Clinical Trial Results:
Immunogenicity, Efficacy and Safety of Treatment with Human-cl rhFVIII in Previously Untreated Patients with Severe Haemophilia A
Summary
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EudraCT number |
2012-002554-23 |
Trial protocol |
GB PL DE ES FR PT SI HR IT |
Global end of trial date |
24 Mar 2020
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Results information
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Results version number |
v1(current) |
This version publication date |
23 Aug 2020
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First version publication date |
23 Aug 2020
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
GENA-05
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Additional study identifiers
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ISRCTN number |
ISRCTN50040185 | ||
US NCT number |
NCT01712438 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Octapharma AG
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Sponsor organisation address |
Seidenstrasse 2, Lachen, Switzerland, CH-8853
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Public contact |
Sigurd Knaub, Octapharma AG, 0041 55 451 21 41, sigurd.knaub@octapharma.com
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Scientific contact |
Sigurd Knaub, Octapharma AG, 0041 55 451 21 41, sigurd.knaub@octapharma.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
Yes
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EMA paediatric investigation plan number(s) |
EMEA-001024-PIP01-10 | ||
Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
Yes
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
21 Jun 2019
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
24 Mar 2020
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To investigate the immunogenicity of Human-cl rhFVIII in 100 PUPs suffering from severe haemophilia A (FVIII:C < 1%).
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Protection of trial subjects |
This trial was conducted in accordance to the principles of ICH- GCP, ensuring that the rights, safety and well-being of patients are protected and in consistency with the Declaration of Helsinki, national regulatory requirements and FDA Code of Federal Regulations.
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.
Clinical safety and tolerability was assessed by monitoring vital signs, adverse events and safety laboratory parameters, including inhibitors against FVIII.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
15 Mar 2013
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Long term follow-up planned |
Yes
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Long term follow-up rationale |
Safety, Efficacy | ||
Long term follow-up duration |
2 Years | ||
Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Poland: 4
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Country: Number of subjects enrolled |
Portugal: 1
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Country: Number of subjects enrolled |
Slovenia: 1
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Country: Number of subjects enrolled |
Spain: 4
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Country: Number of subjects enrolled |
United Kingdom: 7
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Country: Number of subjects enrolled |
France: 11
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Country: Number of subjects enrolled |
Germany: 3
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Country: Number of subjects enrolled |
Belarus: 3
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Country: Number of subjects enrolled |
Canada: 6
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Country: Number of subjects enrolled |
Georgia: 6
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Country: Number of subjects enrolled |
India: 13
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Country: Number of subjects enrolled |
Italy: 2
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Country: Number of subjects enrolled |
Moldova, Republic of: 4
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Country: Number of subjects enrolled |
Morocco: 4
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Country: Number of subjects enrolled |
Russian Federation: 2
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Country: Number of subjects enrolled |
Ukraine: 30
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Country: Number of subjects enrolled |
United States: 7
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Worldwide total number of subjects |
108
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EEA total number of subjects |
33
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
1
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Infants and toddlers (28 days-23 months) |
79
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Children (2-11 years) |
26
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Adolescents (12-17 years) |
2
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Adults (18-64 years) |
0
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
- | ||||||||||||||||||||||||||||||||||||
Pre-assignment
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Screening details |
Patients with documented diagnosis Severe Haemophilia A with no previous treatment with FVIII concentrates or other blood products containing FVIII were screened according to predefined in- and exclusion criteria. | ||||||||||||||||||||||||||||||||||||
Period 1
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Period 1 title |
Overall Trial (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||||||||||||||
Allocation method |
Not applicable
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Blinding used |
Not blinded | ||||||||||||||||||||||||||||||||||||
Arms
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Arm title
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Human-cl rhFVIII | ||||||||||||||||||||||||||||||||||||
Arm description |
Prophylactic treatment was recommended, but finally, it was the decision of the responsible treating physician whether patients were treated prophylactically or on demand. Patients could switch from on-demand to prophylactic treatment, or from prophylactic to on-demand treatment during the course of the study. | ||||||||||||||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Human-cl rhFVIII
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Investigational medicinal product code |
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Other name |
Nuwiq
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Pharmaceutical forms |
Powder and solvent for solution for injection
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Routes of administration |
Intravenous use
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Dosage and administration details |
The decision whether to treat patients prophylactically or on-demand was always at the discretion of the treating physician.
Prophylactic treatment: Recommended dose 20-50 IU FVIII/kg body weight (BW).
On-demand treatment: Dosage and duration of treatment of spontaneous or traumatic bleeds depended on the location and the extent of bleeding as well as on the clinical situation of the patient. Recommended doses: 20-30 IU FVIII/kg BW (minor haemorrhage), 30-40 IU FVIII/kg BW (moderate to major haemorrhage) or 40-60 IU FVIII/kg BW (major to life-threatening haemorrhage).
Surgical prophylaxis: depended on the type of surgery and the patient’s individual incremental FVIII recovery. Recommended doses: 25-30 IU FVIII/kg BW (minor surgeries) or 40-60
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Baseline characteristics reporting groups
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Reporting group title |
Overall Trial
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Human-cl rhFVIII
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Reporting group description |
Prophylactic treatment was recommended, but finally, it was the decision of the responsible treating physician whether patients were treated prophylactically or on demand. Patients could switch from on-demand to prophylactic treatment, or from prophylactic to on-demand treatment during the course of the study. | ||
Subject analysis set title |
Safety Analysis Population
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
All subjects who received at least one dose of Human-cl rhFVIII
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Subject analysis set title |
ITT
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
All subjects who received at least one dose of Human-cl rhFVIII.
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Subject analysis set title |
PROPH
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
All subjects in the ITT population who have at least one prophylactic treatment.
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Subject analysis set title |
BLEED Population
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
Subjects that received any amount of Human-cl rhFVIII for a bleeding episode
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Subject analysis set title |
SURG Population
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
Subjects that received any amount of Human-cl rhFVIII for surgical prophylaxis during a total of 26 surgeries.
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Subject analysis set title |
n (BE)
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Subject analysis set type |
Intention-to-treat | ||
Subject analysis set description |
Number of Bleeding Events in BLEED population during inhibitor-free periods n=804
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Subject analysis set title |
Percentage (%)
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Subject analysis set type |
Intention-to-treat | ||
Subject analysis set description |
Percentage of BE in BLEED population during inhibitor-free periods (n=804)
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Subject analysis set title |
Minor Surgeries
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Subject analysis set type |
Intention-to-treat | ||
Subject analysis set description |
Minor Surgeries
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Subject analysis set title |
Major Surgeries
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Subject analysis set type |
Intention-to-treat | ||
Subject analysis set description |
Major surgery
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End point title |
Immunogenicity: Incidence of Human-cl rhFVIII Inhibitors [1] | ||||||||||||||||||||
End point description |
The primary endpoint of this study was the evaluation of FVIII-inhibitor development (in previously untreated patients) treated with Human-cl rhFVIII. An inhibitor was assessed positive if the modified Bethesda assay (Nijmegen modification) as measured in a central lab and confirmed from a second sample resulted in a titre ≥0.6 BU/mL at any time point during the observation period. The definitions for thresholds were ≥0.6 to <5 BU/mL for a "low titre" inhibitor and ≥5 BU/mL for a "high-titre" inhibitor.
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End point type |
Primary
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End point timeframe |
maximum of 5 years (100 exposure days)
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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: The statistical analysis of the primary, secondary and safety endpoints is to be understood in the exploratory sense. Therefore no confirmative statistical analysis was done and statistical analyses are descriptive only. |
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No statistical analyses for this end point |
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End point title |
Frequency of Monthly Spontaneous Break-through Bleeds | ||||||||
End point description |
The monthly bleeding rate (MBR) was calculated during inhibitor-free periods for spontaneous bleeding events (BEs) during prophylactic treatment with Human cl rhFVIII
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End point type |
Secondary
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End point timeframe |
Up to a maximum 5 years (100 exposure days)
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No statistical analyses for this end point |
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End point title |
Efficacy of Human-cl rhFVIII for the Treatment of Bleeds | |||||||||||||||||||||||||||
End point description |
The efficacy assessment of bleeding episodes at end of a BE was evaluated on an objective four-point scale by the patient’s parent(s)/legal guardian(s) together with the Investigator in case of on-site treatment.
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End point type |
Secondary
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End point timeframe |
At end of a BE
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No statistical analyses for this end point |
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End point title |
Efficacy of Human-cl rhFVIII for Surgical Prophylaxis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point description |
Overall efficacy assessment based on objective 4-point scales (excellent, good, moderate, none) performed jointly by the haematologist and surgeon.
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End point type |
Secondary
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End point timeframe |
At the conclusion of the post-operative phase (ie until ≥ 2 (minor surgeries) or ≥ 6 days post-surgery (major surgeries), until healing is complete and the subject returned to his regular treatment).
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
The frequency of AEs, as monitored throughout the whole study.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
21.1
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Reporting groups
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Reporting group title |
Safety Population (SAF)
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Reporting group description |
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Frequency threshold for reporting non-serious adverse events: 0% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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17 Dec 2012 |
Amendment 1:
• Safety laboratory: clarification regarding the timing of safety laboratory testing.
• ITI patient follow-up: clarification regarding baseline FVIII inhibitor level determination, recovery time-points, and half-life evaluation. One hour time-point was found to be redundant and was deleted in the schedule table.
• Definition/classification of haemorrhages: clarification regarding specification of haemorrhage classification.
• Washout period specification: clarification regarding washout prior to follow-up visits.
• Adverse events: Correction of safety assessments, adding that AEs and SAEs were to be monitored and recorded throughout the study.
• Classification of ADRs: Addressed request asking to further specify the definition regarding expected ADRs.
• Specification of blood volume limits: Addressed request asking to further specify the definition regarding the blood volume limits for sampling in neonates.
• Definition of PP population: clarification regarding definition of PP population. |
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30 Sep 2013 |
Amendment 2:
• IMP vial handling: general clarification.
• Adaptation of ITI: adaption to comply with international ITI target criteria.
• Overall efficacy assessment: clarification regarding the overall efficacy assessment to be done by the surgeon and haematologist together.
• Safety laboratory parameter time points: correction of the time points for testing of safety laboratory parameters.
• Home treatment with IMP: clarification that IMP for home use would be provided in cooling boxes, if appropriate.
• Follow-up visits: clarification regarding timing of the follow-up visits.
• Measurement of vital signs after IMP treatment at study site: changes were made to the schedule for measuring vital signs, allowing some flexibility for parents/patients in terms of avoiding unnecessary waiting times at the study site after IMP administration.
• RNA Expression Analysis: further specification of the time point of RNA expression analysis was added.
• Epitope mapping during ITI follow-up: the time point of epitope mapping analysis was added.
• Administration of IMP at home: it was clarified that nurses could also administer IMP at home.
• Efficacy assessment specification: A clarification/correction was implemented specifying that the post-operative efficacy assessment was performed by the haematologist only.
• Serious adverse event (SAE) reporting: additional reporting line was added.
• Epitope mapping – blood collection volume and time-points: additional specifications and corrections were made in connection with the change of the central laboratory responsible for Epitope mapping.
• Laboratory change: the central laboratory for Epitope mapping was changed. |
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11 Nov 2014 |
Amendment 3:
• Study duration: study duration was updated
• Dose recommendation for prophylactic/on-demand/surgical prophylactic treatment: the dose recommendations were adapted to those from the approved SmPC for the marketed product (Nuwiq).
• Statistical methods and sample size: the first of 2 interim analyses was cancelled since this was not an authority requirement. The second analysis (reported in the interim report) was to be performed as requested by the respective EMA guideline.
• Dose rationale for starting dose: the dose recommendations were adapted to those from the approved SmPC for the marketed product (Nuwiq).
• Safety and tolerability, and safety lab test specification: additional clarification, including more detailed description of the standard laboratory parameters.
• Withdrawal and replacement of patients: a more detailed implementation of the respective EMA guideline with the clarification that patients were not to be replaced only if they had received more than 50 exposures with the IMP.
• Dose and dosing schedule: correction made. Dose and dosing schedule: Immune Tolerance Induction: additional clarification, including specification that patients who do not start ITI within 1 year after inhibitor detection are withdrawn from the study.
• Study conduct: observations per visit: additional clarification that F8 gene mutation analysis is mandatory but could be performed later in the study.
• Data handling and record keeping: documentation of data: general clarification. |
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01 Feb 2018 |
Amendment 4:
• The study completion timeline was clarified. It was stated that the study would be completed in the 4th quarter 2018 for all patients, except those continuing ITI treatment.
• Optional retrospective analysis of blood samples for epitope mapping was introduced in patients who developed an inhibitor against FVIII and started an ITI plus in an inhibitor negative control group.
• For health economic parameters, more clarity on information collected from patients’ parents was provided.
• More clarity on information collected towards patient demographics during screening visit was provided. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |