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    Summary
    EudraCT Number:2019-002278-30
    Sponsor's Protocol Code Number:APH-19
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-01-21
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2019-002278-30
    A.3Full title of the trial
    Phase III, single-arm, open-label, international, multi-centre study to evaluate the efficacy and safety of lomitapide in paediatric patients with Homozygous Familial Hypercholesterolaemia (HoFH) on stable lipid-lowering therapy
    Studio internazionale multicentrico di fase III, a braccio singolo, in aperto volto a valutare l’efficacia e la sicurezza di lomitapide in pazienti pediatrici affetti da ipercolesterolemia familiare omozigote (HoFH) che stanno ricevendo una terapia ipolipemizzante stabile
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A clinical trial to assess the safety and effect of the drug lomitapide in the treatment of children with the condition Homozygous Familial Hypercholesterolaemia (HoFH) who are on Stable Lipid-lowering Therapy
    Studio volto a valutare l’efficacia e la sicurezza del farmaco lomitapide in pazienti pediatrici affetti da ipercolesterolemia familiare omozigote (HoFH) che stanno ricevendo una terapia ipolipemizzante stabile
    A.3.2Name or abbreviated title of the trial where available
    APH-19
    APH-19
    A.4.1Sponsor's protocol code numberAPH-19
    A.7Trial is part of a Paediatric Investigation Plan Yes
    A.8EMA Decision number of Paediatric Investigation PlanP/332/2019
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorAmryt Pharmaceuticals DAC
    B.1.3.4CountryIreland
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportAmryt Pharmaceuticals DAC
    B.4.2CountryIreland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAmryt Pharmaceuticals DAC
    B.5.2Functional name of contact pointHead of Clinical Development
    B.5.3 Address:
    B.5.3.1Street Address90 Harcourt Street
    B.5.3.2Town/ cityDublin 2
    B.5.3.3Post codeD02 CR98
    B.5.3.4CountryIreland
    B.5.4Telephone number+35315180200
    B.5.6E-mailjanet.boylan@amrytpharma.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Lojuxta 5 mg hard capsules
    D.2.1.1.2Name of the Marketing Authorisation holderAmryt Pharmaceuticals DAC
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLojuxta 5 mg hard capsules
    D.3.2Product code [PRD7255830]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLOMITAPIDE
    D.3.9.1CAS number 182431-12-5
    D.3.9.2Current sponsor codeLOMITAPIDE
    D.3.9.4EV Substance CodeSUB34920
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Lojuxta 10 mg hard capsules
    D.2.1.1.2Name of the Marketing Authorisation holderAmryt Pharmaceuticals DAC
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLojuxta 10 mg hard capsules
    D.3.2Product code [PRD7255977]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLOMITAPIDE
    D.3.9.1CAS number 182431-12-5
    D.3.9.2Current sponsor codeLOMITAPIDE
    D.3.9.4EV Substance CodeSUB34920
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Lojuxta 20 mg hard capsules
    D.2.1.1.2Name of the Marketing Authorisation holderAmryt Pharmaceuticals DAC
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLojuxta 20 mg hard capsules
    D.3.2Product code [PRD7256003]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLOMITAPIDE
    D.3.9.1CAS number 182431-12-5
    D.3.9.2Current sponsor codeLOMITAPIDE
    D.3.9.4EV Substance CodeSUB34920
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLomitapide 2mg hard capsules
    D.3.2Product code [Lomitapide 2mg hard capsules]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLOMITAPIDE
    D.3.9.1CAS number 182431-12-5
    D.3.9.2Current sponsor codeLOMITAPIDE
    D.3.9.4EV Substance CodeSUB34920
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Homozygous familial hypercholesterolaemia (HoFH). A rare and life-threatening inherited disorder of lipid metabolism with an estimated prevalence of 1 per 160,000 to 300,000 in the European population.
    Ipercolesterolemia familiare omozigote, una malattia ereditaria del metabolismo dei lipidi rara e pericolosa per la vita, con una prevalenza stimata di 1 su 160,000-30,000 nella popolazione europea.
    E.1.1.1Medical condition in easily understood language
    A condition that runs in families (homozygous familial hypercholesterolaemia or HoFH), which leads to the patient having very high cholesterol from a very early age.
    Una condizione che si tramanda nelle famiglie (ipercolesterolemia familiare omozigote), che porta i pazienti ad avere livelli altissimi di colesterolo a partire da un' età molto precoce.
    E.1.1.2Therapeutic area Body processes [G] - Metabolic Phenomena [G03]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10057100
    E.1.2Term Homozygous familial hypercholesterolaemia
    E.1.2System Organ Class 100000004850
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10057100
    E.1.2Term Homozygous familial hypercholesterolaemia
    E.1.2System Organ Class 100000004850
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the efficacy of lomitapide as defined by the percent change in low-density lipoprotein cholesterol (LDL-C) at the maximum tolerated dose (MTD) at Week 24±3 days (W24) compared to baseline when added to stable lipid-lowering therapy (LLT, including lipoprotein apheresis [LA] where applicable) in paediatric patients (5 to =17 years of age) with HoFH.
    Valutare l’efficacia di lomitapide, definita in base alla variazione percentuale del livello di colesterolo nelle lipoproteine a bassa densità (low density lipoprotein cholesterol, LDL C) alla dose massima tollerata (maximum tolerated dose, MTD) alla Settimana 24±3 giorni rispetto al basale, in caso di aggiunta a terapia ipolipemizzante (lipid lowering stabile, LLT, tra cui aferesi delle lipoproteine [lipoprotein apheresis, LA] ove applicabile) in pazienti pediatrici (età compresa tra 5 e =17 anni) affetti da HoFH.
    E.2.2Secondary objectives of the trial
    To evaluate the efficacy by:
    •% change from baseline in lipid parameters at W24 and at other time-points to W104
    •change in LLT and LA from W24-104
    •% patients achieving EAS target LDL-C of <135 mg/dL (3.5 mmol/L) at W24 and during the study
    To evaluate safety:
    •Incidence AEs, abnormal physical and lab findings
    •Effect on growth, bone health and age
    •Potential effects on maturation, reproductive development, gonadotropins & pituitary adrenal axis variables
    •Hepatic fat accumulation
    To evaluate the PK by sparse blood sampling
    Exploratory objectives:
    •Change in mean CIMT and flow FMD and resolution/regression of xanthomas (W56+W104)
    •Change of lipid parameters (W24)
    Palatability Objective:
    •a 5 point facial hedonic scale, in terms of overall liking.
    •with either food media if taken on apple sauce or mashed banana
    •a 3 point scale of interpretation of the child’s reaction & assessment of ease of admin. of IMP & dietary supplements
    •timing of reaction relative to dosing
    efficacia:
    •Variazione % dal basale alla sett (W) 24 e altri punti temporali fino alla sett 104 nei parametri lipidici
    •Variazione nei livelli LLT e LA dalla W24 giorni fino alla W104±1.
    •% di pazienti pediatrici raggiungono l’obiettivo di LDL C <135 mg/dl (3,5 mmol/l) raccomandato dall' EAS) alla Settimana 24 e in corrispondenza di qualsiasi punto temporale durante lo studio.
    sicurezza:
    •Incidenza AE e risultati anomali di esami obiettivi e di laboratorio.
    •Effetti su crescita, salute delle ossa ed età ossea.
    •Potenziali effetti su maturazione, sviluppo riproduttivo, gonadotropine e variabili dell’asse ipofisi-surrene.
    •Accumulo dei lipidi nel fegato.
    Obiettivi esplorativi:
    •Variazione dal Basale di CIMT e FMD e risoluz/riduz degli xantomi alle W56 e 104.
    •Variazioni dei param lipidici alla W24.
    Palatabilità:
    •gradimento generale (scala edonistica a 5 punti)
    •facilità di somministrazione e reazione del bambino (scala a 3 punti)
    •tempo di reazione
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Male and female patients aged 5 to =17 years with HoFH as defined by any of the following criteria recommended by the Consensus Panel on Familial Hypercholesterolaemia of the EAS (Cuchel, Bruckert et al. 2014):
    a. Genetic confirmation of 2 mutant alleles at the LDL receptor (LDLR), apo B, Proprotein convertase subtilisin/kexin type 9 (PCSK9), or LDL receptor adapter protein 1 (LDLRAP1) gene locus OR
    b. An untreated LDL C >500 mg/dL (13 mmol/L) or treated LDL C =300 mg/dL (8 mmol/L) together with either
    - Cutaneous or tendon xanthoma before age 10 years or
    - Untreated LDL C levels consistent with heterozygous FH in both parents
    2. Baseline LDL C on LLT (maximum concentration [Cmax ] immediately prior to LA, if applicable)
    a. >160 mg/dL (4.1 mmol/L, no documented cardiovascular disease [CVD]) or
    b. >130 mg/dL (3.4 mmol/L, established CVD defined as aortic valve disease and/or coronary atherosclerosis)
    3. Body weight =15 kg or BMI and height both >10th percentile according to World Health Organization (WHO) Growth Charts for Boys and Girls 5 to 19 Years of Age
    4. Patient and/or his/her legal representative has/have been informed, has/have read and understood the patient information/informed consent form, and has/have given written informed assent/consent
    5. Patient and/or his/her legal representative must be able and willing to follow study procedures and instructions, particularly that
    a. LLT (including LA, when applicable) must be stable for at least 6 weeks prior to Baseline (Run in Period) and remain stable through Week 24±3 days (end of Efficacy Phase)
    b. The patient must be compliant with both the low fat diet supplying <20% of energy (calories) from fat or <30 g fat, whichever is the lesser amount starting at the beginning of the Run in Period and the dietary supplement regimen starting at Week 2 of the Run in Period, both continuing until completion of the study (and during the LTE of this study, when applicable)
    6. Postmenarchal female adolescents must be willing to use an effective form of birth control with failure rates <1% per year (e.g., implant, injectable, combined oral contraceptive, intrauterine contraceptive device, sexual abstinence, vasectomy or vasectomised partner) during participation in the study (and at least 4 weeks thereafter). Patients taking oestrogen based oral contraceptives should be advised about possible loss of effectiveness due to diarrhea and/or vomiting. Additional contraceptive measures should be used for 7 days after resolution of symptoms.
    7. Patient must be in stable physical and mental health at screening
    1. Pazienti di sesso maschile e femminile di età compresa tra 5 e =17 anni con HoFH, secondo quanto definito da uno qualsiasi dei seguenti criteri raccomandati dal gruppo di consenso sull’ipercolesterolemia familiare dell’EAS (Cuchel, Bruckert et al. 2014):
    a. Conferma genetica di 2 alleli mutanti nel locus genico del recettore LDL (LDL receptor, LDLR), della apo B, della proproteina convertasi subtilisina/kexina tipo 9 (Proprotein convertase subtilisin/kexin type 9, PCSK9) o della proteina 1 adattatore del recettore LDL (LDL receptor adapter protein 1, LDLRAP1) oppure
    b. LDL C non trattato >500 mg/dl (13 mmol/l) o LDL C trattato =300 mg/dl (8 mmol/l) insieme a
    ¿ Xantoma cutaneo o tendineo prima dei 10 anni di età oppure
    ¿ Livelli di LDL-C non trattato coerenti con FH eterozigote in entrambi i genitori.
    2. LDL C al Basale trattato con LLT (concentrazione massima [Cmax] immediatamente prima della LA, se applicabile):
    a. >160 mg/dl (4,1 mmol/l, nessuna malattia cardiovascolare [cardiovascular disease, CVD] documentata) oppure
    b. >130 mg/dl (3,4 mmol/l, CVD confermata, definita come malattia della valvola aortica e/o aterosclerosi coronarica).
    3. Peso corporeo =15 kg o BMI e altezza entrambi >10° percentile in base ai grafici di crescita dell’Organizzazione Mondiale della Sanità (OMS) relativi a bambini e bambine di età compresa tra 5 e 19 anni.
    4. I pazienti e/o i rispettivi rappresentanti legali sono stati informati, hanno letto e compreso le informazioni per il paziente/il modulo di consenso informato e hanno fornito il proprio assenso/consenso informato scritto.
    5. I pazienti e/o i rispettivi rappresentanti legali devono essere in grado e disposti a seguire le procedure e le istruzioni dello studio, in particolare:
    a. La LLT (inclusa LA, se applicabile) deve essere stabile per almeno 6 settimane prima del Basale (periodo di run-in) e rimanere stabile fino alla Settimana 24±3 giorni (fine della fase di efficacia).
    b. I pazienti devono rispettare entrambe le diete a basso contenuto di grassi che forniscono <20% di energia (calorie) dai grassi o <30 g di grassi, a seconda di quale sia la quantità minore a partire dall’inizio del periodo di run-in e il regime a base di integratori alimentari a partire dalla Settimana -2 del periodo di run-in, continuando entrambi i regimi fino al completamento dello studio (e durante la fase LTE di questo studio, se applicabile).
    6. Le pazienti adolescenti nel periodo post-menarca devono essere disposte a usare un metodo contraccettivo efficace con tassi di fallimento <1% all’anno (ad es. contraccettivo impiantabile, iniettabile, orale combinato, dispositivo contraccettivo intrauterino, astinenza sessuale, vasectomia o compagno vasectomizzato) durante la partecipazione allo studio (e almeno nelle 4 settimane successive). I soggetti che assumono contraccettivi orali a base di estrogeni devono essere informati circa la possibile mancata efficacia a causa di diarrea e/o vomito. Ulteriori misure contraccettive devono essere utilizzate per 7 giorni dopo la risoluzione dei sintomi.
    7. Allo screening, i pazienti devono trovarsi in una condizione di salute fisica e mentale stabile.
    E.4Principal exclusion criteria
    1. Other forms of primary hyperlipoproteinaemia and secondary causes of hypercholesterolaemia (e.g., nephrotic syndrome, hypothyroidism)
    2. Contraindications for the use of lomitapide according to section 4.3 of the EMA Summary of Product Characteristics (SmPC), such as hypersensitivity to the active substance or to any of the excipients listed in section 6.1 of the SmPC, known significant or chronic inflammatory bowel disease or malabsorption
    3. Moderate (Child-Pugh B) or severe hepatic impairment (Child-Pugh C), active liver disease and/or abnormal liver function tests at screening (AST or ALT >1.5 x upper limit of normal (ULN) and/or total bilirubin >1.5 x ULN in the absence of Gilbert’s syndrome or AP >1.5 x ULN [based on appropriate age and gender normal values])
    4. Serum CK >2 x ULN
    5. Chronic renal insufficiency with glomerular filtration rate (GFR) <70 mL/min/1.73 m2 calculated using the Schwartz formula
    6. Uncontrolled hypertension (defined as mean systolic and/or diastolic blood pressure =95% of normal for age and sex) despite medical therapy
    7. New York Heart Association (NYHA) Class III or IV congestive heart failure
    8. Precocious/delayed puberty or endocrine disorder affecting growth (e.g., hypothyroidism, premature adrenarche)
    9. History of drug abuse within the last 3 years or habitual alcohol consumption (defined as >1 ounce [28 g] of liquor or 4 ounce glass [113 g] of wine, or the equivalent, =3 times per week)
    10. Life expectancy predicted to be <5 years
    11. History of a non skin malignancy (with the exception of cervical cancer in situ) within 3 years prior to enrolment
    12. Treatment with any Investigational Medicinal Product (IMP) within 6 months or 5 times the terminal half life of the corresponding IMP, whichever is longer, before the screening
    13. Patient is related to Sponsor or an Investigator of this Clinical Trial
    14. Pregnant or nursing women
    1. Altre forme di iperlipoproteinemia primaria e cause secondarie di ipercolesterolemia (ad es. sindrome nefrosica, ipotiroidismo).
    2. Controindicazioni all’uso di lomitapide in base alla sezione 4.3 del Riassunto delle caratteristiche del prodotto (RCP) dell’Agenzia europea per i medicinali (European Medicines Agency, EMA), tra cui ipersensibilità al principio attivo o ad uno qualsiasi degli eccipienti elencati nella Sezione 6.1 del RCP, nota malattia infiammatoria intestinale significativa o cronica o malassorbimento.
    3. Insufficienza epatica moderata (Child Pugh B) o grave (Child Pugh C), epatopatia attiva e/o test della funzionalità epatica anomali allo screening (AST o ALT >1,5 volte il limite superiore della norma (upper limit of normal, ULN) e/o bilirubina totale >1,5 x ULN in assenza di sindrome di Gilbert o AP >1,5 x ULN [in base ai valori normali appropriati relativi a età e sesso]).
    4. CK sierica >2 x ULN.
    5. Insufficienza renale cronica con velocità di filtrazione glomerulare (glomerular filtration rate, GFR) <70 ml/min/1,73 m2 calcolata utilizzando la formula di Schwartz.
    6. Ipertensione non controllata (definita come pressione arteriosa sistolica e/o diastolica media =95% rispetto ai valori normali correlati a età e sesso) nonostante la terapia medica.
    7. Insufficienza cardiaca congestizia di Classe III o IV secondo l’Associazione dei cardiologi di New York (New York Heart Association, NYHA).
    8. Pubertà precoce/ritardata o disturbo endocrino che influisce sulla crescita (ad es. ipotiroidismo, adrenarca prematuro).
    9. Anamnesi di abuso di sostanze stupefacenti negli ultimi 3 anni o consumo abituale di alcol (definito come quantità di liquore >28 g [1 oncia] o bicchiere di vino da 113 g [4 once], o equivalente, =3 volte alla settimana).
    10. Previsione di aspettativa di vita <5 anni.
    11. Anamnesi di tumore maligno non cutaneo (ad eccezione del carcinoma della cervice in situ) nei 3 anni precedenti l’arruolamento.
    12. Trattamento con qualsiasi prodotto medicinale sperimentale (Investigational Medicinal Product, IMP) entro 6 mesi o 5 volte l’emivita terminale dell’IMP corrispondente, a seconda di quale periodo sia più lungo, prima della visita di screening.
    13. Il paziente è un dipendente dello sponsor, del personale sperimentale o è un diretto familiare.
    14. Donne in stato di gravidanza o in allattamento.
    E.5 End points
    E.5.1Primary end point(s)
    Percent change in LDL-C at Week 24±3 days compared to Baseline
    Variazione percentuale nel valore LDL C alla Settimana 24±3 giorni rispetto al Basale
    E.5.1.1Timepoint(s) of evaluation of this end point
    Week 24±3 days compared to Baseline
    Settimana 24±3 giorni rispetto al Basale
    E.5.2Secondary end point(s)
    Efficacy:
    • Percent change from baseline at Week 24±3 days for the following lipid parameters: TC, Non-HDL-C, VLDL-C, TG, Lp(a), and apo B
    • Percent change from baseline in at all other time points through Week 104±1 week for the following lipid parameters: LDL-C, TC, Non-HDL-C, VLDL-C, TG, Lp(a), and apo B
    • Changes in LLT and LA Week 24±3 days through Week 104±1 week
    • Total number and percent of patients achieving the EAS recommended target LDL-C of <135 mg/dL (3.5 mmol/L) in paediatric HoFH patients at Week 24±3 days and at any time on study; Exploratory:
    - Percent change from Baseline at Week 56±3 days and Week 104±1 week in CIMT and FMD
    - Resolution and/or regression of pre-existing xanthomas at Week 56±3 days and at Week 104±1 week
    - Changes from Baseline through Week 24±3 days in cholesterol and triglyceride content of VLDL, IDL, LDL and HDL, particle number and size of VLDL, LDL, and HDL as well as particle number of their respective lipoprotein subclasses (large, medium, and small) as assessed based on 2D NMR (Liposcale® Test) of PK samples at Week 4±3 days, Week 8±3 days, Week 12±3 days, Week 16±3 days, Week 20±3 days and at Week 24±3 days.; Palatability:
    - Mean and standard deviations with analysis of variance of palatability assessment on the first occasion that any patient takes lomitapide by opening and sprinkling the capsule onto 1 tablespoon of either apple sauce or mashed banana using a 5-point facial hedonic scale, anchored with descriptors.; Safety from Baseline through Week 104±1 week include:
    • Incidence, severity, and relatedness of AEs
    • Physical examinations including regular measurements of height, weight, and BMI
    • Sexual maturation (Tanner staging)
    - In patients with Tanner Stage =2: Changes from Baseline in sex hormones (serum testosterone and serum oestradiol)
    • 12 Lead safety ECG (read locally), vital signs and blood pressure
    • PFT
    • Laboratory tests
    - Standard haematology (complete blood count [CBC]) and clinical chemistry panels (including comprehensive metabolic panel and fasting lipid panel)
    - Liver function tests:Alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (AP), total bilirubin, and serum albumin
    - High-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (apo A-I)
    - Creatinine kinase (CK)
    - Serum lipase
    - Serum levels of essential fatty acids (EFA): Linoleic acid, alpha linoleic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), and eicosatrienoic acid as well as the ratio of eicosatrienoic acid to AA (Holman index)
    - Serum concentrations of fat-soluble vitamins: Vitamin A (retinol), vitamin E (alpha tocopherol), ratio of vitamin E to total lipids (total cholesterol plus fasting triglycerides), and vitamin D (25-hydroxy-D). Levels of vitamin K will be assessed indirectly by measuring total and uncarboxylated levels of serum osteocalcin. (Bone health will be assessed indirectly using growth to track age-appropriate progress, and measurement of 25-hydroxy-D as well as total and uncarboxylated osteocalcin levels.)
    - Pituitary adrenal hormone levels (thyroid stimulating hormone [TSH], follicle stimulating hormone [FSH], luteinising hormone [LH], adrenocorticotrophic hormone [ACTH], and morning serum cortisol)
    - Urinalysis
    - Pharmacokinetics at Baseline, Week 4±3 days, Week 8±3 days, Week 12±3 days, Week 16±3 days, Week 20±3 days and at Week 24±3 days (time of sampling recorded along with the date and time of the previous dose)
    • Lipid accumulation in the liver as measured by NMR imaging or echography (i.e., ultrasound scan) at Baseline and at Week 24±3 days, Week 56±3 days, and at Week 104±1 week (Week 108 for patients who opt not to participate in the Long term extension (LTE) of this study or who are ineligible)
    Endpoint di efficacia secondari
    • Variazione percentuale dal Basale alla Settimana 24±3 giorni nei seguenti parametri lipidici: TC, Non HDL C, VLDL C, TG, Lp(a) e apo B.
    • Variazione percentuale in corrispondenza di tutti gli altri punti temporali, rispetto al Basale, fino alla Settimana 104±1 giorno nei seguenti parametri lipidici: LDL C, TC, Non HDL C, VLDL C, TG, Lp(a) e apo B.
    • Variazione nei livelli LLT e LA dalla Settimana 24±3 giorni fino alla Settimana 104±1 settimana.
    • Numero totale e percentuale di pazienti che raggiungono l’obiettivo di LDL C <135 mg/dl (3,5 mmol/l) raccomandato dall’EAS nei pazienti pediatrici con HoFH alla Settimana 24±3 giorni e in qualsiasi momento dello studio.; Esplorativi:
    • Variazione percentuale dal Basale alla Settimana 56±3 giorni e alla Settimana 104±1 settimana nei valori CIMT e FMD.
    • Risoluzione e/o regressione di xantomi preesistenti alla Settimana 56±3 giorni e alla Settimana 104±1 settimana.
    • Variazioni dal Basale alla Settimana 24±3 giorni nel contenuto di colesterolo e trigliceridi di VLDL, IDL, LDL e HDL, numero e dimensione delle particelle di VLDL, LDL e HDL, nonché numero di particelle delle rispettive sottoclassi di lipoproteine (grandi, medie e piccole) in base alla valutazione eseguita mediante 2D NMR (test Liposcale®) dei campioni di PK alla Settimana 4±3 giorni, Settimana 8±3 giorni, Settimana 12±3 giorni, Settimana 16±3 giorni, Settimana 20±3 giorni e Settimana 24±3 giorni.; Palatabilità:
    • Medie e deviazioni standard con analisi della varianza per la valutazione della palatabilità in occasione della prima assunzione di lomitapide da parte del paziente aprendo la capsula e versandone il contenuto su 1 cucchiaio di purea di mele o di banana, utilizzando una scala edonistica a 5 punti relativa alle espressioni facciali, ancorata con descrittori.; Endpoint di sicurezza
    Le valutazioni e gli endpoint di sicurezza dal Basale alla Settimana 104±1 settimana includono:
    • Incidenza, gravità e correlazione degli AE.
    • Esami obiettivi, con misurazioni regolari di altezza, peso e BMI.
    • Maturazione sessuale (secondo la stadiazione di Tanner).
    • Nei pazienti con stadiazione di Tanner =2: variazioni dal Basale negli ormoni sessuali (livelli sierici di testosterone ed estradiolo).
    • ECG di sicurezza a 12 derivazioni (lettura locale), segni vitali e pressione sanguigna.
    • PFT.
    • Esami di laboratorio:
    • Ematologia standard (emocromo completo [complete blood count, CBC]) e pannelli chimico-clinici (tra cui, pannello metabolico completo e pannello lipidico a digiuno).
    • Esami della funzionalità epatica: alanina transaminasi (Alanine transaminase, ALT), aspartato transaminasi (aspartate transaminase, AST), gamma glutamil transferasi (GGT), fosfatasi alcalina (alkaline phosphatase, AP), bilirubina totale e albumina sierica.
    • Colesterolo delle lipoproteine ad alta densità (HDL-C) e apolipoproteina A-I (apo A-I).
    • Creatinchinasi (Creatinine kinase, CK).
    • Lipasi sierica.
    • Livelli sierici di acidi grassi essenziali (essential fatty acids, EFA): acido linoleico, acido alfa-linoleico (ALA), acido eicosapentaenoico (eicosapentaenoic acid, EPA), acido docosaesaenoico (docosahexaenoic acid, DHA), acido arachidonico (AA) e acido eicosatrienoico, nonché il rapporto tra acido eicosatrienoico e AA (indice di Holman).
    • Concentrazioni sieriche di vitamine liposolubili: vitamina A (retinolo), vitamina E (alfa tocoferolo), rapporto tra vitamina E e lipidi totali (colesterolo totale più trigliceridi a digiuno) e vitamina D (25 idrossi D). I livelli di vitamina K verranno valutati indirettamente mediante la misurazione dei livelli di osteocalcina sierica totale e decarbossilata. (La salute ossea verrà valutata indirettamente utilizzando la crescita per monitorare i progressi appropriati per l’età, la misurazione di 25 idrossi D, nonché i livelli di osteocalcina totale e decarbossilata.)
    • Livelli degli ormoni dell’asse ipofisi-surrene (ormone tireostimolante [thyroid stimulating hormone, TSH], ormone follicolo-stimolante [follicle stimulating hormone, FSH], ormone luteinizzante [luteinising hormone, LH], ormone adrenocorticotropo [adrenocorticotrophic hormone, ACTH] e cortisolo sierico del mattino).
    • Analisi delle urine.
    • Farmacocinetica al Basale, alla Settimana 4±3 giorni, alla Settimana 8±3 giorni, alla Settimana 12±3 giorni, alla Settimana 16±3 giorni, alla Settimana 20±3 giorni e alla Settimana 24±3 giorni (registrazione dell’orario di prelievo dei campioni insieme a data e ora della dose precedente).
    • Accumulo dei lipidi nel fegato misurato mediante NMR per immagini o ecografia (ovvero, scansione a ultrasuoni) al Basale e alla Settimana 24±3 giorni, alla Settimana 56±3 giorni e alla Settimana 104±1 settimana (Settimana 108 per i pazienti che decidono di non partecipare alla fase LTE di questo studio o che non sono idonei).
    E.5.2.1Timepoint(s) of evaluation of this end point
    As specified for each secondary endpoint; As specified for each secondary endpoint; As specified for each secondary endpoint; As specified for each secondary endpoint
    Come specificato per ogni endpoint secondario; Come specificato per ogni endpoint secondario; Come specificato per ogni endpoint secondario; Come specificato per ogni endpoint secondario
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    a dosi crescenti
    Dose-escalation
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA8
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Israel
    Saudi Arabia
    Tunisia
    Turkey
    Germany
    Italy
    Spain
    E.8.7Trial 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
    Completion of the last visit or last assessment for the last subject.
    Completamento dell'ultima visita o dell'ultima valutazione dell'ultimo paziente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months2
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) Yes
    F.1.1.5.1Number of subjects for this age range: 15
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 30
    F.1.2Adults (18-64 years) No
    F.1.3Elderly (>=65 years) No
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state8
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 20
    F.4.2.2In the whole clinical trial 45
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Eligible patients who complete the study per protocol may then enter a separate extension program and continue to be treated with lomitapide . For patients who do not participate in the extension program, they will continue to be treated with their concurrent LLT.
    I pazienti eleggibili che completeranno lo studio per protocol avranno la possibilità di accedere ad un programma di estensione e continuare ad essere trattati con lomitapide. I pazienti che non parteciperanno al programma di estensione continueranno ad essere trattati con la terapia ipolipemizzante standard.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2020-10-01
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-11-11
    P. End of Trial
    P.End of Trial StatusOngoing
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