E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Ambulatory Duchenne Muscular Dystrophy |
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E.1.1.1 | Medical condition in easily understood language |
Duchenne Muscle Dystrophy |
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E.1.1.2 | Therapeutic area | Diseases [C] - Musculoskeletal Diseases [C05] |
MedDRA Classification |
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 | 10013801 |
E.1.2 | Term | Duchenne muscular dystrophy |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Evaluation of the efficacy and safety of pamrevlumab versus placebo in combination with systemic corticosteroids administered every two weeks in ambulatory subjects with Duchenne muscular dystrophy (age 6 to 11 years). |
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Double-blind phase: Age and Consent 1. Males at least 6 to < 12 years of age at screening initiation; 2. Written consent by patient and/legal guardian as per regional/ country and/or IRB/IEC requirements;
DMD Diagnosis: 3. Medical history includes diagnosis of DMD and confirmed Duchenne mutation, including status of exon 44 using a validated genetic test.
Pulmonary Criteria: 4. Average (of Screening and Day 0) percent predicted FVC above 45%; 5. On a stable dose of systemic corticosteroids for a minimum of 6 months, with no substantial change in dosage for a minimum of 3 months (except for adjustments for changes in body weight) prior to screening. Corticosteroid dosage should be in compliance with the DMD Care Considerations Working Group recommendations (e.g. prednisone or prednisolone 0.75 mg/kg per day or deflazacort 0.9 mg/kg per day) orstable dose. A reasonable expectation is that dosage and dosing regimen would not change significantly for the duration of the study.
Performance Criteria: 6. Able to complte 6MWD test with a distance of at least 270M but no more than 450M on two occasions within 3 months prior to Randomisation with <=10% variation between these two tests. 7. Able to rise (TTSTAND) from floor in <10 seconds (without aids/orthoses) at screening visit. 8. Able to undergo MRI test for the lower extremities vastus lateralis muscle.
Vaccination: 9. Agreement to receive annual influenza vaccinations during the course of the study.
Laboratory Criteria: 10. Adequate renal function: cystatin C ≤1.4 mg/L; 11. Adequate hematology and electrolytes parameters: a. Platelets >100,000/mcL b. Hemoglobin >12 g/dL c. Absolute neutrophil count >1500 /μL d. Serum calcium (Ca), potassium (K), sodium (Na), magnesium (Mg) and phosphorus(P) levels are within a clinically accepted range for DMD patients; 12. Adequate hepatic function: a. No history or evidence of liver disease b. Gamma glutamyl transferase (GGT) ≤3x upper limit of normal (ULN) c. Total bilirubin ≤1.5xULN.
Open-label extension phase: All patients must have completed treatment through the primary endpoint and completed the Week 52 visit on the double-blind phase. The study investigator must consider the subject medically stable for continued treatment. Written consent/assent by the patients and/or their legal guardian must be obtained prior to the patient’s participation in the open-label extension phase. |
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E.4 | Principal exclusion criteria |
Both phases: General criteria: 1. Concurrent illness other than DMD that can cause muscle weakness and/or impairment of motor function. 2. Severe intellectual impairment (eg. severe autism, sever cognitive impairment, severe behavioral disturbance) preventing the ability to perform study assessments in the investigator´s judgement. 3. Previous exposure to pamrevlumab. 4. BMI ≥40 kg/m2 or weight >117 kg. 5. History of : a. allergic or anaphylactic reaction to human, humanized, chimeric or murine monoclonal antibodies, b. hypersensitivity to study drug or any component of study drug, 6. Exposure to any investigational drug (for DMD or not), in the 30 days prior to screening initiation or use of approved DMD therapies (e.g., eteplirsen (exondys 51), ataluren, golodirsen (vyondys 53), casimersen (amondys 45)) within 5 half-lives of screening, whichever is longer, with the exception of the systemic corticosteroids, including deflazacort.
Cardiac, Renal and Pulmonary Criteria: 7. Requires >= 16 hours continuous ventilation. 8. Poorly controlled asthma or underlying lung disease such as bronchitis, bronchiectasis, emphysema, recurrent pneumonia that in the opinion of the investigator might impact respiratory function. 9. Hospitalization due to respiratory failure within 8 weeks prior to screening. 10. Severe uncontrolled heart failure (NYHA Classes III-IV), or renal dysfunction, including any of the following: a. Need for intravenous diuretics or inotropic support within 8 weeks prior to screening, b. Hospitalization for a heart failure exacerbation or arrhythmia within 8 weeks prior to screening, c. Patients with glomerular filtration rate (GFR) of less than 30 mL/min/1.73m2 or with other evidence of acute kidney injury as determined by investigator; 11. Arrhythmia requiring anti-arrhythmic therapy. 12. Any other evidence of clinically significant structural or functional heart abnormality.
Clinical Judgments: 13. The Investigator judges that the subject will be unable to fully participate in the study and complete it for any reason, including inability to comply with study procedures and treatment, or any other relevant medical, surgical or psychiatric conditions. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Double-blind phase: Ambulatory functional assessment: • Change in NorthStar Ambulatory Assessment (NSAA) total score
Open label phase: • Change in NorthStar Ambulatory Assessment (NSAA) total score; • Change in 4-stair climb Velocity (4SCV) assessment; • Change in the 10-meter walk/run test; • Change in Time to Stand (TTSTAND); • Change of the time of Loss of Ambulation (LoA) assessment.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Double-blind phase: Change in NorthStar Ambulatory Assessment (NSAA) Linearized total score. Baseline, Week 52
Open label phase: • Change in NorthStar Ambulatory Assessment (NSAA) total score; every 12 weeks • Change in 4-stair climb Velocity (4SCV) assessment; every 12 weeks • Change in the 10-meter walk/run test; every 12 weeks • Change in Time to Stand (TTSTAND); every 12 weeks • Change of the time of Loss of Ambulation (LoA) assessment. every 12 weeks
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E.5.2 | Secondary end point(s) |
Double-blind phase: • Change in 4-stair climb Velocity (4SCV) assessment; • Change in the 10-meter walk/run test; • Change in Time to Stand (TTSTAND); • Time to Loss of Ambulation (LoA). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Double-blind phase: • Change in 4-stair climb Velocity (4SCV) assessment: Baseline, week 52 • Change in the 10-meter walk/run test: Baseline, week 52 • Change in Time to Stand (TTSTAND): Baseline, week 52 • Time to Loss of Ambulation (LoA): Baseline, week 52 |
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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 | 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 | 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) | 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 | Yes |
E.8.1.7.1 | Other trial design description |
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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 | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 16 |
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 |
Canada |
China |
United States |
Austria |
Belgium |
France |
Italy |
Netherlands |
Spain |
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 3 |
E.8.9.1 | In the Member State concerned days | 12 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 8 |
E.8.9.2 | In all countries concerned by the trial days | 19 |