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    Summary
    EudraCT Number:2020-002063-60
    Sponsor's Protocol Code Number:PRN1008-018
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-08-30
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2020-002063-60
    A.3Full title of the trial
    A Phase 3, Multicenter, Randomized, Double-blind, Placebo-Controlled, Parallel-Group Study with an Open-Label Extension to Evaluate the Efficacy and Safety of Oral Rilzabrutinib (PRN1008) in Adults and Adolescents with Persistent or Chronic Immune Thrombocytopenia (ITP)
    Studio di fase 3, multicentrico, randomizzato, in doppio-cieco, controllato verso placebo, a gruppi paralleli con uno studio di estensione in aperto per valutare l’efficacia e la sicurezza di Rilzabrutinib (PRN1008) orale in Adulti e Adolescenti con trombocitopenia immune persistente o cronica (ITP)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Clinical Trial to Test the Safety, Effect, and Activity of Rilzabrutinib (PRN1008) in Adult and Adolescent Patients with Persistent or Chronic Immune Thrombocytopenia (ITP)
    Studio clinico per testare la sicurezza, l'efficacia e l'attività di Rilzabrutinib (PRN1008) in pazienti Adulti e Adolescenti con trombocitopenia immune persistente o cronica (ITP)
    A.3.2Name or abbreviated title of the trial where available
    LUNA 3
    LUNA 3
    A.4.1Sponsor's protocol code numberPRN1008-018
    A.5.4Other Identifiers
    Name:INDNumber:132668
    A.7Trial is part of a Paediatric Investigation Plan Yes
    A.8EMA Decision number of Paediatric Investigation PlanP/306/2020
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorPrincipia Biopharma Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportPrincipia Biopharma, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPrincipia Biopharma, Inc.
    B.5.2Functional name of contact pointClinical Trial Information Desk
    B.5.3 Address:
    B.5.3.1Street AddressEast Grand Avenue, 220
    B.5.3.2Town/ citySouth San Francisco
    B.5.3.3Post code94080
    B.5.3.4CountryUnited States
    B.5.4Telephone number0018334776700
    B.5.5Fax number0000000000000
    B.5.6E-mailclinicaltrials@principiabio.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEU/3/20/2278
    D.3 Description of the IMP
    D.3.1Product nameRilzabrutinib
    D.3.2Product code [PRN1008]
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRILZABRUTINIB
    D.3.9.1CAS number 1575591-66-0
    D.3.9.2Current sponsor codePRN1008
    D.3.9.4EV Substance CodeSUB192772
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number400
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Immune Thrombocytopenia (ITP)
    Trombocitopenia immunitaria (ITP)
    E.1.1.1Medical condition in easily understood language
    Immune Thrombocytopenia (ITP) is a chronic, autoimmune disease that is associated with bleeding risk due to low platelet levels in the blood.
    La trombocitopenia immunitaria (ITP) è una malattia autoimmune cronica associata al rischio di sanguinamento dovuta a bassi livelli di piastrine nel sangue.
    E.1.1.2Therapeutic area Diseases [C] - Blood and lymphatic diseases [C15]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 23.0
    E.1.2Level LLT
    E.1.2Classification code 10074667
    E.1.2Term Immune thrombocytopenic purpura
    E.1.2System Organ Class 100000004851
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    • To demonstrate the efficacy of rilzabrutinib versus placebo in patients with refractory/relapsed ITP, based on the proportion of adult patients able to achieve platelet counts at or above 50,000/µL for at least 8 out of the last 12 weeks of the 24-week blinded treatment period
    •Dimostrare l’efficacia di rilzabrutinib rispetto al placebo in pazienti con ITP refrattaria/recidivante, in base alla percentuale di pazienti adulti in grado di raggiungere una conta piastrinica pari o superiore a 50.000/µl per almeno 8 delle ultime 12 settimane del periodo di trattamento in cieco di 24 settimane.
    E.2.2Secondary objectives of the trial
    •Evaluate effect of rilzabrutinib versus PBO on nr. of wks with PLT count =50,000/µL OR between =30,000/µL and <50,000/µL and at least doubled from baseline, over the 24-wk blinded treatment period in absence of rescue therapy
    •Evaluate effect of rilzabrutinib versus PBO on nr. of wks with PLT counts between =30,000/µL and <50,000/µL and at least doubled from baseline over the 24-wk blinded treatment period in absence of rescue therapy
    •Evaluate effect of rilzabrutinib versus PBO on time to first PLT count of =50,000/µL OR between =30,000/µL and <50,000/µL and at least doubled from baseline
    •Evaluate effect of rilzabrutinib versus PBO on proportion of pts requiring rescue therapy
    •Evaluate effect of rilzabrutinib versus PBO on change from baseline in ITPBAT assessment.
    •Evaluate safety and tolerability of rilzabrutinib in pts aged 12 to <18 yrs and in adult pts (=18 yrs) with refractory/relapsed ITP
    •Characterize PK of rilzabrutinib
    •Evaluate effect of rilzabrutinib on QoL
    •Valutare l’effetto di rilzabrutinib rispetto al PBO- sul n di settimane con conta PLT =50.000/µl O tra =30.000/µl e <50.000/µl e un valore doppio rispetto al valore basale, nel periodo di trattamento in cieco di 24 settimane in assenza di terapia di soccorso - sul n di settimane con conta PLT tra =30.000/µl e <50.000/µl e un valore doppio rispetto al valore basale, nel periodo di trattamento in cieco di 24 settimane in assenza di terapia di soccorso - sul tempo alla prima conta PLT =50.000/µl O tra =30.000/µl e <50.000/µl e un valore doppio rispetto al valore basale - sulla % di pazienti che necessitano di una terapia di soccorso - sulla variazione rispetto al basale nella valutazione del ITPBAT •Valutare sicurezza e tollerabilità di rilzabrutinib in pazienti di età tra 12 e <18 anni e in pazienti adulti (=18 anni) con ITP refrattaria/recidivante •Caratterizzare la PK di rilzabrutinib •Valutare l'effetto di rilzabrutinib sulla QoL
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Patients will be men and women with primary ITP with duration of > 6 months in ages 12 to < 18 years and duration of > 3 months in ages 18 years and above • The following countries will only enroll patients =18 years of age with
    therefore primary ITP with duration of >3 months: Austria, Germany,
    Turkey, Ukraine
    2. Patients who had a response (achievement of platelet count =50,000/µL) to IVIg/anti-D or CSs that was not sustained and who have documented intolerance, insufficient response or any contra-indication to any appropriate courses of standard of care ITP therapy
    3. An average of 2 platelet counts at least 5 days apart of < 30,000µL (and no single platelet count >35,000µL) within 14 days prior to the first dose of study drug
    4. Adequate hematologic, hepatic, and renal function (absolute neutrophil count =1.5 X 109/L, AST/ALT =1.5 x ULN, albumin = 3 g/dL, total bilirubin = 1.5 x ULN, estimated GFR > 50 [Cockcroft and Gault method]
    5. Hemoglobin (Hgb) > 9 g/dL prior to dosing on Study Day 1
    6. Female patients who are of reproductive potential (fertile, following
    menarche and until becoming post-menopausal unless permanently
    sterile) or are likely to reach reproductive potential during the study must agree for the duration of the study to use an effective means of contraception (eg. hormonal contraception methods that inhibit ovulation, intrauterine device, intrauterine hormone-releasing system, bilateral tubal ligation, vasectomized partner or condoms) or practice true abstinence (when this is in line with the usual and preferred lifestyle). For females considered not to have reproductive potential: Any woman of age = 55 years with amenorrhea for >1 year, will be considered as having confirmed menopause and follicle-stimulating hormone (FSH) or pregnancy testing will not be needed. Postmenopausal females <55 years of age (defined as amenorrhea > 1 year) must have menopause confirmed by elevated FSH levels at Screening. Surgically sterile females do not require any further confirmation of menopause and will not be considered to have reproductive potential.
    7. Patients must be able to provide written informed consent or informed assent with corresponding informed consent obtained from the patient's guardian and agree to the schedule of assessments.
    1.I pazienti saranno uomini e donne con ITP primaria di durata >6 mesi per età compresa tra 12 e <18 anni e di durata >3 mesi per età pari o superiore a 18 anni • I seguenti paesi arruolano solo pazienti di età = 18 anni quindi con ITP primaria con durata > 3 mesi: Austria, Germania, Turchia, Ucraina 2.Pazienti che hanno manifestato una risposta (raggiungimento di conta piastrinica =50.000/µl) non costante al trattamento con IVIg/anti-D o CS e che presentano intolleranza documentata, risposta insufficiente o qualsiasi controindicazione a qualsiasi ciclo appropriato di terapia standard di cura per ITP
    3.Una media di 2 conte piastriniche <30.000/µl ad almeno 5 giorni di distanza (e nessuna conta piastrinica singola >35.000/µl) nei 14 giorni precedenti la prima dose del farmaco in studio
    4.Adeguata funzione ematologica, epatica e renale (conta assoluta dei neutrofili =1,5 X 109/l, AST/ALT =1,5 x ULN, albumina =3 g/dl, bilirubina totale =1,5 x ULN, GFR stimata >50 [metodo di Cockcroft e Gault]
    5.Emoglobina >9 g/dl prima della somministrazione il Giorno 1 dello studio
    6.Le pazienti potenzialmente fertili (fertile, a seguito del menarca e fino alla menopausa se non permanentemente sterile) o che probabilmente raggiungeranno il potenziale di fertilità nel corso dello studio) devono acconsentire a usare per l’intera durata dello studio metodi contraccettivi efficaci (ad es. metodi contraccettivi ormonali che inibiscono l’ovulazione, dispositivo intrauterino, sistema intrauterino a rilascio ormonale, legatura bilaterale delle tube, partner vasectomizzato o preservativo) o praticare l’astinenza completa (purché in linea con lo stile di vita abituale e preferito). Per le donne considerate non potenzialmente fertili: qualsiasi donna di età =55 anni con amenorrea da >1 anno sarà considerata come donna in menopausa confermata e non sarà necessario misurare l’ormone follicolo-stimolante (FSH) né eseguire un test di gravidanza. Le donne in postmenopausa (definite come amenorrea da >1 anno) di età <55 anni devono disporre della conferma dello stato menopausale in base a livelli di FSH elevati allo screening. Le donne chirurgicamente sterili non necessitano di alcuna ulteriore conferma della menopausa e non saranno considerate potenzialmente fertili
    7.I pazienti devono essere in grado di fornire un consenso informato scritto o un assenso informato con il corrispondente consenso informato ottenuto dal tutore del paziente e accettare la Programmazione delle valutazioni
    E.4Principal exclusion criteria
    1. Patients with secondary ITP - 2. Pregnant or lactating women - 3. Electrocardiogram findings for patients: • aged = 12 and < 16: QTcF > 449 msec (males) or > 457 msec (females) • aged = 16 and < 18: QTcF >450 msec (males) or > 460 msec (females) • aged >= 18, of QTcF > 450 msec (males) or > 470 msec (females), poorly controlled atrial fibrillation_other clinically significant abnormalities. 4. History or current, active malignancy requiring or likely to require chemotherapeutic or surgical treatment. 5. Transfusion with blood, blood products, plasmapheresis, or use of any other rescue medications. 6. Change in CS and/or TPO-RA dose within 14 days prior to Study Day 1. 7. Immunosuppressant drugs other than CSs within within 5 times the
    elimination half-life of the drug or 14 days of Study Day 1. 8. rituximab or splenectomy within the 3 months prior to Study Day 1. • Patients treated with rituximab will have normal B-cell counts prior to enrollment. 9. Ongoing need for the use of proton pump inhibitor drugs such as omeprazole and esomeprazole. 10. Use of known strong-to-moderate inducers or inhibitors of CYP3A within 3 days or 5 half-lives of Study Day 1 and until the end of the active treatment period. 11. Planned or concomitant use of any anticoagulants and platelet aggregation inhibiting drugs such as aspirin, nonsteroidal anti-inflammatory drugs, thienopyridines within 14 days of Study Day 1 and until the end of the active treatment period. 12. Has received any investigational drug within the 30 days before receiving the first dose of study medication, or at least 5 times elimination half-life of the drug; patient should not be using an investigational device at the time of dosing • Patients who previously received treatment with BTK inhibitors (except rilzabrutinib) within 30 days before the first dose of study drug are not eligible. • Patients who previously received rilzabrutinib at any time are not eligible. 13. Current drug or alcohol abuse. 14. Refractory nausea and vomiting, malabsorption, external biliary shunt, significant bowel resection, or any other condition that would preclude adequate study drug absorption. 15. History of solid organ transplant. 16. Positive at Screening for human immunodeficiency virus, hepatitis B virus or hepatitis C virus • Patients who are hepatitis B virus surface antigen (HBsAg) positive will not be eligible. • Patients who are HBsAg negative and hepatitis B core antigen antibody. (HBcAb) positive will be tested for HBV surface antibody (HBsAb) and HBV DNA. If HBV DNA is negative and HBsAb titer is =100 IU/L, patients may be enrolled • Patients who are HBcAb positive and HBsAg negative with HBsAb titer <100 IU/L or negative, are not eligible. 17. Positive QuantiFERON®-TB Gold, or QuantiFERON®-TB Gold Plus QFT Plus) at Screening unless all of the following 3 conditions are true (except for pts in the UK where positive QFT Plus at Screening is
    exclusionary): a) Chest X-ray does not show evidence suggestive of active tuberculosis (TB) disease b) There are no clinical signs and symptoms of pulmonary and/or extrapulmonary TB disease c) Documented receipt of one of the following prophylactic treatment regimens: i. Oral daily Isoniazid for 6 months or ii. Oral daily Rifampin (RIF) for 4 months or iii. Isoniazid and Rifapentine weekly for 3 months. On a case by case basis, after discussion and approval by the Sponsor, a local TB test that is negative and is considered equivalent to 1 of the above tests may be used for eligibility. 18. History of recurring (2 or more) serious infections requiring intravenous antibiotic therapy or active serious or moderate infection ongoing on the day of randomization. 19. Myelodysplastic syndrome. 20. Live vaccine within 28 days prior to Study Day 1 or plan to receive one . 21. Planned surgery in the time frame of the dosing period. 22. Any other clinically significant disease, that would interfere with patient safety.
    1.Pz con ITP secondaria 2.Don in stato di gravidanza o allattamento 3.Risultati dell’ ECG per pz: -di età tra =12 e <16 anni: QTcF>449 msec (uom) o >457 msec (don)- di età tra =16 e <18 anni: QTcF>450 msec (uom) o >460 msec (don)- età >=18 anni, QTcF>450 msec (uom) o >470 msec (don), fibrillazione atriale scarsamente controllata_ altre anomalie clinicamente significative 4.Anamnesi o attuale tumore maligno in fase attiva che richiede/potrebbe richiedere un trattamento chemioterapico o chirurgico 5.Trasfusione con sangue,emoderivati,plasmaferesi o uso di qualsiasi altro F di soccorso 6.Variazione della dose di CS e/o TPO-RA nei 14 gg precedenti il Gg 1(G1) dello studio 7.F immunosoppressori diversi da CS entro 5 volte l’emivita di eliminazione del f. o 14 gg dal G1 dello studio 8.Rituximab o splenectomia nei 3 mesi precedenti il G1 dello studio - I pz trattati con rituximab dovranno avere conte delle cellule B normali prima dell’arruolamento 9.Necessità costante di ricorrere all’uso di F inibitori della pompa protonica come omeprazolo ed esomeprazolo 10.Uso di induttori o inibitori noti da forti a moderati di CYP3A entro 3 gg o 5 emivite dal G1 fino fine del trattamento 11.Uso programmato o concomitante di anticoagulanti e F inibitori dell’agg piastrinica come l’aspirina, F antinfiammatori non steroidei, tienopiridine entro 14 gg dal G1 fino fine del trattamento 12.Trattamento con qualsiasi F sperimentale nei 30 gg precedenti la somministrazione della prima dose del F in studio o almeno 5 volte l’emivita di eliminazione del F; il pz non deve usare un disp sperimentale al momento della somministrazione:- I pz che hanno ricevuto in precedenza un trattamento con inibitori della tirosin-chinasi di Bruton (eccetto rilzabrutinib) nei 30 gg precedenti la prima dose del F in studio non sono idonei - I pz che in precedenza hanno ricevuto rilzabrutinib in qualsiasi momento non sono idonei 13.Abuso attuale di F o alcol 14.Nausea e vomito refrattari, malassorbimento, shunt biliare esterno, resezione intestinale significativa o qualsiasi altra condizione che impedirebbe un adeguato assorbimento del F in studio 15.Anamnesi di trapianto di organo solido 16.Pos allo screening per il virus dell’immunodeficienza umana, virus dell’epatite B o C:- I pz che risultano pst all’Ag di superficie del virus dell’epatite B non saranno idonei. -I pz ngt all’HBsAg e pst agli anticorpi anti-antigene core dell’epatite B saranno sottoposti al test degli anticorpi di superficie dell’HBV e dell’HBV DNA. Se l’HBV DNA è neg e il titolo di HBsAb è =100 UI/L, i pz possono essere arruolati.- I pz HBcAb-pst e HBsAg-ngt con titolo di HBsAb <100 UI/L o ngt non sono idonei. 17.Pst al test QTP®-TB Gold o QTP®-TB Gold Plus allo screening, a meno che risultino vere tutte le 3 seguenti condizioni (ad eccezione dei pz in UK dove QTP Plus pos allo screening è esclusionario) :a) La radiografia toracica non mostra evidenze indicative di malattia da tubercolosi attiva b) Non vi sono segni e sintomi clinici di malattia da TBC polmonare e/o extra-polmonare c) Ricezione documentata di uno dei seguenti regimi di trattamento profilattico:i. isoniazide orale una volta al gg per 6 mesi o ii. rifampina orale una volta al gg per 4 mesi o iii. isoniazide e rifapentina una volta alla settimana per 3 mesi. Valutando caso per caso, previa discussione e approvazione da parte dello Sponsor, ai fini dell’idoneità può essere usato un test TBC locale che risulti ngt e sia considerato equivalente a 1 dei suddetti test. 18.Anamnesi di infezioni gravi ricorrenti che richiedono una terapia antibiotica endovenosa o infezione grave o moderata attiva in corso il gg della randomizzazione 19.Sindrome mielodisplastica 20.Somministrazione di un vaccino vivo nei 28 gg precedenti il G1 dello studio o intenzione di riceverne uno 21.Intervento chirurgico pianificato nell’intervallo temporale del periodo di dosaggio 22.Qualsiasi altra malattia,clinicamente significativa che interferirebbe con la sicurezza del pz
    E.5 End points
    E.5.1Primary end point(s)
    Proportion of patients able to achieve platelet counts at or above 50,000/µL for at least 8 out of the last 12 weeks of the 24-week blinded treatment period in the absence of rescue therapy
    • Percentuale di pazienti in grado di raggiungere conte piastriniche pari o superiori a 50.000/µl per almeno 8 delle ultime 12 settimane del periodo di trattamento in cieco di 24 settimane in assenza di terapia di soccorso.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Efficacy (blinded period): At every visit Week 2 through Week 25 including weekly lab visits between clinic visits and early withdrawal/unscheduled visits
    Efficacia (periodo in cieco): ad ogni visita dalla settimana 2 alla settimana 25 comprese le visite di laboratorio tra le visite cliniche e le visite di ritiro/non programmate
    E.5.2Secondary end point(s)
    Efficacy
    • Number of weeks with platelet count =50,000/µL OR between = 30,000/µL and <50,000/µL and at least doubled from baseline over the 24-week blinded treatment period in the absence of rescue therapy
    • Number of weeks with platelet counts between = 30,000/µL and <50,000/µL and at least doubled from baseline over the 24-week blinded treatment period in the absence of rescue therapy
    • Time to first platelet count of =50,000/µL OR between = 30,000/µL and <50,000/µL and doubled from baseline
    • Proportion of patients requiring rescue therapy
    • Change from baseline in ITP Specific Bleeding Assessment Tool (ITPBAT) assessment
    Safety
    • Frequency and severity of TEAEs
    • Frequency and severity of bleeding TEAEs
    • Change from baseline in physical examination, ECG, clinical laboratory test results, vital signs. and laboratory tests (serum chemistry, hematology (except for platelet counts included in the primary efficacy endpoint)
    PK
    • Plasma concentrations of rilzabrutinib
    QoL
    • Change from baseline on the Symptoms, Bother and Activity domains
    of the ITP Patient Assessment Questionnaire (ITP-PAQ) in adult patients (=18 years)
    • Change from baseline in disease-specific quality of life (QoL) as measured by the Kids' ITP Tools (ITP-KIT) score in patients ages 12 to <18
    Exploratory
    • Proportion of patients able to achieve platelet counts =50,000/µL for 4 out of last 8 weeks of the 24-week treatment period
    • Proportion of patients who have a platelet count that exceeds 250,000/µL or 450,000/µL (for patients on TPO RA's)
    • Change from baseline on the Fatigue, Psychological, Fear, Social Activity, Women's Reproductive Health, Work, and Overall QoL domains of the ITP-PAQ in adult patients (=18 years)
    • Change from baseline in quality of life as measured by the Euro-QoL-5 Dimensions-5 Level (Euro-QoL-5D-5L) in adult patients (=18 years)
    • Change from baseline in disease-related symptom severity as measured by the Patient Global Impression of Severity (PGIS)
    • Patient perception of disease-related symptom improvement as measured by Patient Global Impression of Change Scale (PGIC)
    • PK parameters as assessed by population pharmacokinetic analysis
    • BTK occupancy
    • Changes from baseline in TPO levels, T/B/NK counts, immunoglobulin (IgG, IgG1, IgG4, IgM, IgE) levels
    Efficacia
    •Numero di settimane con conta piastrinica =50.000/µl O tra =30.000/µl e <50.000/µl e un valore almeno doppio rispetto al valore basale, nell’arco del periodo di trattamento in cieco di 24 settimane in assenza di terapia di soccorso
    •Numero di settimane con conta piastrinica tra =30.000/µl e <50.000/µl e un valore almeno doppio rispetto al valore basale, nell’arco del periodo di trattamento in cieco di 24 settimane in assenza di terapia di soccorso
    •Tempo alla prima conta piastrinica =50.000/µl O tra =30.000/µl e <50.000/µl e un valore doppio rispetto al valore basale
    •Percentuale di pazienti che devono ricorrere a una terapia di soccorso durante il periodo di trattamento in cieco di 24 settimane
    •Variazione rispetto al basale nella valutazione ITP-BAT alla Settimana 25
    Sicurezza
    •Frequenza e gravità dei TEAE
    •Frequenza e gravità dei TEAE emorragici
    •Variazione rispetto al basale a livello di esame obiettivo, ECG, segni vitali e risultati degli esami clinici di laboratorio: ematochimica ed ematologia (fatta eccezione per le conte piastriniche incluse nell’endpoint primario di efficacia)
    Farmacocinetica
    •Concentrazioni plasmatiche di rilzabrutinib
    Qualità della vita
    •Variazione rispetto al basale nei domini Sintomi, Fastidio e Attività del Questionario per la valutazione di pazienti con ITP (ITP-PAQ) in pazienti adulti (=18 anni)
    •Variazione rispetto al basale nella QOL specifica per la malattia misurata mediante il punteggio degli Strumenti per bambini con ITP (ITP-KIT) in pazienti di età compresa tra 12 e <18 anni
    Esplorativi
    •Percentuale di pazienti in grado di raggiungere una conta piastrinica =50.000/µl per 4 delle ultime 8 settimane del periodo di trattamento di 24 settimane
    •Percentuale di pazienti che presentano una conta piastrinica superiore a 250.000/µl o 450.000/µl (per pazienti in terapia con TPO-RA)
    •Variazione rispetto al basale nei domini Affaticamento, Psicologico, Paura, Attività sociale, Salute riproduttiva femminile, Lavoro e QOL complessiva dell’ITP-PAQ in pazienti adulti (=18 anni)
    •Variazione rispetto al basale nella QOL misurata mediante il Questionario europeo sulla QOL a 5 dimensioni e livelli in pazienti adulti (=18 anni)
    •Variazione rispetto al basale nella gravità dei sintomi correlati alla malattia misurata mediante la Scala delle impressioni globali del paziente sulla gravità (PGIS)
    •Percezione del miglioramento dei sintomi correlati alla malattia da parte del paziente, come misurato mediante la Scala delle impressioni globali del paziente sul cambiamento (PGIC)
    •Parametri PK valutati mediante analisi PK di popolazione
    •Occupazione della BTK
    •Variazioni rispetto al basale nei livelli di TPO, nelle conte delle cellule T/B/NK e nei livelli di immunoglobuline (IgG, IgG1, IgG4, IgM, IgE)
    E.5.2.1Timepoint(s) of evaluation of this end point
    Efficacy (blinded period): At every visit Week 2 through Week 25 including weekly lab visits between clinic visits and early withdrawal/unscheduled visits
    Efficacy (open-label): Week 26 through Week 53 including end of study 4-weeks post last dose and early withdrawal/unscheduled visits
    Safety (blinded period, open-label): At every visit
    PK (blinded period): Week 1 and Week 13
    PK (open-label): Week 25 and Week 53
    Efficacia (periodo in cieco): ad ogni visita dalla settimana 2 alla settimana 25 comprese le visite di laboratorio tra le visite cliniche e le visite di ritiro prematuro/non programmate
    Efficacia (periodo in aperto): dalla settimana 26 alla settimana 53 comprese le 4 settimana a conclusione dello studio post ultimo dosaggio e le visite di ritiro prematuro/non programmate
    Sicurezza (periodo in cieco, in aperto): ad ogni visita
    Farmacocinetica (periodo in cieco): settimana 1 e settimana 13
    Farmacocinetica (in aperto): settimana 25 e settimana 53
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    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.8.4.1Number of sites anticipated in Member State concerned6
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA35
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Brazil
    Canada
    Chile
    Israel
    Korea, Republic of
    Mexico
    Russian Federation
    Singapore
    Thailand
    Turkey
    Ukraine
    United States
    Austria
    Bulgaria
    France
    Germany
    Hungary
    Italy
    Netherlands
    Norway
    Poland
    Spain
    United Kingdom
    Czechia
    Argentina
    E.8.7Trial 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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months2
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 30
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 139
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 25
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state11
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 80
    F.4.2.2In the whole clinical trial 194
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Patients may continue in the 12 month LTE until the patient is:
    a) no longer responding (platelet counts <30,000/µL or less than 20,000/µL above baseline on four consecutive visits)
    b) the drug is no longer being developed by the Sponsor for ITP
    c) the program is stopped for safety reasons or
    d) the drug becomes commercially available in the patient's country
    I pazienti possono continuare nell'LTE di 12 nesi fino a quando il paziente:
    a) non risponde più (conta piastrinica <30,000/ µL o meno di 20,000/µL sopra il basale in quattro visite consecutive)
    b) il farmaco non è più sviluppato dallo Sponsor per ITP
    c) il programma viene interrotto per motivi di sicurezza o
    d) il farmaco è disponibile in commercio nel paese del paziente
    G. Investigator Networks to be involved in the Trial
    G.4 Investigator Network to be involved in the Trial: 1
    G.4.1Name of Organisation Medical Research Network Ltd.
    G.4.3.4Network Country United Kingdom
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2020-12-14
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-12-15
    P. End of Trial
    P.End of Trial StatusOngoing
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