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Efficacy and Safety of Anifrolumab Compared to Placebo in Adult Subjects With Active Systemic Lupus Erythematosus

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02446899
Recruitment Status : Completed
First Posted : May 18, 2015
Results First Posted : March 18, 2020
Last Update Posted : March 18, 2020
Sponsor:
Collaborator:
PRA Health Sciences
Information provided by (Responsible Party):
AstraZeneca

Brief Summary:
The purpose of this study is to evaluate the efficacy and safety of an intravenous treatment regimen of anifrolumab versus placebo in adult participants with moderately to severely active, autoantibody-positive systemic lupus erythematosus (SLE).

Condition or disease Intervention/treatment Phase
Active Systemic Lupus Erythematosus Biological: Anifrolumab Drug: Placebo Phase 3

Detailed Description:

This is a Phase 3, multicentre, multinational, randomised, double-blind, placebo-controlled study to evaluate the efficacy and safety of an intravenous treatment regimen of anifrolumab versus placebo in participants with moderately to severely active, autoantibody-positive systemic lupus erythematosus (SLE) while receiving standard of care (SOC) treatment. Participants must be taking either 1 or any combination of the following: oral corticosteroids (OCS), antimalarial, and/or immunosuppressants. The study will be performed in adult participants aged 18 to 70 years of age.

Approximately 360 participants receiving SOC treatment will be randomised in a 1:1 ratio to receive a fixed intravenous dose of anifrolumab 300 mg or placebo every 4 weeks for a total of 13 doses (Week 0 to Week 48), with the primary endpoint evaluated at the Week 52 visit. Investigational product will be administered as an intravenous infusion (IV) via an infusion pump over a minimum of 30 minutes, every 4 weeks.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 373 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: A Multicentre, Randomised, Double-blind, Placebo-controlled, Phase 3 Study Evaluating the Efficacy and Safety of Anifrolumab in Adult Subjects With Active Systemic Lupus Erythematosus
Actual Study Start Date : July 9, 2015
Actual Primary Completion Date : September 27, 2018
Actual Study Completion Date : September 27, 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lupus

Arm Intervention/treatment
Experimental: Anifrolumab
Anifrolumab 300 mg intravenous infusion (IV) administered every 4 weeks for a total of 13 doses.
Biological: Anifrolumab
Intravenous infusion (IV)

Placebo Comparator: Placebo
Placebo intravenous infusion (IV) administered every 4 weeks for a total of 13 doses.
Drug: Placebo
Intravenous infusion (IV)




Primary Outcome Measures :
  1. Number of Participants Who Achieved the British Isles Lupus Assessment Group Based Composite Lupus Assessment (BICLA) Response at Week 52 [ Time Frame: Baseline; Week 52 ]

    Composite endpoint BICLA, was defined by meeting all of the following criteria:

    • Reduction of all baseline British Isles Lupus Assessment Group (BILAG)-2004 A to B/C/D and baseline BILAG-2004 B to C/D, and no BILAG-2004 worsening in other organ systems, as defined by ≥1 new BILAG-2004 A or ≥2 new BILAG-2004 B
    • No worsening from baseline in Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), where worsening is defined as an increase from baseline of >0 points in SLEDAI-2K
    • No worsening from baseline in participants' lupus disease activity, where worsening is defined by an increase ≥0.30 points on a 3-point Physician's Global Assessment (PGA) visual analogue scale (VAS)
    • No discontinuation of investigational product
    • No use of restricted medications beyond the protocol allowed threshold before assessment


Secondary Outcome Measures :
  1. Number of Participants Who Achieved the British Isles Lupus Assessment Group Based Composite Lupus Assessment (BICLA) Response at Week 52 in the IFN Test-High Sub-group [ Time Frame: Baseline; Week 52 ]

    Composite endpoint BICLA, was defined by meeting all of the following criteria:

    • Reduction of all baseline British Isles Lupus Assessment Group (BILAG)-2004 A to B/C/D and baseline BILAG-2004 B to C/D, and no BILAG-2004 worsening in other organ systems, as defined by ≥1 new BILAG-2004 A or ≥2 new BILAG-2004 B
    • No worsening from baseline in Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), where worsening is defined as an increase from baseline to >0 points in SLEDAI-2K
    • No worsening from baseline in participants' lupus disease activity, where worsening is defined by an increase ≥0.30 points on a 3-point Physician's Global Assessment (PGA) visual analogue scale (VAS)
    • No discontinuation of investigational product
    • No use of restricted medications beyond the protocol allowed threshold before assessment

  2. Number of Participants Who Achieved and Maintained an Oral Corticosteroids (OCS) Dose of ≤7.5 mg/Day at Week 52 in the Sub-Group of Participants With Baseline OCS ≥10 mg/Day [ Time Frame: Week 40; Week 52 ]

    Maintained OCS reduction was defined by meeting all of the following criteria:

    • Achieve an OCS dose of ≤7.5 mg/day prednisone or equivalent by Week 40
    • Maintain an OCS dose ≤7.5 mg/day prednisone or equivalent from Week 40 to Week 52
    • No discontinuation of investigational product
    • No use of restricted medications beyond the protocol allowed threshold before assessment

  3. Number of Participants With a ≥50% Reduction in Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) Activity Score at Week 12 in The Sub-Group of Participants With Baseline CLASI Activity Score of ≥10 [ Time Frame: Baseline; Week 12 ]

    50% reduction in CLASI activity score compared to baseline was defined by meeting all of the following criteria:

    • Achieve ≥50% reduction of CLASI activity score at Week 12 compared to baseline
    • No discontinuation of investigational product
    • No use of restricted medications beyond the protocol allowed threshold before assessment

  4. Number of Participants With ≥50% Reduction in Joint Counts at Week 52 in The Sub-group of Participants With ≥6 Swollen and ≥6 Tender Joints at Baseline [ Time Frame: Baseline; Week 52 ]

    50% reduction in the number of swollen and tender joints compared to baseline was defined by meeting all of the following criteria:

    • Achieve ≥50% reduction from baseline in the number of swollen and tender joints, separately
    • No discontinuation of investigational product
    • No use of restricted medications beyond the protocol allowed threshold before assessment

  5. Annualised Flare Rate Through 52 Weeks [ Time Frame: Baseline to Week 52 ]
    A flare was defined as either 1 or more new British Isle Lupus Assessment Group (BILAG-2004) A or 2 or more new BILAG-2004 B items compared to the previous visit. The occurrence of a new flare was checked for each available visit versus the previous available visit up to Week 52. If no new flares occurred, the number of flares was set to 0. Otherwise all flares were counted leading to the maximum number of flares of 13. The annualized flare rate was calculated as the number of flares divided by the flare exposure time in days multiplied with 365.25 (1 year). The flare exposure time is the time up to Week 52 (date of BILAG-2004 assessment at Week 52) or up to the date of last available BILAG-2004 assessment.

  6. Number of Participants With One or More Adverse Events (AEs) [ Time Frame: Baseline to end of study (Maximum of 60 weeks) ]
    An AE is the development of an undesirable medical condition or the deterioration of a pre-existing medical condition following or during exposure to a pharmaceutical product, whether or not considered causally related to the product. AEs were collected throughout the duration of the study, from baseline until end of follow-up (a maximum of 12 weeks post last dose [Week 48]), or until Week 52 for participants who enrolled onto the long term extension (LTE). The reported value is inclusive of serious and non-serious AEs.

  7. Number of Participants With One or More Adverse Events of Special Interest (AESIs) [ Time Frame: Baseline to end of study (Maximum of 60 weeks) ]

    An AESI is an adverse event (AE) of scientific and medical concern specific to understanding biologics. An AESI may be serious or non-serious. AESI are serious infections, including non-opportunistic serious infections, opportunistic infections, anaphylaxis, malignancy, herpes zoster, tuberculosis (TB) (including latent TB), influenza, vasculitis (non-systemic lupus erythematosus [SLE]), and major adverse cardiovascular events (MACE) (including stroke, myocardial infarction [MI], or cardiovascular death).

    AESIs were collected throughout the study, from baseline until end of follow-up (a maximum of 12 weeks post last dose [Week 48]), or until Week 52 for participants who enrolled onto the long term extension (LTE).


  8. Number of Participants With a Potentially Clinically Important Change From Baseline in Vital Sign Measurements [ Time Frame: Baseline to end of study (Maximum of 60 weeks) ]

    Vital sign measurements included oral temperature, blood pressure (BP), pulse rate, and respiratory rate.

    Vital signs were collected throughout the duration of the study, from baseline until end of follow-up (a maximum of 12 weeks post last dose [Week 48]), or until Week 52 for participants who enrolled onto the long term extension (LTE).


  9. Number of Participants With a Potentially Clinically Important Change From Baseline in Clinical Laboratory Tests [ Time Frame: Baseline to end of study (Maximum of 60 weeks) ]

    Clinical laboratory tests were analyzed in a central clinical laboratory and included hematology, serum chemistry and urinalysis tests.

    Laboratory values were collected throughout the duration of the study, from baseline until end of follow-up (a maximum of 12 weeks post last dose [Week 48]), or until Week 52 for participants who enrolled onto the long term extension (LTE).




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:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Aged 18 through 70 years at the time of screening
  2. Diagnosis of paediatric or adult SLE with a diagnosis of SLE according to the ACR 1982 revised criteria ≥24 weeks prior to signing the Informed Consent form (ICF)
  3. Currently receiving at least 1 of the following:

    1. Where prednisone is the single standard of care medication (ie, the subject is not concurrently receiving any medication listed in inclusion criterion 3(c)), a dose of oral prednisone ≥7.5 mg/day but ≤40 mg/day (or prednisone equivalent) for a minimum of 8 weeks prior to Day 1. In addition, the dose of oral prednisone or prednisone equivalent the subject is taking must be stable for a minimum of 2 weeks prior to randomisation
    2. Where prednisone is not the single standard of care medication (ie, the subject is concurrently receiving at least one medication listed in inclusion criterion 3(c), a dose of oral prednisone (≤40 mg/day) (or prednisone equivalent) for a minimum of 2 weeks prior to signing of the ICF. In addition, the dose of oral prednisone or prednisone equivalent the subject is taking must be stable for a minimum of 2 weeks prior to randomisation.
    3. Any of the following medications administered for a minimum of 12 weeks prior to signing the informed consent, and at a stable dose for a minimum of 8 weeks prior to signing the informed consent and through Day 1:

    (i) Azathioprine ≤200 mg/day (ii) Antimalarial (eg, chloroquine, hydroxychloroquine, quinacrine) (iii) Mycophenolate mofetil ≤2 g/day or mycophenolic acid ≤1.44 g/day (iv) Oral, subcutaneous (SC), or intramuscular methotrexate ≤25 mg/week (v) Mizoribine ≤150 mg/day

  4. Fulfils at least 4 of the 11 ACR modified 1982 classification criteria for SLE, at least 1 of which must be:

    1. Positive antinuclear antibody (ANA) test at screening by immunofluorescent assay (IFA) at the central laboratory with titre ≥1:80; OR
    2. Anti-dsDNA antibodies at screening elevated to above normal (including indeterminate), as per the central laboratory; OR
    3. Anti-Smith (anti-Sm) antibody at screening elevated to above normal as per the central laboratory
  5. At Screening, Disease Activity Adjudication Group confirmation of:

    SLEDAI-2K Criteria: SLEDAI-2K score ≥6 points and "Clinical" SLEDAI-2K score ≥4 points. The "Clinical" SLEDAI-2K is the SLEDAI-2K assessment score without the inclusion of points attributable to any urine or laboratory results including immunologic measures.

  6. Must not have active or latent TB on either chest radiograph or by quantiferon gold test
  7. Day 1 "Clinical" SLEDAI-2K score ≥4 points
  8. OCS dose stable for at least 2 weeks prior to randomisation
  9. Stable SLE SOC treatment at the time of randomisation
  10. Women of child-bearing potential must have a negative serum β-hCG test at and negative urine pregnancy test at randomisation prior to administration of investigational product

Exclusion Criteria:

  1. Receipt of any investigational product (small molecule or biologic agent) within 4 weeks or 5 half-lives prior to signing of the ICF, whichever is greater
  2. Receipt of any of the following:

    (a) Intra-articular, intramuscular or IV glucocorticosteroids within 6 weeks prior to Day 1

  3. History of, or current diagnosis of, a clinically significant non SLE-related vasculitis syndrome.
  4. Active severe or unstable neuropsychiatric SLE
  5. Active severe SLE-driven renal disease
  6. Diagnosis (within 1 year of signing the ICF) of mixed connective tissue disease or any history of overlap syndromes of SLE or SSc.
  7. History of, or current, inflammatory joint or skin disease other than SLE
  8. History of any non-SLE disease that has required treatment with oral or parenteral corticosteroids for more than 2 weeks within the last 24 weeks prior to signing the ICF
  9. 26.27. Known history of a primary immunodeficiency, splenectomy, or any underlying condition that predisposes the subject to infection, or a positive result for human immunodeficiency virus (HIV) infection confirmed by central laboratory at screening. Subjects refusing HIV testing during the screening period will not be eligible for study participation
  10. Confirmed positive test for hepatitis B or hepatitis C
  11. Any severe herpes infection at any time prior to Week 0 (Day 1)
  12. Opportunistic infection requiring hospitalisation or intravenous antimicrobial treatment within 3 years prior to randomization
  13. History of cancer, apart from:

    1. Squamous or basal cell carcinoma of the skin that has been successfully treated
    2. Cervical cancer in situ that has been successfully treated

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): NCT02446899


Locations
Show Show 113 study locations
Sponsors and Collaborators
AstraZeneca
PRA Health Sciences
Investigators
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Study Director: Lilia Pineda, MD Medical Science Director
  Study Documents (Full-Text)

Documents provided by AstraZeneca:
Study Protocol  [PDF] May 23, 2019
Statistical Analysis Plan  [PDF] July 26, 2019


Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: AstraZeneca
ClinicalTrials.gov Identifier: NCT02446899    
Other Study ID Numbers: D3461C00004
First Posted: May 18, 2015    Key Record Dates
Results First Posted: March 18, 2020
Last Update Posted: March 18, 2020
Last Verified: March 2020

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by AstraZeneca:
Active Systemic Lupus Erythematosus
Additional relevant MeSH terms:
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Lupus Erythematosus, Systemic
Connective Tissue Diseases
Autoimmune Diseases
Immune System Diseases
Antibodies, Monoclonal
Immunologic Factors
Physiological Effects of Drugs