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    Summary
    EudraCT Number:2018-002748-10
    Sponsor's Protocol Code Number:CC-10004-PSA-014
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2021-01-22
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2018-002748-10
    A.3Full title of the trial
    A Phase 4, Multicenter, Single-Arm, Open-Label Study to Evaluate the Impact of Apremilast (CC-10004) on MRI Outcomes in Subjects with Psoriatic Arthritis
    Studio di Fase 4, multicentrico, a braccio singolo in aperto per valutare l’impatto di apremilast (CC-10004) sugli esiti della Risonanza Magnetica (RM) nei soggetti affetti da artrite psoriasica
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A clinical trial that will look at the effect of Apremilast on MRI Outcomes in Patients with Psoriatic Arthritis
    Una sperimentazione clinica che esaminerà l’effetto di apremilast sugli esiti della risonanza magnetica per immagini (RMI) in pazienti con artrite psoriasica
    A.3.2Name or abbreviated title of the trial where available
    MOSAIC
    MOSAIC
    A.4.1Sponsor's protocol code numberCC-10004-PSA-014
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT03783026
    A.5.3WHO Universal Trial Reference Number (UTRN)U1111-1223-9823
    A.5.4Other Identifiers
    Name:INDNumber:101761
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorCELGENE CORPORATION
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportCelgene Corporation
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCelgene Corporation
    B.5.2Functional name of contact pointClinicalTrialDisclosure
    B.5.3 Address:
    B.5.3.1Street Address9225 Indian Creek Parkway, Suite 900
    B.5.3.2Town/ cityOverland Park, Kansas
    B.5.3.3Post code66210
    B.5.3.4CountryUnited States
    B.5.4Telephone number0018882601599
    B.5.5Fax number0019132660394
    B.5.6E-mailclinicaltrialdisclosure@celgene.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Otezla
    D.2.1.1.2Name of the Marketing Authorisation holderCelgene Europe BV
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApremilast
    D.3.2Product code [CC-10004]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNApremilast 10 mg
    D.3.9.1CAS number 608141-41-9
    D.3.9.2Current sponsor codeCC-10004
    D.3.9.3Other descriptive nameAPREMILAST
    D.3.9.4EV Substance CodeSUB130837
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Otezla
    D.2.1.1.2Name of the Marketing Authorisation holderCelgene Europe BV
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApremilast
    D.3.2Product code [CC-10004]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNApremilast 20 mg
    D.3.9.1CAS number 608141-41-9
    D.3.9.2Current sponsor codeCC-10004
    D.3.9.3Other descriptive nameAPREMILAST
    D.3.9.4EV Substance CodeSUB130837
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Otezla
    D.2.1.1.2Name of the Marketing Authorisation holderCelgene Europe BV
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApremilast
    D.3.2Product code [CC-10004]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNApremilast 30 mg
    D.3.9.1CAS number 608141-41-9
    D.3.9.2Current sponsor codeCC-10004
    D.3.9.3Other descriptive nameAPREMILAST
    D.3.9.4EV Substance CodeSUB130837
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Psoriatic arthritis
    Artrite Psoriasica
    E.1.1.1Medical condition in easily understood language
    Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis (scaly skin). Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis.
    L’artrite psoriasica è una forma di artrite che colpisce alcune persone affette da psoriasi (pelle squamosa). Dolore, rigidità e gonfiore articolari sono i principali sintomi dell’artrite psoriasica.
    E.1.1.2Therapeutic area Diseases [C] - Immune System Diseases [C20]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10037160
    E.1.2Term Psoriatic arthritis
    E.1.2System Organ Class 100000004859
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of the study is to evaluate the efficacy of apremilast 30 mg twice a day (BID) on inflammation indices, assessed by magnetic resonance imaging (MRI) of the hand.
    L’obiettivo primario dello studio consiste nel valutare l’efficacia di apremilast 30 mg due volte al giorno (BID) sugli indici di infiammazione, tramite risonanza magnetica per immagini (RMI) della mano.
    E.2.2Secondary objectives of the trial
    - The efficacy of apremilast 30 mg BID on imaging outcomes associated with structural progression,
    assessed by MRI of the hand.
    - The efficacy of apremilast 30 mg BID on disease activity and functionality, assessed by clinical outcomes
    - The efficacy of apremilast 30 mg BID on inflammation indices of peripheral arthritis and enthesitis, total (sum of arthritis and enthesitis) and separately, assessed by whole-body MRI (WB-MRI)
    - The efficacy of apremilast 30 mg BID on The European League Against Rheumatism Psoriatic Arthritis Impact of Disease 12 domains (PsAID-12)
    - The safety and tolerability of apremilast 30 mg BID
    - Valutare l’efficacia di apremilast 30 mg BID sugli esiti della diagnostica per immagini associati a progressione strutturale, tramite RMI della mano
    - Valutare l’efficacia di apremilast 30 mg BID sull’attività e sulla funzionalità della malattia, tramite gli esiti clinici
    - Valutare l’efficacia di apremilast 30 mg BID sugli indici di infiammazione dell’entesite e dell’artrite periferiche, in totale (somma di artrite ed entesite) e separatamente, tramite RMI dell’intero corpo (RMI-WB)
    - Valutare l’efficacia di apremilast 30 mg BID sul questionario a 12 domini dell’impatto della malattia della Lega europea contro l’artrite psoriasica reumatica (European League Against Rheumatism Psoriatic Arthritis Impact of Disease 12 domains, [PsAID-12])
    - Valutare la sicurezza e la tollerabilità di apremilast 30 mg BID
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Males or females, aged = 18 years at time of consent
    2. For all regions, the local Regulatory Label for treatment with apremilast must be followed. For example, subjects in the EU must have had inadequate response or intolerance to a prior csDMARD.
    3. Must understand and voluntarily sign an informed consent document prior to any study related assessments/procedures being conducted
    4. Able to adhere to the study visit schedule and other protocol requirements
    5. Have a documented diagnosis of PsA of = 3 months AND = 5 years in duration, meeting the CASPAR criteria for PsA (Appendix B, Taylor, 2006) at the time of Screening Visit
    6. Have = 3 swollen AND = 3 tender joints, with hand involvement (defined as = 1 swollen joint or dactylitis [each clinically active joint of a dactylitic digit is counted as one joint]).
    7. Have at least 1 active enthesitis site (one of the SPARCC or LEI sites)
    8. Must not have been treated previously with a TNF blocker or other biologic drug for PsA treatment
    9. Must not have been treated with more than 2 csDMARDs
    10. Subjects taking csDMARDs, with the exception of MTX, cyclosporine, or LEF (see Section 4.4, Exclusion Criterion 18, 19 and 20), do not require a washout period. However, they must discontinue the csDMARD treatment at least one day prior to their Baseline Visit (ie, Visit 2, Day 1)
    11. Subjects who have been previously treated with MTX for < 6 months and who are not on stable doses for at least 3 months will require a 28-day washout prior to the Baseline Visit (ie, Visit 2, Day 1) to participate in the study
    12. Subjects who have been previously treated with LEF will require a 12-week washout prior to the Baseline Visit (ie, Visit 2, Day 1), or treatment with cholestyramine, per LEF
    prescribing label (ie, 8 g cholestyramine 3 times daily for 11 days)
    13. Subjects who have been previously treated with cyclosporine will require a 28-day washout prior to the Baseline Visit (ie, Visit 2, Day 1) to participate in the study
    14. If taking MTX (= 25 mg/week), continuity of treatment will be allowed if duration of treatment is = 6 months and on a stable dose for at least 3 months prior to the Baseline Visit (ie, Visit 2, Day 1)
    15. If taking oral glucocorticoids, must be on a stable dose of prednisone = 10 mg/day or equivalent for at least 4 weeks prior to the Baseline Visit (ie, Visit 2, Day 1)
    16. If taking NSAIDs or narcotic analgesics, must be on stable dose for at least 4 weeks prior to Baseline Visit (ie, Visit 2, Day 1)
    17 and 18: see study protocol for complete list of IC
    1. Soggetti di sesso M e F di età = 18 anni al momento della fornitura del consenso
    2. Per tutte le regioni, seguire l’etichetta concernente la normativa locale per il trattamento con apremilast. Ad esempio, i soggetti nell’UE devono aver avuto una risposta inadeguata o un’intolleranza a un farmaco antireumatico modificante la malattia sintetico convenzionale (conventional synthetic Disease-Modifying Anti-Rheumatic Drugs, [csDMARD]) precedente.
    3. Comprendere e firmare volontariamente un documento di consenso informato prima che siano condotte eventuali valutazioni/procedure correlate allo studio
    4. Capacità di attenersi al programma delle visite dello studio e ad altri requisiti del protocollo;
    5. Presentare una diagnosi documentata di artrite psoriasica (APs) avente una durata = 3 mesi E = 5 anni, secondo i criteri di CASPAR per l’APs (Appendice B, Taylor, 2006), al momento della Visita di screening; 6. Presentare = 3 articolazioni tumefatte e = 3 articolazioni dolenti, con il coinvolgimento della mano (definita come = 1 articolazione tumefatta o dattilite [ogni articolazione clinicamente attiva di dito dattilitico (“dito a salsicciotto”) è conteggiata come singola articolazione]).
    7. Presentare almeno 1 sito entesitico (uno dei siti dell’Indice del Consorzio canadese di ricerca sulla spondiloartrite [Spondyloarthritis Research Consortium of Canada, (SPARCC)] o dell’Indice entesitico di Leeds [Leeds Enthesitis Index, (LEI)]); 8. Non essere stati precedentemente trattati con un bloccante del Tumor Necrosis Factor, [TNF]) o altro farmaco biologico per il trattamento dell’APs
    9. Non essere stati precedentemente trattati con più di 2 csDMARD; 10. I soggetti che assumo csDMARD, fatta eccezione per metotressato (MTX), ciclosporina o leflunomide (LEF) (cfr. Sezione 4.4, Criteri di esclusione 18, 19 e 20) non richiedono un periodo di washout. Tuttavia, i soggetti devono interrompere il trattamento con csDMARD almeno un giorno prima della Visita basale (ossia, Visita 2, Giorno 1)
    11. Per partecipare allo studio, i soggetti precedentemente trattati con MTX per < 6 mesi e che non assumono dosi stabili da almeno 3 mesi richiederanno un periodo di washout di 28 giorni prima della Visita basale (ossia, Visita 2, Giorno 1); 12. I soggetti precedentemente trattati con LEF richiederanno un periodo di washout di 12 settimane prima della Visita basale (ossia, Visita 2, Giorno 1) o un trattamento a base di colestiramina, come da etichetta contenente le indicazioni di prescrizione del LEF (ossia, 8 g di colestiramina 3 volte al giorno per 11 giorni)
    13. Per partecipare allo studio, i soggetti precedentemente trattati con ciclosporina richiederanno un periodo di washout di 28 gg prima della Visita basale (ossia, Visita 2, Giorno 1)
    14. Se i soggetti assumono MTX (= 25 mg/settimana), la continuità del trattamento sarà consentita laddove la durata del trattamento sia = 6 mesi e si assuma una dose stabile da almeno 3 mesi prima della Visita basale (ossia, Visita 2, Giorno 1); 15. Se i soggetti assumono glucocorticoidi orali, è necessario che siano trattati con una dose stabile di prednisone = 10 mg/giorno o equivalente per almeno 4 settimane prima della Visita basale (ossia, Visita 2, Giorno 1) ; 16. Se i soggetti assumono farmaci antiinfiammatori non steroidei (FANS) o analgesici narcotici, è necessario che siano trattati con una dose stabile per almeno 4 settimane prima della Visita basale (ossia, Visita 2, Giorno 1);
    17- 18 Per l'elenco completo consultare il protocollo di studio.
    E.4Principal exclusion criteria
    1. Contraindication to MRI examination including, but not limited to, intracranial metal clips, heart pacemakers, insulin pumps, implanted hearing aids, neurostimulators, metal hip replacements, profound claustrophobia or inability to lie in the MRI machine in an appropriate position to obtain quality images, history of hypersensitivity to gadolinium contrast agent.
    2. Severe renal impairment (creatinine clearance of less than 30 mL per minute estimated by the Cockroft–Gault equation), which would prevent the use of gadolinium enhancement
    3. History of clinically significant (as determined by the investigator) cardiac, endocrine, pulmonary, neurologic, psychiatric, hepatic, renal, hematologic, immunologic disease, or other major uncontrolled disease
    4. Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study
    5. Prior history of suicide attempt at any time in the subject’s lifetime prior to signing the informed consent, or major psychiatric illness requiring hospitalization within the last 3 years prior to signing the informed consent.
    6. Pregnant or breast feeding
    7. Active substance abuse or a history of substance abuse within 6 months prior to screening
    8. History of allergy or hypersensitivity to any component of the IP
    9. History of rare hereditary problems of galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption
    10. History of positive human immunodeficiency virus (HIV), or congenital or acquired immunodeficiency (eg, Common Variable Immunodeficiency Disease)
    11. Active tuberculosis or a history of incompletely treated tuberculosis
    12. Bacterial infections requiring treatment with oral or injectable antibiotics, or significant viral or fungal infections, within 4 weeks of screening. Any treatment for such infections must have been completed and the infection cured, at least 4 weeks prior to screening and no new or recurrent infections prior to the Baseline Visit
    13. Malignancy or history of malignancy or myeloproliferative or lymphoproliferative disease within the past 3 years, except for treated (ie, cured) basal cell or squamous cell in situ skin carcinomas;
    14. Major surgery (including joint surgery) within 8 weeks prior to screening or planned major surgery within 6 months following Baseline Visit
    15. Rheumatic autoimmune disease other than PsA, including, but not limited to: systemic lupus erythematosus, mixed connective tissue disease, scleroderma, polymyositis, or fibromyalgia
    16. Prior history of or current inflammatory joint disease other than PsA (eg, gout, reactive arthritis, RA, ankylosing spondylitis, Lyme disease), which confounds the ability to interpret data from the study
    17. Prior treatment with any biologic DMARD
    18. Prior treatment with more than 2 csDMARDs
    19. Use of the following systemic therapy(ies) within 28 days of the Baseline Visit (ie, Visit 2, Day 1): cyclosporine or other calcineurin inhibitors, glucocorticoids exceeding 10 mg daily prednisone equivalent, as well as mycophenolate.
    20. Use of MTX within 4 weeks of the Baseline Visit (ie, Visit 2, Day 1), unless subject is on stable doses for at least 3 months and total treatment duration with MTX is = 6 months
    21. Use of LEF within 12 weeks of the Baseline Visit (ie, Visit 2, Day 1), unless subject has taken cholestyramine, 8 g three times daily X 11 days after stopping LEF
    22. Previous treatment with a JAK inhibitor (including tyk2 inhibitor)
    23. Prior treatment with apremilast, or participation in a clinical study involving apremilast
    24. Use of intra-articular (IA) glucocorticoid injection within 8 weeks before the Baseline Visit (ie, Visit 2, Day 1).
    25. Use of any investigational drug within 4 weeks of the Baseline Visit, or 5 pharmacokinetic/pharmacodynamic half-lives, if known (whichever is longer)
    1. Controindicazioni all’esame di RMI inclusi, sebbene non limitatamente, clip metalliche intracraniche, pacemaker cardiaci, pompe per insulina, protesi acustiche impiantate, neurostimolatori, protesi d’anca in metallo, claustrofobia grave o incapacità di sdraiarsi all’interno della macchina per l’esame di RMI in una posizione appropriata per ottenere immagini di qualità, anamnesi di ipersensibilità al mezzo di contrasto gadolinio
    2. Insufficienza renale grave (clearance della creatinina inferiore a 30 ml al minuto stimata mediante equazione di Cockroft-Gault), che impedirebbe l’utilizzo dell’effetto di potenziamento mediante gadolinio
    3. Anamnesi di malattia cardiaca, endocrina, polmonare, neurologica, psichiatrica, epatica, renale, ematologica, immunologica o altra grave malattia incontrollata clinicamente significativa (come determinata dallo sperimentatore)
    4. Qualsiasi patologia, inclusa la presenza di valori anormali di laboratorio, che espone il soggetto a un rischio inaccettabile in caso di partecipazione allo studio
    5. Anamnesi di pregresso tentativo di suicidio o malattia psichiatrica maggiore che ha richiesto il ricovero negli ultimi 3 anni precedenti la firma del consenso informato.
    6. Gravidanza o allattamento
    7. Abuso attivo di sostanze stupefacenti o anamnesi di abuso di sostanze stupefacenti entro i 6 mesi precedenti lo screening
    8. Anamnesi di allergia o ipersensibilità a qualsiasi componente dell’IP
    9. Anamnesi di rari problemi ereditari di intolleranza al galattosio, deficit di Lapp lattasi o malassorbimento di glucosio-galattosio
    10. Anamnesi di positività al HIV o di immunodeficienza congenita o acquisita
    11. Tubercolosi attiva o anamnesi di tubercolosi trattata in maniera incompleta
    12. Infezioni batteriche richiedenti un trattamento con antibiotici orali o iniettabili, oppure infezioni virali o fungine significative, entro 4 settimane dallo screening.
    Qualsiasi trattamento per tali infezioni deve essere stato completato e l’infezione deve essere guarita, almeno 4 settimane prima dello screening e non deve essere presente alcuna infezione nuova o ricorrente prima della Visita basale
    13. Malignità o anamnesi di tumore maligno o malattia mieloproliferativa o linfoproliferativa negli ultimi 3 anni, ad eccezione di carcinomi cutanei basocellulari o squamocellulari in situ trattati (ossia, guariti)
    14. Intervento chirurgico maggiore (inclusa la chirurgia articolare) nelle 8 settimane precedenti lo screening o intervento chirurgico maggiore previsto nei 6 mesi successivi alla Visita basale
    15. Malattia autoimmune reumatica diversa dall’APs, tra cui, sebbene non limitatamente: lupus eritematoso sistemico, malattia del tessuto connettivo misto, sclerodermia, polimiosite o fibromialgia
    16. Anamnesi pregressa di o attuale malattia infiammatoria articolare diversa dall’APs (es. gotta, artrite reattiva, artrite reumatoide [AR], spondilite anchilosante, malattia di Lyme), che confonda la capacità di interpretare i dati dello studio
    17. Precedente trattamento con qualsiasi farmaco antireumatico modificante la malattia [DMARD]) biologico
    18. Precedente trattamento con più di 2 csDMARD
    19. Utilizzo di una o più delle seguenti terapie sistemiche entro 28 giorni dalla Visita basale (ossia, Visita 2, Giorno 1): ciclosporina o altri inibitori della calcineurina, glucocorticoidi superiori a 10 mg una volta al giorno di prednisone equivalente, nonché micofenolato.
    20. Utilizzo di MTX entro 4 settimane dalla Visita basale (ossia, Visita 2, Giorno 1), a meno che il soggetto sia sottoposto a dosi stabili da almeno 3 mesi e la durata totale del trattamento con MTX sia = 6 mesi
    21. Utilizzo di LEF entro 12 settimane dalla Visita basale (ossia, Visita 2, Giorno 1), a meno che il soggetto abbia assunto 8 g di colestiramina tre volte al giorno per 11 giorni successivamente all’interruzione del LEF
    22. Precedente trattamento con un inibitore della JAK (incluso inibitore di tyk2)
    23-25: vedi protocollo per elenco completo
    E.5 End points
    E.5.1Primary end point(s)
    Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) Inflammation Score of bone marrow edema [BME] + synovitis + tenosynovitis
    Punteggio dell’infiammazione per la rilevazione di edema midollare osseo (Bone Marrow Edema, [BME]) + sinovite + tenosinovite per l’individuazione del punteggio di risonanza magnetica per immagini dell’artrite psoriasica (Psoriatic Arthritis Magnetic Resonance Imaging Score, [PsAMRIS])
    E.5.1.1Timepoint(s) of evaluation of this end point
    Week 24
    Settimana 24
    E.5.2Secondary end point(s)
    EFFICACY ENDPOINTS
    1. PsAMRIS Inflammation Score of BME + Synovitis + Tenosynovitis
    2. PsAMRIS BME + Synovitis
    3. PsAMRIS Total Inflammation Score (BME + Synovitis + Tenosynovitis + Periarticular Inflammation)
    4. PsAMRIS BME
    5. PsAMRIS Synovitis
    6. PsAMRIS Tenosynovitis
    7. PsAMRIS Periarticular Inflammation
    8. PsAMRIS Total Damage Score (erosion + bone proliferation)
    9. PsAMRIS Erosion
    10. PsAMRIS Bone Proliferation
    11. Swollen Joint Count (SJC)
    12. Tender Joint Count (TJC)
    13. Clinical Disease Activity Index for Psoriatic Arthritis (c-DAPSA)
    14. Spondyloarthritis Research Consortium of Canada (SPARCC)
    15. Leeds Enthesitis Index (LEI)
    16. Enthesitis improvement to 0
    17. Leeds Dactylitis Index (LDI)
    18. Dactylitis improvement to 0
    19. Psoriatic Arthritis Disease Activity Score (PASDAS)
    20. Evaluator’s Global Assessment of Disease Activity
    21. Subject’s Global Assessment of Disease Activity
    22. Subject's Assessment of Pain
    23. Health Assessment Questionnaire-Disability Index (HAQ-DI)
    24. WB-MRI Peripheral Enthesitis Inflammation Index
    25. WB-MRI Peripheral Joints Inflammation Index
    26. WB-MRI Total Peripheral Inflammation Index
    27. BASDAI
    28. The European League Against Rheumatism Psoriatic Arthritis Impact of Disease 12 domains (PsAID-12)
    SAFETY ENDPOINTS
    29. Adverse events (AEs)
    30. Discontinuation due to AEs
    31. Clinically significant changes in physical examination, vital signs, and/or laboratory findings
    ENDPOINT DI EFFICACIA
    1. Punteggio dell’infiammazione per la rilevazione di BME + sinovite + tenosinovite per l’individuazione del PsAMRIS
    2. BME + sinovite per l’individuazione del PsAMRIS
    3. Punteggio totale dell’infiammazione (BME + sinovite + tenosinovite + infiammazione periarticolare) per l’individuazione del PsAMRIS
    4. BME per l’individuazione del PsAMRIS
    5. Sinovite per l’individuazione del PsAMRIS
    6. Tenosinovite per l’individuazione del PsAMRIS
    7. Infiammazione periarticolare per l’individuazione del PsAMRIS
    8. Punteggio della lesione totale (erosione + proliferazione ossea) per l’individuazione del PsAMRIS
    9. Erosione per l’individuazione del PsAMRIS
    10. Proliferazione ossea per l’individuazione del PsAMRIS
    11. Conteggio delle articolazioni tumefatte (Swollen Joint Count, [SJC])
    12. Conteggio delle articolazioni doloranti (Tender Joint Count, [TJC])
    13. Indice di attività delle malattie cliniche per l’artrite psoriasica (Clinical Disease Activity Index for Psoriatic Arthritis, [c-DAPSA])
    14. Consorzio canadese di ricerca sulla spondiloartrite (SPARCC)
    15. Indice entesitico di Leeds (LEI)
    16. Miglioramento dell’entesite a 0
    17. Indice dattilitico di Leeds (Leeds Dactylitis Index, [LDI])
    18. Miglioramento della dattilite a 0
    19. Punteggio di attività della malattia di artrite psoriasica (Psoriatic Arthritis Disease Activity Score, [PASDAS])
    20. Valutazione globale dell’attività della malattia da parte del valutatore
    21. Valutazione globale dell’attività della malattia da parte del soggetto
    22. Valutazione del dolore da parte del soggetto
    23. Questionario di valutazione della salute – Indice di invalidità (Health Assessment Questionnaire-Disability Index, [HAQ-DI])
    24. Indice di infiammazione entesitica periferica mediante RMI-WB
    25. Indice di infiammazione articolare periferica mediante RMI-WB
    26. Indice di infiammazione periferica totale mediante RMI-WB
    27. Indice di attività della malattia della spondilite anchilosante di Bath (Bath Ankylosing Spondylitis Disease Activity Index, [BASDAI])
    28. Questionario a 12 domini dell’impatto della malattia della Lega europea contro l’artrite psoriasica reumatica (PsAID-12)
    ENDPOINT DI SICUREZZA
    29. Eventi avversi (EA)
    30. Interruzione dovuta a EA
    31. Cambiamenti clinicamente significativi nell’esame obiettivo, nei segni vitali e/o nei risultati di laboratorio
    E.5.2.1Timepoint(s) of evaluation of this end point
    #1: Week 48.
    #2 - #28: Week 24 & 48
    #29 - #31: throughout the study
    N. 1: Settimana 48.
    N. 2 – N. 28: Settimane 24 e 48
    N. 29 – N. 31: durante lo studio
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety No
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) Yes
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    in aperto
    open
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA24
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Canada
    Russian Federation
    United States
    Austria
    Belgium
    Denmark
    Germany
    Italy
    Spain
    Switzerland
    United Kingdom
    E.8.7Trial 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
    The End of Trial is defined as either the date of the last visit of the last subject to complete the post-treatment follow-up, or the date of receipt of the last data point from the last subject that is required for primary, secondary and/or exploratory analysis, as prespecified in the protocol, whichever is the later date.
    La Fine della sperimentazione è definita come la data dell’ultima visita dell’ultimo soggetto per completare il follow-up post trattamento, oppure la data di ricezione degli ultimi dati dell’ultimo soggetto necessari per l’analisi primaria, l’analisi secondaria e/o l’analisi esplorativa, come specificato in precedenza nel protocollo, a seconda di quale si verifichi più tardi.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months2
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 105
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 15
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 80
    F.4.2.2In the whole clinical trial 120
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    This is left at the discretion of the treating physician. As Otezla (apremilast) is an approved, marketed product, subjects who benefit from treatment with apremilast during the CC-10004-PSA-014 study will have the option to receive Otezla in accordance with the marketing authorization in their respective country. Subjects are also required to meet a specific Inclusion Criterion to support compliance with the local marketing authorization.
    La decisione è lasciata alla discrezione del medico curante. Poiché Otezla (apremilast) è un prodotto approvato e commercializzato, i soggetti che beneficiano del trattamento con apremilast durante questo studio avranno la possibilità di ricevere Otezla conformemente all’AIC nei rispettivi Paesi. I soggetti sono inoltre tenuti a soddisfare uno specifico criterio di inclusione per supportare la conformità all’autorizzazione locale all’immissione in commercio.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2019-03-28
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-02-18
    P. End of Trial
    P.End of Trial StatusCompleted
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