E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Moderate-to-severe atopic dermatitis |
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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] - Skin and Connective Tissue Diseases [C17] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10003639 |
E.1.2 | Term | Atopic dermatitis |
E.1.2 | System Organ Class | 100000004858 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective is to evaluate the effect of nemolizumab (CD14152) on the pharmacokinetics (PK) of a drug "cocktail" representative of Cytochrome P450 (CYP) 1A2, CYP2C9, CYP2C19, CYP2D6 and CYP3A4/5 sensitive index substrates in adult subjects with moderate-to-severe atopic dermatitis (AD). |
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E.2.2 | Secondary objectives of the trial |
The secondary objective is to assess the safety of nemolizumab. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Subjects aged ≥ 18 years at the time of screening. 2. Chronic AD for at least 2 years before the screening visit, and confirmed according to American Academy of Dermatology Consensus Criteria at the time of the screening visit. 3. EASI score ≥ 16 at both the screening and baseline visits. 4. IGA score ≥ 3 at both the screening and baseline visits. 5. AD involvement ≥ 10% of body surface area (BSA) at both the screening and baseline visits. 6. Peak (maximum) pruritus numeric rating scale (PP NRS) score of at least 4.0 at both the screening and baseline visit. 7. Documented recent history (within 6 months before the screening visit) of inadequate response to topical medications (TCS with or without TCI). All subjects must demonstrate inadequate response to TCS. All subjects who have used TCI within 6 months of the screening visit must also demonstrate inadequate response to TCI. Acceptable documentation includes subject records with information on TCS (with or without TCI) prescription and treatment outcome, or written documentation of the conversation with the subject's treating physician, if different than the investigator. If documentation is inadequate, subjects may be rescreened after such documentation is obtained. 8. Agree to apply a moisturizer throughout the study from the screening visit; for subjects using stable topical background therapy (TCS ± TCI) at screening, agree to apply topical therapy from the screening visit and throughout the study as determined appropriate by the investigator. 9. Female subjects of childbearing potential must agree to use an adequate and approved non-hormonal method of contraception throughout the study and for 12 weeks after the last study drug injection. 10. Female subjects of non-childbearing potential must meet one of the following criteria: • Absence of menstrual bleeding for 1 year prior to screening without any other medical reason • Documented hysterectomy, bilateral salpingectomy, or bilateral oophorectomy at least 3 months before screening. Note: Bilateral tubal ligation is not accepted as reason for non-childbearing potential 11. Subject willing and able to comply with all of the time commitments and procedural requirements of the clinical study protocol. 12. Medically healthy on the basis of medical history, physical examination, renal and hepatic functions. Clinical laboratory test results should be within the laboratory normal range or, if outside of the laboratory normal range, deemed not clinically significant by the investigator or qualified designee. 13. Understand and sign an informed consent form (ICF) before any investigational procedure(s) are performed. |
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E.4 | Principal exclusion criteria |
1. Body weight < 45 kg 2. Subjects meeting 1 or more of the following criteria at screening or baseline: a. Had an exacerbation of asthma requiring hospitalization in the preceding 12 months. b. Reporting asthma that has not been well-controlled (i.e., symptoms occurring on > 2 days per week, night-time awakenings 2 or more times per week, or some interference with normal activities) during the preceding 3 months. c. Asthma Control Test (ACT) ≤ 19 (only for subjects with a history of asthma) d. Peak expiratory flow < 80% of the predicted value. 3. Subjects with a current medical history of chronic obstructive pulmonary disease and/or chronic bronchitis. 4. Cutaneous infection within 1 week prior to the baseline visit, any infection requiring treatment with oral or parenteral antibiotics, antivirals, antiparasitics or antifungals within 2 weeks prior to the baseline visit, or any confirmed or suspected coronavirus disease (COVID)-19 infection within 2 weeks before the screening or baseline visit. Subjects may be rescreened once the infection has resolved. Resolution of COVID-19 infection can be confirmed by recovery assessment methods. 5. Requiring rescue therapy for AD during the screening period or expected to require systemic rescue therapy during the treatment period. 6. Positive serology results (hepatitis B surface antigen [HBsAg] or hepatitis B core antibody [HBcAb], hepatitis C [HCV] antibody with positive HCV RNA, or human immunodeficiency virus [HIV] antibody) at the screening visit. Note: Subjects with a positive HBcAb and a negative HBsAg can be included in this clinical study if hepatitis B surface antibody is positive (considered immune after a natural infection). Subjects who are positive for HCV antibody and negative for HCV RNA may be enrolled. 7. Having received any of the protocol-specified treatments within the specified timeframe before the baseline visit. 8. Previous treatment with nemolizumab. 9. Pregnant women, breastfeeding women, or women planning a pregnancy during the clinical study. 10. History of lymphoproliferative disease or history of malignancy of any organ system within the last 5 years, except for 1) basal cell carcinoma, squamous cell carcinoma in situ (Bowen’s disease), or carcinoma in situ of the cervix that have been treated and have no evidence of recurrence in the last 12 weeks before the screening visit, or 2) actinic keratosis that have been treated. 11. History of hypersensitivity (including anaphylaxis) to an immunoglobulin product (plasma-derived or recombinant, eg, monoclonal antibody) or to any of the study drug excipients. 12. History of hypersensitivity or intolerance to CYP substrates and their excipients. 13. Poor metabolizers for CYP2C9, CYP2C19, or CYP2D6 based on genotyping 14. Subjects for whom administration of the CYP substrates provided in this study is contraindicated or medically inadvisable, in the investigator’s judgment, and according to local label of the products 15. Consumption of any 1 or more of the following food items and/or beverages within 1 week prior to baseline: • Grapefruit or grapefruit juice, apple or apple juice, orange or orange juice, lemons or lemon juice, limes or lime juice, cranberries or cranberry juice • Vegetables from the mustard green family (eg, broccoli, kale) • Charbroiled meats • Beverages, foods, or drugs containing caffeine Subjects who are not willing to abstain from the consumption of these food items and/or beverages for 7 days before and after administration of CYP substrates will also be excluded. 16. Subjects with international normalized ratio (INR) > 1.5. 17. Subjects who have donated ≥ 500 mL of blood in the 3 months prior to dosing. 18. Known active or untreated latent tuberculosis. 19. Known or suspected immunosuppression or unusually frequent, recurrent, severe, or prolonged infections as per investigator judgment. 20. Presence of confounding skin condition. 21. Any medical or psychological condition or any clinically relevant laboratory abnormalities during the screening period that may put the subject at significant risk according to the investigator’s judgment, if he/she participates in the clinical study, or may interfere with study assessments. 22. Presence of malabsorption. 23. History or presence of alcohol or substance abuse within last 6 months. 24. Current smokers. 25. Positive test for illicit drugs (including cannabis) or alcohol abuse. 26. Planned or expected major surgical procedure during the clinical study. 27. Subjects unwilling to refrain from using prohibited medications, foods, drinks, or substances during the clinical study. All prescription medications taken during the study should be reviewed and approved by the Investigator. 28. Currently participating or participated in any other study of a drug or device, within the past 8 weeks before the screening visit, or is in an exclusion period (if verifiable) from a previous study.
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint(s) include: • Change of PK parameters (AUC0-inf, AUC0-last and Cmax) in the 5 probe drugs administered concomitantly [Caffeine, Warfarin Sodium, Omeprazole, Metoprolol Tartrate, and Midazolam] derived from the plasma concentration-time profile before and after 9-week nemolizumab treatment.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Visit 2 (Days 1, 2, 4 and 6) and Visit 6 (Days 71, 72, 74 and 76). |
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E.5.2 | Secondary end point(s) |
Secondary endpoint(s) include: • Incidence and severity of AEs, including TEAEs, AESIs, and SAEs.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | No |
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 | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | No |
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 |
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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 | 1 |
E.8.9.1 | In the Member State concerned months | 11 |
E.8.9.1 | In the Member State concerned days | 18 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 26 |