Clinical Trial Results:
A multicenter, double-blind, randomized, placebo-controlled, parallel-arm study to investigate the efficacy and safety of subcutaneous administration of CSL312 (garadacimab) in the prophylactic treatment of hereditary angioedema
Summary
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EudraCT number |
2020-000570-25 |
Trial protocol |
DE HU NL IT |
Global end of trial date |
07 Jun 2022
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Results information
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Results version number |
v1(current) |
This version publication date |
24 Jun 2023
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First version publication date |
24 Jun 2023
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
CSL312_3001
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT04656418 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
CSL Behring
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Sponsor organisation address |
1020 First Avenue, King of Prussia, United States, 19406
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Public contact |
Trial Registration Coordinator, CSL Behring LLC, +1 610-878-4000, clinicaltrials@cslbehring.com
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Scientific contact |
Trial Registration Coordinator, CSL Behring LLC, +1 610-878-4000, clinicaltrials@cslbehring.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
Yes
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EMA paediatric investigation plan number(s) |
EMEA-002726-PIP01-19 | ||
Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
Yes
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
07 Jun 2022
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
07 Jun 2022
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
The purpose of this study was to evaluate the efficacy and safety of subcutaneous (SC) administration of CSL312 (garadacimab) in the prophylactic treatment of hereditary angioedema.
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Protection of trial subjects |
This study was carried out in accordance with the International Conference on Harmonisation Good Clinical Practice guidelines and standard operating procedures for clinical research and development at CSL Behring.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
27 Jan 2021
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Netherlands: 3
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Country: Number of subjects enrolled |
Germany: 15
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Country: Number of subjects enrolled |
Hungary: 2
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Country: Number of subjects enrolled |
Canada: 8
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Country: Number of subjects enrolled |
Israel: 9
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Country: Number of subjects enrolled |
United States: 21
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Country: Number of subjects enrolled |
Japan: 6
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Worldwide total number of subjects |
64
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EEA total number of subjects |
20
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
6
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Adults (18-64 years) |
52
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From 65 to 84 years |
6
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85 years and over |
0
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Recruitment
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Recruitment details |
Subjects were enrolled at study centers in Canada, Germany, Hungary, Israel, Japan, Netherlands, and the United States from 27 January 2021 to 07 June 2022. | |||||||||||||||
Pre-assignment
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Screening details |
A total of 80 subjects were screened, of which 64 subjects were randomised and received the loading dose in the treatment period. | |||||||||||||||
Period 1
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Period 1 title |
Overall Study (overall period)
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Is this the baseline period? |
Yes | |||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||
Roles blinded |
Subject, Investigator, Data analyst, Carer | |||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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CSL312 | |||||||||||||||
Arm description |
Subjects received a CSL312 loading dose of 400 mg as two 200 mg SC injections in Month 1 along with CSL312 of 200 mg SC injections, once monthly from Months 2 to 6. | |||||||||||||||
Arm type |
Experimental | |||||||||||||||
Investigational medicinal product name |
CSL312
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Investigational medicinal product code |
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Other name |
Factor XIIa inhibitor monoclonal antibody, garadacimab
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Pharmaceutical forms |
Solution for injection
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
A loading dose of 400 mg as two 200 mg injections in Month 1 along with 200 mg injections, once monthly from Months 2 to 6.
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Arm title
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Placebo | |||||||||||||||
Arm description |
Subjects received a CSL312 matched loading dose of placebo as two SC injections in Month 1 along with CSL312 matched placebo SC injections, once monthly from Months 2 to 6. | |||||||||||||||
Arm type |
Placebo | |||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for injection
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
A CSL312 matched loading dose of placebo as two injections in Month 1 along with CSL312 matched placebo injections, once monthly from Months 2 to 6.
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Baseline characteristics reporting groups
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Reporting group title |
CSL312
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Reporting group description |
Subjects received a CSL312 loading dose of 400 mg as two 200 mg SC injections in Month 1 along with CSL312 of 200 mg SC injections, once monthly from Months 2 to 6. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
Subjects received a CSL312 matched loading dose of placebo as two SC injections in Month 1 along with CSL312 matched placebo SC injections, once monthly from Months 2 to 6. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
CSL312
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Reporting group description |
Subjects received a CSL312 loading dose of 400 mg as two 200 mg SC injections in Month 1 along with CSL312 of 200 mg SC injections, once monthly from Months 2 to 6. | ||
Reporting group title |
Placebo
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Reporting group description |
Subjects received a CSL312 matched loading dose of placebo as two SC injections in Month 1 along with CSL312 matched placebo SC injections, once monthly from Months 2 to 6. | ||
Subject analysis set title |
CSL312 and Placebo Comparison Group
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Subject analysis set type |
Intention-to-treat | ||
Subject analysis set description |
CSL312: Subjects received a CSL312 loading dose of 400 mg as two 200 mg SC injections in Month 1 along with CSL312 of 200 mg SC injections, once monthly from Months 2 to 6.
Placebo: Subjects received a CSL312 matched loading dose of placebo as two SC injections in Month 1 along with CSL312 matched placebo SC injections, once monthly from Months 2 to 6.
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End point title |
Time-Normalised Number of Hereditary Angioedema (HAE) Attacks per Month During Treatment Period | ||||||||||||
End point description |
Time-normalised number of HAE attacks per month during treatment was calculated per subject as: [number of HAE attacks / length of subject treatment in days] * 30.4375. ITT analysis set included all the randomised subjects who provided written informed consent and underwent study screening procedures. 'Number of subjects analysed’ indicates the number of subjects with data available for endpoint analysis.
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End point type |
Primary
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End point timeframe |
First injection up to 6 months
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Statistical analysis title |
CSL312 vs Placebo | ||||||||||||
Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [1] | ||||||||||||
P-value |
< 0.001 [2] | ||||||||||||
Method |
Two-sided Wilcoxon test | ||||||||||||
Confidence interval |
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Notes [1] - Test for differences [2] - Compared the time-normalised number of HAE attacks in the active and placebo arms by using a two-sided Wilcoxon test (Hierarchical Testing H01) at alpha = 5%. |
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End point title |
Percentage Change in the Time-Normalised Number of HAE Attacks per Month During the Treatment Period Compared to the Run-in Period | |||||||||||||||||||||
End point description |
Percentage change in the time-normalised number of HAE attacks was calculated within a subject as:
100 * [1 – (time-normalised number of HAE attacks per month during treatment period / time-normalised number of HAE attacks per month during run-in period)]. Time-normalised number of HAE attacks per month during treatment period was calculated per subject as: [number of HAE attacks / length of subject treatment in days] * 30.4375. ITT analysis set included all the randomised subjects who provided written informed consent and underwent study screening procedures. 'Number of subjects analysed’ indicates the number of subjects with data available for endpoint analysis. ‘Number analysed (n)’ indicates the number of subjects with data available for analysis at the specified time point.
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End point type |
Secondary
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End point timeframe |
6 months, first 3-months and second 3-months of treatment period
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Statistical analysis title |
CSL312 vs Placebo | |||||||||||||||||||||
Statistical analysis description |
6 Months of treatment
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Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [3] | |||||||||||||||||||||
P-value |
< 0.001 [4] | |||||||||||||||||||||
Method |
Two-sided Wilcoxon test | |||||||||||||||||||||
Confidence interval |
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Notes [3] - Test for differences [4] - Compared the time-normalised number of HAE attacks in the active and placebo arms by using a two-sided Wilcoxon test. |
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End point title |
Time-Normalised Number of HAE Attacks per Month Requiring On-Demand Treatment | |||||||||||||||||||||
End point description |
Time-normalised number of HAE attacks per month requiring on-demand treatment was calculated per subjects as: [number of HAE attacks requiring on-demand treatment / length of subject treatment in days] * 30.4375. ITT analysis set included all the randomised subjects who provided written informed consent and underwent study screening procedures. 'Number of subjects analysed’ indicates the number of subjects with data available for endpoint analysis. ‘Number analysed (n)’ indicates the total number of HAE attacks available for analysis at the specified time point.
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End point type |
Secondary
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End point timeframe |
6 months, first 3-months and second 3-months of treatment period
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Notes [5] - Overall units analysed: 63 total number of HAE attacks [6] - Overall units analysed:264 total number of HAE attacks; 22 subjects for Second 3-months of treatment |
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Statistical analysis title |
CSL312 vs Placebo | |||||||||||||||||||||
Statistical analysis description |
6 Months of treatment
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Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [7] | |||||||||||||||||||||
P-value |
< 0.001 [8] | |||||||||||||||||||||
Method |
Two-sided Wilcoxon test | |||||||||||||||||||||
Confidence interval |
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Notes [7] - Test for differences [8] - Tested the differences between the active and placebo arms using a two-sided Wilcoxon test at alpha = 5%. |
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Statistical analysis title |
CSL312 vs Placebo | |||||||||||||||||||||
Statistical analysis description |
First 3-months of treatment
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Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [9] | |||||||||||||||||||||
P-value |
< 0.001 [10] | |||||||||||||||||||||
Method |
Two-sided Wilcoxon test | |||||||||||||||||||||
Confidence interval |
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Notes [9] - Test for differences [10] - Tested the differences between the active and placebo arms using a two-sided Wilcoxon test at alpha = 5%. |
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Statistical analysis title |
CSL312 vs Placebo | |||||||||||||||||||||
Statistical analysis description |
Second 3-months of treatment
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Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [11] | |||||||||||||||||||||
P-value |
< 0.001 [12] | |||||||||||||||||||||
Method |
Two-sided Wilcoxon test | |||||||||||||||||||||
Confidence interval |
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Notes [11] - Test for differences [12] - Tested the differences between the active and placebo arms using a two-sided Wilcoxon test at alpha = 5%. |
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End point title |
Time-Normalised Number of Moderate or Severe HAE Attacks per Month | |||||||||||||||||||||
End point description |
Time-normalised number of moderate or severe HAE attacks per month during treatment period was calculated per subject as: [number of moderate or severe HAE attacks / length of subject treatment in days] * 30.4375. ITT analysis set included all the randomised subjects who provided written informed consent and underwent study screening procedures. 'Number of subjects analysed’ indicates the number of subjects with data available for endpoint analysis. ‘Number analysed (n)’ indicates the number of subjects with data available for analysis at the specified time point.
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End point type |
Secondary
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End point timeframe |
6 months, first 3-months and second 3-months of treatment period
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Notes [13] - Overall Number of Units Analysed: 63 total number of HAE attacks [14] - Overall Number of Units Analysed: 264 total number of HAE attacks |
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Statistical analysis title |
CSL312 vs Placebo | |||||||||||||||||||||
Statistical analysis description |
6 Months of treatment
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Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [15] | |||||||||||||||||||||
P-value |
< 0.001 [16] | |||||||||||||||||||||
Method |
Two-sided Wilcoxon test | |||||||||||||||||||||
Confidence interval |
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Notes [15] - Test for differences [16] - Tested the differences between the active and placebo arms using a two-sided Wilcoxon test at alpha = 5%. |
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Statistical analysis title |
CSL312 vs Placebo | |||||||||||||||||||||
Statistical analysis description |
First 3-months of treatment
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Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [17] | |||||||||||||||||||||
P-value |
< 0.001 [18] | |||||||||||||||||||||
Method |
Two-sided Wilcoxon test | |||||||||||||||||||||
Confidence interval |
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Notes [17] - Test for differences [18] - Tested the differences between the active and placebo arms using a two-sided Wilcoxon test at alpha = 5%. |
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Statistical analysis title |
CSL312 vs Placebo | |||||||||||||||||||||
Statistical analysis description |
Second 3-months of treatment
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Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [19] | |||||||||||||||||||||
P-value |
< 0.001 [20] | |||||||||||||||||||||
Method |
Two-sided Wilcoxon test | |||||||||||||||||||||
Confidence interval |
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Notes [19] - Test for differences [20] - Tested the differences between the active and placebo arms using a two-sided Wilcoxon test at alpha = 5% |
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End point title |
Time-Normalised Number of HAE Attacks per Month in the First 3-months and Second 3-months of Treatment Period | ||||||||||||||||||
End point description |
Time-normalised number of HAE attacks per month during treatment was calculated per subject as: [number of HAE attacks / length of subject treatment in days] * 30.4375. ITT analysis set included all the randomised subjects who provided written informed consent and underwent study screening procedures. 'Number of subjects analysed’ indicates the number of subjects with data available for endpoint analysis. ‘Number analysed (n)’ indicates the number of subjects with data available for analysis at the specified time point.
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End point type |
Secondary
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End point timeframe |
First 3-months and second 3-months of treatment period
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Statistical analysis title |
CSL312 vs Placebo | ||||||||||||||||||
Statistical analysis description |
First 3-months of treatment
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Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [21] | ||||||||||||||||||
P-value |
< 0.001 [22] | ||||||||||||||||||
Method |
Two-sided Wilcoxon test | ||||||||||||||||||
Confidence interval |
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Notes [21] - Test for differences [22] - Tested the differences between the active and placebo arms using a two-sided Wilcoxon test at alpha = 5%. |
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Statistical analysis title |
CSL312 vs Placebo | ||||||||||||||||||
Statistical analysis description |
Second 3-months of treatment
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Comparison groups |
CSL312 v Placebo
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Number of subjects included in analysis |
63
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Analysis specification |
Pre-specified
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Analysis type |
other [23] | ||||||||||||||||||
P-value |
< 0.001 [24] | ||||||||||||||||||
Method |
Two-sided Wilcoxon test | ||||||||||||||||||
Confidence interval |
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Notes [23] - Test for differences [24] - Tested the differences between the active and placebo arms using a two-sided Wilcoxon test at alpha = 5%. |
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End point title |
Relative Difference in Means in the Time-Normalised Number of HAE Attacks per Month Between CSL312 to Placebo | ||||||||||||||
End point description |
Relative difference in means in time-normalised number of HAE attacks/month CSL312 to Placebo was calculated as: 100*[(mean time-normalised number of HAE attacks for CSL312 – mean time-normalised number of HAE attacks for placebo) / mean time-normalised number of HAE attacks for placebo]. Time-normalised number of HAE attacks/month during treatment was calculated per subject as:[number of HAE attacks /subject treatment length(days)]*30.4375. ITT analysis set included all the randomised subjects who provided written informed consent and underwent study screening procedures. 'Number of subjects analysed’= number of subjects with data available for endpoint analysis.'n'=number of subjects with data available for analysis at specified time point. As pre-specified in protocol and SAP, data was reported for subjects between CSL312 and Placebo comparison group.
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End point type |
Secondary
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End point timeframe |
6 months, first 3-months and second 3-months of treatment period
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Attachments |
Relative Difference in Means in the Time-Normalise |
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No statistical analyses for this end point |
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End point title |
Percentage of Subjects With a Response to Subject’s Global Assessment of Response to Therapy (SGART) | |||||||||||||||||||||||||||
End point description |
SGART is a self-assessment by the subject and measures the subject’s overall treatment response to the investigational product using the following ratings: 0 (none: worse or no response at all, not acceptable), 1 (poor: very little response, not acceptable), 2 (fair: some response, acceptable but could be better), 3 (good: good response, acceptable), and 4 (excellent: excellent response, as good as can be imagined). ITT analysis set included all the randomised subjects who provided written informed consent and underwent study screening procedures. ‘Number of subjects analysed’ indicates the number of subjects with data available for endpoint analysis.
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End point type |
Secondary
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End point timeframe |
Up to 6 months
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No statistical analyses for this end point |
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End point title |
Number of Subjects With at Least One Adverse Event (AE), Serious Adverse Event (SAE), and AEs of Special Interest (AESI) | ||||||||||||||||||
End point description |
AE is any untoward medical occurrence in a subject administered with an investigational product which does not necessarily have a causal relationship with treatment, can be any unfavorable and unintended sign, symptom, or disease temporally associated with use of an investigational product, whether or not considered related to product. SAE is any untoward medical occurrence that results in death, is life-threatening, requires in-patient hospitalization or prolongation of existing hospitalization, is a congenital anomaly or birth defect, or is a medically significant event. An AESI is an AE of scientific and medical concern specific to sponsor’s product or program, for which ongoing monitoring and rapid communication by investigator to sponsor is appropriate. Safety analysis set included all the randomised subjects who provided written informed consent, underwent study screening procedures and received at least 1 dose of the investigational product.
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End point type |
Secondary
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End point timeframe |
From first dose of study drug up to 3 months after the last injection (approximately 8 months)
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No statistical analyses for this end point |
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End point title |
Number of Subjects With CSL312-induced Anti-CSL312 Antibodies | |||||||||
End point description |
Safety analysis set included all the randomised subjects who provided written informed consent, underwent study screening procedures and received at least 1 dose of the investigational product.
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End point type |
Secondary
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End point timeframe |
Up to 8 months
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No statistical analyses for this end point |
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End point title |
Number of Subjects With Clinically Significant Abnormalities in Laboratory Assessments Reported as Treatment Emergent Adverse Events (TEAEs) | |||||||||
End point description |
Laboratory assessments included: Hematology, biochemistry, urinalysis, and coagulation parameters. Safety analysis set included all the randomised subjects who provided written informed consent, underwent study screening procedures and received at least 1 dose of the investigational product.
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End point type |
Secondary
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End point timeframe |
From first dose of study drug up to 3 months after the last injection (approximately 8 months)
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No statistical analyses for this end point |
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End point title |
Percentage of Subjects With at Least One AE, SAE, and AESI | |||||||||||||||||||||
End point description |
AE is any untoward medical occurrence in a subject administered with an investigational product which does not necessarily have a causal relationship with treatment, can be any unfavorable and unintended sign, symptom, or disease temporally associated with use of an investigational product, whether or not considered related to product. SAE is any untoward medical occurrence that results in death, is life-threatening, requires in-patient hospitalization or prolongation of existing hospitalization, is a congenital anomaly or birth defect, or is a medically significant event. An AESI is an AE of scientific and medical concern specific to sponsor’s product or program, for which ongoing monitoring and rapid communication by investigator to sponsor is appropriate. Safety analysis set included all the randomised subjects who provided written informed consent, underwent study screening procedures and received at least 1 dose of the investigational product.
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End point type |
Secondary
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End point timeframe |
From first dose of study drug up to 3 months after the last injection (approximately 8 months)
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No statistical analyses for this end point |
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End point title |
Percentage of Subjects With CSL312-induced Anti-CSL312 Antibodies | ||||||||||||
End point description |
Safety analysis set included all the randomised subjects who provided written informed consent, underwent study screening procedures and received at least 1 dose of the investigational product.
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End point type |
Secondary
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End point timeframe |
Up to 6 months
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No statistical analyses for this end point |
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End point title |
Percentage of Subjects With Clinically Significant Abnormalities in Laboratory Assessments Reported as TEAEs | ||||||||||||
End point description |
Laboratory assessments included: Hematology, biochemistry, urinalysis, and coagulation parameters. Safety analysis set included all the randomised subjects who provided written informed consent, underwent study screening procedures and received at least 1 dose of the investigational product.
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End point type |
Secondary
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End point timeframe |
From first dose of study drug up to 3 months after the last injection (approximately 8 months)
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
From first dose of study drug up to 3 months after the last injection (approximately 8 months)
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Adverse event reporting additional description |
Safety analysis set included all the randomised subjects who provided written informed consent, underwent study screening procedures and received at least 1 dose of the investigational product.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
25.0
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Reporting groups
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Reporting group title |
CSL312
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Reporting group description |
Subjects received a CSL312 loading dose of 400 mg as two 200 mg SC injections in Month 1 along with CSL312 of 200 mg SC injections, once monthly from Months 2 to 6. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
Subjects received a CSL312 matched loading dose of placebo as two SC injections in Month 1 along with CSL312 matched placebo SC injections, once monthly from Months 2 to 6. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? No | |||
Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |