Patient case: 54-year-old male with malignant hyperthermia; genetic feature: RYR1

Clinical trial: Study Evaluating Efficacy and Safety of Octanorm in Patients With Dermatomyositis

Summary: DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED PHASE III STUDY EVALUATING EFFICACY AND SAFETY OF SUBCUTANEOUS HUMAN IMMUNOGLOBULIN (OCTANORM) IN PATIENTS WITH DERMATOMYOSITIS


Eligibility: Inclusion Criteria:
  1. Subjects with diagnosis of definite or probable DM according to the Bohan and Peter criteria.
  2. Subjects who have responded to IGIV treatment as assessed by the treating physician and being on a stable dose for at least 3 months on 2 g/kg bodyweight (+/- 10%) prior to study enrolment.
  3. For subjects being on other medication(s) for the treatment of DM (immunosuppressants, corticosteroids): a) subject was on such medication(s) at the start of IGIV treatment in the first place, and b) received such medication(s) for at least 3 months prior to study enrolment and at a stable dose for at least 4 weeks prior to study enrolment at the maximally allowed conditions as per Table 2 (see section 4.2.1).
  4. MMT-8 score ≥144, with at least 3 other CSM to be normal or near normal as per the following criteria: Visual Analogue Scale [VAS] of patient global disease activity ≤2 cm, physician's global disease activity ≤2 cm, extra-muscular disease activity ≤2 cm; no muscle enzyme >4 times upper limit of normal due to myositis, Health Assessment Questionnaire [HAQ] ≤0.25.
  5. Males or females ≥18 to <80 years of age.
  6. Voluntarily given, fully informed written consent obtained from subject before any study-related procedures are conducted.
  7. Subject must be capable and willing to understand and comply with the relevant aspects of the study protocol.
  Exclusion Criteria:
  1. Cancer-associated myositis, defined as the diagnosis of myositis within 2 years of the diagnosis of cancer (except basal or squamous cell skin cancer or carcinoma in situ of the cervix that has been excised and cured - at least 1 year for basal or squamous cell skin cancer and 5 years for carcinoma in situ of the cervix must have passed since the excision).
  2. Evidence of active malignant disease or malignancies diagnosed within the previous 5 years (including hematological malignancies and solid tumors) or breast cancer diagnosed within the previous 10 years. Subjects >5 years (>10 years for breast cancer) of cancer diagnosis who have been treated and are in remission are allowed.
  3. Subjects with overlap myositis (except for overlap with Sjögren's syndrome), connective tissue disease associated DM, inclusion body myositis, polymyositis, juvenile dermatomyositis or drug-induced myopathy.
  4. Subjects with immune-mediated necrotizing myopathy with absence of typical DM rash.
  5. Subjects with generalized, severe musculoskeletal conditions other than DM that prevent a sufficient assessment of the subject by the physician.
  6. Subjects who received blood or plasma-derived products (other than IGIV) or plasma exchange within the last 3 months before enrolment.
  7. Subjects with administration of permitted concomitant medications exceeding the maximally allowed conditions as per Table 2: see section 4.2.1.
  8. Subjects with administration of forbidden concomitant medications within the washout periods as defined in Table 3: see section 4.2.2.
  9. Subjects starting or planning to start a physical therapy-directed exercise regimen during the trial. Subjects on stable physical therapy for >4 weeks are allowed but the regimen should remain the same throughout the trial.
  10. Cardiac insufficiency (New York Heart Association III/IV), cardiomyopathy, significant cardiac dysrhythmia requiring treatment, unstable or advanced ischemic heart disease.
  11. Severe liver disease, with signs of ascites and hepatic encephalopathy.
  12. Severe kidney disease (as defined by estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2).
  13. Known active or chronic hepatitis B, hepatitis C or HIV infection. Past hepatitis B or C infection that has been cured is allowed.
  14. Subjects with a history of deep vein thrombosis within the last year prior to study enrolment or pulmonary embolism ever.
  15. Body mass index >40 kg/m2 and/or body weight >120 kg.
  16. Medical conditions whose symptoms and effects could alter protein catabolism and/or IgG utilization (e.g. protein-losing enteropathies, nephrotic syndrome).
  17. Known IgA deficiency with antibodies to IgA.
  18. History of hypersensitivity, anaphylaxis or severe systemic response to immuno-globulin, blood or plasma derived products or any component of octanorm 16.5% such as polysorbate 80 or to sodium chloride.
  19. Known blood hyperviscosity, or other hypercoagulable states.
  20. Subjects with a history of drug abuse within the past 5 years prior to study enrolment.
  21. Participating in another interventional clinical study with investigational treatment within 3 months prior to study enrolment. Subjects who participated in the Octagam 10% Dermatomyositis Study (GAM10-08) can be included.
  22. Women who are breast feeding, pregnant, or planning to become pregnant, or are unwilling to apply an effective birth control method (as per protocol section 7.3.9b) up to four weeks after the last IMP infusion received

Relevance to patient case: not relevant