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    Clinical Trial Results:
    Efficacy, safety and pharmaco-economic assessment of secondary long term prophylaxis with highly purified, standardized, doubly virus inactivated FVIII/VWF concentrates in patients with severe, inherited VWD and frequent bleedings

    Summary
    EudraCT number
    2006-001383-23
    Trial protocol
    IT   GB   ES   DE  
    Global end of trial date
    24 Aug 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    07 Aug 2021
    First version publication date
    07 Aug 2021
    Other versions
    Summary report(s)
    Pro.Will CSR Synopsis

    Trial information

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    Trial identification
    Sponsor protocol code
    Pro.Will
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano
    Sponsor organisation address
    Via Pace 9 , Milan, Italy, 20122
    Public contact
    Prof. Flora Peyvandi, Fondazione Luigi Villa Fondazione IRCCS Cà Granda Ospedale Maggiore Polic, flora.peyvandi@unimi.it
    Scientific contact
    Prof. Flora Peyvandi, Fondazione Luigi Villa Fondazione IRCCS Cà Granda Ospedale Maggiore Polic, flora.peyvandi@unimi.it
    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
    30 Jun 2017
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    24 Aug 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    24 Aug 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate if long term, secondary prophylaxis with highly purified FVIII/VWF concentrates, with respect to on demand treatment with the same pharmacological agent, prevents spontaneous bleedings onset in patients with severe inherited VWD unresponsive to DDAVP and with frequent bleedings
    Protection of trial subjects
    Patients were evaluated for recruitment by a medical visit and a laboratory investigation (including complete blood analysis) to verify general health conditions, the fulfilment of the inclusion criteria and to rule out the presence of any exclusion criteria. At enrolment patients had to be in stable conditions (no bleeding in act). Being the baseline clinical condition an important prognostic factor, the randomisation was stratified according to the following three types of bleeding: gastrointestinal, hemarthrosis, and epistaxis/other bleedings. In general any medication needed to treat concomitant pathologies or to control and ameliorate the general conditions of the patients were allowed. Every patient had the right to discontinue study participation at any time, and every patient may have been discontinued from the study for any reason beneficial to her wellbeing.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    18 Oct 2006
    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
    Germany: 1
    Country: Number of subjects enrolled
    Spain: 2
    Country: Number of subjects enrolled
    Italy: 16
    Worldwide total number of subjects
    19
    EEA total number of subjects
    19
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    2
    Adolescents (12-17 years)
    2
    Adults (18-64 years)
    11
    From 65 to 84 years
    3
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    Recruitment started in 2006 for all study centres ( Germany, Italy and Spain). Recruitment ended in 2015

    Pre-assignment
    Screening details
    Before enter the study a wash out of 10 days from last FVIII/VWF concentrate infusion is mandatory. Being the baseline clinical condition an important prognostic factor, the randomisation will be stratified according to the following three types of bleeding: gastrointestinal, hemarthrosis, and epistaxis/other bleedings.

    Period 1
    Period 1 title
    all study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    on demand -group
    Arm description
    On demand treatment (intended as replacement therapy with FVIII/VWF concentrates) was given only in case of bleeding
    Arm type
    Active comparator

    Investigational medicinal product name
    Fanhdi/Alphanate
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Suspension for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    dosage followed standard recommendations as in SmPC. The amount to be administered and the frequency of administration should always be oriented to the clinical effectiveness in the individual case.

    Arm title
    prophylaxix group
    Arm description
    Prophylaxis was given for 12 consecutive months. Two different schedules were foreseen, according to the individual prominent symptoms and the type of haemorrhagic manifestations to be prevented: - for patients presenting with recurrent hemarthroses or haematomas 60 IU VWF:RCo/kg b.w. was given every third day; - for patients presenting with recurrent mucosal bleeding (gastrointestinal, epistaxis, other) 60 IU VWF:RCo/kg b.w. wase given every second day.
    Arm type
    Active comparator

    Investigational medicinal product name
    Fanhdi/Alphanate
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Suspension for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    - for patients presenting with recurrent hemarthroses or haematomas 60 IU VWF:RCo/kg b.w. was given every third day; - for patients presenting with recurrent mucosal bleeding (gastrointestinal, epistaxis, other) 60 IU VWF:RCo/kg b.w. was given every second day.

    Number of subjects in period 1
    on demand -group prophylaxix group
    Started
    9
    10
    Completed
    7
    5
    Not completed
    2
    5
         Consent withdrawn by subject
    -
    2
         Treatment failure
    1
    -
         Lost to follow-up
    1
    2
         Protocol deviation
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    all study
    Reporting group description
    -

    Reporting group values
    all study Total
    Number of subjects
    19 19
    Age categorical
    Units: Subjects
        Children (2-11 years)
    2 2
        Adolescents (12-17 years)
    2 2
        Adults (18-64 years)
    11 11
        From 65-84 years
    3 3
        85 years and over
    1 1
    Gender categorical
    Units: Subjects
        Female
    5 5
        Male
    14 14

    End points

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    End points reporting groups
    Reporting group title
    on demand -group
    Reporting group description
    On demand treatment (intended as replacement therapy with FVIII/VWF concentrates) was given only in case of bleeding

    Reporting group title
    prophylaxix group
    Reporting group description
    Prophylaxis was given for 12 consecutive months. Two different schedules were foreseen, according to the individual prominent symptoms and the type of haemorrhagic manifestations to be prevented: - for patients presenting with recurrent hemarthroses or haematomas 60 IU VWF:RCo/kg b.w. was given every third day; - for patients presenting with recurrent mucosal bleeding (gastrointestinal, epistaxis, other) 60 IU VWF:RCo/kg b.w. wase given every second day.

    Primary: prevention of spontaneous bleeding

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    End point title
    prevention of spontaneous bleeding [1]
    End point description
    The primary end point was the prevention of spontaneous bleeding onset, expressed as proportion of patients who did not present any spontaneous bleeding episode during the study period. A bleeding episode was defined as spontaneous when occurring in absence of concomitant trauma, local injury, invasive diagnostic or surgical procedures.
    End point type
    Primary
    End point timeframe
    all time of participation in the study
    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: some of the requested statistical data are not available and incomplete data set is not allowed
    End point values
    on demand -group prophylaxix group
    Number of subjects analysed
    9
    6
    Units: bleeding episodes
        bleeding episode
    9
    10
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Time in which patients were participating in the study
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    14.1
    Reporting groups
    Reporting group title
    on demand -group
    Reporting group description
    On demand treatment (intended as replacement therapy with FVIII/VWF concentrates) was given only in case of bleeding

    Reporting group title
    prophylaxix group
    Reporting group description
    Prophylaxis was given for 12 consecutive months. Two different schedules were foreseen, according to the individual prominent symptoms and the type of haemorrhagic manifestations to be prevented: - for patients presenting with recurrent hemarthroses or haematomas 60 IU VWF:RCo/kg b.w. was given every third day; - for patients presenting with recurrent mucosal bleeding (gastrointestinal, epistaxis, other) 60 IU VWF:RCo/kg b.w. wase given every second day.

    Serious adverse events
    on demand -group prophylaxix group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Gastrointestinal disorders
    Intestinal perforation
    Additional description: It resolved with a combination of adjustment to study drug dose, use of concomitant medication and hospitalization
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    on demand -group prophylaxix group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    3 / 9 (33.33%)
    5 / 10 (50.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 9 (11.11%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Orthostatic hypertension
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Chest pain
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Injury, poisoning and procedural complications
    Contusion
         subjects affected / exposed
    0 / 9 (0.00%)
    2 / 10 (20.00%)
         occurrences all number
    0
    2
    Cardiac disorders
    Left ventricular failure
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Tachycardia
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Nervous system disorders
    Dizziness postural
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 9 (11.11%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Iron deficiency anaemia
         subjects affected / exposed
    1 / 9 (11.11%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Lymphadenopathy
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Ear and labyrinth disorders
    Hypoacusis
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Eye disorders
    Eye haemorrhage
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Flatulence
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Haemorrhoids
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Intestinal perforation
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Skin and subcutaneous tissue disorders
    Psoriasis
         subjects affected / exposed
    2 / 9 (22.22%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    1 / 9 (11.11%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    Back pain
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    Rotator cuff syndrome
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    Infection
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    Rhinitis
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    29 Nov 2011
    Specification of substantial amendments: Anti-fibrinogen agents were removed from the prohibited medication list. The protocol was amended in order to include also Spain among the participating Countries, and the fact that the web based system used for the study was updated accordingly. Inclusion criteria relevant to patient's age was modified to include only patients aged 2: 6 years. Moreover, on demand treatment dosage was expressed in a different manner, albeit substantially unchanged, in order to attain international specifications as in the Summary of Product Characteristics (SPCs) of Fanhdi and Alphanate. Finally, QoL generic questionnaires were removed and only specific questionnaires were maintained to assess the patients QoL

    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

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/30747707
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