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Efficacy and Safety of AMG 570 in Subjects With Active Systemic Lupus Erythematosus (SLE)

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ClinicalTrials.gov Identifier: NCT04058028
Recruitment Status : Recruiting
First Posted : August 15, 2019
Last Update Posted : February 25, 2021
Sponsor:
Information provided by (Responsible Party):
Amgen

Study Description
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Brief Summary:
The purpose of this study is to determine if AMG 570 could be a useful therapeutic agent in the current treatment landscape where subjects with systemic lupus erythematosus (SLE) have ongoing disease activity despite treatment with standard of care therapies.

Condition or disease Intervention/treatment Phase
Systemic Lupus Erythematosus (SLE) Drug: AMG 570 Drug: Placebo for AMG 570 Phase 2

Detailed Description:
This is a Bayesian adaptive phase 2b, multi-center, double-blind, randomized, placebo-controlled, 52-week, dose-ranging study in subjects with active SLE and inadequate response to SOC therapies including oral corticosteroids (OCS), immunosuppressants and immunomodulators. Previous biologic use is allowed with an adequate washout period.
Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 320 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:

This is a Bayesian adaptive phase 2b, multi-center, double-blind, randomized, placebo-controlled, 52-week, dose-ranging study in subjects with active systemic lupus erythematosus (SLE) and inadequate response to standard of care (SOC) therapies including oral corticosteroid (OCS), immunosuppressants, and immunomodulators. Subjects will be randomized to receive placebo or 1 of 3 doses of AMG 570 with the last dose at week 50. Treatment will be administered every 2 weeks (Q2W). All subjects will be required to complete a 16-week follow-up period after the 52-week treatment period.

The first interim analysis (IA) will be executed after the first 40 enrolled subjects have had the opportunity to complete the week 24 assessment. Additional IAs may be executed after approximately every 32 newly enrolled subjects have had the opportunity to complete the week 24 assessment. The last IA will occur when all subjects have had the opportunity to complete the week 24 assessment.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 2b Dose Ranging Study to Evaluate the Efficacy and Safety of Rozibafusp Alfa (AMG 570) in Subjects With Active Systemic Lupus Erythematosus (SLE) With Inadequate Response to Standard of Care (SOC) Therapy
Actual Study Start Date : February 19, 2020
Estimated Primary Completion Date : May 16, 2023
Estimated Study Completion Date : March 25, 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lupus

Arms and Interventions
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Arm Intervention/treatment
Experimental: AMG 570, Dose A
Investigational product solution in vial
 Drug: AMG 570
AMG 570 will be presented in 5 mL glass vial
Experimental: AMG 570, Dose B
Investigational product solution in vial
 Drug: AMG 570
AMG 570 will be presented in 5 mL glass vial
Experimental: AMG 570, Dose C
Investigational product solution in vial
 Drug: AMG 570
AMG 570 will be presented in 5 mL glass vial
Placebo Comparator: Placebo for AMG 570
Placebo Investigational product solution in vial
 Drug: Placebo for AMG 570
Placebo for AMG 570 will be presented in 5 mL glass vial


Outcome Measures
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Primary Outcome Measures :
  1. Percent of patients achieving Systemic Lupus Erythematosus Responder Index-4 (SRI-4) response at week 52 [ Time Frame: Week 52 ]
    SRI-4 response at Week 52 is defined as a greater than or equal to 4-point decrease in the hybrid Systemic Lupus Erythematosus Disease Activity Index (hSLEDAI) score; no new British Isles Lupus Assessment Group (BILAG) 2004 A domain score and no greater than 1 new BILAG 2004 B scores compared with baseline; and a less than 0.3-point deterioration from baseline in Physician Global Assessment (PGA) (scale 0 to 3).


Secondary Outcome Measures :
  1. Percent of patients achieving a SRI-4 response at week 24 [ Time Frame: Week 24 ]
    SRI-4 response at Week 24 is defined as a greater than or equal to 4-point decrease in the hybrid Systemic Lupus Erythematosus Disease Activity Index (hSLEDAI) score; no new British Isles Lupus Assessment Group (BILAG) 2004 A domain score and no greater than 1 new BILAG 2004 B scores compared with baseline; and a less than 0.3-point deterioration from baseline in Physician Global Assessment (PGA) (scale 0 to 3).

  2. Percent of patients achieving Lupus Low Disease Activity State (LLDAS) at week 52 [ Time Frame: Week 52 ]
    LLDAS response at week 52 is defined as a hybrid Systemic Lupus Erythematosus Disease Activity Index (hSLEDAI) score ≤ 4 with no activity in major organ systems (renal, central nervous system (CNS), cardiopulmonary, vasculitis, and fever) and no haemolytic anaemia or gastrointestinal activity; no new findings of lupus disease activity compared with the previous assessment; ≤ 1-point in Physician Global Assessment (PGA) (scale 0 to 3) current prednisolone-equivalent dosage ≤ 7.5 mg/day; and standard maintenance dosages of immunosuppressive drugs and approved biologics.

  3. Percent on patients achieving The British Isles Lupus Assessment Group (BILAG) based Combined Lupus Assessment (BICLA) index responses [ Time Frame: Week 24 and Week 52 ]
    BICLA response is defined as at least 1 gradation of improvement in baseline BILAG domain scores in all body systems with moderate or severe disease activity at entry (eg, all A [severe disease] domain scores falling to B [moderate], C [mild], or D [no activity], and all B domain scores falling to C or D); no new BILAG 2004 A domain score and no greater than 1 new BILAG 2004 B domain scores compared with baseline; less than 0.3-point deterioration from baseline in Physician Global Assessment (PGA) (scale 0 to 3); and no initiation of non-protocol treatment.

  4. SRI-4 at week 52 with reduction of OCS to less than or equal to 7.5 mg/day by week 44 and sustained through week 52 in subjects with a baseline OCS dose ≥ 10 mg/day [ Time Frame: week 52 ]
    To evaluate the efficacy of AMG 570 with oral corticosteroid (OCS)-tapering in subjects with SLE with inadequate response to SOC therapy.

  5. Annualized moderate and severe flare rate [ Time Frame: 52 weeks ]
    Measured by SELENA-SLEDAI Flare Index.

  6. Annualized severe flare rate [ Time Frame: 52 weeks ]
    Measured by SELENA-SLEDAI Flare Index.

  7. Annualized flare rate [ Time Frame: 52 weeks ]
    Measured by BILAG score designation of "worse" or "new" resulting in a B score in ≥ 2 organs or an A score in ≥ 1 organ) over 52 weeks.

  8. Total tender and swollen joint count ≥ 50% improvement from baseline at week 12, 24, 36, and 52 in subjects with ≥ 6 tender and swollen joints involving the hands and wrists at baseline [ Time Frame: Baseline, Week 12, 24, 36, and 52 ]
    A 28-joint count will be used to evaluate the effect of AMG 570 on additional SLE efficacy endpoints. A total 28 joints will be scored for presence or absence of swelling. A separated score for joints in the hands and wrists will be calculated

  9. Cutaneous Lupus Erythematosus Area and Severity Index (CLASI) activity score ≥ 50% improvement from baseline at week 12, 24, 36, and 52 in subjects with a CLASI activity score ≥ 8 at baseline [ Time Frame: Baseline, Week 12, 24, 36, and 52 ]
    To evaluate the effect of AMG 570 on additional SLE efficacy endpoints

  10. Patient-Reported Outcome Measurement Information System Fatigue Short Form 7a Instrument (PROMIS-Fatigue SF7A) score change from baseline [ Time Frame: Baseline, Week 12, 24, 36, 44 and 52 ]
    To describe the effect of treatment with AMG 570 using patient reported outcomes

  11. Medical Outcomes Short Form 36 version 2 Questionnaire (SF36v2) score change from baseline [ Time Frame: Baseline, Week 12, 24, 36, 44 and 52 ]
    To describe the effect of treatment with AMG 570 using patient reported outcomes

  12. Lupus Quality of Life (QoL) score and change from baseline [ Time Frame: Baseline, Week 12, 24, 36, 44 and 52 ]
    To describe the effect of treatment with AMG 570 using patient reported outcomes

  13. Patient Global Assessment (PtGA) score change from baseline [ Time Frame: Baseline, Week 12, 24, 36, 44 and 52 ]
    This is an 11-point NRS with 0 indicating lowest disease and 10 highest disease activity.

  14. Subject incidence of Treatment-Emergent Adverse Events [ Time Frame: 52 weeks ]
    To characterize the safety of AMG 570

  15. Subject incidence of Serious adverse events [ Time Frame: 52 weeks ]
    To characterize the safety of AMG 570

  16. Number of Subjects with significant changes in laboratory values [ Time Frame: 52 weeks ]
    To characterize the safety of AMG 570

  17. Number of Subjects with significant changes in vital signs [ Time Frame: 52 weeks ]
    To characterize the safety of AMG 570

  18. Serum AMG 570 trough concentrations [ Time Frame: 52 Weeks ]
    To characterize the pharmacokinetics (PK) of AMG 570

  19. AMG 570 terminal elimination half-life, if possible [ Time Frame: 52 weeks ]
    To characterize the pharmacokinetics (PK) of AMG 570


Eligibility Criteria
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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria Screening Visit:

  • Subject has provided informed consent prior to initiation of any study-specific activities/procedures.
  • Age ≥ 18 years to ≤ 75 years at screening visit.
  • Fulfills classification criteria for SLE according to the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for SLE (Aringer et al, 2019), with antinuclear antibody ≥ 1:80 by immunofluorescence on Hep-2 cells being present at screening.
  • Hybrid SLEDAI score ≥ 6 points with a "Clinical" hSLEDAI score ≥ 4 points. The "Clinical" hSLEDAI is the hSLEDAI assessment score without the inclusion of points attributable to laboratory results, including urine or immunologic parameters.

Additional protocol-specific rules are applied at screening and throughout the study, as follows:

  • Arthritis: Arthritis (at least 3 tender and swollen joints) must involve joints in the hands or wrists for the hSLEDAI scoring.
  • Alopecia: Subjects should have hair loss without scarring; should neither have alopecia areata nor androgenic alopecia; and should have a CLASI activity score for alopecia ≥ 2.
  • Oral ulcers: Ulcers location and appearance must be documented by the investigator.
  • Scleritis and Episcleritis: the presence of stable SLE-related scleritis and episcleritis must be documented by an ophthalmologist and other causes excluded.
  • Renal: subjects with urine protein/creatinine ratio < 3000 mg/g (or equivalent method) in a clear catch spot urine sample can enroll and be scored in the hSLEDAI, provided the subject has a clinical hSLEDAI ≥ 4 and did not receive induction treatment for nephritis within the last year.

  • Pleurisy and Pericarditis: symptoms of pleurisy and pericarditis must be accompanied by objective findings to be scored in the hSLEDAI.

    • Must be taking at least 1 but not more than 2 of the following SLE treatments unless there is a documented intolerance to the following treatments: anti-malarial (hydroxychloroquine, chloroquine, or quinacrine), azathioprine, methotrexate, mycophenolate mofetil/acid mycophenolic, or dapsone. Treatment should be taken for ≥12 weeks prior to screening and must be a stable dose for ≥ 8 weeks prior to screening. If subject is taking 2 of the above mentioned SLE treatments, 1 of these must be either hydroxychloroquine, quinacrine, or chloroquine.
    • For subjects taking OCS, dose must be ≤ 20 mg/day of prednisone or OCS equivalent, and the dose must be stable at baseline visit for ≥ 2 weeks prior to screening visit.

Exclusion Criteria Screening Visit

Subjects are excluded from the study if any of the following criteria apply:

Disease Related

  • Urine protein creatinine ratio ≥ 3000 mg/g (or equivalent) at screening or induction therapy for lupus nephritis within 1 year prior to screening visit.
  • Active CNS lupus within 1 year prior to screening including, but not limited to, aseptic meningitis, ataxia, CNS vasculitis, cranial neuropathy, demyelinating syndrome, optic neuritis, psychosis, seizures, or transverse myelitis.
Contacts and Locations
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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): NCT04058028


Contacts
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Contact: Amgen Call Center 866-572-6436 medinfo@amgen.com

Locations
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Sponsors and Collaborators
Amgen
Investigators
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Study Director: MD Amgen
More Information
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Additional Information:

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Responsible Party: Amgen
ClinicalTrials.gov Identifier: NCT04058028    
Other Study ID Numbers: 20170588
First Posted: August 15, 2019    Key Record Dates
Last Update Posted: February 25, 2021
Last Verified: February 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: De-identified individual patient data for variables necessary to address the specific research question in an approved data sharing request
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
Time Frame: Data sharing requests relating to this study will be considered beginning 18 months after the study has ended and either 1) the product and indication have been granted marketing authorization in both the US and Europe or 2) clinical development for the product and/or indication discontinues and the data will not be submitted to regulatory authorities. There is no end date for eligibility to submit a data sharing request for this study.
Access Criteria: Qualified researchers may submit a request containing the research objectives, the Amgen product(s) and Amgen study/studies in scope, endpoints/outcomes of interest, statistical analysis plan, data requirements, publication plan, and qualifications of the researcher(s). In general, Amgen does not grant external requests for individual patient data for the purpose of re-evaluating safety and efficacy issues already addressed in the product labelling. Requests are reviewed by a committee of internal advisors, and if not approved, may be further arbitrated by a Data Sharing Independent Review Panel. Upon approval, information necessary to address the research question will be provided under the terms of a data sharing agreement. This may include anonymized individual patient data and/or available supporting documents, containing fragments of analysis code where provided in analysis specifications. Further details are available at the link below.
URL: http://www.amgen.com/datasharing

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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 Amgen:
Standard of Care therapies
Oral Corticosteroids
Inmunosuppressants
Inmunodulators
 Systemic Lupus Erythematosus
B cell Activating Factor (BAFF)
Inducible T cell costimulator ligand (ICOSL)
Additional relevant MeSH terms:
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Lupus Erythematosus, Systemic
Connective Tissue Diseases
Autoimmune Diseases
Immune System Diseases