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    Summary
    EudraCT Number:2015-000484-13
    Sponsor's Protocol Code Number:AG-348-C-003
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-01-05
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2015-000484-13
    A.3Full title of the trial
    A Phase 2, Open Label, Randomized, Dose Ranging, Safety, Efficacy, Pharmacokinetic and Pharmacodynamic Study of AG-348 in Adult Patients
    with Pyruvate Kinase Deficiency
    Studio di fase 2, in aperto, randomizzato, dosimetrico, sulla sicurezza, sull'efficacia, sulla farmacocinetica e sulla farmacodinamica di AG-348 in pazienti adulti con deficit di piruvato chinasi
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2, Open Label, Randomized, Dose Ranging, Safety, Efficacy, Pharmacokinetic and Pharmacodynamic Study of AG-348 in Adult Patients
    with Pyruvate Kinase Deficiency
    Studio di fase 2, in aperto, randomizzato, dosimetrico, sulla sicurezza, sull'efficacia, sulla farmacocinetica e sulla farmacodinamica di AG-348 in pazienti adulti con deficit di piruvato chinasi
    A.3.2Name or abbreviated title of the trial where available
    NA
    NA
    A.4.1Sponsor's protocol code numberAG-348-C-003
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorAGIOS PHARMACEUTICALS, INC.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportAgios Pharmaceuticals Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAgios Pharmaceuticals, Inc.
    B.5.2Functional name of contact pointDirector, Scientific Communications
    B.5.3 Address:
    B.5.3.1Street Address88 Sidney Street
    B.5.3.2Town/ cityCambridge MA
    B.5.3.3Post code02138
    B.5.3.4CountryUnited States
    B.5.4Telephone number0018446332332
    B.5.5Fax number0018446332332
    B.5.6E-mailmedinfo@agios.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAG-348 solfato idrato
    D.3.2Product code AG-348
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMitapivat
    D.3.9.1CAS number 2151847-10-6
    D.3.9.2Current sponsor codeAG-348 solfato idrato
    D.3.9.3Other descriptive nameAGI-1480, AGX-0841, AG-348, AG-348 hemisulfate
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMitapivat
    D.3.9.1CAS number 2151847-10-6
    D.3.9.2Current sponsor codeAG-348 solfato idrato
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMitapivat
    D.3.9.1CAS number 2151847-10-6
    D.3.9.2Current sponsor codeAG-348 solfato idrato
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAG-348 sulfate hydrate
    D.3.2Product code AG-348
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMitapivat
    D.3.9.1CAS number 2151847-10-6
    D.3.9.2Current sponsor codeAG-348 sulfate hydrate
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMitapivat
    D.3.9.1CAS number 2151847-10-6
    D.3.9.2Current sponsor codeAG-348 sulfate hydrate
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMitapivat
    D.3.9.1CAS number 2151847-10-6
    D.3.9.2Current sponsor codeAG-348 sulfate hydrate
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Pyruvate Kinase Deficiency
    Deficit da Piruvato Chinasi
    E.1.1.1Medical condition in easily understood language
    Pyruvate Kinase Deficiency
    Deficit da Piruvato Chinasi
    E.1.1.2Therapeutic area Diseases [C] - Blood and lymphatic diseases [C15]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10037682
    E.1.2Term Pyruvate kinase deficiency anaemia
    E.1.2System Organ Class 10010331 - Congenital, familial and genetic disorders
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    CORE PERIOD: Evaluate the safety and tolerability of up to 24 weeks of AG 348 administration in patients with PK deficiency.
    EXTENSION PERIOD: Evaluate the long term safety and tolerability of up to 30 months of AG-348
    administration in patients with PK deficiency.
    PERIODO PRINCIPALE: Valutare la sicurezza e la tollerabilit¿ della somministrazione di AG-348 per un periodo massimo di 24 settimane in pazienti con deficit di piruvato chinasi (deficit di PK).
    PERIODO DI ESTENSIONE: Valutare la sicurezza a lungo termine e la tollerabilit¿ della somministrazione di AG-348 fino a 30 mesi in pazienti con deficit di piruvato chinasi (deficit di PK).
    E.2.2Secondary objectives of the trial
    CORE PERIOD:Evaluate the pharmacokinetics (PK) of AG-348 and the metabolite AGI-8702.
    Evaluate the PD response of ATP and 2,3 DPG after administration of AG-348.
    Evaluate indicators of clinical activity of AG-348 in patients with PK deficiency, including changes in hemoglobin (Hb), HCT, reticulocyte count, haptoglobin (Hp), carboxyhemoglobin (COHb), end tidal carbon monoxide (ETCO), lactate dehydrogenase (LDH), total and indirect bilirubin, erythropoietin (EPO), hepcidin, ferritin, and transferrin saturation (serum iron/iron binding capacity).
    EXTENSION PERIOD: Evaluate the PK of AG-348 and the metabolite AGI-8702.
    Evaluate the PD response of ATP and 2,3-DPG after administration of AG-348.
    Evaluate indicators of clinical activity of AG-348 in patients with PK deficiency, including changes in Hb, HCT, reticulocyte count, Hp, COHb, LDH, total and indirect bilirubin, EPO, hepcidin, ferritin, and transferrin saturation (serum iron/iron binding capacity).
    PERIODO PRINCIPALE: Valutare la farmacocinetica (FC) di AG-348 e del metabolita AGI-8702.
    Valutare la risposta farmacodinamica (FD dell'adenosina trifosfato (ATP) e della 2,3 difosfoglicerato (2,3-DPG) dopo somministrazione di AG-348.
    Valutare gli indicatori di attivit¿ clinica di AG-348 in pazienti con deficit di PK, comprese le variazioni dei livelli di emoglobina (Hb), ematocrito (HCT), conta dei reticolociti, aptoglobina (Hp), carbossiemoglobina (COHb), lattato deidrogenasi (LDH), bilirubina totale e indiretta, eritropoietina (EPO), ferritina e saturazione della transferrina (capacit¿ di legame del ferro/ferro del siero).
    PERIODO ESTESIONE: Valutare FC di AG-348 e del metabolita AGI-8702.Valutare risposta FD dell'ATP e di 2,3-DPG dopo somministrazione di AG-348.Valutare indicatori di attivit¿ clinica di AG-348 in pazienti con deficit di PK, variazioni di Hb,HCT, conta reticolociti, Hp, COHb, LDH,bilirubina totale e indiretta, EPO,ferritina, saturaz. trasferrina.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Signed written informed consent obtained prior to performing any study procedure, including screening procedures. 2.Male or female, aged 18 years and older. 3.Known medical history of PK deficiency.
    4.All patients must have documented clinical laboratory confirmation of PK deficiency by RBC pyruvate kinase enzymatic assay performed at
    Screening by a central designed laboratory or by any participating investigative site's local hematology laboratory. Patients with prior documentation of PK deficiency by RBC enzymatic assay will have a reconfirmation of this result during Screening as a condition of
    enrollment. a.In the event that a patient's screening pyruvate kinase enzymatic assay is negative, the patient will be eligible for enrollment if the genotyping shows a mutant genotype that has been previously documented in the literature to be associated with pyruvate kinase deficiency. If the genotyping shows a previously undescribed mutation in the PKR gene, then the eligibility for enrollment will be determined on a case-by-case basis by the Coordinating Investigator and Medical Monitor in discussion with the Investigator. If no mutation is defined, then the patient will not be eligible. 5.All patients must have genotypic characterization of the mutant PKR gene performed at Screening.Patients whose genotype has already been determined by another laboratory may be enrolled on the basis of that report, with the approval of the Medical Monitor. 6.All patients must have genotypic characterization of the UGT1A1 gene performed by a designated central laboratory to document whether they may have underlying Gilbert's Disease. Patients with Gilbert's Disease are eligible to enroll. 7.Males must have Hb = 12.0 g/dL; femalesHb = 11.0 g/dL. 8.All patients must be considered transfusion independent as defined by: no greater than 3 units of RBCs transfused in the 12-month period up to the first day of study dosing and no transfusions within 4 months of first day of study dosing. Patients who have received more transfusion support than described above will evaluated for eligibility on a case-bycase basis by the Medical Monitor. 9.Eligible patients may still have their spleens in place, or may have undergone prior splenectomy. For splenectomized patients: a.Must have undergone their procedure at least 6 months prior to Screening. b.Must be current in their vaccinations for PCV13, PPSV23, Quadrivalent Meningococcal vaccine, and Hib.. If the patient requires both PCV13 and PPSV23, PCV13 must be given before PPSV23, if possible Administration of PPSV23 should follow
    PCV13 by at least 8 weeks; it is permissible to give PCV13 during Screening followed by PPSV23 following the initiation of AG-348 treatment. Any
    missing vaccinations may be administered starting with the Screening
    Period and during the trial following the initiation of AG-348 dosing as
    necessary according to recommended vaccination guidance
    10.ECOG Performance Status = 2. 11.Patients must be taking at least 1 mg of folic acid daily for at least 21 days prior to first dose and continued daily during study participation. 12.Adequate organ function, defined as: a.Serum AST and ALT= 2.5 × upper limit of normal (ULN) (unless the increased AST is assessed by the Investigator as due to hemolysis).
    b.Normal or elevated levels of serum bilirubin. In patients with serum bilirubin> ULN, the elevation must be attributed to hemolysis with or without
    Gilbert's syndrome and must not be choledocholithiasis, cholecystitis, biliary obstruction, or hepatocellular disease.
    c.Serum creatinine = 1.25 × ULN. If serum creatinine > 1.25 × ULN, then 24 hour measured or calculated (Cockcroft-Gault) glomerular filtration rate (GFR) = 60 mL/min. d.Absolute neutrophil count (ANC) > 1.0 × 109/L. e.Platelet count = 100 × 109/L.
    f.aPTT and INR = 1.25 × ULN, unless the patient is receiving therapeutic anticoagulants. SPAZIO NON SUFFICIENTE
    1.Deve esser stato firmato il consenso informato scritto prima di eseguire qualsiasi procedura di studio, comprese le procedure di
    screening.
    2.Sesso maschile o femminile, età almeno 18 anni.
    3.Storia medica nota di deficit di PK.
    4.Tutti i pazienti devono avere una conferma documentata dal laboratorio clinico di deficit di PK mediante analisi enzimatica di PK
    eritrocitaria eseguita allo Screening da un laboratorio centrale designato o da un laboratorio locale di ematologia di uno dei centri
    partecipanti. I pazienti con previa documentazione di deficit di PK mediante analisi enzimatica eritrocitaria avranno una riconferma
    di questo risultato durante lo Screening come condizione per l'arruolamento.
    a.Nel caso in cui l'analisi enzimatica della PK dello screening di un paziente risulti negativa (ovvero, mostri una normale attività
    della PK), il paziente sarà idoneo all'arruolamento se la genotipizzazione indica un genotipo mutante precedentemente
    documentato in letteratura come correlato a deficit di piruvato chinasi. Se la genotipizzazione mostra una mutazione non ancora
    documentata del gene PKR, l'eleggibilità per l'arruolamento sarà determinata caso per caso dallo sperimentatore coordinatore e
    dal medical monitor di concerto con lo sperimentatore. Se non viene definita nessuna mutazione, il paziente non sarà eleggibile.
    5.Tutti i pazienti devono avere la caratterizzazione genotipica del gene PKR mutante allo Screening. 6.Tutti i pazienti devono avere
    una caratterizzazione genotipica del gene UGT1A1 eseguita da un laboratorio centrale designato per documentare l'eventuale
    presenza della malattia di Gilbert. I pazienti con malattia di Gilbert sono idonei all'arruolamento.
    7.I maschi devono avere Hb = 12,0 g/dL; le femmine Hb = 11,0 g/dL.
    8.Tutti i pazienti devono essere considerati trasfusione-indipendenti secondo la seguente definizione: non più di 3 unità di globuli
    rossi trasfusi nel periodo dei 12 mesi precedenti al primo giorno di dosaggio dello studio e nessuna trasfusione nei 4 mesi
    precedenti. L'idoneità dei pazienti che hanno ricevuto più trasfusioni di quanto descritto sopra saranno valutati caso per caso dal
    Medical Monitor.
    9.I pazienti elegibili possono avere la milza o possono essere splenectomizzati per i pazienti splenectomizzati: a.devono essere
    stati operati almeno 6 mesi prima dello Screening; b.devono avere effettuato i vaccini: PCV13, PPSV23, meningococcico
    quadrivalente e Hib. Se ai pazienti occorre ricevere sia il PCV13 che il PPSV23, il PCV13 deve essere somministrato prima del
    PPSV23, laddove possibile. La somministrazione di PPSV23 dovrebbe avere luogo almeno 8 settimane dopo quella di PCV13; è
    consentita la somministrazione di PCV13 durante lo Screening seguita da quella di PPSV23 dopo l’inizio del trattamento con AG-
    348
    10.Punteggio ECOG di = 2. 11.I pazienti devono assumere almeno 1 mg di acido folico al giorno per almeno 21 giorni prima della
    prima dose e continuare ogni giorno durante la partecipazione allo studio.
    12.Funzionalità organica adeguata, definita come:
    a.AST e ALT = 1,5 × limite superiore normale (ULN) (a meno che l'aumento di AST non venga valutato dallo sperimentatore come
    conseguenza di emolisi). SPAZIO NON SUFFICIENTE
    E.4Principal exclusion criteria
    1.Hemoglobin level > 12.0 g/dL if male; Hb > 11.0 g/dL if female.
    2.Additional diagnosis of any other congenital or acquired blood disorder, including glucose-6-phosphate-dehydrogenase (G6PD)
    deficiency, or any other hemolytic anemia process except for mild alloimmunization as a consequence of transfusion therapy.
    3.Iron overload (hemosiderosis or concurrent hemochromatosis) sufficiently severe to result in a clinical diagnosis by the
    Investigator of cardiac,
    hepatic, or pancreatic insufficiency.
    4.Prior bone marrow or stem cell transplant.
    5.Clinically symptomatic cholelithiasis or cholecystitis. (Prior cholecystectomy is not exclusionary. Patients with symptomatic
    cholelithiasis
    or cholecystitis may be rescreened once the disorder has been treated and clinical symptoms have resolved.)
    6.Currently enrolled in another therapeutic clinical trial involving ongoing therapy with any investigational or marketed product or
    placebo.
    Concurrent participation in the Pyruvate Kinase Deficiency Natural History Study (NCT02053480) is permitted.
    7.Exposure to any investigational drug, device, or procedure within 28 days prior to Screening or trial partecipation.
    8.Concurrent medical condition that could compromise participation in the study such as:
    a.Poorly controlled hypertension (defined as systolic blood pressure (BP) > 150 mm Hg or diastolic BP > 90 mm Hg) refractory to
    medical management.
    b.History of recent (within < 6 months from Screening date) congestive heart failure; myocardial infarction or unstable angina
    pectoris; or hemorrhagic, embolic, or thrombotic stroke; deep venous thrombosis; or pulmonary or arterial embolism.
    c.Currently active infection requiring the use of parenteral antimicrobial agents or that is = Grade 3 (CTCAEv4.03) within 6 months
    of first dose.
    d.A pattern or frequency of post-splenectomy sepsis that in the assessment of the Investigator could reasonably be expected to
    interfere with the ability of the patient to complete the 24 week Core Period study participation.
    e.Positive test for hepatitis B surface antigen (HBsAg) or hepatitis C virus (HCV) antibody with signs of active Hepatitis B or C virus
    infection.
    f.Positive test for human immunodeficiency virus (HIV) 1 or 2 antibody.
    g.Diabetes mellitus judged to be in poor control by the Investigator or requiring > 3 anti-diabetic agents counting insulin; use of
    insulin per se is not exclusionary.
    h.History of any primary malignancy with the exception of: curatively treated non-melanomatous skin cancer; curatively treated
    cervical or breast carcinoma in situ; or other primary tumor treated with curative intent and no known active disease present and
    no treatment administered during the last 3 years.
    9.Undergone major surgery within 6 months of first dose.
    10.Current or recent history of psychiatric disorder that in the opinion of the Investigator or Medical Monitor could compromise the
    ability of the patient to cooperate with study visits and procedures.
    11.Use of any of the restricted list of products known to strongly inhibit CYP3A4 metabolism (Appendix 15.3, Table 7) within 5 days
    prior to Day 1 dosing; or to strongly induce CYP3A4 metabolism (Appendix
    15.3, Table 8) within 28 days prior to Day 1 dosing; or to strongly inhibit P-gp transporter (Appendix 15.3, Table 9) within 5 days
    prior to Day 1
    dosing; or digoxin within 5 days prior to Day 1 dosing. For patients who require chronic inhaled glococorticoid therapy, PI should
    confer with the Medical Monitor.
    12.Serum bilirubin > ULN attributable to factors other than hemolysis and/or Gilbert's syndrome.
    13.Male patients with heart-rate corrected QT (Fridericia's correction factor) QTcF interval > 450 msec, or female patients with
    QTcF interval > 470 msec with the exception of patients with a left bundle branch block (LBBB). Medical Monitor approval needed
    in patients with a LBBB. SPAZIO NON SUFFICIENTE
    1.Livello dell'emoglobina > 12,0 g dL se maschio; Hb > 11,0 g/dL se femmina.
    2.Diagnosi aggiuntiva di qualsiasi altro disturbo ematico congenito o acquisito, tra cui deficit di G6PD, o qualsiasi altro processo di
    anemia emolitica tranne allo-immunizzazione lieve conseguente a terapia trasfusionale.
    3.Sovraccarico di ferro sufficientemente grave da determinare una diagnosi clinica da parte dello Sperimentatore di insufficienza
    cardiaca, epatica o pancreatica.
    4.Previo trapianto di midollo osseo o cellule staminali.
    5.Colecistite o colelitiasi clinicamente sintomatica. (Una colecistectomia previa non costituisce un criterio di esclusione. I pazienti
    con colelitiasi sintomatica o colecistite possono essere sottoposti nuovamente a screening una volta che è stato trattato il disturbo
    e i sintomi clinici sono stati risolti).
    6.Attualmente arruolato in un altro studio clinico terapeutico che prevede una terapia in corso con qualsiasi prodotto sperimentale
    o commercializzato o placebo. È consentita la partecipazione simultanea allo studio NCT02053480 (Pyruvate Kinase Deficiency
    Natural History Study).
    7.Esposizione a qualsiasi farmaco, dispositivo o procedimento sperimentale entro 28 giorni prima dello Screening.
    8.Condizione medica concomitante che potrebbe compromettere la partecipazione allo studio come ad esempio:
    a.Ipertensione scarsamente controllata (definita come BP sistolica > 150 mm Hg o diastolica > 90 mm Hg) refrattaria al
    trattamento medico.
    b.Storia di recente (< 6 mesi dalla data di Screening) insufficienza cardiaca congestizia; infarto miocardico o angina pectoris
    instabile; o ictus emorragico, embolico o trombotico; trombosi venosa profonda; o embolia polmonare o arteriosa.
    c.Infezione attiva che richiede l'uso di agenti antimicrobici parenterali o che è > Grado 3 entro 6 mesi dalla prima dose.
    d.Pattern o frequenza di sepsi post-splenectomia che nella valutazione dello Sperimentatore può ragionevolmente interferire con
    la capacità del paziente di completare la settimana 24 della partecipazione allo studio.
    e.Test positivo per l'antigene di superficie dell' HBsAg o anticorpo del virus HCV con segni di infezione attiva da virus dell'epatite B
    o C.
    f.Test positivo all'anticorpo del virus HIV 1 o 2.
    g.Diabete mellito giudicato sotto scarso controllo dallo Sperimentatore o che necessita di > 3 agenti anti-diabetici contando
    l'insulina (tutte le insuline sono considerate un agente); l'uso di insulina di per sé non costituisce un criterio di esclusione.
    h.Storia di qualsiasi tumore primario ad eccezione di: carcinoma cutaneo non-melanomatoso trattato in modo curativo; carcinoma
    cervicale o mammario in situ trattato in modo curativo; o altro tumore primario trattato con intento curativo e nessuna malattia
    attiva nota presente e nessun trattamento somministrato durante gli ultimi 3 anni.
    9.Intervento chirurgico importante entro 6 mesi dalla prima dose.
    10.Storia attuale o recente di disturbo psichiatrico che nell'opinione dello Sperimentatore o del Medical Monitor potrebbe
    compromettere la capacità del paziente di collaborare con le visite e le procedure dello studio.
    11.Uso di uno dei prodotti appartenenti alla lista ristretta di quelli noti per inibire fortemente il metabolismo del farmaco CYP3A4
    entro 5 giorni prima del Giorno 1 di dosaggio; o per indurre fortemente il metabolismo di CYP3A4 entro 28 giorni prima del Giorno
    1 di dosaggio; o per inibire fortemente il trasportatore della P-gp entro 5 giorni prima del Giorno 1 di dosaggio; o digossina entro 5
    giorni prima del Giorno 1 di dosaggio. Per i pazienti in terapia cronica con glucocorticoidi, i PI devono consultare il Medical monitor.
    SPAZIO NON SUFFICIENTE
    E.5 End points
    E.5.1Primary end point(s)
    The primary outcome measure for the study is the description of safety and tolerability: AEs, including determination of SAEs and AEs leading to
    discontinuation; safety laboratory parameters (hematology, chemistry, urinalysis, coagulation); physical examination findings; vital signs (VS);
    12 lead electrocardiograms (ECGs); and DXA scans. Adverse events will be graded using Common Toxicity Criteria for Adverse Events (CTCAE), Version 4.03. Serum sex hormone levels (testosterone [total and free], estrone, and estradiol), bone turnover markers (serum osteocalcin-Nmid
    and serum C-terminal telopeptide [CTX]),25-hydroxy vitamin D2 and D3 total cholesterol, high-density lipoprotein-cholesterol (HDL-C), and triglycerides.
    Menstruating female patients will also keep a paper-based menstrual cycle diary throughout the core and extension periods.
    L'EndpointPrimaorio per lo studio è la descrizione di sicurezza e tollerabilità: Eventi Avversi,
    compresa la definizione deglo Eventi Avversio Seri e degli Eventi Avversi che portano alla terminazione del trattamento: parametri
    di sicurezza di laboratorio (ematologia, chimica clinica, analisi delle urine, coagulazione); esame obiettivo; segni vitali; ECG a 12
    derivazioni e scansione densitometrica DXA. Gli eventi avversi saranno classificati utilizzando i Criteri Comuni di Tossicità degli
    Eventi Avversi (CTCAE), versione 4.03. Livelli sierici di ormoni sessuali (testosterone totale e libero, estrone ed estradiolo), markers
    del turnover osseo (Osteocalcina-M-mid sierica e telopeptide C-terminale sierico (CTX), 25-idrossi vitamina D2 e D3, il colesterolo
    totale, il lipoprotein-colesterolo ad alta densità (HDL-C) ed i trigliceridi. Le pazienti con ciclo mestruale compileranno un diario
    cartaceo del ciclo mestrale durante il periodo principale ed il periodo d'estensione.
    E.5.1.1Timepoint(s) of evaluation of this end point
    The DRT (Data Review Team) will monitor safety on an on-going basis
    and meet at regular intervals (approximately every 6 weeks), or ad hoc
    as necessary, for as long as any patients are still in the Core Period, to review AEs, VS, clinical laboratory assessments (hematology, clinical
    chemistry, coagulation, and urinalysis), and ECGs . The DRT will also review available PK/PD data and indicators of clinical activity (e.g., changes from baseline in Hb). These DRT meetings will also include data review for all patients that may be under treatment in the Extension Period.
    Il Team di revisione dei Dati (DRT) monitorerà la sicurezza durante lo studio e si riunirà ad intervalli regolari (ogni 6 settimane circa), o ad hoc se necessario, fino a quando i pazienti saranno nel Periodo Principale, per revisionare Eventi Avversi, Segni Vitali, laboratorio clinico (ematologia, chimica clinica, coagulazione ed analisi delle urine), ed ECG. Il DRT revisionerà anche i dati disponibili di FC/FD e gli indicatori di attività clinica (es. modifiche nell'Hb di base). Durante questi meeting DRT saranno anche revisionati i dati di tutti i pazienti che potrebbero proseguire il trattamento nel Periodo di Estensione.
    Statistico ed il Responsabile Medico dello Sponsor.
    E.5.2Secondary end point(s)
    The PK and PD profile of AG-348 will be evaluated by:
    ¿Approximately the first 10 patients treated, contingent on clinical site feasibility, will undergo extensive PK sampling. The remainder of treated patients will undergo limited PK sampling. Serial blood sampling for determination of concentration-time profiles of AG-348 and its metabolite AGI-8702 will be conducted following the first dose and the morning Day 15 dose, and additional trough levels of AG-348 and AGI8702 will be obtained.
    ¿Pharmacodynamic assessments will include 2,3-DPG, ATP (secondary objectives), and PKR activity assay, PKR protein, and glycolytic flux assay (exploratory objectives). The PKR Flux assay and PKR activity assay will only be conducted in clinical sites able to perform these assessments. Approximately the first 10 patients treated will undergo extensive PD sampling.
    Clinical Activity will be evaluated by
    ¿Monitoring of potential indicators of clinical activity will include evaluating changes in Hb, HCT, reticulocyte count, Hp, COHb, LDH, total
    and indirect bilirubin, EPO, ferritin, and transferrin saturation.
    Il profilo Farmacocinetico e Farmacodinamico di AG-348 sar¿ valutato da:
    - I primi 10 pazienti trattati circa, possibilmente con la fattibilit¿ del centro, saranno sottoposti ad una raccolta di campioni per PK molto ampia. Il resto dei pazienti sar¿ sottoposto ad una raccolta di campioni per PK limitata. Verr¿ condotto un campionamento di sangue seriale per la determinazione dei profili di concentrazione-tempo di AG-348 e relativo metabolita AGI-8702 in seguito alla prima dose e alla dose del mattino del Giorno 15 e saranno ottenuti ulteriori livelli intermedi di AG-348 e AGI-8702.
    -Le valutazioni farmacodinamiche includeranno 2,3-DPG, ATP (obiettivi secondari) e dosaggio dell'attivit¿ PKR, proteina PKR e dosaggio del flusso glicolitico (obiettivi esplorativi). Il dosaggio del flusso PKR e dosaggio dell'attivit¿ PKR saranno condotti solo in siti clinici in grado di eseguire tali valutazioni. Approssimativamente, i primi 10 pazienti trattati saranno sottoposti a un vasto campionamento PD.
    L'attivit¿ Clinica sar¿ valutata da
    -Il monitoraggio dei potenziali indicatori di attivit¿ clinica includer¿ le variazioni di Hb, HCT, conta dei reticolociti, COHb, LDH, bilirubina totale e indiretta, EPO, ferritina e saturazione della transferrina.
    E.5.2.1Timepoint(s) of evaluation of this end point
    The DRT will also review (approximately every 6 weeks) available PK/PD data and indicators of clinical activity. PK and PD Observations: including
    changes in 2,3 DPG and ATP; Indicators of Clinical Activity: including changes in Hb, HCT, reticulocyte count, Hp, COHb, LDH, EPO, total and indirect bilirubin, ferritin, and transferrin saturation.
    Il DRT valuter¿ (ogni 6 settimane circa) i dati disponibili di PK/PD e gli indicatori di attivit¿ clinica. Le osservazioni di PK e PD: comprese le modifiche in Hb, HCT, conta dei reticolociti, Hp, COHb, LDH, EPO, bilirubina totale e indiretta, ferritina e saturazione della transferrina.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    NA
    NA
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.4.1Number of sites anticipated in Member State concerned1
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA6
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Canada
    United States
    France
    Italy
    Netherlands
    United Kingdom
    E.8.7Trial 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
    After up to 75 subjects have been randomized and completed the final study visit (Week 24 or Week 28), the study will be completed. Patients who are eligible can enter the Extension Period to receive AG348 for up to 8 years following the end of the Core Period.
    Dopo che 75 soggetti saranno randomizzati e completato la visita finale di studio (settimana 24 o settimana 28), lo studio sar¿ concluso. I pazienti elegibili potranno proseguire nel Periodo di Estensione il trattamento con AG-348 fino a 8 anni dalla fine del Periodo Principale.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 75
    F.1.3Elderly (>=65 years) No
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state5
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 25
    F.4.2.2In the whole clinical trial 75
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Week 25 patients who safely tolerate AG-348 and demonstrate clinical activity of AG-348 may be eligible to roll over to a separate safety extension study for continued treatment with AG-348.
    Alla settimana 25, i pazienti che tollerano in sicurezza AG 348 e dimostrano l'attivit¿ clinica di AG 348 possono essere eleggibili all'arruolamento immediato in uno studio separato di estensione sulla sicurezza per il trattamento continuato.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2015-07-15
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2015-06-09
    P. End of Trial
    P.End of Trial StatusOngoing
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