E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Juvenile Psoriatic Arthritis |
Juveniele artritis psoriatica
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E.1.1.1 | Medical condition in easily understood language |
Juvenile Psoriatic Arthritis |
Juveniele artritis psoriatica
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E.1.1.2 | Therapeutic area | Diseases [C] - Skin and Connective Tissue Diseases [C17] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10076674 |
E.1.2 | Term | Juvenile psoriatic arthritis |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
- Evaluate PK of ustekinumab and guselkumab in jPsA - Evaluate efficacy of ustekinumab and guselkumab in jPsA |
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E.2.2 | Secondary objectives of the trial |
- Evaluate PK of ustekinumab and guselkumab in jPsA - Evaluate efficacy of ustekinumab and guselkumab in jPsA - Evaluate safety of ustekinumab and guselkumab in jPsA - Evaluate immunogenicity of ustekinumab and guselkumab in jPsA |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. ≥5 to <18 years of age, inclusive. 2. Diagnosis of jPsA by Vancouver inclusion criteria, with exclusion of ERA. Diagnosis made ≥3 months (ie. 90 days) prior to screening. Arthritis plus psoriasis, or arthritis plus ≥2 of the following: dactylitis, nail pits, family history of psioriasis in a first or second-degree relative, psoriasis-like rash. 3. Active disease in ≥3 joints at screening and at Week 0 (defined as swelling or loss of motion with pain and/or tenderness). Swelling alone meets the criteria for an active arthritic joint. In the absence of swelling, loss of motion with pain or tenderness or both pain and tenderness meet the criteria for an active arthritic joint. 4. Medically stable on the basis of physical examination, medical history, and vital signs performed at screening. Any abnormalities must be consistent with the underlying illness in the study population and this determination must be recorded in the participant’s source documents and initialed by the investigator. 5. Medically stable on the basis of clinical laboratory tests performed at screening. If the results of the serum chemistry panel or hematology are outside the normal reference ranges, the participant may be included only if the investigator judges the abnormalities or deviations from normal to not be clinically significant or to be appropriate and reasonable for the population under study. This determination must be recorded in the participant's source documents and initialed by the investigator. |
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E.4 | Principal exclusion criteria |
1. Participants with enthesitis-related arthritis (ERA; see definition in Appendix 17 of the study protocol) 2. Taken any disallowed therapies as noted in Section 6.8, Concomitant Therapy within the timeframe specified before the planned first dose of study intervention. 3. If participants were non-responders to previously received IL-23 blockers including guselkumab, tildrakizumab (MK3222) and risankizumab (BI-655066). Prior non-response to an anti-TNFα inhibitor, an IL-17 inhibitor or a Janus kinase (JAK) inhibitor is not an exclusion. Participants who previously discontinued ustekinumab for intolerance or inadequate response may be enrolled into the guselkumab cohort. Patients who previously discontinued guselkumab due to intolerance may be enrolled into the ustekinumab cohort. Participants who previously discontinued tildrakizumab or risankizumab due to intolerance may be enrolled into either cohort. 4. Received an investigational intervention (including investigational vaccines) or used an invasive investigational medical device within 4 weeks or 5 half-lives (whichever is longer) before the planned first dose of either study intervention or is currently enrolled in another study using an investigational intervention or procedure. Receipt of an investigational vaccine for COVID-19 is not an automatic exclusion criterion; discuss with medical monitor. 5. Have a history of latent or active granulomatous infection, including TB, histoplasmosis, or coccidioidomycosis, prior to screening. An exception is made for participants currently receiving treatment for latent TB with no evidence of active TB, or who have a history of latent TB and documentation of having completed appropriate treatment for latent TB prior to the first administration of either study intervention (Section 5.2, Exclusion criterion 14b of the study protocol). |
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E.5 End points |
E.5.1 | Primary end point(s) |
Ustekinumab 1. Steady-state trough concentrations and population PK modelpredicted AUCss over a 12-week dosing interval at Week 28 by baseline age groups. 2. ACR Pedi 30 response at Week 24.
Guselkumab 1. Steady-state trough concentrations and population PK modelpredicted AUCss over a dosing interval (4 or 8 weeks) at Week 28 by baseline age groups. 2. ACR Pedi 30 response at Week 24. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Ustekinumab and Guselkumab 1: Week 28 2: Week 24 |
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E.5.2 | Secondary end point(s) |
PK Ustekinumab 1. Steady-state trough concentrations and population PK modelpredicted AUCss over a 12-week dosing interval at Week 52 by baseline age groups Guselkumab 1. Steady-state trough concentrations and population PK modelpredicted AUCss over a dosing interval (4 or 8 weeks) at Week 52 by baseline age groups. Efficacy Ustekinumab 2. ACR Pedi 30 response at Weeks 4, 8, 12, 16, and 52. 3. ACR Pedi 50 and 70 responses at Weeks 4, 8, 12, 16, 24, and 52. 4. Time to response measured as time to achieving ACR Pedi 30 from baseline through Week 24. 5. Change from baseline in cJADAS 10, JADAS 10, 27, and 71 at Weeks 4, 8, 12, 16, 24, and 52. 6. Change from baseline in PASI score at Week 24 among the participants with ≥3% BSA psoriatic involvement and a PGA psoriasis score of ≥2 (mild) at baseline. Guselkumab 2. ACR Pedi 30 response at Weeks 4, 8, 12, 16, and 52. 3. ACR Pedi 50 and 70 responses at Weeks 4, 8, 12, 16, 24, and 52. 4. Time to response measured as time to achieving ACR Pedi 30 from baseline through Week 24. 5. Change from baseline in cJADAS 10, JADAS 10, 27, and 71 at Weeks 4,8, 12, 16, 24, and 52. 6. Change from baseline in PASI score at Week 24 among the participants with ≥3% BSA psoriatic involvement and a PGA psoriasis score of ≥2 (mild) at baseline. Safety Ustekinumab and Guselkumab 7. The occurrences and type of AEs, SAEs, and reasonably related AEs. Immunogenicity Ustekinumab and Guselkumab 8. The incidence of antibodies to ustekinumab/guselkumab (including peak titers) through Week 52 and Week 68. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1: Week 52 2: Weeks 4, 8, 12, 16, and 52 3: Weeks 4, 8, 12, 16, 24 and 52 4: from baseline through Week 24 5: baseline and Weeks 4, 8, 12, 16, 24, and 52 6: baseline and Week 24 7, 8: from baseline through Week 52 and Week 68 |
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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 | Yes |
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 | Yes |
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) | 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 | No |
E.8.1.1 | Randomised | No |
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 | 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 | No |
E.8.2.3 | Other | No |
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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 28 |
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 |
Argentina |
Mexico |
United Kingdom |
United States |
Denmark |
France |
Germany |
Italy |
Netherlands |
Poland |
Spain |
Türkiye |
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E.8.7 | Trial has a data monitoring committee | No |
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 | 2 |
E.8.9.1 | In the Member State concerned months | 11 |
E.8.9.1 | In the Member State concerned days | 17 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 7 |
E.8.9.2 | In all countries concerned by the trial days | 25 |