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    Clinical Trial Results:
    A Single-Center Phase 3b Trial Investigating the Long-term Effect on Intestinal Absorption, Nutritional Status and Long-Term Safety of treatment with Glepaglutide in Patients with Short Bowel Syndrome (SBS)

    Summary
    EudraCT number
    2020-005194-27
    Trial protocol
    DK  
    Global end of trial date
    05 Sep 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    12 Oct 2024
    First version publication date
    12 Oct 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ZP1848-20060
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    U1111-1260-2961
    Other trial identifiers
    IND: 133151
    Sponsors
    Sponsor organisation name
    Zealand Pharma A/S
    Sponsor organisation address
    Sydmarken 11, Søborg, Denmark, DK-2860
    Public contact
    Head of clinical operations, Zealand Pharma A/S, +45 8877 3600, info@zealandpharma.com
    Scientific contact
    Head of clinical operations, Zealand Pharma A/S, +45 8877 3600, info@zealandpharma.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    02 May 2024
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    05 Sep 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To demonstrate the 24-week effect of glepaglutide on the absorption of fluids.
    Protection of trial subjects
    The study was conducted in accordance with the ethical principles that have their origins in the Declaration of Helsinki, and in adherence to requirements of Good Clinical Practice (GCP) as defined by the International Conference on Harmonization (ICH) Harmonised Tripartite Guideline for Good Clinical Practice. Before a patient was enrolled into the trial, the patient was informed orally and in writing about the trial by the investigator, and written informed consent was obtained from the patient according to regulatory and legal requirements. Informed consent of the patient, and the signature of the investigator obtaining the informed consent, were attained before any trial related procedures were performed.
    Background therapy
    Medications commonly used to treat SBS symptoms including anti-diarrheal agents were allowed during trial participation; however, changes had to be kept to a minimum and the Medical Monitor to be informed on the reason for the change. Any medication or vaccine (including over-the-counter or prescription medicines, vitamins, and/or herbal supplements) other than the trial product that the patient had taken within 7 days prior to and including the screening visit, or received during the trial were recorded.
    Evidence for comparator
    Not applicable
    Actual start date of recruitment
    10 Aug 2021
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Denmark: 10
    Worldwide total number of subjects
    10
    EEA total number of subjects
    10
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    7
    From 65 to 84 years
    3
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The study was planned to enroll a minimum of 6 and a maximum of 16 patients with SBS intestinal failure (SBS-IF) or SBS intestinal insufficiency (SBS-II). All were adults with stable SBS, stable body weight; wet weight of fecal excretion >= 1.500 g/day.

    Pre-assignment
    Screening details
    A total of 12 patients were screened: 1 patient failed the screening, 1 patient was diagnosed with metastatic colorectal cancer and withdrawn before receiving investigational product.

    Period 1
    Period 1 title
    Treatment period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    This as an open-label study.

    Arms
    Arm title
    Glepaglutide 10 mg treatment arm
    Arm description
    Trial patients received glepaglutide 10 mg once weekly for 52 weeks, with a subsequent 4-week follow-up period.
    Arm type
    Experimental

    Investigational medicinal product name
    Glepaglutide 20 mg/mL
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    The trial product Glepaglutide 20 mg/mL was administered with single-use autoinjectors as a SC injection with at a dose of 10 mg once weekly for 52 weeks. Patients chose their preferred injection site area- either on their abdomen or their thigh(s). Unless otherwise agreed with the Investigator, patients used this selected injection site area during the entire trial.

    Number of subjects in period 1
    Glepaglutide 10 mg treatment arm
    Started
    10
    Completed
    9
    Not completed
    1
         Fatal Metastatic neoplasm
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Treatment period
    Reporting group description
    -

    Reporting group values
    Treatment period Total
    Number of subjects
    10 10
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    7 7
        From 65-84 years
    3 3
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    54.6 ( 15.85 ) -
    Gender categorical
    Units: Subjects
        Female
    5 5
        Male
    5 5

    End points

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    End points reporting groups
    Reporting group title
    Glepaglutide 10 mg treatment arm
    Reporting group description
    Trial patients received glepaglutide 10 mg once weekly for 52 weeks, with a subsequent 4-week follow-up period.

    Subject analysis set title
    Baseline group
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Participants assessed at Baseline visit.

    Subject analysis set title
    24 Week group
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Participants assessed at Week 24 visit.

    Primary: Change in absorption of wet weight/fluids from baseline to Week 24

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    End point title
    Change in absorption of wet weight/fluids from baseline to Week 24
    End point description
    The variable was 24-week change in absorption of wet weight/fluids, the population level summary was the arithmetic mean, and intercurrent events were handled as follows: with regards to intercurrent events like lack of compliance with intake of trial product, lack of compliance with instructions concerning intake of food, fluids or PS, or use of prohibited concomitant medication, the treatment policy strategy was applied, i.e., data were included in the analysis even if collected after occurrence of such an intercurrent event.
    End point type
    Primary
    End point timeframe
    From Baseline to Week 24
    End point values
    Baseline group 24 Week group
    Number of subjects analysed
    10
    10 [1]
    Units: g/day
    arithmetic mean (standard deviation)
        Absorption of wet weight/fluids (g/day)
    841.6 ( 1839.10 )
    1240.0 ( 1529.74 )
    Notes
    [1] - The same subjects analyzed at Baseline.
    Statistical analysis title
    Change in absorption
    Comparison groups
    24 Week group v Baseline group
    Number of subjects included in analysis
    20
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0585
    Method
    Paired t-test (2-sided, alpha=0.05)
    Parameter type
    Mean difference (final values)
    Point estimate
    398.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -17.6
         upper limit
    814.4
    Variability estimate
    Standard deviation
    Dispersion value
    581.6

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Safety data cover the period since the first administrated dose till Week 56.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    24.0
    Reporting groups
    Reporting group title
    Treatment arm
    Reporting group description
    Trial patients received glepaglutide 10 mg once weekly for 52 weeks, with a subsequent 4-week follow-up period.

    Serious adverse events
    Treatment arm
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 10 (60.00%)
         number of deaths (all causes)
    1
         number of deaths resulting from adverse events
    1
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Metastatic neoplasm
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Injury, poisoning and procedural complications
    Stoma obstruction
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Altered state of consciousness
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Crohn's disease
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nausea
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pelvic fluid collection
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary mass
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Device related sepsis
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Stoma site abscess
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Treatment arm
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    10 / 10 (100.00%)
    Vascular disorders
    Hot flush
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Hypotension
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Vasculitis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    General disorders and administration site conditions
    Injection site pain
         subjects affected / exposed
    7 / 10 (70.00%)
         occurrences all number
    129
    Injection site reaction
         subjects affected / exposed
    5 / 10 (50.00%)
         occurrences all number
    19
    Oedema peripheral
         subjects affected / exposed
    5 / 10 (50.00%)
         occurrences all number
    6
    Injection site pruritus
         subjects affected / exposed
    3 / 10 (30.00%)
         occurrences all number
    26
    Fatigue
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Injection site erythema
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    22
    Influenza like illness
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Malaise
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Thirst
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Reproductive system and breast disorders
    Ovarian cyst
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Cough
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Rhinorrhoea
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Investigations
    Weight decreased
         subjects affected / exposed
    3 / 10 (30.00%)
         occurrences all number
    3
    Gastrointestinal stoma output abnormal
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Urine output decreased
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Weight increased
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Blood alkaline phosphatase increased
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Blood creatinine increased
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Gastrointestinal stoma output increased
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Gastrointestinal stoma complication
         subjects affected / exposed
    8 / 10 (80.00%)
         occurrences all number
    10
    Fall
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Cardiac disorders
    Supraventricular extrasystoles
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Insomnia
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    3 / 10 (30.00%)
         occurrences all number
    3
    Post viral fatigue syndrome
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Ear and labyrinth disorders
    Hypoacusis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Vertigo
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    3 / 10 (30.00%)
         occurrences all number
    4
    Diarrhoea
         subjects affected / exposed
    3 / 10 (30.00%)
         occurrences all number
    3
    Abdominal distension
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Abdominal hernia
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Abdominal pain upper
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Dyspepsia
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Stomal hernia
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Stoma site dermatitis
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Pruritus
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Renal and urinary disorders
    Nephrolithiasis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Muscle spasms
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Pain in extremity
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Arthralgia
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Musculoskeletal discomfort
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Musculoskeletal pain
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Osteoarthritis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Torticollis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    7
    COVID-19
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    3
    Catheter site infection
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Conjunctivitis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    2
    Erysipelas
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    2
    Folliculitis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Nasopharyngitis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Oesophageal candidiasis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Oral candidiasis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Pneumonia
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    2
    Sinusitis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Tooth abscess
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    3 / 10 (30.00%)
         occurrences all number
    4
    Decreased appetite
         subjects affected / exposed
    2 / 10 (20.00%)
         occurrences all number
    2
    Hypertriglyceridaemia
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Hypophosphataemia
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    18 Feb 2021
    Protocol v.2.0 • Exclusion criteria 13 taken out of CSP • Update of Figure 1 • Minor text adjustment • Section 7.2 Patient withdrawal; stressed on importance of FU assessments
    02 Jul 2021
    Protocol v.3.0 • Correction of hyperlink, Insertion of new references • Adjustment of PS • New wording of carcinogenic findings and other Adverse Events • Updated wording on clinical safety laboratory assessment • Update of flowchart • Introduction of new endpoint; changes in HbA1c before and after glepaglutide treatment, update of flowchart • Table 11, removal of osmolarity by dipstick

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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