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Hemophilia A With InhibitorsPhase 2/3NCT02484638

Study of Recombinant Factor VIIa Fusion Protein (rVIIa-FP, CSL689) for On-demand Treatment of Bleeding Episodes in Patients With Hemophilia A or B With Inhibitors

A Phase 2/3 study testing CSL689 and Eptacog alfa (activated) in people with Hemophilia A With Inhibitors and Hemophilia B With Inhibitors, run by CSL Behring at 10 sites in 9 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The purpose of this study is to investigate the pharmacokinetics (PK), efficacy, and safety of rVIIa-FP (CSL689). The study will enroll approximately 54 male subjects, 12 to 65 years of age, with hemophilia types A or B who have developed inhibitors to FVIII or FIX. Read more about this study

Who is it for?
Ages 12 to 65 years, men only
What is being tested?
CSL689 and Eptacog alfa (activated)
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
25 participants
Where
10 sitesin 9 countries
Study dates
23 Jul 2015to 28 Mar 2018
Phase
Phase 2/3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 12 to 65 years
  • Men only
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Male subjects with hemophilia A or B and inhibitors.
  • Age ≥ 12 and ≤ 65 years.
  • High responding inhibitor with documented historical inhibitor titer > 5 Bethesda Units/mL.

Who cannot join

  • Congenital or acquired coagulation disorders other than hemophilia A or B.
  • Ongoing immune tolerance induction therapy or planned during study.
  • Known or suspected hypersensitivity to activated recombinant human FVII or to any excipient of CSL689.
  • Body mass index > 30 kg/m².
  • Major surgery within 28 days before screening or scheduled major and / or orthopedic surgery during the study.
  • Advanced atherosclerotic disease (ie, known history of ischemic heart disease, or ischemic stroke).
Show all 9Show fewer
  • Any clinical signs or known history of thromboembolic events, including known deep vein thrombosis.
  • Human immunodeficiency virus (HIV)-positive subjects who have low cluster of differentiation 4 (CD4)+ lymphocyte count (200/μL or less) at screening.
  • Use of the following within the screening period or planned during study: a) plasma or coagulation factor concentrates other than rescue therapy or therapy during Part 1, b) other platelet inhibitors, c) desmopressin, and d) fibrinolysis inhibitors, except if used as local treatment (eg, for oral bleeds).

Trial locations and contacts

10 sites in 9 countries.

10 sites in 9 countries

Thailand2 sites
  • Site Reference # 7640006

    Bangkok, 10400

  • Site Reference # 7640004

    Khon Kaen, 40002

Other trials in Thailand

Georgia1 site
  • Site Reference # 2680001

    Tbilisi, 0179

Other trials in Georgia

Italy1 site
  • Site Reference # 3800023

    Milan, 20122

Other trials in Italy

Malaysia1 site
  • Site Reference # 4580001

    Kuala Lumpur, 50400

Other trials in Malaysia

Russia1 site
  • Site Reference # 6430026

    Kemerovo, 650061

Other trials in Russia

South Africa1 site
  • Site Reference # 7100001

    Johannesburg, 2193

Other trials in South Africa

Spain1 site
  • Site Reference # 7240007

    Madrid, 28046

Other trials in Spain

Ukraine1 site
  • Site Reference # 8040005

    Lviv, 79044

Other trials in Ukraine

United Kingdom1 site
  • Site Reference # 8260008

    London, NW3 2 QG

Other trials in United Kingdom

About this study

Official title: A Multicenter, Open-label, Multiple-dose, Dose Escalation Study to Investigate the Pharmacokinetics, Efficacy, and Safety of rVIIa-FP (CSL 689) in Subjects With Hemophilia (A or B) and Inhibitors

The purpose of this study is to investigate the pharmacokinetics (PK), efficacy, and safety of rVIIa-FP (CSL689). The study will enroll approximately 54 male subjects, 12 to 65 years of age, with hemophilia types A or B who have developed inhibitors to FVIII or FIX. The study consists of 3 sequential parts (Parts 1, 2, 3): The purpose of Part 1 (PK part) is to evaluate the PK of a single treatment of CSL689 (low dose or high dose) and compare with the PK of a single treatment of Eptacog alfa (low dose or high dose). In Part 1, CSL689 and Eptacog alfa will be given by the doctor at the study center. The purpose of Part 2 (Dose-evaluation part) is to identify which of the 2 tested dose levels of CSL689 shows the best efficacy and safety in stopping acute bleeding events (this dose will be called the "population best dose"). The purpose of the final Part 3 (Repeated-dose part) is to confirm the efficacy and safety of the "population best dose" identified in Part 2. In Parts 2 and 3, subjects will self-administer a specified number of CSL689 infusions at home on-demand (ie, when a bleeding event occurs), will keep an electronic diary, and will visit the center at monthly intervals. This study is expected to last for up to 16 months for the subjects participating in all 3 parts, and up to 9 months for the subjects participating in Part 3 only.

Being tested
CSL689, Eptacog alfa (activated)

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CSL689Drug

    Recombinant fusion protein, linking activated coagulation factor VII with albumin. Two dose levels (low dose, high dose) will be studied in Parts 1, 2, and 3.

  • Eptacog alfa (activated)Drug

    Recombinant activated coagulation factor VII. Two dose levels (low dose, high dose) will be studied in Part 1.

Study groups in NCT02484638
Study groupRoleWhat they receive
CSL689 low-doseExperimental* Part 1: single injection of low-dose CSL689 for PK evaluation * Part 2: up to 2 injections of low-dose CSL689 per bleeding event (bleeding events 1 to 3*) * Part 3: up to 3 injections of low-dose CSL689 per bleeding event * Note: All subjects in the low-dose arm will be treated with high-dose CSL689 for bleeding events 4-6 in Part 2
Receives: Drug: CSL689
CSL689 high-doseExperimental* Part 1: single injection of high-dose CSL689 for PK evaluation * Part 2: up to 2 injections of high-dose CSL689 per bleeding event (bleeding events 4 to 6*) * Part 3: up to 3 injections of high-dose CSL689 per bleeding event * Note: All subjects in the high-dose arm will be treated with low-dose CSL689 for bleeding events 1-3 in Part 2
Receives: Drug: CSL689
Eptacog alfa low-doseActive comparatorSingle injection of low-dose Eptacog alfa in Part 1 for PK evaluation
Receives: Drug: Eptacog alfa (activated)
Eptacog alfa high-doseActive comparatorSingle injection of high-dose Eptacog alfa in Part 1 for PK evaluation
Receives: Drug: Eptacog alfa (activated)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Area under the curve (AUC0-t)

    Area under plasma factor VIIa activity versus time curve from time 0 to last sample with quantifiable activity (in Part 1 only).

    Measured: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689

  2. Incremental recovery

    Incremental recovery of plasma factor VIIa activity (in Part 1 only)

    Measured: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689

  3. Elimination half-life

    Elimination half-life of plasma factor VIIa activity (in Part 1 only)

    Measured: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689

  4. Total clearance

    Total clearance of plasma factor VIIa activity (in Part 1 only)

    Measured: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689

  5. Treatment success with first CSL689 injection

    Percentage of bleeding events successfully treated with the first injection of CSL689 for each bleeding event in Part 2.

    Measured: Up to 8 hours after first CSL689 injection for each bleeding event

  6. Treatment success with first CSL689 injection at the population best dose

    Percentage of bleeding events successfully treated with the first injection of the population best dose of CSL689 in subjects participating only in Part 3, along with its 95% confidence interval

    Measured: Up to 8 hours after first CSL689 injection for each bleeding event

  7. Treatment success with first or second CSL689 injection at the population best dose

    Percentage of bleeding events successfully treated with the first or second injection of the population best dose of CSL689 in subjects participating in Part 3 only, along with its 95% confidence interval

    Measured: Up to 16 hours after first CSL689 injection for each bleeding event

Secondary outcomes (22)
  1. Treatment success with first or second CSL689 injection

    Percentage of bleeding events successfully treated with the first or second (if required) injection of CSL689 for each bleeding event in Part 2.

    Measured: Up to 16 hours after first CSL689 injection for each bleeding event

  2. Number of bleeding events requiring > 1 CSL689 injection

    Outcome measure will be analyzed for Part 2 and for Part 3

    Measured: Up to 8 hours after first CSL689 injection for each bleeding event

  3. Number of CSL689 injections per bleeding event

    Outcome measure will be analyzed for Part 2 and for Part 3

    Measured: Up to 16 hours (Part 2) or up to 24 hours (Part 3) after first CSL689 injection for each bleeding event

  4. Total dose of CSL689 per bleeding event

    Outcome measure will be analyzed for Part 2 and for Part 3

    Measured: Up to 16 hours (Part 2) or up to 24 hours (Part 3) after first CSL689 injection for each bleeding event

  5. Treatment success with first CSL689 injection at the population best dose

    Percentage of bleeding events successfully treated with the first injection of CSL689 for each bleeding event at the population best dose in subjects participating in Part 3

    Measured: Up to 8 hours after first CSL689 injection for each bleeding event

  6. Percentage of first bleeding events successfully treated with first CSL689 injection at population best dose in Part 3

    Measured: Up to 8 hours after first CSL689 injection for first bleeding event

  7. Treatment success at population best dose

    Percentage of bleeding events successfully treated with the:

    • first or second injection
    • first, second or third injection of the population best dose of CSL689 in Part 3

    Measured: Up to 24 hours after first CSL689 injection for each bleeding event

  8. Treatment success with CSL689 at the dose level that is not the population best dose

    Percentage of bleeding events successfully treated with the:

    • first injection
    • first or second injection
    • first, second or third injection at the dose level that is not the population best dose of CSL689 in Part 3

    Measured: Up to 24 hours after first CSL689 injection for each bleeding event

  9. Percentage of bleeding events with only "definite" or "abrupt" subject-reported pain relief at the population best dose

    Measured: Up to 24 hours after CSL689 injection for each bleeding event

  10. Percentage of bleeding events with "good" or "excellent" investigator-reported assessment of treatment response at the population best dose of CSL689

    Measured: Up to 9 months

  11. Proportion of recurrences

    Recurrence defined as a bleeding in the same joint/anatomical location within 24 hours after an initial "good" or "excellent" response.

    Measured: Up to 9 months

  12. Proportion of bleeding events with ultrarapid progression.

    "Ultrarapid progression" is defined as overt, uncontrolled hemorrhage and / or progressive increase in pain and / or rapid progression in hematoma size

    Measured: Up to 9 months

  13. Proportion of bleeding events requiring post-hemostatic maintenance dosing

    Measured: Up to 9 months

  14. Number of subjects with treatment-emergent adverse events (TEAEs)

    TEAEs are adverse events (AEs) that start on or after the date and time of the first injection of either CSL689 or Eptacog alfa.

    Number of subjects with TEAEs will be presented:

    • Overall
    • Related to CSL689

    Measured: Up to 16 months

  15. Percentage of subjects with TEAEs

    TEAEs are AEs that start on or after the date and time of the first injection of either CSL689 or Eptacog alfa.

    Percentage of subjects with TEAEs will be presented:

    • Overall
    • Related to CSL689

    Measured: Up to 16 months

  16. Number of subjects with an antibody response

    Number of subjects with:

    • Inhibitors against FVII
    • Antibodies to CSL689

    Measured: Up to 16 months

  17. Percentage of subjects with an antibody response

    Percentage of subjects with:

    • Inhibitors against FVII
    • Antibodies to CSL689

    Measured: Up to 16 months

  18. AUC(0-inf)

    Area under plasma factor VIIa activity versus time curve from time 0 extrapolated to infinity

    Measured: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689

  19. Maximum observed plasma FVIIa activity (Cmax)

    Measured: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689

  20. Time of occurrence of maximum observed plasma FVIIa activity (Tmax)

    Measured: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689

  21. Volume of distribution at steady state (Vss)

    Measured: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689

  22. Mean residence time (MRT)

    Measured: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Jun 2015 (estimated)
  2. Study start23 Jul 2015
  3. Primary completion28 Mar 2018
  4. Study completion28 Mar 2018

Why it stopped: Business decision non-safety related.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2/3
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
25 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02484638
Sponsor's protocol ID
CSL689_2001
Other IDs
2012-001309-26
Status last verified
Aug 2019
First submitted
25 Jun 2015
Last updated
28 Aug 2019
Results posted
No
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing CSL689 and Eptacog alfa (activated) in people with Hemophilia A With Inhibitors and Hemophilia B With Inhibitors, run by CSL Behring at 10 sites in 9 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 28 Aug 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in Thailand, Georgia, Italy, Malaysia, Russia and 4 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was stopped early (reason given: Business decision non-safety related.). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Area under the curve (AUC0-t) (time frame: Before injection and at up to 6 time points until 24 hours after injection for Eptacog alfa; before injection and at up to 11 time points until up to 120 hours after injection for CSL689). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Aug 2019.

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