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Evaluation of a Recombinant Factor IX Product, APVO101, in Previously-Treated Pediatric Patients With Hemophilia B

Primary Purpose

Hemophilia B

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
APVO101
Sponsored by
Medexus Pharma, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hemophilia B

Eligibility Criteria

undefined - 12 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age: < 11.5 years of age at the time of the first dose and < 12 years throughout the Treatment Phase of the study (for at least 50 ED).
  2. Informed consent: subject's parent or legal guardian written Institutional Review Board (IRB)/Ethics Committee (EC)-approved informed consent. An assent form (IRB/EC-approved) will be obtained, when required by local regulations/guidelines.
  3. Willingness and ability to make the required study visits, and follow instructions while enrolled in the study (for at least 50 ED; approximately 6 months).
  4. Documented severe or moderately severe hemophilia B diagnosis (factor IX activity ≤ 2 IU/dL); in addition, severity may be indicated by the occurrence of one or more joint bleeding episode(s) at any point in the child's medical history requiring infusion(s) to replace factor IX.
  5. Subjects must be on prophylaxis or switch to a prophylaxis regimen for the duration of the study.
  6. Previously treated patients with a minimum of 50 ED (as documented and determined by the investigator) to a preparation/blood components containing factor IX.
  7. Willingness to adhere to the 4-day washout period of any factor IX replacement therapy prior to PK evaluation. In case of previous exposure to a factor IX product with a prolonged half-life, a washout period of 3 half-lives is required in order to achieve steady state factor IX level prior to exposure to APVO101.
  8. Immunocompetent (CD4 count > 400/mm3) and not receiving immune modulating or chemotherapeutic agents.
  9. Platelet count at least 150,000/mm3.
  10. Liver function: alanine transaminase (ALT) and aspartate transaminase (AST) ≤ 2 times the upper limit of the normal range.
  11. Total bilirubin ≤ 1.5 times the upper limit of the normal range.
  12. Renal function: serum creatinine ≤ 1.25 times the upper limit of the normal range.
  13. Hemoglobin ≥ 7 g/dL.

Exclusion Criteria:

  1. History of factor IX inhibitor ≥ 0.6 Bethesda Units (BU); confirmed by the screening result.
  2. Existence of another coagulation disorder.
  3. Evidence of thrombotic disease, fibrinolysis, or disseminated intravascular coagulation (DIC).
  4. Use of an investigational drug within 30 days prior to study entry.
  5. Previous use of APVO101.
  6. Use of medications that could impact hemostasis, such as aspirin.
  7. Known hypersensitivity to the active substance or to any of the excipients in the investigational products.
  8. Known allergic reaction to hamster proteins.
  9. History of poor compliance, geographic isolation, unreliable transportation, a serious medical or social condition, or any other circumstance that, in the opinion of the investigator, would interfere with participation or compliance with the study protocol.
  10. History of adverse reaction to either plasma-derived factor IX or recombinant factor IX that interfered with the subject's ability to treat bleeding episodes with a factor IX product.
  11. History of any medical condition that would impact the efficacy evaluation and/or safety evaluation of the study product.

Sites / Locations

  • Centro Estadual de Hemopterapia e Hematologia do Espirito Santo
  • Universidade Estadual de Campinas - Centro de Hematologia e Hemoterapia
  • Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo
  • JSC K Eristavi National Center for Experimental and Clinical Surgery
  • PMSI Institute of Mother and Child
  • Worthwhile Clinical Trials, Lakeview Hospital
  • Haemophilia Comprehensive Care Centre
  • Cukurova University School of Medicine
  • Ege University School ofMedicine
  • National Specialized Children's Hospital OKHMATDYT
  • State Institute: Institute of Blood Pathology and Transfusion Medicine of the National Academy of Medical Sciences of Ukraine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

APVO101

Arm Description

APVO101: 35 - 75 IU/kg; twice weekly

Outcomes

Primary Outcome Measures

Annualized Bleed Rate
Measure assessed during the Treatment Phase

Secondary Outcome Measures

Area under the plasma concentration curve from time 0 to t (AUC0-t)
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Terminal Half-life (t 1/2)
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Maximum post-infusion plasma concentration (Cmax)
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Incremental Recovery
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Clearance (CL)
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Volume of Distribution at steady-state (V dss)
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Degree of Hemorrhage Control
Subjects rating of bleed control within 6 hours of the time bleeding has stopped: Excellent: a dramatic response with abrupt pain relief and clear reduction in joint or hemorrhage site size; Good: pain relief or reduction in hemorrhage site size that may have required an additional infusion for resolution; Fair: probable or slight beneficial response usually requiring one of more additional infusions for resolution; Poor: no improvement or condition worsens.

Full Information

First Posted
February 25, 2019
Last Updated
August 26, 2022
Sponsor
Medexus Pharma, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03855280
Brief Title
Evaluation of a Recombinant Factor IX Product, APVO101, in Previously-Treated Pediatric Patients With Hemophilia B
Official Title
Evaluation of a Recombinant Factor IX Product, APVO101, in Previously-Treated Pediatric Patients With Hemophilia B
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Completed
Study Start Date
January 16, 2020 (Actual)
Primary Completion Date
July 4, 2022 (Actual)
Study Completion Date
July 4, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Medexus Pharma, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Phase 3/4, single arm, open-label study to evaluate PK, safety, and efficacy of APVO101 prophylaxis in severe or moderately severe hemophilia B subjects < 12 years of age.
Detailed Description
Study APVO101-903 is a Phase 3/4, single arm, open-label clinical trial. The purpose of the study is to evaluate pharmacokinetics (PK), safety, and efficacy of APVO101 prophylaxis in severe or moderately severe hemophilia B subjects < 12 years of age. The study is designed to gather information in two age groups of previously treated (with a minimum of 50 previous ED to factor IX replacement therapy) pediatric patients, specifically those < 6 years of age and 6 to <12 years of age. Study APVO101-903 consists of three distinct phases: PK Phase - PK evaluation will consist of administration of a single 75 ± 5 IU/kg dose, followed by factor IX activity and safety assessments up to 50 hours post-infusion. Treatment Phase - subjects will receive APVO101 prophylaxis (starting prophylaxis dose to be determined based on APVO101 recovery; ideally within the recommended dose range: 35 - 75 IU/kg; twice weekly) for 50 ED (approximately 6 months). Continuation Phase - subjects may continue to receive APVO101 prophylaxis (recommended dose range: 35 - 75 IU/kg; twice weekly) for an additional ≥ 50 ED.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hemophilia B

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Model Description
Phase 3/4, single arm, open-label study with three defined phases: PK Phase: Initial PK evaluation - single dose of APVO101 Treatment Phase: APVO101 prophylaxis treatment for 50 ED Continuation Phase: After completion of the Treatment Phase, subjects may continue APVO101 prophylaxis treatment (for an additional ≥ 50 ED)
Masking
None (Open Label)
Allocation
N/A
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Arm Title
APVO101
Arm Type
Experimental
Arm Description
APVO101: 35 - 75 IU/kg; twice weekly
Intervention Type
Drug
Intervention Name(s)
APVO101
Other Intervention Name(s)
IB1001, Recombinant factor IX, IXINITY
Intervention Description
APVO101: 35 - 75 IU/kg; twice weekly
Primary Outcome Measure Information:
Title
Annualized Bleed Rate
Description
Measure assessed during the Treatment Phase
Time Frame
6 Months
Secondary Outcome Measure Information:
Title
Area under the plasma concentration curve from time 0 to t (AUC0-t)
Description
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Time Frame
Pre-infusion to 50 hours following infusion
Title
Terminal Half-life (t 1/2)
Description
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Time Frame
Pre-infusion to 50 hours following infusion
Title
Maximum post-infusion plasma concentration (Cmax)
Description
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Time Frame
Pre-infusion to 50 hours following infusion
Title
Incremental Recovery
Description
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Time Frame
Pre-infusion to 50 hours following infusion
Title
Clearance (CL)
Description
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Time Frame
Pre-infusion to 50 hours following infusion
Title
Volume of Distribution at steady-state (V dss)
Description
Factor IX activity at the following time points post-infusion: 15-30 minutes, 4-6 hours, 24-26 hours and 46-50 hours
Time Frame
Pre-infusion to 50 hours following infusion
Title
Degree of Hemorrhage Control
Description
Subjects rating of bleed control within 6 hours of the time bleeding has stopped: Excellent: a dramatic response with abrupt pain relief and clear reduction in joint or hemorrhage site size; Good: pain relief or reduction in hemorrhage site size that may have required an additional infusion for resolution; Fair: probable or slight beneficial response usually requiring one of more additional infusions for resolution; Poor: no improvement or condition worsens.
Time Frame
6 Months

10. Eligibility

Sex
All
Maximum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age: < 11.5 years of age at the time of the first dose and < 12 years throughout the Treatment Phase of the study (for at least 50 ED). Informed consent: subject's parent or legal guardian written Institutional Review Board (IRB)/Ethics Committee (EC)-approved informed consent. An assent form (IRB/EC-approved) will be obtained, when required by local regulations/guidelines. Willingness and ability to make the required study visits, and follow instructions while enrolled in the study (for at least 50 ED; approximately 6 months). Documented severe or moderately severe hemophilia B diagnosis (factor IX activity ≤ 2 IU/dL); in addition, severity may be indicated by the occurrence of one or more joint bleeding episode(s) at any point in the child's medical history requiring infusion(s) to replace factor IX. Subjects must be on prophylaxis or switch to a prophylaxis regimen for the duration of the study. Previously treated patients with a minimum of 50 ED (as documented and determined by the investigator) to a preparation/blood components containing factor IX. Willingness to adhere to the 4-day washout period of any factor IX replacement therapy prior to PK evaluation. In case of previous exposure to a factor IX product with a prolonged half-life, a washout period of 3 half-lives is required in order to achieve steady state factor IX level prior to exposure to APVO101. Immunocompetent (CD4 count > 400/mm3) and not receiving immune modulating or chemotherapeutic agents. Platelet count at least 150,000/mm3. Liver function: alanine transaminase (ALT) and aspartate transaminase (AST) ≤ 2 times the upper limit of the normal range. Total bilirubin ≤ 1.5 times the upper limit of the normal range. Renal function: serum creatinine ≤ 1.25 times the upper limit of the normal range. Hemoglobin ≥ 7 g/dL. Exclusion Criteria: History of factor IX inhibitor ≥ 0.6 Bethesda Units (BU); confirmed by the screening result. Existence of another coagulation disorder. Evidence of thrombotic disease, fibrinolysis, or disseminated intravascular coagulation (DIC). Use of an investigational drug within 30 days prior to study entry. Previous use of APVO101. Use of medications that could impact hemostasis, such as aspirin. Known hypersensitivity to the active substance or to any of the excipients in the investigational products. Known allergic reaction to hamster proteins. History of poor compliance, geographic isolation, unreliable transportation, a serious medical or social condition, or any other circumstance that, in the opinion of the investigator, would interfere with participation or compliance with the study protocol. History of adverse reaction to either plasma-derived factor IX or recombinant factor IX that interfered with the subject's ability to treat bleeding episodes with a factor IX product. History of any medical condition that would impact the efficacy evaluation and/or safety evaluation of the study product.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Khaled Mohamed
Organizational Affiliation
Medexus Pharma, Inc.
Official's Role
Study Chair
Facility Information:
Facility Name
Centro Estadual de Hemopterapia e Hematologia do Espirito Santo
City
Vitória
State/Province
Espirito Santo
ZIP/Postal Code
29040-090
Country
Brazil
Facility Name
Universidade Estadual de Campinas - Centro de Hematologia e Hemoterapia
City
Campinas
ZIP/Postal Code
13083-878
Country
Brazil
Facility Name
Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo
City
Ribeirão Preto
ZIP/Postal Code
14051-140
Country
Brazil
Facility Name
JSC K Eristavi National Center for Experimental and Clinical Surgery
City
Tbilisi
ZIP/Postal Code
0159
Country
Georgia
Facility Name
PMSI Institute of Mother and Child
City
Chisinau
ZIP/Postal Code
MD-2062
Country
Moldova, Republic of
Facility Name
Worthwhile Clinical Trials, Lakeview Hospital
City
Benoni
State/Province
Gauteng
ZIP/Postal Code
1500
Country
South Africa
Facility Name
Haemophilia Comprehensive Care Centre
City
Johannesburg
ZIP/Postal Code
2193
Country
South Africa
Facility Name
Cukurova University School of Medicine
City
Adana
ZIP/Postal Code
01330
Country
Turkey
Facility Name
Ege University School ofMedicine
City
İzmir
ZIP/Postal Code
35100
Country
Turkey
Facility Name
National Specialized Children's Hospital OKHMATDYT
City
Kyiv
ZIP/Postal Code
01135
Country
Ukraine
Facility Name
State Institute: Institute of Blood Pathology and Transfusion Medicine of the National Academy of Medical Sciences of Ukraine
City
Lviv
ZIP/Postal Code
79044
Country
Ukraine

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Evaluation of a Recombinant Factor IX Product, APVO101, in Previously-Treated Pediatric Patients With Hemophilia B

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