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JOURNAL ONKOLOGIE – STUDIE

A Study of Nipocalimab Administered to Adults With Generalized Myasthenia Gravis

Rekrutierend

NCT-Nummer:
NCT04951622

Studienbeginn:
Juli 2021

Letztes Update:
24.04.2024

Wirkstoff:
Nipocalimab, Placebo

Indikation (Clinical Trials):
Myasthenia Gravis, Muscle Weakness

Geschlecht:
Alle

Altersgruppe:
Erwachsene (18+)

Phase:
Phase 3

Sponsor:
Janssen Research & Development, LLC

Collaborator:
-

Studienleiter

Janssen Research & Development, LLC Clinical Trial
Study Director
Janssen Research & Development, LLC

Kontakt

Studienlocations
(3 von 111)

NeuroCure Clinical Research Center
10117 Berlin
(Berlin)
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Universitatsmedizin Gottingen
37075 Göttingen
(Niedersachsen)
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Universitaetsklinikum Leipzig
04103 Leipzig
(Sachsen)
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Universitatsklinikum Schleswig Holstein Campus Lubeck
23538 Lübeck
(Schleswig-Holstein)
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Universitatsklinikum Ulm
89081 Ulm
(Baden-Württemberg)
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DKD HELIOS Klinik Wiesbaden, Fachbereich Neurologie
65191 Wiesbaden
(Hessen)
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Neuromuscular Research Center and Clinic
85028 Paradise Valley
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HonorHealth Neurology
85251 Scottsdale
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University of Southern California
90033 Los Angeles
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Stanford University
94304 Palo Alto
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University of Colorado Anschutz Medical Campus
80045 Aurora
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Yale New Haven Hospital
06519 New Haven
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FM Clinical Research, LLC South Florida Neurology Associates, P. A.
33487 Boca Raton
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University of Florida Health Jacksonville
32209 Jacksonville
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Medsol Clinical Research Center Inc
33952 Port Charlotte
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University of South Florida
33612 Tampa
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Augusta University
30912-3125 Augusta
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University of Kansas Medical Center
66160 Kansas City
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St. Elizabeth Medical Center
02135 Boston
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Lahey Hospital & Medical Center
01805 Burlington
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Washington University School of Medicine
63110 Saint Louis
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Duke University School of Medicine
27710 Durham
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University of Cincinnati
45219 Cincinnati
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The Ohio State University
43210 Columbus
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Medical University of South Carolina
29425 Charleston
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UT Southwestern Medical Center
75390 Dallas
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University of Vermont
05401 Burlington
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Melbourne Neurology Group
3051 North Melbourne
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Gold Coast University Hospital
4215 Southport
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AZ Sint-Jan Brugge-Oostende AV
8000 Brugge
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Cliniques Universitaires Saint Luc
1200 Brussels
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The Ottawa Hospital Research Institute
K1Y 4E9 Ottawa
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Beijing Tiantan Hospital, Capital Medical University
100050 Beijing
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Xuanwu Hospital ,Capital Medical University
100053 Beijing
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The First Bethune Hospital of Jilin University
130021 Changchun
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Central South University Xiangya Hospital The First Affiliated Hospital of Hunan Medical College
410008 Changsha
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West China Hospital of Sichuan University
610041 Chengdu
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Fujian Medical University Union Hospital
350001 Fuzhou
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The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine
510405 Guangzhou
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Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
310020 Hangzhou
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Qianfoshan hospital of Shandong Province
250014 Jinan
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Qilu Hospital of Shandong University
250014 Jinan
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Huashan Hospital Fudan University
200040 Shanghai
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Tianjin Medical University General Hospital
300052 Tianjin
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The Second Affiliated Hospital of Air Force Medical University - Tangdu Hospital
710038 Xi'An
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Neurologie a rehabilitace Skopalíkova
615 00 Brno
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Hopital de la Pitie Salpetriere
75013 Paris
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Hopital PASTEUR
06000 Provence-Alpes-Côte d'Azur
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Istituto Neurologico Carlo Besta
20133 Milano
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Azienda Ospedaliera Univ.- Università Degli studi della Campania - Luigi Vanvitelli
80138 Napoli
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IRCCS C. Mondino, Istituto Neurologico Nazionale, Fondazione
27100 Pavia
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Azienda ospedaliera Sant'Andrea di Roma- Università di Roma La Sapienza
00189 Roma
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Policlinico Universitario Agostino Gemelli
168 Roma
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Hiroshima University Hospital
734 8551 Hiroshima shi
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Teikyo University Hospital
173 8606 Itabashi Ku
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St Marianna University Hospital
216 8511 Kawasaki Shi
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Kagawa University Hospital
761-0793 Kita-Gun
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Kumamoto University Hospital
860-8556 Kumamoto
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Iwate Medical University Hospital
020-8505 Morioka-shi
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National Hospital Organization Nagoya Medical Center
460-0001 Nagoya-shi
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Niigata City General Hospital
950-1197 Niigata
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Hyogo College of Medicine Hospital
663-8501 Nishinomiya-Shi
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Sapporo Medical University Hospital
0608556 Sapporo
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National Hospital Organization Sendai Medical Center
983-8520 Sendai-City
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Tokushima University Hospital
770-8503 Tokushima
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Tokyo Medical University Hospital
160-0023 Tokyo
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Pusan National University Hospital
49241 Busan
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Kyungpook National University Chilgok Hospital
41404 Daegu
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Kyungpook National University Hospital
41944 Daegu
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Severance Hospital Yonsei University Health System
120-752 Seoul
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iBiomed Research Unit
20010 Aguascalientes
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Consultorio Dr. Miguel Cortes
62448 Cuernavaca
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Hospital Civil de Guadalajara Fray Antonio Alcalde
44280 Guadalajara
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Neurocentrum Bydgoszcz Sp Z O O
85-796 Bydgoszcz
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NZOZ Wielospecjalistyczna Poradnia Lekarska 'Synapsis'
40-123 Katowice
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Centrum Neurologii Klinicznej, Krakowska Akademia Neurologii
31-505 Krakow
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Centrum Medyczne NeuroProtect
01-684 Warsaw
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Hosp. Gral. Univ. de Alicante
03010 Alicante
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Hosp. de La Santa Creu I Sant Pau
08025 Barcelona
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Hosp. Univ. I Politecni La Fe
46026 Valencia
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Karolinska Universitetssjukhuset Solna
171 76 Stockholm
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China Medical University Hospital
40447 Taichung
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Shin Kong Wu Ho Su Memorial Hospital
111 Taipei
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Taipei Veterans General Hospital
11217 Taipei
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Alle anzeigen

Studien-Informationen

Detailed Description:

Myasthenia gravis (MG) is a rare, heterogeneous, neuromuscular disease characterized by

fluctuating, fatigable muscle weakness. MG is caused by pathogenic autoantibodies that impair

cholinergic transmission in the postsynaptic membrane at the neuromuscular junction and

impair or prevent muscle contraction. Nipocalimab (also referred to as JNJ-80202135 or M281)

is a fully human, aglycosylated immunoglobulin (Ig)G1 monoclonal antibody (mAb) designed to

selectively bind, saturate, and block the IgG binding site on the endogenous neonatal Fc

receptor (FcRn). This study will consist of a screening phase (up to 4 weeks), treatment

phase (a 24-week double-blind placebo-controlled phase, and an open-label extension [OLE]

phase [up to 2 years]) and a follow-up safety visit (up to 8 weeks after last infusion of

study intervention). Efficacy evaluations will include assessments such as Myasthenia Gravis

- Activities of Daily Living (MG-ADL) score. Safety evaluations (such as adverse events,

physical examination, vital signs, electrocardiogram [ECG], and clinical laboratory tests)

will be performed. The overall duration of study will be up to 4 years and 8 months.

Ein-/Ausschlusskriterien

Inclusion Criteria:

- Diagnosis of myasthenia gravis (MG) with generalized muscle weakness meeting the

clinical criteria for generalized myasthenia gravis (gMG) as defined by the Myasthenia

Gravis Foundation of America (MGFA) Clinical Classification Class II a/b, III a/b, or

IVa/b at screening

- Myasthenia Gravis - Activities of Daily Living (MG-ADL) score of greater than or equal

to (>=) 6 at screening and baseline

- Has sufficient venous access to allow drug administration by infusion and blood

sampling as per the protocol

- A woman of childbearing potential must have a negative highly sensitive serum

(beta-human chorionic gonadotropin [beta-hCG]) at screening and a negative urine

pregnancy test at Day 1 prior to administration of study intervention

- A male participant must agree not to donate sperm for the purpose of reproduction

during the study and for a minimum 90 days after receiving the last administration of

study intervention

Exclusion Criteria:

- Has any confirmed or suspected clinical immunodeficiency syndrome not related to

treatment of his/her gMG, or has a family history of congenital or hereditary

immunodeficiency unless confirmed absent in the participant

- Has MGFA Class I disease or presence of MG crisis (MGFA Class V) at screening, history

of MG crisis within 1 month of screening, or fixed weakness (and/or 'burnt out' MG)

- Has had a thymectomy within 12 months prior to screening, or thymectomy is planned

during the study

- Has known allergies, hypersensitivity, or intolerance to nipocalimab or its excipients

- Has experienced myocardial infarction, unstable ischemic heart disease, or stroke

within 12 weeks of screening

Studien-Rationale

Primary outcome:

1. Average Change from Baseline in Myasthenia Gravis - Activities of Daily Living (MG-ADL) Score (Time Frame - Baseline up to Week 24):
Average change from baseline in MG-ADL score over Weeks 22, 23 and 24 of the double-blind placebo-controlled phase will be reported. Averaging over multiple time points (Weeks 22, 23 and 24) will be done to get a single measure. The MG-ADL provides a rapid assessment of the participant's MG symptom severity. Eight functions (talking, chewing, swallowing, breathing, impairment of ability to brush teeth or comb hair, impairment of ability to arise from a chair, double vision, eyelid droop) are rated on a 4-point scale: 0 (no impairment) to 3 (severe impairment). The total score will be sum of eight function scores and can range from 0 to 24. A higher score indicates greater symptom severity.



Secondary outcome:

1. Average Change in Quantitative Myasthenia Gravis (QMG) Score Over Weeks 22 and 24 of the Double-blind Placebo-controlled Phase (Time Frame - Up to Weeks 22 and 24):
Average change in QMG score over Weeks 22 and 24 of the double-blind placebo-controlled phase will be reported. The QMG test is a standardized quantitative strength assessment comprising 13 components. The quantitative results of each strength component are mapped to the following 4-point scale: 0 equals to (=) none, 1 = mild, 2 = moderate and 3 = severe. The total score will be sum of 13 components scores and can range from 0 to 39. A higher score indicates greater weakness.

2. Percentage of Participants whose Average MG-ADL Total Score Over Weeks 22, 23, and 24 is at least a 2-Point Improvement from Baseline of the Double-blind Placebo-controlled Phase (Time Frame - Baseline up to Weeks 22, 23 and 24):
Percentage of participants whose average MG-ADL total score over Weeks 22, 23, and 24 is at least a 2-point improvement from baseline of the double-blind placebo-controlled phase will be reported.

3. Percentage of Participants with Improvement in MG-ADL Total Score Greater Than Or Equal to (>=) 2 Points at Week 1 and/or Week 2 of the Double-blind Placebo-controlled Phase (Time Frame - Weeks 1 and 2):
Percentage of participants with improvement in MG-ADL total score >= 2 points at Week 1 and/or Week 2 of the double-blind placebo-controlled phase will be reported.

4. Percentage of Participants with Improvement in MG-ADL Total Score >= 2 Points at Week 4 through Week 24 of the Double-blind Placebo-controlled Phase with No More Than 2 Non-consecutive Excursions Allowed Between Weeks 6 through Week 23 (Time Frame - Week 4 up to Week 24):
Percentage of participants with improvement in MG-ADL total score >= 2 points at Week 4 through Week 24 of the double-blind placebo-controlled phase with no more than 2 non-consecutive excursions allowed between Weeks 6 through Week 23 (excursion is defined as loss of improvement in MG-ADL score >= 2 points from baseline) will be reported.

5. Percentage of Participants whose Average Improvement in MG-ADL Total Score Over Weeks 22, 23, and 24 of the Double-blind, Placebo-controlled Phase is at Least a 50% Improvement from Baseline (Time Frame - Baseline, Weeks 22, 23 and 24):
Percentage of participants whose average improvement in MG-ADL total score over Weeks 22, 23, and 24 of the double-blind, placebo-controlled phase is at least a 50% improvement from baseline will be reported.

6. Percentage of Participants with Adverse Events (AEs) (Time Frame - Up to Week 24 of double-blind placebo-controlled phase and up to extension Week 24 of open-label extension phase (up to Week 48)):
An AE is any untoward medical occurrence in a participant participating in a clinical study that does not necessarily have a causal relationship with the pharmaceutical/biological agent under study.

7. Percentage of Participants with Serious Adverse Events (SAEs) (Time Frame - Up to Week 24 of double-blind placebo-controlled phase and up to extension Week 24 of open-label extension phase (up to Week 48)):
A SAE is any untoward medical occurrence that at any dose: results in death; is life-threatening; requires inpatient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; is a congenital anomaly/birth defect; is a suspected transmission of any infectious agent via a medicinal product; is medically important.

8. Percentage of Participants with Adverse Events of Special Interest (AESIs) (Time Frame - Up to Week 24 of double-blind placebo-controlled phase and up to extension Week 24 of open-label extension phase (up to Week 48)):
Percentage of participants with AESIs will be reported. Treatment-emergent AEs associated with the following situations are considered as AESI: 1) severe or medically significant or immediately life-threatening infections requiring intravenous (IV) anti-infective or operative/invasive intervention or requiring hospitalization or prolongation of existing hospitalization; 2) hypoalbuminemia with albumin less than (<) 20 grams per liter (g/L). Treatment-emergent AEs are defined as AEs with onset or worsening on or after date of first dose of study treatment.

9. Percentage of Participants with Change in Vital Signs (Time Frame - Up to Week 24 of double-blind placebo-controlled phase and up to extension Week 24 of open-label extension phase (up to Week 48)):
Percentage of participants with change in vital signs (temperature, blood pressure and heart rate) will be reported.

10. Percentage of Participants with Change in Clinical Laboratory Values (Time Frame - Up to Week 24 of double-blind placebo-controlled phase and up to extension Week 24 of open-label extension phase (up to Week 48)):
Percentage of participants with change in clinical laboratory (serum chemistry, hematology, lipid profiles and urinalysis) values will be reported.

11. Percentage of Participants with Change in Columbia-Suicide Severity Rating Scale (C-SSRS) Score (Time Frame - Up to Week 24 of double-blind placebo-controlled phase and up to extension Week 24 of open-label extension phase (up to Week 48)):
Percentage of participants with change in C-SSRS scale score will be reported. C-SSRS is semi structured clinician-administered questionnaire designed to solicit the occurrence, severity, and frequency of suicide-related ideation and behaviors. Total score ranges from 1 to 10. Higher scores indicate greater severity.

12. Percentage of Participants with Improvement in QMG Score of >= 3 Points from Baseline at Week 2 through Week 24 of the Double-blind Placebo-controlled Phase with No More than 2 Non-consecutive Excursions Allowed at Weeks 4 through 22 (Time Frame - Week 2 up to Week 24):
Percentage of participants with improvement in QMG score of >= 3 points from baseline at Week 2 through Week 24 of the double-blind placebo-controlled phase with no more than 2 non-consecutive excursions allowed at weeks 4 through 22 (excursions defined as loss of improvement in QMG score of >= 3 points from baseline) will be reported.

13. Average Change From Baseline in the Fatigue Items of the Quality of Life in Neurological Disorders Scale (Neuro-QoL Fatigue) Total Score Over Weeks 22 and 24 of Double-blind Placebo-controlled Phase (Time Frame - Baseline up to Weeks 22 and 24):
Average change from baseline in the Neuro-QoL Fatigue total score over Weeks 22 and 24 of double-blind placebo-controlled phase will be reported. Neuro-QoL fatigue is a 19-item questionnaire developed and validated for use in common neurological conditions which assesses patient-reported fatigue and associated impact on physical, mental, and social activities during the past 7 days. Each item included in the Neuro-QoL Fatigue questionnaire is graded on a 5-point Likert-type scale (1=Never; 2=Rarely; 3=Sometimes; 4=Often; 5=Always). The total scores are calculated by summing 19 items score and can range from 19-95. Higher score reflects more fatigue.

14. Average Change from Baseline in the Revised Myasthenia Gravis Quality of Life - 15 Scale (MG-Qol15r) Score Over Weeks 22 And 24 of the Double-blind Placebo-controlled Phase (Time Frame - Baseline up to Weeks 22 and 24):
Average change from baseline in the MG-QoL15r score over Weeks 22 and 24 of the double-blind placebo-controlled phase will be reported. The MG-QoL15r is a participant-reported outcome instrument that measures MG-specific health-related quality of life. The MG-QoL15r contains 15 items that evaluate patients' experience related to Myasthenia Gravis over the "past few weeks" on a 3-point Likert-type scale (0=Not at all; 1=Somewhat; 2=Very much). The total score of the MG-QoL15r can be calculated by summing 15 items score and can range from 0 to 30. A higher score indicates poorer health related quality of life.

15. Change from Baseline in the Visual Analog Scale (VAS) Score of European Quality of Life (EuroQol) 5-Dimension 5-Level (EQ-5D-5L) Scale Over 24 Weeks of the Double-blind Placebo-controlled Phase (Time Frame - Baseline up to 24 weeks):
Change from baseline in the VAS score of EQ-5D-5L scale over 24 weeks of the double-blind placebo-controlled phase will be reported. EQ-5D-5L is a 2-part instrument for use as a measure of health outcome, designed for self-completion by respondents. It consists of EQ-5D-5L descriptive system and EQ VAS. The EQ VAS self-rating records the respondent's own assessment of his or her overall health status at the time of completion, on a scale of 0 (worst imaginable health state) to 100 (best imaginable health state). Positive change in score indicates improvement.

16. Change from Baseline in the Health Status Index of the EQ-5D-5L Scale Over 24 Weeks of the Double-blind Placebo-controlled Phase (Time Frame - Baseline up to 24 weeks):
Change from baseline in health status index of EQ-5D-5L scale over 24 weeks of double-blind placebo-controlled phase will be reported. EQ-5D-5L is standardized instrument for use as measure of health outcome, primarily designed for self-completion by respondents. It consists of EQ-5D-5L descriptive system and EQ-VAS. EQ-5D-5L descriptive system comprises following 5 dimensions: Mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each of 5 dimensions is divided into 5 levels of perceived problems (1 indicating no problem, 2 indicating slight problems, 3 indicating moderate problems, 4 indicating severe problems, 5 indicating extreme problems). Participant selects an answer for each of 5 dimensions considering response that best matches his or her health "today". The responses to 5 dimensions are used to compute a single score ranging from zero (0.0- worst health state) to 1 (1.0- better health state) representing the general health status of the individual.

17. Serum Nipocalimab Concentrations Over Time (Time Frame - Up to 4 years and 8 months):
Serum nipocalimab concentrations over time will be reported.

18. Number of Participants with Antibodies to Nipocalimab (Anti-Drug Antibodies [ADAs] and Neutralizing Antibodies [NAbs]) (Time Frame - Up to 4 years and 8 months):
Number of participants with antibodies to nipocalimab (ADAs and NAbs) will be reported.

19. Percentage of Participants with MG-ADL Score of 0 or 1 Over Time in the Double-blind, Placebo-controlled Phase (Time Frame - Up to Week 24):
Percentage of participants with MG-ADL score of 0 or 1 over time in the double-blind, placebo-controlled phase will be reported.

20. Percentage of Participants with MG-ADL Score of 0 or 1 at Any Time During the Double-blind, Placebo-controlled Phase (Time Frame - Up to Week 24):
Percentage of participants with MG-ADL score of 0 or 1 at any time during the double-blind, placebo-controlled phase will be reported.

21. Percentage of Participants with MG-ADL Score of 0 or 1 at 50% of Timepoints During the Double-blind, Placebo-controlled Phase (Time Frame - Up to Week 24):
Percentage of participants with MG-ADL score of 0 or 1 at 50% of timepoints during the double-blind, placebo-controlled phase will be reported.

22. Percentage of Participants with MG-ADL Score of 0 or 1 at 75% of Timepoints During the Double-blind, Placebo-controlled Phase (Time Frame - Up to Week 24):
Percentage of participants with MG-ADL score of 0 or 1 at 75% of timepoints during the double-blind, placebo-controlled phase will be reported.

23. Change in Total Serum Immunoglobulin G (IgG) Concentrations (Time Frame - Up to 4 years and 8 months):
Change in total serum IgG concentrations will be reported.

24. Change in Levels of Autoantibodies Associated with Generalized Myasthenia Gravis (gMG) (Time Frame - Up to 4 years and 8 months):
Change in levels of autoantibodies associated with gMG will be reported.

25. Change from Baseline in MG-ADL Score as a Function of IgG (Time Frame - Baseline up to 4 years and 8 months):
Change from baseline in MG-ADL score as a function of IgG will be reported.

26. Change from Baseline in QMG Score as a Function of IgG (Time Frame - Baseline up to 4 years and 8 months):
Change from baseline in QMG score as a function of IgG will be reported.

27. Change From Baseline in MG-ADL Score as a Response to Percent Change in Autoantibody Levels, in Seropositive Participants Treated with Nipocalimab (Time Frame - Baseline up to 4 years and 8 months):
Change from baseline in MG-ADL as a response to percent change in autoantibody levels, in seropositive participants (anti-acetylcholine receptor [anti-AChR], anti-muscle-specific kinase [anti-MuSK], anti-lipoprotein-related protein receptor 4 [anti-LRP4]) treated with nipocalimab will be reported.

28. Change From Baseline in QMG Score as a Response to Percent Change in Autoantibody Levels, in Seropositive Participants Treated with Nipocalimab (Time Frame - Baseline up to 4 years and 8 months):
Change from baseline in QMG score as a response to percent change in autoantibody levels, in seropositive participants (anti-AChR, anti-MuSK, anti-LRP4) treated with nipocalimab will be reported.

Studien-Arme

  • Experimental: Nipocalimab
    Double-blind Placebo-controlled Phase: Participants will receive nipocalimab intravenous (IV) infusions once every 2 weeks (q2w) up to 24 weeks during double-blind placebo-controlled phase. Open-label Extension (OLE) Phase: Participants who complete the double-blind placebo-controlled phase will enter the OLE phase and continue to receive nipocalimab q2w IV infusion till study end.
  • Placebo Comparator: Placebo
    Double-blind Placebo-controlled Phase: Participants will receive matching placebo of nipocalimab IV infusion q2w up to 24 weeks during double-blind placebo-controlled phase.

Geprüfte Regime

  • Nipocalimab (JNJ-80202135, M281):
    Nipocalimab will be administered as an IV infusion.
  • Placebo:
    Matching placebo will be administered as an IV infusion.

Quelle: ClinicalTrials.gov


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