Trial of AAV5-hFIX in Severe or Moderately Severe Hemophilia B
Primary Purpose
Hemophilia B
Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
AAV5-hFIX
Sponsored by
About this trial
This is an interventional treatment trial for Hemophilia B focused on measuring Hemophilia B, gene therapy
Eligibility Criteria
Inclusion Criteria:
- Male
- Age ≥ 18 years
Patients with congenital hemophilia B classified as one of the following:
Known severe FIX deficiency with plasma FIX activity level < 1% and a severe bleeding phenotype defined by one of the following:
- Currently on prophylactic FIX replacement therapy for a history of bleeding
- Currently on on-demand therapy with a current or past history of frequent bleeding defined as four or more bleeding episodes in the last 12 months or chronic hemophilic arthropathy (pain, joint destruction, and loss of range of motion) in one or more joints
Known moderately severe FIX deficiency with plasma FIX activity level between ≥ 1% and ≤ 2% and a severe bleeding phenotype defined by one of the following:
- Currently on prophylactic FIX replacement therapy for a history of bleeding
- Currently on on-demand therapy with a current or past history of frequent bleeding defined as four or more bleeding episodes in the last 12 months or chronic hemophilic arthropathy (pain, joint destruction, and loss of range of motion) in one or more joints
- More than 150 previous exposure days of treatment with FIX protein.
- Acceptance to use a condom during sexual intercourse in the period from Investigational Medicinal Product (IMP) administration until AAV5 has been cleared from semen, as evidenced by the central laboratory from negative analysis results for at least 3 consecutively collected semen samples (this criterion is applicable also for subjects who are surgically sterilized)
- Following receipt of verbal and written information about the trial, the subject has provided signed informed consent before any trial related activity is carried out.
Exclusion Criteria:
- History of FIX inhibitors measured to be ≥ 0.6 Bethesda Units (BU)/mL
- FIX inhibitors ≥ 0.6 BU/mL at Visit 1 (measured by the local laboratory)
- Neutralizing antibodies against AAV5 at Visit 1 (measured by the central laboratory)
Visit 1 laboratory values (measured by the central laboratory):
- alanine aminotransferase > 2 times upper normal limit
- aspartate aminotransferase > 2 times upper normal limit
- total bilirubin > 2 times upper normal limit
- alkaline phosphatase > 2 times upper normal limit
- creatinine > 1.5 times upper normal limit
- Positive HIV serological test at Visit 1, not controlled with anti-viral therapy as shown by cluster of differentiation 4+ counts ≤ 200 per μL or by a viral load of >200 copies per mL (measured by the central laboratory)
- Active infection with Hepatitis B or C virus as reflected by Hepatitis B Surface Antigen (HBsAg), Hepatitis B extracellular Antigen (HBeAg), Hepatitis B Virus DeoxyriboNucleic Acid (HBV DNA) or Hepatitis C Virus RiboNucleic Acid (HCV RNA) positivity, respectively, at Visit 1 (measured by the central laboratory).
- History of Hepatitis B or C exposure, currently controlled by antiviral therapy
- Any coagulation disorder other than hemophilia B
- Thrombocytopenia, defined as a platelet count below 50 × 10E9 / L, at Visit 1 (measured by the central laboratory)
- Body mass index < 16 or ≥ 35 kg/m2
- Planned surgery for the initial 6 months after IMP administration in this trial
- Previous arterial or venous thrombotic event (e.g. acute myocardial infarction, cerebrovascular disease and venous thrombosis)
- Active severe infection or any other significant concurrent, uncontrolled medical condition including, but not limited to, renal, hepatic, haematological, gastrointestinal, endocrine, pulmonary, neurological, cerebral or psychiatric disease, alcoholism, drug dependency or any other psychological disorder evaluated by the investigator to interfere with adherence to the protocol procedures or with the degree of tolerance to the IMP
- Known significant medical condition including disseminated intravascular coagulation, fibrinolysis and liver fibrosis which, in the opinion of the investigator, may confound, contraindicate or limit the interpretation of either safety or efficacy data
- Known history of an allergic reaction or anaphylaxis to FIX products
- Known uncontrolled allergic conditions or allergy/hypersensitivity to any component of the IMP excipients
- Previous gene therapy treatment and/or previous participation in a gene therapy clinical trial
- Receipt of an experimental agent within 60 days prior to Visit 1
- Current participation or anticipated participation within one year after IMP administration in this trial in any other interventional clinical trial involving drugs or devices.
Sites / Locations
- uniQure Investigative Site
- uniQure Investigative Site
- uniQure Investigative Site
- uniQure Investigative Site
- uniQure Investigative Site
- uniQure Investigative Site
- uniQure Investigative Site
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Experimental
Arm Label
Cohort 1
Cohort 2
Arm Description
AAV5-hFIX 5 × 10E12 gc/kg intravenous single infusion
AAV5-hFIX 2 × 10E13 gc/kg intravenous single infusion
Outcomes
Primary Outcome Measures
Number of Participants With Adverse Events
Secondary Outcome Measures
FIX-replacement-therapy-free FIX Activity
FIX activity measured any time from 72 hours after latest FIX replacement therapy administration and until next administration of FIX replacement therapy. Only assessments performed more than 10 days after most recent FIX-replacement therapy administration included.
Total Annualized Bleeding Rate (ABR)
Annualized: Sum of post-treatment bleeding episodes divided by subjects' average number of years (365.25 days) from treatment start to until the data cutoff date.
Total Consumption of FIX Replacement Therapy
Change From Baseline in Short Form-36 (SF-36) Quality of Life (QoL) Scores
Scores range from 0 to 100, with a higher score defining a more favorable health state.
Time to Vector DNA Stopped Shedding From Blood, Nasal Secretions, Saliva, Urine, Feces, and Semen
Number of Subjects Developing Neutralizing Antibodies to AAV5
Total IgG and IgM Antibody Titers to AAV5
For subjects with a titer of 109350 and 50, the actual titer is >109350 and <50.
Number of Subjects With a Positive AAV5 Capsid-specific T Cell Response
Specific AAV5 response (results >17 SFC/million PBMCs) were regarded as positive.
Number of Subjects With Antibodies to FIX
Number of Subjects With FIX Inhibitors
Number of Subjects With Clinically Significant Inflammatory Markers: IL-1β, IL-2, IL-6, INFγ, MCP-1
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02396342
Brief Title
Trial of AAV5-hFIX in Severe or Moderately Severe Hemophilia B
Official Title
A Phase I/II, Open-label, Uncontrolled, Single-dose, Dose-ascending, Multi-centre Trial Investigating an Adeno-associated Viral Vector Containing a Codon-optimized Human Factor IX Gene (AAV5-hFIX) Administered to Adult Patients With Severe or Moderately Severe Hemophilia B
Study Type
Interventional
2. Study Status
Record Verification Date
June 2022
Overall Recruitment Status
Completed
Study Start Date
June 10, 2015 (Actual)
Primary Completion Date
April 15, 2021 (Actual)
Study Completion Date
April 15, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
CSL Behring
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This study evaluates how safe gene therapy treatment with AAV5-hFIX is in adult patients with severe or moderately severe hemophilia B and severe bleeding type.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hemophilia B
Keywords
Hemophilia B, gene therapy
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
10 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Cohort 1
Arm Type
Experimental
Arm Description
AAV5-hFIX 5 × 10E12 gc/kg intravenous single infusion
Arm Title
Cohort 2
Arm Type
Experimental
Arm Description
AAV5-hFIX 2 × 10E13 gc/kg intravenous single infusion
Intervention Type
Genetic
Intervention Name(s)
AAV5-hFIX
Other Intervention Name(s)
AAV5 containing a codon-optimized human factor IX gene
Intervention Description
AAV5hFIX gene therapy
Primary Outcome Measure Information:
Title
Number of Participants With Adverse Events
Time Frame
From AMT-060 infusion through end of study (5 years post-dose)
Secondary Outcome Measure Information:
Title
FIX-replacement-therapy-free FIX Activity
Description
FIX activity measured any time from 72 hours after latest FIX replacement therapy administration and until next administration of FIX replacement therapy. Only assessments performed more than 10 days after most recent FIX-replacement therapy administration included.
Time Frame
From AMT-060 infusion through end of study (5 years post-dose)
Title
Total Annualized Bleeding Rate (ABR)
Description
Annualized: Sum of post-treatment bleeding episodes divided by subjects' average number of years (365.25 days) from treatment start to until the data cutoff date.
Time Frame
From AMT-060 infusion through end of study (5 years post-dose)
Title
Total Consumption of FIX Replacement Therapy
Time Frame
From AMT-060 infusion through end of study (5 years post dose).
Title
Change From Baseline in Short Form-36 (SF-36) Quality of Life (QoL) Scores
Description
Scores range from 0 to 100, with a higher score defining a more favorable health state.
Time Frame
From AMT-060 infusion through the end of study (5 years post dose)
Title
Time to Vector DNA Stopped Shedding From Blood, Nasal Secretions, Saliva, Urine, Feces, and Semen
Time Frame
From AMT-060 infusion through end of study (5 years post dose).
Title
Number of Subjects Developing Neutralizing Antibodies to AAV5
Time Frame
From AMT-060 infusion through end of study (5 years post dose)
Title
Total IgG and IgM Antibody Titers to AAV5
Description
For subjects with a titer of 109350 and 50, the actual titer is >109350 and <50.
Time Frame
AMT-060 infusion through end of study (5 years post dose)
Title
Number of Subjects With a Positive AAV5 Capsid-specific T Cell Response
Description
Specific AAV5 response (results >17 SFC/million PBMCs) were regarded as positive.
Time Frame
From AMT-060 infusion through 26 weeks post-dose
Title
Number of Subjects With Antibodies to FIX
Time Frame
From AMT-060 infusion through the end of study (5 years post dose)
Title
Number of Subjects With FIX Inhibitors
Time Frame
From AMT-060 infusion through the end of study (5 years post dose)
Title
Number of Subjects With Clinically Significant Inflammatory Markers: IL-1β, IL-2, IL-6, INFγ, MCP-1
Time Frame
From AMT-060 infusion through 18 weeks post dose
10. Eligibility
Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male
Age ≥ 18 years
Patients with congenital hemophilia B classified as one of the following:
Known severe FIX deficiency with plasma FIX activity level < 1% and a severe bleeding phenotype defined by one of the following:
Currently on prophylactic FIX replacement therapy for a history of bleeding
Currently on on-demand therapy with a current or past history of frequent bleeding defined as four or more bleeding episodes in the last 12 months or chronic hemophilic arthropathy (pain, joint destruction, and loss of range of motion) in one or more joints
Known moderately severe FIX deficiency with plasma FIX activity level between ≥ 1% and ≤ 2% and a severe bleeding phenotype defined by one of the following:
Currently on prophylactic FIX replacement therapy for a history of bleeding
Currently on on-demand therapy with a current or past history of frequent bleeding defined as four or more bleeding episodes in the last 12 months or chronic hemophilic arthropathy (pain, joint destruction, and loss of range of motion) in one or more joints
More than 150 previous exposure days of treatment with FIX protein.
Acceptance to use a condom during sexual intercourse in the period from Investigational Medicinal Product (IMP) administration until AAV5 has been cleared from semen, as evidenced by the central laboratory from negative analysis results for at least 3 consecutively collected semen samples (this criterion is applicable also for subjects who are surgically sterilized)
Following receipt of verbal and written information about the trial, the subject has provided signed informed consent before any trial related activity is carried out.
Exclusion Criteria:
History of FIX inhibitors measured to be ≥ 0.6 Bethesda Units (BU)/mL
FIX inhibitors ≥ 0.6 BU/mL at Visit 1 (measured by the local laboratory)
Neutralizing antibodies against AAV5 at Visit 1 (measured by the central laboratory)
Visit 1 laboratory values (measured by the central laboratory):
alanine aminotransferase > 2 times upper normal limit
aspartate aminotransferase > 2 times upper normal limit
total bilirubin > 2 times upper normal limit
alkaline phosphatase > 2 times upper normal limit
creatinine > 1.5 times upper normal limit
Positive HIV serological test at Visit 1, not controlled with anti-viral therapy as shown by cluster of differentiation 4+ counts ≤ 200 per μL or by a viral load of >200 copies per mL (measured by the central laboratory)
Active infection with Hepatitis B or C virus as reflected by Hepatitis B Surface Antigen (HBsAg), Hepatitis B extracellular Antigen (HBeAg), Hepatitis B Virus DeoxyriboNucleic Acid (HBV DNA) or Hepatitis C Virus RiboNucleic Acid (HCV RNA) positivity, respectively, at Visit 1 (measured by the central laboratory).
History of Hepatitis B or C exposure, currently controlled by antiviral therapy
Any coagulation disorder other than hemophilia B
Thrombocytopenia, defined as a platelet count below 50 × 10E9 / L, at Visit 1 (measured by the central laboratory)
Body mass index < 16 or ≥ 35 kg/m2
Planned surgery for the initial 6 months after IMP administration in this trial
Previous arterial or venous thrombotic event (e.g. acute myocardial infarction, cerebrovascular disease and venous thrombosis)
Active severe infection or any other significant concurrent, uncontrolled medical condition including, but not limited to, renal, hepatic, haematological, gastrointestinal, endocrine, pulmonary, neurological, cerebral or psychiatric disease, alcoholism, drug dependency or any other psychological disorder evaluated by the investigator to interfere with adherence to the protocol procedures or with the degree of tolerance to the IMP
Known significant medical condition including disseminated intravascular coagulation, fibrinolysis and liver fibrosis which, in the opinion of the investigator, may confound, contraindicate or limit the interpretation of either safety or efficacy data
Known history of an allergic reaction or anaphylaxis to FIX products
Known uncontrolled allergic conditions or allergy/hypersensitivity to any component of the IMP excipients
Previous gene therapy treatment and/or previous participation in a gene therapy clinical trial
Receipt of an experimental agent within 60 days prior to Visit 1
Current participation or anticipated participation within one year after IMP administration in this trial in any other interventional clinical trial involving drugs or devices.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
uniQure Clinical Trials
Organizational Affiliation
UniQure Biopharma B.V.
Official's Role
Study Director
Facility Information:
Facility Name
uniQure Investigative Site
City
Copenhagen
Country
Denmark
Facility Name
uniQure Investigative Site
City
Berlin
Country
Germany
Facility Name
uniQure Investigative Site
City
Frankfurt
Country
Germany
Facility Name
uniQure Investigative Site
City
Amsterdam
Country
Netherlands
Facility Name
uniQure Investigative Site
City
Groningen
Country
Netherlands
Facility Name
uniQure Investigative Site
City
Rotterdam
Country
Netherlands
Facility Name
uniQure Investigative Site
City
Utrecht
Country
Netherlands
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
29246900
Citation
Miesbach W, Meijer K, Coppens M, Kampmann P, Klamroth R, Schutgens R, Tangelder M, Castaman G, Schwable J, Bonig H, Seifried E, Cattaneo F, Meyer C, Leebeek FWG. Gene therapy with adeno-associated virus vector 5-human factor IX in adults with hemophilia B. Blood. 2018 Mar 1;131(9):1022-1031. doi: 10.1182/blood-2017-09-804419. Epub 2017 Dec 15.
Results Reference
derived
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Trial of AAV5-hFIX in Severe or Moderately Severe Hemophilia B
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