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    Clinical Trial Results:
    INCIDENCE OF INHIBITORS IN PREVIOUSLY UNTREATED PATIENTS WITH SEVERE HEAMOPHILIA A TREATED WITH OCTANATE

    Summary
    EudraCT number
    2005-004435-22
    Trial protocol
    CZ   FR  
    Global end of trial date
    29 Dec 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    19 Aug 2017
    First version publication date
    19 Aug 2017
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    AVI-403
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Octapharma AG
    Sponsor organisation address
    Seidenstrasse 2, Lachen, Switzerland, CH-8853
    Public contact
    Clinical Research and Development, Octapharma Pharmazeutika Produktionsgesellschaft mbH, 0043 1610320, clinical.department@octapharma.com
    Scientific contact
    Clinical Research and Develpoment, Octapharma Pharmazeutika Produktionsgesellschaft mbH, 0043 1610320, clinical.department@octapharma.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    17 Feb 2017
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    29 Dec 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess immunogenicity of Octanate® in PUPs by monitoring the levels of inhibitor against FVIII (Bethesda assay) every 3-4 exposure days until the 20th exposure day and every 10th exposure day until exposure day 100 or every 3 months, whichever comes first.
    Protection of trial subjects
    This trial was conducted in accordance to the principles of GCP, ensuring that the rights, safety and well-being of patients are protected and in consistency with the Declaration of Helsinki. Inclusion and exclusion criteria were carefully defined in order to protect subjects from contraindications, interactions with other medication and risk factors associated with the investigational medicinal product. Safety was assessed throughout the study, such as occurrence of AEs, testing of virology and testing of immunogenicity .
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    16 Feb 2000
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Czech Republic: 5
    Country: Number of subjects enrolled
    Poland: 42
    Country: Number of subjects enrolled
    Russian Federation: 4
    Worldwide total number of subjects
    51
    EEA total number of subjects
    47
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    2
    Infants and toddlers (28 days-23 months)
    47
    Children (2-11 years)
    2
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    • Previously untreated patients with severe (FVIII:C [factor VIII coagulant activity] <2%) haemophilia A • Patients registered for regular treatment at the study site • Patients without any inhibitor activity prior to admission (cut-off: 0.6 BU).

    Period 1
    Period 1 title
    Overall Trail (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Octanate
    Arm description
    Octanate, a stable, highly purified, freeze-dried concentrate of human coagulation FVIII stabilised with Von Willebrand factor (VWF), and virus inactivated by a Solvent/Detergent method and terminal dry-heat treatment.
    Arm type
    Experimental

    Investigational medicinal product name
    Octanate
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Determined according to the clinical needs of the subject and the opinion of the treating physician.

    Number of subjects in period 1
    Octanate
    Started
    51
    Completed
    51

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Trail
    Reporting group description
    -

    Reporting group values
    Overall Trail Total
    Number of subjects
    51 51
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (full range (min-max))
    0.81 (0.01 to 5.61) -
    Gender categorical
    Units: Subjects
        Female
    0 0
        Male
    51 51

    End points

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    End points reporting groups
    Reporting group title
    Octanate
    Reporting group description
    Octanate, a stable, highly purified, freeze-dried concentrate of human coagulation FVIII stabilised with Von Willebrand factor (VWF), and virus inactivated by a Solvent/Detergent method and terminal dry-heat treatment.

    Primary: development of FVIII-inhibitor

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    End point title
    development of FVIII-inhibitor [1]
    End point description
    The primary endpoint is the absence or occurence of inhibitor activity after treatment start with Octanate® determined by Bethesda assay (Nijmegen method, cut-off point: 0.6 B.U.)
    End point type
    Primary
    End point timeframe
    -Study Entry (pre-treatment) -Exposure day 1 - 20 every 3-4 exposure days, -Exposure day 21 - 100 every 10 exposure days
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Descriptive statistical methods (frequency distributions, descriptive statistics and figures) were used to analyse the data.
    End point values
    Octanate
    Number of subjects analysed
    5 [2]
    Units: Patients
    number (not applicable)
        clinically relevant and high responders
    3
    Notes
    [2] - Of 5 subjects with inhibitors,2 underwent ITI treatment, 1 with successful tolerisation, 1 without
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    AEs were recorded throughout the study.
    Adverse event reporting additional description
    For subjects on home-treatment, any AEs were reported on a treatment form provided. If subjects experienced any confirmed seroconversion during the study, the event was considered serious and handled in the same way as serious adverse events.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.1
    Reporting groups
    Reporting group title
    Octanate
    Reporting group description
    Octanate, a stable, highly purified, freeze-dried concentrate of human coagulation FVIII stabilised with Von Willebrand factor (VWF), and virus inactivated by a Solvent/Detergent method and terminal dry-heat treatment.

    Serious adverse events
    Octanate
    Total subjects affected by serious adverse events
         subjects affected / exposed
    34 / 51 (66.67%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Vascular disorders
    Haemorrhage
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Haematoma
         subjects affected / exposed
    2 / 51 (3.92%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Reproductive system and breast disorders
    Testicular torsion
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Epistaxis
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    Pneumonitis
         subjects affected / exposed
    2 / 51 (3.92%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Investigations
    Parvovirus B19 test positive
         subjects affected / exposed
    16 / 51 (31.37%)
         occurrences causally related to treatment / all
    16 / 16
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Head injury
         subjects affected / exposed
    8 / 51 (15.69%)
         occurrences causally related to treatment / all
    0 / 8
         deaths causally related to treatment / all
    0 / 0
    Traumatic haematoma
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Cardiomyopathy
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Balance disorder
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Factor F VIII inhibition
         subjects affected / exposed
    5 / 51 (9.80%)
         occurrences causally related to treatment / all
    5 / 5
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Enterocolitis
         subjects affected / exposed
    2 / 51 (3.92%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Mouth haemorrhage
         subjects affected / exposed
    2 / 51 (3.92%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Diarrhoea
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gingival bleeding
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vomiting
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Skin haemorrhage
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Haematuria
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Haemarthrosis
         subjects affected / exposed
    4 / 51 (7.84%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    2 / 51 (3.92%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Device related infection
         subjects affected / exposed
    2 / 51 (3.92%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Pharyngitis
         subjects affected / exposed
    2 / 51 (3.92%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Acute tonsillitis
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastroenteristis
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gatroenteritis rotavirus
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Streptococcal sepsis
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Upper respiratory tract infection
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gingivitis
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Octanate
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    36 / 51 (70.59%)
    Gastrointestinal disorders
    Enterocolitis
         subjects affected / exposed
    5 / 51 (9.80%)
         occurrences all number
    5
    Vomiting
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences all number
    3
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    6 / 51 (11.76%)
         occurrences all number
    16
    Skin and subcutaneous tissue disorders
    Dermatitis allergic
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences all number
    4
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    14 / 51 (27.45%)
         occurrences all number
    21
    Nasopharyngitis
         subjects affected / exposed
    12 / 51 (23.53%)
         occurrences all number
    31
    Pharyngitis
         subjects affected / exposed
    12 / 51 (23.53%)
         occurrences all number
    30
    Respiratory tract infection
         subjects affected / exposed
    6 / 51 (11.76%)
         occurrences all number
    6
    Laryngitis
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences all number
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    10 Aug 1999
    Amendment I : - Following an update of the Sponsor’s Safety SOPs, relevant changes were implemented into clinical studies not yet clinically started. Unlikely has been added to the causality assessment scheme -Insurance details corrected - Update of Patient Information and Informed Consent as requested by the Polish regulatory authorities
    08 Feb 2002
    Amendment II : - Octapharma AG moved to new facilities - Contracting a new insurance company
    17 Jul 2006
    Amendment IV: - due ro recruitment of additional centres . To get more clinically significant data it was decided to increase the number of patients to be enrolled from 25 to 35 - Due to the fact that the study was ongoing since more than 6 years, an interim analyses on the safety and efficacy data has been added
    24 Oct 2007
    Amendment VII: - The total number of patients planned to be enrolled is increased from 35 to 50 - Second interim analyses added - New Facility of central lab
    17 Nov 2011
    Amendment VIII: -Change of laboratories addresses -The duration of the study was prolonged until December 2013 -Addition of a new centre in Russia -The conditions for storage of IMP were updated in accordance with Instruction for Octanate -The AE and SAE sections were amended in accordance with current requirements

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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