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Evaluating Efgartigimod in Patients With Guillain-Barré Syndrome

Primary Purpose

Guillain-Barre Syndrome

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Efgartigimod Alfa-Fcab
Intravenous Immunoglobulin (IVIg)
Sponsored by
Chafic Karam
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Guillain-Barre Syndrome

Eligibility Criteria

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

Inclusion Criteria: Provision of signed and dated informed consent form Stated willingness to comply with all study procedures and availability for the duration of the study Male or female, aged 18 years or older Have a diagnosis of GBS according to the National Institute of Neurological Disorders and Stroke Diagnostic Criteria for Guillain-Barré Syndrome Onset of GBS-related weakness ≤14 days prior to infusion GBS-DS score of 3, 4, or 5 Exclusion Criteria: Pregnant and lactating women, and those intending to become pregnant during the trial or within 90 days after the last dosing. Women of childbearing potential should have a negative serum pregnancy test at Screening and a negative urine pregnancy test at Baseline prior to administration of IMP. Note: Women of childbearing potential should use a highly effective method of contraception (i.e., pregnancy rate of less than 1% per year) during the trial and for 90 days after the last administration of the IMP. They must be on a stable regimen, for at least 1 month, of combined estrogen and progestogen hormonal contraception with inhibition of ovulation, progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine device (IUD), intrauterine hormone-releasing system, bilateral tubal occlusion, vasectomized partner, or agree upon continuous abstinence from heterosexual sexual contact. Male patients who are sexually active and do not intend to use effective methods of contraception (as mentioned above) during the trial or within 90 days after the last dosing or male patients who plan to donate sperm during the trial or within 90 days after the last dosing. Note: Sterilized male patients who have had vasectomy with documented aspermia post-procedure, or male patients who have a partner of non-childbearing potential, can be included. GBS DS of 2 or less. Patients with known seropositivity or who test positive for an active viral infection at Screening with: Hepatitis B Virus (HBV) (except patients who are seropositive because of HBV vaccination), Hepatitis C Virus (HCV) or Human Immunodeficiency Virus (HIV) Patients with any known severe bacterial, viral or fungal infection or any major episode of infection that required hospitalization or injectable antimicrobial therapy in the last 8 weeks prior to Screening. Patients with more than 14 days after onset of symptoms. Patients with total IgG level < 6 g/L at Screening. Patients with recurrent GBS. Use of investigational drug within 3 months or 5 half-lives of the drug (whichever is longer) prior to Screening. Patients who have a history of malignancy, including malignant thymoma, or myeloproliferative or lymphoproliferative disorders, unless deemed cured by adequate treatment with no evidence of recurrence for ≥ 3 years before Screening. Patients with completely excised non-melanoma skin cancer (such as basal cell carcinoma or squamous cell carcinoma) or cervical carcinoma in situ would be permitted at any time. Patients with clinical evidence of other significant serious disease or patients who underwent a recent major surgery, which could confound the results of the trial or put the patient at undue risk. Patients with renal/hepatic function impairment can be included.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    Efgartigimod Alfa-Fcab

    Intravenous Immunoglobulin (IVIg)

    Arm Description

    20mg/kg of Intravenous efgartigimod on days 1 and 5, with normal saline administered as placebo on days 2-4

    0.4g/kg of IVIg daily for 5 days

    Outcomes

    Primary Outcome Measures

    Guillain-Barre Syndrome Disability Scale (GBS-DS)
    Scoring system that assesses the functional status of GBS subjects. Scores range from 0 to 6, with higher scores indicating a worse outcome.
    Number and seriousness of adverse events
    Safety monitoring

    Secondary Outcome Measures

    Guillain-Barre Syndrome Disability Scale (GBS-DS)
    Scoring system that assesses the functional status of GBS subjects. Scores range from 0 to 6, with higher scores indicating a worse outcome.
    Neuropathy Impairment Scale (NIS)
    Peripheral neuropathy assessment. Scores range from 0 to 244, with higher scores indicating a worse outcome.
    Inflammatory Rasch-Built Overall Disability Scale (I-RODS)
    Functional outcome assessment. Scores range from 0 to 48, with higher scores indicating a better outcome.
    Forced Vital Capacity (FVC)
    Pulmonary function test that measures the maximum amount of air you can forcibly exhale from your lungs after fully inhaling. Units are Liters and percentages, when comparing to a predicted value.
    Maximal Inspiratory Pressure (MIP)
    Pulmonary function test that evaluates the strength of inspiratory muscles, primarily the diaphragm. Units are cm H2O (centimeters of water).
    Maximal Expiratory Pressure (MEP)
    Pulmonary function test that evaluates the strength of expiratory muscles. Units are cm H2O (centimeters of water).

    Full Information

    First Posted
    January 5, 2023
    Last Updated
    July 5, 2023
    Sponsor
    Chafic Karam
    Collaborators
    argenx
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05701189
    Brief Title
    Evaluating Efgartigimod in Patients With Guillain-Barré Syndrome
    Official Title
    A Phase 2, Randomized, Double-Blind, Controlled, Singe-Site Trial to Evaluate the Safety and Efficacy of Efgartigimod in Patients With Guillain-Barré Syndrome
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    October 2023 (Anticipated)
    Primary Completion Date
    August 2026 (Anticipated)
    Study Completion Date
    May 2027 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor-Investigator
    Name of the Sponsor
    Chafic Karam
    Collaborators
    argenx

    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
    The goal of this clinical trial is to evaluate the safety and effectiveness of Efgartigimod in patients with Guillain-Barre syndrome (GBS). The main questions it aims to answer are: Is Efgartigimod a safe treatment option for GBS patients? Does treatment with Efgartigimod improve patient outcomes? In addition to standard-of-care procedures and assessments, participants will: Undergo seven blood draws during hospitalization and in four follow-up study visits to evaluate the concentration of neurofilament light chain, a protein that is elevated in patients with Guillain-Barré syndrome. The presence of neurofilament light chain is believed to be indicative of damage to the nervous system, with higher levels resulting from greater damage. Complete the Columbia Suicide Severity Rating Scale (C-SSRS) to monitor any suicidal ideation or behaviors during the course of the study.
    Detailed Description
    The following procedures/assessments are standard-of-care for Guillain-Barré syndrome. They will not be performed solely for research purposes in this study, but the study team will use select results from them to draw conclusions related to this research: The study doctor or study staff will ask you about your medical history and any changes to your medications You will have a physical examination Your vital signs, including blood pressure, pulse rate, breathing rate, body temperature, and weight will be measured You will have an electrocardiogram (ECG) Pulmonary function testing, including forced vital capacity (FVC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) will be performed Blood samples will be drawn to evaluate disease progression and safety/efficacy of treatment You will undergo a lumbar puncture, commonly referred to as a spinal tap, to collect cerebrospinal fluid (CSF) for analysis Nerve conduction studies (NCS) will be performed Outcome assessments including the GBS Disability Scale (GBS-DS), Neuropsychological Impairment Scale (NIS), and Inflammatory Rasch-built Overall Disability Scale (I-RODS) will be performed

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Guillain-Barre Syndrome

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    30 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Efgartigimod Alfa-Fcab
    Arm Type
    Experimental
    Arm Description
    20mg/kg of Intravenous efgartigimod on days 1 and 5, with normal saline administered as placebo on days 2-4
    Arm Title
    Intravenous Immunoglobulin (IVIg)
    Arm Type
    Active Comparator
    Arm Description
    0.4g/kg of IVIg daily for 5 days
    Intervention Type
    Drug
    Intervention Name(s)
    Efgartigimod Alfa-Fcab
    Other Intervention Name(s)
    Vyvgart
    Intervention Description
    Efgartigimod is an anti-neonatal Fc receptor (FcRn) immunoglobulin G1 Fc fragment. The FcRn plans a critical role in extending the half-life of IgGs by rescuing them from lysosomal degradation. Antibodies that bind and subsequently block the FcRn with high affinity result in IgGs being degraded more rapidly instead of salvaged. This approach has been shown to be beneficial in the antibody-mediated disorder myasthenia gravis.
    Intervention Type
    Drug
    Intervention Name(s)
    Intravenous Immunoglobulin (IVIg)
    Intervention Description
    IVIg is the standard-of-care treatment for GBS.
    Primary Outcome Measure Information:
    Title
    Guillain-Barre Syndrome Disability Scale (GBS-DS)
    Description
    Scoring system that assesses the functional status of GBS subjects. Scores range from 0 to 6, with higher scores indicating a worse outcome.
    Time Frame
    12 weeks
    Title
    Number and seriousness of adverse events
    Description
    Safety monitoring
    Time Frame
    Through study completion, an average of 3 years
    Secondary Outcome Measure Information:
    Title
    Guillain-Barre Syndrome Disability Scale (GBS-DS)
    Description
    Scoring system that assesses the functional status of GBS subjects. Scores range from 0 to 6, with higher scores indicating a worse outcome.
    Time Frame
    4, 24, and 48-weeks
    Title
    Neuropathy Impairment Scale (NIS)
    Description
    Peripheral neuropathy assessment. Scores range from 0 to 244, with higher scores indicating a worse outcome.
    Time Frame
    4, 24, and 48-weeks
    Title
    Inflammatory Rasch-Built Overall Disability Scale (I-RODS)
    Description
    Functional outcome assessment. Scores range from 0 to 48, with higher scores indicating a better outcome.
    Time Frame
    4, 24, and 48-weeks
    Title
    Forced Vital Capacity (FVC)
    Description
    Pulmonary function test that measures the maximum amount of air you can forcibly exhale from your lungs after fully inhaling. Units are Liters and percentages, when comparing to a predicted value.
    Time Frame
    4, 24, and 48-weeks
    Title
    Maximal Inspiratory Pressure (MIP)
    Description
    Pulmonary function test that evaluates the strength of inspiratory muscles, primarily the diaphragm. Units are cm H2O (centimeters of water).
    Time Frame
    4, 24, and 48-weeks
    Title
    Maximal Expiratory Pressure (MEP)
    Description
    Pulmonary function test that evaluates the strength of expiratory muscles. Units are cm H2O (centimeters of water).
    Time Frame
    4, 24, and 48-weeks
    Other Pre-specified Outcome Measures:
    Title
    Biomarker levels: Neurofilament Light (Nf-L) Chain
    Description
    Exploratory assessment requiring blood collection
    Time Frame
    Baseline and weeks 1, 4, 12, 24, and 48.

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Provision of signed and dated informed consent form Stated willingness to comply with all study procedures and availability for the duration of the study Male or female, aged 18 years or older Have a diagnosis of GBS according to the National Institute of Neurological Disorders and Stroke Diagnostic Criteria for Guillain-Barré Syndrome Onset of GBS-related weakness ≤14 days prior to infusion GBS-DS score of 3, 4, or 5 Exclusion Criteria: Pregnant and lactating women, and those intending to become pregnant during the trial or within 90 days after the last dosing. Women of childbearing potential should have a negative serum pregnancy test at Screening and a negative urine pregnancy test at Baseline prior to administration of IMP. Note: Women of childbearing potential should use a highly effective method of contraception (i.e., pregnancy rate of less than 1% per year) during the trial and for 90 days after the last administration of the IMP. They must be on a stable regimen, for at least 1 month, of combined estrogen and progestogen hormonal contraception with inhibition of ovulation, progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine device (IUD), intrauterine hormone-releasing system, bilateral tubal occlusion, vasectomized partner, or agree upon continuous abstinence from heterosexual sexual contact. Male patients who are sexually active and do not intend to use effective methods of contraception (as mentioned above) during the trial or within 90 days after the last dosing or male patients who plan to donate sperm during the trial or within 90 days after the last dosing. Note: Sterilized male patients who have had vasectomy with documented aspermia post-procedure, or male patients who have a partner of non-childbearing potential, can be included. GBS DS of 2 or less. Patients with known seropositivity or who test positive for an active viral infection at Screening with: Hepatitis B Virus (HBV) (except patients who are seropositive because of HBV vaccination), Hepatitis C Virus (HCV) or Human Immunodeficiency Virus (HIV) Patients with any known severe bacterial, viral or fungal infection or any major episode of infection that required hospitalization or injectable antimicrobial therapy in the last 8 weeks prior to Screening. Patients with more than 14 days after onset of symptoms. Patients with total IgG level < 6 g/L at Screening. Patients with recurrent GBS. Use of investigational drug within 3 months or 5 half-lives of the drug (whichever is longer) prior to Screening. Patients who have a history of malignancy, including malignant thymoma, or myeloproliferative or lymphoproliferative disorders, unless deemed cured by adequate treatment with no evidence of recurrence for ≥ 3 years before Screening. Patients with completely excised non-melanoma skin cancer (such as basal cell carcinoma or squamous cell carcinoma) or cervical carcinoma in situ would be permitted at any time. Patients with clinical evidence of other significant serious disease or patients who underwent a recent major surgery, which could confound the results of the trial or put the patient at undue risk. Patients with renal/hepatic function impairment can be included.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Timothy Burke
    Phone
    2156623033
    Email
    timothy.burke1@pennmedicine.upenn.edu
    First Name & Middle Initial & Last Name or Official Title & Degree
    Kelsey Moulton
    Email
    kelsey.moulton@pennmedicine.upenn.edu
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Madeline Singer, MD
    Organizational Affiliation
    Staff Physician and Neuromuscular Research Fellow
    Official's Role
    Principal Investigator
    First Name & Middle Initial & Last Name & Degree
    Chafic Karam, MD
    Organizational Affiliation
    Staff Physician and Associate Professor of Clinical Neurology
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Learn more about this trial

    Evaluating Efgartigimod in Patients With Guillain-Barré Syndrome

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