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RecruitingInterventionalPhase 3

A Randomized, Double-blind, Placebo-controlled Phase III Study to Evaluate the Efficacy, Safety, and Tolerability of Iptacopan in Patients With Generalized Myasthenia Gravis, Followed by an Open-label Extension Phase

NCT ID: NCT06517758Sponsor: Novartis PharmaceuticalsLast updated: 2026-05-27

Summary

The study is a randomized, double-blind, placebo-controlled, multicenter, Phase III study, to evaluate efficacy, safety and tolerability of iptacopan in patients with AChR+ gMG who are on stable SOC treatment. Participants who meet the eligibility criteria will be randomized in a ratio of 1:1, to receive either iptacopan or matching placebo, for 6 months (180 days) while continuing on a stable SOC treatment. The randomization will be stratified based on region.

Detailed description

The study consists of a 6-month double-blind treatment period for the primary efficacy and safety analysis followed by a maximum duration of 60 month open label extension period. A safety follow up assessment will be performed, one 7 days after the last administration of study treatment and one 30 days after the last administration of study treatment for all participants.

Arms & interventions

  • DrugIptacopan

    Hard gelatin capsule

  • OtherMatching Placebo

    Hard gelatin capsule

Outcome measures

Primary

  • Change from baseline to Month 6 in Myasthenia Gravis Activity of Daily Living (MG-ADL) total score

    The MG-ADL is an 8 item interviewer led patient reporting scale that assesses MG symptoms and their effects on daily activities. MG-ADL is composed of items related to patient's assessment of functional disability secondary to ocular (2 items), bulbar (3 items), respiratory (1 item), and gross motor or limb (2 items) impairment related to effects from MG. Each item is assessed on a 4-points scale where a score 0 represents normal function and a score 3 represents loss of ability to perform that function. The scores ranges from 0 to 24, with a higher score indicating more disability.

    Time frame: Baseline to Month 6

Secondary

  • Change from baseline to Month 6 in Quantitative MG (QMG) total score

    Time frame: Baseline to Month 6

  • Proportion of participants with ≥ 5 points reduction from baseline to Month 6 of QMG total score without rescue medication and/or strongly confounding prohibited medication

    Time frame: Baseline to Month 6

  • Proportion of participants with ≥ 3 points reduction from baseline to Month 6 of MG-ADL total score without rescue medication and/or strongly confounding prohibited medication

    Time frame: Baseline to Month 6

  • Proportion of participants achieving MSE at Month 6, defined as MG-ADL score of 0 or 1 at Month 6 without rescue therapy and/or strongly confounding prohibited medication

    Time frame: Baseline to Month 6

  • Change from baseline to Month 6 in Myasthenia Gravis Composite (MGC) total score

    Time frame: Baseline to Month 6

  • Change from baseline to Month 6 in revised MG Quality of Life Questionnaire (MG-QOL15r) survey score

    Time frame: Baseline to Month 6

  • Incidence of adverse events

    Time frame: Baseline to Month 6

  • Proportion of time during which participants showed a reduction of ≥ 2 points in MG-ADL total score that was maintained up to Month 6

    Time frame: Baseline to Month 6

  • Proportion of early MG-ADL responders during treatment (early responders with first MG-ADL improvement from baseline of ≥ 2 points occurring by week 4)

    Time frame: Baseline to Month 6

  • Change from baseline to Month 6 in EuroQol-5 Dimensions-5 Level (EQ-5D-5L)

    Time frame: Baseline to Month 6

  • Proportion of participants with a reduction of ≥ 3 points from baseline to Month 6 in MGC total score

    Time frame: Baseline to month 6

  • Change from baseline in MG-ADL total score

    Time frame: Baseline to Month 66 (end of extension phase)

  • Proportion of participants achieving a reduction in oral corticosteroids (OCS) dose compared to Core Part that was maintained up to end of Extension Part

    Time frame: Month 6 (end of core phase) to Month 30 (end of extension phase)

  • Incidence of adverse events

    Time frame: Baseline to Month 30 (end of extension phase)

Eligibility criteria

Sex: AllAge: 18 Years to 85 YearsHealthy volunteers: No
Inclusion Criteria: * Adult patients with generalized Myasthenia Gravis (age 18-85 years) at screening * Positive serology testing for AChR+ antibody at screening * Myasthenia Gravis Foundation of America (MGFA) Class II-IV gMG at screening and likely not in need of a respirator for the duration of the study, as judged by the Investigator. * The confirmation of the diagnosis of gMG should be documented and supported by ≥1 of the following 3 tests: * History of abnormal neuromuscular transmission demonstrated by single-fiber electromyography or repetitive nerve stimulation. * History of positive test with short-acting acetylcholinesterase inhibitors (e.g. neostigmine or edrophonium chloride) * Patient has demonstrated improvement in MG signs on oral acetylcholinesterase inhibitors as assessed by the treating physician. * Baseline MG-ADL score ≥6, with ≥50% of the total score due to non-ocular symptoms * Participants receiving at least one of the following treatments for gMG for ≥ 6 months prior to baseline; * One or more NSISTs or * plasmapheresis, plasma exchange, or intravenous immunoglobulin (at least quarterly) to control symptoms despite treatment with steroids and NSISTs; or * an approved FcRN antagonist approved for gMG; or * rituximab or * other approved gMG disease modifying therapies excluding complement inhibitors. * Vaccination against Neisseria meningitidis and Streptococcus pneumoniae infection is required prior to the start of study treatment. If the participant has not been previously vaccinated, or if a booster was required, the vaccine should be given according to local guidelines at least 2 weeks prior to first study drug administration. If study treatment has to start earlier than 2 weeks post-vaccination, prophylactic antibiotic treatment should be initiated at the start of study treatment and continued until at least 2 weeks after vaccination or booster was completed. Note: For US sites participating in Study CLNP023Q12301, the completion of the meningococcal vaccination or booster is required for patients with gMG prior to initiating study treatment, irrespective of prophylactic antibiotic use. Exclusion Criteria: * Have been treated with intravenous immunoglobulin (IVIG)/plasma exchange (PLEX) in the past month, with rituximab in the past 6 months, eculizumab in the past 2 months, ravulizumab or other complement inhibitors in the past 3 months, efgartigimod or other anti- FcRn therapies in the past 3 months, or had a thymectomy in the past 6 months or a planned thymectomy during the trial period. * Participants with clinically significant active or chronic uncontrolled bacterial, viral, or fungal infection at screening, including patients who test positive for an active viral infection at screening with: Active Hepatitis B Virus (HBV); Active Hepatitis C Virus (HCV); * Human Immunodeficiency Virus (HIV) positive serology associated with an Acquired Immune Deficiency Syndrome (AIDS)-defining condition or with a cluster of differentiation 4 (CD4) count * 200 cells/mm3 * Female participants who are pregnant or lactating, or are intending to become pregnant. * Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant from menarche until becoming post-menopausal, unless they are using effective methods of contraception during dosing of study treatment and an additional one week following cessation of study treatment. Women are considered post-menopausal if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g., hormonal profile confirming menopause and/or age-appropriate history of vasomotor symptoms). * Active systemic bacterial, viral (including COVID-19) or fungal infection or any major episode of infection that required hospitalization or injectable antimicrobial therapy within 14 days prior to study drug administration. * History of recurrent invasive infections caused by encapsulated organisms, e.g., N. meningitidis and S. pneumoniae. * Presence of fever ≥ 38 °C (100.4 °F) within 7 days prior to study drug administration

Study locations (21)

Honor Health Research Institute

Scottsdale, Arizona, 85258

Recruiting
Kristy Osgood · Contact
Suraj Muley · Principal Investigator

Fullerton Neuro and Headache Ctr

Fullerton, California, 92835

Recruiting
Alexandra Vasquez · Contact
Jack H Florin · Principal Investigator

SC3 Research Pasadena

Pasadena, California, 91105

Recruiting
Charles Krinel · Contact
M Lorraine Purino · Principal Investigator

California Pacific Medical Center

Sacramento, California, 94115

Recruiting
· Contact
Liberty Jenkins · Principal Investigator

Neurology Offices Of South Florida

Boca Raton, Florida, 33428

Withdrawn

Superior Associates in Research LLC

Hialeah, Florida, 33012

Withdrawn

Augusta University Georgia

Augusta, Georgia, 30912

Recruiting
Christian Ryan · Contact
Benjamin Barnes · Principal Investigator

Hawaii Pacific Neuroscience LLC

Honolulu, Hawaii, 96817

Withdrawn

University of Chicago Medical Centr

Chicago, Illinois, 60637

Recruiting
Kourosh Rezania · Principal Investigator

Prairie Heart Institute

Springfield, Illinois, 62769

Recruiting
Raghav Govindarajan · Principal Investigator

Mid Atlantic Epilepsy and Sleep Ctr

Bethesda, Maryland, 20817-1807

Recruiting
Jonathan Ross · Principal Investigator

Massachusetts General Hospital

Boston, Massachusetts, 02114

Recruiting
Amanda Guidon · Principal Investigator

Henry Ford Health System

Detroit, Michigan, 48202

Recruiting
· Contact
Kavita Grover · Principal Investigator

Duke University Medical Center

Durham, North Carolina, 27710

Recruiting
Kinjal Patel · Contact
Shruti Raja · Principal Investigator

Neuroscience Research Ctr

Canton, Ohio, 44718

Withdrawn

Ohio State University Medical Center

Columbus, Ohio, 43210

Withdrawn

Penn Presbyterian Medical Center

Philadelphia, Pennsylvania, 19104

Recruiting
Sami Khella · Principal Investigator

Vanderbilt University Medical CenterX

Nashville, Tennessee, 37221

Recruiting
Amanda Peltier · Principal Investigator

Nerve and Muscle Center of Texas

Houston, Texas, 77030

Recruiting
Amy Megerle · Contact
Aziz Shaibani. · Principal Investigator

Central TX Neuro Consultants P A

Round Rock, Texas, 78681

Withdrawn

Center for Neurological Disorders G

Greenfield, Wisconsin, 53228-1321

Recruiting
Bhupendra Khatri · Principal Investigator