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Macrophage Activation SyndromePhase 3EMERALDNCT05001737

Evaluate Efficacy, Safety and Tolerability, PK and PD of Emapalumab in Children and Adults With MAS in Still's or SLE

A Phase 3 study testing Emapalumab in people with Macrophage Activation Syndrome and Secondary Hemophagocytic Lymphohistiocytosis, run by Swedish Orphan Biovitrum at 44 sites in 13 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 assess the safety, tolerability and efficacy of emapalumab in children and adults with macrophage activation syndrome (sHLH/MAS) in Still's disease (including systemic juvenile idiopathic arthritis and adult onset Still's disease) or with sHLH/MAS in systemic lupus erythematous… Read more about this study

Who is it for?
Ages 6 months to 80 years
What is being tested?
Emapalumab
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
33 participants
Where
44 sitesin 13 countries
Study dates
15 Dec 2021to 4 Jun 2025
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 6 months to 80 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Informed consent provided by the subject or by the subject s' legally authorized representative(s) with the assent of subjects who are legally capable of providing it, as required by local law.
  • Male and female subjects aged between 6 months and 80 years of age at the time of diagnosis of MAS.
  • MAS defined as per the criteria defined below for each cohort and requiring treatment with GCs.
  • Interventional phase in all cohorts
  • Informed consent provided by the subject or by the subject's legally authorized representative(s) with the assent of subjects who are legally capable of providing it, as as required by local law.
  • Male and female subjects aged between 6 months and 80 years of age at the time of diagnosis of active MAS.
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  • Subjects who have shown an inadequate response to high dose intravenous (i.v.) GCs administered for at least 3 days according to local standard clinical practice, including but not limited to pulses of 30 mg/kg PDN on 3 consecutive days. High i.v. GCs dose is recommended not to be lower than 2 mg/kg/ day PDN equivalent (or at least 60 mg/day in pediatric subjects of 30 kg or more, and at least 1g/day in adult MAS subjects). In case of rapid worsening of the subject's condition and/or laboratory parameters, as per Investigator judgment, inclusion may occur within less than 3 days from starting high dose GCs.
  • Diagnosis of active MAS confirmed by the treating rheumatologist, having ascertained the followings:
  • Febrile subjects presenting with ferritin > 684 ng/mL. b. and any 2 of: i. Platelet count ≤ 181 x109/L ii. AST-level > 48 U/L iii. Triglycerides > 156 mg/dL iv. Fibrinogen level ≤ 360 mg/dL
  • Female subjects of child-bearing potential willing to use highly effective methods of contraception from study drug initiation to 6 months after the last dose of study drug.
  • Specific inclusion criteria to Cohort 1 and Cohort 2
  • Cohort 1:
  • Confirmed sJIA diagnosis. For subjects presenting with MAS in the context of the onset of sJIA, high presumption of sJIA will suffice for eligibility.
  • Confirmed diagnosis of AOSD as per Yamaguchi criteria.
  • Cohort 2:
  • Confirmed diagnosis of SLE as per SLICC'12 criteria.

Who cannot join

  • Primary HLH documented by either the presence of a known causative genetic mutation or abnormal perforin expression and CD107a degranulation assay as described with primary hemophagocytic lymphohistiocytosis or by the presence of family history.
  • Confirmed malignancy. Note: subjects with a suspected malignancy should have mononuclear cells typed by flow cytometry and/or tissue biopsy, as applicable, to rule out malignancy.
  • Treatment with canakinumab, JAK inhibitors, TNF inhibitors and tocilizumab at the time of emapalumab initiation.
  • Ongoing treatment with anakinra at a dose above 4 mg/kg at time of emapalumab initiation.
  • Subjects treated with etoposide for MAS in the last 1 month.
  • Clinically active mycobacteria (typical and atypical), Histoplasma Capsulatum, or Salmonella infections.
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  • Evidence of leishmania infections.
  • Evidence of latent tuberculosis.
  • History of hypersensitivity or allergy to any component of the study drug.
  • Receipt of a Bacillus Calmette-Guerin (BCG) vaccine within 12 weeks prior to screening.
  • Receipt of a live or attenuated live (other than BCG) vaccine within 4 weeks prior to screening.
  • Pregnancy or lactating female subjects.

Trial locations and contacts

44 sites in 13 countries.

44 sites in 13 countries

United States9 sites
  • Akron Children's Hospital

    Akron, Ohio, 44308

  • Children's Healthcare of Atlanta

    Atlanta, Georgia, 30329

  • UAB Hospital

    Birmingham, Alabama, 35233

  • Cincinnati Children's Hospital Medical Center

    Cincinnati, Ohio, 45229

  • Nationwide Children's Hospital, Abigail Wexner Research Institute

    Columbus, Ohio, 43205

  • University of Florida

    Gainesville, Florida, 32610

  • UCLA Health

    Los Angeles, California, 90095

  • University of Minnesota Masonic Children's Hospital

    Minneapolis, Minnesota, 55455

  • UPMC Children's Hospital of Pittsburgh

    Pittsburgh, Pennsylvania, 15213

Other trials in United States

Canada5 sites
  • Alberta Children's Hospital

    Calgary

  • University of Calgary

    Calgary

  • Centre Hospitalier de l'Université de Montréal

    Montreal

  • Centre Hospitalier Universitaire Sainte-Justine

    Montreal

  • Hospital for sick children

    Toronto

Other trials in Canada

France4 sites
  • Hôpital Claude Huriez

    Lille

  • Hôpital De La Conception

    Marseille

  • Hôpital Necker-Enfants Malades

    Paris

  • Hôpital Universitaire Pitié Salpêtrière

    Paris

Other trials in France

Italy4 sites
  • IRCCS G. Gaslini

    Genova

  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

    Milan

  • Ospedale Pediatrico Bambino Gesù

    Roma

  • IRCCS - Materno-Infantile Burlo Garofolo

    Trieste

Other trials in Italy

Japan4 sites
  • St. Marianna University School of Medicine Hospital

    Kawasaki

  • Osaka Medical and Pharmaceutical University Hospital

    Takatsuki

  • Tokyo Medical and Dental University Hospital

    Tokyo

  • Yokohama City University Hospital

    Yokohama

Other trials in Japan

Spain4 sites
  • Hospital Sant Joan de Déu

    Barcelona

  • Hospital Universitario La Paz

    La Paz

  • Hospital Universitario

    La Paz

  • Hospital Universitari i Politècnic La Fe

    Valencia

Other trials in Spain

China3 sites
  • Beijing Children's Hospital

    Beijing

  • Beijing Friendship Hospital

    Beijing

  • Children's Hospital of Fudan University

    Shanghai

Other trials in China

Poland3 sites
  • Szpital Specjalistyczny im. J. Dietla w Krakowie

    Krakow

  • Wojewódzki Specjalistyczny Szpital Dziecięcy im. św. Ludwika w Krakowie

    Krakow

  • Ortopedyczno - Rehabilitacyjny Szpital Kliniczny im. Wiktora Degi Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu

    Poznan

Other trials in Poland

Czechia2 sites
  • Fakultní nemocnice Olomouc

    Olomouc

  • Vseobecna Fakultni Nemocnice v Praze

    Prague

Other trials in Czechia

Germany2 sites
  • Charité Universitätsmedizin

    Berlin

  • Universitätsklinikum Heidelberg

    Heidelberg

Other trials in Germany

United Kingdom2 sites
  • Great Ormond Street Hospital

    London

  • Imperial College Healthcare NHS Trust

    London

Other trials in United Kingdom

Belgium1 site
  • Universitair Ziekenhuis Leuven

    Leuven

Other trials in Belgium

Netherlands1 site
  • UMC Utrecht

    Utrecht

Other trials in Netherlands

About this study

Official title: A Two-cohort, Open-label, Single Arm, Multicenter Study to Evaluate Efficacy, Safety and Tolerability, PK and PD, of Emapalumab in Children and Adults With MAS in Still's Disease or With MAS in Systemic Lupus Erythematous

The purpose of this study is to assess the safety, tolerability and efficacy of emapalumab in children and adults with macrophage activation syndrome (sHLH/MAS) in Still's disease (including systemic juvenile idiopathic arthritis and adult onset Still's disease) or with sHLH/MAS in systemic lupus erythematous, resenting an inadequate response to high dose glucocorticoid treatment.

Read the detailed description

Study NI-0501-14 is a two-cohort trial that enrolls subjects who are diagnosed with sHLH/MAS (MAS being a form of secondary HLH) and who are presenting an inadequate response to high doses of GCs. These subjects will be enrolled in 2 cohorts as per their background disease. The cohorts are defined as follows:

  • Cohort 1: MAS in the context of sJIA and AOSD.
  • Cohort 2: MAS in the context of pediatric and adult SLE.

The study has the objectives to investigate the efficacy, safety and tolerability, for 8 weeks, and PK and PD, QoL and immunogenicity in these 2 cohorts for up to 1 year after last dose of of emapalumab.

Macrophage Activation Syndrome (MAS) Secondary Hemophagocytic Lymphohistiocytosis (sHLH) systemic Juvenile Idiopathic Arthritis (sJIA) Adult-onset Still's Disease (AOSD) Systemic Lupus Erythematosus (SLE)

Being tested
Emapalumab
Medical subject headings
Macrophage Activation Syndrome, Arthritis, Juvenile, Lupus Erythematosus, Systemic

What participants receive

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

  • EmapalumabDrug

    Also called NI-0501, emapalumab-lzsg, ATC code: L04AA39 (WHO)

    Emapalumab iv infusion

Study groups in NCT05001737
Study groupRoleWhat they receive
Cohort 1 (sJIA and AOSD) and Cohort 2 (SLE)ExperimentalMAS in the context of systemic juvenile idiopathic arthritis and adult onset Still's disease (sJIA and AOSD) or SLE
Receives: Drug: Emapalumab

What is being measured

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

  1. Proportion of Subjects With Complete Response (CR) at Week 8 After First Administration of Emapalumab

    Resolution of clinical signs and symptoms present at baseline: The macrophage activation syndrome (MAS) clinical activity will be measured on a visual analog scale (VAS) 10 cm.

    Resolution of clinical signs and symptoms present at baseline: The MAS clinical activity will be measured on a visual analog scale (VAS) 10 cm. Clinical signs will be considered as resolved if VAS is below or equal to 1/10.

    And

    Normalization of laboratory parameters relevant to MAS, as follows:

    WBC above LLN, platelet count above LLN, LDH below 1.5 ULN, ALT below 1.5 ULN, AST below 1.5 ULN, fibrinogen higher than 100 mg/dL, ferritin levels decreased by at least 80 % from values at screening or baseline (whichever is higher) or below 2000 ng/ml, whichever is lower

    Measured: 8 weeks

Secondary outcomes (9)
  1. Number of Patients With Glucocorticoids (GC)s Tapering to a Dose Below 50% of Prednisolone (PDN) Equivalent at the Time of Emapalumab Start or to the Same (or Lower) Dose Being Administered Before the Occurrence of MAS Whichever Occurs First

    GC tapering as per investigator discretion

    Measured: At any time within the first 8 weeks from start of emapalumab treatment

  2. Number of Patients With GCs Tapering to ≤1mg/kg/Day of PDN Equivalent at Any Time Until End of Study (EOS).

    GC tapering as per investigator discretion

    Measured: At any time in the study, up to 1 year

  3. Time to Achieve GCs Tapering

    Median time to achieve GCs tapering to a dose < 50 % of PDN equivalent at the time of emapalumab start or to the same (or lower) dose being administered before the occurrence of MAS (in patients already treated for the underlying condition), or to ≤1mg/kg/Day of PDN Equivalent, whichever occurs first at any time during the study GC tapering as per investigator discretion

    Measured: At any time in the study, up to 1 year

  4. Time to First Complete Response (CR)

    Time to CR until EOS Resolution of clinical signs and symptoms present at baseline: The MAS clinical activity was measured on a visual analog scale (VAS) 10 cm.

    Definition of CR:

    Resolution of clinical signs and symptoms present at baseline: MAS clinical activity was measured on a 10-cm VAS. Clinical signs were considered resolved if VAS was below or equal to 1/10.

    and

    Normalization of laboratory parameters relevant to MAS as follows:

    • WBC >LLN.
    • Platelet count >LLN.
    • LDH <1.5 ULN.
    • ALT <1.5 ULN.
    • AST <1.5 ULN.
    • Fibrinogen >100 mg/dL.
    • Ferritin levels decreased by at least 80% from values at Screening or baseline (whichever was higher) or <2000 ng/mL, whichever was lower.

    Measured: At any time in the study, up to 1 year

  5. Proportion of Subjects With Overall Response as Defined by CR or Partial Response (PR)

    Resolution of clinical signs and symptoms present at baseline: The MAS clinical activity was measured on a visual analog scale (VAS) 10 cm.

    CR:

    Resolution of clinical signs and symptoms present at baseline: MAS clinical activity was measured on a 10-cm VAS. Clinical signs were considered resolved if VAS was below or equal to 1/10.

    and

    Normalization of laboratory parameters relevant to MAS as follows:

    • WBC >LLN.
    • Platelet count >LLN.
    • LDH <1.5 ULN.
    • ALT <1.5 ULN.
    • AST <1.5 ULN.
    • Fibrinogen >100 mg/dL.
    • Ferritin levels decreased by at least 80% from values at Screening or baseline (whichever was higher) or <2000 ng/mL, whichever was lower.

    PR:

    Resolution or improvement in clinical signs and symptoms measured by the MAS clinical activity on the VAS. The patient was classified as PR if he or she presented a VAS <4/10.

    and Normalization of at least 3 of the abnormal baseline laboratory parameters relevant to MAS, as defined above.

    Measured: At week 8

  6. Time to First Overall Response as Defined by CR or PR

    Time to first overall response

    CR:

    Resolution of clinical signs and symptoms present at baseline: MAS clinical activity was measured on a 10-cm VAS. Clinical signs were considered resolved if VAS was below or equal to 1/10.

    and

    Normalization of laboratory parameters relevant to MAS as follows:

    • WBC >LLN.
    • Platelet count >LLN.
    • LDH <1.5 ULN.
    • ALT <1.5 ULN.
    • AST <1.5 ULN.
    • Fibrinogen >100 mg/dL.
    • Ferritin levels decreased by at least 80% from values at Screening or baseline (whichever was higher) or <2000 ng/mL, whichever was lower.

    PR:

    Resolution or improvement in clinical signs and symptoms measured by the MAS clinical activity on the VAS. The patient was classified as PR if he or she presented a VAS <4/10.

    and Normalization of at least 3 of the abnormal baseline laboratory parameters relevant to MAS, as defined above.

    Measured: At any time in the study, up to 1 year

  7. MAS Recurrence at Anytime After Achievement of CR

    Number of patients with MAS recurrence at anytime after achievement of CR

    Measured: At any time after CR, up to 1 year

  8. Withdrawal From the Study Due to Lack of Response

    Number of patients withdrawn from the study due to lack of response as per Investigator decision

    Measured: At any time in the study, up to 1 year

  9. Survival

    Number of patients alive at the end of study

    Measured: At end of study, 1 year

Timeline

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

  1. First posted12 Aug 2021
  2. Study start15 Dec 2021
  3. Primary completion30 Jun 2024
  4. Study completion4 Jun 2025

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
Not applicable
Intervention model
Single group
Model description
2 cohorts
Masking
None (open label)
Enrolment
33 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05001737
Sponsor's protocol ID
NI-0501-14
Other IDs
2021-001577-24
Acronym
EMERALD
Status last verified
Feb 2026
First submitted
16 Jun 2021
Last updated
26 Aug 2026
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 Emapalumab in people with Macrophage Activation Syndrome and Secondary Hemophagocytic Lymphohistiocytosis, run by Swedish Orphan Biovitrum at 44 sites in 13 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 16 inclusion and 12 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 26 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 44 sites in United States, Canada, France, Italy, Japan and 8 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 19 Feb 2026). 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?

Proportion of Subjects With Complete Response (CR) at Week 8 After First Administration of Emapalumab (time frame: 8 weeks). 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 26 Aug 2026; AzTrials last refreshed its copy on 8 Nov 2026.

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