Pozelimab and Cemdisiran Combination Therapy in Adult Participants With Paroxysmal Nocturnal Hemoglobinuria Who Switch From Eculizumab Therapy
Primary Purpose
Paroxysmal Nocturnal Hemoglobinuria
Status
Completed
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Pozelimab
Cemdisiran
Sponsored by
About this trial
This is an interventional treatment trial for Paroxysmal Nocturnal Hemoglobinuria focused on measuring PNH
Eligibility Criteria
Key Inclusion Criteria:
- Diagnosis of paroxysmal nocturnal hemoglobinuria confirmed by a history of high-sensitivity flow cytometry from prior testing
- Treated with stable (ie, no change in dose or frequency) eculizumab therapy at the labeled dosing regimen or a higher dose and/or more frequently administered than labeled for at least 12 weeks prior to screening visit
Key Exclusion Criteria:
- History of bone marrow transplantation or receipt of an organ transplant
- Body weight <40 kg at screening
- Current plans for modification of the following background concomitant medications, as applicable, during screening and treatment period: erythropoietin, immunosuppressive drugs, corticosteroids, anti-thrombotic agents, anticoagulants, iron supplements, and folic acid as described in the protocol
- Any use of complement inhibitor therapy other than eculizumab in the 12 weeks prior to the screening visit or planned use during the study
- Known hypocellular bone marrow based on a history of reduced age-adjusted bone marrow cellularity and/or bone marrow cellularity ≤25%
- No documented meningococcal vaccination within 5 years prior to screening visit unless it is documented that vaccination has been administered during the screening period and prior to initiation of study treatment
- Unable to take antibiotics for meningococcal prophylaxis, if required by local standard of care
- Any active, ongoing infection or a recent infection requiring ongoing systemic treatment with antibiotics, antivirals, or antifungals within 2 weeks of screening or during the screening period
- Documented positive polymerase chain reaction (PCR) or equivalent test based on regional recommendations for COVID-19 or suspected SARS-CoV-2 infection as described in the protocol
- Documented history of active, uncontrolled, ongoing systemic autoimmune diseases
- Recent, unstable medical conditions, excluding PNH and PNH-related complications, within the past 3 months prior to screening visit as described in the protocol
- Anticipated need for major surgery during the study
NOTE: Other protocol-defined Inclusion/ Exclusion Criteria apply.
Sites / Locations
- Regeneron Study Site
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Pozelimab+Cemdisiran
Arm Description
Outcomes
Primary Outcome Measures
Incidence and severity of treatment emergent adverse events (TEAEs)
Open Label Treatment Period (OLTP)
Secondary Outcome Measures
Percent change in LDH from pre-treatment to end-of-treatment period
OLTP
Percent change in LDH from pre-treatment
OLTP
Proportion of participants who are transfusion-free
OLTP Not requiring a RBC transfusion as per protocol algorithm
Proportion of participants who are transfusion-free
OLTP Not requiring a RBC transfusion as per protocol algorithm
Rate of RBCs transfused
OLTP
Rate of RBCs transfused
OLTP
Number of units of RBCs transfused
OLTP
Number of units of RBCs transfused
OLTP
Proportion of participants with breakthrough hemolysis
OLTP
Proportion of participants with breakthrough hemolysis
OLTP
Proportion of participants who maintain adequate control of hemolysis
OLTP
Proportion of participants who maintain adequate control of hemolysis
OLTP
Proportion of participants with adequate control of hemolysis at each visit
OLTP
Proportion of participants with normalization of their LDH at each visit
OLTP
Area under the curve (AUC) of LDH over time
OLTP
AUC of LDH over time
OLTP
Proportion of participants with hemoglobin stabilization
OLTP Participants who do not receive RBC transfusion and have no decrease in hemoglobin levels meeting pre-specified criteria
Proportion of participants with hemoglobin stabilization
OLTP Participants who do not receive RBC transfusion and have no decrease in hemoglobin levels meeting pre-specified criteria.
Change in hemoglobin levels
OLTP
Change in fatigue as measured by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale
OLTP The FACIT-Fatigue is a 13-item, self-reported PRO measure assessing an individual's level of fatigue during their usual daily activities over the past week. This questionnaire is part of the FACIT measurement system, a compilation of questions measuring health-related QoL in patients with cancer and other chronic illnesses. The FACIT-fatigue assesses the level of fatigue using a Likert scale ranging from 0 (not at all) to 4 (very much). Scores range from 0 to 52, with higher scores indicating a higher quality of life.
Change in health related quality of life (HRQoL) as measured by the global health status subscale of the European Organization for Research and Treatment of Cancer (EORTC)- Quality of Life Cancer Patients Questionnaire (QLQ) - 30 Scale
OLTP EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small. A change of 10 - 20 points is considered a moderate change.
Change in physical function (PF) scores on the EORTC QLQ-C30
OLTP
Change in total CH50
OLTP
Concentrations of total pozelimab and eculizumab in serum
OLTP
Concentrations of total cemdisiran in plasma
OLTP
Change from baseline in concentration of total C5
OLTP
Incidence of pozelimab anti-drug antibody (ADA) responses over time
OLTP
Incidence of cemdisiran anti-drug antibody (ADA) responses over time
OLTP
Incidence and severity of TEAEs for participants who receive dose intensification
Intensified OLTP
Incidence and severity of TEAEs in participants treated with pozelimab and cemdisiran combination therapy
Optional Open-Label Extension Period (OLEP)
Change of LDH
OLEP
Change of LDH
OLEP
Percent change of LDH
OLEP
Percent change of LDH
OLEP
Proportion of participants who are transfusion-free
OLEP Not requiring an RBC transfusion as per protocol algorithm
Proportion of participants who are transfusion-free
OLEP Not requiring an RBC transfusion as per protocol algorithm
Rate of RBCs transfused
OLEP
Rate of RBCs transfused
OLEP
Number of units of RBCs transfused
OLEP
Number of units of RBCs transfused
OLEP
Proportion of participants with breakthrough hemolysis
OLEP
Proportion of participants with breakthrough hemolysis
OLEP
Proportion of participants who maintain adequate control of their hemolysis
OLEP
Proportion of participants who maintain adequate control of their hemolysis
OLEP
Proportion of participants with adequate control of hemolysis at each visit
OLEP
Proportion of participants with adequate control of hemolysis at each visit
OLEP
Proportion of participants with normalization of LDH at each visit
OLEP
Proportion of participants with normalization of LDH at each visit
OLEP
AUC of LDH over time
OLEP
AUC of LDH over time
OLEP
Proportion of participants with hemoglobin stabilization
OLEP Participants who do not receive RBC transfusion and have no decrease in hemoglobin levels meeting pre-specified criteria.
Proportion of participants with hemoglobin stabilization
OLEP Participants who do not receive RBC transfusion and have no decrease in hemoglobin levels meeting pre-specified criteria.
Change in hemoglobin levels
OLEP
Change in hemoglobin levels
OLEP
Change in fatigue as measured by FACIT-Fatigue scale
OLEP
Change in GHS/QoL on the EORTC QLQ-C30
OLEP
Change in PF scores on the EORTC QLQ-C30
OLEP
Change in CH50
OLEP
Change in CH50
OLEP
Change in CH50
OLEP
Concentrations of total pozelimab in serum
OLEP
Concentrations of total C5
OLEP
Concentrations of cemdisiran in plasma
OLEP
Incidence of pozelimab anti-drug antibody (ADA) responses over time
OLEP
Incidence of cemdisiran anti-drug antibody (ADA) responses over time
OLEP
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04888507
Brief Title
Pozelimab and Cemdisiran Combination Therapy in Adult Participants With Paroxysmal Nocturnal Hemoglobinuria Who Switch From Eculizumab Therapy
Official Title
A Single Arm, Open-Label Study to Assess the Safety, Efficacy, and Pharmacodynamic Effects of Pozelimab and Cemdisiran Combination Therapy in Patients With Paroxysmal Nocturnal Hemoglobinuria Who Switch From Eculizumab Therapy
Study Type
Interventional
2. Study Status
Record Verification Date
June 2023
Overall Recruitment Status
Completed
Study Start Date
July 8, 2021 (Actual)
Primary Completion Date
May 5, 2022 (Actual)
Study Completion Date
May 4, 2023 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Regeneron Pharmaceuticals
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No
5. Study Description
Brief Summary
The primary objective of the study is to evaluate the safety and tolerability of pozelimab and cemdisiran combination therapy in participants with PNH who switch from eculizumab therapy
The secondary objectives of the study are:
To evaluate the effect of the combination treatment on the following parameters of intravascular hemolysis: lactate dehydrogenase (LDH) control, breakthrough hemolysis, and inhibition of CH50
To evaluate the effect of the combination treatment on the stability of LDH during the transition period from eculizumab monotherapy to combination with pozelimab and cemdisiran
To evaluate the effect of the combination treatment on red blood cell (RBC) transfusion requirements
To evaluate the effect of the combination treatment on hemoglobin levels
To evaluate the effect of the combination treatment on clinical outcome assessments (COAs) measuring fatigue and health related quality of life (HRQoL)
To assess the concentrations of total pozelimab and eculizumab in serum; and total cemdisiran and C5 protein in plasma
To assess the immunogenicity of pozelimab and cemdisiran
To assess safety after dose intensification
To evaluate the long-term safety and efficacy of the combination treatment in an optional open-label extension period (OLEP)
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Paroxysmal Nocturnal Hemoglobinuria
Keywords
PNH
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Pozelimab+Cemdisiran
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Pozelimab
Other Intervention Name(s)
REGN3918
Intervention Description
Intravenous (IV) loading dose (once) followed after 30 minutes by sub-cutaneous (SC) administration
Intervention Type
Drug
Intervention Name(s)
Cemdisiran
Other Intervention Name(s)
ALN-CC5
Intervention Description
SC administration
Primary Outcome Measure Information:
Title
Incidence and severity of treatment emergent adverse events (TEAEs)
Description
Open Label Treatment Period (OLTP)
Time Frame
Through day 225
Secondary Outcome Measure Information:
Title
Percent change in LDH from pre-treatment to end-of-treatment period
Description
OLTP
Time Frame
Screening through Day 225
Title
Percent change in LDH from pre-treatment
Description
OLTP
Time Frame
Screening through Day 29
Title
Proportion of participants who are transfusion-free
Description
OLTP Not requiring a RBC transfusion as per protocol algorithm
Time Frame
Baseline through Day 225
Title
Proportion of participants who are transfusion-free
Description
OLTP Not requiring a RBC transfusion as per protocol algorithm
Time Frame
Day 29 through Day 225
Title
Rate of RBCs transfused
Description
OLTP
Time Frame
Baseline through Day 225
Title
Rate of RBCs transfused
Description
OLTP
Time Frame
Day 29 through Day 225
Title
Number of units of RBCs transfused
Description
OLTP
Time Frame
Baseline through Day 225
Title
Number of units of RBCs transfused
Description
OLTP
Time Frame
Day 29 through Day 225
Title
Proportion of participants with breakthrough hemolysis
Description
OLTP
Time Frame
Baseline through Day 225
Title
Proportion of participants with breakthrough hemolysis
Description
OLTP
Time Frame
Day 29 through Day 225
Title
Proportion of participants who maintain adequate control of hemolysis
Description
OLTP
Time Frame
Post Baseline (on Day 1) through Day 225
Title
Proportion of participants who maintain adequate control of hemolysis
Description
OLTP
Time Frame
Day 57 through Day 225
Title
Proportion of participants with adequate control of hemolysis at each visit
Description
OLTP
Time Frame
Post Baseline (on Day 1) through Day 225
Title
Proportion of participants with normalization of their LDH at each visit
Description
OLTP
Time Frame
Post Baseline (on Day 1) through Day 225
Title
Area under the curve (AUC) of LDH over time
Description
OLTP
Time Frame
Baseline through Day 225
Title
AUC of LDH over time
Description
OLTP
Time Frame
Day 57 through Day 225
Title
Proportion of participants with hemoglobin stabilization
Description
OLTP Participants who do not receive RBC transfusion and have no decrease in hemoglobin levels meeting pre-specified criteria
Time Frame
Baseline through Day 225
Title
Proportion of participants with hemoglobin stabilization
Description
OLTP Participants who do not receive RBC transfusion and have no decrease in hemoglobin levels meeting pre-specified criteria.
Time Frame
Day 29 through Day 225
Title
Change in hemoglobin levels
Description
OLTP
Time Frame
Baseline to Day 225
Title
Change in fatigue as measured by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale
Description
OLTP The FACIT-Fatigue is a 13-item, self-reported PRO measure assessing an individual's level of fatigue during their usual daily activities over the past week. This questionnaire is part of the FACIT measurement system, a compilation of questions measuring health-related QoL in patients with cancer and other chronic illnesses. The FACIT-fatigue assesses the level of fatigue using a Likert scale ranging from 0 (not at all) to 4 (very much). Scores range from 0 to 52, with higher scores indicating a higher quality of life.
Time Frame
Baseline to Day 225
Title
Change in health related quality of life (HRQoL) as measured by the global health status subscale of the European Organization for Research and Treatment of Cancer (EORTC)- Quality of Life Cancer Patients Questionnaire (QLQ) - 30 Scale
Description
OLTP EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small. A change of 10 - 20 points is considered a moderate change.
Time Frame
Baseline to Day 225
Title
Change in physical function (PF) scores on the EORTC QLQ-C30
Description
OLTP
Time Frame
Baseline to Day 225
Title
Change in total CH50
Description
OLTP
Time Frame
Baseline to Day 225
Title
Concentrations of total pozelimab and eculizumab in serum
Description
OLTP
Time Frame
Up to Day 225
Title
Concentrations of total cemdisiran in plasma
Description
OLTP
Time Frame
Up to Day 225
Title
Change from baseline in concentration of total C5
Description
OLTP
Time Frame
Up to Day 225
Title
Incidence of pozelimab anti-drug antibody (ADA) responses over time
Description
OLTP
Time Frame
Up to Day 225
Title
Incidence of cemdisiran anti-drug antibody (ADA) responses over time
Description
OLTP
Time Frame
Up to Day 225
Title
Incidence and severity of TEAEs for participants who receive dose intensification
Description
Intensified OLTP
Time Frame
Through Day 225
Title
Incidence and severity of TEAEs in participants treated with pozelimab and cemdisiran combination therapy
Description
Optional Open-Label Extension Period (OLEP)
Time Frame
Through Week 52
Title
Change of LDH
Description
OLEP
Time Frame
Day 1 to Week 24
Title
Change of LDH
Description
OLEP
Time Frame
Day 1 to Week 52
Title
Percent change of LDH
Description
OLEP
Time Frame
Day 1 to Week 24
Title
Percent change of LDH
Description
OLEP
Time Frame
Day 1 to Week 52
Title
Proportion of participants who are transfusion-free
Description
OLEP Not requiring an RBC transfusion as per protocol algorithm
Time Frame
Day 1 through Week 24
Title
Proportion of participants who are transfusion-free
Description
OLEP Not requiring an RBC transfusion as per protocol algorithm
Time Frame
Day 1 through Week 52
Title
Rate of RBCs transfused
Description
OLEP
Time Frame
Day 1 through Week 24
Title
Rate of RBCs transfused
Description
OLEP
Time Frame
Day 1 through Week 52
Title
Number of units of RBCs transfused
Description
OLEP
Time Frame
Day 1 through Week 24
Title
Number of units of RBCs transfused
Description
OLEP
Time Frame
Day 1 through Week 52
Title
Proportion of participants with breakthrough hemolysis
Description
OLEP
Time Frame
Day 1 through Week 24
Title
Proportion of participants with breakthrough hemolysis
Description
OLEP
Time Frame
Day 1 through Week 52
Title
Proportion of participants who maintain adequate control of their hemolysis
Description
OLEP
Time Frame
Day 1 through Week 24
Title
Proportion of participants who maintain adequate control of their hemolysis
Description
OLEP
Time Frame
Day 1 through Week 52
Title
Proportion of participants with adequate control of hemolysis at each visit
Description
OLEP
Time Frame
Day 1 through Week 24
Title
Proportion of participants with adequate control of hemolysis at each visit
Description
OLEP
Time Frame
Day 1 through Week 52
Title
Proportion of participants with normalization of LDH at each visit
Description
OLEP
Time Frame
Day 1 through Week 24
Title
Proportion of participants with normalization of LDH at each visit
Description
OLEP
Time Frame
Day 1 through Week 52
Title
AUC of LDH over time
Description
OLEP
Time Frame
Day 1 through Week 24
Title
AUC of LDH over time
Description
OLEP
Time Frame
Day 1 through Week 52
Title
Proportion of participants with hemoglobin stabilization
Description
OLEP Participants who do not receive RBC transfusion and have no decrease in hemoglobin levels meeting pre-specified criteria.
Time Frame
Day 1 through Week 24
Title
Proportion of participants with hemoglobin stabilization
Description
OLEP Participants who do not receive RBC transfusion and have no decrease in hemoglobin levels meeting pre-specified criteria.
Time Frame
Day 1 through Week 52
Title
Change in hemoglobin levels
Description
OLEP
Time Frame
Day 1 to Week 24
Title
Change in hemoglobin levels
Description
OLEP
Time Frame
Day 1 to Week 52
Title
Change in fatigue as measured by FACIT-Fatigue scale
Description
OLEP
Time Frame
Day 1 to Week 52
Title
Change in GHS/QoL on the EORTC QLQ-C30
Description
OLEP
Time Frame
Day 1 to Week 52
Title
Change in PF scores on the EORTC QLQ-C30
Description
OLEP
Time Frame
Day 1 to Week 52
Title
Change in CH50
Description
OLEP
Time Frame
Day 1 to Week 16
Title
Change in CH50
Description
OLEP
Time Frame
Day 1 to Week 24
Title
Change in CH50
Description
OLEP
Time Frame
Day 1 to Week 52
Title
Concentrations of total pozelimab in serum
Description
OLEP
Time Frame
Up to Week 52
Title
Concentrations of total C5
Description
OLEP
Time Frame
Up to Week 52
Title
Concentrations of cemdisiran in plasma
Description
OLEP
Time Frame
Up to Week 52
Title
Incidence of pozelimab anti-drug antibody (ADA) responses over time
Description
OLEP
Time Frame
Up to Week 52
Title
Incidence of cemdisiran anti-drug antibody (ADA) responses over time
Description
OLEP
Time Frame
Up to Week 52
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria:
Diagnosis of paroxysmal nocturnal hemoglobinuria confirmed by a history of high-sensitivity flow cytometry from prior testing
Treated with stable (ie, no change in dose or frequency) eculizumab therapy at the labeled dosing regimen or a higher dose and/or more frequently administered than labeled for at least 12 weeks prior to screening visit
Key Exclusion Criteria:
History of bone marrow transplantation or receipt of an organ transplant
Body weight <40 kg at screening
Current plans for modification of the following background concomitant medications, as applicable, during screening and treatment period: erythropoietin, immunosuppressive drugs, corticosteroids, anti-thrombotic agents, anticoagulants, iron supplements, and folic acid as described in the protocol
Any use of complement inhibitor therapy other than eculizumab in the 12 weeks prior to the screening visit or planned use during the study
Known hypocellular bone marrow based on a history of reduced age-adjusted bone marrow cellularity and/or bone marrow cellularity ≤25%
No documented meningococcal vaccination within 5 years prior to screening visit unless it is documented that vaccination has been administered during the screening period and prior to initiation of study treatment
Unable to take antibiotics for meningococcal prophylaxis, if required by local standard of care
Any active, ongoing infection or a recent infection requiring ongoing systemic treatment with antibiotics, antivirals, or antifungals within 2 weeks of screening or during the screening period
Documented positive polymerase chain reaction (PCR) or equivalent test based on regional recommendations for COVID-19 or suspected SARS-CoV-2 infection as described in the protocol
Documented history of active, uncontrolled, ongoing systemic autoimmune diseases
Recent, unstable medical conditions, excluding PNH and PNH-related complications, within the past 3 months prior to screening visit as described in the protocol
Anticipated need for major surgery during the study
NOTE: Other protocol-defined Inclusion/ Exclusion Criteria apply.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Clinical Trial Management
Organizational Affiliation
Regeneron Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Regeneron Study Site
City
Leeds
ZIP/Postal Code
LS9 7TF
Country
United Kingdom
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Plan Description
All Individual Patient Data (IPD) that underlie publicly available results will be considered for sharing
IPD Sharing Time Frame
When Regeneron has received marketing authorization from major health authorities (e.g., FDA, European Medicines Agency (EMA), Pharmaceuticals and Medical Devices Agency (PMDA), etc.) for the product and indication, has made the study results publicly available (e.g., scientific publication, scientific conference, clinical trial registry), has the legal authority to share the data, and has ensured the ability to protect participant privacy.
IPD Sharing Access Criteria
Qualified researchers can submit a proposal for access to individual patient or aggregate level data from a Regeneron-sponsored clinical trial through Vivli. Regeneron's Independent Research Request Evaluation Criteria can be found at: https://www.regeneron.com/sites/default/files/Regeneron-External-Data-Sharing-Policy-and-Independent-Research-Request-Evaluation-Criteria.pdf
IPD Sharing URL
https://vivli.org/
Learn more about this trial
Pozelimab and Cemdisiran Combination Therapy in Adult Participants With Paroxysmal Nocturnal Hemoglobinuria Who Switch From Eculizumab Therapy
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