A Phase 3 interventional study of Suptavumab 30 mg/kg and Placebo Matched to Suptavumab in Respiratory Syncytial Virus Infections, sponsored by Regeneron Pharmaceuticals. Completed at 205 sites in 19 countries. Open to participants aged Up to 6 Months, including healthy volunteers. Per ClinicalTrials.gov, last updated 2018-11-06.
Sponsored by Regeneron Pharmaceuticals · Phase 3, Interventional, and Treatment
The purpose of this study was to evaluate the efficacy, safety, pharmacokinetics (PK), and immunogenicity of suptavumab (REGN2222) in infants born no more than 35 weeks, 6 days gestational age who are no more than 6 months of age at the time of enrollment in their respective geographic location. In order to optimize the potential benefit in this vulnerable population, we conducted this study during the RSV season using dosing regimens that are expected to be effective.
This study occurred in two parts: Part A and Part B.
Part A of the study was an open-label, PK evaluation of intramuscular (IM) administered suptavumab in preterm infants for whom palivizumab was not recommended to enable the selection of dosing regimens for Part B.
Part B of the study was randomized, double-blind, and placebo-controlled, designed to evaluate efficacy, safety, serum concentration and immunogenicity of IM administration of suptavumab in preterm infants for whom palivizumab was not recommended. The total duration of Part B was up to 265 days (includes a 28-day screening period, 57-day treatment period and 180-day follow-up period).
Up to 1515 subjects were planned to be included in Part B of the study. Participants were randomly assigned to 1 of 3 different groups, each with 505 infants; one group received one dose of suptavumab and one dose of placebo, the second group received two doses of suptavumab, and the third group received two doses of placebo.
There was a separate genetic testing sub study.
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Key Inclusion Criteria:
Key Exclusion Criteria:
Note: Other inclusion and exclusion criteria apply
Drug: Suptavumab 30 mg/kg
Drug: Placebo Matched to Suptavumab
Drug: Suptavumab 30 mg/kg- 1 Dose
Drug: Suptavumab 30 mg/kg - 2 Doses
Participants received single dose of suptavumab 30 milligram per kilogram (mg/kg) intramuscularly (IM) on Day 1.
Also known as: REGN2222
Participants received 2 IM doses of placebo matched to suptavumab: the first dose on Day 1 and the second dose on Day 57.
Participants received single dose of suptavumab 30 mg/kg IM on Day 1 and single dose of placebo matched to suptavumab on Day 57.
Participants received 2 doses of suptavumab 30 mg/kg IM: the first dose on Day 1 and the second dose on Day 57.
Part A: Serum Concentration of Suptavumab Over Time
Part A was primarily designed to determine the pharmacokinetics (PK) of suptavumab in infants to inform the dose regimen used in Part B of the study. The study protocol specified the process and criteria for assessment of the dose. The dose used in Part B was to remain the same as Part A if the PK data up to Day 57 demonstrated that the individual PK observations were consistent with model-predicted concentrations, following age and body weight corrections.
Time frame: Day 1 through Day 150
Part B: Percentage of Participants With Medically Attended Respiratory Syncytial Virus (RSV) Infection (Hospitalization or Outpatient Visit With Lower Respiratory Tract Infection [LRTI]) Up to Day 150
A medically attended RSV infection defined as an infant with positive RSV test by Reverse-transcriptase polymerase chain reaction (RT-PCR) with any of following events: Hospitalized (on basis of assessment of admitting physician) for RSV infection or outpatient visit (emergency room \[ER\], urgent care \[UC\], or pediatric clinic visits \[for either a sick or well visit\]) with RSV lower respiratory tract infection (LRTI). An RSV LRTI in an infant: RSV proven respiratory infection (i.e positive RSV RT-PCR test) with parent(s)/guardian(s) report of cough/difficulty breathing, \& with 1 of following signs of LRTI, as assessed by healthcare provider: - lower chest wall in drawing -hypoxemia (peripheral capillary oxygen saturation \<95% breathing room air) - Wheezing/crackles. The 150-day efficacy assessment period: first study drug intake through the Day 150 visit.
Time frame: From first study drug administration up to Day 150
Part A: Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs)
Any untoward medical occurrence in participants, who received investigational medicinal product (IMP) was considered an adverse event (AE) without regard to possibility of causal relationship with this treatment. TEAEs: AEs that developed/worsened/became serious during on-treatment period (defined as time between the date of first study drug administration \& date of end of study/last visit).Serious AE: Any untoward medical occurrence that resulted in any of following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent/significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. Any TEAE included participants with both serious \& non-serious AEs. National Cancer Institute Common Terminology Criteria (NCI-CTCAE) version 4.03(Grade 3 \[severe\] \& Grade 4\[life-threatening\]) was used in this study to grade clinical AEs.
Time frame: Baseline through Day 150
Part B: Serum Concentration of Suptavumab
Serum samples for drug concentration will be collected at pre-specified time points
Time frame: Day 29, 57, 85, 113 and Day 150 Post-dose
Part B: Number of Participants With At Least One Positive Anti-Drug Antibody (ADA) Assay
ADA category of each participant was classified as pre-existing immunoreactivity (a positive ADA response at baseline with a \<4-fold increase in titer for all post baseline samples), treatment-boosted (a positive response at baseline with at least one post baseline titer at \>=4-fold the baseline titer), or treatment-emergent (TE \[any positive post baseline assay response when baseline results were negative or missing\]). TE ADA responses were further classified as persistent (treatment-emergent positive ADA response detected in at least 2 consecutive post baseline samples separated by at least a 12-week post baseline period \[based on nominal sampling time\], with no ADA-negative samples in-between, regardless of any missing samples or a positive response at the last ADA sampling time point), indeterminate (a positive assay response at the last collection time point only, regardless of any missing samples), or transient (not persistent/indeterminate, regardless of any missing samples).
Time frame: Day 1 through Day 150
Part B: Percentage of Participants Hospitalized With Medically Attended RSV Infection or Outpatient Visit Lower Respiratory Tract Infection (LRTI) or Upper Respiratory Tract Infection (URTI) Up to Day 150
A medically attended RSV infection was defined as an infant with a positive RSV test by RT-PCR with any of the following events: -Hospitalized (on the basis of the assessment of the admitting physician) for RSV infection - or Outpatient visit (ER, UC), or pediatric clinic visits \[for either a sick or well visit\]) with RSV LRTI. An RSV LRTI in an infant: RSV-proven respiratory infection (i.e, positive RSV RT-PCR test) with parent(s)/guardian(s) report of cough or difficulty breathing, and with 1 of the following signs of LRTI, as assessed by a healthcare provider: -Lower chest wall indrawing -Hypoxemia (peripheral capillary oxygen saturation \<95% breathing room air) -Wheezing or crackles. The 150-day efficacy assessment period:first study drug intake through the Day 150 visit.
Time frame: From the first study drug administration up to Day 150
The study was conducted in 2 parts between 21-Jul-2015 and 26-Sep-2017. Part A of study was conducted at 6 sites in 3 countries and Part B was conducted at 175 sites in 18 countries. Only Part B of the study was conducted in Europe. A total of 23 participants were enrolled in Part A and a total of 1,154 participants were randomized in Part B.
| Milestone | Part A: Suptavumab 30 mg/kg | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses |
|---|---|---|---|---|
| Started | 23 | 383 | 385 | 381 |
| Completed | 23 | 358 | 360 | 355 |
| Not completed | 0 | 25 | 25 | 26 |
| Withdrew: Adverse event | 0 | 1 | 1 | 0 |
| Withdrew: Death | 0 | 3 | 0 | 1 |
| Withdrew: Lost to follow-up | 0 | 15 | 14 | 9 |
| Withdrew: Physician decision | 0 | 1 | 1 | 0 |
| Withdrew: Protocol violation | 0 | 0 | 1 | 0 |
| Withdrew: Withdrawal by subject | 0 | 5 | 8 | 16 |
Part A was primarily designed to determine the pharmacokinetics (PK) of suptavumab in infants to inform the dose regimen used in Part B of the study. The study protocol specified the process and criteria for assessment of the dose. The dose used in Part B was to remain the same as Part A if the PK data up to Day 57 demonstrated that the individual PK observations were consistent with model-predicted concentrations, following age and body weight corrections.
| mg/L | Part A: Suptavumab 30 mg/kg - 1 Dose |
|---|---|
| Day 2 | 280 ± 92.9 |
| Day 8 | 177 ± 40.2 |
| Day 15 | 145 ± 28.7 |
| Day 22 | 128 ± 3.21 |
| Day 29 | 110 ± 10.3 |
| Day 57 | 70.9 ± 7.62 |
| Day 85 | 60.4 ± 14.0 |
| Day 150 | 15.9 ± 7.88 |
A medically attended RSV infection defined as an infant with positive RSV test by Reverse-transcriptase polymerase chain reaction (RT-PCR) with any of following events: Hospitalized (on basis of assessment of admitting physician) for RSV infection or outpatient visit (emergency room \[ER\], urgent care \[UC\], or pediatric clinic visits \[for either a sick or well visit\]) with RSV lower respiratory tract infection (LRTI). An RSV LRTI in an infant: RSV proven respiratory infection (i.e positive RSV RT-PCR test) with parent(s)/guardian(s) report of cough/difficulty breathing, \& with 1 of following signs of LRTI, as assessed by healthcare provider: - lower chest wall in drawing -hypoxemia (peripheral capillary oxygen saturation \<95% breathing room air) - Wheezing/crackles. The 150-day efficacy assessment period: first study drug intake through the Day 150 visit.
| Percentage of participants | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses |
|---|---|---|---|
| Part B: Percentage of Participants With Medically Attended Respiratory Syncytial Virus (RSV) Infection (Hospitalization or Outpatient Visit With Lower Respiratory Tract Infection [LRTI]) Up to Day 150 | 8.1 | 7.7 | 9.3 |
Any untoward medical occurrence in participants, who received investigational medicinal product (IMP) was considered an adverse event (AE) without regard to possibility of causal relationship with this treatment. TEAEs: AEs that developed/worsened/became serious during on-treatment period (defined as time between the date of first study drug administration \& date of end of study/last visit).Serious AE: Any untoward medical occurrence that resulted in any of following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent/significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. Any TEAE included participants with both serious \& non-serious AEs. National Cancer Institute Common Terminology Criteria (NCI-CTCAE) version 4.03(Grade 3 \[severe\] \& Grade 4\[life-threatening\]) was used in this study to grade clinical AEs.
| Percentage of participants | Part A: Suptavumab 30 mg/kg |
|---|---|
| Any TEAE | 69.6 |
| Any Grade 3/Serious TEAE | 4.3 |
Serum samples for drug concentration will be collected at pre-specified time points
| Milligram per liter (mg/L) | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses |
|---|---|---|
| Day 29 | 142 ± 45.5 | 145 ± 43.4 |
| Day 57 | 95.6 ± 44.2 | 93.5 ± 29.8 |
| Day 85 | 70.1 ± 29.0 | 238 ± 52.9 |
| Day 113 | 38.1 ± 20.1 | 149 ± 54.0 |
| Day 150 | 18.7 ± 9.89 | 70.6 ± 26.4 |
ADA category of each participant was classified as pre-existing immunoreactivity (a positive ADA response at baseline with a \<4-fold increase in titer for all post baseline samples), treatment-boosted (a positive response at baseline with at least one post baseline titer at \>=4-fold the baseline titer), or treatment-emergent (TE \[any positive post baseline assay response when baseline results were negative or missing\]). TE ADA responses were further classified as persistent (treatment-emergent positive ADA response detected in at least 2 consecutive post baseline samples separated by at least a 12-week post baseline period \[based on nominal sampling time\], with no ADA-negative samples in-between, regardless of any missing samples or a positive response at the last ADA sampling time point), indeterminate (a positive assay response at the last collection time point only, regardless of any missing samples), or transient (not persistent/indeterminate, regardless of any missing samples).
| Participants | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses |
|---|---|---|---|
| Negative/Pre-Existing | 351 | 380 | 336 |
| Treatment Boosted | 0 | 0 | 0 |
| Treatment-Emergent | 12 | 9 | 0 |
| Treatment-Emergent: Persistent | 0 | 0 | 0 |
| Treatment-Emergent: Transient | 1 | 0 | 0 |
| Treatment-Emergent: Indeterminate | 11 | 9 | 0 |
A medically attended RSV infection was defined as an infant with a positive RSV test by RT-PCR with any of the following events: -Hospitalized (on the basis of the assessment of the admitting physician) for RSV infection - or Outpatient visit (ER, UC), or pediatric clinic visits \[for either a sick or well visit\]) with RSV LRTI. An RSV LRTI in an infant: RSV-proven respiratory infection (i.e, positive RSV RT-PCR test) with parent(s)/guardian(s) report of cough or difficulty breathing, and with 1 of the following signs of LRTI, as assessed by a healthcare provider: -Lower chest wall indrawing -Hypoxemia (peripheral capillary oxygen saturation \<95% breathing room air) -Wheezing or crackles. The 150-day efficacy assessment period:first study drug intake through the Day 150 visit.
| Percentage of participants | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses |
|---|---|---|---|
| Part B: Percentage of Participants Hospitalized With Medically Attended RSV Infection or Outpatient Visit Lower Respiratory Tract Infection (LRTI) or Upper Respiratory Tract Infection (URTI) Up to Day 150 | 12.5 | 11.9 | 14.5 |
Collected over All Adverse Events (AEs) were collected from signature of the informed consent form up to the final visit (Part A: Day 150 and Part B: Day 237) regardless of seriousness or relationship to investigational product.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Part A: Suptavumab 30 mg/kg | 0/23 (0%) | 0/23 (0%) | 13/23 (56.5%) |
| Part B: Placebo Matched to Suptavumab | 3/384 (0.8%) | 44/384 (11.5%) | 218/384 (56.8%) |
| Part B: Suptavumab 30 mg/kg- 1 Dose | 1/418 (0.2%) | 54/418 (12.9%) | 219/418 (52.4%) |
| Part B: Suptavumab 30 mg/kg - 2 Doses | 0/348 (0%) | 29/348 (8.3%) | 198/348 (56.9%) |
| Event | Part A: Suptavumab 30 mg/kg | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses |
|---|---|---|---|---|
| Respiratory syncytial virus bronchiolitisInfections and infestations | 0/23 | 5/384 | 13/418 | 2/348 |
| BronchiolitisInfections and infestations | 0/23 | 9/384 | 10/418 | 7/348 |
| Respiratory syncytial virus infectionInfections and infestations | 0/23 | 1/384 | 5/418 | 1/348 |
| BronchitisInfections and infestations | 0/23 | 4/384 | 2/418 | 0/348 |
| Inguinal herniaGastrointestinal disorders | 0/23 | 1/384 | 1/418 | 3/348 |
| PyrexiaGeneral disorders | 0/23 | 0/384 | 3/418 | 0/348 |
| CyanosisCardiac disorders | 0/23 | 2/384 | 0/418 | 0/348 |
| DiarrhoeaGastrointestinal disorders | 0/23 | 2/384 | 0/418 | 0/348 |
| Pneumonia respiratory syncytial viralInfections and infestations | 0/23 | 2/384 | 2/418 | 1/348 |
| ApnoeaRespiratory, thoracic and mediastinal disorders | 0/23 | 2/384 | 2/418 | 1/348 |
| Event | Part A: Suptavumab 30 mg/kg | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses |
|---|---|---|---|---|
| Upper respiratory tract infectionInfections and infestations | 3/23 | 74/384 | 92/418 | 75/348 |
| NasopharyngitisInfections and infestations | 0/23 | 53/384 | 30/418 | 35/348 |
| Viral upper respiratory tract infectionInfections and infestations | 3/23 | 20/384 | 19/418 | 21/348 |
| Otitis mediaInfections and infestations | 0/23 | 29/384 | 49/418 | 26/348 |
| AnaemiaBlood and lymphatic system disorders | 2/23 | 13/384 | 16/418 | 11/348 |
| BronchiolitisInfections and infestations | 2/23 | 16/384 | 19/418 | 27/348 |
| Blood alkaline phosphatase increasedInvestigations | 2/23 | 0/384 | 1/418 | 1/348 |
| EczemaSkin and subcutaneous tissue disorders | 2/23 | 12/384 | 8/418 | 8/348 |
| Gastrooesophageal reflux diseaseGastrointestinal disorders | 1/23 | 31/384 | 25/418 | 24/348 |
| PyrexiaGeneral disorders | 0/23 | 31/384 | 32/418 | 22/348 |
| Age, Customized(Participants) | Part A: Suptavumab 30 mg/kg | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses | Total |
|---|---|---|---|---|---|
| <=31 weeks 6 days | 5 | 62 | 59 | 59 | 185 |
| >=32 weeks & <=35 weeks 6 days | 18 | 321 | 326 | 322 | 987 |
| Sex: Female, Male(Participants) | Part A: Suptavumab 30 mg/kg | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses | Total |
|---|---|---|---|---|---|
| Female | 9 | 186 | 172 | 179 | 546 |
| Male | 14 | 197 | 213 | 202 | 626 |
| Ethnicity (NIH/OMB)(Participants) | Part A: Suptavumab 30 mg/kg | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses | Total |
|---|---|---|---|---|---|
| Hispanic or Latino | 3 | 80 | 81 | 75 | 239 |
| Not Hispanic or Latino | 20 | 297 | 300 | 302 | 919 |
| Unknown or Not Reported | 0 | 6 | 4 | 4 | 14 |
| Race/Ethnicity, Customized(Participants) | Part A: Suptavumab 30 mg/kg | Part B: Placebo Matched to Suptavumab | Part B: Suptavumab 30 mg/kg- 1 Dose | Part B: Suptavumab 30 mg/kg - 2 Doses | Total |
|---|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 2 | 0 | 2 |
| Asian | 0 | 2 | 3 | 3 | 8 |
| Native Hawaiian or Other Pacific Islander | 2 | 0 | 0 | 2 | 4 |
| Black or African American | 0 | 32 | 34 | 35 | 101 |
| White | 19 | 338 | 334 | 326 | 1017 |
| Other | 2 | 7 | 9 | 11 | 29 |
| Unknown or Not Reported | 0 | 4 | 3 | 4 | 11 |
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