Study of Safety & PK of Luspatercept (ACE-536) in Pediatric Participants With Beta (β)-Thalassemia

Beta-Thalassemia Clinical Trial

Official title:

A Phase 2a Study to Evaluate the Safety and Pharmacokinetics of Luspatercept (ACE-536) in Pediatric Participants With Beta (β)-Thalassemia

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04143724
• Other study ID #: ACE-536-B-THAL-004
• Secondary ID: U1111-1241-41682
• Status: Recruiting
• Phase: Phase 2
• Start date: November 7, 2019
• Est. completion date: November 17, 2026

Study information

• Verified date: May 2024
• Source: Celgene
• Contact: BMS Study Connect Contact Center www.BMSStudyConnect.com
• Phone: 855-907-3286
• Email: Clinical.Trials[@]bms.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a Phase 2a study to evaluate the safety and pharmacokinetics (PK) of luspatercept in pediatric participants with β-thalassemia.

The study will be conducted in 2 parts for both transfusion-dependent (TD) and non-transfusion-dependent (NTD) β-thalassemia participants: TD Part A will be in adolescent participants aged 12 to <18 years with two dose escalation cohorts, followed by a dose expansion cohort. NTD Part A will be conducted in the same age group participants as TD Part A with dose confirmation and expansion phase. After Part A TD participants have completed at least one year of treatment, all available safety data from Part A adolescent participants will be evaluated before initiating TD and NTD Part B in the age group from 6 to <12 years old. Part B will consist of two dose escalation cohorts for TD and two dose escalation cohorts for NTD.

Upon completion of the Treatment Period, participants of any cohort who are benefiting from the study treatment, will be offered the opportunity to continue luspatercept treatment in the Long-term Treatment Period for up to 5 years from their first dose.

Participants who discontinue study treatment at any time will continue in the Posttreatment Follow-up Period for at least 5 years from their first dose of luspatercept, or 3 years from their last dose, whichever occurs later, or until they withdraw consent/assent, are lost to follow-up, or the End of Trial, whichever occurs first.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 99
• Est. completion date: November 17, 2026
• Est. primary completion date: June 30, 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 6 Years to 17 Years

Eligibility

Inclusion Criteria:

Participants must satisfy the following criteria to be enrolled into the study:

1. Participant must be 6 years to < 18 years of age at the time of signing the informed consent form (ICF)/informed assent form (IAF).

2. Participant (and when applicable, parent/legal representative) must understand and voluntarily sign an ICF/IAF prior to conducting any study-related assessments/procedures.

3. Participant (and when applicable, parent/legal representative) is willing and able to adhere to the study visit schedule and other protocol requirements.

4. Participant must have documented diagnosis of ß-thalassemia or Hemoglobin E/ß-thalassemia.

5. Transfusion dependence:

a. TD participant i. Participant is regularly transfused, defined as: = 4 RBC transfusion events in the 24 weeks prior to enrollment with no transfusion-free period = 42 days during that period. Note: For the purpose of the study, transfusions administered over 2 or 3 consecutive days are considered as part of a single transfusion event. Participant must have a history of regular transfusions for at least 2 years.

b. NTD participant (ex-US sites only) i. Participant must have received < 4 RBC transfusion events in the 24 weeks prior to enrollment. ii. Participant must not be on a regular transfusion program and must be RBC transfusion-free for at least 8 weeks prior to enrollment. iii. Participant must have mean baseline hemoglobin = 10 g/dL, based on a minimum of 2 measurements = 1 week apart within 4 weeks prior to enrollment; hemoglobin values within 21 days post-transfusion will be excluded.

6. Participant has Karnofsky (age =16 years) or Lansky (age < 16 years) performance status score = 50 at screening.

7. Female children of childbearing potential (FCCBP), females of childbearing potential (FCBP), and male participants that have reached puberty (and when applicable, parent/legal representative) must agree to undergo physician-approved reproductive education and discuss the side effects of the study therapy on reproduction.

8. Female children of childbearing potential, defined as females who have achieved menarche and/or breast development in Tanner Stage 2 or greater and have not undergone a hysterectomy or bilateral oophorectomy and females of childbearing potential (FCBP)defined as a sexually mature woman who has achieved menarche at some point, has not undergone a hysterectomy or bilateral oophorectomy and has not been naturally postmenopausal for at least 24 consecutive months (ie, has had menses at any time in the preceding 24 consecutive months) must meet the following conditions below (Note: Secondary amenorrhea from any cause does not rule out childbearing potential):

• Medically supervised serum pregnancy tests with a sensitivity of at least 25 mIU/mL must be conducted in Female children of childbearing potential (FCCBP)/ females of childbearing potential (FCBP), including those who commit to complete abstinence. Female children of childbearing potential/ females of childbearing potential (FCBP) must have 2 negative pregnancy tests as verified by the Investigator prior to starting study therapy (one of these tests should be performed by central laboratory). Female children of childbearing potential/ females of childbearing potential (FCBP)must agree to ongoing pregnancy testing during the course of the study at the End of Treatment (EOT) visit and at the 9-week Safety Follow-up visit.

• Female participants must, as appropriate to age and at the discretion of the site Investigator, either commit to true abstinence* from heterosexual contact (which must be reviewed on a monthly basis) or agree to use, and be able to comply with, effective** contraception without interruption, 28 days prior to starting IP, during the study therapy (including dose interruptions), and for 12 weeks (approximately 5 times the mean terminal t1/2 of luspatercept based on multiple-dose PK data) after discontinuation of study therapy.

9. Male participants, as appropriate to age and the discretion of the study physician:

• Must practice true abstinence* (which must be reviewed on a monthly basis) or agree to use a synthetic or latex condom during sexual contact with a pregnant female or a Female children of childbearing potential (FCCBP)/FCBP while participating in the study, during dose interruptions and for at least 12 weeks (approximately 5 times the mean terminal t1/2 of luspatercept based on multiple-dose PK data) following IP discontinuation, even if he has undergone a successful vasectomy

• True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the participant. [Periodic abstinence (eg, calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.] ** Agreement to use highly effective methods of contraception that alone or in combination result in a failure rate of a Pearl index of less than 1% per year when used consistently and correctly throughout the course of the study. Such methods include: Combined (estrogen and progesterone/progestin containing) hormonal contraception: Oral; Intravaginal; Transdermal; Progestogen/progestin only hormonal contraception associated with inhibition of ovulation: Oral; Injectable hormonal contraception; Implantable hormonal contraception; Placement of an intrauterine device (IUD); Placement of an intrauterine hormone-releasing system (IUS); Bilateral tubal occlusion; Vasectomized partner; Sexual Abstinence.

Exclusion Criteria:

The presence of any of the following will exclude a participant from enrollment into the study:

1. Participant has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the participant from participating in the study.

2. Participant has any condition including the presence of laboratory abnormalities, which places the participant at unacceptable risk if he/she were to participate in the study.

3. Participant has any condition that confounds the ability to interpret data from the study.

4. Participant has a diagnosis of Hemoglobin S/ß-thalassemia or alpha (a)-thalassemia (eg, Hemoglobin H); ß-thalassemia combined with a-thalassemia is allowed.

5. Participant has of active hepatitis C (HCV) infection, as demonstrated by a positive HCF-ribonucleic acid (RNS) test of sufficient sensitivity, or active infectious hepatitis B (as demonstrated by the presence of hepatitis B surface antigen (HBsAG) and/or hepatitis B virus (HBV)-deoxyribonucleic acid (DNA) positive, or known positive human immunodeficiency virus (HIV).

Note: Participants receiving antiviral therapies should have 2 negative HCV-RNA tests 3 months apart before ICF/IAF signature, ie, one test at the end of the antiviral therapy and the second test 3 months following the first test.

6. Participant has severe infection = 28 days prior to enrollment. Additionally, in the case of prior SARS-CoV-2 infection, symptoms must have completely resolved, and based on Investigator assessment in consultation with the Clinical Trial Physician, there are no sequelae that would place the participant at a higher risk of receiving investigational treatment.

7. Participant has received a live COVID-19 vaccine = 28 days prior to screening.

8. Participant has deep vein thrombosis (DVT), stroke, or other thromboembolic event(s) (except clogged indwelling catheter) requiring medical intervention = 24 weeks prior to enrollment.

9. Participant has chronic anticoagulant therapy = 28 days prior to enrollment (Anticoagulant therapies used for prophylaxis for surgery or high-risk procedures as well as low molecular weight [LMW] heparin for superficial vein thrombosis [SVT] and chronic aspirin are allowed).

10. Participant has platelet count > 1000 x 109/L.

11. Participant has poorly controlled diabetes mellitus within 24 weeks prior to enrollment as defined by short term (eg, hyperosmolar or ketoacidotic crisis) and/or history of diabetic cardiovascular complications (eg, stroke or myocardial infarction).

12. Participant has treatment with another investigational drug or device = 28 days prior to enrollment.

13. Participant has prior exposure to sotatercept (ACE-011) or luspatercept (ACE-536).

14. Participant underwent or is scheduled for HSCT or gene therapy

15. Participant has used an erythropoiesis-stimulating agent (ESA) = 24 weeks prior to enrollment.

16. Participant use of iron chelation therapy (ICT), if initiated = 8 weeks prior to enrollment (allowed if initiated > 8 weeks before or during treatment).

17. Participant use of hydroxyurea treatment = 24 weeks prior to enrollment.

18. Participant is pregnant or breastfeeding female.

19. Participant has uncontrolled hypertension. Controlled hypertension for this protocol is considered = Grade 1 according to NCI CTCAE version 5.0.

20. Participant has major organ damage, including:

1. Symptomatic splenomegaly

2. Liver disease with alanine aminotransferase (ALT)/aspartate aminotransferase (AST) > 3X the upper limit of normal (ULN) for age

3. Heart disease, heart failure as classified by the New York Heart Association (NYHA) classification 3 or higher, or significant arrhythmia requiring treatment, or recent myocardial infarction within 6 months of enrollment

4. Lung disease, including pulmonary fibrosis or pulmonary hypertension which are clinically significant

5. Renal insufficiency defined as:

• A serum creatinine based on age/gender based on threshold derived from Schwartz formula for estimating GFR utilizing child length and stature data published by the Centers for Disease Control

21. Participant has proteinuria = Grade 3 according to NCI CTCAE version 5.0 (which is equivalent to a urine protein/creatinine ratio > 215 mg/mmol of creatinine), or a urine albumin/creatinine ratio > 129 mg/mmol of creatinine.

22. Participant use of chronic systemic glucocorticoids = 12 weeks prior to enrollment (physiologic replacement therapy for adrenal insufficiency is allowed). Single day glucocorticoid treatment (eg, for prevention or treatment of transfusion reactions) is allowed.

23. Participant has major surgery = 12 weeks prior to enrollment (participants must have completely recovered from any previous surgery prior to enrollment).

24. Participant has history of severe allergic or anaphylactic reactions or hypersensitivity to recombinant proteins or excipients in the IP (refer to the IB).

25. Participant use of cytotoxic agents, immunosuppressants = 28 days prior to enrollment (ie, antithymocite globulin (ATG) or cyclosporine).

26. Participant has history of malignancy with the exception of:

1. Curatively resected nonmelanoma skin cancer.

2. Curatively treated cervical carcinoma in situ.

3. Other solid tumor with no known active disease in the opinion of the Investigator.

27. Participant who has EMH complications or requires treatment to control the growth of EMH masse(s) during the screening period.

Related Conditions & MeSH terms

• Beta-Thalassemia
• Thalassemia

Intervention

Drug:
• ACE-536
Specified dose on specified days

Locations

Country	Name	City	State
China	Local Institution - 903	Chengdu	Sichuan
China	Local Institution - 901	Guangzhou
China	Local Institution - 902	Guangzhou	Guangdong
China	Local Institution - 904	Nanning Shi	Guangxi
China	Local Institution - 905	Shenzhen	Guangdong
Germany	Local Institution - 102	Essen
Germany	Universitatsklinikum Ulm	Ulm
Greece	General Children's Hospital "Agia Sophia"	Athens
India	Local Institution - 801	Hyderabad	Andhra Pradesh
India	Local Institution - 803	Kolkata
India	Local Institution - 800	Mumbai	Maharashtra
India	Local Institution - 802	Noida	Uttar Pradesh
India	Local Institution - 805	Sakri	Maharashtra
India	Local Institution - 804	Vellore
Italy	Ente Ospedaliero Ospedali Galliera - Centro della Microcitemia e delle Anemie Congenite	Genoa
Italy	AOU dell'Universita degli Studi della Campania Luigi Vanvitelli	Napoli
Italy	Azienda Ospedaliero Universitaria S. Luigi Gonzaga	Orbassano
Italy	Local Institution - 304	Rome	Roma
Lebanon	Local Institution - 700	Beirut
Thailand	Chulalongkorn University Faculty of Medicine - King Chulalongkorn Memorial Hospital	Bangkok
Thailand	Siriraj Hospital Mahidol University	Bangkok
Thailand	Local Institution - 502	Phyathai
Turkey	Ege Universitesi Tip Fakultesi Hastanesi	Izmir
United States	Children's Hospital Of Los Angeles	Los Angeles	California
United States	New York Presbyterian Hospital	New York	New York

Sponsors (2)

Lead Sponsor	Collaborator
Celgene	Acceleron Pharma, Inc., a wholly-owned subsidiary of Merck & Co., Inc., Rahway, NJ USA

Countries where clinical trial is conducted

United States,  China,  Germany,  Greece,  India,  Italy,  Lebanon,  Thailand,  Turkey, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Determination of the Recommended Dose (RD	Determine the recommended dose of luspatercept that is safe and tolerable in pediatric participants with transfusion-dependent B-thalassemia or non-transfusion-dependent ß-thalassemia	Cycle 1 Day 1 up to Cycle 2 Day 1 (each Cycle is 21 days)
Primary	Pharmacokinetics - Cmax	Maximum serum concentration of drug	Time from Cycle 1 Day 1 of Treatment Period up to a maximum of 1 year
Primary	Pharmacokinetics - AUC	Area under the curve	Time from Cycle 1 Day 1 of Treatment Period up to a maximum of 1 year
Primary	Pharmacokinetics (PK) - t1/2	Half-life	Time from Cycle 1 Day 1 of Treatment Period up to a maximum of 1 year
Primary	Pharmacokinetics (PK) - CL/F	Apparent oral clearance	Time from Cycle 1 Day 1 of Treatment Period up to a maximum of 1 year
Primary	Pharmacokinetics (PK) - Vd/F	Apparent volume of distribution	Time from Cycle 1 Day 1 of Treatment Period up to a maximum of 1 year
Secondary	Mean change in Red Blood Cell (RBC) Transfusion Burden for transfusion-dependent ß-thalassemia participants	Change from baseline as continuous variable	12 weeks prior to enrollment; Treatment Period and up to End of Treatment including Long-term Treatment Period - Up to 5 years
Secondary	Mean change in hemoglobin levels for non-transfusion-dependent ß-thalassemia participants	Change from baseline as continuous variable	12 weeks prior to enrollment; Treatment Period and up to End of Treatment including Long-term Treatment Period - Up to 5 years
Secondary	Immunogenicity	Frequency of antidrug antibodies (ADA)	Time from Cycle 1 Day 1 of Treatment Period up to a maximum of 1 year
Secondary	Mean change from baseline in mean daily dose of iron chelation therapy (ICT)	Change from baseline as continuous variable	12 weeks prior to enrollment; Treatment Period and up to End of Treatment including Long-term Treatment Period - Up to 5 years
Secondary	Mean change from baseline in serum ferritin	Change from baseline as continuous variable	12 weeks prior to enrollment; Treatment Period and up to End of Treatment including Long-term Treatment Period - Up to 5 years
Secondary	Safety - Incidence of Adverse Events (AEs)	An AE is any noxious, unintended, or untoward medical occurrence that may appear or worsen in a participant during the course of a study. It may be a new intercurrent illness, a worsening concomitant illness, an injury, or any concomitant impairment of the participant's health, including laboratory test values, regardless of etiology. Any worsening (ie, any clinically significant adverse change in the frequency or intensity of a preexisting condition) should be considered an AE	From enrollment until at least 9 weeks after last dose of study treatment

External Links

•   BMS Clinical Trial Information
•   BMS Clinical Trial Patient Recruiting