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Clinical Trial Details — Status: Terminated

Administrative data

NCT number NCT03600805
Other study ID # EFC15068
Secondary ID 2017-002988-18U1
Status Terminated
Phase Phase 3
First received
Last updated
Start date November 20, 2018
Est. completion date November 24, 2020

Study information

Verified date March 2022
Source Sanofi
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Primary Objective: To evaluate the efficacy of sarilumab in participants with giant cell arteritis (GCA) as assessed by the proportion of participants with sustained remission for sarilumab compared to placebo, in combination with a corticosteroid (CS) tapering course. Secondary Objective: - To demonstrate the efficacy of sarilumab in participants with GCA compared to placebo, in combination with CS taper with regards to: - Clinical responses (such as responses based on disease remission rates, time to first disease flare) over time. - Cumulative CS (including prednisone) exposure. - To assess the safety (including immunogenicity) and tolerability of sarilumab in participants with GCA. - To measure sarilumab serum concentrations in participants with GCA. - To assess the effect of sarilumab on sparing glucocorticoid toxicity as measured by glucocorticoid toxicity index (GTI).


Description:

Study duration per participant was approximately 82 weeks, including an up to 6-week screening period, 52-week treatment period, and 24-week follow-up period.


Recruitment information / eligibility

Status Terminated
Enrollment 83
Est. completion date November 24, 2020
Est. primary completion date November 24, 2020
Accepts healthy volunteers No
Gender All
Age group 50 Years and older
Eligibility Inclusion criteria : - Diagnosis of GCA according to European League Against Rheumatism/American College of Rheumatology classification criteria. - New onset active disease or refractory active disease. - At least one of the symptoms of GCA within 6 weeks of baseline. - Either erythrocyte sedimentation rate greater than or equal to (>=) 30 millimeter per hour or C-reactive protein >=10 mg per liter within 6 weeks of baseline. - Received or were able to receive prednisone 20-60 mg/day for the treatment of active GCA. Exclusion criteria: - Organ transplantation recipient (except corneas, unless it is within 3 months prior to baseline visit). - Major ischemic event, unrelated to GCA, within 12 weeks of screening. - Any prior use of the following therapies, for the treatment of GCA: - Janus kinase inhibitor (e.g., tofacitinib) within 4 weeks of baseline. - Cell-depletion agents (e.g., anti CD20) without evidence of recovery of B cells to baseline level. - Abatacept within 8 weeks of baseline. - Anakinra within 1 week of baseline. - Tumor necrosis factor inhibitors within 2-8 weeks (etanercept within 2 weeks; infliximab, certolizumab, golimumab, or adalimumab within 8 weeks), or less than at least 5 half-lives had elapsed prior to baseline, whichever was longer. - Therapeutic failure, including inadequate response or intolerance, or contraindication, to biological Interleukin 6 (IL-6) IL-6/(R) antagonist (prior experience with IL-6/(R) antagonist that was terminated for reasons unrelated to therapeutic failure at least 3 months before baseline was not exclusionary). - Use of any alkylating agents including cyclophosphamide within 6 months of baseline. - Use of immunosuppressant, such as hydroxychloroquine, cyclosporine, azathioprine, mycophenolate mofetil or leflunomide within 4 weeks of baseline. (Use of methotrexate (MTX) not exceeding 25 mg per week and had been stable for at least 3 months prior to baseline was not exclusionary). - Concurrent use of systemic CS for conditions other than GCA. - Use of intervascular CS at a dose equivalent to 100 mg of methylprednisolone or higher within 8 weeks of baseline for GCA therapy. - Pregnant or breastfeeding woman. - Participants with active or untreated latent tuberculosis. - Participants with history of invasive opportunistic infections. - Participants with fever associated with infection or chronic, persistent or recurring infections requiring active treatment. - Participants with uncontrolled diabetes mellitus. - Participants with non-healed or healing skin ulcers. - Participants who received any live, attenuated vaccine within 3 months of baseline. - Participants who are positive for hepatitis B, hepatitis C and/or HIV. - Participants with a history of active or recurrent herpes zoster. - Participants with a history of or prior articular or prosthetic joint infection. - Prior or current history of malignancy. - Participants who have had surgery within 4 weeks of screening or planned surgery during study. - Participants with a history of inflammatory bowel disease or severe diverticulitis or previous gastrointestinal perforation.. The above information was not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Sarilumab SAR153191
Pharmaceutical form: solution for injection Route of administration: subcutaneous
Sarilumab matching placebo
Pharmaceutical form: solution for injection Route of administration: subcutaneous
Prednisone
Pharmaceutical form: tablets or capsules Route of administration: oral administration
Prednisone matching placebo
Pharmaceutical form: capsules Route of administration: oral administration

Locations

Country Name City State
Argentina Investigational Site Number 0320001 Buenos Aires
Argentina Investigational Site Number 0320002 Caba
Australia Investigational Site Number 0360003 Camberwell
Australia Investigational Site Number 0360006 Clayton
Australia Investigational Site Number 0360001 Kogarah
Belgium Investigational Site Number 0560001 Leuven
Canada Investigational Site Number 1240007 Hamilton
Canada Investigational Site Number 1240010 Montreal
Canada Investigational Site Number 1240001 Rimouski
Canada Investigational Site Number 1240005 Sherbrooke
Canada Investigational Site Number 1240003 Trois-Rivières
Croatia Investigational Site Number 1910001 Zagreb
Denmark Investigational Site Number 2080002 Aarhus C
Denmark Investigational Site Number 2080003 Svendborg
Estonia Investigational Site Number 2330001 Tallinn
France Investigational Site Number 2500005 Brest Cedex
France Investigational Site Number 2500002 Montivilliers
France Investigational Site Number 2500003 Montpellier
France Investigational Site Number 2500007 Mulhouse
France Investigational Site Number 2500001 Paris
France Investigational Site Number 2500006 Pessac
Germany Investigational Site Number 2760001 Berlin
Germany Investigational Site Number 2760002 Dresden
Germany Investigational Site Number 2760003 Kirchheim Unter Teck
Germany Investigational Site Number 2760004 München
Germany Investigational Site Number 2760007 Tübingen
Hungary Investigational Site Number 3480001 Debrecen
Israel Investigational Site Number 3760006 Ashkelon
Israel Investigational Site Number 3760004 Haifa
Italy Investigational Site Number 3800001 Milano
Italy Investigational Site Number 3800005 Rozzano
Netherlands Investigational Site Number 5280007 Den Haag
Netherlands Investigational Site Number 5280005 Leeuwarden
Netherlands Investigational Site Number 5280009 Sittard-Geleen
Netherlands Investigational Site Number 5280001 Venlo
Portugal Investigational Site Number 6200001 Almada
Portugal Investigational Site Number 6200005 Aveiro
Portugal Investigational Site Number 6200004 Ponte De Lima
Russian Federation Investigational Site Number 6430005 Kemerovo
Russian Federation Investigational Site Number 6430002 Moscow
Russian Federation Investigational Site Number 6430003 Moscow
Slovenia Investigational Site Number 7050001 Ljubljana
Spain Investigational Site Number 7240010 Bilbao
Spain Investigational Site Number 7240011 La Coruña
Spain Investigational Site Number 7240014 Madrid
Spain Investigational Site Number 7240016 Sabadell
Spain Investigational Site Number 7240015 Santa Cruz De Tenerife
Sweden Investigational Site Number 7520003 Örebro
Sweden Investigational Site Number 7520001 Uppsala
Switzerland Investigational Site Number 7560002 St. Gallen
United Kingdom Investigational Site Number 8260006 Aberdeen
United Kingdom Investigational Site Number 8260004 Gateshead
United Kingdom Investigational Site Number 8260003 Leeds
United Kingdom Investigational Site Number 8260005 Manchester
United Kingdom Investigational Site Number 8260011 Portsmouth
United States Investigational Site Number 8400002 Boca Raton Florida
United States Investigational Site Number 8400011 Dallas Texas
United States Investigational Site Number 8400017 Gainesville Florida
United States Investigational Site Number 8400014 Iowa City Iowa
United States Investigational Site Number 8400019 Philadelphia Pennsylvania
United States Investigational Site Number 8400018 Portland Oregon

Sponsors (2)

Lead Sponsor Collaborator
Sanofi Regeneron Pharmaceuticals

Countries where clinical trial is conducted

United States,  Argentina,  Australia,  Belgium,  Canada,  Croatia,  Denmark,  Estonia,  France,  Germany,  Hungary,  Israel,  Italy,  Netherlands,  Portugal,  Russian Federation,  Slovenia,  Spain,  Sweden,  Switzerland,  United Kingdom, 

Outcome

Type Measure Description Time frame Safety issue
Primary Percentage of Participants Who Achieved Sustained Disease Remission at Week 52 Disease remission was defined as resolution of signs and symptoms of giant cell arteries (GCA), and normalization of C-reactive protein (CRP) (<10 mg/L). Sustained remission was defined as meeting all of the following parameters: achievement of disease remission not later than Week 12, absence of disease flare (defined as recurrence of signs and symptoms attributable to active GCA plus an increase in corticosteroid [CS] dose due to GCA or elevation of erythrocyte sedimentation rate [ESR] attributable to active GCA plus an increase in CS dose due to GCA) from Week 12 through Week 52, normalization of CRP (to <10 mg/L, with absence of successive elevations to >=10 mg/L) from Week 12 through Week 52, and successful adherence to prednisone taper from Week 12 through Week 52. At Week 52
Primary Percentage of Participants Who Achieved Sustained Disease Remission at Week 24 Disease remission was defined as resolution of signs and symptoms of GCA, and normalization of CRP <10 mg/L. Sustained remission was defined as meeting all of the following parameters: achievement of disease remission not later than Week 12, absence of disease flare (defined as recurrence of signs and symptoms attributable to active GCA plus an increase in CS dose due to GCA, or elevation of ESR attributable to active GCA plus an increase in CS dose due to GCA) from Week 12 through Week 24, normalization of CRP (to <10 mg/L, with an absence of successive elevations to >=10 mg/L) from Week 12 through Week 24, and successful adherence to the prednisone taper from Week 12 through Week 24. At Week 24
Secondary Number of Participants With Achievement of Disease Remission up to Week 12: Week 52 Analysis Set Disease remission was defined as resolution of signs and symptoms of GCA, and normalization of CRP (< 10 mg/L). The status of normalization of CRP (<10 mg/L) was determined based on the last two non-missing post-baseline CRP values measured up to Week 12. If at least one of the value was <10 mg/L, then it was considered as normalization of CRP. Participants who took rescue corticosteroid (CS) due to active GCA prior to Week 12 or who permanently withdrew from the study treatment prior to Week 12 were considered as not achieved disease remission by Week 12. Up to Week 12
Secondary Number of Participants With Achievement of Disease Remission up to Week 12: Intent-to-treat (ITT) Population Disease remission was defined as resolution of signs and symptoms of GCA, and normalization of CRP (< 10 mg/L). The status of normalization of CRP (<10 mg/L) was determined based on the last two non-missing post-baseline CRP values measured up to Week 12. If at least one of the value was <10 mg/L, then it was considered as normalization of CRP. Participants who took rescue CS due to active GCA prior to Week 12 or who permanently withdrew from the study treatment prior to Week 12 were considered as not achieved disease remission by Week 12. Up to Week 12
Secondary Number of Participants With Absence of Disease Flare From Week 12 Through Week 52: Week 52 Analysis Set Disease flare was defined as either recurrence of signs and symptoms attributable to active GCA plus an increase in CS dose due to GCA, or elevation of ESR attributable to active GCA plus an increase in CS dose due to GCA. Number of participants with absence of disease flare from Week 12 through Week 52 were reported. From Week 12 through Week 52
Secondary Number of Participants With Absence of Disease Flare From Week 12 Through Week 24: ITT Population Disease flare was defined as either recurrence of signs and symptoms attributable to active GCA plus an increase in CS dose due to GCA, or elevation of ESR attributable to active GCA plus an increase in CS dose due to GCA. Number of participants with absence of disease flare from Week 12 through Week 24 were reported. From Week 12 through Week 24
Secondary Number of Participants With Normalization of C-Reactive Protein From Week 12 Through Week 52: Week 52 Analysis Set Normalization of CRP was defined as CRP levels <10 mg/L. If there were two or more consecutive visits with CRP >=10 mg/L, then it was categorized as no normalization of CRP. From Week 12 through Week 52
Secondary Number of Participants With Normalization of C-Reactive Protein (CRP) From Week 12 Through Week 24: ITT Population Normalization of CRP was defined as CRP levels <10 mg/L. If there were two or more consecutive visits with CRP >=10 mg/L, then it was categorized as no normalization of CRP. From Week 12 through Week 24
Secondary Number of Participants With Successful Adherence to the Prednisone Taper From Week 12 Through Week 52: Week 52 Analysis Set Successful adherence to the prednisone taper from Week 12 through Week 52 was defined as participants who did not take rescue therapy from Week 12 through Week 52 and might include the use of any excess prednisone (beyond the per protocol CS tapering regimen) with a cumulative dose of <=100 mg (or equivalent), such as those employed to manage adverse event (AE) not related to GCA. From Week 12 through Week 52
Secondary Number of Participants With Successful Adherence to the Prednisone Taper From Week 12 Through Week 24: ITT Population Successful adherence to the prednisone taper from Week 12 through Week 24 was defined as participants who did not take rescue therapy from Week 12 through Week 24 and might include the use of any excess prednisone (beyond the per protocol CS tapering regimen) with a cumulative dose of <=100 mg (or equivalent), such as those employed to manage AE not related to GCA. From Week 12 through Week 24
Secondary Total Cumulative Corticosteroid (Including Prednisone) Dose Cumulative dose of CS used for GCA disease was defined as the dose taken up to the end of treatment, including expected prednisone in tapering regimen per protocol, CS used in rescue therapy and the use of commercial prednisone (an excess of <=100 mg of prednisone during the study treatment period employed to manage AE not related to GCA). The total cumulative CS dose was based on the total number of days with complete or partial intake, no imputation was done on missed tablets. Up to Week 52
Secondary Time to First Giant Cell Arteritis Disease Flare Time to first GCA flare was defined as the duration (in days) from randomization to first GCA flare after clinical remission (defined as resolution of signs and symptoms and normalization of CRP [<10 mg/L]) and up to 52 weeks. Disease flare was defined as either the recurrence of signs or symptoms attributable to active plus an increase in CS dose due to GCA or elevation of ESR attributable to active GCA plus an increase in CS dose due to GCA. Kaplan-Meier method was used for the analysis. Participants who never achieved remission were censored at randomization day; and those who achieved clinical remission and never flared were censored at the end of treatment assessment date up to Week 52. Up to Week 52
Secondary Composite Glucocorticoid Toxicity Index (C-GTI): Cumulative Worsening Score (CWS) and Aggregate Improvement Score (AIS) at Week 24: ITT Population GTI assessed glucocorticoid (GC) related morbidity and GC-sparing ability of other therapies; composed of 2 components: Composite GTI and Specific List. Composite GTI contained 9 domains and Specific List contained of 23 items (11 domains), used as complementary tool to C-GTI. Composite GTI score was the sum of 9 domain-specific scores at each visit and Cumulative GTI score was the sum of composite GTI scores across each visit. Two cumulative GTI scores: CWS and AIS at Week 24 are reported in this outcome measure (OM). CWS assessed cumulative GC toxicity regardless of whether toxicity had lasting effects or was transient. AIS assessed new therapy effectiveness in decreasing any Baseline GC toxicity over time. For CWS, composite score ranged from 0 to 439 and for AIS, composite score ranged from -346 to 439. For both CWS and AIS, the minimum score implies the least toxicity and the maximum score implies the most toxicity. At Week 24
Secondary Composite Glucocorticoid Toxicity Index: Cumulative Worsening Score and Aggregate Improvement Score at Week 52 GTI assessed glucocorticoid (GC) related morbidity and GC-sparing ability of other therapies; composed of 2 components: Composite GTI and Specific List. Composite GTI contained 9 domains and Specific List contained of 23 items (11 domains), used as complementary tool to C-GTI. Composite GTI score was the sum of 9 domain-specific scores at each visit and Cumulative GTI score was the sum of composite GTI scores across each visit. Two cumulative GTI scores: CWS and AIS at Week 52 are reported in this OM. CWS assessed cumulative GC toxicity regardless of whether toxicity had lasting effects or was transient. AIS assessed new therapy effectiveness in decreasing any Baseline GC toxicity over time. For CWS, composite score ranged from 0 to 439 and for AIS, composite score ranged from -346 to 439. For both CWS and AIS, the minimum score implies the least toxicity and the maximum score implies the most toxicity. At Week 52
Secondary Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs) An adverse event (AE) was defined as any untoward medical occurrence in a participant who received study drug and did not necessarily had to have a causal relationship with the treatment. Serious AEs (SAEs) were any untoward medical occurrence that resulted in any of the following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. TEAEs were the AEs that developed or worsened or became serious during the TEAE period (defined as the time from the first dose of the investigational medicinal product (IMP) to the last dose of the SC IMP +60 days). From first dose (i.e., Day 1) up to 60 days after last dose (i.e., up to Week 60)
Secondary Pharmacokinetics (PK): Serum Trough Concentration (Ctrough) of Sarilumab Ctrough was pre dose concentration of drug. Data for this outcome measure was not planned to be collected and analyzed for placebo arms (Placebo+52 Week Taper and Placebo+26 Week Taper) as pre-specified in the protocol. Pre-dose on Week 0 (Baseline), Weeks 2, 4, 12, 16, 24 and 52
Secondary Pharmacokinetics: Serum Drug Concentration of Sarilumab Post-dose at Week 24 Serum concentrations of functional sarilumab were analyzed using validated enzyme linked immunosorbent assay. post-dose at Week 24
Secondary Percentage of Participants With Treatment-emergent Antidrug Antibodies (ADA) Response ADA response categories: 1) Treatment-boosted ADA positive participant: Participant with a positive ADA assay response at Baseline and with at least a 4-fold increase in titer compared to Baseline during TEAE period. 2) Treatment-emergent ADA positive participant: Participant with non-positive assay (meaning negative or missing) response at Baseline but with a positive assay response during the TEAE period (defined as the time from the first dose of the IMP to the last dose of the SC IMP + 60 days). Titer values were categorized as low (titer <1,000); moderate (1,000<= titer <=10,000) and high (titer >10,000). From Day 1 (Baseline) up to last dose date of study drug + 60 days (i.e., up to Week 60)
Secondary Pharmacodynamics: Change From Baseline in Erythrocyte Sedimentation Rate (ESR) at Weeks 2, 4, 8, 12, 16, 20, 24, 32, 40, and 52 ESR is a laboratory test to provide non-specific measure of inflammation in the body. The test assessed the rate at which red blood cells fell in a test tube and was measured in millimeters per hour. Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, 32, 40, and 52
Secondary Pharmacodynamics: Change From Baseline in C-reactive Protein (CRP) Level at Weeks 2, 4, 8, 12, 16, 20, 24, 32, 40, and 52 CRP is a protein made by the liver. CRP levels increase in blood when inflammation occurs in the body. Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, 32, 40, and 52
Secondary Pharmacodynamics: Change From Baseline in Interleukin-6 (IL-6) at Weeks 2, 12, 24, and 52 Interleukin-6 is a protein produced in the body. Levels of IL-6 often increase when there is inflammation (redness, warmth, swelling, and pain as a result of infection, irritation, or injury), either acute or chronic. Baseline, Weeks 2, 12, 24, and 52
Secondary Pharmacodynamics: Change From Baseline in Soluble Interleukin-6 Receptor (sIL-6R) Level at Weeks 2, 12, 24, and 52 Interleukin-6 is a protein produced in the body. Levels of IL-6 often increase when there is inflammation (redness, warmth, swelling, and pain as a result of infection, irritation, or injury), either acute or chronic. sIL-6R is one of the receptors that bind IL-6. Baseline, Weeks 2, 12, 24, and 52
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