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Generalized Myasthenia GravisPhase 3ADAPTscNCT04735432

Evaluating the Pharmacodynamic Noninferiority of Efgartigimod PH20 SC Administered Subcutaneously as Compared to Efgartigimod Administered Intravenously in Patients With Generalized Myasthenia Gravis

A Phase 3 study testing efgartigimod PH20 SC and efgartigimod IV in people with Generalized Myasthenia Gravis, run by argenx at 47 sites in 11 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to investigate the Pharmacodynamics (PD), Pharmacokinetics (PK), safety, tolerability, immunogenicity, and clinical efficacy of efgartigimod coformulated with recombinant human hyaluronidase PH20 (rHuPH20) as compared to efgartigimod IV infused in patients with generalized myasthenia… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Generalized Myasthenia Gravis
What is being tested?
efgartigimod PH20 SC and efgartigimod IV
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
110 participants
Where
47 sitesin 11 countries
Study dates
5 Feb 2021to 13 Dec 2021
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Bullet list of each inclusion criterium:
  • Must be capable of giving signed informed consent, which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.
  • At least 18 years of age at the time of signing the informed consent form.
  • Diagnosed with generalized Myasthenia Gravis (gMG) with confirmed documentation and supported by at least 1 of the following:
  • History of abnormal neuromuscular transmission demonstrated by single fiber electromyography or repetitive nerve stimulation
  • History of positive edrophonium chloride test
  • Demonstrated improvement in Myasthenia Gravis (MG) signs upon treatment with oral acetylcholinesterase (AChE) inhibitors as assessed by the treating physician
  • Meeting the clinical criteria as defined by the Myasthenia Gravis Foundation of America (MGFA) class II, III, IVa, or IVb

Who cannot join

  • Bullet list of each exclusion criterium:
  • Are pregnant or lactating, or intend to become pregnant during the study or within 90 days after the last dose of Investigational Medicinal Product.
  • Has any of the following medical conditions:
  • Clinically significant uncontrolled active or chronic bacterial, viral, or fungal infection at screening
  • Any other known autoimmune disease that, in the opinion of the investigator, would interfere with an accurate assessment of clinical symptoms of myasthenia gravis or put the participant at undue risk.
  • History of malignancy unless deemed cured by adequate treatment with no evidence of reoccurrence for ≥3 years before the first administration of the IMP. Participants with the following cancers can be included at any time:
Show all 11Show fewer
  • adequately treated basal cell or squamous cell skin cancer
  • carcinoma in situ of the cervix
  • carcinoma in situ of the breast
  • incidental histological findings of prostate cancer (TNM Classification of Malignant Tumors stage T1a or T1b).
  • Clinical evidence of other significant serious diseases, or the participant has had a recent major surgery, or who have any other condition that, in the opinion of the investigator, could confound the results of the study or put the participant at undue risk.

Trial locations and contacts

47 sites in 11 countries.

47 sites in 11 countries

United States14 sites
  • Investigator Site 11 - US0010111

    Amherst, New York, 14226

  • Investigator Site 47 - US0010113

    Augusta, Georgia, 30912

  • Investigator Site 28 - US0010066

    Austin, Texas, 78756

  • Investigator site 2 - US0010108

    Boca Raton, Florida, 33428

  • Investigator site 2 - US0010032

    Carlsbad, California, 92011

  • Investigator Site 40 - US0010003

    Chapel Hill, North Carolina, 27514

  • Investigator Site 43 - 0010019

    Cleveland, Ohio, 44195

  • Investigator site 4 - US0010008

    Cordova, Tennessee, 38018

  • Investigator Site 38 - US0010077

    Durham, North Carolina, 27710

  • Investigator Site 42 - US0010015

    Kansas City, Kansas, 66205

  • Investigator Site 41 - US0010004

    Orange, California, 92868

  • Investigator site 1 - US0010110

    Port Charlotte, Florida, 33952

  • Investigator Site 27 - US0010006

    Tampa, Florida, 41076

  • Investigator Site 46 - US0010009

    Texas City, Texas, 78229

Other trials in United States

Japan8 sites
  • Investigator Site 18 - JP0810002

    Chiba, 260-8677

  • Investigator site 6 - JPN0810004

    Hanamaki, 025-0082

  • Investigator Site 33 - JP0810058

    Hiroshima, 0810058

  • Investigator Site 19 - JP0810007

    Osaka, 565-0871

  • Investigator Site 31 - JP0810055

    Sapporo, Hokkaido, 063-0005

  • Investigator Site 34 - JP0810005

    Sendai, 983-8520

  • Investigator Site 32 - JP0810059

    Tokyo, 143-8541

  • Investigator Site 20 - JP0810009

    Tokyo, 160-0023

Other trials in Japan

Poland6 sites
  • Investigator Site 21 - PL0480001

    Gdansk, 80-952

  • Investigator Site 8 - PL0480007

    Katowice, 40-123

  • Investigator Site 9 - PL0480024

    Krakow, 31-2002

  • Investigator Site 22 - PL0480005

    Krakow, 31-505

  • Investigator Site 23 - PL0480018

    Lublin, 20-093

  • Investigator Site 24 - PL0480022

    Warsaw, 02-097

Other trials in Poland

Georgia5 sites
  • Investigator site 13 - GE9950002

    Tbilisi, 0112

  • Investigator site 12 - GE9950001

    Tbilisi, 0114

  • Investigator site 14 - GE9950003

    Tbilisi, 0114

  • Investigator Site 44 - GE9950004

    Tbilisi, 0160

  • Investigator Site 45 - GE9950016

    Tbilisi, 0160

Other trials in Georgia

Spain4 sites
  • Investigator Site 37 - ES0340021

    Barcelona, 08035

  • Investigator Site 26 - ES0340038

    Barcelona, 08041

  • Investigator Site 25 - ES0340002

    Madrid, 28046

  • Investigator Site 10 - ES0340039

    Valencia, 46026

Other trials in Spain

Germany2 sites
  • Investigator Site 30 - DE490006

    Berlin, 10117

  • Investigator Site 29 - DE490009

    Münster, 48149

Other trials in Germany

Hungary2 sites
  • Investigator site 15 - HU0360013

    Budapest, 1082

  • Investigator Site 16 - HU0360020

    Debrecen, 4032

Other trials in Hungary

Italy2 sites
  • Investigator Site 17 - IT0390003

    Milan, 20133

  • Investigator Site 39 - IT0390008

    Roma, 00189

Other trials in Italy

Russia2 sites
  • Investigator Site 35 - RU0070002

    Novosibirsk, 630087

  • Investigator Site 36 - RU0070014

    Saint Petersburg, 194354

Other trials in Russia

Belgium1 site
  • Investigator site 5 - BE0320007

    Ghent, East-Flanders, 9000

Other trials in Belgium

Netherlands1 site
  • Investigator Site 7 - NL0310001

    Leiden, 2333

Other trials in Netherlands

About this study

Official title: A Phase 3, Randomized, Open-Label, Parallel-Group Study to Compare the Pharmacodynamics, Pharmacokinetics, Efficacy, Safety, Tolerability, and Immunogenicity of Multiple Subcutaneous Injections of Efgartigimod PH20 SC With Multiple Intravenous Infusions of Efgartigimod in Patients With Generalized Myasthenia Gravis

The purpose of this study is to investigate the Pharmacodynamics (PD), Pharmacokinetics (PK), safety, tolerability, immunogenicity, and clinical efficacy of efgartigimod coformulated with recombinant human hyaluronidase PH20 (rHuPH20) as compared to efgartigimod IV infused in patients with generalized myasthenia gravis (gMG). The study duration is approximately 12 weeks. After screening, patients will be randomized to receive either efgartigimod infusions or efgartigimod PH20 subcutaneously (SC)

Read the detailed description

Main objective of the trial: To demonstrate that the pharmacodynamic (PD) effect of injections of 1000 mg efgartigimod PH20 SC (efgartigimod co-formulated with recombinant humanhyaluronidase PH20 for subcutaneous administration), administered once weekly for 4 administrations, is NI (noninferior) to IV infusions of efgartigimod (efgartigimod formulation for intravenous infusion) at a dose of 10 mg/kg administered once weekly for 4 administrations.

Secondary objectives: To compare the PD effect of efgartigimod PH20 SC and efgartigimod IV over time; To evaluate the pharmacokinetics (PK) of efgartigimod PH20 SC and efgartigimod IV; To evaluate the safety, tolerability, and immunogenicity of efgartigimod PH20 SC and efgartigimod IV; To evaluate the clinical efficacy of efgartigimod PH20 SC and efgartigimod IV.

Being tested
efgartigimod PH20 SC, efgartigimod IV
Medical subject headings
Myasthenia Gravis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • efgartigimod PH20 SCBiological

    Subcutaneous injection with efgartigimod PH20 SC

  • efgartigimod IVBiological

    Intravenous infusion of efgartigimod

Study groups in NCT04735432
Study groupRoleWhat they receive
efgartigimod PH20 SCExperimentalPatients receiving efgartigimod PH20 subcutaneous (SC) treatment
Receives: Biological: efgartigimod PH20 SC
efgartigimodExperimentalPatients receiving efgartigimod intravenous (IV) treatment
Receives: Biological: efgartigimod IV

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percent Change From Baseline in Total IgG Levels at Day 29 (mITT Analysis Set)

    ANCOVA Analysis of Percent Change From Baseline in Total IgG Level at Day 29 (ie, 7 days after the fourth IV or SC administration).

    Measured: From week 0 to week 4

Secondary outcomes (13)
  1. Percent Change From Baseline in Total IgG Levels Over Time (mITT Analysis Set)

    Total IgG level percent change from baseline over time for the overall population.

    Measured: From baseline to week 10

  2. Percent Change From Baseline in AChR-Ab Levels Over Time in AChR- Ab Positive Patients (mITT Analysis Set)

    Percent reduction from baseline in AChR-Ab levels over time in AChR-Ab positive patients measured in mITT Analysis Set.

    Descriptive statistics have been used for this secondary end point.

    Measured: From baseline to week 10

  3. Percent Change From Baseline in IgG Subtype Levels Over Time (mITT Analysis Set)

    Median (IQR) Percent Change From Baseline for the IgG Subtypes (IgG1, IgG2, IgG3, and IgG4) in the Overall Population.

    The highest number of patients among all weeks for the analysis is chosen for each arm.

    Descriptive statistics have been used for this secondary end point.

    Measured: Baseline to week 10

  4. AUEC of the Percent Change From Baseline in Total IgG Level (mITT Analysis Set)

    AUEC of the percent reduction from baseline total IgG per dosing interval (days 1-8, days 8-15, days 15-22, and days 22-29), days 1-29, days 1-57 and over the entire study (days 1-71).

    The highest number of patients among all weeks for the analysis is chosen for each arm.

    Descriptive statistics have been used for this secondary end point.

    Measured: From baseline to week 10

  5. Еfgartigimod IV and PH20 SC Serum Pharmacokinetic Parameter Ctrough

    Evaluation of observed predose concentration (Ctrough) (after all doses for the IV and SC treatment arms). The analysis will present data from Week 1 to Week 4.

    Descriptive statistics have been used for this secondary end point.

    Measured: From Week 1 to Week 4.

  6. Efgartigimod IV Serum Pharmacokinetic Parameter Cmax

    Evaluation of maximum observed concentration (Cmax) (after all doses for the IV treatment arm). The analysis will present data from Baseline to Week 3.

    Descriptive statistics have been used for this secondary end point.

    Measured: From Baseline to Week 3

  7. Incidence of ADA Against Efgartigimod (Safety Analysis Set)

    Incidence of antidrug antibodies (ADA) against Efgartigimod in the overall population. ADA analysis is performed with a validated ELISA in a 3-tiered approach (ADA screening analysis, confirmatory analysis and a titration assay). Descriptive statistics have been used for this secondary end point.

    Measured: From baseline to week 10

  8. Incidence of Antibodies Against rHuPH20 in the SC Treatment Arm (Safety Analysis Set)

    Incidence of antibodies against rHuPH20 in the Efgartigimod PH20 SC Arm. antibody analysis is performed with a validated ELISA in a 3-tiered approach (screening analysis, confirmatory analysis and a titration assay) Descriptive statistics have been used for this secondary end point.

    Measured: From baseline to week 10

  9. Incidence and Severity of AEs and SAEs (Safety Analysis Set)

    Evaluation of incidence and severity of treatment-emergent adverse events (TEAEs) and incidence of serious AEs (SAEs).

    Descriptive statistics have been used for this secondary end point.

    Measured: From baseline to week 10

  10. MG-ADL Responders (ITT Analysis Set)

    Evaluation of number and percentage of Myasthenia Gravis Activities of Daily Living (MG-ADL) responders in the overall population. The MG-ADL is an 8-item patient-reported scale that assesses MG symptoms and their effects on daily activities. It evaluates a participant's capacity to perform different activities in their daily life, including talking, chewing, swallowing, breathing, brushing their teeth, combing their hair, or getting up from a chair. The MG-ADL also assesses double vision and eyelid droop. It is a discrete quantitative variable in which the 8 items are rated by the participant on a scale of 0 to 3. The total score can range from 0 to 24, with higher total scores indicating more impairment. A participant was considered a MG-ADL responder if he/she showed a reduction of at least 2 points from baseline on the MG-ADL score for at least 4 consecutive weeks. Descriptive statistics have been used for this secondary end point.

    Measured: From baseline to week 10

  11. QMG Responders (ITT Analysis Set)

    Evaluation of number and percentage of Quantitative Myasthenia Gravis (QMG) responders in the overall population (ITT Analysis Set).

    Descriptive statistics have been used for this secondary end point. One subject in the EFG IV arm had no post-baseline QMG assessment and thus was excluded from the denominator.

    Measured: From Baseline to Week 10

  12. Change From Baseline in MG-ADL Total Score Over Time (ITT Analysis Set)

    Evaluation of MG-ADL Total Score Change from baseline over time for the overall population (ITT Analysis Set). Descriptive statistics have been used for this secondary end point.

    The MG-ADL is an 8-item patient-reported scale that assesses MG symptoms and their effects on daily activities. It evaluates a participant's capacity to perform different activities in their daily life, including talking, chewing, swallowing, breathing, brushing their teeth, combing their hair, or getting up from a chair. The MG-ADL also assesses double vision and eyelid droop. It is a discrete quantitative variable in which the 8 items are rated by the participant on a scale of 0 to 3. The total score can range from 0 to 24, with higher total scores indicating more impairment. A participant was considered a MG-ADL responder if he/she showed a reduction of at least 2 points from baseline on the MG-ADL score for at least 4 consecutive weeks.

    Measured: From baseline to week 10

  13. Change From Baseline in QMG Score Over Time (ITT Analysis Set)

    Evaluation of QMG Total Score change from baseline over time for the overall population (ITT Analysis Set). The QMG (Quantitative Myasthenia Gravis) quantifies disease severity based on impairments of body function and structures as defined by the International Classification of Functioning, Disability and Health. The QMG consists of 13 items that assess ocular, bulbar, and limb function. Six of the 13 items are timed endurance tests measured in seconds. Each item has a possible score from 0 to 3. The total possible score is 39, where higher total scores indicate more severe impairments. It is based on qualitative testing of specific muscle groups to assess limb function.

    Descriptive statistics have been used for this secondary end point. A participant was considered a QMG responder if he/she showed a reduction of at least 3 points from baseline on the QMG score for at least 4 consecutive weeks.

    Measured: From baseline to week 10

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Feb 2021
  2. Study start5 Feb 2021
  3. Primary completion2 Nov 2021
  4. Study completion13 Dec 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
110 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04735432
Sponsor's protocol ID
ARGX-113-2001
Acronym
ADAPTsc
Status last verified
Jan 2023
First submitted
26 Jan 2021
Last updated
28 Feb 2023
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing efgartigimod PH20 SC and efgartigimod IV in people with Generalized Myasthenia Gravis, run by argenx at 47 sites in 11 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Feb 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 47 sites in United States, Japan, Poland, Georgia, Spain and 6 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 28 Feb 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percent Change From Baseline in Total IgG Levels at Day 29 (mITT Analysis Set) (time frame: From week 0 to week 4). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Feb 2023.

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