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    Clinical Trial Results:
    Prospective, Open-Label Clinical Study of Andexanet Alfa in Patients Receiving FXa (Activated Factor X) Inhibitor Who Require Urgent Surgery

    Summary
    EudraCT number
    2020-000374-21
    Trial protocol
    DE   AT  
    Global end of trial date
    25 Jan 2022

    Results information
    Results version number
    v2(current)
    This version publication date
    07 Jun 2023
    First version publication date
    15 Dec 2022
    Other versions
    v1
    Version creation reason

    Trial information

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    Trial identification
    Sponsor protocol code
    ALXN2070-19-515
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Alexion Pharmaceuticals, Inc.
    Sponsor organisation address
    100 College Street, New Haven, CT, United States, 06510
    Public contact
    Alexion Europe SAS European Clinical Trial Information, Alexion Pharmaceuticals, Inc., +33 7 87148158, clinicaltrials@alexion.com
    Scientific contact
    Alexion Europe SAS European Clinical Trial Information, Alexion Pharmaceuticals, Inc., +33 7 87148158, clinicaltrials@alexion.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    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
    30 Sep 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    23 Nov 2021
    Global end of trial reached?
    Yes
    Global end of trial date
    25 Jan 2022
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    Prospective, open-label clinical trial to evaluate the efficacy and safety of andexanet alfa participants who require urgent surgery that have been anticoagulated with the FXa (activated factor X) inhibitors.
    Protection of trial subjects
    This study was conducted in accordance with International Conference on Harmonisation (ICH) Good Clinical Practice, and the principles of the Declaration of Helsinki, in addition to following the laws and regulations of the country or countries in which a study is conducted.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    27 Jun 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
    United States: 1
    Country: Number of subjects enrolled
    France: 4
    Country: Number of subjects enrolled
    Austria: 1
    Country: Number of subjects enrolled
    Germany: 4
    Worldwide total number of subjects
    10
    EEA total number of subjects
    9
    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)
    0
    From 65 to 84 years
    10
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Participants who required urgent surgery and received factor Xa (fXa) inhibitors (apixaban, rivaroxaban, edoxaban, or enoxaparin) before surgery were enrolled in the study.

    Pre-assignment
    Screening details
    This study is a single-arm study and all participants received 1 of 2 doses of andexanet based on the specific anticoagulant taken. All data were prespecified to be collected as a single Arm/Group for any participant who received at least 1 dose of the study drug, regardless of their dose level.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Arm title
    Andexanet Alfa
    Arm description
    Participants received a dose of andexanet alfa based on the specific FXa inhibitor, dose, and time since the last dose (<8 hours, ≥8 hours, or unknown).
    Arm type
    Experimental

    Investigational medicinal product name
    Andexanet Alfa
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Participants received Andexanet Alfa at prespecified dose and timepoints.

    Number of subjects in period 1
    Andexanet Alfa
    Started
    10
    Treated with any Amount of Andexanet
    10
    Efficacy Set
    6
    Completed
    5
    Not completed
    5
         Adverse event, serious fatal
    5

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Andexanet Alfa
    Reporting group description
    Participants received a dose of andexanet alfa based on the specific FXa inhibitor, dose, and time since the last dose (<8 hours, ≥8 hours, or unknown).

    Reporting group values
    Andexanet Alfa Total
    Number of subjects
    10 10
    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)
    0 0
        From 65-84 years
    10 10
        85 years and over
    0 0
    Age Continuous
    Units: Years
        arithmetic mean (full range (min-max))
    79.8 (68 to 84) -
    Sex: Female, Male
    Units: Participants
        Female
    7 7
        Male
    3 3
    Race (NIH/OMB)
    Units: Subjects
        American Indian or Alaska Native
    0 0
        Asian
    0 0
        Native Hawaiian or Other Pacific Islander
    0 0
        Black or African American
    0 0
        White
    6 6
        More than one race
    0 0
        Unknown or Not Reported
    4 4
    Ethnicity (NIH/OMB)
    Per local law, ethnicity data not collected for participants located in France.
    Units: Subjects
        Hispanic or Latino
    0 0
        Not Hispanic or Latino
    6 6
        Unknown or Not Reported
    4 4

    End points

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    End points reporting groups
    Reporting group title
    Andexanet Alfa
    Reporting group description
    Participants received a dose of andexanet alfa based on the specific FXa inhibitor, dose, and time since the last dose (<8 hours, ≥8 hours, or unknown).

    Primary: Number of Participants Achieving Effective Hemostasis

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    End point title
    Number of Participants Achieving Effective Hemostasis [1]
    End point description
    Effective hemostasis is defined as excellent or good as assessed by the Investigator; Ineffective hemostasis is defined as moderate or poor as assessed by the Investigator. Efficacy Set: Participants who underwent surgery and had a baseline anti-fXa activity of at least 75 nanograms (ng)/milliliter (mL) for participants receiving apixaban or rivaroxaban, 40 ng/mL for participants receiving edoxaban, and 0.25 international units (IU)/mL for participants on enoxaparin. All data were prespecified to be collected as a single Arm/Group for any participant who received at least 1 dose of the study drug, regardless of their dose level.
    End point type
    Primary
    End point timeframe
    Hemostasis will be assessed from the start of surgery to the end of the procedure.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Endpoint was summarized descriptively.
    End point values
    Andexanet Alfa
    Number of subjects analysed
    6
    Units: Participants
    6
    No statistical analyses for this end point

    Secondary: Percent Change From Baseline In Anti-fXa Activity To Treatment Nadir

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    End point title
    Percent Change From Baseline In Anti-fXa Activity To Treatment Nadir
    End point description
    Baseline is defined as the last non-missing value on or before first study drug administration. On treatment nadir is the minimum value of anti-fXa activity during the period of time from the end of the andexanet bolus to the end of the andexanet infusion. Efficacy Set: Participants who underwent surgery and had a baseline anti-fXa activity of at least 75 ng/mL for participants receiving apixaban or rivaroxaban, 40 ng/mL for participants receiving edoxaban, and 0.25 IU/mL for participants on enoxaparin. All data were prespecified to be collected as a single Arm/Group for any participant who received at least 1 dose of the study drug, regardless of their dose level.
    End point type
    Secondary
    End point timeframe
    Baseline, Treatment nadir (not to exceed a total of 6.5 hours of andexanet dosing)
    End point values
    Andexanet Alfa
    Number of subjects analysed
    6
    Units: Percent Change
        median (full range (min-max))
    -96.13 (-97.4 to -89.2)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Day 1 up to Day 37
    Adverse event reporting additional description
    All data were prespecified to be collected as a single Arm/Group for any participant who received at least 1 dose of the study drug, regardless of their dose level.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.0
    Reporting groups
    Reporting group title
    Andexanet Alfa
    Reporting group description
    Participants received a dose of andexanet alfa based on the specific FXa inhibitor, dose, and time since the last dose (<8 hours, ≥8 hours, or unknown).

    Serious adverse events
    Andexanet Alfa
    Total subjects affected by serious adverse events
         subjects affected / exposed
    7 / 10 (70.00%)
         number of deaths (all causes)
    5
         number of deaths resulting from adverse events
    Injury, poisoning and procedural complications
    Periprosthetic fracture
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Postprocedural hematoma
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Thrombosis
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Cardiac disorders
    Stress cardiomyopathy
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Nervous system disorders
    Ischaemic stroke
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Respiratory, thoracic and mediastinal disorders
    Respiratory arrest
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Renal and urinary disorders
    Acute Kidney Injury
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    Andexanet Alfa
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    2 / 10 (20.00%)
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Vitamin D deficiency
         subjects affected / exposed
    1 / 10 (10.00%)
         occurrences all number
    1
    Vitamin B complex deficiency
         subjects affected / exposed
    1 / 10 (10.00%)
         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
    16 Sep 2019
    Significant changes incorporated to this global amendment included: • Added more exploratory endpoints: - Relationship between hemostatic efficacy and anti fXa activity - Length of time from clinical presentation at the treating facility to the start of surgery - Time hospitalized in a post anesthesia care unit (PACU), assessed at the Day 30 visit - Time in the operating room (OR) • Clarified timing of FXa dosing in relation to surgery to allow enrollment of participants who received their last dose of a FXa inhibitor >15 hours before surgery if their anti fXa activity level is >100 ng/milliliter mL (or >0.5 IU/mL for participants taking enoxaparin) within 2 hours of consent • Clarified criteria for re-dosing and extended infusion • Clarified that only participants with effective levels of anticoagulation will be included in the efficacy analysis population • Updated eligibility criteria to exclude participants who have - acute overt bleeding that is potentially life threatening - overt bleeding associated with a fall in hemoglobin level by ≥ 2 grams (g)/deciliter (dL) or a hemoglobin level of ≤8 g/dL if no baseline hemoglobin is available - acute bleeding in a critical area or organ - a nonsurgical interventional procedure as the primary procedure of efficacy assessment - heparin-induced thrombocytopenia (with or without thrombosis) - inherited coagulopathy - last dose of apixaban <2.5 mg, rivaroxaban <10 mg, edoxaban <30 mg, or enoxaparin 40 mg • Increased sample size to account for possible attrition rates and rare events • Removed null and alternative hypotheses testing • Added ‘physical examination’ and ‘centrally adjudicated’ deaths to the safety assessments and clarified that all safety analyses will be performed in Safety Analysis Population
    19 Nov 2019
    Significant changes incorporated to this global amendment included: • Revised study phase from Phase 3 to Phase 2 • Added that participants will be closely monitored during the period where they are most vulnerable, and the risk of thrombosis is highest • Added allowance of 2.5 mg of apixaban • Updated eligibility criteria to exclude participants who have - Known hypersensitivity to any component of andexanet - Known allergic reaction to hamster proteins - Known or suspected (that is, presumed positive) COVID-19 related illness at the time of Screening • Clarified the section on informed consent to include acknowledgement that proxy consents must be permissible by national regulatory authorities and that emergency consent is not permitted • Reduced the sample size from 200 participants to 100 participants to align with goals for a Phase 2 study

    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.
    The study was terminated early due to the limited value as a single-arm study.
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    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
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