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Pediatric Pyruvate Kinase DeficiencyPhase 3ACTIVATE-KidsNCT05175105

A Study to Evaluate the Efficacy and Safety of Mitapivat in Pediatric Participants With Pyruvate Kinase Deficiency (PKD) Who Are Not Regularly Transfused, Followed by a 5-Year Extension Period

A Phase 3 study testing Mitapivat in people with Pediatric Pyruvate Kinase Deficiency and Pediatric Hemolytic Anemia, run by Agios Pharmaceuticals, Inc. at 19 sites in 7 countries.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
Search all trials

Trial summary

Study ACTIVATE-Kids (AG348-C-023) will evaluate the efficacy and safety of orally administered mitapivat as compared with placebo in pediatric participants with pyruvate kinase deficiency (PKD) who are not regularly receiving blood transfusions. Read more about this study

Who is it for?
Ages 1 year to 17 years
What is being tested?
Mitapivat
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
30 participants
Where
19 sitesin 7 countries
Study dates
6 Jun 2022to Jan 2030
Phase
Phase 3
Are there results?
Not yet: the study is under way

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 1 year to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Written informed consent from the participant, or the participant's legally authorized representative, parent(s), or legal guardian, and the participant's assent, where applicable (informed consent/assent) must be obtained before any study-related procedures are conducted, and participants must be willing to comply with all study procedures for the duration of the study;
  • Aged 1 to <18 years. Participants between 12 and 24 months of age must weigh a minimum of 7 kilograms (kg);
  • Clinical laboratory confirmation of pyruvate kinase deficiency (PKD), defined as documented presence of at least 2 mutant alleles in the pyruvate kinase L/R (PKLR) gene, of which at least 1 is a missense mutation, as determined per the genotyping performed by the study central genotyping laboratory;
  • No more than 5 red blood cell (RBC) transfusions in the 52-week period before providing informed consent/assent and no RBC transfusions ≤12 weeks before administration of the first dose of study drug;
  • Hemoglobin concentration ≤10 grams per deciliter (g/dL) for participants 12 to <18 years of age or ≤9 g/dL for participants 1 to <12 years of age during the screening period. Hb concentration must be based on an average of at least 2 Hb concentration measurements (separated by ≥7 days) collected during the screening period;
  • Receiving folic acid supplementation as part of routine clinical care for at least 21 days before administration of the first dose of study drug, to be continued during study participation;
  • Female participants who have attained menarche and/or breast development in Tanner Stage 2 must be abstinent of sexual activities that may induce pregnancy as part of their usual lifestyle, or agree to use 2 forms of contraception, 1 of which must be considered highly effective, from the time of informed consent/assent, throughout the study, and for 28 days after the last dose of study drug (including the time required to dose taper). The second form of contraception can include an acceptable barrier method.

Who cannot join

  • Pregnant or breastfeeding;
  • Homozygous for the R479H mutation or have 2 nonmissense mutations, without the presence of another missense mutation, in the PKLR gene as determined per the genotyping performed by the study central genotyping laboratory;
  • History of malignancy;
  • History of active and/or uncontrolled cardiac or pulmonary disease or clinically relevant QT prolongation within 6 months before providing informed consent/assent;
  • Hepatobiliary disorders including, but not limited to:
  • Liver disease with histopathological evidence of cirrhosis or severe fibrosis;
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  • Clinically symptomatic cholelithiasis or cholecystitis (participants with prior cholecystectomy are eligible);
  • History of drug-induced cholestatic hepatitis;
  • Aspartate aminotransferase >2.5×upper limit of normal (ULN) (unless due to hemolysis and/or hepatic iron deposition) and alanine aminotransferase >2.5×ULN (unless due to hepatic iron deposition);
  • Renal dysfunction as defined by an estimated glomerular filtration rate <60 milliliters per minute (mL/min)/1.73 m^2;
  • Nonfasting triglycerides >440 milligrams per deciliter (mg/dL) (5 millimoles per liter [mmol/L]);
  • Active uncontrolled infection requiring systemic antimicrobial therapy;
  • Participants with known active hepatitis B or hepatitis C virus infection;
  • Participants with known human immunodeficiency virus (HIV) infection;
  • History of major surgery (including splenectomy) ≤6 months before providing informed consent/assent and/or planning on undergoing a major surgical procedure during the screening or double-blind period;
  • Current enrollment or past participation (within 90 days before the first dose of study drug or a time frame equivalent to 5 half-lives of the investigational study drug, whichever is longer) in any other clinical study involving an investigational study drug or device;
  • Prior exposure to gene therapy, or bone marrow or stem cell transplantation;
  • Currently receiving hematopoietic stimulating agents; the last dose must have been administered at least 28 days or a time frame equivalent to 5 half-lives (whichever is longer) before randomization;
  • Receiving products that are strong inhibitors of CYP3A4/5 that have not been stopped for ≥5 days or a time frame equivalent to 5 half-lives (whichever is longer), or strong inducers of CYP3A4 that have not been stopped for ≥28 days or a time frame equivalent to 5 half-lives (whichever is longer), before randomization;
  • Receiving anabolic steroids, including testosterone preparations, that have not been stopped for at least 28 days before randomization;
  • Known allergy, or other contraindication, to mitapivat or its excipients (microcrystalline cellulose, croscarmellose sodium, sodium stearyl fumarate, mannitol, Opadry® II Blue [hypromellose, titanium dioxide, lactose monohydrate, triacetin, and Food, Drug, and Cosmetics blue dye number 2 (FD\&C Blue #2)], Opadry® II White [hypromellose, titanium dioxide, lactose monohydrate, and triacetin], and magnesium stearate);
  • Any medical, hematologic, psychological, or behavioral condition(s) or prior or current therapy that, in the opinion of the Investigator, may confer an unacceptable risk to participating in the study and/or could confound the interpretation of the study data; also included are:
  • Participants who are institutionalized by regulatory or court order.
  • Participants with any condition(s) that could create undue influence (including but not limited to incarceration, involuntary psychiatric confinement, and financial or familial affiliation with the Investigator or Sponsor).
  • Receiving a pyruvate kinase activator that has not been stopped for ≥52 weeks before providing informed consent/assent.

Trial locations and contacts

19 sites in 7 countries.

19 sites in 7 countries

United States11 sites
  • Children's Healthcare of Atlanta - Emory

    Atlanta, Georgia, 30322

  • Children's Hospital Colorado

    Aurora, Colorado, 80045

  • Boston Children's Hospital

    Boston, Massachusetts, 02115

  • UChicago Medicine

    Chicago, Illinois, 60637

  • UT Southwestern Medical Center

    Dallas, Texas, 75390

  • Children's Hospital of Michigan

    Detroit, Michigan, 48304

  • Duke University Medical Center

    Durham, North Carolina, 27710

  • Texas Children's Hospital

    Houston, Texas, 77030

  • St Jude's Children's Research Hospital

    Memphis, Tennessee, 38105

  • Stanford Medicine

    Palo Alto, California, 94304

  • Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

Other trials in United States

Germany2 sites
  • Charite - UB - CVK - Medizinische Klinik

    Berlin, 13353

  • Universitatsklinikum Wurzburg

    Würzburg, Bavaria, 97080

Other trials in Germany

Spain2 sites
  • Hospital Universitario Vall d'Hebron

    Barcelona, 08035

  • Hospital Universitario Infantil Nino Jesus

    Madrid, 28009

Other trials in Spain

Canada1 site
  • Centre hospitalier Universitaire de Sainte-Justine

    Montreal, Quebec, QC H3T 1C5

Other trials in Canada

France1 site
  • Hôpital Pellegrin

    Bordeaux, Aquitaine, 33000

Other trials in France

Netherlands1 site
  • Universitair Medisch Centrum Utrecht

    Utrecht, 3584 CX

Other trials in Netherlands

Switzerland1 site
  • CHUV University Hospital of Lausanne

    Lausanne, Canton of Bern

Other trials in Switzerland

About this study

Official title: A Phase 3, Multicenter, Randomized, Double-blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Mitapivat in Pediatric Subjects With Pyruvate Kinase Deficiency Who Are Not Regularly Transfused, Followed by a 5-Year Open-label Extension Period

Study ACTIVATE-Kids (AG348-C-023) will evaluate the efficacy and safety of orally administered mitapivat as compared with placebo in pediatric participants with pyruvate kinase deficiency (PKD) who are not regularly receiving blood transfusions. Participants will be randomized 2:1 to receive either mitapivat or matching placebo. Randomization will be stratified by age (1 to < 6 years, 6 to < 12 years, 12 to < 18 years). Participants will be dosed by age and weight during a double-blind period consisting of an 8-week dose titration period followed by a 12-week fixed-dose period. Participants who complete the double-blind period will be eligible to receive mitapivat for up to 5 years in the open-label extension (OLE) period.

Being tested
Mitapivat, Mitapivat-matching placebo
Keywords
Anemia, Hematologic Diseases, Metabolic Diseases, Mitapivat, AG-348, ACTIVATE-Kids, PK Deficiency
Medical subject headings
Anemia, Hematologic Diseases, Metabolic Diseases, Pyruvate Kinase Deficiency of Red Cells

What participants receive

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

  • MitapivatDrug

    Also called AG-348, AG-348 sulfate hydrate, Mitapivat sulfate

    Tablets or granules

  • Mitapivat-matching placeboDrug

    Tablets or granules

Study groups in NCT05175105
Study groupRoleWhat they receive
MitapivatExperimentalDouble-Blind Period: Participants will receive mitapivat orally, at doses based on age and weight, for 8 weeks in the dose titration period and for 12 weeks in the fixed-dose period.
Receives: Drug: Mitapivat
PlaceboPlacebo comparatorDouble-Blind Period: Participants will receive mitapivat-matching placebo orally for 8 weeks in the dose titration period and for 12 weeks in the fixed-dose period.
Receives: Drug: Mitapivat-matching placebo
Mitapivat (OLE period)ExperimentalParticipants who have completed the double-blind period will be eligible to receive mitapivat for up to 5 years in the OLE period. Participants entering the OLE period will first receive blinded mitapivat and placebo for 8 weeks to maintain the double-blind treatment assignment before being transitioned to only receive active, open-label drug (mitapivat).
Receives: Drug: Mitapivat; Drug: Mitapivat-matching placebo

What is being measured

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

  1. Percentage of Participants Achieving a Hemoglobin (Hb) Response

    Hb response is defined as a ≥1.5 grams per deciliter (g/dL) (0.93 millimoles per liter [mmol/L]) increase in Hb concentration from baseline that is sustained at 2 or more scheduled assessments at Weeks 12, 16, and 20 during the double-blind period. The individual participant's baseline Hb concentration is defined as the average of all available Hb concentrations collected for that participant during the screening period up to the first dose of study drug.

    Measured: Baseline up to Week 20

Secondary outcomes (28)
  1. Average Change From Baseline in Hb Concentration at Weeks 12, 16, and 20

    Measured: Baseline, Weeks 12, 16, and 20

  2. Maximal Change in Hb Concentration From Baseline During the Double-blind Period

    Measured: Baseline up to Week 20

  3. Change From Baseline in Estradiol Concentration

    Measured: Baseline up to Week 286

  4. Change From Baseline in Estrone Concentration

    Measured: Baseline up to Week 286

  5. Change From Baseline in Total Testosterone Concentration

    Measured: Baseline up to Week 286

  6. Change From Baseline in Free Testosterone Concentration in Participants ≥7 Years of Age or Tanner Stage ≥2 (Whichever Occurs First)

    Measured: Baseline up to Week 286

  7. Change From Baseline in Luteinizing Hormone Concentration in Participants ≥6 Years of Age

    Measured: Baseline up to Week 286

  8. Change From Baseline in Sexual Maturity Rating with Tanner Stage

    Tanner Stage 1 corresponds to the prepubertal form, with progression to Tanner Stage 5, the final adult form.

    Measured: Baseline up to Week 286

  9. Number of Female Participants With Development of Ovarian Cysts

    Measured: Baseline up to Week 286

  10. Change From Baseline in the Size of Ovarian Cysts in Female Participants

    Measured: Baseline up to Week 286

  11. Change From Baseline in Height-for-age Z-score

    Measured: Baseline up to Week 286

  12. Change From Baseline in Weight-for-age Z-score

    Measured: Baseline up to Week 286

  13. Change From Baseline in Body Mass Index (BMI)-for-age Z-score

    Measured: Baseline up to Week 286

  14. Change From Baseline in Bone Mineral Density (BMD) Z-score

    Measured: Baseline up to Week 286

  15. Average Change From Baseline in Indirect Bilirubin Concentration at Weeks 12, 16, and 20

    Measured: Baseline, Weeks 12, 16, and 20

  16. Average Change From Baseline in Lactose Dehydrogenase (LDH) Concentration at Weeks 12, 16, and 20

    Measured: Baseline, Weeks 12, 16, and 20

  17. Change From Baseline in Haptoglobin Concentration at Week 16

    Measured: Baseline, Week 16

  18. Change From Baseline in Reticulocytes

    Measured: Baseline up to Week 286

  19. Change From Baseline in Serum Iron Concentration

    Measured: Baseline up to Week 280

  20. Change From Baseline in Serum Ferritin Concentration

    Measured: Baseline up to Week 280

  21. Change From Baseline in Total Iron-binding Capacity

    Measured: Baseline up to Week 280

  22. Change From Baseline in Transferrin/Transferrin Saturation

    Measured: Baseline up to Week 280

  23. Change from Baseline in Pediatric Quality of Life (PedsQL) Multidimensional Fatigue Scale

    The PedsQL multidimensional fatigue scale yields a total score from age-appropriate validated questionnaire that asks for perceived fatigue within the domains of 'General', 'Sleep/Rest' and 'Cognitive'. Each domain consists of 6 questions that are rated from 0 to 4 (therefore total score can range from 0 to 72). A higher total score indicates greater fatigue (i.e., worse outcome).

    Measured: Baseline up to Week 280

  24. Change from Baseline in PedsQL Generic Core Scale (GCS)

    PedsQL GCS is designed to measure health-related quality of life in pediatric participants and adolescents (2 to 18 years of age). It encompasses 4 dimensions of functioning (physical [8 items], emotional [5 items], social [5 items], school [3 items]). Age groups: Toddler (2-4 years), Young pediatric (5-7 years), Pediatric (8-12 years), and Teens (13-17 years). Depending on the participant's age, the questionnaire may be completed by parent/caregiver as appropriate. For the Toddler group, the PedsQL GCS consist of 21 items, using a 5-point Likert scale (0 to 4); for all other groups, the PedsQL GCS consist of 23 items, with a 3-point Likert scale (0, 2, 4) for the young pediatric, and a 5-point Likert scale for the pediatric and teens groups. Scores are transformed on a scale from 0 to 100 where 0=100, 1=75, 2=50, 3=25, and 4=0. Higher scores indicate improved quality of life.

    Measured: Baseline up to Week 280

  25. Population Pharmacokinetic (PK) Model Parameter Estimate: Maximum Plasma Concentration (Cmax) of Mitapivat

    Measured: Weeks 2, 8, 12, and 16

  26. Population PK Model Parameter Estimate: Area Under the Concentration-time Curve (AUC) Derived From Plasma Concentrations of Mitapivat

    Measured: Weeks 2, 8, 12, and 16

  27. Concentration at Steady State (Css) of Mitapivat

    Measured: Week 16: 6 and 8 hours postdose

  28. Trough Concentration (Ctrough) of Mitapivat

    Measured: Week 8: ≤30 minutes predose; Week 12: ≤30 minutes predose

Timeline

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

  1. First posted3 Jan 2022
  2. Study start6 Jun 2022
  3. Primary completion13 Dec 2024
  4. Study completionJan 2030 (estimated)

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
30 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05175105
Sponsor's protocol ID
AG348-C-023
Other IDs
2021-003333-11
Acronym
ACTIVATE-Kids
Status last verified
Oct 2026
First submitted
22 Nov 2021
Last updated
28 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Mitapivat in people with Pediatric Pyruvate Kinase Deficiency and Pediatric Hemolytic Anemia, run by Agios Pharmaceuticals, Inc. at 19 sites in 7 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 7 inclusion and 25 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: under way, not looking for participants, as of the sponsor's last update on 28 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 19 sites in United States, Germany, Spain, Canada, France and 2 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

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?

This study is still under way. Results are not available in the source record yet.

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?

Percentage of Participants Achieving a Hemoglobin (Hb) Response (time frame: Baseline up to Week 20). 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 Oct 2026.

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