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    Clinical Trial Results:
    An Open-label, Single-arm, Multi-center Study to Evaluate the Efficacy and Safety of Rasburicase (Fasturtec®) in the Prevention and Treatment of Hyperuricemia in Pediatric Patients with Non-Hodgkin’s Lymphoma and Acute Leukemia

    Summary
    EudraCT number
    2021-003176-14
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    12 Mar 2021

    Results information
    Results version number
    v1(current)
    This version publication date
    14 Sep 2021
    First version publication date
    14 Sep 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    LPS15679
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04349306
    WHO universal trial number (UTN)
    U1111-1233-0737
    Other trial identifiers
    Study name: RAISE, Study code number: RASBUL09107
    Sponsors
    Sponsor organisation name
    Sanofi aventis recherche & développement
    Sponsor organisation address
    1 avenue Pierre Brossolette , Chilly-Mazarin, France, 91380
    Public contact
    Trial Transparency Team, Sanofi aventis recherche & développement, contact-US@sanofi.com
    Scientific contact
    Trial Transparency Team, Sanofi aventis recherche & développement, contact-US@sanofi.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?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    30 Apr 2021
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    12 Mar 2021
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this study was to evaluate the safety of Rasburicase in pediatric subjects with Non-Hodgkin’s Lymphoma (NHL) and Acute Leukemia (AL).
    Protection of trial subjects
    The study was conducted by investigators experienced in the treatment of paediatric patients. The parent(s) or guardian(s) as well as the children were fully informed of all pertinent aspects of the clinical trial as well as the possibility to discontinue at any time. In addition to the consent form for the parent(s)/guardian(s), an assent form in child-appropriate language was provided and explained to the child. Repeated invasive procedures were minimised. The number of blood samples as well as the amount of blood drawn were adjusted according to age and weight. A topical anesthesia might have been used to minimise distress and discomfort.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    14 May 2020
    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
    China: 50
    Worldwide total number of subjects
    50
    EEA total number of subjects
    0
    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)
    44
    Adolescents (12-17 years)
    6
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Study was conducted at 10 study centers in China. A total of 55 subjects were screened between 14 May 2020 and 26-February-2021, of which 5 subjects were screen failures. Screen failures were mainly due to met the exclusion criteria.

    Pre-assignment
    Screening details
    1 subject excluded from enrolled population due to major protocol deviation (met the exclusion criteria) was included in the safety population.

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

    Arms
    Arm title
    Rasburicase
    Arm description
    Subjects received Rasburicase 0.20 milligram per kilogram per day (mg/kg/day) by intravenous (IV) infusion over 30 minutes from Day 1 to Day 5.
    Arm type
    Experimental

    Investigational medicinal product name
    Rasburicase
    Investigational medicinal product code
    SR29142
    Other name
    Fasturtec®
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    0.20 mg/kg/day by intravenous infusion over 30 minutes for Day 1 to Day 5.

    Number of subjects in period 1 [1]
    Rasburicase
    Started
    49
    Completed
    46
    Not completed
    3
         Physician decision
    2
         Withdrawal by Subject
    1
    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: 1 subject excluded from enrolled population due to major protocol deviation (met the exclusion criteria).

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Rasburicase
    Reporting group description
    Subjects received Rasburicase 0.20 milligram per kilogram per day (mg/kg/day) by intravenous (IV) infusion over 30 minutes from Day 1 to Day 5.

    Reporting group values
    Rasburicase Total
    Number of subjects
    49 49
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    6.9 ( 3.39 ) -
    Gender categorical
    Units: Subjects
        Female
    15 15
        Male
    34 34

    End points

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    End points reporting groups
    Reporting group title
    Rasburicase
    Reporting group description
    Subjects received Rasburicase 0.20 milligram per kilogram per day (mg/kg/day) by intravenous (IV) infusion over 30 minutes from Day 1 to Day 5.

    Subject analysis set title
    Rasburicase
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Subjects received Rasburicase 0.20 mg/kg/day by IV infusion over 30 minutes from Day 1 to Day 5.

    Primary: Number of Subjects With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)

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    End point title
    Number of Subjects With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) [1]
    End point description
    An adverse event (AE) was any untoward medical occurrence in a subject administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment. The TEAEs were defined as AEs that occurred, worsened or became serious during the TEAE period (from first dose of study drug until 48 hours after last dose of study treatment [up to Day 7]). SAE was any untoward medical occurrence that at any dose resulted in death or was life-threatening or required inpatient hospitalisation or prolongation of existing hospitalisation or resulted in persistent or significant disability/incapacity or was a congenital anomaly/birth defect or was a medically important event. Analysis was performed on the safety population, which included subjects who received at least one dose of investigational medicinal product (IMP).
    End point type
    Primary
    End point timeframe
    From Day 1 up to Day 7
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Since the endpoint was descriptive in nature, no statistical analysis was provided.
    End point values
    Rasburicase
    Number of subjects analysed
    50
    Units: subject
    number (not applicable)
        TEAEs
    25
        SAE
    4
    No statistical analyses for this end point

    Secondary: Number of Subjects Achieving Normal Uric Acid Levels (<= 8.0 mg/dL) Among Subjects Whose Plasma Uric Acid Levels are >8.0 mg/dL at Baseline

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    End point title
    Number of Subjects Achieving Normal Uric Acid Levels (<= 8.0 mg/dL) Among Subjects Whose Plasma Uric Acid Levels are >8.0 mg/dL at Baseline
    End point description
    Response was defined as achievement of normal uric acid levels (less than or equal to [<=] 8.0 milligram per deciliter [mg/dL]) in the subjects whose uric acid levels were greater than (>) 8.0 mg/dL. Analysis was performed on the intent-to treat (ITT) population which included all enrolled subjects who had received at least one dose of IMP and had one post-treatment assessment of plasma uric acid. Here, ‘number of subjects analysed’ = subjects with available data for this endpoint. Here, “n”= subjects with available data for each specified category.
    End point type
    Secondary
    End point timeframe
    From first administration to 120 hours after the first dose
    End point values
    Rasburicase
    Number of subjects analysed
    19
    Units: subject
    number (not applicable)
        Day 1 (n= 19)
    17
        Day 2 (n= 19)
    19
        Day 3 (n= 19)
    17
        Day 4 (n= 18)
    18
        Day 5 (n= 18)
    18
        Day 6 (n=18)
    17
        Overall (n=19)
    19
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Who Maintain the Normal Uric Acid Levels Among Subjects Whose Baseline Plasma Uric Acid Levels Were <= 8 mg/dL

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    End point title
    Percentage of Subjects Who Maintain the Normal Uric Acid Levels Among Subjects Whose Baseline Plasma Uric Acid Levels Were <= 8 mg/dL
    End point description
    Analysis was performed on the ITT population. Here, ‘number of subjects analysed’ = subjects with available data for this endpoint.
    End point type
    Secondary
    End point timeframe
    From first administration to 120 hours after the first dose
    End point values
    Rasburicase
    Number of subjects analysed
    29
    Units: percentage of subjects
        number (not applicable)
    86.2
    No statistical analyses for this end point

    Secondary: Maximum Percent Change From Baseline in Plasma Uric Acid Level

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    End point title
    Maximum Percent Change From Baseline in Plasma Uric Acid Level
    End point description
    Maximum change in Plasma Uric Acid was calculated by subtracting Baseline value from lowest value divided by Baseline value multiplied by 100. Analysis was performed on the ITT population. Here, ‘n’= subjects with available data for each specified category.
    End point type
    Secondary
    End point timeframe
    From first administration to 120 hours after the first dose
    End point values
    Rasburicase
    Number of subjects analysed
    48
    Units: percent change
    arithmetic mean (standard deviation)
        Day 1 (n=29)
    -94.7868 ( 4.6233 )
        Day 2 (n=29)
    -82.7368 ( 23.3945 )
        Day 3 (n=28)
    -82.1705 ( 24.1585 )
        Day 4 (n=29)
    -75.7560 ( 34.9937 )
        Day 5 (n=28)
    -61.8480 ( 44.9627 )
        Day 6 (n=28)
    -52.2155 ( 51.5712 )
        Maximum Decrease Visit (n= 29)
    -96.6969 ( 3.4990 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Reported AEs are TEAEs that developed/worsened or became serious during the TEAE period (from first dose of study drug until 48 hours after last dose of study treatment [up to Day 7]).
    Adverse event reporting additional description
    Analysis was performed on the safety population. 1 subject excluded from enrolled population due to major protocol deviation (met the exclusion criteria) was included in the safety population.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    24.0
    Reporting groups
    Reporting group title
    Rasburicase
    Reporting group description
    Subjects received Rasburicase 0.20 mg/kg/day by IV infusion over 30 minutes from Day 1 to Day 5.

    Serious adverse events
    Rasburicase
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 50 (8.00%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    Injury, poisoning and procedural complications
    Refractoriness to platelet transfusion
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Anaphylactic shock
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pleural effusion
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Tumour lysis syndrome
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Rasburicase
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    20 / 50 (40.00%)
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    4 / 50 (8.00%)
         occurrences all number
    4
    Aspartate aminotransferase increased
         subjects affected / exposed
    4 / 50 (8.00%)
         occurrences all number
    4
    White blood cell count decreased
         subjects affected / exposed
    4 / 50 (8.00%)
         occurrences all number
    4
    Neutrophil count decreased
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences all number
    3
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    6 / 50 (12.00%)
         occurrences all number
    6
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences all number
    3
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences all number
    3
    Nausea
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences all number
    3
    Vomiting
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences all number
    3
    Hepatobiliary disorders
    Hepatic function abnormal
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences all number
    3
    Metabolism and nutrition disorders
    Hypokalaemia
         subjects affected / exposed
    5 / 50 (10.00%)
         occurrences all number
    5

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    24 Jun 2019
    Following changes were made: Combined inclusion criteria 4 and 5 in to one sentence; changed the high risk of tumor lysis syndrome (TLS) definition of AL subjects from “A. white blood cell (WBC) greater than or equal to (>=) 10.0*10^9/L, or B. WBC less than (<)10.0* 10^9/L with C. lactate dehydrogenase (LDH) >=2* upper limit of normal (ULN)” to “A. WBC >=100.0* 10^9/L, or B. WBC <100.0* 10^9/L with LDH >=28 ULN”; deleted “and with life expectancy of >3 months” in the last inclusion criteria; changed the inclusion criteria 4 from “newly diagnosed NHL or AL; or during the intermission of chemotherapy at screening with hyperuricemia: blood uric acid >8 mg/dL (473 micromole per liter [mcmol/L]).” to “newly diagnosed NHL or AL who was at the initiation of or during the first cycle of chemotherapy, baseline blood uric acid >8 mg/dL (473 mcmol/L) at screening”; changed inclusion criteria 5 from “If newly diagnosed NHL subject with blood uric acid <=8 mg/dL at screening, the subject might diagnosed with Stage III or IV NHL with high tumor burden defined, with one or more of following below” to “If newly diagnosed NHL subject with blood uric acid <=8 mg/dL at screening, the subject might diagnosed with stage III or IV NHL with high tumor burden which would high risk of TLS defined; added “lactate dehydrogenase”, full name of LDH, before LDH in inclusion criteria 5-C; changed the high risk of TLS definition of AL subject from “A. WBC >=10.0* 10^9/L, or B. WBC <10.0* 10^9/L with LDH >=2* ULN” to “A. WBC >=100.0* 10^9/L, or B. WBC <100.0* 10^9/L with LDH >=28 ULN”; changed the sponsor from “Shanghai Branch of Sanofi (China) Investment Co., Ltd.” to “Sanofi (Beijing) pharmaceutical co., LTD”; changed the address from “F19, Tower 3, Kerry Center, 1228 Middle Yan’an Road, Shanghai, China” to “Haihang Industrial building, No. 108 Jian Guo Road, Chaoyang District, Beijing 100022, China”; delete “Tel: 021-22266666 Fax: 021-62880569”.
    29 Sep 2019
    Following changes were made: Changed the endpoints from “For subject who aged <10 years old, written informed consent form (ICF) of subject/legal guardian (as appropriate) was required. For subject who aged 10-18 (inclusive), both written ICF of minor assent form and subject/legal guardian are required.” to For subject who aged <8 years old, written ICF of subject/legal guardian (as appropriate) is required. For subject who aged 8-18 (inclusive), both written ICF of minor assent interruptions form and subject/legal guardian are required; Added “Previous glucose-6-phosphate dehydrogenase testing result was acceptable.
    08 May 2020
    Following changes were made: Changed the endpoint(s) from “In those subject whose baseline plasma uric acid levels are <=8 mg/dL but with a high risk of TLS, the proportion of subject who can maintain the normal uric acid levels throughout the study (from first administration to the end of follow-up: 14 days after the first administration)“ to “In those subject whose Baseline plasma uric acid levels are <=8 mg/dL but with a high risk of TLS, the proportion of subject who can maintain the normal uric acid levels throughout the study (from first administration to the end of follow-up: 7 days after the first administration)“; Changed the procedures of collecting and measuring the uric acid blood sample from “Draw 1 milliliter (mL) whole blood for each collection tube” to “Draw 4 mL whole blood for each collection tube”; Added “This was a post market commitment study and the design of this protocol was served the same commitment purpose of study protocol number “RASBUL06535”, which was cited by national master processing agreement in the imported drug license NO.S20180024”in introduction and rational.

    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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