E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Inherited thrombocytopenias |
Piastrinopenia ereditaria |
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E.1.1.1 | Medical condition in easily understood language |
Inherited thrombocytopenias are a group of diseases characterized by a reduced platelet count due to mutation in specific genes and bleeding tendency that ranges from life-threatening to mild. |
Le piastrinopenie ereditarie sono un gruppo di disordini caratterizzati da riduzione della conta piastrinica dovuta a mutazione di specifici geni e conseguente diatesi emorragica di varia gravità. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Congenital, Hereditary, and Neonatal Diseases and Abnormalities [C16] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 17.0 |
E.1.2 | Level | HLT |
E.1.2 | Classification code | 10043555 |
E.1.2 | Term | Thrombocytopenias |
E.1.2 | System Organ Class | 100000004851 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Phase 1 To ascertain whether and in which forms of inherited thrombocytopenia eltrombopag can be used to transiently increase platelet count over 100 x 109/L and to abolish bleeding tendency. Phase 2 To verify whether and in which forms of inherited thrombocytopenia eltrombopag can be used to stably reduce bleeding tendency in patients with clinical significant bleedings and who had their bleeding tendency reduced during Phase 1 of the study. |
Fase 1: testare se, e in quali forme di piastrinopenia ereditaria, eltrombopag può essere utilizzato per incrementare transitoriamente la conta piastrinica oltre 100 x109/L e abolire la diatesi emorragica. Fase 2: testare se, e in quali forme di piastrinopenia ereditaria, eltrombopag può essere utilizzato per ridurre stabilmente il sanguinamento spontaneo nei pazienti con diatesi emorragica spontanea che hanno ottenuto una riduzione transitoria del sanguinamento al termine della Fase 1 dello studio. |
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E.2.2 | Secondary objectives of the trial |
Phases 1 and 2 - Evaluate safety and tolerability of Eltrombopag in patients with inherited thrombocytopenias. - Identify the dosages of Eltrombopag required to obtain the primary objectives of Phases 1 and 2.
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Fasi 1 e 2: - Valutare sicurezza e tollerabilità del trattamento con eltrombopag nei pazienti con piastrinopenia ereditaria. - Identificare il dosaggio minimo di eltrombopag necessario per l’ottenimento degli obiettivi primari delle Fasi 1 e 2. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Phase 1 Patients with the following forms of inherited thrombocytopenias will be considered for enrolment: - MYH9-related disorders (OMIM 155100, 605249, 153640, 153650) - Bernard-Soulier Syndrome (OMIM 231200) deriving from monoallelic mutations (at variance with biallelic classical BSS, monoallelic form does not present defective platelet function) - Wiskott-Aldrich syndrome (OMIM 301000). - X-linked thrombocytopenia (OMIM 313900). - X-linked thrombocytopenia with thalassemia (OMIM 314050). - Dyserythropoietic anemia with thrombocytopenia (OMIM 300367). - ITGA2B/ITGB3-related thrombocytopenia (OMIM not available). - ANKRD26-related thrombocytopenia (OMIM 188000). - TUBB1-related thrombocytopenia (OMIM not available) - ACTN1-related thrombocytopenia (OMIM not available) - GFI1B-related thrombocytopenia (OMIM not available) Patients will have to fulfill all the following criteria: - Age ≥ 16 years and ≤ 70 years - Average platelet count during the previous year less than 80 x109/L - Written informed consent
Phase 2 Patients with clinically relevant chronic or recurrent bleedings at baseline (grade 2-4 of the WHO bleeding scale) who: (i) completed the phase 1 without severe side effects and (ii) obtained reduction or remission of bleeding by Eltrombopag administration. |
Fase 1: Saranno arruolabili i pazienti affetti dalle seguenti forme di piastrinopenia ereditaria: - Malattia MYH9-correlata (OMIM 155100, 605249, 153640, 153650). - Sindrome di Bernard-Soulier (OMIM 231200), monoallelica o biallelica. - Sindrome di Wiskott-Aldrich (OMIM 301000). - Piastrinopenia legata all’X (OMIM 313900). - Piastrinopenia legata all’X con talassemia (OMIM 314050). - Anemia diseritropoietica con piastrinopenia (OMIM 300367). - Piastrinopenia da mutazioni di ITGA2B/ITGB3 (OMIM non disponibile). - Piastrinopenia da mutazioni di ANKRD26 (OMIM 188000). - Piastrinopenia da mutazioni di TUBB1 (OMIM non disponibile). - Piastrinopenia da mutazioni di ACTN1 (OMIM non disponibile). - Piastrinopenia da mutazioni di GFI1B (OMIM non disponibile). I pazienti dovranno inoltre soddisfare i seguenti criteri: - Età compresa fra 16 e 70 anni (pari o superiore a 16 anni, pari o inferiore a 70 anni) - Conta piastrinica media nell’anno precedente inferiore a 80 x 109/L - Rilascio di consenso informato scritto per l’arruolamento allo studio
Fase 2: Pazienti con sanguinamento spontaneo cronico o ricorrente clinicamente rilevante (grado 2-4 del bleeding score secondo WHO) che: (a) hanno completato la Fase 1 senza effetti collaterali rilevanti e (b) hanno ottenuto una remissione parziale o totale della diatesi emorragica in seguito all’assunzione di eltrombopag. |
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E.4 | Principal exclusion criteria |
Phases 1 and 2 -Hypersensitivity to Eltrombopag or one of the excipients. - History of thromboembolic events. - Treatment with anti-platelet drugs or other drugs affecting platelet function and/or with anticoagulants. - Concurrent diseases or conditions that significantly increase the risk of thromboembolic events, including: malignancies, congestive heart failure (NYHA Grade III/IV), atrial fibrillation or other arrhythmias that predispose to thromboembolic events, known hereditary factors predisposing to venous thromboembolism (factor V mutations, factor II mutations, deficiency of antithrombin III, or protein C, or protein S), antiphospholipid syndrome, hormone replacement therapy and systemic contraception containing estrogen, severe obesity, severe hypertension not controlled by treatment, heavy smoking, diabetes mellitus not controlled by therapy or complicated, severe dislipidemia, haemoglobinopathies increasing the risk of thrombotic events, such as sickle cell anemia or thalassemia major. - Moderate to severe liver failure (Child-Pugh score ≥ 5). - Altered renal function as defined by creatinine ≥ 2 mg/dL - Previous or concurrent clonal disorders of the myeloid series (acute myeloid leukemias and myelodysplastic syndromes). - Females who are pregnant or nursing (a negative pregnancy test is required before enrolment of fertile women). - Formal refusal of any recommendations for a safe contraception. - Alcohol or drug addiction. - Any other disease or condition that by the advice of the responsible physician would make the treatment dangerous for the patient or would make the patient ineligible for this study, including physical, psychiatric, social and behavioral problems. |
Fasi 1 e 2: - Ipersensibilità ad Eltrombopag o ad uno degli eccipienti. - Anamnesi positiva per eventi tromboembolici. - Concomitante terapia cronica con antiaggreganti piastrinici o altri farmaci che interferiscono con la funzione piastrinica e/o concomitante terapia anticoagulante. - Patologie o condizioni concomitanti che aumentano in maniera significativa il rischio di eventi tromboembolici, inclusi: neoplasia maligna, scompenso cardiaco congestizio classe NYHA III/IV, fibrillazione atriale o altre artimie cardiache che predispongono al tromboembolismo, fattori ereditari noti che predispongono al tromboembolismo venoso (mutazioni fattore V, mutazioni fattore II, deficit di antitrombina III, deficit di proteina C, deficit di proteina S), sindrome da anticorpi anti-fosfolipidi, terapia contraccettiva comprendente estrogeni o terapia ormonale sostitutiva, obesità grave, ipertensione arteriosa non controllata dalla terapia, tabagismo grave, diabete mellito non controllato dalla terapia o complicato, dislipidemia grave, severa, emoglobinopatie ad aumentato rischio trombotico come la anemia falciforme o la talassemia major. - Insufficienza epatica da moderata a grave (punteggio Child-Pugh ≥ 5). - Insufficienza renale con creatininemia ≥ 2 mg/dL. - Patologie clonali della serie mieloide (leucemie acute mieloidi e sindromi mielodisplastiche) in atto o pregresse. - Gravidanza o allattamento (per le pazienti di sesso femminile in età fertile è richiesto test di gravidanza negativo all’arruolamento). - Rifiuto formale di adottare metodi di contraccezione sicura durante lo studio. - Alcoolismo o abuso di droghe - Preesistenza di qualsiasi altra condizione o patologia per cui, a giudizio del medico sperimentatore, il trattamento previsto sia pericoloso per il paziente e/o renda il paziente ineleggibile a questa sperimentazione clinica, inclusi problemi fisici, psichiatrici, sociali e comportamentali. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Phase 1: Platelet counts higher than 100 x 109/L and no bleeding events (Grade 0 of WHO bleeding scale) during the last week of treatment.
Phase 2: Long term reduction of bleeding tendency as measured by the WHO bleeding scale. |
Fase 1: raggiungimento di una conta piastrinica superiore a 100 x109/L e assenza di diatesi emorragica spontanea (grado 0 del bleeding score secondo WHO) durante l’ultima settimana di trattamento.
Fase 2: riduzione a lungo termine della tendenza al sanguinamento in termini di riduzione del bleeding score secondo WHO |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Phase 1: last week of treatment Phase 2: end of study |
Fase 1: ultima settimana di trattamento Fase 2: fine studio |
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E.5.2 | Secondary end point(s) |
- Dosages of eltrombopag required for achieving the primary endpoints of Phases 1 and 2. - Ability to receive the programmed treatment with eltrombopag without side effects requiring drug discontinuation
Exploratory Endpoints: Effect of treatment on serum thrombopoietin (TPO) level, number of reticulated platelets, in vitro platelet aggregation.
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- Identificazione del dosaggio minimo di eltrombopag necessario per l’ottenimento degli endpoints primari delle Fasi 1 e 2. - Capacità di ricevere il trattamento previsto di accedere senza la comparsa di effetti collaterali che richiedano la sospensione della terapia.
Endpoints esplorativi: Valutazione dell’effetto del trattamento su alcuni parametri biologici legati alla produzione ed alla funzione delle piastrine: livelli sierici di trombopoietina, numero di piastrine reticolate, aggregazione piastrinica in vitro. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Effects of treatment on biological parameters.
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Effetti del trattamento sui parametri biologici |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 7 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 8 |
E.8.9.2 | In all countries concerned by the trial days | 0 |