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    Summary
    EudraCT Number:2021-005607-13
    Sponsor's Protocol Code Number:NN8640-4467
    National Competent Authority:Lithuania - SMCA
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2023-01-27
    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 ConcernedLithuania - SMCA
    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.
    Tyrimas, skirtas kartą per savaitę vartojamo somapacitano ir kasdien vartojamo „Norditropin®“ poveikiui ir saugumui palyginti, taip pat ilgalaikiam somapacitano saugumui įvertinti kauptinio tyrimo modelyje mažaūgiams vaikams, kurie gimė per maži pagal gestacinį amžių arba kurie turi Turnerio sindromą, Noonano sindromą arba yra idiopatinio mažo ūgio.
    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
    Tyrimas, skirtas lyginti kartą per savaitę vartojamą somapacitaną su kartą per dieną Norditropin® vartojamu vaikams, kuriems reikia padėti augti.
    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
    Vaikai maži pagal gestacinį amžių;
    Turnerio sindromas;
    Noonano sindromas;
    Vaikai idiopatinio mažo ūgio.
    E.1.1.1Medical condition in easily understood language
    Short stature born small for gestational age
    Turner syndrome
    Noonan syndrome
    Idiopathic short stature
    Vaikai maži pagal gestacinį amžių;
    Turnerio sindromas;
    Noonano sindromas;
    Vaikai idiopatinio mažo ūgio.
    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 10028395 - Musculoskeletal and connective tissue disorders
    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 10036585 - Pregnancy, puerperium and perinatal conditions
    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.
    Šio tyrimo pagrindinis tikslas yra patvirtinti, kad kartą per savaitę vartojamas somapacitanas nenusileidžia kasdien vartojamam „Norditropin®“, vertinant 52-ąją savaitę pagal augimo dinamiką, remiantis kiekvieną iš keturių skyrimo indikacijų MGA, TS, NS arba IMŪ atitinkančių vaikų augimo greičio matavimais.
    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.
    Šio tyrimo svarbiausi papildomi tikslai yra įvertinti kitus augimo dinamikos aspektus ir kartą per savaitę vartojamo somapacitano saugumą, įskaitant ilgalaikį saugumą, lyginant su kasdien vartojamu „Norditropin®“, vertinant pagal saugumo parametrus, remiantis kiekvieną iš keturių skyrimo indikacijų MGA, TS, NS arba IMŪ atitinkančių vaikų gliukozės metabolizmo matavimais.
    Be to, nusistovėjus tiriamojo vaistinio preparato pusiausvyros apykaitai, bus įvertinta kiekvieną iš keturių skyrimo indikacijų MGA, TS, NS arba IMŪ atitinkančių vaikų kartą per savaitę vartojamo somapacitano farmakokinetika.
    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
    Keturios sub-studijos nurodytos tyrimo protokole.
    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.Prieš pradedant bet kokius su tyrimu susijusius veiksmus, turi būti gautas informuotų dalyvio tėvų arba teisiškai priimtino atstovo sutikimas ir, priklausomai nuo amžiaus, vaiko pritarimas. Su tyrimu susiję veiksmai apibrėžiami kaip bet kokios tyrimo tikslais atliekamos procedūros, įskaitant veiksmus, skirtus tinkamumui dalyvauti tyrime nustatyti.
    2.Jokio ankstesnio augimo skatinančio gydymo, įskaitant, be kita ko, gydymą augimo hormonu, IGF-1 ir grelino analogais.
    Taikoma vaikams su MGA diagnoze:
    3.Gimę maži pagal gestacinį amžių (gimimo ūgis < -2 SNR ARBA gimimo svoris < -2 SNR, ARBA abu) (pagal nacionalines normas). Japonija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    4.Vaikai iki lytinio brendimo:
    a)Berniukai:
    •Amžius ≥ 2 metai ir 26 savaitės, bet < 11,0 metų atrankos metu.
    •Sėklidžių tūris < 4 ml.2
    b)Mergaitės:
    •Amžius ≥ 2 metai ir 26 savaitės, bet < 10,0 metų atrankos metu.
    •1 brendimo stadija pagal Tanerį (angl. Tanner), vertinant krūtų išsivystymą: nėra apčiuopiamo liaukinio krūties audinio.
    5.Sutrikęs ūgis, apibrėžiamas kaip ūgis atrankos metu, mažiausiai 2,5 standartinio nuokrypio mažesnis už vidutinį ūgį, atsižvelgiant į chronologinį amžių ir lytį, pagal Ligų kontrolės ir prevencijos centrų (angl. Centers for Disease Control and Prevention) normas.3 Indija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    6.Sutrikęs augimo greitis apibrėžiamas kaip remiantis ne trumpesnio kaip 6 mėnesių ir ne ilgesnio kaip 18 mėnesių laikotarpio iki atrankos duomenimis apskaičiuotas metinis augimo greitis, mažesnis už 50-ąjį procentilį, atsižvelgiant į chronologinį amžių ir lytį, pagal Preiderio (angl. Prader) normas.4
    7.Kūno masės indeksas, mažesnis už 95-ąjį procentilį, pagal Ligų kontrolės ir prevencijos centrų (angl. Centers for Disease Control and Prevention) kūno masės indekso, atsižvelgiant į amžių, lenteles augantiems vaikams.3 Indija: Žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    Taikoma mergaitėms su TS diagnoze:
    8.Patvirtinta TS diagnozė, remiantis 30 (ar daugiau) limfocitų chromosomine analize.* Jungtinė Karalystė: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    9.Mergaitės iki lytinio brendimo:
    •amžius ≥ 2 metai ir 26 savaitės, bet < 10,0 metų atrankos metu.
    •1 brendimo stadija pagal Tanerį (angl. Tanner), vertinant krūtų išsivystymą: nėra apčiuopiamo liaukinio krūties audinio.
    10.Sutrikęs ūgis, apibrėžiamas kaip ūgis atrankos metu, mažiausiai 2,0 standartinio nuokrypio mažesnis už vidutinį ūgį, atsižvelgiant į chronologinį amžių ir lytį, pagal Ligų kontrolės ir prevencijos centrų (angl. Centers for Disease Control and Prevention) normas.3 Indija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    11.Istorinis ūgis, išmatuotas prieš 6–18 mėnesių iki atrankos.
    12.Pakankama ir bent 90 dienų iki skyrimo į atsitiktinės atrankos būdu sudaromas tiriamojo vaistinio preparato vartojimo grupes (randomizacijos) stabili pakaitinė terapija skydliaukės hormonais, jei taikoma.
    Taikoma vaikams su NS diagnoze:
    13.Klinikinė NS diagnozė pagal van der Burgt įverčių sąrašą (žr. 8-2 lentelę).5 Japonija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    14.Vaikai iki lytinio brendimo:
    a)Berniukai:
    •Amžius ≥ 2 metai ir 26 savaitės, bet < 11,0 metų atrankos metu.
    •Sėklidžių tūris < 4 ml.2
    b)Mergaitės:
    •Amžius ≥ 2 metai ir 26 savaitės, bet < 10,0 metų atrankos metu.
    •1 brendimo stadija pagal Tanerį (angl. Tanner), vertinant krūtų išsivystymą: nėra apčiuopiamo liaukinio krūties audinio.
    15.Sutrikęs ūgis, apibrėžiamas kaip ūgis, kuris mažiausiai 2,0 standartiniais nuokrypiais mažesnis už vidutinį ūgį, atsižvelgiant į chronologinį amžių ir lytį, atrankos metu pagal Ligų kontrolės ir prevencijos centrų standartus.3 Indija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    16.Istorinis ūgis, išmatuotas prieš 6–18 mėnesių iki atrankos.
    17.Pakankama ir bent 90 dienų iki skyrimo į atsitiktinės atrankos būdu sudaromas tiriamojo vaistinio preparato vartojimo grupes (randomizacijos) stabili pakaitinė terapija skydliaukės hormonais, jei taikoma.
    Taikoma vaikams su IMŪ diagnoze:
    18.Vaikai iki lytinio brendimo:
    a)Berniukai:
    •Amžius ≥ 2 metai ir 26 savaitės, bet < 11,0 metų atrankos metu.
    •Sėklidžių tūris < 4 ml.2
    b)Mergaitės:
    •Amžius ≥ 2 metai ir 26 savaitės, bet < 10,0 metų atrankos metu.
    •1 brendimo stadija pagal Tanerį (angl. Tanner), vertinant krūtų išsivystymą: nėra apčiuopiamo liaukinio krūties audinio.
    19.Kaulinis amžius:
    a)Berniukai:
    •Kaulinis amžius mažesnis arba atitinka 12 metų.
    •Kaulinis amžius neatsilieka arba nelenkia chronologinio daugiau kaip 2 metais.
    b)Mergaitės:
    •Kaulinis amžius mažesnis arba atitinka 11 metų.
    •Kaulinis amžius neatsilieka arba nelenkia chronologinio daugiau kaip 2 metais.
    Prašome 20-22 kriterinijus žiūrėti protokolo santraukoje.
    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.Žinomas arba įtariamas padidėjęs jautrumas tiriamajai (-osioms) intervencijai (-oms) arba susijusiems preparatams.
    2.Ankstesnis skyrimas į atsitiktinės atrankos būdu sudaromas tiriamojo vaistinio preparato vartojimo grupes tam pačiame daliniame tyrime (šio tyrimo dalyje).
    3.Bet kokio tiriamojo vaistinio preparato vartojimas per 3 mėnesius iki atrankos arba dalyvavimas kitame klinikiniame tyrime skyrimo į atsitiktinės atrankos būdu sudaromas tiriamojo vaistinio preparato vartojimo grupes (randomizacijos) metu. Brazilija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    4.Vaikai, kuriems pagal vietos praktiką įtariama arba patvirtinta augimo hormono stoka.
    5.Vaikai, kuriems diagnozuotas cukrinis diabetas, arba atrankos metu centrinėje laboratorijoje atlikto:
    a.gliukozės kiekio plazmoje nevalgius tyrimo rezultatas didesnis arba lygus 126 mg/dl (7,0 mmol/l), arba
    b.HbA1c tyrimo rezultatas didesnis arba lygus 6,5 %.
    6.Esamos uždegiminės ligos, dėl kurių reikėjo sisteminio gydymo kortikosteroidais ilgiau nei 2 savaites iš eilės per paskutinius 3 mėnesius iki atrankos.
    7.Vaikai, kuriems reikėjo gydymo inhaliuojamaisiais gliukokortikoidais didesne nei 400 µg inhaliuojamojo budezonido paros doze arba lygiaverte kito preparato paros doze (pavyzdžiui, 250 µg flutikazono propionato paros doze) ilgiau nei 4 savaites iš eilės per pastaruosius 12 mėnesių iki atrankos.
    8.Greta taikomas kitas gydymas, galintis turėti įtakos augimui, pavyzdžiui, be kita ko, dėmesio trūkumo ir hiperaktyvumo sutrikimo (ADHD, angl. attention deficit hyperactivity disorder) gydymas metilfenidatu.
    9.Dėmesio trūkumo ir hiperaktyvumo sutrikimo (ADHD) diagnozė.
    10.Piktybinis procesas, įskaitant intrakranijinius navikus, šiuo metu arba anamnezėje.
    11.Aktyvus hepatitas B arba hepatitas C šiuo metu arba anamnezėje (šio neįtraukimo kriterijaus išimtis – antikūnų buvimas dėl skiepijimo nuo hepatito B).
    12.Bet kokie sutrikimai, kurie, tyrėjo nuomone, gali kelti pavojų dalyvio saugumui ar neleisti laikytis protokolo reikalavimų.
    13.Tyrėjo manymu tikėtina, kad dalyvis arba jo tėvai / teisiškai priimtinas atstovas gali nesilaikyti dalyvavimo tyrime reikalavimų.
    14.Šiuo metu taikomas gydymas lytiniais hormonais arba aromatazės inhibitoriais.
    Taikoma vaikams su MGA diagnoze:
    15.Bet kokia žinoma ar įtariama kliniškai reikšminga anomalija, galinti turėti įtakos augimui arba galimybei augimą įvertinti matuojant ūgį stovint, pavyzdžiui, be kita ko (Indija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus):
    a.Žinoma šeiminė skeleto displazija.
    b.Reikšmingos stuburo anomalijos, įskaitant, be kita ko, skoliozę, kifozę ir įskilo stuburo (spina bifida) variantus.
    c.Bet koks kitas sutrikimas / būklė, galintys lemti mažą ūgį, pavyzdžiui, be kita ko, blogos psichosocialinės sąlygos, mitybos sutrikimai, lėtinės sisteminės ligos ir lėtinė inkstų liga.
    d.TS (įskaitant mozaikiškumą). Indija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    e.NS.
    f.Hormonų stoka.
    g.Vaikai, kurie maži dėl prastos mitybos (apibrėžiama kaip -2 standartiniai nuokrypiai pagal normas). 0–5 metai: nustatoma, remiantis svoriu, atsižvelgiant į ūgį, pagal Pasaulio sveikatos organizacijos 2006 m. daugiacentrį augimo normų tyrimą. Vyresni nei 5 metų: nustatoma, remiantis Pasaulio sveikatos organizacijos 2007 m. kūno masės indeksu. Indija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus.
    h.Žinoma chromosominė aneuploidija arba reikšmingos genų mutacijos, lemiančios su mažu ūgiu susijusius medicininius sindromus, įskaitant, be kita ko, Larono (angl. Laron) sindromą, Preiderio-Vilio (angl. Prader-Willi) sindromą, Raselo-Silverio (angl. Russell-Silver) sindromą, skeleto displazijas, nenormalius SHOX geno tyrimo rezultatus arba AH receptorių nebuvimą.
    Taikoma vaikams su TS diagnoze:
    16.Bet kokia žinoma ar įtariama kliniškai reikšminga anomalija, galinti turėti įtakos augimui arba galimybei augimą įvertinti matuojant ūgį stovint, pavyzdžiui, be kita ko (Indija: žr. 11 priede (10.11 skyrius) pateiktus vietos reikalavimus):
    a.Žinoma šeiminė skeleto displazija.
    b.Reikšmingos stuburo anomalijos, įskaitant, be kita ko, skoliozę, kifozę ir įskilo stuburo (spina bifida) variantus.
    c.Bet koks kitas sutrikimas / būklė, galintys lemti mažą ūgį, pavyzdžiui, be kita ko, blogos psichosocialinės sąlygos, mitybos sutrikimai, lėtinės sisteminės ligos ir lėtinė inkstų liga.
    d.NS.
    e.Mozaikiškumas < 10 %.
    f.TS su Y chromosomos mozaikiškumu, jei neatlikta gonadektomija.
    g.II ar aukštesnė klasė pagal NYHA arba reikia vaistų dėl bet kokios širdies ligos.
    h.Celiakija, jei dalyvis per pastaruosius 12 mėnesių iki atrankos ne visada laikėsi beglitimės dietos.
    Taikoma vaikams su NS diagnoze:
    Dėl 17-18 kriterijų prašome žiūrėti protokolo santrauką.
    E.5 End points
    E.5.1Primary end point(s)
    Height velocity reported for each indication separately.
    Augimo greitis nurodytas kiekvienai indikacijai atskirai.
    E.5.1.1Timepoint(s) of evaluation of this end point
    From baseline (week 0) to visit 7 (week 52)
    Nuo pradinio lygio (0 savaitė) iki 7 vizito (52 savaitė)
    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 Ūgio pokytis SDS, apie kurį pranešama atskirai kiekvienai indikacijai.
    1.2 Aukščio greičio pokytis SDS, apie kurį pranešama atskirai kiekvienai indikacijai.
    1.3 Kaulų amžiaus pokytis, apie kurį pranešta atskirai kiekvienai indikacijai
    1.4 IGF-I SDS pokytis, apie kurį pranešta atskirai kiekvienai indikacijai.
    1.5 IGFBP-3 SDS pokytis, apie kurį pranešama atskirai kiekvienai indikacijai.

    2.1 Gliukozės kiekio plazmoje nevalgius pokytis, apie kurį pranešta atskirai kiekvienai indikacijai.
    2.2 Homeostatinio modelio įvertinimo-B (HOMA-B) pokytis, apie kurį pranešama atskirai kiekvienai indikacijai.
    2.3 Homeostatinio modelio vertinimo pokytis-IR (HOMAIR), apie kurį pranešama atskirai kiekvienai indikacijai.
    2.4 Glikuoto hemoglobino (HbA1c) pokytis, nurodytas atskirai kiekvienai indikacijai.

    3.1 Vidutinė savaitės somapacitano koncentracija (Cavg), pagrįsta populiacijos FK analize.

    4.1 Gliukozės kiekio plazmoje nevalgius pokytis, apie kurį pranešta atskirai kiekvienai indikacijai.
    4.2 Homeostatinio modelio įvertinimo-B (HOMA-B) pokytis, apie kurį pranešama atskirai kiekvienai indikacijai.
    4.3 Homeostatinio modelio įvertinimo-IR (HOMA-IR) pokytis, apie kurį pranešta kiekvienai indikacijai
    atskirai.
    4.4 Glikuoto hemoglobino (HbA1c) pokytis, nurodytas atskirai kiekvienai indikacijai.
    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 Nuo pradinio lygio (0 savaitė) iki V7 (52 savaitė).
    1.2 Nuo pradinio lygio (0 savaitė) iki V7 (52 savaitė).
    1.3 SGA, TS ir NS: nuo pradinio lygio (0 savaitė) iki V7 (52 savaitė).
    ISS: nuo patikrinimo (V1) iki V7 (52 savaitė).
    1.4 Nuo pradinio lygio (0 savaitė) iki V7 (52 savaitė).
    1.5 Nuo pradinio lygio (0 savaitė) iki V7 (52 savaitė).
    2.1 Nuo atrankos (V1) iki V7 (52 savaitė).
    2.2 Nuo atrankos (V1) iki V7 (52 savaitė).
    2.3 Nuo atrankos (V1iki V7 (52 savaitė).
    2.4 Nuo atrankos (V1) iki V7 (52 savaitė).
    3.1 Nuo 3 vizito (4 savaitė) iki V7 (52 savaitė).
    4.1 Nuo atrankos (V1) iki V15 (156 savaitė).
    4.2 Nuo atrankos (V1) iki V15 (156 savaitė).
    4.3 Nuo atrankos (V1) iki V15 (156 savaitė).
    4.4 Nuo atrankos (V1) iki V15 (156 savaitė).
    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 Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.4.1Number of sites anticipated in Member State concerned1
    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
    Malaysia
    Switzerland
    Brazil
    Canada
    China
    India
    Israel
    Japan
    Korea, Republic of
    Mexico
    Russian Federation
    Saudi Arabia
    Serbia
    South Africa
    Thailand
    United Kingdom
    United States
    European Union
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LSLV
    PPPV
    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 state10
    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 Decision2023-03-24
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-03-22
    P. End of Trial
    P.End of Trial StatusOngoing
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