Phase III Study of Efficacy and Safety of Secukinumab Versus Placebo, in Combination With Glucocorticoid Taper Regimen, in Patients With Giant Cell Arteritis (GCA)

Giant Cell Arteritis (GCA) Clinical Trial

Official title:

A Randomized, Parallel-group, Double-blind, Placebo-controlled, Multicenter Phase III Trial to Investigate the Efficacy and Safety of Secukinumab 300 mg and 150 mg Administered Subcutaneously Versus Placebo, in Combination With a Glucocorticoid Taper Regimen, in Patients With Giant Cell Arteritis (GCA) (GCAptAIN)

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04930094
• Other study ID #: CAIN457R12301
• Secondary ID: 2020-004809-31
• Status: Active, not recruiting
• Phase: Phase 3
• Start date: October 6, 2021
• Est. completion date: July 2, 2027

Study information

• Verified date: June 2024
• Source: Novartis
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a phase III study of efficacy and safety of secukinumab versus placebo, in combination with glucocorticoid taper regimen, in patients with giant cell arteritis (GCA)

Description:

Randomized, parallel-group, double-blind, placebo-controlled, multi-center, Phase III study to evaluate the efficacy of secukinumab in combination with a 26-week prednisone taper regimen compared to pllacebo in combination with a 52-week prednisone taper regimen

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 354
• Est. completion date: July 2, 2027
• Est. primary completion date: April 11, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years and older

Eligibility

Inclusion Criteria:

1. Signed informed consent must be obtained prior to participation in the study.

2. Patient must be able to understand and communicate with the investigator and comply with the requirements of the study.

3. Male or non-pregnant, non-lactating female patients at least 50 years of age.

4. Diagnosis of GCA based on meeting all of the following criteria:

• Age at onset of disease = 50 years.

• Unequivocal cranial symptoms of GCA (e.g., new-onset localized headache, scalp or temporal artery tenderness, permanent or temporary ischemia-related vision loss, or otherwise unexplained mouth or jaw pain upon mastication), and/or unequivocal symptoms of polymyalgia rheumatica (PMR) (defined as shoulder and/or hip girdle pain associated with inflammatory morning stiffness) and/or symptoms of limb ischemia (claudication).

• TAB revealing features of GCA and/or cross-sectional imaging study such as ultrasound (e.g., cranial or axillary), MRI/MRA, CTA, or PET-CT with evidence of vasculitis.

5. Active disease as defined by meeting both of the following within 6 weeks of BSL (see Section 8.1 for details)

• Presence of signs or symptoms attributed to active GCA and not related to prior damage (e.g., visual loss that occurred prior to 6 weeks before BSL without new findings occurring within 6 weeks of BSL)

• Elevated ESR = 30 mm/hr or CRP = 10 mg/L attributed to active GCA or active GCA on TAB or on imaging study.

6. Patients to meet definition of new-onset GCA or relapsing GCA:

• Definition of new-onset GCA*: GCA that is diagnosed within 6 weeks of BSL visit

• Definition relapsing GCA:

• GCA diagnosed > 6 weeks before BSL visit and

• Following institution of an appropriate treatment course for GCA, participant has experienced recurrence of active symptoms or signs of disease after resolution.

• The 6-week timeframe is to be calculated from the date of suspected GCA diagnosis. Suspected diagnosis is defined as date when GC therapy was initiated.

7. Patients' current GCA episode should be treatable with a dose of prednisone (or equivalent) designed to adequately achieve disease control in accordance with international guidelines. If this is not possible due to concerns regarding GC toxicity, the patient should not be enrolled. It must be medically appropriate for the patient to receive prednisone (or equivalent) 20 mg-60 mg daily (or equivalent) at BSL.

8. Patients taking MTX (= 25 mg/week) are allowed to continue their medication provided they have taken it for at least 2 months and are on a stable dose for at least 4 weeks prior to randomization and if they are on stable folic acid treatment before randomization.

Exclusion Criteria:

1. 1. Pregnant or nursing (lactating) women where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive human chorionic gonadotropin (hCG) laboratory test.

2. Women of childbearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using effective methods of contraception during study treatment or longer if required by locally approved prescribing information (e.g., in European Union (EU) 20 weeks after treatment discontinuation). Also, contraception should be used in accordance with locally approved prescribing information of concomitant medications administered (e.g., rescue treatment). Effective contraception methods include:

• Total abstinence (when this is in line with the preferred and usual lifestyle of the patient). Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.

• Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy or bilateral tubal ligation at least 6 weeks before taking investigational drug. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow-up hormone level assessment.

• Male sterilization (at least 6 months prior to screening). For female patients on the study, the vasectomized male partner should be the sole partner for that patient

• Barrier methods of contraception: Condom or Occlusive cap (diaphragm or cervical/vault caps). NOTE: for United Kingdom: with spermicidal foam/gel/film/cream/vaginal suppository.

• Use of oral, (estrogen and progesterone), injected or implanted hormonal methods of contraception or other forms of hormonal contraception that have comparable efficacy. In case of use of oral contraception women should have been stable on the same pill for a minimum of 3 months before taking study treatment.

• Women are considered post-menopausal if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g., age-appropriate history of vasomotor symptoms). Women are considered not of child-bearing potential if they are post-menopausal or have had surgical bilateral oophorectomy (with or without hysterectomy), total hysterectomy or bilateral tubal ligation at least six weeks prior to enrollment on study. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow-up hormone level assessment is she considered to be not of child-bearing potential.

If local regulations are more stringent than the contraception methods listed above to prevent pregnancy, local regulations apply and will be described in the Informed Consent Form (ICF).

3. Previous exposure to secukinumab or other biologic drug directly targeting IL-17 or IL-17 receptor.

4. Patients treated with any cell-depleting therapies.

5. Previous participation in a clinical trial where the outcome of treatment with the GCA drug is unknown. This does not include trials where the treatment for GCA was GCs, MTX, leflunomide or azathioprine

6. Patients who have been treated with inhibitors directly targeting IL-1, or IL-1 receptor, IL-12 and IL-23, or abatacept within 4 weeks or within 5 half-lives of the drug (whichever is longer) prior to BSL.

7. Treatment with tocilizumab, other IL-6/IL6-R inhibitor or JAK inhibitor within 12 weeks or within 5 half-lives of the drug (whichever is longer) prior to BSL, or if the patient did not respond to or experienced a relapse during treatment any time before BSL.

8. Any treatment received for GCA in which patient did not respond to treatment or experienced a relapse while on that treatment any time before BSL. This also includes patients who were treated in a clinical trial for GCA. Patients who failed on treatment with GCs, MTX, leflunomide and/or azathioprine may be included.

9. Patients treated with i.v. immunoglobulins or plasmapheresis within 8 weeks prior to BSL.

10. Patients treated with cyclophosphamide or hydroxychloroquine within 6 months prior to BSL, or tacrolimus, everolimus, cyclosporine A, azathioprine, sulfasalazine, mycophenolate mofetil within 4 weeks prior to BSL.

11. Patients treated with leflunomide within 8 weeks of BSL unless a cholestyramine washout has been performed in which case the patient must be treated within 4 weeks of BSL.

12. Patients treated with an alkylating agent within 5 years prior to BSL, unless specified in other exclusion criteria.

13. Patients requiring or anticipated to require systemic chronic glucocorticoid therapy or pulses of glucocorticoids for reasons other than GCA (e.g., COPD, asthma, planned surgery) at screening or randomization.

14. Criterion removed in protocol V01.

15. Patients requiring chronic (i.e., not occasional "prn") high potency opioid analgesics for pain management.

16. Use of other investigational drugs within 5 half-lives of enrollment or within 30 days (e.g. small molecules) or until the expected pharmacodynamic effect has returned to BSL (e.g., biologics), whichever is longer; or longer if required by local regulations.

17. History of hypersensitivity or contraindication to any of the study treatments or its excipients or to drugs of similar chemical classes.

18. Active IBD or other ongoing inflammatory diseases other than GCA that might confound the evaluation of the benefit of secukinumab therapy, including uveitis at screening or randomization.

19. Major ischemic event (e.g., myocardial infarction, stroke, etc.) or transient ischemic attack (TIA) (except ischemia-related vision loss), related or unrelated to GCA, within 12 weeks of screening.

20. Confirmed diagnosis of any primary form of systemic vasculitis, other than GCA.

21. Any other biologics (e.g., denosumab, TNFa inhibitors) within 4 weeks or within 5 half-lives of the drug (whichever is longer) prior to BSL, or anticipated use of a biologic prior to EOS.

22. Active ongoing diseases which in the opinion of the investigator immunocompromises the patient and/or places the patient at unacceptable risk for treatment with immunomodulatory therapy.

23. Significant medical problems or diseases, including but not limited to the following:

uncontrolled hypertension (= 160/95 mmHg), congestive heart failure (New York Heart Association (NYHA) status of class III or IV) and uncontrolled diabetes mellitus.

24. History of clinically significant liver disease or liver injury as indicated by abnormal liver function tests (LFTs) such as Aspartate Aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) or serum bilirubin. The investigator should be guided by the following criteria:

• SGOT (AST) and SGPT (ALT) may not exceed 3 × the upper limit of normal (ULN). A single parameter elevated up to and including 3 × ULN should be re-checked once more as soon as possible, and in all cases, at least prior to randomization, to rule-out laboratory error.

• Alkaline phosphatase may not exceed 2 × ULN. An elevation up to and including 2 × ULN should be re-checked once more as soon as possible, and in all cases, at least prior to randomization, to rule-out laboratory error.

• Total bilirubin may not exceed 2 × ULN. If the total bilirubin concentration is increased above 2 × ULN, total bilirubin should be differentiated into the direct and indirect reacting bilirubin.

25. Criterion removed in protocol V01

26. Screening total WBC count < 3,000/µL, or platelets < 100,000/µL or neutrophils < 1,500/µL or Hgb < 8.3 g/dL (83 g/L).

27. Active infections during the last 2 weeks prior to randomization.

28. History of ongoing, chronic or recurrent infectious disease or evidence of tuberculosis infection as defined by a positive QuantiFERON TB-Gold Plus test. Patients with a positive test may participate in the study if further work up (according to local practice/guidelines) establishes conclusively that the patient has no evidence of active TB. If the test result is indeterminate, the investigator may repeat the test once or may proceed directly to perform the work-up for TB as per local procedures. If presence of latent TB is established then treatment according to local country guidelines must be initiated prior to randomization.

29. Known infection with human immunodeficiency virus (HIV), hepatitis B or hepatitis C at screening or randomization (if not treated and cured).

30. History of lymphoproliferative disease or any known malignancy or history of malignancy of any organ system within the past 5 years (except for basal cell carcinoma or actinic keratosis that have been treated with no evidence of recurrence in the past 3 months, carcinoma in situ of the cervix or non-invasive malignant colon polyps that have been removed).

31. Live vaccinations (e.g., monkey pox vaccine, oral polio vaccine, varicella/zoster vaccines) within 6 weeks prior to BSL, or planned or anticipated potential need for live vaccination during study participation until 12 weeks after last study treatment administration.

32. Current severe progressive or uncontrolled disease, which in the judgment of the clinical investigator renders the patient unsuitable for the trial.

33. Any medical or psychiatric condition, which, in the investigator's opinion, would preclude the patient from adhering to the protocol or completing the study per protocol.

34. Donation or loss of 400 mL or more of blood within 8 weeks before randomization.

35. History or evidence of ongoing alcohol or drug abuse, within the last 6 months before randomization.

36. Specific for MRI/MRA imaging sub-study: absolute contraindications to MRI/MRA (e.g., metallic implants, metallic foreign bodies, pacemaker, defibrillator) and to the use of gadolinium-based agents (e.g., people with severe kidney failure, patients with previous severe allergic/anaphylactoid reaction to a gadolinium-based contrast agent); patients with severe renal disease [eGFR <30 mL/min/1.73 m2 by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)], or acutely deteriorating renal function, who would be at risk of nephrogenic systemic fibrosis. Subjects with renal impairment of a lesser severity may be excluded from the imaging substudy in accordance with local practice.

Related Conditions & MeSH terms

• Arteritis
• Giant Cell Arteritis
• Giant Cell Arteritis (GCA)
• Polymyalgia Rheumatica

Intervention

Biological:
• Secukinumab 300 mg
Secukinumab 300 mg

Other:
• Placebo
Placebo

Biological:
• Secukinumab 150 mg
Secukinumab

Locations

Country	Name	City	State
Argentina	Novartis Investigative Site	Capital Federal
Argentina	Novartis Investigative Site	La Plata	Buenos Aires
Australia	Novartis Investigative Site	Heidelberg Heights	Victoria
Australia	Novartis Investigative Site	Hobart	Tasmania
Australia	Novartis Investigative Site	Liverpool	New South Wales
Australia	Novartis Investigative Site	Malvern East	Victoria
Australia	Novartis Investigative Site	Murdoch	Western Australia
Australia	Novartis Investigative Site	Parramatta
Australia	Novartis Investigative Site	Southport	Queensland
Austria	Novartis Investigative Site	Graz
Austria	Novartis Investigative Site	Innsbruck
Belgium	Novartis Investigative Site	Leuven
Belgium	Novartis Investigative Site	Liege
Brazil	Novartis Investigative Site	Juiz de Fora	MG
Brazil	Novartis Investigative Site	Porto Alegre	RS
Brazil	Novartis Investigative Site	Sao Jose do Rio Preto	SP
Bulgaria	Novartis Investigative Site	Plovdiv
Bulgaria	Novartis Investigative Site	Plovdiv
Canada	Novartis Investigative Site	Montreal	Quebec
Canada	Novartis Investigative Site	Sherbrooke	Quebec
Canada	Novartis Investigative Site	Trois-Rivieres	Quebec
Czechia	Novartis Investigative Site	Brno Bohunice
Czechia	Novartis Investigative Site	Praha 11
Czechia	Novartis Investigative Site	Praha 2
Czechia	Novartis Investigative Site	Uherske Hradiste
Denmark	Novartis Investigative Site	Aarhus
Denmark	Novartis Investigative Site	Esbjerg
Denmark	Novartis Investigative Site	Vejle
Estonia	Novartis Investigative Site	Tallinn
Estonia	Novartis Investigative Site	Tartu
Finland	Novartis Investigative Site	Helsinki
Finland	Novartis Investigative Site	Kuopio
Finland	Novartis Investigative Site	Lahti
Finland	Novartis Investigative Site	Turku
France	Novartis Investigative Site	Brest
France	Novartis Investigative Site	Dijon
France	Novartis Investigative Site	Le Mans
France	Novartis Investigative Site	Lille
France	Novartis Investigative Site	Marseille
France	Novartis Investigative Site	Nantes Cedex 1
France	Novartis Investigative Site	Paris
France	Novartis Investigative Site	Paris 13
France	Novartis Investigative Site	Strasbourg
France	Novartis Investigative Site	Toulouse
Germany	Novartis Investigative Site	Berlin
Germany	Novartis Investigative Site	Bonn
Germany	Novartis Investigative Site	Dresden
Germany	Novartis Investigative Site	Dresden
Germany	Novartis Investigative Site	Erlangen
Germany	Novartis Investigative Site	Freiburg
Germany	Novartis Investigative Site	Herne
Germany	Novartis Investigative Site	Ludwigshafen
Germany	Novartis Investigative Site	Wuerzburg
Greece	Novartis Investigative Site	Athens
Guatemala	Novartis Investigative Site	Guatemala
Guatemala	Novartis Investigative Site	Guatemala City
Guatemala	Novartis Investigative Site	Guatemala City
Hungary	Novartis Investigative Site	Budapest
Hungary	Novartis Investigative Site	Debrecen
Hungary	Novartis Investigative Site	Pecs
Hungary	Novartis Investigative Site	Szeged
Israel	Novartis Investigative Site	Tel Aviv
Italy	Novartis Investigative Site	Brescia	BS
Italy	Novartis Investigative Site	Cona	FE
Italy	Novartis Investigative Site	Firenze	FI
Italy	Novartis Investigative Site	Milano	MI
Italy	Novartis Investigative Site	Siena	SI
Norway	Novartis Investigative Site	Gjettum
Norway	Novartis Investigative Site	Moss
Poland	Novartis Investigative Site	Bydgoszcz
Poland	Novartis Investigative Site	Krakow
Portugal	Novartis Investigative Site	Lisboa
Portugal	Novartis Investigative Site	Ponte de Lima
Spain	Novartis Investigative Site	Badalona	Catalunya
Spain	Novartis Investigative Site	Barcelona	Catalunya
Spain	Novartis Investigative Site	Barcelona
Spain	Novartis Investigative Site	Bilbao	Pais Vasco
Spain	Novartis Investigative Site	Madrid
Spain	Novartis Investigative Site	Madrid
Spain	Novartis Investigative Site	Pamplona	Navarra
Spain	Novartis Investigative Site	Sabadell	Barcelona
Spain	Novartis Investigative Site	Santander	Cantabria
Spain	Novartis Investigative Site	Santiago De Compostela	Galicia
Spain	Novartis Investigative Site	Valencia
Sweden	Novartis Investigative Site	Malmo
Switzerland	Novartis Investigative Site	Basel
Switzerland	Novartis Investigative Site	Geneve
Switzerland	Novartis Investigative Site	St Gallen
Switzerland	Novartis Investigative Site	Zurich
Turkey	Novartis Investigative Site	Ankara
Turkey	Novartis Investigative Site	Istanbul	TUR
Turkey	Novartis Investigative Site	Pendik	Istanbul
United Kingdom	Novartis Investigative Site	Dundee
United Kingdom	Novartis Investigative Site	Edinburgh
United Kingdom	Novartis Investigative Site	Newcastle Upon Tyne
United Kingdom	Novartis Investigative Site	Stoke on Trent	Staffordshire
United States	Massachusetts General Hospital	Boston	Massachusetts
United States	Precision Comp Clin Research	Grapevine	Texas
United States	Osteoporosis and Clinical Trial Ctr	Hagerstown	Maryland
United States	Novartis Investigative Site	Iowa City	Iowa
United States	West Tennessee Research Institute	Jackson	Tennessee
United States	Cedars Sinai Medical Center .	Los Angeles	California
United States	Integral Rheumatology and Immunology Specialists IRIS	Plantation	Florida
United States	Sarasota Arthritis Research Center	Sarasota	Florida
United States	Advanced Rheumatology of Houston .	Spring	Texas

Sponsors (1)

Lead Sponsor	Collaborator
Novartis Pharmaceuticals

Countries where clinical trial is conducted

United States,  Argentina,  Australia,  Austria,  Belgium,  Brazil,  Bulgaria,  Canada,  Czechia,  Denmark,  Estonia,  Finland,  France,  Germany,  Greece,  Guatemala,  Hungary,  Israel,  Italy,  Norway,  Poland,  Portugal,  Spain,  Sweden,  Switzerland,  Turkey,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Proportion of participants with sustained remission	Primary objective is to determine whether the efficacy of secukinumab 300 mg s.c. in combination with a 26-week GC taper regimen is superior to placebo in combination with a 52-week glucocorticoids (GC) taper regimen in participants with giant cell arteritis (GCA) based on sustained remission at Week 52	52 weeks
Secondary	Time to clinical failure	To demonstrate that the efficacy of secukinumab 300 mg s.c. in combination with a 26-week GC taper regimen is superior to placebo in combination with a 52-week GC taper regimen in participants with GCA based on time to clinical failure through Week 52	52 weeks
Secondary	Cumulative GC Dose	To demonstrate that the efficacy of secukinumab 300 mg s.c. in combination with a 26-week GC taper regimen is superior to placebo in combination with a 52-week GC taper regimen, in participants with GCA, based on cumulative GC dose through Week 52	52 weeks
Secondary	Proportion of participants with sustained remission	To demonstrate that the efficacy of secukinumab 150 mg s.c. in combination with a 26-week GC taper regimen is superior to placebo in combination with a 52-week GC taper regimen in participants with GCA based on sustained remission at Week 52	52 weeks
Secondary	Time to clinical failure	To demonstrate that the efficacy of secukinumab 150 mg s.c. in combination with a 26-week GC taper regimen is superior to placebo in combination with a 52-week GC taper regimen in participants with GCA based on time to clinical failure through Week 52	52 weeks
Secondary	Cumulative GC Dose	To demonstrate that the efficacy of secukinumab 150 mg s.c. in combination with a 26-week GC taper regimen is superior to placebo in combination with a 52-week GC taper regimen, in participants with GCA, based on cumulative GC dose through Week 52	52 Weeks
Secondary	Change in SF-36 score (PCS)	To demonstrate that the effect on participant's QoL of secukinumab 300 mg s.c. or 150 mg s.c. in combination with a 26-week GC taper regimen is superior to placebo in combination with a 52-week GC taper regimen, in participants with GCA based on change of SF-36 score (PCS) at Week 52	52 weeks
Secondary	Change in GlucocorticoidToxicity Index (GTI)	To demonstrate that the effect of secukinumab 300 mg s.c. or 150 mg s.c. in combination with a 26-week GC taper regimen is superior to placebo in combination with a 52-week GC taper regimen, in participants with GCA based on change in Glucocorticoid Toxicity Index (GTI) at Week 52	52 weeks
Secondary	Change in FACIT-Fatigue Score	To demonstrate that the effect on participant's QoL of secukinumab 300 mg s.c. or 150 mg s.c. in combination with a 26-week GC taper regimen is superior to placebo in combination with a 52-week GC taper regimen, in participants with GCA based on change in FACIT-Fatigue score at Week 52	52 weeks
Secondary	Safety and tolerability of secukinumab	Adverse events (AEs) and serious adverse events (SAEs) (incidence, severity, and relationship to study drug)	52 weeks
Secondary	Safety and tolerability of secukinumab	Clinically significant changes in clinical laboratory measures and vital signs, as assessed by the Investigator	52 weeks