Uveitis
Conditions
Brief summary
Primary Objective: To evaluate the efficacy of sarilumab at Week 16 in participants with non-infectious uveitis (NIU). Secondary Objectives: To evaluate the change in best corrected visual acuity (BCVA). To evaluate the safety of subcutaneous sarilumab in participants with NIU. To evaluate the change in macular edema. To evaluate the change in other signs of ocular inflammation. To evaluate the effect on retinal vessel leakage. To evaluate the effect of sarilumab on reducing concomitant immunosuppressant therapy. To evaluate the change in ocular inflammation in the anterior chamber. To evaluate the pharmacokinetics of sarilumab in NIU participants. To evaluate the immunogenicity with anti-drug antibodies (ADA).
Detailed description
The total duration per participant was up to 58 weeks, which included a 2 week screening period, 16 weeks principal treatment period (Part A), 34 weeks extension treatment period (Part B) or open label treatment period (Part C), and 6 weeks after last treatment administration. Participants with decrease in vitreous haze (VH) ≥2; or corticosteroids dose \<10 mg/day at Week 16 were considered as responders. Participants who did not complete the principal treatment period (Part A) due to lack of efficacy; or no decrease in VH ≥2 and corticosteroids dose ≥10 mg/day at Week 16; or no decrease in VH ≥2 and corticosteroids dose missing at Week 16; or non-responder according to medical review, were considered as non-responders. Responder participants, observed at Week 16 (at the end of Part A), were invited to continue in the extension treatment period (Part B). Non-responder participants, observed within the first 16 weeks, were offered to be treated by open-label sarilumab (Part C).
Interventions
Pharmaceutical form: Prefilled syringes; Route of administration: Subcutaneous
Pharmaceutical form: Tablet or Capsule; Route of administration: Oral
Pharmaceutical form: Tablet or Capsule or Suspension; Route of administration: Orally or intravenously or intramuscular
Pharmaceutical form: Tablet or Capsule; Route of administration: Oral
Pharmaceutical form: Prefilled syringes; Route of administration: Subcutaneous
Sponsors
Study design
Eligibility
Inclusion criteria
* ≥18 years of age. * Non-infectious intermediate, posterior, or pan-uveitis in the study eye. * Active disease at screening or evidence of activity within the 3 months prior to screening visit. Following the approval of amendment-2, only participants with active disease as defined above were enrolled in the study. * Starting oral prednisone dose must be greater than or equal to 15 mg/day and less than 80 mg/day. * At screening, participants must be receiving oral prednisone (≥15 mg and \<80 mg/day \[or equivalent oral corticosteroid\]) as single immunosuppressive therapy or in combination with MTX (≤25 mg/week) orally or intravenously or intramuscular or subcutaneous). - * Participants could be receiving one or several of the following therapies: Azathioprine (≤2.5 mg/kg/day), Mycophenolate mofetil (≤2 g daily, orally), Cyclosporine (≤4 mg/kg daily, orally), Tacrolimus (≤4 mg daily, orally). * The doses might not had been increased for at least 4 weeks prior to the randomization visit. * At randomization, participants had been receiving oral prednisone (≥15 mg and \<80 mg/day \[or equivalent oral corticosteroid\]) as single immunosuppressive therapy or in combination with MTX (≤25 mg/week) orally or intravenously or intramuscular or subcutaneous). * Azathioprine, mycophenolate mofetil, cyclosporine and tacrolimus had to be permanently discontinued at least 48 hours prior to the first study treatment injection, or longer as per Investigator's judgment. These immunomodulatory therapies (IMTs) were not permitted anytime during the treatment period. * Signed written informed consent.
Exclusion criteria
* Participants with best-corrected visual acuity (BCVA) worse than 20 early treatment diabetic retinopathy study (ETDRS) letters in at least one eye. * Participants with confirmed or suspected uveitis of infectious etiology or uveitis of traumatic etiology. * Participants with primary diagnosis of anterior uveitis. * Prior treatment with anti-interleukin-6 (IL-6) or interleukin-6 receptor complex (IL-6R) antagonist therapies, including tocilizumab and sarilumab. The above information is not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With at Least 2-step Reduction in Vitreous Haze (VH) or Prednisone Dose <10 mg/Day at Week 16 | Week 16 | At least 2-step reduction in VH per central review from baseline was evaluated on Miami 9-step scale. VH is the obscuration of fundus by vitreous cells and protein exudation. Each of the 9-step scale (from grade 0 \[low opacity\] to 8 \[more opacity\]) images (in increasing order of opacity) are equivalent to approximately 0.3 log units of degradation in visual acuity based on the Bangerter calibration. Participants with prednisone dose \<10 mg/day (or equivalent oral corticosteroid) were also evaluated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Anterior Chamber (AC) Cell Score = 0 or At Least 2-step Reduction in Score at Week 16 | Week 16 | Participants with AC cell score = 0 or with ≥2 step reduction from baseline at Week 16 were evaluated. Slit lamp examinations were conducted at each visit to assess AC cell count. The number of AC cells observed within a 1 mm × 1 mm slit beam was used to determine the grade according to the Standardization of Uveitis Nomenclature (SUN) criteria: grade 0 = no cells; grade +0.5 = 1 - 5 cells; grade +1 = 6 - 25 cells; grade +2= 26 - 50 cells; grade +3 = too many to count. |
| Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Week 16 | Baseline to Week 16 | BCVA score is based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters, and then at 1 meter. The range of ETDRS is 0 to 100 letters. The lower the number of letters read correctly on the eye chart, the worse the vision (or visual acuity). An increase in the number of letters read correctly means that vision has improved. LS mean was calculated using MMRM model with treatment groups, randomization strata of VH level (\<4, \>=4), visits and visit-by-treatment groups interaction as fixed categorical effects, as well as, fixed continuous covariate of baseline BCVA. |
| Change From Baseline in Central Retinal Thickness (CRT) At Week 16 | Baseline to Week 16 | CRT was measured by spectral domain optical coherence tomography (SD-OCT), a non-invasive diagnostic system providing high-resolution imaging sections of the retina. All images were transmitted to the central reading center. SD-OCT was performed in the study eye after pupil dilation. LS mean was calculated using MMRM model with treatment groups, randomization strata of VH level (\<4, \>=4), visits and visit-by-treatment groups interaction as fixed categorical effects, as well as, fixed continuous covariate of baseline CRT. |
| Percent Change From Baseline in CRT at Week 16 | Baseline to Week 16 | CRT was measured by SD-OCT, a non-invasive diagnostic system providing high-resolution imaging sections of the retina. All images were transmitted to the central reading center. SD-OCT was performed in the study eye after pupil dilation. LS mean was calculated using MMRM model with treatment groups, randomization strata of VH level (\<4, \>=4), visits and visit-by-treatment groups interaction as fixed categorical effects, as well as, fixed continuous covariate of baseline CRT. |
| Change From Baseline in VH Scale at Week 16 | Baseline to Week 16 | Change from baseline in VH scale was evaluated on Miami 9-step scale. VH is the obscuration of fundus by vitreous cells and protein exudation. Each of the 9-step scale (from grade 0 \[low opacity\] to 8 \[more opacity\]) images (in increasing order of opacity) were equivalent to approximately 0.3 log units of degradation in visual acuity based on the Bangerter calibration. Least squares (LS) mean was calculated using mixed model for repeated measurements (MMRM) model with treatment groups, visits and visit-by-treatment groups interaction as fixed categorical effects as well as fixed continuous covariate of baseline adjudicated VH. |
| Percentage of Participants Without Retinal Vessel Leakage on Fluorescein Angiography (FA) at Week 16 | Week 16 | — |
| Percentage of Participants With Prednisone Dose of ≤5 mg/Day (or Equivalent Oral Corticosteroid) at Week 16 | Week 16 | Participants with prednisone dose ≤5 mg/day (or equivalent oral corticosteroid) at Week 16 were evaluated. |
| Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | Predose on Day 1 (Baseline), Week 2, 4, 8, 12, 16, 24, 36, 52, and end of study (EOS) (Week 56) | Serum functional (unbound) sarilumab concentrations were determined using an enzyme-linked immunosorbent assay (ELISA) method with a lower limit of quantification (LLOQ) of 294 ng/mL. Concentrations below LLOQ were set to zero for samples at predose. Post-treatment concentrations below LLOQ were replaced by LLOQ/2. The samples were considered non-eligible for the analysis if the previous dosing time was \<11 days or \>17 days before the sampling time for every other week regimens. |
| Percentage of Participants With CRT Thickness <300 Microns at Week 16 | Week 16 | — |
Countries
Czechia, France, Italy, Spain, Turkey (Türkiye), United States
Participant flow
Recruitment details
The study was conducted at 18 centers in 6 countries. A total of 82 participants were screened between 30 October 2013 and 17 March 2015 of whom 58 participants were randomized and 24 were screen failures. Screen failures were mainly due to exclusion criteria met.
Pre-assignment details
Participants were randomized in 2:1 ratio (Sarilumab:Placebo) and treated for 16 weeks during principal treatment period (Part A), 30 responders treated up to Week 50 with same dose during extension treatment period (Part B) while 10 non-responders and 11 participants (not completed Part A) treated with open label treatment up to Week 50 (Part C).
Participants by arm
| Arm | Count |
|---|---|
| Placebo Placebo (for Sarilumab) SC injection q2w for 16 weeks during principal treatment period (Part A) with background therapy of Prednisone (or equivalent oral corticosteroid) ≥15 mg/day and \<80 mg/day as single therapy or in combination with MTX 10 to 25 mg/week and folic acid per local prescribing practice. Responders continued with the same treatment regimen up to Week 50 during extension treatment period (Part B) and non-responders were proposed to be treated with open-label Sarilumab 200 mg q2w in open-label treatment period (Part-C). | 20 |
| Sarilumab 200 mg q2w Sarilumab 200 mg SC injection q2w for 16 weeks during principal treatment period (Part A) with background therapy of Prednisone (or equivalent oral corticosteroid) ≥15 mg/day and \<80 mg/day as single therapy or in combination with MTX 10 to 25 mg/week and folic acid per local prescribing practice. Responders continued with the same treatment regimen up to Week 50 during extension treatment period (Part B) and non-responders were proposed to be treated with open-label Sarilumab 200 mg q2w in open-label treatment period (Part-C). | 38 |
| Total | 58 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Extended Treatment Period (Part B) | Adverse Event | 0 | 2 | 0 |
| Extended Treatment Period (Part B) | Lack of Efficacy | 1 | 7 | 0 |
| Extended Treatment Period (Part B) | Other than specified above | 0 | 1 | 0 |
| Open-Label Treatment Period (Part C) | Adverse Event | 0 | 0 | 2 |
| Open-Label Treatment Period (Part C) | Lack of Efficacy | 0 | 0 | 3 |
| Open-Label Treatment Period (Part C) | Withdrawal by Subject | 0 | 0 | 3 |
| Principal Treatment Period (Part A) | Adverse Event | 1 | 3 | 0 |
| Principal Treatment Period (Part A) | Lack of Efficacy | 6 | 6 | 0 |
| Principal Treatment Period (Part A) | Other than specified above | 0 | 1 | 0 |
Baseline characteristics
| Characteristic | Placebo | Sarilumab 200 mg q2w | Total |
|---|---|---|---|
| Age, Continuous | 41.5 years STANDARD_DEVIATION 13 | 39.3 years STANDARD_DEVIATION 15.3 | 40.0 years STANDARD_DEVIATION 14.5 |
| Sex: Female, Male Female | 13 Participants | 23 Participants | 36 Participants |
| Sex: Female, Male Male | 7 Participants | 15 Participants | 22 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 13 / 20 | 25 / 38 | 15 / 21 |
| serious Total, serious adverse events | 2 / 20 | 5 / 38 | 0 / 21 |
Outcome results
Percentage of Participants With at Least 2-step Reduction in Vitreous Haze (VH) or Prednisone Dose <10 mg/Day at Week 16
At least 2-step reduction in VH per central review from baseline was evaluated on Miami 9-step scale. VH is the obscuration of fundus by vitreous cells and protein exudation. Each of the 9-step scale (from grade 0 \[low opacity\] to 8 \[more opacity\]) images (in increasing order of opacity) are equivalent to approximately 0.3 log units of degradation in visual acuity based on the Bangerter calibration. Participants with prednisone dose \<10 mg/day (or equivalent oral corticosteroid) were also evaluated.
Time frame: Week 16
Population: Modified intent-to-treat population (mITT) included all randomized participants who received at least 1 injection analyzed according to the group to which the participant was allocated by the randomization schedule. Modified multiple imputation approach was used on VH missing adjudicated scores.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo (Part A) | Percentage of Participants With at Least 2-step Reduction in Vitreous Haze (VH) or Prednisone Dose <10 mg/Day at Week 16 | 30.0 Percentage of participants |
| Sarilumab 200 mg q2w (Part A) | Percentage of Participants With at Least 2-step Reduction in Vitreous Haze (VH) or Prednisone Dose <10 mg/Day at Week 16 | 46.1 Percentage of participants |
Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Week 16
BCVA score is based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters, and then at 1 meter. The range of ETDRS is 0 to 100 letters. The lower the number of letters read correctly on the eye chart, the worse the vision (or visual acuity). An increase in the number of letters read correctly means that vision has improved. LS mean was calculated using MMRM model with treatment groups, randomization strata of VH level (\<4, \>=4), visits and visit-by-treatment groups interaction as fixed categorical effects, as well as, fixed continuous covariate of baseline BCVA.
Time frame: Baseline to Week 16
Population: Analysis was performed on mITT population. Number of participants analyzed = participants with BCVA score assessment at baseline and post-baseline visits.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo (Part A) | Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Week 16 | 3.5 units on a scale | Standard Error 1.84 |
| Sarilumab 200 mg q2w (Part A) | Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Week 16 | 9.3 units on a scale | Standard Error 1.36 |
Change From Baseline in Central Retinal Thickness (CRT) At Week 16
CRT was measured by spectral domain optical coherence tomography (SD-OCT), a non-invasive diagnostic system providing high-resolution imaging sections of the retina. All images were transmitted to the central reading center. SD-OCT was performed in the study eye after pupil dilation. LS mean was calculated using MMRM model with treatment groups, randomization strata of VH level (\<4, \>=4), visits and visit-by-treatment groups interaction as fixed categorical effects, as well as, fixed continuous covariate of baseline CRT.
Time frame: Baseline to Week 16
Population: Analysis was performed on mITT population. Number of participants analyzed = participants with CRT assessment at baseline and post-baseline visits.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo (Part A) | Change From Baseline in Central Retinal Thickness (CRT) At Week 16 | -8.9 µm (microns) | Standard Error 11.46 |
| Sarilumab 200 mg q2w (Part A) | Change From Baseline in Central Retinal Thickness (CRT) At Week 16 | -35.4 µm (microns) | Standard Error 8.36 |
Change From Baseline in VH Scale at Week 16
Change from baseline in VH scale was evaluated on Miami 9-step scale. VH is the obscuration of fundus by vitreous cells and protein exudation. Each of the 9-step scale (from grade 0 \[low opacity\] to 8 \[more opacity\]) images (in increasing order of opacity) were equivalent to approximately 0.3 log units of degradation in visual acuity based on the Bangerter calibration. Least squares (LS) mean was calculated using mixed model for repeated measurements (MMRM) model with treatment groups, visits and visit-by-treatment groups interaction as fixed categorical effects as well as fixed continuous covariate of baseline adjudicated VH.
Time frame: Baseline to Week 16
Population: Analysis was performed on mITT population. Number of participants analyzed = participants with VH assessment at baseline and post-baseline visits.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo (Part A) | Change From Baseline in VH Scale at Week 16 | -0.1 units on a scale | Standard Error 0.23 |
| Sarilumab 200 mg q2w (Part A) | Change From Baseline in VH Scale at Week 16 | -0.9 units on a scale | Standard Error 0.16 |
Percentage of Participants With Anterior Chamber (AC) Cell Score = 0 or At Least 2-step Reduction in Score at Week 16
Participants with AC cell score = 0 or with ≥2 step reduction from baseline at Week 16 were evaluated. Slit lamp examinations were conducted at each visit to assess AC cell count. The number of AC cells observed within a 1 mm × 1 mm slit beam was used to determine the grade according to the Standardization of Uveitis Nomenclature (SUN) criteria: grade 0 = no cells; grade +0.5 = 1 - 5 cells; grade +1 = 6 - 25 cells; grade +2= 26 - 50 cells; grade +3 = too many to count.
Time frame: Week 16
Population: Analysis was performed on mITT population. Number of participants analyzed = participants with non-missing AC cell score at Week 16.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo (Part A) | Percentage of Participants With Anterior Chamber (AC) Cell Score = 0 or At Least 2-step Reduction in Score at Week 16 | 86.7 Percentage of participants |
| Sarilumab 200 mg q2w (Part A) | Percentage of Participants With Anterior Chamber (AC) Cell Score = 0 or At Least 2-step Reduction in Score at Week 16 | 86.2 Percentage of participants |
Percentage of Participants With CRT Thickness <300 Microns at Week 16
Time frame: Week 16
Population: This endpoint was replaced by the percent change from baseline in CRT at Week 16 as this is more clinically relevant. Zero participant was analyzed.
Percentage of Participants Without Retinal Vessel Leakage on Fluorescein Angiography (FA) at Week 16
Time frame: Week 16
Population: Analysis of this endpoint was not performed as no retinal vessel leakage data was collected at Week 16. Zero participants were analyzed.
Percentage of Participants With Prednisone Dose of ≤5 mg/Day (or Equivalent Oral Corticosteroid) at Week 16
Participants with prednisone dose ≤5 mg/day (or equivalent oral corticosteroid) at Week 16 were evaluated.
Time frame: Week 16
Population: Analysis was performed on mITT population. Number of participants analyzed = participants with non-missing data for prednisone (or equivalent oral corticosteroid) dose at Week 16.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo (Part A) | Percentage of Participants With Prednisone Dose of ≤5 mg/Day (or Equivalent Oral Corticosteroid) at Week 16 | 40.0 Percentage of participants |
| Sarilumab 200 mg q2w (Part A) | Percentage of Participants With Prednisone Dose of ≤5 mg/Day (or Equivalent Oral Corticosteroid) at Week 16 | 41.4 Percentage of participants |
Percent Change From Baseline in CRT at Week 16
CRT was measured by SD-OCT, a non-invasive diagnostic system providing high-resolution imaging sections of the retina. All images were transmitted to the central reading center. SD-OCT was performed in the study eye after pupil dilation. LS mean was calculated using MMRM model with treatment groups, randomization strata of VH level (\<4, \>=4), visits and visit-by-treatment groups interaction as fixed categorical effects, as well as, fixed continuous covariate of baseline CRT.
Time frame: Baseline to Week 16
Population: Analysis was performed on mITT population. Number of participants analyzed = participants with CRT assessment at baseline and post-baseline visits.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo (Part A) | Percent Change From Baseline in CRT at Week 16 | 0.0 percent change | Standard Error 2.9 |
| Sarilumab 200 mg q2w (Part A) | Percent Change From Baseline in CRT at Week 16 | -6.4 percent change | Standard Error 2.15 |
Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration
Serum functional (unbound) sarilumab concentrations were determined using an enzyme-linked immunosorbent assay (ELISA) method with a lower limit of quantification (LLOQ) of 294 ng/mL. Concentrations below LLOQ were set to zero for samples at predose. Post-treatment concentrations below LLOQ were replaced by LLOQ/2. The samples were considered non-eligible for the analysis if the previous dosing time was \<11 days or \>17 days before the sampling time for every other week regimens.
Time frame: Predose on Day 1 (Baseline), Week 2, 4, 8, 12, 16, 24, 36, 52, and end of study (EOS) (Week 56)
Population: PK population: all participants who received at least one dose or part of a dose of investigational medicinal product (IMP) with at least one post-dose, non-missing serum concentration value and were analyzed according to treatment actually received. Data of this endpoint was planned to be analyzed for Sarilumab 200 mg q2w arm in Part A and B only.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | At Baseline | 0.0 ng/mL | Standard Deviation 0 |
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | At Week 2 | 7383.3 ng/mL | Standard Deviation 6547.1 |
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | At Week 4 | 9876.6 ng/mL | Standard Deviation 8262.9 |
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | At Week 8 | 15958.9 ng/mL | Standard Deviation 12813.1 |
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | At Week 12 | 19705.2 ng/mL | Standard Deviation 15480.9 |
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | At Week 16 | 19598.4 ng/mL | Standard Deviation 17280.8 |
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | At Week 24 | 22406.8 ng/mL | Standard Deviation 14584.2 |
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | At Week 36 | 24375.4 ng/mL | Standard Deviation 19121.7 |
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | At Week 52 | 25046.0 ng/mL | Standard Deviation 17870.7 |
| Placebo (Part A) | Pharmacokinetics (PK) Assessment: Serum Functional Sarilumab Concentration | EOS (Week 56) | 1730.0 ng/mL | — |