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    The EU Clinical Trials Register currently displays   43974   clinical trials with a EudraCT protocol, of which   7311   are clinical trials conducted with subjects less than 18 years old.   The register also displays information on   18700   older paediatric trials (in scope of Article 45 of the Paediatric Regulation (EC) No 1901/2006).

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    EudraCT Number:2017-003114-10
    Sponsor's Protocol Code Number:NI-0501-09
    National Competent Authority:UK - MHRA
    Clinical Trial Type:EEA CTA
    Trial Status:GB - no longer in EU/EEA
    Date on which this record was first entered in the EudraCT database:2018-08-03
    Trial results View results
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    A. Protocol Information
    A.1Member State ConcernedUK - MHRA
    A.2EudraCT number2017-003114-10
    A.3Full title of the trial
    An Open-label, Single Arm, Multicenter Study to Broaden Access to Emapalumab, an Anti-Interferon Gamma (Anti-IFNγ) Monoclonal Antibody, and to Assess its Efficacy, Safety, Impact on Quality of Life, and Long-term Outcome in Pediatric Patients with Primary Hemophagocytic Lymphohistiocytosis
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study conducted in several Countries, to give access to emapalumab, and to study how efficacious and safe is in children with primary Hemophagocytic Lymphohistiocytosis (pHLH)
    A.4.1Sponsor's protocol code numberNI-0501-09
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT01818492
    A.5.4Other Identifiers
    Name:US IND numberNumber:111015
    A.7Trial is part of a Paediatric Investigation Plan Yes
    A.8EMA Decision number of Paediatric Investigation PlanP/358/2017
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorSwedish Orphan Biovitrum AG
    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 supportSwedish Orphan Biovitrum AG
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationSwedish Orphan Biovitrum AG
    B.5.2Functional name of contact pointMassimo Dapra
    B.5.3 Address:
    B.5.3.1Street Address10 Messeplatz
    B.5.3.2Town/ cityBasel
    B.5.3.3Post code4058
    B.5.4Telephone number+4161 2011 325
    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 Yes
    D.2.5.1Orphan drug designation numberEU/3/10/749
    D.3 Description of the IMP
    D.3.1Product nameEmapalumab
    D.3.2Product code NI-0501
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNEMAPALUMAB
    D.3.9.2Current sponsor codeNI-0501
    D.3.9.3Other descriptive nameFully human anti-interferon gamma monoclonal antibody
    D.3.9.4EV Substance CodeSUB188645
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    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. cell therapy medicinal product No
    D. therapy medical product No
    D. Engineered Product No
    D. ATIMP (i.e. one involving a medical device) No
    D. on Advanced therapies (CAT) has issued a classification for this product No
    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
    Primary Hemophagocytic Lymphohistiocytosis (pHLH)
    E.1.1.1Medical condition in easily understood language
    A rare, life-threatening condition affecting predominantly children. The disease is characterized by uncontrolled inflammation.
    E.1.1.2Therapeutic area Diseases [C] - Immune System Diseases [C20]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10071583
    E.1.2Term Haemophagocytic lymphohistiocytosis
    E.1.2System Organ Class 10021428 - Immune system disorders
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    • To gather additional safety and efficacy data on emapalumab in pHLH patients.
    E.2.2Secondary objectives of the trial
    • To assess a starting dose of emapalumab of 3 mg/kg.
    • To assess the impact of emapalumab on Quality of Life (QOL).
    • To gather additional evidence on the long-term outcome of pHLH patients treated with emapalumab.
    • To further evaluate the pharmacokinetic (PK) profile of emapalumab in pHLH patients.
    • To further evaluate the pharmacodynamic (PD) effects (levels of circulating Total Interferon Gamma (IFNγ) and biomarkers of its neutralization, namely CXCL9 and CXCL10).
    • To assess the profile of other relevant HLH biomarkers, e.g., sCD25 and other exploratory biomarkers.
    •To monitor for potential occurrence of anti-drug antibodies (ADAs).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Of note, the enrolment of patients will continue until emapalumab is commercially available for a given indication, or until sample size is reached, whichever comes first; thus, US enrolment will be limited to
    treatment-naïve patients. Male and female pHLH patients, from birth up to and including 18 years at diagnosis of HLH.
    2. A molecular diagnosis or familial history consistent with pHLH or fulfilment of HLH-2004 diagnostic criteria, i.e., five of the eight criteria below:
    - Fever
    - Splenomegaly
    - Cytopenias affecting 2 of 3 lineages in the peripheral blood (hemoglobin <90 g/L; platelets <100 x 109/L; neutrophils <1 x 109/L)
    - Hypertriglyceridemia (fasting triglycerides ≥3 mmol/L or ≥265 mg/dL) and/or hypofibrinogenemia (≤1.5 g/L)
    - Hemophagocytosis in bone marrow, spleen or lymph nodes, with no evidence of malignancy
    - Low or absent natural killer (NK)-cell activity
    - Ferritin ≥500 µg/L
    - Soluble CD25 (sCD25, i.e., soluble IL-2 receptor) ≥2400 U/mL.
    3. Presence of active HLH disease as assessed by the treating physician.
    4. Patients having already received conventional HLH therapy must fulfil one of the following criteria as assessed by the treating physician:
    - Having not responded
    - Having not achieved a satisfactory response
    - Having reactivated
    - Showing intolerance to previous conventional treatment of HLH.
    5. Informed consent signed 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.
    6. Having received guidance on contraception for both male and female patients sexually active and having reached puberty.
    Females of child-bearing potential require use of highly effective contraceptive measures (failure rate of less than 1% per year) from Screening until 6 months after receiving last dose of the study drug.
    Males with partner(s) of child-bearing potential must agree to take appropriate precautions (such as sexual abstinence, barrier contraception, vasectomy) to avoid fathering a child from Screening until 6 months after receiving last dose of study drug.
    E.4Principal exclusion criteria
    1. Diagnosis of secondary HLH consequent to a proven rheumatic, metabolic or neoplastic disease.
    2. Active mycobacteria, Histoplasma Capsulatum, Shigella, Salmonella, Campylobacter or Leishmania infections.
    3. Evidence of latent tuberculosis.
    4. Presence of malignancy.
    5. Patients who have another concomitant disease or malformation severely affecting cardiovascular, pulmonary, central nervous system (CNS), liver, or renal function that in the opinion of the Investigator may significantly affect the likelihood to respond to treatment and/or the assessment of emapalumab safety and/or efficacy.
    6. History of hypersensitivity or allergy to any component of the study regimen (e.g., polysorbate).
    7. Receipt of a bacille Calmette-Guerin (BCG) vaccine within 12 weeks prior to Screening.
    8. Receipt of a live or attenuated live (other than BCG) vaccine within 6 weeks prior to Screening.
    9. Pregnant or lactating female patients.
    E.5 End points
    E.5.1Primary end point(s)
    Primary efficacy endpoint:
    • Overall Response, i.e., achievement of either Complete or Partial Response or HLH Improvement, at End of Treatment (EOT) or Week 8 (whichever occurs earlier).
    E.5.1.1Timepoint(s) of evaluation of this end point
    See E.5.1
    E.5.2Secondary end point(s)
    Secondary efficacy endpoints:
    • Overall Survival, including survival to HSCT and survival after either HSCT or last emapalumab infusion (if HSCT is not performed)
    • Event-free Survival
    • Overall Response, i.e., achievement of either Complete or Partial Response or HLH Improvement, at start of conditioning (or at last emapalumab infusion if HSCT is not performed)
    • Duration of Response, ie, maintenance of response achieved any time during the study (with censoring time at start of conditioning for patients with no events)
    • Time to Response at any time during the study
    • Number of patients able to reduce glucocorticoids by 50% or more of baseline dose during emapalumab treatment
    • Number of patients able to proceed to HSCT, when deemed indicated
    • (QOL) indices.

    Safety endpoints:
    • Incidence, severity, causality and outcomes of AEs (serious and non-serious).
    • Evolutions of relevant laboratory parameters, e.g., complete blood cell (CBC) count, liver and renal function tests, and coagulation parameters.
    • Number of patients who discontinued emapalumab treatment for safety reasons.

    PK/PD Endpoints:
    • Serum concentrations of emapalumab to further evaluate emapalumab PK profile.
    • Determination of PD parameters (levels of circulating total IFNγ and markers of its neutralization, namely CXCL9 and CXCL10).
    • Determination of other relevant disease biomarkers, eg, sCD25 and other exploratory biomarkers.
    • Measurement of emapalumab concentrations and PD parameters in other matrices, eg, cerebrospinal fluid (CSF), bronchoalveolar lavage fluid (BALF), if clinically appropriate (exploratory).
    • Level (if any) of circulating antibodies against emapalumab (ADAs).

    E.5.2.1Timepoint(s) of evaluation of this end point
    See E.5.2.
    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 No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic Yes
    E.6.13Others No
    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. trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    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 Yes
    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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA15
    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 No
    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 Kingdom
    United States
    E.8.7Trial 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
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years4
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1Number of subjects for this age range: 33
    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) Yes
    F. of subjects for this age range: 2
    F.1.1.4Infants and toddlers (28 days-23 months) Yes
    F. of subjects for this age range: 18
    F.1.1.5Children (2-11years) Yes
    F. of subjects for this age range: 10
    F.1.1.6Adolescents (12-17 years) Yes
    F. of subjects for this age range: 3
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 1
    F.1.3Elderly (>=65 years) No
    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 Yes
    F. of subjects incapable of giving consent
    Newborns, infants and toddlers
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state10
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 31
    F.4.2.2In the whole clinical trial 41
    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)
    In case of HLH reactivation (eg transplant failure), the patient will be treated according to the standard of care of the site.
    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 Decision2018-09-13
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-11-30
    P. End of Trial
    P.End of Trial StatusGB - no longer in EU/EEA
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