E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Active ulcerative colitis |
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E.1.1.1 | Medical condition in easily understood language |
Active inflammatory disease of large intestine or colon |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10045365 |
E.1.2 | Term | Ulcerative colitis |
E.1.2 | System Organ Class | 100000004856 |
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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 |
The primary efficacy objective is to evaluate the efficacy of ST-0529 in achieving clinical remission in subjects with moderately to severely active ulcerative colitis.
The safety objective is to evaluate the safety and tolerability of treatment with ST-0529 in subjects with moderately to severely active UC. |
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E.2.2 | Secondary objectives of the trial |
To characterize the pharmacokinetics and pharmacodynamics of ST-0529 in subjects with UC. To determine the effect of treatment with ST-0529 on health-related Quality of Life in subjects with moderately to severely active UC.
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
A PK sub-study will be conducted in a subset of centers and subjects to develop a more detailed understanding of the whole blood PK of ST-0529 in UC subjects. Approximately 40 subjects are targeted to be enrolled into the PK sub-study, with whole blood samples being collected at Week 2 at 0 (pre-dose), and at 2, 4, 6, and 8 hours post-dose.
The PK sub-study is an integral part of the main protocol |
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E.3 | Principal inclusion criteria |
1. Male and female adult subjects 18 to 75 years old, inclusive. 2. Diagnosis of UC established at least 3 months prior to the Baseline visit, by clinical and endoscopic evidence (colonoscopy or flexible sigmoidoscopy) and corroborated by assessment of biopsies in a histopathology report. 3. Moderately to severely active UC defined as the 3-Component Adapted Mayo Score of 5-9, inclusive, with an endoscopic sub-score of ≥ 2 (from central reading), and a rectal bleeding sub-score of ≥ 1, as determined 10 days (± 3 days) prior to Baseline. 4. Evidence of active UC, confirmed histologically (from local read), extending proximal to the rectum with ≥ 15 cm of involved colon. 5. At Screening, a colonoscopy will be required if the subject has had extensive colitis or pancolitis of > 8 years duration or left-sided colitis of > 12 years duration but has not had a colonoscopy within 1 year of the initial screening date. If the subject has had a colonoscopy within 1 year of the initial screening date, a flexible sigmoidoscopy may be used. 6. Subjects presenting at Screening with moderately to severely active UC demonstrating an inadequate response or loss of response or intolerance/medical contraindication to at least one of the following conventional therapies for UC: a. Corticosteroids i. Signs and symptoms of active disease despite treatment with an adequate dose (e.g. prednisolone > 40 mg/day or equivalent) over a period of 4 weeks for oral therapy or IV for up to 1 week or > 9 mg/day oral budesonide; OR ii. Unable to reduce corticosteroids below the equivalent of prednisolone 10 mg daily orally within 3 months of starting steroids or experienced a relapse within 3 months of stopping steroids; OR iii. History of, or current intolerance to corticosteroids (including, but not limited to Cushing’s syndrome, osteopenia/osteoporosis, hyperglycemia, insomnia, infection). b. Immunomodulators i. Signs and symptoms of active disease despite at least 3 months of treatment with a sufficient dose (oral azathioprine ≥ 1.5 mg/kg or 6-MP ≥ 0.75 mg/kg); OR ii. History of, or current dose-limiting toxicity associated with use of the agent (e.g. but not limited to nausea/vomiting, abdominal pain, pancreatitis, LFT abnormalities, lymphopenia, TPMT genetic mutation, infection). c. Anti-TNF agents i. Signs and symptoms of active disease despite treatment with a single anti-TNF agent. Treatment failure is defined as a relapse after an initial response to therapy as follows: • Infliximab: At least 4 infusions of at least 5 mg/kg within a 14-week timeframe for induction and maintenance; • Adalimumab: Induction regimen incorporating 160 mg at Week 0 (four 40 mg injections in one day or two 40 mg injections per day for two consecutive days) and 80 mg at Week 2, followed by maintenance treatment of 40 mg every other week up to at least Week 8; • Golimumab: Induction regimen incorporating 200 mg sc injection at Week 0, followed by 100 mg at Week 2 and then maintenance treatment of 50 mg or 100 mg (weight dependent) every 4 weeks after completion of the induction regimen up to at least Week 12; OR ii. History of, or current intolerance (with an initial response), defined as the presence of clinically significant side-effects, including infusion-related hypersensitivity. d. Vedolizumab i. Signs and symptoms of active disease despite a history of at least one induction regimen, defined as at least a 14-week (10 weeks in the EU) induction consisting of 300 mg IV at Weeks 0, 2 and 6. OR ii. History of intolerance to vedolizumab including, but not limited to, serious infections, hepatotoxicity, heart failure, allergic reactions, or any other condition that contributed to discontinuation of the agent. 7. Subjects receiving oral corticosteroids for the treatment of UC must be on a stable dose of ≤ 40 mg/day (prednisolone or equivalent), or ≤ 9 mg/day budesonide. This dose must be stable from the initial Screening visit until 1 week after the initiation of study treatment. 8. Subjects receiving oral 5-ASA must be on a stable dose from the initial Screening visit until the end of the study.
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E.4 | Principal exclusion criteria |
1. Subjects without previous treatment for UC. 2. Ulcerative colitis limited to rectum (ulcerative proctitis). 3. Evidence of acute severe colitis with toxic megacolon, abdominal abscess, bowel stricture or bowel perforation. 4. A diagnosis of Crohn’s colitis, colitis yet to be classified, ischemic colitis, NSAID induced colitis, idiopathic colitis or radiation colitis. 5. Subjects with evidence of pathogenic bowel infection (Clostridium difficile, Escheria coli, Salmonella, Shigella or Campylobacter). 6. Previous surgery for UC or, in the opinion of the Investigator, will likely require surgery for UC during the study. 7. Any histological evidence of mucosal dysplasia. 8. Any of the following laboratory abnormalities during the screening period – if values are initially outside the prescribed limits, the evaluation may be repeated once within the screening period to determine eligibility: a. Hemoglobin level < 8.0 g/dL b. Absolute WBC count < 3.0 × 10^9/L c. Absolute Lymphocyte count < 0.5 × 10^9/L d. Absolute neutrophil count < 1.2 × 10^9/L e. Platelet count < 100 × 10^9/L or >1200 × 10^9/L f. ALT or AST > 2.5 × ULN g. Alkaline phosphatase > 2.5 × ULN h. Serum creatinine > 1.5 × ULN i. Bilirubin > 1.5 × ULN 9. Treatment with anti-TNF agents or vedolizumab within 56 days prior to the Baseline visit. 10. Treatment with any calcineurin inhibitor (e.g. cyclosporine or tacrolimus) within 28 days prior to the Baseline visit. 11. Treatment with methotrexate from the initial Screening visit until the end of the study. 12. Initiation of treatment with an oral or IV corticosteroid from the initial Screening visit until the end of the study.
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy endpoint is clinical remission at Week 12, defined as a stool frequency sub-score of ≤ 1 associated with a decrease ≥ 1 point from Baseline, rectal bleeding sub-score of 0, and an endoscopic sub-score of ≤ 1 using the 3-Component Adapted Mayo Score |
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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) |
• Clinical response at Week 12, defined as a decrease from Baseline in the 3-Component Adapted Mayo Score of ≥ 2 points and ≥ 30%, with an accompanying decrease in the sub-score for rectal bleeding of ≥ 1 point or an absolute sub-score for rectal bleeding of ≤ 1. • Endoscopic healing (I) at Week 12 visit defined as endoscopic sub-score of ≤ 1. • Corticosteroid-free clinical response at Week 12 in subjects receiving corticosteroids at Baseline. • Corticosteroid-free clinical remission at Week 12 in subjects receiving corticosteroids at Baseline. • Changes from Baseline in individual Adapted Mayo sub-scores. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | Yes |
E.6.4 | Safety | Yes |
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 | No |
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 | 4 |
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 | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 46 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Canada |
Israel |
United States |
Belarus |
Russian Federation |
Serbia |
Ukraine |
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E.8.7 | Trial has a data monitoring committee | Yes |
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 | |
E.8.9.1 | In the Member State concerned months | 24 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 24 |