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    Clinical Trial Results:
    A Phase 2, Multi-center, Randomized, Placebo Controlled, Double-Blind Study with LJPC-401 for the Treatment of Iron Overload in Adult Patients with Hereditary Hemochromatosis

    Summary
    EudraCT number
    2017-003598-33
    Trial protocol
    GB   FR  
    Global end of trial date
    22 Nov 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    11 Jan 2022
    First version publication date
    11 Jan 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    LJ401-HH01
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03395704
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    La Jolla Pharmaceutical Company
    Sponsor organisation address
    4747 Executive Drive, Suite 240, San Diego, United States, 92121
    Public contact
    Regulatory Affairs, La Jolla Pharmaceutical Company, 001 8314211450, lajollaregulatoryaffairs@ljpc.com
    Scientific contact
    Regulatory Affairs, La Jolla Pharmaceutical Company, 001 8314211450, lajollaregulatoryaffairs@ljpc.com
    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?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    09 Oct 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    22 Nov 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    22 Nov 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the effect of weekly dosing of LJPC-401 for 12 weeks on Transferrin saturation (TSAT) in adult patients with hereditary hemochromatosis
    Protection of trial subjects
    This study was conducted in accordance with the ethical principles founded in the Declaration of Helsinki and in compliance with the protocol, the International Council on Harmonisation (ICH) for Good Clinical Practice (GCP) and the appropriate regulatory requirements. The study was conducted in accordance with the ICH E6 GCP for obtaining informed consent. Each patient provided written informed consent after the study was fully explained and before any study-specific procedures (including screening procedures) were performed.
    Background therapy
    All enrolled patients were allowed to receive standard of care therapy (phlebotomy) per protocol-specified guidelines.
    Evidence for comparator
    -
    Actual start date of recruitment
    05 Jan 2018
    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
    United Kingdom: 9
    Country: Number of subjects enrolled
    France: 3
    Country: Number of subjects enrolled
    Australia: 23
    Country: Number of subjects enrolled
    United States: 35
    Worldwide total number of subjects
    70
    EEA total number of subjects
    3
    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)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    44
    From 65 to 84 years
    26
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The first patient was enrolled on 08 May 2018 and the last patient completed the study on 28 Oct 2019. The study enrolled patients in Australia, the United Kingdom, France and the United States.

    Pre-assignment
    Screening details
    Patients were screened to ensure they were clinically diagnosed with hereditary hemochromatosis for which therapeutic phlebotomy was prescribed. Patients were to be more than 18 years old with a serum ferritin level greater than or equal to 100 mg/mL and a TSAT level greater than 45%.

    Period 1
    Period 1 title
    Treatment (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Single blind
    Roles blinded
    Subject
    Blinding implementation details
    Investigators and unblinded pharmacists at the sites had access to treatment allocation information. Investigators at sites had access to TSAT results. Patients were blinded. The study pharmacist was to prepare either LJPC-401 or placebo in identical syringes to maintain the blind. The sponsor and Safety Monitoring Committee had access to unblinded data for interim analyses and safety monitoring.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    LJPC-401
    Arm description
    Interventional arm - patients received LJPC-401
    Arm type
    Experimental

    Investigational medicinal product name
    synthetic human hepcidin
    Investigational medicinal product code
    LJPC-401
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Study drug was administered QW. Dosing was as follows: - Week 1: 5 mg LJPC-401 or volume-matched placebo - Week 2: 10 mg LJPC-401 or volume matched placebo - Week 3: 10 mg LJPC-401 or volume-matched placebo - Week 3: Fasting TSAT (postdose 24 (+/-4) hours) determined the Week 4 dose If the TSAT was > 45%, then the dose at Week 4 increased to 20 mg LJPC-401 or volume-matched placebo. If the TSAT was < or = 45%, then dose at Week 4 maintained at 10 mg LJPC-401 or volume-matched placebo. - At Weeks 9 and 13 (after Weeks 8 and 12 fasting TSAT results were available): - Maintained or increased dose to 20 mg if TSAT was > 45% - Maintained dose (10 or 20 mg) if TSAT remained < or = 45%, and no dose reduction was required for toxicity.

    Arm title
    Placebo
    Arm description
    Volume-matched 0.9% sodium chloride for injection
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    0.9% sodium chloride injection, USP
    Pharmaceutical forms
    Injection
    Routes of administration
    Intramuscular and intravenous use
    Dosage and administration details
    Placebo was the volume-matched equivalent of the LJPC-401 dosing regimen.

    Number of subjects in period 1 [1]
    LJPC-401 Placebo
    Started
    34
    35
    Completed
    30
    33
    Not completed
    4
    2
         Consent withdrawn by subject
    2
    1
         Adverse event, non-fatal
    2
    1
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: One patient was enrolled in the study, but did not initiate study treatment. Therefore, they are counted in the worldwide enrollment numbers, but are not included in Period 1 of the study.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    LJPC-401
    Reporting group description
    Interventional arm - patients received LJPC-401

    Reporting group title
    Placebo
    Reporting group description
    Volume-matched 0.9% sodium chloride for injection

    Reporting group values
    LJPC-401 Placebo Total
    Number of subjects
    34 35 69
    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 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    23 20 43
        From 65-84 years
    11 15 26
        85 years and over
    0 0 0
    Age continuous
    Units: years
        least squares mean (standard deviation)
    55 ± 13.83 60 ± 12.43 -
    Gender categorical
    Units: Subjects
        Female
    9 18 27
        Male
    25 17 42
    Hereditary Hemochromatosis Genotype
    Units: Subjects
        HFE
    1 2 3
        Not Available
    5 5 10
        Other
    28 28 56

    End points

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    End points reporting groups
    Reporting group title
    LJPC-401
    Reporting group description
    Interventional arm - patients received LJPC-401

    Reporting group title
    Placebo
    Reporting group description
    Volume-matched 0.9% sodium chloride for injection

    Primary: Post-dose TSAT

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    End point title
    Post-dose TSAT
    End point description
    End point type
    Primary
    End point timeframe
    Baseline to Week 16
    End point values
    LJPC-401 Placebo
    Number of subjects analysed
    21
    28
    Units: percent
        least squares mean (standard deviation)
    -32.8 ± 20.53
    -2.5 ± 18.50
    Statistical analysis title
    Week 16 TSAT Change from Baseline
    Comparison groups
    Placebo v LJPC-401
    Number of subjects included in analysis
    49
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    General Linear Model
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From consent through End of Study.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20.1
    Reporting groups
    Reporting group title
    LJPC-401
    Reporting group description
    Interventional arm - patients received LJPC-401

    Reporting group title
    Placebo
    Reporting group description
    Placebo was locally-sourced 0.9% sodium chloride injection, USP (or equivalent).

    Serious adverse events
    LJPC-401 Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    2 / 34 (5.88%)
    2 / 35 (5.71%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 35 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 35 (2.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Arteriospasm coronary
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 35 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Seizure
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 35 (2.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Hernia pain
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 35 (2.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyponatraemia
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 35 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    LJPC-401 Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    33 / 34 (97.06%)
    30 / 35 (85.71%)
    Injury, poisoning and procedural complications
    Contusion
         subjects affected / exposed
    0 / 34 (0.00%)
    2 / 35 (5.71%)
         occurrences all number
    0
    2
    Vascular disorders
    Hypertension
         subjects affected / exposed
    2 / 34 (5.88%)
    2 / 35 (5.71%)
         occurrences all number
    2
    2
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    2 / 34 (5.88%)
    0 / 35 (0.00%)
         occurrences all number
    2
    0
    Headache
         subjects affected / exposed
    2 / 34 (5.88%)
    3 / 35 (8.57%)
         occurrences all number
    2
    3
    Presyncope
         subjects affected / exposed
    0 / 34 (0.00%)
    2 / 35 (5.71%)
         occurrences all number
    0
    3
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    2 / 34 (5.88%)
    5 / 35 (14.29%)
         occurrences all number
    4
    5
    Influenza like illness
         subjects affected / exposed
    0 / 34 (0.00%)
    2 / 35 (5.71%)
         occurrences all number
    0
    2
    Injection site bruising
         subjects affected / exposed
    6 / 34 (17.65%)
    0 / 35 (0.00%)
         occurrences all number
    7
    0
    Injection site erythema
         subjects affected / exposed
    17 / 34 (50.00%)
    0 / 35 (0.00%)
         occurrences all number
    56
    0
    Injection site haemorrhage
         subjects affected / exposed
    0 / 34 (0.00%)
    2 / 35 (5.71%)
         occurrences all number
    0
    2
    Injection site induration
         subjects affected / exposed
    2 / 34 (5.88%)
    0 / 35 (0.00%)
         occurrences all number
    7
    0
    Injection site mass
         subjects affected / exposed
    3 / 34 (8.82%)
    0 / 35 (0.00%)
         occurrences all number
    7
    0
    Injection site nodule
         subjects affected / exposed
    3 / 34 (8.82%)
    0 / 35 (0.00%)
         occurrences all number
    3
    0
    Injection site pain
         subjects affected / exposed
    8 / 34 (23.53%)
    0 / 35 (0.00%)
         occurrences all number
    40
    0
    Injection site pruritus
         subjects affected / exposed
    14 / 34 (41.18%)
    1 / 35 (2.86%)
         occurrences all number
    50
    1
    Injection site rash
         subjects affected / exposed
    2 / 34 (5.88%)
    0 / 35 (0.00%)
         occurrences all number
    2
    0
    Injection site reaction
         subjects affected / exposed
    4 / 34 (11.76%)
    0 / 35 (0.00%)
         occurrences all number
    29
    0
    Injection site swelling
         subjects affected / exposed
    2 / 34 (5.88%)
    0 / 35 (0.00%)
         occurrences all number
    6
    0
    Gastrointestinal disorders
    Abdominal pain upper
         subjects affected / exposed
    0 / 34 (0.00%)
    2 / 35 (5.71%)
         occurrences all number
    0
    2
    Diarrhoea
         subjects affected / exposed
    5 / 34 (14.71%)
    4 / 35 (11.43%)
         occurrences all number
    10
    5
    Nausea
         subjects affected / exposed
    4 / 34 (11.76%)
    1 / 35 (2.86%)
         occurrences all number
    7
    1
    Respiratory, thoracic and mediastinal disorders
    Oropharyngeal pain
         subjects affected / exposed
    2 / 34 (5.88%)
    1 / 35 (2.86%)
         occurrences all number
    2
    1
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    4 / 34 (11.76%)
    10 / 35 (28.57%)
         occurrences all number
    4
    1
    Rash
         subjects affected / exposed
    2 / 34 (5.88%)
    1 / 35 (2.86%)
         occurrences all number
    3
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    6 / 34 (17.65%)
    4 / 35 (11.43%)
         occurrences all number
    8
    6
    Back pain
         subjects affected / exposed
    4 / 34 (11.76%)
    2 / 35 (5.71%)
         occurrences all number
    4
    2
    Muscle spasms
         subjects affected / exposed
    2 / 34 (5.88%)
    1 / 35 (2.86%)
         occurrences all number
    2
    1
    Pain in extremity
         subjects affected / exposed
    2 / 34 (5.88%)
    1 / 35 (2.86%)
         occurrences all number
    2
    1
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    3 / 34 (8.82%)
    1 / 35 (2.86%)
         occurrences all number
    3
    1
    Rhinitis
         subjects affected / exposed
    1 / 34 (2.94%)
    3 / 35 (8.57%)
         occurrences all number
    1
    4
    Upper respiratory tract infection
         subjects affected / exposed
    3 / 34 (8.82%)
    3 / 35 (8.57%)
         occurrences all number
    3
    3
    Urinary tract infection
         subjects affected / exposed
    0 / 34 (0.00%)
    3 / 35 (8.57%)
         occurrences all number
    0
    4
    Metabolism and nutrition disorders
    Type 2 diabetes mellitus
         subjects affected / exposed
    0 / 34 (0.00%)
    2 / 35 (5.71%)
         occurrences all number
    0
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    30 Nov 2017
    - Clarified study endpoints - Updated to use the 2011 Iron Disorders Institute (IDI) phlebotomy guidelines for patients with hereditary hemochromatosis (HH) - Updated to require standard-of-care phlebotomy for all randomized patients on Day 1. Thereafter, phlebotomy decisions by the investigator were to be assessed at Weeks 4, 8 and 12 per the 2011 IDI guidelines - Added a secondary endpoint to assess the number of phlebotomy events - Added HH diagnosis and genotype as part of medical history data collection - Added that complete iron lab samples should be drawn predose at the same time of day each visit, whenever possible - Added contraception language - Revised TSAT stratification factor - Amended statistical methods to align with the revisions to study endpoints
    08 Mar 2018
    - Updated adverse event reporting to start at the time of consent - Revised statistical methods to align with the statistical analysis plan - Modified phlebotomy language to allow investigator to remove blood volume based on weight - Specified diabetes Type 2 exclusion criteria to exclude patients with poorly controlled diabetes - Amended a phlebotomy event in subgroups as either based on a phlebotomy or having a fasting TSAT > 45% - Update planned enrollment to at least 48 evaluable patients - Revised excluded medications and therapies - Revised the comparability group to include subgroups of interest
    18 Jun 2018
    - Study design changed from double-blind to single-blind - Extended the screening period to 90 days - Added rescreening specifics - Blood collections for TSAT and other iron parameters were changed from weekly to extended durations - Dosage was revised to a more fixed design - Added glycemic control as an exploratory objective and change in hemoglobin A1c from baseline to Week 16 as an exploratory endpoint - Added additional endpoint and blood sample collection at Week 17 for complete iron studies - Revised inclusion criteria for serum ferritin from 150 to greater than or equal to 100 ng/mL to < 1,000 ng/mL - Updated exclusion criteria to exclude patients receiving chelation therapy within 7 days prior to the first dose of study drug - Updated exclusion criteria to exclude patients initiation phlebotomy therapy less than 3 months from first dose of study drug - Removed type 2 diabetes as an exclusion criteria - Removed clinically significant arrhythmias as an exclusion criteria - Specified the timing of certain screening evaluations - Removed requirement for a formal DMC - Revised randomizations by baseline of phlebotomy frequency over the last 12 months
    02 Oct 2018
    - Revised primary endpoint to account for patients who received phlebotomy and patients who did not receive a phlebotomy after Week 1 - Added an iron parameter endpoint at Week 17 - Revised statistical methods - Added 10 mg/mL concentration to the IMP description - Corrected dose adjustment information - Added a safety monitoring committee - Added an interim analysis to evaluate initial data after the first 16 patients completed Week 16 assessments or had a phlebotomy after the SOC phlebotomy on Day 1 and before Week 16 - Added an exclusion criteria based on ECG findings and clinical significant arrhythmias - Added an exclusion criteria to exclude patients with poorly controlled Type 2 diabetes
    14 Dec 2018
    - Amended the Efficacy Analysis Population to include those patients enrolled under global protocol version 4.0 or later only

    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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