Clinical Trial Results:
A Phase 3, Randomized, Double-Blind Trial of Pamrevlumab (FG 3019) or Placebo in Combination with Systemic Corticosteroids in Subjects with Non-Ambulatory Duchenne Muscular Dystrophy (DMD)
Summary
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EudraCT number |
2020-000698-26 |
Trial protocol |
FR AT CZ NL BE GB IT ES |
Global end of trial date |
17 Aug 2023
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Results information
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Results version number |
v1(current) |
This version publication date |
06 Mar 2024
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First version publication date |
06 Mar 2024
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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 |
FGCL-3019-093
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT04371666 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
FibroGen, Inc.
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Sponsor organisation address |
409 Illinois Street, San Francisco, United States, CA 94158
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Public contact |
Clinical Trial Information Desk, FibroGen, Inc., FG3019-093DMDStudy@fibrogen.com
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Scientific contact |
Clinical Trial Information Desk, FibroGen, Inc., FG3019-093DMDStudy@fibrogen.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
Yes
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EMA paediatric investigation plan number(s) |
EMEA-002979-PIP01-21 | ||
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? |
Yes
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
17 Aug 2023
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
17 Aug 2023
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Was the trial ended prematurely? |
Yes
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General information about the trial
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Main objective of the trial |
The main objective of this trial was to evaluate the efficacy and safety of pamrevlumab versus placebo in combination with systemic corticosteroids in participants with DMD (non-ambulatory, aged ≥12 years).
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Protection of trial subjects |
This study was conducted in accordance with the Declaration of Helsinki, Good Clinical Practice (GCP), the International Council for Harmonisation (ICH) E6 Guidance for GCP, any other applicable local health and regulatory requirements, and Ethics Committee (EC) requirements.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
30 Jul 2020
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Long term follow-up planned |
No
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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 |
United States: 51
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Country: Number of subjects enrolled |
France: 8
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Country: Number of subjects enrolled |
Italy: 10
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Country: Number of subjects enrolled |
Spain: 5
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Country: Number of subjects enrolled |
United Kingdom: 2
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Country: Number of subjects enrolled |
Switzerland: 1
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Country: Number of subjects enrolled |
Austria: 1
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Country: Number of subjects enrolled |
New Zealand: 1
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Country: Number of subjects enrolled |
Belgium: 2
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Country: Number of subjects enrolled |
Czechia: 5
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Country: Number of subjects enrolled |
China: 12
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Worldwide total number of subjects |
98
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EEA total number of subjects |
31
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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) |
77
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Adults (18-64 years) |
21
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
- | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
The study included 2 periods: Double-blind (DB) Treatment Period and Open-label Extension (OLE) Period. | ||||||||||||||||||||||||
Period 1
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Period 1 title |
DB Treatment Period (52 Weeks)
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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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Pamrevlumab | ||||||||||||||||||||||||
Arm description |
Participants received pamrevlumab intravenously (IV) every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
Pamrevlumab
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Investigational medicinal product code |
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Other name |
FG-3019
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
Pamrevlumab was administered per dose and schedule specified in the arm description.
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Arm title
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Placebo | ||||||||||||||||||||||||
Arm description |
Participants received placebo matched to pamrevlumab IV every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||||||||||||||||||||||||
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 |
Intravenous use
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Dosage and administration details |
Placebo matched to pamrevlumab was administered per schedule specified in the arm description.
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Period 2
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Period 2 title |
OLE (Maximum Exposure: 93.4 Weeks)
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Is this the baseline period? |
No | ||||||||||||||||||||||||
Allocation method |
Not applicable
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Blinding used |
Not blinded | ||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Pamrevlumab | ||||||||||||||||||||||||
Arm description |
Participants received pamrevlumab IV every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
Pamrevlumab
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Investigational medicinal product code |
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Other name |
FG-3019
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
Pamrevlumab was administered per dose and schedule specified in the arm description.
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Arm title
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Placebo | ||||||||||||||||||||||||
Arm description |
Participants received placebo matched to pamrevlumab IV every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||||||||||||||||||||||||
Arm type |
Placebo | ||||||||||||||||||||||||
Investigational medicinal product name |
Pamrevlumab
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Investigational medicinal product code |
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Other name |
FG-3019
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
Pamrevlumab was administered per dose and schedule specified in the arm description.
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Notes [1] - The number of subjects starting the period is not consistent with the number completing the preceding period. It is expected the number of subjects starting the subsequent period will be the same as the number completing the preceding period. Justification: 4 participants who completed the DB Treatment Period did not enter in to the OLE period. |
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Baseline characteristics reporting groups
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Reporting group title |
Pamrevlumab
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Reporting group description |
Participants received pamrevlumab intravenously (IV) every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
Participants received placebo matched to pamrevlumab IV every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Pamrevlumab
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Reporting group description |
Participants received pamrevlumab intravenously (IV) every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||
Reporting group title |
Placebo
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Reporting group description |
Participants received placebo matched to pamrevlumab IV every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||
Reporting group title |
Pamrevlumab
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Reporting group description |
Participants received pamrevlumab IV every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||
Reporting group title |
Placebo
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Reporting group description |
Participants received placebo matched to pamrevlumab IV every 2 weeks for up to 52 weeks in the DB treatment period. After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. |
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End point title |
Change From Baseline in the Total Score of Performance of Upper Limb (PUL) 2.0 Version at Week 52 | ||||||||||||
End point description |
The PUL module is an observer-administered performance battery of upper extremity mobility tasks for the shoulder (upper, 6 items, 12 points), elbow (middle, 9 items, 17 points) and wrist/hand (distal, 7 items, 13 points). Higher scores indicate higher level of function. Total score ranges from 0-42 points and is the sum of the scores for the 3 subscales. Analysis was done using a random coefficient model (RCM), which included fixed effects of time (as a continuous variable), treatment, and treatment-by-time interaction, with baseline ordinal PUL entry score as covariate. The modified intent-to-treat (mITT) population included all randomized participants with a PUL Entry score ≥2 (excluding PUL entry scores of 1) at baseline. Here, 'Overall number of participants analyzed' = participants evaluable for specified outcome measure.
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End point type |
Primary
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End point timeframe |
Baseline, Week 52
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Statistical analysis title |
Statistical Analysis 1 | ||||||||||||
Comparison groups |
Pamrevlumab v Placebo
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Number of subjects included in analysis |
78
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||
P-value |
= 0.8802 [1] | ||||||||||||
Method |
Random coefficient model | ||||||||||||
Parameter type |
Least square (LS) Mean Difference | ||||||||||||
Point estimate |
0.083
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-1.01 | ||||||||||||
upper limit |
1.176 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.5494
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Notes [1] - Threshold for significance at 0.05 level. |
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End point title |
Change From Baseline in Percent Predicted Forced Vital Capacity (ppFVC) at Week 52, Assessed by Spirometry | ||||||||||||
End point description |
FVC is a standard pulmonary function test used to quantify respiratory muscle weakness. FVC was the volume of air that can forcibly be blown out after full inspiration in the upright position, measured in liters. Predicted FVC is based on a formula using sex, age and height of a person, and is an estimate of healthy lung capacity. Percent of predicted FVC = (observed value)/(predicted value) * 100%. Analysis was done using an RCM, which included fixed effects of time (as a continuous variable), treatment, and treatment-by-time interaction, with baseline value as covariate. The mITT population included all randomized participants with a PUL Entry score ≥2 (excluding PUL entry scores of 1) at baseline. Here, 'Overall number of participants analyzed' = participants evaluable for specified outcome measure.
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End point type |
Secondary
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End point timeframe |
Baseline, Week 52
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No statistical analyses for this end point |
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End point title |
Change From Baseline in the Grip Strength of the Hands at Week 52, Assessed by Hand Held Myometry (HHM) | ||||||||||||||||||
End point description |
The HHM was used to measure distal upper arm strength (grip strength). Data has been presented by dominant and non-dominant hand. Grip Strength was analyzed using a MMRM with fixed effects for treatment, visit (as a factor), treatment-by-visit interaction, and covariates (baseline values). The mITT population included all randomized participants with a PUL Entry score ≥2 (excluding PUL entry scores of 1) at baseline. Here, 'Overall number of participants analyzed' = participants evaluable for specified outcome measure. 'n' = participants evaluable for specified category.
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End point type |
Secondary
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End point timeframe |
Baseline, Week 52
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No statistical analyses for this end point |
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End point title |
Change From Baseline in Left Ventricular Ejection Fraction percentage (LVEF %) at Week 52, Assessed by Magnetic Resonance Imaging (MRI) | ||||||||||||
End point description |
LVEF% is an important measure of cardiac function. LVEF is a fraction of blood (in percent) pumped out of the left ventricle of the heart (the main pumping chamber). The LVEF% was analyzed using an analysis of covariance (ANCOVA) model with treatment and baseline value. The mITT population included all randomized participants with a PUL Entry score ≥2 (excluding PUL entry scores of 1) at baseline. Here, 'Overall number of participants analyzed' = participants evaluable for specified outcome measure.
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End point type |
Secondary
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End point timeframe |
Baseline, Week 52
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No statistical analyses for this end point |
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End point title |
Change From Baseline in Percent Predicted Peak Expiratory Flow (ppPEF) at Week 52, Assessed by Spirometry | ||||||||||||
End point description |
The ppPEF is a measure of the maximal or peak flow produced during an exhalation with maximal effort and, as such, is the most effort-dependent measure of lung function. The ppFEV1 was analyzed using an RCM including fixed effects of time, treatment, and treatment-by-time interaction, with baseline as covariate. The ITT set included all randomized participants. Here, 'Overall number of participants analyzed' = participants evaluable for specified outcome measure.
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End point type |
Secondary
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End point timeframe |
Baseline, Week 52
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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 |
DB treatment period: From first dose of study drug up to 61 weeks
OLE period: From first dose of study drug up to study termination by Sponsor and safety follow-up (up to approximately 102 weeks)
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Adverse event reporting additional description |
The safety analysis set included all participants who received any dose of study medication.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
26.0
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Reporting groups
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Reporting group title |
DB Period: Placebo
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Reporting group description |
Participants received placebo matched to pamrevlumab IV every 2 weeks for up to 52 weeks in the DB treatment period. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
OLE Period: Pamrevlumab
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Reporting group description |
After completing Week 52 of the DB treatment period, participants in the OLE period then moved to Week 2 of the OLE period and received pamrevlumab IV every 2 weeks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
DB Period: Pamrevlumab
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Reporting group description |
Participants received pamrevlumab IV every 2 weeks for up to 52 weeks in the DB treatment period. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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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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10 Apr 2020 |
It included following changes:
- Muscle fibrosis MRI assessment was removed from inclusion criteria, and the fibrosis MRI assessment was added as an exploratory endpoint, per Food and Drug Administration (FDA) feedback. |
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15 Sep 2020 |
It included following changes:
- Safety follow-up was extended to 60 days (+ 3 days) after the last infusion to align with 5 times the half-life of pamrevlumab (12.2 days).
- Clarification was added that participants already on an approved DMD therapy should not discontinue that therapy to be eligible for the study.
- Study drug administration window was extended from 24 to 48 hours to align with updated pamrevlumab stability information.
- Electrocardiograms (ECGs) were removed to align with DMD standard of care.
- Basophils were added to include all components of the lab testing panel.
- Pulmonary function test (PFT) inclusion criteria were clarified.
- Criteria for participants to continue into the OLE period were clarified.
- Muscle fibrosis MRI assessment and fibrosis endpoint were removed from the OLE period. |
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26 Oct 2020 |
It included following changes:
- Per investigator feedback, Inclusion Criterion was changed to average (of Screening and Day 0) ppFVC between 45 and 85, inclusive, to mitigate risk and safeguard the wellbeing of the DMD participants, who could have potentially suffered from exhaustion with the original ppFVC requirements. |
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09 Jul 2021 |
It included following changes:
- Participation requirements for cardiac MRI, pneumonia and influenza vaccinations, and acceptable ranges for central laboratory assessments were clarified.
- Inclusion Criterion was changed to remove the requirement for cardiomyopathy diagnosis.
- The exclusion criterion for allergic reactions was expanded to include hypersensitivity to the study drug components or the gadolinium-based contrast agents required for the MRI.
- Casimersen (amondys 45) was added to the prohibited concomitant medications, due to its recent drug approval.
- Cardiac and pulmonary assessment exclusion criteria were expanded to exclude participants with abnormal glomerular filtration rate (GFR) or acute kidney injury.
- Clarification was added to state that pamrevlumab would be permanently discontinued in the case of a serious or life-threatening allergic reaction.
- Instruction was added for participants to speak to the study doctor and assess if an unscheduled visit is required after any adverse reaction during an home health care (HHC) visit.
- Guidance regarding the time separation between study drug and COVID-19 vaccination was added.
- Guidance regarding visit modality (in-person vs remote) and visit scheduling was added to align with FDA/European Medicines Agency (EMA) guidance regarding the COVID-19 pandemic and the resulting need for flexibility for visits and assessments.
• Contraception requirements were added to include permitted methods, such as condoms and abstinence.
• Clarification was added that subjects who discontinue from the Double-blind Treatment period were not eligible for OLE participation.
• AE reporting and AE definition were updated to reflect International Council for Harmonisation (ICH) E2A standard language. |
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01 Nov 2022 |
It included following changes:
- Bone fracture safety assessments were added to align with the pediatric investigational plan.
- Secondary endpoints were rearranged to align with the revised analysis plan.
- The exploratory endpoint of summarizing the subscores of the 3 regional dimensions of the PUL was added.
- Withdrawal criteria were updated to include a description for participants discontinuing infusions.
• Additional pharmacokinetics (PK), anti-drug antibodies (ADA), antidrug antibody neutralizing antibody (ADA-NA), and immunogenic reaction blood draws were added to increase the scope of specialty lab testing. |
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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 |