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    Clinical Trial Results:
    Emicizumab in Patients with Acquired Hemophilia A: Multicenter, Single-Arm, Open-Label Clinical Trial

    Summary
    EudraCT number
    2019-004430-42
    Trial protocol
    DE   AT  
    Global end of trial date
    04 Jan 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    06 Mar 2024
    First version publication date
    06 Mar 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    AHA-EMI
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04188639
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    GWT-TUD GmbH
    Sponsor organisation address
    Freiberger Str. 33, Dresden, Germany, 01067
    Public contact
    Medical Consulting, GWT-TUD GmbH, +49 35125933100, medical.consulting@g-wt.de
    Scientific contact
    Medical Consulting, GWT-TUD GmbH, +49 35125933172, medical.consulting@g-wt.de
    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
    14 Nov 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    04 Jan 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    04 Jan 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of the present study is to evaluate the efficacy of prophylactic emicizumab administered on a scheduled basis to prevent bleeds in patients with acquired hemophilia A (AHA).
    Protection of trial subjects
    An independent data monitoring committee / Data safety monitoring board (DSMB/DMC) will be formed to oversee the safety of the trial subjects in the clinical trial by periodically assessing the safety of the trial therapy. The DSMB will consist at least of two physicians who are not involved in the trial and who are external to the sponsor. The study DSMB charter will elaborate the guidelines for the DSMB. The DSMB will meet according to the intervals mentioned in the DSMB Charter.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    25 Mar 2021
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Austria: 9
    Country: Number of subjects enrolled
    Germany: 38
    Worldwide total number of subjects
    47
    EEA total number of subjects
    47
    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)
    10
    From 65 to 84 years
    32
    85 years and over
    5

    Subject disposition

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    Recruitment
    Recruitment details
    From 25 Mar 2021 through 10 Jun 2022, a total of 49 patients were screened at 11 study sites in Germany and 2 study sites in Austria.

    Pre-assignment
    Screening details
    47 of 49 screened patients entered the study and received at least one dose of the study drug emicizumab. Overall, 42 patients completed 12 weeks of treatment and 43 started the FU period.

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

    Arms
    Arm title
    Treatment period
    Arm description
    Day 1 (6 mg/kg body weight (bw) subcutaneously) Day 2 (3 mg/kg bw) Maintenance dose: 1.5 mg/kg bw SC weekly starting week 2 (day 8 to 10) up to week 12
    Arm type
    Experimental

    Investigational medicinal product name
    Emicizumab
    Investigational medicinal product code
    Other name
    Hemlibra®
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Emicizumab will be given on day 1 (6 mg/kg body weight (bw) subcutaneously) and day 2 (3 mg/kg bw), followed by maintenance doses of 1.5 mg/kg bw weekly starting week 2 (day 8 to 10) and up to week 12. Emicizumab treatment will be discontinued in case of achieving spontaneous partial remission of AHA, defined as FVIII activity (chromogenic test with bovine components) increased to >50% of normal.

    Number of subjects in period 1
    Treatment period
    Started
    47
    Completed
    42
    Not completed
    5
         partial remission
    1
         Consent withdrawn by subject
    1
         Physician decision
    2
         Adverse event, non-fatal
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Emicizumab treatment
    Reporting group description
    -

    Reporting group values
    Emicizumab treatment Total
    Number of subjects
    47 47
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    10 10
        From 65-84 years
    32 32
        85 years and over
    5 5
    Gender categorical
    Units: Subjects
        Female
    23 23
        Male
    24 24
    Subject analysis sets

    Subject analysis set title
    PPS
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The PPS consisted of all patients who were treated for at least 12 weeks without major protocol deviations.

    Subject analysis sets values
    PPS
    Number of subjects
    35
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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)
    8
        From 65-84 years
    23
        85 years and over
    4
    Age continuous
    Units:
        
    ( )
    Gender categorical
    Units: Subjects
        Female
    19
        Male
    16

    End points

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    End points reporting groups
    Reporting group title
    Treatment period
    Reporting group description
    Day 1 (6 mg/kg body weight (bw) subcutaneously) Day 2 (3 mg/kg bw) Maintenance dose: 1.5 mg/kg bw SC weekly starting week 2 (day 8 to 10) up to week 12

    Subject analysis set title
    PPS
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The PPS consisted of all patients who were treated for at least 12 weeks without major protocol deviations.

    Primary: number of clinically significant new bleeds per patient-week

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    End point title
    number of clinically significant new bleeds per patient-week
    End point description
    The primary endpoint was the number of clinically significant new bleeds per patient-week after the first dose of emicizumab until Week 12 after starting emicizumab treatment or dropout, whatever occurred first.
    End point type
    Primary
    End point timeframe
    12 weeks
    End point values
    Treatment period PPS
    Number of subjects analysed
    47
    35
    Units: bleeding rate
        number (not applicable)
    22
    11
    Statistical analysis title
    Full Analysis
    Comparison groups
    Treatment period v PPS
    Number of subjects included in analysis
    82
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    < 0.001
    Method
    Chi-squared
    Parameter type
    likelihood-ratio test
    Confidence interval
         level
    2.5%
         sides
    1-sided
         lower limit
    -
         upper limit
    0.061
    Variability estimate
    Standard deviation
    Dispersion value
    0.0704

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    12 weeks
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    24.0
    Reporting groups
    Reporting group title
    Overall
    Reporting group description
    -

    Serious adverse events
    Overall
    Total subjects affected by serious adverse events
         subjects affected / exposed
    16 / 47 (34.04%)
         number of deaths (all causes)
    1
         number of deaths resulting from adverse events
    1
    Injury, poisoning and procedural complications
    Concussion
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Contusion
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Post procedural hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Transfusion-related circulatory overload
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Traumatic hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Traumatic intracranial hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Shock hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hematoma
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Anal hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intestinal ischemia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intra-abdominal hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Retroperitoneal hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Covid-19
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Diverticulitis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infected dermal cyst
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Hyperglycemia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Overall
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    32 / 47 (68.09%)
    Vascular disorders
    Hematoma
         subjects affected / exposed
    3 / 47 (6.38%)
         occurrences all number
    4
    Hypertension
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Surgical and medical procedures
    Catheter placement
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Debridement
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Skin graft
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Wound treatment
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    General disorders and administration site conditions
    nflammation
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Vessel puncture site thrombosis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Immune system disorders
    Anaphylactic shock
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Drug hypersensitivity
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Hypogammaglobulinemia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Reproductive system and breast disorders
    Benign prostatic hyperplasia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Bronchospasm
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Dyspnea
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Nasal congestion
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Psychiatric disorders
    Depressed mood
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Insomnia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Investigations
    Blood bilirubin increased
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Blood creatinine increased
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Blood potassium decreased
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    C-reactive protein increased
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Hemoglobin decreased
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Red blood cell count decreased
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    2 / 47 (4.26%)
         occurrences all number
    3
    Contusion
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    2
    Head injury
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Overdose
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Skin abrasion
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Skin laceration
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Toxicity to various agents
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Congenital, familial and genetic disorders
    Phimosis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Bradycardia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Cardiac failure
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Nervous system disorders
    Headache
         subjects affected / exposed
    2 / 47 (4.26%)
         occurrences all number
    3
    Extrapyramidal disorder
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Paresthesia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Peroneal nerve palsy
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Lymphadenopathy
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Eye disorders
    Dry eye
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Eye hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Gastrointestinal disorders
    Diarrhea
         subjects affected / exposed
    3 / 47 (6.38%)
         occurrences all number
    3
    Constipation
         subjects affected / exposed
    2 / 47 (4.26%)
         occurrences all number
    2
    Diverticulum
         subjects affected / exposed
    2 / 47 (4.26%)
         occurrences all number
    2
    Abdominal pain
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Barrett's esophagus
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Chronic gastritis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Gastritis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Gastroesophageal reflux disease
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Ileus
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Proctitis ulcerative
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Hepatobiliary disorders
    Cholelithiasis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    2 / 47 (4.26%)
         occurrences all number
    2
    Dermal cyst
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Erythema
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Skin hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Urticaria
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    2 / 47 (4.26%)
         occurrences all number
    2
    Bladder disorder
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Renal cyst
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Ureterolithiasis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Urinary incontinence
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Muscle hemorrhage
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Muscle spasms
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Pain in extremity
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Infections and infestations
    COVID-19
         subjects affected / exposed
    2 / 47 (4.26%)
         occurrences all number
    2
    Bacteriuria
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Clostridium difficile infection
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Conjunctivitis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Device related infection
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Laryngitis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Nasopharyngitis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Urinary tract infection
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Urosepsis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Hyperkalemia
         subjects affected / exposed
    2 / 47 (4.26%)
         occurrences all number
    2
    Fluid overload
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Hyperglycemia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Hyperuricemia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Hypocalcemia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Hyponatremia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Hypokalemia
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Lactic acidosis
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1
    Vitamin K deficiency
         subjects affected / exposed
    1 / 47 (2.13%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Mar 2022
    Version 3.0 dated 01 Mar 2022 including new safety information from updated Investigator´s Brochure and adaptation of study procedures

    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
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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