E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Neuromyelitis Optica Spectrum Disorder (NMOSD) |
|
E.1.1.1 | Medical condition in easily understood language |
Neuromyelitis Optica Spectrum Disorder (NMOSD) |
|
E.1.1.2 | Therapeutic area | Body processes [G] - Genetic Phenomena [G05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10077875 |
E.1.2 | Term | Neuromyelitis optica spectrum disorder |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
|
E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the efficacy of ravulizumab in pediatric participants with NMOSD |
|
E.2.2 | Secondary objectives of the trial |
- To evaluate the effect of ravulizumab on disease-related disability in pediatric participants with NMOSD - To evaluate the effect of ravulizumab on neurologic function in pediatric participants with NMOSD - To characterize the PK of treatment with ravulizumab in pediatric participants with NMOSD - To characterize the PD of treatment with ravulizumab in pediatric participants with NMOSD - To assess quality of life based on patient-reported outcomes in pediatric participants with NMOSD based on treatment with Ravulizumab - To evaluate safety of ravulizumab in pediatric participants with NMOSD - To assess immunogenicity to ravulizumab in pediatric participants with NMOSD - Descriptive comparison of ravulizumab data to historical data from a NMOSD observational study (NCT 03766437) to contextualize efficacy data from this study. - To characterize the long-term effect of ravulizumab on efficacy, safety, PK, PD, and immunogenicity |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Participant must be ≥ 2 to < 18 years of age at the time of signing the informed consent/assent.
2. Participants must be anti-AQP4 Ab-positive and have a diagnosis of NMOSD as defined by the 2015 international consensus diagnostic criteria.
3. Complement inhibitor treatment-naïve participants must have had at least 1 attack or relapse in the last 12 months prior to the Screening Period
4. Expanded Disability Status Scale (EDSS) score ≤ 7
5. Eculizumab-experienced participants must be clinically stable per Investigator for 30 days and have been treated with eculizumab in Study ECU-NMO-303 for at least 90 days prior to screening with no missed doses within 2 months prior to Day 1
6. Participants who enter the study receiving supportive IST(s) (eg, corticosteroid, azathioprine [AZA], mycophenolate mofetil [MMF], methotrexate [MTX], tacrolimus [TAC], cyclosporin [CsA], or cyclophosphamide [CYC]) for the prevention of relapse, either in combination or monotherapy, must be on a stable dosing regimen of adequate duration prior to Screening and remain on a stable dosing regimen during the Screening Period.
7. To reduce the risk of meningococcal infection (Neisseria meningitidis), all participants must be vaccinated against meningococcal infection from serogroups A, C, W 135, and Y within 3 years prior to, or at least 14 days prior to Day 1, according to national/local guidelines. Participants who do not meet this requirement will be vaccinated against meningococcal infection according to national/local guidelines and will receive prophylactic antibiotics for at least 2 weeks after meningococcal vaccination if Day 1 occurs < 2 weeks after initial vaccination.
8. Documented vaccination for Hib and S pneumoniae at least 14 days prior to Day 1 according to national/local guidelines for the applicable age group.
Please see the detailed list of inclusion criteria in the protocol. |
|
E.4 | Principal exclusion criteria |
1. Known to be human immunodeficiency virus (HIV) positive
2. History of N meningitidis infection
3. Active systemic bacterial, viral, or fungal infection within 14 days prior to Day 1.
4. Hypersensitivity to ravulizumab, murine proteins or to one of the excipients of ravulizumab.
5. Use of rituximab within 6 months prior to Day 1.
6. Currently treated with a biologic medications (other than eculizumab) that may affect immune system functioning, or has stopped treatment with a biologic medication that may affect immune system functioning, and 5 half lives of the medication have not elapsed by the time of the Screening Visit
7. Use of intravenous immunoglobulin (IVIg) or plasma exchange (PE) within 3 weeks prior to Screening.
8. Participation in another investigational drug or investigational device study (other than Study ECU-NMO-303) within 5 half lives of that investigational product (if known) or 30 days before initiation of the first dose of study drug, whichever is longer.
9. Use of immunomodulatory therapies for multiple sclerosis within 3 months prior to Screening.
Please see the detailed list of exclusion criteria in the protocol. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
- The change from baseline in the annualized relapse rate (ARR) - Time to First Adjudicated On-trial Relapse (TFR) |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
Primary treatment period: On-Trial Relapses will be monitored throughout the study and at 50 weeks |
|
E.5.2 | Secondary end point(s) |
Primary treatment period:
Efficacy: - Change from baseline in expanded disability status scale (EDSS) score - Change from baseline in Hauser Ambulation Index (HAI) - The change from baseline in visual acuity at the end of the Primary Treatment Period - The change from baseline in confrontational visual fields at the end of the Primary Treatment Period - The change from baseline in color vision at the end of the Primary Treatment Period
PK/PD: - Serum ravulizumab concentrations through the end of the Primary Treatment Period - Absolute values, change from baseline, and percentage change from baseline for free serum C5 concentrations over time through the end of the Primary Treatment Period
Health-related QoL: - Change from baseline in PedsQL Scales at the end of the Primary Treatment Period
Safety: - Incidence of AEs and SAEs - Change from baseline in vital signs, physical growth (weight, height, and head circumference [participants ≤ 3 years of age only]), and laboratory parameters at scheduled visits
Extension treatment period: The endpoints of the Primary Treatment Period will be evaluated during the Extension Period. |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Primary treatment period: throughout the primary treatment period and at 50 weeks Extension treatment period: 104 weeks |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Immunogenicity Assessments and quality of life |
|
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
|
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
|
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 10 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Canada |
Japan |
Korea, Republic of |
United States |
France |
Spain |
Germany |
Italy |
|
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 5 |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 9 |