E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Hereditary angioedema attacks caused by Type 1 and 2 C1-Inhibitor Deficiency |
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E.1.1.1 | Medical condition in easily understood language |
Hereditary angioedema (HAE) is a disorder that results in recurrent attacks of severe swelling |
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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 | 23.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10019860 |
E.1.2 | Term | Hereditary angioedema |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10080956 |
E.1.2 | Term | Hereditary angioedema type I |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10080957 |
E.1.2 | Term | Hereditary angioedema C1 inhibitor deficiency |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 24.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10080960 |
E.1.2 | Term | Hereditary angioedema type II |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic 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 evaluate the safety of long-term on-demand treatment with PHA-022121 for acute hereditary angioedema (HAE) attacks including laryngeal attacks. |
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E.2.2 | Secondary objectives of the trial |
• To evaluate the efficacy of PHA-022121 in achieving symptom relief in patients with acute HAE attacks including laryngeal attacks, • To evaluate the maintenance of PHA-022121 efficacy in achieving symptom relief for any subsequent acute HAE attacks including laryngeal attacks, • To evaluate the proportion of PHA-022121-treated attacks requiring a second dose of PHA-022121 to achieve symptom relief. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Provision of written informed consent. 2. Male or female, aged ≥ 18 years at the time of providing written informed consent. 3. Patients must have received at least 1 dose of study drug (including the non-attack visit) in Study PHA022121-C201. 4. Female patients of childbearing potential must agree to the protocol specified pregnancy testing and to be abstinent from heterosexual intercourse or to use an acceptable form of contraception methods from enrollment until 30 days after the last study drug administration. Methods acceptable for this study include male condom with or without spermicide, cervical cap, diaphragm or sponge with spermicide, a combination of male condom with cap, diaphragm or sponge with spermicide (double-barrier methods), progestin-only hormonal methods (oral, injectable, or implantable), intrauterine device (IUD, all types), intrauterine hormone releasing systems (IUS). Females of non-childbearing potential, defined as surgically sterile (status post hysterectomy, bilateral oophorectomy, or bilateral tubal ligation) or post-menopausal (defined as no menses for at least 12 months without an alternative medical cause and a follicle-stimulating hormone (FSH) test result indicative of post-menopausal status) do not require contraception during the study. There are no contraceptive requirements for male patients. 5. In the opinion of the investigator is willing and able to comply with the protocol. |
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E.4 | Principal exclusion criteria |
1. Any female who is pregnant or is breast-feeding. 2. Presence of any medical condition that could interfere with the assessment of safety or efficacy or negatively affect the patient’s safety, including clinically significant abnormal ECG, most notably a QTcF > 470 ms (for females) or > 450 ms (for males), cardiovascular disease, abnormal liver function and abnormal kidney function. 3. Any other systemic disease (e.g., gastrointestinal, renal, respiratory, neurological) or significant disease or disorder that would interfere with the patient’s safety or ability to participate in the study. 4. Use of lanadelumab for long-term HAE prophylactic therapy within 12 weeks prior to study enrollment. Patients who have recently used short or long-term HAE prophylaxis or on-demand HAE treatment will not be excluded from the study provided the following washout period is observed (i.e., study screening or enrollment should be delayed allowing for washout): • 2-week washout period before enrollment should be respected for patients who have used any C1-INH product, oral kallikrein inhibitors, attenuated androgens, or anti-fibrinolytics for long-term prophylactic HAE therapy. • 1-week washout period before enrollment should be respected for patients who have used plasma derived C1-INH concentrates (Berinert, Cinryze, Haegarda) for on-demand treatment or short-term prophylaxis. • 24-hour washout period before enrollment should be respected for patients who have used recombinant C1-INH (Ruconest) for on-demand treatment or short-term prophylaxis. 6. History of alcohol or drug abuse within the previous year, or current evidence of substance dependence or abuse. 7. Discontinued from Study PHA022121-C201 after enrollment for any study drug-related safety reason. 8. Participation in any other investigational drug study (except with PHA-022121) currently, within the last 30 days prior to the first PHA-022121 dose or within 5 half-lives of study drug at enrollment, whichever is longer. 9. Use of concomitant medications that are potent CYP3A4 inhibitors (e.g., clarithromycin, erythromycin, itraconazole, ketoconazole, ritonavir, grapefruit) or potent CYP3A4 inducers (e.g., phenytoin, rifampicin, St. John's Wort). |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoints of the study are •TEAEs, treatment-related TEAEs, treatment-emergent serious adverse events (TESAEs), and treatment-related TESAEs • Clinical laboratory tests • Vital signs |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
• TEAES will be evaluated when taking place • Clinical laboratory tests will be evaluated as follows: Part A: at Screening visit and every 3 months Part B: when patients transition to Part B, then every 3 months for the first 6 months, and every 6 months thereafter and 14 to 28 days after the last treatment administration • Vital signs Part A: at Screening visit and every 3 months Part B: when patients transition to Part B, then every 3 months for the first 6 months, and every 6 months thereafte |
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E.5.2 | Secondary end point(s) |
•Time to onset of symptom relief (TOSR) defined as ≥ 50% reduction in VAS-3 or VAS-5 • Time to almost complete (defined as all individual VAS scores are ≤10) or complete (defined as all individual VAS scores = 0) symptom relief (TACSR and TCSR) assessed by VAS-3 or VAS-5 • Time to symptom improvement based on PGI-S • Time to symptom improvement based on PGI-C • Change of VAS-3 score and individual VAS score from pre-treatment to 4 h post-treatment for non-laryngeal attacks • Change in MSCS score at 4 h post-treatment • TOS at 4 h post-treatment • Proportion of PHA-022121-treated attacks requiring a second dose of PHA-022121 • TSQM scores at 48 h post-treatment |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
-VAS-3 *; VAS-5**, PGI-S and PGI-C: every hour (±30 min) up to 6 h from initiation of PHA-022121 treatment and then at 8 (±1.5 h), 12 h (±2.5 h), 24 h (±9.5 h), and 48 h (±14.5 h) from initiation of treatment -MSCS-TOS: at 4 h (±30 min), 12 h (±2.5 h), 24 h (±9.5 h), and 48 h (±14.5 h) from initiation of the PHA-022121 treatment -TSQM score: at 48 h (±14.5 h) from initiation of the PHA-022121 treatment
* Non-laryngeal Attacks only ** Laryngeal attacks only |
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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 | Yes |
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) | 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 | No |
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 | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Different dosage of the same product |
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E.8.2.4 | Number of treatment arms in the trial | 3 |
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 | No |
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 | 13 |
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 |
Canada |
Israel |
United States |
France |
Poland |
Bulgaria |
Spain |
Czechia |
Germany |
Italy |
Hungary |
United Kingdom |
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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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The End-of-Study visit is to occur between 14 to 28 days after the last treatment administration and if possible in case of withdrawal from the study. |
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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 | 2 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |