E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Painful diabetic neuropathy |
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E.1.1.1 | Medical condition in easily understood language |
Pain resulting from diabetes causing damage to nerves |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10012680 |
E.1.2 | Term | Diabetic neuropathy |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the efficacy of MEDI7352 versus placebo on chronic pain in subjects with painful diabetic neuropathy (PDN) currently taking standard of care medication for their PDN pain. |
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E.2.2 | Secondary objectives of the trial |
To assess the safety and tolerability of MEDI7352 in subjects with PDN
To assess the pharmacokinetics , pharmacodynamics and immunogenicity of MEDI7352 in subjects with PDN
To characterise the dose-response relationship of MEDI7352 on chronic pain in subjects with PDN |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Male, or postmenopausal or surgically sterile female, 18 to 80 years of age
Post-menopausal women must have had ≥ 12 months of spontaneous amenorrhea and a negative pregnancy test within 7 days of treatment. Surgically sterile women must have had a hysterectomy, bilateral ovariectomy (oophorectomy), or bilateral tubal ligation
Males who are biologically capable of having children must use of adequate contraception for the duration of the treatment period and for 3 months after the last administration of study drug
Body mass index of ≤42 kg/m2
Chronic PDN persistent for 6 months or longer not adequately controlled by standard of care treatments
Pain (beginning in the feet and with relatively symmetrical onset for 6 months or greater) due to bilateral peripheral neuropathy caused by either type 1 or type 2 diabetes mellitus, with bilateral decrease or absent reflexes at the ankles, or bilateral decrease of a sensory sign in the distal lower extremities
Mean pain intensity score ≥4, as measured on an 11 point NRS for a minimum of 7 days prior to Day 1
Willing and able to discontinue all NSAID or COX-2 analgesic therapy during study
Subjects taking medication for the treatment of PDN consistent with standard of care which has been stable for at least 3 months and are willing to maintain this dosing regimen for the duration of the study and use only protocol specified rescue medications
Treatment for non-excluded medical conditions must be stable for at least 28 days before Day 1 and expected to remain stale for the duration of the study
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E.4 | Principal exclusion criteria |
Treatment with another biologic therapeutic agent
Previous treatment with any form of anti-NGF or anti-TNF therapy
Participation in another clinical study within 60 days or 5 half lves prior to screening
Plasma donation within 28 days of screening or any blood donation or blood loss >500 mL within 2 months of screening
Allogeneic bone marrow or stem cell transplant
Non-leukocyte-depleted whole blood transfusion within 120 days of the genetic research sample collection, if participating in the optional genetic research
Poor venous access such that IV drug delivery would be difficult
Involvement in the planning and/or conduct of the study
Presence of other clinically significant neuropathy (eg, hereditary neuropathy, inflammatory neuropathy) or other clinically significant disorder (eg, nerve compression injury) involving abnormal peripheral sensation, with an aetiology considered to be distinct from that of PDN, and likely to interfere with assessment of peripheral nerve function
History of osteonecrosis, rapidly progressing OA, subchondral insufficiency fractures, neurogenic arthropathy, or analgesia-induced arthropathy
Diagnosis of clinically significant OA currently affecting a major joint in the upper or lower extremity or axial spine; or other degenerative disease affecting any joint where there is an identified risk of osteonecrosis, rapidly progressing OA, subchondral insufficiency fractures, neurogenic arthropathy or analgesia-induced arthropathy
Chronic pain condition, other than PDN, likely to interfere with the evaluation of PDN pain
Major psychiatric disorder likely to confound interpretation of drug effect, affect pain assessment or ability to complete the study
Significant cardiovascular disease, congestive heart failure, clinically significant stenosis or occlusion of a carotid or vertebral artery or clinically significant arrhythmias
Significant or chronic lung disease, including severe or unstable COPD or severe or unstable asthma
Known or suspected systemic infection, including HIV, HBV, HCV, or tuberculosis
History or evidence of any significant autoimmune disease or disorder, including inflammatory bowel disease, multiple sclerosis, or systemic lupus erythematosus
History of severe allergy/hypersensitivity reactions or history of hypersensitivity to immunisations or immunoglobulins
History of cancer within 5 years except non-metastatic basal cell carcinoma of the skin, carcinoma in situ of the cervix, or non-progressive prostate cancer
Transient ischaemic attack or stroke in the last 3 years
History of alcohol or recreational drug dependence within 2 years except nicotine dependence
Myocardial infarction, hospitalisation for unstable angina or arrhythmia or unexplained syncope within 1 year
Clinically important infection, including chronic, persistent, or acute infection, within 3 months of screening or between screening and randomisation
Current serious or unstable clinically important illness, including avascular necrosis, respiratory, cardiovascular, gastrointestinal, endocrinologic (excluding well-controlled type 1 or type 2 diabetes), immunologic, haematologic, neurologic, or other major disease likely to detieriorate or affect ability to complete the study
Any significant medical or surgical procedure or trauma within 28 days of Day 1, or planned to be undertaken within the timeframe of the clinical trial, that will likely affect the subject’s safety or ability to complete the study, or the scientific integrity of the study data
Clinically important abnormality in physical examination, vital signs, or clinical laboratory test at screening that could affect the subject’s safety or ability to complete the study, or the integrity of the clinical trial data
Poorly controlled hypertension (defined as systolic blood pressure [SBP] of >150 mmHg and/or diastolic blood pressure [DBP] of >90 mmHg measured in the clinic) or orthostatic hypotension (defined as a sustained reduction of SBP of at least 20 mmHg and/or a DBP reduction of at least 10 mmHg within 3 minutes of standing from a supine position)
Prolonged QTcF of >470 msec or family history of long QT syndrome, or shortened QTcF of <360 msec or family history of short QT syndrome, or any clinically significant abnormality in ECG rhythm, conduction, or morphology
Haemoglobin A1C >8.5%
Aspartate aminotransferase or alanine aminotransferase >1.5 × the upper limit of normal
Screening creatinine clearance of <60 mL/min
Clinically significant abnormal findings in coagulation or haematology laboratory tests
Positive pregnancy test
Positive drug screen for drugs of abuse |
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E.5 End points |
E.5.1 | Primary end point(s) |
Change in the weekly average of the average daily NRS pain scores from the baseline of MEDI7352 compared to placebo |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Efficacy:
Change in the weekly average of the average daily pain score (NRS) from baseline
Percentage of subjects who have achieved ≥30% and ≥50% reductions in the weekly average of the average daily pain score from baseline
Change in Galer Neuropathic Pain Scale (NPS) from baseline
Change in Daily Sleep Interference Scale (DSIS) from baseline
Proportion of subjects who have ‘improved’, ‘much improved,’ or ‘very much improved’ relative to baseline on the Patient Global Impression of Change (PGIC)
Change in the 36-item Short-Form Health Survey (SF-36) from baseline
Change in the amount of rescue medication used from baseline
Safety and tolerability: AEs and SAEs, physical examinations, neuropathy strength and deep tendon reflex assessments, vital signs, ECG, clinical laboratory testing , motor and sensory nerve conduction, concomitant medication assessment, injection site reaction and infusion reaction assessments
PK, PD and immunogenicity:
PK parameters of MEDI7352
Free and/or total NGF
Anti-drug antibodies (ADA)
Dose response:
Change in the weekly average of the average daily NRS pain scores from the baseline week to Week 12 versus dose
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Change in the weekly average of the average NRS score from baseline:Weeks 2, 4, 6, 8, and 10 of treatment and the week before the follow-up visit
Change in the weekly average of the average daily NRS scores from the baseline versus dose: Week 12
Percentage of subjects who have achieved ≥30% and ≥50% reductions in the weekly average of the average daily pain score from baseline: Weeks 4, 8, and 12 of treatment and the week before follow-up
Change in NPS, DSIS, PGIC : Days 28, 56, and 84 , week 18
Change in SF-36 : Day 84
Change in the amount of rescue medication :Week 12
NGF, PK, vital signs: Days 1,14,28,42,56,70,71,77,84, week 18
ADAs: Day 14,28,56,70,84, week 18
Safety assessments: Days 1, 14,28,42,56,70, 84, Week 18
Motor and sensory nerve conduction: Week 18
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | No |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 36 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |