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    Clinical Trial Results:
    A trial investigating the long-term efficacy and safety of two doses of NN-220 (somatropin [genetical recombination]) in short stature due to Noonan syndrome.

    Summary
    EudraCT number
    2018-000750-22
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    12 Jul 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    07 Feb 2019
    First version publication date
    07 Feb 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GHLIQUID-4020
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01927861
    WHO universal trial number (UTN)
    U1111-1131-5892
    Other trial identifiers
    JAPIC: JapicCTI-132336
    Sponsors
    Sponsor organisation name
    Novo Nordisk A/S
    Sponsor organisation address
    Novo Allé, Bagsvaerd, Denmark, 2880
    Public contact
    Clinical Reporting Anchor and Disclosure (1452), Novo Nordisk A/S, clinicaltrials@novonordisk.com
    Scientific contact
    Clinical Reporting Anchor and Disclosure (1452), Novo Nordisk A/S, clinicaltrials@novonordisk.com
    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?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    27 Nov 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    12 Jul 2018
    Global end of trial reached?
    Yes
    Global end of trial date
    12 Jul 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the growth promoting effect of NN-220 (somatropin [genetical recombination]) from baseline to 104 weeks of treatment in short stature due to Noonan syndrome.
    Protection of trial subjects
    The trial was conducted in accordance with the Declaration of Helsinki (2008), International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Good Clinical Practice (1996) and the Ministry of Health and Welfare (MHW) Ordinance on Good Clinical Practice (1997).
    Background therapy
    Not applicable.
    Evidence for comparator
    Not applicable.
    Actual start date of recruitment
    19 Aug 2013
    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
    Japan: 51
    Worldwide total number of subjects
    51
    EEA total number of subjects
    0
    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)
    51
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The trial was conducted at 26 sites in Japan.

    Pre-assignment
    Screening details
    Not applicable.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Investigator, Monitor, Carer, Data analyst, Assessor, Subject
    Blinding implementation details
    Both trial products were indistinguishable from one another. The code for a particular subject could be broken by the investigator if a medical emergency took place.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    NN-220 0.033 mg/kg/day
    Arm description
    The subjects received NN-220 0.033 mg/kg/day for 208 weeks (4 years) as per the following sequence: 104 weeks (2 years) in the pivotal phase and 104 weeks (2 years) in the extension phase.
    Arm type
    Experimental

    Investigational medicinal product name
    Somatropin
    Investigational medicinal product code
    Other name
    Norditropin®
    Pharmaceutical forms
    Solution for injection in pre-filled pen
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    NN-220 0.033 mg/kg/day was administered as once daily subcutaneous (s.c.; under the skin) injections by use of prefilled pens, alternating between the upper arm, thigh, abdominal wall or gluteal region. The dose was selected based on the subject’s body weight at each visit.

    Arm title
    NN-220 0.066 mg/kg/day
    Arm description
    The subjects received NN-220 0.066 mg/kg/day for 208 weeks (4 years) as per the following sequence: 104 weeks (2 years) in the pivotal phase and 104 weeks (2 years) in the extension phase.
    Arm type
    Experimental

    Investigational medicinal product name
    Somatropin
    Investigational medicinal product code
    Other name
    Norditropin®
    Pharmaceutical forms
    Solution for injection in pre-filled pen
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    NN-220 0.066 mg/kg/day was administered as once daily s.c. injections by use of prefilled pens, alternating between the upper arm, thigh, abdominal wall or gluteal region. The dose was selected based on the subject’s body weight at each visit.

    Number of subjects in period 1
    NN-220 0.033 mg/kg/day NN-220 0.066 mg/kg/day
    Started
    25
    26
    Completed
    25
    23
    Not completed
    0
    3
         Adverse event, non-fatal
    -
    2
         Unclassified
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    NN-220 0.033 mg/kg/day
    Reporting group description
    The subjects received NN-220 0.033 mg/kg/day for 208 weeks (4 years) as per the following sequence: 104 weeks (2 years) in the pivotal phase and 104 weeks (2 years) in the extension phase.

    Reporting group title
    NN-220 0.066 mg/kg/day
    Reporting group description
    The subjects received NN-220 0.066 mg/kg/day for 208 weeks (4 years) as per the following sequence: 104 weeks (2 years) in the pivotal phase and 104 weeks (2 years) in the extension phase.

    Reporting group values
    NN-220 0.033 mg/kg/day NN-220 0.066 mg/kg/day Total
    Number of subjects
    25 26 51
    Age Categorical
    Units: Subjects
        Children (2-11 years)
    25 26 51
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    6.57 ( 2.42 ) 6.06 ( 2.25 ) -
    Gender Categorical
    Units: Subjects
        Female
    11 8 19
        Male
    14 18 32
    Height standard deviation score (SDS)
    Units: Standard deviation score
        arithmetic mean (standard deviation)
    -3.24 ( 0.76 ) -3.25 ( 0.71 ) -
    Insulin-like growth factor I (IGF-I)
    Units: ng/mL
        arithmetic mean (standard deviation)
    70.2 ( 35.8 ) 69.7 ( 35.2 ) -
    Glycosylated haemoglobin A1c (HbA1c)
    Units: Percentage of HbA1c
        arithmetic mean (standard deviation)
    5.19 ( 0.19 ) 5.10 ( 0.29 ) -

    End points

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    End points reporting groups
    Reporting group title
    NN-220 0.033 mg/kg/day
    Reporting group description
    The subjects received NN-220 0.033 mg/kg/day for 208 weeks (4 years) as per the following sequence: 104 weeks (2 years) in the pivotal phase and 104 weeks (2 years) in the extension phase.

    Reporting group title
    NN-220 0.066 mg/kg/day
    Reporting group description
    The subjects received NN-220 0.066 mg/kg/day for 208 weeks (4 years) as per the following sequence: 104 weeks (2 years) in the pivotal phase and 104 weeks (2 years) in the extension phase.

    Subject analysis set title
    NN-220 0.033 mg/kg/day
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The subjects received NN-220 0.033 mg/kg/day for 104 weeks (2 years; pivotal phase).

    Subject analysis set title
    NN-220 0.066 mg/kg/day
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The subjects received NN-220 0.066 mg/kg/day for 104 weeks (2 years; pivotal phase).

    Subject analysis set title
    NN-220 0.033 mg/kg/day
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The subjects received NN-220 0.033 mg/kg/day for 104 weeks (2 years; pivotal phase).

    Subject analysis set title
    NN-220 0.066 mg/kg/day
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The subjects received NN-220 0.066 mg/kg/day for 104 weeks (2 years; pivotal phase).

    Primary: Change in height SDS

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    End point title
    Change in height SDS
    End point description
    The change from baseline (week 0) in the height standard deviation score (SDS) after 104 weeks of treatment was analysed using an analysis of covariance (ANCOVA) model with treatment as a fixed effect and baseline height SDS as a covariate. Missing values were imputed using the last observation carried forward (LOCF) method. Results are based on the full analysis set (FAS), which included all randomised subjects.
    End point type
    Primary
    End point timeframe
    From baseline to 104 weeks of treatment
    End point values
    NN-220 0.033 mg/kg/day NN-220 0.066 mg/kg/day
    Number of subjects analysed
    25
    26
    Units: Standard deviation score
        least squares mean (standard error)
    0.84 ( 0.09 )
    1.47 ( 0.09 )
    Statistical analysis title
    NN-220 0.066 mg/kg/day vs. NN-220 0.033 mg/kg/day
    Statistical analysis description
    The change from baseline (week 0) in the height SDS after 104 weeks of treatment was analysed using an ANCOVA model with treatment as a fixed effect and baseline height SDS as a covariate.
    Comparison groups
    NN-220 0.033 mg/kg/day v NN-220 0.066 mg/kg/day
    Number of subjects included in analysis
    51
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    < 0.0001
    Method
    ANCOVA
    Parameter type
    Treatment difference
    Point estimate
    0.63
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.38
         upper limit
    0.88

    Secondary: Incidence of treatment emergent adverse events (AEs)

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    End point title
    Incidence of treatment emergent adverse events (AEs)
    End point description
    A treatment emergent AE (TEAE; for the pivotal phase) was defined as an event that had onset date on or after the date of visit 2 (week 0; start of treatment) and no later than the date of visit 12 (104 weeks; end of pivotal phase). For withdrawal subjects (if any), an AE with onset date no later than 7 days after the last day of NN-220 treatment was included. Results are based on the safety analysis set (SAS), which included all subjects receiving at least one dose of trial product (NN-220 0.033 mg/kg/day and NN-220 0.066 mg/kg/day of NN-220).
    End point type
    Secondary
    End point timeframe
    During 104 weeks of treatment
    End point values
    NN-220 0.033 mg/kg/day NN-220 0.066 mg/kg/day
    Number of subjects analysed
    25
    26
    Units: Events
    265
    306
    No statistical analyses for this end point

    Secondary: Change in IGF-I

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    End point title
    Change in IGF-I
    End point description
    Change from baseline (in between week -4 and week 0) in IGF-I was evaluated after 104 weeks of treatment. Missing values were imputed using the LOCF method. Results are based on the SAS.
    End point type
    Secondary
    End point timeframe
    From baseline to 104 weeks of treatment
    End point values
    NN-220 0.033 mg/kg/day NN-220 0.066 mg/kg/day
    Number of subjects analysed
    25
    26
    Units: ng/mL
        arithmetic mean (standard deviation)
    90.4 ( 65.5 )
    159.1 ( 88.0 )
    No statistical analyses for this end point

    Secondary: Change in HbA1c

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    End point title
    Change in HbA1c
    End point description
    Change from baseline (in between week -4 and week 0) in HbA1c was evaluated after 104 weeks of treatment. Results are based on the SAS.
    End point type
    Secondary
    End point timeframe
    From baseline to 104 weeks of treatment
    End point values
    NN-220 0.033 mg/kg/day NN-220 0.066 mg/kg/day
    Number of subjects analysed
    25
    26
    Units: Percentage of HbA1c
        arithmetic mean (standard deviation)
    0.14 ( 0.18 )
    0.13 ( 0.20 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Week 0 to week 234 (208 weeks treatment period + 26 weeks extended treatment period) + 7 days (follow-up period).
    Adverse event reporting additional description
    All presented AEs are TEAEs. A TEAE (for the entire trial) was defined as an event that had onset date on or after the date of visit 2 (week 0; start of treatment) and no later than 7 days after the last day of trial product administration. Results are based on the SAS, which included all subjects receiving at least one dose of trial product.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18
    Reporting groups
    Reporting group title
    NN-220 0.033 mg/kg/day
    Reporting group description
    The subjects received NN-220 0.033 mg/kg/day for 208 weeks (4 years) as per the following sequence: 104 weeks (2 years) in the pivotal phase and 104 weeks (2 years) in the extension phase. Treatment was further extended to 234 weeks for subjects who agreed to continue treatment after completion of the extension phase.

    Reporting group title
    NN-220 0.066 mg/kg/day
    Reporting group description
    The subjects received NN-220 0.066 mg/kg/day for 208 weeks (4 years) as per the following sequence: 104 weeks (2 years) in the pivotal phase and 104 weeks (2 years) in the extension phase. Treatment was further extended to 234 weeks for subjects who agreed to continue treatment after completion of the extension phase.

    Serious adverse events
    NN-220 0.033 mg/kg/day NN-220 0.066 mg/kg/day
    Total subjects affected by serious adverse events
         subjects affected / exposed
    9 / 25 (36.00%)
    10 / 26 (38.46%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Congenital, familial and genetic disorders
    Arnold-Chiari malformation
         subjects affected / exposed
    1 / 25 (4.00%)
    0 / 26 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Craniosynostosis
         subjects affected / exposed
    1 / 25 (4.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hamartoma
         subjects affected / exposed
    1 / 25 (4.00%)
    0 / 26 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Phimosis
         subjects affected / exposed
    1 / 25 (4.00%)
    0 / 26 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    Pulmonary artery therapeutic procedure
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Febrile convulsion
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ear and labyrinth disorders
    Conductive deafness
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Dental caries
         subjects affected / exposed
    2 / 25 (8.00%)
    0 / 26 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Salivary gland calculus
         subjects affected / exposed
    1 / 25 (4.00%)
    0 / 26 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Supernumerary teeth
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Testicular swelling
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Velopharyngeal incompetence
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Head banging
         subjects affected / exposed
    1 / 25 (4.00%)
    0 / 26 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Polymyositis
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Gastroenteritis
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    1 / 25 (4.00%)
    0 / 26 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia mycoplasmal
         subjects affected / exposed
    1 / 25 (4.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tonsillitis
         subjects affected / exposed
    0 / 25 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    NN-220 0.033 mg/kg/day NN-220 0.066 mg/kg/day
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    24 / 25 (96.00%)
    26 / 26 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Skin papilloma
         subjects affected / exposed
    2 / 25 (8.00%)
    0 / 26 (0.00%)
         occurrences all number
    2
    0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    9 / 25 (36.00%)
    9 / 26 (34.62%)
         occurrences all number
    24
    12
    Immune system disorders
    Seasonal allergy
         subjects affected / exposed
    2 / 25 (8.00%)
    1 / 26 (3.85%)
         occurrences all number
    2
    1
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    3 / 25 (12.00%)
    2 / 26 (7.69%)
         occurrences all number
    4
    3
    Cough
         subjects affected / exposed
    6 / 25 (24.00%)
    3 / 26 (11.54%)
         occurrences all number
    8
    5
    Epistaxis
         subjects affected / exposed
    3 / 25 (12.00%)
    1 / 26 (3.85%)
         occurrences all number
    4
    1
    Rhinitis allergic
         subjects affected / exposed
    4 / 25 (16.00%)
    4 / 26 (15.38%)
         occurrences all number
    4
    4
    Rhinorrhoea
         subjects affected / exposed
    2 / 25 (8.00%)
    3 / 26 (11.54%)
         occurrences all number
    3
    3
    Upper respiratory tract inflammation
         subjects affected / exposed
    7 / 25 (28.00%)
    9 / 26 (34.62%)
         occurrences all number
    35
    30
    Psychiatric disorders
    Attention deficit/hyperactivity disorder
         subjects affected / exposed
    2 / 25 (8.00%)
    0 / 26 (0.00%)
         occurrences all number
    2
    0
    Injury, poisoning and procedural complications
    Arthropod bite
         subjects affected / exposed
    2 / 25 (8.00%)
    3 / 26 (11.54%)
         occurrences all number
    2
    8
    Arthropod sting
         subjects affected / exposed
    0 / 25 (0.00%)
    2 / 26 (7.69%)
         occurrences all number
    0
    3
    Chillblains
         subjects affected / exposed
    2 / 25 (8.00%)
    0 / 26 (0.00%)
         occurrences all number
    4
    0
    Contusion
         subjects affected / exposed
    1 / 25 (4.00%)
    2 / 26 (7.69%)
         occurrences all number
    1
    2
    Skin abrasion
         subjects affected / exposed
    2 / 25 (8.00%)
    0 / 26 (0.00%)
         occurrences all number
    2
    0
    Thermal burn
         subjects affected / exposed
    2 / 25 (8.00%)
    0 / 26 (0.00%)
         occurrences all number
    2
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    6 / 25 (24.00%)
    2 / 26 (7.69%)
         occurrences all number
    10
    5
    Eye disorders
    Conjunctivitis allergic
         subjects affected / exposed
    6 / 25 (24.00%)
    5 / 26 (19.23%)
         occurrences all number
    11
    5
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    2 / 25 (8.00%)
    2 / 26 (7.69%)
         occurrences all number
    2
    10
    Dental caries
         subjects affected / exposed
    4 / 25 (16.00%)
    4 / 26 (15.38%)
         occurrences all number
    4
    11
    Diarrhoea
         subjects affected / exposed
    7 / 25 (28.00%)
    3 / 26 (11.54%)
         occurrences all number
    12
    4
    Enteritis
         subjects affected / exposed
    2 / 25 (8.00%)
    1 / 26 (3.85%)
         occurrences all number
    3
    1
    Nausea
         subjects affected / exposed
    2 / 25 (8.00%)
    1 / 26 (3.85%)
         occurrences all number
    2
    1
    Stomatitis
         subjects affected / exposed
    0 / 25 (0.00%)
    5 / 26 (19.23%)
         occurrences all number
    0
    6
    Toothache
         subjects affected / exposed
    0 / 25 (0.00%)
    2 / 26 (7.69%)
         occurrences all number
    0
    2
    Vomiting
         subjects affected / exposed
    4 / 25 (16.00%)
    3 / 26 (11.54%)
         occurrences all number
    9
    3
    Skin and subcutaneous tissue disorders
    Dermatitis
         subjects affected / exposed
    0 / 25 (0.00%)
    2 / 26 (7.69%)
         occurrences all number
    0
    2
    Dry skin
         subjects affected / exposed
    1 / 25 (4.00%)
    2 / 26 (7.69%)
         occurrences all number
    1
    2
    Eczema
         subjects affected / exposed
    3 / 25 (12.00%)
    8 / 26 (30.77%)
         occurrences all number
    4
    13
    Hyperkeratosis
         subjects affected / exposed
    0 / 25 (0.00%)
    2 / 26 (7.69%)
         occurrences all number
    0
    3
    Miliaria
         subjects affected / exposed
    2 / 25 (8.00%)
    5 / 26 (19.23%)
         occurrences all number
    2
    10
    Rash
         subjects affected / exposed
    3 / 25 (12.00%)
    0 / 26 (0.00%)
         occurrences all number
    3
    0
    Urticaria
         subjects affected / exposed
    5 / 25 (20.00%)
    2 / 26 (7.69%)
         occurrences all number
    8
    2
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    2 / 25 (8.00%)
    2 / 26 (7.69%)
         occurrences all number
    2
    2
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    4 / 25 (16.00%)
    7 / 26 (26.92%)
         occurrences all number
    5
    12
    Bronchitis bacterial
         subjects affected / exposed
    0 / 25 (0.00%)
    2 / 26 (7.69%)
         occurrences all number
    0
    2
    Conjunctivitis
         subjects affected / exposed
    5 / 25 (20.00%)
    6 / 26 (23.08%)
         occurrences all number
    6
    6
    Gastroenteritis
         subjects affected / exposed
    8 / 25 (32.00%)
    14 / 26 (53.85%)
         occurrences all number
    14
    33
    Gingivitis
         subjects affected / exposed
    2 / 25 (8.00%)
    1 / 26 (3.85%)
         occurrences all number
    2
    1
    Hordeolum
         subjects affected / exposed
    1 / 25 (4.00%)
    3 / 26 (11.54%)
         occurrences all number
    1
    5
    Impetigo
         subjects affected / exposed
    2 / 25 (8.00%)
    2 / 26 (7.69%)
         occurrences all number
    2
    2
    Influenza
         subjects affected / exposed
    20 / 25 (80.00%)
    18 / 26 (69.23%)
         occurrences all number
    34
    31
    Molluscum contagiosum
         subjects affected / exposed
    3 / 25 (12.00%)
    1 / 26 (3.85%)
         occurrences all number
    3
    1
    Nasopharyngitis
         subjects affected / exposed
    19 / 25 (76.00%)
    21 / 26 (80.77%)
         occurrences all number
    115
    121
    Otitis media
         subjects affected / exposed
    7 / 25 (28.00%)
    8 / 26 (30.77%)
         occurrences all number
    9
    9
    Otitis media acute
         subjects affected / exposed
    4 / 25 (16.00%)
    1 / 26 (3.85%)
         occurrences all number
    6
    1
    Pharyngitis
         subjects affected / exposed
    2 / 25 (8.00%)
    5 / 26 (19.23%)
         occurrences all number
    3
    6
    Pharyngitis streptococcal
         subjects affected / exposed
    0 / 25 (0.00%)
    2 / 26 (7.69%)
         occurrences all number
    0
    2
    Rhinitis
         subjects affected / exposed
    1 / 25 (4.00%)
    4 / 26 (15.38%)
         occurrences all number
    1
    7
    Sinusitis
         subjects affected / exposed
    5 / 25 (20.00%)
    2 / 26 (7.69%)
         occurrences all number
    14
    2
    Streptococcal infection
         subjects affected / exposed
    2 / 25 (8.00%)
    3 / 26 (11.54%)
         occurrences all number
    3
    4
    Tinea pedis
         subjects affected / exposed
    0 / 25 (0.00%)
    5 / 26 (19.23%)
         occurrences all number
    0
    9
    Upper respiratory tract infection
         subjects affected / exposed
    8 / 25 (32.00%)
    9 / 26 (34.62%)
         occurrences all number
    38
    43
    Varicella
         subjects affected / exposed
    2 / 25 (8.00%)
    5 / 26 (19.23%)
         occurrences all number
    2
    5
    Metabolism and nutrition disorders
    Hyperinsulinaemia
         subjects affected / exposed
    0 / 25 (0.00%)
    2 / 26 (7.69%)
         occurrences all number
    0
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    20 Jun 2013
    Specification that randomisation occurred when subject eligibility was confirmed at visit 2 (week 0).
    19 Aug 2013
    Corrections of errors in translation of Japanese characters. Correction of error in Protocol section-Methods and assessments (visit 1 (screening visit)) on subject identification numbers.
    30 Oct 2013
    Clarification of exclusion criterion 8: Children who had received systemic administration of adrenocortical steroid during the treatment period of greater than or equal to13 weeks were excluded (regardless of the dose level of hydrocortisone). Specification that the investigator was to evaluate and classify the findings from the 12-lead ECG examination, even if corrected QT interval (QTc) greater than 450 msec was defined as “abnormal” referring to the ICH E14 guideline.
    07 Nov 2013
    Correction of errors in translation of Japanese characters. Specifications added for assessments to be performed within the visit window stated in the flow chart (oral glucose tolerance test (OGTT), electrocardiogram (ECG), transthoracic echocardiography (TTE) and bone age).
    26 Apr 2016
    Update of flowchart to clarify that the informed consent was to be obtained before the screening visit. Specification that the investigator’s signature and date for evaluation were mandatory in the daily dosage note. The secondary efficacy endpoints were added to Section 4.2 (endpoints) (i.e. no changes to endpoints). Correction in the protocol Appendix C (reference listing for the dosage scale based on the subject's body weight) and Subject Information/Informed Consent form to elaborate on the NN-220 doses. Information of the doses was insufficient, and therefore explanations of the doses were added.
    01 Jun 2017
    Clarification that the extension phase could be further extended to week 234 for subjects who wanted to complete visit 20 (week 208) no later than the end of the month following marketing approval date for use of Norditropin for treatment of ‘short stature due to Noonan syndrome’ in Japan and who consented to receive the trial products during the period. Clarification of when the test to identify gene mutations that cause Noonan syndrome could be performed during the extension phase and that an informed consent was to be obtained before the genetic test was performed. Clarification that the trial would be classified as a post marketing clinical trial after getting the marketing approval for treatment of ‘short stature due to Noonan syndrome’ in Japan.

    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
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