Efficacy and Safety Study of BERIPLEX® P/N (Kcentra) Compared With Plasma in Patients With Acute Major Bleeding Caused by Anticoagulant Therapy
Primary Purpose
Blood Coagulation Disorders, Acute Major Bleeding
Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Beriplex® P/N (Kcentra)
Fresh frozen plasma
Sponsored by
About this trial
This is an interventional treatment trial for Blood Coagulation Disorders focused on measuring Anticoagulant reversal, Prothrombin, Complex, Concentrate, Coagulopathy, induced by, coumarin, derivatives, Kcentra
Eligibility Criteria
Inclusion Criteria:
- Male and female subjects ≥ 18 years
- Subjects who have received oral vitamin K-antagonist therapy
- Subjects who have acute major bleeding, defined as one of the following: life-threatening or potentially life-threatening, acute bleeding associated with a fall in hemoglobin (Hb) level ≥ 2g/dL, bleeding requiring blood product transfusion
- INR ≥ 2 within 3 hours before start of study treatment
- Informed consent has been obtained
Exclusion Criteria:
- Expected survival of less than 3 days, or expected surgery in less than 1 day
- Acute trauma for which reversal of vitamin K antagonists alone would not be expected to control the acute bleeding event
- Use of unfractionated or low molecular weight heparin use from 24 hours prior to enrollment or expected need within 24 hours after start of infusion
- For patients with ICH: Glasgow coma score (GCS) < 7; intracerebral hematoma volume > 30cc as assessed by ABC/21; for subdural hematomas: maximum thickness ≥ 10 mm, midline shift ≥ 5 mm; for subarachnoid hemorrhage: any evidence of hydrocephalus; infratentorial ICH location; epidural hematomas; intraventricular extension of hemorrhage; modified Rankin score (mRS) of >3 prior to ICH
- History of thrombotic event, myocardial infarction, disseminated intravascular coagulation, cerebral vascular accident, transient ischemic attack, unstable angina pectoris, or severe peripheral vascular disease within 3 months of enrollment
- Known history of antiphospholipid antibody syndrome or lupus anticoagulant antibodies
- Suspected or confirmed sepsis at time of enrollment
- Administration of whole blood, plasma, plasma fractions or platelets within 2 weeks prior to inclusion into the study
- Large blood vessel rupture (e.g. in advanced cancer patient)
- Pre-existing progressive fatal disease with a life expectancy of less than 2 months
- Known inhibitors to coagulation factors II, VII, IX, or X; or hereditary protein C or protein S deficiency; or heparin-induced, type II thrombocytopenia
- Treatment with any other investigational medicinal product within 30 days prior to inclusion into the study
- Presence or history of hypersensitivity to components of the study medication
- Pregnant or breast-feeding women
- Prior inclusion in this study or any other CSL Behring-sponsored Beriplex study
Sites / Locations
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- Study Site 2
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Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Beriplex® P/N
Fresh frozen plasma
Arm Description
Outcomes
Primary Outcome Measures
Percentage of Participants Achieving Hemostatic Efficacy of Stopping an Ongoing Major Bleed
Hemostatic efficacy was determined by a blinded independent board as excellent, good, or poor/none, based on prespecified definitions. Assessments of visible or non-visible musculoskeletal bleeding were made at 1 and 4 hours after the end of infusion. Hemostatic efficacy was the binary endpoint of effective or non-effective hemostasis, where 'effective' was a hemostatic efficacy rating of "excellent" or "good," and 'non-effective' was a hemostatic efficacy rating of "poor/none".
Percentage of Participants Who Had a Rapid Decrease of the International Normalized Ratio (INR)
A rapid decrease of the international normalized ratio (INR) was defined as an INR ≤ 1.3 at 30 minutes after the end of the infusion. The INR is a standard way to describe the time it takes for blood to clot; an INR range of 0.8 to 1.2 is considered normal for a healthy person who is not using oral anticoagulant therapy.
Secondary Outcome Measures
Percentage of Participants Who Had Hemostatic Efficacy for Visible or Non-visible Musculoskeletal Bleeding
Hemostatic efficacy was determined by a blinded independent board as excellent, good, or poor/none, based on prespecified definitions. Assessments of visible or non-visible musculoskeletal bleeding were made at 3 and 6 hours after the start of infusion. Hemostatic efficacy was the binary endpoint of effective or non-effective hemostasis, where 'effective' was a hemostatic efficacy rating of "excellent" or "good," and 'non-effective' was a hemostatic efficacy rating of "poor/none".
Incremental in Vivo Recovery (IVR) (Response) of Factors II, VII, IX, and X, Protein C, and Protein S for Beriplex
The incremental IVR [(IU/dL)/(IU/kg)] was calculated as follows: (IU/dL activity rise in plasma)/(IU/kg body weight infused) = [maximum increase in component plasma level within 3 hours compared to pre-infusion (IU/dL)]/{[exact dose of component in drug administered (IU)]/[body weight (kg)]}.
Plasma Levels of Factors II, VII, IX, and X, Protein C, and Protein S
Plasma levels are presented as the percentage of normal at pre-infusion and 30 min and 24 h after the start of infusion. The plasma level assay results are reported as a potency relative to a standard, where 100% is considered to be normal.
Percentage of Participants With INR Correction at Various Times After the Start of Infusion
The time taken from the start of infusion to INR correction (defined as an INR ≤ 1.3) was recorded. The percentage of participants with INR correction was calculated at 0.5, 1, 3, 6, 12, and 24 h after the start of infusion.
Percentage of Participants With INR Correction at Various Times After Randomization
The time taken from randomization to INR correction (defined as an INR ≤ 1.3) was recorded. The percentage of participants with INR correction was calculated at 2.5, 3, 5, 8, 14, and 26 h after randomization.
Transfusion of Red Blood Cells
Red blood cells were packed red blood cells (PRBCs).
Use of Other Blood Products and Hemostatic Agents
Other blood products and hemostatic agents containing coagulation factors (such as whole blood, plasma, albumin, platelets) not including PRBCs.
45-Day All-cause Mortality
Overall Treatment-emergent Adverse Events (TEAEs)
Number of participants with TEAEs. Treatment-related AEs were defined as events whose relationship to study treatment was definitely related, probably related, or possibly related in the opinion of the investigator. AEs with missing relationship were considered related to treatment. Serious TEAEs were treatment-emergent SAEs. Deaths reported up to and including Day 45; one additional Beriplex death occurred after Day 45.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT00708435
Brief Title
Efficacy and Safety Study of BERIPLEX® P/N (Kcentra) Compared With Plasma in Patients With Acute Major Bleeding Caused by Anticoagulant Therapy
Official Title
An Open-label, Randomized, Multicenter Phase IIIb Study to Assess the Efficacy, Safety and Tolerance of BERIPLEX® P/N Compared With Plasma for Rapid Reversal of Coagulopathy Induced by Coumarin Derivatives in Subjects With Acute Major Bleeding
Study Type
Interventional
2. Study Status
Record Verification Date
September 2013
Overall Recruitment Status
Completed
Study Start Date
June 2008 (undefined)
Primary Completion Date
November 2010 (Actual)
Study Completion Date
November 2010 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
CSL Behring
4. Oversight
5. Study Description
Brief Summary
The purpose of this study is to evaluate efficacy, safety and tolerance of BERIPLEX® P/N (Kcentra) compared with plasma in regard to rapid reversal of coagulopathy induced by coumarin derivatives in subjects who require immediate correction of INR (International Normalized Ratio)and to stop an acute major bleeding.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Blood Coagulation Disorders, Acute Major Bleeding
Keywords
Anticoagulant reversal, Prothrombin, Complex, Concentrate, Coagulopathy, induced by, coumarin, derivatives, Kcentra
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
216 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Beriplex® P/N
Arm Type
Experimental
Arm Title
Fresh frozen plasma
Arm Type
Active Comparator
Intervention Type
Biological
Intervention Name(s)
Beriplex® P/N (Kcentra)
Other Intervention Name(s)
Kcentra
Intervention Description
Intravenous infusion, dosage depending on baseline INR, amount of coagulation factor IX and body weight
Intervention Type
Biological
Intervention Name(s)
Fresh frozen plasma
Intervention Description
Intravenous Infusion, dosage depending on baseline INR and body weight
Primary Outcome Measure Information:
Title
Percentage of Participants Achieving Hemostatic Efficacy of Stopping an Ongoing Major Bleed
Description
Hemostatic efficacy was determined by a blinded independent board as excellent, good, or poor/none, based on prespecified definitions. Assessments of visible or non-visible musculoskeletal bleeding were made at 1 and 4 hours after the end of infusion. Hemostatic efficacy was the binary endpoint of effective or non-effective hemostasis, where 'effective' was a hemostatic efficacy rating of "excellent" or "good," and 'non-effective' was a hemostatic efficacy rating of "poor/none".
Time Frame
At 1 and 4 hours after the end of infusion
Title
Percentage of Participants Who Had a Rapid Decrease of the International Normalized Ratio (INR)
Description
A rapid decrease of the international normalized ratio (INR) was defined as an INR ≤ 1.3 at 30 minutes after the end of the infusion. The INR is a standard way to describe the time it takes for blood to clot; an INR range of 0.8 to 1.2 is considered normal for a healthy person who is not using oral anticoagulant therapy.
Time Frame
30 minutes after end of infusion
Secondary Outcome Measure Information:
Title
Percentage of Participants Who Had Hemostatic Efficacy for Visible or Non-visible Musculoskeletal Bleeding
Description
Hemostatic efficacy was determined by a blinded independent board as excellent, good, or poor/none, based on prespecified definitions. Assessments of visible or non-visible musculoskeletal bleeding were made at 3 and 6 hours after the start of infusion. Hemostatic efficacy was the binary endpoint of effective or non-effective hemostasis, where 'effective' was a hemostatic efficacy rating of "excellent" or "good," and 'non-effective' was a hemostatic efficacy rating of "poor/none".
Time Frame
At 3 and 6 hours after the start of infusion
Title
Incremental in Vivo Recovery (IVR) (Response) of Factors II, VII, IX, and X, Protein C, and Protein S for Beriplex
Description
The incremental IVR [(IU/dL)/(IU/kg)] was calculated as follows: (IU/dL activity rise in plasma)/(IU/kg body weight infused) = [maximum increase in component plasma level within 3 hours compared to pre-infusion (IU/dL)]/{[exact dose of component in drug administered (IU)]/[body weight (kg)]}.
Time Frame
Before infusion and up to 3 h after the start of infusion
Title
Plasma Levels of Factors II, VII, IX, and X, Protein C, and Protein S
Description
Plasma levels are presented as the percentage of normal at pre-infusion and 30 min and 24 h after the start of infusion. The plasma level assay results are reported as a potency relative to a standard, where 100% is considered to be normal.
Time Frame
From preinfusion until 24 h after the start of infusion
Title
Percentage of Participants With INR Correction at Various Times After the Start of Infusion
Description
The time taken from the start of infusion to INR correction (defined as an INR ≤ 1.3) was recorded. The percentage of participants with INR correction was calculated at 0.5, 1, 3, 6, 12, and 24 h after the start of infusion.
Time Frame
From the start of infusion until INR correction; calculated at 0.5, 1, 3, 6, 12, and 24 h after the start of infusion.
Title
Percentage of Participants With INR Correction at Various Times After Randomization
Description
The time taken from randomization to INR correction (defined as an INR ≤ 1.3) was recorded. The percentage of participants with INR correction was calculated at 2.5, 3, 5, 8, 14, and 26 h after randomization.
Time Frame
From randomization until INR correction; calculated at 2.5, 3, 5, 8, 14, and 26 h after randomization.
Title
Transfusion of Red Blood Cells
Description
Red blood cells were packed red blood cells (PRBCs).
Time Frame
From the start of infusion until 24 h after the start of infusion
Title
Use of Other Blood Products and Hemostatic Agents
Description
Other blood products and hemostatic agents containing coagulation factors (such as whole blood, plasma, albumin, platelets) not including PRBCs.
Time Frame
From the start of infusion until 24 h after the start of infusion
Title
45-Day All-cause Mortality
Time Frame
Until Day 45
Title
Overall Treatment-emergent Adverse Events (TEAEs)
Description
Number of participants with TEAEs. Treatment-related AEs were defined as events whose relationship to study treatment was definitely related, probably related, or possibly related in the opinion of the investigator. AEs with missing relationship were considered related to treatment. Serious TEAEs were treatment-emergent SAEs. Deaths reported up to and including Day 45; one additional Beriplex death occurred after Day 45.
Time Frame
From the start of infusion up to the allowed time window of the Day 10 visit for non-serious AEs and from the start of infusion up to the allowed time window of the Day 45 visit for SAEs.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male and female subjects ≥ 18 years
Subjects who have received oral vitamin K-antagonist therapy
Subjects who have acute major bleeding, defined as one of the following: life-threatening or potentially life-threatening, acute bleeding associated with a fall in hemoglobin (Hb) level ≥ 2g/dL, bleeding requiring blood product transfusion
INR ≥ 2 within 3 hours before start of study treatment
Informed consent has been obtained
Exclusion Criteria:
Expected survival of less than 3 days, or expected surgery in less than 1 day
Acute trauma for which reversal of vitamin K antagonists alone would not be expected to control the acute bleeding event
Use of unfractionated or low molecular weight heparin use from 24 hours prior to enrollment or expected need within 24 hours after start of infusion
For patients with ICH: Glasgow coma score (GCS) < 7; intracerebral hematoma volume > 30cc as assessed by ABC/21; for subdural hematomas: maximum thickness ≥ 10 mm, midline shift ≥ 5 mm; for subarachnoid hemorrhage: any evidence of hydrocephalus; infratentorial ICH location; epidural hematomas; intraventricular extension of hemorrhage; modified Rankin score (mRS) of >3 prior to ICH
History of thrombotic event, myocardial infarction, disseminated intravascular coagulation, cerebral vascular accident, transient ischemic attack, unstable angina pectoris, or severe peripheral vascular disease within 3 months of enrollment
Known history of antiphospholipid antibody syndrome or lupus anticoagulant antibodies
Suspected or confirmed sepsis at time of enrollment
Administration of whole blood, plasma, plasma fractions or platelets within 2 weeks prior to inclusion into the study
Large blood vessel rupture (e.g. in advanced cancer patient)
Pre-existing progressive fatal disease with a life expectancy of less than 2 months
Known inhibitors to coagulation factors II, VII, IX, or X; or hereditary protein C or protein S deficiency; or heparin-induced, type II thrombocytopenia
Treatment with any other investigational medicinal product within 30 days prior to inclusion into the study
Presence or history of hypersensitivity to components of the study medication
Pregnant or breast-feeding women
Prior inclusion in this study or any other CSL Behring-sponsored Beriplex study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Program Director, Clinical R&D
Organizational Affiliation
CSL Behring
Official's Role
Study Director
Facility Information:
Facility Name
Study Site
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35248-3280
Country
United States
Facility Name
Study Site
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
Study Site
City
San Franciso
State/Province
California
ZIP/Postal Code
94115
Country
United States
Facility Name
Study Site
City
Newark
State/Province
Delaware
ZIP/Postal Code
19718
Country
United States
Facility Name
Study Site
City
Orlando
State/Province
Florida
ZIP/Postal Code
32806
Country
United States
Facility Name
Study Site
City
Tampa
State/Province
Florida
ZIP/Postal Code
33606
Country
United States
Facility Name
Study Site
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Study Site
City
Oak Park
State/Province
Illinois
ZIP/Postal Code
60302
Country
United States
Facility Name
Study Site
City
Hazard
State/Province
Kentucky
ZIP/Postal Code
41701
Country
United States
Facility Name
Study Site
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21201
Country
United States
Facility Name
Study Site
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21205
Country
United States
Facility Name
Study Site
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Study Site
City
Worchester
State/Province
Massachusetts
ZIP/Postal Code
01655
Country
United States
Facility Name
Study Site
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48106
Country
United States
Facility Name
Study Site
City
Royal Oak
State/Province
Michigan
ZIP/Postal Code
48073
Country
United States
Facility Name
Study Site
City
Duluth
State/Province
Minnesota
ZIP/Postal Code
55805
Country
United States
Facility Name
Study Site
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55114
Country
United States
Facility Name
Study Site
City
Jackson
State/Province
Mississippi
ZIP/Postal Code
39216
Country
United States
Facility Name
Study Site
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Study Site
City
Albuquerque
State/Province
New Mexico
ZIP/Postal Code
87131
Country
United States
Facility Name
Study Site
City
Albany
State/Province
New York
ZIP/Postal Code
12208
Country
United States
Facility Name
Study Site
City
Johnson City
State/Province
New York
ZIP/Postal Code
13790
Country
United States
Facility Name
Study Site
City
New York
State/Province
New York
ZIP/Postal Code
10003
Country
United States
Facility Name
Study Site
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
Study Site
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
Study Site
City
Rochester
State/Province
New York
ZIP/Postal Code
14642
Country
United States
Facility Name
Study Site
City
Staten Island
State/Province
New York
ZIP/Postal Code
10305
Country
United States
Facility Name
Study Site
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Study Site
City
Allentown
State/Province
Pennsylvania
ZIP/Postal Code
18103
Country
United States
Facility Name
Study Site
City
Hershey
State/Province
Pennsylvania
ZIP/Postal Code
17033
Country
United States
Facility Name
Study Site
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
Study Site
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19140
Country
United States
Facility Name
Study Site
City
West Reading
State/Province
Pennsylvania
ZIP/Postal Code
19611
Country
United States
Facility Name
Study Site
City
Austin
State/Province
Texas
ZIP/Postal Code
78701
Country
United States
Facility Name
Study Site
City
El Paso
State/Province
Texas
ZIP/Postal Code
79905
Country
United States
Facility Name
Study Site 2
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Study Site
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Study Site
City
Temple
State/Province
Texas
ZIP/Postal Code
76508
Country
United States
Facility Name
Study Site
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States
Facility Name
Study Site
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States
Facility Name
Study Site
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23298
Country
United States
Facility Name
Study Site 1
City
Minsk
Country
Belarus
Facility Name
Study Site 2
City
Minsk
Country
Belarus
Facility Name
Study Site
City
Pleven
Country
Bulgaria
Facility Name
Study Site
City
Plovdiv
Country
Bulgaria
Facility Name
Study Site
City
Rousse
Country
Bulgaria
Facility Name
Study Site 1
City
Sofia
Country
Bulgaria
Facility Name
Study Site 2
City
Sofia
Country
Bulgaria
Facility Name
Study Site 3
City
Sofia
Country
Bulgaria
Facility Name
Study Site 4
City
Sofia
Country
Bulgaria
Facility Name
Study Site
City
Brasov
Country
Romania
Facility Name
Study Site 1
City
Bucharest
Country
Romania
Facility Name
Study Site 2
City
Bucharest
Country
Romania
Facility Name
Study Site 3
City
Bucharest
Country
Romania
Facility Name
Study Site
City
Cluj-Napoca
Country
Romania
Facility Name
Study Site
City
Timisoara
Country
Romania
Facility Name
Study Site
City
Arkhangelsk
Country
Russian Federation
Facility Name
Study Site 1
City
Barnaul
Country
Russian Federation
Facility Name
Study Site 2
City
Barnaul
Country
Russian Federation
Facility Name
Study Site
City
Kazan
Country
Russian Federation
Facility Name
Study Site
City
Kemerovo
ZIP/Postal Code
650002
Country
Russian Federation
Facility Name
Study Site 1
City
Moscow
Country
Russian Federation
Facility Name
Study Site 2
City
Moscow
Country
Russian Federation
Facility Name
Study Site 1
City
Nizhny Novgorod
Country
Russian Federation
Facility Name
Study Site 2
City
Nizhny Novgorod
Country
Russian Federation
Facility Name
Study Site 1
City
St. Petersburg
Country
Russian Federation
Facility Name
Study Site 2
City
St. Petersburg
Country
Russian Federation
Facility Name
Study Site
City
Kharkov
Country
Ukraine
Facility Name
Study Site
City
Vinnytsa
Country
Ukraine
12. IPD Sharing Statement
Citations:
PubMed Identifier
23935011
Citation
Sarode R, Milling TJ Jr, Refaai MA, Mangione A, Schneider A, Durn BL, Goldstein JN. Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation. 2013 Sep 10;128(11):1234-43. doi: 10.1161/CIRCULATIONAHA.113.002283. Epub 2013 Aug 9.
Results Reference
result
Links:
URL
http://www.cslbehring.com/clinical-trials/contact-us.htm?registryRefNum=NCT00708435®istryName=ctgov
Description
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Efficacy and Safety Study of BERIPLEX® P/N (Kcentra) Compared With Plasma in Patients With Acute Major Bleeding Caused by Anticoagulant Therapy
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