Investigating Efficacy and Safety of Once-weekly NNC0195-0092 (Somapacitan) Treatment Compared to Daily Growth Hormone Treatment (Norditropin® FlexPro®) in Growth Hormone Treatment naïve Pre-pubertal Children With Growth Hormone Deficiency
Investigating Efficacy and Safety of Once-weekly NNC0195-0092 (Somapacitan) Treatment Compared to Daily Growth Hormone Treatment (Norditropin® FlexPro®) in Growth Hormone Treatment naïve Pre-pubertal Children With Growth Hormone Deficiency
This trial is conducted globally. The aim of the trial is to investigate efficacy and safety
 of once-weekly NNC0195-0092 (somapacitan) treatment compared to daily growth hormone
 treatment (Norditropin® FlexPro®) in growth hormone treatment naïve pre-pubertal children
 with growth hormone deficiency.

 The trial consists of a 26 week main trial period, followed by a 26 week extension trial
 period, a 104 week safety extension period, a 208 week longterm safety extension trial period
 and a 30 day follow up period. Participants receive NNC0195-0092 (somapacitan) (0.04
 mg/kg/week) during the main trial and the extension period and thereafter NNC0195-0092
 (somapacitan) (0.16 mg/kg/week) during the safety extension and the long-term safety
 extension periods. Two additional age groups, cohort II (age below 2 years and 26 weeks at
 screening) and cohort III (above 9 years (girls)/ above 10 years (boys) and equal to or below
 17 years at screening) are included in the 208 week long-term safety extension trial period
 only.
Inclusion Criteria:

 Cohort I:

 -  Boys: Tanner stage 1 for pubic hair and testis volume below 4 ml , age at least 2
 years and 26 weeks and below or equal to 10.0 years at screening

 -  Girls: Tanner stage 1 for breast development (no palpable glandular breast tissue) and
 pubic hair, age at least 2 years and 26 weeks and below or equal to 9.0 years at
 screening

 -  Confirmed diagnosis of GHD (growth hormone deficiency) within 12 months prior to
 screening as determined by two different GH (growth hormone) stimulation tests,
 defined as a peak GH level of below or equal to 7.0 ng/ml. For children with three or
 more pituitary hormone deficiencies only one GH stimulation test is needed

 -  No prior exposure to GH therapy and/or IGF-I (insulin-like growth factor I) treatment

 -  Height of at least 2.0 standard deviations below the mean height for chronological age
 (CA) and gender according to the standards of Centers for Disease Control and
 Prevention 2-20 years: Girls/Boys stature-for-age and weight-for-age percentiles CDC
 at screening

 -  Annualized height velocity (HV) below the 25th percentile for CA (chronological age)
 and gender or below -0.7 SD (standard deviation) score for CA and sex, according to
 the standards of Prader calculated over a time span of minimum 6 months and maximum 18
 months

 Cohort II:

 -  Below 2 years and 26 weeks and a minimum weight of 5 kg at screening.

 -  Confirmed diagnosis of GHD, the GHD diagnosis must be confirmed by investigator
 according to local practice.

 -  For GH treatment naïve subjects, no prior exposure to GH therapy and/or IGF-I
 treatment.

 -  For GH treatment naïve subjects, IGF-1 SDS below -1.0 at screening, compared to age
 and sex normalized range according to central laboratory measurements.

 Cohort III:

 Age:

 -  Girls: Above 9 years and below or equal to 17 years at screening.

 -  Boys: Above 10 years and below or equal to 17 years at screening.

 -  Confirmed diagnosis of GHD

 1. for GH treatment naïve subjects, confirmed diagnosis within 12 months prior to
 screening as determined by two different GH stimulation tests, defined as a peak
 GH level of equal to or below 7.0 ng/ml. For children with three or more
 pituitary hormone deficiencies only one GH stimulation test is needed. FOR JAPAN
 ONLY: Confirmed diagnosis of GHD within 12 months prior to screening as
 determined by one GH stimulation tests for patients with intracranial organic
 disease or symptomatic hypoglycaemia and two different GH stimulation test for
 other patients, defined as a peak GH level of equal to or below 6 ng/ml by assay
 using recombinant GH standard.

 2. for non-GH treatment naïve subjects, confirmed GHD diagnosis by investigator
 according to local practice

 -  For GH treatment naïve subjects, no prior exposure to GH therapy and/or IGF-I
 treatment.

 -  Open epiphyses; defined as bone age below 14 years for females and bone age below 16
 years for males.

 Exclusion Criteria:

 -  Any clinically significant abnormality likely to affect growth or the ability to
 evaluate

 -  growth with standing/length measurements: Chromosomal aneuploidy and significant gene
 mutations causing medical "syndromes" with short stature, including but not limited to
 Turner syndrome, Laron syndrome, Noonan syndrome, or absence of GH receptors.
 Congenital abnormalities (causing skeletal abnormalities), including but not limited
 to Russell-Silver Syndrome, skeletal dysplasias. Significant spinal abnormalities
 including but not limited to scoliosis, kyphosis and spina bifida variants

 -  Children born small for gestational age (SGA - birth weight and/or birth length
 below-2 SD for gestational age)

 -  Concomitant administration of other treatments that may have an effect on growth (not
 applicable to non-GH treatment naïve subjects in cohort II and III), including but not
 limited to methylphenidate for treatment of attention deficit hyperactivity disorder
 (ADHD)

 -  Prior history or presence of malignancy and/or intracranial tumour