Study of Modified Recombinant Factor VIII (OBI-1) in Subjects With Acquired Hemophilia A
Primary Purpose
Acquired Hemophilia A
Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
OBI-1
Sponsored by
About this trial
This is an interventional treatment trial for Acquired Hemophilia A focused on measuring haemophilia A, blood coagulation disorders, coagulation protein disorder, hemophilia A, Acquired Hemophilia A, hematologic diseases, hemorrhagic disorders
Eligibility Criteria
Inclusion Criteria:
- Written informed consent from subject, trusted person or person who is legally authorized to sign on behalf of the participant (Legal Representative in U.S.), depending on local regulations
- Participants with acquired hemophilia with autoimmune inhibitory antibodies to human factor VIII with a clinical diagnosis established by the following criteria: a) Prolonged activated partial thromboplastin time (aPTT), b) Prothrombin time (PT) ≤ upper limit of normal (ULN) + 2 seconds and platelet count within normal range, c) Abnormal aPTT mixing study (patient-normal control 1:1) consistent with a factor VIII inhibitors reduced factor VIII activity level (below 10%)
- Has a serious bleeding episode, as documented by the investigator
- Be willing and able to follow all instructions and attend all study visits
- Participants taking anti-thrombotics (such as clopidogrel, heparin or heparin analogue) may be included provided three half-lives of the agent have elapsed since the last dose of the agent
- Life expectancy, prior to onset of the hemorrhagic episode, of at least 90 days
- Participants of reproductive age must use acceptable methods of contraception and if female, undergo pregnancy testing as part of the screening process
Exclusion Criteria:
- Hemodynamically unstable after blood transfusion, fluid resuscitation and pharmacologic or volume replacement pressor therapy. This hemodynamic instability is characterized by symptomatic hypotension resulting in vital organ dysfunction, such as cardiac ischemia, oliguria (urine volume <0.5 mL/kg in the previous six hours), central nervous system hypoperfusion manifested by mental status change such as confusion (unless head injury or intracranial hemorrhage is present), pulmonary compromise, and/or acidosis (manifested by pH and lactate levels)
- Has an established reason for bleeding that is not correctable
- Bleeding episode assessed likely to resolve on its own if left untreated
- Anti-OBI-1 inhibitor that exceeds 20 Bethesda Units (BU) (prospectively or retrospectively)
- Subsequent bleeding episode at the site of the initial qualifying bleeding episode within two weeks following the final OBI-1 dose for the initial qualifying bleeding episode, or subsequent bleeding episode at a different site than the initial qualifying bleeding episode within 1 week following the final OBI-1 dose for the initial qualifying bleeding episode will not be considered "new" qualifying bleeding episodes
- Prior history of bleeding disorder other than acquired hemophilia.
- Known major sensitivity to therapeutic products of pig or hamster origin; examples include therapeutics of porcine origin (e.g. previously marketed porcine factor VIII, Hyate-C®) and recombinant therapeutics prepared from hamster cells (e.g. Humira®, Advate® and Enbrel®)
- Use of hemophilia medication: rFVIIa within 3 hours prior to OBI-1 administration or aPCC treatment within 6 hours prior to OBI-1 administration
- Participation in any other clinical study within 30 days of the first OBI-1 treatment
- Anticipated need for treatment or device during the study that may interfere with the evaluation of the safety or efficacy of OBI-1, or whose safety or efficacy may be affected by OBI-1
- Is currently pregnant, breastfeeding, or planning to become pregnant or father a child during the study
- Abnormal baseline findings, any other medical condition(s) or laboratory findings that, in the opinion of the investigator, might jeopardize the subject's safety or decrease the chance of obtaining satisfactory data needed to achieve the objectives of the study
- Inability or unwillingness to comply with the study design, protocol requirements, or the follow-up procedures
- Participant of majority age under legal protection
Sites / Locations
- Indiana Hemophilia and Thrombosis Center
- Louisiana Center for Bleeding & Clotting Disorders
- National Institutes of Health - Warren G. Magnuson Clinical Center
- Tufts Medical Center
- Brigham and Women's Hospital
- University of North Carolina at Chapel Hill Hospital
- The Pennsylvania State University and Milton S. Hershey Medical Center
- Vanderbilt University Medical Center, Hemostasis/Hemophilia Clinic
- Maisonneuve-Rosemont Hospital
- Apollo Hospitals
- Royal Free Hospital-Katharine Dormandy Haemophilia Centre and Thrombosis Unit
- Basingstoke and North Hampshire NHS Foundation Trust
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
OBI-1
Arm Description
Initial dose: 200 U/kg - additional doses at the discretion of the investigator based on FVIII activity level and clinical assessment of response to treatment (upper limit: 400 U/kg every 2 hours)
Outcomes
Primary Outcome Measures
Percentage of Serious Bleeding Episodes Responsive to OBI-1
The initial serious ("qualifying") bleeding episode for each subject was analyzed for the primary efficacy outcome measure. A 'positive response' is defined as 'effective' (bleeding stopped with clinical control and FVIII levels of 50% or higher ) or 'partially effective' (bleeding reduced with clinical stabilization and FVIII levels of 20% or higher) control of bleeding, as determined by the investigator using a 4-point rating scale (effective - partially effective - poorly effective - not effective). 'Poorly effective' is defined as 'bleeding slightly reduced or unchanged and FVIII levels of less than 50%'. 'Not effective' is defined as 'bleeding worsening and FVIII levels of less than 50%'.
Secondary Outcome Measures
Overall Percentage of Serious Bleeding Episodes Successfully Controlled With OBI-1 Therapy, as Assessed by the Investigator
Treatment success was defined as control of qualifying bleeding episode at the time of final treatment dosing. A serious bleeding episode was considered 'successfully controlled' if the investigator had checked 'completed OBI-1 therapy as treatment success' on the eCRF.
Percentage of Serious Bleeding Episodes Responsive to OBI-1 Therapy at Designated Assessment Time Points After the Initiation of Therapy, as Assessed by the Investigator
A 'positive response' is defined as 'effective' (bleeding stopped with clinical control and FVIII levels of 50% or higher ) or 'partially effective' (bleeding reduced with clinical stabilization and FVIII levels of 20% or higher) control of bleeding, as determined by the investigator using a 4-point rating scale (effective - partially effective - poorly effective - not effective). 'Poorly effective' is defined as 'bleeding slightly reduced or unchanged and FVIII levels of less than 50%'. 'Not effective' is defined as 'bleeding worsening and FVIII levels of less than 50%'.
Percentage of Serious Bleeding Episodes Responsive to OBI-1 Therapy at Designated Assessment Time Points After the Initiation of Therapy, as Assessed by the Investigator
A 'positive response' is defined as 'effective' (bleeding stopped with clinical control and FVIII levels of 50% or higher ) or 'partially effective' (bleeding reduced with clinical stabilization and FVIII levels of 20% or higher) control of bleeding, as determined by the investigator using a 4-point rating scale (effective - partially effective - poorly effective - not effective). 'Poorly effective' is defined as 'bleeding slightly reduced or unchanged and FVIII levels of less than 50%'. 'Not effective' is defined as 'bleeding worsening and FVIII levels of less than 50%'.
Frequency of Infusions of OBI-1 Required to Successfully Control Qualifying Bleeding Episodes
'Frequency of infusions' was calculated as the 'average number of infusions per day'. 'Qualifying bleeding episode' was defined as the 'initial, serious bleeding episode'.
Total Dose of OBI-1 Required to Successfully Control 'Qualifying' Bleeding Episodes
'Qualifying bleeding episode' was defined as the 'initial, serious bleeding episode'.
Total Number of Infusions of OBI-1 Required to Successfully Control 'Qualifying' Bleeding Episodes
'Qualifying bleeding episode' was defined as the 'initial, serious bleeding episode'. A serious bleeding episode was considered 'successfully controlled' if the investigator had checked 'completed OBI-1 therapy as treatment success' on the eCRF.
Correlation Between Positive Response to OBI-1 Therapy at 8 Hours and Eventual Control of Serious Bleeding Episodes at 24 Hours
Correlation Between Response to OBI-1 Therapy at 16 Hours and Eventual Control of Serious Bleeding Episodes at 24 Hours
Correlation Between Response to OBI-1 Therapy at Specified Time Points and Eventual Control of Serious Bleeding Episodes at 24 Hours
Correlation Between the Pre-infusion Anti-OBI-1 Antibody Titers, the Total Dose of OBI-1, the Outcome at 24 Hours and the Eventual Control of the Bleeding Episode
Pharmacokinetics (PK) Analysis- Plasma Clearance
Participation in the PK sampling was optional. PK parameters obtained from the non-bleeding state were summarized with descriptive statistics.
PK Analysis- Volume of Distribution (Vd) at Steady State
Participation in the PK sampling was optional. PK parameters obtained from the non-bleeding state were summarized with descriptive statistics.
PK Analysis- Area Under the Concentration-time Curve (AUC) From Time 0 to the Last Measurable Concentration
Participation in the PK sampling was optional. PK parameters obtained from the non-bleeding state were summarized with descriptive statistics. AUC was calculated as area under the percent activity-time curve.
PK Analysis- Terminal Half-life
Participation in the PK sampling was optional. PK parameters obtained from the non-bleeding state were summarized with descriptive statistics. Half-life was calculated as the time it took to reduce percent activity by half.
Number of Participants Who Developed de Novo Anti-OBI-1 Antibody Titers
Number of Participants Who Developed an Anti-host Cell Protein Baby Hamster Kidney (BHK) Antibody Titer
Full Information
NCT ID
NCT01178294
First Posted
August 6, 2010
Last Updated
April 17, 2021
Sponsor
Baxalta now part of Shire
1. Study Identification
Unique Protocol Identification Number
NCT01178294
Brief Title
Study of Modified Recombinant Factor VIII (OBI-1) in Subjects With Acquired Hemophilia A
Official Title
Efficacy and Safety of B-Domain Deleted Recombinant Porcine Factor VIII (OBI-1) in the Treatment of Acquired Hemophilia A Due to Factor VIII Inhibitory Auto-antibodies
Study Type
Interventional
2. Study Status
Record Verification Date
April 2021
Overall Recruitment Status
Completed
Study Start Date
November 10, 2010 (Actual)
Primary Completion Date
July 1, 2013 (Actual)
Study Completion Date
October 9, 2013 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Baxalta now part of Shire
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This study is to test whether the study drug (OBI-1) is safe and effective for the treatment of serious bleeding episodes in people with acquired hemophilia A.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acquired Hemophilia A
Keywords
haemophilia A, blood coagulation disorders, coagulation protein disorder, hemophilia A, Acquired Hemophilia A, hematologic diseases, hemorrhagic disorders
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
29 (Actual)
8. Arms, Groups, and Interventions
Arm Title
OBI-1
Arm Type
Experimental
Arm Description
Initial dose: 200 U/kg - additional doses at the discretion of the investigator based on FVIII activity level and clinical assessment of response to treatment (upper limit: 400 U/kg every 2 hours)
Intervention Type
Biological
Intervention Name(s)
OBI-1
Intervention Description
Intravenous infusion
Primary Outcome Measure Information:
Title
Percentage of Serious Bleeding Episodes Responsive to OBI-1
Description
The initial serious ("qualifying") bleeding episode for each subject was analyzed for the primary efficacy outcome measure. A 'positive response' is defined as 'effective' (bleeding stopped with clinical control and FVIII levels of 50% or higher ) or 'partially effective' (bleeding reduced with clinical stabilization and FVIII levels of 20% or higher) control of bleeding, as determined by the investigator using a 4-point rating scale (effective - partially effective - poorly effective - not effective). 'Poorly effective' is defined as 'bleeding slightly reduced or unchanged and FVIII levels of less than 50%'. 'Not effective' is defined as 'bleeding worsening and FVIII levels of less than 50%'.
Time Frame
24 hours after initiation of treatment
Secondary Outcome Measure Information:
Title
Overall Percentage of Serious Bleeding Episodes Successfully Controlled With OBI-1 Therapy, as Assessed by the Investigator
Description
Treatment success was defined as control of qualifying bleeding episode at the time of final treatment dosing. A serious bleeding episode was considered 'successfully controlled' if the investigator had checked 'completed OBI-1 therapy as treatment success' on the eCRF.
Time Frame
At the time of final treatment dosing (varied from participant to participant depending on bleeding episodes)
Title
Percentage of Serious Bleeding Episodes Responsive to OBI-1 Therapy at Designated Assessment Time Points After the Initiation of Therapy, as Assessed by the Investigator
Description
A 'positive response' is defined as 'effective' (bleeding stopped with clinical control and FVIII levels of 50% or higher ) or 'partially effective' (bleeding reduced with clinical stabilization and FVIII levels of 20% or higher) control of bleeding, as determined by the investigator using a 4-point rating scale (effective - partially effective - poorly effective - not effective). 'Poorly effective' is defined as 'bleeding slightly reduced or unchanged and FVIII levels of less than 50%'. 'Not effective' is defined as 'bleeding worsening and FVIII levels of less than 50%'.
Time Frame
8 hours
Title
Percentage of Serious Bleeding Episodes Responsive to OBI-1 Therapy at Designated Assessment Time Points After the Initiation of Therapy, as Assessed by the Investigator
Description
A 'positive response' is defined as 'effective' (bleeding stopped with clinical control and FVIII levels of 50% or higher ) or 'partially effective' (bleeding reduced with clinical stabilization and FVIII levels of 20% or higher) control of bleeding, as determined by the investigator using a 4-point rating scale (effective - partially effective - poorly effective - not effective). 'Poorly effective' is defined as 'bleeding slightly reduced or unchanged and FVIII levels of less than 50%'. 'Not effective' is defined as 'bleeding worsening and FVIII levels of less than 50%'.
Time Frame
16 hours
Title
Frequency of Infusions of OBI-1 Required to Successfully Control Qualifying Bleeding Episodes
Description
'Frequency of infusions' was calculated as the 'average number of infusions per day'. 'Qualifying bleeding episode' was defined as the 'initial, serious bleeding episode'.
Time Frame
Time of successful control of qualifying bleeding episode (varied from participant to participant)
Title
Total Dose of OBI-1 Required to Successfully Control 'Qualifying' Bleeding Episodes
Description
'Qualifying bleeding episode' was defined as the 'initial, serious bleeding episode'.
Time Frame
Time of successful control of qualifying bleeding episode (varied from participant to participant)
Title
Total Number of Infusions of OBI-1 Required to Successfully Control 'Qualifying' Bleeding Episodes
Description
'Qualifying bleeding episode' was defined as the 'initial, serious bleeding episode'. A serious bleeding episode was considered 'successfully controlled' if the investigator had checked 'completed OBI-1 therapy as treatment success' on the eCRF.
Time Frame
Time of successful control of qualifying bleeding episode (varied from participant to participant)
Title
Correlation Between Positive Response to OBI-1 Therapy at 8 Hours and Eventual Control of Serious Bleeding Episodes at 24 Hours
Time Frame
24 hours
Title
Correlation Between Response to OBI-1 Therapy at 16 Hours and Eventual Control of Serious Bleeding Episodes at 24 Hours
Time Frame
24 hours
Title
Correlation Between Response to OBI-1 Therapy at Specified Time Points and Eventual Control of Serious Bleeding Episodes at 24 Hours
Time Frame
24 hours
Title
Correlation Between the Pre-infusion Anti-OBI-1 Antibody Titers, the Total Dose of OBI-1, the Outcome at 24 Hours and the Eventual Control of the Bleeding Episode
Time Frame
Through 90 days ± 7 days following final OBI-1 dose
Title
Pharmacokinetics (PK) Analysis- Plasma Clearance
Description
Participation in the PK sampling was optional. PK parameters obtained from the non-bleeding state were summarized with descriptive statistics.
Time Frame
Pre-infusion 15-20 minutes, Post-infusion 1, 3, 6, 12, 18, 24 hours
Title
PK Analysis- Volume of Distribution (Vd) at Steady State
Description
Participation in the PK sampling was optional. PK parameters obtained from the non-bleeding state were summarized with descriptive statistics.
Time Frame
Pre-infusion 15-20 minutes, Post-infusion 1, 3, 6, 12, 18, 24 hours
Title
PK Analysis- Area Under the Concentration-time Curve (AUC) From Time 0 to the Last Measurable Concentration
Description
Participation in the PK sampling was optional. PK parameters obtained from the non-bleeding state were summarized with descriptive statistics. AUC was calculated as area under the percent activity-time curve.
Time Frame
Pre-infusion 15-20 minutes, Post-infusion 1, 3, 6, 12, 18, 24 hours
Title
PK Analysis- Terminal Half-life
Description
Participation in the PK sampling was optional. PK parameters obtained from the non-bleeding state were summarized with descriptive statistics. Half-life was calculated as the time it took to reduce percent activity by half.
Time Frame
Pre-infusion 15-20 minutes, Post-infusion 1, 3, 6, 12, 18, 24 hours
Title
Number of Participants Who Developed de Novo Anti-OBI-1 Antibody Titers
Time Frame
Through 90 days ± 7 days following final OBI-1 dose
Title
Number of Participants Who Developed an Anti-host Cell Protein Baby Hamster Kidney (BHK) Antibody Titer
Time Frame
Through 90 days ± 7 days following final OBI-1 dose
Other Pre-specified Outcome Measures:
Title
Anti-human Factor VIII Antibody Titer
Time Frame
Through 90 days ± 7 days following final OBI-1 dose
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Written informed consent from subject, trusted person or person who is legally authorized to sign on behalf of the participant (Legal Representative in U.S.), depending on local regulations
Participants with acquired hemophilia with autoimmune inhibitory antibodies to human factor VIII with a clinical diagnosis established by the following criteria: a) Prolonged activated partial thromboplastin time (aPTT), b) Prothrombin time (PT) ≤ upper limit of normal (ULN) + 2 seconds and platelet count within normal range, c) Abnormal aPTT mixing study (patient-normal control 1:1) consistent with a factor VIII inhibitors reduced factor VIII activity level (below 10%)
Has a serious bleeding episode, as documented by the investigator
Be willing and able to follow all instructions and attend all study visits
Participants taking anti-thrombotics (such as clopidogrel, heparin or heparin analogue) may be included provided three half-lives of the agent have elapsed since the last dose of the agent
Life expectancy, prior to onset of the hemorrhagic episode, of at least 90 days
Participants of reproductive age must use acceptable methods of contraception and if female, undergo pregnancy testing as part of the screening process
Exclusion Criteria:
Hemodynamically unstable after blood transfusion, fluid resuscitation and pharmacologic or volume replacement pressor therapy. This hemodynamic instability is characterized by symptomatic hypotension resulting in vital organ dysfunction, such as cardiac ischemia, oliguria (urine volume <0.5 mL/kg in the previous six hours), central nervous system hypoperfusion manifested by mental status change such as confusion (unless head injury or intracranial hemorrhage is present), pulmonary compromise, and/or acidosis (manifested by pH and lactate levels)
Has an established reason for bleeding that is not correctable
Bleeding episode assessed likely to resolve on its own if left untreated
Anti-OBI-1 inhibitor that exceeds 20 Bethesda Units (BU) (prospectively or retrospectively)
Subsequent bleeding episode at the site of the initial qualifying bleeding episode within two weeks following the final OBI-1 dose for the initial qualifying bleeding episode, or subsequent bleeding episode at a different site than the initial qualifying bleeding episode within 1 week following the final OBI-1 dose for the initial qualifying bleeding episode will not be considered "new" qualifying bleeding episodes
Prior history of bleeding disorder other than acquired hemophilia.
Known major sensitivity to therapeutic products of pig or hamster origin; examples include therapeutics of porcine origin (e.g. previously marketed porcine factor VIII, Hyate-C®) and recombinant therapeutics prepared from hamster cells (e.g. Humira®, Advate® and Enbrel®)
Use of hemophilia medication: rFVIIa within 3 hours prior to OBI-1 administration or aPCC treatment within 6 hours prior to OBI-1 administration
Participation in any other clinical study within 30 days of the first OBI-1 treatment
Anticipated need for treatment or device during the study that may interfere with the evaluation of the safety or efficacy of OBI-1, or whose safety or efficacy may be affected by OBI-1
Is currently pregnant, breastfeeding, or planning to become pregnant or father a child during the study
Abnormal baseline findings, any other medical condition(s) or laboratory findings that, in the opinion of the investigator, might jeopardize the subject's safety or decrease the chance of obtaining satisfactory data needed to achieve the objectives of the study
Inability or unwillingness to comply with the study design, protocol requirements, or the follow-up procedures
Participant of majority age under legal protection
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Study Director
Organizational Affiliation
Takeda
Official's Role
Study Director
Facility Information:
Facility Name
Indiana Hemophilia and Thrombosis Center
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46260
Country
United States
Facility Name
Louisiana Center for Bleeding & Clotting Disorders
City
New Orleans
State/Province
Louisiana
ZIP/Postal Code
70112-2699
Country
United States
Facility Name
National Institutes of Health - Warren G. Magnuson Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892-1508
Country
United States
Facility Name
Tufts Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02111
Country
United States
Facility Name
Brigham and Women's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
University of North Carolina at Chapel Hill Hospital
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599-7305
Country
United States
Facility Name
The Pennsylvania State University and Milton S. Hershey Medical Center
City
Hershey
State/Province
Pennsylvania
ZIP/Postal Code
17033
Country
United States
Facility Name
Vanderbilt University Medical Center, Hemostasis/Hemophilia Clinic
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232-9830
Country
United States
Facility Name
Maisonneuve-Rosemont Hospital
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H1T 2M4
Country
Canada
Facility Name
Apollo Hospitals
City
Chennai
State/Province
Tamil Nadu
ZIP/Postal Code
600006
Country
India
Facility Name
Royal Free Hospital-Katharine Dormandy Haemophilia Centre and Thrombosis Unit
City
London
State/Province
England
ZIP/Postal Code
NW3 2QG
Country
United Kingdom
Facility Name
Basingstoke and North Hampshire NHS Foundation Trust
City
Basingstoke
State/Province
Hampshire/England
ZIP/Postal Code
RG249NA
Country
United Kingdom
12. IPD Sharing Statement
Citations:
PubMed Identifier
25623166
Citation
Kruse-Jarres R, St-Louis J, Greist A, Shapiro A, Smith H, Chowdary P, Drebes A, Gomperts E, Bourgeois C, Mo M, Novack A, Farin H, Ewenstein B. Efficacy and safety of OBI-1, an antihaemophilic factor VIII (recombinant), porcine sequence, in subjects with acquired haemophilia A. Haemophilia. 2015 Mar;21(2):162-170. doi: 10.1111/hae.12627. Epub 2015 Jan 27.
Results Reference
result
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Study of Modified Recombinant Factor VIII (OBI-1) in Subjects With Acquired Hemophilia A
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