E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Blood clot (s) in the vein |
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E.1.1.2 | Therapeutic area | Diseases [C] - Blood and lymphatic diseases [C15] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10066899 |
E.1.2 | Term | Venous thromboembolism |
E.1.2 | System Organ Class | 100000004866 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective is to demonstrate the non-inferiority of edoxaban to standard of care (SOC; including low molecular weight heparin (LMWH), vitamin K antagonist (VKA), or synthetic pentasaccharide (SP) Xa inhibitors) in the treatment and secondary prevention of VTE in pediatric subjects with regard to the composite efficacy endpoint (ie, symptomatic recurrent VTE, death as result of VTE, and no change or extension of thrombotic burden) during the first 3-month treatment period (for Cohort 5, the intended duration of treatment is 6-12 weeks).
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E.2.2 | Secondary objectives of the trial |
- To compare edoxaban vs SOC: during the first 3-month treatment period (for Cohort 5, the intended duration of treatment is 6-12 weeks) as regards:
• a combination of major and CRNM bleedings occurring during or within 3 days of completing,interrupting or stopping treatment
• the individual components of the composite efficacy endpoints from first to the last dose +30 days regarding:
• the occurrence of DVT,catheter-related thrombosis,PE,sinovenous thrombosis
• a combination of major and CRNM bleedings,symptomatic recurrent VTE,death due to VTE
• all bleedings
• a composite combination of major and CRNM bleedings from randomization to the last dose +30 days regarding:
• the composite efficacy endpoint/all-cause mortality
To characterize the multiple dose PK of edoxaban and to assess the effect of certain covariates on the edoxaban PK
To evaluate the relationship between edoxaban exposure and safety and efficacy
To characterize the effect of IMP on biomarkers of coagulation |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Subjects must satisfy all of the following criteria to be included in the study:
1. Male or female pediatric subjects between birth (defined as 38 weeks gestational age) and less than 18 years of age at the time of consent.
2. Pediatric subjects with the presence of documented VTE confirmed by
appropriate diagnostic imaging and requiring anticoagulant therapy for
at least 90 days.
-Subjects <6 months old (Cohort 5) with the presence of documented
VTE confirmed by appropriate diagnostic imaging and requiring
anticoagulant therapy for at least 6 to12 weeks
3. Subjects must have received at least 5 days of heparin (LMWH or SP Xa inhibitors or UFH according to the edoxaban label for VTE treatment) therapy prior to randomization to treat the newly identified index VTE. In addition, prior to being randomized to edoxaban or SOC, subjects initially treated with VKA are
recommended to have an INR ≤ 2.5.
4. Subject and/or parent(s)/legal guardian(s) or legally acceptable representative is informed and provides signed consent for the child to participate in the study with edoxaban treatment. Pediatric subjects with appropriate intellectual maturity will be required to sign an assent form in addition to the signed informed consent from the parent(s)/legal guardian(s) or any legally acceptable representative.
5. Female subjects who have menarche must test negative for pregnancy at Screening and must consent to avoid becoming pregnant by using an approved contraception method throughout the study.
The following use of reliable method(s) of contraception, and/or abstinence, for the duration of therapeutic product exposure is recommended.
a. Highly effective methods:
Highly effective methods of contraception, when used consistently and correctly, result in low failure rates. These may include: intrauterine device (IUD) or intrauterine system (IUS); vasectomy and tubal ligation. Highly effective methods of contraception might not always be achievable in the clinical trial setting and, therefore, the most effective alternative can be achieved using methods in combination.
b. Effective methods:
Effective methods may include: barrier methods of contraception (eg, male condom, female condom, cervical cap, diaphragm, contraceptive sponge).
Note: When used consistently and correctly, "double barrier" methods of contraception (eg, male condom with diaphragm, male condom with cervical cap) can be used as an effective alternative to the highly effective contraception methods described above. |
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E.4 | Principal exclusion criteria |
Subjects who meet any of the following criteria will be disqualified from entering the
study:
1. Subjects with active bleeding or high risk of bleeding contraindicating treatment with LMWH, SP Xa inhibitors, VKAs, or direct oral anticoagulants (DOACs; identified high risk of bleeding during prior experimental administration of DOACs).
2. Subjects who have been or are being treated with thrombolytic agents, thrombectomy or insertion of a caval filter for the newly identified index VTE.
3. Administration of antiplatelet therapy is contraindicated in both arms except for low dose aspirin defined as 1-5 mg/Kg/day with maximum of 100 mg/day.
4. Administration of rifampin is prohibited during the study and subjects
on concomitant use of rifampin are excluded.
5a. Subjects with severe hepatic impairment or hepatic disease
associated with coagulopathy (eg acute hepatitis, chronic active
hepatitis, and cirrhosis).
b) Subjects with ALT > 5 × the upper limit of normal (ULN) or total
bilirubin >2 × ULN with direct bilirubin > 20% of the total at Screening.
c) Subjects with aPTT >50 seconds or international
normalized ratio [INR] >2.0 not related to
anticoagulation therapy.
6. Subjects with estimated glomerular filtration rate (GFR) < 30% of
normal for age and size
7. Subjects with stage 2 hypertension defined as blood pressure (BP)
systolic and/or diastolic confirmed > 99th percentile + 5 mmHg.
8. Subject with thrombocytopenia <50 × 109/L at Screening Visit.
Subjects with a history of heparin-induced thrombocytopenia may be
enrolled in the study at the Investigator's discretion.
9. Life expectancy less than the expected study treatment duration (3
months).
10. Subjects who are known to be pregnant or breastfeeding.
11. Subjects with the following diagnosis and situations: active cancer undergoing chemotherapy, radiation, or major surgery within the next 3 months.
12. Subjects who participated in another interventional clinical study or
were treated with an experimental therapy with less than a 30-day
wash-out period prior to identifying the qualifying index VTE.
13. Hypersensitivity to the active ingredient or to any of the excipients of
any components of the trial treatment.
14. Patients with a history of thrombosis who are diagnosed with
antiphospholipid syndrome who are triple positive (for lupus
anticoagulant, anticardiolipin antibodies, and anti-beta 2-glycoprotein I
antibodies). |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy endpoint is the composite endpoint consisting of incidence of symptomatic recurrent venous thromboembolic disease, death as result of VTE, and no change or extension of thrombotic burden (as defined in the protocol) during the first 3-months period.
-For subjects in Cohort 5, (ie, <6 months old), the primary efficacy
endpoint is a composite endpoint consisting of the incidence of
symptomatic recurrent VTE, death as a result of VTE, and no change or
extension of thrombotic burden within 6 to 12 weeks + 3 days. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
3 month treatment period
For subjects in Cohort 5, (ie, <6 months old) within 6 to 12 weeks + 3
days |
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E.5.2 | Secondary end point(s) |
The secondary efficacy endpoints include:
A composite endpoint consisting of the incidence of symptomatic recurrent venous thromboembolic disease, death as a result of VTE, and no change or extension of thrombotic burden from randomization to the date of the last dose
of study drug + 30 days.
The individual components of the primary efficacy endpoint during the first 3 month period
(for Cohort 5, the intended duration of treatment is 6-12 weeks):
Symptomatic recurrent VTE
Death as a result of VTE
No change or extension of thrombotic burden.
All-cause mortality from randomization to last dose + 30 days.
The DVT, Catheter-related thrombosis, PE, and sinovenous thrombosis
events within and after the first 3-month treatment period (for Cohort 5,
the intended duration of treatment is 6-12 weeks).
Net Clinical Outcome Endpoint:
Composite of symptomatic recurrent VTE events, death as a result of VTE, and major and CRNM bleeding that occurred from the date of the first dose of study drug to the date of last dose of study drug + 30 days.
Safety Endpoints:
The safety endpoints are:
A combination of major and clinically relevant non- major (CRNM)
bleedings occurring during treatment or within 3 days of completing or
interrupting or stopping study during the first 3- month treatment
period. For subjects in Cohort 5, ie,<6 months old, the primary safety
endpoint, is a combination of major and CRNM bleedings occurring
during treatment or within 3 days of completing or interrupting or
stopping study within 6 to 12 weeks period + 3 days.
All bleedings from first to the last dose + 30 days.
A combination of major and CRNM bleedings from first to the last dose +
30 days.
Pharmacokinetic and Pharmacodynamic Endpoints:
Approximately, the first 12 subjects of each age cohort (total of
approximately 53 to 60 subjects) randomized to the edoxaban treatment
arm will participate in the multiple-dose PK/PD assessment on Day 5
Pharmacokinetics:
Using population PK analysis, the following PK parameters will be
estimated: apparent systemic
clearance (CL/F) and apparent volume ofdistribution (V/F) of edoxaban.
Pharmacodynamics:
The following biomarkers of coagulation will be
estimated: PT, aPTT, anti-FXa for edoxaban treatment arm.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Efficacy Endpoints:
3 month treatment period (for Cohort 5,the intended duration of
treatment is 6-12 weeks)
randomization to last dose +30 days
Net Clinical Outcome:
first dose of study drug to the date of last dose of study drug +30 days
Safety Endpoints:
-during treatment or within 3 days of completing or interrupting or
stopping study during the first 3- month treatment period. From first to
the last dose +30 days
-for subjects in Cohort 5, ie,<6 months old, during treatment or within 3
days of completing or interrupting or stopping study within 6 to 12
weeks period +3 days.
PK/PD endpoints:
Day of the fifth dose of edoxaban (Day 5+3 days)
Pre-dose sample.
Post-dose sample can be taken either:
any time between 1.0 to 3 hrs post-dose or any time between 5 to 8 hrs |
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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 | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
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 | Yes |
E.8.1.1 | Randomised | Yes |
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 | Yes |
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) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 43 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Brazil |
Canada |
Chile |
China |
Colombia |
El Salvador |
Guatemala |
India |
Israel |
Kenya |
Korea, Democratic People's Republic of |
Lebanon |
Malaysia |
Panama |
Russian Federation |
Serbia |
Singapore |
Taiwan |
Thailand |
Turkey |
Ukraine |
United States |
Bulgaria |
Croatia |
France |
Germany |
Hungary |
Italy |
Netherlands |
Norway |
Poland |
Portugal |
Romania |
Slovenia |
Spain |
Czechia |
Argentina |
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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.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 10 |
E.8.9.2 | In all countries concerned by the trial days | 0 |