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A Study of Nipocalimab in Pregnancies at Risk for Severe Hemolytic Disease of the Fetus and Newborn (HDFN) (AZALEA)

Primary Purpose

Hemolytic Disease of the Fetus and Newborn

Status
Not yet recruiting
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Nipocalimab
Placebo
Sponsored by
Janssen Research & Development, LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hemolytic Disease of the Fetus and Newborn

Eligibility Criteria

18 Years - 45 Years (Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria: Pregnant and an estimated gestational age (GA) (based on ultrasound dating) from Week 13^0/7 to Week 16^6/7 at randomization History of severe Hemolytic Disease of the Fetus and Newborn (HDFN) in a prior pregnancy defined as: documented fetal anemia, or received greater than or equal to (>=)1 IUT as a result of HDFN or fetal loss or neonatal death as a result of HDFN, with maternal alloantibody titers for Rhesus antigen D protein (RhD), Kell, Kell Rhesus antigen C protein (Rhc), Rhesus antigen E protein (RhE), or RhC antigen above the critical levels (anti-Kell >=4; other >=16) and evidence of an antigen-positive fetus During the current pregnancy, presence of maternal alloantibody to RhD, Rhc, RhE, or RhC antigen with titers above the critical level (anti-Kell >= 4; other >=16) based on the designated central lab results at screening Evidence of antigen-positivity corresponding to the current maternal alloantibody (RhD, Kell, Rhc, RhE, or RhC) confirmed by non-invasive antigen cell-free fetal DNA (cffDNA) performed at the central laboratory. Have screening laboratory values within the study protocol-specified parameters: a) albumin, >=2.6 grams (g) per deciliter (g/dL), international system (SI): >=26 gram per liter (g/L); b) alanine transaminase (AST) less than or equal to (<=) 2 × upper limit of normal (ULN); c) alanine transaminase (ALT) <=2 × ULN d) creatinine <=0.8 milligrams per deciliter (mg/dL), SI: <=70.7 micromole per liter (μmol/L), and Serum total immunoglobulins G (IgG) ≥ 600 mg/dL SI: >=6 g/L Otherwise healthy on the basis of physical examination, medical history, vital signs, 12-lead ECG, and clinical laboratory tests performed at screening. Exclusion Criteria: Currently pregnant with a multiple gestation (twins or more) Evidence of fetal anemia prior to randomization in the current pregnancy Current uncontrolled hypertension History of myocardial infarction, unstable ischemic heart disease, or stroke Has any confirmed or suspected clinical immunodeficiency syndrome or has a family history of congenital or hereditary immunodeficiency unless confirmed absent in the participant Has inflammatory or autoimmune diseases requiring immunosuppressive therapies that may jeopardize the safety of the participant Currently has a malignancy or has a history of malignancy within 3 years before screening (with the exception of localized basal cell carcinoma and/or squamous cell carcinoma skin cancer that has been adequately treated with no evidence of recurrence for at least 3 months Is currently receiving systemic corticosteroids or other immunosuppressants for disorders unrelated to the pregnancy Has received or planning to receive plasmapheresis, immunoadsorption therapy, intravenous immunoglobulin (IVIg), or any immunoglobulin (Ig)G fragment crystallizable (Fc)-related protein therapeutics during the current pregnancy Has a severe infection including opportunistic infections Presence of abnormal (protocol-specified) hematologic laboratory values during screening History of severe preeclampsia prior to GA Week 34 or severe fetal growth restriction (estimated fetal weight <3rd percentile, based on local fetal growth normative standards) in a previous pregnancy

Sites / Locations

  • Yale New Haven Hospital
  • Yale New Haven Hospital
  • Columbia University Medical Center
  • University of North Carolina (UNC) - School of Medicine
  • University of North Carolina
  • Cincinnati Children's Hospital Medical Center
  • University of Cincinnati
  • Oregon Health and Science University
  • Dell Children's Medical Center of Central Texas
  • Instituto de Mastologia e Oncologia
  • Centre Hospitalier Sainte Justine
  • The Chaim Sheba Medical Center
  • Birmingham Children's Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Nipocalimab

Placebo

Arm Description

Participants will receive nipocalimab intravenously (IV) once weekly (qw) from randomization through gestational age (GA) Week 35.

Participants will receive matching placebo IV qw from randomization through GA Week 35.

Outcomes

Primary Outcome Measures

Percentage of Pregnancies That did not Result in Fetal Loss, Intrauterine Transfusion (IUT), Hydrops Fetalis, or Neonatal Death
Percentage of pregnancies that did not result in fetal loss, IUT, hydrops fetalis, or neonatal death (during the neonatal period) will be reported. Hydrops fetalis is defined as the presence of greater than or equal to(>=)2 abnormal fluid collections in the fetus or neonate, such as ascites, pleural effusions, pericardial effusion, and generalized skin edema (skin thickness greater (>)5 millimeter (mm). PMA is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (chronological age).

Secondary Outcome Measures

Number of Participants With Hemolytic Disease of the Fetus and Newborn (HDFN) by Severity
Number of participants with HDFN by severity will be reported. The severity of HDFN is defined as: 5 (fatal): fetal or neonatal death due to any reason; 4 (severe): hydrops fetalis (in fetus or newborn) or receiving IUT during pregnancy as a result of HDFN but not 5 (fatal); 3 (moderate): neonatal exchange transfusions received as a result of HDFN related hemolysis and jaundice but not 4 (severe) or 5 (fatal); 2 (mild): neonatal simple transfusions received due to HDFN after birth, with or without phototherapy, but not 3 (moderate), 4 (severe), or 5 (fatal); and 1 (minimal or none): not in 2 (mild), 3 (moderate), 4 (severe), or 5 (fatal) as described above. Here database lock implies the last participant has given birth or terminated their pregnancy, completed the Week 4 visit after delivery, and whose neonate has also completed the Week 4 visit (or 41 weeks PMA, whichever is later) or died prior to this timepoint.
Time to First Occurrence of IUT or Hydrops Fetalis
Time to first occurrence of IUT or hydrops fetalis will be reported.
Neonatal Mortality and Morbidity Index (NMMI) in Liveborn Neonates
The NMMI will be assessed with the following categories: fatal: fetal/neonatal death; major morbidity: any of intraventricular hemorrhage grade 3/4, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage 2/3, respiratory distress syndrome requiring mechanical ventilation, bronchopulmonary dysplasia requiring oxygen support, or persistent pulmonary hypertension; Minor morbidity: anemia requiring simple transfusion, hyperbilirubinemia requiring an exchange transfusion, hypotension requiring treatment, intraventricular hemorrhage grade 1/2, necrotizing enterocolitis stage 1, or respiratory distress syndrome not requiring mechanical ventilation; None: no major or minor morbidities described above. Hyperbilirubinemia requiring phototherapy will be classified in this category'
Number of IUT's Received During the Pregnancy
Number of IUT's received during the pregnancy will be reported.
Percentage of Pregnancies With Fetal Loss
Percentage of pregnancies with fetal loss will be reported.
Percentage of Pregnancies With Fetal or Neonatal Death
Percentage of pregnancies with fetal or neonatal death (through the neonatal period) as a result of HDFN will be reported.
Percentage of Pregnancies With Hydrops Fetalis
Percentage of pregnancies with hydrops fetalis will be reported. Hydrops fetalis is defined as the presence of >=2 abnormal fluid collections in the fetus or neonate, such as ascites, pleural effusions, pericardial effusion, and generalized skin edema (skin thickness >5 mm).
Percentage of Pregnancies Receiving IUT During Pregnancy
Percentage of pregnancies receiving IUT during pregnancy will be reported.
Gestational Age (GA) at First IUT
GA at first IUT will be reported.
Percentage of Pregnancies Receiving >1 IUT During Pregnancy
Percentage of pregnancies receiving >1 IUT during pregnancy will be reported.
Percentage of Pregnancies Receiving IUT or HDFN Resulting in Fetal Demise (Less Than) <GA Week 20
Percentage of pregnancies receiving IUT or HDFN resulting in fetal demise <GA Week 20 will be reported.
Gestational Age at Delivery
Gestational age at delivery will be reported.
Percentage of Pregnancies With Neonatal Death Through the Neonatal Period
Percentage of pregnancies with neonatal death through the neonatal period will be reported.
Percentage of Liveborn Neonates With HDFN-related Morbidities Other Than Anemia and Hyperbilirubinemia or Jaundice
Percentage of liveborn neonates with HDFN-related morbidities other than anemia and hyperbilirubinemia or jaundice will be reported.
Absolute Weight of Liveborn Neonates or Infants
Absolute weight of liveborn neonates or infants will be reported.
Change From Baseline in Weight of Liveborn Neonates or Infants
Change from baseline in weight of liveborn neonates or infants will be reported.
Liveborn Neonates Length of Stay in Neonatal Intensive Care Unit
Liveborn neonates length of stay in neonatal intensive care unit will be reported.
Percentage of Liveborn Neonates Receiving Exchange Transfusions for HDFN
Percentage of liveborn neonates receiving exchange transfusions for HDFN will be reported.
Number of Neonatal Exchange Transfusions per Liveborn Neonate
Number of neonatal exchange transfusions per liveborn neonate will be reported.
Percentage of Liveborn Neonates or Infants with Simple Transfusions for HDFN
Percentage of liveborn neonates or infants with simple transfusions for HDFN through the neonatal period (for the first database lock) or 12 weeks (for the second database lock) after birth will be reported.
Number of Simple Transfusions for HDFN per Liveborn Neonate or Infant
Number of simple transfusions for HDFN per liveborn neonate or infant through the neonatal period (for the first database lock) or 12 weeks (for the second database lock) after birth will be reported.
Percentage of Liveborn Neonates With Hyperbilirubinemia Treated With Phototherapy
Percentage of liveborn neonates with hyperbilirubinemia treated with phototherapy will be reported.
Number of Days of Phototherapy Received for Hyperbilirubinemia per Liveborn Neonate
Number of days of phototherapy received for hyperbilirubinemia per liveborn neonate will be reported.
Percentage of Liveborn Neonates or Infants Receiving Intravenous Immunoglobulin (IVIg) for HDFN Treatment
Percentage of liveborn neonates or infants receiving IVIg for HDFN treatment will be reported.
Number of Maternal Deaths
Number of maternal deaths will be reported.
Number of Participants with Adverse Events (AEs)
Number of participants with AEs, serious adverse events, and AEs of special interest (AESIs), AE's leading to discontinuations, infections, serious infections, infusion reactions, and hypersensitivity reactions will be reported. Treatment-emergent adverse events associated with the following situations are considered as AESIs: hypoalbuminemia, clinically significant bleeding with a corresponding placental finding on ultrasound, maternal infections that led to clinically significant morbidities or mortalities in fetus or neonates, Infections that are severe or require intravenous (IV) anti-infective or operative or invasive intervention in maternal participants or neonates or infants, and infants with hypogammaglobulinemia.
Number of Maternal Pregnancy Complications
Number of maternal pregnancy complications will be reported.
Number of IUT Related complications
Number of participants with IUT related complications will be reported.
Percentage of Pregnancies With Cesarean Delivery, Preterm Birth, Fetal Growth, and Preeclampsia
Percentage of pregnancies with cesarean delivery, cesarean delivery due to IUT complications, preterm birth <GA week 28, preterm birth <GA week 32, preterm birth <GA week 34, preterm birth <GA week 37, fetal growth restriction, and preeclampsia will be reported.
Percentage of Liveborn Neonates or Infants Who Died
Percentage of liveborn neonates or infants who died will be reported.
Percentage of Liveborn Neonates or Infants With AEs
Percentage of liveborn neonates or infants with AEs, SAEs, AESIs, infections, serious infections will be reported. An AE is any untoward medical occurrence in a clinical study participant administered a pharmaceutical (investigational or non-investigational) product. Any event requiring hospitalization (or prolongation of hospitalization) that occurs during participation in the study must be reported as an SAE.
Percentage of Liveborn Neonates or Infants Receiving IVIg for Non-HDFN Indications
Percentage of liveborn neonates or infants receiving IVIg for non-HDFN indications will be reported.
Percentage of Liveborn Neonates or Infants With Abnormal Hearing
Percentage of liveborn neonates or infants with abnormal hearing will be reported.
Bayley Scales of Infant Development and Toddler Development
The Bayley Scales of infant development is considered the standard assessment of early child development and includes cognition, language, motor skills, social emotional, and adaptive behavior will be reported. The Bayley Scales (3rd edition) are reference standards that measure infant and toddler development in five areas: cognition, language, motor skills, social-emotional and adaptive behavior. The cognition, language and motor skills scales are directly administered to the infant, while social-emotional, and adaptive behavior scales are caregiver questionnaires. The scores are standardized using norm reference samples with representative demographics and age adjusted for prematurity. Higher scores in the Bayley Scales indicate better outcomes.
Change From Baseline in Generalized Anxiety Disorder 7-Item (GAD7) Over time During Pregnancy and Postpartum
Change from baseline in GAD7 over time during pregnancy and postpartum will be reported. The GAD-7 scale is a self-administered questionnaire designed to measure anxiety. The recall period for all items is the past 2 weeks. Responses to all items are rated on a 4-point Likert scale ranging from 0 "not at all" to 3 "nearly every day". The total score ranges from 0 to 21, with higher scores indicating higher severity of anxiety symptoms.
Change From Baseline in Short Form 36 Version 2 (SF-36v2) Acute Form Domain Score
Change from baseline in SF-36v2 acute form domain score will be reported. The SF-36 version 2 acute is a self-administered, 36-item questionnaire measuring health-related quality of life and includes 8 domains that measure physical functioning, role limitations due to physical health problems, bodily pain, general health, vitality social functioning, role limitations due to emotional problems, and mental health. The 8 domains can be aggregated into 2 summary scales that reflect physical and mental health: a physical component summary and a mental component summary. Responses to all items are rated on a 3, 5, or 6-point Likert scale, with higher scores indicating better health status.
Change From Baseline in EuroQol Five-dimension Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Score
Change from baseline in EQ-5D-5L visual analogue score will be reported. The EQ-5D descriptive system is comprised of 5 items across the following 5 dimensions: mobility, self-care, usual activities, pain or discomfort and anxiety or depression. The EQ-5D-5L uses a 5-point Likert response scale ranging from "no problems" to "extreme problems", with higher scores indicating better quality of life. EQ-5D-5L consists of the EQ-5D descriptive system and the EQ visual analogue scale (EQ-VAS). EQ-VAS score ranges from 0 to 100, where 0 = worst imaginable health state and 100 = best imaginable health state. Higher score indicates good health state.
Change From Baseline in EuroQol 5-Dimension Descriptive (EQ-5D) Index Score
Change from baseline in EQ-5D index score will be reported. The EQ-5D descriptive system is comprised of 5 items across the following 5 dimensions: mobility, self-care, usual activities, pain or discomfort and anxiety or depression. The EQ-5D-5L descriptive system uses a 5-point Likert response scale ranging from "no problems" to "extreme problems", with higher scores indicating better quality of life.
Infant Health-Related Quality of Life Instrument (IQI) Score for Neonate or Infant Overtime
IQI score for neonate or infant will be reported. The IQI consists of 7 health attributes including sleeping, feeding, breathing, stooling or poo, mood, skin, and interaction. Responses to all items are rated on a 4-point Likert scale, with higher scores indicating better quality of life.

Full Information

First Posted
June 13, 2023
Last Updated
October 10, 2023
Sponsor
Janssen Research & Development, LLC
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1. Study Identification

Unique Protocol Identification Number
NCT05912517
Brief Title
A Study of Nipocalimab in Pregnancies at Risk for Severe Hemolytic Disease of the Fetus and Newborn (HDFN)
Acronym
AZALEA
Official Title
A Phase 3 Randomized, Placebo-Controlled, Double-Blind, Multicenter Study to Evaluate the Efficacy and Safety of Nipocalimab in Pregnancies at Risk for Severe Hemolytic Disease of the Fetus and Newborn (HDFN)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
January 23, 2024 (Anticipated)
Primary Completion Date
August 5, 2027 (Anticipated)
Study Completion Date
July 10, 2029 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Janssen Research & Development, LLC

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 purpose of this study is to assess the effectiveness of nipocalimab when compared to placebo in decreasing the risk of fetal anemia (a condition in which a baby's red blood cell volume falls below normal levels while the baby is developing in the womb) with live neonates in pregnant participants at risk for severe hemolytic disease of the fetus and newborn.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hemolytic Disease of the Fetus and Newborn

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
The participants will be randomized in a 2:1 to receive nipocalimab and placebo treatment.
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
120 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Nipocalimab
Arm Type
Experimental
Arm Description
Participants will receive nipocalimab intravenously (IV) once weekly (qw) from randomization through gestational age (GA) Week 35.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Participants will receive matching placebo IV qw from randomization through GA Week 35.
Intervention Type
Drug
Intervention Name(s)
Nipocalimab
Other Intervention Name(s)
- JNJ-80202135, - M281
Intervention Description
Nipocalimab will be administered as an intravenous infusion.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo will be administered as an intravenous infusion.
Primary Outcome Measure Information:
Title
Percentage of Pregnancies That did not Result in Fetal Loss, Intrauterine Transfusion (IUT), Hydrops Fetalis, or Neonatal Death
Description
Percentage of pregnancies that did not result in fetal loss, IUT, hydrops fetalis, or neonatal death (during the neonatal period) will be reported. Hydrops fetalis is defined as the presence of greater than or equal to(>=)2 abnormal fluid collections in the fetus or neonate, such as ascites, pleural effusions, pericardial effusion, and generalized skin edema (skin thickness greater (>)5 millimeter (mm). PMA is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (chronological age).
Time Frame
From randomization in the study through 4 weeks of age or 41 weeks Postmenstrual Age (PMA) during neonatal period, whichever is later
Secondary Outcome Measure Information:
Title
Number of Participants With Hemolytic Disease of the Fetus and Newborn (HDFN) by Severity
Description
Number of participants with HDFN by severity will be reported. The severity of HDFN is defined as: 5 (fatal): fetal or neonatal death due to any reason; 4 (severe): hydrops fetalis (in fetus or newborn) or receiving IUT during pregnancy as a result of HDFN but not 5 (fatal); 3 (moderate): neonatal exchange transfusions received as a result of HDFN related hemolysis and jaundice but not 4 (severe) or 5 (fatal); 2 (mild): neonatal simple transfusions received due to HDFN after birth, with or without phototherapy, but not 3 (moderate), 4 (severe), or 5 (fatal); and 1 (minimal or none): not in 2 (mild), 3 (moderate), 4 (severe), or 5 (fatal) as described above. Here database lock implies the last participant has given birth or terminated their pregnancy, completed the Week 4 visit after delivery, and whose neonate has also completed the Week 4 visit (or 41 weeks PMA, whichever is later) or died prior to this timepoint.
Time Frame
For first database lock: from randomization in the study through 4 weeks of age or 41 weeks PMA during neonatal period, whichever is later for the first database lock; for second database lock: through 12 weeks after birth
Title
Time to First Occurrence of IUT or Hydrops Fetalis
Description
Time to first occurrence of IUT or hydrops fetalis will be reported.
Time Frame
From randomization to delivery of baby (Up to 38 weeks)
Title
Neonatal Mortality and Morbidity Index (NMMI) in Liveborn Neonates
Description
The NMMI will be assessed with the following categories: fatal: fetal/neonatal death; major morbidity: any of intraventricular hemorrhage grade 3/4, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage 2/3, respiratory distress syndrome requiring mechanical ventilation, bronchopulmonary dysplasia requiring oxygen support, or persistent pulmonary hypertension; Minor morbidity: anemia requiring simple transfusion, hyperbilirubinemia requiring an exchange transfusion, hypotension requiring treatment, intraventricular hemorrhage grade 1/2, necrotizing enterocolitis stage 1, or respiratory distress syndrome not requiring mechanical ventilation; None: no major or minor morbidities described above. Hyperbilirubinemia requiring phototherapy will be classified in this category'
Time Frame
Through 38 weeks PMA or at discharge if earlier than 38 weeks PMA
Title
Number of IUT's Received During the Pregnancy
Description
Number of IUT's received during the pregnancy will be reported.
Time Frame
From randomization to delivery of baby (Up to 38 weeks)
Title
Percentage of Pregnancies With Fetal Loss
Description
Percentage of pregnancies with fetal loss will be reported.
Time Frame
Time to delivery of baby (Up to 38 weeks)
Title
Percentage of Pregnancies With Fetal or Neonatal Death
Description
Percentage of pregnancies with fetal or neonatal death (through the neonatal period) as a result of HDFN will be reported.
Time Frame
Through Week 4 or 41 weeks PMA
Title
Percentage of Pregnancies With Hydrops Fetalis
Description
Percentage of pregnancies with hydrops fetalis will be reported. Hydrops fetalis is defined as the presence of >=2 abnormal fluid collections in the fetus or neonate, such as ascites, pleural effusions, pericardial effusion, and generalized skin edema (skin thickness >5 mm).
Time Frame
Up to 41 weeks PMA
Title
Percentage of Pregnancies Receiving IUT During Pregnancy
Description
Percentage of pregnancies receiving IUT during pregnancy will be reported.
Time Frame
Up to 35 weeks of GA period
Title
Gestational Age (GA) at First IUT
Description
GA at first IUT will be reported.
Time Frame
Up to 35 weeks of GA period
Title
Percentage of Pregnancies Receiving >1 IUT During Pregnancy
Description
Percentage of pregnancies receiving >1 IUT during pregnancy will be reported.
Time Frame
Up to 35 weeks of GA period
Title
Percentage of Pregnancies Receiving IUT or HDFN Resulting in Fetal Demise (Less Than) <GA Week 20
Description
Percentage of pregnancies receiving IUT or HDFN resulting in fetal demise <GA Week 20 will be reported.
Time Frame
Up to 20 weeks
Title
Gestational Age at Delivery
Description
Gestational age at delivery will be reported.
Time Frame
Up to 38 weeks
Title
Percentage of Pregnancies With Neonatal Death Through the Neonatal Period
Description
Percentage of pregnancies with neonatal death through the neonatal period will be reported.
Time Frame
From randomization in the study through 4 weeks of age or 41 weeks PMA during neonatal period, whichever is later
Title
Percentage of Liveborn Neonates With HDFN-related Morbidities Other Than Anemia and Hyperbilirubinemia or Jaundice
Description
Percentage of liveborn neonates with HDFN-related morbidities other than anemia and hyperbilirubinemia or jaundice will be reported.
Time Frame
From day of birth up to 4 weeks
Title
Absolute Weight of Liveborn Neonates or Infants
Description
Absolute weight of liveborn neonates or infants will be reported.
Time Frame
Up to 104 weeks
Title
Change From Baseline in Weight of Liveborn Neonates or Infants
Description
Change from baseline in weight of liveborn neonates or infants will be reported.
Time Frame
Baseline to up to 104 weeks
Title
Liveborn Neonates Length of Stay in Neonatal Intensive Care Unit
Description
Liveborn neonates length of stay in neonatal intensive care unit will be reported.
Time Frame
From day of birth up to 27 days
Title
Percentage of Liveborn Neonates Receiving Exchange Transfusions for HDFN
Description
Percentage of liveborn neonates receiving exchange transfusions for HDFN will be reported.
Time Frame
From day of birth up to 27 days
Title
Number of Neonatal Exchange Transfusions per Liveborn Neonate
Description
Number of neonatal exchange transfusions per liveborn neonate will be reported.
Time Frame
From day of birth up to 27 days
Title
Percentage of Liveborn Neonates or Infants with Simple Transfusions for HDFN
Description
Percentage of liveborn neonates or infants with simple transfusions for HDFN through the neonatal period (for the first database lock) or 12 weeks (for the second database lock) after birth will be reported.
Time Frame
For first database lock: From birth up to 4 weeks; for second database lock: From birth up to 12 weeks
Title
Number of Simple Transfusions for HDFN per Liveborn Neonate or Infant
Description
Number of simple transfusions for HDFN per liveborn neonate or infant through the neonatal period (for the first database lock) or 12 weeks (for the second database lock) after birth will be reported.
Time Frame
For first database lock: From birth up to 4 weeks; for second database lock: From birth up to 12 weeks
Title
Percentage of Liveborn Neonates With Hyperbilirubinemia Treated With Phototherapy
Description
Percentage of liveborn neonates with hyperbilirubinemia treated with phototherapy will be reported.
Time Frame
From day of birth up to 27 days
Title
Number of Days of Phototherapy Received for Hyperbilirubinemia per Liveborn Neonate
Description
Number of days of phototherapy received for hyperbilirubinemia per liveborn neonate will be reported.
Time Frame
From day of birth up to 27 days
Title
Percentage of Liveborn Neonates or Infants Receiving Intravenous Immunoglobulin (IVIg) for HDFN Treatment
Description
Percentage of liveborn neonates or infants receiving IVIg for HDFN treatment will be reported.
Time Frame
For first database lock: From birth up to 4 weeks; for second database lock: From birth up to 12 weeks
Title
Number of Maternal Deaths
Description
Number of maternal deaths will be reported.
Time Frame
Form randomization up to 24 weeks postpartum
Title
Number of Participants with Adverse Events (AEs)
Description
Number of participants with AEs, serious adverse events, and AEs of special interest (AESIs), AE's leading to discontinuations, infections, serious infections, infusion reactions, and hypersensitivity reactions will be reported. Treatment-emergent adverse events associated with the following situations are considered as AESIs: hypoalbuminemia, clinically significant bleeding with a corresponding placental finding on ultrasound, maternal infections that led to clinically significant morbidities or mortalities in fetus or neonates, Infections that are severe or require intravenous (IV) anti-infective or operative or invasive intervention in maternal participants or neonates or infants, and infants with hypogammaglobulinemia.
Time Frame
From randomization up to 24 weeks postpartum
Title
Number of Maternal Pregnancy Complications
Description
Number of maternal pregnancy complications will be reported.
Time Frame
Up to 38 weeks
Title
Number of IUT Related complications
Description
Number of participants with IUT related complications will be reported.
Time Frame
Up to 35 weeks of GA period
Title
Percentage of Pregnancies With Cesarean Delivery, Preterm Birth, Fetal Growth, and Preeclampsia
Description
Percentage of pregnancies with cesarean delivery, cesarean delivery due to IUT complications, preterm birth <GA week 28, preterm birth <GA week 32, preterm birth <GA week 34, preterm birth <GA week 37, fetal growth restriction, and preeclampsia will be reported.
Time Frame
Up to 38 weeks of GA period
Title
Percentage of Liveborn Neonates or Infants Who Died
Description
Percentage of liveborn neonates or infants who died will be reported.
Time Frame
Up to 104 weeks
Title
Percentage of Liveborn Neonates or Infants With AEs
Description
Percentage of liveborn neonates or infants with AEs, SAEs, AESIs, infections, serious infections will be reported. An AE is any untoward medical occurrence in a clinical study participant administered a pharmaceutical (investigational or non-investigational) product. Any event requiring hospitalization (or prolongation of hospitalization) that occurs during participation in the study must be reported as an SAE.
Time Frame
Up to 104 weeks
Title
Percentage of Liveborn Neonates or Infants Receiving IVIg for Non-HDFN Indications
Description
Percentage of liveborn neonates or infants receiving IVIg for non-HDFN indications will be reported.
Time Frame
Up to 104 weeks
Title
Percentage of Liveborn Neonates or Infants With Abnormal Hearing
Description
Percentage of liveborn neonates or infants with abnormal hearing will be reported.
Time Frame
Up to 104 weeks
Title
Bayley Scales of Infant Development and Toddler Development
Description
The Bayley Scales of infant development is considered the standard assessment of early child development and includes cognition, language, motor skills, social emotional, and adaptive behavior will be reported. The Bayley Scales (3rd edition) are reference standards that measure infant and toddler development in five areas: cognition, language, motor skills, social-emotional and adaptive behavior. The cognition, language and motor skills scales are directly administered to the infant, while social-emotional, and adaptive behavior scales are caregiver questionnaires. The scores are standardized using norm reference samples with representative demographics and age adjusted for prematurity. Higher scores in the Bayley Scales indicate better outcomes.
Time Frame
Week 52 and 104
Title
Change From Baseline in Generalized Anxiety Disorder 7-Item (GAD7) Over time During Pregnancy and Postpartum
Description
Change from baseline in GAD7 over time during pregnancy and postpartum will be reported. The GAD-7 scale is a self-administered questionnaire designed to measure anxiety. The recall period for all items is the past 2 weeks. Responses to all items are rated on a 4-point Likert scale ranging from 0 "not at all" to 3 "nearly every day". The total score ranges from 0 to 21, with higher scores indicating higher severity of anxiety symptoms.
Time Frame
Baseline (Day 1) and Week 30 during pregnancy and Week 4 postpartum
Title
Change From Baseline in Short Form 36 Version 2 (SF-36v2) Acute Form Domain Score
Description
Change from baseline in SF-36v2 acute form domain score will be reported. The SF-36 version 2 acute is a self-administered, 36-item questionnaire measuring health-related quality of life and includes 8 domains that measure physical functioning, role limitations due to physical health problems, bodily pain, general health, vitality social functioning, role limitations due to emotional problems, and mental health. The 8 domains can be aggregated into 2 summary scales that reflect physical and mental health: a physical component summary and a mental component summary. Responses to all items are rated on a 3, 5, or 6-point Likert scale, with higher scores indicating better health status.
Time Frame
Baseline (Day 1) and Week 30 during pregnancy and Week 4 postpartum
Title
Change From Baseline in EuroQol Five-dimension Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Score
Description
Change from baseline in EQ-5D-5L visual analogue score will be reported. The EQ-5D descriptive system is comprised of 5 items across the following 5 dimensions: mobility, self-care, usual activities, pain or discomfort and anxiety or depression. The EQ-5D-5L uses a 5-point Likert response scale ranging from "no problems" to "extreme problems", with higher scores indicating better quality of life. EQ-5D-5L consists of the EQ-5D descriptive system and the EQ visual analogue scale (EQ-VAS). EQ-VAS score ranges from 0 to 100, where 0 = worst imaginable health state and 100 = best imaginable health state. Higher score indicates good health state.
Time Frame
Baseline (Day 1) and Week 30 during pregnancy and Week 4 postpartum
Title
Change From Baseline in EuroQol 5-Dimension Descriptive (EQ-5D) Index Score
Description
Change from baseline in EQ-5D index score will be reported. The EQ-5D descriptive system is comprised of 5 items across the following 5 dimensions: mobility, self-care, usual activities, pain or discomfort and anxiety or depression. The EQ-5D-5L descriptive system uses a 5-point Likert response scale ranging from "no problems" to "extreme problems", with higher scores indicating better quality of life.
Time Frame
Baseline (Day 1) and Week 30 during pregnancy and Week 4 postpartum
Title
Infant Health-Related Quality of Life Instrument (IQI) Score for Neonate or Infant Overtime
Description
IQI score for neonate or infant will be reported. The IQI consists of 7 health attributes including sleeping, feeding, breathing, stooling or poo, mood, skin, and interaction. Responses to all items are rated on a 4-point Likert scale, with higher scores indicating better quality of life.
Time Frame
Weeks 4, 8 and 52

10. Eligibility

Sex
Female
Gender Based
Yes
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Pregnant and an estimated gestational age (GA) (based on ultrasound dating) from Week 13^0/7 to Week 16^6/7 at randomization History of severe Hemolytic Disease of the Fetus and Newborn (HDFN) in a prior pregnancy defined as: documented fetal anemia, or received greater than or equal to (>=)1 IUT as a result of HDFN or fetal loss or neonatal death as a result of HDFN, with maternal alloantibody titers for Rhesus antigen D protein (RhD), Kell, Kell Rhesus antigen C protein (Rhc), Rhesus antigen E protein (RhE), or RhC antigen above the critical levels (anti-Kell >=4; other >=16) and evidence of an antigen-positive fetus During the current pregnancy, presence of maternal alloantibody to RhD, Rhc, RhE, or RhC antigen with titers above the critical level (anti-Kell >= 4; other >=16) based on the designated central lab results at screening Evidence of antigen-positivity corresponding to the current maternal alloantibody (RhD, Kell, Rhc, RhE, or RhC) confirmed by non-invasive antigen cell-free fetal DNA (cffDNA) performed at the central laboratory. Have screening laboratory values within the study protocol-specified parameters: a) albumin, >=2.6 grams (g) per deciliter (g/dL), international system (SI): >=26 gram per liter (g/L); b) alanine transaminase (AST) less than or equal to (<=) 2 × upper limit of normal (ULN); c) alanine transaminase (ALT) <=2 × ULN d) creatinine <=0.8 milligrams per deciliter (mg/dL), SI: <=70.7 micromole per liter (μmol/L), and Serum total immunoglobulins G (IgG) ≥ 600 mg/dL SI: >=6 g/L Otherwise healthy on the basis of physical examination, medical history, vital signs, 12-lead ECG, and clinical laboratory tests performed at screening. Exclusion Criteria: Currently pregnant with a multiple gestation (twins or more) Evidence of fetal anemia prior to randomization in the current pregnancy Current uncontrolled hypertension History of myocardial infarction, unstable ischemic heart disease, or stroke Has any confirmed or suspected clinical immunodeficiency syndrome or has a family history of congenital or hereditary immunodeficiency unless confirmed absent in the participant Has inflammatory or autoimmune diseases requiring immunosuppressive therapies that may jeopardize the safety of the participant Currently has a malignancy or has a history of malignancy within 3 years before screening (with the exception of localized basal cell carcinoma and/or squamous cell carcinoma skin cancer that has been adequately treated with no evidence of recurrence for at least 3 months Is currently receiving systemic corticosteroids or other immunosuppressants for disorders unrelated to the pregnancy Has received or planning to receive plasmapheresis, immunoadsorption therapy, intravenous immunoglobulin (IVIg), or any immunoglobulin (Ig)G fragment crystallizable (Fc)-related protein therapeutics during the current pregnancy Has a severe infection including opportunistic infections Presence of abnormal (protocol-specified) hematologic laboratory values during screening History of severe preeclampsia prior to GA Week 34 or severe fetal growth restriction (estimated fetal weight <3rd percentile, based on local fetal growth normative standards) in a previous pregnancy
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Study Contact
Phone
844-434-4210
Email
Participate-In-This-Study@its.jnj.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Janssen Research & Development, LLC Clinical Trial
Organizational Affiliation
Janssen Research & Development, LLC
Official's Role
Study Director
Facility Information:
Facility Name
Yale New Haven Hospital
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06511
Country
United States
Facility Name
Yale New Haven Hospital
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06520-8064
Country
United States
Facility Name
Columbia University Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
University of North Carolina (UNC) - School of Medicine
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599-7516
Country
United States
Facility Name
University of North Carolina
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599-7516
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Facility Name
University of Cincinnati
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45267
Country
United States
Facility Name
Oregon Health and Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
Dell Children's Medical Center of Central Texas
City
Austin
State/Province
Texas
ZIP/Postal Code
78723
Country
United States
Facility Name
Instituto de Mastologia e Oncologia
City
Goiânia
ZIP/Postal Code
74110060
Country
Brazil
Facility Name
Centre Hospitalier Sainte Justine
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H3T 1C5
Country
Canada
Facility Name
The Chaim Sheba Medical Center
City
Ramat Gan
ZIP/Postal Code
5265601
Country
Israel
Facility Name
Birmingham Children's Hospital
City
Birmingham
ZIP/Postal Code
B15 2TG
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The data sharing policy of the Janssen Pharmaceutical Companies of Johnson & Johnson is available at www.janssen.com/clinical-trials/transparency. As noted on this site, requests for access to the study data can be submitted through Yale Open Data Access (YODA) Project site at yoda.yale.edu
IPD Sharing URL
https://www.janssen.com/clinical-trials/transparency

Learn more about this trial

A Study of Nipocalimab in Pregnancies at Risk for Severe Hemolytic Disease of the Fetus and Newborn (HDFN)

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