Efficacy and Safety of ALXN1840 Administered for 48 Weeks Versus Standard of Care in Participants With Wilson Disease
A Phase 3, Randomized, Rater-Blinded, Multi-Center Study to Evaluate the Efficacy and Safety of ALXN1840 Administered for 48 Weeks Versus Standard of Care in Patients With Wilson Disease Aged 12 Years and Older, With an Extension Period of up to 60 Months
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
The study consists of 2 cohorts. Cohort 1: Participants who have received SoC therapy for > 28 days and Cohort 2: Participants who are treatment-naïve or who have received SoC therapy for ≤ 28 days.
All enrolled participants were randomized by cohort in a 2:1 ratio to treatment with ALXN1840 or SoC (either as continued therapy in Cohort 1 or as continued or initial therapy in Cohort 2).
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Adelaide, Australia, 5000
- Research Site
-
Concord, Australia, 2139
- Research Site
-
Parkville, Australia, 3050
- Research Site
-
Parkville, Australia, VIC 3052
- Research Site
-
-
-
-
-
Graz, Austria, 8036
- Research Site
-
Innsbruck, Austria, 6020
- Research Site
-
Vienna, Austria, 1090
- Research Site
-
-
-
-
Ontario
-
Toronto, Ontario, Canada, M5G 2C4
- Research Site
-
-
-
-
-
Praha 2, Czechia, 128 08
- Research Site
-
-
-
-
-
Århus N, Denmark, 8200
- Research Site
-
-
-
-
-
Bron, France, 69667
- Research Site
-
Paris, France, 75010
- Research Site
-
-
-
-
-
Hamburg, Germany, 20099
- Research Site
-
Heidelberg, Germany, 69120, DE
- Research Site
-
Leipzig, Germany, 04103
- Research Site
-
-
-
-
-
Hong Kong, Hong Kong, 852
- Research Site
-
-
-
-
-
Budapest, Hungary, 1083
- Research Site
-
-
-
-
-
Jerusalem, Israel, 9112001
- Research Site
-
Ramat Gan, Israel, 5265601
- Research Site
-
-
-
-
-
Chiba, Japan, 266-0007
- Research Site
-
Kumamoto-shi, Japan, 860-8556
- Research Site
-
Kurume-shi, Japan, 830-0011
- Research Site
-
Matsuyama-city, Japan, 790-0024
- Research Site
-
Meguro-ku, Japan, 153-8515
- Research Site
-
Sapporo-shi, Japan, 063-0005
- Research Site
-
Takatsuki-shi, Japan, 569-8686
- Research Site
-
Yokohama-shi, Japan, 230-8765
- Research Site
-
-
-
-
-
Daegu, Korea, Republic of, 41944
- Research Site
-
-
-
-
-
Grafton, New Zealand, 1010
- Research Site
-
-
-
-
-
Warsaw, Poland, 04-730
- Research Site
-
Warszawa, Poland, 02-957
- Research Site
-
-
-
-
-
Moscow, Russian Federation, 117292
- Research Site
-
Moscow, Russian Federation, 119021
- Research Site
-
Moscow, Russian Federation, 115446
- Research Site
-
Nizhniy Novgorod, Russian Federation, 603005
- Research Site
-
St. Petersburg, Russian Federation, 194017
- Research Site
-
-
-
-
-
Belgrade, Serbia, 11000
- Research Site
-
-
-
-
-
Singapore, Singapore, 169608
- Research Site
-
-
-
-
-
Barcelona, Spain, 08036
- Research Site
-
Málaga, Spain, 29011
- Research Site
-
Sabadell, Spain, 08208
- Research Site
-
-
-
-
-
Taipei, Taiwan, 10002
- Research Site
-
Taoyuan City, Taiwan, 333
- Research Site
-
-
-
-
-
Ankara, Turkey, 06230
- Research Site
-
Istanbul, Turkey, 34093
- Research Site
-
Istanbul, Turkey, 34010
- Research Site
-
Izmir, Turkey, 35100
- Research Site
-
-
-
-
-
Edgbaston, United Kingdom, B15 2WB
- Research Site
-
Guildford, United Kingdom, GU2 7WG
- Research Site
-
London, United Kingdom, SE5 9RS
- Research Site
-
-
-
-
California
-
Los Angeles, California, United States, 90095
- Research Site
-
-
Connecticut
-
New Haven, Connecticut, United States, 06510
- Research Site
-
-
Illinois
-
Chicago, Illinois, United States, 60611
- Research Site
-
-
Michigan
-
Ann Arbor, Michigan, United States, 48109
- Research Site
-
-
Texas
-
Houston, Texas, United States, 77030
- Research Site
-
-
Washington
-
Seattle, Washington, United States, 98105
- Research Site
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Key Inclusion Criteria:
- Established diagnosis of WD by Leipzig-Score ≥ 4
- Female participants of childbearing potential, if heterosexually active, must be willing to follow protocol-specified guidance for highly effective contraception starting at least 6 weeks before the Day 1 visit and continuing through 28 days after the last dose of either ALXN1840 or SoC
- Male participants, if heterosexually active, must be willing to follow protocol-specified guidance for highly effective contraception beginning at Day 1 visit and continuing through 90 days after last dose of either ALXN1840 or SoC
Key Exclusion Criteria:
- Decompensated hepatic cirrhosis
- MELD score > 13
- Modified Nazer score > 7
- Clinically significant gastrointestinal bleed within past 3 months
- Alanine aminotransferase > 2 X upper limit of normal (ULN) for participants treated for > 28 days with WD therapy (Cohort 1)
- Alanine aminotransferase > 5 X ULN for treatment-naïve participants or participants who have been treated for ≤ 28 days (Cohort 2)
- Marked neurological disease requiring either nasogastric feeding or intensive inpatient medical care
- Hemoglobin < 9 grams/deciliter
- History of seizure activity within 6 months prior to informed consent
- Pregnant (or women who are planning to become pregnant) or breastfeeding women
- Active infection with hepatitis B virus (positive hepatitis B surface antigen) or C virus or seropositivity for human immunodeficiency virus (HIV)
- Previous treatment with tetrathiomolybdate
- Participants with end-stage renal disease on dialysis (chronic kidney disease stage 5) or creatinine clearance < 30 milliliter/minute
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: ALXN1840
ALXN1840 was administered orally for 48 weeks at doses ranging from 15 milligrams (mg) every other day (QOD) up to a titrated dose of 60 mg daily. Participants who completed the Primary Evaluation Period had the option to participate in the up to 60-month Extension Period. |
ALXN1840 administered orally in 15 mg tablets
Other Names:
|
|
Active Comparator: Standard of Care (SoC) Medication
SoC medication was administered for 48 weeks.
Participants who completed the Primary Evaluation Period had the option to participate in the up to 60-month Extension Period.
|
Depending on the site/region, participants randomized to receive SoC treatment will receive trientine, penicillamine, Zinc, or a combination of these medicines, administered according to standard regimens.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Daily Mean Area Under The Effect-time Curve (AUEC) of Directly Measured Non-ceruloplasmin-bound Copper (dNCC) From 0 to 48 Weeks (dNCC AUEC0-48W)
Time Frame: Baseline to Week 48
|
dNCC is the directly quantified copper not bound to ceruloplasmin, obtained by inductively coupled plasma mass spectrometry after immunocapture and removal of ceruloplasmin.
Baseline was defined as last non-missing value on or before first study drug administration.
Least square (LS) mean and standard error (SE) was calculated using analysis of covariance (ANCOVA).
|
Baseline to Week 48
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Number of Participants With Treatment-emergent Adverse Events (TEAEs)
Time Frame: Baseline up to Week 48
|
An AE was any untoward medical occurrence in a participant administered the study drug and which did not necessarily have a causal relationship with this treatment.
TEAEs were defined as those AEs with onset after the first dose of randomized treatment or existing events that worsened in severity after the first dose of randomized treatment.
A summary of all Serious Adverse Events and Other Adverse Events (nonserious) regardless of causality is located in the 'Reported Adverse Events' Section.
|
Baseline up to Week 48
|
|
Change From Baseline in UWDRS Part III Functional Subscale Score at Week 48
Time Frame: Baseline, Week 48
|
UWDRS Part III Functional Subscale consists of speech, handwriting, arising from chair, and gait from UWDRS Part III.
The standardized score of the first 3 items ranges from 0 (normal) to 10 (worst), and standardized transformed score of gait ranges from 0 (normal) to 10 (worst).
The average of these scores was used to create the Part III Functional Subscale with a range of 0 (normal) - 10 (worst) with higher scores indicating more functional disability.
|
Baseline, Week 48
|
|
Change From Baseline in UWDRS Part III Individual Items/Subscales (Speech, Handwriting, Arising From a Chair, and Gait) Score at Week 48
Time Frame: Baseline, Week 48
|
UWDRS Part III individual items speech, handwriting, arising from chair, and gait are reported here.
For speech (Question 12), original score ranges from 0 (normal) to 4 (unintelligible).
For handwriting (Question 20), original score ranges from 0 (normal) to 4 (cannot hold a pen).
For arising from chair (Question 27), original score ranges from 0 (normal) to 4 (unable to arise without help).
For gait (Question 29), the original score (range: 0 [normal] to 10 [severe condition]) was calculated by summing subscores (0 [normal] to 4 [severe]) of Part A (Right and Left Leg dystonia), B (Ataxia), and C (Parkinsonism).
|
Baseline, Week 48
|
|
Clinical Global Impression-Improvement Scale (CGI-I) Score at Week 48
Time Frame: Week 48
|
The CGI-I is a 7-point scale where the clinician assessed how much participant's illness improved or worsened relative to a Baseline state at the beginning of the intervention and rated as: 1, very much improved; 2, much improved; 3, minimally improved; 4, no change; 5, minimally worse; 6, much worse; or 7, very much worse.
|
Week 48
|
|
Change From Baseline in Clinical Global Impression Severity Scale (CGI-S) Score at Week 48
Time Frame: Baseline, Week 48
|
The CGI-S is a 7-point scale where the investigator rated severity of participant's illness at the time of assessment, relative to the investigator's past experience with participants who have the same diagnosis.
Considering total clinical experience, a participant was assessed on severity of illness at time of rating as: 1, normal, not at all ill; 2, borderline ill; 3, mildly ill; 4, moderately ill; 5, markedly ill; 6, severely ill; or 7, extremely ill.
|
Baseline, Week 48
|
|
Change From Baseline in the Unified Wilson Disease Rating Scale (UWDRS) Part II Total Score at Week 48
Time Frame: Baseline, Week 48
|
The UWDRS comprises 3 parts: UWDRS Part I (level of consciousness, item 1), UWDRS Part II (a patient-reported review of daily activity items [disability], items 2 to 11 [10 items in total]), and UWDRS Part III (a detailed neurological examination, items 12 to 34 [23 items in total]).
The UWDRS Part II total score was calculated as the sum of Question 2 to Question 11 (each question has range 0 [none] to 4 [severe]).
The UWDRS Part II total score ranges from 0 (no disability) to 40 (severe disability), with lower score indicating improvement in condition and a better outcome.
Change from baseline was calculated as: postbaseline assessment value - baseline assessment value when both values were not missing.
|
Baseline, Week 48
|
|
Change From Baseline in UWDRS Part III Total Score at Week 48
Time Frame: Baseline, Week 48
|
The UWDRS comprises 3 parts: UWDRS Part I (level of consciousness, item 1), UWDRS Part II (a patient-reported review of daily activity items [disability], items 2 to 11 [10 items in total]), and UWDRS Part III (a detailed neurological examination, items 12 to 34 [23 items in total]).
The UWDRS Part I and III was assessed by a neurologist who was blinded to the treatment randomization.
The UWDRS Part III total score was calculated as the sum of Question 12 to Question 34.
The UWDRS Part III total score ranges from 0 (normal) to 175 (severe disease), with lower score indicating improvement in condition and a better outcome.
Change from baseline was calculated as: postbaseline assessment value - baseline assessment value when both values were not missing.
|
Baseline, Week 48
|
|
Change From Baseline in Model for End-Stage Liver Disease (MELD) Score at Week 48
Time Frame: Baseline, Week 48
|
The MELD score uses the participant's values for bilirubin, creatinine, and the international normalized ratio (INR).
The initial MELD score (MELD[i]) is calculated according to the following formula: MELD(i) = 3.78*ln[serum bilirubin (mg/dL)] + 11.2*ln[INR] + 9.57*ln[serum creatinine (mg/dL)] + 6.43.
Creatinine, bilirubin, and INR values less than 1.0 are set to 1.0 and creatinine values greater than 4.0 are set to 4.0 when calculating MELD(i).
Additionally, creatinine, bilirubin, and INR are rounded to the 10th decimal place prior to performing the calculation.
The initial MELD score is then rounded to the nearest integer.
The MELD score ranges from 6 (least sick) - 40 (most sick), with higher values indicating more advanced disease.
|
Baseline, Week 48
|
|
Absolute Change From Baseline in Calculated Non-Ceruloplasmin Bound Copper (cNCC) or Calculated Non-Ceruloplasmin Bound Copper Corrected (cNCCcorrected) in Plasma at Week 48
Time Frame: Baseline, Week 48
|
cNCC = Plasma Total Copper (Cu) [micrograms (µg)/L]-(3.15*ceruloplasmin
[milligrams (mg)/L])/63.5 [µg/µmol] For ALXN1840-treated participants, cNCC in plasma corrected for amount of Cu bound to ALXN1840 tripartite complex (TPC) cNCCcorrected = (√cNCC- 0.993)2√Mo, (Mo= molybdenum).
In calculation of cNCC and cNCCcorrected following rules apply: - For plasma total Cu concentration <lower limit of quantification (LLOQ), cNCC was considered missing (LLOQ = 20 nanograms [ng]/mL); - Serum ceruloplasmin concentration values <LLOQ are set to 0 (LLOQ = 22.5 mg/L); - Plasma total Mo concentration values <LLOQ are set to 0 (LLOQ = 1 ng/L); - If cNCC calculation produces a negative result, cNCC was considered missing and cNCCcorrected was not derived; - cNCCcorrected was set to 0 when 0.993√Mo > √cNCC.
|
Baseline, Week 48
|
|
Percent Change From Baseline in cNCC or cNCCcorrected in Plasma at Week 48
Time Frame: Baseline, Week 48
|
cNCC [µmol/L] = Plasma Total Cu [µg/L]-(3.15*ceruloplasmin
[mg/L])/63.5 [µg/µmol] For ALXN1840-treated participants, cNCC in plasma was corrected for amount of Cu bound to the ALXN1840 TPC using square root-based cNCC correction method: cNCCcorrected = (√cNCC- 0.993)2√Mo, where Mo = molybdenum.
In calculation of cNCC and cNCCcorrected following rules apply: - For plasma total Cu concentration values <LLOQ, cNCC was considered missing (LLOQ = 20 ng/mL); - Serum ceruloplasmin concentration values <LLOQ are set to 0 (LLOQ = 22.5 mg/L); - Plasma total Mo concentration values <LLOQ are set to 0 (LLOQ = 1 ng/L); - In cases where cNCC calculation produces a negative result, cNCC was considered missing and cNCCcorrected was not derived; - cNCCcorrected was set to 0 when 0.993√Mo > √cNCC.
|
Baseline, Week 48
|
|
cNCC/cNCCcorrected Responder at Week 48
Time Frame: Week 48
|
cNCC/cNCCcorrected responder was defined as participants who achieved or maintained normalized cNCC/cNCCcorrected concentration (0.8-2.3 μmol) within (at or before) 48 weeks or reached a reduction of at least 25% in cNCC/cNCCcorrected within 48 weeks.
Thus, a participant was considered a cNCC/cNCCcorrected responder if they met at least 1 of the following criteria: - Achieved normalized cNCC/cNCCcorrected concentration for 2 consecutive measurements within 48 weeks, for participants who had elevated cNCC concentrations at baseline; - Maintained normalized cNCC/cNCCcorrected concentration within 48 weeks, for participants who had normal cNCC concentrations at baseline; - Reached a reduction of at least 25% in cNCC/cNCCcorrected for 2 consecutive measurements within 48 weeks.
|
Week 48
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Study Director: Eugene S. Swenson, M.D., Ph.D., Alexion Pharmaceuticals, Inc.
Publications and helpful links
Helpful Links
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 (Actual)
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
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Metabolic Diseases
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Liver Diseases
- Genetic Diseases, Inborn
- Basal Ganglia Diseases
- Movement Disorders
- Neurodegenerative Diseases
- Metabolism, Inborn Errors
- Heredodegenerative Disorders, Nervous System
- Brain Diseases, Metabolic
- Brain Diseases, Metabolic, Inborn
- Metal Metabolism, Inborn Errors
- Hepatolenticular Degeneration
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antimetabolites
- Antineoplastic Agents
- Gastrointestinal Agents
- Angiogenesis Inhibitors
- Angiogenesis Modulating Agents
- Growth Substances
- Growth Inhibitors
- Hypolipidemic Agents
- Lipid Regulating Agents
- Chelating Agents
- Sequestering Agents
- Nootropic Agents
- Lipotropic Agents
- Choline
- Tetrathiomolybdate
Other Study ID Numbers
Other Study ID Numbers
- WTX101-301
- 2017-004135-36 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal.
All request will be evaluated as per the AZ disclosure commitment:
https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. Yes, indicates that AZ are accepting requests for IPD, but this does not mean all requests will be shared.
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Wilson Disease
-
NCT07476417Not yet recruitingPeriodontal Diseases | Dental Caries | Tooth Diseases | Malocclusion | Craniofacial Abnormalities | Tooth Abnormalities | Oral Mucosal Disease | Oral Health Related Quality of Life (OHRQoL) | Sleep Related Breathing Disorder | Mowat-Wilson Syndrome
-
NCT05792319Not yet recruitingClinical Outcome in WILSON Disease
-
NCT06196931Not yet recruitingHepatolenticular Degeneration; Wilson
-
NCT05917327Terminated
-
NCT07226622Active, not recruiting
-
NCT07159581Enrolling by invitationWilson Disease
-
NCT07173933Not yet recruiting
-
NCT07301216Recruiting
-
NCT00212355Completed
Clinical Trials on ALXN1840
-
NCT02273596Completed
-
NCT05641311Completed
-
NCT04573309Completed
-
NCT05047523Terminated
-
NCT01665144CompletedSecondary Progressive Multiple Sclerosis
-
NCT05319912Completed
-
NCT05686564No longer available