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A Phase 2 Proof of Concept Study to Evaluate the Efficacy and Safety of Daxdilimab in Participants With Dermatomyositis (DM) or Anti-synthetase Inflammatory Myositis (ASIM)

Primary Purpose

Idiopathic Inflammatory Myositis

Status
Recruiting
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Daxdilimab
Placebo
Sponsored by
Horizon Therapeutics Ireland DAC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Idiopathic Inflammatory Myositis focused on measuring Anti-synthetase syndrome, Myositis, Polymyositis

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Key Inclusion Criteria: Adult men or women 18 and ≤ 75 years of age at the time of signing the informed consent (ICF). A diagnosis of definite or probable myositis according to American College of Rheumatology/European League Against Rheumatism 2017 (ACR/EULAR 2017) criteria: Population 1: DM Diagnosis of DM with DM rash current or historical, or Population 2: ASIM Anti-histidyl tRNA synthetase-(Anti-Jo-1) antibodies must be positive during screening by central laboratory testing, or One of following antibodies must be positive by historical testing: directed against anti-alanyl- (anti-PL-12), anti-threonyl-(anti PL-7), anti-asparaginyl-(anti-KS), anti-glycyl-(anti-EJ), anti-isoleucyl-(anti-OJ), anti-phenylalanyl-transfer RNA synthetase-(anti-ZO), anti-tyrosil-YRS(HA). Currently active myositis with all the following (a, b, and c) during screening: Manual Muscle Testing (MMT 8) score < 142 At least 2 other abnormal core set measures (CSM) from the following list: Patient global disease activity (PtGDA) ≥ 2cm in a 10 cm visual analog scale (VAS) Physician's Global Disease Activity (PhGDA) ≥ 2 cm in a 10 cm VAS Extramuscular activity ≥ 2cm in a 10 cm VAS At least one muscle enzyme 1.5 times upper limit of normal (ULN) Health assessment questionnaire-disability index (HAQ-DI) ≥ 0.5 Global muscle damage score ≤ 5 on a 10 cm VAS on the myositis damage index (MDI). Participants should be on stable standard of care therapy if tolerated; if they are not able to tolerate it or have failed standard of care, medications should have a washed out period. Participants should be willing to taper corticosteroid dose per protocol when stable or improving. Exclusion Criteria: Any condition that, in the opinion of the investigator or sponsor, would interfere with the evaluation of investigational product (IP) or interpretation of participant safety or study results. Weight > 160 kg (352 pounds) at screening. Breastfeeding or pregnant women or women who intend to become pregnant anytime from signing the ICF through 6 months after receiving the last dose of IP. History of clinically meaningful cardiac disease including unstable angina, myocardial infarction, congestive heart failure within 6 months prior to randomization; arrhythmia requiring active therapy, except for clinically insignificant extra systoles, or minor conduction abnormalities; or presence of clinically meaningful abnormality on electrocardiogram (ECG) if, in the opinion of the Investigator, it would increase the risk of study participation. History of cancer within the past 5 years, except as follows: In situ carcinoma of the cervix treated with apparent success with curative therapy > 12 months prior to screening, or Cutaneous basal cell or squamous cell carcinoma treated with curative therapy. Any underlying condition that in the opinion of the Investigator significantly predisposes the participant to infection. Known history of a primary immunodeficiency or an underlying condition, such as known human immunodeficiency virus (HIV) infection, or a positive result for HIV infection per central laboratory. Confirmed positive test for hepatitis B virus serology as defined in the protocol. Active tuberculosis (TB), or a positive interferon gamma (IFN-γ) release assay (IGRA) test at screening, unless documented history of appropriate treatment for active or latent TB according to local guidelines. Any severe herpes virus family infection (including Epstein-Barr virus, cytomegalovirus [CMV]) at any time prior to randomization. Opportunistic infection requiring hospitalization or parenteral antimicrobial treatment within 2 years prior to randomization. Significant organ system involvement or myositis damage (global muscle damage score > 5 on a 10cm VAS scale on the MDI) that poses risks in the study or impedes assessments. Diagnosis of immune-mediated necrotizing myopathy (IMNM) [(positive 3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGR), anti-signal recognition particle (anti- SRP), or antibody negative)], inclusion body myositis (IBM) (including positive anti-cytosolic 5'-nucleotidase 1A (anti cN1A), or drug-induced myositis. Current musculoskeletal, joint, or inflammatory disease, including significant joint contractures or calcinosis that in the opinion of the investigator, could interfere with the muscle strength assessments and confound the disease activity assessments. Wheelchair bound participants. Current inflammatory skin disease other than DM or ASIM that, in the opinion of the investigator, could interfere with the inflammatory skin assessments or confound the disease activity assessments. Severe interstitial lung disease where respiratory symptoms limit participant function or progressive pulmonary fibrosis. Myositis in overlap with another connective tissue disease that precludes the accurate assessment of a treatment response (for example, difficulty in assessing muscle strength in a scleroderma patient with associated myositis).

Sites / Locations

  • Advanced Research CenterRecruiting
  • Griffith University AustrailiaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Daxdilimab

Placebo

Arm Description

Daxdilimab will be administered by subcutaneous (SC) injection over a total of 44 weeks.

Matching placebo will be administered by SC injection over a total of 24 weeks, then will be administered active drug by SC injection up to Week 44

Outcomes

Primary Outcome Measures

Efficacy of daxdilimab compared to placebo as measured by Total Improvement Score (TIS)
TIS is a composite endpoint based on improvement in the 6 Disease Activity Core Set Measure (CSM) scores and range from 0 to 100 (2016 European League Against Rheumatism [EULAR]/American College of Rheumatology [ACR] Myositis Response Criteria) where a higher score is indicative of more improvement

Secondary Outcome Measures

Proportion of participants with improvement of TIS ≥ 40 and without deterioration at 2 consecutive visits at 24 weeks
TIS is a composite endpoint based on improvement in the 6 Disease Activity Core Set Measure (CSM) scores and range from 0 to 100 (2016 European League Against Rheumatism [EULAR]/American College of Rheumatology [ACR] Myositis Response Criteria) where a higher score is indicative of more improvement
Proportion of participants with improvement of TIS ≥ 20 and without deterioration at 2 consecutive visits at 24 weeks
TIS is a composite endpoint based on improvement in the 6 Disease Activity Core Set Measure (CSM) scores and range from 0 to 100 (2016 European League Against Rheumatism [EULAR]/American College of Rheumatology [ACR] Myositis Response Criteria) where a higher score is indicative of more improvement
Change in the cutaneous dermatomyositis disease area and severity index (CDASI) activity score from Baseline (Day 1) to Week 24
The CDASI is used to assess the severity of cutaneous DM and detect improvement in disease activity. The scale rates disease involvement in 15 different body areas using 3 activity (erythema, scale, erosion/ulceration) and 2 damage (poikiloderma, calcinosis) measures. The activity score ranges from 0 to 100 and the damage score from 0 to 32. Higher scores indicate greater disease severity
Proportion of participants on an oral corticosteroid (OCS) dose ≥ 10 mg of prednisone or equivalent at baseline who achieve a clinically meaningful reduction in the OCS dose at Week 24
A clinically meaningful reduction is measured as either a 25% decrease or an OCS dose of 7.5 mg/day of prednisone or equivalent
Serum concentration of daxdilimab over time
Proportion of the participants with anti-drug antibodies (ADA) positive post-baseline only or boosted their pre-existing ADA during the study period.
Incidence of ADA directed against daxdilimab over time
Titer of ADA to daxdilimab over time
Incidence of treatment emergent adverse events (TEAEs)
Incidence of treatment emergent serious adverse events (TESAEs)
Incidence of treatment emergent adverse events of special interest (TEAESIs)
TEAESIs including hypersensitivity reactions, anaphylaxis, herpes zoster infection, severe [(common terminology criteria for adverse events (CTCAE)] Grade 3 or higher) viral infection/reactivation, opportunistic infection, and malignancy (except non melanoma skin cancer)

Full Information

First Posted
December 20, 2022
Last Updated
September 20, 2023
Sponsor
Horizon Therapeutics Ireland DAC
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1. Study Identification

Unique Protocol Identification Number
NCT05669014
Brief Title
A Phase 2 Proof of Concept Study to Evaluate the Efficacy and Safety of Daxdilimab in Participants With Dermatomyositis (DM) or Anti-synthetase Inflammatory Myositis (ASIM)
Official Title
A Phase 2, Randomized, Double-blind, Placebo-controlled, Efficacy and Safety Study of Daxdilimab Subcutaneous Injection in Adult Participants With Inadequately Controlled Dermatomyositis or Anti-synthetase Inflammatory Myositis.
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 31, 2023 (Anticipated)
Primary Completion Date
October 3, 2026 (Anticipated)
Study Completion Date
May 22, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Horizon Therapeutics Ireland DAC

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 primary efficacy objective: To evaluate the effect of daxdilimab compared with placebo in reducing disease activity at Week 24. The secondary efficacy objectives include: To evaluate the effect of daxdilimab compared with placebo in reducing disease activity at Week 24. To evaluate the effect of daxdilimab compared with placebo on skin symptoms at Week 24. To evaluate the effect of daxdilimab on decreasing the use of corticosteroid at Week 24. Other secondary objectives include: To characterize the pharmacokinetics (PK) and immunogenicity of daxdilimab in participants. To evaluate the safety and tolerability of daxdilimab in participants.
Detailed Description
The study will enroll 96 participants with 2 idiopathic inflammatory myositis populations: Population 1 or dermatomyositis (DM): participants with DM with definite or probable myositis according to the American College of Rheumatology/European League Against Rheumatism 2017 (ACR/EULAR 2017) criteria and a DM rash. Population 2 or anti-synthetase inflammatory myositis (ASIM): participants with ASIM with definite or probable myositis according to ACR/EULAR 2017 criteria and a positive ASIM associated antibody. Participants will be randomized by population in a 1:1 ratio and receive investigational product (IP) daxdilimab or placebo by subcutaneous injection. The estimated total study duration will be up to 60 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Idiopathic Inflammatory Myositis
Keywords
Anti-synthetase syndrome, Myositis, Polymyositis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
96 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Daxdilimab
Arm Type
Experimental
Arm Description
Daxdilimab will be administered by subcutaneous (SC) injection over a total of 44 weeks.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Matching placebo will be administered by SC injection over a total of 24 weeks, then will be administered active drug by SC injection up to Week 44
Intervention Type
Drug
Intervention Name(s)
Daxdilimab
Other Intervention Name(s)
HZN-7734
Intervention Description
Participants will be administered daxdilimab by subcutaneous (SC) injection
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Participants will be administered identically matching placebo by SC injection over a total of 24 weeks, then participants will be given active treatment for the remainder of the study.
Primary Outcome Measure Information:
Title
Efficacy of daxdilimab compared to placebo as measured by Total Improvement Score (TIS)
Description
TIS is a composite endpoint based on improvement in the 6 Disease Activity Core Set Measure (CSM) scores and range from 0 to 100 (2016 European League Against Rheumatism [EULAR]/American College of Rheumatology [ACR] Myositis Response Criteria) where a higher score is indicative of more improvement
Time Frame
At Week 24
Secondary Outcome Measure Information:
Title
Proportion of participants with improvement of TIS ≥ 40 and without deterioration at 2 consecutive visits at 24 weeks
Description
TIS is a composite endpoint based on improvement in the 6 Disease Activity Core Set Measure (CSM) scores and range from 0 to 100 (2016 European League Against Rheumatism [EULAR]/American College of Rheumatology [ACR] Myositis Response Criteria) where a higher score is indicative of more improvement
Time Frame
At 24 Weeks
Title
Proportion of participants with improvement of TIS ≥ 20 and without deterioration at 2 consecutive visits at 24 weeks
Description
TIS is a composite endpoint based on improvement in the 6 Disease Activity Core Set Measure (CSM) scores and range from 0 to 100 (2016 European League Against Rheumatism [EULAR]/American College of Rheumatology [ACR] Myositis Response Criteria) where a higher score is indicative of more improvement
Time Frame
At 24 Weeks
Title
Change in the cutaneous dermatomyositis disease area and severity index (CDASI) activity score from Baseline (Day 1) to Week 24
Description
The CDASI is used to assess the severity of cutaneous DM and detect improvement in disease activity. The scale rates disease involvement in 15 different body areas using 3 activity (erythema, scale, erosion/ulceration) and 2 damage (poikiloderma, calcinosis) measures. The activity score ranges from 0 to 100 and the damage score from 0 to 32. Higher scores indicate greater disease severity
Time Frame
Baseline (Day1) to Week 24
Title
Proportion of participants on an oral corticosteroid (OCS) dose ≥ 10 mg of prednisone or equivalent at baseline who achieve a clinically meaningful reduction in the OCS dose at Week 24
Description
A clinically meaningful reduction is measured as either a 25% decrease or an OCS dose of 7.5 mg/day of prednisone or equivalent
Time Frame
Baseline to Week 24
Title
Serum concentration of daxdilimab over time
Time Frame
Baseline to Week 56
Title
Proportion of the participants with anti-drug antibodies (ADA) positive post-baseline only or boosted their pre-existing ADA during the study period.
Time Frame
Baseline to Week 56
Title
Incidence of ADA directed against daxdilimab over time
Time Frame
Baseline to Week 56
Title
Titer of ADA to daxdilimab over time
Time Frame
Baseline to Week 56
Title
Incidence of treatment emergent adverse events (TEAEs)
Time Frame
Baseline to Week 56
Title
Incidence of treatment emergent serious adverse events (TESAEs)
Time Frame
Baseline to Week 56
Title
Incidence of treatment emergent adverse events of special interest (TEAESIs)
Description
TEAESIs including hypersensitivity reactions, anaphylaxis, herpes zoster infection, severe [(common terminology criteria for adverse events (CTCAE)] Grade 3 or higher) viral infection/reactivation, opportunistic infection, and malignancy (except non melanoma skin cancer)
Time Frame
Baseline to Week 56

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria: Adult men or women 18 and ≤ 75 years of age at the time of signing the informed consent (ICF). A diagnosis of definite or probable myositis according to American College of Rheumatology/European League Against Rheumatism 2017 (ACR/EULAR 2017) criteria: Population 1: DM Diagnosis of DM with DM rash current or historical, or Population 2: ASIM Anti-histidyl tRNA synthetase-(Anti-Jo-1) antibodies must be positive during screening by central laboratory testing, or One of following antibodies must be positive by historical testing: directed against anti-alanyl- (anti-PL-12), anti-threonyl-(anti PL-7), anti-asparaginyl-(anti-KS), anti-glycyl-(anti-EJ), anti-isoleucyl-(anti-OJ), anti-phenylalanyl-transfer RNA synthetase-(anti-ZO), anti-tyrosil-YRS(HA). Currently active myositis with all the following (a, b, and c) during screening: Manual Muscle Testing (MMT 8) score < 142 At least 2 other abnormal core set measures (CSM) from the following list: Patient global disease activity (PtGDA) ≥ 2cm in a 10 cm visual analog scale (VAS) Physician's Global Disease Activity (PhGDA) ≥ 2 cm in a 10 cm VAS Extramuscular activity ≥ 2cm in a 10 cm VAS At least one muscle enzyme 1.5 times upper limit of normal (ULN) Health assessment questionnaire-disability index (HAQ-DI) ≥ 0.5 Global muscle damage score ≤ 5 on a 10 cm VAS on the myositis damage index (MDI). Participants should be on stable standard of care therapy if tolerated; if they are not able to tolerate it or have failed standard of care, medications should have a washed out period. Participants should be willing to taper corticosteroid dose per protocol when stable or improving. Exclusion Criteria: Any condition that, in the opinion of the investigator or sponsor, would interfere with the evaluation of investigational product (IP) or interpretation of participant safety or study results. Weight > 160 kg (352 pounds) at screening. Breastfeeding or pregnant women or women who intend to become pregnant anytime from signing the ICF through 6 months after receiving the last dose of IP. History of clinically meaningful cardiac disease including unstable angina, myocardial infarction, congestive heart failure within 6 months prior to randomization; arrhythmia requiring active therapy, except for clinically insignificant extra systoles, or minor conduction abnormalities; or presence of clinically meaningful abnormality on electrocardiogram (ECG) if, in the opinion of the Investigator, it would increase the risk of study participation. History of cancer within the past 5 years, except as follows: In situ carcinoma of the cervix treated with apparent success with curative therapy > 12 months prior to screening, or Cutaneous basal cell or squamous cell carcinoma treated with curative therapy. Any underlying condition that in the opinion of the Investigator significantly predisposes the participant to infection. Known history of a primary immunodeficiency or an underlying condition, such as known human immunodeficiency virus (HIV) infection, or a positive result for HIV infection per central laboratory. Confirmed positive test for hepatitis B virus serology as defined in the protocol. Active tuberculosis (TB), or a positive interferon gamma (IFN-γ) release assay (IGRA) test at screening, unless documented history of appropriate treatment for active or latent TB according to local guidelines. Any severe herpes virus family infection (including Epstein-Barr virus, cytomegalovirus [CMV]) at any time prior to randomization. Opportunistic infection requiring hospitalization or parenteral antimicrobial treatment within 2 years prior to randomization. Significant organ system involvement or myositis damage (global muscle damage score > 5 on a 10cm VAS scale on the MDI) that poses risks in the study or impedes assessments. Diagnosis of immune-mediated necrotizing myopathy (IMNM) [(positive 3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGR), anti-signal recognition particle (anti- SRP), or antibody negative)], inclusion body myositis (IBM) (including positive anti-cytosolic 5'-nucleotidase 1A (anti cN1A), or drug-induced myositis. Current musculoskeletal, joint, or inflammatory disease, including significant joint contractures or calcinosis that in the opinion of the investigator, could interfere with the muscle strength assessments and confound the disease activity assessments. Wheelchair bound participants. Current inflammatory skin disease other than DM or ASIM that, in the opinion of the investigator, could interfere with the inflammatory skin assessments or confound the disease activity assessments. Severe interstitial lung disease where respiratory symptoms limit participant function or progressive pulmonary fibrosis. Myositis in overlap with another connective tissue disease that precludes the accurate assessment of a treatment response (for example, difficulty in assessing muscle strength in a scleroderma patient with associated myositis).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Horizon Therapeutics
Phone
1-866-479-6742
Email
clinicaltrials@horizontherapeutics.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Medical Director, MD
Organizational Affiliation
Horizon Therapeutics
Official's Role
Study Director
Facility Information:
Facility Name
Advanced Research Center
City
Anaheim
State/Province
California
ZIP/Postal Code
92805-5854
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Halynn Nguyen
Phone
714-999-6688
Email
hnguyen@arctrials.com
First Name & Middle Initial & Last Name & Degree
Steven Macina, DO
Facility Name
Griffith University Austrailia
City
Spring Hill
ZIP/Postal Code
QLD 4000
Country
Australia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tracey Brumby
Phone
+61756780929
Email
t.brumby@griffith.edu.au
First Name & Middle Initial & Last Name & Degree
Claire Costello, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Phase 2 Proof of Concept Study to Evaluate the Efficacy and Safety of Daxdilimab in Participants With Dermatomyositis (DM) or Anti-synthetase Inflammatory Myositis (ASIM)

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