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    Clinical Trial Results:
    Open-Label, Single-Dose Study to Evaluate the Response and Pharmacokinetics/Pharmacodynamics of Different Doses of CINRYZE® [C1 Inhibitor (Human)] For Treatment of Acute Angioedema Attacks in Children Less Than 12 Years of Age With Hereditary Angioedema

    Summary
    EudraCT number
    2011-000369-11
    Trial protocol
    HU   DE  
    Global end of trial date
    15 Jul 2013

    Results information
    Results version number
    v1(current)
    This version publication date
    21 Sep 2019
    First version publication date
    25 Apr 2015
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    0624-203
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01095510
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Shire Development LLC
    Sponsor organisation address
    725 Chesterbrook Boulevard Wayne,, Pennsylvania, United States, 19087
    Public contact
    Daniella Tierens, ViroPharma SPRL, +32 2791 76 29,
    Scientific contact
    Daniella Tierens, ViroPharma SPRL, +32 2791 76 29,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-000568-PIP01-09
    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?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    15 Jul 2013
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    15 Jul 2013
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The objectives of the study were to evaluate (1) The dose response. (2) The Pharmacokinetics (PK) /Pharmacodynamics (PD) of intravenous (IV) administration of CINRYZE (C1 esterase inhibitor [human]) for the treatment of acute angioedema attacks in children above and below 25 kilogram (kg) and less than 12 years of age with Hereditary angioedema (HAE) and (3) To determine the safety and tolerability following IV administration of CINRYZE in this study population.
    Protection of trial subjects
    The study was performed in accordance with the ethical principles stated in the Declaration of Helsinki and the International Conference on Harmonisation (ICH) Tripartite Guideline for Good Clinical Practice (GCP).
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    02 Jun 2010
    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
    United States: 9
    Worldwide total number of subjects
    9
    EEA total number of subjects
    0
    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)
    9
    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
    Subjects were not enrolled in the lower body weight category (10-25 kg) 1000 Units (U) dose group despite substantial recruitment efforts.

    Pre-assignment
    Screening details
    Of 12 subjects screened, 9 subjects were enrolled and treated. The reason for 3 subjects were screen failures in 3 subjects was that they did not meet the inclusion criteria.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    500 U CINRYZE (10-25 kg Body Weight)
    Arm description
    Single IV dose of 500 Unit (U) CINRYZE.
    Arm type
    Experimental

    Investigational medicinal product name
    CINRYZE® 500 U
    Investigational medicinal product code
    VP 20624
    Other name
    C1 esterase inhibitor (human)
    Pharmaceutical forms
    Powder and solvent for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Single IV dose of 500 U CINRYZE.

    Arm title
    1000 U CINRYZE (>25 kg Body Weight)
    Arm description
    Single IV dose of 1000 U CINRYZE.
    Arm type
    Experimental

    Investigational medicinal product name
    CINRYZE®1000 U
    Investigational medicinal product code
    VP 20624
    Other name
    C1 esterase inhibitor (human)
    Pharmaceutical forms
    Powder and solvent for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Single IV dose of 1000 U CINRYZE.

    Arm title
    1500 U CINRYZE (>25 kg Body Weight)
    Arm description
    Single IV dose of 1500 U CINRYZE.
    Arm type
    Experimental

    Investigational medicinal product name
    CINRYZE® 1500 U
    Investigational medicinal product code
    VP 20624
    Other name
    C1 esterase inhibitor (human)
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Single IV dose of 1500 U CINRYZE.

    Number of subjects in period 1
    500 U CINRYZE (10-25 kg Body Weight) 1000 U CINRYZE (>25 kg Body Weight) 1500 U CINRYZE (>25 kg Body Weight)
    Started
    3
    3
    3
    Completed
    3
    3
    3

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    500 U CINRYZE (10-25 kg Body Weight)
    Reporting group description
    Single IV dose of 500 Unit (U) CINRYZE.

    Reporting group title
    1000 U CINRYZE (>25 kg Body Weight)
    Reporting group description
    Single IV dose of 1000 U CINRYZE.

    Reporting group title
    1500 U CINRYZE (>25 kg Body Weight)
    Reporting group description
    Single IV dose of 1500 U CINRYZE.

    Reporting group values
    500 U CINRYZE (10-25 kg Body Weight) 1000 U CINRYZE (>25 kg Body Weight) 1500 U CINRYZE (>25 kg Body Weight) Total
    Number of subjects
    3 3 3 9
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        median (full range (min-max))
    7 (6 to 9) 9 (7 to 9) 10 (8 to 11) -
    Gender categorical
    Units: Subjects
        Female
    3 3 2 8
        Male
    0 0 1 1

    End points

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    End points reporting groups
    Reporting group title
    500 U CINRYZE (10-25 kg Body Weight)
    Reporting group description
    Single IV dose of 500 Unit (U) CINRYZE.

    Reporting group title
    1000 U CINRYZE (>25 kg Body Weight)
    Reporting group description
    Single IV dose of 1000 U CINRYZE.

    Reporting group title
    1500 U CINRYZE (>25 kg Body Weight)
    Reporting group description
    Single IV dose of 1500 U CINRYZE.

    Primary: Presence of Unequivocal Beginning of Relief of the Defining Attack Symptom

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    End point title
    Presence of Unequivocal Beginning of Relief of the Defining Attack Symptom [1]
    End point description
    Intent-to-treat efficacy (ITT-E) population included all subjects with baseline and at least one post-infusion investigator assessment of the hereditary angioedema (HAE) attack.
    End point type
    Primary
    End point timeframe
    Within 4 hours following treatment
    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: Only descriptive statistics were done, no inferential statistical analyses were performed.
    End point values
    500 U CINRYZE (10-25 kg Body Weight) 1000 U CINRYZE (>25 kg Body Weight) 1500 U CINRYZE (>25 kg Body Weight)
    Number of subjects analysed
    3
    3
    3
    Units: subjects
        Yes
    3
    3
    3
        No
    0
    0
    0
    No statistical analyses for this end point

    Secondary: Time to Unequivocal Beginning of Relief of the Defining Attack Symptom

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    End point title
    Time to Unequivocal Beginning of Relief of the Defining Attack Symptom
    End point description
    ITT-E population.
    End point type
    Secondary
    End point timeframe
    Within 4 hours following treatment
    End point values
    500 U CINRYZE (10-25 kg Body Weight) 1000 U CINRYZE (>25 kg Body Weight) 1500 U CINRYZE (>25 kg Body Weight)
    Number of subjects analysed
    3
    3
    3
    Units: hours
        median (full range (min-max))
    1.25 (0.25 to 1.75)
    0.25 (0.25 to 0.5)
    0.5 (0.25 to 2.5)
    No statistical analyses for this end point

    Secondary: Time to Complete Resolution of the Attack

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    End point title
    Time to Complete Resolution of the Attack
    End point description
    ITT-E population.
    End point type
    Secondary
    End point timeframe
    Within 1 week following treatment
    End point values
    500 U CINRYZE (10-25 kg Body Weight) 1000 U CINRYZE (>25 kg Body Weight) 1500 U CINRYZE (>25 kg Body Weight)
    Number of subjects analysed
    3
    3
    3
    Units: hours
        median (full range (min-max))
    13.58 (11.48 to 37.35)
    10 (1.57 to 22.33)
    29.07 (1.58 to 102.33)
    No statistical analyses for this end point

    Secondary: Change in C1 Inhibitor (C1 INH) Antigen and Functional C1 INH Concentrations

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    End point title
    Change in C1 Inhibitor (C1 INH) Antigen and Functional C1 INH Concentrations
    End point description
    No subject agreed to the additional but optional blood sampling necessary to obtain a PK profile for antigenic and functional C1 INH levels (additional blood samples collected through 8 hours post-infusion on Day 1, and on Days 3, 5, and 8). Hence this endpoint was then planned not to be analysed.
    End point type
    Secondary
    End point timeframe
    Pre-dose, 2, 4, 8 hours post dose on Day 1; Day 2, 3, 5, 8
    End point values
    500 U CINRYZE (10-25 kg Body Weight) 1000 U CINRYZE (>25 kg Body Weight) 1500 U CINRYZE (>25 kg Body Weight)
    Number of subjects analysed
    0 [2]
    0 [3]
    0 [4]
    Units: Not applicable
    Notes
    [2] - Data was not reported due to change in planned analysis.
    [3] - Data was not reported due to change in planned analysis.
    [4] - Data was not reported due to change in planned analysis.
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events were collected through 1 week following the dose of study drug.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.0
    Reporting groups
    Reporting group title
    500 U CINRYZE (10-25 kg Body Weight)
    Reporting group description
    Single IV dose of 500 U CINRYZE

    Reporting group title
    1000 U CINRYZE (>25 kg Body Weight)
    Reporting group description
    Single IV dose of 1000 U CINRYZE

    Reporting group title
    1500 U CINRYZE (>25 kg Body Weight)
    Reporting group description
    Single IV dose of 1500 U CINRYZE

    Serious adverse events
    500 U CINRYZE (10-25 kg Body Weight) 1000 U CINRYZE (>25 kg Body Weight) 1500 U CINRYZE (>25 kg Body Weight)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    0 / 3 (0.00%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    500 U CINRYZE (10-25 kg Body Weight) 1000 U CINRYZE (>25 kg Body Weight) 1500 U CINRYZE (>25 kg Body Weight)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    0 / 3 (0.00%)
    Gastrointestinal disorders
    Diarrhea
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    Nausea
         subjects affected / exposed
    1 / 3 (33.33%)
    0 / 3 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Mar 2010
    •Exclusion criterion was added to exclude pregnant or breastfeeding females •This amendment addressed a comment from an Independent Reviewing Authority (IRA), which requested that the protocol explicitly exclude pregnant females from study participation
    20 Dec 2010
    •The time from onset of symptoms of an acute HAE attack to initiation of study drug treatment was increased from 4 hours to 8 hours •Information on the reconstitution of CINRYZE was updated to include the use of Mix2Vial transfer system •Throughout the protocol, the trademark symbol “™” was replaced with the registration symbol “®”
    29 Jun 2011
    •Monitoring for potential thrombotic events (Venous thromboembolism (VTE), both Deep vein thrombosis (DVT) and Pulmonary embolism (PE)) •Added urinalysis with microscopy (if subject able to provide specimen; Groups 1-4) on Day 1 (pre-dose) and Day 2, and Complete blood count (CBC) with White blood cell (count) (WBC) count differential, platelet count (Groups 3 and 4, only) •Revised total blood volume collected to approximately 26 milliliter (mL) (from 22 mL) for Groups 1 and 2 •Specified that 41 mL of blood collected for subjects with minimum PK assessments, and 77 mL (from 51 mL) for subjects with all additional PK assessments in Groups 3 and 4 •Inclusion criteria: removed history of C1 INH gene mutation •Exclusion criteria: -timeframe of within 7 days prior to dosing for any prior HAE attack and specified “for the treatment or prevention of an HAE attack” with regard to receipt of any C1 INH product within 7 days prior to dosing -added suspect alternate explanation for symptoms other than acute HAE attack, and history of narcotic-seeking behavior and/or drug/alcohol abuse •Added information on thrombogenicity from preclinical data with Cetor and CINRYZE, and Thrombotic/thromboembolic events (T/TE) events from previous studies •Stopping and restarting rules were added for T/TE events and anaphylactic reaction •Laryngeal attack definition was expanded as pharyngeal or oral swelling that resulted in airway compromise •Vital signs to be measured immediately post completion of the infusion •Added dietary and electrolyte supplements as prior and concomitant medications •To report all SAEs occurring up to 30 days after the last dose to the Sponsor and IRA and SAEs with an onset greater than 30 days after last dose if considered related to study drug •Serum BUN and creatinine measurements were added to Days 3 and 5 if the subjects had the optional PK visit
    13 Dec 2012
    •Inclusion Criteria: The requirement for subjects to have a history of swelling of the face, extremities, gastrointestinal tract, genitourinary tract, or larynx was removed. •Ethical Conduct of the Study, was added.

    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.
    Change in C1 INH antigen and functional C1 INH concentrations endpoint was not analysed as no subjects agreed to additional and optional blood sampling.
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