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GSK1550188 A 52 Week Study of Belimumab Versus Placebo in the Treatment of Subjects With Systemic Lupus Erythematosus (SLE) Located in Northeast Asia

GSK1550188 A 52 Week Study of Belimumab Versus Placebo in the Treatment of Subjects With Systemic Lupus Erythematosus (SLE) Located in Northeast Asia

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01345253
Enrollment
709
Registered
2011-05-02
Start date
2011-05-23
Completion date
2018-09-21
Last updated
2019-10-04

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

Conditions

Systemic Lupus Erythematosus

Keywords

SLEDAI, Asia, placebo, BLys, PGA, BILAG, systemic lupus erythematosus, SELENA, Lupus, SRI, efficacy, B cell, SLE Flare Index, belimumab, safety, phase III, B lymphocyte

Brief summary

The purpose of this study is to evaluate the efficacy and safety of belimumab in addition to standard therapy compared to placebo in subjects in Northeast Asia with systemic lupus erythematosus (SLE) over a 52 week period.

Detailed description

The purpose of this study is to demonstrate the efficacy and safety of belimumab 10mg/kg administered intravenously (IV) every 4 weeks compared to placebo, in patients with SLE when added to standard of care therapy, as measured by the SLE Responder Index (SRI) at 52 weeks, defined by a composite endpoint using SELENA SLEDAI score, Physician's Global Assessment (PGA) and BILAG A and B organ domain scores.

Interventions

DRUGBelimumab

10mg/kg administered intravenously. Dosing at Weeks 0, 2, and 4, then every 4 weeks through Week 48, with a final evaluation at Week 52. All study subjects will receive standard SLE therapies during the study.

DRUGPlacebo

Administered intravenously. Dosing at Weeks 0, 2, and 4, and then every 4 weeks through Week 48, with a final evaluation at Week 52. All study subjects will receive standard SLE therapies during the study.

Sponsors

Human Genome Sciences Inc.
CollaboratorINDUSTRY
GlaxoSmithKline
Lead SponsorINDUSTRY

Study design

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

Eligibility

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

Inclusion criteria

* Age 18 years and older. * Have a clinical diagnosis of SLE according to the American College of Rheumatology (ACR) classification criteria. * Have active SLE disease. * Have positive anti-nuclear antibody (ANA) test results. * Are on a stable SLE treatment regimen. * Females of childbearing age are willing to use appropriate contraception

Exclusion criteria

* Have received treatment with any B cell targeted therapy at any time. * Have received a biologic investigational agent in the past year. * Have received 3 or more courses of systemic corticosteroids in the past year. * Have received intravenous (IV) cyclophosphamide within 180 days prior to Day 0. * Have severe lupus kidney disease. * Have active central nervous system (CNS) lupus. * Have had a major organ transplant. * Have significant unstable or uncontrolled acute or chronic diseases or conditions not due to SLE. * Have a planned surgical procedure. * Cancer within the last 5 years, except for adequately treated skin cancer, or carcinoma in situ of the uterine cervix. * Have required management of acute or chronic infections in the past 60 days. * Have current drug or alcohol abuse or dependence. * Have a historically positive test, or test positive at screening for HIV, Hepatitis B, or Hepatitis C. * Have an IgA deficiency. * Have severe laboratory Abnormalities. * Have had anaphylactic reaction to X-ray contrast agents or biologic agents. * Suicidal behavior or ideation.

Design outcomes

Primary

MeasureTime frameDescription
Percent of Participants Achieving Systemic Lupus Erythematosus (SLE) Responder Index (SRI) Response Rate at Week 52 for Double-blind Phase.Week 52SRI response is a composite index, defined as the percent of participants with \>=4 point reduction from Baseline in safety of estrogen in lupus national assessment (SELENA) systemic lupus erythematosus disease activity index (SLEDAI) score and no worsening (increase of \< 0.30 points from Baseline) in physicians global assessment (PGA) and no new British isles lupus assessment group (BILAG) A organ domain score or 2 new BILAG B organ domain scores compared with Baseline at the time of assessment (at Week 52 of the blinded period). A SELENA SLEDAI score of 0 would suggest no lupus activity; while a score of 105 is the maximum calculable if all items were scored as being present from active lupus. PGA ranges from 0 (no activity) to 3 (severe activity). BILAG has no range. The higher thresholds of SELENA SLEDAI improvement (i.e., SRI5, SRI6, and SRI7) indicates a higher response (SRI5 is a 5 point SELENA SLEDAI reduction, SRI6 is a 6 point reduction, and SRI7 is a 7 point reduction).

Secondary

MeasureTime frameDescription
Percent of Participants With >=4 Point Reduction From Baseline in SELENA SLEDAI Score at Week 52 for Double-blind Phase.Baseline (Day 0) and Week 52The SELENA SLEDAI score is a weighted index for assessing SLE disease activity in which signs and symptoms, laboratory tests and physician's assessment for each of 9 organ system were given a weighted score and summed if present at the time of the visit or in the preceding 10 days. A SELENA SLEDAI score of 0 would suggest no lupus activity; while a score of 105 is the maximum calculable if all items were scored as being present from active lupus. A decrease of 4 points or more equates to a clinically meaningful improvement. The Baseline value of a variable is defined as the value of the variable measured at Day 0 prior to dosing. In case of multiple results on Day 0 prior to dosing, the latest result was used. If a Day 0 value was not available, the last available value prior to Day 0 was used.
Percent of Participants With SRI7 Response at Week 52 for Double-blind Phase.Baseline (Day 0) and Week 52SRI7 response is defined as the percent of participants with \>=7 point reduction from Baseline in SELENA SLEDAI score and no worsening (increase of \< 0.30 points from Baseline) in PGA and no new BILAG A organ domain score or 2 new BILAG B organ domain scores compared with Baseline at the time of assessment (at Week 52 of the blinded period). A SELENA SLEDAI score of 0 would suggest no lupus activity; while a score of 105 is the maximum calculable if all items were scored as being present from active lupus. PGA ranges from 0 (no activity) to 3 (severe activity). BILAG has no range. The higher thresholds of SELENA SLEDAI improvement (i.e., SRI5, SRI6, and SRI7) indicates a higher response (SRI5 is a 5 point SELENA SLEDAI reduction, SRI6 is a 6 point reduction, and SRI7 is a 7 point reduction).
Number of Days of Daily Prednisone Dose <=7.5 mg/Day and/or Reduced by 50 Percent From Baseline Over 52 Weeks for Double-blind Phase.Week 52Number of days of daily prednisone dose \<=7.5 mg/day and/or reduced by 50 percent over time through each scheduled visit during the blinded period were compared between belimumab and placebo using Rank ANCOVA model which was used for comparing belimumab and placebo. The independent variables in the model included treatment group, Baseline prednisone dose level, country, Baseline SELENA SLEDAI score (\<=9 vs. \>=10) and complement levels (low C3 and/or C4 vs. no low C3 or C4). This analysis was perfomed on the participants who used prednisone \>7.5 mg/day at Baseline.
Time to First Severe SLE Flare Index (SFI) Flare Over 52 Weeks for Double-blind Phase.52 weeksTime to first severe SLE flare is defined as the number of days from first treatment until the participant had an event (event date-treatement start date +1). If a participant had a severe SFI flare and received protocol restricted medication then the event date was the earliest of the first severe SFI flare date, and the treatment failure date. Analysis of severe SFI flare was performed on the modified SELENA SLEDAI SLE flare index in which the modification excluded severe flares that were triggered only by an increase in SELENA SLEDAI score to \>12. Analysis was from Cox proportional hazards model for the comparison between belimumab and placebo adjusting for country, Baseline SELENA SLEDAI score (\<=9 vs. \>=10) and complement levels (low C3 and/or C4 vs. no low C3 or C4).
Percent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeeks 24 and 48 for Years 2, 3, 4, 5 and 6SRI response is a composite index, defined as the percent of participants with \>=4 point reduction from Baseline in SELENA SLEDAI score and no worsening (increase of \< 0.30 points from Baseline) in PGA and no new BILAG A organ domain score or 2 new BILAG B organ domain scores compared with Baseline at time of assessment. Excludes participants with a SELENA SLEDAI score \<4 at baseline. Participants randomized to belimumab in double-blinded (DB) phase, Baseline is last available value before first belimumab dose received in DB phase. Participants randomized to placebo in DB phase, Baseline is last available value before receiving first belimumab dose in OL phase. Observed case data are presented.Year 6 Week 48 is the Exit Visit obtained by slotting the Exit Visit to Week 48. A SELENA SLEDAI score of 0 (no lupus activity) and a score of 105 (maximum). PGA ranges from 0 (no activity) to 3 (severe activity). BILAG has no range.

Countries

China, Japan, South Korea

Participant flow

Recruitment details

This study consisted of a 52 week blinded treatment period in Northeast Asia (China, Japan, Korea) which was followed by an optional open-label (OL) extension period in China for evaluation of belimumab in participants (par.) with active systemic lupus erythematosus (SLE).

Pre-assignment details

A total of 707 par. were randomized, 705 received at least 1 dose of investigational product (Safety Population), 677 par. were included in the primary efficacy population (MITT Population) of which 663 were evaluable for the primary endpoint. The participant flow and baseline characteristics are presented for MITT Population (Pop).

Participants by arm

ArmCount
Placebo
Participants received placebo intravenously (IV) on Day 0, Day 14, Day 28 and then every 28 days until Week 48 of the double-blind period. All China participants who completed double-blind period and eligible to enter open-label phase received belimumab 10 milligrams (mg)/kilogram (kg) up to Year 5 Week 28.
226
Belimumab 10 mg/kg
Participants received belimumab 10 mg/kg IV on Day 0, Day 14, Day 28 and then every 28 days until Week 48 of the double-blind period. All China participants who completed double-blind period and eligible to enter open-label phase received belimumab 10 mg/kg up to Year 5 Week 28.
451
Total677

Withdrawals & dropouts

PeriodReasonFG000FG001
Double-blind (DB) Phase (52 Weeks)Adverse Event2227
Double-blind (DB) Phase (52 Weeks)Lack of Efficacy117
Double-blind (DB) Phase (52 Weeks)Lost to Follow-up38
Double-blind (DB) Phase (52 Weeks)Met Protocol Defined Stopping Criteria61
Double-blind (DB) Phase (52 Weeks)Physician Decision412
Double-blind (DB) Phase (52 Weeks)Protocol Violation15
Double-blind (DB) Phase (52 Weeks)Withdrawal by Subject919
Open-label Phase (Up to Year 5 Week 44)Adverse Event718
Open-label Phase (Up to Year 5 Week 44)Death01
Open-label Phase (Up to Year 5 Week 44)Lack of Efficacy37
Open-label Phase (Up to Year 5 Week 44)Lost to Follow-up46
Open-label Phase (Up to Year 5 Week 44)Not Recorded11
Open-label Phase (Up to Year 5 Week 44)Physician Decision1124
Open-label Phase (Up to Year 5 Week 44)Protocol Violation25
Open-label Phase (Up to Year 5 Week 44)Withdrawal by Subject3782

Baseline characteristics

CharacteristicBelimumab 10 mg/kgTotalPlacebo
Age, Continuous32.3 Years
STANDARD_DEVIATION 9.65
32.1 Years
STANDARD_DEVIATION 9.5
31.7 Years
STANDARD_DEVIATION 9.18
Race/Ethnicity, Customized
Asian - Central/South Asian Heritage
4 Participants6 Participants2 Participants
Race/Ethnicity, Customized
Asian - East Asian Heritage
403 Participants598 Participants195 Participants
Race/Ethnicity, Customized
Asian - Japanese Heritage
40 Participants64 Participants24 Participants
Race/Ethnicity, Customized
Asian - Mixed Race
1 Participants2 Participants1 Participants
Race/Ethnicity, Customized
Asian - South East Asian Heritage
3 Participants7 Participants4 Participants
Sex: Female, Male
Female
419 Participants629 Participants210 Participants
Sex: Female, Male
Male
32 Participants48 Participants16 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
1 / 2350 / 4701 / 424
other
Total, other adverse events
108 / 235207 / 470263 / 424
serious
Total, serious adverse events
43 / 23558 / 47096 / 424

Outcome results

Primary

Percent of Participants Achieving Systemic Lupus Erythematosus (SLE) Responder Index (SRI) Response Rate at Week 52 for Double-blind Phase.

SRI response is a composite index, defined as the percent of participants with \>=4 point reduction from Baseline in safety of estrogen in lupus national assessment (SELENA) systemic lupus erythematosus disease activity index (SLEDAI) score and no worsening (increase of \< 0.30 points from Baseline) in physicians global assessment (PGA) and no new British isles lupus assessment group (BILAG) A organ domain score or 2 new BILAG B organ domain scores compared with Baseline at the time of assessment (at Week 52 of the blinded period). A SELENA SLEDAI score of 0 would suggest no lupus activity; while a score of 105 is the maximum calculable if all items were scored as being present from active lupus. PGA ranges from 0 (no activity) to 3 (severe activity). BILAG has no range. The higher thresholds of SELENA SLEDAI improvement (i.e., SRI5, SRI6, and SRI7) indicates a higher response (SRI5 is a 5 point SELENA SLEDAI reduction, SRI6 is a 6 point reduction, and SRI7 is a 7 point reduction).

Time frame: Week 52

Population: Modified Intention-to-Treat (MITT) Population: all participants who were randomized and treated with at least one dose of study treatment, with exclusion of participants from the site 086485.

ArmMeasureValue (NUMBER)
PlaceboPercent of Participants Achieving Systemic Lupus Erythematosus (SLE) Responder Index (SRI) Response Rate at Week 52 for Double-blind Phase.40.1 Percentage of participants
Belimumab 10 mg/kgPercent of Participants Achieving Systemic Lupus Erythematosus (SLE) Responder Index (SRI) Response Rate at Week 52 for Double-blind Phase.53.8 Percentage of participants
p-value: 0.000195% CI: [1.4, 2.82]Regression, Logistic
Secondary

Number of Days of Daily Prednisone Dose <=7.5 mg/Day and/or Reduced by 50 Percent From Baseline Over 52 Weeks for Double-blind Phase.

Number of days of daily prednisone dose \<=7.5 mg/day and/or reduced by 50 percent over time through each scheduled visit during the blinded period were compared between belimumab and placebo using Rank ANCOVA model which was used for comparing belimumab and placebo. The independent variables in the model included treatment group, Baseline prednisone dose level, country, Baseline SELENA SLEDAI score (\<=9 vs. \>=10) and complement levels (low C3 and/or C4 vs. no low C3 or C4). This analysis was perfomed on the participants who used prednisone \>7.5 mg/day at Baseline.

Time frame: Week 52

Population: MITT Population

ArmMeasureValue (MEDIAN)
PlaceboNumber of Days of Daily Prednisone Dose <=7.5 mg/Day and/or Reduced by 50 Percent From Baseline Over 52 Weeks for Double-blind Phase.0.0 Days
Belimumab 10 mg/kgNumber of Days of Daily Prednisone Dose <=7.5 mg/Day and/or Reduced by 50 Percent From Baseline Over 52 Weeks for Double-blind Phase.0.0 Days
p-value: 0.0288Rank ANCOVA
Secondary

Percent of Participants Achieving SLE SRI Response Rate for Open-label (OL) Phase

SRI response is a composite index, defined as the percent of participants with \>=4 point reduction from Baseline in SELENA SLEDAI score and no worsening (increase of \< 0.30 points from Baseline) in PGA and no new BILAG A organ domain score or 2 new BILAG B organ domain scores compared with Baseline at time of assessment. Excludes participants with a SELENA SLEDAI score \<4 at baseline. Participants randomized to belimumab in double-blinded (DB) phase, Baseline is last available value before first belimumab dose received in DB phase. Participants randomized to placebo in DB phase, Baseline is last available value before receiving first belimumab dose in OL phase. Observed case data are presented.Year 6 Week 48 is the Exit Visit obtained by slotting the Exit Visit to Week 48. A SELENA SLEDAI score of 0 (no lupus activity) and a score of 105 (maximum). PGA ranges from 0 (no activity) to 3 (severe activity). BILAG has no range.

Time frame: Weeks 24 and 48 for Years 2, 3, 4, 5 and 6

Population: Efficacy Population: all participants in China who received at least 1 dose of belimumab during open-label phase, exclusive of site 086485. Only those participants available at the specified time points were analyzed (represented by n=x).

ArmMeasureGroupValue (NUMBER)
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 24, Year 2, n=32666.0 Percentage of participants
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 48, Year 2, n=29969.6 Percentage of participants
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 24, Year 3, n=27172.3 Percentage of participants
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 48, Year 3, n=24770.9 Percentage of participants
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 24, Year 4, n=23371.7 Percentage of participants
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 48, Year 4, n=19476.8 Percentage of participants
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 24, Year 5, n= 15681.4 Percentage of participants
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 48, Year 5, n= 8280.5 Percentage of participants
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 24, Year 6, n= 3686.1 Percentage of participants
PlaceboPercent of Participants Achieving SLE SRI Response Rate for Open-label (OL) PhaseWeek 48, Year 6, n= 560.0 Percentage of participants
Secondary

Percent of Participants With >=4 Point Reduction From Baseline in SELENA SLEDAI Score at Week 52 for Double-blind Phase.

The SELENA SLEDAI score is a weighted index for assessing SLE disease activity in which signs and symptoms, laboratory tests and physician's assessment for each of 9 organ system were given a weighted score and summed if present at the time of the visit or in the preceding 10 days. A SELENA SLEDAI score of 0 would suggest no lupus activity; while a score of 105 is the maximum calculable if all items were scored as being present from active lupus. A decrease of 4 points or more equates to a clinically meaningful improvement. The Baseline value of a variable is defined as the value of the variable measured at Day 0 prior to dosing. In case of multiple results on Day 0 prior to dosing, the latest result was used. If a Day 0 value was not available, the last available value prior to Day 0 was used.

Time frame: Baseline (Day 0) and Week 52

Population: MITT Population. Only those participants available at the specified time points were analyzed.

ArmMeasureValue (NUMBER)
PlaceboPercent of Participants With >=4 Point Reduction From Baseline in SELENA SLEDAI Score at Week 52 for Double-blind Phase.42.2 Percentage of participants
Belimumab 10 mg/kgPercent of Participants With >=4 Point Reduction From Baseline in SELENA SLEDAI Score at Week 52 for Double-blind Phase.55.7 Percentage of participants
p-value: 0.000195% CI: [1.41, 2.83]Regression, Logistic
Secondary

Percent of Participants With SRI7 Response at Week 52 for Double-blind Phase.

SRI7 response is defined as the percent of participants with \>=7 point reduction from Baseline in SELENA SLEDAI score and no worsening (increase of \< 0.30 points from Baseline) in PGA and no new BILAG A organ domain score or 2 new BILAG B organ domain scores compared with Baseline at the time of assessment (at Week 52 of the blinded period). A SELENA SLEDAI score of 0 would suggest no lupus activity; while a score of 105 is the maximum calculable if all items were scored as being present from active lupus. PGA ranges from 0 (no activity) to 3 (severe activity). BILAG has no range. The higher thresholds of SELENA SLEDAI improvement (i.e., SRI5, SRI6, and SRI7) indicates a higher response (SRI5 is a 5 point SELENA SLEDAI reduction, SRI6 is a 6 point reduction, and SRI7 is a 7 point reduction).

Time frame: Baseline (Day 0) and Week 52

Population: MITT Population. Only those participants available at the specified time point were analyzed.

ArmMeasureValue (NUMBER)
PlaceboPercent of Participants With SRI7 Response at Week 52 for Double-blind Phase.23.5 Percentage of participants
Belimumab 10 mg/kgPercent of Participants With SRI7 Response at Week 52 for Double-blind Phase.32.4 Percentage of participants
p-value: 0.011695% CI: [1.13, 2.74]Regression, Logistic
Secondary

Time to First Severe SLE Flare Index (SFI) Flare Over 52 Weeks for Double-blind Phase.

Time to first severe SLE flare is defined as the number of days from first treatment until the participant had an event (event date-treatement start date +1). If a participant had a severe SFI flare and received protocol restricted medication then the event date was the earliest of the first severe SFI flare date, and the treatment failure date. Analysis of severe SFI flare was performed on the modified SELENA SLEDAI SLE flare index in which the modification excluded severe flares that were triggered only by an increase in SELENA SLEDAI score to \>12. Analysis was from Cox proportional hazards model for the comparison between belimumab and placebo adjusting for country, Baseline SELENA SLEDAI score (\<=9 vs. \>=10) and complement levels (low C3 and/or C4 vs. no low C3 or C4).

Time frame: 52 weeks

Population: MITT Population

ArmMeasureValue (MEDIAN)
PlaceboTime to First Severe SLE Flare Index (SFI) Flare Over 52 Weeks for Double-blind Phase.NA Days
Belimumab 10 mg/kgTime to First Severe SLE Flare Index (SFI) Flare Over 52 Weeks for Double-blind Phase.NA Days
p-value: 0.000495% CI: [0.34, 0.73]Regression, Cox

Source: ClinicalTrials.gov · Data processed: Jul 5, 2026