E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Neuromyelitis optica spectrum disorder (NMOSD; also known as Devic's syndrome and previously known as neuromyelitis optica [NMO]) |
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E.1.1.1 | Medical condition in easily understood language |
Disorder of the central nervous system, which is a rare condition that damages the optic nerve (optic neuritis) and spinal cord (myelitis). |
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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 | 10077875 |
E.1.2 | Term | Neuromyelitis optica spectrum disorder |
E.1.2 | System Organ Class | 10029205 - Nervous system 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 |
1. To characterize the PK of inebilizumab administered in pediatric subjects with NMOSD
2. To characterize the PD of inebilizumab administered in pediatric subjects with NMOSD
3. To assess the safety and tolerability of inebilizumab administered in pediatric subjects with NMOSD |
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E.2.2 | Secondary objectives of the trial |
1. To assess disease activity when inebilizumab is administered in pediatric subjects with NMOSD
2. To assess health-related quality of life (HRQoL) when inebilizumab is administered in pediatric subjects with NMOSD
3. To assess visual acuity when inebilizumab is administered in pediatric subjects with NMOSD
4. To assess disability when inebilizumab is administered in pediatric subjects with NMOSD
5. To characterize the immunogenicity of inebilizumab administered in pediatric subjects with NMOSD
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Written informed consent and any locally required data privacy authorization obtained from the subject’s legally authorized representative in accordance with regional laws or regulations and the subject’s assent, when applicable, prior to performing any protocol-related procedures.
2. Male or female subjects age 2 to < 18 years at the time of screening.
3. Positive serum anti-AQP4-IgG result at screening (verified by the central laboratory) and diagnosed with NMOSD
4. Documented history of one or more NMOSD acute relapses within the last year, or 2 or more NMOSD acute relapses within 2 years prior to screening.
5. Female subjects of childbearing potential who are sexually active with a nonsterilized male partner must agree to use a highly effective method of contraception from screening until 6 months after the final dose of investigational product (IP)
6. Nonsterilized male subjects who are sexually active with a female partner of childbearing potential must agree to use a male condom from Day 1 until 3 months after the final dose of IP. |
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E.4 | Principal exclusion criteria |
1. Any condition that, in the opinion of the Investigator, would interfere with the evaluation or administration of the IP or interpretation of subject safety or study results
2. Concurrent/previous enrollment in another clinical study involving an investigational treatment within 4 weeks or 5 published half-lives of the investigational treatment, whichever is the longer, prior to Day 1
3. Females who are breastfeeding, pregnant, or who intend to become pregnant at any time from screening until 6 months after the final dose of IP
4. Known history of allergy or reaction to any component of the IP formulation or history of anaphylaxis following any biologic therapy
5. Evidence of alcohol, drug, or chemical abuse, or a recent history of such abuse < 1 year prior to Day 1
6. Major surgery within 8 weeks prior to screening
7. Spontaneous or induced abortion, still or live birth, or pregnancy ≤ 4 weeks prior to screening
8. Evidence of significant hepatic, renal, or metabolic dysfunction or significant hematological abnormality
9. Receipt of rituximab or any experimental B-cell depleting agent within 6 months prior to screening unless B-cell counts have returned to ≥ one-half the LLN
10. Receipt of intravenous immunoglobulin (IVIG) within one month prior to Day 1
11. Receipt of particular immunosuppressive therapy within 2 months prior to Day 1
12. Receipt of natalizumab (Tysabri®) within 6 months prior to Day 1
13. Severe drug allergic history or anaphylaxis to 2 or more food products or medicine
14. Diagnosed with a concurrent autoimmune disease that is uncontrolled (unless approved by the medical monitor)
15. Receipt of any of the following:
a. Any live or attenuated vaccine within 4 weeks prior to Day 1
b. Bacillus Calmette-Guérin vaccine within one year of screening
c. Blood transfusion within 4 weeks prior to screening or during screening
16. Clinically significant serious active or chronic viral, bacterial, or fungal infection that requires treatment with anti-infectives, within 2 months prior to Day 1
17. Known history of congenital or acquired immunodeficiency that predisposes the subject to infection
18. Positive test for chronic hepatitis B infection at screening
19. Positive test for hepatitis C virus antibody
20. Negative test for varicella zoster virus (VZV)-IgG
21. History of cancer, apart from squamous cell or basal cell carcinoma of the skin treated with documented success of curative therapy > 3 months prior to Day 1
22. History of active or latent tuberculosis |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. PK parameters, including maximum observed concentration (Cmax), area under the concentration-time curve from time 0 to 14 days post dose (AUC0-14d) and from time 0 extrapolated to infinity (AUC0-inf), systemic clearance, terminal elimination half-life (t½), and volume of distribution at steady state (Vss)
2. CD20-positive B-cell counts on Days 1, 8, 15, 29, 57, 85, 113, 155, and 197
3. Safety and tolerability assessments, including incidence of adverse events (AEs)/serious adverse events (SAEs)/adverse events of special interest (AESIs) and changes in laboratory parameters and vital signs
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
From randomization until end of the trial |
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E.5.2 | Secondary end point(s) |
1. Disease activity endpoints include:
− Time to first relapse
− Proportion of relapse-free subjects
− Annualized relapse rate
2. HRQoL endpoints include:
− Change in Euro Quality of Life-5 Dimension Youth (EQ-5D-Y) score
− Change in Pediatric Quality of Life Inventory (PedsQL)
3. Change in visual acuity
4. Change in EDSS
5. Presence of anti-drug antibody (ADA)
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
From randomization until end of the trial |
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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 | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
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 | 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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
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 | 1 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 6 |
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 |
Brazil |
Canada |
Serbia |
United Kingdom |
United States |
France |
Netherlands |
Poland |
Spain |
Sweden |
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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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The study will be complete when the last active subject completes the Week 80/EDV visit (Week 52 visit for those subjects who wish to continue receiving inebilizumab through a Sponsor-supported managed access program or equivalent or discontinues prematurely from the study). |
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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 | 1 |
E.8.9.1 | In the Member State concerned days | 4 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 1 |
E.8.9.2 | In all countries concerned by the trial days | 4 |