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    Summary
    EudraCT Number:2021-000639-30
    Sponsor's Protocol Code Number:AB20009
    National Competent Authority:Portugal - INFARMED
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-07-15
    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 ConcernedPortugal - INFARMED
    A.2EudraCT number2021-000639-30
    A.3Full title of the trial
    A 96-Week, Prospective, Multicenter, Randomised, Double-Blind, Placebo-Controlled, Phase 3 Study to compare Efficacy and Safety of Masitinib Dose Titration to 4.5 mg/kg/day versus Placebo in the Treatment of Patients with Primary Progressive or Secondary Progressive Multiple Sclerosis Without Relapse.
    Ensaio clínico de fase 3, multicêntrico, aleatorizado, duplamente cego e controlado por placebo com duração de 96 semanas para comparar a eficácia e segurança de 4,5 mg/kg/dia de masitinib versus placebo no tratamento de doentes com esclerose múltipla primária our secundária progressiva sem recaída
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A phase 3 study to compare efficacy and safety of masitinib with placebo in the patients with primary progressive or secondary progressive multiple sclerosis without relapse.
    Um estudo de fase 3 para comparar a eficácia e segurança de masitinibe com placebo em pacientes com esclerose múltipla progressiva primária ou secundária progressiva sem recaída.
    A.3.2Name or abbreviated title of the trial where available
    Multiple sclerosis
    Esclerose múltipla
    A.4.1Sponsor's protocol code numberAB20009
    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 SponsorABScience
    B.1.3.4CountryFrance
    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 supportABScience
    B.4.2CountryFrance
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAlpha Bioresearch S.L.
    B.5.2Functional name of contact pointConsuelo Pozo
    B.5.3 Address:
    B.5.3.1Street AddressC/ López de Hoyos 155, 3 6-7
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28002
    B.5.3.4CountrySpain
    B.5.4Telephone number0034917452520
    B.5.5Fax number0034917450653
    B.5.6E-mailregulatory@alphabioresearch.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.3.1Product nameMasitinib
    D.3.2Product code AB1010
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMasitinib mesilate
    D.3.9.1CAS number 790299-79-5
    D.3.9.2Current sponsor codeAB1010
    D.3.9.3Other descriptive nameMASITINIB
    D.3.9.4EV Substance CodeSUB32266
    D.3.10 Strength
    D.3.10.1Concentration unit mg/kg milligram(s)/kilogram
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    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 No
    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 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.3.1Product nameMasitinib
    D.3.2Product code AB1010
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMasitinib mesilate
    D.3.9.1CAS number 790299-79-5
    D.3.9.2Current sponsor codeAB1010
    D.3.9.3Other descriptive nameMASITINIB
    D.3.9.4EV Substance CodeSUB32266
    D.3.10 Strength
    D.3.10.1Concentration unit mg/kg milligram(s)/kilogram
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    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 No
    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
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboFilm-coated tablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Patients with primary progressive or secondary progressive multiple sclerosis without relapse
    Pacientes com esclerose múltipla progressiva primária ou secundária progressiva sem recidiva
    E.1.1.1Medical condition in easily understood language
    Multiple sclerosis
    Esclerosa múltipla
    E.1.1.2Therapeutic area Diseases [C] - Nervous System Diseases [C10]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10063400
    E.1.2Term Secondary progressive multiple sclerosis
    E.1.2System Organ Class 10029205 - Nervous system disorders
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10063401
    E.1.2Term Primary progressive multiple sclerosis
    E.1.2System Organ Class 10029205 - Nervous system disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of the study is to evaluate whether masitinib treatment will show a significant delay on three-month confirmed disease progression versus placebo in the study patients.
    O objetivo primário do estudo é avaliar se o tratamento com masitinibe mostrará um atraso significativo na progressão da doença confirmada em três meses versus placebo nos pacientes do estudo.
    E.2.2Secondary objectives of the trial
    The secondary objectives of the study are to evaluate the efficacy of masitinib compared with placebo on a range of clinical parameters of multiple sclerosis. The secondary objectives also include the assessment of safety and tolerability of masitinib as compared to placebo in terms of adverse events, vital signs, physical examination, ECG, and clinical laboratory tests.
    Os objetivos secundários do estudo são avaliar a eficácia de masitinibe em comparação com placebo em uma série de parâmetros clínicos de esclerose múltipla. Os objetivos secundários também incluem a avaliação da segurança e tolerabilidade do masitinibe em comparação ao placebo em termos de eventos adversos, sinais vitais, exame físico, ECG e testes laboratoriais clínicos.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    A patient must fulfil all of the following inclusion criteria to be eligible to participate in the study:
    Related to the disease:
    1. Patients with either primary progressive or secondary progressive multiple sclerosis with onset of symptoms at least five years before inclusion and with no relapse diagnosed according to the 2017 revised McDonald’s criteria at least two years before screening
    2. Patients with Expanded Disability Status Scale (EDSS) score between 3.0 to 6.0 (both inclusive) at screening and baseline
    3. Patients with an EDSS score progression ≥1 point with no improvement during 2 years before screening
    4. Absence of T1 Gadolinium-enhancing brain lesions at baseline as measured by MRI at screening
    Other inclusion criteria:
    5. Male or female patients aged between 18 and 65 years at screening
    6. Weight >45 kg and BMI between 18 and 35 kg/m2 at screening or baseline
    7. Contraception, to be assessed at screening and baseline:
    - Female patients of childbearing potential (entering the study after a menstrual period and who has a negative pregnancy test both at screening and at baseline), who agrees to use a highly effective method of contraception and an effective method of contraception by her male partner during the study and for 3 months and a half after the last treatment intake
    - Male patients with a female partner of childbearing potential who agrees to use a highly effective method of contraception and an effective method of contraception by his female partner during the study and for 3 months and 2 weeks after the last treatment intake OR who agrees to use an effective method of contraception and a highly effective method of contraception by his female partner during the study and for 3 months and 2 weeks after the last treatment intake
    Highly effective and effective methods of contraception are detailed in the appendix 14.1 of the protocol
    8. Patient able to understand, and willing to sign, and date the written informed consent form prior to any protocol-specific procedures, at screening. If patients are duly capable of study consent but are unable to sign by themselves due to aggravation of disease condition, written informed consent can be obtained from a legally authorized representative who can sign on behalf of the patients after confirming the patients' agreement to study participation
    9. Patient able and willing to comply with study protocol and to come on-site as per protocol visits schedule, assessed at screening and at baseline
    Critérios de Inclusão
    Relacionados com a doença
    1. Os participantes com esclerose múltipla primária progressiva ou secundária progressiva com o início dos sintomas pelo menos cinco anos antes da visita de baseline e sem recaída diagnosticada de acordo com os Critérios de McDonald revistos em 2017 pelo menos dois anos antes do rastreio
    2. Participantes com uma pontuação da Escala Expandida do Estado de Incapacidade (EDSS) entre 3.0 e 6.0 (inclusive) nas visitas de rastreio e de baseline.
    3. Participantes com uma progressão da pontuação de EDSS ≥1 ponto sem melhoria durante 2 anos antes da visita de rastreio
    4. Ausência de lesões cerebrais T1 com gadolínio conforme a medição da RM na visita de rastreio
    Outros critérios de inclusão
    5. Participantes do sexo feminino ou masculino entre os 18 e os 65 anos na altura na visita de rastreio
    6. Peso >45 kg e IMC entre 18 e 35 kg/m2 nas visitas de rastreio e de baseline.
    7. Contraceção a ser avaliada nas visitas de rastreio e de baseline.:
    As participantes do sexo feminino em idade fértil (que entrem no estudo após um período menstrual e que tenham um teste de gravidez negativo), que concordem em usar um método de contraceção altamente eficaz e um método efetivo de contraceção pelo parceiro do sexo masculino durante o estudo e até 3 meses e meio após a última toma do medicamento
    Os participantes do sexo masculino com uma parceira de sexo feminino em idade fértil que aceite utilizar um método de contraceção altamente eficaz durante o estudo e durante mais 3 meses após a última toma do medicamento OU que aceite utilizar um método de contraceção durante o estudo e durante os 3 meses e meio após a última toma do medicamento
    Os métodos de contraceção eficazes e altamente eficazes estão detalhados no Anexo 14.1 do protocolo.
    8. Os participantes capazes de perceber e dispostos a assinar e datar os formulários de consentimento informado antes de quaisquer procedimentos específicos ao protocolo, na visita de pre-estudo. Se os participantes estiverem devidamente capazes de dar o consentimento mas não puderem assinar devido ao agravamento da doença, o consentimento informado por escrito pode ser obtido junto de um representante legal autorizado que possa assinar em nome dos participantes depois de confirmar que o doente concorda em participar no estudo
    9. Os participantes capazes e dispostos a cumprir o protocolo do estudo e a deslocar-se ao centro de acordo com o calendário das visitas do protocolo, explicado nas visitas de rastreio e de baseline..


    E.4Principal exclusion criteria
    Related to the disease:
    1. Patients suffering from a disease other than MS that would better explain the neurological clinical signs and symptoms and/or MRI lesions observed at screening
    2. Inability to complete screening MRI (contraindications for MRI) and/or any known allergy/hypersensitivity/any contra-indication to gadolinium macrocyclic
    3. Patients treated with other disease modifying treatments in the time frames and conditions mentioned under previous treatment wash out period, assessed at baseline
    4. Patients with lymphocytes <1.0 × 109/L at screening and baseline
    Other exclusion criteria:
    5. Patients with hypersensitivity masitinib/its excipients at screening
    6. Patients with history/family history of severe skin toxicities or reactions at screening or patients taking concomitant treatment/therapies associated with severe drug-induced skin toxicity
    7. Patients with history of severe bone marrow disorders e.g. agranulocytosis or aplasia, or with abnormal laboratory results at screening and baseline:
    - Neutropenia with ANC <1.5 × 109/L
    - Anemia with Hgb <10 g/dl
    - Thrombocytopenia with platelet counts <75 × 109/L
    8. Patients with history of severe hepatic disorders, e.g. viral hepatitis or steatohepatitis, and alcohol steatosis, or with abnormal laboratory results:
    - Hepatic transaminase levels >2 ULN at baseline, or
    - Total bilirubin level >1.5 ULN at baseline, or
    - Both hepatic transaminase levels and total bilirubin level outside of the normal ranges, at screening and baseline, or
    - Albuminemia <1 × LLN at screening and baseline, or
    - Patients with concomitant medication known to be associated with severe hepatotoxicity
    9. Patients with pre-existing severe renal impairment, or with abnormal laboratory results at screening:
    - Creatinine clearance <60 mL/min (Cockcroft and Gault formula) or
    - Proteinuria >30 mg/dL (1+) on dipstick; if the proteinuria ≥1+ on the dipstick, 24 hours proteinuria must be >1.5 g/24 hours
    10. Patients with current or history of severe cardiovascular disease, assessed at screening:
    - Myocardial infarction
    - Unstable angina pectoris
    - Coronary revascularization procedure
    - Congestive heart failure of NYHA Class III or IV
    - Stroke, including a transient ischemic attack
    - 2nd or 3rd degree atrioventricular block not successfully treated with a pacemaker
    - Bi-fascicular block
    - QTc Fridericia interval > 450 millisec. for males and > 470 millisec. for females
    - Drug induced heart failure or ischemic heart disease
    - Radiotherapy induced cardiomyopathy
    - Family history of unexpected death of cardiovascular origin
    - Edema of cardiac origin and left ventricular ejaculation fraction ≤50%
    11. Patients with ≥2 of the risk factors listed below assessed by a cardiologist at screening as Very High Risk (calculated SCORE* ≥10%) or High Risk (calculated SCORE* ≥5% and <10%) according to the Systematic Coronary Risk Estimation (SCORE*):
    - Hypertension (uncontrolled)
    - Diabetes
    - Kidney disease
    - Current tabagism (≥10 Pack-year: equivalent to 1 pack of 20 cigarettes for 10 years with the formula N (number of packs of 20 cigarettes smoked daily) × T (number years smoking)). Patients who stopped smoking 6 months prior to the evaluation, are not concerned.
    - Hypercholesterolemia,
    - Chronic obstructive pulmonary disease (COPD)
    * acc. to the Systematic Coronary Risk Estimation (SCORE) using the country specific free full version of HeartScore®, available at https://www.heartscore.org/en_GB/access
    If the country specific version is not available, EU one should be used.
    12. Patients with active severe infection e.g. tuberculosis, viral hepatitis, human immunodeficiency virus infection, syphilis or COVID-19 (confirmed by positive RT-PCR and/or other applicable methods), from medical files assessed at screening or baseline
    13. Patient treated concomitantly with known substrates of P-gp and/or BCRP with narrow therapeutic index
    14. Any medical condition at screening and baseline that, in the opinion of the Investigator, might interfere with the patients’ participation in the trial, poses any added risk for the patients, or confounds the assessment of the patients
    15. Patients under psychiatric care, protected by law under guardianship or curatorship, in emergency situations, prisoners and patients without national health insurance at screening and baseline
    16. Patients who had major surgery within 2 weeks prior to screening visit
    17. Pregnant/nursing female patients at screening or baseline
    18. Patients with a diagnosis of cancer or evidence of continued disease within five years before screening
    19. Previous participation in an earlier study with masitinib, assessed at screening
    20. Patient who has been exposed to an investigational treatment within 3 months or 5 half-lives of an investigational product, whichever is longer, before the screening visit
    21. Subjects who have received a live vaccine within 30 days prior to first IMP administration.
    Critérios de Exclusão:
    Relacionados com a doença
    1. Os participantes que sofram de uma doença que não esclerose múltipla que possa explicar melhor os sinais clínicos neurológicos do doente e os sintomas e/ou lesões na RM observados na visita de rastreio
    2. Incapacidade de completar a RM na visita de rastreio (contraindicações para RM) e/ou qualquer alergia conhecida ou hipersensibilidade ou qualquer contraindicação ao gadolínio macrocíclico
    3. Os participantes tratados com outros tratamentos de modificação de doença nos períodos temporais e condições mencionados no período de expulsão do tratamento prévio, avaliados na visita de baseline
    4. Participantes com linfócitos <1,0 × 109/L nas visitas de rastreio e de baseline
    Outros critérios de exclusão
    5. Participantes com hipersensibilidade ao masitinib ou aos seus excipientes nna visita de rastreio
    6. Participantes com um historial (ou história familiar) de toxicidades cutâneas graves ou reações na visita de rastreio ou participantes que estejam a fazer um tratamento concomitante ou terapêuticas associadas com uma toxicidade na pele induzida por medicamentos nas visitas de rastreio e baseline.
    7. Participantes com um historial de perturbações graves da medula óssea tais como agranulocitose ou aplasia, ou com resultados de análises normais nas visitas de rastreio e de baseline definidos como:
    - Neutropenia com ANC <1,5 × 109/L
    - Anemia com Hgb <10 g/dl
    - Trombocitopenia com contagem de plaquetas <75 × 109/L
    8. Participantes com um historial de perturbações hepáticas graves, tais como hepatite viral ou esteatose hepática, e esteatose de álcool ou com resultados de análises anormais definidos como:
    - Níveis de transaminase hepática >2 ULN na linha de base ou
    - Nível total de bilirrubina >1,5 ULN na linha de base, ou
    - Níveis de transaminase hepática e nível total de bilirrubina fora dos intervalos normais no rastreio e linha de base, ou
    - Albuminemia <1 × LLN nas visitas de rastreio e de baseline ou
    - Participantes a fazermedicação concomitante que se sabe estar associada a toxicidade hepática grave
    9. Participantes com perturbações renais graves preexistentes ou com valores laboratoriais anormais na visita de rastreio:
    - Depuração de creatinina <60 mL/min (fórmula de Cockcroft e Gault) ou
    - Proteinuria >30 mg/dL (1+) na vareta; no caso de proteinuria ≥1+ na vareta, a proteinuria a 24 horas deve ser de >1,5 g/24 horas
    10. Os participantes com um historial atual de doença cardiovascular grave, avaliada na visita de rastreio:
    - Enfarte do miocárdio
    - Angina instável
    - Intervenção de revascularização coronária
    - Insuficiência cardíaca congestiva e Classe III ou IV NYHA
    - AVC, incluindo acidente isquémico transitório
    - Bloqueio atrioventricular de segundo grau ou terceiro grau não tratado com êxito com um pacemaker
    - Bloqueio bifascicular
    - Intervalo de Fridericia QTc >450 milissegundos para homens e >470 milissegundos para mulheres
    - Insuficiência cardíaca induzida por medicamentos ou doença cardíaca isquémica
    - Cardiomiopatia induzida por radioterapia
    - História famíliar de morte inesperada de causa cardíaca
    - Edema de origem cardíaca e fração de ejeção do ventrículo esquerdo ≤50%
    11. Participantes, com dois ou mais dos fatores de risco enumerados em baixo avaliados por um cardiologista na visita de rastreio como sendo de Muito Alto Risco (SCORE* calculado ≥10%.) ou Risco Elevado (SCORE* calculado ≥5% e <10%) segundo a Avaliação de Risco Coronário Sistemático (SCORE):
    - Hipertensão (não controlada)
    - Diabetes
    - Doença renal
    - Tabagismo atual (≥ ano de 10 maços: equivalente a 1 maço de cigarros durante 10 anos com a fórmula N (número de maços de 20 cigarros fumados por dia) × T (número de anos a fumar)) Os participantes que tenham deixado de fumar 6 meses antes da avaliação não são incluídos.
    - Hipercolesterolemia
    - Doença pulmonar obstrutiva crónica (DPOC)
    * Esta avaliação é feita de acordo com a Avaliação de Risco Coronário Sistemático (SCORE) usando a versão completa gratuita específica ao país do HeartScore®, a ferramenta interativa usada para prever e gerir o risco de ataque cardíaco e AVC na Europa, disponível em https://www.heartscore.org/en_GB/access
    Se a versão específica do país não estiver disponível, deve ser usada a da UE.
    12. Os participantes com uma infeção grave ativa como tuberculose, hepatite viral, infeção por vírus da imunodeficiência humana, sífilis ou COVID-19 (confirmado com um RT-PCR positivo e/ou outros métodos aplicáveis), avaliado nas visitas de rastreio ou de baseline.
    13. Participante tratado concomitantemente com substratos conhecidos de glicoproteína-p (gp-P) e/ou Proteína de resistência do cancro da mama (BCRP) com índice terapêutico estreito.
    14. .......




    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint is to assess the efficacy of masitinib 3.0 mg/kg/day with a dose escalation to 4.5 mg/kg/day after four weeks on the time to confirmed (12-weeks CDP) EDSS progression. Progression is defined as 1-point worsening when EDSS score ≤5.5, or 0.5-point worsening if baseline score >5.5.
    O desfecho primário é avaliar a eficácia de 3,0 mg/kg/dia de masitinibe com um aumento da dose para 4,5 mg/kg/dia após quatro semanas no momento da progressão de EDSS confirmada (12 semanas de CDP). A progressão é definida como piora de 1 ponto quando a pontuação EDSS ≤ 5,5, ou piora de 0,5 ponto se a pontuação inicial > 5,5.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Week 96
    Semana 96
    E.5.2Secondary end point(s)
    The secondary endpoints of the study include the following:
    Expanded Disability Status Scale (EDSS):
    • Time to confirmed (24-weeks CDP) EDSS progression. Progression is defined as 1-point worsening when EDSS score ≤5.5, or 0.5 if baseline score >5.5)
    • Expanded Disability Status Scale (EDSS): Absolute and ordinal change from baseline considering all measurements up to Week 96
    • Time to EDSS score of 7.0
    Clinical Global Assessment Tools:
    • Timed 25-foot walk (T25-FW) from baseline up to Week 96 and 12 weeks confirmed worsening using 20% threshold
    • Nine-hole peg test (9-HPT), right and left hands sides (finger dexterity) from baseline up to Week 96 and 12 weeks confirmed worsening using 20% threshold
    • The Symbol Digit Modalities Test (SDMT) from baseline up to Week 96 and 12 weeks confirmed worsening using 4-point threshold
    Brain MRI Assessments:
    • Brain Volume and Lesions will be measured and assessed at Baseline, Week 48 and Week 96, or early termination (only if patient discontinues after Week 48 and more than 24 weeks have elapsed since last MRI) for the following endpoints: Brain atrophy - Percent brain volume change (PBVC) from baseline at Week 96 or early termination
    • New/newly enlarged T2 lesion count (compared with baseline MRI scan) at Week 96 or early termination
    Quality of Life assessment:
    • Quality of life assessment: Multiple Sclerosis Quality of Life (MSQOL)-54 instrument from baseline up to Week 96
    • Modified Fatigue Impact Scale (MFIS) from baseline up to Week 96
    • Hamilton Depression Rating Scale (HAM-D) from baseline up to Week 96
    • Disability Impact Profile (DIP) from baseline up to Week 96
    Relapses:
    • Occurrence of new or worsening neurological symptoms attributable to MS
    • Symptoms persisting for >24 hours
    • Symptoms not attributable to confounding clinical factors (e.g., fever, infection, injury, adverse reactions to medications)
    • Symptoms immediately preceded by a stable or improving neurological state for at least 30 days
    • Ssymptoms accompanied by objective neurological worsening consistent with an increase
    of at least half a step on the EDSS scale
    Biomarker(s):
    • Comparison of serum Neurofilament Light Chain (NfL) and Glial Fibrillary Acidic Protein (GFAP) levels at Baseline and Week 96 or early termination (only if patient discontinues after Week 48 and more than 24 weeks have elapsed since last test)
    These biomarkers are to be tested in a subgroup of 200 patients of pre-selected sites
    Elevated blood concentrations of Comparison of serum Neurofilament Light Chain (NfL) were found to correlate with an increase in the number of relapses, disability worsening, MRI disease activity and brain volume loss in Multiple Sclerosis (MS). Glial Fibrilliary Acidic Protein (GFAP) is the major intermediate cytoskeletal protein of astrocytes and that of axons may be released into the cerebrospinal fluid (CSF) during pathological processes in the central nervous system (CNS). GFAP, is a marker for astrogliosis and a potential biomarker for MS progression.
    Os desfechos secundários do estudo incluem o seguinte:
    Escala expandida de status de deficiência (EDSS):
    • Tempo para progressão de EDSS confirmada (CDP de 24 semanas). A progressão é definida como piora de 1 ponto quando a pontuação EDSS ≤ 5,5 ou 0,5 se a pontuação inicial > 5,5)
    • Escala Expandida do Estado de Incapacidade (EDSS): Mudança absoluta e ordinal da linha de base considerando todas as medições até a Semana 96
    • Tempo para pontuação EDSS de 7,0
    Ferramentas de Avaliação Clínica Global:
    • Caminhada cronometrada de 25 pés (T25-FW) da linha de base até a Semana 96 e 12 semanas confirmou piora usando limite de 20%
    • Teste de pinos de nove buracos (9-HPT), lados direito e esquerdo das mãos (destreza dos dedos) desde a linha de base até a semana 96 e 12 semanas confirmou piora usando limite de 20%
    • O Teste de Modalidades de Dígitos de Símbolos (SDMT) da linha de base até a Semana 96 e 12 semanas confirmou a piora usando o limite de 4 pontos
    Avaliações de ressonância magnética cerebral:
    • O Volume Cerebral e as Lesões serão medidos e avaliados na Linha de Base, Semana 48 e Semana 96, ou término precoce (somente se o paciente descontinuar após a Semana 48 e mais de 24 semanas se passaram desde a última RM) para os seguintes parâmetros: Atrofia cerebral - Porcentagem alteração do volume cerebral (PBVC) desde a linha de base na Semana 96 ou término precoce
    • Contagem de lesões T2 novas/recém-aumentadas (em comparação com a RM de linha de base) na Semana 96 ou término precoce
    Avaliação da qualidade de vida:
    • Avaliação da qualidade de vida: instrumento de Qualidade de Vida da Esclerose Múltipla (MSQOL)-54 desde a linha de base até a Semana 96
    • Escala de Impacto de Fadiga Modificada (MFIS) desde a linha de base até a Semana 96
    • Escala de Avaliação de Depressão de Hamilton (HAM-D) desde a linha de base até a Semana 96
    • Perfil de Impacto de Deficiência (DIP) desde a linha de base até a Semana 96
    Recaídas:
    • Ocorrência de sintomas neurológicos novos ou agravados atribuíveis à EM
    • Sintomas que persistem por >24 horas
    • Sintomas não atribuíveis a fatores clínicos de confusão (por exemplo, febre, infecção, lesão, reações adversas a medicamentos)
    • Sintomas imediatamente precedidos por um estado neurológico estável ou melhorando por pelo menos 30 dias
    • Sintomas acompanhados de piora neurológica objetiva consistente com um aumento
    de pelo menos meio passo na escala EDSS
    Biomarcador(es):
    • Comparação dos níveis séricos da Cadeia Leve do Neurofilamento (NfL) e da Proteína Fibrilar Ácida Glial (GFAP) na Linha de Base e na Semana 96 ou término precoce (somente se o paciente descontinuar após a Semana 48 e mais de 24 semanas se passaram desde o último teste)
    Esses biomarcadores devem ser testados em um subgrupo de 200 pacientes de locais pré-selecionados
    As concentrações sanguíneas elevadas de Comparação da Cadeia Leve de Neurofilamento (NfL) sérica foram correlacionadas com um aumento no número de recaídas, piora da incapacidade, atividade da doença de RM e perda de volume cerebral na Esclerose Múltipla (EM). A proteína ácida fibrilar glial (GFAP) é a principal proteína intermediária do citoesqueleto dos astrócitos e a dos axônios pode ser liberada no líquido cefalorraquidiano (LCR) durante processos patológicos no sistema nervoso central (SNC). GFAP, é um marcador para astrogliose e um potencial biomarcador para progressão da EM.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Week 96
    Semana 96
    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 Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    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 Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    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 Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA75
    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
    Canada
    Israel
    South Africa
    United States
    Finland
    France
    Poland
    Sweden
    Bulgaria
    Romania
    Spain
    Germany
    Greece
    Italy
    Hungary
    Portugal
    Russian Federation
    Ukraine
    United Kingdom
    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
    The end of study is defined as the date of the last visit of the last patient undergoing the trial.
    O fim do estudo é definido como a data da última visita do último paciente submetido ao estudo.
    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 months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years1
    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: 800
    F.1.3Elderly (>=65 years) No
    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 state10
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 720
    F.4.2.2In the whole clinical trial 800
    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)
    None
    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 Decision2023-03-27
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-09-20
    P. End of Trial
    P.End of Trial StatusOngoing
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