E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Hemophilia A or Hemophilia B |
Hemofilia A o Hemofilia B |
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E.1.1.1 | Medical condition in easily understood language |
Hemophilia is an inherited bleeding disorder in which the blood does not clot normally and can result in internal bleeding into the muscles and joints. |
La hemofilia es un trastorno hemorrágico hereditario en el que la sangre no coagula normalmente y puede dar lugar a sangrado interno en los músculos y las articulaciones. |
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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 | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10060613 |
E.1.2 | Term | Hemophilia A (Factor VIII) |
E.1.2 | System Organ Class | 100000004850 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10060614 |
E.1.2 | Term | Hemophilia B (Factor IX) |
E.1.2 | System Organ Class | 100000004850 |
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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 |
To evaluate the efficacy of fitusiran compared to on demand treatment with factor concentrates, as determined by the frequency of bleeding episodes. |
Evaluar la eficacia de fitusirán en comparación con el tratamiento a demanda con concentrados de factores, determinada por la frecuencia de episodios hemorrágicos |
|
E.2.2 | Secondary objectives of the trial |
To evaluate the efficacy of fitusiran compared to on demand treatment with factor concentrates, as determined by the frequency of spontaneous bleeding episodes, the frequency of joint bleeding episodes in patients, and health related quality of life (HRQOL) in patients receiving fitusiran. |
Evaluar la eficacia de fitusirán en comparación con el tratamiento a demanda con concentrados de factores, determinada por la frecuencia de episodios hemorrágicos espontáneos, la frecuencia de episodios hemorrágicos articulares y la calidad de vida relacionada con la salud (CVRS) en pacientes que reciban fitusirán. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Males ≥12 years of age.
Severe hemophilia A or B (evidenced by a central laboratory FVIII <1% or FIX level ≤2% at Screening) without inhibitors (evidenced by inhibitor titer of <0.6 BU/mL and supported by medical records)
AT activity ≥60% at Screening
A minimum of 6 bleeding episodes requiring factor concentrate treatment within the last 6 months
Willing and able to comply with the study requirements and to provide written informed consent and assent in the case of patients under the age of legal consent |
Varones de ≥ 12 años de edad.
Hemofilia A o B grave (demostrada mediante medición en el laboratorio central de FVIII < 1 % o FIX ≤ 2 % en la selección) sin inhibidores (demostrado por un título de inhibidores < 0,6 BU/ml documentado en la historia clínica)
Actividad AT ≥ 60 % en la selección
Mínimo de 6 episodios hemorrágicos con necesidad de tratamiento con concentrados de factores en los 6 meses previos.
Disposición y capacidad para cumplir los requisitos del estudio y para otorgar el consentimiento informado por escrito y el asentimiento en el caso de los menores de edad para dar el consentimiento. |
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E.4 | Principal exclusion criteria |
1. Known co-existing bleeding disorders other than hemophilia A or B, ie, Von Willebrand’s disease, additional factor deficiencies, or platelet disorders. 2. Current use of factor concentrates as regularly administered prophylaxis designed to prevent spontaneous bleeding episodes. 3. AT activity <60% at Screening as determined by central laboratory measurement. 4. Presence of clinically significant liver disease, or as indicated by any of the conditions below: a. INR >1.2; b. ALT and/or AST >1.5× upper limit of normal reference range (ULN); c. Total bilirubin >ULN (>1.5 ULN in patients with Gilbert’s Syndrome); d. History of portal hypertension, esophageal varices, or hepatic encephalopathy; e. Presence of ascites by physical exam 5. Hepatitis C virus antibody positive, except patients with a history of HCV infection who meet both conditions a. and b.: a. Completed curative treatment at least 12 weeks prior to enrollment and attained sustained virologic response as documented by a negative HCV RNA at screening, or they have spontaneously cleared infection as documented by negative HCV RNA at Screening. b. No evidence of cirrhosis according to one of the following assessments: FibroScan <12.5 kPa (where available), or FibroTest score <0.75 and APRI <2 (if FibroScan unavailable) 6. Presence of acute hepatitis, ie, hepatitis A, hepatitis E. 7. Presence of acute or chronic hepatitis B infection (IgM anti-HBc antibody positive or HBsAg positive). 8. Platelet count ≤100,000/μL. 9. Presence of acute infection at Screening. 10. Known to be HIV positive with CD4 count <200 cells/μL. 11. Estimated glomerular filtration rate ≤45 mL/min/1.73m2 (using the Modification of Diet in Renal Disease [MDRD] formula). 12. Co-existing thrombophilic disorder, as determined by presence of any of the below as identified at central laboratory (or via historical results, where available): a. FV Leiden (homozygous or heterozygous) b. Protein S deficiency c. Protein C deficiency d. Prothrombin mutation (G20210A; homozygous or heterozygous) 13. History of antiphospholipid antibody syndrome. 14. History of arterial or venous thromboembolism, atrial fibrillation, significant valvular disease, myocardial infarction, angina, transient ischemic attack, or stroke. Patients who have experienced thrombosis associated with indwelling venous access may be enrolled. 15. Had a malignancy within 2 years, except for basal or squamous cell carcinoma of the skin that has been successfully treated. 16. Any condition (eg, medical concern), which in the opinion of the Investigator, would make the patient unsuitable for dosing on Day 1 or which could interfere with the study compliance, the patient’s safety and/or the patient’s participation in the completion of the treatment period of the study. This includes significant active and poorly controlled (unstable) cardiovascular, neurologic, gastrointestinal, endocrine, renal or psychiatric disorders unrelated to hemophilia identified by key laboratory abnormalities or medical history. 17. At Screening, anticipated need of surgery during the study or planned surgery scheduled to occur during the study. 18. Completion of a surgical procedure within 14 days prior to Screening, or currently receiving additional factor infusion for postoperative hemostasis. 19. History of multiple drug allergies or history of allergic reaction to an oligonucleotide or GalNAc. 20. Inadequate venous access, as determined by the Investigator, to allow the blood draws required by the study protocol. 21. History of intolerance to SC injection(s). 22. Current or future participation in another clinical study, scheduled to occur during this study, involving an investigational product other than fitusiran or investigational device; in order to participate in this study, patient must discontinue the investigational product at least 30 days (or 5× the investigational product half-life, whichever is longer) prior to dosing (Day 1). 23. Current or prior participation in a gene therapy trial. 24. History of alcohol abuse within the 12 months before Screening. Alcohol abuse is defined as regular weekly intake of more than 14 units (unit: 1 glass of wine [approximately 125 mL] = 1 measure of spirits (approximately 1 fluid ounce) = ½ pint of beer [approximately 284 mL]). |
1. Trastornos hemorrágicos coexistentes conocidos distintos de la hemofilia A o B, es decir, enfermedad de Von Willebrand, otras carencias de factores o trastornos de las plaquetas. 2. Uso actual de concentrados de factores como tratamiento profiláctico habitual destinado a evitar episodios hemorrágicos espontáneos. 3. Actividad AT < 60 % en la selección, según la medición del laboratorio central. 4. Presencia de hepatopatía clínicamente significativa, o como indique cualquiera de las circunstancias siguientes: a. INR > 1,2; b. ALT/AST > 1,5 × límite superior de la normalidad (LSN); c. Bilirrubina total > LSN (> 1,5 LSN en pacientes con síndrome de Gilbert); d. Antecedentes de hipertensión portal, varices esofágicas o encefalopatía hepática; e. Presencia de ascitis constatada en la exploración física. 5. Positivo para anticuerpos contra el virus de la hepatitis C, salvo los pacientes con antecedentes de infección por el VHC que cumplas las condiciones a. y b.: a. Tratamiento curativo finalizado al menos 12 semanas antes de la inscripción y consecución de respuesta virológica sostenida, documentada por un ARN del VHC negativo en la selección, o desaparición espontánea de la infección documentada por un ARN del VHC negativo en la selección. b. Ausencia de indicios de cirrosis según una de las evaluaciones siguientes: FibroScan < 12,5 kPa (si está disponible), o Puntuación de FibroTest < 0,75 y APRI < 2 (si FibroScan no está disponible) 6. Presencia de hepatitis aguda, es decir, hepatitis A, hepatitis E. 7. Presencia de infección aguda o crónica por el virus de la hepatitis B (positivo para HBsAg o positivo para el anticuerpo IgM anti-HBc). 8. Recuento de plaquetas ≤ 100. 000/μl. 9. Presencia de infección aguda en la selección. 10. VIH positivo con recuento de CD4 < 200 células/μl. 11. Filtración glomerular estimada ≤ 45 ml/min/1,73 m2 (empleando la fórmula de la Modificación de la dieta en enfermedad renal [MDRD]). 12. Trastorno trombofílico coexistente, determinado por la presencia de cualquiera de lo siguiente identificado en el laboratorio central (o por los resultados históricos, si se dispone de ellos): a. Mutación del FV Leiden (homocigótica o heterocigótica) b. Deficiencia de proteína S c. Deficiencia de proteína C d. Mutación de la protrombina (G20210A; homocigótica o heterocigótica) 13. Antecedentes de síndrome de anticuerpos antifosfolípidos. 14. Antecedentes de tromboembolia arterial o venosa, fibrilación auricular, valvulopatía importante, infarto de miocardio, angina, accidente isquémico transitorio o derrame cerebral. Podrán participar pacientes que hayan sufrido una trombosis relacionada con un acceso venoso permanente. 15. Neoplasia maligna en los 2 años anteriores, salvo carcinoma basocelular o espinocelular de la piel tratado con éxito. 16. Cualquier trastorno (p. ej. , enfermedad) que, en opinión del investigador, motive que el paciente no sea adecuado para la administración de la medicación el día 1 o que pueda dificultar el cumplimiento del estudio, la seguridad del paciente o la participación del paciente en el período de tratamiento del estudio. Esto incluye trastornos cardiovasculares, neurológicos, digestivos, endocrinos, renales o psiquiátricos importantes activos y mal controlados (inestables) no relacionados con la hemofilia, identificados mediante la historia médica o alteraciones analíticas fundamentales. 17. En la selección, necesidad prevista de una intervención quirúrgica durante el estudio o intervención quirúrgica programada durante el estudio. 18. Realización de un procedimiento quirúrgico en los 14 días anteriores a la selección o tratamiento actual adicional con infusión de factores para hemostasia posquirúrgica. 19. Antecedentes de alergias múltiples a fármacos o antecedentes de reacción alérgica a un oligonucleótido o a GalNAc. 20. Acceso venoso inadecuado, en opinión del investigador, para hacer las extracciones de sangre exigidas por el protocolo de estudio. 21. Antecedente de intolerancia a inyecciones s. c. 22. Participación actual o futura en otro estudio clínico, que se vaya a producir durante este estudio, con un medicamento experimental distinto de fitusirán o un producto sanitario experimental; para poder participar en este estudio, el paciente debe suspender el medicamento en investigación al menos 30 días (o 5 × la semivida del fármaco experimental, lo que suponga más tiempo) antes de la administración (día 1). 23. Participación actual o previa en un ensayo de genoterapia. 24. Antecedente de alcoholismo en los 12 meses previos a la selección. El alcoholismo se define como el consumo semanal regular de más de 14 unidades (unidad: 1 vaso de vino [unos 125 ml] = una bebida de alta graduación (unos 30 ml) = 284 ml de cerveza. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Annualized bleeding rate (ABR) |
Tasa de hemorragias anualizada (THA) |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
Through 9 months |
Durante 9 meses |
|
E.5.2 | Secondary end point(s) |
Annualized Bleeding rate in the treatment period Annualized Spontaneous Bleeding rate in the efficacy period Annualized joint bleeding rate in the efficacy period Change in Haem-A-QOL score in the treatment period Annualized Bleeding rate in the onset period |
Tasa de hemorragias anualizada en el periodo de tratamiento Tasa de hemorragias espontáneas anualizada en el periodo de eficacia Tasa de hemorragias articulares anualizada en el periodo de eficacia Cambio en la puntuación Haem-A-QoL en el periodo de tratamiento Tasa de hemorragias anualizada en el periodo de arranque |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Through 9 months |
Durante 9 meses |
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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 | Yes |
E.6.3 | Therapy | No |
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 | 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) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Tratamiento de rescate estándar |
Rescue SOC |
|
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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 25 |
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 |
Australia |
Brazil |
Bulgaria |
Canada |
China |
Denmark |
France |
Germany |
Hungary |
India |
Ireland |
Israel |
Italy |
Japan |
Korea, Republic of |
Malaysia |
Netherlands |
Portugal |
Russian Federation |
South Africa |
Spain |
Taiwan |
Turkey |
Ukraine |
United Kingdom |
United States |
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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
|
|
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 | 6 |
E.8.9.1 | In the Member State concerned days | |
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 | 6 |