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Study to Evaluate the Efficacy and Safety of Deferasirox Film-coated Tablet Versus Phlebotomy in Patients With Hereditary Hemochromatosis (HH)

Primary Purpose

Hereditary Hemochromatosis

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Deferasirox FCT
Phlebotomy
Sponsored by
Novartis Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hereditary Hemochromatosis focused on measuring hereditary hemochromatosis, ICL670, deferasirox FCT, iron overload

Eligibility Criteria

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

Inclusion Criteria:

Written informed consent must be obtained prior to any screening procedures.

Patients eligible for inclusion must meet all following criteria prior to receiving study treatment:

1. Male or female ≥ 18-years-old 2. Documented genotype testing confirming homozygous for the C282Y mutation (C282Y/C282Y) 3. Transferrin saturation ≥ 45% (at either screening visit) 4. Serum ferritin (SF) ≥ 500 μg/L (at either screening visit)

-

Exclusion Criteria:

  1. Medical conditions that preclude inclusion:

    • Iron overload not due to HH
    • Condition which might significantly alter the absorption, distribution, metabolism or excretion of oral deferasirox
    • Systemic disease which prevents taking study treatment or any contraindication to phlebotomy
    • Inflammatory condition or immunological disease which may interfere with the SF interpretation, such as an active infection, collagen vascular disorders, irritable bowel syndrome, lupus, or immune thrombocytopenia
    • Significantly impaired gastrointestinal function or disease that may significantly alter the absorption of oral deferasirox, e.g. ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection.
    • Psychiatric or addictive disorder which prevent giving informed consent or undergoing any of the treatment options or unwilling or unable to comply with the protocol
    • Uncontrolled or significant cardiac disease or symptomatic cardiac arrhythmias, e.g., sustained ventricular tachycardia and clinically significant second or third degree AV block without a pacemaker.
    • Illicit drug use and/or alcohol use, defined as an average alcohol consumption greater than one standard drink a day for women or two standard drinks a day for men within the 12 months prior to enrolment. A standard drink is generally considered to be 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits
    • Cirrhosis, including Child-Pugh class A, B, and C, diagnosed by liver biopsy, elastography, radiologic exams, or clinical criteria
    • Active hepatitis B or C (hepatitis B carrier will be allowed)
    • History of HIV seropositivity (ELISA or Western blot)
    • Organ transplant recipient
    • Malignancy of any organ system, treated or untreated, within the past 5 years whether or not there is evidence of local recurrence or metastases, except localized basal cell carcinoma of the skin, or any history of hepatocellular carcinoma
  2. Concomitant therapy that precludes enrollment:

    • Prior iron chelation therapy
    • Prohibited concomitant medications with deferasirox
  3. Abnormal Laboratory Values:

    • Significant anemia that contraindicates phlebotomy (males with hemoglobin < 130g/L, females with hemoglobin < 120g/L) in both screening visit samples
    • Platelets ≤ 50 x 109/L in both screening visit samples
    • Urine protein/urine creatinine ratio > 1.0 mg/mg in both non-first void urine screening visit samples
    • Creatinine clearance ≤ 40 ml/min, or use the locally approved contraindication limit in prescribing information if it is stricter, in both screening visit samples
    • Serum creatinine > 1.5 x ULN in both screening visit samples
    • ALT ≥ 5 x ULN in both screening visit samples
    • Total bilirubin > 1.5 x ULN in both screening visit samples
  4. Participation in an investigational study:

    • Observational registry study is allowable
    • Within 30 days prior to enrollment or within 5-half-lives of an investigational product, whichever is longer
    • Treatment with a systemic investigational drug within 4 weeks or topical investigational drug within 7 days of starting the study
  5. Pregnancy and contraception:

    • Pregnant or nursing (lactating) women
    • Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless using basic methods of contraception, such as:
    • Total abstinence Periodic abstinence (calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are unacceptable methods.
    • Female sterilization (bilateral oophorectomy with or without hysterectomy), total hysterectomy, or tubal ligation at least six weeks before taking study treatment. If oophorectomy alone, hormone levels must confirm menopause.
    • Male sterilization (at least 6 months prior to screening). The vasectomized male must be the sole partner.
    • Barrier methods of contraception: condom or occlusive cap For UK: spermicidal foam/gel/film/cream/vaginal suppository
    • Placement of an intrauterine device or intrauterine system
    • Women considered as post-menopausal and not of childbearing potential are allowed to be enrolled in the trial if they have had 12 months of natural (spontaneous) amenorrhea with an expected clinical profile, e.g., age appropriate and history of vasomotor symptoms.

Other protocol-defined inclusion/exclusion may apply. -

Sites / Locations

  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Deferasirox FCT Arm

phlebotomy

Arm Description

randomized in a 2:1 ratio: Deferasirox or phebotomy

randomized in a 2:1 ratio: Deferasirox or phebotomy

Outcomes

Primary Outcome Measures

Response rate by month 24
Percentage of participants achieving target serum ferritin (SF) ≤ 100 μg/L on or before 24 months.

Secondary Outcome Measures

Percentage of participants with ocular adverse events (AEs)
Percentage of participants with at least one ocular AE (new or worsening from baseline) occurring during on-treatment period. On-treatment period: from the day of the first dose of study medication or the first phlebotomy to 30 days after the last dose of study medication or last phlebotomy.
Change from baseline at months 6, 12, 18 and 24 in visual acuity
Visual acuity will be measured using a Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The ETDRS letter score is based on the number of letters correctly identified from specified distances. Higher scores correspond to better visual acuity.
Change from baseline at months 6, 12, 18 and 24 in intra-ocular pressure
Intraocular pressure will be measured by tonometry for each eye side.
Number of participants with and without opacity
A slit lamp examination with Lens Opacities Classification System III (LOCS III) will be used to assess lens opacities. The number of patients with and without opacity will be provided
Number of participants with and without abnormality in the fundus occuli
The number of patients with and without abnormalities in the fundus oculi will be provided
Percentage of participants who interrupt due to reaching target SF ≤ 100 μg/L and re-initiate therapy when ≥ 300 μg/L
Percentage of participants who interrupt deferasirox FCT at least once due to SF level ≤ 100 μg/L and the re-initiate therapy at SF level ≥ 300 μg/L
Time to response (TTR)
TTR defined as the time from the date of randomization to the date of the first time the SF is achieving a value ≤ 100 μg/L during the treatment phase

Full Information

First Posted
June 22, 2017
Last Updated
May 17, 2023
Sponsor
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT03203850
Brief Title
Study to Evaluate the Efficacy and Safety of Deferasirox Film-coated Tablet Versus Phlebotomy in Patients With Hereditary Hemochromatosis (HH)
Official Title
A Phase II, Multicenter, Open-label, Randomized Two-year Study to Evaluate the Efficacy and Safety of Deferasirox Film-coated Tablet Versus Phlebotomy in Patients With Hereditary Hemochromatosis.
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
January 11, 2018 (Actual)
Primary Completion Date
April 17, 2023 (Actual)
Study Completion Date
April 17, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis Pharmaceuticals

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to evaluate the efficacy and safety of deferasirox film coated tablet (FCT) versus phlebotomy for the management of iron overload in adults with HH at risk of iron-related morbidity. This evaluation will provide information on the two treatment options in terms of the rate of response of proportion of patients reaching the study target SF ≤ 100 μg/L and their associated safety profiles. In addition to exploring the safety and efficacy of deferasirox FCT in hereditary hemochromatosis (HH), this study is being conducted to fulfill an FDA post-marketing requirement [PMC 750-10 (Exjade) /PMR 2888-8 (Jadenu)] to provide additional randomized data to confirm the ocular safety profile of deferasirox through detailed ocular assessments in patients treated with deferasirox FCT for 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hereditary Hemochromatosis
Keywords
hereditary hemochromatosis, ICL670, deferasirox FCT, iron overload

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
45 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Deferasirox FCT Arm
Arm Type
Experimental
Arm Description
randomized in a 2:1 ratio: Deferasirox or phebotomy
Arm Title
phlebotomy
Arm Type
Experimental
Arm Description
randomized in a 2:1 ratio: Deferasirox or phebotomy
Intervention Type
Drug
Intervention Name(s)
Deferasirox FCT
Other Intervention Name(s)
ICL670
Intervention Description
Taken orally once per day (QD)
Intervention Type
Procedure
Intervention Name(s)
Phlebotomy
Intervention Description
according to investigator's decision
Primary Outcome Measure Information:
Title
Response rate by month 24
Description
Percentage of participants achieving target serum ferritin (SF) ≤ 100 μg/L on or before 24 months.
Time Frame
Up to 24 months
Secondary Outcome Measure Information:
Title
Percentage of participants with ocular adverse events (AEs)
Description
Percentage of participants with at least one ocular AE (new or worsening from baseline) occurring during on-treatment period. On-treatment period: from the day of the first dose of study medication or the first phlebotomy to 30 days after the last dose of study medication or last phlebotomy.
Time Frame
24 months
Title
Change from baseline at months 6, 12, 18 and 24 in visual acuity
Description
Visual acuity will be measured using a Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The ETDRS letter score is based on the number of letters correctly identified from specified distances. Higher scores correspond to better visual acuity.
Time Frame
At Months 6, 12, 18 and 24
Title
Change from baseline at months 6, 12, 18 and 24 in intra-ocular pressure
Description
Intraocular pressure will be measured by tonometry for each eye side.
Time Frame
At Months 6, 12, 18 and 24
Title
Number of participants with and without opacity
Description
A slit lamp examination with Lens Opacities Classification System III (LOCS III) will be used to assess lens opacities. The number of patients with and without opacity will be provided
Time Frame
At Months 6, 12, 18 and 24
Title
Number of participants with and without abnormality in the fundus occuli
Description
The number of patients with and without abnormalities in the fundus oculi will be provided
Time Frame
At Months 6, 12, 18 and 24
Title
Percentage of participants who interrupt due to reaching target SF ≤ 100 μg/L and re-initiate therapy when ≥ 300 μg/L
Description
Percentage of participants who interrupt deferasirox FCT at least once due to SF level ≤ 100 μg/L and the re-initiate therapy at SF level ≥ 300 μg/L
Time Frame
Up to 24 months
Title
Time to response (TTR)
Description
TTR defined as the time from the date of randomization to the date of the first time the SF is achieving a value ≤ 100 μg/L during the treatment phase
Time Frame
Up to 24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent must be obtained prior to any screening procedures. Patients eligible for inclusion must meet all following criteria prior to receiving study treatment: 1. Male or female ≥ 18-years-old 2. Documented genotype testing confirming homozygous for the C282Y mutation (C282Y/C282Y) 3. Transferrin saturation ≥ 45% (at either screening visit) 4. Serum ferritin (SF) ≥ 500 μg/L (at either screening visit) - Exclusion Criteria: Medical conditions that preclude inclusion: Iron overload not due to HH Condition which might significantly alter the absorption, distribution, metabolism or excretion of oral deferasirox Systemic disease which prevents taking study treatment or any contraindication to phlebotomy Inflammatory condition or immunological disease which may interfere with the SF interpretation, such as an active infection, collagen vascular disorders, irritable bowel syndrome, lupus, or immune thrombocytopenia Significantly impaired gastrointestinal function or disease that may significantly alter the absorption of oral deferasirox, e.g. ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection. Psychiatric or addictive disorder which prevent giving informed consent or undergoing any of the treatment options or unwilling or unable to comply with the protocol Uncontrolled or significant cardiac disease or symptomatic cardiac arrhythmias, e.g., sustained ventricular tachycardia and clinically significant second or third degree AV block without a pacemaker. Illicit drug use and/or alcohol use, defined as an average alcohol consumption greater than one standard drink a day for women or two standard drinks a day for men within the 12 months prior to enrolment. A standard drink is generally considered to be 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits Cirrhosis, including Child-Pugh class A, B, and C, diagnosed by liver biopsy, elastography, radiologic exams, or clinical criteria Active hepatitis B or C (hepatitis B carrier will be allowed) History of HIV seropositivity (ELISA or Western blot) Organ transplant recipient Malignancy of any organ system, treated or untreated, within the past 5 years whether or not there is evidence of local recurrence or metastases, except localized basal cell carcinoma of the skin, or any history of hepatocellular carcinoma Concomitant therapy that precludes enrollment: Prior iron chelation therapy Prohibited concomitant medications with deferasirox Abnormal Laboratory Values: Significant anemia that contraindicates phlebotomy (males with hemoglobin < 130g/L, females with hemoglobin < 120g/L) in both screening visit samples Platelets ≤ 50 x 109/L in both screening visit samples Urine protein/urine creatinine ratio > 1.0 mg/mg in both non-first void urine screening visit samples Creatinine clearance ≤ 40 ml/min, or use the locally approved contraindication limit in prescribing information if it is stricter, in both screening visit samples Serum creatinine > 1.5 x ULN in both screening visit samples ALT ≥ 5 x ULN in both screening visit samples Total bilirubin > 1.5 x ULN in both screening visit samples Participation in an investigational study: Observational registry study is allowable Within 30 days prior to enrollment or within 5-half-lives of an investigational product, whichever is longer Treatment with a systemic investigational drug within 4 weeks or topical investigational drug within 7 days of starting the study Pregnancy and contraception: Pregnant or nursing (lactating) women Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless using basic methods of contraception, such as: Total abstinence Periodic abstinence (calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are unacceptable methods. Female sterilization (bilateral oophorectomy with or without hysterectomy), total hysterectomy, or tubal ligation at least six weeks before taking study treatment. If oophorectomy alone, hormone levels must confirm menopause. Male sterilization (at least 6 months prior to screening). The vasectomized male must be the sole partner. Barrier methods of contraception: condom or occlusive cap For UK: spermicidal foam/gel/film/cream/vaginal suppository Placement of an intrauterine device or intrauterine system Women considered as post-menopausal and not of childbearing potential are allowed to be enrolled in the trial if they have had 12 months of natural (spontaneous) amenorrhea with an expected clinical profile, e.g., age appropriate and history of vasomotor symptoms. Other protocol-defined inclusion/exclusion may apply. -
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Novartis Pharmaceuticals
Organizational Affiliation
Novartis Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Novartis Investigative Site
City
Leuven
ZIP/Postal Code
3000
Country
Belgium
Facility Name
Novartis Investigative Site
City
Limoges cedex
ZIP/Postal Code
87042
Country
France
Facility Name
Novartis Investigative Site
City
Rennes
ZIP/Postal Code
35043
Country
France
Facility Name
Novartis Investigative Site
City
Sibiu
ZIP/Postal Code
550245
Country
Romania
Facility Name
Novartis Investigative Site
City
Moscow
ZIP/Postal Code
125167
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
Bratislava
ZIP/Postal Code
831 01
Country
Slovakia
Facility Name
Novartis Investigative Site
City
Bratislava
ZIP/Postal Code
85107
Country
Slovakia
Facility Name
Novartis Investigative Site
City
Manresa
State/Province
Espana
ZIP/Postal Code
08241
Country
Spain
Facility Name
Novartis Investigative Site
City
Baracaldo
State/Province
Vizcaya
ZIP/Postal Code
48903
Country
Spain
Facility Name
Novartis Investigative Site
City
Las Palmas de Gran Canaria
ZIP/Postal Code
35010
Country
Spain
Facility Name
Novartis Investigative Site
City
Lugano
ZIP/Postal Code
6900
Country
Switzerland

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com

Learn more about this trial

Study to Evaluate the Efficacy and Safety of Deferasirox Film-coated Tablet Versus Phlebotomy in Patients With Hereditary Hemochromatosis (HH)

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