E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Paroxysmal Nocturnal Hemoglobinuria |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Body processes [G] - Immune system processes [G12] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10034042 |
E.1.2 | Term | Paroxysmal nocturnal haemoglobinuria |
E.1.2 | System Organ Class | 10038359 - Renal and urinary disorders |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
• To determine the efficacy of oral BCX9930 monotherapy administered for 12 weeks, as compared to placebo, in subjects with paroxysmal nocturnal hemoglobinuria (PNH) • To evaluate the long-term safety and tolerability of oral BCX9930 monotherapy administered for up to 52 weeks in subjects with PNH |
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E.2.2 | Secondary objectives of the trial |
• To evaluate the safety and tolerability of BCX9930 monotherapy administered for 12 weeks, as compared to placebo, in subjects with PNH • To characterize the effects of BCX9930 monotherapy administered for 12 weeks, as compared to placebo, using clinical and laboratory measurements, including complement and thrombosis biomarkers, and PNH clone size • To evaluate the effects of BCX9930 monotherapy administered for 12 weeks, as compared to placebo, on FACIT-Fatigue scale and other PROs • To assess the effectiveness of BCX9930 monotherapy administered for up to 52 weeks • To characterize the effects of BCX9930 monotherapy administered for up to 52 weeks using clinical and laboratory measurements, including complement and thrombosis biomarkers, and PNH clone size • To evaluate the effects of BCX9930 monotherapy administered for up to 52 weeks on FACIT-Fatigue scale and other PROs • To characterize BCX9930 plasma concentrations and pharmacokinetic (PK) parameters
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
PK/PD substudy - within the same protocol V2, 27 May 2021 |
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E.3 | Principal inclusion criteria |
1. Male or female, aged 18 - 70 years old at screening. 2. Body weight ≥ 50 kg. 3. Documented diagnosis of PNH confirmed by flow cytometry with a PNH granulocyte or monocyte clone size of ≥ 10% during screening. 4. Are either: (a) naïve to treatment with a complement inhibitor, or (b) have received no treatment with a complement inhibitor for at least 12 months prior to the screening visit. 5. Recorded the following results during screening: a. Hb ≤ 105 g/L (≤ 10.5 g/dL). b. LDH ≥ 2 × upper limit of normal reference range (ULN) c. ARC of ≥ 100 × 109 cells/L (≥ 100,000 cells/µL; ≥ 100 G/L). d. Absolute neutrophil count (ANC) of ≥ 0.75 × 109 cells/L (≥ 750 cells/µL; ≥ 0.75 G/L). e. Platelet count of ≥ 30 × 109/L (≥ 30,000/µL; ≥ 30 G/L). f. Estimated glomerular filtration rate of ≥ 50 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (Levey and Stevens 2010). 6. Contraception requirements: Female participants must meet at least one of the following requirements: a. Be a woman of nonchildbearing potential. b. Be a woman of childbearing potential who agrees to use a highly effective contraceptive method throughout the study and for a duration of 30 days after the last dose of study drug. c. Alternatively, true abstinence is acceptable for women of childbearing potential when it is in line with the subject’s preferred and usual lifestyle. Male participants must meet at least one of the following requirements: a. Males with a female partner of childbearing potential must use condoms throughout the study and for a duration of 90 days after the dose of study drug unless their partner is using a highly effective contraceptive method independent of the study. b. Alternatively, true abstinence is acceptable when it is in line with the subject’s preferred and usual lifestyle 7. Documentation of current vaccinations against Neisseria meningitidis types A, C, W, and Y, and Streptococcus pneumoniae, or willingness to start vaccination series at least 14 days prior to Day 1. 8. In the opinion of the investigator, the subject is expected to adequately comply with all required study procedures and restrictions for the study, including compliance with the BID dosing schedule for BCX9930. 9. Willing and able to provide written informed consent
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E.4 | Principal exclusion criteria |
1. Known history of or existing diagnosis of hereditary complement deficiency. 2. History of hematopoietic cell transplant or solid organ transplant or anticipated candidate for transplantation during the study. 3. Myocardial infarction or cerebrovascular accident within 30 days prior to screening, or current and uncontrolled clinically significant cardiovascular or cerebrovascular condition, including unstable angina, severe congestive heart failure, unexplained syncope, arrhythmia, and critical aortic stenosis. 4. History of malignancy within 5 years prior to the screening visit, with exception of adequately treated non-melanoma skin or superficial bladder cancer, curatively treated carcinoma in situ of the cervix, or other curatively treated solid tumor deemed by the investigator and medical monitor to be at low risk for recurrence. 5. Active bacterial, viral, or fungal infection or any other serious infection within 14 days prior to screening. (Note: Suspected or confirmed coronavirus disease [COVID-19]; persistent or recurrent positive test(s) for severe acute respiratory syndrome coronavirus 2 [SARS CoV 2] nucleic acids or antigens; and worsening of dyspnea not due to PNH, vasculitic rash, and persistent fever or other symptoms consistent with multisystem inflammatory syndrome in adults [MIS A] are exclusionary.) 6. Current participation in any other investigational drug study or participation in an investigational drug study within 30 days prior to the screening visit, or 5.5 half-lives of the investigational drug, whichever is longer. 7. Treatment with anti-thymocyte globulin within 180 days prior to the screening visit. 8. Initiation of treatment with an erythropoiesis-stimulating agent (eg, erythropoietin), a thrombopoietin receptor agonist (eg, eltrombopag), or danazol within 28 days prior to the screening visit. (Note: Treatment with these medications initiated > 28 days prior to the screening visit is not exclusionary, if the dose is stable and there is a reasonable expectation that treatment will be continued.) 9. Receiving iron with an unstable dose in the 28 days prior to the screening visit. 10. Clinically significant abnormal electrocardiogram (ECG) at the screening visit. (Note: This includes, but is not limited to, a QT interval corrected using Fridericia’s method [QTcF] of > 450 msec in males or > 470 msec in females, or ventricular and/or atrial premature contractions that are more frequent than occasional, and/or as couplets or higher in grouping.) 11. Subjects with any of the following results at the screening visit: a. Alanine aminotransferase (ALT; also serum glutamic-pyruvic transaminase [SGPT]) > 3 × ULN. b. AST (SGOT) > 3 × ULN. (Note: Subjects may be enrolled with AST > 3 × ULN if explained by hemolysis.) c. Total serum bilirubin > 2 × ULN (Note: Subjects may be enrolled with total serum bilirubin > 2 × ULN if explained by hemolysis or Gilbert’s syndrome. In the case of hemolysis, total serum bilirubin must be < 5 × ULN and in the case of Gilbert’s syndrome, total serum bilirubin must be < 11 × ULN.) 12. Current use of a prohibited concomitant medication within 7 days prior to Day 1 13. Positive serology for human immunodeficiency virus, or active infection with hepatitis B virus or hepatitis C virus. 14. Positive drugs of abuse screen, unless by prescription or alcohol dependence, defined as consumption of ≥ 40 g pure alcohol per day for men and ≥ 20 g pure alcohol for women. 15. Pregnant, planning to become pregnant, or breastfeeding. 16. Known or suspected hypersensitivity to BCX9930 or any of its formulation excipients. 17. History of severe hypersensitivity to any medicinal product, which was associated with swelling, severe rash requiring treatment/hospitalization, or anaphylaxis. 18. Any other clinically significant medical or psychiatric condition that, in the opinion of the investigator, would interfere with the subject’s ability to participate in the study or increase the risk of participation for that subject.
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E.5 End points |
E.5.1 | Primary end point(s) |
Part1 • Change from baseline (CFB) in hemoglobin (Hb) Part2 • Number and proportion of subjects with a TEAE • Number and proportion of subjects who discontinue due to a TEAE • Number and proportion of subjects who experience a TESAE • Number and proportion of subjects who experience a CTCAE Grade 3 or Grade 4 TEAE • Number and proportion of subjects who experience a treatment-emergent CTCAE Grade 3 or Grade 4 laboratory abnormality
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Part 1 - Week 12 Part 2 - week 52 |
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E.5.2 | Secondary end point(s) |
Part 1 1. Proportion of subjects who are transfusion-free 2. Number of units of packed red blood cells (pRBCs) transfused 3. Percent CFB in lactate dehydrogenase (LDH) 4. CFB in FACIT-Fatigue scale score Part 2 • CFB in Hb • Proportion of subjects with Hb ≥ 12 g/dL • Proportion of subjects achieving Hb stabilization (avoidance of a > 2 g/dL decrease in the absence of transfusion) • Proportion of subjects who are transfusion-free • Number of units of pRBCs transfused • Percent reduction in rate of pRBCs transfused • Percent CFB in LDH • CFB in ARC • Proportion of subjects with ARC in the normal range • CFB in haptoglobin • Proportion of subjects with haptoglobin ≥ LLN • CFB in total PNH RBC clone size • CFB in total PNH RBC clone size relative to PNH WBC clone size
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Part 1 - Week 12 Part 2 - week 52 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 15 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Albania |
Argentina |
Azerbaijan |
Brazil |
Canada |
China |
Czechia |
Italy |
Lithuania |
Poland |
Romania |
Serbia |
South Africa |
Spain |
Sweden |
Turkey |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 11 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |