search
Back to results

Gene Therapy for Haemophilia A. (GO-8)

Primary Purpose

Hemophilia A

Status
Recruiting
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
AAV2/8-HLP-FVIII-V3
Sponsored by
University College, London
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hemophilia A

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion criteria:

I. Adult males, ≥ 18 years of age; confirmed diagnosis of severe HA (baseline plasma hFVIII levels of <1% of normal; assessed by a one-stage clotting or chromogenic assay) resulting from gene mutations that have a low risk for inhibitor development, such as intron 22 inversions, intron 1 inversions, splice-site mutations, small deletions/insertions, duplications and missense mutations; II. A severe bleeding phenotype as defined by at least one of the following: (a) On prophylaxis for a history of bleeding or (b) On demand therapy with a current or past history of 4 or more bleeding episodes/year or (c) evidence of chronic haemophilic arthropathy (pain, joint damage, and loss of range of motion) III. Received treatment with hFVIII concentrates with at least >50 exposure days; IV. Able to give full informed consent and able to comply with all requirements of the trial including 5-year long-term follow-up; V. Willing to practice barrier contraception until at least three consecutive semen samples after vector administration are below the sensitivity of the assay for vector sequences;

Exclusion criteria:

VI. Presence of neutralising anti-hFVIII antibodies (inhibitor, determined by the Bethesda inhibitor assay) at the time of enrolment or a previous history of hFVIII inhibitor; VII. Severe haemophilia A patients with large deletions (multiple exons) and nonsense mutations of the F8 gene.

VIII. Use of investigational therapy for haemophilia within 30 days before enrolment; IX. Subjects with active hepatitis B or C, and HBsAg or HCV RNA viral load positivity, respectively or currently on antiviral therapy for hepatitis B or C. (Negative viral assays in two samples, collected at least six months apart, will be required to be considered negative. Both natural clearers and those who have cleared HCV on antiviral therapy are eligible).

X. Serological evidence of HIV; XI. Evidence of liver dysfunction (persistently elevated ALT >1.5X upper limit of normal); XII. Uncontrolled glaucoma, diabetes mellitus, or hypertension (systolic BP consistently ≥140 mmHg or diastolic BP consistently ≥90 mmHg); XIII. Any disease or condition (including cancer) at the physician's discretion that would prevent the patient from fully complying with the requirements of the study.; XIV. Suspicious lung lesions on CT scan that raise the possibility of cancer or premalignant pathology (based on chest CT scan done at screening or within 6 months prior to the screening visit) XV. Presence of liver abnormality that is suspicious of malignancy on screening liver ultrasound XVI. Patients with uncontrolled cardiac failure or unstable angina; XVII. Detectable neutralising anti-AAV8 antibodies XVIII. Received an AAV vector, or any other gene transfer agent in the previous 6 months XIX. History of active tuberculosis, fungal disease or other chronic infection XX. Subjects who are unwilling to provide the required semen samples XXI. Poor performance status (WHO score >1) XXII. Patients at high risk of thromboembolic events (high risk patients would include those with a history of arterial or venous thromboembolism (e.g. deep vein thrombosis, pulmonary embolism, non-haemorrhagic stroke, arterial embolus) and those with acquired thrombophilia including conditions such as atrial fibrillation).

XXIII. Patients with a CHA2DS2-VASc score of 2 and above

Sites / Locations

  • St. Luke'S Regional Medical Center, Ltd
  • University of KentuckyRecruiting
  • St Jude's Children's Research HospitalRecruiting
  • Royal Free HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment Arm

Arm Description

Treatment with AAV2/8-HLP-FVIII-V3

Outcomes

Primary Outcome Measures

Safety - Dose Limiting Toxicity possibly attributable to the gene therapy
Toxicity will be assessed according to CTCAE, version 4.03 based on the monitoring schedule which comprises a number of clinical and laboratory evaluations
Safety - Neutralising anti-hFVIII antibody development following gene therapy
The presence of neutralising hFVIII antibodies will be assessed by regular laboratory tests during patient follow up post infusion

Secondary Outcome Measures

Plasma hFVIII activity
Assessments of plasma hFVIII activity
Bleeding frequency
Assessment of bleeding frequency using participant diaries before and after gene transfer
hFVIII concentrate usage
Assessment of hFVIII concentrate usage as per participant treatment records before and after gene transfer
Immune response to the AAV8 capsid.
Immune response to the AAV8 capsid will be assessed by measurement of the AAV8 antibody titre (humoral response) in plasma samples collected at various time points after gene transfer. Cellular immune response to AAV capsid will be determined using gamma interferon (IFNγ) ELIspot assay to AAV8 capsid
Viral shedding
Serum and bodily secretions will be collected to assess clearance of vector genomes

Full Information

First Posted
December 9, 2016
Last Updated
October 23, 2023
Sponsor
University College, London
Collaborators
Medical Research Council
search

1. Study Identification

Unique Protocol Identification Number
NCT03001830
Brief Title
Gene Therapy for Haemophilia A.
Acronym
GO-8
Official Title
GO-8: Gene Therapy for Haemophilia A Using a Novel Serotype 8 Capsid Pseudotyped Adeno-associated Viral Vector Encoding Factor VIII-V3
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 14, 2017 (Actual)
Primary Completion Date
January 2029 (Anticipated)
Study Completion Date
December 2029 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University College, London
Collaborators
Medical Research Council

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The GO-8 study focuses on assessing safety and efficacy of gene therapy for patients with severe haemophilia A
Detailed Description
Haemophilia A is an x-linked, life threatening bleeding disorder arising from defects in the coagulation factor VIII (FVIII) gene. Current treatment for haemophilia A, the commonest inherited bleeding disorder (prevalence of 1 in 5000 individuals) consists of life-long, 2-3 times/week, intravenous injection of clotting factor concentrates, which is demanding and expensive. In contrast, gene therapy offers the potential of a cure for haemophilia A. In a previous gene therapy study in haemophilia B the investigators showed that a single intravenous administration of a serotype 8 based adeno-associated virus, (AAV8) vector encoding the factor IX (FIX) gene resulted in stable (>6 years) therapeutic expression of FIX without long-lasting toxicity. The investigators plan to use the same AAV8 platform to evaluate a novel FVIII expression cassette, AAV2/8-HLP-FVIII-V3, in patient with haemophilia A. Extensive preclinical studies demonstrate that AAV2/8-HLP-FVIII-V3 leads to long-term, endogenous expression of FVIII in mouse and non-human primate models without toxicity even when twenty-fold higher doses than the proposed starting clinical trial dose were used. Therefore, an open label, Phase I/II dose escalation study entailing a single systemic administration of AAV2/8-HLP-FVIII-V3 in adults (>18 years of age) with severe haemophilia A who have baseline factor FVIII levels of <1% of normal has been designed to establish safety and efficacy of our approach. Dosing will begin at 6x10^11 vector genome (vg)/kg progressing sequentially to 2x10^12vg/kg and ultimately 6x10^12vg/kg in the absence of toxicity. A minimum of 2 patients will be recruited at each dose with a possibility of expanding the dose cohort to a maximum of 6 patients based on safety and efficacy. The study duration for each patient will be 5 years after vector infusion.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hemophilia A

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
18 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment Arm
Arm Type
Experimental
Arm Description
Treatment with AAV2/8-HLP-FVIII-V3
Intervention Type
Biological
Intervention Name(s)
AAV2/8-HLP-FVIII-V3
Intervention Description
Infusion of AAV2/8-HLP-FVIII-V3
Primary Outcome Measure Information:
Title
Safety - Dose Limiting Toxicity possibly attributable to the gene therapy
Description
Toxicity will be assessed according to CTCAE, version 4.03 based on the monitoring schedule which comprises a number of clinical and laboratory evaluations
Time Frame
Up to 5 years post-infusion
Title
Safety - Neutralising anti-hFVIII antibody development following gene therapy
Description
The presence of neutralising hFVIII antibodies will be assessed by regular laboratory tests during patient follow up post infusion
Time Frame
Up to 5 years post-infusion
Secondary Outcome Measure Information:
Title
Plasma hFVIII activity
Description
Assessments of plasma hFVIII activity
Time Frame
Regularly up to 5 years post-infusion
Title
Bleeding frequency
Description
Assessment of bleeding frequency using participant diaries before and after gene transfer
Time Frame
Annual review for 5 years
Title
hFVIII concentrate usage
Description
Assessment of hFVIII concentrate usage as per participant treatment records before and after gene transfer
Time Frame
Annual review for 5 years
Title
Immune response to the AAV8 capsid.
Description
Immune response to the AAV8 capsid will be assessed by measurement of the AAV8 antibody titre (humoral response) in plasma samples collected at various time points after gene transfer. Cellular immune response to AAV capsid will be determined using gamma interferon (IFNγ) ELIspot assay to AAV8 capsid
Time Frame
Weeks 3, 6, 9 & 12, month 6 and annually post-infusion to Year 5
Title
Viral shedding
Description
Serum and bodily secretions will be collected to assess clearance of vector genomes
Time Frame
Weekly from 7 days post infusion until sample clearance.

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: I. Adult males, ≥ 18 years of age; confirmed diagnosis of severe haemophilia A (baseline plasma hFVIII levels of <1% of normal; assessed by a one-stage clotting or chromogenic assay) II. A severe bleeding phenotype as defined by at least one of the following: (a) On prophylaxis for a history of bleeding or (b) On demand therapy with a current or past history of 4 or more bleeding episodes/year or (c) evidence of chronic haemophilic arthropathy (pain, joint damage, and loss of range of motion) III. Received treatment with hFVIII concentrates with at least >50 exposure days; IV. Able to give full informed consent and able to comply with all requirements of the trial including 5-year long-term follow-up; V. Willing to practice barrier contraception until at least three consecutive semen samples after vector administration are below the sensitivity of the assay for vector sequences. Exclusion criteria: VI. Presence of neutralising anti-hFVIII antibodies (inhibitor, determined by the Bethesda inhibitor assay) at the time of enrolment or a previous history of hFVIII inhibitor on at least two occasions that required clinical management ; VII. Use of investigational therapy for haemophilia within 30 days before enrolment; VIII. Subjects with active hepatitis B or C, and HBsAg or hepatitis C RNA viral load positivity, respectively or currently on antiviral therapy for hepatitis B or C. (Negative viral assays in two samples, collected at least six months apart, will be required to be considered negative. Both natural clearers and those who have cleared hepatitis C on antiviral therapy are eligible). IX. Serological evidence of HIV; X. Evidence of liver dysfunction (persistently elevated alanine transaminase >1.5 times upper limit of normal); XI. Uncontrolled glaucoma, diabetes mellitus, or hypertension (systolic BP consistently ≥140 mmHg or diastolic BP consistently ≥90 mmHg); XII. Any disease or condition (including cancer) at the physician's discretion that would prevent the patient from fully complying with the requirements of the study.; XIII. Suspicious lung lesions on CT scan that raise the possibility of cancer or premalignant pathology (based on chest CT scan done at screening or within 6 months prior to the screening visit) XIV. Presence of liver abnormality that is suspicious of malignancy on screening liver ultrasound XV. Patients with uncontrolled cardiac failure or unstable angina; XVI. Detectable neutralising anti-AAV8 antibodies XVII. Received an AAV vector, or any other gene transfer agent in the previous 6 months except for vaccines XVIII. History of active tuberculosis, fungal disease or other chronic infection XIX. Subjects who are unwilling to provide the required semen samples XX. Poor performance status (WHO score >1) XXI. Patients at high risk of thromboembolic events (high risk patients would include those with a history of arterial or venous thromboembolism (e.g. deep vein thrombosis, pulmonary embolism, non-haemorrhagic stroke, arterial embolus) and those with acquired thrombophilia including conditions such as atrial fibrillation). XXII. Patients with a CHA2DS2-VASc score of 2 and above
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Joanna Calvert
Phone
020 7794 0500
Ext
38784
Email
joanna.calvert@nhs.net
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pratima Chowdary, MD
Organizational Affiliation
Royal Free London NHS Foundation Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
St. Luke'S Regional Medical Center, Ltd
City
Boise
State/Province
Idaho
ZIP/Postal Code
83712
Country
United States
Individual Site Status
Active, not recruiting
Facility Name
University of Kentucky
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40506
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Vlad Radulescu, MD
Facility Name
St Jude's Children's Research Hospital
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38105-3678
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ulrike Reiss, MD
First Name & Middle Initial & Last Name & Degree
Andrew Davidoff, MD
Facility Name
Royal Free Hospital
City
London
ZIP/Postal Code
NW3 2QG
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pratima Chowdary
First Name & Middle Initial & Last Name & Degree
Amit Nathwani
First Name & Middle Initial & Last Name & Degree
Edward Tuddenham

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Gene Therapy for Haemophilia A.

We'll reach out to this number within 24 hrs