A Study of AG-348 in Adult Participants With Pyruvate Kinase (PK) Deficiency
A Phase 2, Open Label, Randomized, Dose Ranging, Safety, Efficacy, Pharmacokinetic and Pharmacodynamic Study of AG-348 in Adult Patients With Pyruvate Kinase Deficiency
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 2
Contacts and Locations
Study Locations
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Ontario
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Toronto, Ontario, Canada, M5G 2C4
- University Health Network
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Nord
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Lille, Nord, France, 59000
- Hôpital Saint-Vincent de Paul
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Île-de-France Region
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Créteil, Île-de-France Region, France, 94010
- Hopital Henri Mondor
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Milan, Italy, 20122
- UOC Oncoematologia Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
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Utrecht, Netherlands, 3584 CX
- Universitair Medisch Centrum Utrecht
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London, United Kingdom, W12 0NN
- Hammersmith Hospital
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California
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Palo Alto, California, United States, 94304
- Stanford University
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Massachusetts
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Boston, Massachusetts, United States, 02215
- Boston Children's Hospital
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Michigan
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Detroit, Michigan, United States, 48201
- Wayne State University School of Medicine - Children's Hospital of Michigan
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New York
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New York, New York, United States, 10065
- New York Presbyterian Hospital- Weil Cornell Medical College
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Pennsylvania
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Belleville, Pennsylvania, United States, 17004
- Central Pennsylvania Clinic
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Philadelphia, Pennsylvania, United States, 19104
- Children Hospital of Philadelphia (CHOP)
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Utah
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Salt Lake City, Utah, United States, 84113
- University of Utah
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Informed consent
- Male or female, aged 18 years and older
- Known medical history of PK deficiency
- PK deficiency confirmed by enzymatic assay at Screening
- Genotypic characterization of PKR gene at Screening
- Genotypic characterization of uridine-5'-diphosphate-glucuronyltransferase-A1 (UGTA1) gene to document underlying Gilbert's disease (Gilbert's disease patients are eligible)
- Males Hb ≤ 12.0 g/dL, females Hb ≤ 11 g/dL
- Transfusion independent, defined as no more than 3 units of red blood cells (RBC) transfused in 12 months prior to the first day of study dosing and no transfusions within 4 months of first day of study dosing
- Splenectomized patients must have had the procedure at least 6 months prior to Screening and must be up-to-date in recommended vaccinations
- Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
- Must be taking at least 1 mg folic acid daily in the 21 days prior to screening
- Adequate organ function defined by liver function, kidney function, platelet count and coagulation assessments
- Agreement to use approved contraceptive measures
Women must not be breastfeeding
For entry into the Extension Period, patients must meet criteria # 15-16:
- Must have completed 24 weeks of treatment during the Core Period and tolerated AG-348
- The treating Investigator agrees that there is a potential for clinical benefit to continued treatment and recommends participation in the Extension Period and the Medical Monitor approves
Exclusion criteria
- Hb ˃ 12.0 g/dL if male, Hb ˃11.0 g/dL if female
- Additional diagnosis of other congenital or acquired blood disorder
- Iron overload sufficiently severe to result in cardiac, hepatic or pancreatic insufficiency
- Bone marrow or stem cell transplant
- Clinically symptomatic cholelithiasis or cholecystitis
- Currently enrolled in any other investigational trial. Participation in the PK Deficiency Natural History Study (NCT02053480) is permitted
- Exposure to any investigational drug, device or procedure within 28 days prior to screening or during trial participation
- Concurrent medical condition such as poorly controlled hypertension, heart failure, active infection, frequent post-splenectomy sepsis, Hepatitis B or C, Human Immunodeficiency Virus type 1 (HIV1) or Human Immunodeficiency Virus type 2 (HIV2) infection, poorly controlled diabetes mellitus, history of primary malignancy with the exception of curatively treated nonmelanomatous skin cancer, cervical cancer of breast cancer in situ
- Major surgery in the last 6 months
- Psychiatric disorder that could compromise the ability of the patient to cooperate with the study
- Serum bilirubin higher to the upper limit of normal attributable to factors other than hemolysis or Gilbert's Syndrome
- Use of restricted products known to strongly inhibit cytochrome P450 (CYP) 3A4 metabolism within 5 days prior to Prior Day 1 dosing, or to strongly induce cytochrome P450 3A4 (CYP3A4) metabolism within 28 days prior to Day 1 dosing, or to strongly inhibit P-glycoprotein transporter within 5 days prior to Day 1 dosing, or digoxin within 5 days prior to Day 1 dosing.
- Heart-rate corrected QT interval - Fridericia's method (QTcF) interval ˃ 450 ms in male, QTcF > 470 ms in female, with the exception of patients with a left Bundle Branch Block
- Cardiac arrhythmias that are clinically significant or treated with drugs that are substrates of CYP3A4
- Allergy to sulfonamides if characterized by acute hemolytic anemia, anaphylaxis, rash of erythema multiforme type or Stevens-Johnson Syndrome
- Any other medical or psychological condition deemed by the Investigator to be likely to interfere with a patient's ability to participate in the study
- Patients will not be permitted to enter the Extension Period if: The patient experienced AEs during the Core Period that are considered by the treating Investigator or the Sponsor's designated Medical Monitor to pose a significant safety risk to the patient if treatment were to be extended
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
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Experimental: AG-348 50 mg BID
Participants with Pyruvate Kinase (PK) deficiency will receive AG-348, 50 milligrams (mg), as initial dose, twice daily (BID) for 24 weeks (Core Period).
Participants will be assigned to initial doses, however, over the course of the Core Period they will be treated across a range of doses due to treatment emergent adverse events (AEs) and hemoglobin (Hb) levels exceeding mid-point of sex-adjusted ranges.
At the Week 24 visit, Core Period participants who have safely tolerated AG-348 and demonstrating clinical activity in response to AG-348 will be rolled over to the Extension Period.
During the extension period, participants will continue to receive AG-348 50 mg, BID, for up to 102 months.
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Tablets
Other Names:
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Experimental: AG-348 300 mg BID
Participants with PK deficiency will receive AG-348, 300 mg, as initial dose, BID for 24 weeks (Core Period).
Participants will be assigned to initial doses, however, over the course of the Core Period they will be treated across a range of doses due to treatment emergent AEs and Hb levels exceeding mid-point of sex-adjusted ranges.
At the Week 24 visit, Core Period participants who have safely tolerated AG-348 and demonstrating clinical activity in response to AG-348 will be rolled over to the Extension Period.
During the extension period, participants will continue to receive AG-348 300 mg, BID, up to 102 months.
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Tablets
Other Names:
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Percentage of Participants Experiencing at Least One Adverse Event (AEs) in the Core Period
Time Frame: Up to Week 24
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An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not considered study drug-related.
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Up to Week 24
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Change From Baseline in Hemoglobin (Hb) Value at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Increased Hb values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Hematocrit at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Increased hematocrit values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Reticulocyte Count at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased reticulocyte count values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Haptoglobin at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Increased haptoglobin values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Lactate Dehydrogenase (LDH) at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased LDH values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Total Bilirubin at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased total bilirubin values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Indirect Bilirubin at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased indirect bilirubin values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Erythropoietin (EPO) at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased EPO values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Hepcidin at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased hepcidin values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Ferritin at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased ferritin values indicate improvement.
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Baseline and Week 24
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Change From Baseline in Transferrin Saturation at Week 24
Time Frame: Baseline and Week 24
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Transferrin saturation is the ratio of serum iron to iron-binding capacity.
Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased transferrin saturation values indicate improvement.
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Baseline and Week 24
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Percentage of Participants Experiencing at Least One AE up to Month 102
Time Frame: Up to Month 102
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An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not considered study drug-related.
Safety data for cumulative period (Core period and Extension period) has been reported in this outcome measure.
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Up to Month 102
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Change From Baseline Hb Value up to Month 102
Time Frame: Baseline, Months 12, 36, 60, 84, and 102
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Increased Hb values indicate improvement.
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Baseline, Months 12, 36, 60, 84, and 102
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Change From Baseline in Hematocrit up to Month 102
Time Frame: Baseline, Months 12, 36, 60, 84, and 102
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Increased hematocrit values indicate improvement.
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Baseline, Months 12, 36, 60, 84, and 102
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Change From Baseline in Reticulocyte Count up to Month 102
Time Frame: Baseline, Months 12, 36, 60, 84, and 102
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Change (absolute change) from baseline will be calculated as post-baseline value - baseline value.
Decreased reticulocyte count values indicate improvement.
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Baseline, Months 12, 36, 60, 84, and 102
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Change From Baseline in Haptoglobin up to Month 102
Time Frame: Baseline, Months 12, 36, 60, 84, and 102
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Increased haptoglobin values indicate improvement.
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Baseline, Months 12, 36, 60, 84, and 102
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Change From Baseline in Carboxyhemoglobin (COHb) at Week 24
Time Frame: Baseline and Week 24
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased COHb values indicate improvement.
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Baseline and Week 24
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Change From Baseline in COHb up to Month 30
Time Frame: Baseline, Months 12, 18, 24, and 30
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased COHb values indicate improvement.
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Baseline, Months 12, 18, 24, and 30
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Change From Baseline in LDH up to Month 30
Time Frame: Baseline, Months 12, 18, 24, and 30
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased LDH values indicate improvement.
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Baseline, Months 12, 18, 24, and 30
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Change From Baseline in Total Bilirubin up to Month 102
Time Frame: Baseline, Months 12, 36, 60, 84, and 102
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased total bilirubin values indicate improvement.
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Baseline, Months 12, 36, 60, 84, and 102
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Change From Baseline in Indirect Bilirubin up to Month 102
Time Frame: Baseline, Months 12, 36, 60, 84, and 102
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased indirect bilirubin values indicate improvement.
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Baseline, Months 12, 36, 60, 84, and 102
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Change From Baseline in (EPO) up to Month 30
Time Frame: Baseline, Months 12, 18, 24, and 30
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased EPO values indicate improvement.
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Baseline, Months 12, 18, 24, and 30
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Change From Baseline in Hepcidin up to Month 30
Time Frame: Baseline, Months 12, 18, 24, and 30
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased hepcidin values indicate improvement.
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Baseline, Months 12, 18, 24, and 30
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Change From Baseline in Ferritin up to Month 102
Time Frame: Baseline, Months 12, 36, 60, 84, and 102
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Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased ferritin values indicate improvement.
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Baseline, Months 12, 36, 60, 84, and 102
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Change From Baseline in Transferrin Saturation up to Month 102
Time Frame: Baseline, Months 12, 36, 60, 84, and 102
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Transferrin saturation is the ratio of serum iron to iron-binding capacity.
Change (absolute change) from baseline was calculated as post-baseline value - baseline value.
Decreased transferrin saturation values indicate improvement.
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Baseline, Months 12, 36, 60, 84, and 102
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Area Under the Concentration-time Curve From Time Zero to the Last Non-zero Concentration (AUC0-t) for AG-348 and Its Metabolite AGI-8702
Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Participants with pre-dose concentrations on Day 1 were excluded from the pharmacokinetics analysis, if any.
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pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Maximum Plasma Concentration (Cmax) for AG-348 and Its Metabolite AGI-8702
Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Participants with pre-dose concentrations on Day 1 were excluded from the pharmacokinetics analysis, if any.
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pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Time to Reach Peak Plasma Concentration (Tmax) for AG-348 and Its Metabolite AGI-8702
Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Participants with pre-dose concentrations on Day 1 were excluded from the pharmacokinetics analysis, if any.
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pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Apparent Clearance at Steady-State (Clss/F) for AG-348 and Its Metabolite AGI-8702
Time Frame: pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Participants with pre-dose concentrations on Day 1 were excluded from the pharmacokinetics analysis, if any.
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pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Maximum Change From Baseline Response Value Over 12 Hours Post-dose (BRmax) for Adenosine Triphosphate (ATP)
Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1
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Pre-dose concentration observed on Day 1 was used as Baseline for calculation of change from baseline.
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pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1
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Maximum Change From Baseline Response Value Over 8 Hours Post-dose at Steady State (BRmax ss) for ATP
Time Frame: pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Pre-dose concentration observed on Day 1 was used as Baseline for calculation of change from baseline.
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pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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BRmax for 2,3 - Diphosphoglycerate (2,3-DPG)
Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1
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Pre-dose concentration observed on Day 1 was used as Baseline for calculation of change from baseline.
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pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1
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BRmax ss for 2,3-DPG
Time Frame: pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Pre-dose concentration observed on Day 1 was used as Baseline for calculation of change from baseline.
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pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15
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Collaborators and Investigators
Sponsor
Sponsor
Publications and helpful links
General Publications
- Rab MAE, Van Oirschot BA, Kosinski PA, Hixon J, Johnson K, Chubukov V, Dang L, Pasterkamp G, Van Straaten S, Van Solinge WW, Van Beers EJ, Kung C, Van Wijk R. AG-348 (Mitapivat), an allosteric activator of red blood cell pyruvate kinase, increases enzymatic activity, protein stability, and ATP levels over a broad range of PKLR genotypes. Haematologica. 2021 Jan 1;106(1):238-249. doi: 10.3324/haematol.2019.238865.
- Grace RF, Rose C, Layton DM, Galacteros F, Barcellini W, Morton DH, van Beers EJ, Yaish H, Ravindranath Y, Kuo KHM, Sheth S, Kwiatkowski JL, Barbier AJ, Bodie S, Silver B, Hua L, Kung C, Hawkins P, Jouvin MH, Bowden C, Glader B. Safety and Efficacy of Mitapivat in Pyruvate Kinase Deficiency. N Engl J Med. 2019 Sep 5;381(10):933-944. doi: 10.1056/NEJMoa1902678.
- Al-Samkari H, Grace RF, Glenthoj A, Andres O, Barcellini W, Galacteros F, Kuo KHM, Layton DM, Morado Arias M, Viprakasit V, Dong Y, Tai F, Hawkins P, Gheuens S, Morales-Arias J, Gilroy KS, Porter JB, van Beers EJ. Early-onset reduced bone mineral density in patients with pyruvate kinase deficiency. Am J Hematol. 2023 Mar;98(3):E57-E60. doi: 10.1002/ajh.26830. Epub 2023 Jan 9. No abstract available.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- AG348-C-003
- 2015-000484-13 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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