Clinical Trial Results:
A Phase 2, randomized, double-blind placebo-controlled study to test the efficacy and safety of KPL-301 in giant cell arteritis
Summary
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EudraCT number |
2018-001003-36 |
Trial protocol |
EE GB DE ES NL BE SI IT HR |
Global end of trial date |
25 Nov 2020
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Results information
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Results version number |
v2(current) |
This version publication date |
22 Jan 2022
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First version publication date |
13 Dec 2021
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Other versions |
v1 |
Version creation reason |
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Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
KPL-301-C001
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT03827018 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Kiniksa Pharmaceuticals, Ltd.
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Sponsor organisation address |
Clarendon House 2 Church Street, Hamilton, Bermuda, HM 11
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Public contact |
Kiniksa Medical Information Group, Kiniksa Pharmaceuticals, Ltd. (Hamilton, Bermuda), 1 7814319100, medinfo@kiniksa.com
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Scientific contact |
Kiniksa Medical Information Group, Kiniksa Pharmaceuticals, Ltd. (Hamilton, Bermuda), 1 7814319100, medinfo@kiniksa.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
30 Aug 2021
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
25 Nov 2020
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Global end of trial reached? |
Yes
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Global end of trial date |
25 Nov 2020
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
The primary objective of the trial was to evaluate the efficacy of KPL-301 versus placebo, coadministered with a 26-week steroid taper, for maintaining sustained remission for 26 weeks in subjects with new-onset or relapsing/refractory giant cell arteritis (GCA).
Secondary objectives of the trial were:
a) To evaluate the effect of KPL-301 vs placebo on cumulative corticosteroid dose.
b) To evaluate the effect of KPL-301 vs placebo on health-related quality of life (HRQoL).
c) To evaluate the safety and tolerability of KPL-301.
d) To evaluate the pharmacokinetics (PK) of KPL-301.
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Protection of trial subjects |
This study was conducted in accordance with the protocol and with the consensus ethical principles derived from international guidelines including the Declaration of Helsinki and Council for International Organizations of Medical Sciences International Ethical Guidelines, and applicable International Council for/Conference on Harmonization (ICH) Good Clinical Practice (GCP) Guidelines, and applicable country and local laws and regulations. Subjects were informed that their participation was voluntary. Subjects or their legally authorized representative were required to sign a statement of informed consent that met the requirements of 21 Code of Federal Regulations 50, local regulations, ICH guidelines, Health Insurance Portability and Accountability Act requirements, where applicable, and the IRB/IEC or study center.
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Background therapy |
All subjects received an unblinded 26-week oral prednisone taper according to a standardized tapering protocol. The oral steroid taper was self-administered by study subjects on a daily basis. | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
20 Sep 2018
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Long term follow-up planned |
Yes
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Long term follow-up rationale |
Safety | ||
Long term follow-up duration |
3 Months | ||
Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Netherlands: 3
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Country: Number of subjects enrolled |
Slovenia: 2
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Country: Number of subjects enrolled |
Spain: 8
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Country: Number of subjects enrolled |
United Kingdom: 8
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Country: Number of subjects enrolled |
Belgium: 6
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Country: Number of subjects enrolled |
Estonia: 8
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Country: Number of subjects enrolled |
Germany: 7
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Country: Number of subjects enrolled |
Ireland: 2
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Country: Number of subjects enrolled |
Italy: 8
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Country: Number of subjects enrolled |
Australia: 6
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Country: Number of subjects enrolled |
New Zealand: 3
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Country: Number of subjects enrolled |
Serbia: 7
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Country: Number of subjects enrolled |
United States: 2
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Worldwide total number of subjects |
70
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EEA total number of subjects |
44
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
18
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From 65 to 84 years |
51
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85 years and over |
1
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Recruitment
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Recruitment details |
Subjects who met all of the inclusion criteria and none of the exclusion criteria were enrolled into the study. Eligible subjects entered the double-blind treatment period after randomization 3:2 to blinded treatment with KPL-301 150 mg or placebo administered subcutaneously (SC) every other week (every 2 weeks). | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
The study consisted of a screening period up to 6 weeks. Potential subjects were screened for meeting study-specified diagnostic criteria for GCA. Prior to first administration of KPL-301 or placebo, all subjects were required to have achieved remission. | ||||||||||||||||||||||||
Period 1
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Period 1 title |
Base Treatment Period (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | ||||||||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor, Data analyst, Carer, Assessor | ||||||||||||||||||||||||
Blinding implementation details |
This was a double-blind study in which KPL-301 and placebo were identical in appearance/viscosity. Neither the subject nor any of the investigator or sponsor staff who were involved in the treatment or clinical evaluation of the subjects were aware of the treatment received.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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KPL-301 150mg | ||||||||||||||||||||||||
Arm description |
Treatment with KPL-301 150 mg administered subcutaneously (SC) every other week (every 2 weeks). KPL-301 was coadministered with a 26-week corticosteroid taper. | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
KPL-301
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for infusion in pre-filled syringe
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
Subjects randomized to KPL-301 received 150 mg every other week by SC injection coadministered with a 26-week steroid taper.
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Arm title
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Placebo | ||||||||||||||||||||||||
Arm description |
Treatment with placebo administered subcutaneously (SC) every other week (every 2 weeks). Placebo was coadministered with a 26-week corticosteroid taper. | ||||||||||||||||||||||||
Arm type |
Placebo | ||||||||||||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for infusion in pre-filled syringe
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
Subjects randomized to Placebo received sterile, clear, colorless, free from visible particles liquid product identical in appearance/viscosity to the KPL-301 every other week by SC injection coadministered with a 26-week steroid taper.
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Baseline characteristics reporting groups
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Reporting group title |
KPL-301 150mg
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Reporting group description |
Treatment with KPL-301 150 mg administered subcutaneously (SC) every other week (every 2 weeks). KPL-301 was coadministered with a 26-week corticosteroid taper. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
Treatment with placebo administered subcutaneously (SC) every other week (every 2 weeks). Placebo was coadministered with a 26-week corticosteroid taper. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
mITT Analysis Set
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Subject analysis set type |
Modified intention-to-treat | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
All randomized subjects who received at least 1 dose of KPL-301 or placebo and at least had 1 assessment in the Double-blind Treatment period. Efficacy analyses were based on the Modified intent-to-treat (mITT) analysis set. All analyses based on mITT were based on each subject’s randomized treatment assignment.
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Subject analysis set title |
Safety Analysis Set
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Subject analysis set type |
Safety analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
All randomized subjects who took at least 1 dose of KPL-301 or placebo. Safety analyses were based on the medication that was actually administered to each subject.
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Subject analysis set title |
Per Protocol Analysis Set
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Subject analysis set type |
Per protocol | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
All mITT subjects without important protocol deviations deemed to impact efficacy or ethical conduct.
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Subject analysis set title |
PK Analysis Set
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Subject analysis set type |
Sub-group analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
All subjects who received at least 1 dose of KPL-301 and had sufficient KPL-301 concentration data for calculation of KPL-301 PK parameters were included in the PK analysis set.
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End points reporting groups
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Reporting group title |
KPL-301 150mg
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Reporting group description |
Treatment with KPL-301 150 mg administered subcutaneously (SC) every other week (every 2 weeks). KPL-301 was coadministered with a 26-week corticosteroid taper. | ||
Reporting group title |
Placebo
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Reporting group description |
Treatment with placebo administered subcutaneously (SC) every other week (every 2 weeks). Placebo was coadministered with a 26-week corticosteroid taper. | ||
Subject analysis set title |
mITT Analysis Set
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Subject analysis set type |
Modified intention-to-treat | ||
Subject analysis set description |
All randomized subjects who received at least 1 dose of KPL-301 or placebo and at least had 1 assessment in the Double-blind Treatment period. Efficacy analyses were based on the Modified intent-to-treat (mITT) analysis set. All analyses based on mITT were based on each subject’s randomized treatment assignment.
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Subject analysis set title |
Safety Analysis Set
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Subject analysis set type |
Safety analysis | ||
Subject analysis set description |
All randomized subjects who took at least 1 dose of KPL-301 or placebo. Safety analyses were based on the medication that was actually administered to each subject.
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Subject analysis set title |
Per Protocol Analysis Set
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Subject analysis set type |
Per protocol | ||
Subject analysis set description |
All mITT subjects without important protocol deviations deemed to impact efficacy or ethical conduct.
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Subject analysis set title |
PK Analysis Set
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
All subjects who received at least 1 dose of KPL-301 and had sufficient KPL-301 concentration data for calculation of KPL-301 PK parameters were included in the PK analysis set.
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End point title |
Time to Flare by Week 26 [1] [2] | ||||||||||
End point description |
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End point type |
Primary
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End point timeframe |
By Week 26
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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: Descriptive statistics were included for this primary endpoint. Kaplan-Meier method used to estimate the survival functions for each treatment arm. [2] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period. Justification: Placebo hasn't been included in this endpoint as there is no data for Time to Flare - Hazard Ratio. |
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No statistical analyses for this end point |
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End point title |
Sustained Remission at Week 26 | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
At Week 26
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No statistical analyses for this end point |
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End point title |
Time to Elevated ESR by Week 26 | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
By Week 26
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No statistical analyses for this end point |
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End point title |
Time to Elevated CRP by Week 26 [3] | ||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
By Week 26
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Notes [3] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period. Justification: Placebo hasn't been included in this endpoint as there is no data for Time to Flare - Hazard Ratio. |
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No statistical analyses for this end point |
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End point title |
Time to Signs/Symptoms of GCA or New/Worsening Vasculitis by Imaging by Week 26 [4] | ||||||||||
End point description |
Time to Symptoms of GCA, New/Worsening Vasculitis
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End point type |
Secondary
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End point timeframe |
By Week 26
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Notes [4] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period. Justification: Placebo hasn't been included in this endpoint as there is no data for Hazard Ratio (KPL-301 vs Placebo). |
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No statistical analyses for this end point |
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End point title |
Cumulative Steroid Dose at Week 26 | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
At Week 26
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No statistical analyses for this end point |
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End point title |
Percentage of Subjects Completing Corticosteroid Taper and with Normal ESR by Week 26 | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
By Week 26
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No statistical analyses for this end point |
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End point title |
Percentage of Subjects Completing Corticosteroid Taper and with Normal CRP by Week 26 | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
By Week 26
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No statistical analyses for this end point |
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End point title |
Percentage of Subjects Completing Corticosteroid Taper and with No Signs/Symptoms of GCA by Week 26 | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
By Week 26
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No statistical analyses for this end point |
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End point title |
Cumulative Steroid Dose at the end of the Washout Safety Follow-up Period | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
At the end of the Washout Safety Follow-up Period
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No statistical analyses for this end point |
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End point title |
Sustained Remission at week 26 (Independent Adjudication) | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
At Week 26
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
Adverse events were monitored from Day 1 of treatment till Week 26 and during the following 12-week safety follow-up period.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
21.0
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Reporting groups
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Reporting group title |
KPL-301 150mg
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Reporting group description |
Treatment with KPL-301 150 mg administered subcutaneously (SC) every other week (every 2 weeks). KPL-301 was coadministered with a 26-week corticosteroid taper. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
Treatment with placebo administered subcutaneously (SC) every other week (every 2 weeks). Placebo was coadministered with a 26-week corticosteroid taper. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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15 Oct 2018 |
Rationale for Amendment – Protocol Amendment v2.0 was completed to clarify aspects of protocol version 1.0 as well as to incorporate feedback from global Regulatory and Ethical bodies.
Substantial changes to this version include:
• Limiting the double-blind period to 26-weeks total, removing the extended exposure for patients who enroll earlier in the study.
• Removal of the Open-Label Extension – Per Regulatory feedback, open-label KPL-301 should only be provided to patients after proof of efficacy has been established
• Addition of 12-week Washout Safety Follow-up period to ensure patients have continued access to open-label study supplied prednisone and are adequately followed and weaned back to Standard of Care
• Updated inclusion criteria regarding pregnancy and contraception methods to ensure highly effective methods of contraception are reflected
• Provided clarification on sample size and event calculations
• Addition of Serum Pregnancy test during screening, additional urine pregnancy tests, safety labs, and anti-KPL-301 antibody testing during the study.
• Addition of Definition of SUSAR and defined Study Termination criteria |
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30 Nov 2018 |
Rationale for Amendment – Protocol Amendment v3.0 was completed to clarify aspects of protocol version 2.0 as well as to incorporate feedback from global Regulatory bodies.
Substantial changes to this version include:
• Discontinuation of study drug (KPL-301 or placebo) in the event of a GCA Flare
• Additional PK samples added to Schedule of Activities
• Clarification of individual patient and study stopping criteria
• Correction of the US Safety contact number |
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30 Mar 2020 |
Rationale for Amendment – Protocol Amendment v4.0 was completed to clarify aspects of protocol version 3.0 as well as to incorporate feedback from global Regulatory bodies.
Substantial changes to this version include:
• Updated secondary endpoints and analysis; and inserted study endpoints into the Synopsis Objective section.
• The planned number of subjects to be enrolled in the study was updated from approximately 60 to approximately 70 subjects (42 subjects planned to be assigned to the KPL-301 arm and 28 subjects planned to be assigned to the placebo arm) to align with the updated sample size
estimation.
• Added clarification that SAEs will be recorded in the eCRF within 24 hours of discovery. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |