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A Study to Assess the Efficacy and Safety of IGIV-C in Patients With Myasthenia Gravis Exacerbations

Primary Purpose

Myasthenia Gravis Exacerbations

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
IGIV-C
Sponsored by
Grifols Therapeutics LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myasthenia Gravis Exacerbations

Eligibility Criteria

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

Inclusion Criteria:

  • Was male or female aged ≥18 years.
  • Subjects must be willing and able to provide written informed consent (if applicable, a legally authorized representative may provide informed consent on behalf of the subject).
  • Subjects who met the clinical criteria for diagnosis of MG with an exacerbation defined as worsening of MG symptoms as defined by an Myasthenia Gravis Foundation of America (MGFA) classification IVb or V.
  • Subjects on long-term (8 weeks) corticosteroid treatment for MG.
  • Female subjects of child-bearing potential must have a negative test for pregnancy (human chorionic gonadotropin [HCG]-based assay).
  • Subjects must be willing to comply with all aspects of the clinical trial protocol, including blood sampling and long-term storage of extra samples, for the entire duration of the study.

Exclusion Criteria:

  • Subjects who had received immune globulin treatment given by IV, subcutaneous or intramuscular route within the last 30 days.
  • Subjects with documentation of a lack of clinical response to intravenous immunoglobulin (IVIg) therapy for MG.
  • Subjects documented positive for antibodies directed against Muscle specific kinase (MuSK).
  • Subjects with corticosteroid (CS) treatment initiated within the last 8 weeks or modified within the last 2 weeks.
  • Subjects with plasma exchange (PLEX) within the last 30 days.
  • Subjects with MG exacerbation attributable to change in medication or infection or evident infection as defined by, but not limited to, the presence of at least one of the following diagnostic features: 1) axillary temperature ≥38°C, 2) positive blood culture of infective microorganism, 3) white blood cell count >12×10^9/L and differential white blood cell count of >10% band neutrophils (>1.2×10^9/L), and 4) pulmonary infiltrate with consolidation on chest X-ray. Alternatively, other signs and symptoms may be considered for the diagnosis of evident infection according to the Investigator's judgement.
  • Subjects with inadequate venous access.
  • Subjects with a history of anaphylactic reactions or severe reactions to any blood-derived product.
  • Subjects with a history of intolerance to any component of the investigational products.
  • Subjects with a documented diagnosis of thrombotic complications to polyclonal IVIG therapy in the past.
  • Subjects with a history of recent (within the last year) myocardial infarction, stroke or uncontrolled hypertension.
  • Subjects who suffered from uncontrolled congestive heart failure, embolism or documented electrocardiogram (ECG) changes indicative of myocardial ischemia or atrial fibrillation.
  • Subjects with current known hyperviscosity or hypercoagulable state.
  • Subjects currently receiving anti-coagulation therapy.
  • Subjects with a history of chronic alcoholism or illicit drug abuse (addiction) in the 12 months preceding the Baseline Visit.
  • Subjects currently receiving, or having received within 3 months prior to the Baseline Visit, any investigational medicinal product or device.
  • Subjects with a known Immunoglobulin A (IgA) deficiency and anti-IgA serum antibodies.
  • Subjects with renal impairment (i.e., serum creatinine exceeds more than 1.5 times the upper limit of normal [ULN] for the expected normal range for the testing laboratory).
  • Subjects with aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels exceeding more than 2.5 times the ULN for the expected normal range for the testing laboratory.
  • Subjects with haemoglobin levels <9 g/dL.

Sites / Locations

  • Hospital Italiano
  • Hospital General de Agudos Dr. J. M.
  • Hospital Cordoba
  • AZ St Lucas Gent
  • UZ Leuven
  • University of Alberta Hospital
  • London Health Sciences Centre
  • University Health Network (UHN) - Toronto General Hospital
  • Fakultni nemocnice Brno, Neurologicka klinika
  • Fakultni nemocnice Ostrava, Neurologická klinika
  • Vseobecna fakultni nemocnice v Praze
  • East Tallinn Central Hospital
  • Hopital Neurologique Pierre Wertheimer
  • Hôpital Albert Michallon
  • Hopital Roger Salengro
  • Hôpital de la Timone
  • Hôpital Hautepierre Strasbourg
  • CHU de Toulouse - Hôpital Purpan
  • Jahn Ferenc Del-Pesti Korhaz
  • Pest Megyei Flor Ferenc Korhaz
  • Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház
  • University of Szeged, Faculty of Medicine
  • Zala Megyei Korhaz
  • Riga East Clinical University Hospital
  • Uniwersyteckie Centrum Kliniczne
  • Institutul Clinic Fundeni
  • Spitalul Clinic Judetean de Urgenta Targu-Mures
  • State Budgetary Institution of Healthcare of Nizhniy Novgorod region. Nizhniy Novgorod Regional Clinical Hospital named after N.A.Semashko
  • Saint-Petersburg State Budgetary Institution of Healthcare. City Multi-field Hospital # 2
  • State Budgetary Institution of Healthcare "Samara Regional Clinical Hospital. V.D.Seredavin
  • Groote Schuur Hospital,

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

IGIV-C Treatment

Arm Description

In this arm, subjects with myasthenia gravis exacerbations were treated with an IV dose of 2 g/kg of IGIV-C, which was administered over 2 consecutive days at a dose of 1 g/kg per day.

Outcomes

Primary Outcome Measures

Change in Quantitative Myasthenia Gravis (QMG) Scale Score
Mean Change in Quantitative Myasthenia Gravis (QMG) Scale Score from Baseline (Day 0) to Day 14. The minimum and maximum scores of the QMG Scale are 0 and 39, respectively, and a higher score means a worse outcome.

Secondary Outcome Measures

Percentage of Subjects With Clinical Improvement Assessed by QMG
The percentage of subjects with clinical improvement at Day 14 as assessed by the Quantitative Myasthenia Gravis (QMG) scale in the Evaluable population is presented, in which clinical improvement is defined as at least 3-point decrease in QMG score from Baseline (Day 0) to Day 14. The minimum and maximum scores of the QMG scale are 0 and 39, respectively, and a higher score means a worse outcome.
Percentage of Subjects With Clinical Improvement Assessed by MG-Activities of Daily Living (MG-ADL) Scale
The percentage of subjects with clinical improvement at Day 14 as assessed by the MG-ADL Scale in the Evaluable population is presented, in which clinical improvement is defined as at least 2-point decrease in the MG-ADL score. The minimum and maximum scores of the MG-DAL scale are 0 and 24, respectively, and a higher score means a worse outcome.
Percentage of Subjects With Clinical Improvement Assessed by the MG Composite
The percentage of subjects with clinical improvement at Day 14 as assessed by the MG Composite scale in the Evaluable population is presented in which clinical improvement is defined as at least 3-point decrease in the MG Composite score. The minimum and maximum scores of the MG Composite scale are 0 and 50, respectively, with a higher score meaning a worse outcome.

Full Information

First Posted
April 7, 2015
Last Updated
April 9, 2020
Sponsor
Grifols Therapeutics LLC
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1. Study Identification

Unique Protocol Identification Number
NCT02413580
Brief Title
A Study to Assess the Efficacy and Safety of IGIV-C in Patients With Myasthenia Gravis Exacerbations
Official Title
A Multicenter, Prospective, Open-label, Non-controlled Clinical Trial to Assess the Efficacy and Safety of Immune Globulin (Human), 10% Caprylate/Chromatography Purified (IGIV-C) in Patients With Myasthenia Gravis Exacerbations
Study Type
Interventional

2. Study Status

Record Verification Date
April 2020
Overall Recruitment Status
Completed
Study Start Date
March 2015 (undefined)
Primary Completion Date
April 2018 (Actual)
Study Completion Date
April 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Grifols Therapeutics LLC

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This was a multicenter, prospective, open-label, non-controlled study to assess the efficacy and safety of an IV dose of 2 g/kg of IGIV-C in subjects with MG exacerbations.
Detailed Description
The study consisted of a single dose course of IGIV-C treatment followed by 28-days of post-infusion assessments. The total duration of study participation for each subject was up to 28 ± 2 days. Approximately 50 subjects, ages 18 or greater, were planned to be enrolled in the study and receive a single, total dose of 2 g/kg of IGIV-C over 2 consecutive days (dose of 1 g/kg per day) across multiple centers in Argentina, Canada, Europe, and South Africa.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myasthenia Gravis Exacerbations

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
49 (Actual)

8. Arms, Groups, and Interventions

Arm Title
IGIV-C Treatment
Arm Type
Experimental
Arm Description
In this arm, subjects with myasthenia gravis exacerbations were treated with an IV dose of 2 g/kg of IGIV-C, which was administered over 2 consecutive days at a dose of 1 g/kg per day.
Intervention Type
Biological
Intervention Name(s)
IGIV-C
Intervention Description
An IV dose of 2 g/kg of IGIV-C was administered over 2 consecutive days at a dose of 1 g/kg per day.
Primary Outcome Measure Information:
Title
Change in Quantitative Myasthenia Gravis (QMG) Scale Score
Description
Mean Change in Quantitative Myasthenia Gravis (QMG) Scale Score from Baseline (Day 0) to Day 14. The minimum and maximum scores of the QMG Scale are 0 and 39, respectively, and a higher score means a worse outcome.
Time Frame
From Baseline (Day 0) to Day 14
Secondary Outcome Measure Information:
Title
Percentage of Subjects With Clinical Improvement Assessed by QMG
Description
The percentage of subjects with clinical improvement at Day 14 as assessed by the Quantitative Myasthenia Gravis (QMG) scale in the Evaluable population is presented, in which clinical improvement is defined as at least 3-point decrease in QMG score from Baseline (Day 0) to Day 14. The minimum and maximum scores of the QMG scale are 0 and 39, respectively, and a higher score means a worse outcome.
Time Frame
Baseline (Day 0) to Day 14
Title
Percentage of Subjects With Clinical Improvement Assessed by MG-Activities of Daily Living (MG-ADL) Scale
Description
The percentage of subjects with clinical improvement at Day 14 as assessed by the MG-ADL Scale in the Evaluable population is presented, in which clinical improvement is defined as at least 2-point decrease in the MG-ADL score. The minimum and maximum scores of the MG-DAL scale are 0 and 24, respectively, and a higher score means a worse outcome.
Time Frame
Baseline (Day 0) to Day 14
Title
Percentage of Subjects With Clinical Improvement Assessed by the MG Composite
Description
The percentage of subjects with clinical improvement at Day 14 as assessed by the MG Composite scale in the Evaluable population is presented in which clinical improvement is defined as at least 3-point decrease in the MG Composite score. The minimum and maximum scores of the MG Composite scale are 0 and 50, respectively, with a higher score meaning a worse outcome.
Time Frame
Baseline (Day 0) to Day 14

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Was male or female aged ≥18 years. Subjects must be willing and able to provide written informed consent (if applicable, a legally authorized representative may provide informed consent on behalf of the subject). Subjects who met the clinical criteria for diagnosis of MG with an exacerbation defined as worsening of MG symptoms as defined by an Myasthenia Gravis Foundation of America (MGFA) classification IVb or V. Subjects on long-term (8 weeks) corticosteroid treatment for MG. Female subjects of child-bearing potential must have a negative test for pregnancy (human chorionic gonadotropin [HCG]-based assay). Subjects must be willing to comply with all aspects of the clinical trial protocol, including blood sampling and long-term storage of extra samples, for the entire duration of the study. Exclusion Criteria: Subjects who had received immune globulin treatment given by IV, subcutaneous or intramuscular route within the last 30 days. Subjects with documentation of a lack of clinical response to intravenous immunoglobulin (IVIg) therapy for MG. Subjects documented positive for antibodies directed against Muscle specific kinase (MuSK). Subjects with corticosteroid (CS) treatment initiated within the last 8 weeks or modified within the last 2 weeks. Subjects with plasma exchange (PLEX) within the last 30 days. Subjects with MG exacerbation attributable to change in medication or infection or evident infection as defined by, but not limited to, the presence of at least one of the following diagnostic features: 1) axillary temperature ≥38°C, 2) positive blood culture of infective microorganism, 3) white blood cell count >12×10^9/L and differential white blood cell count of >10% band neutrophils (>1.2×10^9/L), and 4) pulmonary infiltrate with consolidation on chest X-ray. Alternatively, other signs and symptoms may be considered for the diagnosis of evident infection according to the Investigator's judgement. Subjects with inadequate venous access. Subjects with a history of anaphylactic reactions or severe reactions to any blood-derived product. Subjects with a history of intolerance to any component of the investigational products. Subjects with a documented diagnosis of thrombotic complications to polyclonal IVIG therapy in the past. Subjects with a history of recent (within the last year) myocardial infarction, stroke or uncontrolled hypertension. Subjects who suffered from uncontrolled congestive heart failure, embolism or documented electrocardiogram (ECG) changes indicative of myocardial ischemia or atrial fibrillation. Subjects with current known hyperviscosity or hypercoagulable state. Subjects currently receiving anti-coagulation therapy. Subjects with a history of chronic alcoholism or illicit drug abuse (addiction) in the 12 months preceding the Baseline Visit. Subjects currently receiving, or having received within 3 months prior to the Baseline Visit, any investigational medicinal product or device. Subjects with a known Immunoglobulin A (IgA) deficiency and anti-IgA serum antibodies. Subjects with renal impairment (i.e., serum creatinine exceeds more than 1.5 times the upper limit of normal [ULN] for the expected normal range for the testing laboratory). Subjects with aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels exceeding more than 2.5 times the ULN for the expected normal range for the testing laboratory. Subjects with haemoglobin levels <9 g/dL.
Facility Information:
Facility Name
Hospital Italiano
City
Buenos Aires
ZIP/Postal Code
C1181ACH
Country
Argentina
Facility Name
Hospital General de Agudos Dr. J. M.
City
Buenos Aires
ZIP/Postal Code
C1221ADC
Country
Argentina
Facility Name
Hospital Cordoba
City
Cordoba
ZIP/Postal Code
X5004CDT
Country
Argentina
Facility Name
AZ St Lucas Gent
City
Ghent
State/Province
East Flanders
ZIP/Postal Code
9000
Country
Belgium
Facility Name
UZ Leuven
City
Leuven
ZIP/Postal Code
3000
Country
Belgium
Facility Name
University of Alberta Hospital
City
Edmonton
State/Province
Alberta
ZIP/Postal Code
T6G 2B7
Country
Canada
Facility Name
London Health Sciences Centre
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 5A5
Country
Canada
Facility Name
University Health Network (UHN) - Toronto General Hospital
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2C4
Country
Canada
Facility Name
Fakultni nemocnice Brno, Neurologicka klinika
City
Brno
Country
Czechia
Facility Name
Fakultni nemocnice Ostrava, Neurologická klinika
City
Ostrava
ZIP/Postal Code
70800
Country
Czechia
Facility Name
Vseobecna fakultni nemocnice v Praze
City
Prague
ZIP/Postal Code
12808
Country
Czechia
Facility Name
East Tallinn Central Hospital
City
Tallinn
ZIP/Postal Code
10138
Country
Estonia
Facility Name
Hopital Neurologique Pierre Wertheimer
City
Bron
State/Province
Lyon
ZIP/Postal Code
69677
Country
France
Facility Name
Hôpital Albert Michallon
City
Grenoble
ZIP/Postal Code
38700
Country
France
Facility Name
Hopital Roger Salengro
City
Lille
ZIP/Postal Code
59037
Country
France
Facility Name
Hôpital de la Timone
City
Marseille
ZIP/Postal Code
13385
Country
France
Facility Name
Hôpital Hautepierre Strasbourg
City
Strasbourg
ZIP/Postal Code
67200
Country
France
Facility Name
CHU de Toulouse - Hôpital Purpan
City
Toulouse
ZIP/Postal Code
31059
Country
France
Facility Name
Jahn Ferenc Del-Pesti Korhaz
City
Budapest
ZIP/Postal Code
1204
Country
Hungary
Facility Name
Pest Megyei Flor Ferenc Korhaz
City
Kistarcsa
ZIP/Postal Code
2143
Country
Hungary
Facility Name
Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház
City
Nyíregyháza
Country
Hungary
Facility Name
University of Szeged, Faculty of Medicine
City
Szeged
ZIP/Postal Code
4400
Country
Hungary
Facility Name
Zala Megyei Korhaz
City
Zalaegerszeg
ZIP/Postal Code
8900
Country
Hungary
Facility Name
Riga East Clinical University Hospital
City
Riga
ZIP/Postal Code
LV-1038
Country
Latvia
Facility Name
Uniwersyteckie Centrum Kliniczne
City
Gdansk
Country
Poland
Facility Name
Institutul Clinic Fundeni
City
Bucuresti
ZIP/Postal Code
22328
Country
Romania
Facility Name
Spitalul Clinic Judetean de Urgenta Targu-Mures
City
Targu Mures
ZIP/Postal Code
RO540136
Country
Romania
Facility Name
State Budgetary Institution of Healthcare of Nizhniy Novgorod region. Nizhniy Novgorod Regional Clinical Hospital named after N.A.Semashko
City
Nizhniy Novgorod
ZIP/Postal Code
603126
Country
Russian Federation
Facility Name
Saint-Petersburg State Budgetary Institution of Healthcare. City Multi-field Hospital # 2
City
Saint Petersburg
ZIP/Postal Code
357538
Country
Russian Federation
Facility Name
State Budgetary Institution of Healthcare "Samara Regional Clinical Hospital. V.D.Seredavin
City
Samara
ZIP/Postal Code
443095
Country
Russian Federation
Facility Name
Groote Schuur Hospital,
City
Cape Town
Country
South Africa

12. IPD Sharing Statement

Learn more about this trial

A Study to Assess the Efficacy and Safety of IGIV-C in Patients With Myasthenia Gravis Exacerbations

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