Clinical Trial Results:
A Randomized, Double-Blind, Parallel Group, Multicenter Study to Assess the Immunogenicity and Safety of Transitioning Subjects With Rheumatoid Arthritis to Biosimilar Rituximab (DRL_RI) or Continued Treatment With Rituxan® or MabThera®
Summary
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EudraCT number |
2019-002810-37 |
Trial protocol |
HU DE LT PL BG |
Global end of trial date |
20 Apr 2022
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Results information
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Results version number |
v1(current) |
This version publication date |
29 Apr 2023
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First version publication date |
29 Apr 2023
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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 |
RI-01-007
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT04268771 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Dr. Reddy’s Laboratories S.A.
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Sponsor organisation address |
Elisabethenanlage 11, Basel, Switzerland, CH-4051
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Public contact |
Dr. Narendra Maharaj, Dr. Reddy’s Laboratories Ltd., +91 4044644000, narendramaharaj@drreddys.com
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Scientific contact |
Dr. Vinu Jose, Dr. Reddy’s Laboratories Ltd., +91 4044644000, vinujosem@drreddys.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 |
30 Jan 2023
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
20 Apr 2022
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Global end of trial reached? |
Yes
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Global end of trial date |
20 Apr 2022
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To assess the immunogenicity of transitioning subjects with RA to DRL_RI (biosimilar rituximab) from US rituximab/EU rituximab to continued treatment with US rituximab/EU rituximab.
To assess the safety of transitioning subjects with RA to DRL_RI from US rituximab/EU rituximab to continued treatment with US rituximab/EU rituximab.
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Protection of trial subjects |
Insured, Investigator care
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Background therapy |
Methotrexate | ||
Evidence for comparator |
MabThera in combination with methotrexate is indicated for the treatment of adult patients with severe active rheumatoid arthritis who have had an inadequate response or intolerance to other disease-modifying anti-rheumatic drugs (DMARD) including one or more tumour necrosis factor (TNF) inhibitor therapies. MabThera has been shown to reduce the rate of progression of joint damage as measured by X-ray and to improve physical function, when given in combination with methotrexate. | ||
Actual start date of recruitment |
21 Jan 2020
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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 |
6 Months | ||
Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
United States: 45
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Country: Number of subjects enrolled |
Poland: 4
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Country: Number of subjects enrolled |
Bulgaria: 44
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Country: Number of subjects enrolled |
Czechia: 3
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Country: Number of subjects enrolled |
Germany: 13
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Country: Number of subjects enrolled |
Hungary: 21
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Country: Number of subjects enrolled |
Lithuania: 10
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Worldwide total number of subjects |
140
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EEA total number of subjects |
95
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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) |
86
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From 65 to 84 years |
52
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85 years and over |
2
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Recruitment
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Recruitment details |
A total of 140 subjects were randomly assigned to receive DRL_RI or US-rituximab/EU-rituximab: 70 subjects received DRL_RI and 70 subjects received US-rituximab (Rituxan, n=22) or EU-rituximab (MabThera, n=48). | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
Screening period (Days -14 to 0) | ||||||||||||||||||||||||
Pre-assignment period milestones
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Number of subjects started |
224 [1] | ||||||||||||||||||||||||
Number of subjects completed |
140 | ||||||||||||||||||||||||
Pre-assignment subject non-completion reasons
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Reason: Number of subjects |
Eligibility criteria not met: 77 | ||||||||||||||||||||||||
Reason: Number of subjects |
Withdrawn consent: 6 | ||||||||||||||||||||||||
Reason: Number of subjects |
Eligibility criteria not met and withdrew consent: 1 | ||||||||||||||||||||||||
Notes [1] - The number of subjects reported to have started the pre-assignment period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same. Justification: A total of 224 subjects were screened of whom 84 failed the screening. The primary reason for screen failure was eligibility criteria not met (77 subjects), 6 subjects had withdrawn consent and 1 had met eligibility criteria & withdrew consent. 140 subjects were enrolled in the study (70 for each treatment group). |
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Period 1
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Period 1 title |
Double-blind period (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | ||||||||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor, Data analyst, Carer, Assessor | ||||||||||||||||||||||||
Blinding implementation details |
The investigators and the subjects were unaware of the treatment assignment. Study center staff involved in study treatment administration and study endpoints assessments, CRO personnel, and the sponsor team including study statistician were blinded. The clinical laboratories analyzing the blood/plasma samples and the concentration/incidence of anti-rituximab antibodies were also blinded.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Arm A - Treatment arm | ||||||||||||||||||||||||
Arm description |
DRL_RI | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
Rituximab
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Investigational medicinal product code |
DRL_RI
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Other name |
NIL
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Pharmaceutical forms |
Concentrate for solution for infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
The study drugs were administered as two 1000-mg IV infusions separated by 2 weeks.
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Arm title
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Arm B - Reference arm | ||||||||||||||||||||||||
Arm description |
US-rituximab or EU-rituximab | ||||||||||||||||||||||||
Arm type |
Active comparator | ||||||||||||||||||||||||
Investigational medicinal product name |
Rituximab
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Investigational medicinal product code |
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Other name |
Rituxan®, MabThera®
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Pharmaceutical forms |
Concentrate for solution for infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
The study drugs were administered as two 1000-mg IV infusions separated by 2 weeks.
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Baseline characteristics reporting groups
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Reporting group title |
Arm A - Treatment arm
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Reporting group description |
DRL_RI | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Arm B - Reference arm
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Reporting group description |
US-rituximab or EU-rituximab | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
Safety population
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Subject analysis set type |
Full analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
Safety population: The safety population included all subjects who were randomly assigned and received at least 1 dose of study drug.
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Subject analysis set title |
Immunogenicity population
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Subject analysis set type |
Sub-group analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
Immunogenicity population: The immunogenicity population included all subjects with at least 1 post-dose ADA assessment result available.
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End points reporting groups
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Reporting group title |
Arm A - Treatment arm
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Reporting group description |
DRL_RI | ||
Reporting group title |
Arm B - Reference arm
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Reporting group description |
US-rituximab or EU-rituximab | ||
Subject analysis set title |
Safety population
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
Safety population: The safety population included all subjects who were randomly assigned and received at least 1 dose of study drug.
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Subject analysis set title |
Immunogenicity population
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
Immunogenicity population: The immunogenicity population included all subjects with at least 1 post-dose ADA assessment result available.
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End point title |
The incidence of ADAs [1] | ||||||||||||
End point description |
To assess the immunogenicity of transitioning subjects with RA to DRL_RI (biosimilar rituximab) from US-rituximab/EU-rituximab to continued treatment with US-rituximab/EU-rituximab.
- The incidence of ADAs
- The incidence of Nabs
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End point type |
Primary
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End point timeframe |
The immunogenicity endpoint was measured while on study over up to 12 weeks or until death, regardless of use of prohibited therapies or treatment missed/discontinuation due to any other reasons.
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Notes [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: No statistical analysis has been provided, instead all data is included in Descriptive summary statistics. |
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No statistical analyses for this end point |
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End point title |
The incidence of Nabs [2] | ||||||||||||
End point description |
To assess the immunogenicity of transitioning subjects with RA to DRL_RI (biosimilar rituximab) from US-rituximab/EU-rituximab to continued treatment with US-rituximab/EU-rituximab.
- The incidence of ADAs
- The incidence of Nabs
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End point type |
Primary
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End point timeframe |
The immunogenicity endpoint was measured while on study over up to 12 weeks or until death, regardless of use of prohibited therapies or treatment missed/discontinuation due to any other reasons.
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Notes [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: No statistical analysis has been provided, instead all data is included in Descriptive summary statistics. |
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
Investigators and other site personnel informed, as appropriate, the sponsor’s designated safety services of any SAEs that occurred (whether or not attributable to the study drug) in the course of the study within 24 hours of awareness.
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Adverse event reporting additional description |
Follow-up information on SAEs and a nonserious AE became serious, this and other relevant follow-up information was also provided to sponsor within 24 hours of awareness. All SAEs were reported. All SAEs were recorded in the CRF. The investigator was responsible for informing the IEC/IRB of the SAEs per local requirements.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
25.0
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Reporting groups
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Reporting group title |
Arm A - Treatment arm
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Reporting group description |
DRL_RI | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Arm B - Reference arm
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Reporting group description |
US-rituximab or EU-rituximab | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 3% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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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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12 Aug 2019 |
The following is a summary of the major changes implemented with Protocol Amendment 1, Version 2.0, dated 12 Aug 2019:
• Updated exclusion criterion 2 for clarity.
• Added exclusion criterion 18: Subjects with hypogammaglobulinemia (low IgG) are immunocompromised and more susceptible for both infections and side effects; hence, such subjects should be excluded.
• Guidance in Section 5.4.1 Packaging was reworded for better clarity. Sentence modified to: “Rituximab concentrate for solution for infusion will be packaged in a carton or kit.”
• Added the following text in Section 6.1 of Schedule of Assessments to clarify data capture at unscheduled visits: “If any unscheduled visits happen at any time during the study, visit details/appropriate data including reason will be captured in the eCRF.”
• Added assessment of IgG (Section 6.1.1) to align with addition of new exclusion criterion 18 to exclude the subjects with low IgG.
• Added clarification for estimation of rituximab concentration in Section 3.1.2 and Section 6.2.1: time-matched blood samples for estimation of rituximab concentration were added to aid in subsequent data interpretation as and if needed. Relevant procedures (i.e., time-matched blood sample collection and blood loss for estimation of rituximab concentration) were added in Section 6.1.2, Section 6.1.3, Section 6.1.4, Section 6.5, and Appendix 1.
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10 Jul 2020 |
Summary of the major changes implemented with Protocol Amendment 2, Version 3.0 dated 10 Jul 2020:
• Study was extended to 6 months and included an additional follow-up visit at Week 26 with safety and serum pregnancy test in WOCBP.
• Reconsent was mandated for additional follow-up.
• A new Section 3.2 was included for contingency measures to be taken for smooth functioning of the study during the COVID-19 pandemic.
• Exclusion criterion 6 was revised to update the requirement of historical “severe” hypersensitivity to reference product or any of its excipients.
• Exclusion criterion 16 was updated to include definition of WOCBP and birth control measures
• Exclusion criterion 17 was updated to clarify that sexually active male subjects, who do not agree to use one of the highly effective methods of birth control during treatment and for at least 12 months after the last administration of study drug, will be excluded from the study.
• Section 4.2.2 was revised to emphasize that subjects could take their own independent decision to withdraw from study drug and/or study participation at any time.
• Section 6.1 and Appendix 1 were updated to include information that complete physical examination was to be performed at all study visits.
• Information regarding immunological testing in humans was included in Section 6.2.2
• Detailed definitions of IRRs and hypersensitivity reactions were added in Section 6.3
• Section 6.3.1.2 was updated to clarify that all ongoing SAEs were to be followed up until resolution or stabilization or until a predefined outcome was reached.
• Text was clarified regarding the assessment of adverse events outcome in Section 6.3.1.4
• ANC count was added to Section 6.3.4
• Clarified requirement of serum FSH testing (Section 6.3.4).
• A note of clarification was added for HBcAb evaluation in across protocol
• Clarified that the study sites were advised to follow local or country-specific guidelines while obtaining consent.
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |