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    Clinical Trial Results:
    Immunogenicity, Efficacy and Safety of Treatment with Human-cl rhFVIII in Previously Untreated Patients with Severe Haemophilia A

    Summary
    EudraCT number
    2012-002554-23
    Trial protocol
    GB   PL   DE   ES   FR   PT   SI   HR   IT  
    Global end of trial date
    24 Mar 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    23 Aug 2020
    First version publication date
    23 Aug 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GENA-05
    Additional study identifiers
    ISRCTN number
    ISRCTN50040185
    US NCT number
    NCT01712438
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Octapharma AG
    Sponsor organisation address
    Seidenstrasse 2, Lachen, Switzerland, CH-8853
    Public contact
    Sigurd Knaub, Octapharma AG, 0041 55 451 21 41, sigurd.knaub@octapharma.com
    Scientific contact
    Sigurd Knaub, Octapharma AG, 0041 55 451 21 41, sigurd.knaub@octapharma.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-001024-PIP01-10
    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
    21 Jun 2019
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    24 Mar 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To investigate the immunogenicity of Human-cl rhFVIII in 100 PUPs suffering from severe haemophilia A (FVIII:C < 1%).
    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.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    15 Mar 2013
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy
    Long term follow-up duration
    2 Years
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 4
    Country: Number of subjects enrolled
    Portugal: 1
    Country: Number of subjects enrolled
    Slovenia: 1
    Country: Number of subjects enrolled
    Spain: 4
    Country: Number of subjects enrolled
    United Kingdom: 7
    Country: Number of subjects enrolled
    France: 11
    Country: Number of subjects enrolled
    Germany: 3
    Country: Number of subjects enrolled
    Belarus: 3
    Country: Number of subjects enrolled
    Canada: 6
    Country: Number of subjects enrolled
    Georgia: 6
    Country: Number of subjects enrolled
    India: 13
    Country: Number of subjects enrolled
    Italy: 2
    Country: Number of subjects enrolled
    Moldova, Republic of: 4
    Country: Number of subjects enrolled
    Morocco: 4
    Country: Number of subjects enrolled
    Russian Federation: 2
    Country: Number of subjects enrolled
    Ukraine: 30
    Country: Number of subjects enrolled
    United States: 7
    Worldwide total number of subjects
    108
    EEA total number of subjects
    33
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    1
    Infants and toddlers (28 days-23 months)
    79
    Children (2-11 years)
    26
    Adolescents (12-17 years)
    2
    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
    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
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    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
    Investigational medicinal product code
    Other name
    Nuwiq
    Pharmaceutical forms
    Powder and solvent for solution for injection
    Routes of administration
    Intravenous use
    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

    Number of subjects in period 1
    Human-cl rhFVIII
    Started
    108
    Completed
    85
    Not completed
    23
         98 EDs
    1
         refuse to continue
    1
         non-compliance with protocol
    1
         sponsor request/ study ending
    2
         Switch to other product
    2
         unwilling to perform visit
    1
         Consent withdrawn by subject
    4
         family moving
    1
         FVIII positive but no ITI
    3
         Adverse event, non-fatal
    1
         Therapy Failure
    3
         Protocol Violation
    1
         no real severe HA, not reached 100 ED
    1
         Lost to follow-up
    1

    Baseline characteristics

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

    Reporting group values
    Overall Trial Total
    Number of subjects
    108 108
    Age categorical
    Units: Subjects
        <1 month
    1 1
        1-6 months
    9 9
        6-12 months
    47 47
        >12 months
    51 51
    Age continuous
    Units: months
        arithmetic mean (full range (min-max))
    21.6 (0 to 146) -
    Gender categorical
    Units: Subjects
        Female
    0 0
        Male
    108 108

    End points

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    End points reporting groups
    Reporting group title
    Human-cl rhFVIII
    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
    Subject analysis set type
    Full analysis
    Subject analysis set description
    All subjects who received at least one dose of Human-cl rhFVIII

    Subject analysis set title
    ITT
    Subject analysis set type
    Full analysis
    Subject analysis set description
    All subjects who received at least one dose of Human-cl rhFVIII.

    Subject analysis set title
    PROPH
    Subject analysis set type
    Full analysis
    Subject analysis set description
    All subjects in the ITT population who have at least one prophylactic treatment.

    Subject analysis set title
    BLEED Population
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Subjects that received any amount of Human-cl rhFVIII for a bleeding episode

    Subject analysis set title
    SURG Population
    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.

    Subject analysis set title
    n (BE)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Number of Bleeding Events in BLEED population during inhibitor-free periods n=804

    Subject analysis set title
    Percentage (%)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Percentage of BE in BLEED population during inhibitor-free periods (n=804)

    Subject analysis set title
    Minor Surgeries
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Minor Surgeries

    Subject analysis set title
    Major Surgeries
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Major surgery

    Primary: Immunogenicity: Incidence of Human-cl rhFVIII Inhibitors

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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.
    End point type
    Primary
    End point timeframe
    maximum of 5 years (100 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: 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.
    End point values
    Safety Analysis Population
    Number of subjects analysed
    Units: Participants
    number (not applicable)
        High titre inhibitor (>5 BU/mL)
    17
        High titre inhibitor (>5 BU/mL) %
    16.2
        Low titre inhibitor (<5 BU/mL)
    11
        Low titre inhibitor (<5 BU/mL) %
    10.5
        Any inhibitor (>0.6 BU/mL)
    28
        Any inhibitor (>0.6 BU/mL) %
    26.7
    No statistical analyses for this end point

    Secondary: Frequency of Monthly Spontaneous Break-through Bleeds

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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
    End point type
    Secondary
    End point timeframe
    Up to a maximum 5 years (100 exposure days)
    End point values
    PROPH
    Number of subjects analysed
    103
    Units: MBR
        arithmetic mean (confidence interval 95%)
    0.080 (0.035 to 0.125)
    No statistical analyses for this end point

    Secondary: Efficacy of Human-cl rhFVIII for the Treatment of Bleeds

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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.
    End point type
    Secondary
    End point timeframe
    At end of a BE
    End point values
    n (BE) Percentage (%)
    Number of subjects analysed
    94
    100
    Units: BE
    number (not applicable)
        Excellent
    510
    63.4
        Good
    237
    29.5
        Moderate
    51
    6.3
        None
    6
    0.7
        Total number of assessed BE
    804
    100
    No statistical analyses for this end point

    Secondary: Efficacy of Human-cl rhFVIII for Surgical Prophylaxis

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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.
    End point type
    Secondary
    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).
    End point values
    SURG Population Minor Surgeries Major Surgeries
    Number of subjects analysed
    24
    13
    11
    Units: Number of surgeries assessed
    number (not applicable)
        Excellent
    15
    7
    8
        Excellent (%)
    71.4
    70.0
    72.7
        Good
    3
    1
    2
        Good (%)
    14.3
    10.0
    18.2
        Moderate
    2
    1
    1
        Moderate (%)
    9.5
    10.0
    9.1
        None
    1
    1
    0
        None (%)
    4.8
    10.0
    0.0
        missing
    5
    5
    0
        Total
    21
    10
    11
        Total (%)
    100.0
    100.0
    100.0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    The frequency of AEs, as monitored throughout the whole study.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    21.1
    Reporting groups
    Reporting group title
    Safety Population (SAF)
    Reporting group description
    -

    Serious adverse events
    Safety Population (SAF)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    48 / 108 (44.44%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Injury, poisoning and procedural complications
    Contusion
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Fall
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Head injury
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Injury
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Limb injury
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Scrotal haematoma
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin injury
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Subdural haematoma
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Subdural haemorrhage
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Traumatic haematoma
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Haematoma
         subjects affected / exposed
    4 / 108 (3.70%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Haemorrhage intracranial
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Factor IX inhibition
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Factor VIII inhibition
    Additional description: 2 FVIII inhibitor relapses during ITI Therapy.
         subjects affected / exposed
    28 / 108 (25.93%)
         occurrences causally related to treatment / all
    30 / 30
         deaths causally related to treatment / all
    0 / 0
    Haemorrhagic anaemia
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    5 / 108 (4.63%)
         occurrences causally related to treatment / all
    4 / 8
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Ileus
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mouth haemorrhage
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Apnoea
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Haemarthrosis
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Joint swelling
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Device related infection
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Device related sepsis
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Ear infection
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Fungal skin infection
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal infection
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Influenza
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nasopharyngitis
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Periodontitis
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Septic shock
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Staphylococcal infection
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Tonsillitis
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Product issues
    Device issue
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Type 1 diabetes mellitus
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Safety Population (SAF)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    97 / 108 (89.81%)
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    21 / 108 (19.44%)
         occurrences all number
    28
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    60 / 108 (55.56%)
         occurrences all number
    131
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    14 / 108 (12.96%)
         occurrences all number
    20
    Teething
         subjects affected / exposed
    10 / 108 (9.26%)
         occurrences all number
    11
    Vomiting
         subjects affected / exposed
    11 / 108 (10.19%)
         occurrences all number
    23
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    15 / 108 (13.89%)
         occurrences all number
    29
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    11 / 108 (10.19%)
         occurrences all number
    14
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    11 / 108 (10.19%)
         occurrences all number
    18
    Ear infection
         subjects affected / exposed
    11 / 108 (10.19%)
         occurrences all number
    20
    Conjunctivitis
         subjects affected / exposed
    10 / 108 (9.26%)
         occurrences all number
    10
    Gastroenteritis
         subjects affected / exposed
    7 / 108 (6.48%)
         occurrences all number
    9
    Laryngitis
         subjects affected / exposed
    6 / 108 (5.56%)
         occurrences all number
    9
    Nasopharyngitis
         subjects affected / exposed
    34 / 108 (31.48%)
         occurrences all number
    72
    Respiratory tract infection
         subjects affected / exposed
    7 / 108 (6.48%)
         occurrences all number
    11
    Rhinitis
         subjects affected / exposed
    20 / 108 (18.52%)
         occurrences all number
    37
    Upper respiratory tract infection
         subjects affected / exposed
    12 / 108 (11.11%)
         occurrences all number
    20
    Varicella
         subjects affected / exposed
    8 / 108 (7.41%)
         occurrences all number
    8

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    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.
    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.
    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.
    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.

    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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