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    Summary
    EudraCT Number:2021-005607-13
    Sponsor's Protocol Code Number:NN8640-4467
    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:2022-07-01
    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 number2021-005607-13
    A.3Full title of the trial
    A study comparing the effect and safety of once weekly dosing of somapacitan with daily Norditropin® as well as evaluating long-term safety of somapacitan in a basket study design in
    children with short stature either born small for gestational age or with Turner syndrome,
    Noonan syndrome, or idiopathic short stature.
    Estudio que compara el efecto y la seguridad de somapacitán administrado una vez a la semana frente a Norditropin® administrado una vez al día y que evalúa la seguridad a largo plazo de somapacitán en un estudio con diseño de canasta en niños con talla baja que han nacido pequeños para la edad gestacional o con síndrome de Turner, síndrome de Noonan, o talla baja idiopática
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A research study to compare somapacitan once a week with Norditropin® once a day in children who need help to grow
    Estudio para comparar somapacitán una vez a la semana con Norditropin® una vez al día en niños que necesitan ayuda para crecer
    A.4.1Sponsor's protocol code numberNN8640-4467
    A.5.3WHO Universal Trial Reference Number (UTRN)U1111-1270-0862
    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 SponsorNovo Nordisk A/S
    B.1.3.4CountryDenmark
    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 supportNovo Nordisk A/S
    B.4.2CountryDenmark
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationNovo Nordisk A/S
    B.5.2Functional name of contact pointClinical Transparency (2834)
    B.5.3 Address:
    B.5.3.1Street AddressNovo Allé
    B.5.3.2Town/ cityBagsværd
    B.5.3.3Post code2880
    B.5.3.4CountryDenmark
    B.5.6E-mailclinicaltrials@novonordisk.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 Sogroya 10 mg/1.5 mL solution for injection in pre-filled pen
    D.2.1.1.2Name of the Marketing Authorisation holderNovo Nordisk A/S
    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 numberEMA/OD/041/18
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Solution for injection in pre-filled pen
    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 INNSomapacitan
    D.3.9.3Other descriptive nameSomapacitan
    D.3.9.4EV Substance CodeSUB186254
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6.7
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    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 Yes
    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 Yes
    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 Yes
    D.2.5.1Orphan drug designation numberEMA/OD/041/18
    D.3 Description of the IMP
    D.3.1Product namesomapacitan 5 mg/1.5 mL PDS290
    D.3.4Pharmaceutical form Solution for injection in pre-filled pen
    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 INNSomapacitan
    D.3.9.3Other descriptive nameSomapacitan
    D.3.9.4EV Substance CodeSUB186254
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number3.3
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    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 Yes
    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 Yes
    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: 3
    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 Yes
    D.2.5.1Orphan drug designation numberEMA/OD/041/18
    D.3 Description of the IMP
    D.3.1Product nameSomapacitan 15 mg/1.5 mL PDS290
    D.3.4Pharmaceutical form Solution for injection in pre-filled pen
    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 INNSomapacitan
    D.3.9.3Other descriptive nameSomapacitan
    D.3.9.4EV Substance CodeSUB186254
    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 No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    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 Yes
    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 Yes
    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: 4
    D.1.2 and D.1.3IMP RoleComparator
    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 Norditropin FlexPro 10 mg/1.5 ml, solution for injection in pre-filled pen
    D.2.1.1.2Name of the Marketing Authorisation holderNovo Nordisk A/S
    D.2.1.2Country which granted the Marketing AuthorisationDenmark
    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.3.4Pharmaceutical form Solution for injection in pre-filled pen
    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 INNSomatropin
    D.3.9.3Other descriptive nameSomatropin
    D.3.9.4EV Substance CodeSUB10584MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6.7
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    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 Yes
    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 Yes
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Short stature born small for gestational age
    Turner syndrome
    Noonan syndrome
    Idiopathic short stature
    Pequeño para la edad gestacional
    Síndrome de Turner
    Síndrome de Noonan
    Baja estatura idiopática
    E.1.1.1Medical condition in easily understood language
    Short stature born small for gestational age
    Turner syndrome
    Noonan syndrome
    Idiopathic short stature
    Pequeño para la edad gestacional
    Síndrome de Turner
    Síndrome de Noonan
    Baja estatura idiopática
    E.1.1.2Therapeutic area Diseases [C] - Hormonal diseases [C19]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10045181
    E.1.2Term Turner's syndrome
    E.1.2System Organ Class 10010331 - Congenital, familial and genetic disorders
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10029748
    E.1.2Term Noonan syndrome
    E.1.2System Organ Class 10010331 - Congenital, familial and genetic disorders
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 23.0
    E.1.2Level LLT
    E.1.2Classification code 10066333
    E.1.2Term Idiopathic short stature
    E.1.2System Organ Class 100000004859
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10041093
    E.1.2Term Small for gestational age
    E.1.2System Organ Class 100000004868
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To confirm non-inferiority of once-weekly somapacitan compared with once-daily
    Norditropin® in terms of longitudinal growth measured by height velocity at week 52 in
    children with each of the four indications: SGA, TS, NS or ISS.
    El objetivo principal de este estudio es confirmar la no inferioridad de somapacitán una vez a la semana en comparación con Norditropin® una vez al día en cuanto al crecimiento en estatura medido por la velocidad en la semana 52 en niños con cada una de las cuatro indicaciones PEG, ST, SN o BEI.
    E.2.2Secondary objectives of the trial
    1.To evaluate once-weekly somapacitan compared with once-daily Norditropin® in terms of other aspects of longitudinal growth in children with each of the four indications: SGA, TS, NS or ISS.

    2. To evaluate safety of once-weekly somapacitan compared with once-daily Norditropin® in terms of safety parameters measured by glucose metabolism in children with each of the four indications: SGA, TS, NS or ISS.

    3. To evaluate the steady state pharmacokinetics of once-weekly somapacitan in children with
    each of the four indications: SGA, TS, NS or ISS.

    4. To evaluate long-term safety of once-weekly somapacitan in terms of safety parameters measured by glucose metabolism in children with each of the four indications: SGA, TS, NS or ISS.
    1. Evaluar otros aspectos del crecimiento en estatura de somapacitán una vez a la semana en comparación con Norditropin® una vez al día en niños con cada una de las cuatro indicaciones PEG, ST, SN, BEI.
    2. Evaluar la seguridad de somapacitán una vez a la semana en comparación con Norditropin® una vez al día en cuanto a los parámetros de seguridad medidos mediante el metabolismo de la glucosa en niños con cada una de las cuatro indicaciones PEG, ST, SN, BEI.
    3. Evaluar la farmacocinética en estado de equilibrio de somapacitán una vez a la semana en niños con cada una de las cuatro indicaciones PEG, ST, SN, BEI.
    4. Evaluar la seguridad a largo plazo de somapacitán una vez a la semana en cuanto a los parámetros de seguridad medidos mediante el metabolismo de la glucosa en niños con cada una de las cuatro indicaciones PEG, ST, SN, BEI.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Four sub-studies are described in this protocol
    Se describen cuatro sub-estudios en este protocolo
    E.3Principal inclusion criteria
    1. Informed consent of parent or legally acceptable representative of participant and child assent, as age appropriate must be obtained before any study-related activities. Study-related activities are any procedures that are carried out as part of the study, including activities to determine suitability for the study.
    2. No prior exposure to growth promoting therapy, including but not limited to growth hormone, IGF-I and ghrelin analogues.
    Applicable to children with SGA:
    3. Born small for gestational age (birth length below -2 SDS OR birth weight below -2 SDS OR both) (according to national standards).
    4. Prepubertal children:
    a) Boys:
    • Age above or equal to 2 years and 26 weeks and below 11.0 years at screening.
    • Testis volume below 4 mL
    b) Girls:
    • Age above or equal to 2 years and 26 weeks and below 10.0 years at screening.
    • Tanner stage 1 for breast development: No palpable glandular breast tissue.
    5. Impaired height defined as at least 2.5 standard deviations below the mean height for chronological age and sex at screening according to the standards of Centers for Disease Control and Prevention.
    6. Impaired height velocity defined as annualised height velocity below the 50th percentile for chronological age and sex according to the standards of Prader calculated over a time span of minimum 6 months and maximum 18 months prior to screening.
    7. Body Mass Index below the 95th percentile according to Centers for Disease Control and Prevention, Body Mass Index-for-age growth charts.
    Applicable to girls with TS:
    8. Confirmed diagnosis of TS by 30-cell (or more) lymphocyte chromosomal analysis.*
    9. Prepubertal girls:
    • Age above or equal to 2 years and 26 weeks and below 10.0 years at screening.
    • Tanner stage 1 for breast development: No palpable glandular breast tissue.
    10. Impaired height defined as at least 2.0 standard deviations below the mean height for chronological age and sex at screening according to the standards of Centers for Disease Control and Prevention.
    11. Historical height measured 6–18 months prior to screening.
    12. Thyroid hormone replacement therapy should be adequate and stable for at least 90 days prior to randomisation, if applicable.
    Applicable to children with NS:
    13. Clinical diagnosis of NS according to van der Burgt score list
    14. Prepubertal children:
    a) Boys:
    • Age above or equal to 2 years and 26 weeks and below 11.0 years at screening.
    • Testis volume below 4 mL
    b) Girls:
    • Age above or equal to 2 years and 26 weeks and below 10.0 years at screening.
    • Tanner stage 1 for breast development: No palpable glandular breast tissue.
    15. Impaired height defined as at least 2.0 standard deviations below the mean height for chronological age and sex at screening according to the standards of Centers for Disease Control and Prevention.
    16. Historical height measured 6–18 months prior to screening.
    17. Thyroid hormone replacement therapy should be adequate and stable for at least 90 days prior to randomisation, if applicable.
    Applicable to children with ISS:
    18. Prepubertal children:
    a) Boys:
    • Age above or equal to 2 years and 26 weeks and below 11.0 years at screening.
    • Testis volume below 4 mL
    b) Girls:
    • Age above or equal to 2 years and 26 weeks and below 10.0 years at screening.
    • Tanner stage 1 for breast development: No palpable glandular breast tissue.
    19. Bone age:
    a) Boys:
    • Bone age below or equal to 12 years.
    • Bone age not delayed or advanced more than 2 years compared to chronological age.
    b) Girls:
    • Bone age below or equal to 11 years.
    • Bone age not delayed or advanced more than 2 years compared to chronological age.
    20. Impaired height defined as at least 2.5 standard deviations below the mean height for chronological age and sex at screening according to the standards of Centers for Disease Control and Prevention.
    21. Historical height measured 6–18 months prior to screening.
    22. One normal GH secretion (GH peak above 7 ng/mL) during GH stimulation test performed within 18 months prior to screening or if such a test is not available for children with ISS, a test should be performed as part of the screening assessments and the result must be available prior to randomisation.
    *If a 30-cell count is not available for patients with TS, a test should be done, and results must be available prior to randomisation
    1. Deberá obtenerse el consentimiento informado del progenitor o representante legal del participante y el asentimiento del niño, según proceda para la edad, antes de realizar ninguna actividad relacionada con el estudio. Se consideran actividades relacionadas con el estudio todos los procedimientos que se lleven a cabo como parte del estudio, incluidas las actividades para determinar la idoneidad para el mismo
    2. Ausencia exposición previa a tratamiento que favorezca el crecimiento, como hormona del crecimiento, IGF-I y análogos de grelina
    Aplicable a niños con PEG:
    3.Pequeño para la edad gestacional (longitud al nacer 2 SDS inferior O peso al nacer 2 SDS inferior O ambas cosas) (según los patrones de referencia nacionales)
    4. Niños prepúberes:
    Niños:
    -Edad igual o superior a 2 años y 26 semanas e inferior a 11,0 años en la selección
    -Volumen testicular inferior a 4 ml2
    Niñas:
    -Edad igual o superior a 2 años y 26 semanas e inferior a 10,0 años en la selección
    -Estadio 1 de Tanner para desarrollo mamario: Sin tejido mamario glandular palpable
    5. Retraso crecimiento, definido como al menos 2,5 desviaciones estándar por debajo de la estatura media para la edad cronológica y el sexo en el momento de la selección según los patrones de referencia “Center for Disease Control and Prevention”.
    6.Alteración de la velocidad de crecimiento, definida como una velocidad de crecimiento anualizada por debajo del percentil 50 para la edad cronológica y el sexo según las normas de Prader calculada durante un período mínimo de 6 meses y máximo de 18 meses antes de la selección
    7.Índice de masa corporal por debajo del percentil 95 según las tablas de crecimiento del Índice de masa corporal para la edad de los Centers for Disease Control and Prevention
    Aplicable a niñas con ST:
    8.Diagnóstico confirmado de ST mediante análisis cromosómico de 30 linfocitos (o más). *
    9. Niñas prepúberes:
    - Edad igual o superior a 2 años y 26 semanas e inferior a 10,0 años en la selección
    - Estadio 1 de Tanner para el desarrollo mamario: Sin tejido mamario glandular palpable
    10.Retraso del crecimiento, definido como al menos 2,0 desviaciones estándar por debajo de la estatura media para la edad cronológica y el sexo en el momento de la selección según los patrones de referencia de los Center for Disease Control and Prevention
    11.Historial de altura medida entre 6 y 18 meses antes de la selección
    12.El tratamiento de reposición de hormonas tiroideas debe ser suficiente y estable durante al menos 90 días antes de la aleatorización, si procede
    Aplicable a niños con SN:
    13.Diagnóstico clínico de SN según el índice de Van der Burgt
    14. Niños prepúberes:
    a) Niños:
    -Edad igual o superior a 2 años y 26 semanas e inferior a 11,0 años en la selección
    -Volumen testicular inferior a 4 ml2
    b) Niñas:
    -Edad igual o superior a 2 años y 26 semanas e inferior a 10,0 años en la selección
    -Estadio 1 de Tanner para el desarrollo mamario: Sin tejido mamario glandular palpable
    15. Retraso del crecimiento, definido como al menos 2,0 desviaciones estándar por debajo de la estatura media para la edad cronológica y el sexo en el momento de la selección según los patrones de referencia de los Center for Disease Control and Prevention
    16. Historial de altura medida entre 6 y 18 meses antes de la selección
    17. El tratamiento de reposición de hormonas tiroideas debe ser suficiente y estable durante al menos 90 días antes de la aleatorización, si procede
    Aplicable a niños con BEI:
    18. Niños prepúberes:
    a) Niños:
    -Edad igual o superior a 2 años y 26 semanas e inferior a 11,0 años en la selección
    -Volumen testicular inferior a 4 ml2
    b) Niñas:
    -Edad igual o superior a 2 años y 26 semanas e inferior a 10,0 años en la selección
    -Estadio 1 de Tanner para el desarrollo mamario: Sin tejido mamario glandular palpable
    19. Edad ósea:
    a) Niños:
    -Edad ósea inferior o igual a 12 años
    -Edad ósea no retrasada o avanzada más de 2 años con respecto a la edad cronológica
    b) Niñas:
    -Edad ósea inferior o igual a 11 años
    -Edad ósea no retrasada o avanzada más de 2 años con respecto a la edad cronológica
    20. Retraso del crecimiento, definido como al menos 2,5 desviaciones estándar por debajo de la estatura media para la edad cronológica y el sexo en el momento de la selección según los patrones de referencia de los Center for Disease Control and Prevention
    21. Historial de altura medida entre 6 y 18 meses antes de la selección
    22. Una secreción normal de GH (máximo de GH superior a 7 ng/ml) durante la prueba de estimulación de GH realizada en los 18 meses previos a la selección o, si no se dispone de dicha prueba en niños con BEI, deberá hacerse como parte de las evaluaciones de selección y los resultados deberán estar disponibles antes de la aleatorización.
    *Si no se dispone de un recuento de 30 linfocitos en pacientes con ST, deberá hacerse una prueba y disponerse de los resultados antes de la aleatorización
    E.4Principal exclusion criteria
    1. Known or suspected hypersensitivity to study intervention(s) or related products.
    2. Previous randomisation into same sub-study in this study.
    3. Receipt of any investigational medicinal product within 3 months before screening or participation in another clinical study at the time of randomisation.
    4. Children with suspected or confirmed growth hormone deficiency according to local practice.
    5. Children diagnosed with diabetes mellitus or screening values from the central laboratory of
    a. fasting plasma glucose above or equal to 126 mg/dL (7.0 mmol/L) or
    b. HbA1c above or equal to 6.5%.
    6. Current inflammatory diseases requiring systemic corticosteroid treatment for longer than 2 consecutive weeks within the last 3 months prior to screening.
    7. Children requiring inhaled glucocorticoid therapy at a dose greater than 400 µg/day of inhaled budesonide or equivalent (i.e., 250 µg/day for fluticasone propionate) for longer than 4 consecutive weeks within the last 12 months prior to screening.
    8. Concomitant administration of other treatments that may have an effect on growth, e.g., but not limited to methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD).
    9. Diagnosis of attention deficit hyperactivity disorder (ADHD).
    10. History or known presence of malignancy including intracranial tumours.
    11. History or known presence of active Hepatitis B or Hepatitis C (exceptions to this exclusion criterion is the presence of antibodies due to vaccination against Hepatitis B).
    12. Any disorder, which in the investigator’s opinion, might jeopardise participant’s safety or compliance with the protocol.
    13. The participant or the parent/legally acceptable representative is likely to be non-compliant in respect to study conduct, as judged by the investigator.
    14. Current treatment with sex hormones or aromatase inhibitors.
    15. Any known or suspected clinically significant abnormality likely to affect growth or the ability to evaluate growth with standing height measurements, such as, but not limited to:
    a. Known family history of skeletal dysplasia.
    b. Significant spinal abnormalities including but not limited to scoliosis, kyphosis and spina bifida variants.
    c. Any other disorder/condition that can cause short stature such as, but not limited to, psychosocial deprivation, nutritional disorders, chronic systemic illness and chronic renal disease.
    Applicable to children with SGA:
    a. TS (including mosaicism).
    b. NS.
    c. Hormonal deficiencies.
    d. Children who are small due to malnutrition defined as -2 standard deviations according to standards. 0¬–5 years: weight for height on World Health Organisation Multicentre Growth Reference Study 2006. Above 5 years: World Health Organisation 2007 Body Mass Index.
    e. Known chromosomal aneuploidy or significant gene mutations causing medical ‘syndromes’ with short stature, including but not limited to Laron syndrome, Prader-Willi syndrome, Russell-Silver Syndrome, skeletal dysplasias, abnormal SHOX gene analysis or absence of GH receptors.
    Applicable to children with TS:
    a. NS.
    b. Mosaicism below 10%.
    c. TS with Y-chromosome mosaicism where gonadectomy has not been performed.
    d. NYHA class II or above or requiring medication for any heart condition.
    e. Coeliac disease where participant is not stable on gluten free diet for the previous 12 months prior to screening.
    Applicable to children with NS:
    a. TS (including mosaicism).
    b. Noonan-related disorders: Noonan syndrome with multiple lentigines (formerly called ‘LEOPARD’ syndrome), Noonan syndrome with loose anagen hair, cardiofaciocutaneous syndrome (CFC), Costello syndrome, neurofibromatosis type 1 (NF1) and Legius syndrome. Molecular genetic testing results must be available prior to randomisation to exclude these.
    c. Coeliac disease where participant is not stable on gluten free diet for the previous 12 months prior to screening.
    Applicable to children with ISS:
    a. TS (including mosaicism).
    b. NS.
    c. Hormonal deficiencies.
    d. Born small for gestational age (defined as birth length below -2 SDS OR birth weight below -2 SDS OR both) (according to national standards).
    e. Known chromosomal aneuploidy or significant gene mutations causing medical ‘syndromes’ with short stature, including but not limited to Laron syndrome, Prader-Willi syndrome, Russell-Silver Syndrome, skeletal dysplasias, abnormal SHOX gene analysis or absence of GH receptors.
    1.Hipersensibilidad conocida o presunta a las intervenciones del estudio o a productos relacionados.
    2.Aleatorización previa al mismo subestudio en este estudio.
    3.Recepción de cualquier producto en investigación en los 3 meses previos a la selección o participación en otro estudio clínico en el momento de la aleatorización.
    4.Niños con sospecha o confirmación de déficit de hormona del crecimiento según la práctica local.
    5.Niños con diagnóstico de diabetes mellitus o un valor de cribado del laboratorio central de
    a. glucemia en ayunas igual o superior a 126 mg/dl (7,0 mmol/l) o
    b. HbA1c superior o igual al 6,5 %.
    6.Enfermedades inflamatorias en curso que necesitan tratamiento con corticosteroides sistémicos durante más de 2 semanas consecutivas en los 3 meses previos a la selección.
    7.Niños que necesiten tratamiento con glucocorticoides inhalados en una dosis superior a 400 µg/día de budesónida inhalada o equivalente (250 µg/día de fluticasona propionato) durante más de 4 semanas consecutivas en los 12 meses previos a la selección.
    8.Administración concomitante de otros tratamientos que puedan tener un efecto sobre el crecimiento, como, por ejemplo, metilfenidato para el tratamiento del trastorno por déficit de atención con hiperactividad (TDAH)
    9.Diagnóstico de trastorno por déficit de atención con hiperactividad (TDAH).
    10.Antecedentes o presencia conocida de neoplasias malignas, incluidos tumores intracraneales.
    11.Antecedentes o presencia conocida de hepatitis B o C activa (las excepciones a este criterio de exclusión son la presencia de anticuerpos debido a la vacunación contra la hepatitis B).
    12.Cualquier trastorno que, en opinión del investigador, pueda poner en peligro la seguridad del paciente o el cumplimiento del protocolo
    13.Según el criterio del investigador, es probable que el participante o el progenitor o representante legal no cumplan las exigencias del estudio.
    14.Tratamiento actual con hormonas sexuales o inhibidores de la aromatasa.
    15.Cualquier anomalía de importancia clínica conocida o sospechada que probablemente afecte al crecimiento o a la capacidad de evaluar el crecimiento con mediciones de la estatura en bipedestación, como, por ejemplo:
    a. Antecedentes familiares conocidos de displasia esquelética.
    b. Anomalías vertebrales importantes como escoliosis, cifosis y variantes de la espina bífida, entre otras.
    c. Cualquier otro trastorno o afección que pueda causar una estatura baja, entre otros, privación psicosocial, trastornos nutricionales, enfermedad sistémica crónica y nefropatía crónica
    Aplicable a los niños PEG:
    a. ST (incluido el mosaicismo)
    b. SN.
    c. Deficiencias hormonales.
    d. Niños pequeños por desnutrición con un tamaño 2 desviaciones estándar inferior a los patrones de referencia. 0–5 años: peso para la altura en el World Health Organisation Multicentre Growth Reference Study 2006. Mayores de 5 años: índice de masa corporal 2007 de la Organización Mundial de la Salud.
    e. Aneuploidía cromosómica conocida o mutaciones génicas importantes que causan «síndromes» médicos de baja estatura, entre ellos, el síndrome de Laron, el síndrome de Prader-Willi, el síndrome de Russell-Silver, las displasias óseas, el análisis anómalo del gen SHOX o ausencia de receptores de GH.
    Aplicable a niños con ST:
    a. SN.
    b. Mosaicismo por debajo del 10 %.
    c. ST con mosaicismo del cromosoma Y en el que no se ha realizado gonadectomía.
    d. Clase II o superior de la NYHA o necesidad de medicación para cualquier enfermedad cardíaca.
    e. Enfermedad celíaca en la que el participante no esté estable con una dieta sin gluten durante los 12 meses previos a la selección
    Aplicable a niños con SN:
    a. ST (incluido el mosaicismo)
    b. Trastornos relacionados con Noonan: síndrome de Noonan con lentigos múltiples (anteriormente denominado síndrome «LEOPARD»), síndrome de Noonan con cabello anágeno suelto, síndrome cardiofaciocutáneo (CFC), síndrome de Costello, neurofibromatosis de tipo 1 (NF1) y síndrome de Legius. Los resultados de los análisis de genética molecular deberán estar disponibles antes de la aleatorización para descartarlos.
    c. Enfermedad celíaca en la que el participante no esté estable con una dieta sin gluten durante los 12 meses previos a la selección.
    Aplicable a los niños con BEI:
    a. ST (incluido el mosaicismo).
    b. SN.
    c. Deficiencias hormonales.
    d. Pequeño para la edad gestacional (definido como una longitud al nacer 2 DE inferior O un peso al nacer 2 DE inferior O ambos) (según los patrones de referencia nacionales).
    e. Aneuploidía cromosómica conocida o mutaciones génicas importantes que causan «síndromes» médicos de baja estatura, entre ellos, el síndrome de Laron, el síndrome de Prader-Willi, el síndrome de Russell-Silver, las displasias óseas, el análisis anómalo del gen SHOX o ausencia de receptores de GH.
    E.5 End points
    E.5.1Primary end point(s)
    Height velocity reported for each indication separately.
    Velocidad de crecimiento notificada para cada indicación por separado
    E.5.1.1Timepoint(s) of evaluation of this end point
    From baseline (week 0) to visit 7 (week 52)
    Desde el momento basal (semana 0) hasta la visita 7 (semana 52)
    E.5.2Secondary end point(s)
    1.1 Change in Height SDS reported for each indication separately.
    1.2 Change in Height Velocity SDS reported for each indication separately.
    1.3 Change in bone age reported for each indication separately
    1.4 Change in IGF-I SDS reported for each indication separately.
    1.5 Change in IGFBP-3 SDS reported for each indication separately.

    2.1 Change in fasting plasma glucose reported for each indication separately.
    2.2 Change in homeostatic model assessment-B (HOMA-B) reported for each indication separately.
    2.3 Change in homeostatic model assessment-IR (HOMAIR) reported for each indication separately.
    2.4 Change in glycated haemoglobin (HbA1c) reported for each indication separately.

    3.1 Weekly average somapacitan concentration (Cavg) based on population PK analysis.

    4.1 Change in fasting plasma glucose reported for each indication separately.
    4.2 Change in homeostatic model assessment-B (HOMA-B) reported for each indication separately.
    4.3 Change in homeostatic model assessment-IR (HOMA-IR) reported for each indication
    separately.
    4.4 Change in glycated haemoglobin (HbA1c) reported for each indication separately.
    1.1 Variación en la SDS (puntuación de la desviación estándar) de la altura notificada para cada indicación por separado
    1.2 Variación en la SDS de la velocidad de crecimiento notificada para cada indicación por separado
    1.3 Variación en la edad osea notificada para cada indicación por separado
    1.4 Variación en la SDS del IGF-I notificada para cada indicación por separado.
    1.5 Variación en la SDS del IGFBP-3 notificada para cada indicación por separado
    2.1 Variación de la glucosa plasmática en ayunas comunicada para cada indicación por separado.
    2.2. Variación en el índice de evaluación del modelo hemostático-B (HOMA-B) notificada para cada indicación por separado
    2.3 Variación en el índice de evaluación del modelo hemostático-IR(HOMAIR) notificada para cada indicación por separado
    2.4 Variación de la HbA1c notificada para cada indicación por separado
    3.1 Concentración media semanal de somapacitán (Cmed.) según el análisis de FC poblacional.
    4.1 Variación de la glucosa plasmática en ayunas comunicada para cada indicación por separado.
    4.2. Variación en el índice de evaluación del modelo hemostático-B (HOMA-B) notificada para cada indicación por separado
    4.3 Variación en el índice de evaluación del modelo hemostático-IR(HOMAIR) notificada para cada indicación por separado
    4.4 Variación de la HbA1c notificada para cada indicación por separado
    E.5.2.1Timepoint(s) of evaluation of this end point
    1.1 From baseline (week 0) to visit 7 (week 52).
    1.2 From baseline (week 0) to visit 7 (week 52).
    1.3 For SGA, TS and NS: From baseline (week 0) to visit 7 (week 52).
    For ISS: From screening (visit 1) to visit 7 (week 52).
    1.4 From baseline (week 0) to visit 7 (week 52).
    1.5 From baseline (week 0) to visit 7 (week 52).


    2.1 From screening (visit 1) to visit 7(week 52).
    2.2 From screening (visit 1) to visit 7(week 52).
    2.3 From screening (visit 1) to visit 7(week 52).
    2.4 From screening (visit 1) to visit 7(week 52).

    3.1 From visit 3 (week 4) to visit 7 (week 52).

    4.1 From screening (visit 1) to visit 15 (week 156).
    4.2 From screening (visit 1) to visit 15 (week 156).
    4.3 From screening (visit 1) to visit 15 (week 156).
    4.4 From screening (visit 1) to visit 15 (week 156).
    1.1 Desde momento basal (semana 0) hasta v 7 (semana 52)
    1.2 Desde momento basal (semana 0) hasta v 7 (semana 52)
    1.3 Para PEG, ST y SN: Desde el momento basal (semana 0) hasta v 7 (semana 52)
    Para BEI: Desde selección (v1) hasta v 7 (semana 52)
    1.4 Desde momento basal (semana 0) hasta v7 (semana 52)
    1.5 Desde momento basal (semana 0) hasta v 7 (semana 52)
    2.1 Desde selección (v1) hasta v 7 (semana 52)
    2.2 Desde selección (v1) hasta v7 (semana 52)
    2.3 Desde selección (v1) hasta v7 (semana 52)
    2.4 Desde selección (v1) hasta v7 (semana 52)
    3.1 Desde visita 3 (semana 4) hasta v7 (semana 52)
    4.1 Desde selección (v1) hasta v15 (semana 156)
    4.2 Desde selección (v1) hasta v15 (semana 156)
    4.3 Desde selección (v1) hasta v15(semana 156)
    4.4 Desde selección (v1) hasta v15(semana156)
    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 No
    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 Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    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) Yes
    E.8.2.2Placebo No
    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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA61
    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
    Brazil
    Canada
    China
    India
    Israel
    Japan
    Korea, Republic of
    Malaysia
    Mexico
    Saudi Arabia
    South Africa
    Thailand
    United States
    European Union
    Switzerland
    Russian Federation
    Serbia
    United Kingdom
    E.8.7Trial 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
    LSLV
    UVUP
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months1
    E.8.9.1In the Member State concerned days15
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months1
    E.8.9.2In all countries concerned by the trial days15
    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: 395
    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) Yes
    F.1.1.5.1Number of subjects for this age range: 395
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) No
    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 state12
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 126
    F.4.2.2In the whole clinical trial 395
    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 Decision2022-12-09
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-11-16
    P. End of Trial
    P.End of Trial StatusOngoing
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