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    Summary
    EudraCT Number:2021-002873-24
    Sponsor's Protocol Code Number:RM-493-035
    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:2022-02-24
    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 number2021-002873-24
    A.3Full title of the trial
    A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study: 5 Independent Sub-studies of Setmelanotide in Patients with POMC/PCSK1, LEPR, SRC1, SH2B1, or PCSK1 N221D Gene Defects in the Melanocortin-4 Receptor Pathway
    Estudio en fase III, aleatorizado a doble ciego y controlado con placebo: 5 subestudios
    independientes de setmelanotide en pacientes con defectos en los genes POMC, PCSK1, LEPR, SRC1, SH2B1 o PCSK1 N221D en la vía del receptor 4 de melanocortina
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study of setmelanotide in obese patients with specific genetic defects
    Un estudio de setmelanotida en pacientes obesos con defectos genéticos específicos
    A.3.2Name or abbreviated title of the trial where available
    Setmelanotide in patients with specific gene defects
    Setmelanotide en pacientes obesos con defectos genéticos específocs
    A.4.1Sponsor's protocol code numberRM-493-035
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation PlanP/215/2021
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorRhythm Pharmaceuticals Inc.
    B.1.3.4CountryUnited States
    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 supportRhythm Pharmaceuticals Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationRhythm Pharmaceuticals Inc.
    B.5.2Functional name of contact pointClinical Operations
    B.5.3 Address:
    B.5.3.1Street Address222 Berkeley Street, 12th floor
    B.5.3.2Town/ cityBoston
    B.5.3.3Post codeMA02116
    B.5.3.4CountryUnited States
    B.5.4Telephone number+1 857 264 4280
    B.5.5Fax number+1 857 264 4299
    B.5.6E-mailoohayon@rhythmtx.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 Yes
    D.2.1.1.1Trade name Imcivree
    D.2.1.1.2Name of the Marketing Authorisation holderRhythm Pharmaceuticals Netherlands B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEU/3/16/1703, EU/3/18/2101
    D.3 Description of the IMP
    D.3.1Product nameSetmelanotide
    D.3.2Product code RM-493
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNSetmelanotide
    D.3.9.1CAS number 920014-72-8
    D.3.9.2Current sponsor codeRM-493
    D.3.9.4EV Substance CodeAS1
    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 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 placeboSolution for injection
    D.8.4Route of administration of the placeboSubcutaneous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    POMC/PCSK1, LEPR, SRC1, SH2B1, and PCSK1 N221D Gene Defects in the Melanocortin-4 Receptor Pathway
    Defectos de los genes POMC/PCSK1, LEPR, SRC1, SH2B1 y PCSK1 N221D en la vía del receptor de melanocortina 4
    E.1.1.1Medical condition in easily understood language
    Improper function of certain messenger materials in the body that control body weight and hunger in people
    Funcionamiento incorrecto de ciertos materiales mensajeros en el cuerpo que controlan el peso corporal y el hambre en las personas
    E.1.1.2Therapeutic area Body processes [G] - Digestive System and Oral Physiological Phenomena [G10]
    MedDRA Classification
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the efficacy of setmelanotide on changes in body weight.
    Evaluar la eficacia de Setmelanotide para modificar el peso corporal.
    E.2.2Secondary objectives of the trial
    Key:
    • To evaluate the efficacy of setmelanotide based on the portion of patients with a clinically meaningful decrease in body weight defined as > or =5% decrease from baseline
    • To evaluate the efficacy of setmelanotide on changes in body weight in adult patients with obesity
    • To evaluate changes in hunger score in response to setmelanotide from baseline to 52 weeks of treatment
    • To evaluate the efficacy of setmelanotide on the portion of patients with at least 10% decrease in body weight
    Other:
    • To evaluate the efficacy of setmelanotide on changes in BMI in pediatric patients with obesity
    • To evaluate change in waist circumference in response to setmelanotide from baseline to 52 weeks of treatment
    • To evaluate the safety and tolerability of setmelanotide
    • To evaluate quality of life parameters following treatment with setmelanotide
    • To evaluate the ability of an initial response to setmelanotide (defining a responder population) to predict long-term benefit.
    Clave:
    •Evaluar eficacia de Setmelanotide a partir de la proporción de pacientes con descenso clínicamente significativo del peso corporal, definido como un descenso > o =5% respecto al valor inicial
    •Evaluar eficacia de Setmelanotide para modificar el peso corporal en adultos con obesidad
    •Evaluar cambios en puntuación del hambre en respuesta a Setmelanotide entre el momento inicial y 52 semanas de tratamiento
    •Evaluar eficacia de Setmelanotide en la porción de pacientes con descenso del peso corporal de un 10% como mínimo
    Otros:
    •Evaluar eficacia de Setmelanotide según variaciones del IMC en pacientes pediátricos obesos
    •Evaluar cambios en el perímetro de cintura en respuesta a Setmelanotide entre momento inicial y las 52 semanas
    •Evaluar seguridad y tolerabilidad
    •Evaluar parámetros de calidad de vida tras el tratamiento
    •Evaluar capacidad de respuesta inicial (lo que define a una población de pacientes que responden) para predecir el efecto beneficioso a largo plazo
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    This master protocol describes 5, independent, randomized, double-blind, placebo-controlled, sub-studies of setmelanotide in patients with obesity with 6 specific gene defects in the melanocortin-4 receptor (MC4R) pathway:
    • pro-opiomelanocortin (POMC) or proprotein convertase subtilisin/kexin type 1 (PCSK1) (Sub-study 035a)
    • leptin receptor (LEPR) (Sub-study 035b)
    • steroid receptor coactivator-1 (SRC1) (Sub-study 035c)
    • SRC homology 2 B adapter protein 1 (SH2B1) (Sub-study 035d)
    • PCSK1 N221D (Sub-study 035e)
    These 5 sub-studies have a high degree of similarities. The objectives and endpoints are identical for all 5 sub-studies in patients with POMC and/or PCSK1 (Sub-study 035a), LEPR (Sub-study 035b), SRC1 (Sub-study 035c), SH2B1 (Sub-study 035d), and PCSK1 N221D (Sub-study 035e) gene defects in the MC4R pathway.
    Este protocolo maestro describe 5 subestudios independientes, aleatorizados, doble ciego y controlados con placebo de setmelanotida en pacientes con obesidad con 6 defectos genéticos específicos en la vía del receptor de melanocortina-4 (MC4R):
    - pro-opiomelanocortina (POMC) o proproteína convertasa subtilisina/kexina tipo 1 (PCSK1) (Subestudio 035a)
    - receptor de leptina (LEPR) (subestudio 035b)
    - coactivador del receptor de esteroides-1 (SRC1) (Subestudio 035c)
    - proteína adaptadora SRC homología 2 B 1 (SH2B1) (Subestudio 035d)
    - PCSK1 N221D (Subestudio 035e)
    Estos 5 subestudios tienen un alto grado de similitud. Los objetivos y criterios de valoración son idénticos para los 5 subestudios en pacientes con defectos de los genes POMC y/o PCSK1 (Subestudio 035a), LEPR (Subestudio 035b), SRC1 (Subestudio 035c), SH2B1 (Subestudio 035d) y PCSK1 N221D (Subestudio 035e) en la vía MC4R.
    E.3Principal inclusion criteria
    1. Patients must have a pre-identified:
    • Heterozygous genetic variant in the POMC gene or PCSK1 gene (Sub-study 035a),
    • Heterozygous genetic variant in the LEPR gene (Sub-study 035b),
    • Homozygous, heterozygous, or compound heterozygous variant in the SRC1 gene (Sub-study 035c),
    • Homozygous, heterozygous, or compound heterozygous variant in SH2B1 gene, or chromosomal 16p11.2 deletion encompassing the SH2B1 gene (Sub-study 035d),
    • Heterozygous N221D variant in the PCSK1 gene (Sub-study 035e).
    For POMC, PCSK1, LEPR, SRC1 and SH2B1 gene variants, to be considered for inclusion, the variant must either:
    • Be categorized by a Clinical Laboratory Improvement Amendments (CLIA)/College of American Pathologists (CAP)/International Organisation for Standardization (ISO) 15189 -certified laboratory using ACMG criteria as
    a) pathogenic; or
    b) likely pathogenic; or
    c) VUS
    OR
    • Be an N221D variant of the PCSK1 gene
    If a patient has composite heterozygous variants eligible for the study, she/he will be accounted for in the higher category based on ACMG classification.
    • For example, if a patient is a composite heterozygous for POMC pathogenic variant, and LEPR VUS, the patient will be categorized as POMC pathogenic (Sub-study 035a).
    If the 2 variants have the same ACMG classification, adjudication will be assigned to the less prevalent gene sub-study. For example:
    • If a patient is a composite heterozygous for LEPR VUS and SRC1 VUS, the patient will be categorized as SRC1 (Sub-study 035c).
    • If a patient is a composite heterozygous for SH2B1 VUS and SRC1 VUS, the patient will be assigned to SRC1 (Sub-study 035c).
    The final sub-study assignment will follow this hierarchy: deletion (of the 16p11.2 including SH2B1) > pathogenic > likely pathogenic > VUS > RISK. Patients that harbor RISK variants are not eligible with the exception of PCSK1 N221D
    If a patient has 2 or more variants with 2 or more of the same P/LP ACMG classification, adjudication will be assigned following this hierarchy based on predicted prevalence: 1) SH2B1 deletion, 2) SRC1-P/LP, 3) SH2B1-P/LP, 4) POMC-P/LP, 5) PCSK1-P/LP, 6) LEPR-P/LP.
    If a patient has 2 or more variants with 2 or more of the same VUS ACMG classification, adjudication will be assigned following this hierarchy based on predicted prevalence: 1) PCSK1-VUS, 2) LEPR-VUS, 3) SRC1-VUS, 4) SH2B1-VUS, 5) POMC-VUS, 6) PCSK1-p.N221D.
    2. Between 6 and 65 years of age at the time of provision of informed consent/assent.
    3. Obesity, with reported onset in childhood, and BMI > or =30 kg/m2 for patients > or =18 years of age or BMI ≥95th percentile for age and gender for patients 6 to 17 years of age, based on the United States (US) CDC criteria, at screening.
    4. Patient and/or parent or guardian is able to communicate well with the Investigator, understand and comply with the requirements of the study (including once daily [QD] injection regimen and all other study procedures), and is able to understand and sign the written informed consent/assent. Patients who are unable to comply with all study procedures due to cognitive limitations or any other reason should not be enrolled into the study.
    5. Patient and/or parent or guardian reports that the patient experienced childhood obesity, defined as the patient and/or parent or guardian reporting that the patient was significantly overweight prior to the age of 6 years old.
    1. Los pacientes deben tener una variante genética preidentificada:
    - Variante genética heterocigota en el gen POMC o en el gen PCSK1 (Subestudio 035a),
    - Variante genética heterocigota en el gen LEPR (Subestudio 035b),
    - Variante homocigota, heterocigota o heterocigota compuesta en el gen SRC1 (Subestudio 035c),
    - Variante homocigota, heterocigota o heterocigota compuesta en el gen SH2B1, o deleción cromosómica 16p11.2 que abarca el gen SH2B1 (Subestudio 035d),
    - Variante heterocigota N221D en el gen PCSK1 (Subestudio 035e).
    En el caso de las variantes de los genes POMC, PCSK1, LEPR, SRC1 y SH2B1, para que se considere su inclusión, la variante debe
    - Estar categorizada por un laboratorio certificado por la Clinical Laboratory Improvement Amendments (CLIA)/College of American Pathologists (CAP)/International Organisation for Standardization (ISO) 15189 utilizando los criterios del ACMG como
    a) patógeno; o
    b) probablemente patógeno; o
    c) VUS
    O
    - Ser una variante N221D del gen PCSK1
    Si un paciente tiene variantes heterocigotas compuestas elegibles para el estudio, se le contabilizará en la categoría más alta según la clasificación del ACMG.
    - Por ejemplo, si un paciente es heterocigoto compuesto para la variante patogénica POMC, y LEPR VUS, el paciente será categorizado como patogénico POMC (Subestudio 035a).
    Si las 2 variantes tienen la misma clasificación ACMG, la adjudicación se asignará al subestudio del gen menos prevalente. Por ejemplo:
    - Si un paciente es un heterocigoto compuesto para LEPR VUS y SRC1 VUS, el paciente será categorizado como SRC1 (Subestudio 035c).
    - Si un paciente es un heterocigoto compuesto para SH2B1 VUS y SRC1 VUS, el paciente será asignado a SRC1 (Subestudio 035c).
    La asignación final del subestudio seguirá la siguiente jerarquía: deleción (del 16p11.2 incluyendo SH2B1) > patogénico > probablemente patogénico > VUS > RISK. Los pacientes que albergan variantes RISK no son elegibles con la excepción de PCSK1 N221D
    Si un paciente tiene 2 o más variantes con 2 o más de la misma clasificación P/LP ACMG, la adjudicación se asignará siguiendo esta jerarquía basada en la prevalencia prevista: 1) deleción de SH2B1, 2) SRC1-P/LP, 3) SH2B1-P/LP, 4) POMC-P/LP, 5) PCSK1-P/LP, 6) LEPR-P/LP.
    Si un paciente tiene 2 o más variantes con 2 o más de la misma clasificación VUS ACMG, la adjudicación se asignará siguiendo esta jerarquía basada en la prevalencia prevista: 1) PCSK1-VUS, 2) LEPR-VUS, 3) SRC1-VUS, 4) SH2B1-VUS, 5) POMC-VUS, 6) PCSK1-p.N221D.
    2. Entre 6 y 65 años de edad en el momento de otorgar el consentimiento informado/asentimiento.
    3. Obesidad, con inicio declarado en la infancia, e IMC > o =30 kg/m2 para los pacientes > o =18 años de edad o IMC ≥95º percentil para la edad y el sexo para los pacientes de 6 a 17 años de edad, según los criterios de los CDC de Estados Unidos, en el momento del cribado.
    4. El paciente y/o sus padres o tutores pueden comunicarse bien con el investigador, comprender y cumplir los requisitos del estudio (incluida la pauta de inyecciones una vez al día [QD] y todos los demás procedimientos del estudio), y son capaces de comprender y firmar el consentimiento informado por escrito. Los pacientes que no puedan cumplir con todos los procedimientos del estudio debido a limitaciones cognitivas o a cualquier otra razón no deben ser inscritos en el estudio.
    5. El paciente y/o sus padres o tutores informan de que el paciente sufrió obesidad infantil, definida como el paciente y/o sus padres o tutores informan de que el paciente tenía un sobrepeso significativo antes de los 6 años de edad.
    E.4Principal exclusion criteria
    1. Bariatric surgery or procedure (e.g., gastric bypass/band/sleeve, duodenal switch, gastric balloon, intestinal barrier, etc.) within the last 6 months. All patients with a history of bariatric surgery or procedures must be discussed with, and receive approval from, the Sponsor prior to enrollment.
    2. Weight loss >2% in the previous 3 months. NOTE: Dietary and/or exercise regimens, with or without the use of medications, supplements or herbal treatments associated with weight loss (e.g., orlistat, lorcaserin, phentermine, topiramate, naltrexone, bupropion, Glucagon-like peptide-1 [GLP-1] receptor agonists, etc.) are allowed if:
    • the regimen and/or dose has been stable for at least 3 months prior to randomization
    • the patient has not experienced weight loss >2% during the previous 3 months, AND
    • the patient intends to keep the regimen and/or dose stable throughout the course of the study.
    3. Documented diagnosis of any psychiatric disorder(s) that the Investigator believes will interfere significantly with study compliance.
    4. Clinically significant depression or suicidality as defined by: any suicidal ideation of type 4 or 5 on the Columbia Suicide Severity Rating Scale (C-SSRS) during Screening, any suicide attempt during the patient’s lifetime, or any suicidal behavior in the last month, or a Patient Health Questionnaire-9 (PHQ-9) score of > or = 15 during Screening.
    5. Current, clinically significant pulmonary, cardiac, or oncologic disease considered severe enough to interfere with the study and/or confound the results. Any patient with a potentially clinically significant disease should be reviewed with the Sponsor to determine eligibility.
    6. HbA1c >10% at Screening.
    7. History of significant liver disease other than non-alcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH).
    8. Estimated glomerular filtration rate (GFR) <30 mL/min/1.73 m2 at Screening.
    9. History or close family history (parents or siblings) of melanoma, or patient history of oculocutaneous albinism.
    10. Significant dermatologic findings relating to melanoma or pre-melanoma skin lesions (excluding non-invasive basal or squamous cell lesion), determined as part of a comprehensive skin evaluation performed by the Investigator during Screening. Any concerning lesions identified during Screening will be biopsied and results known to be benign prior to enrollment. If the pre-treatment biopsy results are of concern, the patient may need to be excluded from the study.
    11. Patient is, in the opinion of the Investigator, not suitable to participate in the study.
    12. Participation in any clinical study with an investigational drug/device within 3 months or 5 half-lives, whichever is longer, prior to the first day of dosing.
    13. Previously enrolled in a clinical study involving setmelanotide or any previous exposure to setmelanotide.
    14. Significant hypersensitivity to any excipient in the study drug.
    15. If female, pregnant or breastfeeding, or planning or desiring to become pregnant during the duration of the trial.
    16. Patients with the following mutations: biallelic BBS (and/or clinical diagnosis of Bardet-Biedl syndrome [BBS]) or biallelic ALMS1.
    1. 2. Cirugía o procedimiento bariátrico (por ejemplo, bypass gástrico/banda/manga, switch duodenal, balón gástrico, barrera intestinal, etc.) en los últimos 6 meses. Todos los pacientes con antecedentes de cirugía o procedimientos bariátricos deben ser discutidos con el Patrocinador y recibir su aprobación antes de la inscripción.
    2. Pérdida de peso >2% en los 3 meses anteriores. NOTA: Los regímenes dietéticos y/o de ejercicio, con o sin el uso de medicamentos, suplementos o tratamientos herbales asociados a la pérdida de peso (por ejemplo, orlistat, lorcaserina, fentermina, topiramato, naltrexona, bupropión, agonistas del receptor del péptido similar al glucagón-1 [GLP-1], etc.) están permitidos si
    - el régimen y/o la dosis han sido estables durante al menos 3 meses antes de la aleatorización
    - el paciente no ha experimentado una pérdida de peso >2% durante los 3 meses anteriores, Y
    - el paciente tiene la intención de mantener el régimen y/o la dosis estables durante el transcurso del estudio.
    3. 3. Diagnóstico documentado de cualquier trastorno psiquiátrico que el investigador considere que va a interferir significativamente en el cumplimiento del estudio.
    4. Depresión o suicidio clínicamente significativos, definidos por: cualquier ideación suicida de tipo 4 o 5 en la Escala de Calificación de la Severidad del Suicidio de Columbia (C-SSRS) durante el cribado, cualquier intento de suicidio durante la vida del paciente, o cualquier comportamiento suicida en el último mes, o una puntuación del Cuestionario de Salud del Paciente-9 (PHQ-9) de > o = 15 durante el cribado.
    5. 5. Enfermedad pulmonar, cardíaca u oncológica actual y clínicamente significativa que se considere lo suficientemente grave como para interferir con el estudio y/o confundir los resultados. Cualquier paciente con una enfermedad potencialmente significativa debe ser revisado con el patrocinador para determinar su elegibilidad.
    6. HbA1c >10% en el momento del cribado.
    7. Historial de enfermedad hepática significativa que no sea enfermedad de hígado graso no alcohólico (NAFLD) o esteatohepatitis no alcohólica (NASH).
    8. Tasa de filtración glomerular (TFG) estimada <30 mL/min/1,73 m2 en el momento del cribado.
    9. Historia o antecedentes familiares cercanos (padres o hermanos) de melanoma, o historia del paciente de albinismo oculocutáneo.
    10. Hallazgos dermatológicos significativos relacionados con lesiones cutáneas de melanoma o premelanoma (excluyendo las lesiones de células basales o escamosas no invasivas), determinados como parte de una evaluación cutánea completa realizada por el investigador durante el cribado. Cualquier lesión preocupante identificada durante el cribado se someterá a una biopsia y se sabrá que los resultados son benignos antes de la inscripción. Si los resultados de la biopsia previa al tratamiento son preocupantes, puede ser necesario excluir al paciente del estudio.
    11. El paciente, en opinión del Investigador, no es apto para participar en el estudio.
    12. Participación en cualquier estudio clínico con un fármaco/dispositivo en investigación dentro de los 3 meses o 5 vidas medias, lo que sea más largo, antes del primer día de dosificación.
    13. Haber participado previamente en un estudio clínico con setmelanotida o cualquier exposición previa a la setmelanotida.
    14. Hipersensibilidad significativa a cualquier excipiente del medicamento en estudio.
    15. Si es mujer, está embarazada o en periodo de lactancia, o planea o desea quedarse embarazada durante la duración del ensayo.
    16. Pacientes con las siguientes mutaciones: BBS bialélico (y/o diagnóstico clínico de síndrome de Bardet-Biedl [BBS]) o ALMS1 bialélico.
    E.5 End points
    E.5.1Primary end point(s)
    The difference in mean change in body weight from baseline at 52 weeks in patients treated with setmelanotide compared to placebo, assessed as percent change from baseline body mass index (BMI)
    Diferencia a las 52 semanas respecto al valor inicial en la variación media del peso
    corporal en pacientes tratados con setmelanotide en comparación con el
    placebo, valorada como la variación porcentual respecto al índice de masa
    corporal (IMC) inicial.
    E.5.1.1Timepoint(s) of evaluation of this end point
    52 weeks
    52 semanas
    E.5.2Secondary end point(s)
    Key Secondary:
    • The proportion of patients who achieve at least 5% reduction in baseline BMI at 52 weeks, in patients treated with setmelanotide compared to placebo
    • The difference in mean change in body weight from baseline at 52 weeks in adult patients (age > or =18 years at baseline) treated with setmelanotide compared to placebo, assessed as percent change in baseline body weight
    • The difference in mean percent change in the weekly average most hunger score at 52 weeks in patients treated with setmelanotide compared to placebo, utilizing the Hunger Questions for Patients > or =12 years of Age
    • The proportion of patients who achieve at least 10% reduction in baseline BMI at 52 weeks, in patients treated with setmelanotide compared to placebo
    Other Secondary:
    • The difference in mean change in BMI from baseline at 52 weeks in pediatric patients (age <18 years at baseline) treated with setmelanotide compared to placebo, assessed as change in baseline BMI Z-score
    • The difference in change from baseline at 52 weeks in % Centers for Disease Control and Prevention (CDC) BMI 95th percentile in patients <18 years at baseline treated with setmelanotide compared to placebo
    • The difference from baseline at 52 weeks in mean change in waist circumference in patients treated with setmelanotide compared to placebo.
    • The overall safety and tolerability of setmelanotide in patients with genetic defects in the MC4R pathway.
    • The difference in mean change from baseline at 52 weeks in physical functioning score and total score for Impact of Weight on Quality of Life in adults (IWQOL-Lite) and in children (IWQOL-Kids-Parent Proxy) in patients treated with setmelanotide compared to placebo
    • The difference in mean body weight loss, and % body weight loss at 52 weeks in setmelanotide responders (defined as patients with > or =5% body weight loss if >18 years of age, or a decrease in BMI by > or =3% if <18 years of age, after 12 weeks of therapy at 3.0 mg/day or at the maximally tolerated dose) as compared to the placebo group
    Clave:
    • Proporción de pacientes que alcanza una reducción de al menos el 5 % del IMC inicial a las 52 semanas, en pacientes tratados con Setmelanotide en comparación con el placebo
    • Diferencia a las 52 semanas respecto al valor inicial de la variación media del peso corporal en pacientes adultos (> o =18 años de edad en el momento inicial) tratados con Setmelanotide en comparación con el placebo, valorada como la variación porcentual respecto al peso corporal inicial.
    • Diferencia en la variación porcentual media en el promedio semanal de la puntuación máxima del hambre a las 52 semanas, en pacientes tratados con Setmelanotide en comparación con el placebo, utilizando las preguntas sobre el hambre para pacientes > o =12 años de edad (Hunger Questions for Patients > o =12 years of Age © ).
    • Proporción de pacientes que alcanzan una reducción de al menos el 10% en el IMC inicial a las 52 semanas, en pacientes tratados con Setmelanotide en comparación con el placebo.

    Otros:
    • Diferencia a las 52 semanas respecto al valor inicial en la variación media del IMC en pacientes pediátricos (edad <18 años en el momento inicial) tratados con Setmelanotide en comparación con el placebo, evaluados como el cambio de la puntuación Z del IMC inicial.
    • Diferencia a las 52 semanas respecto al valor inicial del percentil 95 del IMC según los Centros para el Control y la Prevención de Enfermedades (CDC) en pacientes <18 años en el momento inicial tratados con Setmelanotide en comparación con el placebo.
    • Diferencia a las 52 semanas respecto al valor inicial en la variación media en el perímetro de la cintura en pacientes tratados con
    Setmelanotide en comparación con el placebo.
    • Evaluar la seguridad y tolerabilidad globales de Setmelanotide en pacientes con defectos genéticos en la vía MC4R.
    • Diferencia a las 52 semanas respecto al valor inicial en la puntuación de funcionalidad física y la puntuación total para el impacto del peso
    en la calidad de vida en adultos (IWQOL-Lite) y en niños (IWQOL-Kids con padres o sus representantes) en pacientes tratados con
    Setmelanotide en comparación con el placebo.
    • Diferencia en la media de pérdida de peso corporal y pérdida porcentual de peso corporal a las 52 semanas en pacientes tratados con Setmelanotide que responden al tratamiento (definidos como pacientes con una pérdida de peso > o =5 % si tienen >18 años de edad, o un descenso del IMC > o =3 % si tienen <18 años de edad, después de 12 semanas de tratamiento con 3,0 mg/día o con la dosis máxima tolerada)
    en comparación con el grupo del placebo
    E.5.2.1Timepoint(s) of evaluation of this end point
    12 and 52 weeks
    12 y 52 semanas
    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 Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Tolerability
    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 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 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 EEA25
    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
    China
    France
    Germany
    Greece
    Israel
    Italy
    Netherlands
    Saudi Arabia
    Spain
    Turkey
    United Kingdom
    United States
    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 years5
    E.8.9.1In the Member State concerned months1
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years5
    E.8.9.2In all countries concerned by the trial months1
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1Number of subjects for this age range: 150
    F.1.1.1In Utero No
    F.1.1.1.1Number of subjects for this age range: 0
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.2.1Number of subjects for this age range: 0
    F.1.1.3Newborns (0-27 days) No
    F.1.1.3.1Number of subjects for this age range: 0
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.4.1Number of subjects for this age range: 0
    F.1.1.5Children (2-11years) Yes
    F.1.1.5.1Number of subjects for this age range: 50
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 100
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 410
    F.1.3Elderly (>=65 years) No
    F.1.3.1Number of subjects for this age range: 0
    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 Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    minors
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state33
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 100
    F.4.2.2In the whole clinical trial 560
    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)
    Patients who respond to setmelanotide may be offered the option of enrolling into a Long-Term Extension study.
    A los pacientes que responden a la setmelanotida se les puede ofrecer la opción de participar en un estudio de extensión a largo plazo.
    G. Investigator Networks to be involved in the Trial
    G.4 Investigator Network to be involved in the Trial: 1
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-04-25
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-03-29
    P. End of Trial
    P.End of Trial StatusOngoing
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