E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Fibrodysplasia Ossificans Progressiva (FOP)
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E.1.1.1 | Medical condition in easily understood language |
FOP is a rare, severely disabling disease characterized by heterotopic ossification in muscles, tendons, and ligaments often associated with painful and recurrent episodes of soft tissue swelling. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Musculoskeletal Diseases [C05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10068715 |
E.1.2 | Term | Fibrodysplasia ossificans progressiva |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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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 evaluate the efficacy of palovarotene in decreasing heterotopic ossification (HO) in adult and pediatric subjects with FOP as assessed by low-dose, whole body computed tomography (WBCT), excluding head, as compared to untreated subjects from Clementia’s FOP natural history study over 24 months. • To evaluate the safety of palovarotene in adult and pediatric subjects with FOP.
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E.2.2 | Secondary objectives of the trial |
• To evaluate the effect of palovarotene on flare-up rate and proportion of subjects reporting at least one flare-up. • To evaluate the effect of palovarotene on range of motion (ROM) as assessed by the Cumulative Analogue Joint Involvement Scale for FOP (CAJIS). • To evaluate the effect of palovarotene on physical function using age-appropriate forms of the FOP-FOP-PFQ. • To evaluate the effect of palovarotene on physical and mental health using age-appropriate forms of the PROMIS Global Health Scale. • To evaluate the pharmacokinetics of palovarotene. Secondary Objective (Part B) • To continue to provide palovarotene to adult and pediatric subjects with FOP and to monitor longer-term safety. Secondary Objective (Part C): • To implement safety measures based on DMC recommendations in order to ensure that assessments of safety continue for up to 2 years post last dose of study treatment for skeletally immature subjects.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Subjects must meet all of the following criteria to be eligible for enrollment: 1. Written, signed, and dated informed subject/parent consent; and for subjects who are minors, age-appropriate assent (performed according to local regulations). 2. Male or female at least 4 years of age. 3. Previous participation in the NHS; or clinically diagnosed with FOP, with the R206H ACVR1 mutation or other FOP variants reported to be associated with progressive HO (who have not previously participated in any Clementia sponsored study); or participants in Study PVO 1A 202 or Study PVO-1A-204 who cannot currently receive the chronic/flare-up regimen due to country of residence or those traveling long distances to participate in the Phase 2 trial. 4. No flare-up symptoms within the past 4 weeks, including at the time of enrollment. 5. Females of child-bearing potential must have a negative blood or urine pregnancy test (with sensitivity of at least 50 mIU/mL) prior to administration of palovarotene. Male and FOCBP subjects must agree to remain abstinent from heterosexual sex during treatment and for 1 month after treatment or, if sexually active, to use two effective methods of birth control during and for 1 month after treatment. Additionally, sexually active FOCBP subjects must already be using two effective methods of birth control 1 month before treatment is to start. Specific risk of the use of retinoids during pregnancy, and the agreement to remain abstinent or use two effective methods of birth control will be clearly defined in the informed consent and the subject or legally authorized representatives (eg, parents, caregivers, or legal guardians) must specifically sign this section. 6. Must be accessible for treatment and follow-up, and be able to undergo all study procedures. Subjects living at distant locations from the investigational site must be able and willing to travel to a site for the initial and all on-site follow-up visits. Subjects must be able to undergo low-dose, WBCT (excluding head) without sedation. |
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E.4 | Principal exclusion criteria |
Subjects meeting any of the following criteria are not eligible for enrollment: 1. Weight <10 kg. 2. If currently using vitamin A or beta carotene, multivitamins containing vitamin A or beta carotene, or herbal preparations, fish oil, and unable or unwilling to discontinue use of these products during palovarotene treatment. 3. Exposure to synthetic oral retinoids other than palovarotene within 4 weeks prior to screening. 4. Concurrent treatment with tetracycline or any tetracycline derivatives due to the potential increased risk of pseudotumor cerebri. 5. History of allergy or hypersensitivity to retinoids, gelatin or lactose (note that lactose intolerance is not exclusionary). 6. Concomitant medications that are strong inhibitors or inducers of cytochrome P450 (CYP450) 3A4 activity; or kinase inhibitors such as imatinib (see Section 5.2.1). 7. Amylase or lipase >2x above the upper limit of normal (ULN) or with a history of chronic pancreatitis. 8. Elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >2.5x ULN. 9. Fasting triglycerides >400 mg/dL with or without therapy. 10. Female subjects who are breastfeeding. 11. Subjects with uncontrolled cardiovascular, hepatic, pulmonary, gastrointestinal, endocrine, metabolic, ophthalmologic, immunologic, psychiatric, or other significant disease. 12. Subjects experiencing suicidal ideation (type 4 or 5) or any suicidal behavior within the past month as defined by the Columbia-Suicide Severity Rating Scale (C-SSRS). 13. Simultaneous participation in another interventional clinical research study (other than palovarotene studies) within 4 weeks prior to Screening; or within five half-lives of the investigational agent, whichever is longer. 14. Any reason that, in the opinion of the Investigator, would lead to the inability of the subject and/or family to comply with the protocol.
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E.5 End points |
E.5.1 | Primary end point(s) |
The annualized change in new HO volume as assessed by low-dose, WBCT (excluding head) compared to untreated subjects from the NHS over 24 months. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Month 6, 12, 18 and 24 months (final analysis). It will also be evaluated in supportive analyses at 36 and 48 months. |
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E.5.2 | Secondary end point(s) |
1. The proportion of subjects with any new HO. 2. The change from baseline in the number of body regions with new HO. 3. The proportion of subjects reporting flare-ups. 4. The flare-up rate per subject-month exposure. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Month 6, 12, 18 and 24 months (final analysis). They will also be evaluated in supportive analyses at 36 and 48 months. |
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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 | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
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 | Yes |
E.8.1.7.1 | Other trial design description |
The trial has en external control (NHS study - untreated subjects) |
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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 | Yes |
E.8.2.3.1 | Comparator description |
The trial has en external control (NHS study - untreated subjects) |
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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
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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 | 5 |
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 |
Australia |
Argentina |
Brazil |
Canada |
Italy |
Japan |
Spain |
Sweden |
United Kingdom |
United States |
France |
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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 | 4 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |