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 |
Hemophilia A is a genetic deficiency of blood clotting factor VIII, which causes increased bleeding. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Congenital, Hereditary, and Neonatal Diseases and Abnormalities [C16] |
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 | 10060612 |
E.1.2 | Term | Hemophilia A |
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 | 10053751 |
E.1.2 | Term | Hemophilia A with anti factor VIII |
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 overall safety and tolerability of prophylactic administration of emicizumab |
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E.2.2 | Secondary objectives of the trial |
•To evaluate the efficacy of prophylactic administration of emicizumab •To evaluate the immunogenicity of emicizumab •To obtain emicizumab PK data
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- As per the investigator’s judgment, a willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures, including the patient-reported outcome (PRO) questionnaires and bleed diaries through the use of an electronic device or paper - Aged 12 years or older at the time of informed consent - Diagnosis of congenital hemophilia A with persistent inhibitors against FVIII - Documented treatment with bypassing agents or FVIII concentrates in the last 6 months (on-demand or prophylaxis). Prophylaxis needs to be discontinued the latest by a day before starting emicizumab - Adequate hematologic, hepatic, and renal function - For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use a highly effective contraceptive method with a failure rate of <1% per year during the treatment period and for at least five elimination half-lives (24 weeks) after the last dose of emicizumab
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E.4 | Principal exclusion criteria |
- Inherited or acquired bleeding disorder other than hemophilia A - Ongoing (or plan to receive during the study) immune tolerance induction (ITI) therapy (prophylaxis regimens with FVIII and/or bypassing agents must be discontinued prior to enrollment). Patients receiving ITI therapy will be eligible following the completion of a 72-hour washout period prior to the first emicizumab administration - History of illicit drug or alcohol abuse within 12 months prior to screening, as per the investigator’s judgment - High risk for thrombotic microangiopathy (TMA) (e.g., have a previous medical or family history of TMA), as per the investigator’s judgment - Previous (in the past 12 months) or current treatment for thromboembolic disease (with the exception of previous catheter-associated thrombosis for which antithrombotic treatment is not currently ongoing) or current signs of thromboembolic disease - Other conditions (e.g., certain autoimmune diseases) that may increase the risk of bleeding or thrombosis - History of clinically significant hypersensitivity reaction associated with monoclonal antibody therapies or components of the emicizumab injection - Known human immunodeficiency virus (HIV) infection with CD4 count <200 cells/μL within 6 months prior to screening - Use of systemic immunomodulators (e.g., interferon or rituximab) at enrollment or planned use during the study, with the exception of antiretroviral therapy - Concurrent disease, treatment, or abnormality in clinical laboratory tests that could interfere with the conduct of the study or that would, in the opinion of the investigator or Sponsor, preclude the patient’s safe participation in and completion of the study or interpretation of the study results - Receipt of: •Emicizumab in a prior investigational study •An investigational drug to treat or reduce the risk of hemophilic bleeds within five half-lives of last drug administration •A non-hemophilia-related investigational drug within last 30 days or five half-lives, whichever is shorter •Any concurrent investigational drug. - Pregnancy or lactation, or intent to become pregnant during the study - Positive serum pregnancy test result within 7 days prior to initiation of emicizumab(females only)
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Incidence and severity of all adverse events including thromboembolic events, microangiopathic hemolytic anemia or, TMA (e.g. hemolytic uremic syndrome)systemic hypersensitivity, anaphylaxis, and anaphylactoid events 2. Changes in physical examination findings, vital signs, and laboratory parameters
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
1. Number of bleeds over time 2. Hemophilia Adult Quality of Life Questionnaire (Haem-A-QoL) (>=18 y) or Hemophilia Quality of Life Short Form (Haemo-QoL-SF) (ages 12−17) scores over time 3. EuroQoL Five-Dimension-Five Levels Questionnaire (EQ-5D-5L) scores over time 4. Patient preference for the emicizumab regimen compared with the previous regimen used 5. The incidence and clinical significance of anti-emicizumab antibodies 6. Pharmacokinetics data for emicizumab at defined timepoints
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1. Screening (Week-4 to Week 0), Week 1, Week 2, Week 3, Week 5, Month 3, Month 6, Month 9, Month 12, Month 15, Month 18, Month 21, Month 24, at safety follow-up 2-3. Week 1, Month 3, Month 6, Month 12, Month 18, Month 24 4. Up to 2 years 5. Week 1, Week 5, Month 3, Month 6, Month 12, Month 18, Month 24, at safety follow-up 6. Week 1, Week 2, Week 3, and Week 5, Month 3, Month 6, Month 12, Month 18, Month 24, at safety follow-up
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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 | 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 | 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.8.2.4 | Number of treatment arms in the trial | 1 |
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 | 6 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 45 |
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 |
Belgium |
Brazil |
Bulgaria |
Canada |
Colombia |
Denmark |
Dominican Republic |
Finland |
Germany |
Guatemala |
Hungary |
Israel |
Italy |
Mexico |
Netherlands |
Panama |
Poland |
Portugal |
Romania |
Russian Federation |
Saudi Arabia |
Spain |
Sweden |
Switzerland |
United Kingdom |
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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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The end of this study is defined as the date when the last remaining patient has completed the last visit (i.e., LPLV). The study will end when all patients have been treated with emicizumab for 2 years, or earlier, if one of the following is documented: Withdrawal of consent OR Completed the 24 week safety follow-up visit 24 weeks after discontinuing emicizumab OR Lost to follow-up OR Death.
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |