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Efficacy and Safety of Ofatumumab in Treatment of Pemphigus Vulgaris

Primary Purpose

Pemphigus Vulgaris

Status
Terminated
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Ofatumumab
Placebo
Sponsored by
Novartis Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pemphigus Vulgaris focused on measuring Pemphigus, MAB, autoimmune disorder, human CD20 antigen, subcutaneous, vulgaris, Phase 3, monoclonal antibody, ofatumumab, PV, rare disease, OMB157, adult

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria

  • Adults (18 through 70 years of age) with clinically-documented diagnosis of PV for >2 months and <10 years.
  • History of biopsy consistent with PV (Hematoxylin and Eosin staining and direct immunofluorescence). If no history, a biopsy may be performed during the Screening Period.
  • At least 1 previous episode of a failed steroid taper (ie, disease flare/relapse) at a prednisone/prednisolone dose >10 mg/day. The following criteria must have been met as evidence of disease severity at the time of the failed steroid taper: a) A Pemphigus Severity of Clinical Disease score of moderate (2) or severe (3) (may be historical/retrospective assessment). b) Required a treatment change at the time of the failed steroid taper of at least one of the following: i) A steroid increase to >=20 mg/day OR ii) The addition of immunosuppressive/immunomodulatory agent/treatment OR iii) A dose increase of immunosuppressive/immunomodulatory agent/treatment
  • Screening anti-Dsg antibodies consistent with a diagnosis of PV (ie, elevated antiDsg3 antibodies).
  • Has initiated and received a stable dose of prednisone/prednisolone from a minimum of 20 mg/day (example: 0.25 mg/kg/day for an 80 kg person) up to a maximum of 120 mg/day or 1.5 mg/kg/day (whichever is higher) for >=2 weeks prior to randomization.
  • Has exhibited PV disease control, defined as no new lesions for >=2 weeks.
  • A female subject is eligible to enter the study if she: Is of non-child bearing potential, who is either surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or post-hysterectomy) or is postmenopausal without menses for >2 years. Women who are <2 years postmenopausal are required to have menopausal status confirmed by follicle-stimulating hormone (FSH) and estradiol levels at the screening evaluation. If FSH and estradiol levels do not provide confirmation of menopause, subject will be considered to be of childbearing potential.

Exclusion Criteria:

  • Diagnosis of pemphigus foliaceus, paraneoplastic pemphigus, or other autoimmune blistering disease (other than pemphigus vulgaris).
  • Past or current history of hypersensitivity to components of the investigational product or medically significant adverse effects (including allergic reactions) from cetirizine (or antihistamine equivalent) or paracetamol/acetaminophen.
  • Prior treatment with rituximab without achieving disease control within 6 months of initiating rituximab dosing.
  • Prior treatment with immunosuppressant or immunomodulation agents within the protocol specified periods
  • Evidence or history of clinically significant infections

For Japan: Evidence or history of clinically significant infection or medical condition including: Pneumocystis pneumonia or interstitial pneumonia

  • Past or current malignancy, except for cervical carcinoma Stage 1B or less, noninvasive basal cell and squamous cell skin carcinoma and cancer diagnoses with a duration of complete response (remission) >5 years
  • Significant concurrent, uncontrolled medical condition that could affect the subject's safety, impair the subject's reliable participation in the study, impair the evaluation of endpoints, or necessitate the use of medication not allowed by the protocol. This includes subjects who require any systemic steroid treatment for a concurrent medical condition (other than pemphigus vulgaris).
  • Use of an investigational drug or other experimental therapy within 4 weeks, 5 pharmacokinetic half-lives, or the duration of biological effect (whichever is longer) prior to Screening.
  • Electrocardiogram (ECG) showing a clinically significant abnormality or showing a QTc interval ≥450 msec (≥480 msec for subjects with a bundle branch block)
  • Woman who is breastfeeding.

Sites / Locations

  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site
  • Novartis Investigational Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Ofatumumab

Placebo

Arm Description

Subject received subcutaneous administration of ofatumumab 20 mg once every 4 weeks through Week 56, with an additional 20 mg dose (that is 40mg total) at both Week 0 and Week 4.

Subject received subcutaneous administration of matching placebo of ofatumumab once every 4 weeks through Week 56, with an additional dose at both Week 0 and Week 4.

Outcomes

Primary Outcome Measures

Number of Subjects Who Experienced Sustained Remission on Minimal Steroid Therapy
Sustained remission = time from randomization to the time of the subject's initial reduction of prednisone/prednisolone dose to <=10 mg/day and maintenance of a dose <=10 mg/day with no new or nonhealing lesions for >=8 weeks and maintenance of the status until Week 60.
Duration of Remission on Minimal Steroid Therapy
Sum of all periods of absence of new or nonhealing lesions while on an oral prednisone/prednisolone dose of <=10 mg/day up to Week 60 was assessed.

Secondary Outcome Measures

Percentage of Subjects Achieving Remission on Minimal Steroid Therapy at Week 60
Percentage of subjects who achieved absence of new or nonhealing lesions while on an oral prednisone/prednisolone dose of <=10 mg/day for > or = 8 weeks at Week 60 was assessed. Time to remission was not estimable.
Time to Remission While on Minimal Steroid Therapy by Week 60.
Time from randomization to the time of the subject's initial reduction of prednisone/prednisolone dose to <=10 mg/day and maintained dose at <=10 mg/day with no new or nonhealing lesions for >=8 weeks by Week 60 was assessed
Percentage of Subjects Achieving Remission While Off Steroid Therapy by Week 60
Percentage of subjects with initial reduction of all steroids for >=8 weeks with an absence of new or nonhealing (established) lesions by Week 60 were to be assessed. All subjects remained on prednisone/prednisolone so this endpoint could not be analyzed.Time to remission off steroid therapy also could not be analyzed
Number of Days a Subject Maintained Minimal Steroid Therapy by Week 60.
Number of days a subject maintained minimal steroid therapy (an oral prednisone/prednisolone dose of ≤10 mg/day in the absence of new or nonhealing lesions) by Week 60.
Time to Initial Flare/Relapse by Week 60
Time from randomization to the time of appearance of >=3 new lesions within 1 month that did not heal spontaneously within 1 week, or to the time when there was an extension of lesions that were present at the randomization by Week 60 was assessed
Percentage of Participants With no Flare/Relapse by Week 60
Percentage of participants achieving absence of new or nonhealing lesions while on an oral prednisone/prednisolone dose of <=10 mg/day and did not subsequently have a appearance of >=3 new lesions within 1 month that did not heal spontaneously within 1 week, or to the time when there was an extension of lesions that were present at the randomization by Week 60 was assessed
Plasma Trough Concentrations of Ofatumumab
Only plasma (trough) concentrations of ofatumumab were presented
Number of Participants With Values Below Lower Limit of Normal for Immunoglobulin A
Assessed by the incidence, titer, and type of human anti-human antibody (HAHA) immune response
Number of Participants With Values Below Lower Limit of Normal for Immunoglobulin G
Assessed by the incidence, titer, and type of human anti-human antibody (HAHA) immune response
Number of Participants With Values Below Lower Limit of Normal for Immunoglobulin M
Assessed by the incidence, titer, and type of human anti-human antibody (HAHA) immune response
Largest Mean Decrease From Baseline for Immunoglobulin A, G and M
Immunoglobulins A, G and M were assessed by the incidence, titer, and type of human anti-human antibody (HAHA) immune response
Change From Baseline for CD19+ B Cell Count
CD19+ B cell count will be performed using Flow Cytometry

Full Information

First Posted
July 3, 2013
Last Updated
May 14, 2019
Sponsor
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT01920477
Brief Title
Efficacy and Safety of Ofatumumab in Treatment of Pemphigus Vulgaris
Official Title
OPV116910: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study to Investigate the Efficacy and Safety of Ofatumumab Injection for Subcutaneous Use in Subjects With Pemphigus Vulgaris
Study Type
Interventional

2. Study Status

Record Verification Date
May 2019
Overall Recruitment Status
Terminated
Why Stopped
Novartis has acquired the rights to ofatumumab and terminated the OPV116910 and OPV117059 studies. This decision is not linked to any safety consideration.
Study Start Date
August 13, 2013 (Actual)
Primary Completion Date
April 13, 2016 (Actual)
Study Completion Date
January 11, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis Pharmaceuticals

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Pemphigus vulgaris (PV) is a rare, chronic, debilitating, and potentially life-threatening autoimmune disorder that is characterized by mucocutaneous blisters. Ofatumumab is a novel monoclonal antibody (mAb) that specifically binds to the human CD20 antigen, which is expressed only in B lymphocytes. The purpose of this study was to evaluate the efficacy, tolerability, and safety of ofatumumab injection for subcutaneous use (ofatumumab SC) 20 milligrams (mg) administered once in every 4 weeks, (with an additional 20 mg loading dose [i.e. 40 mg total] at both Week 0 and Week 4) in subjects with PV. It was anticipated that with sustained B-cell depletion in the presence of ofatumumab SC, and the resultant reduction of pathogenic anti Dsg (desmoglein) autoantibodies in PV, that clinical remission of the disease would result.
Detailed Description
Novartis terminated the development of the PV program and this study was terminated for non-safety reasons

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pemphigus Vulgaris
Keywords
Pemphigus, MAB, autoimmune disorder, human CD20 antigen, subcutaneous, vulgaris, Phase 3, monoclonal antibody, ofatumumab, PV, rare disease, OMB157, adult

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
35 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ofatumumab
Arm Type
Experimental
Arm Description
Subject received subcutaneous administration of ofatumumab 20 mg once every 4 weeks through Week 56, with an additional 20 mg dose (that is 40mg total) at both Week 0 and Week 4.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Subject received subcutaneous administration of matching placebo of ofatumumab once every 4 weeks through Week 56, with an additional dose at both Week 0 and Week 4.
Intervention Type
Biological
Intervention Name(s)
Ofatumumab
Intervention Description
Ofatumumab (human monoclonal antibody) was provided in prefilled glass syringes initial syringes contained 0.6ml (60mg) of concentration 100 mg/m: drug product subsequently modified to 0.4 mL (20mg) concentration (50mg/ML) drug product
Intervention Type
Biological
Intervention Name(s)
Placebo
Intervention Description
Placebo to match the active doses will consist of prefilled glass syringes filled with normal saline.
Primary Outcome Measure Information:
Title
Number of Subjects Who Experienced Sustained Remission on Minimal Steroid Therapy
Description
Sustained remission = time from randomization to the time of the subject's initial reduction of prednisone/prednisolone dose to <=10 mg/day and maintenance of a dose <=10 mg/day with no new or nonhealing lesions for >=8 weeks and maintenance of the status until Week 60.
Time Frame
Baseline up to approximately 60 weeks
Title
Duration of Remission on Minimal Steroid Therapy
Description
Sum of all periods of absence of new or nonhealing lesions while on an oral prednisone/prednisolone dose of <=10 mg/day up to Week 60 was assessed.
Time Frame
Baseline up to approximately 60 weeks
Secondary Outcome Measure Information:
Title
Percentage of Subjects Achieving Remission on Minimal Steroid Therapy at Week 60
Description
Percentage of subjects who achieved absence of new or nonhealing lesions while on an oral prednisone/prednisolone dose of <=10 mg/day for > or = 8 weeks at Week 60 was assessed. Time to remission was not estimable.
Time Frame
Week 60
Title
Time to Remission While on Minimal Steroid Therapy by Week 60.
Description
Time from randomization to the time of the subject's initial reduction of prednisone/prednisolone dose to <=10 mg/day and maintained dose at <=10 mg/day with no new or nonhealing lesions for >=8 weeks by Week 60 was assessed
Time Frame
Baseline up to approximately 60 weeks
Title
Percentage of Subjects Achieving Remission While Off Steroid Therapy by Week 60
Description
Percentage of subjects with initial reduction of all steroids for >=8 weeks with an absence of new or nonhealing (established) lesions by Week 60 were to be assessed. All subjects remained on prednisone/prednisolone so this endpoint could not be analyzed.Time to remission off steroid therapy also could not be analyzed
Time Frame
Baseline up to approximately 60 weeks
Title
Number of Days a Subject Maintained Minimal Steroid Therapy by Week 60.
Description
Number of days a subject maintained minimal steroid therapy (an oral prednisone/prednisolone dose of ≤10 mg/day in the absence of new or nonhealing lesions) by Week 60.
Time Frame
Baseline up to approximately 60 weeks
Title
Time to Initial Flare/Relapse by Week 60
Description
Time from randomization to the time of appearance of >=3 new lesions within 1 month that did not heal spontaneously within 1 week, or to the time when there was an extension of lesions that were present at the randomization by Week 60 was assessed
Time Frame
Baseline up to approximately 60 weeks
Title
Percentage of Participants With no Flare/Relapse by Week 60
Description
Percentage of participants achieving absence of new or nonhealing lesions while on an oral prednisone/prednisolone dose of <=10 mg/day and did not subsequently have a appearance of >=3 new lesions within 1 month that did not heal spontaneously within 1 week, or to the time when there was an extension of lesions that were present at the randomization by Week 60 was assessed
Time Frame
Baseline up to approximately 60 weeks
Title
Plasma Trough Concentrations of Ofatumumab
Description
Only plasma (trough) concentrations of ofatumumab were presented
Time Frame
4 hours post baseline, Days 1-4,7,14, Weeks 4,8,12,16,20,24,36,48,52,56, up to approximately 60 weeks
Title
Number of Participants With Values Below Lower Limit of Normal for Immunoglobulin A
Description
Assessed by the incidence, titer, and type of human anti-human antibody (HAHA) immune response
Time Frame
Baseline up to approximately 60 weeks
Title
Number of Participants With Values Below Lower Limit of Normal for Immunoglobulin G
Description
Assessed by the incidence, titer, and type of human anti-human antibody (HAHA) immune response
Time Frame
Baseline up to approximately 60 weeks
Title
Number of Participants With Values Below Lower Limit of Normal for Immunoglobulin M
Description
Assessed by the incidence, titer, and type of human anti-human antibody (HAHA) immune response
Time Frame
Baseline up to approximately 60 weeks
Title
Largest Mean Decrease From Baseline for Immunoglobulin A, G and M
Description
Immunoglobulins A, G and M were assessed by the incidence, titer, and type of human anti-human antibody (HAHA) immune response
Time Frame
Baseline up to approximately 60 weeks
Title
Change From Baseline for CD19+ B Cell Count
Description
CD19+ B cell count will be performed using Flow Cytometry
Time Frame
Baseline up to approximately 60 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria Adults (18 through 70 years of age) with clinically-documented diagnosis of PV for >2 months and <10 years. History of biopsy consistent with PV (Hematoxylin and Eosin staining and direct immunofluorescence). If no history, a biopsy may be performed during the Screening Period. At least 1 previous episode of a failed steroid taper (ie, disease flare/relapse) at a prednisone/prednisolone dose >10 mg/day. The following criteria must have been met as evidence of disease severity at the time of the failed steroid taper: a) A Pemphigus Severity of Clinical Disease score of moderate (2) or severe (3) (may be historical/retrospective assessment). b) Required a treatment change at the time of the failed steroid taper of at least one of the following: i) A steroid increase to >=20 mg/day OR ii) The addition of immunosuppressive/immunomodulatory agent/treatment OR iii) A dose increase of immunosuppressive/immunomodulatory agent/treatment Screening anti-Dsg antibodies consistent with a diagnosis of PV (ie, elevated antiDsg3 antibodies). Has initiated and received a stable dose of prednisone/prednisolone from a minimum of 20 mg/day (example: 0.25 mg/kg/day for an 80 kg person) up to a maximum of 120 mg/day or 1.5 mg/kg/day (whichever is higher) for >=2 weeks prior to randomization. Has exhibited PV disease control, defined as no new lesions for >=2 weeks. A female subject is eligible to enter the study if she: Is of non-child bearing potential, who is either surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or post-hysterectomy) or is postmenopausal without menses for >2 years. Women who are <2 years postmenopausal are required to have menopausal status confirmed by follicle-stimulating hormone (FSH) and estradiol levels at the screening evaluation. If FSH and estradiol levels do not provide confirmation of menopause, subject will be considered to be of childbearing potential. Exclusion Criteria: Diagnosis of pemphigus foliaceus, paraneoplastic pemphigus, or other autoimmune blistering disease (other than pemphigus vulgaris). Past or current history of hypersensitivity to components of the investigational product or medically significant adverse effects (including allergic reactions) from cetirizine (or antihistamine equivalent) or paracetamol/acetaminophen. Prior treatment with rituximab without achieving disease control within 6 months of initiating rituximab dosing. Prior treatment with immunosuppressant or immunomodulation agents within the protocol specified periods Evidence or history of clinically significant infections For Japan: Evidence or history of clinically significant infection or medical condition including: Pneumocystis pneumonia or interstitial pneumonia Past or current malignancy, except for cervical carcinoma Stage 1B or less, noninvasive basal cell and squamous cell skin carcinoma and cancer diagnoses with a duration of complete response (remission) >5 years Significant concurrent, uncontrolled medical condition that could affect the subject's safety, impair the subject's reliable participation in the study, impair the evaluation of endpoints, or necessitate the use of medication not allowed by the protocol. This includes subjects who require any systemic steroid treatment for a concurrent medical condition (other than pemphigus vulgaris). Use of an investigational drug or other experimental therapy within 4 weeks, 5 pharmacokinetic half-lives, or the duration of biological effect (whichever is longer) prior to Screening. Electrocardiogram (ECG) showing a clinically significant abnormality or showing a QTc interval ≥450 msec (≥480 msec for subjects with a bundle branch block) Woman who is breastfeeding.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Novartis Pharmaceuticals
Organizational Affiliation
Novartis Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Novartis Investigational Site
City
Los Angeles
State/Province
California
ZIP/Postal Code
90045
Country
United States
Facility Name
Novartis Investigational Site
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
Novartis Investigational Site
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48103
Country
United States
Facility Name
Novartis Investigational Site
City
Buffalo
State/Province
New York
ZIP/Postal Code
14203
Country
United States
Facility Name
Novartis Investigational Site
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Novartis Investigational Site
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States
Facility Name
Novartis Investigational Site
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States
Facility Name
Novartis Investigational Site
City
East Melbourne
State/Province
Victoria
ZIP/Postal Code
3002
Country
Australia
Facility Name
Novartis Investigational Site
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
3050
Country
Australia
Facility Name
Novartis Investigational Site
City
Thessalonica
ZIP/Postal Code
54643
Country
Greece
Facility Name
Novartis Investigational Site
City
Ramat-Gan
ZIP/Postal Code
52621
Country
Israel
Facility Name
Novartis Investigational Site
City
Tel Aviv
ZIP/Postal Code
64239
Country
Israel
Facility Name
Novartis Investigational Site
City
Milano
State/Province
Lombardia
ZIP/Postal Code
20122
Country
Italy
Facility Name
Novartis Investigational Site
City
Tokyo
ZIP/Postal Code
160-8582
Country
Japan
Facility Name
Novartis Investigational Site
City
Warszawa
ZIP/Postal Code
02-008
Country
Poland
Facility Name
Novartis Investigational Site
City
Cluj-Napoca
ZIP/Postal Code
400006
Country
Romania

12. IPD Sharing Statement

Plan to Share IPD
Undecided
IPD Sharing Plan Description
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com

Learn more about this trial

Efficacy and Safety of Ofatumumab in Treatment of Pemphigus Vulgaris

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