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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/ct2/show/NCT04598451




Registration number
NCT04598451
Ethics application status
Date submitted
8/10/2020
Date registered
22/10/2020
Date last updated
22/09/2023

Titles & IDs
Public title
A Study to Assess the Efficacy and Safety of a Subcutaneous Formulation of Efgartigimod PH20 SC in Adults With Pemphigus (Vulgaris or Foliaceus)
Scientific title
A Randomized, Double-Blinded, Placebo-Controlled Trial to Investigate the Efficacy, Safety, and Tolerability of Efgartigimod PH20 SC in Adult Patients With Pemphigus (Vulgaris or Foliaceus)
Secondary ID [1] 0 0
ARGX-113-1904
Universal Trial Number (UTN)
Trial acronym
ADDRESS
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Pemphigus Vulgaris 0 0
Pemphigus Foliaceus 0 0
Condition category
Condition code
Skin 0 0 0 0
Dermatological conditions
Skin 0 0 0 0
Other skin conditions
Inflammatory and Immune System 0 0 0 0
Autoimmune diseases

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Other interventions - efgartigimod PH20 SC
Other interventions - Placebo
Treatment: Drugs - prednisone

Experimental: efgartigimod PH20 SC - patients receiving efgartigimod PH20 SC on top of prednisone

Experimental: placebo - patients receiving placebo on top of prednisone


Other interventions: efgartigimod PH20 SC
Subcutaneous injection of efgartigimod using rHuPH20 (PH20) as a permeation enhancer

Other interventions: Placebo
Subcutaneous injection of placebo

Treatment: Drugs: prednisone
Oral prednisone tablets
Intervention code [1] 0 0
Other interventions
Intervention code [2] 0 0
Treatment: Drugs
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Proportion of Pemphigus Vulgaris (PV) participants who achieve complete clinical remission (CR) on minimal Prednisone therapy
Timepoint [1] 0 0
30 weeks treatment period
Secondary outcome [1] 0 0
Proportion of Pemphigus Vulgaris (PV) and Pemphigus Foliaceus (PF) participants who achieve complete clinical remission (CR) on minimal Prednisone therapy
Timepoint [1] 0 0
30 weeks treatment period
Secondary outcome [2] 0 0
Cumulative prednisone dose over the trial in Pemphigus Vulgaris participants
Timepoint [2] 0 0
Up to 30 weeks
Secondary outcome [3] 0 0
Time to complete clinical remission in Pemphigus Vulgaris participants
Timepoint [3] 0 0
Up to 30 weeks
Secondary outcome [4] 0 0
Time to Disease Control (DC) in Pemphigus Vulgaris (PV) participants
Timepoint [4] 0 0
Up to 30 weeks
Secondary outcome [5] 0 0
Proportion of Pemphigus Foliaceus (PF) participants who achieve complete clinical remission (CR) on minimal prednisone therapy
Timepoint [5] 0 0
30 weeks treatment period
Secondary outcome [6] 0 0
Cumulative prednisone dose over the trial in Pemphigus Vulgaris and Pemphigus Foliaceus participants
Timepoint [6] 0 0
Up to 30 weeks
Secondary outcome [7] 0 0
Time to complete clinical remission in Pemphigus Vulgaris and Pemphigus Foliaceus participants
Timepoint [7] 0 0
Up to 30 weeks
Secondary outcome [8] 0 0
Time to disease control in Pemphigus Vulgaris and Pemphigus Foliaceus participants
Timepoint [8] 0 0
Up to 30 weeks
Secondary outcome [9] 0 0
Rate of treatment failure
Timepoint [9] 0 0
Up to 30 weeks
Secondary outcome [10] 0 0
Rate of flare
Timepoint [10] 0 0
Up to 30 weeks
Secondary outcome [11] 0 0
Pemphigus Disease Area Index at each visit
Timepoint [11] 0 0
Up to 41 weeks
Secondary outcome [12] 0 0
Incidence of Treatment-Emergent Adverse Events (TEAE), Adverse Events of Special Interest (AESI), and Serious Adverse Events (SAE)
Timepoint [12] 0 0
Up to 41 weeks
Secondary outcome [13] 0 0
Severity of Treatment-Emergent Adverse Events (TEAE), Adverse Events of Special Interest (AESI), and Serious Adverse Events (SAE)
Timepoint [13] 0 0
Up to 41 weeks
Secondary outcome [14] 0 0
Composite Glucocorticoid Toxicity Index (C-GTI) comprising the Aggregate Improvement Score (AIS) and the Cumulative Worsening Score (CWS)
Timepoint [14] 0 0
Up to 30 weeks
Secondary outcome [15] 0 0
EuroQol Five-Dimension Five-Level Scale (EQ-5D-5L) score
Timepoint [15] 0 0
30 weeks treatment period
Secondary outcome [16] 0 0
Autoimmune Bullous Disease Quality of Life (ABQOL) score
Timepoint [16] 0 0
30 weeks treatment period
Secondary outcome [17] 0 0
Efgartigimod serum concentrations
Timepoint [17] 0 0
Up to 38 weeks
Secondary outcome [18] 0 0
Total immunoglobulin G and subtype (IgG1, IgG2, IgG3, IgG4) serum levels
Timepoint [18] 0 0
Up to 41 weeks
Secondary outcome [19] 0 0
Anti desmoglein-1 and -3 autoantibodies serum levels
Timepoint [19] 0 0
Up to 41 weeks
Secondary outcome [20] 0 0
Incidence of anti-drug antibodies (ADA) to efgartigimod PH20 SC
Timepoint [20] 0 0
Up to 38 weeks
Secondary outcome [21] 0 0
Prevalence of anti-drug antibodies (ADA) to efgartigimod PH20 SC
Timepoint [21] 0 0
Up to 38 weeks
Secondary outcome [22] 0 0
Incidence of antibodies produced against recombinant human hyaluronidase (rHuPH20) (plasma levels)
Timepoint [22] 0 0
Up to 31 weeks
Secondary outcome [23] 0 0
Prevalence of antibodies produced against recombinant human hyaluronidase (rHuPH20)
Timepoint [23] 0 0
Up to 31 weeks
Secondary outcome [24] 0 0
Number of participants or caregivers completing the self-administration training
Timepoint [24] 0 0
Up to 41 weeks
Secondary outcome [25] 0 0
Percentage of participants or caregivers completing the self-administration training
Timepoint [25] 0 0
Up to 41 weeks
Secondary outcome [26] 0 0
Number of participants or caregivers determined by the site staff to be sufficiently competent to self-administer efgartigimod PH20 SC
Timepoint [26] 0 0
Up to 41 weeks
Secondary outcome [27] 0 0
Percentage of participants or caregivers determined by the site staff to be sufficiently competent to self-administer efgartigimod PH20 SC
Timepoint [27] 0 0
Up to 41 weeks
Secondary outcome [28] 0 0
Number of participants or caregivers that self-administer efgartigimod PH20 SC under site staff supervision
Timepoint [28] 0 0
Up to 41 weeks
Secondary outcome [29] 0 0
Percentage of participants or caregivers that self-administer efgartigimod PH20 SC under site staff supervision
Timepoint [29] 0 0
Up to 41 weeks

Eligibility
Key inclusion criteria
1. Ability to understand the requirements of the trial, to provide written informed
consent (including consent for the use and disclosure of research-related health
information), willingness and ability to comply with the trial protocol procedures
(including required trial visits).

2. The participant is male or female, and aged from 18 years at the time of signing the
informed consent form (ICF).

3. The participant has a clinical diagnosis of PV (mucosal, cutaneous, mucocutaneous) or
PF which has been confirmed by cutaneous histology, positive direct immunofluorescence
(IF), and positive indirect IF and/or enzyme-linked immunosorbent assay (ELISA).

4. The participant meets one of the following profiles:

1. Newly diagnosed disease with PDAI =15 at baseline and naïve to treatment

2. Newly diagnosed disease with PDAI =15 while receiving a first course of oral
prednisone (or equivalent). According to clinical judgment, the participant has
shown no significant improvement of PV or PF signs for at least 2 weeks before
baseline and is considered fit to start prednisone treatment at 0.5 mg/kg qd at
baseline.

3. Experiencing flare with PDAI =15, a maximum of 4 years since diagnosis, and off
prednisone therapy ± a conventional immunosuppressant (e.g., azathioprine,
cyclophosphamide, methotrexate, mycophenolate mofetil) or dapsone. Note:
conventional immunosuppressants and dapsone must be discontinued before baseline.

4. Experiencing flare with PDAI =15, a maximum of 4 years since diagnosis, and
receiving a tapered dose of oral prednisone (or the equivalent), provided that
prednisone has been given at stable dose ± a conventional immunosuppressant for
at least 2 weeks and patients are fit to start prednisone treatment at 0.5 mg/kg
qd at baseline.

5. Contraceptive use by men and women should be consistent with local regulations
regarding the methods of contraception for those participating clinical trials and:

1. Male participants: Male participants must agree to use acceptable method of
contraception, and not donate sperm from signing the ICF until the end of the
study.

2. Female participants: Women of childbearing potential must:

- have a negative serum pregnancy test at screening and negative urine
pregnancy test at baseline before the IMP can be administered.

- agree to use a highly effective or acceptable contraception method, which
should be maintained at minimum until after the last dose of IMP

6. For Japanese participants enrolled in sites in Japan only: A Japanese participant is
defined as a participant whose parents and 4 grandparents are Japanese, and who has
Japanese nationality, was born in Japan, has not lived outside of Japan for a total of
>10 years, and currently lives in Japan.
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
1. Participant has a confirmed diagnosis of paraneoplastic pemphigus, drug-induced
pemphigus, pemphigus vegetans, pemphigus erythematosus, or any other non-PV/non-PF
autoimmune blistering disease.

2. Participants with mild disease severity as defined by PDAI <15 at baseline.

3. Participants who show a significant improvement of PV or PF in the period from
screening to baseline according to clinical judgment (eg, the patient has achieved DC
or a substantial reduction in PDAI activity score during screening period).

4. The participant has been administered therapy(ies) other than oral prednisone or
conventional immunosuppressants (e.g., azathioprine, cyclophosphamide, methotrexate,
mycophenolate mofetil) or dapsone within 2 months before the baseline visit and that
can affect clinical disease activity. For example, excluded medications are
intravenous methylprednisolone, dapsone, sulfasalazine, tetracyclines, nicotinamide at
doses above the recommended daily allowance (RDA)/dietary reference intake (DRI),
plasmapheresis/ plasma exchange, immunoadsorption, and IVIg.

5. Use of any monoclonal antibody (including rituximab or another anti-CD20 biologic)
within 6 months before the baseline visit.

6. Known hypersensitivity to any of the components of the administered treatments.

7. The participant has a known contraindication to oral prednisone.

8. The participant has a history of refractory disease, as defined by a failure to
respond to first-line and second-line therapies

9. Participants who have a history of malignancy unless deemed cured by adequate
treatment with no evidence of recurrence for =3 years before first IMP administration.
Participants with any of the following cancers can be included at any time, provided
they are adequately treated prior to their participation in the study:

- Basal cell or squamous cell skin cancer,

- Carcinoma in situ of the cervix,

- Carcinoma in situ of the breast,

- Incidental histological finding of prostate cancer

10. Participants with clinical evidence of other significant serious disease or
participants who recently underwent or have planned a major surgery during the period
of the trial, or any other condition in the opinion of the investigator, that could
confound the results of the trial or put the patient at undue risk.

11. Pregnant and lactating women and those intending to become pregnant during the trial.

12. Current or history (i.e. within 12 months of screening) of alcohol, drug, or
medication abuse.

13. Any other known autoimmune disease that, in the opinion of the investigator, would
interfere with an accurate assessment of clinical symptoms of PV or PF or put the
participant at undue risk.

14. The participant has a Karnofsky Performance score <60%.

15. Vaccination with live viral vaccines within 28 days prior to randomization.

16. The participant has clinically significant uncontrolled active or chronic bacterial,
viral, or fungal infection.

17. Positive serum test at screening for an active viral infection with any of the
following conditions: Hepatitis B Virus, Hepatitis C Virus , HIV.

18. The participant has total immunoglobulin G (IgG) <6 g/L at screening.

19. The participant has previously participated in a trial with efgartigimod and has
received at least one administration of IMP.

20. Use of an investigational drug within 3 months or 5 half-lives of the drug (whichever
is longer) prior to first IMP administration

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Phase
Phase 3
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
1/12/2020
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
22/08/2023
Sample size
Target
Accrual to date
Final
222
Recruitment in Australia
Recruitment state(s)
NSW,VIC
Recruitment hospital [1] 0 0
Investigator site 24 - AU0610006 - Sydney
Recruitment hospital [2] 0 0
Investigator site 5 - AU0610007 - Parkville
Recruitment hospital [3] 0 0
Investigator site 103 - AU0610013 - Melbourne
Recruitment postcode(s) [1] 0 0
2217 - Sydney
Recruitment postcode(s) [2] 0 0
3050 - Parkville
Recruitment postcode(s) [3] 0 0
3065 - Melbourne
Recruitment outside Australia
Country [1] 0 0
United States of America
State/province [1] 0 0
Alabama
Country [2] 0 0
United States of America
State/province [2] 0 0
Arizona
Country [3] 0 0
United States of America
State/province [3] 0 0
California
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United States of America
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Colorado
Country [5] 0 0
United States of America
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Florida
Country [6] 0 0
United States of America
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Indiana
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United States of America
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Minnesota
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United States of America
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Missouri
Country [9] 0 0
United States of America
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New York
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United States of America
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North Carolina
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United States of America
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Ohio
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United States of America
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Pennsylvania
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United States of America
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Texas
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United States of America
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Virginia
Country [15] 0 0
Bulgaria
State/province [15] 0 0
Pleven
Country [16] 0 0
Bulgaria
State/province [16] 0 0
Plovdiv
Country [17] 0 0
Bulgaria
State/province [17] 0 0
Sofia
Country [18] 0 0
China
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Beijing
Country [19] 0 0
China
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Chendu
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China
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Chongqing
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China
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Fujian
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China
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Guangzhou
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China
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Guanzhou
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China
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Nanjing
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China
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Shanghai
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China
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Wuhan
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China
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Zhengzhou
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France
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Bobigny
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France
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La Tronche
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France
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Rouen
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France
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Saint-Étienne
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Georgia
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Tbilisi
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Germany
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Berlin
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Germany
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Dresden
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Frankfurt am main
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Freiburg
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Kiel
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Lübeck
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Marburg
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Tübingen
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Ulm
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Germany
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Würzburg
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Greece
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Athens
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Greece
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Chaïdári
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Greece
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Thessaloníki
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Hungary
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Budapest
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Hungary
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Debrecen
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Hungary
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Pécs
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Hungary
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Szeged
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India
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Ahmedabad
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India
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Chandigarh
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India
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Lucknow
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India
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Nagpur
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Israel
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Tel Aviv
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Italy
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Lazio
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Italy
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Catania
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Italy
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Firenze
Country [58] 0 0
Italy
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Genova
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Italy
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Perugia
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Italy
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Roma
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Italy
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Siena
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Japan
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Aichi
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Japan
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Hiroshima
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Japan
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Kurume
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Japan
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Kofu
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Japan
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Okayama
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Japan
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Osaka
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Japan
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Sapporo
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Japan
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Sendai
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Japan
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Tokyo
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Poland
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Katowice
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Poland
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Poznan
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Poland
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Rzeszów
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Poland
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Wroclaw
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Poland
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Lódz
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Romania
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Bucharest
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Romania
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Cluj-Napoca
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Romania
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Iasi
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Russian Federation
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Chelyabinsk
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Russian Federation
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Ekaterinburg
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Russian Federation
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Kazan
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Russian Federation
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Krasnodar
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Russian Federation
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Rostov-on-Don
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Russian Federation
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Saint Petersburg
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Russian Federation
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Saratov
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Serbia
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Belgrade
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Serbia
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Belgrad
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Serbia
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Niš
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Serbia
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Novi Sad
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Spain
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Barcelona
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Spain
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Granada
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Spain
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Madrid
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Spain
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Málaga
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Spain
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Pamplona
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Spain
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Sevilla
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Turkey
State/province [96] 0 0
Gaziantep
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Turkey
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Istanbul
Country [98] 0 0
Ukraine
State/province [98] 0 0
Dnipro
Country [99] 0 0
Ukraine
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Ivano-Frankivs'k
Country [100] 0 0
Ukraine
State/province [100] 0 0
Kyiv
Country [101] 0 0
Ukraine
State/province [101] 0 0
Lviv
Country [102] 0 0
Ukraine
State/province [102] 0 0
Zaporizhzhia
Country [103] 0 0
United Kingdom
State/province [103] 0 0
Birmingham
Country [104] 0 0
United Kingdom
State/province [104] 0 0
Bristol
Country [105] 0 0
United Kingdom
State/province [105] 0 0
Southampton

Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
Name
argenx
Address
Country

Ethics approval
Ethics application status

Summary
Brief summary
This is a prospective, multicenter, randomized, double-blinded, placebo-controlled trial to
investigate the efficacy, safety, patient outcome measures, tolerability, immunogenicity, PK,
and PD of efgartigimod PH20 SC in adult participants aged from 18 years with PV or PF. The
trial comprises a screening period of up to 3 weeks, a treatment period of up to 30 weeks,
and an 8-week follow-up period for participants who do not enroll into the open-label
extension (OLE) trial ARGX-113-1905. The primary objective of the ARGX-113-1904 trial is to
demonstrate the efficacy of subcutaneous administration of efgartigimod co-formulated with
recombinant human hyaluronidase PH20 (Efgartigimod PH20 SC) compared to placebo in the
treatment of participants with Pemphigus Vulgaris (PV). Secondary objectives are to also
demonstrate the efficacy of efgartigimod PH20 SC in the treatment of participants with
Pemphigus Foliaceus (PF), and to demonstrate early onset of action and a prednisone-sparing
effect. After confirmation of eligibility, participants will be randomized in a 2: 1 ratio to
receive efgartigimod PH20 SC or placebo
Trial website
https://clinicaltrials.gov/ct2/show/NCT04598451
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/ct2/show/NCT04598451