Phase 1 Safety, Pharmacokinetics And Pharmacodynamics Study Of Recombinant Factor VIIa Variant (813d) In Adult Subjects With Hemophilia

Hemophilia A Clinical Trial

Official title:

An Ascending Single Dose Study To Evaluate The Safety, Tolerability And Pharmacokinetics/Pharmacodynamics Of Pf-05280602, A Recombinant Factor Viia Variant (813d), In Adult Hemophilia A And B Subjects With Or Without Inhibitors

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01439971
• Other study ID #: B3051001
• Secondary ID: 2011-002170-23
• Status: Completed
• Phase: Phase 1
• First received: August 26, 2011
• Last updated: April 3, 2017
• Start date: December 2011
• Est. completion date: October 2015

Study information

• Verified date: April 2017
• Source: Catalyst Biosciences
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study hypothesizes that the study drug, PF-05280602 (at the selected doses) will be safe to administer to subjects with severe Hemophilia A or B with or without inhibitors and will demonstrate evidence of hemostatic activity. This is supported by the preclinical findings in hemophilic animal models.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 29
• Est. completion date: October 2015
• Est. primary completion date: October 2015
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years to 64 Years

Eligibility

Inclusion Criteria:

• Male subjects 18 to <65 years old with severe hemophilia A or B with or without inhibitors to FVIII or FIX.

• Subjects is willing and able to comply with the mandatory washout periods prior to screening and prior to dosing and through 48 hours post dosing. At screening this includes a washout of FIX for 96 hours and FVIII for 72 houts. At dosing this includes a washout of FIX for 96 hours and FVIII and other hemostatic agents for 72 hours through 48 hours post dosing.

• Subjects must agree and commit to using a a highly effective method of birth control from the time of screening through four weeks after study drug administration.

Exclusion Criteria:

• Presence of a bleeding disorder in addition to hemophilia A or B.

• Regular, concomitant therapy with immunomodulating drugs (eg, intravenous immunoglobulin, and routine systemic corticosteroids).

• History of coronary artery disease, thrombolic disease or diagnosis of prothrombic disorder.

Related Conditions & MeSH terms

• Hemophilia A

Intervention

Biological:
• PF-05280602
0.5 micrograms per kilogram of PF-05280602, IV infusion, single dose
• PF-05280602
4.5 micrograms per kilogram of PF-05280602, IV infusion, single dose
• PF-05280602
9.0 micrograms per kilogram of PF-05280602, IV infusion, single dose
• PF-05280602
18.0 micrograms per kilogram of PF-05280602, IV infusion, single dose
• PF-05280602
30.0 micrograms per kilogram of PF-05280602, IV infusion, single dose

Locations

Country	Name	City	State
Belgium	Pfizer Clinical Research Unit	Bruxelles
Hungary	Semmelweis Egyetem Altalanos Orvostudomanyi Kar/ I.sz. Belgyogyaszati Klinika	Budapest
Italy	Dipartimento di Medicina Clinica 1-Centro Regionale per le Malattie del Sangue	Castelfranco Veneto (TV)
Italy	Servizio Farmacia- Ospedale Castelfranco Veneto	Castelfranco Veneto - Treviso
Italy	Centro Emofilia e Trombosi "Angelo Bianchi Bonomi" U.O.S. Dipartimentale per la Diagnosi e la Terapi	Milano
Italy	Servizio Farmacia Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico	Milano
Italy	Centro Malattie Emorragiche e Trombotiche - Ematologia	Vicenza
Italy	Farmacia Ospedaliera Ospedale San Bortolo	Vicenza
New Zealand	Christchurch Clinical Studies Trust	Christchurch
South Africa	Phoenix Pharma (Pty) Ltd	Port Elizabeth	Eastern Cape
Turkey	Ege University Tip Fakultesi	Izmir
United Kingdom	Haematology Department	London
United Kingdom	Royal Free Hampstead NHS Trust, Royal Free Hospital	London
United Kingdom	Central Manchester Universtiy Hospitals NHS Foundation Trust	Manchester
United States	Rush University Medical Center	Chicago	Illinois
United States	Cincinnati Children's Hospital Medical Center	Cincinnati	Ohio
United States	New Haven Clinical Research Unit	New Haven	Connecticut
United States	CTRC	Philadelphia	Pennsylvania
United States	Penn Comprehensive Hemophilia Program - Center for Blood Disorders	Philadelphia	Pennsylvania
United States	Doernbecher Children's Hospital	Portland	Oregon
United States	OHSU Investigational Pharmacy	Portland	Oregon
United States	Oregon Health & Science University	Portland	Oregon
United States	University of California San Diego Medical Center	San Diego	California

Sponsors (1)

Lead Sponsor	Collaborator
Catalyst Biosciences

Countries where clinical trial is conducted

United States,  Belgium,  Hungary,  Italy,  New Zealand,  South Africa,  Turkey,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change From Baseline in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)	Supine blood pressure (BP) was measured with the participant's arm supported at the level of the heart, and recorded to the nearest millimeters of mercury (mmHg) after 5 minutes of rest. The same arm (preferably the dominant arm) was to be used throughout the study.	Baseline, Day 2, Day 3, and Day 15
Primary	Change From Baseline in Body Weight		Baseline, Day 2, Day 3, and Day 15
Primary	Change From Baseline in Body Temperature	Body temperature was measured by mouth (oral) or ear (tympanic). A temperature greater than 38.5 degree Celsius was considered a fever.	Baseline, Day 2, Day 3, and Day 15
Primary	Change From Baseline in Respiration Rate	Respiration rate measured as respirations per minute (resp/min).	Baseline, Day 2, Day 3, and Day 15
Primary	Change From Baseline in Supine Pulse Rate	Change from baseline is the vital sign value at Day 2, Day 3, and Day 15 minus vital sign value at baseline.	Baseline, Day 2, Day 3, and Day 15
Primary	Number of Participants With Changes Since Previous Physical Examination	Physical examinations were conducted by a physician, trained physician's assistant, or nurse practitioner. A complete physical examination included head, ears, eyes, nose, mouth, skin, heart and lung examinations, lymph nodes, genitourinary, gastrointestinal, musculoskeletal, and neurological systems. The limited or abbreviated physical examination focused on general appearance, the respiratory and cardiovascular systems, as well as towards participant reported symptoms.	Baseline (Day 0), Day 1, Day 2, Day 3, Day 15
Primary	Number of Participants With Potentially Clinically Significant Electrocardiogram (ECG) Findings	ECG findings of potential clinical concern were: PR interval greater than or equal to (>=)300 milliseconds (msec), >=25% increase from baseline for baseline values >200 msec, >=50% increase from baseline for baseline values less than or equal to (<=)200 msec; QRS complex >=140 msec or >=50% increase from baseline; QTcF interval (Fridericia's correction) >=450 msec or >=30 msec increase from baseline.	Baseline through Day 15
Primary	Number of Participants With Treatment-Emergent Adverse Events (AEs), Serious Adverse Events (SAEs), and Withdrawals Due to AEs (Except Hemophilia AEs)	An AE was any untoward medical occurrence in a participant who received study drug. An SAE was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Treatment-emergent are events between first dose of study drug and up to Day 15 that were absent before treatment or that worsened relative to pre-treatment state. AEs included both SAEs and non-SAEs.	Baseline through Day 60
Primary	Number of Participants With Treatment-Emergent Hemophilia AEs and Withdrawals Due to Hemophilia AEs	Hemophilia AEs included spontaneous (no known contributing factor) and traumatic (known or presumed contributing factor/reason) bleeding episodes.	Baseline through Day 60
Primary	Number of Treatment-Emergent AEs and SAEs by Severity (Except Hemophilia AEs)	AE severity were graded as mild, moderate, or severe. Mild severity AEs do not interfere with the participant's usual function. Moderate AEs interfere to some extent with the participant's usual function. Severe AEs interfere significantly with the participant's usual function.	Baseline through Day 60
Primary	Number of Treatment-Emergent Hemophilia AEs by Severity	Mild severity AEs do not interfere with the participant's usual function. Moderate AEs interfere to some extent with the participant's usual function. Severe AEs interfere significantly with the participant's usual function.	Baseline through Day 60
Primary	Number of Participants With Treatment-Emergent Abnormal Troponin-T Levels by Magnitude	Troponin-T is a cardiac marker for the evaluation of possible cardiovascular injury. Troponin-T levels of potential clinical concern are values >1.5 times the upper limit of normal (1.5X ULN) or >=2.5X ULN.	Baseline through Day 15
Primary	Number of Participants With Treatment-Emergent Abnormal Anti-Thrombin III (ATIII) Levels by Magnitude	ATIII is a protein in the blood that blocks abnormal blood clots from forming. Low levels of ATIII can cause abnormal blood clots. ATIII levels of potential clinical concern are values <1X LLN and >1X ULN.	Baseline through Day 3
Primary	Number of Participants With Treatment-Emergent Abnormal Tissue Factor Pathway Inhibitor (TFPI) Levels by Magnitude	TFPI is a polypeptide that can regulate blood coagulation. TFPI levels of potential clinical concern are values <1X LLN and >1X ULN.	Baseline through Day 3
Primary	Number of Participants With Treatment-Emergent Laboratory Test Abnormalities (Normal Baseline)	The following laboratory parameters were analyzed: hematology (hemoglobin, hematocrit, red blood cell [RBC] count, platelets, leukocytes, total neutrophils, eosinophils, basophils, lymphocytes, monocytes); chemistry (total bilirubin, direct bilirubin, indirect bilirubin, aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase, creatinine, blood urea nitrogen [BUN], glucose, uric acid, sodium, potassium, chloride, bicarbonate, calcium, albumin, total protein, creatine kinase); urinalysis (urine white blood cell [WBC], urine RBC); other (troponin T).	Baseline through Day 15
Primary	Number of Participants With Clinically Significant Laboratory Abnormalities Meeting Stopping Criteria	Clinically significant findings for stopping rules are: hemoglobin <8 grams/deciliter (g/dL) or >20% decrease from normal baseline; WBC >20,000 cells/mm^3 or <1,500 decrease with normal baseline; platelets <100,000/mm^3 or >33% decrease from baseline; total bilirubin >1.5X ULN; AST or ALT >2.5X ULN; alkaline phosphatase >3X ULN; creatinine >1.5X baseline; BUN >31.0 mg/dL; glucose <0.6 or >1.5X reference range; uric acid > ULN; sodium >150 or <130 mEq/L; potassium >5.5 or <3.0 mEq/L; calcium >11.5 or <8.0 mg/dL; albumin <2.0 g/L; total protein <5.0 g/L; positive D-dimer at Day 15; PT prolonged by 3 seconds above baseline; ATIII < LLN and >20% decrease from baseline; troponin-T values above the reference range; fibrinogen <0.75X LLN or >25% decrease from baseline.	Baseline through Day 15
Primary	Number of Participants With Positive Immune Response (Anti-Drug Antibodies [ADA], PF-05280602 Inhibitor, Factor VIIa Inhibitor, Factor VII Inhibitor, and Depletion of Factor VII Activity)	Assays for the determination of a positive immune response was performed. An antibody immune response was defined as a confirmed post-treatment positive ELISA result in combination with a negative baseline sample ELISA result. Positive antibody immune responses to PF-05280602 by ELISA was evaluated for cross reactivity to NovoSeven RT and to Factor VII.	Baseline through Day 60
Secondary	Maximum Observed Plasma Concentration (Cmax)		Day 1 (pre-dose and 5 min, 10 min, 20 min, 30 min, 1 hr, 3 hr, 6 hr, 9 hr, and 12 hrs post-dose), Day 2 (24 hrs post-dose), Day 3 (48 hrs post-dose)
Secondary	Area Under the Curve From Time Zero to Last Quantifiable Concentration (AUClast)	Area under the plasma concentration time-curve from zero to the last measured concentration (AUClast)	Day 1 (pre-dose and 5 min, 10 min, 20 min, 30 min, 1 hr, 3 hr, 6 hr, 9 hr, and 12 hrs post-dose), Day 2 (24 hrs post-dose), Day 3 (48 hrs post-dose)
Secondary	Terminal Elimination Half-Life (t1/2)	t1/2 is the time measured for the plasma concentration to decrease by one half.	Day 1 (pre-dose and 5 min, 10 min, 20 min, 30 min, 1 hr, 3 hr, 6 hr, 9 hr, and 12 hrs post-dose), Day 2 (24 hrs post-dose), Day 3 (48 hrs post-dose)
Secondary	Incremental Recovery (IncRec)	IncRec is the maximum rise in plasma concentration per administered dose.	Day 1 (pre-dose and 5 min, 10 min, 20 min, 30 min, 1 hr, 3 hr, 6 hr, 9 hr, and 12 hrs post-dose), Day 2 (24 hrs post-dose), Day 3 (48 hrs post-dose)
Secondary	Area Under the Curve From Time Zero to Extrapolated Infinite Time (AUCinf)	AUCinf is area under the plasma concentration-time curve from time 0 extrapolated to infinite time.	Day 1 (pre-dose and 5 min, 10 min, 20 min, 30 min, 1 hr, 3 hr, 6 hr, 9 hr, and 12 hrs post-dose), Day 2 (24 hrs post-dose), Day 3 (48 hrs post-dose)
Secondary	Mean Residence Time (MRT)	MRT is AUMCinf/AUCinf, where AUMC is the area under the first moment curve.	Day 1 (pre-dose and 5 min, 10 min, 20 min, 30 min, 1 hr, 3 hr, 6 hr, 9 hr, and 12 hrs post-dose), Day 2 (24 hrs post-dose), Day 3 (48 hrs post-dose)
Secondary	Volume of Distribution at Steady State (Vss)	Volume of distribution is defined as the theoretical volume in which the total amount of drug would need to be uniformly distributed to produce the desired blood concentration of a drug. Steady state volume of distribution (Vss) is the apparent volume of distribution at steady-state.	Day 1 (pre-dose and 5 min, 10 min, 20 min, 30 min, 1 hr, 3 hr, 6 hr, 9 hr, and 12 hrs post-dose), Day 2 (24 hrs post-dose), Day 3 (48 hrs post-dose)
Secondary	Clearance (CL)	Drug clearance is a quantitative measure of the rate at which a drug substance is removed from the blood (rate at which a drug is metabolized or eliminated by normal biological processes). Clearance obtained after intravenous infusion dose is influenced by the fraction of the dose absorbed.	Day 1 (pre-dose and 5 min, 10 min, 20 min, 30 min, 1 hr, 3 hr, 6 hr, 9 hr, and 12 hrs post-dose), Day 2 (24 hrs post-dose), Day 3 (48 hrs post-dose)
Secondary	Time to Reach Maximum Observed Plasma Concentration (Tmax)		Day 1 (pre-dose and 5 min, 10 min, 20 min, 30 min, 1 hr, 3 hr, 6 hr, 9 hr, and 12 hrs post-dose), Day 2 (24 hrs post-dose), Day 3 (48 hrs post-dose)
Secondary	Maximum Mean Decrease From Baseline in Prothrombin Time (PT)	PT measures how long it takes blood to clot. Maximum mean decrease from baseline at any time point was reported.	Baseline through Day 15
Secondary	Maximum Mean Decrease From Baseline in Activated Partial Thromboplastin Time (aPTT)	aPTT is a blood test that characterizes blood coagulation. Maximum mean decrease from baseline at any time point was reported.	Baseline through Day 15
Secondary	Maximum Mean Increase From Baseline in Thrombin Anti-Thrombin (TAT) Complexes	TAT complex is a parameter of coagulation and fibrinolysis. The normal reference range of values for TAT is 1 to 4.1 mcg/L. Elevated TAT concentrations may signify predisposition to thrombosis. Maximum mean increase from baseline at any time point was reported.	Baseline through Day 3
Secondary	Maximum Mean Increase From Baseline in Prothrombin Fragments 1+2	Prothrombin fragment 1+2 is a coagulation factor, released when prothrombin is cleaved by activated Factor X. Elevated plasma levels of prothrombin fragment 1+2 indicate high risk of thrombosis. Maximum mean increase from baseline at any time point was reported.	Baseline through Day 3
Secondary	Maximum Mean Increase From Baseline in D-Dimers	D-dimer is an indicator of fibrin formation and its subsequent lysis and is a useful biomarker representing overall activation of blood coagulation. Maximum mean increase from baseline at any time point was reported.	Baseline through Day 15
Secondary	Maximum Mean Increase From Baseline in Endogenous Thrombin Potential (ETP)	ETP was evaluated using a Thrombin Generation Assay (TGA), a validated automated ex-vivo assay that measures the ability of plasma to generate thrombin. Thrombin generation curves are generated and calculated using dedicated software. ETP is the area under the thrombin generation curve and represents the total amount of generated thrombin. Maximum mean increase from baseline at any time point was reported.	Baseline through Day 3
Secondary	Maximum Mean Decrease From Baseline in Thrombin Generation Lag Time	The lag time is defined as the time to reach one sixth of the peak height and is a measure of the initiation phase. It is equivalent to the clotting time. Maximum mean decrease from baseline at any time point was reported.	Baseline through Day 3
Secondary	Maximum Mean Increase From Baseline in Peak Thrombin Generation	The peak height is defined as the maximum thrombin concentration produced. Maximum mean increase from baseline at any time point was reported.	Baseline through Day 3

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