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    Clinical Trial Results:
    A Randomized, Double-Blind, Placebo-Controlled, Phase 2 Trial to Evaluate the Efficacy and Safety of Three Dose Levels of KVD824, an Oral Plasma Kallikrein Inhibitor, for Long-Term Prophylactic Treatment of Hereditary Angioedema Type I or II

    Summary
    EudraCT number
    2021-000136-59
    Trial protocol
    HU   DE   IT   CZ   BG  
    Global end of trial date
    27 Oct 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    29 Sep 2023
    First version publication date
    29 Sep 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    KVD824-201
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    IND number: 152196
    Sponsors
    Sponsor organisation name
    KalVista Pharmaceuticals Ltd.
    Sponsor organisation address
    Porton Science Park, Bybrook Road, Porton Down, Salisbury, United Kingdom, SP4 0BF
    Public contact
    KalVista Clinical, KalVista Pharmaceuticals Ltd., +44 1980619368, clinical@kalvista.com
    Scientific contact
    KalVista Clinical, KalVista Pharmaceuticals Ltd., +44 1980619368, clinical@kalvista.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    01 Jun 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    27 Oct 2022
    Global end of trial reached?
    Yes
    Global end of trial date
    27 Oct 2022
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To demonstrate the clinical efficacy of prophylactic treatment with KVD824 compared with placebo in preventing hereditary angioedema (HAE) attacks.
    Protection of trial subjects
    The procedures in the clinical trial protocol were designed to ensure that the sponsor and the investigator abided by the principles of the ICH guidelines on GCP E6 (R2), applicable local regulatory requirements, and the Declaration of Helsinki. The clinical trial also followed national and local legal requirements. Informed consent was obtained from the subjects according to the regulatory and legal requirements of the participating country. The investigator was not to undertake any investigation specifically required for the clinical trial until valid consent had been obtained.
    Background therapy
    Conventional care including on-demand treatment for an HAE attack.
    Evidence for comparator
    Placebo was used as a comparator.
    Actual start date of recruitment
    06 Aug 2021
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    North Macedonia: 2
    Country: Number of subjects enrolled
    United States: 10
    Country: Number of subjects enrolled
    United Kingdom: 2
    Country: Number of subjects enrolled
    Australia: 2
    Country: Number of subjects enrolled
    Bulgaria: 1
    Country: Number of subjects enrolled
    Czechia: 4
    Country: Number of subjects enrolled
    France: 2
    Country: Number of subjects enrolled
    Germany: 3
    Country: Number of subjects enrolled
    Hungary: 2
    Country: Number of subjects enrolled
    Italy: 5
    Worldwide total number of subjects
    33
    EEA total number of subjects
    17
    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)
    29
    From 65 to 84 years
    4
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    A sample size of 48 subjects was chosen to evaluate a clinically relevant treatment effect between KVD824 and placebo groups. 33 subjects were randomly assigned to receive the IMP.

    Pre-assignment
    Screening details
    The screening period included the screening visit and run-in period. After screening, subjects entered into a run-in period of up to 8 weeks in duration. The start of the run-in period was determined by the type of HAE therapy being used by the subject at the time of screening.

    Period 1
    Period 1 title
    Treatment period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator
    Blinding implementation details
    Subjects, investigators, and site personnel were not blinded to the number of tablets a subject was assigned (1, 2, or 3 tablets) but were blinded to the treatment administered until the trial was complete and the database was locked.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    300 mg KVD824 BID
    Arm description
    Subjects received 300 mg KVD824 (1 × 300 mg tablet) BID.
    Arm type
    Experimental

    Investigational medicinal product name
    KVD824
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Modified-release tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received 1 × 300 mg tablet KVD824 (TDD of 600 mg). Tablets were to be swallowed whole; tablets were not to be crushed or modified in any way.

    Arm title
    600 mg KVD824 BID
    Arm description
    Subjects received 600 mg KVD824 (2 × 300 mg tablet) BID.
    Arm type
    Experimental

    Investigational medicinal product name
    KVD824
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Modified-release tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received 2 × 300 mg tablet KVD824 (TDD of 1200 mg). Tablets were to be swallowed whole; tablets were not to be crushed or modified in any way.

    Arm title
    900 mg KVD824 BID
    Arm description
    Subjects received 900 mg KVD824 (3 × 300 mg tablet) BID.
    Arm type
    Experimental

    Investigational medicinal product name
    KVD824
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Modified-release tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received 3 × 300 mg tablet KVD824 (TDD of 1800 mg). Tablets were to be swallowed whole; tablets were not to be crushed or modified in any way.

    Arm title
    Placebo BID
    Arm description
    The placebo group received either 1, 2, or 3 IP matching placebo tablets.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Modified-release tablet
    Routes of administration
    Oral use
    Dosage and administration details
    The placebo group received either 1, 2, or 3 placebo tablets to be consumed BID. Tablets were to be swallowed whole; tablets were not to be crushed or modified in any way.

    Number of subjects in period 1 [1]
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID
    Started
    7
    8
    7
    7
    Completed
    5
    4
    4
    2
    Not completed
    2
    4
    3
    5
         Consent withdrawn by subject
    -
    -
    -
    2
         Adverse event, non-fatal
    -
    2
    2
    1
         Trial termination by sponsor
    2
    2
    1
    2
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: 33 subjects were assigned to receive treatment. 29 subjects received treatment and are included in safety and efficacy analysis sets.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    300 mg KVD824 BID
    Reporting group description
    Subjects received 300 mg KVD824 (1 × 300 mg tablet) BID.

    Reporting group title
    600 mg KVD824 BID
    Reporting group description
    Subjects received 600 mg KVD824 (2 × 300 mg tablet) BID.

    Reporting group title
    900 mg KVD824 BID
    Reporting group description
    Subjects received 900 mg KVD824 (3 × 300 mg tablet) BID.

    Reporting group title
    Placebo BID
    Reporting group description
    The placebo group received either 1, 2, or 3 IP matching placebo tablets.

    Reporting group values
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID Total
    Number of subjects
    7 8 7 7 29
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    5 8 6 7 26
        From 65-84 years
    2 0 1 0 3
    Age continuous
    Units: years
        median (full range (min-max))
    46.0 (25 to 74) 44.0 (23 to 61) 35.0 (25 to 66) 53.0 (26 to 57) -
    Gender categorical
    Units: Subjects
        Female
    6 4 3 3 16
        Male
    1 4 4 4 13
    Subject analysis sets

    Subject analysis set title
    SAF
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The SAF (Safety Analysis Set) included all subjects who were randomized and received at least one dose of IMP. Subjects were analyzed according to the actual treatment received.

    Subject analysis set title
    FAS
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS (Full Analysis Set) included all subjects who were randomized and received at least one dose of IMP. Subjects were analyzed according to randomized treatment. The FAS population was the population for efficacy analyses.

    Subject analysis set title
    PPS
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The PPS (Per-Protocol Set) included all subjects from the FAS who completed at least 28 days of dosing and who did not have predefined major protocol deviations that might have affected the primary efficacy endpoint.

    Subject analysis set title
    Randomized Set
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Randomized Set included all subjects who are randomized.

    Subject analysis sets values
    SAF FAS PPS Randomized Set
    Number of subjects
    29
    29
    23
    33
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    26
    26
        From 65-84 years
    3
    3
    Age continuous
    Units: years
        median (full range (min-max))
    47.0 (23 to 74)
    47.0 (23 to 74)
    Gender categorical
    Units: Subjects
        Female
    16
    16
        Male
    13
    13

    End points

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    End points reporting groups
    Reporting group title
    300 mg KVD824 BID
    Reporting group description
    Subjects received 300 mg KVD824 (1 × 300 mg tablet) BID.

    Reporting group title
    600 mg KVD824 BID
    Reporting group description
    Subjects received 600 mg KVD824 (2 × 300 mg tablet) BID.

    Reporting group title
    900 mg KVD824 BID
    Reporting group description
    Subjects received 900 mg KVD824 (3 × 300 mg tablet) BID.

    Reporting group title
    Placebo BID
    Reporting group description
    The placebo group received either 1, 2, or 3 IP matching placebo tablets.

    Subject analysis set title
    SAF
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The SAF (Safety Analysis Set) included all subjects who were randomized and received at least one dose of IMP. Subjects were analyzed according to the actual treatment received.

    Subject analysis set title
    FAS
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS (Full Analysis Set) included all subjects who were randomized and received at least one dose of IMP. Subjects were analyzed according to randomized treatment. The FAS population was the population for efficacy analyses.

    Subject analysis set title
    PPS
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The PPS (Per-Protocol Set) included all subjects from the FAS who completed at least 28 days of dosing and who did not have predefined major protocol deviations that might have affected the primary efficacy endpoint.

    Subject analysis set title
    Randomized Set
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Randomized Set included all subjects who are randomized.

    Primary: Rate of investigator-confirmed HAE attacks during the treatment period

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    End point title
    Rate of investigator-confirmed HAE attacks during the treatment period
    End point description
    Negative binomial regression on investigator-confirmed HAE attacks while on treatment (FAS) were evaluated. The primary efficacy results should be interpreted with caution acknowledging that an insufficient number of subjects were randomized to achieve adequate power to detect treatment effects between KVD824 and placebo groups.
    End point type
    Primary
    End point timeframe
    During treatment period
    End point values
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID
    Number of subjects analysed
    7
    8
    7
    7
    Units: HAE attacks
    number (confidence interval 95%)
        Estimated HAE attack rate per 4 weeks
    1.476 (0.786 to 2.774)
    1.072 (0.534 to 2.152)
    1.566 (0.814 to 3.012)
    2.380 (1.282 to 4.418)
    Statistical analysis title
    Statistical analysis 300 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 300 mg KVD824 BID had Bonferroni multiplicity adjustment for multiple dose levels, therefore pairwise comparison tests were 2-sided with an alpha of 0.0167. The p-values, rates, and rate ratios (95% CI) were from a negative binomial regression model including treatment as a fixed factor, run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable, and the logarithm of time each subject was observed ‘while on treatment’ as an offset.
    Comparison groups
    300 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.2862
    Method
    Negative binomial regression model
    Parameter type
    HAE rate ratio (Active vs. Placebo)
    Point estimate
    0.62
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.258
         upper limit
    1.492
    Statistical analysis title
    Statistical analysis 600 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 600 mg KVD824 BID had Bonferroni multiplicity adjustment for multiple dose levels, therefore pairwise comparison tests were 2-sided with an alpha of 0.0167. The p-values, rates, and rate ratios (95% CI) were from a negative binomial regression model including treatment as a fixed factor, run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable, and the logarithm of time each subject was observed ‘while on treatment’ as an offset.
    Comparison groups
    Placebo BID v 600 mg KVD824 BID
    Number of subjects included in analysis
    15
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0918
    Method
    Negative binomial regression model
    Parameter type
    HAE rate ratio (Active vs. Placebo)
    Point estimate
    0.45
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.178
         upper limit
    1.138
    Statistical analysis title
    Statistical analysis 900 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 900 mg KVD824 BID had Bonferroni multiplicity adjustment for multiple dose levels, therefore pairwise comparison tests were 2-sided with an alpha of 0.0167. The p-values, rates, and rate ratios (95% CI) were from a negative binomial regression model including treatment as a fixed factor, run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable, and the logarithm of time each subject was observed ‘while on treatment’ as an offset.
    Comparison groups
    Placebo BID v 900 mg KVD824 BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.3685
    Method
    Negative binomial regression model
    Parameter type
    HAE rate ratio (Active vs. Placebo)
    Point estimate
    0.658
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.264
         upper limit
    1.639

    Secondary: Proportion of subjects without investigator-confirmed HAE attacks during the treatment period

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    End point title
    Proportion of subjects without investigator-confirmed HAE attacks during the treatment period
    End point description
    Logistic regression on subjects were measured without investigator-confirmed HAE Attacks (FAS).
    End point type
    Secondary
    End point timeframe
    During treatment period
    End point values
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID
    Number of subjects analysed
    7
    8
    7
    7
    Units: Participants
        Subjects without HAE attack, n
    1
    2
    3
    1
    Statistical analysis title
    Statistical analysis 300 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 300 mg KVD824 BID vs. Placebo was from a logistic regression model including treatment as a fixed effect and run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable.
    Comparison groups
    Placebo BID v 300 mg KVD824 BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.9798
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.04
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.07
         upper limit
    15.6
    Statistical analysis title
    Statistical analysis 600 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 600 mg KVD824 BID vs. Placebo was from a logistic regression model including treatment as a fixed effect and run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable.
    Comparison groups
    600 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    15
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.8112
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.36
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.11
         upper limit
    17.2
    Statistical analysis title
    Statistical analysis 900 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 900 mg KVD824 BID vs. Placebo was from a logistic regression model including treatment as a fixed effect and run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable.
    Comparison groups
    900 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.3683
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    3.09
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.26
         upper limit
    36.1

    Secondary: Rate of investigator-confirmed HAE attacks that require conventional treatment during the Treatment Period

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    End point title
    Rate of investigator-confirmed HAE attacks that require conventional treatment during the Treatment Period
    End point description
    A summary of negative binomial regression on investigator-confirmed HAE attacks with conventional treatment is presented for the FAS.
    End point type
    Secondary
    End point timeframe
    During treatment period
    End point values
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID
    Number of subjects analysed
    7
    8
    7
    7
    Units: HAE Attacks rate ratio
    number (confidence interval 95%)
        Estimated HAE attack rate per 4 weeks
    1.003 (0.461 to 2.183)
    1.093 (0.485 to 2.464)
    1.229 (0.554 to 2.728)
    1.635 (0.754 to 3.548)
    Statistical analysis title
    Statistical analysis 300 mg KVD824 BID
    Statistical analysis description
    Statistical tests were considered exploratory. No multiplicity adjustments were made. The P values were 2-sided with alpha of 0.05. The P values, rates, and rate ratios (95% CI) were from a negative binomial regression model including treatment as a fixed factor, run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable, and the logarithm of time each subject was observed ‘while on treatment’ as an offset.
    Comparison groups
    300 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.3833
    Method
    Negative binomial regression model
    Parameter type
    HAE rate ratio (Active vs. Placebo)
    Point estimate
    0.613
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.204
         upper limit
    1.84
    Statistical analysis title
    Statistical analysis 600 mg KVD824 BID
    Statistical analysis description
    Statistical tests were considered exploratory. No multiplicity adjustments were made. The P values were 2-sided with alpha of 0.05. The P values, rates, and rate ratios (95% CI) were from a negative binomial regression model including treatment as a fixed factor, run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable, and the logarithm of time each subject was observed ‘while on treatment’ as an offset.
    Comparison groups
    Placebo BID v 600 mg KVD824 BID
    Number of subjects included in analysis
    15
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.4819
    Method
    Negative binomial regression model
    Parameter type
    HAE rate ratio (Active vs. Placebo)
    Point estimate
    0.668
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.217
         upper limit
    2.055
    Statistical analysis title
    Statistical analysis 900 mg KVD824 BID
    Statistical analysis description
    Statistical tests were considered exploratory. No multiplicity adjustments were made. The P values were 2-sided with alpha of 0.05. The P values, rates, and rate ratios (95% CI) were from a negative binomial regression model including treatment as a fixed factor, run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable, and the logarithm of time each subject was observed ‘while on treatment’ as an offset.
    Comparison groups
    Placebo BID v 900 mg KVD824 BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.6147
    Method
    Negative binomial regression model
    Parameter type
    HAE rate ratio (Active vs. Placebo)
    Point estimate
    0.752
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.248
         upper limit
    2.282

    Secondary: AE-QoL Questionnaire total score and domain scores during the treatment period

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    End point title
    AE-QoL Questionnaire total score and domain scores during the treatment period
    End point description
    Angioedema Quality of Life (AE-QoL) Total Score and domain scores was measured during treatment period.
    End point type
    Secondary
    End point timeframe
    During treatment period
    End point values
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID
    Number of subjects analysed
    7
    8
    7
    7
    Units: Participants
        QoL Functioning Domain Score
    7
    6
    6
    4
        QoL Fatigue Domain Score
    7
    6
    6
    4
        QoL Fear Domain Score
    7
    6
    6
    4
        QoL Nutrition Domain Score
    7
    6
    6
    4
        QoL Total Score
    7
    6
    6
    4
    Statistical analysis title
    Statistical analysis 300 mg KVD824 BID
    Statistical analysis description
    Statistical analysis for QoL Total Score, 300 mg KVD824 BID, were from ANCOVA model with change from baseline to the end of treatment visit as dependent variable, treatment group as main effect, run-in period investigator-confirmed HAE attack rate per 4 weeks and baseline value as covariates.
    Comparison groups
    300 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7676
    Method
    ANCOVA
    Parameter type
    LS means difference from placebo
    Point estimate
    3.11
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -18.74
         upper limit
    24.96
    Statistical analysis title
    Statistical analysis 600 mg KVD824 BID
    Statistical analysis description
    Statistical analysis for QoL Total Score, 600 mg KVD824 BID, were from ANCOVA model with change from baseline to the end of treatment visit as dependent variable, treatment group as main effect, run-in period investigator-confirmed HAE attack rate per 4 weeks and baseline value as covariates.
    Comparison groups
    600 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    15
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.4367
    Method
    ANCOVA
    Parameter type
    LS means difference from placebo
    Point estimate
    -8.38
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -30.59
         upper limit
    13.82
    Statistical analysis title
    Statistical analysis 900 mg KVD824 BID
    Statistical analysis description
    Statistical analysis for QoL Total Score, 900 mg KVD824 BID, were from ANCOVA model with change from baseline to the end of treatment visit as dependent variable, treatment group as main effect, run-in period investigator-confirmed HAE attack rate per 4 weeks and baseline value as covariates.
    Comparison groups
    900 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.73
    Method
    ANCOVA
    Parameter type
    LS means difference from placebo
    Point estimate
    3.67
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -18.42
         upper limit
    25.77

    Secondary: AECT score during the treatment period

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    End point title
    AECT score during the treatment period
    End point description
    A summary of observed values and change from baseline in AECT total score was measured for the FAS. The higher AECT scores indicate a higher level of angioedema control.
    End point type
    Secondary
    End point timeframe
    From baseline to EOT visit
    End point values
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID
    Number of subjects analysed
    7
    8
    7
    7
    Units: Participants
        AECT total score change from baseline to EOT visit
    7
    6
    6
    4
    Statistical analysis title
    Statistical analysis 300 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 300 mg KVD824 BID was from ANCOVA model with change from baseline to the end of treatment visit as dependant variable, treatment group as main effect, run-in period investigator-confirmed HAE attack rate per 4 weeks and baseline value as covariates.
    Comparison groups
    300 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.6224
    Method
    ANCOVA
    Parameter type
    LS means difference from placebo
    Point estimate
    1.48
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -4.73
         upper limit
    7.69
    Statistical analysis title
    Statistical analysis 600 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 600 mg KVD824 BID was from ANCOVA model with change from baseline to the end of treatment visit as dependant variable, treatment group as main effect, run-in period investigator-confirmed HAE attack rate per 4 weeks and baseline value as covariates.
    Comparison groups
    600 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    15
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.2506
    Method
    ANCOVA
    Parameter type
    LS means difference from placebo
    Point estimate
    3.7
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.86
         upper limit
    10.27
    Statistical analysis title
    Statistical analysis 900 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 900 mg KVD824 BID was from ANCOVA model with change from baseline to the end of treatment visit as dependant variable, treatment group as main effect, run-in period investigator-confirmed HAE attack rate per 4 weeks and baseline value as covariates.
    Comparison groups
    900 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.9969
    Method
    ANCOVA
    Parameter type
    LS means difference from placebo
    Point estimate
    0.01
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -6.44
         upper limit
    6.47

    Secondary: Proportion of subjects with an AECT score ≥12 at the end of the treatment period

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    End point title
    Proportion of subjects with an AECT score ≥12 at the end of the treatment period
    End point description
    Summary of Logistic Regression on proportion of subjects with AECT Score ≥12 was measured at the End of the Treatment Period (FAS).
    End point type
    Secondary
    End point timeframe
    At the End of the Treatment Period (FAS)
    End point values
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID
    Number of subjects analysed
    7
    8
    7
    7
    Units: Subjects with AECT score ≥12, n (%)
        Yes
    4
    5
    2
    1
        No
    3
    1
    4
    3
        Missing
    0
    2
    1
    3
    Statistical analysis title
    Statistical analysis 300 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 300 mg KVD824 BID were from a logistic regression model including treatment as a fixed effect and run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable.
    Comparison groups
    300 mg KVD824 BID v Placebo BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.3171
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.3
         upper limit
    60.3
    Statistical analysis title
    Statistical analysis 600 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 600 mg KVD824 BID were from a logistic regression model including treatment as a fixed effect and run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable.
    Comparison groups
    Placebo BID v 600 mg KVD824 BID
    Number of subjects included in analysis
    15
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0891
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    15
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.7
         upper limit
    339.4
    Statistical analysis title
    Statistical analysis 900 mg KVD824 BID
    Statistical analysis description
    Statistical analysis 900 mg KVD824 BID were from a logistic regression model including treatment as a fixed effect and run-in period investigator-confirmed HAE attack rate per 4 weeks as an adjustment variable.
    Comparison groups
    Placebo BID v 900 mg KVD824 BID
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7726
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.1
         upper limit
    26

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Safety analyses were performed by treatment group using the SAF and were presented during treatment period.
    Adverse event reporting additional description
    TEAEs in most subjects were mild or moderate in severity. There were no deaths reported in the trial. The trial was terminated due to blinded observation of significant liver enzyme elevations in multiple subjects across dosing groups in the trial.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.1
    Reporting groups
    Reporting group title
    300 mg KVD824 BID
    Reporting group description
    Subjects received 300 mg KVD824 (1 × 300 mg tablet) BID.

    Reporting group title
    600 mg KVD824 BID
    Reporting group description
    Subjects received 600 mg KVD824 (2 × 300 mg tablet) BID.

    Reporting group title
    900 mg KVD824 BID
    Reporting group description
    Subjects received 900 mg KVD824 (3 × 300 mg tablet) BID.

    Reporting group title
    Placebo BID
    Reporting group description
    The placebo group received either 1, 2, or 3 IP matching placebo tablets.

    Serious adverse events
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 7 (14.29%)
    1 / 8 (12.50%)
    2 / 7 (28.57%)
    0 / 7 (0.00%)
         number of deaths (all causes)
    0
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Hepatic neoplasm
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Hepatic steatosis
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Hepatitis acute
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Laryngeal oedema
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    300 mg KVD824 BID 600 mg KVD824 BID 900 mg KVD824 BID Placebo BID
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    5 / 7 (71.43%)
    6 / 8 (75.00%)
    6 / 7 (85.71%)
    1 / 7 (14.29%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Hepatic neoplasm
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    0
    1
    0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Fatigue
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Reproductive system and breast disorders
    Menstruation irregular
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    0
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Laryngeal oedema
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Psychiatric disorders
    Mixed anxiety and depressive disorder
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    1 / 7 (14.29%)
         occurrences all number
    0
    0
    0
    1
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 7 (14.29%)
    1 / 8 (12.50%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    1
    1
    1
    0
    Aspartate aminotransferase increased
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    0
    1
    0
    Hepatic enzyme increased
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    0
    1
    0
    Liver function test abnormal
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Liver function test increased
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    0
    1
    0
    Weight decreased
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Weight increased
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Injury, poisoning and procedural complications
    Contusion
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Fall
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Rib fracture
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Skin laceration
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    0 / 7 (0.00%)
    2 / 8 (25.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    2
    0
    0
    Eye disorders
    Vision blurred
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    0
    1
    0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    1
    0
    Hepatobiliary disorders
    Hepatic steatosis
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    1
    0
    Cholelithiasis
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Hepatic cytolysis
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Hepatitis acute
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    0
    1
    0
    Skin and subcutaneous tissue disorders
    Dermatitis
         subjects affected / exposed
    0 / 7 (0.00%)
    0 / 8 (0.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    0
    0
    1
    0
    Ecchymosis
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Hyperkeratosis
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Pruritus
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Skin odour abnormal
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Renal and urinary disorders
    Urine odour abnormal
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Musculoskeletal and connective tissue disorders
    Costochondritis
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Myalgia
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Infections and infestations
    COVID-19
         subjects affected / exposed
    1 / 7 (14.29%)
    2 / 8 (25.00%)
    1 / 7 (14.29%)
    0 / 7 (0.00%)
         occurrences all number
    1
    2
    1
    0
    Gastroenteritis
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Pharyngitis
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Pulpitis dental
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Tonsillitis
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Viral infection
         subjects affected / exposed
    1 / 7 (14.29%)
    0 / 8 (0.00%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    1
    0
    0
    0
    Viral upper respiratory track infection
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0
    Metabolism and nutrition disorders
    Dyslipidaemia
         subjects affected / exposed
    0 / 7 (0.00%)
    1 / 8 (12.50%)
    0 / 7 (0.00%)
    0 / 7 (0.00%)
         occurrences all number
    0
    1
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    16 Feb 2021
    Protocol Version 2.0: • Removed the subject assessment of attack trigger. • Added subject assessment of attack severity. • Clarified that the investigator (or qualified designee) would rate the severity of each attack rather than site staff and removed definitions for the severity ratings. • Provided contact information for Pharmacovigilance for SAE reporting and added that pregnancies would be reported using the pregnancy reporting form using this contact information.
    29 Mar 2021
    Protocol Version 3.0: • Clarified that subjects were allowed to receive the COVID-19 vaccination before, during, or after participation in the trial. • Extended number of days permitted between completing the run-in period and the randomization visit from 7 days to 10 days and allowed randomization to occur prior to the randomization visit if the site was dispensing the IMP during the in-clinic randomization visit. • Clarified in exclusion criterion 11 that ongoing participation in an investigational COVID-19 vaccine trial was not allowed within 4 weeks of screening. • Allowed for IMP to be dispensed at the trial site instead of direct shipment to subjects required by local regulations or per the site’s local practice. • Provided fax numbers for reporting SAEs. • Removed requirement that subjects had to make reasonable efforts to store IMP at a specific temperature range as IMP was to be stored at room temperature and storage requirements were provided on the label per local regulations. • Clarified that investigators should make every effort possible to follow-up and document the course and outcome of all infants up to 1 year of age born to exposed mothers or born to partners of male subjects. • Clarified when subjects were to begin entering HAE attacks in the eDiary. • Clarified that an investigator must withdraw a subject from the trial if she had a positive pregnancy test during the trial. • Added volume of blood that was to be taken for clinical safety laboratory assessments. • Added clinical safety laboratory hematology tests to match the central laboratory standard panel.
    05 May 2021
    Protocol Version 4.0: • Incorporated the following additional safety criteria: - Subjects with inadequate organ function were excluded from participation in the trial. - Individual and trial stopping criteria were added. • Excluded use of strong CYP3A4 inhibitors and inducers in the absence of a formal drug-drug interaction trial for KVD824. • Clarified the difference between subject’s withdrawal of consent versus subject discontinuation from the trial for other reasons (eg, safety or investigator’s discretion). • Clarified that any relevant diseases occurring between the screening visit and the first dose of IMP were to be captured as medical history. • Clarified that clinically significant laboratory abnormalities, as determined by the treating investigator, were to be recorded as AEs after the start of KVD824 dosing.
    31 Mar 2022
    Protocol Version 5.0: • Added the trial name of KOMPLETE. • Added laboratory assessments at Week 4 to assess liver enzymes in conjunction with the update to the trial stopping criteria in Section 14 of the trial protocol. • Updated the name of the Pharmacovigilance vendor and fax numbers for SAE reporting. • Clarified the following inclusion criteria: - Clarified that C1-INH retesting could occur any time prior to randomization. - Clarified that historical C1-INH functional diagnostic test results for a subject could be used to confirm diagnosis of HAE type I or II in lieu of central or local lab testing. • Clarified that IMP was to be stored at room temperature as labeled. • Added procedural details of RTSM unblinding for investigators if unblinding a subject was needed. • Clarified on the timing of androgen washout period. • Incorporated the following trial stopping criteria: - The occurrence in any subject of a life-threatening SAE not related to HAE. - Liver-related AE that met Hy’s Law in more than 1 subject: 1. ALT or AST elevation of >3 × ULN 2. TBL elevation of >2 × ULN 3. Absence of initial findings of cholestasis (ie, absence of elevation of ALP to >2 × ULN) 4. No other reason could be found to explain the combination of increased ALT and TBL, such as viral hepatitis A through E; other preexisting or acute liver disease; or another drug capable of causing the observed injury. - Similar grade 3 or higher AE, excluding liver-related AE, in more than 1 subject. • Removed the sentence of “repeat laboratory assessments may be performed” in Section 15.3.4 of the trial protocol. • Clarified timing for the collection of SAE to start at the time of informed consent and to align with other country requirements. • Removed the sentence of “without baseline attack rate as fixed covariate” in Section 18.7 of the trial protocol to correct typographical error. • Added 2 new references.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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