Clinical Trial Results:
A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study Evaluating Efficacy and Safety of Rozanolixizumab in Adult Patients With Generalized Myasthenia Gravis
Summary
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EudraCT number |
2019-000968-18 |
Trial protocol |
DK GB PL DE HU CZ BE ES IT |
Global end of trial date |
26 Oct 2021
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Results information
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Results version number |
v1(current) |
This version publication date |
06 Nov 2022
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First version publication date |
06 Nov 2022
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Other versions |
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 |
MG0003
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT03971422 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
UCB Biopharma SRL
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Sponsor organisation address |
Allée de la Recherche 60, Brussels, Belgium, 1070
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Public contact |
Clin Trial Reg & Results Disclosure, UCB BIOSCIENCES GmbH, clinicaltrials@ucb.com
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Scientific contact |
Clin Trial Reg & Results Disclosure, UCB BIOSCIENCES GmbH, clinicaltrials@ucb.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 |
12 Nov 2021
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
31 Aug 2021
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Global end of trial reached? |
Yes
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Global end of trial date |
26 Oct 2021
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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 |
Demonstrate the clinical efficacy of rozanolixizumab in participants with generalized myasthenia gravis (MG)
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Protection of trial subjects |
During the conduct of the study all participants were closely monitored.
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Background therapy |
Background therapy as permitted in the protocol. | ||
Evidence for comparator |
Not applicable | ||
Actual start date of recruitment |
03 Jun 2019
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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 Years | ||
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 |
Canada: 19
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Country: Number of subjects enrolled |
Czechia: 3
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Country: Number of subjects enrolled |
Denmark: 5
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Country: Number of subjects enrolled |
France: 18
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Country: Number of subjects enrolled |
Georgia: 13
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Country: Number of subjects enrolled |
Germany: 9
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Country: Number of subjects enrolled |
Hungary: 1
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Country: Number of subjects enrolled |
Italy: 13
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Country: Number of subjects enrolled |
Japan: 13
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Country: Number of subjects enrolled |
Poland: 27
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Country: Number of subjects enrolled |
Russian Federation: 14
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Country: Number of subjects enrolled |
Serbia: 9
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Country: Number of subjects enrolled |
Spain: 8
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Country: Number of subjects enrolled |
Taiwan: 7
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Country: Number of subjects enrolled |
United States: 41
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Worldwide total number of subjects |
200
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EEA total number of subjects |
84
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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) |
151
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From 65 to 84 years |
47
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85 years and over |
2
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Recruitment
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Recruitment details |
The study started to enroll study participants in Jun 2019 and concluded in Oct 2021. Two participants randomized to RLZ ~7mg/kg, were administered RLZ ~10mg/kg at baseline visit. So, these two participants were included in RLZ ~7 mg/kg group in randomized set, but in RLZ ~10 mg/kg group in safety set. | ||||||||||||||||||||||||||||||||||||||||||||
Pre-assignment
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Screening details |
Participant Flow refers to the Randomized Set which consisted of all study participants who were randomized and analyzed according to the treatment assigned instead of the actual treatment received. | ||||||||||||||||||||||||||||||||||||||||||||
Period 1
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Period 1 title |
Overall Study (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, Carer, Assessor | ||||||||||||||||||||||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Placebo | ||||||||||||||||||||||||||||||||||||||||||||
Arm description |
Participants received placebo subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||||||||||||||||||||||||||||||||||||||||||||
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
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
Participants received placebo at pre-specified time points.
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Arm title
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Rozanolixizumab ~7 mg/kg | ||||||||||||||||||||||||||||||||||||||||||||
Arm description |
Participants received rozanolixizumab (RLZ) equivalent to approximately 7 milligrams/kilogram (mg/kg) subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||||||||||||||||||||||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Rozanolixizumab
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Investigational medicinal product code |
UCB7665
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Other name |
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
Participants received rozanolixizumab equivalent to approximately 7 mg at pre-specified time points.
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Arm title
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Rozanolixizumab ~10 mg/kg | ||||||||||||||||||||||||||||||||||||||||||||
Arm description |
Participants received rozanolixizumab equivalent to approximately 10 mg/kg subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||||||||||||||||||||||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Rozanolixizumab
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Investigational medicinal product code |
UCB7665
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Other name |
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
Participants received rozanolixizumab equivalent to approximately 10 mg at pre-specified time points.
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Baseline characteristics reporting groups
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Reporting group title |
Placebo
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Reporting group description |
Participants received placebo subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Rozanolixizumab ~7 mg/kg
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Reporting group description |
Participants received rozanolixizumab (RLZ) equivalent to approximately 7 milligrams/kilogram (mg/kg) subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Rozanolixizumab ~10 mg/kg
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Reporting group description |
Participants received rozanolixizumab equivalent to approximately 10 mg/kg subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Placebo
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Reporting group description |
Participants received placebo subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||
Reporting group title |
Rozanolixizumab ~7 mg/kg
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Reporting group description |
Participants received rozanolixizumab (RLZ) equivalent to approximately 7 milligrams/kilogram (mg/kg) subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||
Reporting group title |
Rozanolixizumab ~10 mg/kg
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Reporting group description |
Participants received rozanolixizumab equivalent to approximately 10 mg/kg subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||
Subject analysis set title |
Rozanolixizumab ~10 mg/kg
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Subject analysis set type |
Safety analysis | ||
Subject analysis set description |
Participants received rozanolixizumab equivalent to approximately 10 mg/kg subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14).
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End point title |
Change from Baseline to Day 43 in Myasthenia Gravis-Activities of Daily Living (MG-ADL) score | ||||||||||||||||
End point description |
The Myasthenia Gravis Activities of Daily Living (MG-ADL) is an 8-item patient-reported outcome (PRO) instrument developed on the basis of the Quantitative Myasthenia Gravis (QMG). The MG-ADL targeted symptoms and disability across ocular, bulbar, respiratory, and axial symptoms. The total MG-ADL score was obtained by summing the responses to each individual item (8 items; Grades: 0, 1, 2, 3), where 0 represents no symptoms or impaired performance and 3 represents the most severe symptoms or impaired performance. The total score ranges from 0 to 24, with a higher score indicating more disability. A positive change in the score indicates worsening and a negative change indicates improvement. The Randomized Set consisted of all study participants who were randomized and analyzed according to the treatment assigned instead of the actual treatment received.
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End point type |
Primary
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End point timeframe |
Baseline and Day 43
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Statistical analysis title |
Statistical Analysis 1 | ||||||||||||||||
Statistical analysis description |
The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
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Comparison groups |
Placebo v Rozanolixizumab ~7 mg/kg
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Number of subjects included in analysis |
133
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Analysis specification |
Pre-specified
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Analysis type |
superiority [1] | ||||||||||||||||
P-value |
< 0.001 [2] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-2.586
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Confidence interval |
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level |
95% | ||||||||||||||||
sides |
2-sided
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lower limit |
-4.091 | ||||||||||||||||
upper limit |
-1.249 | ||||||||||||||||
Notes [1] - Mixed model repeated measure (MMRM) analysis of covariance (ANCOVA) model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [2] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
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Statistical analysis title |
Statistical Analysis 2 | ||||||||||||||||
Statistical analysis description |
The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
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Comparison groups |
Placebo v Rozanolixizumab ~10 mg/kg
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Number of subjects included in analysis |
134
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Analysis specification |
Pre-specified
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Analysis type |
superiority [3] | ||||||||||||||||
P-value |
< 0.001 [4] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-2.619
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Confidence interval |
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level |
95% | ||||||||||||||||
sides |
2-sided
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lower limit |
-3.994 | ||||||||||||||||
upper limit |
-1.163 | ||||||||||||||||
Notes [3] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [4] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
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End point title |
Percentage of participants achieving Myasthenia Gravis-Activities of Daily Living (MG-ADL) response at Day 43 | ||||||||||||||||
End point description |
The MG-ADL is an 8-item PRO instrument developed on the basis of the QMG. The MG-ADL targeted symptoms and disability across ocular, bulbar, respiratory, and axial symptoms. The total MG-ADL score was obtained by summing the responses to each individual item (8 items; Grades: 0, 1, 2, 3), where 0 represents no symptoms or impaired performance and 3 represents the most severe symptoms or impaired performance. The total score ranges from 0 to 24, with a higher score indicating more disability. A positive change in the score indicates worsening and a negative change indicates improvement. Study participants were classified as responders at Day 43 if the value was at least a 2-point improvement (decrease) from Baseline at Day 43. The Randomized Set consisted of all study participants who were randomized and analyzed according to the treatment assigned instead of the actual treatment received.
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End point type |
Secondary
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End point timeframe |
Day 43
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Statistical analysis title |
Statistical Analysis 2 | ||||||||||||||||
Comparison groups |
Placebo v Rozanolixizumab ~10 mg/kg
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Number of subjects included in analysis |
134
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Analysis specification |
Pre-specified
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Analysis type |
superiority [5] | ||||||||||||||||
P-value |
< 0.001 [6] | ||||||||||||||||
Method |
Wald test | ||||||||||||||||
Parameter type |
Odds ratio (OR) | ||||||||||||||||
Point estimate |
4.273
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Confidence interval |
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level |
95% | ||||||||||||||||
sides |
2-sided
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lower limit |
1.653 | ||||||||||||||||
upper limit |
11.791 | ||||||||||||||||
Notes [5] - The OR of responder rates is estimated and tested between treatment groups using logistic regression model with treatment group, Baseline MG-ADL score and stratification factor (MuSK+ or AChR+). An OR > 1 favours rozanolixizumab. [6] - p-value is nominal. Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
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Statistical analysis title |
Statistical Analysis 1 | ||||||||||||||||
Comparison groups |
Placebo v Rozanolixizumab ~7 mg/kg
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Number of subjects included in analysis |
133
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Analysis specification |
Pre-specified
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Analysis type |
superiority [7] | ||||||||||||||||
P-value |
< 0.001 [8] | ||||||||||||||||
Method |
Wald test | ||||||||||||||||
Parameter type |
Odds ratio (OR) | ||||||||||||||||
Point estimate |
5.765
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Confidence interval |
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level |
95% | ||||||||||||||||
sides |
2-sided
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lower limit |
2.1 | ||||||||||||||||
upper limit |
14.882 | ||||||||||||||||
Notes [7] - The OR of responder rates is estimated and tested between treatment groups using logistic regression model with treatment group, Baseline MG-ADL score and stratification factor (MuSK+ or AChR+). An OR > 1 favours rozanolixizumab. [8] - p-value is nominal. Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
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End point title |
Change from Baseline to Day 43 in Myasthenia Gravis-Composite (MG-C) total score | ||||||||||||||||
End point description |
MG-C scale is a validated assessment and scale tests 10 items with individual item being weighted differently. The items included ptosis/upward gaze (range: 0 [>45 second] - 3 [Immediate]), double vision on lateral gaze (range: 0 [>45 second] - 4 [Immediate]), eye closure (range: 0 [Normal] - 2 [severe weakness]), talking (range: 0 [Normal] - 6 [difficult to understand speech]), chewing (range: 0 [Normal] - 6 [gastric tube]), swallowing (range: 0 [Normal] - 6 [gastric tube]), breathing (range: 0 [Normal] - 9 [ventilator dependence]), neck flexion (range: 0 [Normal] - 4 [severe weakness]), shoulder abduction (range: 0 [Normal] - 5 [severe weakness]) and hip flexion (range: 0 [Normal] - 5 [severe weakness]), lower scores= lower disease activity. Total MG-C score was obtained by summing responses to each individual item and score ranges from 0 to 50, with lower scores indicating lower disease activity. A positive change indicates worsening and a negative change indicates improvement.
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End point type |
Secondary
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End point timeframe |
Baseline and Day 43
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Statistical analysis title |
Statistical Analysis 2 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
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Comparison groups |
Placebo v Rozanolixizumab ~10 mg/kg
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Number of subjects included in analysis |
134
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Analysis specification |
Pre-specified
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Analysis type |
superiority [9] | ||||||||||||||||
P-value |
< 0.001 [10] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-5.525
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Confidence interval |
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level |
95% | ||||||||||||||||
sides |
2-sided
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lower limit |
-8.303 | ||||||||||||||||
upper limit |
-2.968 | ||||||||||||||||
Notes [9] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [10] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
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Statistical analysis title |
Statistical Analysis 1 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
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Comparison groups |
Placebo v Rozanolixizumab ~7 mg/kg
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Number of subjects included in analysis |
133
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Analysis specification |
Pre-specified
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Analysis type |
superiority [11] | ||||||||||||||||
P-value |
< 0.001 [12] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-3.901
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Confidence interval |
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level |
95% | ||||||||||||||||
sides |
2-sided
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lower limit |
-6.634 | ||||||||||||||||
upper limit |
-1.245 | ||||||||||||||||
Notes [11] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [12] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
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End point title |
Change from Baseline to Day 43 in Quantitative Myasthenia Gravis (QMG) total score | ||||||||||||||||
End point description |
The QMG is a validated assessment and the scale tested 13 items, including ocular and facial involvement, swallowing, speech, limb strength, and forced vital capacity. The total QMG score was obtained by summing the responses to each individual item (13 items; Responses: None=0, Mild=1, Moderate=2, Severe=3) and the score ranges from 0 to 39, with lower scores indicating lower disease activity. A positive change in the score indicates worsening and a negative change indicates improvement. The Randomized Set consisted of all study participants who were randomized and analyzed according to the treatment assigned instead of the actual treatment received.
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End point type |
Secondary
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End point timeframe |
Baseline and Day 43
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Statistical analysis title |
Statistical Analysis 1 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
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Comparison groups |
Placebo v Rozanolixizumab ~7 mg/kg
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Number of subjects included in analysis |
133
|
||||||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||||||
Analysis type |
superiority [13] | ||||||||||||||||
P-value |
< 0.001 [14] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-3.483
|
||||||||||||||||
Confidence interval |
|||||||||||||||||
level |
95% | ||||||||||||||||
sides |
2-sided
|
||||||||||||||||
lower limit |
-5.614 | ||||||||||||||||
upper limit |
-1.584 | ||||||||||||||||
Notes [13] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [14] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
|||||||||||||||||
Statistical analysis title |
Statistical Analysis 2 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
|
||||||||||||||||
Comparison groups |
Placebo v Rozanolixizumab ~10 mg/kg
|
||||||||||||||||
Number of subjects included in analysis |
134
|
||||||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||||||
Analysis type |
superiority [15] | ||||||||||||||||
P-value |
< 0.001 [16] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-4.756
|
||||||||||||||||
Confidence interval |
|||||||||||||||||
level |
95% | ||||||||||||||||
sides |
2-sided
|
||||||||||||||||
lower limit |
-6.821 | ||||||||||||||||
upper limit |
-2.859 | ||||||||||||||||
Notes [15] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [16] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
|
|||||||||||||||||
End point title |
Change from Baseline to Day 43 in the Myasthenia Gravis (MG) Symptoms Patient Reported Outcome (PRO) 'Muscle Weakness Fatigability' score | ||||||||||||||||
End point description |
MG symptoms PRO instrument consisted of 42 items across 5 scales: ocular muscle weakness (items 1-5); bulbar muscle weakness (items 6-15); respiratory muscle weakness (items 16-18); physical fatigue (items 19-33) and muscle weakness fatigability (items 34-42). Participants were asked to choose response option that how frequently they experienced muscle weakness fatigability (items 34-42) over past 7 days using a 5-point Likert scale (1=“none of the time” to 5=“all of the time”) for each item. Sum of each item score is linearly transformed to have all domain scores ranging from 0 to 100. Total score is calculated as: (sum of item scores within the scale)/(raw score range) x (total number of items in the scale)/(number of non-missing items in the scale) x100 and ranged from 0 to 100, where higher scores indicated severe symptoms. Randomized Set consisted of all study participants who were randomized and analyzed according to the treatment assigned instead of actual treatment received.
|
||||||||||||||||
End point type |
Secondary
|
||||||||||||||||
End point timeframe |
Baseline and Day 43
|
||||||||||||||||
|
|||||||||||||||||
Statistical analysis title |
Statistical Analysis 1 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
|
||||||||||||||||
Comparison groups |
Placebo v Rozanolixizumab ~7 mg/kg
|
||||||||||||||||
Number of subjects included in analysis |
133
|
||||||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||||||
Analysis type |
superiority [17] | ||||||||||||||||
P-value |
< 0.001 [18] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-12.441
|
||||||||||||||||
Confidence interval |
|||||||||||||||||
level |
95% | ||||||||||||||||
sides |
2-sided
|
||||||||||||||||
lower limit |
-21.804 | ||||||||||||||||
upper limit |
-4.089 | ||||||||||||||||
Notes [17] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [18] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
|||||||||||||||||
Statistical analysis title |
Statistical Analysis 2 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
|
||||||||||||||||
Comparison groups |
Placebo v Rozanolixizumab ~10 mg/kg
|
||||||||||||||||
Number of subjects included in analysis |
134
|
||||||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||||||
Analysis type |
superiority [19] | ||||||||||||||||
P-value |
< 0.001 [20] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-15.163
|
||||||||||||||||
Confidence interval |
|||||||||||||||||
level |
95% | ||||||||||||||||
sides |
2-sided
|
||||||||||||||||
lower limit |
-23.596 | ||||||||||||||||
upper limit |
-6.45 | ||||||||||||||||
Notes [19] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [20] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
|
|||||||||||||||||
End point title |
Change from Baseline to Day 43 in the Myasthenia Gravis (MG) Symptoms Patient Reported Outcome (PRO) 'Physical Fatigue' score | ||||||||||||||||
End point description |
MG symptoms PRO instrument consisted of 42 items across 5 scales: ocular muscle weakness (items 1-5); bulbar muscle weakness (items 6-15); respiratory muscle weakness (items 16-18); physical fatigue (items 19-33) and muscle weakness fatigability (items 34-42). Study participants were asked to choose the response option that how frequently they experienced physical fatigue (items 19-33) over the past 7 days using a 5-point Likert scale (1=“none of the time” to 5=“all of the time”) for each item. Sum of each item score is linearly transformed to have all domain scores ranging from 0 to 100. Total score is calculated as: (sum of item scores within the scale)/(raw score range) x (total number of items in the scale)/(number of non-missing items in the scale) x100 and ranged from 0 to 100, where higher scores indicated severe symptoms. Randomized Set consisted of all study participants who were randomized and analyzed according to treatment assigned instead of actual treatment received.
|
||||||||||||||||
End point type |
Secondary
|
||||||||||||||||
End point timeframe |
Baseline and Day 43
|
||||||||||||||||
|
|||||||||||||||||
Statistical analysis title |
Statistical Analysis 2 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
|
||||||||||||||||
Comparison groups |
Placebo v Rozanolixizumab ~10 mg/kg
|
||||||||||||||||
Number of subjects included in analysis |
134
|
||||||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||||||
Analysis type |
superiority [21] | ||||||||||||||||
P-value |
< 0.001 [22] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-14.822
|
||||||||||||||||
Confidence interval |
|||||||||||||||||
level |
95% | ||||||||||||||||
sides |
2-sided
|
||||||||||||||||
lower limit |
-23.759 | ||||||||||||||||
upper limit |
-5.936 | ||||||||||||||||
Notes [21] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [22] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
|||||||||||||||||
Statistical analysis title |
Statistical Analysis 1 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
|
||||||||||||||||
Comparison groups |
Placebo v Rozanolixizumab ~7 mg/kg
|
||||||||||||||||
Number of subjects included in analysis |
133
|
||||||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||||||
Analysis type |
superiority [23] | ||||||||||||||||
P-value |
= 0.012 [24] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-8.65
|
||||||||||||||||
Confidence interval |
|||||||||||||||||
level |
95% | ||||||||||||||||
sides |
2-sided
|
||||||||||||||||
lower limit |
-18.058 | ||||||||||||||||
upper limit |
-0.134 | ||||||||||||||||
Notes [23] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [24] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
|
|||||||||||||||||
End point title |
Change from Baseline to Day 43 in the Myasthenia Gravis (MG) Symptoms Patient Reported Outcome (PRO) 'Bulbar Symptoms' score | ||||||||||||||||
End point description |
The MG symptoms PRO instrument consisted of 42 items across 5 scales: ocular muscle weakness (items 1-5); bulbar muscle weakness (items 6-15); respiratory muscle weakness (items 16-18); physical fatigue (items 19-33) and muscle weakness fatigability (items 34-42). Study participants were asked to choose response option that best described severity of bulbar muscle weakness (items 6-15) symptoms over past 7 days using a 4-point Likert scale (1=“none” to 4=“severe”) for each item. Sum of each item score is linearly transformed to have all domain scores ranging from 0 to 100. Total score is calculated as: (sum of item scores within the scale)/(raw score range) x (total number of items in the scale)/(number of non-missing items in the scale) x100 and ranged from 0 to 100, where higher scores indicated severe symptoms. The Randomized Set consisted of all study participants who were randomized and analyzed according to the treatment assigned instead of the actual treatment received.
|
||||||||||||||||
End point type |
Secondary
|
||||||||||||||||
End point timeframe |
Baseline, Day 43
|
||||||||||||||||
|
|||||||||||||||||
Statistical analysis title |
Statistical Analysis 1 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
|
||||||||||||||||
Comparison groups |
Placebo v Rozanolixizumab ~7 mg/kg
|
||||||||||||||||
Number of subjects included in analysis |
133
|
||||||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||||||
Analysis type |
superiority [25] | ||||||||||||||||
P-value |
< 0.001 [26] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-11.32
|
||||||||||||||||
Confidence interval |
|||||||||||||||||
level |
95% | ||||||||||||||||
sides |
2-sided
|
||||||||||||||||
lower limit |
-18.958 | ||||||||||||||||
upper limit |
-4.998 | ||||||||||||||||
Notes [25] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [26] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
|||||||||||||||||
Statistical analysis title |
Statistical Analysis 2 | ||||||||||||||||
Statistical analysis description |
A sequential testing procedure was used. The parallel gatekeeping testing procedure with a truncated Hochberg test was used to control the familywise type I error rate at a 2-sided alpha level of 0.05.
|
||||||||||||||||
Comparison groups |
Placebo v Rozanolixizumab ~10 mg/kg
|
||||||||||||||||
Number of subjects included in analysis |
134
|
||||||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||||||
Analysis type |
superiority [27] | ||||||||||||||||
P-value |
< 0.001 [28] | ||||||||||||||||
Method |
Lehmacher and Wassmer method | ||||||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||||||
Point estimate |
-10.705
|
||||||||||||||||
Confidence interval |
|||||||||||||||||
level |
95% | ||||||||||||||||
sides |
2-sided
|
||||||||||||||||
lower limit |
-17.787 | ||||||||||||||||
upper limit |
-3.998 | ||||||||||||||||
Notes [27] - MMRM ANCOVA model included treatment group, Baseline score, region, stratification factor (MuSK+ or AChR+) and treatment group by day (interaction term) as fixed factors and participant as a random effect. [28] - Confidence intervals and p-values are based on stage-wise inverse normal combination using the Lehmacher and Wassmer method. |
|
|||||||||||||
End point title |
Number of Participants With treatment-emergent adverse events (TEAEs) [29] | ||||||||||||
End point description |
A TEAE is defined as an AE starting on or after the time of first administration of investigational medicinal product (IMP) up to and including 8 weeks after the last dose. The Safety Set consisted of all randomized study participants who received at least one dose of IMP and analyzed according to the actual treatment the participants received. Two participants randomized to RLZ ~7mg/kg, were administered RLZ ~10mg/kg at baseline visit. So, these two participants were included in RLZ ~7 mg/kg group in randomized set, but in RLZ ~10 mg/kg group in safety set.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
From Baseline until End of Study Visit (up to Week 14)
|
||||||||||||
Notes [29] - 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: No formal statistical hypothesis testing was planned for this study. Results were summarized in tables as descriptive statistics only. |
|||||||||||||
|
|||||||||||||
No statistical analyses for this end point |
|
|||||||||||||
End point title |
Number of Participants With treatment-emergent adverse events (TEAEs) leading to withdrawal of investigational medicinal product (IMP) [30] | ||||||||||||
End point description |
A TEAE is defined as an AE starting on or after the time of first administration of IMP up to and including 8 weeks after the last dose. The Safety Set consisted of all randomized study participants who received at least one dose of IMP and analyzed according to the actual treatment the participants received. Two participants randomized to RLZ ~7mg/kg, were administered RLZ ~10mg/kg at baseline visit. So, these two participants were included in RLZ ~7 mg/kg group in randomized set, but in RLZ ~10 mg/kg group in safety set.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
From Baseline until End of Study Visit (up to Week 14)
|
||||||||||||
Notes [30] - 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: No formal statistical hypothesis testing was planned for this study. Results were summarized in tables as descriptive statistics only. |
|||||||||||||
|
|||||||||||||
No statistical analyses for this end point |
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adverse events information
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Timeframe for reporting adverse events |
From Baseline until End of Study Visit (up to Week 14)
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adverse event reporting additional description |
Safety Set was analyzed for TEAEs. Two participants randomized to RLZ ~7mg/kg, were administered RLZ ~10mg/kg at baseline visit. So, these two participants were included in RLZ ~7 mg/kg group in randomized set, but in RLZ ~10 mg/kg group in safety set.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Assessment type |
Non-systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
24.0
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting groups
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group description |
Participants received placebo subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Rozanolixizumab ~10 mg/kg
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group description |
Participants received rozanolixizumab equivalent to approximately 10 mg/kg subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Rozanolixizumab ~7 mg/kg
|
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Reporting group description |
Participants received rozanolixizumab equivalent to approximately 7 mg/kg, subcutaneously on a weekly basis over a 6-week Treatment Period. After 6-week Treatment Period, participants were followed for up to 8 weeks (up to Week 14). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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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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30 Oct 2019 |
Protocol Amendment 1 (dated 30 Oct 2019) was implemented to add an additional “other” efficacy endpoint (time to first rescue therapy), an additional exploratory objective and endpoint (tetanus IgG antibodies), amend 2 secondary endpoints (both patient-reported outcomes [PROs] with text added to include muscle/limb weakness in the score), and remove 2 “other” efficacy endpoints at each scheduled assessment during the Treatment and Observation Periods as
follows: 1) value and change from Baseline in the MG Symptoms PRO multi-component total score and 2) value and change from Baseline in the enhanced MG Symptoms PRO total score. |
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04 Mar 2020 |
Protocol Amendment 2 (dated 04 Mar 2020) was implemented to incorporate the harmonization of inclusion criteria with studies performed across the rozanolixizumab development program, and include a new section to include temporary discontinuation of IMP in case of low IgG levels observed in study participants. Furthermore, additional blood and PK samples, as well details pertaining to a substudy were incorporated to provide the opportunity to increase confidence in the PK exposure from the selected doses and help clinically validate the ADA assay’s drug tolerance through analysis of a drug onboard postdose sample as opposed to the predose samples that were likely to be below the limit of quantification (BLQ). Protocol Amendment 2 was an internally approved document, which was not implemented at the study sites or submitted to the regulatory authorities. Protocol Amendment 3 included changes related to the coronavirus disease 2019 (COVID-19) pandemic and incorporated the changes
made in Protocol Amendment 2. |
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29 Jul 2020 |
Protocol Amendment 3 (dated 29 Jul 2020) was implemented to introduce the MG0007 study as the OLE study to MG0003 and closure of the MG0004 study once the MG0007 study was
available, decrease the complexity of assessments to be performed (including revising the MG Impairment Index [MGII] from mandatory to optional), to clarify some operational aspects of the study, and to include the management of study participant treatment during the COVID-19 pandemic, including contingency measures. |
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23 Feb 2021 |
Protocol Amendment 4 (dated 23 Feb 2021) included the following changes:
• Updated the requirement for study participants who received rescue therapy to be followed up through to the end of the Observation Period
• Updated the criteria for discontinuation due to other adverse events (AEs) or medical conditions
• Remove the participant exit interview.
• Additional updates have been incorporated to provide further clarity on the protocol and/or to correct errors. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? Yes | |||||||
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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 |