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    Clinical Trial Results:
    CLINICAL STUDY TO INVESTIGATE THE EFFICACY AND SAFETY OF WILATE DURING PROPHYLAXIS IN PREVIOUSLY TREATED PATIENTS WITH VON WILLEBRAND DISEASE (VWD)

    Summary
    EudraCT number
    2018-004675-13
    Trial protocol
    BG   HU   HR  
    Global end of trial date
    23 Apr 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    03 Mar 2023
    First version publication date
    03 Mar 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    WIL-31
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04052698
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    IND: 011303
    Sponsors
    Sponsor organisation name
    Octapharma AG
    Sponsor organisation address
    Seidenstrasse 2, Lachen, Switzerland, 8853
    Public contact
    Sigurd Knaub, Octapharma AG, sigurd.knaub@octapharma.com
    Scientific contact
    Sylvia Werner, Octapharma AG, sylvia.werner@octapharma.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?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    11 Nov 2022
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    23 Apr 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this study was to determine the efficacy of Wilate in the prophylactic treatment of previously treated patients with type 3, type 2 (except 2N), or severe type 1 VWD
    Protection of trial subjects
    This trial was conducted in accordance to the principles of ICH- GCP, ensuring that the rights, safety and well-being of patients are protected and in consistency with the Declaration of Helsinki, national regulatory requirements and FDA Code of Federal Regulations. Inclusion and exclusion criteria were carefully defined in order to protect subjects from contraindications, interactions with other medication and risk factors associated with the investigational medicinal product. Throughout the study safety was assessed, such as monitoring of AEs, SAEs and concomitant medication.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    05 Jun 2020
    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
    Croatia: 2
    Country: Number of subjects enrolled
    Bulgaria: 3
    Country: Number of subjects enrolled
    Hungary: 2
    Country: Number of subjects enrolled
    Belarus: 2
    Country: Number of subjects enrolled
    Lebanon: 16
    Country: Number of subjects enrolled
    Russian Federation: 6
    Country: Number of subjects enrolled
    Ukraine: 11
    Country: Number of subjects enrolled
    United States: 1
    Worldwide total number of subjects
    43
    EEA total number of subjects
    7
    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)
    10
    Adolescents (12-17 years)
    14
    Adults (18-64 years)
    19
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Patients aged ≥6 years with diagnose of Von Willebrand Disease VWD type 1, 2A, 2B, 2M, or 3 according to medical history and requiring substitution therapy with a VWF-containing product to control bleeding were screened according to predefined in- and exclusion criteria.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Wilate
    Arm description
    The FVIII/VWF concentrate Wilate, produced from plasma of human donors, was presented as a powder and solvent for intravenous injection containing nominally 500 IU or 1000 IU human VWF and human FVIII per vial. The prophylactic dose for each patient was determined by the Principal Investigator based on each patient’s clinical condition.
    Arm type
    Experimental

    Investigational medicinal product name
    Wilate
    Investigational medicinal product code
    Other name
    Wilate , Factor VIII (plasma derived)
    Pharmaceutical forms
    Powder and solvent for solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    For the PK assessment in patients (6–16 years), a single dose of 60 ± 10 IU/kg BW was to be administered. For prophylactic treatment, IMP was to be administered 2–3 x/week (20–40 IU/kg BW for 12 months). The prophylactic dose was determined by the Investigator based on the patient’s clinical condition and at following time points: In patients (≥17 years), first prophylactic dose was to be administered at time of the baseline IVR assessment, in patients (6–16 years) after completion of the PK phase. In case of unacceptably frequent spontaneous breakthrough BEs (i.e., more than 2 spontaneous BEs or 1 major spontaneous BE within a 30-day period), the dose of Wilate was to be increased by approx. 5 IU/kg (depending on the entire content of the additional vials that need to be reconstituted). If, after a dose increase, patients still experienced more than 2 spontaneous bleeding episodes, the dosing interval was to be shortened from 2 x/week to 3 x/week.

    Number of subjects in period 1
    Wilate
    Started
    43
    Completed
    30
    Not completed
    13
         Protocol violation
    10
         Adverse event, non-fatal
    2
         permanently left country for job
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Trial
    Reporting group description
    -

    Reporting group values
    Overall Trial Total
    Number of subjects
    43 43
    Age categorical
    Units: Subjects
        6-<12 yrs
    10 10
        12-<17 yrs
    8 8
        ≥17 yrs
    25 25
    Age continuous
    Units: years
        median (full range (min-max))
    17 (7.0 to 61.0) -
    Gender categorical
    Units: Subjects
        Female
    17 17
        Male
    26 26

    End points

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    End points reporting groups
    Reporting group title
    Wilate
    Reporting group description
    The FVIII/VWF concentrate Wilate, produced from plasma of human donors, was presented as a powder and solvent for intravenous injection containing nominally 500 IU or 1000 IU human VWF and human FVIII per vial. The prophylactic dose for each patient was determined by the Principal Investigator based on each patient’s clinical condition.

    Subject analysis set title
    Patients 6-<12 years
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Pediatric patients 6-<12

    Subject analysis set title
    Patients 12-<17 years
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Patients aged 12-<17 years

    Subject analysis set title
    Patients ≥17
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Adult patients aged ≥17 years

    Subject analysis set title
    Full Analysis Set ( FAS)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    All enrolled patients who received at least one dose of IMP after the Baseline IVR Visit in adults or the Baseline PK Visit in children.

    Subject analysis set title
    Modified full analysis set (mFAS)
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    The modified full analysis set (mFAS) was a subset of the FAS excluding all patients for whom laboratory results did not confirm the patient's VWD status, i.e., severe VWD Type 1, 2A, 2B, 2M or 3. These patients seem to have had mild VWD, Hemophilia A, or an unknown bleeding disorder, and were excluded from the mFAS as they were not a true representation of the target population.

    Subject analysis set title
    Estimated Rate WIL-29
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    For the efficacy assessment the individual annualized bleeding rates under prophylactic treatment in this study was compared to the annualized bleeding rates recorded for the same patient during the previous, non-interventional study WIL-29

    Subject analysis set title
    Estimated Rate WIL-31
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Annualized bleeding rates under prophylactic treatment in study WIL-31 , which was compared to the annualized bleeding rates recorded for the same patient during the previous, non-interventional study WIL-29

    Subject analysis set title
    6-<12 years (mFAS)
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Population of mFAS Set aged 6-<12 years

    Subject analysis set title
    12-<17 yrs (mFAS)
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Population from mFAS Set aged 12-<17 years

    Subject analysis set title
    ≥17 yrs (mFAS)
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Population from mFAS Seit aged ≥17 years

    Subject analysis set title
    Type 1 VWD (mFAS)
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Type 1 VWD

    Subject analysis set title
    Type 2 VWD (mFAS)
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Type 2 VWD

    Subject analysis set title
    Type 3 VWD (mFAS)
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Type 3 VWD

    Primary: Total annualized bleeding rate (TABR)

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    End point title
    Total annualized bleeding rate (TABR)
    End point description
    The primary endpoint of this study was to demonstrate that prophylactic treatment with Wilate lowers the patients’ total annualized bleeding rate (TABR) observed during on-demand treatment by more than 50%. The individual annualized bleeding rates under prophylactic treatment in this study was compared to the annualized bleeding rates recorded for the same patient during a previous, non-interventional study (WIL-29).
    End point type
    Primary
    End point timeframe
    Time period between first prophylactic dose of IMP at baseline and the day of the last dose at 12 months.
    End point values
    Estimated Rate WIL-29 Estimated Rate WIL-31
    Number of subjects analysed
    33
    33
    Units: bleeding events per year
        number (not applicable)
    33.3751
    5.4914
    Statistical analysis title
    Ratio of TABR in WIL-31 and WIL-29
    Statistical analysis description
    Ratio calculated as the ABR during the prophylaxis period in WIL-31 vs the corresponding ABR during the On-Demand Period in WIL-29.
    Comparison groups
    Estimated Rate WIL-29 v Estimated Rate WIL-31
    Number of subjects included in analysis
    66
    Analysis specification
    Pre-specified
    Analysis type
    other [1]
    P-value
    < 0.0001 [2]
    Method
    Regression, Linear
    Parameter type
    mean ratio
    Point estimate
    0.1645
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.10194
         upper limit
    0.26558
    Notes
    [1] - Ratio calculated as the ABR during the prophylaxis period in WIL-31 vs the corresponding ABR during the On-Demand Period in WIL-29
    [2] - p-value from a 1-sided test whether the mean ratio is less than 0.5 utilizing a negative binomial counting regression model.

    Secondary: Spontaneous annualized bleeding rate (SABR)

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    End point title
    Spontaneous annualized bleeding rate (SABR)
    End point description
    The individual spontanoeaous annualized bleeding rates under prophylactic treatment in this study was compared to the spontaneous annualized bleeding rates recorded for the same patient during a previous, non-interventional study (WIL-29) using a negative binomial counting regression model.
    End point type
    Secondary
    End point timeframe
    Time period between first prophylactic dose of IMP at baseline and the day of the last dose at 12 months.
    End point values
    Estimated Rate WIL-29 Estimated Rate WIL-31
    Number of subjects analysed
    33
    33
    Units: bleeding events per year
        number (not applicable)
    24.4168
    3.3925
    Statistical analysis title
    Ratio of SABR in WIL-31 and WIL-29
    Statistical analysis description
    Ratio calculated as the ABR during the prophylaxis period in WIL-31 vs the corresponding ABR during the On-Demand Period in WIL-29.
    Comparison groups
    Estimated Rate WIL-31 v Estimated Rate WIL-29
    Number of subjects included in analysis
    66
    Analysis specification
    Pre-specified
    Analysis type
    other [3]
    P-value
    < 0.0001 [4]
    Method
    Regression, Linear
    Parameter type
    mean ratio
    Point estimate
    0.1389
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.07664
         upper limit
    0.25187
    Notes
    [3] - Ratio calculated as the ABR during the prophylaxis period in WIL-31 vs the corresponding ABR during the On-Demand Period in WIL-29
    [4] - p-value from a 1-sided test whether the mean ratio is less than 0.5 utilizing a negative binomial counting regression model

    Secondary: Wilate consumption for prophylaxis

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    End point title
    Wilate consumption for prophylaxis
    End point description
    Wilate consumption (VWF/FVIII IU/kg per week per patient) for prophylaxis.
    End point type
    Secondary
    End point timeframe
    From Baseline to end of study at month 12.
    End point values
    Modified full analysis set (mFAS) 6-<12 years (mFAS) 12-<17 yrs (mFAS) ≥17 yrs (mFAS)
    Number of subjects analysed
    33
    9
    6
    18
    Units: IU/kg
        median (full range (min-max))
    58.28 (28.2 to 113.7)
    66.34 (42.6 to 113.7)
    64.44 (52.6 to 101.0)
    53.46 (28.2 to 109.6)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    AEs have been elicited at each visit (Baseline up to Study Completion Visit) , whether scheduled or unscheduled.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    Safety Set
    Reporting group description
    The safety (SAF) set included all patients who received at least one dose of IMP.

    Serious adverse events
    Safety Set
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 43 (9.30%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Gastrointestinal disorders
    Food poisoning
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haemorrhoidal haemorrhage
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Reproductive system and breast disorders
    Menorrhagia
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    COVID-19 pneumonia
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 4.7%
    Non-serious adverse events
    Safety Set
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    26 / 43 (60.47%)
    Investigations
    Parvovirus B19 test positive
         subjects affected / exposed
    2 / 43 (4.65%)
         occurrences all number
    2
    Nervous system disorders
    Headache
         subjects affected / exposed
    7 / 43 (16.28%)
         occurrences all number
    20
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    2 / 43 (4.65%)
         occurrences all number
    2
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    2 / 43 (4.65%)
         occurrences all number
    4
    Respiratory, thoracic and mediastinal disorders
    Rhinitis allergic
         subjects affected / exposed
    2 / 43 (4.65%)
         occurrences all number
    2
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    2 / 43 (4.65%)
         occurrences all number
    3
    Musculoskeletal and connective tissue disorders
    Pain in extremity
         subjects affected / exposed
    2 / 43 (4.65%)
         occurrences all number
    2
    Infections and infestations
    COVID-19
         subjects affected / exposed
    3 / 43 (6.98%)
         occurrences all number
    3
    Nasopharyngitis
         subjects affected / exposed
    2 / 43 (4.65%)
         occurrences all number
    3
    Respiratory tract infection
         subjects affected / exposed
    5 / 43 (11.63%)
         occurrences all number
    7

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    13 Jun 2019
    Protocol Version 2 (Amendment 1) - Refinement of Exclusion criteria 1 and 6 - The 1-Month and 2-Month Contacts were changed into formal study visits that also include an IVR assessment. - Between the 3- and 6-Month Visits, the 6- and 9-Month Visits, and the 9- and 12-Month Visits, monthly telephone contacts were added. - The Wilate dose for the first IVR assessment at the time of the Baseline IVR Visit was changed from 60±10 IU/kg BW to being each patient’s individually assigned prophylactic dose as used for subsequent visits. - Obtaining female patients’ history of heavy menstrual bleeding was added at screening. - The PROMIS-29 was added as an additional QoL assessment. - Assessment of joint status using the Hemophilia Joint Health Score (HJHS) and the documentation of target joints were added. - The Pictorial Blood Loss Assessment Chart was implemented and the PBAC score was added as a tool to estimate menstrual blood loss. - The minimum number of patients aged ≥6 to <17 years was increased from 2 to 4. - The methods of VWF:Ac determination to be used were clearly specified as being VWF:RCo and VWF:GpIbM. - A clarification was added that, if no mutation was identified in the VWF gene for patients with VWD Type 2B, additional genetic testing was to be performed to exclude pseudo-VWD.
    22 Aug 2019
    Protocol Version 3 (Amendment 2): The protocol was amended to comply with FDA requests. - A PK assessment in pediatric patients was added as a secondary objective and a secondary endpoint. - The number of pediatric patients was increased from 4 to 10. - Patients with body weight <20 kg were excluded. - The protocol author and contact for SAE reporting was changed. - The possible interval between the Screening Visit and the Baseline IVR Visit was reduced from 30 days to 2 weeks. - The estimated start date of the study was changed from Q4 2019 to Q1 2020. - The definition of target joint assessment was extended to the Study Completion Visit. - In this protocol, seroconversion for Parvovirus B19 was to be reported as an AE.
    25 Feb 2020
    Protocol Version 5 (Amendment 3) - VWF:Ag testing was removed - FVIII:C was added as a parameter in IVR assessments. - Inclusion criterion 3 was updated to allow for patients that switched to prophylaxis within the past 2 years and had reliable documentation of on-demand treatment before switching. - Menstrual bleeds excluded from calculation of TABR. -The annual rate of heavy (i.e., major) menstrual bleeds was added as an exploratory endpoint. -Clarification that the Screening and Baseline Visits could coincide in adults, but- must not coincide in children was added. - Standard anesthetic medication was not to be collected as concomitant medications. - The patient diary was handed out at screening, NOT baseline. - All patients were to use their previous product between screening and baseline. - Previous product was to be documented as concomitant medication. - BEs were to be documented under BEs. - Number of pregnancy tests were reduced. - Number of blood draws for hematology/chemistry were reduced. - Wilate consumption data added as secondary endpoint.
    01 Mar 2021
    Protocol Version 7 (Amendment 4) - Increased number of patients to be enrolled, in order to get 25 evaluable patients, from 28 to 40. Increased number of pediatric patients from 4 to 6. -The following sentence added: If, after a dose increase, patients still experience more than 2 spontaneous bleeding episodes, the dosing interval should be shortened from 2 times per week to 3 times per week. - Added forbidden medication in Section 4.2 (consistent with other protocols). - Added that BUN or urea could be tested. - Corrected the “within 60 -/+5 min before infusion time point” to “within 60 min before infusion”.

    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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