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CSL Behring Sclero XIII

Primary Purpose

Systemic Sclerosis

Status
Unknown status
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Fibrogammin®P, coagulation factor XIII concentrate (Human)
0.9% sodium chloride
Sponsored by
University College, London
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Systemic Sclerosis focused on measuring Digital Ulcers, Raynauds Phenomenon, Factor XIII

Eligibility Criteria

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

Inclusion Criteria:

  • Male and female adults.
  • Subjects with a diagnosis of systemic sclerosis (scleroderma, SSc) according to the 2013 American College of Rheumatology European League Against Rheumatism (ACR EULAR) classification criteria. They will be classified according to LeRoy criteria as limited or diffuse subset.
  • Females of childbearing potential must be willing to use a reliable form of medically acceptable contraception and have a negative pregnancy test.
  • Subjects will have serological status for hepatitis A and B assessed at screening.
  • Patients who have given their free and informed consent. -≥ 18 years.

Exclusion Criteria:

Participants must:

  • Be willing to use an effective method of contraception (hormonal or barrier method of birth control; abstinence) from the time consent is signed until 6 weeks after treatment discontinuation (females of childbearing potential and males)
  • Have a negative pregnancy test within 7 days prior to being registered for trial treatment (females of childbearing potential). NOTE: Subjects are considered not of child bearing potential if they are surgically sterile (i.e. they have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are postmenopausal.
  • Not be breastfeeding (females).

Participants must not:

  • Have allergies to excipients of the investigational medicinal product (IMP) and placebo
  • Have uncontrolled systemic hypertension as evidenced by sitting systolic blood pressure ≥ 160 mmHg or sitting diastolic blood pressure ≥ 100 mmHg.
  • Have portal hypertension or chronic liver disease defined as mild to severe hepatic impairment (Child-Pugh Class A-C). Subjects positive for Hepatitis C with evidence of active viral replication on sensitive polymerase chain reaction (PCR) testing are also excluded.
  • Have hepatic dysfunction, defined as aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) ≥ 3 times the upper limit of the normal range (× ULN) at the Screening Visit.
  • Have chronic renal insufficiency as defined by a serum creatinine ≥ 2.5 mg/dL (≤ 221 micromol/L) or requires dialysis.
  • Have a haemoglobin concentration ≤ 10 g/dL (≤ 100 g/L) at the Screening Visit.
  • Have a history of left-sided heart disease and/or clinically significant cardiac disease, including but not limited to any of the following: aortic or mitral valve disease (stenosis or regurgitation) defined as more than minimum aortic insufficiency and more than moderate mitral regurgitation (stenosis or regurgitation≥ grade 1); pericardial constriction; restrictive or congestive cardiomyopathy; left ventricular ejection fraction ≤ 40 % by multiple gated acquisition scan (MUGA), angiography, or echocardiography; left ventricular shortening fraction ≤ 22 % by echocardiography; or symptomatic coronary disease with demonstrable ischemia.
  • Have a history of malignancies within 5 years of Screening Visit with the exception of localized skin or cervical carcinomas.
  • Have psychiatric, addictive, or other disorder that compromises the ability to give informed consent for participating in this study. This includes subjects with a recent history of abusing alcohol or illicit drugs.
  • Be receiving ongoing treatment with hyperbaric oxygen
  • Have pulmonary artery hypertension (PAH)
  • Have received IV Iloprost within the last 2 months
  • Have been treated with sympathectomy or toxin botulinum A within the last 3 months
  • Have had thrombosis, stroke, pulmonary embolism or myocardial infarction in the last 6 months
  • Have a diagnosis of diabetes mellitus requiring dietary restriction of carbohydrate.
  • Be on a low sodium diet on medical advice.
  • Be participating in another clinical trial involving an investigational medicinal product.

Sites / Locations

  • Royal Free London NHS Foundation TrustRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Active treatment arm

Placebo arm

Arm Description

Fibrogammin®P, coagulation factor XIII concentrate (Human) IV infusion

Placebo will be 0.9 % Sodium chloride solution IV infusion

Outcomes

Primary Outcome Measures

Primary outcome assessed by skin involvement measured with modified Rodnan skin score
Primary outcome assessed by skin involvement measured with Raynaud condition score

Secondary Outcome Measures

Pulmonary function measured by pulmonary function test
Pulmonary function measured by pulmonary function test
Hand function measured with Cochin hand function
Hand function measured with Cochin hand function
Quality of life measured with Short Form-36 (SF-36) quality of life questionnaire
Quality of life measured with SF36 quality of life questionnaire
Number of new digital ulcers (DU)
Prevention of new DU: Number of new DU developed during a 24-week period of treatment
Complete healing of digital ulcers (DU)
Healing of DU: Complete healing of DUs present at baseline; each DU is considered as an entity
Digital ulcer pain assessment
DU Pain assessment at 4, 8, 12, 16, 24 weeks of treatment: Pain will be assessed by analogue scale for pain (Visual Analogue Scale, VAS)
Digital ulcer pain assessment
DU Pain assessment at 4, 8, 12, 16, 24 weeks of treatment: Pain will be assessed by Raynaud's severity (Raynaud's condition score)
Digital ulcer worsening: hospitalisation required
Number of overnight hospitalisations for digital ulcers
Digital ulcer worsening: surgical intervention required
Number of additional surgical treatments for digital ulcer in outpatient clinic
Digital ulcer worsening: Digital ulcer infection
Number of digital ulcers with infections
Digital ulcer worsening: Gangrene
Number of episodes of gangrene
Digital ulcer worsening: Amputation
Number of amputations
Digital ulcer worsening: Need of local sympathectomy
Number of local sympathectomies
Digital ulcer worsening: Need of toxin Botulinum A
Number of treatments with Botulinum toxin A
Digital ulcer worsening: Need of oral or parenteral antibiotic
Number of treatments needed with oral or parenteral antibiotic
Digital ulcer worsening: Need of intravenous (IV) Iloprost : this is considered treatment failure
Number of treatments needed with intravenous (IV) Iloprost : this is considered treatment failure

Full Information

First Posted
December 17, 2014
Last Updated
May 27, 2016
Sponsor
University College, London
Collaborators
CSL Behring
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1. Study Identification

Unique Protocol Identification Number
NCT02551042
Brief Title
CSL Behring Sclero XIII
Official Title
A Phase II, Double-blind, Randomized, Placebo-controlled Study to Investigate Pharmacokinetics (PK), Safety and Efficacy of Intravenous Factor XIII Treatment in Patients With Systemic Sclerosis
Study Type
Interventional

2. Study Status

Record Verification Date
May 2016
Overall Recruitment Status
Unknown status
Study Start Date
September 2015 (undefined)
Primary Completion Date
September 2016 (Anticipated)
Study Completion Date
September 2018 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University College, London
Collaborators
CSL Behring

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Many patients with Scleroderma (Systemic sclerosis) experience damage to blood vessels, mainly to the small arteries. A common manifestation of this is Raynaud's phenomenon (fingers or toes turning white then blue in the cold) and digital ulcers (open sores on the fingertips). The purpose of this study is to see how effective the study drug Human Factor XIII Concentrate is in treating patients who have these and other common manifestation of Scleroderma. It will be given in addition to the accepted treatments used for this disease.
Detailed Description
This is a phase II, double-blind, randomized, placebo-controlled study to investigate pharmacokinetics (PK), safety and efficacy of intravenous factor XIII treatment in patients with systemic sclerosis. Scleroderma (Systemic sclerosis) is a multisystem rheumatic disease that is characterised by progressive vascular damage e.g Raynaud's phenomenon and digital ulcers and organ fibrosis e.g. skin thickening and pulmonary fibrosis.The disease is associated with significant morbidity and mortality and current therapeutic options are only partially effective, including Cyclophosphamide for skin or lung fibrosis and Bosentan which reduces but does not heal digital ulcers. There is no cure available and there is therefore a high need for new therapeutic options.Administration of human Factor XIII (FXIII) concentrate in patients with scleroderma demonstrated promising results in the 1980s and 1990s . However these studies were not performed according to current Good Clinical Practice (GCP) guidelines and involved relatively small sample sizes. This is a single site study, therefore all study participants will be seen at the Royal Free London National Health Service (NHS) Foundation Trust.Total study duration is 36 months and will involve 2 phases: an initial single dose, pharmacokinetic (PK) phase in 8 subjects over 6 weeks and a multiple dose, active treatment phase in 18 subjects over 24 weeks. During the treatment phase subjects will be randomized at 2:1 ratio to either FXIII or Placebo and will receive biweekly injection of either factor XIII Concentrate or placebo.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Systemic Sclerosis
Keywords
Digital Ulcers, Raynauds Phenomenon, Factor XIII

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
26 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Active treatment arm
Arm Type
Experimental
Arm Description
Fibrogammin®P, coagulation factor XIII concentrate (Human) IV infusion
Arm Title
Placebo arm
Arm Type
Placebo Comparator
Arm Description
Placebo will be 0.9 % Sodium chloride solution IV infusion
Intervention Type
Drug
Intervention Name(s)
Fibrogammin®P, coagulation factor XIII concentrate (Human)
Other Intervention Name(s)
Factor XIII
Intervention Description
IV infusion
Intervention Type
Drug
Intervention Name(s)
0.9% sodium chloride
Other Intervention Name(s)
Normal saline
Intervention Description
IV infusion
Primary Outcome Measure Information:
Title
Primary outcome assessed by skin involvement measured with modified Rodnan skin score
Time Frame
24 weeks
Title
Primary outcome assessed by skin involvement measured with Raynaud condition score
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Pulmonary function measured by pulmonary function test
Description
Pulmonary function measured by pulmonary function test
Time Frame
24 weeks
Title
Hand function measured with Cochin hand function
Description
Hand function measured with Cochin hand function
Time Frame
24 weeks
Title
Quality of life measured with Short Form-36 (SF-36) quality of life questionnaire
Description
Quality of life measured with SF36 quality of life questionnaire
Time Frame
24 weeks
Title
Number of new digital ulcers (DU)
Description
Prevention of new DU: Number of new DU developed during a 24-week period of treatment
Time Frame
24 weeks
Title
Complete healing of digital ulcers (DU)
Description
Healing of DU: Complete healing of DUs present at baseline; each DU is considered as an entity
Time Frame
24 weeks
Title
Digital ulcer pain assessment
Description
DU Pain assessment at 4, 8, 12, 16, 24 weeks of treatment: Pain will be assessed by analogue scale for pain (Visual Analogue Scale, VAS)
Time Frame
24 weeks
Title
Digital ulcer pain assessment
Description
DU Pain assessment at 4, 8, 12, 16, 24 weeks of treatment: Pain will be assessed by Raynaud's severity (Raynaud's condition score)
Time Frame
24 weeks
Title
Digital ulcer worsening: hospitalisation required
Description
Number of overnight hospitalisations for digital ulcers
Time Frame
24 weeks
Title
Digital ulcer worsening: surgical intervention required
Description
Number of additional surgical treatments for digital ulcer in outpatient clinic
Time Frame
24 weeks
Title
Digital ulcer worsening: Digital ulcer infection
Description
Number of digital ulcers with infections
Time Frame
24 weeks
Title
Digital ulcer worsening: Gangrene
Description
Number of episodes of gangrene
Time Frame
24 weeks
Title
Digital ulcer worsening: Amputation
Description
Number of amputations
Time Frame
24 weeks
Title
Digital ulcer worsening: Need of local sympathectomy
Description
Number of local sympathectomies
Time Frame
24 weeks
Title
Digital ulcer worsening: Need of toxin Botulinum A
Description
Number of treatments with Botulinum toxin A
Time Frame
24 weeks
Title
Digital ulcer worsening: Need of oral or parenteral antibiotic
Description
Number of treatments needed with oral or parenteral antibiotic
Time Frame
24 weeks
Title
Digital ulcer worsening: Need of intravenous (IV) Iloprost : this is considered treatment failure
Description
Number of treatments needed with intravenous (IV) Iloprost : this is considered treatment failure
Time Frame
24 weeks
Other Pre-specified Outcome Measures:
Title
Safety endpoints: Physical examination (including height, weight, BMI, digital ulcer characterization)
Description
Physical examination (including height, weight, BMI, digital ulcer characterization)
Time Frame
24 weeks
Title
Safety endpoints: Adverse events
Description
Adverse events
Time Frame
24 weeks
Title
Safety endpoints: Serious adverse events
Description
Serious adverse events
Time Frame
24 weeks
Title
Safety endpoints: ECG
Description
ECG
Time Frame
24 weeks
Title
Safety endpoints: Vital signs
Description
Vital signs
Time Frame
24 weeks
Title
Safety endpoints: Clinical laboratory parameters
Description
Clinical laboratory parameters
Time Frame
24 weeks
Title
Safety endpoints: Pregnancy
Description
Serum or urine pregnancy tests will be performed at each visit and will be reported positive or negative
Time Frame
24 weeks
Title
Safety endpoints -Adverse events of special interest: thromboembolic events
Description
Adverse events of special interest: thromboembolic events
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female adults. Subjects with a diagnosis of systemic sclerosis (scleroderma, SSc) according to the 2013 American College of Rheumatology European League Against Rheumatism (ACR EULAR) classification criteria. They will be classified according to LeRoy criteria as limited or diffuse subset. Females of childbearing potential must be willing to use a reliable form of medically acceptable contraception and have a negative pregnancy test. Subjects will have serological status for hepatitis A and B assessed at screening. Patients who have given their free and informed consent. -≥ 18 years. Exclusion Criteria: Participants must: Be willing to use an effective method of contraception (hormonal or barrier method of birth control; abstinence) from the time consent is signed until 6 weeks after treatment discontinuation (females of childbearing potential and males) Have a negative pregnancy test within 7 days prior to being registered for trial treatment (females of childbearing potential). NOTE: Subjects are considered not of child bearing potential if they are surgically sterile (i.e. they have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are postmenopausal. Not be breastfeeding (females). Participants must not: Have allergies to excipients of the investigational medicinal product (IMP) and placebo Have uncontrolled systemic hypertension as evidenced by sitting systolic blood pressure ≥ 160 mmHg or sitting diastolic blood pressure ≥ 100 mmHg. Have portal hypertension or chronic liver disease defined as mild to severe hepatic impairment (Child-Pugh Class A-C). Subjects positive for Hepatitis C with evidence of active viral replication on sensitive polymerase chain reaction (PCR) testing are also excluded. Have hepatic dysfunction, defined as aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) ≥ 3 times the upper limit of the normal range (× ULN) at the Screening Visit. Have chronic renal insufficiency as defined by a serum creatinine ≥ 2.5 mg/dL (≤ 221 micromol/L) or requires dialysis. Have a haemoglobin concentration ≤ 10 g/dL (≤ 100 g/L) at the Screening Visit. Have a history of left-sided heart disease and/or clinically significant cardiac disease, including but not limited to any of the following: aortic or mitral valve disease (stenosis or regurgitation) defined as more than minimum aortic insufficiency and more than moderate mitral regurgitation (stenosis or regurgitation≥ grade 1); pericardial constriction; restrictive or congestive cardiomyopathy; left ventricular ejection fraction ≤ 40 % by multiple gated acquisition scan (MUGA), angiography, or echocardiography; left ventricular shortening fraction ≤ 22 % by echocardiography; or symptomatic coronary disease with demonstrable ischemia. Have a history of malignancies within 5 years of Screening Visit with the exception of localized skin or cervical carcinomas. Have psychiatric, addictive, or other disorder that compromises the ability to give informed consent for participating in this study. This includes subjects with a recent history of abusing alcohol or illicit drugs. Be receiving ongoing treatment with hyperbaric oxygen Have pulmonary artery hypertension (PAH) Have received IV Iloprost within the last 2 months Have been treated with sympathectomy or toxin botulinum A within the last 3 months Have had thrombosis, stroke, pulmonary embolism or myocardial infarction in the last 6 months Have a diagnosis of diabetes mellitus requiring dietary restriction of carbohydrate. Be on a low sodium diet on medical advice. Be participating in another clinical trial involving an investigational medicinal product.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Christopher Denton, PhD
Phone
02073177544
Email
c.denton@ucl.ac.uk
First Name & Middle Initial & Last Name or Official Title & Degree
Rachel Ochiel
Phone
02073177544
Email
rachel.ochiel@nhs.net
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christopher Denton, PhD
Organizational Affiliation
Royal Free London NHS Foundation Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
Royal Free London NHS Foundation Trust
City
London
ZIP/Postal Code
NW3 2QG
Country
United Kingdom
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
No
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Links:
URL
http://ec.europa.eu/health/documents/community-register/2012/20120903123586/anx_123586_en.pdf
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CSL Behring Sclero XIII

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