Prophylaxis Regimen for Hemophilia A Patients

Hemophilia A Clinical Trial

— PREDICT  

Official title:

A Multicenter, Prospective, Open-label, Clinical Study to Assess the Effect of Using a New Risk Score Approach to Select the Most Appropriate Prophylaxis Regimen for Reaching a Favorable Outcome, When Hemophilia A Patients Switch From Standard Half-life Products to Damoctocog Alfa Pegol (Jivi)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05036278
• Other study ID #: 21924
• Secondary ID: 2021-006191-16
• Status: Recruiting
• Phase: Phase 4
• Start date: July 28, 2022
• Est. completion date: September 14, 2024

Study information

• Verified date: June 2024
• Source: Bayer
• Contact: Bayer Clinical Trials Contact
• Phone: (+)1-888-84 22937
• Email: clinical-trials-contact[@]bayer.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Researchers are looking for a better way to treat people who have hemophilia A. Hemophilia A is a genetic bleeding disorder that is caused by the lack of a protein in the blood called "clotting factor 8" (FVIII). FVIII is naturally found in the blood where it causes the blood to clump together to help prevent and stop bleeding. People with lower levels of FVIII or with FVIII that does not work properly may bleed for a long time from minor wounds, have painful bleeding into joints, or have internal bleeding.

The study treatment, Jivi (also called damoctocog alfa pegol), is already available for doctors to prescribe to people with hemophilia A to treat and prevent bleeding. It works by replacing the missing FVIII, or the FVIII that does not work properly.

People with hemophilia A need frequent injections of FVIII products into the vein. So called standard half-life (SHL) products need to be given 2 to 4 times a week for the prevention of bleeding. In recent years, new products like Jivi called extended half-life (EHL) products have become available. These products last longer in the body so that they require to be given less often with injections every 3-5 days. Thus, these treatments may be easier and more comfortable to stick to in daily life. There is no general plan concerning the best amount of treatment and the frequency of injections for the prevention of bleeding, since the severity may be different and individual risk factors have to be considered. Doctors often decide on a treatment plan based on their experience.

The main purpose of this study is to learn how well a new scoring approach works to select a treatment plan for the prevention of bleeding in people with hemophilia A who switch their treatment from SHL products to Jivi. Different types of information are used to calculate the risk score like bleeding history, certain biological factors, and physical activity of the participant.

All participants will receive Jivi for 6 months.

In the first four weeks, all participants will receive Jivi 2 times a week at a dose level of 40 IU per kilogram body weight (also known as 40 IU/kg/dose, recommended maximum dose is 6,000 IU). Then, based on their risk score, each participant will be assigned to one of three treatment plans:

• participants with a high risk remain on Jivi administration 2 times a week at 40 IU/kg/dose

• participants with a medium risk will switch to Jivi administration every 5 days at 50 IU/kg/dose

• participants with a low risk will switch to Jivi administration every 5 days at 50 IU/kg/dose and after 4 weeks to a less frequent administration (e.g., every 7 days) at 60 IU/kg/dose To check how well the new scoring approach works for choosing the right treatment plan, researchers will look at how many participants have a favourable outcome.

This means that the participant has either fewer bleeding events vs. the pre-study treatment and takes Jivi less often or as often as the previous SHL treatment but with fewer bleeding events, or that the participant has a comparable number of bleeding events but needs to take Jivi less often than the previous treatment. Each participant will be in the study for approximately 7.5 months. During this time, 4 visits to the study site and 3 phone calls are planned. During the study, the doctors and their study team will: • do physical examinations

• take blood samples • ask the participants questions about how they are feeling and what adverse events they are having. In addition, participants or their guardians are required to write down the dates of Jivi treatments and bleeding events in an electronic diary and to fill in different questionnaires on their quality of life, health status, work/ school productivity, pain, and treatment satisfaction. In addition, participants are expected to keep appointments for visits and to adhere to the assigned treatment regimen.

An adverse event is any medical problem that a participant has during a study. Doctors keep track of all adverse events that happen in studies, even if they do not think the adverse events might be related to the study treatments.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 25
• Est. completion date: September 14, 2024
• Est. primary completion date: August 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 12 Years and older

Eligibility

Inclusion Criteria:

• Participants must be = 12 years of age inclusive, at the time of signing the informed consent/assent.

• Previously treated patients (= 150 EDs) with congenital hemophilia A.

• Prophylaxis with any SHL FVIII product with a stable frequency for at least 6 consecutive months within the last 12 months prior to screening before entering the study and documented in medical records. Stable frequency is defined as a minimum 18 weeks of treatment in a 6 (consecutive) calendar month period in the 12 months prior to screening. Patients can be on any non-Jivi EHL between the 6-month stable SHL prophylaxis period and start of study treatment.

• Documented bleeding rate (ABR) while on stable frequency SHL prophylaxis for at least 6 consecutive months within the last 12 months prior to screening.

• No current evidence (= 0.6 BU/mL) of FVIII inhibitors. If a participant has had a positive inhibitor titer in the past (= 0.6 BU/mL on two occasions) but has been tolerized for at least 1 year since the last positive titer with at least 1 negative inhibitor assay test during that period, they can be enrolled. If a participant has had a positive inhibitor titer in the past (= 0.6 BU/mL) but did not require tolerization and has had at least 1 negative inhibitor assay test during a minimum period of at least 1 year since the last positive titer, they can be enrolled.

• If they are human immunodeficiency virus (HIV) positive, cluster of differentiation 4 (CD4+) lymphocyte count should be > 200/mm^3 within 1 year before entering the study and documented in medical records. -

• Participants who are willing to complete an electronic diary (eDiary).

• Contraceptive use should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.

• For adolescent participants (= 12 to < 18 years), a legal guardian must be available to help the study-site personnel ensure follow-up; accompany the participant to the study site on each assessment day according to the Schedule of Activities (SoA) (e.g. able to comply with scheduled visits, treatment plan, laboratory tests and other study procedures); consistently and consecutively be available to provide information on the participant using the PROs during the scheduled study visits; accurately and reliably dispense study intervention as directed.

• For adolescent participants, a legal guardian must be able to accurately maintain the child's take-home record, including items of general health.

Exclusion Criteria:

• Any other inherited or acquired bleeding disorder in addition to hemophilia A. Note:

von Willebrand disease should be diagnosed per local clinical practice. Participants with a diagnosis of von Willebrand disease in medical records or diagnosed at the time of screening will be excluded.

• Platelet count < 100,000/mm^3

• Evidence of inhibitor to FVIII (= 0.6 BU/mL) within the last 1 year

• The participant is currently participating in another investigational drug study or has participated in a clinical study involving an investigational drug or device within 30 days of signing informed consent.

• The participant has a planned major surgery.

• Documentation of missing risk score parameters other than physical activity .

• Known hypersensitivity to the drug substance, excipients, or mouse or hamster protein.

• Any other significant medical condition that the investigator feels would be a risk to the participant or would impede the study.

• Close affiliation with the investigational site; e.g. a close relative of the investigator, dependent person (e.g. employee or student of the investigational site).

• Otherwise vulnerable participants (e.g. participants who are in custody by order of an authority).

• Judgment by the investigator that the participant should not participate in the study if the participant is unlikely to comply with study procedures (i.e. eDiary completion, clinic visits, phone updates), restrictions, and requirements.

Related Conditions & MeSH terms

• Hemophilia A

Intervention

Biological:
• Damoctocog alfa-pegol is a recombinant B-domain deleted human coagulation FVIII variant site specifically conjugated with a 60 kDa, branched (30 kDa each) polyethylene glycol (PEG).
Dosage Levels: 40 IU/kg/dose two times per week 50 IU/kg/dose every 5 days 60 IU/kg/dose, Less frequent dosing (e.g. every 7 days), the total recommended maximum dose/infusion is 6000 IU.

Locations

Country	Name	City	State
United States	Aflac Cancer and Blood Disorders Center	Atlanta	Georgia
United States	Augusta University Medical Center	Augusta	Georgia
United States	University of Colorado Hospital	Aurora	Colorado
United States	Johns Hopkins Univ School Med|Sidney Kimmel Comp Cancer Cntr	Baltimore	Maryland
United States	Rush University Medical Center	Chicago	Illinois
United States	Michigan State University	East Lansing	Michigan
United States	Gulf States Hemophilia & Thrombophilia Center-UT Physicians	Houston	Texas
United States	The University of Iowa - Div of Sponsored Programs	Iowa City	Iowa
United States	Dr. Akshat Jain - Loma Linda University Medical Center	Loma Linda	California
United States	Orthopaedic Institute for Children	Los Angeles	California
United States	University of Miami Hospital	Miami	Florida
United States	University of Minnesota Medical Center	Minneapolis	Minnesota
United States	Rutgers Robert Wood Johnson Medical School	New Brunswick	New Jersey
United States	Children's Hospital of Oklahoma	Oklahoma City	Oklahoma
United States	University of California - Davis	Sacramento	California
United States	Loma Linda Children's Hospital	San Bernardino	California
United States	Loma Linda Children's Hospital	San Bernardino	California

Sponsors (1)

Lead Sponsor	Collaborator
Bayer

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Occurrence of favorable outcome on the score selected dosing regimen	To assess the effect of using a baseline risk score, based on a participant's phenotypic and biologic variables, to select the most appropriate prophylaxis regimen for reaching a favorable outcome, when switching from a SHL product to Jivi.	6 months
Secondary	ABR (total, joint, spontaneous)	To assess the efficacy of Jivi compared to a previous SHL treatment.	6 months
Secondary	Change in total ABR from pre-study	To assess the efficacy of Jivi compared to a previous SHL treatment.	6 months
Secondary	Change in the frequency of pre-study SHL treatment to the frequency of Jivi administration (infusions/month)	To assess the frequency of Jivi administration.	6 months
Secondary	Occurrence of participants with 0 and = 1 spontaneous bleeds	To assess the proportion of participants with 0 and = 1 spontaneous bleeds.	6 months
Secondary	Change in Haemophilia Quality of Life Questionnaire (Haem-A-QoL or Haemo-QoL)	To assess participant quality of life (QoL) and physical activity, as measured by Patient Reported Outcomes (PROs).	6 months
Secondary	Patient's Global Impression of Change (PGI-C)	To assess participant quality of life (QoL) and physical activity, as measured by Patient Reported Outcomes (PROs).	6 months
Secondary	EuroQoL 5 Dimensions (EQ-5D-5L) questionnaire	To assess participant quality of life (QoL) and physical activity, as measured by Patient Reported Outcomes (PROs).	6 months
Secondary	Treatment Satisfaction Questionnaire for Medication (TSQM)	To assess participant quality of life (QoL) and physical activity, as measured by Patient Reported Outcomes (PROs).	6 months
Secondary	Work Productivity and Activity Impairment (WPAI) questionnaire scores	To assess participant quality of life (QoL) and physical activity, as measured by Patient Reported Outcomes (PROs).	6 months
Secondary	Number of target joints and change in target joint status from baseline	To assess target joint status, per International Society on Thrombosis and Haemostasis (ISTH) guidelines	6 momth

External Links

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