E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Active Systemic Lupus Erythematosus |
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E.1.1.1 | Medical condition in easily understood language |
Systemic Lupus Erythematosus |
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E.1.1.2 | Therapeutic area | Body processes [G] - Immune system processes [G12] |
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 | 10025139 |
E.1.2 | Term | Lupus erythematosus systemic |
E.1.2 | System Organ Class | 100000004859 |
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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 |
Evaluate the efficacy of efavaleukin alfa at week 52, as measured by the SRI-4 response |
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E.2.2 | Secondary objectives of the trial |
- Evaluate the efficacy of efavaleukin alfa at week 52, as measured by the BICLA index responses - Evaluate the efficacy of efavaleukin alfa at week 52, as measured by LLDAS response - Evaluate the efficacy of efavaleukin alfa at week 52, as measured by OCS tapering - Evaluate the efficacy of efavaleukin alfa at week 24, as measured by SRI-4 response - Evaluate the efficacy of efavaleukin alfa at week 24, as measured by the BICLA index responses - Evaluate the efficacy of efavaleukin alfa at weeks 24 and 52, as measured by hSLEDAI - Evaluate the efficacy of efavaleukin alfa on joints and skin - Evaluate the efficacy of efavaleukin alfa using BILAG score - Evaluate the efficacy of efavaleukin alfa using patient reported outcomes - Characterize the safety of efavaleukin alfa - Characterize the PK of efavaleukin alfa |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Screening: 101 Subject has provided informed consent prior to initiation of any study specific activities/procedures. 102 Age ≥ 18 years to 75 years at screening. 103 Fulfills classification criteria for SLE according to the 2019 EULAR/ACR classification criteria for SLE (Aringer et al, 2019), with antinuclear antibody ≥ 1:80 by immunofluorescence on Hep-2 cells being present at screening. Anti-dsDNA results based on the Phadia method will be used for the purposes of hSLEDAI scoring during screening and throughout the study. 110 Hybrid SLEDAI score ≥ 6 points with a "Clinical" hSLEDAI score ≥ 4 points. The "Clinical" hSLEDAI is the hSLEDAI assessment score without the inclusion of points attributable to laboratory results, including urine and immunologic parameters. Including the following protocol specific rules: - Arthritis: for hSLEDAI scoring purposes, a minimum of 3 joints with pain and signs of inflammation (ie, tenderness with swelling or effusion) must involve small joints in the hands, wrists, or a combination of joints in hands and wrists. - Alopecia: subjects should have active hair loss without scarring; should neither have alopecia areata nor androgenic alopecia; and should have a CLASI activity score for alopecia ≥2. - Oral ulcers: ulcers location and appearance must be documented by the investigator. - Scleritis and episcleritis: the presence of stable SLE-related scleritis and episcleritis (ie, that will likely not require initiation/increase in immunosuppressants/immunomodulators as outlined in the inclusion/exclusion criteria) must be documented by an ophthalmologist and other causes excluded. - Renal: subjects with urine protein/creatinine ratio < 2000 mg/g (or equivalent) in a clean catch spot urine sample can enroll and be scored in the hSLEDAI, provided the subject has a clinical hSLEDAI ≥ 4. - Pleurisy and Pericarditis: symptoms of pleurisy and pericarditis must be accompanied by objective findings to be scored in the hSLEDAI. 105 BILAG index score (BILAG 2004) of ≥ 1 A item or ≥ 2 B items. 106 Must be taking ≥ 1 of the following SLE treatments (or regional equivalent): hydroxychloroquine, chloroquine, quinacrine, mycophenolate mofetil, azathioprine, methotrexate, dapsone, or oral calcineurin inhibitors, or OCS. A subject may enter the study on OCS alone (prednisone ≥ 10 mg/day or equivalent) only if the subject has previously documented trial of anti-malarial or immunosuppressant treatment for SLE. Subjects must be on a stable dose for ≥ 8 weeks prior to screening for all antimalarials and immunosuppressants, with the exception of OCS doses which must be stable for ≥ 2 weeks prior to screening. 107 For subjects taking OCS, the dose must be ≤ 20 mg/day of prednisone or OCS equivalent, and the dose must be stable for ≥ 2 weeks prior to screening visit. 111. For France, affiliation to a social security scheme is required. Day 1 (Baseline): The baseline/day 1 visit should occur after confirmation of eligibility by the adjudication team within 33 days after the screening visit. At the baseline/day 1 visit, the following 2 criteria should be assessed prior to randomization: 108 Stability of SLE treatments: OCS and other immunosuppressants/immunomodulator agents and doses must be stable since screening visit. 109 Disease activity: active disease as indicated by clinical hSLEDAI score ≥ 4 must be observed (clinical hSLEDAI score is the hSLEDAI assessment score without the inclusion of points attributable to laboratory results including urine and immunologic parameters). |
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E.4 | Principal exclusion criteria |
231 Lupus nephritis if any of the following are present: urine protein creatinine ratio ≥ 2000 mg/g at screening, OR requiring induction therapy currently or within 1 year prior to screening, OR histological evidence of diffuse proliferative glomerulonephritis within 12 weeks prior to screening. 202 Active CNS lupus within 1 year prior to screening including, but not limited to, aseptic meningitis, ataxia, CNS vasculitis, cranial neuropathy, demyelinating syndrome, optic neuritis, psychosis, seizures, or transverse myelitis. 232 Currently present or within 1 year prior to screening a diagnosis of any chronic inflammatory disease other than SLE which would interfere with SLE disease assessment. 204 History of any disease other than SLE that has required treatment with oral or parenteral corticosteroids for > 2 weeks within 4 months prior to screening. 205 Active infection for which anti-infectives are indicated currently or within 4 weeks prior to screening visit OR presence of serious infection, defined as requiring hospitalization or intravenous anti-infectives within 8 weeks prior to screening visit. 206 Active tuberculosis or latent tuberculosis with no documented past history of adequate treatment per local standard of care. 207 Positive test for tuberculosis during screening defined as: either a positive or indeterminate QuantiFERON®-TB or T-spot test OR positive purified protein derivative (PPD) (≥ 5 mm of induration at 48 to 72 hours after test is placed). 233 Positive for hepatitis B surface antigen (HBsAg); or positive for hepatitis B core antibody (HBcAb). A positive hepatitis B surface antibody (HBsAb) without history of hepatitis B infection (ie, positive HBsAg, negative HBsAg and negative HBcAb) is allowed. 234 Positive for hepatitis C antibody 210 Known history of HIV or positive HIV test at screening. 235 Presence of 1 or more significant concurrent medical conditions, including but not limited to the following: poorly controlled diabetes or hypertension, symptomatic heart failure, myocardial infarction or unstable angina pectoris within the past 12 months prior to screening, severe chronic pulmonary disease requiring oxygen therapy, multiple sclerosis or any other demyelinating disease. 212 Any history of malignancy with the following exceptions: resolved non-melanoma skin cancers > 5 years prior to screening resolved cervical carcinoma > 5 years prior to screening resolved breast ductal carcinoma in situ > 5 years of screening 213 Currently receiving or had treatment with: cyclophosphamide, chlorambucil, nitrogen mustard, or any other alkylating agent within 6 months prior to screening or sirolimus within 4 weeks prior to screening. 237 Currently receiving or had treatment with a Janus kinase (JAK) inhibitor within less than 5 drug half-lives prior to screening. 215 Currently receiving or had treatment with an immune checkpoint inhibitor 216 Currently receiving or had treatment within 12 months prior to screening with T-cell depleting agents 217 Currently receiving or had treatment with an IL-2 based therapy 238 Current or previous treatment with a biologic agent with immunosuppressive/immunomodulatory activity as follows: rituximab within 6 months prior to screening; abatacept, belimumab, and anifrolumab within the past 3 months prior to screening; other biologics within < 5 drug half-lives prior to screening. 219 Subjects who have received intraarticular, intralesional, or intramuscular corticosteroids within 2 weeks prior to screening or intravenous corticosteroids within 6 weeks prior to screening. 220 Subjects who have received live vaccines within 5 weeks prior to screening, or plan to receive live vaccines during the treatment period and up to 6 weeks after the end of treatment period in the study. 221 Currently receiving treatment in another investigational device or drug study. 222 Ending a treatment with an investigational drug or investigational device less than 3 months or 5 half-lives from the last dose of the investigational drug at screening. 236 Presence of laboratory abnormalities at screening 224 Any other laboratory abnormality, which in the opinion of the investigator, poses a safety risk, will prevent the subject from completing the study or will interfere with the interpretation of the study results, or might cause the study to be detrimental to the subject |
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E.5 End points |
E.5.1 | Primary end point(s) |
- SRI-4 response at week 52 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
- BICLA response at week 52 - LLDAS response at week 52 - Reduction of OCS to ≤ 7.5 mg/day by week 44 and sustained through week 52 in subjects with a baseline OCS dose ≥ 10 mg/day - SRI-4 response at week 24 - BICLA response at week 24 - hSLEDAI response (ie, reduction ≥ 4 points from baseline) at week 24 hSLEDAI response (ie, reduction ≥ 4 points from baseline) at week 52 - Improvement from baseline in tender and swollen joint count ≥ 50% at weeks 8, 12, 24, 36, and 52 in subjects with ≥ 6 tender and swollen joints involving hands and wrists at baseline - Improvement from baseline in CLASI activity score ≥ 50% at week 8, 12, 24, 36, and 52 in subjects with a CLASI activity score ≥ 8 at baseline - Annualized flare rate (as measured by BILAG score designation of “worse” or “new” resulting in a B score in ≥ 2 organs or an A score in ≥ 1 organ) over 52 weeks - Change from baseline in fatigue standardized score using the PROMIS Fatigue SF 7a at week 12, 24, 36, and 52 - Change from baseline in the physical component score, mental component score and individual domains of the SF 36 v2 at week 12, 24, 36, and 52 - Change from baseline in the domain scores on the Lupus QoL at weeks 12, 24, 36, and 52 - Treatment-emergent adverse events - Serious adverse events - Clinically significant changes in laboratory values and vital signs - Trough and sparse post-dose serum concentrations of efavaleukin alfa |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Weeks 8, 12, 24, 36, and 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 | No |
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 | 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 | No |
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 | 4 |
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 | 7 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 50 |
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 |
Chile |
Colombia |
Hong Kong |
Japan |
Korea, Republic of |
Mexico |
South Africa |
Taiwan |
United States |
Switzerland |
Russian Federation |
Turkey |
Austria |
Bulgaria |
France |
Greece |
Italy |
Poland |
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 | 7 |
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 | 0 |