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    Clinical Trial Results:
    An Open-Label Clinical Study to Evaluate the Long-Term Efficacy and Tolerability of Treatment With Dimethyl Fumarate (DMF) In Adults With Chronic Plaque Psoriasis (Study DIMESKIN 2)

    Summary
    EudraCT number
    2017-003818-11
    Trial protocol
    IT  
    Global end of trial date
    05 Nov 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    16 Oct 2022
    First version publication date
    16 Oct 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    M-41008-42
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Almirall, S.A
    Sponsor organisation address
    General Mitre, 151, Barcelona, Spain, 08022
    Public contact
    Almirall, S.A, Mercè De Frias, +34 933128993,
    Scientific contact
    Mercè De Frias, Almirall, S.A, +34 933128993,
    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
    05 Nov 2020
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    05 Nov 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objective of this study was to evaluate the efficacy of dimethyl fumarate (DMF) in adults with moderate-to-severe chronic plaque psoriasis. Efficacy was expressed as the percentage of subjects with a greater than or equal to (>=) 75% reduction from baseline of the psoriasis area and severity index (PASI) after 1 year of treatment and to test the new drug on the Italian population.
    Protection of trial subjects
    The study was carried out in compliance with the ethical principles established by the Declaration of Helsinki, including any amendments and conducted in accordance with the principles of Good Clinical Practice (GCP) as required by the Regulation (EU) No. 536/2014 and the Corrigendum to Regulation (EU) 536/2014, and local regulations.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    31 May 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Italy: 165
    Worldwide total number of subjects
    165
    EEA total number of subjects
    165
    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)
    142
    From 65 to 84 years
    23
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    This study was conducted at 36 sites in Italy from 31 May 2018 to 05 November 2020.

    Pre-assignment
    Screening details
    A total of 191 subjects were screened, of which 165 subjects were enrolled in this study and 26 subjects were excluded due to screening failure.

    Period 1
    Period 1 title
    Overall study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Dimethyl fumarate (DMF)
    Arm description
    All subjects received DMF tablets at a dose of 30 mg for first three weeks and 120 mg for subsequent weeks. The total duration of treatment was 52 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    Dimethyl fumarate
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received dimethyl fumarate tablets at a dose of 30 mg for first 3 three weeks and 120 mg for subsequent weeks.

    Number of subjects in period 1
    Dimethyl fumarate (DMF)
    Started
    165
    Completed
    66
    Not completed
    99
         Adverse event, serious fatal
    1
         Consent withdrawn by subject
    7
         Adverse event, non-fatal
    54
         Incompliance with treatment
    1
         Unspecified
    12
         Lost to follow-up
    7
         Decision of the Investigator
    17

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Dimethyl fumarate (DMF)
    Reporting group description
    All subjects received DMF tablets at a dose of 30 mg for first three weeks and 120 mg for subsequent weeks. The total duration of treatment was 52 weeks.

    Reporting group values
    Dimethyl fumarate (DMF) Total
    Number of subjects
    165 165
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    142 142
        From 65-84 years
    23 23
        85 years and over
    0 0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    48.75 ± 14.92 -
    Gender categorical
    Units: Subjects
        Female
    55 55
        Male
    110 110
    Race
    Units: Subjects
        Arab
    1 1
        Asian
    1 1
        Black or Afroamerican
    1 1
        Caucasian
    162 162

    End points

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    End points reporting groups
    Reporting group title
    Dimethyl fumarate (DMF)
    Reporting group description
    All subjects received DMF tablets at a dose of 30 mg for first three weeks and 120 mg for subsequent weeks. The total duration of treatment was 52 weeks.

    Primary: Percentage of Subjects Achieving 75% or Greater Reduction in Psoriasis Area and Severity Index (PASI 75) at Week 52

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    End point title
    Percentage of Subjects Achieving 75% or Greater Reduction in Psoriasis Area and Severity Index (PASI 75) at Week 52 [1]
    End point description
    The PASI was a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. For each lesion, the PASI assigns a score ranging from 0 (no lesion) to 4 (extremely severe lesion) on the basis of three parameters (erythema, induration and desquamation) and a weighted assessment of the affected area classified by body part (head, trunk, upper limbs and lower limbs). The PASI score ranges from 0 (no psoriatic lesions) to 72 (severe psoriasis). PASI 75 is defined as at least a 75% reduction in PASI score compared with the Baseline PASI score. Intent to treat population (ITT) included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. Multiple imputation (MI) method applied. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Primary
    End point timeframe
    Week 52
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Only descriptive analysis was planned for this endpoint.
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    141
    Units: Percentage of Subjects
        number (confidence interval 95%)
    86.67 (78.73 to 94.60)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Achieving PASI 75 at Week 4, 8, 12, 24, 36 and 48

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    End point title
    Percentage of Subjects Achieving PASI 75 at Week 4, 8, 12, 24, 36 and 48
    End point description
    The PASI was a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. For each lesion, the PASI assigns a score ranging from 0 (no lesion) to 4 (extremely severe lesion) on the basis of three parameters (erythema, induration and desquamation) and a weighted assessment of the affected area classified by body part (head, trunk, upper limbs and lower limbs). The PASI score ranges from 0 (no psoriatic lesions) to 72 (severe psoriasis). PASI 75 is defined as at least a 75% reduction in PASI score compared with the Baseline PASI score. ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. MI method applied. -99999, 99999= 95% confidence interval (CI) not estimable. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Week 4, 8, 12, 24, 36 and 48
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    141
    Units: Percentage of Subjects
    number (confidence interval 95%)
        Week 4
    8.51 (-99999 to 99999)
        Week 8
    17.38 (10.80 to 23.96)
        Week 12
    40.74 (31.79 to 49.70)
        Week 24
    70.64 (60.85 to 80.43)
        Week 36
    78.76 (69.30 to 88.22)
        Week 48
    86.24 (78.63 to 93.85)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Achieving 50% or Greater Reduction in Psoriasis Area and Severity Index (PASI 50) at Week 4, 8, 12, 24, 36, 48 and 52

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    End point title
    Percentage of Subjects Achieving 50% or Greater Reduction in Psoriasis Area and Severity Index (PASI 50) at Week 4, 8, 12, 24, 36, 48 and 52
    End point description
    The PASI was a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. For each lesion, the PASI assigns a score ranging from 0 (no lesion) to 4 (extremely severe lesion) on the basis of three parameters (erythema, induration and desquamation) and a weighted assessment of the affected area classified by body part (head, trunk, upper limbs and lower limbs). The PASI score ranges from 0 (no psoriatic lesions) to 72 (severe psoriasis). PASI 50 is defined as at least a 50% reduction in PASI score compared with the Baseline PASI score. ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. MI method applied. -99999, 99999= 95% CI not estimable. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Week 4, 8, 12, 24, 36, 48 and 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    141
    Units: Percentage of Subjects
    number (confidence interval 95%)
        Week 4
    15.60 (-99999 to 99999)
        Week 8
    41.06 (32.76 to 49.36)
        Week 12
    68.12 (59.27 to 76.97)
        Week 24
    86.52 (79.38 to 93.67)
        Week 36
    93.97 (89.22 to 98.73)
        Week 48
    95.60 (91.61 to 99.60)
        Week 52
    95.96 (91.51 to 100.00)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Achieving 90% or Greater Reduction in Psoriasis Area and Severity Index (PASI 90) at Week 4, 8, 12, 24, 36, 48 and 52

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    End point title
    Percentage of Subjects Achieving 90% or Greater Reduction in Psoriasis Area and Severity Index (PASI 90) at Week 4, 8, 12, 24, 36, 48 and 52
    End point description
    The PASI was a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. For each lesion, the PASI assigns a score ranging from 0 (no lesion) to 4 (extremely severe lesion) on the basis of three parameters (erythema, induration and desquamation) and a weighted assessment of the affected area classified by body part (head, trunk, upper limbs and lower limbs). The PASI score ranges from 0 (no psoriatic lesions) to 72 (severe psoriasis). PASI 90 is defined as at least a 90% reduction in PASI score compared with the Baseline PASI score. ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. MI method applied. -99999, 99999 = 95% CI not estimable. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Week 4, 8, 12, 24, 36, 48 and 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    141
    Units: Percentage of Subjects
    number (confidence interval 95%)
        Week 4
    1.42 (-99999 to 99999)
        Week 8
    6.88 (2.65 to 11.11)
        Week 12
    14.93 (8.48 to 21.38)
        Week 24
    40.60 (31.05 to 50.15)
        Week 36
    45.92 (34.36 to 57.49)
        Week 48
    57.02 (46.75 to 67.29)
        Week 52
    56.17 (46.68 to 65.66)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Achieving 100% or Greater Reduction in Psoriasis Area and Severity Index (PASI 100) at Week 4, 8, 12, 24, 36, 48 and 52

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    End point title
    Percentage of Subjects Achieving 100% or Greater Reduction in Psoriasis Area and Severity Index (PASI 100) at Week 4, 8, 12, 24, 36, 48 and 52
    End point description
    The PASI was a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. For each lesion, the PASI assigns a score ranging from 0 (no lesion) to 4 (extremely severe lesion) on the basis of three parameters (erythema, induration and desquamation) and a weighted assessment of the affected area classified by body part (head, trunk, upper limbs and lower limbs). The PASI score ranges from 0 (no psoriatic lesions) to 72 (severe psoriasis). PASI 100 is defined as at least a 100% reduction in PASI score compared with the Baseline PASI score. ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. MI method applied. -99999, 99999 = 95% CI not estimable. Here, “number of subjects analysed” signifies number of subjects who were evaluable f
    End point type
    Secondary
    End point timeframe
    Week 4, 8, 12, 24, 36, 48 and 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    141
    Units: Percentage of Subjects
    number (confidence interval 95%)
        Week 4
    0.71 (-99999 to 99999)
        Week 8
    0.74 (0.00 to 2.20)
        Week 12
    6.81 (2.20 to 11.42)
        Week 24
    15.50 (8.68 to 22.31)
        Week 36
    18.90 (11.31 to 26.49)
        Week 48
    20.92 (11.64 to 30.20)
        Week 52
    22.13 (13.92 to 30.33)
    No statistical analyses for this end point

    Secondary: Change From Baseline in PASI Index at Week 52

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    End point title
    Change From Baseline in PASI Index at Week 52
    End point description
    The PASI was a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. For each lesion, the PASI assigns a score ranging from 0 (no lesion) to 4 (extremely severe lesion) on the basis of three parameters (erythema, induration and desquamation) and a weighted assessment of the affected area classified by body part (head, trunk, upper limbs and lower limbs). The PASI score ranges from 0 (no psoriatic lesions) to 72 (severe psoriasis). ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    65
    Units: Units on a scale
        arithmetic mean (standard deviation)
    -13.10 ± 5.18
    No statistical analyses for this end point

    Secondary: Change From Baseline in Physician’s Global Assessment (PGA) Score at Week 52

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    End point title
    Change From Baseline in Physician’s Global Assessment (PGA) Score at Week 52
    End point description
    The PGA index provides a descriptive evaluation of disease severity. The evaluation, based on clinical judgment, is global and does not distinguish the different body areas affected by the disease. The PGA provides an evaluation of treatment efficacy by means of a score ranging from 0 (no sign of psoriasis) to 5 (severe psoriasis). ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    65
    Units: Units on a scale
        arithmetic mean (standard deviation)
    -2.32 ± 0.87
    No statistical analyses for this end point

    Secondary: Change From Baseline in Body Surface Area (BSA) Score at Week 52

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    End point title
    Change From Baseline in Body Surface Area (BSA) Score at Week 52
    End point description
    The BSA index provides an evaluation of the extension of the body area affected by psoriasis. ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    65
    Units: Units on a scale
        arithmetic mean (standard deviation)
    -20.74 ± 11.69
    No statistical analyses for this end point

    Secondary: Change From Baseline in Dermatology Life Quality Index (DLQI) Score at Week 52

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    End point title
    Change From Baseline in Dermatology Life Quality Index (DLQI) Score at Week 52
    End point description
    The DLQI is a questionnaire used to quantifying the impact of dermatological disease on the subject’s quality of life. In psoriasis subjects, DLQI score is used to assess the impact of psoriasis in daily life, asking simple questions related to work, school, personal relationships, and therapy. The DLQI questionnaire is based on 10 questions and provides an evaluation of a subject’s quality of life by means of a score ranging from 0 to 30. 0-1: no effect, 2-5: small effect, 6-10: moderate effect, 11-20: very large effect and 21-30: extremely large effect on subject’s life. The higher the score, the more quality of life is impaired. ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    63
    Units: Units on a scale
        arithmetic mean (standard deviation)
    -6.63 ± 5.06
    No statistical analyses for this end point

    Secondary: Percentage Change From Baseline in Pruritus Visual Analogic Scale (VAS) at Week 52

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    End point title
    Percentage Change From Baseline in Pruritus Visual Analogic Scale (VAS) at Week 52
    End point description
    Pruritus VAS is a visual method to assess the intensity of itching. The subject is asked to place a single mark along a 100 millimetre(mm) line, the left extremity represents the absence of itching (i.e., pruritus VAS equal to 0) and the right one unbearable itching (i.e., pruritus VAS equal to 100). ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    62
    Units: Percent Change
        arithmetic mean (standard deviation)
    -34.93 ± 138.74
    No statistical analyses for this end point

    Secondary: Subject Satisfaction VAS Score Assessment at Week 24 and 52

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    End point title
    Subject Satisfaction VAS Score Assessment at Week 24 and 52
    End point description
    Satisfaction VAS is a visual method to assess satisfaction grade of treatment. The subject is asked to place a single mark along a 100 mm line, the left extremity represents complete unsatisfaction (i.e., satisfaction VAS equal to 0) and the right one complete satisfaction (i.e., satisfaction VAS equal to 100). ). ITT included all enrolled subjects who took the study product, had no protocol violations that regard inclusion/exclusion criteria and had at least one post-baseline assessment of the PASI. Here, “number of subjects analysed (N)” signifies number of subjects who were evaluable for this end point. Number analysed (n) signifies number of subjects evaluable for specified rows.
    End point type
    Secondary
    End point timeframe
    Week 24 and 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    75
    Units: Units on a scale
    arithmetic mean (standard deviation)
        Week 24 (n=75)
    79.89 ± 23.00
        Week 52 (n=63)
    79.37 ± 29.39
    No statistical analyses for this end point

    Secondary: Duration of Treatment Exposure

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    End point title
    Duration of Treatment Exposure
    End point description
    Safety population included all enrolled subjects who took at least one dose of the study treatment. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    158
    Units: Months
        median (full range (min-max))
    5.78 (0.30 to 17.22)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects With Adverse Events (AEs) and Serious Adverse Events (SAEs)

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    End point title
    Percentage of Subjects With Adverse Events (AEs) and Serious Adverse Events (SAEs)
    End point description
    An AE was any untoward medical occurrence in a clinical trial subject administered a medicinal product and which does not necessarily have a causal relationship with this treatment. SAE was any untoward medical occurrence that at any dose resulted in death; was life-threatening; required in-patient hospitalisation or prolongation of existing hospitalization; resulted in a persistent or significant disability or incapacity; congenital anomaly or birth defect; was considered as “clinically relevant event”. Safety population included all enrolled subjects who took at least one dose of the study treatment. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    From Baseline up to end of study or premature discontinuation (up to Week 52)
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    158
    Units: Percentage of Subjects
    number (not applicable)
        AEs
    89.24
        SAEs
    4.43
    No statistical analyses for this end point

    Secondary: Percentage of Subjects With AEs Leading to Permanent Interruption of Treatment With DMF

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    End point title
    Percentage of Subjects With AEs Leading to Permanent Interruption of Treatment With DMF
    End point description
    An AE was any untoward medical occurrence in a clinical trial subject administered a medicinal product and which does not necessarily have a causal relationship with this treatment. Percentage of subjects with AEs led to permanent interruption of treatment with DMF were reported. Safety population included all enrolled subjects who took at least one dose of the study treatment. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    From Baseline up to end of study or premature discontinuation (up to Week 52)
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    158
    Units: Percentage of Subjects
        number (not applicable)
    34.18
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with Laboratory Abnormalities: Hematology Parameters

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    End point title
    Percentage of Subjects with Laboratory Abnormalities: Hematology Parameters
    End point description
    Hematology parameters included white blood cells, red blood cells, hemoglobin, hematocrit, platelets, absolute neutrophils, absolute lymphocytes, absolute monocytes, absolute eosinophils, absolute basophils. Low indicates lower than normal range and high indicates higher than normal range. Safety population included all enrolled subjects who took at least one dose of the study treatment. Here, "99999" signifies low and high values were not observed in subjects for specific categories. Here, “number of subjects analysed” signifies number of subjects who were evaluable for this end point.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    52
    Units: Percentage of Subjects
    number (not applicable)
        White blood cells - Low
    9.62
        White blood cells - High
    99999
        Red blood cells - Low
    7.69
        Red blood cells - High
    3.85
        Hemoglobin - Low
    13.46
        Hemoglobin - High
    1.92
        Hematocrit - Low
    5.77
        Hematocrit - High
    99999
        Platelets - Low
    1.92
        Platelets - High
    99999
        Absolute Neutrophils - Low
    99999
        Absolute Neutrophils - High
    13.46
        Absolute Lymphocytes - Low
    53.85
        Absolute Lymphocytes - High
    99999
        Absolute Monocytes - Low
    99999
        Absolute Monocytes - High
    1.92
        Absolute Eosinophils - Low
    99999
        Absolute Eosinophils - High
    99999
        Absolute Basophils - Low
    1.92
        Absolute Basophils - High
    99999
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with Laboratory Abnormalities: Biochemistry Parameters

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    End point title
    Percentage of Subjects with Laboratory Abnormalities: Biochemistry Parameters
    End point description
    Biochemistry parameters included creatinine, total bilirubin, aspartate aminotransferase (AST)/ serum glutamic oxaloacetic transaminase (SGOT), alanine aminotransferase (ALT)/ serum glutamate pyruvate transaminase (SGPT), gamma glutamyl transferase (Gamma-GT), alkaline phosphatase. Low indicates lower than normal range and high indicates higher than normal range. Safety population included all enrolled subjects who took at least one dose of the study treatment. Here, "99999" signifies low and high values were not observed in subjects for specific categories. . Here, “number of subjects analysed (N)” signifies number of subjects who were evaluable for this end point. Number analysed (n) signifies number of subjects evaluable for specified rows.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Dimethyl fumarate (DMF)
    Number of subjects analysed
    52
    Units: Percentage of Subjects
    number (not applicable)
        Creatinine - Low (n=52)
    9.62
        Creatinine - High (n=52)
    1.92
        Total bilirubin - Low (n=51)
    99999
        Total bilirubin - High (n=51)
    7.84
        AST/SGOT - Low (n=52)
    1.92
        AST/SGOT - High (n=52)
    3.85
        ALT/SGPT - Low (n=52)
    99999
        ALT/SGPT - High (n=52)
    5.77
        Gamma-GT - Low (n=52)
    99999
        Gamma-GT - High (n=52)
    7.69
        Alkaline phosphatase - Low (n=52)
    99999
        Alkaline phosphatase - High (n=52)
    1.92
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From Baseline up to end of study or premature discontinuation (up to week 52)
    Adverse event reporting additional description
    The number of occurrences were updated same as the number of subjects affected for non-serious adverse events. Safety population included all enrolled subjects who took at least one dose of the study treatment.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    Dimethyl fumarate (DMF)
    Reporting group description
    All subjects received DMF tablets at a dose of 30 mg for first three weeks and 120 mg for subsequent weeks. The total duration of treatment was 52 weeks.

    Serious adverse events
    Dimethyl fumarate (DMF)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    7 / 158 (4.43%)
         number of deaths (all causes)
    1
         number of deaths resulting from adverse events
    Cardiac disorders
    Myocardial infarction
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Nervous system disorders
    Multiple sclerosis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Leukopenia
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Lymphopenia
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Dermatitis exfoliative generalised
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Infection
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Dimethyl fumarate (DMF)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    134 / 158 (84.81%)
    Vascular disorders
    Circulatory collapse
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Flushing
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Hot flush
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Hypertension
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Pallor
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Surgical and medical procedures
    Cataract operation
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Haemorrhoid operation
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Knee operation
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Tooth extraction
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Chills
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Feeling hot
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Influenza like illness
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Malaise
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Oedema peripheral
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Pain
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Pyrexia
         subjects affected / exposed
    7 / 158 (4.43%)
         occurrences all number
    7
    Reproductive system and breast disorders
    Benign prostatic hyperplasia
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Dysmenorrhoea
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Epiglottic oedema
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Epistaxis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Oropharyngeal pain
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Pneumonitis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Rhinitis allergic
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Rhinorrhoea
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Insomnia
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Mixed anxiety and depressive disorder
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Panic attack
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Investigations
    Blood pressure decreased
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Platelet count decreased
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Foreign body in eye
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Nervous system disorders
    Dysgeusia
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Headache
         subjects affected / exposed
    13 / 158 (8.23%)
         occurrences all number
    13
    Lumbar radiculopathy
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Migraine
         subjects affected / exposed
    10 / 158 (6.33%)
         occurrences all number
    10
    Neuralgia
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Paraesthesia
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Post herpetic neuralgia
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Somnolence
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Eosinophilia
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Leukocytosis
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Leukopenia
         subjects affected / exposed
    4 / 158 (2.53%)
         occurrences all number
    4
    Lymphopenia
         subjects affected / exposed
    34 / 158 (21.52%)
         occurrences all number
    34
    Neutrophilia
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Eye disorders
    Diabetic retinopathy
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Retinal detachment
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Visual impairment
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Gastrointestinal disorders
    Abdominal distension
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Abdominal pain
         subjects affected / exposed
    41 / 158 (25.95%)
         occurrences all number
    41
    Abdominal pain upper
         subjects affected / exposed
    22 / 158 (13.92%)
         occurrences all number
    22
    Abdominal tenderness
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Colitis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Constipation
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Diarrhoea
         subjects affected / exposed
    51 / 158 (32.28%)
         occurrences all number
    51
    Dry mouth
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Dyspepsia
         subjects affected / exposed
    4 / 158 (2.53%)
         occurrences all number
    4
    Faeces soft
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Flatulence
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Gastritis
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Gastrointestinal disorder
         subjects affected / exposed
    7 / 158 (4.43%)
         occurrences all number
    7
    Gastrointestinal pain
         subjects affected / exposed
    4 / 158 (2.53%)
         occurrences all number
    4
    Gastrooesophageal reflux disease
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Haemorrhoidal haemorrhage
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Nausea
         subjects affected / exposed
    24 / 158 (15.19%)
         occurrences all number
    24
    Stomatitis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Tooth disorder
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Toothache
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Vomiting
         subjects affected / exposed
    9 / 158 (5.70%)
         occurrences all number
    9
    Gastroenteritis viral
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Dermatitis
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Dermatitis allergic
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Erythema
         subjects affected / exposed
    42 / 158 (26.58%)
         occurrences all number
    42
    Erythrodermic psoriasis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Pruritus
         subjects affected / exposed
    17 / 158 (10.76%)
         occurrences all number
    17
    Rash
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Rash pruritic
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Trichorrhexis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Urticaria
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Renal and urinary disorders
    Renal colic
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    4 / 158 (2.53%)
         occurrences all number
    4
    Back pain
         subjects affected / exposed
    9 / 158 (5.70%)
         occurrences all number
    9
    Bone pain
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Intervertebral disc disorder
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Myalgia
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Neck pain
         subjects affected / exposed
    5 / 158 (3.16%)
         occurrences all number
    5
    Pain in extremity
         subjects affected / exposed
    4 / 158 (2.53%)
         occurrences all number
    4
    Spinal pain
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Infections and infestations
    Acariasis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Asymptomatic COVID-19
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Conjunctivitis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Cystitis
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Diverticulitis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Dysentery
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Gastroenteritis
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Haemorrhoid infection
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Herpes zoster
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Infected cyst
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Infection
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Influenza
         subjects affected / exposed
    15 / 158 (9.49%)
         occurrences all number
    15
    Oral herpes
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Nasopharyngitis
         subjects affected / exposed
    3 / 158 (1.90%)
         occurrences all number
    3
    Pharyngitis
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Respiratory tract infection
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Tinea versicolour
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Tonsillitis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Tooth abscess
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Tracheitis
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Urinary tract infection
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Vaginal infection
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    2 / 158 (1.27%)
         occurrences all number
    2
    Lactose intolerance
         subjects affected / exposed
    1 / 158 (0.63%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    24 Nov 2017
    Reviewed the study of safety measures in relation to progressive multifocal leukoencephalopathy. Moreover, methodological considerations were reported, following which the study was described as a Phase IIIb study. In addition, the possibility of using the MDRD equation for the estimated glomerular filtration rate (eGFR) was added, changes were made in patient recommendations on taking the experimental drug with milk or derivatives.
    17 Jan 2018
    Provided information on highly effective contraceptive measures adopted both by women of childbearing age and by sexually active males with heterosexual partners of childbearing age; HIV, HBV, HCV and/or tuberculosis tests to selection visit; treatment interruption criteria in case of adverse events or lack of efficacy.

    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
    For support, Contact us.
    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
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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