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    Summary
    EudraCT Number:2020-005364-57
    Sponsor's Protocol Code Number:HLX04-O-wAMD
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-11-02
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2020-005364-57
    A.3Full title of the trial
    A Phase 3, Two-part (Open-label Followed by Randomized Double-masked Active Controlled) Study to Compare the Efficacy and Safety of HLX04-O Administered by Intravitreal Injection with Ranibizumab in Subjects with wet Age related Macular Degeneration (wAMD)
    Estudio de fase 3, de dos partes (abierta, seguida por otra aleatorizada, en doble ciego y controlada con tratamiento activo), para comparar la eficacia y la seguridad de HLX04-O administrado por inyección intravítrea frente a Ranibizumab en sujetos con degeneración macular húmeda relacionada con la edad
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 3 study of HLX04-O efficacy and safety, administered in to the eye by injection, with Ranibizumab in subjects with wet Age related Macular Degeneration
    Estudio de fase 3, de eficacia y seguridad de HLX04-O administrado en el ojo por inyección, frente a Ranibizumab en sujetos con degeneración macular húmeda relacionada con la edad
    A.4.1Sponsor's protocol code numberHLX04-O-wAMD
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorShanghai Henlius Biotech. Inc.
    B.1.3.4CountryChina
    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 supportShanghai Henlius Biotech. Inc.
    B.4.2CountryChina
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationShanghai Henlius Biotech. Inc.
    B.5.2Functional name of contact pointDong Min
    B.5.3 Address:
    B.5.3.1Street AddressRoom 330, No. 222, Kangnan Road, Pilot Free Trade Zone
    B.5.3.2Town/ cityShanghai
    B.5.3.3Post code-
    B.5.3.4CountryChina
    B.5.4Telephone number+8621333958006260
    B.5.5Fax number----
    B.5.6E-mailmin_dong@henlius.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 No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.2Product code HLX04-O
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravitreal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRecombinant Anti-VEGF Humanized Monoclonal Antibody Ophthalmic Injection
    D.3.9.1CAS number 216974-75-3
    D.3.9.2Current sponsor codeHLX04-O
    D.3.9.3Other descriptive nameBEVACIZUMAB BIOSIMILAR
    D.3.9.4EV Substance CodeSUB179936
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    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 Yes
    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.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    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 Yes
    D.2.1.1.1Trade name Lucentis
    D.2.1.1.2Name of the Marketing Authorisation holderNovartis Europharm Limited
    D.2.1.2Country which granted the Marketing AuthorisationIreland
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLucentis
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravitreal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRanibizumab
    D.3.9.1CAS number 347396-82-1
    D.3.9.3Other descriptive nameRANIBIZUMAB
    D.3.9.4EV Substance CodeSUB22314
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    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 Yes
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Wet Age-related Macular Degeneration (wAMD)
    Degeneración macular húmeda relacionada con la edad (wAMD).
    E.1.1.1Medical condition in easily understood language
    Patients with wet Age-related Macular Degeneration in need of treatment
    Pacientes con Degeneración macular húmeda relacionada con la edad que necesitan tratamiento
    E.1.1.2Therapeutic area Diseases [C] - Eye Diseases [C11]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10075568
    E.1.2Term Wet age-related macular degeneration
    E.1.2System Organ Class 100000004853
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Part 1 (Safety Run-in Portion):
    To evaluate the safety and tolerability of HLX04-O in patient's study eyes with wAMD.
    Part 2 (Non-inferiority Study):
    To evaluate the efficacy of HLX04-O at Week 48 compared with ranibizumab in patients' study eyes with wAMD.
    Parte 1 (prueba de seguridad):
    Evaluar la seguridad y tolerabilidad de HLX04-O en el ojo de estudio del paciente con wAMD.
    Parte 2 (estudio de no inferioridad):
    Evaluar la eficacia de HLX04-O en la semana 48 en comparación con ranibizumab en el ojo del estudio del paciente con wAMD.
    E.2.2Secondary objectives of the trial
    Part 1 (Safety Run-in Portion):
    To evaluate the efficacy of HLX04-O at Week 12, 36 and 48 in patient's study eyes with wAMD.
    To assess the safety of HLX04-O.
    To characterize the systemic pharmacokinetics of HLX04-O IVT administration.
    Part 2 (Non-inferiority Study):
    To evaluate the efficacy of HLX04-O at Week 12, 36 and 48 compared with ranibizumab in patient's study eyes with wAMD.
    To evaluate the safety and tolerability of HLX04-O compared with ranibizumab in patients with wAMD.
    To characterize the systemic pharmacokinetics of HLX04-O IVT administration.
    Parte 1 (prueba de seguridad):
    Evaluar la eficacia de HLX04-O en las semanas 12, 36 y 48 en el ojo del estudio del paciente con wAMD.
    Evaluar la seguridad de HLX04-O.
    Caracterizar la farmacocinética sistémica de la administración de HLX04-O por IVT.
    Parte 2 (estudio de no inferioridad):
    Evaluar la eficacia de HLX04-O en las semanas 12, 24, 36 y 48 en comparación con ranibizumab en el ojo del estudio del paciente con wAMD.
    Evaluar la seguridad y tolerabilidad de HLX04-O en comparación con ranibizumab en pacientes con wAMD.
    Caracterizar la farmacocinética sistémica de la administración de HLX04-O por IVT
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Capable to understand and sign the informed consent form (ICF) which includes compliance with the requirements and restrictions.
    2. Women or men aged ≥50 years when signing the ICF.
    3. In the Investigator’s judgment, willing and able to complete all visits and assessments adhering to the prohibitions and restrictions specified in the protocol.
    4. Newly diagnosed or recurrently, active subfoveal or juxtafoveal CNV lesions secondary to age-related macular degeneration in the study eye. Active CNV was defined as leakage on fluorescein angiography (FA) and subretinal or intraretinal fluid on optical coherence tomography (OCT) with confirmation of the reading center during screening.
    5. The total lesion area (including bleeding, scar and neovascularization) of the study eye ≤12 disc area (DA) with confirmation of the reading center before randomization
    6. The BCVA letters between 24 and 73, inclusive, in the study eye, using Early Treatment Diabetic Retinopathy Study (ETDRS) charts.
    7. Participants’ fellow (non-study) eyes must have had a BCVA of 24 letters or better.
    8. Clear ocular media and adequate pupillary dilatation to allow acquisition of good quality retinal images to confirm the diagnosis.
    1. Capaz de comprender y firmar el formulario de consentimiento informado (FCI) como se describe en el apartado 10.1.3 que incluye el cumplimiento de los requisitos y restricciones enumerados en el FCI y en este protocolo.
    2. Mujeres u hombres ≥50 años en el momento de firmar el FCI.
    3. A juicio del Investigador, estar dispuesto y ser capaz de completar todas las visitas y evaluaciones respetando las prohibiciones y restricciones especificadas en este protocolo.
    4. Lesiones de NVC subfoveales o yuxtafoveales activas recién diagnosticadas o recurrentes secundarias a degeneración macular asociada a la edad en el ojo de estudio. La NVC activa se definió como la fuga en la angiografía con fluoresceína (AF) y el líquido subretiniano o intrarretiniano en la tomografía de coherencia óptica (TCO) con confirmación del centro de lectura durante la selección.
    5. El área total de la lesión (incluyendo sangrado, cicatriz y neovascularización) del ojo de estudio es ≤12 áreas papilares (disc área, DA) con confirmación del centro de lectura antes de la aleatorización
    6. Las letras de MAVC entre 24 y 73, inclusive, en el ojo del estudio, utilizando las tablas del Estudio de retinopatía diabética de tratamiento temprano (Early Treatment for Diabetic Retinopathy Study, ETDRS).
    7. El otro ojo (que no es del estudio) de los participantes debe haber tenido una MAVC de 24 letras o mejor.
    8. Medios oculares claros y dilatación pupilar adecuada para permitir la adquisición de imágenes retinianas de buena calidad para confirmar el diagnóstico.
    E.4Principal exclusion criteria
    1. Macular-related retinal pigment epithelial tears in the study eye, scar, fibrosis or atrophy involving the fovea, or CNV due to other causes in the study eye (e.g., ocular histoplasmosis, trauma, pathological myopia, or polypoidal choroidal vasculopathy (PCV), etc.) with confirmation of the reading center.
    2. The fellow (non study) eye needs anti-VEGF IVT injection (e.g. CNV due to wAMD, trauma, pathological myopia or PCV, retina vein occlusion, diabetic macular edema, etc) in the next 3 months after randomization, in the investigator’s judgment.
    3. Aphakia (except intraocular lens) or posterior capsular rupture of the lens (except yttrium-aluminium-garnet (YAG) laser posterior capsulotomy after intraocular lens implantation ≥30 days prior to first dose) in the study eye.
    4. Active or recent (within 1 month prior to dose 1) intraocular, extraocular or periocular infection (including conjunctivitis, keratitis, scleritis or endophthalmitis), or history of idiopathic or autoimmune-associated uveitis in either eye.
    5. Vitreous hemorrhage in the study eye within 3 months prior to dose 1.
    6. Corneal dystrophy or history of corneal transplantation, scleral softening or history of scleral softening, history of rhegmatogenous retinal detachment or macular hole (Stage II, II or IV) in the study eye.
    7. Uncontrolled glaucoma in the study eye (defined as intraocular pressure [IOP] ≥25 mmHg despite treatment with antiglaucoma medication), and/or glaucoma filtering surgery (e.g., trabeculectomy, scleral nipping, non-penetrating trabeculectomy, etc.)
    8. Equivalent spherical diopter of the study eye ≥−8D. For participants who had undergone refractive correction or cataract surgery, the equivalent spherical diopter of the study eye before surgery ≥−8D.
    9. Estimated by the Investigator any concurrent intraocular except wAMD (e.g., diabetic retinopathy, dry AMD, retina vein occlusion, uveitis, angioid streaks, retinal detachment, macular hole, macular edema, amblyopia, central serous chorioretinopathy, etc.) in the study eye that limited the potential to gain visual acuity upon treatment with the investigational product, or could have required medical or surgical intervention during the study to prevent or treat visual loss.
    10. Underwent intraocular surgery including verteporfin photodynamic therapy (PDT), transpupillary thermotherapy, macular translocation, vitrectomy, laser photocoagulation in macular area, other surgery in macular area or surgery to treat AMD.
    11. Previous extraocular or periocular surgery within 1 month prior to dose 1, or current unhealed wound, moderate or severe ulcer or fracture in the study eye.
    12. Subconjunctival or intraocular or systemic use of corticosteroids within 3 months (including subconjunctival or intraocular long-acting implant within 6 months) prior to dose 1 in the study eye.
    13. Previous systemic anti-VEGF therapy or IVT injection of any anti-VEGF drug into either eye or other ocular use of anti-VEGF drug within 3 months prior to dose 1.
    14. Participated in any drug (other than vitamins and minerals) or device clinical trials 3 months or the duration of 5 half-lives of the study drug (which is longer) before the first dose and have used the test drug or received device treatment.
    15. Pregnancy or lactation, or fertile men or women not willing to use effective contraception from the day when ICF was signed to at least 6 months following the last dose of study intervention.
    16. Infertile women or men fail to meet either of the following ones: 1) menopause (≥12 continuous months of amenorrhea with no identified cause other than menopause before screening); 2) surgically sterilized.
    Fertile women or men fail to meet either of the following ones: 1) women of childbearing potential must have a negative serum pregnancy test result within 14 days prior to initiation of the study intervention, and should not breastfeed; 2) agreement to remain abstinent (refrain from heterosexual intercourse) or use effective contraceptive methods from signed ICF to at least 6 months following the last dose of study intervention. Effective contraceptive methods include bilateral tubal ligation, male sterilization, barrier contraceptive (e.g. condom), established, proper use of hormonal contraceptives that inhibit ovulation, hormone releasing intrauterine devices (IUDs), and copper IUDs.
    17. In the Investigator’s judgment, there is evidence of a disease or condition that contraindicates the use an investigational drug or that might affect interpretation of the results of the study or render the participant at high risk for treatment complications (e.g. stroke or myocardial infarction within 6 months prior to dose 1, uncontrolled hypertension (systolic blood pressure ≥160 mmHg, or diastolic blood pressure >100 mmHg), etc.).
    18. Uncontrolled diabetes (defined as HbA1c>10.0%).
    Check the protocol for the rest of the Exclusion Criteria (IC no 19, 20, 21, 22, 23, 24, 25, 26, 26 and 28)
    1. Desgarros epiteliales del pigmento retiniano relacionados con la macular en el ojo del estudio; cicatriz, fibrosis o atrofia de la fóvea, o NVC por otras causas en el ojo de estudio (p. ej., histoplasmosis ocular, traumatismo, miopía patológica o vasculopatía coroidea polipoidea (PCV), etc.) con confirmación del centro de lectura.
    2. El otro ojo (que no es del estudio) necesita una inyección de anti-VEGF IVT (p. ej. NVC debido a wAMD, traumatismo, miopía patológica o PCV, oclusión de la vena de la retina, edema macular diabético, etc.) en los 3 meses siguientes a la aleatorización, a juicio del investigador.
    3. Afaquia (excepto lente intraocular) o rotura capsular posterior de la lente (excepto capsulotomía posterior con láser de granate de itrio y aluminio (YAG) tras la implantación de la lente intraocular ≥30 días antes de la primera dosis) en el ojo del estudio.
    4. Infección intraocular, extraocular o periocular activa o reciente (dentro de 1 mes antes de la dosis 1) (incluyendo conjuntivitis, queratitis, escleritis o endoftalmitis), o antecedentes de uveítis idiopática o asociada a autoinmunidad en cualquiera de los ojos.
    5. Hemorragia vítrea en el ojo del estudio en los 3 meses anteriores a la dosis 1.
    6. Distrofia corneal o antecedentes de trasplante de córnea, ablandamiento escleral o antecedentes de ablandamiento escleral, antecedentes de desprendimiento de retina regmatógeno o agujero macular (estadio II, III o IV) en el ojo del estudio.
    7. Glaucoma no controlado en el ojo del estudio (definido como presión intraocular [PIO] ≥25 mmHg a pesar del tratamiento con medicación antiglaucoma) y/o cirugía de filtrado de glaucoma (p. ej., trabeculectomía, pellizco escleral, trabeculectomía no penetrante, etc.)
    8. Dioptría esférica equivalente del ojo de estudio ≥−8D. Para participantes que se habían sometido a corrección refractiva o cirugía de cataratas, la dioptría esférica equivalente del ojo del estudio antes de la cirugía es ≥−8D.
    9. Estimado por el investigador, cualquier afección intraocular concurrente excepto wAMD (p. ej., retinopatía diabética, DMAE seca, oclusión de la vena de la retina, uveítis, estrías angioides, desprendimiento de retina, edema macular, ambliopía, coriorretinopatía serosa central, etc.) en el ojo del estudio que limitaba el potencial de adquisición de agudeza visual con el tratamiento con el producto en investigación, o que podría haber requerido una intervención médica o quirúrgica durante el estudio para prevenir o tratar la pérdida visual.
    10. Haberse sometido a cirugía intraocular que incluyó terapia fotodinámica con verteporfina (TFD), termoterapia transpupilar, translocación macular, vitrectomía, fotocoagulación con láser en el área macular, otra cirugía en el área macular o cirugía para tratar la DMAE.
    11. Cirugía extraocular o periocular previa dentro de 1 mes antes de la dosis 1, o herida actual sin cicatrizar, úlcera o fractura moderada o grave en el ojo del estudio.
    12. Uso subconjuntival, intraocular o sistémico de corticosteroides dentro de los 3 meses (incluido el implante subconjuntival o intraocular de acción prolongada dentro de los 6 meses) antes de la dosis 1 en el ojo del estudio.
    13. Terapia anti-VEGF sistémica previa o inyección IVT de cualquier fármaco anti-VEGF en el ojo u otro uso ocular de fármaco anti-VEGF dentro de los 3 meses anteriores a la dosis 1.
    14. Haber participado en ensayos clínicos de cualquier fármaco (que no sean vitaminas y minerales) o producto sanitario durante 3 meses o la duración de 5 semividas del fármaco en estudio (lo que sea más largo) antes de la primera dosis y haber utilizado el fármaco en pruebas o recibido tratamiento del producto sanitario.
    15. Embarazo o lactancia, o hombres o mujeres fértiles que no estén dispuestos a utilizar un método anticonceptivo eficaz desde el día en que se firmó el FCI hasta al menos 6 meses después de la última dosis de intervención del estudio.
    16. Las mujeres u hombres infértiles que no cumplan con ninguno de los siguientes: 1) menopausia (≥12 meses continuos de amenorrea sin otra causa identificada que la menopausia antes de la selección); 2) esterilizado quirúrgicamente.
    Las mujeres u hombres fértiles no cumplen con ninguno de los siguientes: 1) las mujeres en edad fértil deben tener un resultado de prueba de embarazo en suero negativo dentro de los 14 días anteriores al inicio de la intervención del estudio y no deben amamantar; 2) acuerdo para permanecer abstinente (abstenerse de tener relaciones heterosexuales) o usar métodos anticonceptivos efectivos desde la firma del FCI hasta al menos 6 meses después de la última dosis de intervención del estudio.

    Ver protocolo para resto de criterios de exclusión (cont. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 y 28)
    E.5 End points
    E.5.1Primary end point(s)
    Part 1 (Safety Run-in Portion)

    Safety events: toxicity and causality (related to, or possibly related to HLX04-O) that occurs within 28 days after the first treatment (single administration) including:
    • Ocular AEs
    ➢ Severe clinically significant inflammation (4+ ocular inflammation; 2-3+ ocular inflammation that fails to decrease to 1+ or less within 3028 days of the onset of the event, according to an ocular inflammation grading scale);
    ➢ New retinal tear or detachment, intravitreal hemorrhage (grade 3 or worse according to a hemorrhage density grading scale);
    ➢ BCVA: Loss of 30 letters or more compared with pre-injection visual acuity; or sustained (>15 minutes) loss of light perception;
    ➢ IOP: 20 mmHg higher than pre-injection baseline within 7 days of the onset of the event despite medication; or sustained (>15 minutes) loss of light perception due to elevated IOP;
    • Non-ocular AEs
    ➢ Hematological toxicity Grade ≥4
    ➢ Non-hematological toxicity Grade ≥3

    Part 2 (Non-inferiority Study)
    • Mean change from baseline in best-corrected visual acuity (BCVA) at Week 48.
    Parte 1 (prueba de seguridad)
    Eventos de seguridad: toxicidad y causalidad (relacionadas o posiblemente relacionadas con HLX04-O) que ocurren dentro de los 28 días posteriores al primer tratamiento (administración única), que incluyen:
    • EA oculares
    ➢ Inflamación grave clínicamente significativa (inflamación ocular 4+; inflamación ocular 2-3+ que no disminuye a 1+ o menos dentro de los 28 días posteriores al inicio del evento, según una escala de clasificación de inflamación ocular1);
    ➢ Nuevo desgarro o desprendimiento de retina, hemorragia intravítrea (grado 3 o peor según una escala de clasificación de densidad de hemorragia2);
    ➢ MAVC: pérdida de 30 letras o más en comparación con la agudeza visual previa a la inyección; o pérdida sostenida (>15 minutos) de percepción de la luz;
    ➢ PIO : 20 mmHg más alta que la basal previa a la inyección dentro de los 7 días posteriores al inicio del evento a pesar de la medicación; o pérdida sostenida (>15 minutos) de la percepción de la luz debido a PIO elevada;
    • EA no oculares
    ➢ Grado de toxicidad hematológica ≥4;
    ➢ Grado de toxicidad no hematológica ≥3.


    Parte 2 (estudio de no inferioridad)
    • Cambio medio desde el valor basal en la mejor agudeza visual corregida (MAVC) en la semana 48.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Day 28
    Week 48
    Día 28
    Semana 48
    E.5.2Secondary end point(s)
    Part 1 (Safety Run-in Portion)
    • Mean change from baseline in BCVA at Week 12, 24 and 48;
    • Mean change in the BCVA over time;
    ➢ Proportion of patients gaining at least 15 letters in the BCVA at Week12, 24, 36, and 48;
    ➢ Proportion of patients gaining at least 10 letters in the BCVA at Week 12, 24, 36, and 48;
    ➢ Proportion of patients gaining at least 5 letters in the BCVA at Week 12, 24, 36, and 48;
    • Mean change from baseline in size of CNV and the total area of fluorescein leakage on FA at Week 12, 36, and 48 (as measured by the Fundus Photograph Reading Center);
    • Mean change from baseline in central retina thickness (CRT) on OCT at Week 12, 24, 36, and 48 (as measured by the OCT Reading Center);
    • Change from baseline in NEI VFQ-25 scale score at Week 12, 24, and 48.
    • Percentage and severity of ocular AEs (IVT procedure related and Investigation Medication related), non-ocular AEs; laboratory abnormalities; vital sign, physical examination abnormalities, etc.
    • Incidence of ADAs and NAbs against HLX04-O following IVT administration.
    • HLX04-O systemic PK parameters following IVT administration of Dose 1 and Dose 4, including but not limited to:
    ➢ AUC(0-t): Area under the serum concentration-time curve during the dosage interval;
    ➢ Cmax: Maximum drug concentration;
    ➢ Cmin: Minimum drug concentration;
    ➢ Tmax: Time to Cmax;
    ➢ t1/2: Elimination half-life, as data permit;
    ➢ CL/F: Apparent total body clearance;
    ➢ Accumulation ratios (Dose 4/Dose 1) for AUC(0-t), Cmax and Cmin.

    Part 2 (Non-inferiority Study)
    • Mean change from baseline in BCVA at Week 12, 24 and 36;
    • Mean change in the BCVA over time;
    ➢ Proportion of patients gaining at least 15 letters in the BCVA at Week 12, 24, 36 and 48;
    ➢ Proportion of patients gaining at least 10 letters in the BCVA at Week 12, 24, 36 and 48;
    ➢ Proportion of patients gaining at least 5 letters in the BCVA at Week 12, 24, 36 and 48;
    • Mean change from baseline in size of CNV and the total area of fluorescein leakage on FA at Week 12, 24, and 48 (as measured by the Fundus Photograph Reading Center);
    • Mean change from baseline in central retina thickness (CRT) on OCT at Week 12, 24, 36 and 48 (as measured by the OCT Reading Center);
    • Change from baseline in NEI VFQ-25 scale score at Week 12, 24, and 48.
    • Percentage and severity of ocular AEs (IVT procedure related and Investigation Medication related), non-ocular AEs; laboratory abnormalities; vital sign, physical examination abnormalities, etc.
    • Incidence of ADAs and NAbs against HLX04-O following IVT administration.
    • HLX04-O serum concentrations before Dose 1, Dose 2, Dose 6, Dose 9, Dose 12 and the last visit as data permit.
    Parte 1 (prueba de seguridad)
    • Cambio medio respecto al valor basal de la MAVC en las semanas 12, 24 y 48;
    • Cambio medio en la MAVC a lo largo del tiempo;
    ➢ Proporción de pacientes que obtuvieron al menos 15 letras en la MAVC en las semanas 12, 24, 36 y 48;
    ➢ Proporción de pacientes que obtuvieron al menos 10 letras en la MAVC en las semanas 12, 24, 36 y 48;
    ➢ Proporción de pacientes que obtuvieron al menos 5 letras en la MAVC en las semanas 12, 24, 36 y 48;
    • Cambio medio con respecto al valor basal en el tamaño de la NVC y el área total de fuga de fluoresceína en la AF en las semanas 12, 36 y 48 (según lo medido por Fundus Photograph Reading Center);
    • Cambio medio desde el valor basal en el grosor de la retina central (CRT) en en las semanas 12, 24, 36 y 48 (según lo medido por el OCT Reading Center);
    • Cambio con respecto al valor basal en la puntuación de la escala NEI VFQ-25 en las semanas 12, 24 y 48.
    • Porcentaje y gravedad de EA oculares (relacionados con el procedimiento de IVT y relacionados con la medicación de investigación), EA no oculares; anomalías de laboratorio; constantes vitales, anomalías en la exploración física, etc.
    • Incidencia de ADA y NAb contra HLX04-O tras la administración por IVT.
    • Parámetros farmacocinéticos (PK) sistémicos de HLX04-O tras la administración por IVT de la Dosis 1 y la Dosis 4, incluyendo, pero no limitado a:
    ➢ AUC (0-t): Área bajo la curva de concentración sérica-tiempo durante el intervalo de dosificación;
    ➢ Cmax: Concentración máxima de fármaco;
    ➢ Cmin: Concentración mínima de fármaco;
    ➢ Tmax: Tiempo hasta Cmax;
    ➢ t1/2: Semivida de eliminación, según lo permitan los datos;
    ➢ CL/F: Aclaramiento corporal total aparente tras la dosis 4 en estado estacionario
    ➢ Relaciones de acumulación (dosis 4/dosis 1) para AUC (0-t), Cmax y Cmin.

    Parte 2 (estudio de no inferioridad)
    • Cambio medio respecto al valor basal de la MAVC en las semanas 12, 24 y 36;
    • Cambio medio en la MAVC a lo largo del tiempo;
    ➢ Proporción de pacientes que obtuvieron al menos 15 letras en la MAVC en las semanas 12, 24, 36 y 48;
    ➢ Proporción de pacientes que obtuvieron al menos 10 letras en la MAVC en las semanas 12, 24, 36 y 48;
    ➢ Proporción de pacientes que obtuvieron al menos 5 letras en la MAVC en las semanas 12, 24, 36 y 48;
    • Cambio medio con respecto al valor basal en el tamaño de la NVC y el área total de fuga de fluoresceína en la AF en las semanas 12, 24 y 48 (según lo medido por Fundus Photograph Reading Center);
    • Cambio medio desde el valor basal en el grosor de la retina central (CRT) en TCO en las semanas 12, 24, 36 y 48 (según lo medido por el OCT Reading Center);
    • Cambio con respecto al valor basal en la puntuación de la escala NEI VFQ-25 en las semanas 12, 24 y 48.
    • Porcentaje y gravedad de EA oculares (relacionados con el procedimiento de IVT y relacionados con la medicación de investigación), EA no oculares; anomalías de laboratorio; signos vitales, anomalías en el examen físico, etc.
    • Incidencia de ADA y NAb contra HLX04-O tras la administración por IVT.
    • Concentraciones séricas de HLX04-O antes de la dosis 1, dosis 2, dosis 6, dosis 9, dosis 12 y la última visita, según permitan los datos.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Weeks 12, 24, 36 and 48
    Throughout the duration of the study
    Semanas 12, 24, 36 y 48
    A lo largo de la duración del estudio
    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 No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    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 No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    Estudio dos partes:abierta,seguida por aleatorizada,doble ciego y controlada con tratamiento activo
    Two-part Study: Open-label Followed by Randomized Double-masked Active Controlled
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    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 concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA33
    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 No
    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
    China
    Russian Federation
    Serbia
    Singapore
    Hungary
    Latvia
    Poland
    Spain
    Czechia
    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
    última visita del último paciente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months8
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months1
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    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) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 20
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 374
    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 state50
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 120
    F.4.2.2In the whole clinical trial 394
    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)
    In this study, no further treatment or medical care to study eye and fellow eye is planned after the end of the study.
    En este estudio no está previsto realizar tratamiento o atención médica al ojo en estudio o al otro ojo después del final del estudio
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-05-25
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-04-30
    P. End of Trial
    P.End of Trial StatusOngoing
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