E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Adult patients with immune thrombocytopenia (ITP) with mild to severe bleeding manifestations. |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Blood and lymphatic diseases [C15] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10083842 |
E.1.2 | Term | Immune thrombocytopenia |
E.1.2 | System Organ Class | 10005329 - Blood and lymphatic system 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 demonstrate the non-inferiority in term of short-term response of oral dexamethasone given at 40 mg on days 1 to 4 compared to IVIg given at 1g/kg on days 1 and 2 in combination with prednisone (1 mg/kg per day for 3 weeks) in adult patients with immune thrombocytopenia (ITP) with mild to severe bleeding manifestations. |
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E.2.2 | Secondary objectives of the trial |
To compare initial rate of CR in the two arms and the delay to obtain a CR.
To compare the duration of the response in the two arms.
To assess the acceptability/feasibility of the protocol, by comparing the proportion of early treatment switches (before day 5) across arms.
To estimate the interaction between treatment effect and the severity/risk of bleeding.
To compare the initial response on bleeding manifestations in both arms.
To compare the duration of hospital, stay in the two arms.
To compare the efficacy (overall response rate) at Day 28 and 6 months in the two arms.
To compare safety profile in the two arms.
To estimate the incremental (decremental) cost effectiveness of DXM vs IVIg at 6 months given the non-inferiority design our hypothesis is that DMX is cheaper and non-inferior decrementally cost effective compared to IVIg .
To assess whether the presence of anti-platelet antibodies is associated with the outcome (Chronic or Cured) at 6 months in the two arms. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Age ≥ 18 years ≤ 80 years
- Diagnosis of ITP according to the standard definition
- Platelet count ≤ 20 x 109/L
- Any cutaneous and/or any mucosal bleeding manifestations
- Normal marrow aspirate for patients aged of 60 and over
- Affiliated to a social security regime
- Written consent from patient
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E.4 | Principal exclusion criteria |
- Life-threatening bleeding defined as Intracranial hemorrhage and/or active organ bleeding (GI tract, urinary tract or menorrhagia with at least a 2 g/dl decrease of hemoglobin value from baseline).
- Ongoing anticoagulation treatment (Therapeutic Low molecular weight heparins (LMWHs), direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs))
- Previous non-response to IVIg or DEX
- Treatment with prednisone (1 mg/kg per day) for more than 3 days
- Any, contraindications to the prescribed Ig IV or prednisone patent medicine and to Neofordex®
- Ongoing severe infection
- Severe Renal insufficiency (DFG < 45 ml.min.1.73m2)
- Severe Cardiac insufficiency (FEVG < 30 %)
- Ongoing viral infection (HIV, Viral hepatitis, herpes, varicella, zona)
- Uncontrolled diabetes
- Psychotic state not yet controlled by treatment
- Inability or refusal to understand or refusal to sign the informed consent from study participation
- Persons deprived of their liberty by judicial or administrative decision,
- Persons under legal protection (guardianship, curatorship)
- Pregnant or breastfeeding woman or ineffective contraception
- Participation in another interventional study involving human participants or being in the exclusion period at the end of a previous study involving human participants.
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E.5 End points |
E.5.1 | Primary end point(s) |
Time (in days) to achieve an initial response (R) within 5 days.
Initial response (R) will be defined according to international guidelines (5) as a platelet count ≥ 30x109/L with at least a doubling of the baseline value in the absence of new bleeding and absence of the use of any other ITP directed therapies (other than the one of the treatment arm)
Non-Response will be defined as platelet count < 30 x 109/L or new bleeding manifestations or use of any other ITP directed therapies including use of IVIg in the arm of DXM or DXM in the arm of IVIg.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
We will assess the primary end point at day 5. |
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E.5.2 | Secondary end point(s) |
- Time (in days) to achieve an initial complete response (CR) in both arms (defined by a platelet count > 100 x 109/L in the absence use of any other ITP directed therapies between Day 1 and Day 5) in the two arms.
- Duration in time (in days) of overall response from Day 1 to the end of the study (6 months) in the two arms.
- Proportion of early (before day 5) treatment switches across arms
- Number of new bleeding manifestations between Day 1 and Day 5 in two arms. Bleeding manifestations will be assessed the score reported by Khellaf et al. without taking into account the age of the patient.
- Rates of response (R) and complete response (CR) at 28 days, and 6 months in the two arms.
- Number of bleeding manifestations between Day 5 and Day 28 in the two arms.
- Number of days of hospitalization between Day 1 and Day 28 in the two arms.
- Number of adverse events in the two arms.
- Incremental (decremental) cost effectiveness ratio expressed in cost per responder at 6 months
- Comparison of the number of responders, and outcome at 6 months in patients with positive and negative anti-platelets antibodies in the two arms.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
We will assess secondary endpoints at 6 months. |
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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 | No |
E.6.7 | Pharmacodynamic | No |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
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) | Yes |
E.8.2.2 | Placebo | No |
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 | 39 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | No |
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 | 3 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |