In this study, researchers will learn more about a study drug called litifilimab (BIIB059) in participants with systemic lupus erythematosus (SLE). The study will focus on adults who have active disease and are already taking standard of care medications. These may include antimalarials, steroids, and immunosuppressants. This is an extension study of 230LE303 and 230LE304 (TOPAZ-1 and TOPAZ-2). It will include participants who completed the treatment periods of either one of those parent studies. The main goal of the study is to learn more about the long-term safety of litifilimab in adults. The main question researchers want to answer is: \- How many participants have adverse events and serious adverse events during the study? Adverse events are health problems that may or may not be caused by the study drug. Researchers will also learn about: * The effect of litifilimab on controlling symptoms of SLE and lowering its activity. * How participants' immune systems respond to litifilimab. * The effect of litifilimab on the quality of life of participants. The study will be done as follows: * This study begins when the participant has finished 1 of the parent studies (either 230LE303 or 230LE304). * Participants who were getting either a high or low dose of litifilimab in either parent study will continue getting the same doses. * Participants who were getting the placebo in the parent studies will be randomized to get either a high or low dose of litifilimab. * Neither the researchers nor the participants will know which doses of litifilimab the participants are getting. * All participants will get litifilimab as injections under the skin once every 4 weeks. The treatment period will last up to 260 weeks. Participants may continue to take their standard of care medications. * There will be a follow-up safety period that lasts up to 24 weeks. * In total, participants will have up to 67 study visits. At these visits, the study doctor will do tests to check the participants' overall health, including the status of their SLE symptoms. They will also measure the participants' height, weight, and vital signs and collect blood and urine samples. Participants will also complete questionnaires or answer questions about how they are feeling and about their daily lives. * Each participant will be in the study for up to 284 weeks. Optional Substudy: * Some participants may be invited to join an optional "substudy" after being in the main study for at least 4 months. * This substudy will test a new injector device for delivering litifilimab. The injector device is an automatic device that delivers the full dose in 1 injection without needing to push a plunger. * Researchers will learn more about the safety of the injector device and how the body reacts to it. This will be compared to the current prefilled syringe method. * The substudy will last up to 3 months and will include about 120 participants.
This is an extension study for all participants who completed study 230LE303 (NCT04895241) and 230LE304 (NCT04961567) (parent phase 3 studies) through Week 52 and did not discontinue litifilimab or placebo. Eligible participants from parent phase 3 studies will be followed for up to 284 weeks. The primary objective of this study is to evaluate the long-term safety and tolerability of litifilimab in participants with active systemic lupus erythematosus (SLE). The secondary objectives of this study are to evaluate the long-term effect of litifilimab on disease activity in participants with SLE, to evaluate the long-term effect of litifilimab in participants with SLE in maintaining low disease activity, to evaluate the effect of litifilimab in participants with active SLE in preventing irreversible organ damage, to assess long-term use of oral corticosteroid (OCS) with participants receiving litifilimab treatment, to assess the impact of litifilimab on participant-reported Health-Related Quality-of-Life Questionnaire (HRQoL), symptoms, and impacts of SLE, to evaluate long-term effect of litifilimab on laboratory parameters, and to evaluate immunogenicity of litifilimab. A phase-3, randomized, dose-blind, substudy is added in this extension study for all participants who have been enrolled in the 230LE306 Phase 3 LTE study for a minimum of 4 months and have at least four remaining visits in the Phase 3 LTE study. The primary objective of this substudy is to evaluate the safety of injector device used for administering litifilimab in participants with active SLE. The secondary objective of this substudy is to evaluate the tolerability of injector device used for administering litifilimab in participants with active SLE.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
864
Administered as specified in the treatment arm.
Administered as specified in the treatment arm.
Arizona Arthritis & Rheumatology Associates, P.C.
Phoenix, Arizona, United States
Wallace Rheumatic Study Center
Beverly Hills, California, United States
Care Access Research - Huntington Beach
Huntington Beach, California, United States
Providence Facey Medical Foundation
Mission Hills, California, United States
Inland Rheumatology Clinical Trials, Inc.
Upland, California, United States
Number of Participants with Treatment Emergent Adverse Events (TEAEs)
An adverse event (AE) is any untoward medical occurrence in a participant or clinical investigation participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product. A TEAE is an AE that started or worsened in severity after the first dose of study treatment through 28 days after the last dose of study treatment or end of study (EOS) date, whichever comes earlier.
Time frame: Up to Week 284
Number of Participants with Serious Adverse Events (SAEs)
An SAE is any untoward medical occurrence that at any dose results in death, in the view of the Investigator, places the participant at immediate risk of death (a life threatening event), requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, results in a congenital anomaly/birth defect, and is a medically important event.
Time frame: Up to Week 284
Percentage of Participants who Achieved an Systemic Lupus Erythematosus Responder Index (SRI)-4 Response
SRI-4 is a composite endpoint defined as the following: * A reduction from baseline of ≥4 points in Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) score. * No new organ system affected, as defined by no new British Isles Lupus Activity Group-2004 (BILAG-2004 grade A) and no more than 1 new BILAG 2004 grade B versus previous visit. * No worsening from baseline in lupus disease activity as defined by \<0.3-point increase on 3-point Physician's Global Assessment (PGA) visual analog scale (VAS). * No violation of protocol-specified medication rules
Time frame: Up to Week 284
Percentage of Participants With at Least 4 Joints (Both Swollen and Tender) at Baseline who Achieved a Joint-50 Response
Joint-50 response is a 50% reduction in total active joint count from baseline. An active joint is defined as a joint with pain and signs of inflammation (e.g., tenderness, swelling or effusion). A 28-joint assessment will be performed to determine the active joint count, which is defined as the sum of tender and swollen joint counts.
Time frame: Up to Week 284
Percentage of Participants With a Cutaneous Lupus Erythematosus Disease Area and Severity Index - Activity (CLASI-A) Score ≥10 at Baseline who Achieved a CLASI-50, CLASI-70, and CLASI-90 Response
CLASI score is used to evaluate lupus skin manifestations. The activity scale (CLASI-A) includes measurements of erythema, scale and hypertrophy, and mucous membrane disease. Each part of the body is listed separately, from the scalp to the feet, in addition to sections focusing on mucous membrane involvement and alopecia. Points are given for the presence of erythema, scale, mucous membrane lesions, recent hair loss, and inflammatory alopecia. Scores for each area are assigned based on the most severe lesion within the area of interest. CLASI-A scores of 0 to 9, 10 to 20, and 21 to 70 represent disease severity of mild, moderate, and severe, respectively. CLASI-50, CLASI-70, and CLASI-90 responders are defined as ≥ 50%, ≥ 70%, and ≥ 90% improvement in CLASI-A score from baseline at the specified timepoint.
Time frame: Up to Week 284
Percentage of Participants who Achieved a British Isles Lupus Assessment Group based Composite Lupus Assessment (BICLA) Response
BICLA is a composite endpoint defined as the following: * BILAG-2004 improvement, defined as all of BILAG-2004 Grade A at baseline improved to B, C, or D and all of BILAG-2004 Grade B at baseline improved to C or D. * No BILAG-2004 worsening in other BILAG-2004 organ systems such that there are no new BILAG-2004 Grade A or greater than 1 new BILAG-2004 Grade B. * No worsening in the SLEDAI-2K total score compared to baseline. * No worsening from baseline in lupus disease activity as defined by \<0.3-point increase on 3-point PGA VAS. * No violation of protocol-specified medication rules.
Time frame: Up to Week 260
Annualized Severe Safety of Estrogens in Systemic Lupus Erythematosus National Assessment - Systemic Lupus Erythematosus Disease Activity Index Flare Index (SFI) Flare Rate
A severe flare is defined as any of the following: * Change in SLEDAI instrument score to \>12 * New or worse: central nervous system SLE; vasculitis; nephritis; myositis; platelets \<60,000/mL, or hemolytic anemia with hemoglobin \<7 grams per deciliter (g/dL) or decrease in hemoglobin \>3 g/dL and requiring: doubling prednisone dose, increase to \>0.5 milligrams per kilograms per day (mg/kg/day) or hospitalization * Increase in prednisone dose to \>0.5 mg/kg/day * New requirement for cyclophosphamide, azathioprine, methotrexate, or mycophenolate for SLE activity * Hospitalization for SLE activity * Increase in PGA score to \>2.5
Time frame: Up to Week 260
Percentage of Time Spent in Lupus Low Disease Activity State (LLDAS)
LLDAS is a composite endpoint defined as the following: i. SLEDAI-2K score ≤ 4, with no activity in a major organ system (renal, central nervous system, cardiopulmonary, vasculitis, fever); and ii. No new features of lupus disease activity compared with the previous assessment; and iii. SELENA-SLEDAI PGA ≤ 1; and iv. Current prednisone (or equivalent) dose ≤ 7.5 mg/day; and v. Standard maintenance doses of immunosuppressive drugs and approved biological agents. "No new features" is defined as any new SLEDAI-2K component that was not present at the previous assessment. The SELENA-SLEDAI PGA Scale ranges from 0-3, where 0 is no disease activity and 3 is maximum disease activity. "Standard maintenance doses" include drugs limited to those allowed per protocol.
Time frame: Up to Week 284
Percentage of Participants With Sustained LLDAS
LLDAS is a composite endpoint defined as the following: i. SLEDAI-2K score ≤ 4, with no activity in a major organ system (renal, central nervous system, cardiopulmonary, vasculitis, fever); and ii. No new features of lupus disease activity compared with the previous assessment; and iii. SELENA-SLEDAI PGA ≤ 1; and iv. Current prednisone (or equivalent) dose ≤ 7.5 mg/day; and v. Standard maintenance doses of immunosuppressive drugs and approved biological agents. "No new features" is defined as any new SLEDAI-2K component that was not present at the previous assessment. The SELENA-SLEDAI PGA Scale ranges from 0-3, where 0 is no disease activity and 3 is maximum disease activity. "Standard maintenance doses" include drugs limited to those allowed per protocol.
Time frame: Up to Week 284
Duration of Sustained LLDAS as Defined by the Number of Visits in LLDAS
LLDAS is a composite endpoint defined as the following: i. SLEDAI-2K score ≤ 4, with no activity in a major organ system (renal, central nervous system, cardiopulmonary, vasculitis, fever); and ii. No new features of lupus disease activity compared with the previous assessment; and iii. SELENA-SLEDAI PGA ≤ 1; and iv. Current prednisone (or equivalent) dose ≤ 7.5 mg/day; and v. Standard maintenance doses of immunosuppressive drugs and approved biological agents. "No new features" is defined as any new SLEDAI-2K component that was not present at the previous assessment. The SELENA-SLEDAI PGA Scale ranges from 0-3, where 0 is no disease activity and 3 is maximum disease activity. "Standard maintenance doses" include drugs limited to those allowed per protocol.
Time frame: Up to Week 284
Annual Change From Baseline Value From the Parent Phase 3 Studies in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) Score
SDI score is used to assess the accumulated damage in participants with SLE. It assess 12 organ systems and records damage in participants with lupus, regardless of its cause. Damage could be due to previous disease activity, medication, or intercurrent illness (such as surgery or cancer). To distinguish between active inflammation and damage, an item must be present for at least 6 months. It is assumed that persistent inflammation (for at least 6 months) would result in tissue injury and hence damage. SDI is evaluated on a scale 0-47 with higher score indicating higher damage.
Time frame: Up to Week 260
Cumulative Exposure to OCS Over Time
Time frame: Up to Week 260
Percentage of Participants With OCS ≤7.5 mg
Time frame: Up to Week 260
Percentage of Participants With OCS ≤5 mg
Time frame: Up to Week 260
Change From Baseline in Lupus-Specific Health-Related Quality-Of-Life (LupusQoL) Score
The LupusQoL is a participant-reported, lupus-specific, HRQoL questionnaire consisting of 34 items grouped in 8 domains: physical health, pain, planning, intimate relationships, burden to others, emotional health, body image and fatigue. Participants indicate their responses on a 5-point Likert response format, where 4 = never, 3 = occasionally, 2 = a good bit of the time, 1 = most of the time, and 0 = all the time. A LupusQoL score for each domain will be reported on a 0 to 100 scale, with greater values indicating better HRQoL.
Time frame: Up to Week 260
Change From Baseline in Short Form Health Survey-36 (SF-36) (Acute Version) Score
The SF-36 is a 36-item scale which assesses HRQoL in 8 domains: limitations in physical activities due to health problems, limitations in social activities due to physical or emotional problems, limitations in usual role activities due to physical health problems, bodily pain, general mental health (psychological distress and well-being), limitations in usual role activities due to emotional problems, vitality (energy and fatigue), general health perceptions. The SF-36 (Acute Version) form asks for participants to reply to questions (items) according to how they have felt over a specifically defined period of time. Items 1-4 primarily contribute to the physical component summary (PCS) score of the SF-36. Items 5-8 primarily contribute to the mental component summary (MCS) score of the SF-36 where higher scores indicate best health. Scores on each item are summed and averaged (range: 0=worse health to 100=best possible health).
Time frame: Up to Week 156
Change From Baseline in European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L)
The EQ-5D is a standardized generic measure of health status developed by the European Quality of Life Group. This study uses the EQ-5D-3L version of the instrument. This instrument consists of 2 sections. The first section comprises 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. All dimensions are measured on a 3-point scale, 1: No problems; 2: Some problems; 3: Extreme problems. The second section comprises the Visual Analogue Scale, which records the respondent's self-rated health on a vertical scale ranging from 0 to 100, lower scores indicate the worst possible health state.
Time frame: Up to Week 156
Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Score
The FACIT-Fatigue is a participant-administered HRQoL questionnaire that evaluates participant's fatigue in 5 broad categories: physical well-being, social/family well-being, emotional well-being, functional well-being and additional concerns. The level of fatigue is measured by questions assessed on a 5-point scale (0 = not at all; 1 = a little bit; 2 = somewhat; 3 = quite a bit; 4 = very much). The responses for each item are added to obtain a total score which ranges from 0 to 52, with a higher score indicating less fatigue.
Time frame: Up to Week 260
Change From Baseline in Patient Health Questionnaire-9 (PHQ-9) Score
The PHQ-9 is a participant-administered HRQoL questionnaire to screen for the presence and severity of depression. The PHQ-9 is a participant-reported outcome (PRO) that is used to measure depression in adults. It contains 9 questions, with a 2 week recall period. The PHQ-9 yields an overall severity score that can range from 0 to 27 with the following severity scores: 0-4 = none; 5-9 = mild; 10-14 = moderate; 15-19 = moderate-to-severe; and 20-27 = severe.
Time frame: Up to Week 260
Change From Baseline in Work Productivity and Activity Impairment (WPAI):Lupus Score
WPAI questionnaire is a validated instrument to measure impairments in work and activities. The WPAI yields four types of scores: 1. Absenteeism (work time missed) 2. Presenteesism (impairment at work / reduced on-the-job effectiveness) 3. Work productivity loss (overall work impairment / absenteeism plus presenteeism) 4. Activity Impairment. Each score ranges from 0 to 100, with higher numbers indicating greater impairment and less productivity.
Time frame: Up to Week 260
Change from Baseline in Patient Global Assessment (PtGA) Score
The PtGA is participant-administered, single-item question evaluating the impact of health and illness, with responses ranging from very poor to very well on a 100 mm VAS. The participant will consider the previous week when addressing this question.
Time frame: Up to Week 260
Number of Participants with Clinically Relevant Abnormalities in Standard Laboratory Parameters
Standard laboratory parameters will include hematology, blood chemistry, urinalysis, and coagulation.
Time frame: Up to Week 284
Number of Participants with Clinically Relevant Abnormalities in Electrocardiogram (ECG) Results
Time frame: Up to Week 260
Number of Participants with Antibodies to Litifilimab
Time frame: Up to Week 284
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