Clinical Trial Results:
An Open-Label, Multicenter Evaluation of the Safety and Efficacy of Recombinant Coagulation Factor VIII Fc Fusion Protein (rFVIIIFc; BIIB031) in the Prevention and Treatment of Bleeding in Previously Untreated Patients With Severe Hemophilia A
Summary
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EudraCT number |
2013-005512-10 |
Trial protocol |
GB IE IT ES SE DE PL FR DK NL |
Global end of trial date |
23 Sep 2019
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Results information
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Results version number |
v1(current) |
This version publication date |
03 Apr 2020
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First version publication date |
03 Apr 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 |
997HA306
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT02234323 | ||
WHO universal trial number (UTN) |
- | ||
Other trial identifiers |
PUPs A: EFC16225 | ||
Sponsors
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Sponsor organisation name |
Bioverativ, a Sanofi company
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Sponsor organisation address |
225 Second Avenue, Waltham, Massachusetts (MA), United States, 02451
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Public contact |
Trial Transparency Team, Bioverativ, a Sanofi company, clinicaltrials@bioverativ.com
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Scientific contact |
Trial Transparency Team, Bioverativ, a Sanofi company, clinicaltrials@bioverativ.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-001114-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 |
18 Nov 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 |
23 Sep 2019
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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 evaluate the safety of Recombinant Coagulation Factor VIII Fc Fusion Protein (rFVIIIFc) in previously untreated patients (PUPs) with severe hemophilia A.
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Protection of trial subjects |
The study was conducted by investigators experienced in the treatment of pediatric patients. The parent(s) or guardian(s) as well as the children were fully informed of all pertinent aspects of the clinical trial as well as the possibility to discontinue at any time. In addition to the consent form for the parent(s)/guardian(s), an assent form in child-appropriate language was provided and explained to the child. Repeated invasive procedures were minimized. The number of blood samples as well as the amount of blood drawn were adjusted according to age and weight. A topical anesthesia may have been used to minimize distress and discomfort.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
12 Jan 2015
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Long term follow-up planned |
No
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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: 8
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Country: Number of subjects enrolled |
Spain: 2
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Country: Number of subjects enrolled |
Sweden: 2
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Country: Number of subjects enrolled |
United Kingdom: 15
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Country: Number of subjects enrolled |
France: 4
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Country: Number of subjects enrolled |
Germany: 6
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Country: Number of subjects enrolled |
Ireland: 6
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Country: Number of subjects enrolled |
Italy: 11
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Country: Number of subjects enrolled |
Australia: 7
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Country: Number of subjects enrolled |
Brazil: 14
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Country: Number of subjects enrolled |
Canada: 11
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Country: Number of subjects enrolled |
New Zealand: 1
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Country: Number of subjects enrolled |
United States: 21
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Worldwide total number of subjects |
108
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EEA total number of subjects |
54
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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) |
6
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Infants and toddlers (28 days-23 months) |
93
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Children (2-11 years) |
9
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Adolescents (12-17 years) |
0
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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 |
The study was conducted at 44 active centers in 13 countries between 12-Jan-2015 to 23-Sep-2019. | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
110 subjects screened, 108 enrolled, 103 received drug. | ||||||||||||||||||||||||
Period 1
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Period 1 title |
All Enrolled
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Is this the baseline period? |
No | ||||||||||||||||||||||||
Allocation method |
Not applicable
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Blinding used |
Not blinded | ||||||||||||||||||||||||
Arms
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Arm title
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Not Applicable | ||||||||||||||||||||||||
Arm description |
- | ||||||||||||||||||||||||
Arm type |
No intervention | ||||||||||||||||||||||||
Investigational medicinal product name |
No investigational medicinal product assigned in this arm
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Period 2
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Period 2 title |
All Treated
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Is this the baseline period? |
Yes [1] | ||||||||||||||||||||||||
Allocation method |
Not applicable
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Blinding used |
Not blinded | ||||||||||||||||||||||||
Arms
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Arm title
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Recombinant Coagulation Factor VIII Fc Fusion Protein | ||||||||||||||||||||||||
Arm description |
Subjects were to receive rFVIIIFc as follows -PR (Prophylaxis regimen): rFVIIIFc 25-80 international units per kilogram (IU/kg), weekly until subject reached >= 50 exposure days (ED: 24-hour period in which >=1 injection/dose of rFVIIIFc was given), or study withdrawal/end of study. Adjustments to dose/dosing interval was done as needed by investigator; Treatment with an optional ER (Episodic regimen) can be initiated before PR at investigators discretion; ITI: rFVIIIFc 200 IU/kg, daily for subjects who, after exposure to rFVIIIFc, had positive high titre inhibitor (>=5.00 Bethesda Units per milliliter [BU/mL]) or positive low titre inhibitor (>=0.60 and <5.00 BU/mL) and had poorly controlled bleeding despite increased rFVIIIFc doses, or required bypassing agent to treat bleeding. | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
rFVIIIFc
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Investigational medicinal product code |
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Other name |
BIIB031
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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 |
Subjects received rFVIIIFc as an intravenous (IV) injection for one or more of three treatment regimens: episodic, prophylactic and ITI.
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Notes [1] - Period 1 is not the baseline period. It is expected that period 1 will be the baseline period. Justification: Baseline data was reported for safety analysis set which was less than all enrolled set. Period 2 shows the disposition of safety analysis set. |
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Notes [2] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same. Justification: Baseline data was reported for safety analysis set which was less than all enrolled set. Period 2 shows the disposition of safety analysis set. [3] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left. Justification: Subjects could be treated in more than one regimen and were counted in all categories wherever applicable. [4] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left. Justification: Subjects could be treated in more than one regimen and were counted in all categories wherever applicable. |
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Baseline characteristics reporting groups
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Reporting group title |
All Treated
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Reporting group description |
The Safety Analysis Set was defined as all subjects who received at least 1 dose of rFVIIIFc. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Not Applicable
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Reporting group description |
- | ||
Reporting group title |
Recombinant Coagulation Factor VIII Fc Fusion Protein
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Reporting group description |
Subjects were to receive rFVIIIFc as follows -PR (Prophylaxis regimen): rFVIIIFc 25-80 international units per kilogram (IU/kg), weekly until subject reached >= 50 exposure days (ED: 24-hour period in which >=1 injection/dose of rFVIIIFc was given), or study withdrawal/end of study. Adjustments to dose/dosing interval was done as needed by investigator; Treatment with an optional ER (Episodic regimen) can be initiated before PR at investigators discretion; ITI: rFVIIIFc 200 IU/kg, daily for subjects who, after exposure to rFVIIIFc, had positive high titre inhibitor (>=5.00 Bethesda Units per milliliter [BU/mL]) or positive low titre inhibitor (>=0.60 and <5.00 BU/mL) and had poorly controlled bleeding despite increased rFVIIIFc doses, or required bypassing agent to treat bleeding. |
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End point title |
Percentage of Subjects With Confirmed Inhibitor Development as Measured by the Nijmegen-Modified Bethesda Assay [1] | ||||||||
End point description |
A positive inhibitor result occurs when a subject has a value >=0.6 Bethesda Units (BU)/mL by central laboratory testing using Nijmegen-modified Bethesda assay, that is confirmed on re-testing of a separate sample collected >=2 weeks after the initial sample. Exposure day (ED) is a 24-hour period in which subject received >=1 dose of rFVIIIFc injections. Positive inhibitor incidence rate=Number of subjects with an inhibitor/Number of subjects reaching >=10 EDs and had >=1 inhibitor test performed at or beyond this milestone or who have an inhibitor. Any subject who develops an inhibitor following the initial rFVIIIFc administration will be included in the numerator and denominator. Analysis performed on subjects in safety analysis set (all subjects who received >=1 dose of study treatment) meeting above criteria.
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End point type |
Primary
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End point timeframe |
Up to 3 years
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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: Analysis was descriptive in nature, no inferential analysis was provided. |
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No statistical analyses for this end point |
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End point title |
Annualized Number of Bleeding Episodes (Spontaneous and Traumatic) per Subject (Annualized Bleeding Rate [ABR]) | ||||||||||||||
End point description |
ABR is annualized number of bleeding episodes during efficacy period (EP) per subject annualized to a 1-year interval of time. Bleeding episodes were classified as spontaneous if parent/caregiver/subject records bleeding event when there is no known contributing factor such as definite trauma or antecedent “strenuous” activity and as traumatic when there is known reason for bleed. ABR=(Number of bleeding episodes during EP/total number of days during EP)*365.25. EP is sum of all intervals of time during which subjects were treated with rFVIIIFc per treatment regimens of study excluding surgical/rehabilitation periods and large injection intervals (greater than [>]28 days). Subjects were included in summary of more than 1 treatment regimen if their regimen changed during study. Analysis performed on Full Analysis Set (FAS) subjects within the EP. FAS included all enrolled subjects with >=1 dose of study treatment. n= number of FAS subjects analysed in each treatment regimen.
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End point type |
Secondary
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End point timeframe |
Up to 3 years
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No statistical analyses for this end point |
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End point title |
Annualized Number of Spontaneous Joint Bleeding Episodes | ||||||||||||||
End point description |
Bleeding episodes were classified as spontaneous if parent/caregiver/subject records a bleeding event when there is no known contributing factor such as a definite trauma or antecedent “strenuous” activity. Annualized spontaneous joint bleeding episodes=(Total number of spontaneous joint bleeding episodes during EP divided by total number of days during EP)*365.25. EP reflects sum of all intervals of time during which subjects were treated with rFVIIIFc per treatment regimen excluding major and minor surgical/rehabilitation periods and large injection intervals (> 28 days). Bleeding episodes were summarized by treatment regimen. Subjects were included in summary of more than 1 treatment regimen if their regimen changed during study. Analysis performed on FAS subjects within the EP. Here, ‘n’ signifies number of FAS subjects who were analysed in each treatment regimen.
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End point type |
Secondary
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End point timeframe |
Up to 3 years
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No statistical analyses for this end point |
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End point title |
Number of rFVIIIFc Injections with Excellent or Good, Moderate or None Treatment Response Assessed Using a 4-Point Scale | ||||||||||||||||||||||||||||||||
End point description |
Using e-diary, each subject’s parent/caregiver rated treatment response to any bleeding episode (BE) at approximately (approx.) 8-12 hours(hr) from time of injection and prior to additional doses of rFVIIIFc given for same BE, using 4-point scale: 1=Excellent: abrupt pain relief and/or improvement in signs of bleeding within approx. 8hr after initial injection; 2=Good: definite pain relief and/or improvement in signs of bleeding within approx. 8hr after injection, but possibly requiring more than 1 injection after 24–48 hr for complete resolution; 3=Moderate: Probable/slight beneficial effect within 8 hr after initial injection and requires more than 1 injection and 4=None: No improvement or condition worsens within approx. 8 hr after initial injection. Subjects included in more than 1 treatment regimen if their regimen changed during study. Analysis performed on FAS subjects within the EP and based on all injections. n= number of injections reported for each treatment regimen.
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End point type |
Secondary
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End point timeframe |
Up to 3 years
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No statistical analyses for this end point |
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End point title |
Total Number of Exposure Days (EDs) | ||||||||
End point description |
An ED was defined as a 24-hour period in which a subject received one or more doses of rFVIIIFc injections, with the time of the first injection of rFVIIIFc defined as the start of the ED. Subjects who did not have a particular injection type are counted as having zero injections for that type. Analysis performed on safety analysis set.
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End point type |
Secondary
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End point timeframe |
Up to 3 years
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No statistical analyses for this end point |
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End point title |
Total Annualized rFVIIIFc Consumption per Subject for the Prevention and Treatment of Bleeding Episodes | ||||||||||||||
End point description |
Total annualized rFVIIIFc consumption (in IU/kg) was calculated for each subject as: Annualized consumption = (Total IU/kg of rFVIIIFc during EP divided by total number of days during EP)*365.25. EP reflects the sum of all intervals of time during which subjects are treated with rFVIIIFc according to the treatment regimens of the study excluding surgical/rehabilitation periods and large injection intervals (>28 days). Subjects were included in summary of more than 1 treatment regimen if their regimen changed during study. Analysis performed on FAS subjects within the EP. Here, ‘n’ signifies number of FAS subjects who were analysed in each treatment regimen.
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End point type |
Secondary
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End point timeframe |
Up to 3 years
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No statistical analyses for this end point |
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End point title |
Number of Injections of rFVIIIFc Required to Resolve a Bleeding Episode | ||||||||||||||
End point description |
Number of Injections of rFVIIIFc required to resolve a bleeding episode during EP were reported. EP reflects the sum of all intervals of time during which subjects were treated with rFVIIIFc according to the treatment regimens of the study excluding surgical/rehabilitation periods and large injection intervals (>28 days). All injections given from the initial sign of a bleed, until the last date/time within the bleed window were counted. Subjects were included in summary of more than 1 treatment regimen if their regimen changed during study. Analysis performed on FAS subjects within the EP. Here, ‘n’ signifies number of FAS subjects who were analysed in each treatment regimen.
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End point type |
Secondary
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End point timeframe |
Up to 3 years
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No statistical analyses for this end point |
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End point title |
Average Dose per Injection of rFVIIIFc Required to Resolve a Bleeding Episode | ||||||||||||||
End point description |
The average dose of rFVIIIFc per injection per bleeding episode was calculated as the average of all doses (IU/kg) administered to treat the bleeding episode during efficacy period (EP). EP begins with the first treatment regimen dose of rFVIIIFc and ends with the last dose (regardless of the reason for dosing). Surgery/rehabilitation periods are not included in the EP. Subjects were included in summary of more than 1 treatment regimen if their regimen changed during study. Analysis performed on FAS subjects within the EP. Here, ‘n’ signifies number of FAS subjects who were analysed in each treatment regimen.
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End point type |
Secondary
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End point timeframe |
Up to 3 years
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No statistical analyses for this end point |
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End point title |
Change From Baseline in rFVIIIFc Incremental Recovery | ||||||||||||||||||||||||||||
End point description |
Blood samples were taken at trough (predose) and Cmax for assessment of incremental recovery, measured by the one-stage clotting assay. IR (International Units per deciliter [IU/dL] per IU/kg) = (Cmax for FVIII activity – Pre-dose FVIII activity) (IU/dL)/ Actual dose (IU/kg), where Cmax (maximum concentration) is 30-minute FVIII activity post-dose and FVIII activity less than (<)0.5 IU/dL was set to 0 IU/dL for calculation of IR. Analysis performed on FAS subjects within the EP. Here ‘n’ signifies number of FAS subjects with available data for each visit.
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End point type |
Secondary
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End point timeframe |
Baseline, Weeks 12, 24, 36, 48, 60, 72, 84, 96, 108 and 120
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No statistical analyses for this end point |
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End point title |
Number of Subjects with Response to Immune Tolerance Induction (ITI) | ||||||||||||||
End point description |
Complete Success was defined as meeting all of the following criteria: Negative inhibitor titres in 2 consecutive determinations at least 4 weeks apart; IR >=66% of baseline in 2 consecutive determinations at least 4 weeks apart; Half life >=6 hours. Partial Success was defined as meeting the first criteria for Complete Success and one of the other 2 after 33 months of ITI. Analysis performed on ITI analysis set which was defined as all subjects who consented to and initiated the ITI sub-study.
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End point type |
Secondary
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End point timeframe |
Up to 3 years
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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 |
All Adverse Events (AEs) were collected from signature of the informed consent form up to end of the study (up to 3 years) regardless of seriousness or relationship to investigational product.
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Adverse event reporting additional description |
Reported AE are treatment-emergent AE i.e. AE that was present prior to receiving first injection of rFVIIIFc and subsequently worsened in severity, or was not present prior to receiving first injection but subsequently appeared before last visit/follow-up call, whichever came later. Analysis performed on safety analysis set.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
22.0
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Reporting groups
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Reporting group title |
Recombinant Coagulation Factor VIII Fc Fusion Protein
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Reporting group description |
Subjects were to receive rFVIIIFc as follows -PR (Prophylaxis regimen): rFVIIIFc 25-80 international units per kilogram (IU/kg), weekly until subject reached >= 50 exposure days (ED: 24-hour period in which >=1 injection/dose of rFVIIIFc was given), or study withdrawal/end of study. Adjustments to dose/dosing interval was done as needed by investigator; Treatment with an optional ER (Episodic regimen) can be initiated before PR at investigators discretion; ITI: rFVIIIFc 200 IU/kg, daily for subjects who, after exposure to rFVIIIFc, had positive high titre inhibitor (>=5.00 Bethesda Units per milliliter [BU/mL]) or positive low titre inhibitor (>=0.60 and <5.00 BU/mL) and had poorly controlled bleeding despite increased rFVIIIFc doses, or required bypassing agent to treat bleeding. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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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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06 Apr 2015 |
The primary reason for this amendment was to change the cut-off age for the study from <18 years old to <6 years old to align with other studies focusing on previously untreated pediatric subjects. |
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22 Jul 2016 |
The primary reason for this amendment was to add provisions requested by regulatory authorities including revision of definitions of ITI therapy outcomes; addition of a tapering regimen and a monitoring period after ITI; replacement of the exclusion criterion related to hypersensitivity to IV immunoglobulin (IVIG) administration, with an exclusion criterion related to hypersensitivity to FVIIIFc administration; addition of data collection for concomitant medications administered to breastfeeding mothers of subjects; justification of collection of race and ethnicity data.
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22 Sep 2016 |
The primary reason for this amendment was to correct outdated information regarding the enrollment criteria that was inadvertently left in the protocol. These changes included: the collection of AEs was removed from the screening period and subjects awaiting ITI were asked to follow the Prophylaxis Regimen rather than the Episodic Regimen.
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24 Feb 2017 |
The primary reason for this amendment was to incorporate a change in responsibility and obligations of the study sponsor (according to Directive 2001/20/EC as well as International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Guideline on Good Clinical Practice (GCP) E6[RI]). Bioverativ Therapeutics Inc took over the responsibility and obligations of the study sponsor from Biogen Idec Research Limited (UK) or Biogen MA Inc (US) or Biogen Australia Pty Ltd (Australia). |
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12 Feb 2018 |
The primary reason for this amendment was to redefine the EOS criteria for the study in light of the new draft version of the updated EMA guideline on the clinical investigation of recombinant and human plasma-derived factor VIII products. |
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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 |