A Study of Fitusiran (ALN-AT3SC) in Severe Hemophilia A and B Patients With Inhibitors (ATLAS-INH)

March 15, 2022 updated by: Genzyme, a Sanofi Company

ATLAS-INH: A Phase 3 Study to Evaluate the Efficacy and Safety of Fitusiran in Patients With Hemophilia A or B, With Inhibitory Antibodies to Factor VIII or IX

The purpose of this study was to determine the frequency of bleeding episodes in participants receiving fitusiran as prophylactic treatment of hemophilia compared to participants who were assigned to continue with their regular medication. In addition, the study assessed safety, quality of life, pharmacodynamics (PD), and pharmacokinetics (PK).

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The duration of treatment with fitusiran was 9 months. The estimated total time on study, inclusive of screening, for each participant was up to 11 months for all participants who enroll in the extension study and participants in the on-demand arm who did not enroll in the extension study. The estimated total time on study was up to 17 months in fitusiran treatment arm participants who did not enroll in the extension study due to the requirement for up to an additional 6 months of follow-up monitoring for antithrombin levels.

Study Type

Interventional

Enrollment (Actual)

60

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Camperdown, Australia, 2050
        • Investigational Site Number 6101
      • Clayton, Australia, 3168
        • Investigational Site Number 6104
      • Montreal, Canada, H1T 2M4
        • Investigational Site Number 1102
      • Beijing, China, 100045
        • Investigational Site Number 8604
      • Guangzhou, China, 510515
        • Investigational Site Number 8602
      • Hangzhou, China, 310003
        • Investigational Site Number 8605
      • Shanghai, China, 200025
        • Investigational Site Number 8603
      • Tianjin, China, 300020
        • Investigational Site Number 8601
      • Lyon, France, 69677
        • Investigational Site Number 3303
      • Rouen, France, 76038
        • Investigational Site Number 3301
      • Frankfurt Am Main, Germany, 60590
        • Investigational Site Number 4905
      • Leipzig, Germany, 4103
        • Investigational Site Number 4906
      • Bangalore, India, 560034
        • Investigational Site Number 9102
      • India, India
        • Investigational Site Number 9108
      • Jaipur, India, 302017
        • Investigational Site Number 9104
      • Lucknow, India, 226003
        • Investigational Site Number 9106
      • Pune, India, 411001
        • Investigational Site Number 9103
      • Pune, India, 411004
        • Investigational Site Number 9111
      • Vellore, India, 632004
        • Investigational Site Number 9105
      • Florence, Italy, 50134
        • Investigational Site Number 3901
      • Padua, Italy, 35128
        • Investigational Site Number 3904
      • Japan, Japan
        • Investigational Site Number 8110
      • Kita Kyushu-Shi, Japan
        • Investigational Site Number 8103
      • Daejeon, Korea, Republic of, 35233
        • Investigational Site Number 8202
      • Seoul, Korea, Republic of, 3722
        • Investigational Site Number 8203
      • Seoul, Korea, Republic of
        • Investigational Site Number 8204
      • Kota Kinabalu, Malaysia, 88586
        • Investigational Site Number 6003
      • Malaysia, Malaysia
        • Investigational Site Number 6004
      • Parktown, South Africa, 2193
        • Investigational Site Number 2701
      • Polokwane, South Africa, 699
        • Investigational Site Number 2703
      • Port Elizabeth, South Africa, 6001
        • Investigational Site Number 2702
      • Madrid, Spain, 28046
        • Investigational Site Number 3402
      • Changhua, Taiwan, 500
        • Investigational Site Number 8803
      • Taipei, Taiwan, 110
        • Investigational Site Number 8801
      • Taiwan, Taiwan
        • Investigational Site Number 8804
      • Taiwan, Taiwan
        • Investigational Site Number 8805
      • Adana, Turkey, ?01130
        • Investigational Site Number 9002
      • Akdeniz, Turkey, 07059
        • Investigational Site Number 9004
      • Ankara, Turkey, 06100
        • Investigational Site Number 9001
      • Istanbul, Turkey, 34093
        • Investigational Site Number 9005
      • Izmir, Turkey, 35100
        • Investigational Site Number 9003
      • Turkey, Turkey
        • Investigational Site Number 9006
      • Kyiv, Ukraine, 01135
        • Investigational Site Number 8003
      • Kyiv, Ukraine, 04060
        • Investigational Site Number 8001
      • Lviv, Ukraine, 79044
        • Investigational Site Number 8002
      • London, United Kingdom, E1 2ES
        • Investigational Site Number 4407
    • Arizona
      • Phoenix, Arizona, United States, 85016
        • Investigational Site Number 0117
    • California
      • Los Angeles, California, United States, 90027
        • Investigational Site Number 0139
      • Orange, California, United States, 92868
        • Investigational Site Number 0135
      • San Diego, California, United States, 92123
        • Investigational Site Number 0137
    • Florida
      • Gainesville, Florida, United States, 32610
        • Investigational Site Number 0128
      • Jacksonville, Florida, United States, 32207
        • Investigational Site Number 0115
      • Miami, Florida, United States, 33136
        • Investigational Site Number 0105
      • Tampa, Florida, United States, 33607
        • Investigational Site Number 0103
    • Louisiana
      • New Orleans, Louisiana, United States, 70112
        • Investigational Site Number 0119
    • Maryland
      • Baltimore, Maryland, United States, 21205
        • Investigational Site Number 0136
    • Nevada
      • Las Vegas, Nevada, United States, 89135
        • Investigational Site Number 0111
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19104-5127
        • Investigational Site Number 0104

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

8 years and older (Child, Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Male

Description

Inclusion Criteria:

  • Males, greater than or equal to (>=) 12 years of age.
  • Severe hemophilia A or B with inhibitors.

    • (Severity confirmed by a central laboratory where coagulation factor VIII (FVIII) level was less than (<)1% or factor IX (FIX) level was less than or equal to [<=]2% at Screening; Inhibitors defined as inhibitor titer of >=0.6 Bethesda units per milliliter [BU/mL] or as evidenced by medical records).
  • A minimum of 6 bleeding episodes requiring BPA treatment within the last 6 months prior to screening.
  • Willing and able to comply with the study requirements and to provide written informed consent and assent.

Exclusion Criteria:

  • Known co-existing bleeding disorders other than hemophilia A or B.
  • Antithrombin (AT) activity <60% at Screening.
  • Co-existing thrombophilic disorder.
  • Clinically significant liver disease.
  • Active hepatitis C virus infection.
  • HIV positive with a cluster of differentiation-4 count of <200 cells/microliter.
  • History of arterial or venous thromboembolism.
  • Inadequate renal function.
  • History of multiple drug allergies or history of allergic reaction to an oligonucleotide or N-Acetylgalactosamine.
  • History of intolerance to SC injection(s).
  • Any other conditions or comorbidities that would make the participant unsuitable for enrollment or could interfere with participation in or completion of the study, per Investigator judgement.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Bypassing Agents (BPA) On-demand
Participants received On-demand BPAs (use of these agents, as needed, for episodic bleeding episodes, and not on a regular regimen intended to prevent spontaneous bleeding) per Investigator discretion from Day 1 for treatment of breakthrough bleeding episodes, up to a total of 9 months.
solution for injection; by intravenous (IV) injection
Experimental: Fitusiran 80 mg Prophylaxis
Participants received Fitusiran 80 mg subcutaneously (SC) as prophylaxis once monthly from Day 1, along with the on-demand BPAs (per investigator's discretion and within bleeding dosing guidelines) for treatment of breakthrough bleeding episodes, up to a total of 9 months.
solution for injection; by subcutaneous (SC) injection

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Estimated Annualized Bleeding Rate (ABR) for Treated Bleeds During the Efficacy Period
Time Frame: From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
ABR for a participant during efficacy period (EP) was defined as annualized number of bleeding episodes during EP annualized to a 1-year interval of time. Treated Bleeding episode: any occurrence of hemorrhage that required administration of BPA or factor. It started from first sign of a bleed and ended no more than 72 hours after last treatment for bleed, within which any symptoms of bleeding at same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. EP was defined as time duration starting from Day 29 when antithrombin (AT) lowering capacity of fitusiran had achieved therapeutic target range to the earliest of (Day 246 or last day of bleeding follow up) (maximum duration of EP: from Day 29 to Day 246). This outcome measure (OM) represents estimated results (i.e., results received by applying negative binomial [NB] regression model on data collected during EP).
From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Observed Annualized Bleeding Rate (ABR) for Treated Bleeds During the Efficacy Period
Time Frame: From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
ABR for a participant during EP was defined as annualized number of bleeding episodes during EP annualized to a 1-year interval of time. ABR= number of bleeding episodes during EP divided by total number of days during EP*365.25. A bleeding episode was defined as any occurrence of hemorrhage that required administration of BPA or factor. It started from the first sign of a bleed and ended no more than 72 hours after the last treatment for the bleed, within which any symptoms of bleeding at the same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. EP was defined as time duration starting from Day 29 when the AT lowering capacity of fitusiran had achieved therapeutic target range to the earliest of (Day 246 or the last day of bleeding follow up) (maximum duration of EP: from Day 29 to Day 246). This OM represents observed results (i.e., descriptive statistics values based on the data which was collected during EP).
From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Estimated Annualized Bleeding Rate (ABR) for Treated Bleeds During the Treatment Period
Time Frame: From Day 1 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
ABR for a participant during treatment period (TP) was defined as annualized number of bleeding episodes during TP annualized to a 1-year interval of time. Bleeding episode: any occurrence of hemorrhage that required administration of BPA or factor. It started from first sign of a bleed and ended no more than 72 hours after last treatment for bleed, within which any symptoms of bleeding at same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. TP was sum of onset period (first 28 days after first dose of fitusiran) and EP (starting on Day 29 when AT lowering capacity of fitusiran had achieved therapeutic target range to earliest of [Day 246 or last day of bleeding follow up])(maximum duration of TP: from Day 1 to Day 246). This OM represents estimated results (i.e., results received by applying NB regression model on data collected during TP).
From Day 1 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Observed Annualized Bleeding Rate (ABR) for Treated Bleeds During the Treatment Period
Time Frame: From Day 1 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
ABR for a participant during TP was defined as annualized number of bleeding episodes during TP annualized to a 1-year interval of time. ABR= number of bleeding episodes during TP divided by total number of days during TP*365.25. Bleeding episode: any occurrence of hemorrhage that required administration of BPA or factor. It started from the first sign of a bleed and ended no more than 72 hours after last treatment for bleed, within which any symptoms of bleeding at the same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. TP was sum of onset period (first 28 days after the first dose of fitusiran) and EP (starting on Day 29 when AT lowering capacity of fitusiran had achieved therapeutic target range to the earliest of [Day 246 or the last day of bleeding follow up]) (maximum duration of TP: from Day 1 to Day 246). This OM represents observed results (i.e., descriptive statistics values based on data collected during TP).
From Day 1 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Estimated Annualized Spontaneous Bleeding Rate for Treated Bleeds During Efficacy Period
Time Frame: From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Annualized spontaneous bleeding rate for a participant during EP was defined as annualized number of spontaneous bleeding episodes during EP annualized to a 1-year interval of time. Spontaneous bleeding episode was bleeding event that occurred for no apparent or known reason, particularly into joints, muscles, and soft tissues. It started from first sign of a bleed and ended no more than 72 hours after last treatment for the bleed, within which any symptoms of bleeding at the same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. EP was defined as time duration starting from Day 29 when AT lowering capacity of fitusiran had achieved therapeutic target range to the earliest of (Day 246 or last day of bleeding follow up) (maximum duration of EP: from Day 29 to Day 246). This OM represents estimated results (i.e., results received by applying NB regression model on data collected during EP).
From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Observed Annualized Spontaneous Bleeding Rate for Treated Bleeds During the Efficacy Period
Time Frame: From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
ABR for participant during EP was defined as annualized number of spontaneous bleeding episodes during EP annualized to a 1-year interval of time. ABR=number of treated spontaneous bleeding episodes during EP divided by total number of days during EP*365.25. Spontaneous bleeding episode was bleeding event that occurred for no apparent or known reason, into joints, muscles, and soft tissues. It started from the first sign of a bleed and ended no more than 72 hours after the last treatment for bleed, within which any symptoms of bleeding at the same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. EP: time duration starting from Day 29 when the AT lowering capacity of fitusiran had achieved therapeutic target range to earliest of (Day 246 or the last day of bleeding follow up) (maximum duration of EP: from Day 29 to Day 246). This OM represents observed results (i.e., descriptive statistics values based on data collected during EP).
From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Estimated Annualized Joint Bleeding Rate for Treated Bleeds During the Efficacy Period
Time Frame: From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Annualized joint bleeding rate for a participant during EP was defined as annualized number of bleeding episodes during EP annualized to a 1-year interval of time. Joint bleeding episode was characterized by an unusual sensation in the joint ("aura") in combination with 1) increasing swelling or warmth over the skin, joint, 2) increased pain, or 3) progressive loss of range of motion or difficulty in using the limb as compared with Baseline. It started from first sign of a bleed and ended no more than 72 hours after last treatment for the bleed. EP was defined as time duration starting from Day 29 when the AT lowering capacity of fitusiran had achieved therapeutic target range to the earliest of (Day 246 or the last day of bleeding follow up) (maximum duration of EP: from Day 29 to Day 246). This OM presents estimated results (i.e., results received by applying NB regression model on data collected during EP).
From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Observed Annualized Joint Bleeding Rate for Treated Bleeds During the Efficacy Period
Time Frame: From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Annualized joint bleeding rate for participant during EP was defined as annualized number of joint bleeding episodes during EP annualized to 1-year interval of time. ABR= number of treated joint bleeding episodes during EP divided by total number of days during EP*365.25. A joint bleeding episode was characterized by an unusual sensation in joint ("aura") in combination with 1) increasing swelling or warmth over skin, joint, 2) increased pain, or 3) progressive loss of range of motion or difficulty in using limb as compared with Baseline. It started from first sign of a bleed and ended no more than 72 hours after the last treatment for the bleed. EP: time duration starting from Day 29 when the AT lowering capacity of fitusiran had achieved therapeutic target range to the earliest of (Day 246 or last day of bleeding follow up) (maximum duration of EP: from Day 29 to Day 246). This OM presents observed results (i.e., descriptive statistics values based on data collected during EP).
From Day 29 up to Day 246 or up to the last day of bleeding follow up (any day up to Day 246), whichever was the earliest
Health-related Quality of Life (HRQOL): Change From Baseline in Haemophilia Quality of Life Questionnaire for Adults (Haem-A-QOL) Physical Health Domain Score at Month 9
Time Frame: Baseline (Day 1), Month 9
Haem-A-QoL: participant-reported questionnaire designed for adult participants (>=17 years of age) with hemophilia; and consisted of 46 items comprising 10 domains (physical health, feelings, view of yourself, sports and leisure, work and school, dealing with hemophilia, treatment, future, family planning, partnership and sexuality). Items were rated along five response options: never, rarely, sometimes, often, or all the time. Change from baseline in physical Health domain score was reported in this outcome measure. Raw score for physical health domain were transformed to a scale ranged from 0 to 100, where lower scores denoted better physical health.
Baseline (Day 1), Month 9
Health-related Quality of Life (HRQOL): Change From Baseline in Haem-A-QOL Total Score at Month 9
Time Frame: Baseline (Day 1), Month 9
Haem-A-QoL: participant-reported questionnaire designed for adult participants (>=17 years of age) with hemophilia; and consisted of 46 items comprising 10 domains (physical health, feelings, view of yourself, sports and leisure, work and school, dealing with hemophilia, treatment, future, family planning, partnership and sexuality). Items were rated along five response options: never, rarely, sometimes, often, or all the time. Raw score for each domain were transformed to a scale ranged from 0 to 100, where lower scores denoted better health. Haem-A-QoL Total Score was average of all domain scores and ranged from 0 to 100, where lower scores denoted better quality of life.
Baseline (Day 1), Month 9
Estimated Annualized Bleeding Rate (ABR) for Treated Bleeds During the Onset Period
Time Frame: From Day 1 up to Day 28 or up to the last day of bleeding follow up (any day up to Day 28), whichever was the earliest
ABR was annualized number of bleeding episodes during onset period per participant annualized to a 1-year interval of time. A treated bleeding episode was defined as any occurrence of hemorrhage that may required administration of BPA or factor. It started from the first sign of a bleed and ended no more than 72 hours after the last treatment for the bleed, within which any symptoms of bleeding at the same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. The onset period was defined as time interval from Day 1 to the earlier of Day 28 or the last day of bleeding follow up. This OM represents estimated results (i.e., results received by applying NB regression model on data collected during onset period).
From Day 1 up to Day 28 or up to the last day of bleeding follow up (any day up to Day 28), whichever was the earliest
Number of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment-Emergent Serious Adverse Events (TESAEs)
Time Frame: From Baseline (Day 1) up to 15 months (i.e. 9 months treatment period + 6-months follow-up)
An adverse Event (AE) was defined as any untoward medical occurrence in a participant who received study drug which did not necessarily have a causal relationship with the treatment. Treatment emergent AEs were defined as any AE with onset date after first dose of fitusiran in the fitusiran prophylaxis arm or after Day 1 visit in the BPA on-demand arm. A Serious AE (SAE) was defined as any untoward medical occurrence that at any dose: resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability or incapacity, was a congenital anomaly or birth defect, or was a medically important event.
From Baseline (Day 1) up to 15 months (i.e. 9 months treatment period + 6-months follow-up)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Investigators

  • Study Director: Clinical Sciences & Operations, MD, Sanofi

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 14, 2018

Primary Completion (Actual)

November 25, 2020

Study Completion (Actual)

June 23, 2021

Study Registration Dates

First Submitted

January 25, 2018

First Submitted That Met QC Criteria

January 30, 2018

First Posted (Actual)

January 31, 2018

Study Record Updates

Last Update Posted (Actual)

March 28, 2022

Last Update Submitted That Met QC Criteria

March 15, 2022

Last Verified

March 1, 2022

More Information

Terms related to this study

Other Study ID Numbers

  • EFC14768
  • 2016-001463-36 (EudraCT Number)
  • ALN-AT3SC-003 (Other Identifier: Alnylam)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

Yes

IPD Plan Description

Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

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.

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