E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Paroxysmal Nocturnal Haemoglobinuria (PNH) |
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E.1.1.1 | Medical condition in easily understood language |
acquired genetic haemolytic anaemia |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10034042 |
E.1.2 | Term | Paroxysmal nocturnal haemoglobinuria |
E.1.2 | System Organ Class | 10038359 - Renal and urinary disorders |
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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 demonstrate the efficacy of rVA576 plus SoC compared to SoC in patients with uncontrolled haemolysis due to paroxysmal nocturnal haemoglobinuria (PNH). |
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E.2.2 | Secondary objectives of the trial |
To assess the safety and tolerability of rVA576 in treatment of patients with PNH. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Willing to give informed consent to treatment with rVA576
2. Diagnosed with paroxysmal nocturnal haemoglobinuria (PNH) confirmed by flow cytometry
3. Have not received any complement inhibitor within the 4 months prior to screening
4. ≥ 18 years of age at the time of screening
5. Weight ≥50kg
6. Complete transfusion medical history for 12 months prior to entering the observation period and definitely prior to receiving the qualifying transfusion must be available to the patient's investigator and be verifiable by the Sponsor or its representative.
7. Transfusion dependent and has received at least 4 episodes of transfusion of whole blood or PRBC during the 12 months prior to entering the observation period (Part 1), with a minimum of 4 units in total, and a minimum of 1unit at each transfusion episode.
8. LDH ≥1.5 x the ULN per the local lab.
9. Willing to receive appropriate prophylaxis against Neisseria meningitidis infection by both immunisation and continuous or intermittent antibiotics.
10. Willing to avoid prohibited medications such as other complement inhibitors and chemotherapeutic agents
11. Patients must agree to avoid pregnancy and fathering children from the time of signing the Informed Consent Form until 90 days after the last dose of rVA576. Permitted contraceptive methods that are ≥99% effective in preventing pregnancy should be communicated to trial patients and their understanding confirmed. Two approved methods of highly effective contraception must be used by the patient and their partner.
12. Patients who are on erythropoietin and/or immunosuppressant treatment should be on stable doses for at least 6 months prior to entering the observation period (Part 1). The dose of these drugs should not be changed during Part 1 or 2.
13. Patients who are taking systemic corticosteroids should be on a stable dose for at least 4 weeks prior entering the observation period (Part 1). If corticosteroids, either topical or systemic, are being taken for reasons unconnected with the target condition (e.g. for allergic rhino-conjunctivitis) they may be adjusted as clinically appropriate but otherwise should remain at constant dosage.
14. Patients on anticoagulant therapy should be well-controlled prior to entry into the observation period (Part 1) and control should be maintained as long as anticoagulation is considered to be an appropriate therapy. A change of up to 20% to a previously stable anticoagulant therapy is permitted
15. Patients taking iron and/or folic acid supplements should be on a stable dose for at least 4 weeks prior to entering the observation period (Part 1). The dose of iron and/or folic acid supplements should not be adjusted during the trial.
PART 2 Inclusion Criteria
1. Complete transfusion medical history for 12 months prior to receiving qualifying transfusion must be available to the patient's investigator and be verifiable by the Sponsor or its representative.
2. A qualifying transfusion is mandatory during Part 1 with Hb≤70g/L (7g/dL) with or without symptoms or >70g/L (7g/dL) to ≤90g/L (9g/dL) with symptoms.
3. The qualifying transfusion during the observation period (Part 1) requiring a minimum of 1 unit of PRBC. The quantity of PRBC to be transfused will be according to the algorithm in the protocol.
4. Patient must be within 15g/L (1.5g/dL) of the mean haemoglobin from the previous 12 months
5. Will have a minimum of 1 sign or 1 symptom of PNH from the following list: frank haemoglobinuria, dysphagia, dyspnoea, abdominal pain, erectile dysfunction, evidence of recent thrombotic event, or excessive fatigue, which leads to the qualifying transfusion.
6. A negative nasal and throat swab result for N. meningitidis in the last assessment.
7. Patient must be available to enter Part 2 within 3 days of receiving a qualifying transfusion in Part 1.
8. Continues to meet all the inclusion criteria and none of the exclusion criteria.
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E.4 | Principal exclusion criteria |
1. Patients whose mean haemoglobin level over the previous 12 months prior to screening was greater than 105 g/L (10.5g/dL).
2. Severe bone marrow failure as manifested by (a) a peripheral blood reticulocyte count <20 x 10exp9/L OR (b) neutrophils < 0.5 x 10exp9/L
3. Patients with a platelet count of ≤ 70 x 10exp9/L
4. Patients with known or suspected acquired somatic mutations affecting the bone marrow (e.g. acute myeloid leukaemia) which may be associated with PNH.
5. Chemotherapy within 3 months of screening visit.
6. History of recurrent bacterial infections or suspicion of active bacterial infections requiring antibiotic therapy.
7. Planned or actual pregnancy or breast feeding (females).
8. Known allergy to ticks or severe reaction to arthropod venom (e.g. bee or wasp venom).
9. Unresolved N. meningitidis infection. Patients who have positive nasal or throat swabs must be excluded until eradication of the organism by antibiotic treatment has been confirmed by repeat swabbing and growth testing.
10. Patients who are not willing to receive adequate immunisation against N. meningitidis unless, in the opinion of the investigator, the risks of delaying therapy outweigh the risks of developing a meningococcal infection.
11. Impaired hepatic function (bilirubin > 1.5 x ULN and AST/ALT >2.5 x ULN) unless, in the opinion of the investigator, the risks of delaying therapy outweigh the risks of treatment in the presence of impaired hepatic function.
12. Patients with a glomerular filtration rate (GFR) of <30mL/min/1.73m2 unless, in the opinion of the investigator, the risks of delaying therapy outweigh the risks of treatment in the presence of impaired renal function.
13. Participation in other clinical trials within 4 weeks of signing the consent form.
14. History of active systemic autoimmune diseases other than the target condition. Dermatologic diseases such as psoriasis will not be a reason for exclusion unless there are associated systemic symptoms such as psoriatic arthritis.
15. Any other systemic disorders that could interfere with the evaluation of the study treatment.
16. Failure to comply with protocol requirements
17. Known Hepatitis B or Hepatitis C, as per medical history.
PART 2 Exclusion Criteria
1. Presence or suspicion of active bacterial infection requiring antibiotic therapy in the opinion of the Investigator.
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is haemoglobin stabilisation rate defined as haemoglobin greater than the set point for each patient defined during the pre-study randomisation period, and the avoidance of PRBC transfusions during the treatment period. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The primary endpoint will be assessed at the end of Part 2. |
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E.5.2 | Secondary end point(s) |
•Number of units of PRBC transfused from baseline Day 1 (start of Part 2) to Day 180
•Percentage of patients who achieve transfusion avoidance from baseline Day 1(start of Part 2) to Day 180
•Change in QoL score using FACIT-F from baseline Day 1 (start of Part 2) to Day 180
•AUC [LDH] from baseline Day 1 (start of Part 2) to Day 180
•CH50 levels from baseline Day 1 (start of Part 2) to Day 180
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | 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 | No |
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) | No |
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
| 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 | 3 |
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 |
Ecuador |
Kazakhstan |
Peru |
Sri Lanka |
Turkey |
Lithuania |
Romania |
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E.8.7 | Trial has a data monitoring committee | No |
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 | 2 |
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 | 2 |
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 |