A Study to Assess Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of Multiple- Dose BIVV009 in Participants With Chronic Immune Thrombocytopenia (ITP)

Purpura, Thrombocytopenic, Idiopathic Clinical Trial

Official title:

A Phase 1 Safety, Tolerability, and Pharmacokinetics & Pharmacodynamics Study of Multiple- Dose BIVV009 in Patients With Chronic Immune Thrombocytopenia (ITP)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03275454
• Other study ID #: TDR16218
• Secondary ID: BIVV009-201
• Status: Completed
• Phase: Phase 1
• Start date: August 14, 2017
• Est. completion date: February 16, 2021

Study information

• Verified date: April 2022
• Source: Sanofi
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to explore the safety, preliminary clinical benefit, and activity of BIVV009 in patients with chronic immune thrombocytopenia.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 12
• Est. completion date: February 16, 2021
• Est. primary completion date: February 16, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria

Part A:

• Chronic immune thrombocytopenia (ITP) (ITP lasting for greater than or equal to ([>=] 12 months) as defined in the protocol

• Normal prothrombin time (PT/INR) and activated partial thromboplastin time (aPTT)

• No history of a coagulation disorder

• Hemoglobin level greater than (>) 10 gram per deciliter (g/dL) (following blood transfusion is acceptable) and normal white blood cell (WBC) and neutrophil counts (elevated WBC/absolute neutrophil count [ANC] attributed to steroid treatment is acceptable)

• Eastern Cooperative Oncology Group (ECOG) performance status grade less than or equal to (<=) 2

• Documented vaccinations against encapsulated bacterial pathogens (Neisseria meningitis, including serogroup B meningococcus [where available], Haemophilus influenzae, and Streptococcus pneumoniae) within 5 years of enrollment

• Adequate intravenous (IV) access

Part B:

• Able to comprehend and to give informed consent for Part B

• History of ITP and previously treated with at least 1 dose of BIVV009 in Part A

• Evidence of treatment efficacy to BIVV009 as defined by a platelet count > 30*10^9/L on at least 1 occasion OR a doubling of the platelet count from baseline

• Participants who have completed the 21-week Part A treatment period but have not reached the Part A End of Study (EOS) visit must have evidence of ongoing or recurrent thrombocytopenia during the Part A safety follow-up/washout period as demonstrated by a platelet count less than (<) 50*10^9/L or a >= 50 percent (%) decrease in platelet count over < 1 week

Exclusion Criteria:

Part A:

• Clinically significant medical history or ongoing chronic illness that would jeopardize the safety of the participant or compromise the quality of the data derived from his/her participation in this study

• Clinically relevant infection of any kind within the preceding month of enrollment

• History of venous or arterial thrombosis within the preceding year of enrollment

• Use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or anticoagulants within 1 week of enrollment

• Clinical diagnosis of systemic lupus erythematosus (SLE) or other active autoimmune disorders associated with anti-nuclear antibodies (ANAs) including those that are medically controlled, at Screening (other than ITP)

• Secondary immune thrombocytopenia from any cause including lymphoma, chronic lymphocytic leukemia, and drug-induced thrombocytopenia

• Positive hepatitis panel (including hepatitis B surface antigen and/or hepatitis C virus antibody) prior to or at Screening

• Positive human immunodeficiency virus (HIV) test result prior to or at Screening

Part B:

• Presence of unacceptable side effects or toxicity associated with BIVV009 (including prior hypersensitivity reactions to BIVV009) such that there is an unfavorable risk-benefit assessment for continued treatment with BIVV009 in the opinion of the Investigator and/or Sponsor

• For participants who have completed the 9-week safety follow-up/washout period and final study visit before entry into Part B, a positive hepatitis panel (including hepatitis B surface antigen and/or hepatitis C virus antibody) prior to or at Screening. Patients who have undergone hepatitis C antiviral therapy may be allowed if they are documented to be negative for hepatitis C virus ribonucleic acid (RNA) on at least 2 occasions separated by at least 3 months (including 1 RNA test at least 6 months after completion of antiviral therapy) and are also negative for hepatitis C virus RNA at Screening

• Use of prescribed or over-the-counter medications, supplements, vitamins, and/or herbal remedies within 2 weeks before the first dose of BIVV009 in Part B, which in the judgment of the Investigator may adversely affect the participants welfare or the integrity of the study results (excluding hormonal contraception in female participants)

• If previously treated with rituximab, the last dose of rituximab was administered < 12 weeks before the first dose of BIVV009 in Part B

• Clinical diagnosis of systemic lupus erythematosus (SLE) or other active autoimmune disorders associated with anti-nuclear antibodies (ANA), including those that are medically controlled, at Screening (other than ITP). Positive ANAs at screening that are not associated with an autoimmune disorder (other than ITP) may be allowed if present for >= 28 days without associated clinically relevant symptoms

Related Conditions & MeSH terms

• Purpura
• Purpura, Thrombocytopenic
• Purpura, Thrombocytopenic, Idiopathic
• Thrombocytopenia

Intervention

Drug:
• BIVV009 6.5 grams
Participants who weigh less than 75 kilogram (kg) will receive fixed doses of 6.5 grams of BIVV009.
• BIVV009 7.5 grams
Participants who weigh 75 kg or more will receive fixed doses of 7.5 grams of BIVV009.

Locations

Country	Name	City	State
Germany	Essen University Hospital Department of Hematology	Essen
United Kingdom	University College Hospital	London
United States	Massachusetts General Hospital - Cancer Center	Boston	Massachusetts
United States	Georgetown Lombardi Comprehensive Cancer Center	Georgetown	District of Columbia
United States	University of Pittsburgh Medical Center (UPMC) Hilman Cancer Center	Pittsburgh	Pennsylvania

Sponsors (1)

Lead Sponsor	Collaborator
Bioverativ, a Sanofi company

Countries where clinical trial is conducted

United States,  Germany,  United Kingdom, 

References & Publications (1)

Broome CM, Roth A, Kuter DJ, Scully M, Smith R, Wang J, Reuter C, Hobbs W, Daak A. Safety and efficacy of classical complement pathway inhibition with sutimlimab in chronic immune thrombocytopenia. Blood Adv. 2023 Mar 28;7(6):987-996. doi: 10.1182/bloodad — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Incidence of Treatment-Emergent Adverse Events	An AE is any untoward medical occurrence in a participant participating in a clinical study that does not necessarily have a causal relationship with the pharmaceutical/biological agent under study. A serious adverse event (SAE) is any AE that results in: death, persistent or significant disability/incapacity, requires inpatient hospitalization or prolongation of existing hospitalization, is life-threatening experience, is a congenital anomaly/birth defect and may jeopardize participant and/or may require medical or surgical intervention to prevent one of the outcomes listed above.	Up to 97 weeks
Primary	Number of Participants With Premature Study Terminations	Number of participants with premature study terminations will be assessed.	Approximately 97 weeks
Primary	Number of Participants With Clinical Laboratory Abnormalities	Clinical laboratory abnormalities including one or more specific target-organs for toxicity of BIVV009, abnormalities in D-dimer, thrombin-anti-thrombin assay, and Systemic Lupus Erythematosus (SLE) panel.	Approximately 97 weeks
Secondary	Part A: Change From Baseline in Peripheral Blood Platelet Count at Part A End of Treatment (A-EOT)	Change from baseline in peripheral blood platelet count at A-EOT will be assessed.	Baseline and A-EOT (Day 147)
Secondary	Part A: Change From Baseline in Peripheral Blood Platelet Count during BIVV009 Treatment	Change from baseline in peripheral blood platelet count during BIVV009 treatment will be assessed.	Baseline up to Day 147
Secondary	Part A: Number of Participants who are independent from using combination Immune Thrombocytopenia (ITP) therapy during A-EOT but receive combination ITP therapy after A-EOT	Number of participants who are independent from using combination ITP therapy during A-EOT but receive combination ITP therapy after A-EOT will be assessed.	Day 147 (A-EOT) up to Day 196 (EOS)
Secondary	Part A: Number of Participants who Achieve Complete Response Through A-EOT	Complete response (CR) is defined as a platelet count greater than or equal to (>=) 100*10^9/liter (L) measured on 2 occasions at least 7 days apart and the absence of bleeding on and through these two visits and the lack of combination ITP therapy on and through these two visits.	Up to Day 147
Secondary	Part A: Number of Participants who Achieve Response Through A-EOT	Response or Better: Response (R) is defined as a platelet count >= 30*10^9/L and a greater than 2-fold increase from baseline measured on 2 occasions at least 7 days apart and the absence of bleeding on and through these two visits and the lack of combination ITP therapy on and through these two visits; and CR: A platelet count >=100*10^9/L measured on 2 occasions at least 7 days apart and the absence of bleeding on and through these two visits and the lack of combination ITP therapy on and through these two visits.	Up to Day 147
Secondary	Part A: Duration of Complete Response per Each CR	Duration of CR is defined as the number of consecutive days in which a patient's peripheral blood platelet count is >= 100*10^9/L and the absence of bleeding, and the lack of platelet transfusions or other ITP therapy.	Up to Day 196
Secondary	Part A: Duration of Response per Each Response	Duration of response is defined as the number of consecutive days in which a patient's peripheral blood platelet count is >= 30*10^9/L and the absence of bleeding, and the lack of platelet transfusions or other ITP therapy.	Up to Day 196
Secondary	Part A: Time to First Platelet Response	Time to first platelet response is defined as greater than or equal to 30*10^9/L, 50*10^9/L, 100*10^9/L (confirmed by a consecutive platelet response at least 7 days apart).	Up to Day 196
Secondary	Part A: Number of Participants who Report Loss of Response Among Those who Achieve Response	Number of participants who report loss of response among those who achieve response will be reported. For a participant with a response (R), the loss of the response is defined as a platelet count < 30*10^9/L measured on 2 consecutive occasions at least 1 day apart, or a less than 2-fold increase in platelet count from baseline measured on 2 consecutive occasions at least 1 day apart, or the presence of bleeding, or use of the combination ITP therapy.	Up to Day 196
Secondary	Part A: Number of Participants who Report Loss of Complete Response Among Those who Achieve Complete Response	Number of participants who report loss of complete response among those who achieve complete response will be reported. For a participant with a complete response (CR), loss of complete response is defined as a platelet count less than (<) 100*10^9/L measured on 2 consecutive occasions more than 1 day apart and/or the presence of bleeding or use of the combination ITP therapy.	Up to Day 196
Secondary	Part B: Change From Baseline in Peripheral Blood Platelet Count to B-EOT	Change from baseline (Part B) in peripheral blood platelet count to B-EOT will be assessed.	Baseline up to 52 weeks
Secondary	Part B: Number of Participants who Achieve CR and the Lack of Platelet Transfusions or Other ITP Therapy During Treatment Period	Number of participants who achieve CR and the lack of platelet transfusions or other ITP therapy during Part B treatment period will be reported. Complete response (CR): A platelet count >= 100*10^9/L measured on 2 occasions at least 7 days apart and the absence of bleeding on and through these two visits and the lack of combination ITP therapy on and through these two visits.	Up to 52 weeks
Secondary	Part B: Number of Participants who Achieve Response Through Part B End of Treatment (B-EOT)	Number of participants who achieve response through B-EOT will be reported.	Up to 52 weeks
Secondary	Part B: Duration of Complete Response per Each CR	Duration of CR is defined as the number of consecutive days in which a participant's peripheral blood platelet count is >= 100*10^9/L and the absence of bleeding, and the lack of platelet transfusions or other ITP therapy.	Up to 52 weeks
Secondary	Part B: Duration of Response per each Response	Duration of response is defined as the number of consecutive days in which a participant's peripheral blood platelet count is >= 30*10^9/L and the absence of bleeding, and the lack of platelet transfusions or other ITP therapy.	Up to 52 weeks
Secondary	Part B: Number of Participants who achieve a platelet count >= 100*10^9/L on 2 consecutive occasions at least 7 days apart and have the absence of bleeding on and through these two visits and use any combination ITP therapy through B-EOT	Number of participants who achieve a platelet count >= 100*10^9/L on 2 consecutive occasions at least 7 days apart and have the absence of bleeding on and through these two visits and use any combination ITP therapy through B-EOT will be assessed.	Up to 52 weeks
Secondary	Part B: Number of Participants who achieve a platelet count >=30*10^9/L, a >2-fold increase from baseline measured on 2 consecutive occasions at least 7 days apart, have absence of bleeding on and through these two visits, use any combination ITP therapy	Number of participants who achieve a platelet count >= 30*10^9/L and a greater than (>) 2-fold increase from baseline measured on 2 consecutive occasions at least 7 days apart and have the absence of bleeding on and through these two visits and use any combination ITP therapy through B-EOT will be assessed.	Up to 52 weeks
Secondary	Part B: Number of Participants who do not Require Other Immune Thrombocytopenia (ITP) Therapy (non-transfusion) During the Part B Treatment Period	Number of Participants who do not require other ITP therapy (non-transfusion) following the last BIVV009 dose will be assessed.	Up to 52 weeks
Secondary	Part B: Number of Participants who do not Require Platelet Transfusions During the Part B Treatment Period	Number of Participants who do not require platelet transfusions during the Part B treatment period will be reported.	Up to 52 weeks
Secondary	Part B: Number of Participants who Experience any Bleeding Episode, Bleeding by Grade or Serious Bleeding	Number of participants who experience any bleeding episode, bleeding by grade or serious bleeding according to the International Working Group (IWG) Bleeding Assessment Tool (BAT) will be reported.	Up to 52 weeks
Secondary	Plasma Concentrations of BIVV009	Plasma concentrations of BIVV009 will be assessed.	Approximately 97 weeks
Secondary	Maximum Observed Plasma Concentration (Cmax) of BIVV009	Maximum observed concentration of BIVV009 in plasma will be assessed.	Approximately 97 weeks
Secondary	Time to Reach Maximum Observed Plasma Concentration (Tmax) of BIVV009	Time to Reach Maximum Observed Plasma Concentration (Tmax) of BIVV009 will be assessed.	Approximately 97 weeks
Secondary	Area Under the Concentration-time Curve (AUC) From Hour 0 to the last quantifiable time point (AUC [0-t]) of BIVV009	AUC (0-t) is the area under the Concentration-time curve (AUC) from hour 0 to the last quantifiable time point of BIVV009.	Approximately 97 weeks
Secondary	Number of Participants With Anti-drug antibodies (ADAs) Against BIVV009	Blood samples will be collected to determine number of participants with anti-drug antibodies (ADAs) against BIVV009.	Up to 97 weeks
Secondary	Complement System Classical Pathway Levels as Measured by WIESLAB Assay	Inhibition by BIVV009 of the complement system classical pathway measured by the WIESLAB assay.	Up to 97 weeks
Secondary	Total Complement (CH50) Levels	Complement CH50 is a blood test that helps us determine whether protein abnormalities and deficiencies in the complement system are responsible for any increase in autoimmune activity. It will be assessed using complement assays.	Up to 97 weeks
Secondary	Total Complement Factor C4 Levels	Total C4 Levels will be assessed in plasma using complement assays.	Up to 97 weeks
Secondary	C1 Complex Components: C1q	C1q Levels will be assessed in plasma using complement assays.	Up to 97 weeks
Secondary	Thrombopoietin Level	Thrombopoietin level will be assessed in plasma using complement assays.	Up to 97 weeks