 3) non si trova in stato di post-menopausa naturale (l'amenorrea dovuta a terapia per il cancro non esclude la potenziale fertilità) da almeno 24 mesi consecutivi (ovvero ha avuto cicli mestruali in un momento qualsiasi dei precedenti 24 mesi consecutivi). Le FCBP che partecipano allo studio devono:
    a. Presentare due test di gravidanza negativi verificati dallo Sperimentatore prima di
    iniziare la terapia in studio. Accettare di sottoporsi a test di gravidanza continuativi nel corso dello studio e dopo la conclusione del trattamento dello studio. Questo si applica anche se il soggetto pratica astinenza totale dal contatto eterosessuale.
    b. Impegnarsi all'astinenza totale dal contatto eterosessuale (che deve essere riesaminata con cadenza mensile e documentata) o accettare di usare ed essere in grado di attenersi a un metodo di contraccezione efficace senza interruzione, 28 giorni prima di iniziare il trattamento con il prodotto sperimentale, durante la terapia in studio (incluse le interruzioni della dose) e per 12 settimane (circa cinque volte l'emivita terminale media di luspatercept sulla base di dati di farmacocinetica [PK] per dosi multiple) dopo l'interruzione della terapia in studio.
    7. I soggetti di sesso maschile devono:
    a. Praticare l'astinenza totale (che deve essere riesaminata con cadenza mensile) o accettare di utilizzare il preservativo durante il contatto sessuale con una donna in gravidanza o con una donna in età fertile** nel corso del periodo di partecipazione allo studio, durante le interruzioni della dose e per almeno 12 settimane (circa cinque volte l'emivita terminale media di luspatercept sulla base di dati di PK per dosi multiple) dopo l'interruzione del trattamento con il prodotto sperimentale, anche se sono stati sottoposti a intervento riuscito di vasectomia.
    8. Il soggetto deve comprendere e firmare volontariamente un ICF prima che sia effettuata qualsiasi valutazione/procedura correlata allo studio.
    9. Il soggetto intende ed è in grado di attenersi al programma di visite dello studio e agli altri requisiti del protocollo.
    E.4Principal exclusion criteria
    1. Subject use of hydroxyurea or other drugs with potential effects on hematopoiesis or ongoing adverse events from previous treatment = 112 days immediately up to the enrollment date.
    a. Systemic corticosteroids are permitted for non hematological conditions providing the subject is receiving a stable or decreasing dose for = 84 days immediately up to enrollment and is receiving a constant dose equivalent to = 10 mg prednisone for the 28 days immediately up to enrollment.
    2. Cohort 1 and 2 only: subjects treated with JAK2 inhibitors = 112 days immediately up to the enrollment date or if anticipated/substantial likelihood for subject to receive ruxolitinib within the first 168 days on
    the study.
    3. Cohort 3 only: subjects not receiving ruxolitinib:
    a.for at least 280 days (40 weeks) without interruptions exceeding 2 consecutive weeks;
    b. on a stable daily dose for at least 112 days (16 weeks) immediately up to the enrollment date as part of their standard-of-care therapy;.
    4. Subject use of ESAs or androgenic steroids = 112 days immediately up to the enrollment date.
    5. Initiation of iron chelation therapy (ICT) or change with ICT dose within = 112 days up to the enrollment date.
    6. Subject with anemia from iron deficiency, B12 and folate deficiencies, hemolytic anemia, infection, or bleeding.
    7. Pregnant or breastfeeding females.
    8. Subject with blood myeloblasts = 5%.
    9. Subject with major surgery within 8 weeks up to the enrollment date.
    Subject must have completely recovered from any previous surgery immediately up to the enrollment date.
    10. Subject with prior history of malignancies, other than disease under study, unless the subject has been free of the disease for = 5 years.
    However, subject with the following history/concurrent conditions is allowed:
    - Basal or squamous cell carcinoma of the skin
    - Carcinoma in situ of the cervix
    - Carcinoma in situ of the breast
    - Incidental histologic finding of prostate cancer (T1a or T1b using the tumor, nodes, metastasis [TNM] clinical staging system)
    11. Subj with prior therapy of luspatercept or sotatercept.
    12. Subj participation in any other clinical protocol or investigational trial that involves administration of experimental therapy and/or therapeutic devices within 30 days immediately up to the enrollment date.
    13. Subj with prior hematopoietic cell transplant.
    14. Subj with any of the following laboratory abnormalities:
    - Neutrophils < 1 x 10^9/L
    - Platelets
    i. Cohorts 1 and 2: < 25 x 10^9/L
    ii. Cohort 3A and 3B: < 50 x 10^9/L
    - Estimated glomerular filtration rate < 45 mL/min/1.73 m2 (via the 4-variable modification of diet in renal disease [MDRD] formula)
    - Aspartate aminotransferase (AST) or alanine transaminase (ALT) > 3.0 x upper limit of normal (ULN)
    - Direct bilirubin = 2 x ULN
    i. higher levels are acceptable if these can be attributed to active red blood cell precursor destruction within the bone marrow (ie, ineffective erythropoiesis)
    - Uncontrolled hyperthyroidism or hypothyroidism
    15. Subj with stroke, deep venous thrombosis, pulmonary or arterial
    embolism within 6 months immediately up to the enrollment date.
    16. Subject with diastolic blood pressure = 90 mmHg or systolic blood
    pressure = 140 mHg measured during the Screening Period despite appropriate treatment.
    17. Subj with inadequately controlled heart disease and/or have a
    known left ventricular ejection fraction <35%.
    18. Subj with history of severe allergic or anaphylactic reactions or
    hypersensitivity to recombinant proteins or excipients in the
    investigational product (see luspatercept IB).
    19. Subj with uncontrolled systemic fungal, bacterial, or viral
    infection (defined as ongoing signs/symptoms related to the infection
    without improvement despite appropriate antibiotics, antiviral therapy,
    and/or other treatment).
    20. Subj with human immunodeficiency virus (HIV), evidence of
    active infectious Hepatitis B (HepB), and/or evidence of active Hepatitis
    C (HepC).
    for the remaining refer to the synopsis
    1Utilizzo da parte del sogg di idrossiurea o di altri farmaci con potenziali effetti sull’ematopoiesi o eventi avversi in corso da trattamento precedente nei = 112 giorni immed precedenti la data di arruolamento.
    a. I corticosteroidi sistemici sono consentiti per le condizioni non ematologiche nel sogg che sta ricevendo una dose stabile o in diminuzione dai = 84 gg immed precedenti l’arruolamento e che sta ricevendo una dose costante equivalente a = 10 mg di prednisone dai 28 gg immed precedenti l’arruolamento.
    2. Soltanto per le coorti 1 e 2: sogg trattati con gli inibitori di JAK2 nei = 112 gg immed precedenti la data dell’arruolamento o probabilità prevista/significativa per i sogg di ricevere ruxolitinib entro i primi 168 giorni di partecipazione allo studio.
    3. Soltanto per la coorte 3: sogg che non ricevono una dose stabile di ruxolitinib
    a. da almeno 280 giorni (40 sett) senza interruzioni superiori a 2 settim consecutive;
    b. in trattamento con una dose giornaliera stabile da almeno 112 gg (16 sett) immed successivi fino alla data di arruolamento come parte della loro terapia standard di cura.
    4. Utilizzo da parte del sogg di ESA o steroidi androgeni nei = 112 giorni immediatamente precedenti la data dell’arruolamento.
    5. Inizio della terapia ferro-chelante (ICT) o passaggio alla dose ferro-chelante entro = 112 giorni fino alla data dell’arruolamento.
    6. Sogg affetto da anemia causata da mancanza di ferro e da carenza di vitamina B12 e folato, da anemia emolitica, infezione o sanguinamento.
    7. Sogg di sesso femminile in gravidanza o in allattamento.
    8. Sogg con mieloblasti nel sangue = 5%.
    9. Sogg sottoposto a intervento chirurgico importante entro 8 settimane fino alla data di arruolamento. Il soggetto deve essersi completamente ristabilito da qualsiasi precedente intervento chirurgico nel periodo immediatamente successivo fino alla data di arruolamento.
    10. Sogg con anamnesi precedente di tumori maligni diversi dalla malattia in studio, a meno che il sogg non presenti tracce di malattia da = 5 anni. Sono tuttavia ammessi i sogg con anamnesi/condizioni concomitanti seguenti:
    - Carcinoma della pelle a cellule basali o cellule squamose
    - Carcinoma cervicale in situ
    - Carcinoma mammario in situ
    - Riscontro istologico accidentale di cancro alla prostata (T1a o T1b usando il sistema di classificazione clinica di tumore, nodo, metastasi [TNM])
    11. Sogg sottoposto precedentemente a terapia con luspatercept o sotatercept.
    12. La partecipazione del sogg a qualsiasi altro protocollo clinico o studio di sperimentazione che coinvolge la somministrazione di terapie e/o dispositivi terapeutici sperimentali nei 30 gg immediatamente successivi fino alla data di arruolamento.
    13. Sogg che ha ricevuto precedent un trapianto di cellule ematopoietiche.
    14. Sogg con una delle seguenti anomalie nei valori di laboratorio:
    - Neutrofili < 1 x 10^9/l
    - Piastrine
    i. Coorti 1 e 2: < 25 x 10^9/l
    ii. Coorti 3A e 3B: < 50 x 10^9/l
    - Velocità di filtrazione glomerulare stimata < 45 ml/minuto/1,73 m2 (utilizzando la formula di modifica della dieta nella malattia renale [Modification of Diet in Renal Disease, MDRD] a 4 variabili)
    - Aspartato aminotransferasi (AST) o alanina aminotransferasi (ALT) > 3,0 x il limite superiore della norma (ULN)
    Bilirubina diretta = 2 x ULN
    i. Livelli più elevati sono accettabili se attribuibili a distruzione di precursori dei globuli rossi attiva all'interno del midollo osseo (ad es. eritropoiesi inefficiente)
    - Ipertiroidismo o ipertiroidismo non controllato
    15. Sogg con ictus, trombosi venosa profonda, embolia polmonare o arteriosa entro i 6 mesi immediat precedenti la data di arruolamento.
    16. Sogg con pressione arteriosa diastolica = 90 mmHg o pressione arteriosa sistolica = 140 mHg misurata durante il periodo di screening nonostante un trattam appropriato.
    17. Sogg con malattia cardiaca controllata in modo inadeguato e/o con frazione di eiezione ventricolare sinistra nota <35%.
    per i rimanenti riferirsi alla sinossi
    E.5 End points
    E.5.1Primary end point(s)
    1) Anemia response as it relates to hemoglobin (Hgb) increase
    2) Anemia response as it relates to increased red blood cell (RBC) – transfusion independence
    1) Risposta all’anemia correlata all’aumento di emoglobina (Hgb)
    2) Risposta all’anemia correlata all’aumento dell’indipendenza dalle trasfusioni di globuli rossi (RBC)
    E.5.1.1Timepoint(s) of evaluation of this end point
    1.) Cohorts 1 and 3A: Any consecutive "rolling" 84-day period from Day 1 through and including Day 168
    2.) Cohorts 2 and 3B: Any consecutive "rolling" 84-day period from Day 1 through and including Day 168
    1.) Coorti 1 e 3A: Qualsiasi periodo "a rotazione" consecutivo di 84 giorni dal primo giorno al giorno 168 compreso compreso
    2.) Coorti 2 e 3B: Qualsiasi periodo "a rotazione" consecutivo di 84 giorni dal primo giorno al giorno 168 compreso compreso
    E.5.2Secondary end point(s)
    1. Time to anemia response
    2. Duration of anemia response
    3. Frequency of RBC transfusions
    4. Frequency of RBC-transfusion dependence
    5. Proportion of subjects who achieve = 50% reduction in fatigue symptom as measured by the Myeloproliferative Neoplasm Symptom
    Assessment Form Total Symptom Score (MPN-SAF TSS)
    6. The proportion of subjects who achieve = 50% reduction in total
    symptom score (TSS)
    7. Health-related quality of life (HRQoL)
    8. Functional Assessment of Cancer Therapy ¿ Anemia (FACTAn)
    9. EQ-5D-5L questionnaires
    10. Adverse Events (AEs)
    11. Antidrug antibodies (ADA)
    12. Pharmacokinetic - AUC
    13. Pharmacokinetic - Cmax
    14. Changes in hemoglobin in the absence of RBC transfusions (Cohorts 1 and 3A)
    15 Mean hemoglobin increase
    1. Tempo alla risposta all¿anemia
    2. Durata della risposta all¿anemia
    3. Frequenza delle trasfusioni di RBC
    4. Frequenza della dipendenza dalle trasfusioni di RBC
    5. Percentuale dei soggetti che raggiungono = 50% della riduzione del sintomo di affaticamento misurato dal punteggio totale dei sintomi del modulo di valutazione dei sintomi della neoplasia mieloproliferativa (TSS MPN-SAF)
    6. Percentuale dei soggetti che raggiungono = 50% della riduzione del punteggio totale dei sintomi (TSS)
    7. Qualit¿ di vita associata alla salute (HRQoL)
    8. Valutazione funzionale della terapia tumorale ¿ Anemia (FACTAn)
    9. Questionari EQ-5D-5L
    10. Eventi avversi (AE)
    11. Anticorpi anti-farmaco (ADA)
    12. Farmacocinetica - AUC
    13. Farmacocinetica - Cmax
    14. Variazioni dei livelli di emoglobina in assenza di trasfusioni di globuli rossi (Coorti 1 e 3A)
    15. Aumento medio dell'emoglobina
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to 2 years
    2. Up to 2 years
    3. Up to 2 years
    4. Up to 2 years
    5. Up to 2 years
    6. Up to 2 years
    7. Up to 2 years
    8. Up to 2 years
    9. Up to 2 years
    10. Up to 2 years
    11. Up to 2 years
    12. Up to 1 year
    13. Up to 1 year
    14. Up to 2 years
    15. Any consecutive "rolling" 84-day period from Day 1 through and including Day 168; Day 1 through end of
    treatment
    1. Fino a 2 anni
    2. Fino a 2 anni
    3. Fino a 2 anni
    4. Fino a 2 anni
    5. Fino a 2 anni
    6. Fino a 2 anni
    7. Fino a 2 anni
    8. Fino a 2 anni
    9. Fino a 2 anni
    10. Fino a 2 anni
    11. Fino a 2 anni
    12. Fino a 1 anno
    13. Fino a 1 anno
    14. Fino a 2 anni
    15. Qualsiasi periodo “consecutivo” di 84 giorni, dal Giorno 1 fino al Giorno 168 incluso; Giorno 1 fino alla fine del trattamento
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Biomarkers
    Biomarcatori
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA12
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    United States
    France
    Italy
    United Kingdom
    E.8.7Trial has a data monitoring committee No
    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
    The End of Trial is defined as either the date of the last visit of the last subject to complete the Posttreatment Follow-up Period, or the date of receipt of the last data point from the last subject that is required for primary, secondary and/or exploratory analysis, as prespecified in the protocol, whichever is the later date.
    La fine studio è definita come la data dell'ultima visita dell'ultimo soggetto per completare il periodo di follow-up dopo-trattamento, piuttosto che la data di ricevimento dell'ultimo punto dei dati dell'ultimo soggetto che è richiesto per l'analisi primaria, secondaria e/o esplorativa, come prespecificato nel protocollo, qualsiasi sia la data più lontana.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years5
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years5
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 11
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 65
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state17
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 35
    F.4.2.2In the whole clinical trial 76
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Subjects will be treated according to normal standard of care. The Sponsor may end the trial when all key endpoints and objectives of the study have been analyzed, and the availability of a roll-over protocol exists into which any subjects remaining on study may be consented and continue to receive access to luspatercept and/or complete posttreatment follow up. Such a protocol would only be written for a compound that would not yet be commercially available.
    I soggetti saranno trattati col normale standard di cura. Lo Sponsor potrò concludere lo studio quando tutti gli endpoint e gli obiettivi principali dello studio saranno stati analizzati e vi sia la disponibilit¿ di un protocollo di rollover nel quale possano essere ammessi eventuali soggetti che restano nello studio continuando ad avere accesso a luspatercept e/o completando il follow-up post-trattamento. Tale protocollo sarebbe redatto solo per un composto non ancora disponibile in commercio.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2017-11-08
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-09-26
    P. End of Trial
    P.End of Trial StatusOngoing
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