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Avatrombopag in the Treatment of Adult Immune Thrombocytopenia With Autoantibodies

Primary Purpose

Immune Thrombocytopenia, Autoantibodies, Evan Syndrome

Status
Recruiting
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Avatrombopag
Sponsored by
Institute of Hematology & Blood Diseases Hospital, China
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Immune Thrombocytopenia

Eligibility Criteria

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

Inclusion Criteria:

  • The patients have provided written informed consent prior to enrollment.
  • Men and women greater than or equal to 18 years of age.
  • Diagnosed as ITP secondary to connective tissue diseases (including but not limited to systemic lupus erythematosus, Sjogren's syndrome and rheumatoid arthritis), primary ITP with positive antinuclear antibody but not up to the diagnostic criteria of connective tissue diseases, primary Evans syndrome, Evans syndrome secondary to connective tissue diseases, and primary ITP with positive Coomb's test but not up to the diagnostic criteria of Evans syndrome.
  • Platelet count<30 ×10^9/L at screening.
  • Patients who have previously failed to receive Eltrombopag or Herombopag [poor efficacy (Eltrombopag 75 mg/d or Herombopag 7.5 mg/D, at least 4 weeks), or the efficacy cannot be maintained], or who have contraindications, can not tolerate or refuse Eltrombopag or Herombopag treatment.
  • Treatment for ITP (including but not limited to glucocorticoids, recombinant human thrombopoietin, and other thrombopoietin receptor agonists other than Avatrombopag) must be completed before enrollment, or the dose must be stable or in a phase of reduction within 2 weeks before enrollment.
  • Effective contraceptive measures will be taken during the clinical trial.

Exclusion Criteria:

  • Patients with active thyroid disease requiring treatment.
  • Patients with any prior history of arterial or venous thrombosis within 3 months, and with any of the following risk factors: cancer, Factor V Leiden, ATIII deficiency, or patients who are using anticoagulants or antiplatelet drugs at the beginning of screening.
  • Those who had received rituximab within 3 months.
  • Patients who had failed to respond to the previous use of Avatrombopag (40mg once a day for more than 4 weeks).
  • Subjects known to be allergic to Avatrombopag or any of its excipients.
  • Patients who had received splenectomy within 3 months or have splenectomy plan within 3 months.
  • Patients with lupus encephalopathy or lupus nephritis.
  • Patients with cataract.
  • Patients with infectious fever (including but not limited to pulmonary infection) within 1 month or with active infection during screening.
  • Existing hepatitis B virus, hepatitis C virus replication or HIV infection.
  • Severe liver dysfunction (alanine aminotransferase or glutamic oxaloacetic transaminase > 3×ULN).
  • Patients with severe cardiac or pulmonary dysfunction.
  • Severe renal damage (creatinine clearance < 30 ml/min).
  • There are surgical planners during the study.
  • History of psychiatric disorder.
  • Pregnant or lactating women or those planning to be pregnant during the trial.
  • Patients with a history of drug/alcohol abuse (within 2 years before the study).
  • Patients that had participated in other experimental researches within one month before enrollment.
  • Any other circumstances that the investigator considers that the patient is not suitable to participate in the trial.

Sites / Locations

  • Institute of Hematology & Blood Diseases HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment group

Arm Description

Fifty-two subjects will be enrolled with the indicated treatment dose of avatrombopag

Outcomes

Primary Outcome Measures

Platelet response
Percentage of participants achieving a platelet count >=30×10^9/L and at least doubling of the baseline count within 12 weeks of treatment.

Secondary Outcome Measures

Platelet response
Proportion of subjects who achieve response (R) within 1, 2, 4 and 8 weeks of treatment.
Platelet response
Proportion of subjects who achieve complete response (CR) within 4, 8 and 12 weeks of treatment.
Duration of platelet response
Proportion of subjects with a platelet count >=30×10^9/L for at least 4 consecutive weeks during the 12 week treatment period without remedial treatment.
Platelet response
Percentage of participants achieving a platelet count >=50×10^9/L within 12 weeks of treatment.
Time to platelet response
Time to response is defined as time from the start of treatment to the first time of achieving a platelet count >= 30×10^9/L and at least doubling of the baseline count during the whole 12 weeks.
Duration of platelet response
Total duration of time a participant with a response of R.
Proportion of patients receiving remedial treatment.
Proportion of patients receiving remedial treatment.
Bleeding score
The incidence and grade of bleeding symptoms according to the World Health Organization Bleeding Scale.
Changes of disease activity index in patients with systemic lupus erythematosus
The proportion of subjects with improvement of disease activity index in patients with systemic lupus erythematosus according to the SLEDAI standard.
The improvement of symptoms
The proportion of subjects with improvement of symptoms including skin symptom, joint pain, dry mouth and dry eyes.
Improvement in immune indexes
The proportion of subjects with improvement immune indexes including antinuclear antibody, extractable nuclear antigens spectrum and Coomb's test.
Discontinuation rate of glucocorticoids
The proportion of subjects with discontinuation use of glucocorticoids.
Functional assessment of chronic illness therapy-fatigue
In all participants, functional assessment of chronic illness therapy-fatigue questionnaire will be used to assess the health related quality of life before and after treatment.
ITP-Patient Assessment Questionnaire
In all participants, ITP-Patient Assessment Questionnaire will be used to assess the health related quality of life before and after treatment.

Full Information

First Posted
August 3, 2021
Last Updated
July 18, 2022
Sponsor
Institute of Hematology & Blood Diseases Hospital, China
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1. Study Identification

Unique Protocol Identification Number
NCT04993885
Brief Title
Avatrombopag in the Treatment of Adult Immune Thrombocytopenia With Autoantibodies
Official Title
Efficacy and Safety of Avatrombopag in the Treatment of Adult Immune Thrombocytopenia With Autoantibodies Fail to Eltrombopag or Herombopag Treatment: a Single-center, Prospective, One-arm Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Recruiting
Study Start Date
September 1, 2021 (Actual)
Primary Completion Date
July 31, 2024 (Anticipated)
Study Completion Date
September 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Institute of Hematology & Blood Diseases Hospital, China

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This prospective, open-label, single-center, one-arm clinical trial aims at evaluating the efficacy and safety of avatrombopag in Chinese adult Immune Thrombocytopenia (ITP) patients with autoantibodies fail (due to intolerance or resistance) to eltrombopag or herombopag treatment.
Detailed Description
This prospective, open-label, single-center, one-arm clinical trial aims at evaluating the efficacy and safety of avatrombopag in Chinese adult ITP patients with autoantibodies fail (due to intolerance or resistance) to eltrombopag or herombopag treatment. The subjects include ITP secondary to connective tissue diseases (including but not limited to systemic lupus erythematosus, Sjogren's syndrome and rheumatoid arthritis), primary ITP with positive antinuclear antibody but not up to the diagnostic criteria of connective tissue diseases, primary Evans syndrome, Evans syndrome secondary to connective tissue diseases, and primary ITP with positive Coomb's test but not up to the diagnostic criteria of Evans syndrome. Fifty-two eligible subjects will be enrolled in this study. The dose will be adjusted according to the platelet count during the period from week 1 to week 12.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Immune Thrombocytopenia, Autoantibodies, Evan Syndrome, Connective Tissue Diseases

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
52 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment group
Arm Type
Experimental
Arm Description
Fifty-two subjects will be enrolled with the indicated treatment dose of avatrombopag
Intervention Type
Drug
Intervention Name(s)
Avatrombopag
Intervention Description
The subjects will receive avatrombopag treatment with an initial dose of 40mg once a day. Platelet counts will be obtained weekly during the first 4 weeks and then every 2 weeks until week 12 after treatment. The dose adjustment range is 20 mg per week to 40 mg per day to maintain the platelet level between 30×10^9/L and 200×10^9/L. If the platelet count does not reach to 30×10^9/L after taking avatrombopag 40mg once a day for 4 consecutive weeks, the treatment will be stopped.
Primary Outcome Measure Information:
Title
Platelet response
Description
Percentage of participants achieving a platelet count >=30×10^9/L and at least doubling of the baseline count within 12 weeks of treatment.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Secondary Outcome Measure Information:
Title
Platelet response
Description
Proportion of subjects who achieve response (R) within 1, 2, 4 and 8 weeks of treatment.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Platelet response
Description
Proportion of subjects who achieve complete response (CR) within 4, 8 and 12 weeks of treatment.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Duration of platelet response
Description
Proportion of subjects with a platelet count >=30×10^9/L for at least 4 consecutive weeks during the 12 week treatment period without remedial treatment.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Platelet response
Description
Percentage of participants achieving a platelet count >=50×10^9/L within 12 weeks of treatment.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Time to platelet response
Description
Time to response is defined as time from the start of treatment to the first time of achieving a platelet count >= 30×10^9/L and at least doubling of the baseline count during the whole 12 weeks.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Duration of platelet response
Description
Total duration of time a participant with a response of R.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Proportion of patients receiving remedial treatment.
Description
Proportion of patients receiving remedial treatment.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Bleeding score
Description
The incidence and grade of bleeding symptoms according to the World Health Organization Bleeding Scale.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Changes of disease activity index in patients with systemic lupus erythematosus
Description
The proportion of subjects with improvement of disease activity index in patients with systemic lupus erythematosus according to the SLEDAI standard.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
The improvement of symptoms
Description
The proportion of subjects with improvement of symptoms including skin symptom, joint pain, dry mouth and dry eyes.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Improvement in immune indexes
Description
The proportion of subjects with improvement immune indexes including antinuclear antibody, extractable nuclear antigens spectrum and Coomb's test.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Discontinuation rate of glucocorticoids
Description
The proportion of subjects with discontinuation use of glucocorticoids.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
Functional assessment of chronic illness therapy-fatigue
Description
In all participants, functional assessment of chronic illness therapy-fatigue questionnaire will be used to assess the health related quality of life before and after treatment.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Title
ITP-Patient Assessment Questionnaire
Description
In all participants, ITP-Patient Assessment Questionnaire will be used to assess the health related quality of life before and after treatment.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.
Other Pre-specified Outcome Measures:
Title
Incidence of Toxicity
Description
The proportion of subjects with specific pre-defined toxicity, including headache, fever, nausea and abdominal pain, and unpredictable toxicity.
Time Frame
From the start of study treatment (Day 1) up to the end of week 12.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The patients have provided written informed consent prior to enrollment. Men and women greater than or equal to 18 years of age. Diagnosed as ITP secondary to connective tissue diseases (including but not limited to systemic lupus erythematosus, Sjogren's syndrome and rheumatoid arthritis), primary ITP with positive antinuclear antibody but not up to the diagnostic criteria of connective tissue diseases, primary Evans syndrome, Evans syndrome secondary to connective tissue diseases, and primary ITP with positive Coomb's test but not up to the diagnostic criteria of Evans syndrome. Platelet count<30 ×10^9/L at screening. Patients who have previously failed to receive Eltrombopag or Herombopag [poor efficacy (Eltrombopag 75 mg/d or Herombopag 7.5 mg/D, at least 4 weeks), or the efficacy cannot be maintained], or who have contraindications, can not tolerate or refuse Eltrombopag or Herombopag treatment. Treatment for ITP (including but not limited to glucocorticoids, recombinant human thrombopoietin, and other thrombopoietin receptor agonists other than Avatrombopag) must be completed before enrollment, or the dose must be stable or in a phase of reduction within 2 weeks before enrollment. Effective contraceptive measures will be taken during the clinical trial. Exclusion Criteria: Patients with active thyroid disease requiring treatment. Patients with any prior history of arterial or venous thrombosis within 3 months, and with any of the following risk factors: cancer, Factor V Leiden, ATIII deficiency, or patients who are using anticoagulants or antiplatelet drugs at the beginning of screening. Those who had received rituximab within 3 months. Patients who had failed to respond to the previous use of Avatrombopag (40mg once a day for more than 4 weeks). Subjects known to be allergic to Avatrombopag or any of its excipients. Patients who had received splenectomy within 3 months or have splenectomy plan within 3 months. Patients with lupus encephalopathy or lupus nephritis. Patients with cataract. Patients with infectious fever (including but not limited to pulmonary infection) within 1 month or with active infection during screening. Existing hepatitis B virus, hepatitis C virus replication or HIV infection. Severe liver dysfunction (alanine aminotransferase or glutamic oxaloacetic transaminase > 3×ULN). Patients with severe cardiac or pulmonary dysfunction. Severe renal damage (creatinine clearance < 30 ml/min). There are surgical planners during the study. History of psychiatric disorder. Pregnant or lactating women or those planning to be pregnant during the trial. Patients with a history of drug/alcohol abuse (within 2 years before the study). Patients that had participated in other experimental researches within one month before enrollment. Any other circumstances that the investigator considers that the patient is not suitable to participate in the trial.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Rongfeng Fu, M.D.
Phone
+862223909009
Email
furongfeng@ihcams.ac.cn
First Name & Middle Initial & Last Name or Official Title & Degree
Lei Zhang, M.D.
Phone
+862223909240
Email
zhanglei1@ihcams.ac.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lei Zhang, M.D.
Organizational Affiliation
Institute of Hematology & Blood Diseases Hospital, China
Official's Role
Principal Investigator
Facility Information:
Facility Name
Institute of Hematology & Blood Diseases Hospital
City
Tianjin
State/Province
Tianjin
ZIP/Postal Code
300020
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rongfeng Fu, MD
Phone
+862223909009
Email
furongfeng@ihcams.ac.cn
First Name & Middle Initial & Last Name & Degree
Lei Zhang, MD
Phone
+862223909240
Email
zhanglei1@ihcams.ac.cn

12. IPD Sharing Statement

Learn more about this trial

Avatrombopag in the Treatment of Adult Immune Thrombocytopenia With Autoantibodies

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