E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Severe hemophilia A (FVIII <1%) |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Blood and lymphatic diseases [C15] |
MedDRA Classification |
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 |
The primary objective is to determine safety including immunogenicity of BAX 855 based on the incidence of inhibitor development to FVIII (≥ 0.6 Bethesda unit (BU)/mL using the Nijmegen modification of the Bethesda assay). |
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E.2.2 | Secondary objectives of the trial |
Safety - To determine the immunogenicity of BAX 855 in terms of binding IgG and IgM antibodies to FVIII, PEG-FVIII and PEG - To determine the safety of BAX 855 based on AEs and SAEs 7.3.2
Hemostatic Efficacy - To assess the efficacy of prophylactic treatment with BAX 855 - To characterize the efficacy of BAX 855 in the control of bleeding episodes - To evaluate the efficacy of BAX 855 for perioperative management, if surgery is required
Pharmacokinetics - To determine incremental recovery (IR) of BAX 855 at baseline and over time - To determine abbreviated half-life at baseline (optional)
ITI Objectives - To evaluate efficacy and safety of ITI with BAX 855 - To determine the rate of success, partial success and failure of ITI with BAX 855
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Subjects who meet ALL of the following criteria are eligible for this study: 1. Subject is <6 years old at the time of screening 2. Subject is previously untreated with <3 EDs to ADVATE, BAX 855 or plasma transfusion at any time prior to screening 3. Subject has severe hemophilia A (FVIII <1%) as determined by the central laboratory, or a historical FVIII level <1% as determined at any local laboratory, optionally supported by an additional FVIII gene mutation consistent with severe hemophilia A 4. Subject is immune competent with a CD4+ count >200 cells/mm3, as confirmed by the central laboratory at screening 5. Parent or legally authorized representative is willing and able to comply with the requirements of the protocol
Additional inclusion criteria for Part B (ITI) 1. Parent or legal representative has/have voluntarily provided signed informed consent for ITI portion 2. Subject has a confirmed positive high titer inhibitor (>5.00 BU) or has a positive confirmed low titer inhibitor (≥0.6 BU) as determined by the central laboratory based on a second repeat blood sample with - a. poorly controlled bleeding despite increased BAX 855 doses, or - b. requires bypassing agents to treat bleeding |
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E.4 | Principal exclusion criteria |
Subjects who meet ANY of the following criteria are not eligible for this study: 1. Subject has detectable FVIII inhibitory antibodies (≥0.6 BU using the Nijmegen modification of the Bethesda assay) as confirmed by central laboratory at screening 2. Subject has a history of FVIII inhibitory antibodies (≥0.6 BU using the Nijmegen modification of the Bethesda assay or the Bethesda assay) at any time prior to screening 3. Subject has been diagnosed with an inherited or acquired hemostatic defect other than hemophilia A (eg, qualitative platelet defect or von Willebrand’s disease) 4. Subject has been previously treated with any type of FVIII concentrate other than ADVATE or BAX 855, or was administered ADVATE, BAX 855 or plasma transfusion for ≥3 EDs at any time prior to screening 5. Subject receives >2 EDs of ADVATE in total during the periods prior to enrollment and during the screening period, until the baseline infusion. 6. The subject’s weight is anticipated to be <5 kg at the baseline visit 7. Subject’s platelet count is <100,000/mL 8. Subject has known hypersensitivity towards mouse or hamster proteins, PEG or Tween 80 9. Subject has severe chronic hepatic dysfunction [eg, >5 times upper limit of normal alanine aminotransferase (ALT), aspartate aminotransferase (AST), or a documented INR >1.5] in his medical history or at the time of screening 10. Subject has severe renal impairment (serum creatinine >1.5 times the upper limit of normal) 11. Subject has current or recent (<30 days) use of other PEGylated drugs prior to study participation or is scheduled to use such drugs during study participation 12. Subject is scheduled to receive during the course of the study a systemic immunomodulating drug (e.g. corticosteroid agents at a dose equivalent to hydrocortisone greater than 10 mg/day, or α-interferon) other than anti-retroviral chemotherapy 13. Subject has participated in another clinical study involving an IP or investigational device within 30 days prior to enrollment or is scheduled to participate in another clinical study involving an IP or investigational device during the course of this study 14. Parent or legally authorized representative has a medical, psychiatric, or cognitive illness or recreational drug/alcohol use that, in the opinion of the investigator, would affect subject safety or compliance 15. Parent, legally authorized representative or subject are a member of the team conducting this study or is in a dependent relationship with one of the study team members. Dependent relationships include close relatives (ie, children, partner/spouse, siblings, parents) as well as employees of the investigator or site personnel conducting the study.
Additional exclusion criteria for Part B (ITI) 1. Spontaneous disappearance of the inhibitor prior to ITI 2. FVIII inhibitor titer ≥0.6 BU is not confirmed by a second new blood sample and determined at the central laboratory 3. Inability or unwillingness to comply with the protocol |
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E.5 End points |
E.5.1 | Primary end point(s) |
- Incidence of FVIII inhibitor development - The success rate of ITI therapy with BAX 855 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
- Part A of the study (approximately 5 years) - up to 33 months |
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E.5.2 | Secondary end point(s) |
Safety - Binding IgG and IgM antibodies to FVIII, PEG-FVIII and PEG - AEs and SAEs - Clinically significant changes in vital signs and clinical laboratory parameters (hematology and clinical chemistry)
Efficacy - Annualized bleeding rate (ABR) for prophylactic and on-demand treatment - Number of BAX 855 infusions per bleeding episode - Overall hemostatic efficacy rating at 24 h after initiation of treatment and at resolution of bleed - Weight-adjusted consumption of BAX 855 per month, per year and per event (prophylaxis, treatment of bleeding episode and surgery) and the number of infusions per month and per year - Assessment of intra-, post- and perioperative hemostatic efficacy in case of surgery - Intra- and postoperative blood loss in case of surgery
Pharmacokinetics - IR at baseline and over time - Half-life at baseline (optional). This is based on an abbreviated PK using 2 post-infusion timepoints: 15-30 minutes and 24–48 hours
ITI: - The rate of partial success and failure of ITI with BAX 855. - ABR during ITI - Weight-adjusted consumption of BAX 855 per month and per year for each ITI regimen employed - Catheter-related complications - Binding IgG and IgM antibodies to FVIII, PEG-FVIII, and PEG |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Safety : Throughout Part A and B of the study (approximately 8.5 years) Efficacy: Throughout Part A of the study (approximately 5 years) Pharmacokinetics: Pre-infusion within 30 minutes; and post-infusion at 15-30 minutes and 24-48 hours ITI: Up to 33 months |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | Yes |
E.6.2 | Prophylaxis | Yes |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
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 | Yes |
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.8.3 |
Will this trial be conducted at a single site globally?
| No |
E.8.4 | Will this trial be conducted at multiple sites globally? | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | Specify the countries outside of the EEA in which trial sites are planned |
Canada |
Hong Kong |
Korea, Republic of |
Malaysia |
Singapore |
Taiwan |
Thailand |
United States |
Turkey |
Ukraine |
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E.8.7 | Trial has a data monitoring committee | Yes |
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.8.9.2 | In all countries concerned by the trial years | 8 |
E.8.9.2 | In all countries concerned by the trial months | 6 |