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    Clinical Trial Results:
    A Prospective, Single-blind, Randomized, Phase III Study to Evaluate the Safety and Efficacy of Fibrin Sealant Grifols (FS Grifols) as an Adjunct to Hemostasis During Soft Tissue Open Surgeries

    Summary
    EudraCT number
    2013-005159-34
    Trial protocol
    HU  
    Global end of trial date
    04 Jun 2015

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

    Trial information

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    Trial identification
    Sponsor protocol code
    IG1103
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01731938
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Instituto Grifols, S.A
    Sponsor organisation address
    Can Guasch, 2, Parets del Valles, Barcelona, Spain, 08150
    Public contact
    Department of Clinical Trials, Instituto Grifols, S.A., +34 935712200, IGregulatory.affairs@grifols.com
    Scientific contact
    Department of Clinical Trials, Instituto Grifols, S.A., +34 935712200, IGregulatory.affairs@grifols.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-001598-PIP01-13
    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
    28 Apr 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    04 Jun 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    04 Jun 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the safety and the hemostasis efficacy of human plasma-derived fibrin sealant Grifols (FS Grifols) in soft tissue surgery
    Protection of trial subjects
    For each investigative site, the Primary Part (II) started only after the enrollment of 4 subjects in the Preliminary Part (I). Further, all SAEs must have been expeditiously reported, whether or not considered attributable to the study treatment. When the investigator became aware of an SAE, a completed, signed, and dated SAE Report Form must have been submitted within 24 hours to the sponsor. After the initial report, all relevant information for SAE follow-up and the outcome must have also been supplied to the sponsor in a timely manner (within 3 days from its identification or within 24 hours for relevant new information) by means of the SAE Report Form or by other appropriate means such as data clarification forms issued by the sponsor or CRO. SAEs were assessed by the sponsor for expectedness assuming all subjects were treated with FS Grifols. If the event was considered serious, potentially related, and unexpected, treatment allocation would have been unblinded. Three possibilities resulting from the procedure of unblinding would have been considered: 1. If the study treatment administered to the subject was FS Grifols, the case would be reported in accordance to local regulations 2. If the study treatment administered to the subject was Surgicel, the event would be reassessed for expectedness according to the reference safety information and: a. If the event was still considered unexpected, it would have been reported in accordance with applicable requirements and guidelines. b. If the event was considered expected, it would not have been reported, unless specifically requested by local regulations
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    19 Nov 2012
    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
    Serbia: 78
    Country: Number of subjects enrolled
    Hungary: 45
    Country: Number of subjects enrolled
    United States: 204
    Worldwide total number of subjects
    327
    EEA total number of subjects
    45
    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)
    11
    Children (2-11 years)
    5
    Adolescents (12-17 years)
    2
    Adults (18-64 years)
    243
    From 65 to 84 years
    61
    85 years and over
    5

    Subject disposition

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    Recruitment
    Recruitment details
    Study Initiation Date: 19 Nov 2012; Study Completion Date: 04 Jun 2015 Subjects were recruited from Hungary, Serbia and USA.

    Pre-assignment
    Screening details
    A total of 498 subjects were screened in this study. Of these, 327 subjects were randomized and 171 were screen failures.

    Pre-assignment period milestones
    Number of subjects started
    498 [1]
    Number of subjects completed
    327

    Pre-assignment subject non-completion reasons
    Reason: Number of subjects
    Consent withdrawn by subject: 13
    Reason: Number of subjects
    Lost to follow up: 5
    Reason: Number of subjects
    Physician decision: 4
    Reason: Number of subjects
    Protocol deviation: 1
    Reason: Number of subjects
    Inclusion/exclusion criteria not met: 118
    Reason: Number of subjects
    Others: 30
    Notes
    [1] - The number of subjects reported to have started the pre-assignment period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: 171 patients are screen failed and hence not enrolled.
    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Single blind
    Roles blinded
    Subject
    Blinding implementation details
    In both parts of the study, subjects were blinded to their study treatment; investigator was not blinded as this was not feasible due to the different nature of the 2 hemostatic treatments. Data from the Primary Part (II), including treatment assignment and accumulating efficacy data, were blinded from the sponsor, except for personnel from study drug supply groups. Treatment group assignments were made using sealed blinded randomization envelopes, only opened upon identification of the TBS.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Preliminary Part I - FS Grifols
    Arm description
    Subjects in the Preliminary Part (I) were to be randomized in 1:1 ratio into 1 of 2 treatment groups: FS Grifols or Surgicel. The main objective of this part of the clinical study was to ensure that local study teams familiarized themselves with the technique for FS Grifols application and with intra-operative procedures required by the protocol of the clinical study.
    Arm type
    Experimental

    Investigational medicinal product name
    FS Grifols
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for sealant
    Routes of administration
    Topical use
    Dosage and administration details
    Up to two 3-mL kits applied topically via drip or spray applicator tip at the target bleeding site (TBS)

    Arm title
    Preliminary Part I - Surgicel
    Arm description
    Subjects in the Preliminary Part (I) were to be randomized in 1:1 ratio into 1 of 2 treatment groups: FS Grifols or Surgicel. The main objective of this part of the clinical study was to ensure that local study teams familiarized themselves with the technique for FS Grifols application and with intra-operative procedures required by the protocol of the clinical study.
    Arm type
    Medical device

    Investigational medicinal product name
    Surgicel (regenerated oxidized cellulose)
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Sealant matrix
    Routes of administration
    Topical use
    Dosage and administration details
    Up to four (4) 4" x 8" sheets of Surgicel

    Arm title
    Primary Part II - FS Grifols
    Arm description
    Subjects in the Primary (II) Part of the study were randomly allocated into one of two treatment groups: FS Grifols or Surgicel. This part of the clinical trial had two main objectives: 1. assessment of the efficacy of FS Grifols 2. assessment of safety of FS Grifols
    Arm type
    Experimental

    Investigational medicinal product name
    FS Grifols
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for sealant
    Routes of administration
    Topical use
    Dosage and administration details
    Up to two 3-mL kits applied topically via drip or spray applicator tip at the target bleeding site (TBS)

    Arm title
    Primary Part II - Surgicel
    Arm description
    Subjects in the Primary (II) Part of the study were randomly allocated into one of two treatment groups: FS Grifols or Surgicel. This part of the clinical trial had two main objectives: 1. assessment of the efficacy of FS Grifols 2. assessment of safety of FS Grifols
    Arm type
    Medical device

    Investigational medicinal product name
    Surgicel (regenerated oxidized cellulose)
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Sealant matrix
    Routes of administration
    Topical use
    Dosage and administration details
    Up to four (4) 4" x 8" sheets of Surgicel

    Number of subjects in period 1
    Preliminary Part I - FS Grifols Preliminary Part I - Surgicel Primary Part II - FS Grifols Primary Part II - Surgicel
    Started
    51
    52
    116
    108
    Completed
    48
    44
    103
    95
    Not completed
    3
    8
    13
    13
         Adverse event, serious fatal
    -
    -
    2
    1
         Physician decision
    1
    -
    -
    -
         Consent withdrawn by subject
    2
    2
    5
    4
         Others
    -
    3
    -
    -
         any other
    -
    -
    -
    3
         other(s)
    -
    -
    2
    -
         Lost to follow-up
    -
    3
    4
    5

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Preliminary Part I - FS Grifols
    Reporting group description
    Subjects in the Preliminary Part (I) were to be randomized in 1:1 ratio into 1 of 2 treatment groups: FS Grifols or Surgicel. The main objective of this part of the clinical study was to ensure that local study teams familiarized themselves with the technique for FS Grifols application and with intra-operative procedures required by the protocol of the clinical study.

    Reporting group title
    Preliminary Part I - Surgicel
    Reporting group description
    Subjects in the Preliminary Part (I) were to be randomized in 1:1 ratio into 1 of 2 treatment groups: FS Grifols or Surgicel. The main objective of this part of the clinical study was to ensure that local study teams familiarized themselves with the technique for FS Grifols application and with intra-operative procedures required by the protocol of the clinical study.

    Reporting group title
    Primary Part II - FS Grifols
    Reporting group description
    Subjects in the Primary (II) Part of the study were randomly allocated into one of two treatment groups: FS Grifols or Surgicel. This part of the clinical trial had two main objectives: 1. assessment of the efficacy of FS Grifols 2. assessment of safety of FS Grifols

    Reporting group title
    Primary Part II - Surgicel
    Reporting group description
    Subjects in the Primary (II) Part of the study were randomly allocated into one of two treatment groups: FS Grifols or Surgicel. This part of the clinical trial had two main objectives: 1. assessment of the efficacy of FS Grifols 2. assessment of safety of FS Grifols

    Reporting group values
    Preliminary Part I - FS Grifols Preliminary Part I - Surgicel Primary Part II - FS Grifols Primary Part II - Surgicel Total
    Number of subjects
    51 52 116 108 327
    Age categorical
    Units: Subjects
        In utero
    0 0 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0 0 0
        Newborns (0-27 days)
    0 0 0 0 0
        Infants and toddlers (28 days-23 months)
    5 6 0 0 11
        Children (2-11 years)
    3 2 0 0 5
        Adolescents (12-17 years)
    0 1 1 0 2
        Adults (18-64 years)
    27 28 98 90 243
        From 65-84 years
    13 14 16 18 61
        85 years and over
    3 1 1 0 5
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    47.17 ± 25.635 45.39 ± 25.024 48.51 ± 14.369 46.72 ± 14.33 -
    Gender categorical
    Units: Subjects
        Female
    27 28 87 86 228
        Male
    24 24 29 22 99

    End points

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    End points reporting groups
    Reporting group title
    Preliminary Part I - FS Grifols
    Reporting group description
    Subjects in the Preliminary Part (I) were to be randomized in 1:1 ratio into 1 of 2 treatment groups: FS Grifols or Surgicel. The main objective of this part of the clinical study was to ensure that local study teams familiarized themselves with the technique for FS Grifols application and with intra-operative procedures required by the protocol of the clinical study.

    Reporting group title
    Preliminary Part I - Surgicel
    Reporting group description
    Subjects in the Preliminary Part (I) were to be randomized in 1:1 ratio into 1 of 2 treatment groups: FS Grifols or Surgicel. The main objective of this part of the clinical study was to ensure that local study teams familiarized themselves with the technique for FS Grifols application and with intra-operative procedures required by the protocol of the clinical study.

    Reporting group title
    Primary Part II - FS Grifols
    Reporting group description
    Subjects in the Primary (II) Part of the study were randomly allocated into one of two treatment groups: FS Grifols or Surgicel. This part of the clinical trial had two main objectives: 1. assessment of the efficacy of FS Grifols 2. assessment of safety of FS Grifols

    Reporting group title
    Primary Part II - Surgicel
    Reporting group description
    Subjects in the Primary (II) Part of the study were randomly allocated into one of two treatment groups: FS Grifols or Surgicel. This part of the clinical trial had two main objectives: 1. assessment of the efficacy of FS Grifols 2. assessment of safety of FS Grifols

    Subject analysis set title
    Preliminary Part (I) - FS Grifols (ITT)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    In the Preliminary Part (I), the intent-to-treat (ITT) analysis set was defined as all subjects randomized to FS Grifols.

    Subject analysis set title
    Preliminary Part (I) - Surgicel (ITT)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    In the Preliminary Part (I), the intent-to-treat (ITT) analysis set was defined as all subjects randomized to Surgicel.

    Subject analysis set title
    Primary Part (II) - FS Grifols (ITT)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    In the Primary Part (II), the intent-to-treat (ITT) analysis set was defined as all subjects randomized to FS Grifols.

    Subject analysis set title
    Primary Part (II) - Surgicel (ITT)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    In the Primary Part (II), the intent-to-treat (ITT) analysis set was defined as all subjects randomized to Surgicel.

    Subject analysis set title
    Preliminary Part (I) - FS Grifols (PP)
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The per protocol (PP) population included all subjects in the ITT population excluding any subject for whom there was at least one major protocol deviation that might have an impact on the primary efficacy assessment. The major protocol deviations were determined at a data review meeting and were documented in a data review report prior to the database lock.

    Subject analysis set title
    Preliminary Part (I) - Surgicel (PP)
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The per protocol (PP) population included all subjects in the ITT population excluding any subject for whom there was at least one major protocol deviation that might have an impact on the primary efficacy assessment. The major protocol deviations were determined at a data review meeting and were documented in a data review report prior to the database lock.

    Subject analysis set title
    Primary Part (II) - FS Grifols (PP)
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The per protocol (PP) population included all subjects in the ITT population excluding any subject for whom there was at least one major protocol deviation that might have an impact on the primary efficacy assessment. The major protocol deviations were determined at a data review meeting and were documented in a data review report prior to the database lock.

    Subject analysis set title
    Primary Part (II) - Surgicel (PP)
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The per protocol (PP) population included all subjects in the ITT population excluding any subject for whom there was at least one major protocol deviation that might have an impact on the primary efficacy assessment. The major protocol deviations were determined at a data review meeting and were documented in a data review report prior to the database lock.

    Primary: Proportion of subjects achieving hemostasis at the TBS by four (4) minutes

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    End point title
    Proportion of subjects achieving hemostasis at the TBS by four (4) minutes
    End point description
    Proportion of subjects enrolled into the Primary Part (II) achieving hemostasis (Yes/No) at the target bleeding site (TBS) by T4 without occurrence of re-bleeding and reapplication of study treatment after T4 and until TClosure and without brisk bleeding and use of alternative hemostatic treatment after TStart and until TClosure.
    End point type
    Primary
    End point timeframe
    From the start of treatment application (Tstart) at the TBS to the achievement of hemostasis at that site by T4
    End point values
    Primary Part (II) - FS Grifols (ITT) Primary Part (II) - Surgicel (ITT) Primary Part (II) - FS Grifols (PP) Primary Part (II) - Surgicel (PP)
    Number of subjects analysed
    116
    108
    104
    102
    Units: percent
        number (not applicable)
    82.8
    77.8
    83.7
    76.5
    Statistical analysis title
    Primary efficacy endpoint analysis (ITT)
    Comparison groups
    Primary Part (II) - FS Grifols (ITT) v Primary Part (II) - Surgicel (ITT)
    Number of subjects included in analysis
    224
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [1]
    P-value
    = 0.401
    Method
    Fisher exact
    Parameter type
    Risk ratio (RR)
    Point estimate
    1.064
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.934
         upper limit
    1.213
    Notes
    [1] - Primary efficacy endpoint
    Statistical analysis title
    Primary efficacy endpoint analysis (PP)
    Comparison groups
    Primary Part (II) - FS Grifols (PP) v Primary Part (II) - Surgicel (PP)
    Number of subjects included in analysis
    206
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.224
    Method
    Fisher exact
    Parameter type
    Risk ratio (RR)
    Point estimate
    1.094
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.954
         upper limit
    1.255

    Secondary: Cumulative proportion of subjects achieving hemostasis at TBS by T3

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    End point title
    Cumulative proportion of subjects achieving hemostasis at TBS by T3
    End point description
    The cumulative proportion of subjects achieving hemostasis at the TBS by T3 was defined as an absence/cessation of bleeding at the TBS by that time point without occurrence of re-bleeding, brisk bleeding, use of alternative hemostatic treatment, and reapplication of study treatment after T4 and until TClosure.
    End point type
    Secondary
    End point timeframe
    From the start of treatment application (Tstart) at the TBS to achievement of hemostasis at that site by T3.
    End point values
    Primary Part (II) - FS Grifols (ITT) Primary Part (II) - Surgicel (ITT)
    Number of subjects analysed
    116
    108
    Units: percent
        number (not applicable)
    75.9
    60.2
    Statistical analysis title
    Secondary efficacy analysis of hemostasis by T3
    Statistical analysis description
    The ratio of proportion of subjects meeting the efficacy endpoint in the two treatment groups in Primary Part II.
    Comparison groups
    Primary Part (II) - FS Grifols (ITT) v Primary Part (II) - Surgicel (ITT)
    Number of subjects included in analysis
    224
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.015
    Method
    Fisher exact
    Parameter type
    Risk ratio (RR)
    Point estimate
    1.26
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.048
         upper limit
    1.516

    Secondary: Time to Hemostasis (TTH)

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    End point title
    Time to Hemostasis (TTH)
    End point description
    The TTH was measured from TStart at the TBS. The precise TTH was not observable in this study. However, if hemostasis was not achieved at an assessment time point but was achieved at the next time point, it could be inferred that the true TTH was between those 2 assessment time points. Therefore, TTH, although not observed directly, was ascertained as falling into the following hemostatic time categories (HTCs): ≤2 minutes from TStart to hemostasis (HTC ≤2). >2 minutes to ≤3 minutes from TStart to hemostasis (HTC >2 to ≤3). >3 minutes to ≤4 minutes from TStart to hemostasis (HTC >3 to ≤4). >4 minutes to ≤5 minutes from TStart to hemostasis (HTC >4 to ≤5). >5 minutes to ≤7 minutes from TStart to hemostasis (HTC >5 to ≤7). >7 minutes to ≤10 minutes from TStart to hemostasis (HTC >7 to ≤10). In addition, 1 non-hemostatic time category (NHTC) was defined: • Persistent bleeding at TBS beyond 10-minute observational period (more than 10 minutes from TStart) (NHTC >10)
    End point type
    Secondary
    End point timeframe
    The TTH would be the time passed from TStart to that last effective hemostatic time point.
    End point values
    Primary Part (II) - FS Grifols (ITT) Primary Part (II) - Surgicel (ITT)
    Number of subjects analysed
    116
    108
    Units: minutes
        arithmetic mean (standard error)
    3.6 ± 0.25
    4.2 ± 0.29
    Statistical analysis title
    Analysis of TTH at TBS (ITT)
    Comparison groups
    Primary Part (II) - FS Grifols (ITT) v Primary Part (II) - Surgicel (ITT)
    Number of subjects included in analysis
    224
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.06
    Method
    Logrank
    Confidence interval

    Secondary: Cumulative proportion of subjects achieving hemostasis at TBS by T2, T5, T7, and T10

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    End point title
    Cumulative proportion of subjects achieving hemostasis at TBS by T2, T5, T7, and T10
    End point description
    End point type
    Secondary
    End point timeframe
    From the start of treatment application (Tstart) at the TBS to the achievement of hemostasis at that site or to the end of the 10-minute observational period if hemostasis has not yet been achieved
    End point values
    Primary Part (II) - FS Grifols (ITT) Primary Part (II) - Surgicel (ITT)
    Number of subjects analysed
    116
    108
    Units: percent
    number (not applicable)
        Hemostasis by 2 minutes
    53.4
    43.5
        Hemostasis by 5 minutes
    83.6
    78.7
        Hemostasis by 7 minutes
    86.2
    81.5
        Hemostasis by 10 minutes
    89.7
    83.3
    Statistical analysis title
    Secondary efficacy analysis
    Comparison groups
    Primary Part (II) - FS Grifols (ITT) v Primary Part (II) - Surgicel (ITT)
    Number of subjects included in analysis
    224
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.144 [2]
    Method
    Fisher exact
    Confidence interval
    Notes
    [2] - Hemostasis by 2 minutes: p= 0.144 Hemostasis by 5 minutes: p= 0.394 Hemostasis by 7 minutes: p= 0.367 Hemostasis by 10 minutes: p= 0.176

    Secondary: Prevalence of treatment failures

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    End point title
    Prevalence of treatment failures
    End point description
    The following cases were considered treatment failures: •Persistent bleeding at the TBS beyond T4. •The event of breakthrough (brisk and forceful) bleeding from the TBS that jeopardized subject safety according to the investigator’s judgment at any moment during the 10 minute observational period and until TClosure. •Re-bleeding at the TBS after the assessment of the primary efficacy endpoint at T4 and until TClosure. •Use of alternative hemostatic treatments or maneuvers (other than the study treatment) at the TBS during the 10-minute observational period and until TClosure or use of study treatment at the TBS beyond T4 and until TClosure. Note: the reasons were not mutually exclusive
    End point type
    Secondary
    End point timeframe
    From the Tstart until the completion (when the last skin closure stitch is placed) of the surgical closure by layers of the exposed surgical field containing the TBS (TClosure)
    End point values
    Primary Part (II) - FS Grifols (ITT) Primary Part (II) - Surgicel (ITT)
    Number of subjects analysed
    116
    108
    Units: percent
    number (not applicable)
        Persistent bleeding
    13.8
    21.3
        Breakthrough bleeding
    2.6
    2.8
        Re-bleeding
    4.3
    2.8
        Use of alternative hemostatic treatment or maneuve
    7.8
    16.7
        Re-applied treatment
    1.7
    0
        Treatment failures, total
    17.2
    22.2
    Statistical analysis title
    Prevalence of treatment failures
    Comparison groups
    Primary Part (II) - FS Grifols (ITT) v Primary Part (II) - Surgicel (ITT)
    Number of subjects included in analysis
    224
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.401
    Method
    Fisher exact
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.776
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.456
         upper limit
    1.321

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Subjects were monitored from the time of the signature of the informed consent to Post-Operative Week 6 ± 4 Days
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16
    Reporting groups
    Reporting group title
    FS Grifols [pooled Preliminary Part (I) + Primary Part (II)]
    Reporting group description
    Subjects from the Preliminary Part (I) and from the Primary Part (II) of the study treated with Fibrin Sealant Grifols have been pooled for summarizing safety data of the study.

    Reporting group title
    Surgicel [pooled Preliminary Part (I) + Primary Part (II)]
    Reporting group description
    -

    Serious adverse events
    FS Grifols [pooled Preliminary Part (I) + Primary Part (II)] Surgicel [pooled Preliminary Part (I) + Primary Part (II)]
    Total subjects affected by serious adverse events
         subjects affected / exposed
    17 / 169 (10.06%)
    18 / 158 (11.39%)
         number of deaths (all causes)
    2
    1
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Meningioma
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Abdominal wound dehiscence
         subjects affected / exposed
    2 / 169 (1.18%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anastomotic complication
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal anastomotic leak
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Post procedural haemorrhage
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Postoperative ileus
         subjects affected / exposed
    2 / 169 (1.18%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Postoperative wound complication
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subdural haematoma
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound dehiscence
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound evisceration
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound secretion
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    1 / 169 (0.59%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac arrest
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Death
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Fatigue
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Malaise
         subjects affected / exposed
    2 / 169 (1.18%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    2 / 169 (1.18%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Systemic inflammatory response syndrome
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    Drug hypersensitivity
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal hernia
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ileus
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intra-abdominal haemorrhage
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Hydrothorax
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypoxia
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Laryngospasm
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumothorax
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory failure
         subjects affected / exposed
    2 / 169 (1.18%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Psychiatric disorders
    Mental status changes
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal failure acute
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal impairment
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Clostridium difficile colitis
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pelvic abscess
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peritonitis
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Postoperative wound infection
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyelonephritis
         subjects affected / exposed
    0 / 169 (0.00%)
    3 / 158 (1.90%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Retroperitoneal abscess
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 169 (0.59%)
    2 / 158 (1.27%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Septic shock
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 158 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    0 / 169 (0.00%)
    2 / 158 (1.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound infection
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 158 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    FS Grifols [pooled Preliminary Part (I) + Primary Part (II)] Surgicel [pooled Preliminary Part (I) + Primary Part (II)]
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    149 / 169 (88.17%)
    139 / 158 (87.97%)
    Injury, poisoning and procedural complications
    Incision site pain
         subjects affected / exposed
    9 / 169 (5.33%)
    7 / 158 (4.43%)
         occurrences all number
    9
    7
    Procedural nausea
         subjects affected / exposed
    24 / 169 (14.20%)
    31 / 158 (19.62%)
         occurrences all number
    25
    31
    Procedural pain
         subjects affected / exposed
    92 / 169 (54.44%)
    86 / 158 (54.43%)
         occurrences all number
    95
    86
    Vascular disorders
    Hypertension
         subjects affected / exposed
    13 / 169 (7.69%)
    12 / 158 (7.59%)
         occurrences all number
    13
    12
    Hypotension
         subjects affected / exposed
    11 / 169 (6.51%)
    5 / 158 (3.16%)
         occurrences all number
    11
    5
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    12 / 169 (7.10%)
    14 / 158 (8.86%)
         occurrences all number
    12
    15
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    12 / 169 (7.10%)
    15 / 158 (9.49%)
         occurrences all number
    12
    16
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    19 / 169 (11.24%)
    11 / 158 (6.96%)
         occurrences all number
    19
    11
    Nausea
         subjects affected / exposed
    23 / 169 (13.61%)
    18 / 158 (11.39%)
         occurrences all number
    27
    19
    Vomiting
         subjects affected / exposed
    12 / 169 (7.10%)
    9 / 158 (5.70%)
         occurrences all number
    13
    10
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    9 / 169 (5.33%)
    10 / 158 (6.33%)
         occurrences all number
    9
    10
    Infections and infestations
    Cervicitis
         subjects affected / exposed
    9 / 169 (5.33%)
    6 / 158 (3.80%)
         occurrences all number
    9
    6

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    16 Jul 2012
    Protocol Version 2.0 was approved on 16 Jul 2012 and applied to all study centers in the US. Major changes included: - Removing age restriction of ≥3 years old to comply with Pediatric Research Equity Act Requirements. - Removing the weight restriction of <20 kg. - Modifying the Preliminary Part (I) of the study to randomize subjects into the FS Grifols or Surgicel treatment groups, providing the investigators an opportunity to become familiar with using the FS Grifols and Surgicel products in a variety of bleed types and to also generate data to corroborate the Primary Part (II) effect size assumptions. - Excluding mild bleeding subjects from the Preliminary Part (I) of the study to further increase the relevance of the experience gained in the Preliminary Part (I). In addition, the exclusion aligned the study to the intra-operative inclusion criteria of a TBS with moderate bleeding intensity. - Adjusting sample size calculations due to the change in the randomization ratio from 2:1 to 1:1 to FS Grifols or Surgicel treatment groups. - Disallowing FS Grifols and Surgicel application after the primary endpoint assessment (T4) or at sites other than the TBS to reduce/minimize confounding factors in the assessment of efficacy and safety. - Reducing intraoperative vital signs measurements to alleviate the number of procedures performed in a short period without adding substantial benefit in terms of safety monitoring. - Adding a procedure for handling missing data for the primary efficacy endpoint. Missing hemostatic assessment would be treated as a failure or as not achieving hemostasis at TBS at T4. - Adding sensitivity analysis adjusted for the study center. - Addition of the testing method and multiplicity adjustment for secondary efficacy endpoints. - Adjusting blood sampling requirements for pediatric subjects <30 kg by eliminating the virology Follow-Up Visits.
    24 Oct 2012
    Protocol Version 2.1 was approved on 24 Oct 2012 and applied to all study centers in the US. The major change included: Addition of TStart2 and TEnd2 time points due to the FDA’s request to capture times of study drug reapplication, if applicable.
    23 Aug 2013
    Protocol Version 3.0 was approved on 23Aug2013 and applied to all centers in the US. Major changes were: - Testing FS Grifols in additional soft tissue surgical types beyond retroperitoneal and pelvic regions, ie mastopexies and abdominoplasties. The % of subjects enrolled with mastopexies and abdominoplasties could not have been >35% in the Primary Part (II). Lymphadenectomies were permitted in the retroperitoneal or pelvic region, only. - Excluding subjects requiring thoracic & abdominal surgery due to trauma. - Clarification that pregnant females or nursing a child at baseline (within 24 hours prior to surgical procedure) were excluded from the study. Laboratory testing for determination of subject’s eligibility was to be performed locally at the site. - Removing exclusion criterion #5 to allow testing of FS Grifols in subjects previously exposed to other thrombin products. The collection of safety information in those subjects would help determine safety profile of FS Grifols in a broader subject population. - Clarification that maximum total volume of FS Grifols allowed to be applied at the TBS would be approximately 12 mL (equivalent to the full content of 2 FS Grifols kits). - Reducing number of Post-Operative Visits by removing visits on Post-Operative Days 1 & 3. - Shifting the following procedures from Post-Operative Days 1 & 3 to Post-Operative Day 2: coagulation panel (INR and aPTT ratio), CBC, and serum clinical chemistry. - Clarification of laboratory panels for pediatric sampling. In pediatric subjects weighing <30 kg, pediatric tubes must have been utilized for CBC, blood coagulation parameters, and serum clinical chemistry. Virology and immunogenicity sampling was eliminated. In pediatric subjects weighing ≥30 kg, pediatric or adult tubes could be utilized for CBC, blood coagulation parameters, and serum clinical chemistry. Virology and immunogenicity sampling may or may not have been performed according to the judgement of the investigator
    16 Jan 2014
    Protocol Version 4.0 was approved on 16 Jan 2014. The key update to this protocol amendment was the addition of approximately 6 study centers in 2 new countries, Hungary and Serbia. An additional major change included: - Removing the Month 6 Visit for virus safety testing after study drug administration. Removing the Month 6 Visit shortened the observation period from 6 months to 3 months and also shortened the subject’s expected length of participation period from 7 months to 4 months.
    25 Mar 2014
    Protocol Version 4.1 was approved on 25 Mar 2014 and applied only to study centers in Hungary. This country-specific protocol amendment was implemented to include the exclusion criteria (listed below) required by Hungary’s national competent authority. - Have known (documented) history of thrombophilia. - Have known (documented) history of IgA deficiency.
    16 Dec 2014
    Protocol Version 5.0 and Version 5.1 were approved on 16 Dec 2014. Protocol Version 5.0 applied to all study centers in the US and Serbia; Version 5.1 applied to all study centers in Hungary. The major changes included: - Increasing the number of preliminary pediatric subjects from 15 to 24 to supplement pediatric population. - Decreasing the Hgb levels criterion from ≥9.0 g/dL to ≥8.0 g/dL at baseline (within 24 hours prior to surgical procedure) to allow the enrollment of subjects with lower Hgb levels (eg, subjects receiving chemotherapy prior to surgery or pediatric subjects) that otherwise would be screening failures. Laboratory testing for determination of subject’s eligibility was performed locally at the investigative study center. - Updating the FS Grifols shelf-life from 1 year to 2 years when stored at a temperature of ≤-18ºC (≤-0.40ºF). - Clarification that baseline central laboratory samples could be drawn shortly after anesthesia but before the start of surgery.

    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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