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Patient Perception of Treatment Burden in Weekly Versus Daily Growth Hormone Injections in Children With GHD

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ClinicalTrials.gov Identifier: NCT03831880
Recruitment Status : Recruiting
First Posted : February 6, 2019
Last Update Posted : August 22, 2019
Sponsor:
Information provided by (Responsible Party):
Pfizer

Brief Summary:
This is an open label randomized 24 week crossover trial assessing the treatment burden of a weekly growth hormone injection regimen (somatrogon) compared to a daily growth hormone injection regimen (Genotropin). Approximately 90 children with growth hormone deficiency who have been stable on treatment with daily Genotropin will be enrolled.

Condition or disease Intervention/treatment Phase
Growth Hormone Deficiency Drug: Genotropin Drug: somatrogon Phase 3

Detailed Description:
Subjects will be randomized to one of two sequences, either 12 weeks of continued treatment with daily Genotropin followed by 12 weeks of treatment with weekly somatrogon, or 12 weeks of treatment with weekly somatrogon followed by 12 weeks of treatment with daily Genotropin. Subjects will have study visits at Baseline, Weeks 6, 12, 18, and 24. Subjects will also be followed up by phone 8 to 12 days after each treatment period begins (Week 1 and Week 13). Subjects and caregivers (as a Dyad) will complete questionnaires assessing treatment burden at baseline and at the end of each 12 week treatment period. All subjects/caregivers will receive a follow up phone call at Week 28.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 90 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: A PHASE 3, RANDOMIZED, MULTICENTER, OPEN-LABEL, CROSSOVER STUDY ASSESSING SUBJECT PERCEPTION OF TREATMENT BURDEN WITH USE OF WEEKLY GROWTH HORMONE (SOMATROGON) VERSUS DAILY GROWTH HORMONE (GENOTROPIN (REGISTERED)) INJECTIONS IN CHILDREN WITH GROWTH HORMONE DEFICIENCY
Actual Study Start Date : February 7, 2019
Estimated Primary Completion Date : March 26, 2020
Estimated Study Completion Date : March 26, 2020


Arm Intervention/treatment
Daily to Weekly
Genotropin to somatrogon
Drug: Genotropin
Genotropin (dose [mg] at time of enrollment) given subcutaneously once daily

Drug: somatrogon
0.66 mg/kg/week given subcutaneously once weekly

Weekly to Daily
somatrogon to Genotropin
Drug: Genotropin
Genotropin (dose [mg] at time of enrollment) given subcutaneously once daily

Drug: somatrogon
0.66 mg/kg/week given subcutaneously once weekly




Primary Outcome Measures :
  1. Treatment burden assessed as the difference in mean overall 'Life Interference' total scores between the weekly injection schedule and daily injection schedule after each treatment schedule experience. [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 7 questions using a 5 point scale (never [1], rarely [2], sometimes [3], often [4] and always [5]) using the dyad questionnaire (Patient Life Interference Section I) and completed by the subject/caregiver. The total score can range from 7 to 35; a lower score for Life Interference is considered to be a better outcome.


Secondary Outcome Measures :
  1. Pen ease of use - Assessment 1 [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 5 questions using a 5 point scale (Very easy [1], Somewhat easy [2], Neither easy nor difficult [3], Somewhat difficult [4], and Very difficult [5]) using the dyad questionnaire (Pen Ease of Use Section I)) and completed by the subject/caregiver. The total score can range from 5 to 25; a lower score for Pen Ease of Use is considered to be a better outcome. The difference in mean overall 'Pen Ease of Use' total scores between the weekly injection schedule and daily injection schedule after each treatment schedule experience will be assessed.

  2. Ease of the injection schedule - Assessment 1 [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 1 question using a 5 point scale (Very easy [1], Somewhat easy [2], Neither easy nor difficult [3], Somewhat difficult [4] and Very difficult [5]) using the dyad questionnaire (Ease of Injection Schedule, Section I) and completed by the subject/caregiver. The total score can range from 1 to 5; a lower score for Ease of Injection Schedule is considered to be a better outcome. The difference in mean overall 'Ease of Injection Schedule' total score between the weekly injection schedule and daily injection schedule after each treatment schedule experience will be assessed.

  3. Convenience of the injection schedule - Assessment 1 [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 1 question using a 7 point scale (Extremely convenient [1], Very convenient [2], Convenient [3], Neither convenient nor inconvenient [4], Inconvenient [5], Very inconvenient [6], and Extremely inconvenient [7]) using the dyad questionnaire (Ease of Injection Schedule, Section I) and completed by the subject/caregiver. The total score can range from 1 to 7; a lower score for Convenience of the Injection Schedule is considered to be a better outcome. The difference in mean overall 'Convenience of the Injection Schedule' total scores between the weekly injection schedule and daily injection schedule after each treatment schedule experience will be assessed.

  4. Satisfaction with overall treatment experience- Comparative assessment of 1 question, using a 5 point scale (Very satisfied to Very dissatisfied) comparing the weekly treatment experience to the daily treatment experience- Assessment 1 [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 1 question, using a 5 point scale (Very satisfied [1], Satisfied [2], Neither satisfied nor dissatisfied [3], Dissatisfied [4], and Very dissatisfied [5]) using the dyad questionnaire (Patient Satisfaction and Willingness to Continue, Section I) and completed by the subject/caregiver. The total score can range from 1 to 5; a lower score for Satisfaction with Overall Treatment Experience is considered to be a better outcome. The difference in mean overall 'Patient Satisfaction' total scores between the weekly injection schedule and daily injection schedule after each treatment schedule experience will be assessed.

  5. Willingness to continue injection schedule - Assessment 1 [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 1 question, using a 5 point scale (Extremely [1], Very [2], Moderately [3], Slightly [4], and Not at all [5)] using the dyad questionnaire (Patient Satisfaction and Willingness to Continue, Section I) and completed by the subject/caregiver. The total score can range from 1 to 5; a lower score for Willingness to Continue Injection Schedule is considered to be a better outcome. The difference in mean overall 'Patient Willingness to Continue' total scores between the weekly injection schedule and daily injection schedule after each treatment schedule experience will be assessed.

  6. Injection signs and symptoms (from the patient; completed by subjects 8 years and older) - Assessment 1 [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 4 questions, each using an 11 point scale (No pain [0] to Worst possible pain [10]; No stinging [0] to Worst possible stinging [10]; No bruising [0] to Worst possible bruising [10]; and No bleeding [0] to Worst possible bleeding [10]) using the dyad questionnaire (Patient Injection Signs and Symptoms) and completed by the subjects 8-17 years old. The total score can range from 0 to 40; a lower score for Patient Injection Signs and Symptoms is considered to be a better outcome. The difference in mean overall 'Patient Injection Signs and Symptoms' total scores between the weekly injection schedule and daily injection schedule after each treatment schedule experience in subjects 8 years and older will be assessed.

  7. Assessment of signs (from the caregiver; completed by caregiver for subjects under 8 years of age) - Assessment 1 [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 4 questions, each using an 11 point scale (No bruising [0] to Worst possible bruising [10]; and No bleeding [0] to Worst possible bleeding [10]) using the dyad questionnaire (Patient Injection Signs and Symptoms) and completed by the caregiver for subjects less than 8 years old. The total score can range from 0 to 20; a lower score for Patient Injection Signs and Symptoms is considered to be a better outcome. The difference in mean overall 'Patient Injection Signs and Symptoms' total scores between the weekly injection schedule and daily injection schedule after each treatment schedule experience in subjects under 8 years will be assessed.

  8. Caregiver life interference, including family life interference - Assessment 1 [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 13 questions using a 5 point scale (Never [1], Rarely [2], Sometimes [3], Often [4] and Always [5]) using the dyad questionnaire (Caregiver Life Interference Section I) and completed by the caregiver. The total score can range from 13 to 65; a lower score for Caregiver Life Interference, Including Family Life Interference is considered to be a better outcome. The difference in mean overall 'Caregiver Life Interference, Including Family Life Interference' total scores between the weekly injection schedule and daily injection schedule after each treatment schedule experience will be assessed.

  9. Missed Injections - Assessment 1 [ Time Frame: Change from Week 12 to Week 24 ]
    Comparative assessment of 2 questions, 1 question assessing number of missed injections during past 4 weeks (filled in by subject/caregiver) and the other question assessing the reason for missing injection(s) using a list of multiple potential reasons of which the subject/caregiver can check all that apply, using the dyad questionnaire (Missed Injections [Daily or Weekly Administration], Section I). The difference in percent injections missed and reasons for missing injections between the weekly injection schedule and daily injection schedule after each treatment schedule experience will be assessed.

  10. Choice of injection pen - Assessment 2 [ Time Frame: 24 Weeks ]
    Assessment of 1 question in which the patient/caregiver is asked to choose 1 option (Choose the Daily pen or Choose the Weekly pen) using the dyad questionnaire (The Injection Pen Assessment Questionnaire, Section II). The proportion of subjects selecting each option will be assessed.

  11. Preferred injection schedule - Assessment 2 [ Time Frame: 24 Weeks ]
    Assessment of 1 question in which the patient/caregiver is asked to choose 1 option (Prefer the Daily injection schedule or Prefer the Weekly injection schedule or No preference) using the dyad questionnaire (The Injection Pen Assessment Questionnaire, Section II). The proportion of subjects selecting each option will be assessed.

  12. Convenience of injection schedule - Assessment 2 [ Time Frame: 24 Weeks ]
    Assessment of 1 question in which the patient/caregiver is asked to choose 1 option (Daily injection schedule was more convenient or Weekly injection schedule was more convenient or No difference) using the dyad questionnaire (The Injection Pen Assessment Questionnaire, Section II). The proportion of subjects selecting each option will be assessed.

  13. Ease of the injection schedule - Assessment 2 [ Time Frame: 24 Weeks ]
    Assessment of 1 question in which the patient/caregiver is asked to choose 1 option (Easier to follow Daily injection schedule or Easier to follow Weekly injection schedule or No difference) using the dyad questionnaire (The Injection Pen Assessment Questionnaire, Section II). The proportion of subjects selecting each option will be assessed.

  14. Patient Life Interference - Assessment 2 [ Time Frame: 24 Weeks ]
    Assessment of 5 activities in which the subject/caregiver is asked to choose 1 option (Daily injection schedule interfered less or Weekly injection schedule interfered less or No difference) for each activity using the dyad questionnaire (Patient Life Interference, Section II). The proportion of subjects selecting each option will be assessed.

  15. Caregiver Life Interference, including family life interference - Assessment 2 [ Time Frame: 24 Weeks ]
    Assessment of 2 questions, one related to the caregiver's activities (5 activities) and the other related to other family members' activities (5 activities) in which the caregiver is asked to choose 1 option (Daily injection schedule interfered less or Weekly injection schedule interfered less or No difference) for each activity using the dyad questionnaire (Patient Life Interference, Section II). The proportion of subjects selecting each option will be assessed.

  16. Benefit relating to the injection schedule - Assessment 2 [ Time Frame: 24 Weeks ]
    Assessment of 1 question using a 5 point scale (Extremely [1], Very [2], Moderately [3], Slightly [4], and Not at all [5]) answered by subject/caregiver of how beneficial it is to take injections less often, using the dyad questionnaire (Patient Satisfaction and Willingness to Continue, Section II). The total score can range from 1 to 5; a lower score for Patient Satisfaction and Willingness to Continue is considered to be a better outcome.

  17. Intention to Comply - Assessment 2 [ Time Frame: 24 Weeks ]
    Assessment of 4 questions in which subject/caregiver must choose 1 option for each question (More likely to follow Daily injection schedule or More likely to follow Weekly injection schedule or No Difference); (Better able to follow Daily injection schedule or Better able to follow Weekly injection schedule or No difference); (More likely to follow Daily injection schedule for a longer time or More likely to follow Weekly injection schedule for a longer time or No difference); (Better able to follow Daily injection schedule for a longer time or Better able to follow Weekly injection schedule for a longer time or No difference) using the dyad questionnaire (Patient Intention to Comply with Treatment, Section II). The proportion of subjects selecting each option will be assessed.

  18. The Patient Global Impression Severity - Impact on Daily Activities [ Time Frame: Change from baseline at week 12 and week 24. ]
    Comparative assessment of 1 question using a 7 point scale (Not present [1], Very mild [2], Mild [3], Moderate [4], Moderately severe [5], Severe [6], Extremely severe [7]) using the Patient Global Impression Severity - Impact on Daily Activities and completed by the subject/caregiver. The total score can range from 1 to 7; a score of 1 is considered to be a better outcome.

  19. Frequency, severity, and relationship of adverse events (including serious adverse events and discontinuations due to adverse events) by treatment group [ Time Frame: 24 Weeks ]
    Frequency, severity, and relationship of adverse events (including serious adverse events and discontinuations due to adverse events) by treatment group

  20. Frequency and severity of abnormal lab values by treatment group. [ Time Frame: 24 Weeks ]
    Frequency and severity of abnormal lab values by treatment group.

  21. Frequency of anti-rhGH antibodies (and neutralizing antibodies) by treatment group. [ Time Frame: 24 Weeks ]
    Frequency of anti-rhGH antibodies (and neutralizing antibodies) by treatment group.

  22. Frequency of anti-somatrogon antibodies (and neutralizing antibodies) by treatment group. [ Time Frame: 24 Weeks ]
    Frequency of anti-somatrogon antibodies (and neutralizing antibodies) by treatment group. Note that anti-somatrogon antibodies are tested at the 12 week and 24 week time points for subjects who have been on somatrogon for the previous 12 weeks of treatment.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   3 Years to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Children aged 3 years old and <18 years with either isolated GHD, or GH insufficiency.
  2. Currently on treatment with either Genotropin Pen or Genotropin GoQuick Pen for at least 3 months and have been compliant on a stable dose (+/-10%) for at least 3 months prior to screening.
  3. IGF I SDS < 2.
  4. Subjects on hormonal replacement therapy for other hypothalamic pituitary axis (HPA) hormonal deficiencies and/or diabetes insipidus must be on an optimized and stable treatment regimen, as determined by the Investigator, for at least 3 months prior to screening.

Exclusion Criteria

  1. History of leukemia, lymphoma, sarcoma or any other cancer.
  2. History of radiation therapy or chemotherapy.
  3. Children with psychosocial dwarfism.
  4. Children born small for gestational age (SGA) - birth weight and/or birth length < 2 SDS for gestational age.
  5. Other causes of short stature such as uncontrolled primary hypothyroidism and rickets.
  6. Chromosomal abnormalities including Turner's syndrome, Laron syndrome, Noonan syndrome, Prader Willi syndrome, Russell Silver syndrome, short stature homeobox (SHOX) mutations/deletions or skeletal dysplasias.
  7. Treatment with regularly scheduled daily or weekly injectable medications other than Genotropin Pen or Genotropin GoQuick.
  8. Diabetes Mellitus.
  9. Current treatment with Genotropin MiniQuick.
  10. History of any exposure to a long acting hGH preparation.
  11. Known or suspected human immunodeficiency virus (HIV) positive patient, or patient with advanced diseases such as acquired immunodeficiency syndrome (AIDS) or tuberculosis.
  12. Drug, substance, or alcohol abuse.
  13. Known hypersensitivity to the components of the medication.
  14. Pregnant female subjects; breastfeeding female subjects; fertile male subjects and female subjects of childbearing potential who are unwilling or unable to use a highly effective method of contraception as outlined in this protocol for the duration of the study and for at least 28 days after the last dose of investigational product.
  15. Other acute or chronic medical or psychiatric condition including recent (within the past year) or active suicidal ideation or behavior or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the subject inappropriate for entry into this study.
  16. Investigator site staff members directly involved in the conduct of the study and their family members, site staff members otherwise supervised by the investigator, or subjects who are Pfizer employees, including their family members, directly involved in the conduct of the study.
  17. Participation in other studies involving investigational drug(s) within 30 days prior to study entry and/or during study participation.
  18. Patient and/or the parent/legal guardian are likely to be non-compliant with respect to study conduct.
  19. Subject and/or the parent/legal guardian are unable to understand written and/or verbal instructions on the proper use of growth hormone injection devices.
  20. Children with closed epiphyses (this determination can be based on available existing clinical data).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03831880


Contacts
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Contact: Pfizer CT.gov Call Center 1-800-718-1021 ClinicalTrials.gov_Inquiries@pfizer.com

Locations
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United States, California
Center of Excellence in Diabetes and Endocrinology Recruiting
Sacramento, California, United States, 95821
United States, Colorado
Children's Hospital Colorado Not yet recruiting
Aurora, Colorado, United States, 80045
Rocky Mountain Pediatric Endocrinology Not yet recruiting
Centennial, Colorado, United States, 80112
Pediatric Endocrine Associates, PC Recruiting
Greenwood Village, Colorado, United States, 80111
United States, Florida
Nemours Children's Health System Recruiting
Jacksonville, Florida, United States, 32207
Nemours Children's Specialty Care Recruiting
Jacksonville, Florida, United States, 32207
Nemours Children's Specialty Care Recruiting
Pensacola, Florida, United States, 32514
Shriners Hospitals for Children Not yet recruiting
Tampa, Florida, United States, 33612
United States, Georgia
Emory Children's Center Not yet recruiting
Atlanta, Georgia, United States, 30322
Investigational Drug Services, The Emory Clinic Not yet recruiting
Atlanta, Georgia, United States, 30322
United States, Massachusetts
Tufts Medical Center IDS - Pharmacy Not yet recruiting
Boston, Massachusetts, United States, 02111
Tufts Medical Center/Floating Hospital for Children Not yet recruiting
Boston, Massachusetts, United States, 02111
Boston Children's Hospital Not yet recruiting
Boston, Massachusetts, United States, 02115
United States, Missouri
Children's Mercy Hospital and Clinics Not yet recruiting
Kansas City, Missouri, United States, 64111
United States, New Jersey
Hackensack University Medical Center Not yet recruiting
Hackensack, New Jersey, United States, 07601
United States, Pennsylvania
Children's Hospital of Pittsburgh of UPMC Not yet recruiting
Pittsburgh, Pennsylvania, United States, 15224
United States, Texas
Cook Children's Medical Center - Pharmacy/Investigational Drug Services Recruiting
Fort Worth, Texas, United States, 76104-2796
Cook Children's Endocrinology and Diabetes Clinic Recruiting
Fort Worth, Texas, United States, 76104
Cook Children's Medical Center Recruiting
Fort Worth, Texas, United States, 76104
United States, Washington
Seattle Children's Not yet recruiting
Seattle, Washington, United States, 98105
MultiCare Health System - Mary Bridge Children's Health Center Recruiting
Tacoma, Washington, United States, 98405
MultiCare Institute for Research & Innovation Recruiting
Tacoma, Washington, United States, 98405
United Kingdom
St. Georges University Hospitals NHS Foundation Trust Not yet recruiting
London, United Kingdom, SW17 0QT
St. Georges University Hospital NHS Foundation Trust Not yet recruiting
London, United Kingdom, SW17 0RE
The Institute of Child Health, University College London Not yet recruiting
London, United Kingdom, WC1N 1EH
Great Ormond Street Hospital Not yet recruiting
London, United Kingdom, WC1N 3JH
NIHR Clinical Research Facility, Great Ormond Street Hospital for Children NHS Trust Not yet recruiting
London, United Kingdom, WC1N 3JH
Sponsors and Collaborators
Pfizer
Investigators
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Study Director: Pfizer CT.gov Call Center Pfizer

Additional Information:
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Responsible Party: Pfizer
ClinicalTrials.gov Identifier: NCT03831880     History of Changes
Other Study ID Numbers: C0311002
2018‐000918‐38 ( EudraCT Number )
First Posted: February 6, 2019    Key Record Dates
Last Update Posted: August 22, 2019
Last Verified: August 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Pfizer will provide access to individual de-identified participant data and related study documents (e.g. protocol, Statistical Analysis Plan (SAP), Clinical Study Report (CSR)) upon request from qualified researchers, and subject to certain criteria, conditions, and exceptions. Further details on Pfizer's data sharing criteria and process for requesting access can be found at: https://www.pfizer.com/science/clinical_trials/trial_data_and_results/data_requests.
URL: https://www.pfizer.com/science/clinical_trials/trial_data_and_results/data_requests

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Dwarfism, Pituitary
Pituitary Diseases
Endocrine System Diseases
Dwarfism
Bone Diseases, Developmental
Bone Diseases
Musculoskeletal Diseases
Bone Diseases, Endocrine
Hypopituitarism
Hypothalamic Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs