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    Clinical Trial Results:
    Open-label multi-center study of Exjade (deferasirox) for treatment of transfusional iron overload in MDS, thalassemia and other anemia patients.

    Summary
    EudraCT number
    2015-003531-35
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    18 May 2011

    Results information
    Results version number
    v1(current)
    This version publication date
    11 Feb 2017
    First version publication date
    11 Feb 2017
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CICL670ARU01
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01250951
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Novartis Pharma AG
    Sponsor organisation address
    CH-4002, Basel, Switzerland,
    Public contact
    Clinical Disclosure Office, Novartis Pharma AG, +41 613241111,
    Scientific contact
    Clinical Disclosure Office, Novartis Pharma AG, +41 613241111,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    18 May 2011
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    18 May 2011
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Primary objective was to assess the degree of reduction of the ferritin level during Exjade therapy in the patients with transfusion iron overload.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and the International Conference on Harmonization (ICH) Good Clinical Practice (GCP) Guidelines. All the local regulatory requirements pertinent to safety of trial subjects were also followed during the conduct of the trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    18 May 2009
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Russian Federation: 108
    Worldwide total number of subjects
    108
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    28
    Adolescents (12-17 years)
    15
    Adults (18-64 years)
    61
    From 65 to 84 years
    4
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Data about 3 subjects was not included in the statistical data management as it was decided by the Sponsoring Company (when these subjects were being included in the protocol) some regulations were violated. 111 subjects were enrolled but only 108 were analyzed.

    Pre-assignment
    Screening details
    A patient was given the study drug for the first time only when the results of the whole screening examination were obtained as well as the assessment of his correspondence to the inclusion/exclusion criteria was carried out.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Arm title
    Exjade
    Arm description
    The patients were prescribed the drug in the initial dosage depending on the extent of iron overload and transfusion therapy. -The initial dosage is 30 mg/kg/ day provided that the ferritin level >2500 µg/l and more than 4 transfusions of a donor erythrocytes is received per month -The initial dosage is 10 mg/kg/day provided that the ferritin level <1500 µg/l and less than 2 transfusions of a donor erythrocytes is received per month; -The initial dosage is 20 mg/kg/day in other cases.
    Arm type
    Experimental

    Investigational medicinal product name
    Deferasirox
    Investigational medicinal product code
    Other name
    Exjade®
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Each dosage of the drug was prepared when the dispersant tablets were dissolved in a glass of water or juice (100-200ml) until a homogeneous suspension occurred. The dosage was calculated in accordance with a patient’s weight and was rounded upward to a full tablet. The drug was taken daily, 1 time a day, on an empty stomach, 30 minutes prior to a meal.

    Number of subjects in period 1
    Exjade
    Started
    108
    Completed
    63
    Not completed
    45
         Adverse event, serious fatal
    10
         Non-medical reasons
    1
         Protocol violation
    2
         Adverse event, non-fatal
    2
         Drug side effect
    1
         Refusal to continue
    17
         Patient loss out of observation
    9
         Bone-marrow transplantation
    3

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    108 108
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    28 28
        Adolescents (12-17 years)
    15 15
        Adults (18-64 years)
    61 61
        From 65-84 years
    4 4
        85 years and over
    0 0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    38.4 ( 26.37 ) -
    Gender categorical
    Units: Subjects
        Female
    64 64
        Male
    44 44
        Not recorded
    0 0
    Subject analysis sets

    Subject analysis set title
    Adult group
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Adult group consisted of 65 patients the average age in this group is 59 years old.

    Subject analysis set title
    Children - 2-12 years old
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    The mean age was 6.9 years old.

    Subject analysis set title
    Children - 13-17 years old
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    In the teenage group the average age was 15 years old.

    Subject analysis sets values
    Adult group Children - 2-12 years old Children - 13-17 years old
    Number of subjects
    65
    30
    13
    Age categorical
    Units: Subjects
        In utero
    0
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
    0
        Newborns (0-27 days)
    0
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
    0
        Children (2-11 years)
    0
    28
    0
        Adolescents (12-17 years)
    0
    2
    13
        Adults (18-64 years)
    61
    0
    0
        From 65-84 years
    4
    0
    0
        85 years and over
    0
    0
    0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    58 ( 15.6 )
    6.9 ( 3.4 )
    15.1 ( 1.7 )
    Gender categorical
    Units: Subjects
        Female
    38
    17
    9
        Male
    27
    13
    4
        Not recorded
    0
    0
    0

    End points

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    End points reporting groups
    Reporting group title
    Exjade
    Reporting group description
    The patients were prescribed the drug in the initial dosage depending on the extent of iron overload and transfusion therapy. -The initial dosage is 30 mg/kg/ day provided that the ferritin level >2500 µg/l and more than 4 transfusions of a donor erythrocytes is received per month -The initial dosage is 10 mg/kg/day provided that the ferritin level <1500 µg/l and less than 2 transfusions of a donor erythrocytes is received per month; -The initial dosage is 20 mg/kg/day in other cases.

    Subject analysis set title
    Adult group
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Adult group consisted of 65 patients the average age in this group is 59 years old.

    Subject analysis set title
    Children - 2-12 years old
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    The mean age was 6.9 years old.

    Subject analysis set title
    Children - 13-17 years old
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    In the teenage group the average age was 15 years old.

    Primary: To assess the degree of reduction of the ferritin level during Exjade therapy in the patients with transfusion iron overload.

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    End point title
    To assess the degree of reduction of the ferritin level during Exjade therapy in the patients with transfusion iron overload. [1]
    End point description
    Exjade efficacy was assessed by the degree of reduction of the ferritin serum level and by the evident manifestations of hemosiderosis of parenchymatous organs. For this reason the iron content in liver tissue and in cardiac muscle was conducted by means of magnetic resonance therapy once a month.
    End point type
    Primary
    End point timeframe
    From Baseline for monthly assessments for up to 1 year
    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 is not performed between 2 groups as this is a single arm study and combined output of all randomized patients that were analyzed.
    End point values
    Exjade
    Number of subjects analysed
    108 [2]
    Units: mkg/l
    arithmetic mean (standard deviation)
        Baseline
    3837.2 ( 3737.7 )
        Month 1
    3445.3 ( 3194.4 )
        Month 2
    3140.9 ( 2687.3 )
        Month 3
    2928.5 ( 2449.2 )
        Month 4
    2749 ( 2429.2 )
        Month 5
    2648.7 ( 2270 )
        Month 6
    2812.8 ( 2173 )
        Month 7
    2555.5 ( 2292.5 )
        Month 8
    2756.9 ( 2083.2 )
        Month 9
    1899.7 ( 1202.7 )
        Month 10
    3050.3 ( 5489.3 )
        Month 11
    2150.9 ( 1891.4 )
        Month 12
    2269.2 ( 2021.7 )
    Notes
    [2] - 3 patients were not included in the statistical data management
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events are collected from First Patient First Visit (FPFV) until Last Patient Last Visit (LPLV). All adverse events reported in this record are from date of First Patient First Treatment until Last Patient Last Visit.
    Adverse event reporting additional description
    Consistent with EudraCT disclosure specifications, Novartis has reported under the Serious adverse events field “number of deaths resulting from adverse events” all those deaths, resulting from serious adverse events that are deemed to be causally related to treatment by the investigator.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    Unspecified
    Dictionary version
    0
    Reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Serious adverse events
    Overall trial
    Total subjects affected by serious adverse events
         subjects affected / exposed
    23 / 108 (21.30%)
         number of deaths (all causes)
    10
         number of deaths resulting from adverse events
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute leukemia
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    Cancer without primary neoplasm, bone metastasis
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Myelodysplastic Syndrome
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Vascular disorders
    Thromboembolia
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Vasovagal syncope
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Thrombophlebitis, soft tissue infection
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorder, hypotension
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Acute coronary syndrome
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Aortic valve disorder
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Cardiac decompensation
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary edema
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Nervous system disorders
    Cerebrum neoplasm benign
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Flu-like semiotics
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Oxymortia
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Blood and lymphatic system disorders
    DIC syndrome
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Thrombocytopenia
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Ear and labyrinth disorders
    Ear infection
         subjects affected / exposed
    1 / 108 (0.93%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Toxic hepatitis
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    2 / 108 (1.85%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Overall trial
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    56 / 108 (51.85%)
    Investigations
    Transaminase level increase
         subjects affected / exposed
    17 / 108 (15.74%)
         occurrences all number
    219
    Bilirubin level increase
         subjects affected / exposed
    17 / 108 (15.74%)
         occurrences all number
    219
    Renal and urinary disorders
    Urinary tract infection
         subjects affected / exposed
    11 / 108 (10.19%)
         occurrences all number
    219
    Infections and infestations
    Flu-like symptoms
         subjects affected / exposed
    11 / 108 (10.19%)
         occurrences all number
    219

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Apr 2009
    It introduced the following changes: • Increasing the number of patients from 60 to 150; • Increasing the number of research centers from 7 to 20; • Increasing the patient observation duration from 4 to 4-6 months; • Lack of necessity to conduct all the completion procedures with the patients who have recalled their informed consent or refused to continue their participation in the trial; • New conditions for providing the study drug to the patients in terms of providing the centers with the drug at the expense of Novartis Pharma Company during the first 6 months of the therapy. Later if a medical institution isn’t able to provide the drug, the patients continue to be observed within the protocol; • Lowering the cases of returning of the unused drug and giving the next portion of the study drug to the patients once every 3 months instead of once a month; • Optional mode of Visits 7-11 to the patients who have stopped taking the drug after 6 months of the trial; • Control MRI only to the patients who have been taking the drug during the whole period of the investigation; • Optional mode of clinical and biochemical blood and urine analyses and ferrum metabolism variables on Visits 7-11 with the patients who stopped taking the drug after 6 months of the trial; • Optional mode of USC, ECG, EchoCG, an oculist and an otolaryngologist consultations, audiographics on the Final Visit to the patients who stopped taking the drug after 6 months of the trial.
    06 Jul 2009
    The amendment introduced the following changes: • Change in the expected duration of the observation of the patients from 6 to 4 months after the last center was initiated. The whole period of patients selection was 8 months (from the time when the first center was initiated); • Addition to the inclusion criteria №2 the possibility to include patients with other rare forms of aplastic and hemolytic anemias after the Sponsor’s preliminary approval; • Specification to the inclusion criteria №9 concerning the date when the pregnancy test should be done. Before the amendment fertile women must have done the test 7 days prior to the inclusion in the trial. After the amendment they should do the test 48 hours prior to the inclusion in the trial. Postmenopausal women must have their last menstruation not later than a year ago. • Allowance to conduct EchoCG, X-ray examination of the thoracic cage organs, MRI, audiogram from 2 weeks during the screening examination to 6 months prior to the inclusion in the trial; • Specification to dates when the interim Visits must be conducted (1 month ± 7 days from the date of inclusion in the protocol); • Prolonging the final Visit to 2 weeks; • Lack of necessity to conduct the glucose-resistance test to the patients who suffer from verified diabetes; • Allowance to use the standard methods of the particular institution to calculate the creatinine clearance; • In order to get the accurate results of the pregnancy tests some specification was done concerning the age categories of women patients (teenagers aged ≥ 10 y.o. with fixed menstrual cycle) and the number of negative results (there must be at least 2 negative results).
    17 Nov 2009
    The amendment introduced the following changes: • In accordance with the Sponsor’s decision the target number of patients must be decreased from 150 to 120; • Shortening of the expected duration of the patients selection from 4 to 2 months after the last center was initiated in order to make it 12 months total; • The patients should stay in the investigation and the Visits should continue even in case of the study drug has stopped being taken. Upon that the reasons for the participation completion weren’t alternated.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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