- ICH GCP
- Registre américain des essais cliniques
- Essai clinique NCT06798012
Une étude de TAK-411 chez les adultes atteints de polyradiculoneuropathie démyélinante inflammatoire chronique (CIDP) (CASCA)
Une étude de phase 2, ouverte et de preuve de concept pour étudier l'efficacité, la sécurité et la tolérabilité du TAK-411 chez les sujets adultes atteints de polyradiculoneuropathie démyélinisante inflammatoire chronique (l'étude CASCA)
CIDP is an autoimmune disease. This means that the body's germ fighting (immune) system attacks itself. In CIDP, the immune system attacks the protective covering around the nerves called myelin. Over time, these nerves lose their ability to send signals to the muscles in the body. This leads to muscle weakness and loss of sensation in arms and legs among other symptoms. Participants with CIDP can be treated with a protein called immunoglobulin (or IG).
TAK-411 is a special type of immune globulin G (hsIgG) that has been chemically changed. It is made from IG that comes from human plasma. This study will test if TAK-411 can decrease inflammation and improve symptoms of CIDP.
The main aim of this study is to check how TAK-411 affects the physical functioning of adults with CIDP when compared with results of the placebo group of a historical trial.
Participants may be treated with TAK-411 for up to 1 year (51 weeks) and will be followed up for 3 weeks after last dose.
During the study, participants may visit their study clinic up to approximately 21 times.
Aperçu de l'étude
Statut
Intervention / Traitement
Type d'étude
Inscription (Estimé)
Phase
- Phase 2
Contacts et emplacements
Coordonnées de l'étude
- Nom: Takeda Contact
- Numéro de téléphone: +1-877-825-3327
- E-mail: medinfoUS@takeda.com
Lieux d'étude
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Alberta
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Calgary, Alberta, Canada, T2N 4Z6
- Recrutement
- University of Calgary
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Contact:
- Site Contact
- Numéro de téléphone: 403-210-7006
- E-mail: chris.white@ahs.ca
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Chercheur principal:
- Christopher White
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Ontario
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Toronto, Ontario, Canada, M5G 2C4
- Recrutement
- University Health Network
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Contact:
- Site Contact
- Numéro de téléphone: 416-340-3662
- E-mail: hans.katzberg@uhn.ca
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Chercheur principal:
- Hans Katzberg
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Bogotá, Colombie, 111711
- Recrutement
- Universidad del Rosario
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Contact:
- Site Contact
- E-mail: drandresdiazcampos@gmail.com
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Chercheur principal:
- Andres Diaz Campos
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Bucaramanga, Colombie, 680001
- Recrutement
- Fundacion Oftalmologica de Santander - FOSCAL
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Contact:
- Site Contact
- Numéro de téléphone: (577) 6382828
- E-mail: ivanmauricio@rocketmail.com
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Chercheur principal:
- Ivan Peña
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Antioquia
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Medellín, Antioquia, Colombie, 50021
- Recrutement
- Neuro ClinicaS.A.S
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Contact:
- Site Contact
- Numéro de téléphone: (604) 3222813
- E-mail: juan.solano@udea.edu.co
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Chercheur principal:
- Juan Marcos Solano Atehortua
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D.C.
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Bogotá, D.C., Colombie
- Recrutement
- Hospital Universitario San Ignacio
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Contact:
- Site Contact
- Numéro de téléphone: 2473 57 (1) 5946161
- E-mail: luciamarent@gmail.com
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Chercheur principal:
- Alba Lucia Marentes Cubillos
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Valle del Cauca Department
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Cali, Valle del Cauca Department, Colombie, 760032
- Recrutement
- Fundacion Valle del Lili
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Contact:
- Site Contact
- Numéro de téléphone: 4022 - 4028 (602) 3319090
- E-mail: francisco.arias@fvl.org.co
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Chercheur principal:
- Francisco Arias Mora
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California
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La Jolla, California, États-Unis, 92093
- Recrutement
- University of California San Diego
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Contact:
- Site Contact
- Numéro de téléphone: 619-543-3500
- E-mail: dferrey@health.ucsd.edu
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Chercheur principal:
- Dominic Ferrey
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San Francisco, California, États-Unis, 94109
- Recrutement
- California Pacific Medical Center
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Contact:
- Site Contact
- Numéro de téléphone: 415-600-3604
- E-mail: Liberty.Jenkins@sutterhealth.org
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Chercheur principal:
- Liberty Jenkins
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District of Columbia
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Washington D.C., District of Columbia, États-Unis, 20017
- Recrutement
- MedStar Georgetown University Hospital
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Contact:
- Site Contact
- Numéro de téléphone: 202-681-8127
- E-mail: Noushin.Jazebi@medstar.net
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Chercheur principal:
- Noushin Jazebi
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Florida
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Jacksonville, Florida, États-Unis, 32209
- Recrutement
- UF Health Neurology - Jacksonville
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Contact:
- Site Contact
- Numéro de téléphone: 904-244-9922
- E-mail: Michael.Pulley@jax.ufl.edu
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Chercheur principal:
- Michael Pulley
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Miami, Florida, États-Unis, 33133
- Recrutement
- Visionary Investigators Network
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Chercheur principal:
- Andrew Lerman
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Contact:
- Site Contact
- Numéro de téléphone: 833-732-2484
- E-mail: support@VINTrials.com
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Rockledge, Florida, États-Unis, 32955
- Recrutement
- Knight Neurology
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Chercheur principal:
- Vaibhav Shah
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Contact:
- Site Contact
- Numéro de téléphone: 855-564-4485
- E-mail: vshah@knightneurology.com
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Tampa, Florida, États-Unis, 33612
- Recrutement
- University of South Florida
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Chercheur principal:
- Kathleen Murray
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Contact:
- Site Contact
- Numéro de téléphone: 813-974-9413
- E-mail: jessshaw@usf.edu
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Georgia
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Atlanta, Georgia, États-Unis, 30322
- Recrutement
- Emory University
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Contact:
- Site Contact
- Numéro de téléphone: 404-727-1638
- E-mail: christina.nicole.fournier@emory.edu
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Chercheur principal:
- Christina Nicole Fournier
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Massachusetts
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Boston, Massachusetts, États-Unis, 02215
- Recrutement
- Beth Israel Deaconess Medical Center
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Chercheur principal:
- Fernanda Wajnsztajn Yungher
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Contact:
- Site Contact
- Numéro de téléphone: 617-667-2501
- E-mail: Agottli2@bidmc.harvard.edu
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Minnesota
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Rochester, Minnesota, États-Unis, 55905
- Recrutement
- Mayo Clinic Rochester
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Contact:
- Site Contact
- Numéro de téléphone: 507-284-5236
- E-mail: pinto.marcus@mayo.edu
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Chercheur principal:
- Marcus Pinto
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Missouri
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Columbia, Missouri, États-Unis, 65212-0001
- Recrutement
- The Curators of the University of Missouri on behalf of University of Missouri Health Care
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Chercheur principal:
- William Arnold
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Contact:
- Site Contact
- E-mail: wdavidarnold@health.missouri.edu
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St Louis, Missouri, États-Unis, 63110
- Recrutement
- The Washington University
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Contact:
- Site Contact
- Numéro de téléphone: 314-273-8160
- E-mail: C.roach@wustl.edu
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Chercheur principal:
- Charles Roach
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North Carolina
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Raleigh, North Carolina, États-Unis, 27607
- Recrutement
- Velocity Clinical Research - Raleigh
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Chercheur principal:
- Timothy Ryan
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Contact:
- Site Contact
- E-mail: tryan@velocityclinical.com
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Pennsylvania
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Philadelphia, Pennsylvania, États-Unis, 19104
- Recrutement
- Penn Blood Disorders Program - Hospital of The University of Pennsylvania
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Chercheur principal:
- Chafic Karam
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Contact:
- Site Contact
- Numéro de téléphone: 503-494-0744
- E-mail: Chafic.Karam@Pennmedicine.upenn.edu
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Washington
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Seattle, Washington, États-Unis, 98195
- Recrutement
- University of Washington
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Contact:
- Site Contact
- Numéro de téléphone: 206-598-7688
- E-mail: mdweiss@uw.edu
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Chercheur principal:
- Michael Weiss
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Key Inclusion Criteria
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The participant is at least 18 years of age, inclusive, at the time of signing the Informed Consent Form (ICF).
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The participant has a body weight of less than or equal to (<=) 150 kilogram (kg).
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The participant has a documented diagnosis of typical CIDP, as confirmed by a neurologist specializing/experienced in neuromuscular diseases and consistent with the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) 2021 criteria.
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The participant has responded to IgG treatment in the past (documented partial or complete resolution of neurological symptoms and deficits).
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The participant has had disease activation within 24 months before screening, as documented in medical records and in the opinion of the investigator, defined as one of the following:
- Clinically meaningful deterioration of symptoms on interruption or dose reduction of IgG treatment.
- Clinically meaningful deterioration of symptoms requiring IgG treatment dose increase with subsequent clinical improvement.
- Clinically meaningful deterioration of symptoms at the end of IgG treatment dose interval with improvement after next dose administration.
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The participant is on a stable dose of immunoglobulin treatment intravenously (IGIV) treatment, (within the dose range of 0.4 to 2.4 grams per kilogram [g/kg] every 2 to 6 weeks [inclusive]). A stable dose is defined as no change greater than 10 percentage (%) in frequency or dose of IGIV therapy within the 3 months before and throughout screening.
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The participant has an INCAT score between 0 and 7 (inclusive) at screening.
Key Exclusion Criteria
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The participant has a documented diagnosis of a CIDP variant per EAN/PNS 2021 criteria.
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The participant has any neuropathy of other causes, including the following:
- Hereditary demyelinating neuropathies, such as hereditary sensory and motor neuropathy, Charcot-Marie-Tooth disease, and hereditary sensory and autonomic neuropathies.
- Neuropathies secondary to infections, disorders, or systemic diseases such as Borrelia burgdorferi infection (Lyme disease), diphtheria, systemic lupus erythematosus, POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome, osteosclerotic myeloma, diabetic and nondiabetic lumbosacral radiculoplexus neuropathy, lymphoma, amyloidosis.
- Multifocal motor neuropathy.
- Drug-, biologic-, chemotherapy-, or toxin-induced peripheral neuropathy.
- Diabetic peripheral neuropathy.
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The participant has any chronic or debilitating disease, or central nervous disorder that causes neurological symptoms or that may interfere with assessment of CIDP or outcome measures, including (but not limited to) multiple sclerosis, arthritis, stroke, and Parkinson's disease.
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The participant is required to take or has taken either of the following for treatment of CIDP:
- Immunomodulatory/immunosuppressive agents (except IGIV) that include, but are not limited to, complement inhibitors, efgartigimod, and chemotherapeutic drugs, within 3 months or 5 half-lives, whichever is longer, of screening.
- B-cell affecting biologics (e.g. rituximab) within 6 months of screening.
Note: Participants on a long-term, stable dosing regimen of certain immunomodulatory agents (eg, hydroxychloroquine) for any disease other than CIDP may be eligible, provided the dose regimen has been stable for 3 months before screening and is expected to remain stable throughout the study.
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The participant has undergone plasma exchange within 3 months of screening.
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The participant has a history of malignancy with less than 2 years of complete remission before screening, or active malignancy requiring chemotherapy and/or radiotherapy.
Note: Participants with adequately treated basal cell or squamous cell carcinoma of the skin, carcinoma in situ of the cervix, or stable prostate cancer not requiring treatment are eligible.
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The participant has experienced deep vein thrombosis or arterial thromboembolic events (example, cerebrovascular accident, pulmonary embolism) within 12 months of screening.
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The participant has any medical condition, laboratory finding, or physical examination finding that precludes participation or with clinical evidence of any significant acute or chronic disease that, in the opinion of the investigator, may interfere with successful completion of the study or place the participant at undue medical risk.
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The participant has participated in another clinical study involving an IP or investigational device within 30 days before screening or is scheduled to participate in another clinical study involving an IP or investigational device during the course of this study.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: N / A
- Modèle interventionnel: Affectation à un seul groupe
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: TAK-411
Participants will receive TAK-411 400 milligrams per kilogram (mg/kg), IV infusion as an induction dose on Day 1 of initial treatment period. The induction dose may be repeated once after 3 weeks if participants exhibit no clinical change. Thereafter, participants will receive TAK-411 200 mg/kg, IV infusion every 3 weeks for a total of 24 weeks (initial treatment period), followed by an optional additional 27 weeks (extended treatment period). |
TAK-411 IV infusion.
Autres noms:
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Number of Participants With Improvement in Functional Ability at Week 24
Délai: At Week 24
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Improvement in functional ability is defined as decrease of >=1 point in INCAT score at Week 24 compared with baseline (last assessment before first investigational product [IP] administration on Day 1). INCAT disability scale consists of upper and lower extremity components, which are scored based on a participant's level of impairment/disability in their arms and legs, respectively. Each component is scored from 0 to 5 points, which are summed for an overall INCAT disability score ranging from 0 to 10 points, where a score of 0 indicates no signs of disability (example, no upper limb problems and walking not affected) and a score of 10 indicates most severe disability (example, inability to move either arm for any purposeful movement and restricted to a wheelchair, unable to stand and walk a few steps with help). Adjusted INCAT disability score remains identical to INCAT disability score, except that changes in upper limb function from 0 (normal) to 1 (minor symptoms) are excluded. |
At Week 24
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Nombre de participants avec des événements indésirables émergents du traitement (TEAES)
Délai: Dès le début de l'étude Administration du médicament jusqu'à 54 semaines
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Dès le début de l'étude Administration du médicament jusqu'à 54 semaines
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Nombre de participants ayant des arrêts de perfusion, des interruptions et des réductions de taux de perfusion dues aux TEAS liés à TAK-411
Délai: Dès le début de l'étude Administration du médicament jusqu'à 54 semaines
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Dès le début de l'étude Administration du médicament jusqu'à 54 semaines
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Nombre de participants avec des anticorps contre les protéines des cellules hôtes (HCP), la bêta-1,4-galactosyltransférase (B4GALT1) et l'alpha-2,6-sialyltransférase (ST6GAL1)
Délai: Jusqu'à 54 semaines
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Jusqu'à 54 semaines
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Number of Participants With Improvement in Functional Ability at Weeks 12 and 54
Délai: At 12 and 54 weeks
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Improvement in functional ability is defined as decrease of >=1 point in the adjusted INCAT score at 12 and 54 weeks compared with baseline (last assessment before first IP administration on Day 1). INCAT disability scale consists of upper and lower extremity components, which are scored based on a participant's level of impairment/disability in their arms and legs, respectively. Each component is scored from 0 to 5 points, which are summed for an overall INCAT disability score ranging from 0 to 10 points, where a score of 0 indicates no signs of disability (example, no upper limb problems and walking not affected) and a score of 10 indicates most severe disability (example, inability to move either arm for any purposeful movement and restricted to a wheelchair, unable to stand and walk a few steps with help). Adjusted INCAT disability score remains identical to INCAT disability score, except that changes in upper limb function from 0 (normal) to 1 (minor symptoms) are excluded. |
At 12 and 54 weeks
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Change From Baseline in Adjusted Inflammatory Neuropathy Cause and Treatment (INCAT) Score
Délai: Baseline (last assessment prior first dose on Day 1), at 12, 24 and 54 weeks
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INCAT disability scale consists of upper and lower extremity components, which are scored based on a participant's level of impairment/disability in their arms and legs, respectively. Each component is scored from 0 to 5 points, which are summed for an overall INCAT disability score ranging from 0 to 10 points, where a score of 0 indicates no signs of disability (example, no upper limb problems and walking not affected) and a score of 10 indicates most severe disability (example, inability to move either arm for any purposeful movement and restricted to a wheelchair, unable to stand and walk a few steps with help). Adjusted INCAT disability score remains identical to INCAT disability score, except that changes in upper limb function from 0 (normal) to 1 (minor symptoms) are excluded. |
Baseline (last assessment prior first dose on Day 1), at 12, 24 and 54 weeks
|
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Change From Screening in the Adjusted INCAT Score
Délai: Screening, at 12, 24 and 54 weeks
|
INCAT disability scale consists of upper and lower extremity components, which are scored based on a participant's level of impairment/disability in their arms and legs, respectively. Each component is scored from 0 to 5 points, which are summed for an overall INCAT disability score ranging from 0 to 10 points, where a score of 0 indicates no signs of disability (example, no upper limb problems and walking not affected) and a score of 10 indicates most severe disability (example, inability to move either arm for any purposeful movement and restricted to a wheelchair, unable to stand and walk a few steps with help). Adjusted INCAT disability score remains identical to INCAT disability score, except that changes in upper limb function from 0 (normal) to 1 (minor symptoms) are excluded. |
Screening, at 12, 24 and 54 weeks
|
|
Number of Participants With Improvement in Functional Ability on Inflammatory Rasch-built Overall Disability Scale (I-RODS) Score
Délai: At 12, 24 and 54 weeks
|
Improvement in functional ability defined as increase of greater than or equal to (>=) 4 points in the raw summed I-RODS score at 12, 24, and 54 weeks compared with baseline. I-RODS is a validated, participants-reported, linearly weighted overall disability scale that was specifically designed to capture current activity and social participation limitations in participants with immune-mediated peripheral neuropathies including CIDP. I-RODS comprises 24 items for which participants are asked to rate their functioning related to a variety of everyday tasks at the moment of completion. The participant assigns a score between 0 and 2 to each item as follows:0 (impossible to perform),1 (performed with difficulty), 2 (easily performed) with a lower score indicating more severe activity and social participation limitations. A total I-RODS score of 0 (complete disability) to 48 (no disability) is tabulated by totalling the 24-item responses where higher score represents better outcomes. |
At 12, 24 and 54 weeks
|
|
Change From Baseline in I-RODS Score
Délai: Baseline (last assessment prior first dose on Day 1), at 12, 24 and 54 weeks
|
The I-RODS is a validated, participants-reported, linearly weighted overall disability scale that was specifically designed to capture current activity and social participation limitations in participants with immune-mediated peripheral neuropathies including CIDP. The I-RODS comprises 24 items for which participants are asked to rate their functioning related to a variety of everyday tasks at the moment of completion. The participant assigns a score between 0 and 2 to each item as follows: 0 (impossible to perform), 1 (performed with difficulty), 2 (easily performed) with a lower score indicating more severe activity and social participation limitations. A total I-RODS score of 0 (complete disability) to 48 (no disability) is tabulated by totalling the 24-item responses where higher score represents better outcomes. |
Baseline (last assessment prior first dose on Day 1), at 12, 24 and 54 weeks
|
|
Change From Screening in I-RODS Score
Délai: Screening, at 12, 24 and 54 weeks
|
The I-RODS is a validated, participants-reported, linearly weighted overall disability scale that was specifically designed to capture current activity and social participation limitations in participants with immune-mediated peripheral neuropathies including CIDP. The I-RODS comprises 24 items for which participants are asked to rate their functioning related to a variety of everyday tasks at the moment of completion. The participant assigns a score between 0 and 2 to each item as follows: 0 (impossible to perform), 1 (performed with difficulty), 2 (easily performed) with a lower score indicating more severe activity and social participation limitations. A total I-RODS score of 0 (complete disability) to 48 (no disability) is tabulated by totalling the 24-item responses where higher score represents better outcomes. |
Screening, at 12, 24 and 54 weeks
|
|
Change From Baseline in Medical Research Council Sum Score (MRC-SS)
Délai: Baseline (last assessment prior first dose on Day 1), at 12, 24 and 54 weeks
|
The MRC-SS is used clinician-reported measure of muscle strength. Assessments are conducted bilaterally on six muscle groups: upper arm abductors, elbow flexors, wrist extensors, hip flexors, knee extensors, and foot dorsal flexors. Each muscle is rated from 0 to 5, where 0 indicates no visible contraction and 5 indicates normal strength. The scores are summed to obtain the MRC-SS, which ranges from 0 (quadriplegic) to 60 (normal strength). |
Baseline (last assessment prior first dose on Day 1), at 12, 24 and 54 weeks
|
|
Change From Screening in MRC-SS
Délai: Screening, at 12, 24 and 54 weeks
|
The MRC-SS is used clinician-reported measure of muscle strength. Assessments are conducted bilaterally on six muscle groups: upper arm abductors, elbow flexors, wrist extensors, hip flexors, knee extensors, and foot dorsal flexors. Each muscle is rated from 0 to 5, where 0 indicates no visible contraction and 5 indicates normal strength. The scores are summed to obtain the MRC-SS, which ranges from 0 (quadriplegic) to 60 (normal strength). |
Screening, at 12, 24 and 54 weeks
|
|
Change From Baseline in Bilateral Hand Grip Strength
Délai: Baseline (last assessment prior first dose on Day 1), at 12, 24 and 54 weeks
|
Bilateral hand grip strength assessments will be performed by prescribing physicians or qualified designees using the Martin Vigorimeter, measuring strength in kilopascals (kPa) ranging from 0 to 160 kPa. |
Baseline (last assessment prior first dose on Day 1), at 12, 24 and 54 weeks
|
|
Change From Screening in Bilateral Grip Strength
Délai: Screening, at 12, 24 and 54 weeks
|
Bilateral hand grip strength assessments will be performed by prescribing physicians or qualified designees using the Martin Vigorimeter, measuring strength in kPa ranging from 0 to 160 kPa. |
Screening, at 12, 24 and 54 weeks
|
Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Directeur d'études: Study Director, Takeda
Publications et liens utiles
Liens utiles
- <p>Click here to ask Takeda's chatbot for comprehensive and easy-to-understand information about clinical trials - even across products and indications - in your local language.</p>
- <p>Click here for more information about this trial in easy-to-understand language, including a Plain Language Summary of the results if the trial has been completed.</p>
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
- Maladies du système nerveux
- Processus pathologiques
- Maladies neuromusculaires
- Maladie chronique
- Attributs de la maladie
- Maladies auto-immunes
- Maladies du système immunitaire
- Maladies du système nerveux périphérique
- Maladies auto-immunes du système nerveux
- Maladies démyélinisantes
- Polyneuropathies
- Polyradiculonévrite
- Conditions pathologiques, signes et symptômes
- Polyradiculonévrite Chronique Inflammatoire Démyélinisante
Autres numéros d'identification d'étude
- TAK-411-2001
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Description du régime IPD
Takeda provides access to the de-identified individual participant data (IPD) for eligible studies to aid qualified researchers in addressing legitimate scientific objectives (Takeda's data sharing commitment is available on https://clinicaltrials.takeda.com/takedas-commitment?commitment=5). These IPDs will be provided in a secure research environment following approval of a data sharing request, and under the terms of a data sharing agreement.
Critères d'accès au partage IPD
IPD from eligible studies will be shared with qualified researchers according to the criteria and process described on https://vivli.org/ourmember/takeda/ For approved requests, the researchers will be provided access to anonymized data (to respect patient privacy in line with applicable laws and regulations) and with information necessary to address the research objectives under the terms of a data sharing agreement.
Type d'informations de prise en charge du partage d'IPD
- PROTOCOLE D'ÉTUDE
- SÈVE
- CIF
- RSE
Informations sur les médicaments et les dispositifs, documents d'étude
Étudie un produit pharmaceutique réglementé par la FDA américaine
Étudie un produit d'appareil réglementé par la FDA américaine
Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .