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    Summary
    EudraCT Number:2021-005607-13
    Sponsor's Protocol Code Number:NN8640-4467
    National Competent Authority:Croatia - MIZ
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-12-06
    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 ConcernedCroatia - MIZ
    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.
    Ispitivanje u kojem se uspoređuje djelotvornost i sigurnost primjene somapacitana jednom tjedno u odnosu na dnevnu primjenu lijeka Norditropin®, kao i procjena dugoročne sigurnosti primjene somapacitana u niske djece rođene male za gestacijsku dob ili s Turnerovim sindromom ili s Noonanovim sindromom ili djece s idiopatski niskim rastom
    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
    Kliničko ispitivanje kojim se uspoređuje somapacitan primijenjen jednom tjedno u odnosu na lijek Norditropin® primijenjen jednom dnevno u djece s problemom rasta
    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
    Djeca rođena mala za gestacijsku dob
    Turnerov sindrom
    Noonanov sindrom
    Djeca s idiopatski niskim rastom
    E.1.1.1Medical condition in easily understood language
    Short stature born small for gestational age
    Turner syndrome
    Noonan syndrome
    Idiopathic short stature
    Djeca rođena mala za gestacijsku dob
    Turnerov sindrom
    Noonanov sindrom
    Djeca s idiopatski niskim rastom
    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.
    Potvrditi neinferiornost somapacitana primjenjivanog jednom tjedno u usporedbi s Norditropinom® primjenjivanog jednom dnevno u smislu mjerenja brzine longitudinalnog rasta visine u 52. tjednu kod niske djece rođene male za gestacijsku dob, ili s Turnerovim sindromom, ili s Noonanovim sindromom ili djece s idiopatski niskim rastom.
    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. Procijeniti somapacitan koji se primijenjuje jednom tjedno u usporedbi s lijekom Norditropin® koji se primijenjuje jednom dnevno u smislu drugih aspekata longitudinalnog rasta kod djece kod svake od četiri indikacije: SGA, TS, NS ili ISS.
    2. Procijeniti sigurnost somapacitana primjenjenog jednom tjedno u usporedbi s lijekom Norditropin® primjenjenog jednom dnevno u pogledu sigurnosnih parametara mjerenjem metabolizma glukoze kod djece kod svake od četiri indikacije: SGA, TS, NS ili ISS
    3. Procijeniti farmakokinetiku u stanju dinamičke ravnoteže kod primjene somapacitana jednom tjedno djece s jednom od sljedećih četiri indikacija SGA, TS, NS ili ISS.
    4. Procijeniti dugoročnu sigurnost primjene somapacitana koji se daje jednom tjedno u smislusigurnosnhi parametara mjerenih metabolizmom glukoze u djece s jednom od 4 indikacije SGA, TS, NS ili ISS.
    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
    U ovom su planu ispitivanja opisane četiri podstudije
    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.Potpisani Informirani pristanak roditelja ili ispitanikovog zakonski ovlaštenog zastupnika/skrbnika i pristanak djeteta, prije bilo kakvih aktivnosti povezanih s ispitivanjem. Pod aktivnosti povezane s ispitivanjem ubrajaju se svi postupci koji se provode kao dio ispitivanja kao i uvrđivanje prikladnosti ispitanika za sudjelovanje u ispitivanju.
    2.Nužno je da ispitanik prethodno ne bude izložen terapiji za poticanje rasta, uključujući ali ne i limitirajući se na hormone rasta, IGF-I i analoge greline.

    Za djecu sa SGA:
    3.Djeca rođena malena za gestacijsku dob (duljina kod porođaja ispod -2 SDS ili težina pri porođaju ispod -2 SDS ili oboje) (prema nacionalnim standardima)
    4.Predpubertetska djeca:
    a)Dječaci:
    • Dob ≥ 2 godine i 26 tjedana i < od 11 godina u trenutku probira
    • Volumen testisa manji od 4 mL
    b)Djevojčice:
    • Dob ≥ 2 godine i 26 tjedana i < od 10 godina u trenutku probira
    • Tannerov stupanj 1 za razvoj grudi: nema opipljivog žlijezdanog tkiva dojke
    5.Poremećaj rasta definiran kao najmanje 2,5 standardne devijacije ispod srednje visine za kronološku dob i spol pri probiru prema standardima Centers for Disease Control and Prevention
    6.Poremećaj rasta definiran kao godišnja brzina rasta umanjena za 50 % za kronološku dob i spol prema Praderovim standardima izračunata u vremenskom rasponu od najmanje 6 mjeseci i najviše 18 mjeseci prije probira.
    7.Indeks tjelesne mase < 95 percentila prema standardima grafikona rasta i indeksa tjelesne mase za dob Centers for Disease Control and Prevention.
    Za djevojčice s Turnerovim sindromom:
    8.Potvrđena dijagnoza Turnerova síndroma kromosomskom analizom limfocita od 30 (ili više) stanica (ako broj od 30 stanica nije dostupan za pacijente s Turnerovim sindromom, potrebno je napraviti test, a rezultati moraju biti dostupni prije randomizacije)
    9.Djevojčice u prepubertetu:
    • Dob ≥ 2 godine i 26 tjedana i manja od 10 godina u trenutku probira
    • Tunnerov stupanj 1 za razvoj grudi: nema opipljivog žlijezdanog tkiva dojke
    10.Poremećaj rasta definiran kao najmanje 2,0 standardne devijacije ispod srednje visine za kronološku dob i spol pri probiru prema standardima Centers for Disease Control and Prevention. Mjerena visina 6-18 mjeseci prije probira
    11.Nadomjesna terapija hormonima štitnjače mora biti odgovarajuća i stabilna najmanje 90 dana prije randomizacije, ako je primjenjivo.

    Za djecu s Noonanovim sindromom:
    12. Klinička dijagnoza Noonanovog síndroma prema van der Burgtovoj bodovnoj listi
    13.Predpubertetska djeca:
    a)Dječaci:
    • Dob ≥ 2 godine i 26 tjedana i < od 11 godina u trenutku probira
    • Volumen testisa manji od 4 Ml
    b)Djevojčice:
    • Dob ≥ 2 godine i 26 tjedana i < od 10 godina u trenutku probira
    • Tannerov stupanj 1 za razvoj grudi: nema opipljivog žlijezdanog tkiva dojke
    14.Poremećaj rasta definiran kao najmanje 2,0 standardne devijacije ispod srednje visine za kronološku dob i spol pri probiru prema standardima Centers for Disease Control and Prevention. Mjerena visina 6-18 mjeseci prije probira
    15.Nadomjesna terapija hormonima štitnjače mora biti odgovarajuća i stabilna najmanje 90 dana prije randomizacije, ako je primjenjivo.

    Za djecu s ISS:
    16.Predpubertetska djeca:
    a)Dječaci:
    • Dob ≥ 2 godine i 26 tjedana i < od 11 godina u trenutku probira
    • Volumen testisa manji od 4 mL
    b)Djevojčice:
    • Dob ≥ 2 godine i 26 tjedana i < od 10 godina u trenutku probira
    • Tannerov stupanj 1 za razvoj grudi: nema opipljivog žlijezdanog tkiva dojke
    17. Koštana dob:
    a) Dječaci:
    • Koštana dob ≤ 12 godina
    • Koštana dob nije odgođena ili uznapredovala više od 2 godine u usporedbi s kronološkom dobi
    b)Djevojčice:
    • Koštana dob ≤ 11 godina
    • Koštana dob nije odgođena ili uznapredovala više od 2 godine u usporedbi s kronološkom dobi
    18.Poremećaj rasta definiran kao najmanje 2,5 standardne devijacije ispod srednje visine za kronološku dob i spol pri probiru prema standardima Centers for Disease Control and Prevention. Mjerena visina 6-18 mjeseci prije probira
    19.Jedno normalno izlučivanje GH (vršna vrijednost iznad 7 ng/ml) tijekom testa stimulacije GH obavljenog unutar 18 mjeseci prije probira ili ukoliko takav test nije dostupan za djecu s ISS, test treba provesti kao dio procjene ispitanika, a rezultat mora biti dostupan prije randomizacije.
    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.Poznate preosjetljivosti ili sumnja na preosjetljivost na ispitivanu(e) supstancu ili srodne tvari.
    2.Prethodna randomizacija u istu podstudiju u ovom ispitivanju
    3.Primanje bilo kojeg ispitivanog lijeka unutar 3 mjeseca prije probira ili sudjelovanje u drugom kliničkom ispitivanju u vrijeme randomizacije.
    4.Djeca sa sumnjom ili potvrđenim nedostatkom hormona rasta prema lokalnoj praksi
    5.Djeca s dijagnozom šećerne bolesti ili sa sljedećim vrijednostima mjerenim u centralnom laboratoriju na probiru :
    a) Glukoza u plazmi natašte ≥ 7,0 mmol/L ili
    b) HbA1c ≥ 6,5%
    6.Aktivne upalne bolesti koje zahtjevaju sistemsko liječenje kortikosteroidima dulje od 2 uzastopna tjedna unutar 3 mjeseca prije probira.
    7.Djeca kojoj je potrebna inhalacijska glukokortikoidna terapija u dozi većoj od 400 μg/ dan inhaliranog budezonida ili ekvivalenta (tj 250 μg/ dan za flutikazonpropionat) dulje od 4 uzastopna tjedna unutar 12 mjeseci prije probira.
    8.Istodobna primjena drugih tretmana koji mogu imati učinak na rast, npr. metilfenidat za liječenje poremećaja pažnje i hiperaktivnosti (ADHD), ali i drugih.
    9.Dijagnoza poremećaja pažnje i hiperaktivnosti (ADHD)
    10.Povijest ili poznata prisutnost zloćudnog tumora uključujući intrakranijalne tumore
    11.Povijest ili poznata prisutnost aktivnog hepatitisa B ili hepatitisa C (izuzetak od ovog isključnog kriterija je prisutnost protutijela zbog cijepljenja protiv hepatitisa B)
    12.Svaki poremećaj koji bi po mišljenju glavnog ispitivača mogao uzgroziti sigurnost ispitanika ili praćenje plana ispitivanja.
    13.Ispitanik ili roditelj / zakonski ovlašteni zastupnik koji nisu u skladu s provođenjem ispitivanja
    14.Aktivno liječenje spolnim hormonima ili inhibitorima aromataza
    15.Svaka poznata klinički značajna abnormalnost ili sumnja na nju koja bi mogla utjecati na rast ili sposobnost procjene rasta mjerenjem visine u stojećem položaju, kao što su (ali ne ograničavajući se na njih):
    a)Poznata obiteljska povijest skeletne displazije
    b)Značajne abnormalnosti kralježnice kao što su: oblici skolioze, kifoze, spine bifide itd...
    c)Bilo koji drugi poremećaj/stanje koje može uzrokovati nizak rast kao što su: psihosocijalna deprivacija, poremećaj prehrane, kroničke sistemske bolesti, kronične bolesti bubrega itd.

    Primjeljivo za djecu sa SGA:
    a) Turnerov sindrom (uključujući mozaicizam)
    b) Noonan sindrom
    c) Hormonalni nedostatci
    d) Djeca koja su mala zbog pothranjenosti definirana kao -2 SDS. 0-5 godina: težina u odnosu na visinu prema Multicentričnoj referentnoj studiji rasta Svjetske zdravstvene organizacije 2006. Iznad 5 godina: Indeks tjelesne mase
    e) Poznata kromosomska aneuploidija ili značajne mutacije gena koje uzrokuju medicinske “sindrome” s niskim rastom, uključujući ali se ne ograničavajući na Laronov sindrom, Prader-Wilijev sindrom, Russell-Silverov sindrom, skeletne displazije, abnormalnu analizu SHOX gena ili odsutnost GH receptora.

    Primjeljivo za djecu s Turnerovim sindromom:
    a) Noonanov sindrom
    b) Mozaicizam ispod 10%
    c) Turnerov sindrom s mozaicizmom Y kromosoma gdje gonadektomija nije učinjena
    d) NYHA klasa II ili veća,ili ona djeca koja zahtjevaju lijekove za bilo koje srčano oboljenje
    e) Celijakija kod koje ispitanik nije stabilan na bezglutenskoj dijeti prethodnih 12 mjeseci prije probira

    Primjeljivo za djecu s Noonanovim sindromom:
    a) Turnernov sindrom (uključujući mozaicizam)
    b) Poremećaji povezani s Noonanom: Noonan sindrom s višestrukim lentiginima (ranije zvan “Leopard” sindrom), Noonan sindrom s opuštenom anagenom kosom, kardiofacijalno-kožni sindrom (CFC), Costellov sindrom, neurofibromatoza tipa 1 (NF1) i Legiusov sindrom. Rezultati molekularno genetičkog testiranja, moraju biti dostupni prije randomizacije kako bi se oni isključiti
    c) Celijakija kod koje ispitanik nije stabilan na bezglutenskoj dijeti prethodnih 12 mjeseci prije probira

    Primjeljivo za djecu s ISS-om:
    a) Turnerov sindrom (uključujući mozaicizam)
    b) Noonanov sindrom
    c) Hormonalni nedostatci
    d) Djeca rođena mala za gestacijsku dob (definirano kao porodna duljina ispod -2 SD ili porođajna težina ispod -2 SDS ili oboje)
    e) Poznata kromosomska aneuploidija ili značajne mutacije gena koje uzrokuju medicinske “síndrome” s niskim rastom, uključujući ali ne i ograničavajući se na : Laronov sindrom, Prader-Wilijev sindrom, Russell-Silverov sindrom, skeletne displazije, abnormalnu analizu SHOX gena ili odsutnost GH receptora.
    E.5 End points
    E.5.1Primary end point(s)
    Height velocity reported for each indication separately.
    Brzina rasta kod svake indikacije zasebno
    E.5.1.1Timepoint(s) of evaluation of this end point
    From baseline (week 0) to visit 7 (week 52)
    Od početka ispitivanja (tjedan 0) do 52. tjedna
    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 Promjena u visini standardne devijacije visine (SDS, Standard Deviation Score) za svaku indikaciju zasebno
    1.2 Promjena u brzini povišenja standardne devijacije visine (SDS, Standard Deviation Score) za svaku indikaciju zasebno,
    1.3 Promjena u koštanoj dobi za svaku indikaciju zasebno
    1.4 promjena u razini IGF-1 (inzulinu sličan faktor rasta 1) standardne devijacije visine (SDS, Standard Deviation Score) za svaku indikaciju zasebno
    1.5 Promjena u IGFBP-3 SDS za svaku indikaciju zasebno

    2.1 Promjena u vrijednosti glukoze u plazmi natašte (mmol/L), za svaku indikaciju zasebno
    2.2 Promjena u procjeni homeostatskog modela-B (HOMA-B) svaku indikaciju zasebno.
    2.3 Promjena u procjeni homeostatskog modela-IR (HOMAIR) za svaku indikaciju zasebno.
    2.4 Promjena HbA1c za svaku indikacija zasebno.

    3.1Prosječna tjedna koncentracija somapacitana (ng/mL) izračunato na temelju populacijskih PK analiza
    4.1 Promjena u vrijednosti glukoze u plazmi natašte (mmol/L), za svaku indikaciju zasebno
    4.2 Promjena u procjeni homeostatskog modela-B (HOMA-B) svaku indikaciju zasebno.
    4.3 Promjena u procjeni homeostatskog modela-IR (HOMAIR) za svaku indikaciju zasebno.
    4.4 Promjena HbA1c za svaku indikacija zasebno
    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 i 1.2 Od početka ispitivanja (tjedan 0) do posjeta 7 (52. tjedan).
    1.3 Za SGA, TS i NS: od početka ispitivanja (tjedan 01) do posjeta 7 (52. tjedan).
    Za ISS: od probira (posjet 1) do posjeta 7 (52. tjedan)
    1.4 i 1.5 Od početka ispitivanja (tjedan 0) do posjeta 7 (52. tjedan).
    2.1, 2.2, 2.3 i 2.4 Od probira (posjet 1) do posjeta 7 (52. tjedan).
    3.1 Od posjeta 3 (tjedan 4) do posjeta 7 (52. tjedan).
    4.1 Od probira (posjet 1) do posjeta 15 (tjedan 156).
    4.2 Od probira (posjet 1) do posjeta 15 (tjedan 156).
    4.3 Od probira (posjet 1) do posjeta 15 (tjedan 156).
    4.4 Od probira (posjet 1) do posjeta 15 (tjedan 156).
    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 concerned2
    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
    United Kingdom
    Serbia
    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
    LSLV
    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.1.2.1Number of subjects for this age range: 0
    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 No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state6
    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
    Nema
    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 Decision2022-11-24
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-09-29
    P. End of Trial
    P.End of Trial StatusOngoing
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