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BI 655066 (Risankizumab) Proof of Concept Dose Finding Study in Ankylosing Spondylitis (AS)

Primary Purpose

Ankylosing Spondylitis (AS)

Status
Completed
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
placebo for risankizumab
risankizumab
Sponsored by
AbbVie
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ankylosing Spondylitis (AS)

Eligibility Criteria

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

Inclusion criteria:

  1. Male and female patients
  2. Age = 18 years and = 70 years
  3. Definite AS based on the modified New York criteria (1984)
  4. Documented disease duration = 3 months at screening
  5. Active disease at screening, defined as:

    1. BASDAI score (0-10) = 4, AND
    2. Spinal pain level assessed by the 2nd BASDAI question (0-10) = 4
  6. Have either a documented inadequate response for axial symptoms to 30 days of optimal daily doses of at least two non-steroidal anti-inflammatory drugs (NSAIDs), or documented intolerance to NSAIDs
  7. Female patients who meet any of the following criteria from screening visit up to the End of Observation visit (EOO):

    • using adequate contraception, e.g. any of the following methods plus condom: implants, injectables, combined oral contraceptives, intrauterine device (IUD)
    • sexually abstinent
    • have a vasectomised sexual partner (vasectomy at least 1 year prior to enrolment)
    • surgically sterilised (including hysterectomy)
    • postmenopausal defined as at least 1 year of spontaneous Amenorrhea
  8. Patients (males or females) receiving background MTX or Leflunomide therapy who are following the national regulatory guidelines regarding contraception
  9. Signed and dated written informed consent prior to admission to the study in accordance with GCP and local legislation

Exclusion criteria:

  1. Radiographic evidence of total ankylosis of the spine at screening or before (spinal XRay examinations at screening visit/ during screening period are not mandatory ¿ see footnote 12 from Flow-Chart 1)
  2. Patient previously treated with any biological immunomodulating agent for AS, either licensed or experimental
  3. Previous or current participation in a clinical trial testing an investigational drug for AS within 12 weeks prior to randomization (any biological immunomodulating agents are excluded)
  4. Usage of any investigational drug within 30 days prior to randomization or the planned use of an investigational drug during the course of the actual study
  5. Active uveitis or inflammatory bowel disease at screening
  6. Diagnosed psoriatic arthritis at screening, satisfying the modified New York criteria
  7. Patients who had received intraarticular injection(s) with corticosteroids within 4 weeks prior to screening visit
  8. Patients who must or wish to continue the intake of restricted medications (cf. Section 4.2.2.1) or any drug considered likely to interfere with the safe conduct of the study
  9. Major surgery performed within 8 weeks prior to screening or planned within 12 months after screening (e.g. hip replacement)
  10. Chronic or relevant acute infections including HIV, viral hepatitis and tuberculosis (positive tests for HIV, HBV/HCV at screening will be exclusionary)

    For tuberculosis patients, they are not eligible according to the following screening criteria:

    • Have signs or symptoms suggestive of current active or latent TB upon medical history, physical examination and/or a chest radiograph (both posterior-anterior and lateral views, taken within 3 months prior to the first administration of study drug and read by a qualified radiologist)
    • Have history of latent or active TB prior to screening, except for patients who have documentation of having completed an adequate treatment regimen at least 6 months prior to the first administration of study agent
    • Have positive QuantiFERON-TB Gold In-Tube test within 2 months prior to or during screening, in which active TB has not been ruled out, except for patients with history of latent TB and documentation of having completed an adequate treatment regimen at least 6 months prior to the first administration of study agent
  11. Any documented active or suspected malignancy or history of malignancy within 5 years prior to screening, except appropriately treated basal cell carcinoma of the skin or in situ carcinoma of uterine cervix
  12. Evidence of current or previous clinically significant disease, medical condition other than AS, finding of the medical examination (including vital signs and ECG), or laboratory value at the screening visit outside the reference range that is of clinical relevance, that in the opinion of the Investigator, would compromise the safety of the patient or the quality of the data. This criterion provides an opportunity for the investigator to exclude patients based on clinical judgment, even if other eligibility criteria are satisfied.
  13. History of allergy/hypersensitivity to a systemically administered biologic agent or its excipients
  14. History of alcohol abuse within last 12 months (intake of more than 30 g/day)
  15. History of drug abuse within last 12 months

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm Type

    Placebo Comparator

    Experimental

    Experimental

    Experimental

    Arm Label

    Placebo

    Risankizumab 18 mg

    Risankizumab 90 mg

    Risankizumab 180 mg

    Arm Description

    Subcutaneous injection of Placebo (solution for injection matching risankizumab, 1 mL pre-filled syringe) administered every 8 weeks (At Day1 and at Weeks 8, 16, and 24) up to 4 times during the regular treatment period.

    Subcutaneous injection of risankizumab 18 mg administered every 8 weeks at Day 1 only, followed by placebo every 8 weeks (i.e. at Week 8, 16 and 24), up to a total duration of 24 weeks

    Subcutaneous injection of risankizumab 90 mg administered every 8 weeks (At Day1 and at Weeks 8, 16, and 24) up to 4 times during the regular treatment period

    Subcutaneous injection of risankizumab 180 mg administered every 8 weeks (At Day1 and at Weeks 8, 16, and 24) up to 4 times during the regular treatment period

    Outcomes

    Primary Outcome Measures

    Percentage of Patients Who Achieved Assessment of Spondyloarthritis International Society (ASAS) 40 Improvement Criteria at Week 12.
    ASAS 40 evaluations are based on the following 4 components (also called domains) that include patient' self-assessments on a numerical rating scale (NRS) from 0 to 10 with higher numbers representing a worse disease status: Global AS disease activity Inflammation based on the mean of Bath AS Disease Activity Index (BASDAI) questions addressing the level of morning stiffness and duration Spinal pain based on the mean of 2 questions Physical function based on the Bath AS Functional Index (BASFI) The ASAS 40 response is defined as an improvement in 3 of 4 components and no worsening in the remaining component; an improvement is defined as a reduction from baseline of ≥40% and an absolute reduction of ≥2 units in each of the 3 components.

    Secondary Outcome Measures

    Change From Baseline to Week 12 in Disease Activity Assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS).
    This is the key secondary endpoint. ASDAS is a linear function of Back Pain (Question 2 from Bath Ankylosing Spondylitis (AS) Disease Activity Index (BASDAI): range 0-10), Duration of Morning Stiffness (Question 6 from BASDAI: range 0-10), Patient's global assessment of the disease on Numerical rating Scale (NRS) (range 0-10), peripheral joint pain/swelling (Question 3 from BASDAI: range 0-10) and the C-reactive protein (CRP) lab value at the visit. ASDAS-CRP: 0.121*Back pain +0.058*Duration of Morning Stiffness +0.11*Patient Global + 0.073*Peripheral pain/ Swelling + 0.579*Ln (CRP +1). For all of the scales that make up the ASDAS, higher indicates worse disease.
    Percentage of Patients Who Achieved ASAS 5/6 Improvement Criteria at Week 12
    The ASAS 5/6 evaluation is based on 6 components: Global AS disease activity Inflammation based on the mean of BASDAI questions addressing the level-of morning stiffness and duration Spinal pain Physical function based on the Bath AS Functional Index (BASFI) Spinal mobility assessment (lateral lumbar flexion), corresponding to one out of 5 measurements of Bath Ankylosing Spondylitis Metrology Index (BASMI) Serum CRP levels The ASAS 5/6 response is defined as an improvement in any 5 of the 6 components and no worsening in the remaining component. A reduction from baseline of ≥20% is defined as an improvement according to the ASAS criteria.
    Percentage of Patients Who Achieved Partial Remission According to the ASAS Criteria at Week 12
    Percentage of patients who achieved partial remission according to the ASAS criteria at Week 12 is presented
    Percentage of Patients Who Achieved ASAS 20 Improvement Criteria at Week 12
    ASAS 20 evaluations are based on the following 4 components (also called domains) that include patient' self-assessments on a numerical rating scale (NRS) from 0 to 10 with higher numbers representing a worse disease status: Global AS disease activity Inflammation based on the mean of Bath AS Disease Activity Index (BASDAI) questions addressing the level of morning stiffness and duration Spinal pain based on the mean of 2 questions Physical function based on the Bath AS Functional Index (BASFI) The ASAS 20 response is defined as an improvement in 3 of 4 components and no worsening in the remaining component; an improvement is defined as a reduction from baseline of ≥20% and an absolute reduction of ≥1 units in each of the 3 components.
    Change From Baseline to Week 12 in Disease Activity Assessed by BASDAI
    BASDAI assesses the AS disease activity of a patient within the last week based on 6 questions on a NRS (1 to 10) How would you describe the overall level of fatigue/tiredness you have experienced? AS neck, back or hip pain you have had? pain/swelling in joints other than neck, back or hips you have had? discomfort you have had from any areas tender to touch or pressure? morning stiffness you have had from the time you wake up? How long does your morning stiffness last from the time you wake up? A score of 10 means very severe disease activity for each of the BASDAI questions 1, 2, 3, 4 and 5. BASDAI question 6 addresses the stiffness duration. A NRS of 0 means 0 h; a NRS of 10 mean ≥2 h. The BASDAI was computed in the following way: the sum of the values of question 1 to 4 was calculated and the mean of questions 5 and 6 was added. This value was divided by 5.
    Percentage of Patients Who Achieved ASAS 40 Improvement Criteria at Week 24
    Percentage of patients who achieved ASAS 40 improvement criteria at Week 24 is presented

    Full Information

    First Posted
    January 24, 2014
    Last Updated
    May 30, 2019
    Sponsor
    AbbVie
    Collaborators
    Boehringer Ingelheim
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02047110
    Brief Title
    BI 655066 (Risankizumab) Proof of Concept Dose Finding Study in Ankylosing Spondylitis (AS)
    Official Title
    A 48 Weeks, Phase II, Randomized, Double-blind, Placebo-controlled, Proof of Concept and Dose Finding Study of Three Different Dose Regimens of BI 655066 Administered Subcutaneously in Patients With Ankylosing Spondylitis.
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    May 2019
    Overall Recruitment Status
    Completed
    Study Start Date
    January 28, 2014 (Actual)
    Primary Completion Date
    March 5, 2015 (Actual)
    Study Completion Date
    July 25, 2016 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    AbbVie
    Collaborators
    Boehringer Ingelheim

    4. Oversight

    5. Study Description

    Brief Summary
    The overall purpose of the trial is to assess the clinical efficacy of three different subcutaneous doses of BI 655066 (risankizumab) in adult patients with AS, in order to provide clinical proof of concept and to select dose (s) for confirmatory clinical trials.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Ankylosing Spondylitis (AS)

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    Double
    Allocation
    Randomized
    Enrollment
    159 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Subcutaneous injection of Placebo (solution for injection matching risankizumab, 1 mL pre-filled syringe) administered every 8 weeks (At Day1 and at Weeks 8, 16, and 24) up to 4 times during the regular treatment period.
    Arm Title
    Risankizumab 18 mg
    Arm Type
    Experimental
    Arm Description
    Subcutaneous injection of risankizumab 18 mg administered every 8 weeks at Day 1 only, followed by placebo every 8 weeks (i.e. at Week 8, 16 and 24), up to a total duration of 24 weeks
    Arm Title
    Risankizumab 90 mg
    Arm Type
    Experimental
    Arm Description
    Subcutaneous injection of risankizumab 90 mg administered every 8 weeks (At Day1 and at Weeks 8, 16, and 24) up to 4 times during the regular treatment period
    Arm Title
    Risankizumab 180 mg
    Arm Type
    Experimental
    Arm Description
    Subcutaneous injection of risankizumab 180 mg administered every 8 weeks (At Day1 and at Weeks 8, 16, and 24) up to 4 times during the regular treatment period
    Intervention Type
    Drug
    Intervention Name(s)
    placebo for risankizumab
    Intervention Description
    Placebo for risankizumab administered by subcutaneous (SC) injection
    Intervention Type
    Drug
    Intervention Name(s)
    risankizumab
    Other Intervention Name(s)
    ABBV-066, BI 655066, SKYRIZI
    Intervention Description
    Risankizumab administered by subcutaneous (SC) injection
    Primary Outcome Measure Information:
    Title
    Percentage of Patients Who Achieved Assessment of Spondyloarthritis International Society (ASAS) 40 Improvement Criteria at Week 12.
    Description
    ASAS 40 evaluations are based on the following 4 components (also called domains) that include patient' self-assessments on a numerical rating scale (NRS) from 0 to 10 with higher numbers representing a worse disease status: Global AS disease activity Inflammation based on the mean of Bath AS Disease Activity Index (BASDAI) questions addressing the level of morning stiffness and duration Spinal pain based on the mean of 2 questions Physical function based on the Bath AS Functional Index (BASFI) The ASAS 40 response is defined as an improvement in 3 of 4 components and no worsening in the remaining component; an improvement is defined as a reduction from baseline of ≥40% and an absolute reduction of ≥2 units in each of the 3 components.
    Time Frame
    Week 12
    Secondary Outcome Measure Information:
    Title
    Change From Baseline to Week 12 in Disease Activity Assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS).
    Description
    This is the key secondary endpoint. ASDAS is a linear function of Back Pain (Question 2 from Bath Ankylosing Spondylitis (AS) Disease Activity Index (BASDAI): range 0-10), Duration of Morning Stiffness (Question 6 from BASDAI: range 0-10), Patient's global assessment of the disease on Numerical rating Scale (NRS) (range 0-10), peripheral joint pain/swelling (Question 3 from BASDAI: range 0-10) and the C-reactive protein (CRP) lab value at the visit. ASDAS-CRP: 0.121*Back pain +0.058*Duration of Morning Stiffness +0.11*Patient Global + 0.073*Peripheral pain/ Swelling + 0.579*Ln (CRP +1). For all of the scales that make up the ASDAS, higher indicates worse disease.
    Time Frame
    Baseline and Week 12
    Title
    Percentage of Patients Who Achieved ASAS 5/6 Improvement Criteria at Week 12
    Description
    The ASAS 5/6 evaluation is based on 6 components: Global AS disease activity Inflammation based on the mean of BASDAI questions addressing the level-of morning stiffness and duration Spinal pain Physical function based on the Bath AS Functional Index (BASFI) Spinal mobility assessment (lateral lumbar flexion), corresponding to one out of 5 measurements of Bath Ankylosing Spondylitis Metrology Index (BASMI) Serum CRP levels The ASAS 5/6 response is defined as an improvement in any 5 of the 6 components and no worsening in the remaining component. A reduction from baseline of ≥20% is defined as an improvement according to the ASAS criteria.
    Time Frame
    Week 12
    Title
    Percentage of Patients Who Achieved Partial Remission According to the ASAS Criteria at Week 12
    Description
    Percentage of patients who achieved partial remission according to the ASAS criteria at Week 12 is presented
    Time Frame
    Week 12
    Title
    Percentage of Patients Who Achieved ASAS 20 Improvement Criteria at Week 12
    Description
    ASAS 20 evaluations are based on the following 4 components (also called domains) that include patient' self-assessments on a numerical rating scale (NRS) from 0 to 10 with higher numbers representing a worse disease status: Global AS disease activity Inflammation based on the mean of Bath AS Disease Activity Index (BASDAI) questions addressing the level of morning stiffness and duration Spinal pain based on the mean of 2 questions Physical function based on the Bath AS Functional Index (BASFI) The ASAS 20 response is defined as an improvement in 3 of 4 components and no worsening in the remaining component; an improvement is defined as a reduction from baseline of ≥20% and an absolute reduction of ≥1 units in each of the 3 components.
    Time Frame
    Week 12
    Title
    Change From Baseline to Week 12 in Disease Activity Assessed by BASDAI
    Description
    BASDAI assesses the AS disease activity of a patient within the last week based on 6 questions on a NRS (1 to 10) How would you describe the overall level of fatigue/tiredness you have experienced? AS neck, back or hip pain you have had? pain/swelling in joints other than neck, back or hips you have had? discomfort you have had from any areas tender to touch or pressure? morning stiffness you have had from the time you wake up? How long does your morning stiffness last from the time you wake up? A score of 10 means very severe disease activity for each of the BASDAI questions 1, 2, 3, 4 and 5. BASDAI question 6 addresses the stiffness duration. A NRS of 0 means 0 h; a NRS of 10 mean ≥2 h. The BASDAI was computed in the following way: the sum of the values of question 1 to 4 was calculated and the mean of questions 5 and 6 was added. This value was divided by 5.
    Time Frame
    Baseline and Week 12
    Title
    Percentage of Patients Who Achieved ASAS 40 Improvement Criteria at Week 24
    Description
    Percentage of patients who achieved ASAS 40 improvement criteria at Week 24 is presented
    Time Frame
    Week 24

    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: Male and female patients Age = 18 years and = 70 years Definite AS based on the modified New York criteria (1984) Documented disease duration = 3 months at screening Active disease at screening, defined as: BASDAI score (0-10) = 4, AND Spinal pain level assessed by the 2nd BASDAI question (0-10) = 4 Have either a documented inadequate response for axial symptoms to 30 days of optimal daily doses of at least two non-steroidal anti-inflammatory drugs (NSAIDs), or documented intolerance to NSAIDs Female patients who meet any of the following criteria from screening visit up to the End of Observation visit (EOO): using adequate contraception, e.g. any of the following methods plus condom: implants, injectables, combined oral contraceptives, intrauterine device (IUD) sexually abstinent have a vasectomised sexual partner (vasectomy at least 1 year prior to enrolment) surgically sterilised (including hysterectomy) postmenopausal defined as at least 1 year of spontaneous Amenorrhea Patients (males or females) receiving background MTX or Leflunomide therapy who are following the national regulatory guidelines regarding contraception Signed and dated written informed consent prior to admission to the study in accordance with GCP and local legislation Exclusion criteria: Radiographic evidence of total ankylosis of the spine at screening or before (spinal XRay examinations at screening visit/ during screening period are not mandatory ¿ see footnote 12 from Flow-Chart 1) Patient previously treated with any biological immunomodulating agent for AS, either licensed or experimental Previous or current participation in a clinical trial testing an investigational drug for AS within 12 weeks prior to randomization (any biological immunomodulating agents are excluded) Usage of any investigational drug within 30 days prior to randomization or the planned use of an investigational drug during the course of the actual study Active uveitis or inflammatory bowel disease at screening Diagnosed psoriatic arthritis at screening, satisfying the modified New York criteria Patients who had received intraarticular injection(s) with corticosteroids within 4 weeks prior to screening visit Patients who must or wish to continue the intake of restricted medications (cf. Section 4.2.2.1) or any drug considered likely to interfere with the safe conduct of the study Major surgery performed within 8 weeks prior to screening or planned within 12 months after screening (e.g. hip replacement) Chronic or relevant acute infections including HIV, viral hepatitis and tuberculosis (positive tests for HIV, HBV/HCV at screening will be exclusionary) For tuberculosis patients, they are not eligible according to the following screening criteria: Have signs or symptoms suggestive of current active or latent TB upon medical history, physical examination and/or a chest radiograph (both posterior-anterior and lateral views, taken within 3 months prior to the first administration of study drug and read by a qualified radiologist) Have history of latent or active TB prior to screening, except for patients who have documentation of having completed an adequate treatment regimen at least 6 months prior to the first administration of study agent Have positive QuantiFERON-TB Gold In-Tube test within 2 months prior to or during screening, in which active TB has not been ruled out, except for patients with history of latent TB and documentation of having completed an adequate treatment regimen at least 6 months prior to the first administration of study agent Any documented active or suspected malignancy or history of malignancy within 5 years prior to screening, except appropriately treated basal cell carcinoma of the skin or in situ carcinoma of uterine cervix Evidence of current or previous clinically significant disease, medical condition other than AS, finding of the medical examination (including vital signs and ECG), or laboratory value at the screening visit outside the reference range that is of clinical relevance, that in the opinion of the Investigator, would compromise the safety of the patient or the quality of the data. This criterion provides an opportunity for the investigator to exclude patients based on clinical judgment, even if other eligibility criteria are satisfied. History of allergy/hypersensitivity to a systemically administered biologic agent or its excipients History of alcohol abuse within last 12 months (intake of more than 30 g/day) History of drug abuse within last 12 months
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Boehringer Ingelheim
    Organizational Affiliation
    Boehringer Ingelheim
    Official's Role
    Study Chair

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    29945918
    Citation
    Baeten D, Ostergaard M, Wei JC, Sieper J, Jarvinen P, Tam LS, Salvarani C, Kim TH, Solinger A, Datsenko Y, Pamulapati C, Visvanathan S, Hall DB, Aslanyan S, Scholl P, Padula SJ. Risankizumab, an IL-23 inhibitor, for ankylosing spondylitis: results of a randomised, double-blind, placebo-controlled, proof-of-concept, dose-finding phase 2 study. Ann Rheum Dis. 2018 Sep;77(9):1295-1302. doi: 10.1136/annrheumdis-2018-213328. Epub 2018 Jun 26.
    Results Reference
    derived
    Links:
    URL
    http://rxabbvie.com
    Description
    Related Info

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    BI 655066 (Risankizumab) Proof of Concept Dose Finding Study in Ankylosing Spondylitis (AS)

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