Clinical Trial Results:
A Phase 3, Randomized, Double-blind, Controlled Study Evaluating the Efficacy and Safety of VX-445 Combination Therapy in Subjects With Cystic Fibrosis Who Are Heterozygous for the F508del Mutation and a Gating or Residual Function Mutation (F/G and F/RF Genotypes)
Summary
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EudraCT number |
2018-002835-76 |
Trial protocol |
GB IE DE DK FR BE NL IT |
Global end of trial date |
12 Jun 2020
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Results information
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Results version number |
v2(current) |
This version publication date |
22 Jul 2021
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First version publication date |
26 Dec 2020
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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 |
VX18-445-104
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT04058353 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Vertex Pharmaceuticals Incorporated
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Sponsor organisation address |
50 Northern Avenue, Boston, Massachusetts, United States,
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Public contact |
Medical Monitor, Vertex Pharmaceuticals Incorporated, +1 617 341 6777, medicalinfo@vrtx.com
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Scientific contact |
Medical Monitor, Vertex Pharmaceuticals Incorporated, +1 617 341 6777, medicalinfo@vrtx.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? |
Yes
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
30 Jun 2020
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
12 Jun 2020
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Global end of trial reached? |
Yes
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Global end of trial date |
12 Jun 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 |
To evaluate the efficacy of elexacaftor (ELX)/tezacaftor (TEZ)/ivacaftor (IVA) in cystic fibrosis (CF) subjects who are heterozygous for F508del and a gating or residual function mutation (F/G and F/RF genotypes).
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Protection of trial subjects |
The study was conducted in accordance with the ethical principles stated in the Declaration of Helsinki and the International Council on Harmonization (ICH) Guideline for Good Clinical Practice (GCP).
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
28 Aug 2019
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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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 |
United States: 92
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Country: Number of subjects enrolled |
Australia: 27
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Country: Number of subjects enrolled |
France: 27
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Country: Number of subjects enrolled |
United Kingdom: 25
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Country: Number of subjects enrolled |
Italy: 20
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Country: Number of subjects enrolled |
Germany: 16
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Country: Number of subjects enrolled |
Netherlands: 14
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Country: Number of subjects enrolled |
Belgium: 13
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Country: Number of subjects enrolled |
Canada: 12
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Country: Number of subjects enrolled |
Spain: 12
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Country: Number of subjects enrolled |
Ireland: 11
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Country: Number of subjects enrolled |
Denmark: 2
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Worldwide total number of subjects |
271
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EEA total number of subjects |
140
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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) |
24
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Adults (18-64 years) |
242
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From 65 to 84 years |
5
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85 years and over |
0
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Recruitment
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Recruitment details |
- | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
This study was conducted in cystic fibrosis (CF) subjects aged 12 years or older. | ||||||||||||||||||||||||
Period 1
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Period 1 title |
Triple Combination 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 |
Investigator, Carer, Assessor, Subject | ||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Control: IVA or TEZ/IVA | ||||||||||||||||||||||||
Arm description |
Following an IVA or TEZ/IVA run-in period of 4 weeks, subjects either received IVA 150 milligrams (mg) every 12 hours (q12h) or TEZ 100 mg once daily (qd)/IVA 150 mg q12h in the treatment period for 8 weeks. | ||||||||||||||||||||||||
Arm type |
Active comparator | ||||||||||||||||||||||||
Investigational medicinal product name |
IVA
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Investigational medicinal product code |
VX-770
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Other name |
Ivacaftor
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Subjects received IVA every 12 hours.
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Investigational medicinal product name |
TEZ/IVA
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Investigational medicinal product code |
VX-661/VX-770
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Other name |
Tezacaftor/Ivacaftor
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Subjects received TEZ once daily and IVA every 12 hours.
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Arm title
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Triple Combination (TC): ELX/TEZ/IVA | ||||||||||||||||||||||||
Arm description |
Following an IVA or TEZ/IVA run-in period of 4 weeks, subjects received ELX 200 mg qd/TEZ 100 mg qd/IVA 150 mg q12h in the treatment period for 8 weeks. | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
ELX/TEZ/IVA
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Investigational medicinal product code |
VX-445/VX-661/VX-770
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Other name |
Elexacaftor/Tezacaftor/Ivacaftor
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Subjects received VX-445/TEZ/IVA fixed-dose combination once daily in the morning.
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Investigational medicinal product name |
IVA
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Investigational medicinal product code |
VX-770
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Other name |
Ivacaftor
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Subjects received IVA once daily in the evening.
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Notes [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same. Justification: A total of 271 subjects enrolled, 12 subjects discontinued in run-in period of the study. Of 259 subjects, 1 subject randomized but not dosed in the treatment period. Therefore, only 258 subjects are included in the subject disposition and baseline sections. |
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Baseline characteristics reporting groups
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Reporting group title |
Control: IVA or TEZ/IVA
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Reporting group description |
Following an IVA or TEZ/IVA run-in period of 4 weeks, subjects either received IVA 150 milligrams (mg) every 12 hours (q12h) or TEZ 100 mg once daily (qd)/IVA 150 mg q12h in the treatment period for 8 weeks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Triple Combination (TC): ELX/TEZ/IVA
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Reporting group description |
Following an IVA or TEZ/IVA run-in period of 4 weeks, subjects received ELX 200 mg qd/TEZ 100 mg qd/IVA 150 mg q12h in the treatment period for 8 weeks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Control: IVA or TEZ/IVA
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Reporting group description |
Following an IVA or TEZ/IVA run-in period of 4 weeks, subjects either received IVA 150 milligrams (mg) every 12 hours (q12h) or TEZ 100 mg once daily (qd)/IVA 150 mg q12h in the treatment period for 8 weeks. | ||
Reporting group title |
Triple Combination (TC): ELX/TEZ/IVA
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Reporting group description |
Following an IVA or TEZ/IVA run-in period of 4 weeks, subjects received ELX 200 mg qd/TEZ 100 mg qd/IVA 150 mg q12h in the treatment period for 8 weeks. |
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End point title |
Absolute Change in Percent Predicted Forced Expiratory Volume in 1 Second (ppFEV1) for the ELX/TEZ/IVA Group [1] [2] | ||||||||
End point description |
FEV1 is the volume of air that can forcibly be blown out in one second, after full inspiration. Full analysis set (FAS) included all randomized subjects who have the intended CF transmembrane conductance regulator (CFTR) allele mutation and received at least 1 dose of study drug in the treatment period.
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End point type |
Primary
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End point timeframe |
From Baseline Through Week 8
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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: Only within treatment group comparison was planned for this endpoint. Individual within-group comparison cannot be reported in the EudraCT database. Therefore, no statistical comparisons were reported. [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: This endpoint was applicable only for the triple combination arm. |
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No statistical analyses for this end point |
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End point title |
Absolute Change in Sweat Chloride (SwCl) for ELX/TEZ/IVA Group [3] | ||||||||
End point description |
Sweat samples were collected using an approved collection device. FAS.
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End point type |
Secondary
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End point timeframe |
From Baseline Through Week 8
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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: This endpoint was applicable only for the triple combination arm. |
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No statistical analyses for this end point |
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End point title |
Absolute Change in ppFEV1 for the ELX/TEZ/IVA Group Compared to the Control Group | ||||||||||||
End point description |
FEV1 is the volume of air that can forcibly be blown out in one second, after full inspiration. FAS.
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End point type |
Secondary
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End point timeframe |
From Baseline Through Week 8
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Statistical analysis title |
Statistical Analysis | ||||||||||||
Comparison groups |
Control: IVA or TEZ/IVA v Triple Combination (TC): ELX/TEZ/IVA
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Number of subjects included in analysis |
258
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
< 0.0001 | ||||||||||||
Method |
Mixed-effects model for repeated measure | ||||||||||||
Parameter type |
Least Squares (LS) Mean Difference | ||||||||||||
Point estimate |
3.5
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
2.2 | ||||||||||||
upper limit |
4.7 |
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End point title |
Absolute Change in SwCl for ELX/TEZ/IVA Group Compared to the Control Group | ||||||||||||
End point description |
Sweat samples were collected using an approved collection device. FAS.
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End point type |
Secondary
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End point timeframe |
From Baseline Through Week 8
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Statistical analysis title |
Statistical Analysis | ||||||||||||
Comparison groups |
Control: IVA or TEZ/IVA v Triple Combination (TC): ELX/TEZ/IVA
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Number of subjects included in analysis |
258
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
< 0.0001 | ||||||||||||
Method |
Mixed-effects model for repeated measure | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
-23.1
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-26.1 | ||||||||||||
upper limit |
-20.1 |
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End point title |
Absolute Change in Cystic Fibrosis Questionnaire-Revised (CFQ-R) Respiratory Domain Score for ELX/TEZ/IVA Group [4] | ||||||||
End point description |
The CFQ-R is a validated subject-reported outcome measuring health-related quality of life for subjects with cystic fibrosis. Respiratory domain assessed respiratory symptoms, score range: 0-100; higher scores indicating fewer symptoms and better health-related quality of life. FAS.
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End point type |
Secondary
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End point timeframe |
From Baseline Through Week 8
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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: This endpoint was applicable only for the triple combination arm. |
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No statistical analyses for this end point |
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End point title |
Absolute Change in CFQ-R Respiratory Domain Score for ELX/TEZ/IVA Group Compared to the Control Group | ||||||||||||
End point description |
The CFQ-R is a validated subject-reported outcome measuring health-related quality of life for subjects with cystic fibrosis. Respiratory domain assessed respiratory symptoms, score range: 0-100; higher scores indicating fewer symptoms and better health-related quality of life. FAS.
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End point type |
Secondary
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End point timeframe |
From Baseline Through Week 8
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Statistical analysis title |
Statistical Analysis | ||||||||||||
Comparison groups |
Control: IVA or TEZ/IVA v Triple Combination (TC): ELX/TEZ/IVA
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Number of subjects included in analysis |
258
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
< 0.0001 | ||||||||||||
Method |
Mixed-effects model for repeated measure | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
8.7
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
5.3 | ||||||||||||
upper limit |
12.1 |
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End point title |
Safety and Tolerability as Assessed by Number of Subjects With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | |||||||||||||||
End point description |
Safety set included all subjects who received at least 1 dose of study drug in the treatment period.
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End point type |
Secondary
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End point timeframe |
Day 1 up to Week 12
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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 |
Day 1 up to Week 12
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
23.0
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Reporting groups
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Reporting group title |
Control: IVA or TEZ/IVA
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Reporting group description |
Following an IVA or TEZ/IVA run-in period of 4 weeks, subjects either received IVA 150 mg q12h or TEZ 100 mg qd/IVA 150 mg q12h in the treatment period for 8 weeks. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
TC: ELX/TEZ/IVA
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Reporting group description |
Following an IVA or TEZ/IVA run-in period of 4 weeks, subjects received ELX 200 mg qd/TEZ 100 mg qd/IVA 150 mg q12h in the treatment period for 8 weeks. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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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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02 Dec 2019 |
Amended to add an exploratory endpoint. |
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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 |