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Phase III Study in Refractory Behcet's Disease

A 24 Week Multicenter, Randomized, Double-masked, Placebo Controlled Study to Assess the Difference in the Rate of Recurrent Exacerbations in Behçet¿s Patients With Posterior or Panuveitis Treated With AIN457 vs Placebo Adjunctive to Standard-of-care Immunosuppressive Therapy

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00995709
Acronym
SHIELD
Enrollment
118
Registered
2009-10-15
Start date
2009-10-31
Completion date
2010-07-31
Last updated
2015-08-31

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Behcet Disease

Keywords

Behçet's disease,, intermediate uveitis, panuveitis, posterior uveitis, uveitis

Brief summary

The purpose of this pivotal trial is to evaluate subcutaneous (SQ) AIN457 as an adjunctive therapy to reduce the rate of exacerbations of posterior uveitis or panuveitis secondary to Behçet's disease during the 24 weeks of study therapy as compared to standard of care alone.

Interventions

DRUGAIN457
DRUGPlacebo

Sponsors

Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Patients with Behçet's disease and with a history of recurrent uveitis in a least one eye. * Documented evidence of \>2 recurrent exacerbations of either intermediate uveitis, posterior uveitis or panuveitis in the study eye within the past 6 months (this could include the current exacerbation for patients having an acute exacerbation at screening). Exacerbations fulfilling the study inclusion criteria must have one or more of the following recorded in the patients patients medical record for each recurrent exacerbation: * \>2+ vitreous haze with \<2+ anterior chamber cell grade (intermediate or posterior uveitis) or \>2+ vitreous haze with \>2+ anterior chamber cell grade (panuveitis) * presence of retinal infiltrates or vasculitis or hemorrhages * documented \>10 ETDRS letter or 2 line Snellen decrease in visual acuity attributed to ocular inflammation secondary to the recurrent exacerbation of Behçet's disease. * Requirement for either of the following immunosuppressive therapies for at least 3 of the past 6 months for the treatment of or to prevent an exacerbation of ocular inflammation related to Behçet's disease: * Prednisone or equivalent \>10 mg daily * The need for at least \>1 periocular injection or \>1 intravitreal corticosteroid injection in the study eye within the past 6 months (the last injection must have not been given within 6 weeks of screening) * Treatment with cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, mycophenolic acid or methotrexate either as monotherapy or in combination with or without steroids. (Patients treated at any time with chlorambucil or cyclophosphamide are not eligible for the study.) * Patients not meeting the above specified criteria for immunomodulatory therapies are eligible for enrollment if they are intolerant to systemic immunomodulatory therapy as determined by the study investigator.

Exclusion criteria

* Subjects with infectious uveitis, uveitis due to other causes than Behçet's disease, or uveitis of unknown etiology. * Less severe (i.e. anterior) uveitis associated with Behçet's disease. Ocular treatments * Treatment with intravitreal anti-VEGF agents administered to the study eye within 3 months prior to study screening. * Treatment with any injected or implantable corticosteroid releasing device (i.e., flucinolone acetonide implant, Retisert®) in the study eye within the last 3 years. * Intraocular surgery or laser photocoagulation in the study eye within the last 6 weeks prior to screening except for a diagnostic vitreous or aqueous tap with a small-gauge needle. Systemic conditions or treatments * Treatment with any live or live-attenuated vaccine (including vaccine for varicella-zoster virus or measles) within 2 months prior to screening. * Any systemic biologic therapy (e.g. interferon, infliximab, daclizumab, etanercept, or adalimumab) given intravenously or subcutaneously within 3 months prior to screening and no prior treatment with AIN457. * Any prior treatment with systemic alkylating agents (cyclophosphamide, chlorambucil). Other protocol-defined inclusion/

Design outcomes

Primary

MeasureTime frame
Rate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by TreatmentBaseline to week 24

Secondary

MeasureTime frameDescription
Change From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)24 weeksFor each corticosteroid medication, dose of the corticosteroid was first converted to a prednisone-equivalent dose. To determine the prednisone equivalent dose, the corticosteroid dose was multiplied by a conversion factor. . The total prednisone equivalent dose was calculated as the sum of the prednisone equivalent doses of all corticosteroids. Consequently, the total converted prednisone equivalent dose was used to obtain the immunosuppressive score. The key secondary efficacy variable was the change in total post-baseline immunosuppressive medication score from baseline.The score is actually the prednisoone equivalents taken by patient as calculated by conversion table. A reduction in prenisone or prenisone equivalents is a positive outcome. An increase in the number of prednisone equivalents suggests that the treatment is not efficacious or that there is disease progression. A score of 0 would be the lowest ( no steriods taken) and the upper limit is indeterminate.
To Determine the Effect of AIN457 on Macular Edema and Visual Acuity in Patients With Posterior Segment Uveitis Secondary to Behçet's Disease as Determined by Optical Coherence Tomography.baseline, and wk 24 (end of study)Optical coherence tomography (OCT) is amedical imaging technique that uses light to capture micrometer-resolution, three-dimensional images from within optical scattering media (e.g., biological tissue). OCT is based on low-coherence interferometry, typically employing near-infrared light. The use of relatively long wavelength light allows it to penetrate into the scattering medium. OCT is a noninvasive procedure that uses optical interferometry to visualize the structures within the retina. Following dilation of the pupil, a light source operating at 850nm provides probe illumination which is split and detected with and without the refraction of the retinal tissues. Cross-sectional imaging is accomplished in 1.3 second by acquiring a sequence of interferometric A-scans. A false color tomogram of optical reflectivity is produced by the computer. Central foveal thickness will be the primary variable derived from OCT. A increase in thickness could translate to disease progression.
To Establish the Impact of AIN457 on Quality of Life of Posterior Segment Uveitis Patients Secondary to Behçet's Disease Refractory to Systemic Immunomodulatory Therapy as Measured by National Eye Institute Visual Function Questionaire-25 and Euroqol.screening, and wk 24 (end of study)The VFQ-25 is a reliable and valid 25-item version of the 51-item National Eye Institute Visual Function Questionnaire (NEI-VFQ). It is especially useful in settings such as clinical trials, where interview length is a critical consideration. Scores range from 0 to 100, with higher scores indicating better visual function.
To Observe the Effect of AIN457 on the Systemic Non-ocular Manifestations of Behçet's Disease in Patients With Posterior Segment Uveitis Requiring Systemic Immunosuppression as Measured by the Bechet's Disease Current Activity Form.baseline and wk 24 (end of study)The BDCAF scores oral and genital ulceration, skin, joint and gastrointestinal involvement, presence of fatigue and headache according to the duration of symptoms. The presence and type of large-vessel and central nervous system (CNS) involvement are documented. Eye activity was deemed present if there was a history of blurring of vision or if the eye was painful or red. . The BDCAF score was calculated by adding the score of each index and ranged between 0 and 12 A reduction in score signifies a lessening of the disease.

Countries

Egypt, France, Germany, Greece, Hong Kong, India, Israel, Italy, Jordan, Singapore, South Korea, Spain, Switzerland, Taiwan, Tunisia, Turkey (Türkiye), United States

Participant flow

Participants by arm

ArmCount
AIN457C 300 mg Every 2 Week Dosage Regimen
AIN457 300 mg was administered in 2 subcutaneous (s.c.) injections of 150 mg each.
39
AIN457C 300 mg Monthly Dosage Regimen (a)
AIN457 300 mg was administered in 2 subcutaneous (s.c.) injections of 150 mg each
40
Placebo to AIN457C
Placebo was administered in 2 s.c. injections
39
Total118

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyAdverse Event420
Overall StudyDeath010
Overall StudyLack of Efficacy014
Overall StudyLost to Follow-up100
Overall StudyProtocol Violation210
Overall StudyWithdrawal by Subject041

Baseline characteristics

CharacteristicTotalAIN457C 300 mg Every 2 Week Dosage RegimenAIN457C 300 mg Monthly Dosage Regimen (a)Placebo to AIN457C
Age, Continuous34.2 Years
STANDARD_DEVIATION 11.09
36.2 Years
STANDARD_DEVIATION 10.96
34.0 Years
STANDARD_DEVIATION 11.86
32.5 Years
STANDARD_DEVIATION 10.34
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants0 Participants0 Participants1 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
115 Participants39 Participants39 Participants37 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
2 Participants0 Participants1 Participants1 Participants
Region of Enrollment
Egypt
5 Participants1 Participants2 Participants2 Participants
Region of Enrollment
France
1 Participants1 Participants0 Participants0 Participants
Region of Enrollment
Germany
3 Participants1 Participants1 Participants1 Participants
Region of Enrollment
Greece
12 Participants3 Participants5 Participants4 Participants
Region of Enrollment
Hong Kong
3 Participants1 Participants1 Participants1 Participants
Region of Enrollment
India
4 Participants1 Participants2 Participants1 Participants
Region of Enrollment
Israel
3 Participants2 Participants0 Participants1 Participants
Region of Enrollment
Italy
7 Participants3 Participants2 Participants2 Participants
Region of Enrollment
Jordan
3 Participants0 Participants2 Participants1 Participants
Region of Enrollment
Korea, Republic Of
10 Participants2 Participants4 Participants4 Participants
Region of Enrollment
Singapore
2 Participants1 Participants0 Participants1 Participants
Region of Enrollment
Spain
2 Participants1 Participants0 Participants1 Participants
Region of Enrollment
Taiwan, Province Of China
1 Participants1 Participants0 Participants0 Participants
Region of Enrollment
Tunisia
5 Participants2 Participants1 Participants2 Participants
Region of Enrollment
Turkey
55 Participants19 Participants18 Participants18 Participants
Region of Enrollment
United States
2 Participants0 Participants2 Participants0 Participants
Sex: Female, Male
Female
38 Participants12 Participants11 Participants15 Participants
Sex: Female, Male
Male
80 Participants27 Participants29 Participants24 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
28 / 3925 / 3922 / 39
serious
Total, serious adverse events
6 / 398 / 395 / 39

Outcome results

Primary

Rate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment

Time frame: Baseline to week 24

Population: Full Analysis Set

ArmMeasureValue (MEAN)Dispersion
AIN457C 300 mg Every 2 Week Dosage RegimenRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment7.7 Ocular ExacerbationsStandard Deviation 22.4
AIN457C 300 mg Monthly Dosage Regimen (a)Rate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment11.5 Ocular ExacerbationsStandard Deviation 28.19
Placebo to AIN457CRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment7.7 Ocular ExacerbationsStandard Deviation 22.35
Primary

Rate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment

Patients number of occurences during a 24 week period.

Time frame: 24 weeks

Population: Full analysis set

ArmMeasureGroupValue (NUMBER)
AIN457C 300 mg Every 2 Week Dosage RegimenRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment3 or more recurrences8 Participants
AIN457C 300 mg Every 2 Week Dosage RegimenRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment2 recurrences8 Participants
AIN457C 300 mg Every 2 Week Dosage RegimenRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment1 recurrence8 Participants
AIN457C 300 mg Every 2 Week Dosage RegimenRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment0 recurrences15 Participants
AIN457C 300 mg Monthly Dosage Regimen (a)Rate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment2 recurrences3 Participants
AIN457C 300 mg Monthly Dosage Regimen (a)Rate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment1 recurrence14 Participants
AIN457C 300 mg Monthly Dosage Regimen (a)Rate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment0 recurrences15 Participants
AIN457C 300 mg Monthly Dosage Regimen (a)Rate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment3 or more recurrences7 Participants
Placebo to AIN457CRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment1 recurrence13 Participants
Placebo to AIN457CRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment0 recurrences11 Participants
Placebo to AIN457CRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment3 or more recurrences10 Participants
Placebo to AIN457CRate of Recurrent Ocular Exacerbations in the Study Eye During 24 Weeks by Treatment2 recurrences5 Participants
Secondary

Change From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)

For each corticosteroid medication, dose of the corticosteroid was first converted to a prednisone-equivalent dose. To determine the prednisone equivalent dose, the corticosteroid dose was multiplied by a conversion factor. . The total prednisone equivalent dose was calculated as the sum of the prednisone equivalent doses of all corticosteroids. Consequently, the total converted prednisone equivalent dose was used to obtain the immunosuppressive score. The key secondary efficacy variable was the change in total post-baseline immunosuppressive medication score from baseline.The score is actually the prednisoone equivalents taken by patient as calculated by conversion table. A reduction in prenisone or prenisone equivalents is a positive outcome. An increase in the number of prednisone equivalents suggests that the treatment is not efficacious or that there is disease progression. A score of 0 would be the lowest ( no steriods taken) and the upper limit is indeterminate.

Time frame: 24 weeks

Population: Full Analysis Set

ArmMeasureGroupValue (MEAN)Dispersion
AIN457C 300 mg Every 2 Week Dosage RegimenChange From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)Week 24 (n=34,32,34)7.441 immunosuppressive medication scoreStandard Deviation 4.4641
AIN457C 300 mg Every 2 Week Dosage RegimenChange From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)Baseline Score (n=39,39,39)7.769 immunosuppressive medication scoreStandard Deviation 4.306
AIN457C 300 mg Every 2 Week Dosage RegimenChange From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)LOCF (n=39,39,39)7.769 immunosuppressive medication scoreStandard Deviation 4.3036
AIN457C 300 mg Monthly Dosage Regimen (a)Change From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)Week 24 (n=34,32,34)10.09 immunosuppressive medication scoreStandard Deviation 5.3331
AIN457C 300 mg Monthly Dosage Regimen (a)Change From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)Baseline Score (n=39,39,39)10.11 immunosuppressive medication scoreStandard Deviation 5.3236
AIN457C 300 mg Monthly Dosage Regimen (a)Change From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)LOCF (n=39,39,39)10.11 immunosuppressive medication scoreStandard Deviation 5.3236
Placebo to AIN457CChange From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)Baseline Score (n=39,39,39)9.231 immunosuppressive medication scoreStandard Deviation 3.8064
Placebo to AIN457CChange From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)LOCF (n=39,39,39)9.231 immunosuppressive medication scoreStandard Deviation 3.8064
Placebo to AIN457CChange From Baseline for Composite Immunosuppressive Medication Score at Week 24 by Treatment (Full Analysis Set)Week 24 (n=34,32,34)8.722 immunosuppressive medication scoreStandard Deviation 3.2027
Secondary

To Determine the Effect of AIN457 on Macular Edema and Visual Acuity in Patients With Posterior Segment Uveitis Secondary to Behçet's Disease as Determined by Optical Coherence Tomography.

Optical coherence tomography (OCT) is amedical imaging technique that uses light to capture micrometer-resolution, three-dimensional images from within optical scattering media (e.g., biological tissue). OCT is based on low-coherence interferometry, typically employing near-infrared light. The use of relatively long wavelength light allows it to penetrate into the scattering medium. OCT is a noninvasive procedure that uses optical interferometry to visualize the structures within the retina. Following dilation of the pupil, a light source operating at 850nm provides probe illumination which is split and detected with and without the refraction of the retinal tissues. Cross-sectional imaging is accomplished in 1.3 second by acquiring a sequence of interferometric A-scans. A false color tomogram of optical reflectivity is produced by the computer. Central foveal thickness will be the primary variable derived from OCT. A increase in thickness could translate to disease progression.

Time frame: baseline, and wk 24 (end of study)

Population: (Full Analysis Set)

ArmMeasureValue (MEAN)Dispersion
AIN457C 300 mg Every 2 Week Dosage RegimenTo Determine the Effect of AIN457 on Macular Edema and Visual Acuity in Patients With Posterior Segment Uveitis Secondary to Behçet's Disease as Determined by Optical Coherence Tomography.-26.5 change from baseline : micrometersStandard Deviation 131.32
AIN457C 300 mg Monthly Dosage Regimen (a)To Determine the Effect of AIN457 on Macular Edema and Visual Acuity in Patients With Posterior Segment Uveitis Secondary to Behçet's Disease as Determined by Optical Coherence Tomography.3.6 change from baseline : micrometersStandard Deviation 75.29
Placebo to AIN457CTo Determine the Effect of AIN457 on Macular Edema and Visual Acuity in Patients With Posterior Segment Uveitis Secondary to Behçet's Disease as Determined by Optical Coherence Tomography.-49.4 change from baseline : micrometersStandard Deviation 174.25
Secondary

To Establish the Impact of AIN457 on Quality of Life of Posterior Segment Uveitis Patients Secondary to Behçet's Disease Refractory to Systemic Immunomodulatory Therapy as Measured by National Eye Institute Visual Function Questionaire-25 and Euroqol.

The VFQ-25 is a reliable and valid 25-item version of the 51-item National Eye Institute Visual Function Questionnaire (NEI-VFQ). It is especially useful in settings such as clinical trials, where interview length is a critical consideration. Scores range from 0 to 100, with higher scores indicating better visual function.

Time frame: screening, and wk 24 (end of study)

Population: Full Analysis Set

ArmMeasureGroupValue (MEAN)Dispersion
AIN457C 300 mg Every 2 Week Dosage RegimenTo Establish the Impact of AIN457 on Quality of Life of Posterior Segment Uveitis Patients Secondary to Behçet's Disease Refractory to Systemic Immunomodulatory Therapy as Measured by National Eye Institute Visual Function Questionaire-25 and Euroqol.Baseline (n= 38,35,39)62.46 ScoreStandard Deviation 21.817
AIN457C 300 mg Every 2 Week Dosage RegimenTo Establish the Impact of AIN457 on Quality of Life of Posterior Segment Uveitis Patients Secondary to Behçet's Disease Refractory to Systemic Immunomodulatory Therapy as Measured by National Eye Institute Visual Function Questionaire-25 and Euroqol.Week 24 (n=38,35,38)66.09 ScoreStandard Deviation 24.295
AIN457C 300 mg Monthly Dosage Regimen (a)To Establish the Impact of AIN457 on Quality of Life of Posterior Segment Uveitis Patients Secondary to Behçet's Disease Refractory to Systemic Immunomodulatory Therapy as Measured by National Eye Institute Visual Function Questionaire-25 and Euroqol.Baseline (n= 38,35,39)64.17 ScoreStandard Deviation 25.549
AIN457C 300 mg Monthly Dosage Regimen (a)To Establish the Impact of AIN457 on Quality of Life of Posterior Segment Uveitis Patients Secondary to Behçet's Disease Refractory to Systemic Immunomodulatory Therapy as Measured by National Eye Institute Visual Function Questionaire-25 and Euroqol.Week 24 (n=38,35,38)73.68 ScoreStandard Deviation 22.634
Placebo to AIN457CTo Establish the Impact of AIN457 on Quality of Life of Posterior Segment Uveitis Patients Secondary to Behçet's Disease Refractory to Systemic Immunomodulatory Therapy as Measured by National Eye Institute Visual Function Questionaire-25 and Euroqol.Baseline (n= 38,35,39)62.11 ScoreStandard Deviation 24.416
Placebo to AIN457CTo Establish the Impact of AIN457 on Quality of Life of Posterior Segment Uveitis Patients Secondary to Behçet's Disease Refractory to Systemic Immunomodulatory Therapy as Measured by National Eye Institute Visual Function Questionaire-25 and Euroqol.Week 24 (n=38,35,38)69.29 ScoreStandard Deviation 21.858
Secondary

To Observe the Effect of AIN457 on the Systemic Non-ocular Manifestations of Behçet's Disease in Patients With Posterior Segment Uveitis Requiring Systemic Immunosuppression as Measured by the Bechet's Disease Current Activity Form.

The BDCAF scores oral and genital ulceration, skin, joint and gastrointestinal involvement, presence of fatigue and headache according to the duration of symptoms. The presence and type of large-vessel and central nervous system (CNS) involvement are documented. Eye activity was deemed present if there was a history of blurring of vision or if the eye was painful or red. . The BDCAF score was calculated by adding the score of each index and ranged between 0 and 12 A reduction in score signifies a lessening of the disease.

Time frame: baseline and wk 24 (end of study)

Population: Full Analysis set

ArmMeasureValue (MEAN)Dispersion
AIN457C 300 mg Every 2 Week Dosage RegimenTo Observe the Effect of AIN457 on the Systemic Non-ocular Manifestations of Behçet's Disease in Patients With Posterior Segment Uveitis Requiring Systemic Immunosuppression as Measured by the Bechet's Disease Current Activity Form.-1.3 change from baseline scoreStandard Deviation 1.81
AIN457C 300 mg Monthly Dosage Regimen (a)To Observe the Effect of AIN457 on the Systemic Non-ocular Manifestations of Behçet's Disease in Patients With Posterior Segment Uveitis Requiring Systemic Immunosuppression as Measured by the Bechet's Disease Current Activity Form.-1.7 change from baseline scoreStandard Deviation 1.49
Placebo to AIN457CTo Observe the Effect of AIN457 on the Systemic Non-ocular Manifestations of Behçet's Disease in Patients With Posterior Segment Uveitis Requiring Systemic Immunosuppression as Measured by the Bechet's Disease Current Activity Form.-1.1 change from baseline scoreStandard Deviation 1.22

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026