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A Pharmacokinetic and Clotting Activity Study of FVIII-PEGLip

Primary Purpose

Hemophilia A With Inhibitor

Status
Unknown status
Phase
Phase 2
Locations
Russian Federation
Study Type
Interventional
Intervention
PEGylated Liposome (PEGLip)
Sponsored by
Ascension Healthcare Development Limited
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hemophilia A With Inhibitor focused on measuring Hemophilia A, Inhibitors

Eligibility Criteria

18 Years - 60 Years (Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Male adult patients aged 18 to 60 years;
  • Severe Haemophilia A (FVIII plasma level <1IU/dL) with documented history of bleeds (for at least 6 months prior to enrolment);
  • For patients without inhibitors: inhibitor titre < 0,6 Bethesda units and no medi-cal history of inhibitors;
  • For patients with inhibitors: inhibitor titre ≥0,6 Bethesda units or documented medical history of inhibitors titre ≥0,6 Bethesda units;
  • Adequate hematologic function, defined as platelet count ≥ 100,000/μL and hemoglobin ≥ 8 g/dL (≥ 4.97 mmol/L) at the time of screening;
  • Adequate hepatic function, defined as total bilirubin ≤ 1.5 × the upper limit of normal (ULN) (excluding Gilbert's syndrome) and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3 ×ULN at the time of screening; no clinical signs or known laboratory/radiographic evidence consistent with cirrho-sis;
  • Adequate renal function, defined as serum creatinine ≤ 2.5 × ULN and creati-nine clearance by Cockcroft-Gault formula ≥ 30 mL/min;
  • Patient's written informed consent, confirming his willingness to comply with the requirements of this protocol.

Exclusion Criteria:

  • Low platelet counts (<100000 / μl);
  • Congenital or acquired bleeding defects (including acquired hemophilia) other than Hemophilia A;
  • Abnormal renal function (serum creatinine concentrations greater than 1.3 mg/dL);
  • Active hepatic disease (persistent aspartate aminotransferase [AST] or alanine aminotransferase [ALT] increases to greater than five times the upper limit of normal);
  • A history of severe adverse reactions to blood products and/or plasma derived FVIII concentrates or liposomes, or PEG, or Nuwiq;
  • A history of allergic reactions to bypassing agents;
  • Any concomitant immunological disease (e.g. autoimmune chronic active hepati-tis, autoimmune thrombocytopenic purpura or Immune Thrombocytopenic Pur-pura (ITP), lupus, Multiple Sclerosis (MS));
  • Patients receiving immunosuppressive treatment (excluding glucocorticoids);
  • Patients receiving therapy with interferon;
  • Patients receiving any immune tolerance induction (ITI) therapy at the moment of the screening;
  • Any individual with known dyslipidemia disease or actively taking cholesterol lowering drugs for the treatment of hypercholesterolemia or hyperlipidemia (e.g., statins, cholesterol absorption inhibitors, bile acid sequestrates, nicotinic acid or fibrates);
  • Intake of NSAIDs (except COX-2 inhibitors), acetylsalicylic acid (Aspirin) or any other antiplatelet agents, opioids.;
  • Patients who have participated in another Clinical Trial (including medical device studies) within the past 60 days;
  • Concurrent disease, treatment, or abnormality in clinical laboratory tests that could interfere with the conduct of the study or that would, in the opinion of the investigator or Sponsor, preclude the patient's safe participation in and completion of the study or interpretation of the study results, according to the Investigator.
  • For patients without inhibitors - a history of demonstrating long half-lives for FVIII.

Sites / Locations

  • Kemerovo District Clinical HospitalRecruiting
  • Kirov Scientific Research Institute of Hematology and Blood TransfusionRecruiting
  • National Medical Research Centre of HematologyRecruiting
  • Novosibirsk State Medical University, Novosibirsk City Haematology CenterRecruiting
  • Samara State Medical UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Other

Arm Label

Inhibitors

Non-inhibitors

Arm Description

Patients with inhibitors to FVIII

Patients without inhibitors to FVIII

Outcomes

Primary Outcome Measures

Clotting activity based on ROTEM [single dose]
Clotting profile of single IV injection of FVIII-PEGLip based on key ROTEM parameters (CT+CFT) determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Clotting activity based on FVIII:C concentration [single dose]
Clotting profile of single IV injection of FVIII-PEGLip based on FVIII:C plasma assay measured at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Clotting activity based on ROTEM [multiple dose]
Dynamics of blood clotting activity as quantified by key ROTEM parameters (CT+CFT) measured before and 20 minutes after each injection of FVIII-PEGLip at weeks 2, 4 and 6 of 6-week multiple dosing of FVIII-PEGLip in severe Haemophilia A patients with inhibitors and patients without inhibitors.
Bleed frequency
Frequency of spontaneous bleeding episodes and average length (days) of bleeding-free periods
Area under the concentration-time curve (AUC) of FVIII:C (FVIII-PEGLip) [single dose]
AUC0-∞ of FVIII:C after single IV FVIII-PEGLip injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Area under the concentration-time curve (AUC) of FVIII:C (FVIII-WFI) [single dose]
AUC0-∞ of FVIII:C after single IV FVIII-WFI injection in severe Haemophilia A patients without inhibitors
Maximum plasma concentration (Cmax) of FVIII:C (FVIII-PEGLip) [single dose]
Cmax of FVIII:C after single IV FVIII-PEGLip injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Maximum plasma concentration (Cmax) of FVIII:C (FVIII-WFI) [single dose]
Cmax of FVIII:C after single IV FVIII-WFI injection in severe Haemophilia A patients without inhibitors
Time to reaching maximum plasma concentration (Tmax) of FVIII:C (FVIII-PEGLip) [single dose]
Tmax of FVIII:C after single IV FVIII-PEGLip injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Time to reaching maximum plasma concentration (Tmax) of FVIII:C (FVIII-WFI) [single dose]
Tmax of FVIII:C after single IV FVIII-WFI injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Half-life (t1/2) of FVIII:C (FVIII-PEGLip) [single dose]
T1/2 of FVIII:C after single IV FVIII-PEGLip injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Half-life (t1/2) of FVIII:C (FVIII-WFI)
T1/2 of FVIII:C after single IV FVIII-WFI injection in severe Haemophilia A patients without inhibitors

Secondary Outcome Measures

Inhibitor titres
Individual changes of inhibitor titres from baseline measurement to 168 hours after single IV injection of FVIII-PEGLip and at weeks 2, 4, and 6 of 6-week FVIII-PEGLip multiple dosing period
Area under the concentration-time curve (AUC) of PEGLip [single dose]
AUC0-∞ of PEGLip determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after single IV injection of FVIII-PEGLip
Maximum plasma concentration (Cmax) of PEGLip [single dose]
Cmax of PEGLip determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after single IV injection of FVIII-PEGLip
Time to reaching maximum plasma concentration (Tmax) of PEGLip [single dose]
Tmax of PEGLip determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after single IV injection of FVIII-PEGLip
Half-life (t1/2) of PEGLip [single dose]
t1/2 of PEGLip determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after single IV injection of FVIII-PEGLip
PEGLip concentration [multiple dose]
PEGLip concentration measured before and 20 minutes after each injection of FVIII-PEGLip at weeks 2, 4 and 6 of 6-week multiple dosing of FVIII-PEGLip

Full Information

First Posted
September 21, 2020
Last Updated
October 20, 2021
Sponsor
Ascension Healthcare Development Limited
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1. Study Identification

Unique Protocol Identification Number
NCT04592692
Brief Title
A Pharmacokinetic and Clotting Activity Study of FVIII-PEGLip
Official Title
A Pharmacokinetic and Clotting Activity Study of FVIII-PEGLip Administered Intravenously to Severe Haemophilia A Patients With and Without Inhibitors to FVIII
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Unknown status
Study Start Date
December 23, 2019 (Actual)
Primary Completion Date
February 28, 2022 (Anticipated)
Study Completion Date
May 31, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ascension Healthcare Development Limited

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to demonstrate that PEGylated liposomes (PEGLip) can shield FVIII from the immune system and inhibitors, and therefore provide a prophylactic FVIII replacement therapy for patients with inhibitors to FVIII.
Detailed Description
This is an open-label multicenter trial for patients with severe haemophilia A with inhibitors to FVIII and without inhibitors as control. The trial consists of 4 periods: Screening, Stage A, Stage B and Safety Follow-up. After signing informed consent, patients are assessed for eligibility during a Screening period lasting up to 21 days. All eligible patients enter Stage A - Regimen estimation. The non-inhibitor patients receive a single IV injection at a dose of 35 IU/kg FVIII reconstituted with Water For Injection. Following a 4-day wash-out period, these patients as well as patients with inhibitors receive a single IV injection of FVIII-PEGLip at a dose of 35 IU/kg FVIII + PEGLip 22 mg/kg to determine the duration of haemostatic cover and therefore required injection frequency to prevent bleeds. Stage B - multiple dosing: all patients receive injections of FVIII-PEGLip for 6 weeks at a frequency determined in Stage A for each individual patient. Safety follow-up: 15 and 30 days after the last injection of FVIII-PEGLip, patients are contacted for any adverse events or bleeding episodes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hemophilia A With Inhibitor
Keywords
Hemophilia A, Inhibitors

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Inhibitors
Arm Type
Experimental
Arm Description
Patients with inhibitors to FVIII
Arm Title
Non-inhibitors
Arm Type
Other
Arm Description
Patients without inhibitors to FVIII
Intervention Type
Drug
Intervention Name(s)
PEGylated Liposome (PEGLip)
Other Intervention Name(s)
Simoctocog alfa
Intervention Description
Intravenous co-administration of PEGLip with Simoctocog alfa
Primary Outcome Measure Information:
Title
Clotting activity based on ROTEM [single dose]
Description
Clotting profile of single IV injection of FVIII-PEGLip based on key ROTEM parameters (CT+CFT) determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Time Frame
7 days
Title
Clotting activity based on FVIII:C concentration [single dose]
Description
Clotting profile of single IV injection of FVIII-PEGLip based on FVIII:C plasma assay measured at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Time Frame
7 days
Title
Clotting activity based on ROTEM [multiple dose]
Description
Dynamics of blood clotting activity as quantified by key ROTEM parameters (CT+CFT) measured before and 20 minutes after each injection of FVIII-PEGLip at weeks 2, 4 and 6 of 6-week multiple dosing of FVIII-PEGLip in severe Haemophilia A patients with inhibitors and patients without inhibitors.
Time Frame
6 weeks
Title
Bleed frequency
Description
Frequency of spontaneous bleeding episodes and average length (days) of bleeding-free periods
Time Frame
6 weeks
Title
Area under the concentration-time curve (AUC) of FVIII:C (FVIII-PEGLip) [single dose]
Description
AUC0-∞ of FVIII:C after single IV FVIII-PEGLip injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Time Frame
7 days
Title
Area under the concentration-time curve (AUC) of FVIII:C (FVIII-WFI) [single dose]
Description
AUC0-∞ of FVIII:C after single IV FVIII-WFI injection in severe Haemophilia A patients without inhibitors
Time Frame
4 days
Title
Maximum plasma concentration (Cmax) of FVIII:C (FVIII-PEGLip) [single dose]
Description
Cmax of FVIII:C after single IV FVIII-PEGLip injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Time Frame
7 days
Title
Maximum plasma concentration (Cmax) of FVIII:C (FVIII-WFI) [single dose]
Description
Cmax of FVIII:C after single IV FVIII-WFI injection in severe Haemophilia A patients without inhibitors
Time Frame
4 days
Title
Time to reaching maximum plasma concentration (Tmax) of FVIII:C (FVIII-PEGLip) [single dose]
Description
Tmax of FVIII:C after single IV FVIII-PEGLip injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Time Frame
7 days
Title
Time to reaching maximum plasma concentration (Tmax) of FVIII:C (FVIII-WFI) [single dose]
Description
Tmax of FVIII:C after single IV FVIII-WFI injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Time Frame
4 days
Title
Half-life (t1/2) of FVIII:C (FVIII-PEGLip) [single dose]
Description
T1/2 of FVIII:C after single IV FVIII-PEGLip injection in severe Haemophilia A patients with inhibitors and in patients without inhibitors
Time Frame
7 days
Title
Half-life (t1/2) of FVIII:C (FVIII-WFI)
Description
T1/2 of FVIII:C after single IV FVIII-WFI injection in severe Haemophilia A patients without inhibitors
Time Frame
4 days
Secondary Outcome Measure Information:
Title
Inhibitor titres
Description
Individual changes of inhibitor titres from baseline measurement to 168 hours after single IV injection of FVIII-PEGLip and at weeks 2, 4, and 6 of 6-week FVIII-PEGLip multiple dosing period
Time Frame
Approximately 12 weeks
Title
Area under the concentration-time curve (AUC) of PEGLip [single dose]
Description
AUC0-∞ of PEGLip determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after single IV injection of FVIII-PEGLip
Time Frame
7 days
Title
Maximum plasma concentration (Cmax) of PEGLip [single dose]
Description
Cmax of PEGLip determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after single IV injection of FVIII-PEGLip
Time Frame
7 days
Title
Time to reaching maximum plasma concentration (Tmax) of PEGLip [single dose]
Description
Tmax of PEGLip determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after single IV injection of FVIII-PEGLip
Time Frame
7 days
Title
Half-life (t1/2) of PEGLip [single dose]
Description
t1/2 of PEGLip determined at 0 hours (pre-injection) and at 20 min, 1, 2, 4, 8, 24, 48, 72, 96, 120, 144 and 168 hours after single IV injection of FVIII-PEGLip
Time Frame
7 days
Title
PEGLip concentration [multiple dose]
Description
PEGLip concentration measured before and 20 minutes after each injection of FVIII-PEGLip at weeks 2, 4 and 6 of 6-week multiple dosing of FVIII-PEGLip
Time Frame
6 weeks
Other Pre-specified Outcome Measures:
Title
Adverse events
Description
Adverse events / Serious Adverse Events developed in the course of the study
Time Frame
Approximately 12 weeks

10. Eligibility

Sex
Male
Gender Based
Yes
Gender Eligibility Description
Male patients only
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male adult patients aged 18 to 60 years; Severe Haemophilia A (FVIII plasma level <1IU/dL) with documented history of bleeds (for at least 6 months prior to enrolment); For patients without inhibitors: inhibitor titre < 0,6 Bethesda units and no medi-cal history of inhibitors; For patients with inhibitors: inhibitor titre ≥0,6 Bethesda units or documented medical history of inhibitors titre ≥0,6 Bethesda units; Adequate hematologic function, defined as platelet count ≥ 100,000/μL and hemoglobin ≥ 8 g/dL (≥ 4.97 mmol/L) at the time of screening; Adequate hepatic function, defined as total bilirubin ≤ 1.5 × the upper limit of normal (ULN) (excluding Gilbert's syndrome) and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3 ×ULN at the time of screening; no clinical signs or known laboratory/radiographic evidence consistent with cirrho-sis; Adequate renal function, defined as serum creatinine ≤ 2.5 × ULN and creati-nine clearance by Cockcroft-Gault formula ≥ 30 mL/min; Patient's written informed consent, confirming his willingness to comply with the requirements of this protocol. Exclusion Criteria: Low platelet counts (<100000 / μl); Congenital or acquired bleeding defects (including acquired hemophilia) other than Hemophilia A; Abnormal renal function (serum creatinine concentrations greater than 1.3 mg/dL); Active hepatic disease (persistent aspartate aminotransferase [AST] or alanine aminotransferase [ALT] increases to greater than five times the upper limit of normal); A history of severe adverse reactions to blood products and/or plasma derived FVIII concentrates or liposomes, or PEG, or Nuwiq; A history of allergic reactions to bypassing agents; Any concomitant immunological disease (e.g. autoimmune chronic active hepati-tis, autoimmune thrombocytopenic purpura or Immune Thrombocytopenic Pur-pura (ITP), lupus, Multiple Sclerosis (MS)); Patients receiving immunosuppressive treatment (excluding glucocorticoids); Patients receiving therapy with interferon; Patients receiving any immune tolerance induction (ITI) therapy at the moment of the screening; Any individual with known dyslipidemia disease or actively taking cholesterol lowering drugs for the treatment of hypercholesterolemia or hyperlipidemia (e.g., statins, cholesterol absorption inhibitors, bile acid sequestrates, nicotinic acid or fibrates); Intake of NSAIDs (except COX-2 inhibitors), acetylsalicylic acid (Aspirin) or any other antiplatelet agents, opioids.; Patients who have participated in another Clinical Trial (including medical device studies) within the past 60 days; Concurrent disease, treatment, or abnormality in clinical laboratory tests that could interfere with the conduct of the study or that would, in the opinion of the investigator or Sponsor, preclude the patient's safe participation in and completion of the study or interpretation of the study results, according to the Investigator. For patients without inhibitors - a history of demonstrating long half-lives for FVIII.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Sam Yurdakul
Phone
+44(0)2072915400
Email
sam.yurdakul@ascension.co.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sam Yurdakul
Organizational Affiliation
Ascension Healthcare
Official's Role
Study Director
Facility Information:
Facility Name
Kemerovo District Clinical Hospital
City
Kemerovo
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kosinova
Facility Name
Kirov Scientific Research Institute of Hematology and Blood Transfusion
City
Kirov
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Timofeeva
Facility Name
National Medical Research Centre of Hematology
City
Moscow
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Zozulia
Facility Name
Novosibirsk State Medical University, Novosibirsk City Haematology Center
City
Novosibirsk
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pospelova
Facility Name
Samara State Medical University
City
Samara
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kurtov

12. IPD Sharing Statement

Plan to Share IPD
No

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A Pharmacokinetic and Clotting Activity Study of FVIII-PEGLip

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