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    Summary
    EudraCT Number:2021-005607-13
    Sponsor's Protocol Code Number:NN8640-4467
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-04-26
    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 ConcernedItaly - Italian Medicines Agency
    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
    Studio per confrontare l’effetto e la sicurezza della somministrazione settimanale di somapacitan con la somministrazione una volta al giorno di Norditropin® e per valutare la sicurezza a lungo termine di somapacitan in uno studio basket in bambini di bassa statura nati piccoli per l’età gestazionale (SGA) o con sindrome di Turner (ST), o con sindrome di Noonan (NS) o con bassa statura idiopatica (ISS)
    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
    Studio clinico per confrontare somapacitan una volta a settimana con Norditropin® una volta al giorno in bambini che hanno bisogno di aiuto per crescere
    A.3.2Name or abbreviated title of the trial where available
    REAL 8
    REAL 8
    A.4.1Sponsor's protocol code numberNN8640-4467
    A.5.3WHO Universal Trial Reference Number (UTRN)U1111-1270-0862
    A.5.4Other Identifiers
    Name:REAL 8Number:NN8640-4467
    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. S.P.A.
    B.1.3.4CountryItaly
    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 support
    B.4.2Country
    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 soluzione per iniezione in penna pre-riempita
    D.2.1.1.2Name of the Marketing Authorisation holderNovo Nordisk A/S
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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 nameSogroya 10 mg/1.5 mL solution for injection in pre-filled pen
    D.3.2Product code [NN8640]
    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.3.9.1CAS number 1338578-34-9
    D.3.9.2Current sponsor codeNA
    D.3.9.3Other descriptive nameSomapacitan
    D.3.9.4EV Substance CodeSUB186254
    D.3.10 Strength
    D.3.10.1Concentration unit mg/l milligram(s)/litre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6700
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 15 mg/1.5 mL PDS290
    D.3.2Product code [NN8640]
    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.3.9.1CAS number 1338578-34-9
    D.3.9.2Current sponsor codeNA
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 Yes
    D.2.1.1.1Trade name Norditropin
    D.2.1.1.2Name of the Marketing Authorisation holderNovo Nordisk A/S
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameNorditropin
    D.3.2Product code [NA]
    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 INNSomatropina
    D.3.9.2Current sponsor codeNA
    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 typenot less then
    D.3.10.3Concentration number6
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 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.3.2Product code [NN8640]
    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.3.9.1CAS number 1338578-34-9
    D.3.9.2Current sponsor codeNA
    D.3.9.3Other descriptive namesomapacitan
    D.3.9.4EV Substance CodeSUB186254
    D.3.10 Strength
    D.3.10.1Concentration unit mg/l milligram(s)/litre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number3300
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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
    Nati piccoli per età gestazionale
    Sindrome di Turner
    Sindrome di Noonan
    Bassa statura idiopatica
    E.1.1.1Medical condition in easily understood language
    Short stature born small for gestational age
    Turner syndrome
    Noonan syndrome
    Idiopathic short stature
    Nati piccoli per età gestazionale
    Sindrome di Turner
    Sindrome di Noonan
    Bassa statura idiopatica
    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.
    Confermare la non inferiorità di somapacitan una volta alla settimana rispetto a Norditropin® una volta al giorno in termini di crescita longitudinale misurata in base alla velocità di crescita alla settimana 52 in bambini con ciascuna delle quattro indicazioni: SGA, TS, NS o ISS.
    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 oncedaily 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. Valutare somapacitan una volta alla settimana rispetto a Norditropin® una volta al giorno in termini di altri aspetti della crescita longitudinale misurata in bambini con ciascuna delle quattro indicazioni: SGA, TS, NS o ISS.
    2. Valutare la sicurezza di somapacitan una volta alla settimana rispetto a Norditropin® una volta al giorno in termini di parametri di sicurezza misurati mediante il metabolismo del glucosio in bambini con ciascuna delle quattro indicazioni: SGA, TS, NS o ISS.
    3. Valutare la farmacocinetica nello stato stazionario di somapacitan una volta a settimana in bambini con ciascuna delle quattro indicazioni: SGA, TS, NS o ISS.
    4. Valutare la sicurezza a lungo termine di somapacitan una volta alla settimana in termini di parametri di sicurezza misurati mediante il metabolismo del glucosio in bambini con ciascuna delle quattro indicazioni: SGA, TS, NS o 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

    Other types of substudies
    Specify title, date and version of each substudy with relative objectives: Four sub-studies are described in this protocol.

    Altre tipologie di sottostudi
    specificare il titolo, la data e la versione di ogni sottostudio con i relativi obiettivi: 4 sottostudi sono descritti nel protocollo.
    E.3Principal inclusion criteria
    1. Informed consent of parent or LAR 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 CDCP.
    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 CDCP, 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 CDCP.
    11. Historical height measured 6–18 months prior to screening.
    12. Thyroid hormone replacement therapy 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 CDCP.
    16. Historical height (6–18 months prior to screening).
    17. Thyroid hormone replacement therapy 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 CDCP.
    21. Historical height measured 6–18 months prior to screening.
    22. Normal GH secretion during GH stimulation test performed within 18 months prior to screening or a test should be during 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. Consenso informato e assenso del minore in base all’età.
    2. No precedente esposizione a terapia di promozione della crescita, inclusi, a titolo esemplificativo ma non esaustivo, analoghi ormone della crescita, IGF-I e grelina.
    Applicabile ai bambini SGA:
    3. Nati piccoli per età gestazionale
    4. Bambini in età prepuberale:
    a) Maschi:
    • Età maggiore o uguale a 2 anni e 26 settimane e minore di 11,0 anni allo screening.
    • Volume testicolare inferiore a 4 ml
    b) Femmine:
    • Età maggiore o uguale a 2 anni e 26 settimane e minore di 10,0 anni allo screening.
    • Stadio di Tanner 1 per lo sviluppo mammario: assenza di tessuto mammario ghiandolare palpabile
    5. Altezza insufficiente: almeno 2,5 deviazioni standard sotto l’altezza media per età cronologica e sesso allo screening secondo gli standard dei CDCP.
    6. Velocità di crescita ridotta: velocità di crescita annualizzata inferiore al 50° percentile per età cronologica e sesso secondo gli standard di Prader (periodo di tempo minimo di 6 mesi e massimo di 18 mesi prima di screening).
    7. Indice di massa corporea inferiore al 95° percentile secondo i CDCP, grafici di crescita dell’Indice di massa corporea per età.
    Applicabile alle bambine con TS:
    8. Diagnosi confermata di TS con analisi cromosomica di linfociti in 30 cellule (o più)*
    9. Bambine in età prepuberale:
    • Età maggiore o uguale a 2 anni e 26 settimane e minore 10,0 anni allo screening.
    • Stadio di Tanner 1 per lo sviluppo mammario: assenza di tessuto mammario ghiandolare palpabile
    10. Altezza insufficiente: almeno 2,0 deviazioni standard al di sotto di altezza media per età cronologica e sesso allo screening secondo standard dei CDCP. 11. Altezza cronologica: 6-18 mesi prima di screening.
    12. Terapia sostitutiva di ormoni tiroidei adeguata e stabile per almeno 90 giorni prima della randomizzazione, se applicabile.
    Applicabile ai bambini con NS:
    13. Diagnosi clinica di NS secondo i criteri di van der Burgt
    14. Bambini in età prepuberale:
    a) Maschi:
    • Età maggiore o uguale a 2 anni e 26 settimane e minore di 11,0 anni allo screening.
    • Volume testicolare inferiore a 4 ml
    b) Femmine:
    • Età maggiore o uguale a 2 anni e 26 settimane e minore di 10,0 anni allo screening.
    • Stadio di Tanner 1 per lo sviluppo mammario: assenza di tessuto mammario ghiandolare palpabile
    15. Altezza ridotta definita come almeno 2,0 deviazioni standard al di sotto dell’altezza media per età cronologica e sesso allo screening secondo gli standard dei CDCP.
    16. Altezza cronologica misurata 6-18 mesi prima dello screening.
    17. La terapia sostitutiva degli ormoni tiroidei adeguata e stabile per almeno 90 giorni prima della randomizzazione, se applicabile.
    Applicabile ai i bambini con ISS:
    18. Bambini in età prepuberale:
    a) Maschi:
    • Età maggiore o uguale a 2 anni e 26 settimane e minore di 11,0 anni allo screening.
    • Volume testicolare inferiore a 4 ml
    b) Femmine:
    • Età maggiore o uguale a 2 anni e 26 settimane e minore di 10,0 anni allo screening.
    • Stadio di Tanner 1 per lo sviluppo mammario: nessun tessuto mammario ghiandolare palpabile
    19. Età ossea:
    a) Maschi:
    • Età ossea minore o uguale a 12 anni.
    • Età ossea non ritardata o avanzata di oltre 2 anni rispetto all’età cronologica.
    b) Femmine:
    • Età ossea minore o uguale a 11 anni.
    • Età ossea non ritardata o avanzata di oltre 2 anni rispetto all’età cronologica.
    20. Altezza ridotta definita come almeno 2,5 deviazioni standard al di sotto dell’altezza media per età cronologica e sesso allo screening secondo gli standard dei CDCP.
    21. Altezza cronologica misurata 6-18 mesi prima di screening.
    22. Normale secrezione di GH durante il test di stimolazione del GH eseguito nei 18 mesi precedenti lo screening oppure, deve essere eseguito un test nell’ambito delle valutazioni di screening e il risultato deve essere disponibile prima di randomizzazione.
    *Se non è disponibile una conta di 30 cellule per i pazienti con TS, deve essere eseguito un test, i risultati devono essere disponibili prima di randomizzazione.
    E.4Principal exclusion criteria
    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).
    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.
    4. Bambini con deficit ormone crescita sospetto o confermato secondo pratica locale.
    5. Diabete mellito o valori di screening :
    a. glucosio plasmatico a digiuno superiore o pari a 126 mg/dl (7,0 mmol/l) o
    b. HbA1c maggiore o uguale a 6,5%
    6. Malattie infiammatorie attualmente presenti richiedenti un trattamento sistemico con corticosteroidi per più di 2 settimane consecutive nei 3 mesi precedenti screening
    7. Bambini che necessitano terapia glucocorticoidi per via inalatoria a dose maggiore 400 µg/die budesonide per via inalatoria o equivalenti per più di 4 settimane consecutive nei 12 mesi precedenti screening
    8. Somministrazione concomitante di altri trattamenti che possono avere un effetto sulla crescita
    9. Diagnosi di disturbo da ADHD)
    10. Anamnesi o presenza di tumori maligni, inclusi i tumori intracranici
    11. Anamnesi o presenza nota epatite B o epatite C attiva (eccezione vaccinazione epatite B)
    14. Attuale trattamento con ormoni sessuali o inibitori aromatasi
    SGA:
    15. Qualsiasi anomalia clinicamente significativa nota o sospetta che possa influire sulla crescita o sulla capacità di valutare la crescita con misurazioni altezza in piedi eg:
    a. Anamnesi familiare notadisplasia scheletrica.
    b. Anomalie spinali significative
    c. Qualsiasi altro disturbo/condizione che possa causare bassa statura
    d. TS (compreso il mosaicismo)
    e. NS
    f. Deficit ormonali
    g. Bambini piccoli per malnutrizione, deviazioni standard -2 in base agli standard.
    h. Aneuploidia cromosomica nota o mutazioni genetiche significative che causano “sindromi” mediche con bassa statura
    TS
    16. Qualsiasi anomalia clinicamente significativa nota o sospetta che possa influire sulla crescita o sulla capacità di valutare crescita con misurazioni altezza in piedi eg:
    a. Anamnesi familiare nota displasia scheletrica.
    b. Anomalie spinali significative
    c. Qualsiasi altro disturbo/condizione che possa causare bassa statura
    d. NS
    e. Mosaicismo inferiore 10%
    f. TS con mosaicismo del cromosoma Y in cui non è stata eseguita gonadectomia
    g. NYHA di classe II o superiore o che richiede farmaci per qualsiasi condizione cardiaca
    h. Celiachia in cui il partecipante non ha seguito dieta priva di glutine stabile nei 12 mesi precedenti screening
    NS
    17. Qualsiasi anomalia clinic significativa nota o sospetta che possa influire su crescita o capacità di valutare crescita con misurazioni altezza in piedi, eg:
    a. Anamnesi familiare nota displasia scheletrica.
    b. Anomalie spinali significative
    c. Qualsiasi altro disturbo/condizione che possa causare bassa statura
    d. TS (compreso mosaicismo)
    e. Disturbi correlati alla sindrome di Noonan: sindrome di Noonan con lentiggini multiple, sindrome di Noonan con capelli caduchi in fase anagen, sindrome cardio-facio-cutanea, sindrome di Costello, neurofibromatosi di tipo 1 e sindrome di Legius. I risultati dei test genetici molecolari devono essere disponibili prima di randomizzazione
    f. Celiachia in cui il partecipante non ha seguito dieta stabile priva di glutine nei 12 mesi precedenti screening.
    ISS
    18. Qualsiasi anomalia clinic significativa nota o sospetta che possa influire sulla crescita o sulla capacità di valutare la crescita con misurazioni dell’altezza in piedi eg:
    a. Anamnesi familiare nota displasia scheletrica
    b. Anomalie spinali significative
    c. Qualsiasi altro disturbo/condizione che possa causare bassa statura
    d. TS (compreso il mosaicismo).
    e. NS.
    f. Deficit ormonali.
    g. Nati piccoli per l’età gestazionale (definiti da lunghezza alla nascita inferiore a -2 SDS OPPURE peso alla nascita inferiore a -2 SDS OPPURE entrambi) (secondo gli standard nazionali).
    h. Aneuploidia cromosomica nota o mutazioni genetiche significative che causano “sindromi” mediche con bassa statura, incluse ma non limitate a sindrome di Laron, sindrome di Prader-Willi, sindrome di Russell-Silver, displasie scheletriche analisi anomala del gene SHOX o assenza di recettori GH.
    E.5 End points
    E.5.1Primary end point(s)
    Height velocity reported for each indication separately
    Velocità di crescita riportata separatamente per ciascuna indicazione
    E.5.1.1Timepoint(s) of evaluation of this end point
    From baseline (week 0) to visit 7 (week 52)
    Dal basale (settimana 0) alla visita 7 (settimana 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 Variazione dello SDS dell’altezza riportato separatamente per ciascuna indicazione
    1.2 Variazione dello SDS della velocità di crescita riportato separatamente per ciascuna indicazione.
    1.3 Variazione dell’età ossea riportata separatamente per ciascuna indicazione
    1.4 Variazione dello SDS del fattore di crescita insulino simile di tipo 1 (IGF-1) riportata separatamente per ciascuna indicazione
    1.5 Variazione dello SDS della proteina 3 legante il fattore di crescita insulino-simile (IGFBP-3) riportato separatamente per ciascuna indicazione
    2.1 Variazione della glicemia plasmatica a digiuno riportata separatamente per ciascuna indicazione
    2.2 Variazione nella valutazione del modello omeostatico-Funzione delle cellule ß (HOMA-B) riportata separatamente per ciascuna indicazione
    2.3 Variazione nella valutazione del modello omeostatico-Insulino-resistenza (HOMA-IR) riportata separatamente per ciascuna indicazione
    2.4 Variazione nell’emoglobina glicata (HbA1c) riportata separatamente per ciascuna indicazione
    3.1 Concentrazione media settimanale di somapacitan (Cmedia) in base all’analisi PK per popolazione
    4.1 Variazione della glicemia plasmatica a digiuno riportata separatamente per ciascuna indicazione
    4.2 Variazione nella valutazione del modello omeostatico-Funzione delle cellule ß (HOMA-B) riportata separatamente per ciascuna indicazione
    4.3 Variazione della valutazione del modello omeostatico-IR (HOMA-IR) riportata separatamente per ciascuna indicazione
    4.4 Variazione nell’emoglobina glicata (HbA1c) riportata separatamente per ciascuna indicazione
    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 Dal basale (settimana 0) alla visita 7 (settimana 52)
    1.2 Dal basale (settimana 0) alla visita 7 (settimana 52)
    1.3 Per SGA, TS e NS: dal basale (settimana 0) alla visita 7 (settimana 52). Per ISS: dallo screening (visita 1) alla visita 7 (settimana 52)
    1.4 Dal basale (settimana 0) alla visita 7 (settimana 52)
    1.5 Dal basale (settimana 0) alla visita 7 (settimana 52)
    2.1 Dallo screening (visita 1) alla visita 7 (settimana 52)
    2.2 Dallo screening (visita 1) alla visita 7 (settimana 52)
    2.3 Dallo screening (visita 1) alla visita 7 (settimana 52)
    2.4 Dallo screening (visita 1) alla visita 7 (settimana 52)
    3.1 Dalla visita 3 (settimana 4) alla visita 7 (settimana 52)
    4.1, 4.2, 4.3, 4.4: Dallo screening (visita 1) alla visita 15 (settimana 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 concerned6
    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 Information not present in EudraCT
    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
    Russian Federation
    Saudi Arabia
    Serbia
    South Africa
    Thailand
    United States
    United Kingdom
    Switzerland
    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
    LVLS
    LVLS
    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.1.1.1In 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 state16
    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)
    NA
    NA
    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 Decision2022-07-07
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-15
    P. End of Trial
    P.End of Trial StatusOngoing
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