E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Multiple sclerosis is a long-term disease that attacks the central nervous system, affecting the brain, spinal cord, and optic nerves. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10063401 |
E.1.2 | Term | Primary progressive multiple sclerosis |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10080700 |
E.1.2 | Term | Relapsing multiple sclerosis |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
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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 |
• To demonstrate pharmacokinetics (PK) non-inferiority of the SC formulation of ocrelizumab in patients with MS |
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E.2.2 | Secondary objectives of the trial |
• To determine the maximum serum concentration (Cmax) of ocrelizumab SC in patients with MS • To evaluate the radiological effects of ocrelizumab SC compared with ocrelizumab IV in patients with MS • To evaluate and compare the safety profile after administration of ocrelizumab SC versus ocrelizumab IV and to assess the safety of ocrelizumab SC at the selected dose in patients with MS • To evaluate the immune response to ocrelizumab SC and IV, and rHuPH0 • To evaluate the effect of ocrelizumab SC compared with IV ocrelizumab on the pharmacodynamics (PD) marker for the mechanism of action of ocrelizumab (i.e. B cell depletion)
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Diagnosis of primary progressive multiple sclerosis (PPMS) or relapsing multiple sclerosis (RMS) according to the revised McDonald 2017 criteria • Age 18-65 years, inclusive, at time of signing Informed Consent Form • Ability to comply with the study protocol and schedule of protocol assessments, in the investigator's judgment • Expanded disability status scale (EDSS) score, 0-6.5, inclusive, at screening. • Neurological stability for >=30 days prior to both screening and baseline • Disease duration from onset of MS symptoms of less than 15 years for patients with EDSS score <2.0 at screening • Women of childbearing potential must agree to remain abstinent (refrain from heterosexual intercourse) or use adequate contraception during the treatment period and for 6 months or 12 months (as applicable by the ocrelizumab IV [Ocrevus] local label) after the final dose of ocrelizumab • Female patients without reproductive potential may be enrolled if post-menopausal unless the patient is receiving a hormonal therapy for her menopause or if surgically sterile (i.e., hysterectomy, complete bilateral oophorectomy) |
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E.4 | Principal exclusion criteria |
• Any known or suspected active infection at screening or baseline (except nailbed infections), or any major episode of infection requiring hospitalization or treatment with IV anti-microbials within 8 weeks prior to and during screening or treatment with oral anti microbials within 2 weeks prior to and during screening • History of confirmed or suspected progressive multifocal leukoencephalopathy (PML) • History of cancer, including hematologic malignancy and solid tumors, within 10 years of screening • Immunocompromised state • Receipt of a live attenuated vaccine within 6 weeks prior to randomization • Inability to complete an MRI or contraindication to gadolinium administration • Contraindications to mandatory pre-medications (i.e., corticosteroids and antihistamines) for infusion-related reaction (IRRs), including closed angle glaucoma for antihistamines • Known presence of other neurologic disorders that could interfere with the diagnosis of MS or assessments of efficacy and/or safety during the study • Any concomitant disease that may require chronic treatment with systemic corticosteroids (e.g., mineralocorticoids and glucocorticoids) or immunosuppressants during the course of the study • Significant, uncontrolled disease, such as cardiovascular (including cardiac arrhythmia), pulmonary (including obstructive pulmonary disease), renal, hepatic, endocrine or gastrointestinal, or any other significant disease that may preclude patient from participating in the study • History of or currently active primary or secondary (non-drug related) immunodeficiency • Pregnant or breastfeeding or intending to become pregnant during the study and 6 or 12 months (as applicable by the ocrelizumab [Ocrevus] local label) after last administration of the study drug. • Lack of peripheral venous access • History of alcohol or other drug abuse within 12 months prior to screening • Treatment with any investigational agent within 24 weeks prior to screening or 5 half-lives of the investigational drug (whichever is longer), or treatment with any experimental procedure for MS • Patients who have previously received anti-CD20s (including ocrelizumab) if the last treatment was less than 2 years before screening, and/or if B-cell count is below lower limit of normal, and/or the discontinuation of the treatment was due to safety reasons or lack of efficacy • Previous treatment with cladribine, atacicept, and alemtuzumab • Previous treatment with fingolimod, siponimod, ponesimod, or ozanimod within 6 weeks of baseline • Previous treatment with interferons beta (1a or 1b), or glatiramer acetate within 2 weeks of baseline • Previous treatment with natalizumab within 4.5 months of baseline • Treatment with mitoxantrone within 2 years prior to baseline visit or evidence of cardiotoxicity following mitoxantrone use or a cumulative lifetime dose of more than 60 milligrams per meter square (mg/m^2) • Previous treatment with any other immunomodulatory or immunosuppressive medication not already listed above without appropriate washout as described in the applicable local label • If the washout requirements are not described in the applicable local label, then the wash out period must be 5 times the half-life of the medication. The PD effects of the previous medication must also be considered when determining the required time for washout • Any previous treatment with bone marrow transplantation and hematopoietic stem cell transplantation • Any previous history of transplantation or anti-rejection therapy • Treatment with IV immunoglobulin (Ig) or plasmapheresis within 12 weeks prior to randomization • Systemic corticosteroid therapy within 4 weeks prior to screening • Positive screening tests for active, latent, or inadequately treated hepatitis B • Sensitivity or intolerance to any ingredient (including excipients) of ocrelizumab • Any additional exclusionary criterion as per ocrelizumab (Ocrevus®) local label, if more stringent than the above |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Serum ocrelizumab area under the concentration-time curve (AUC[w1-12]) after SC administration compared to IV infusion from Day 1 to Week 12 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
1. At Week 1 (Days 1, 2, 3, 5, 7, and 10), Weeks 2, 4, 8 and 12 |
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E.5.2 | Secondary end point(s) |
1. Maximum serum concentration (Cmax) of ocrelizumab SC in patients with MS 2. Total number of T1Gd+ lesions as detected by brain magnetic resonance imaging (MRI) at Weeks 8 and 24 3. Total number of new or enlarging T2 lesions as detected by brain MRI at Weeks 12 and 24 relative to the previous scan 4. Incidence and severity of adverse events, with severity determined according to the national cancer institute common terminology criteria for adverse events (NCI-CTCAE) version 5.0 5. Change from baseline in targeted vital signs 6. Change from baseline in targeted clinical laboratory test results 7. Incidence of treatment-emergent antidrug antibodies (ADAs) to ocrelizumab after SC or IV administration relative to the presence of ADAs at baseline 8. Relationship between ADA status to ocrelizumab and pharmacokinetics, pharmacodynamics, and safety 9. Incidence of treatment-emergent antibodies to rHuPH20 after SC administration relative to the presence at baseline 10. Relationships between antibodies to rHuPH20 and safety 11. Percentage of patients achieving CD19+ B cell level <5 cells/microliter at Weeks 12 and 24 |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1. At Weeks 1, 2, 4, 8, 12, 16, 24 and 48 2. At Weeks 8 and 24 3. At Weeks 12 and 24 4. Up to approximately 48 Weeks 5. Baseline (Day 1), Weeks 2, 12, 24, 48 and safety follow up visit (every 24 weeks until 28 weeks after the last dose) 6. Baseline (Day 1), Weeks 12, 22, 46 and safety follow up visit (every 24 weeks until 28 weeks after the last dose) 7-10. Baseline (Day 1), Weeks 24, 48 and safety follow up visit (every 24 weeks until 28 weeks after the last dose) 11. At Weeks 12 and 24
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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 | No |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
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 | Yes |
E.6.13.1 | Other scope of the trial description |
immunogenicity, radiological and clinical effects of SC administration. |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
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 | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Ocrelizumab, Concentrate for Solution for Infusion, 300mg |
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E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 30 |
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 |
Australia |
Brazil |
Canada |
New Zealand |
Russian Federation |
Turkey |
Ukraine |
United States |
Czechia |
France |
Italy |
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 | 5 |
E.8.9.1 | In the Member State concerned days | 15 |
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 | 2 |
E.8.9.2 | In all countries concerned by the trial days | 0 |