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    Clinical Trial Results:
    Phase 4, Multicenter, Prospective, Interventional, Post-Marketing Study in Hemophilia A Patients in India Receiving ADVATE as On-Demand or Prophylaxis Under Standard Clinical Practice

    Summary
    EudraCT number
    2022-004149-11
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    10 Feb 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    23 Aug 2023
    First version publication date
    23 Aug 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    TAK-761-4009
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04985682
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Takeda
    Sponsor organisation address
    95 Hayden Avenue, Lexington, United States, MA 02421
    Public contact
    Study Director, Takeda, TrialDisclosures@takeda.com
    Scientific contact
    Study Director, Takeda, TrialDisclosures@takeda.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
    10 Feb 2023
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    10 Feb 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objective of this study is to assess the safety of ADVATE based on serious adverse events (SAEs) [including factor VIII (FVIII) inhibitors].
    Protection of trial subjects
    All study participants or legally authorised representative (in case of study participants <18 years of age) were required to read and sign an informed consent form (ICF).
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    14 Jan 2022
    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
    India: 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)
    14
    Adolescents (12-17 years)
    10
    Adults (18-64 years)
    26
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Participants took part in the study at 4 investigative sites in India from 14 January 2022 to 10 February 2023.

    Pre-assignment
    Screening details
    Participants previously treated for hemophilia A who met eligibility criteria were enrolled to receive ADVATE according to a dosing regimen determined by the treating physician and in accordance with the national product label.

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

    Arms
    Arm title
    Hemophilia A Group
    Arm description
    Participants with hemophilia A were treated with ADVATE according to a regimen determined by the treating physician at the study site and in accordance with the national product label under standard clinical practice for 6.7 months.
    Arm type
    Experimental

    Investigational medicinal product name
    ADVATE
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder and solvent for solution for injection
    Routes of administration
    Intravenous bolus use
    Dosage and administration details
    Antihemophilic factor (AHF) activity expressed in international units (IU) per vial.

    Number of subjects in period 1
    Hemophilia A Group
    Started
    50
    Completed
    49
    Not completed
    1
         Consent withdrawn by subject
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Hemophilia A Group
    Reporting group description
    Participants with hemophilia A were treated with ADVATE according to a regimen determined by the treating physician at the study site and in accordance with the national product label under standard clinical practice for 6.7 months.

    Reporting group values
    Hemophilia A Group Total
    Number of subjects
    50
    Age Categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    19.5 ( 13.01 ) -
    Gender categorical
    Units: Subjects
        Female
    0 0
        Male
    50 50
    Race (NIH/OMB)
    Units: Subjects
        American Indian or Alaska Native
    0 0
        Asian
    50 50
        Native Hawaiian or Other Pacific Islander
    0 0
        Black or African American
    0 0
        White
    0 0
        More than one race
    0 0
        Unknown or Not Reported
    0 0
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    0 0
        Not Hispanic or Latino
    50 50
        Unknown or Not Reported
    0 0
    Region of Enrollment
    Units: Subjects
        India India
    50 50
    Weight
    Units: kilograms (kg)
        arithmetic mean (standard deviation)
    48.5 ( 20.95 ) -
    Height
    Units: centimetres (cm)
        arithmetic mean (standard deviation)
    152.0 ( 22.68 ) -
    Body Mass Index (BMI)
    BMI = Weight (kg)/Height (m)^2
    Units: kilograms per meter square (kg/m^2)
        arithmetic mean (standard deviation)
    19.9 ( 5.42 ) -

    End points

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    End points reporting groups
    Reporting group title
    Hemophilia A Group
    Reporting group description
    Participants with hemophilia A were treated with ADVATE according to a regimen determined by the treating physician at the study site and in accordance with the national product label under standard clinical practice for 6.7 months.

    Primary: Number of Participants With Serious Adverse Events (SAE) at Least Possibly Related to ADVATE

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    End point title
    Number of Participants With Serious Adverse Events (SAE) at Least Possibly Related to ADVATE [1]
    End point description
    An adverse event (AE) was defined as any untoward medical occurrence in a participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this investigational product or medicinal product. An SAE was defined as any untoward medical occurrence that resulted in death; was life-threatening; required inpatient hospitalization or prolongation of present hospitalization; resulted in persistent or significant disability/incapacity; was a congenital anomaly/birth defect or was a medically important event. Number of participants with SAEs (including FVIII inhibitor formation) that were at least possibly related to ADVATE were reported. Safety Analysis Set (SAS) included all participants who received ADVATE at any time during the study.
    End point type
    Primary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    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: Only descriptive statistics were planned to be analysed for this endpoint.
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: participants
    0
    No statistical analyses for this end point

    Secondary: Number of Participants With Non-serious Adverse Events (AEs) at Least Possibly Related to ADVATE

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    End point title
    Number of Participants With Non-serious Adverse Events (AEs) at Least Possibly Related to ADVATE
    End point description
    An AE was any untoward medical occurrence in a participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this investigational product or medicinal product. Number of participants with non-serious AEs that were at least possibly related to ADVATE were reported. SAS included all participants who received ADVATE at any time during the study.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: participants
    0
    No statistical analyses for this end point

    Secondary: Total Annualized Bleeding Rate (ABR) With Prophylactic Treatment of ADVATE

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    End point title
    Total Annualized Bleeding Rate (ABR) With Prophylactic Treatment of ADVATE
    End point description
    ABR was defined as number of bleeding episodes during the study period divided by total number of study period days multiplied by 365.25. The mean ABR and standard error was estimated using a generalized linear model (GLM). The total ABR is reported in this outcome measure. EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: bleeds per year
    arithmetic mean (standard error)
        Total ABR
    2.65 ( 0.195 )
    No statistical analyses for this end point

    Secondary: Number of Participants With Clinically Significant Changes in Clinical Laboratory Parameters

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    End point title
    Number of Participants With Clinically Significant Changes in Clinical Laboratory Parameters
    End point description
    Clinical laboratory parameters included hematology, clinical chemistry, viral serology, factor VIII (FVIII) antigen, FVIII activity, incremental recovery, and FVIII inhibitor. Clinical significance was judged as per Investigator’s assessment. SAS included all participants who received ADVATE at any time during the study.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: participants
    0
    No statistical analyses for this end point

    Secondary: ABR With Prophylactic Treatment of ADVATE Categorized Based on Location of Bleed

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    End point title
    ABR With Prophylactic Treatment of ADVATE Categorized Based on Location of Bleed
    End point description
    ABR was defined as number of bleeding episodes during the study period divided by total number of study period days multiplied by 365.25. The mean ABR and standard error were estimated using a GLM. The ABR by bleed sites (example, joint, soft tissue, muscle, other [mouth, gums or nose] are reported in this outcome measure. EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: bleeds per year
    arithmetic mean (standard error)
        Bleed Location: Joint
    2.33 ( 0.203 )
        Bleed Location: Soft Tissue
    0.04 ( 1.000 )
        Bleed Location: Muscle
    0.16 ( 0.628 )
        Bleed Location: Other (Mouth, Gums or Nose)
    0.12 ( 0.813 )
    No statistical analyses for this end point

    Secondary: Average Number of ADVATE Infusions Required per Week During Prophylactic Treatment

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    End point title
    Average Number of ADVATE Infusions Required per Week During Prophylactic Treatment
    End point description
    EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: infusions per week
    arithmetic mean (standard deviation)
        Per Week
    2.5 ( 0.87 )
    No statistical analyses for this end point

    Secondary: Total Number of ADVATE Infusions Required During Prophylactic Treatment

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    End point title
    Total Number of ADVATE Infusions Required During Prophylactic Treatment
    End point description
    EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: infusions
        arithmetic mean (standard deviation)
    65.8 ( 22.92 )
    No statistical analyses for this end point

    Secondary: ABR With Prophylactic Treatment of ADVATE Categorized Based on Type of Bleed

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    End point title
    ABR With Prophylactic Treatment of ADVATE Categorized Based on Type of Bleed
    End point description
    ABR was defined as number of bleeding episodes during the study period divided by total number of study period days multiplied by 365.25. The mean ABR and standard error were estimated using a GLM. The ABR by bleed cause (example, spontaneous, injury, and unknown) are reported in this outcome measure. EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: bleeds per year
    arithmetic mean (standard error)
        Bleed Type: Spontaneous
    1.86 ( 0.211 )
        Bleed Type: Injury
    0.20 ( 0.692 )
        Bleed Type: Unknown
    0.59 ( 0.541 )
    No statistical analyses for this end point

    Secondary: Average Body Mass Adjusted Consumption of ADVATE per Week During Prophylactic Treatment

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    End point title
    Average Body Mass Adjusted Consumption of ADVATE per Week During Prophylactic Treatment
    End point description
    Body mass adjusted consumption (IU/kg) was derived as the total units infused (IU) divided by the last available body weight (kg) prior to the infusion. EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: IU/kg per week
    arithmetic mean (standard deviation)
        Per Week
    67.1 ( 24.12 )
    No statistical analyses for this end point

    Secondary: Total Body Mass Adjusted Consumption of ADVATE During Prophylactic Treatment

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    End point title
    Total Body Mass Adjusted Consumption of ADVATE During Prophylactic Treatment
    End point description
    Body mass adjusted consumption international units per kilograms (IU/kg) was derived as the total units infused (IU) divided by the last available body weight (kg) prior to the infusion. EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: IU/kg
        arithmetic mean (standard deviation)
    1739.7 ( 621.18 )
    No statistical analyses for this end point

    Secondary: Average Number of ADVATE Infusions Required per Month During Prophylactic Treatment of Bleeding Episode

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    End point title
    Average Number of ADVATE Infusions Required per Month During Prophylactic Treatment of Bleeding Episode
    End point description
    EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: infusions per month
        arithmetic mean (standard deviation)
    11.0 ( 3.76 )
    No statistical analyses for this end point

    Secondary: Overall Hemostatic Efficacy Rating of ADVATE for Treatment of Bleeding Episodes

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    End point title
    Overall Hemostatic Efficacy Rating of ADVATE for Treatment of Bleeding Episodes
    End point description
    Overall hemostatic efficacy for bleeding episodes treatment was rated on 4-point Likert scale as:excellent=full relief of pain,cessation of objective signs of bleeding after single infusion,no additional infusion is required for control of bleeding,administration of further infusion to maintain hemostasis would not affect scoring;good=definite pain relief and/or improvement in signs of bleeding after single infusion,possibly requires more than 2 infusions for complete resolution,administration of further infusion to maintain hemostasis would not affect scoring;moderate=probable and/or slight relief of pain and slight improvement in signs of bleeding after a single infusion,required multiple infusions for complete resolution;none=no improvement of signs/symptoms/conditions worsen.EFAS=all participants for whom all inclusion and none of the exclusion criteria were met.Number of subjects analysed=participants with bleeds who required ADVATE infusion for management of bleeding episode.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    24
    Units: bleeding episodes
        Excellent
    21
        Good
    26
        Moderate
    4
        None
    0
    No statistical analyses for this end point

    Secondary: Number of ADVATE Infusions Required to Achieve Resolution of Bleeding Episodes

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    End point title
    Number of ADVATE Infusions Required to Achieve Resolution of Bleeding Episodes
    End point description
    EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met. Number of subjects analysed are the number of participants with bleeds who required ADVATE infusion for management of the bleeding episode.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    24
    Units: infusions
        arithmetic mean (standard deviation)
    1.2 ( 0.46 )
    No statistical analyses for this end point

    Secondary: Average Body Mass Adjusted Consumption of ADVATE per Month During Prophylactic Treatment

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    End point title
    Average Body Mass Adjusted Consumption of ADVATE per Month During Prophylactic Treatment
    End point description
    Body mass adjusted consumption (IU/kg) was derived as the total units infused (IU) divided by the last available body weight (kg) prior to the infusion. EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    50
    Units: IU/kg per month
        arithmetic mean (standard deviation)
    291.7 ( 104.80 )
    No statistical analyses for this end point

    Secondary: Total Body Mass Adjusted Consumption of ADVATE per Bleeding Episode

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    End point title
    Total Body Mass Adjusted Consumption of ADVATE per Bleeding Episode
    End point description
    Body mass adjusted consumption (IU/kg) was derived as the total units infused (IU) divided by the last available body weight (kg) prior to the infusion. EFAS comprised of all participants for whom all inclusion and none of the exclusion criteria were met. Number of subjects analysed are the number of participants with bleeds who required ADVATE infusion for management of the bleeding episode.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0) up to end of study (up to 12.9 months)
    End point values
    Hemophilia A Group
    Number of subjects analysed
    24
    Units: IU/kg
        arithmetic mean (standard deviation)
    34.8 ( 19.79 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline (Day 0) up to end of study (up to 12.9 months)
    Adverse event reporting additional description
    SAS included all participants who received ADVATE at any time during the study.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.0
    Reporting groups
    Reporting group title
    Hemophilia A Group
    Reporting group description
    Participants with hemophilia A were treated with ADVATE according to a regimen determined by the treating physician at the study site and in accordance with the national product label under standard clinical practice for 6.7 months.

    Serious adverse events
    Hemophilia A Group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 50 (0.00%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Hemophilia A Group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    6 / 50 (12.00%)
    Injury, poisoning and procedural complications
    Animal bite
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences all number
    1
    Joint injury
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences all number
    3
    Skin laceration
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences all number
    2
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences all number
    2
    Infections and infestations
    Varicella
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    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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