E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10071400 |
E.1.2 | Term | Axial spondyloarthritis |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10076297 |
E.1.2 | Term | Non-radiographic axial spondyloarthritis |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10002556 |
E.1.2 | Term | Ankylosing spondylitis |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
• To evaluate the efficacy of upadacitinib compared with placebo on reduction of signs and symptoms in adult subjects with active axSpA including AS who had an inadequate response to a biologic disease-modifying antirheumatic drug (bDMARD) therapy (Study 1) and nr axSpA (Study 2);
• To assess the safety and tolerability of upadacitinib in subjects with active axSpA including bDMARD-IR AS (Study 1) and with nr axSpA (Study 2).
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E.2.2 | Secondary objectives of the trial |
• To evaluate the safety and tolerability of upadacitinib in extended treatment in adult subjects with active axSpA including bDMARD-IR AS who have completed the Double Blind Period (Study 1) and with nr-axSpA who have completed the Double Blind Period (Study 2). |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• adult females and males who are at least 18 years of age
• clinical diagnosis of AS who meet the modified New York Criteria for AS (Study 1); OR
• clinical diagnosis of nr-axSpA fulfilling the 2009 ASAS classification criteria for axSpA but not meeting the radiologic criterion of the modified New York criteria for AS and have objective signs of active inflammation on MRI of sacroiliac joints or based on high sensitivity CRP > ULN (Study 2).
• must have a BASDAI score ≥ 4 and a Patient's Assessment of Total Back Pain score ≥ 4 based on a 0 – 10 numerical rating scale at the Screening and Baseline Visits.
• For Study 1, subjects must have discontinued 1 bDMARD (either 1 tumor necrosis factor (TNF) inhibitor or 1 interleukin [IL]-17 inhibitor) due to either lack of efficacy (after at least 12 weeks of treatment with a bDMARD at an adequate dose) or intolerance (irrespective of treatment duration).
• For Study 2, prior treatment with at most 1 bDMARD (either 1 TNF inhibitor or 1 IL-17 inhibitor) is allowed in at least 25%, but not exceeding 35% of subjects |
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E.4 | Principal exclusion criteria |
• Subject must not have total spinal ankylosis
• Subjects who have had an inadequate response to both a TNF inhibitor and IL-17 inhibitor are not eligible. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Study 1 - proportion of subjects achieving an ASAS 40 response
Study 2 - proportion of subjects achieving an ASAS 40 response |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Study 1 - Week 14
Study 2 - Week 14 (EU/EMA regulatory purposes); Week 52 (US/FDA regulatory purposes). |
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E.5.2 | Secondary end point(s) |
Study 1:
1. Change from Baseline in Ankylosing Spondylitis Disease Activity Score (ASDAS);
2. Change from Baseline in magnetic resonance imaging (MRI) Spondyloarthritis Research Consortium of Canada (SPARCC) score (spine);
3. Proportion of subjects with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 response;
4. Proportion of subjects with ASAS20 response
5. Proportion of subjects with ASDAS Inactive Disease (ASDAS score < 1.3);
6. Change from baseline in Patient's Assessment of Total Back Pain
(Total Back Pain);
7. Change from baseline in Patient's Assessment of Nocturnal Back Pain (Nocturnal Back Pain);
8. Proportion of subjects with ASDAS Low Disease Activity (ASDAS score < 2.1);
9. Change from Baseline in Bath Ankylosing Spondylitis Functional Index (BASFI);
10. Proportion of subjects with ASAS partial remission (PR) (an absolute score of = 2 units for each of the 4 domains identified in ASAS 40);
11. Change from Baseline in Ankylosing Spondylitis Quality of Life
(ASQoL);
12. Change from Baseline in ASAS Health Index (HI);
13. Change from Baseline in Maastricht Ankylosing Spondylitis Enthesitis Score (MASES);
14. Change from Baseline in Linear Bath Ankylosing Spondylitis
Metrology Index (BASMIlin).
Study 2:
1. Change from Baseline in ASDAS;
2. Change from Baseline in MRI SPARCC score (SI joints);
3. Proportion of subjects with BASDAI 50 response;
4. Proportion of subjects with ASAS20 response;
5. Proportion of subjects with ASDAS Inactive Disease (ASDAS score < 1.3);
6. Change from baseline in Patient's Assessment of Total Back Pain (Total Back Pain);
7. Change from baseline in Patient's Assessment of Nocturnal Back Pain (Nocturnal Back Pain);
8. Proportion of subjects with ASDAS Low Disease Activity (ASDAS score < 2.1);
9. Change from Baseline in BASFI;
10. Proportion of subjects with ASAS PR (an absolute score of = 2 units for each of the 4 domains identified in ASAS40);
11. Change from Baseline in ASQoL
12. Change from Baseline in ASAS HI
13. Change from Baseline in MASES
14. Change from Baseline in BASMIlin |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Study 1 and Study 2 - Week 14 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 92 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Argentina |
Australia |
Brazil |
Canada |
China |
Japan |
Korea, Republic of |
Mexico |
New Zealand |
Russian Federation |
Taiwan |
Turkey |
Ukraine |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 7 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 2 |
E.8.9.2 | In all countries concerned by the trial days | 0 |