Hidradenitis Suppurativa
Conditions
Keywords
acne inversa, Hidradenitis suppurativa (HS), maladie de Verneuil, inflammatory disease, AIN457, AIN457M, Secukinumab, Loss of Response (LOR), Hidradenitis Suppurativa Clinical Response (HiSCR), interleukin-17A (IL-17A)
Brief summary
The purpose of this extension study is to evaluate maintenance of Hidradenitis Suppurativa Clinical Response (HiSCR response) in either continuous or interrupted therapy (using a randomized withdrawal period) of two dose regimens and to assess long-term efficacy, safety and tolerability of Secukinumab in subjects with moderate to severe hidradenitis suppurativa completing either of the 2 Phase III studies. This is an expanded access trial for the core trials CAIN457M2301 (NCT03713619) and CAIN457M2302 (NCT03713619).
Detailed description
This is a multicenter extension study to both core Phase III studies CAIN457M2301 and CAIN457M2302 (Core studies). This study contains a randomized withdrawal design, double blinded and placebo controlled up to Week 104 or loss of response. The subjects with HiSCR response after 52 weeks of treatment in the "Core studies" will be randomized at 2:1 ratio to either continue on one of the two Secukinumab dosing regimens assigned in "Core studies" for another 52 weeks or will be placed on placebo. The primary endpoint is loss of response (LOR) assessed during the 52-week treatment duration (up to Week 104). Subjects who attained LOR will be transferred to open-label treatment to continue until the end of the study. Subjects on placebo who did not reach LOR up to Week 104 will be offered to continue in the open-label treatment or discontinue the study. Thus for subjects who were HiSCR responders at Week 52 of "Core studies", the open label treatment duration will vary and start either from the time of LOR or from Week 104 dose and last until Week 260 followed by 8 weeks of a post treatment follow-up period to week 268. Subjects who were HiSCR non-responders at the end of "Core studies" will be offered to continue in open-label treatment until Week 260. Subjects who prematurely discontinue the study, or who complete the study will enter a post-treatment follow up period (8 weeks) The primary objective is to evaluate maintenance of HiSCR response at Week 104 in either continuous or interrupted therapy compared to placebo. Secondary objectives are to assess the long-term safety and tolerability evaluated by adverse events, abnormal laboratory values and vital signs.
Interventions
secukinumab 300mg every 2 weeks
Sponsors
Study design
Masking description
Patients considered HiSCR responders will be randomized 2:1 to continue their current regimen or undergo withdrawal to placebo. HiScr non-responders will enter open label therapy with Secukinumab if desired
Intervention model description
Multicenter, double-blind, randomized withdrawal extension, parallel group study followed by an open-label, active-treatment period with two Secukinumab dose regimens in approximately 856 patients with moderate to severe hidradenitis suppurativa (HS)
Eligibility
Inclusion criteria
* written informed consent must be obtained before any assessment is performed * subject must have completed the study treatment period (52 weeks) in the core studies (AIN457M2301 or AIN457M2302) and had received secukinumab treatment during Treatment Period 2
Exclusion criteria
* protocol deviation in the core study which will prevent the meaningful analysis of the extension study * ongoing or planned use of prohibited HS or non-HS treatment * participation in the extension could expose the subject to an undue safety risk * current sever progressive or uncontrolled disease which renders the subject unsuitable for the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | Up to 52 weeks: from randomization at the extension study (Week 52) up to Week 104 or loss of response. Study day is defined with respect to the core studies. | Loss of response was defined as: * at least a 50% increase in abscess and/or nodules (AN) count compared to the average AN count from the 3 previous visits or at Week 52, whichever is lower and the increase was at least of 3 AN. * at least a 30% increase in AN compared to the average AN count from the 3 previous visits or Week 52, whichever is lower, with an increase of at least 2 AN and a further increase in the AN count of at least 2 AN at a re-assessment visit within 2-4 weeks |
| Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | Up to 52 weeks: from randomization at the extension study (Week 52) up to Week 104 or loss of response. Study day is defined with respect to the core studies. | The incidence rate of participants achieving Loss of Response (LOR) was based on the primary estimand. * Day 1 = Date of 1st dose intake in the extension study. * Subjects at risk = Subjects who did not have LOR and were not censored before or at the start of the specified time interval. * Incidence rate (%) = (number of subjects with LOR / number of subjects at risk) x 100. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Treatment Emergent Adverse Events | Up to 216 weeks: from randomization at the extension study (Week 52) up to Week 268. Study day is defined with respect to the core studies. | To assess the long-term safety and tolerability of Secukinumab in subjects with moderate to severe hidradenitis suppurativa (HS) |
Countries
Argentina, Australia, Austria, Belgium, Bulgaria, Canada, Colombia, Croatia, Czechia, France, Germany, Greece, Guatemala, Hungary, India, Israel, Italy, Japan, Lebanon, Lithuania, Malaysia, Mexico, Netherlands, Philippines, Poland, Portugal, Russia, Singapore, Slovakia, South Africa, South Korea, Spain, Switzerland, Taiwan, Turkey (Türkiye), United Kingdom, United States, Vietnam
Contacts
Novartis Pharmaceuticals
Participant flow
Recruitment details
This study is conducted in 191 centers in 38 countries worldwide
Participants by arm
| Arm | Count |
|---|---|
| AIN457 Q2WR-Q2W HiSCR responders at Week 52 who were on Secukinumab every 2 weeks (Q2W) in the core studies and were randomized to Secukinumab Q2W in the Randomized Withdrawal Period (Week 52 to Week 104 or loss of response) in the extension. After loss of response (LOR) or Week 104, patients could continue with open-label Secukinumab 300 mg Q2W | 136 |
| AIN457 Q2WR-PBO HiSCR responders at Week 52 who were on Secukinumab every 2 weeks (Q2W) in the core studies and were randomized to placebo in the Randomized Withdrawal Period (Week 52 to Week 104 or loss of response) in the extension. After loss of response (LOR) or Week 104, patients could continue with open-label Secukinumab 300 mg Q2W | 71 |
| AIN457 Q4WR-Q4W HiSCR responders at Week 52 who were on Secukinumab every 4 weeks (Q4W) in the core studies and were randomized to Secukinumab Q4W in the Randomized Withdrawal Period (Week 52 to Week 104 or loss of response) in the extension. After loss of response (LOR), patients could continue with open-label Secukinumab 300 mg Q2W. After Week 104, if no LOR, patients could continue with open-label Secukinumab 300 mg Q4W or be up titrated to Q2W at principal investigator discretion. | 121 |
| AIN457 Q4WR-PBO HiSCR responders at Week 52 who were on Secukinumab every 4 weeks (Q4W) in the core studies and were randomized to placebo in the Randomized Withdrawal (Week 52 to Week 104 or loss of response) in the extension. After loss of response (LOR) or Week 104, patients could continue with open-label Secukinumab 300 mg Q4W or Q2W at principal investigator discretion | 63 |
| AIN457 Q2WNR-Q2W HiSCR non-responders at Week 52 who were on secukinumab every 2 weeks (Q2W) in the core studies and stay on Q2W in the extension | 151 |
| AIN457 Q4WNR-Q2W HiSCR non-responders at Week 52 who were on secukinumab every 4 weeks (Q4W) in the core studies and are up-titrated to Q2W in the extension | 157 |
| Total | 699 |
Baseline characteristics
| Characteristic | AIN457 Q2WR-Q2W | AIN457 Q2WR-PBO | AIN457 Q4WR-Q4W | AIN457 Q4WR-PBO | AIN457 Q2WNR-Q2W | AIN457 Q4WNR-Q2W | Total |
|---|---|---|---|---|---|---|---|
| Age, Continuous | 35.7 Years STANDARD_DEVIATION 11.26 | 34.8 Years STANDARD_DEVIATION 10.55 | 35.4 Years STANDARD_DEVIATION 12.59 | 36.0 Years STANDARD_DEVIATION 11.32 | 37.3 Years STANDARD_DEVIATION 11 | 37.1 Years STANDARD_DEVIATION 11.13 | 36.1 Years STANDARD_DEVIATION 11.31 |
| Race/Ethnicity, Customized American Indian or Alaska Native | 2 Participants | 2 Participants | 5 Participants | 2 Participants | 3 Participants | 3 Participants | 17 Participants |
| Race/Ethnicity, Customized Asian | 12 Participants | 11 Participants | 13 Participants | 6 Participants | 24 Participants | 28 Participants | 94 Participants |
| Race/Ethnicity, Customized Black or African American | 8 Participants | 6 Participants | 11 Participants | 7 Participants | 6 Participants | 14 Participants | 52 Participants |
| Race/Ethnicity, Customized Multiple | 1 Participants | 1 Participants | 2 Participants | 0 Participants | 2 Participants | 1 Participants | 7 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 113 Participants | 51 Participants | 90 Participants | 48 Participants | 115 Participants | 111 Participants | 528 Participants |
| Sex: Female, Male Female | 73 Participants | 38 Participants | 64 Participants | 28 Participants | 91 Participants | 78 Participants | 372 Participants |
| Sex: Female, Male Male | 63 Participants | 33 Participants | 57 Participants | 35 Participants | 60 Participants | 79 Participants | 327 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk |
|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 137 | 0 / 70 | 0 / 121 | 0 / 63 | 0 / 180 | 0 / 637 | 0 / 687 | 0 / 307 |
| other Total, other adverse events | 44 / 137 | 23 / 70 | 46 / 121 | 16 / 63 | 71 / 180 | 379 / 637 | 428 / 687 | 199 / 307 |
| serious Total, serious adverse events | 2 / 137 | 4 / 70 | 5 / 121 | 5 / 63 | 11 / 180 | 72 / 637 | 80 / 687 | 37 / 307 |
Outcome results
Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders
The incidence rate of participants achieving Loss of Response (LOR) was based on the primary estimand. * Day 1 = Date of 1st dose intake in the extension study. * Subjects at risk = Subjects who did not have LOR and were not censored before or at the start of the specified time interval. * Incidence rate (%) = (number of subjects with LOR / number of subjects at risk) x 100.
Time frame: Up to 52 weeks: from randomization at the extension study (Week 52) up to Week 104 or loss of response. Study day is defined with respect to the core studies.
Population: Full Analysis Set of HiSCR responders (FAS-R) with an available value for the outcome measure.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| AIN457 Q2WR-Q2W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 2 to 85 days | 26.9 Percentage of participants |
| AIN457 Q2WR-Q2W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 86 to 141 days | 12.4 Percentage of participants |
| AIN457 Q2WR-Q2W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 254 to 309 days | 10.4 Percentage of participants |
| AIN457 Q2WR-Q2W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 310 to 351 days | 3.3 Percentage of participants |
| AIN457 Q2WR-Q2W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 198 to 253 days | 8.1 Percentage of participants |
| AIN457 Q2WR-Q2W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 142 to 197 days | 8.4 Percentage of participants |
| AIN457 Q2WR-Q2W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 352 to 399 days | 5.4 Percentage of participants |
| AIN457 Q2WR-Q2W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | Day 1 | 0.0 Percentage of participants |
| AIN457 Q2WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 352 to 399 days | 0.0 Percentage of participants |
| AIN457 Q2WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 198 to 253 days | 8.1 Percentage of participants |
| AIN457 Q2WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 254 to 309 days | 18.2 Percentage of participants |
| AIN457 Q2WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 2 to 85 days | 23.9 Percentage of participants |
| AIN457 Q2WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | Day 1 | 0.0 Percentage of participants |
| AIN457 Q2WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 86 to 141 days | 21.2 Percentage of participants |
| AIN457 Q2WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 310 to 351 days | 0.0 Percentage of participants |
| AIN457 Q2WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 142 to 197 days | 9.8 Percentage of participants |
| AIN457 Q4WR-Q4W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 254 to 309 days | 6.5 Percentage of participants |
| AIN457 Q4WR-Q4W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 352 to 399 days | 5.4 Percentage of participants |
| AIN457 Q4WR-Q4W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 2 to 85 days | 24.2 Percentage of participants |
| AIN457 Q4WR-Q4W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 310 to 351 days | 1.8 Percentage of participants |
| AIN457 Q4WR-Q4W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 86 to 141 days | 12.4 Percentage of participants |
| AIN457 Q4WR-Q4W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | Day 1 | 0.0 Percentage of participants |
| AIN457 Q4WR-Q4W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 142 to 197 days | 6.6 Percentage of participants |
| AIN457 Q4WR-Q4W | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 198 to 253 days | 10.1 Percentage of participants |
| AIN457 Q4WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 310 to 351 days | 4.2 Percentage of participants |
| AIN457 Q4WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | Day 1 | 0.0 Percentage of participants |
| AIN457 Q4WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 2 to 85 days | 30.2 Percentage of participants |
| AIN457 Q4WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 86 to 141 days | 25.6 Percentage of participants |
| AIN457 Q4WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 142 to 197 days | 9.4 Percentage of participants |
| AIN457 Q4WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 198 to 253 days | 13.8 Percentage of participants |
| AIN457 Q4WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 254 to 309 days | 4.0 Percentage of participants |
| AIN457 Q4WR-PBO | Incidence Rate of Participants Achieving Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 352 to 399 days | 9.1 Percentage of participants |
Time to Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders
Loss of response was defined as: * at least a 50% increase in abscess and/or nodules (AN) count compared to the average AN count from the 3 previous visits or at Week 52, whichever is lower and the increase was at least of 3 AN. * at least a 30% increase in AN compared to the average AN count from the 3 previous visits or Week 52, whichever is lower, with an increase of at least 2 AN and a further increase in the AN count of at least 2 AN at a re-assessment visit within 2-4 weeks
Time frame: Up to 52 weeks: from randomization at the extension study (Week 52) up to Week 104 or loss of response. Study day is defined with respect to the core studies.
Population: Full Analysis Set of HiSCR responders (FAS-R)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| AIN457 Q2WR-Q2W | Time to Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 283 Days |
| AIN457 Q2WR-PBO | Time to Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 239 Days |
| AIN457 Q4WR-Q4W | Time to Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 365 Days |
| AIN457 Q4WR-PBO | Time to Loss of Response (LOR) up to Week 104 in Hidradenitis Suppurativa Clinical Response (HiSCR) Responders | 171 Days |
Number of Participants With Treatment Emergent Adverse Events
To assess the long-term safety and tolerability of Secukinumab in subjects with moderate to severe hidradenitis suppurativa (HS)
Time frame: Up to 216 weeks: from randomization at the extension study (Week 52) up to Week 268. Study day is defined with respect to the core studies.