Efficacy and Safety Study of BERIPLEX® P/N (Kcentra) Compared With Plasma in Patients With Acute Major Bleeding Caused by Anticoagulant Therapy

An Open-label, Randomized, Multicenter Phase IIIb Study to Assess the Efficacy, Safety and Tolerance of BERIPLEX® P/N Compared With Plasma for Rapid Reversal of Coagulopathy Induced by Coumarin Derivatives in Subjects With Acute Major Bleeding

The purpose of this study is to evaluate efficacy, safety and tolerance of BERIPLEX® P/N (Kcentra) compared with plasma in regard to rapid reversal of coagulopathy induced by coumarin derivatives in subjects who require immediate correction of INR (International Normalized Ratio)and to stop an acute major bleeding.

Study Overview

• Status: Completed
• Conditions: Blood Coagulation Disorders; Acute Major Bleeding
• Intervention / Treatment: Biological: Beriplex® P/N (Kcentra); Biological: Fresh frozen plasma

• Study Type: Interventional
• Enrollment (Actual): 216
• Phase: Phase 3

Contacts and Locations

Study Locations

• Belarus
  • Minsk, Belarus
    • Study Site 1
  • Minsk, Belarus
    • Study Site 2
• Bulgaria
  • Pleven, Bulgaria
    • Study Site
  • Plovdiv, Bulgaria
    • Study Site
  • Rousse, Bulgaria
    • Study Site
  • Sofia, Bulgaria
    • Study Site 1
  • Sofia, Bulgaria
    • Study Site 2
  • Sofia, Bulgaria
    • Study Site 3
  • Sofia, Bulgaria
    • Study Site 4
• Romania
  • Brasov, Romania
    • Study Site
  • Bucharest, Romania
    • Study Site 1
  • Bucharest, Romania
    • Study Site 2
  • Bucharest, Romania
    • Study Site 3
  • Cluj-Napoca, Romania
    • Study Site
  • Timisoara, Romania
    • Study Site
• Russian Federation
  • Arkhangelsk, Russian Federation
    • Study Site
  • Barnaul, Russian Federation
    • Study Site 1
  • Barnaul, Russian Federation
    • Study Site 2
  • Kazan, Russian Federation
    • Study Site
  • Kemerovo, Russian Federation, 650002
    • Study Site
  • Moscow, Russian Federation
    • Study Site 1
  • Moscow, Russian Federation
    • Study Site 2
  • Nizhny Novgorod, Russian Federation
    • Study Site 1
  • Nizhny Novgorod, Russian Federation
    • Study Site 2
  • St. Petersburg, Russian Federation
    • Study Site 1
  • St. Petersburg, Russian Federation
    • Study Site 2
• Ukraine
  • Kharkov, Ukraine
    • Study Site
  • Vinnytsa, Ukraine
    • Study Site
• United States
  • Alabama
    • Birmingham, Alabama, United States, 35248-3280
      • Study Site
  • California
    • Los Angeles, California, United States, 90033
      • Study Site
    • San Franciso, California, United States, 94115
      • Study Site
  • Delaware
    • Newark, Delaware, United States, 19718
      • Study Site
  • Florida
    • Orlando, Florida, United States, 32806
      • Study Site
    • Tampa, Florida, United States, 33606
      • Study Site
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Study Site
    • Oak Park, Illinois, United States, 60302
      • Study Site
  • Kentucky
    • Hazard, Kentucky, United States, 41701
      • Study Site
  • Maryland
    • Baltimore, Maryland, United States, 21205
      • Study Site
    • Baltimore, Maryland, United States, 21201
      • Study Site
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Study Site
    • Worchester, Massachusetts, United States, 01655
      • Study Site
  • Michigan
    • Ann Arbor, Michigan, United States, 48106
      • Study Site
    • Royal Oak, Michigan, United States, 48073
      • Study Site
  • Minnesota
    • Duluth, Minnesota, United States, 55805
      • Study Site
    • Minneapolis, Minnesota, United States, 55114
      • Study Site
  • Mississippi
    • Jackson, Mississippi, United States, 39216
      • Study Site
  • Missouri
    • St. Louis, Missouri, United States, 63110
      • Study Site
  • New Mexico
    • Albuquerque, New Mexico, United States, 87131
      • Study Site
  • New York
    • Albany, New York, United States, 12208
      • Study Site
    • Johnson City, New York, United States, 13790
      • Study Site
    • New York, New York, United States, 10032
      • Study Site
    • New York, New York, United States, 10003
      • Study Site
    • New York, New York, United States, 10029
      • Study Site
    • Rochester, New York, United States, 14642
      • Study Site
    • Staten Island, New York, United States, 10305
      • Study Site
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • Study Site
  • Pennsylvania
    • Allentown, Pennsylvania, United States, 18103
      • Study Site
    • Hershey, Pennsylvania, United States, 17033
      • Study Site
    • Philadelphia, Pennsylvania, United States, 19107
      • Study Site
    • Philadelphia, Pennsylvania, United States, 19140
      • Study Site
    • West Reading, Pennsylvania, United States, 19611
      • Study Site
  • Texas
    • Austin, Texas, United States, 78701
      • Study Site
    • El Paso, Texas, United States, 79905
      • Study Site
    • Houston, Texas, United States, 77030
      • Study Site
    • Houston, Texas, United States, 77030
      • Study Site 2
    • Temple, Texas, United States, 76508
      • Study Site
  • Utah
    • Salt Lake City, Utah, United States, 84132
      • Study Site
  • Virginia
    • Charlottesville, Virginia, United States, 22908
      • Study Site
    • Richmond, Virginia, United States, 23298
      • Study Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Male and female subjects ≥ 18 years
• Subjects who have received oral vitamin K-antagonist therapy
• Subjects who have acute major bleeding, defined as one of the following: life-threatening or potentially life-threatening, acute bleeding associated with a fall in hemoglobin (Hb) level ≥ 2g/dL, bleeding requiring blood product transfusion
• INR ≥ 2 within 3 hours before start of study treatment
• Informed consent has been obtained

Exclusion Criteria:

• Expected survival of less than 3 days, or expected surgery in less than 1 day
• Acute trauma for which reversal of vitamin K antagonists alone would not be expected to control the acute bleeding event
• Use of unfractionated or low molecular weight heparin use from 24 hours prior to enrollment or expected need within 24 hours after start of infusion
• For patients with ICH: Glasgow coma score (GCS) < 7; intracerebral hematoma volume > 30cc as assessed by ABC/21; for subdural hematomas: maximum thickness ≥ 10 mm, midline shift ≥ 5 mm; for subarachnoid hemorrhage: any evidence of hydrocephalus; infratentorial ICH location; epidural hematomas; intraventricular extension of hemorrhage; modified Rankin score (mRS) of >3 prior to ICH
• History of thrombotic event, myocardial infarction, disseminated intravascular coagulation, cerebral vascular accident, transient ischemic attack, unstable angina pectoris, or severe peripheral vascular disease within 3 months of enrollment
• Known history of antiphospholipid antibody syndrome or lupus anticoagulant antibodies
• Suspected or confirmed sepsis at time of enrollment
• Administration of whole blood, plasma, plasma fractions or platelets within 2 weeks prior to inclusion into the study
• Large blood vessel rupture (e.g. in advanced cancer patient)
• Pre-existing progressive fatal disease with a life expectancy of less than 2 months
• Known inhibitors to coagulation factors II, VII, IX, or X; or hereditary protein C or protein S deficiency; or heparin-induced, type II thrombocytopenia
• Treatment with any other investigational medicinal product within 30 days prior to inclusion into the study
• Presence or history of hypersensitivity to components of the study medication
• Pregnant or breast-feeding women
• Prior inclusion in this study or any other CSL Behring-sponsored Beriplex study

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

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Beriplex® P/N	Biological: Beriplex® P/N (Kcentra); Intravenous infusion, dosage depending on baseline INR, amount of coagulation factor IX and body weight; Other Names: Kcentra
Active Comparator: Fresh frozen plasma	Biological: Fresh frozen plasma; Intravenous Infusion, dosage depending on baseline INR and body weight

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants Achieving Hemostatic Efficacy of Stopping an Ongoing Major Bleed	Hemostatic efficacy was determined by a blinded independent board as excellent, good, or poor/none, based on prespecified definitions. Assessments of visible or non-visible musculoskeletal bleeding were made at 1 and 4 hours after the end of infusion. Hemostatic efficacy was the binary endpoint of effective or non-effective hemostasis, where 'effective' was a hemostatic efficacy rating of "excellent" or "good," and 'non-effective' was a hemostatic efficacy rating of "poor/none".	At 1 and 4 hours after the end of infusion
Percentage of Participants Who Had a Rapid Decrease of the International Normalized Ratio (INR)	A rapid decrease of the international normalized ratio (INR) was defined as an INR ≤ 1.3 at 30 minutes after the end of the infusion. The INR is a standard way to describe the time it takes for blood to clot; an INR range of 0.8 to 1.2 is considered normal for a healthy person who is not using oral anticoagulant therapy.	30 minutes after end of infusion

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants Who Had Hemostatic Efficacy for Visible or Non-visible Musculoskeletal Bleeding	Hemostatic efficacy was determined by a blinded independent board as excellent, good, or poor/none, based on prespecified definitions. Assessments of visible or non-visible musculoskeletal bleeding were made at 3 and 6 hours after the start of infusion. Hemostatic efficacy was the binary endpoint of effective or non-effective hemostasis, where 'effective' was a hemostatic efficacy rating of "excellent" or "good," and 'non-effective' was a hemostatic efficacy rating of "poor/none".	At 3 and 6 hours after the start of infusion
Incremental in Vivo Recovery (IVR) (Response) of Factors II, VII, IX, and X, Protein C, and Protein S for Beriplex	The incremental IVR [(IU/dL)/(IU/kg)] was calculated as follows: (IU/dL activity rise in plasma)/(IU/kg body weight infused) = [maximum increase in component plasma level within 3 hours compared to pre-infusion (IU/dL)]/{[exact dose of component in drug administered (IU)]/[body weight (kg)]}.	Before infusion and up to 3 h after the start of infusion
Plasma Levels of Factors II, VII, IX, and X, Protein C, and Protein S	Plasma levels are presented as the percentage of normal at pre-infusion and 30 min and 24 h after the start of infusion. The plasma level assay results are reported as a potency relative to a standard, where 100% is considered to be normal.	From preinfusion until 24 h after the start of infusion
Percentage of Participants With INR Correction at Various Times After the Start of Infusion	The time taken from the start of infusion to INR correction (defined as an INR ≤ 1.3) was recorded. The percentage of participants with INR correction was calculated at 0.5, 1, 3, 6, 12, and 24 h after the start of infusion.	From the start of infusion until INR correction; calculated at 0.5, 1, 3, 6, 12, and 24 h after the start of infusion.
Percentage of Participants With INR Correction at Various Times After Randomization	The time taken from randomization to INR correction (defined as an INR ≤ 1.3) was recorded. The percentage of participants with INR correction was calculated at 2.5, 3, 5, 8, 14, and 26 h after randomization.	From randomization until INR correction; calculated at 2.5, 3, 5, 8, 14, and 26 h after randomization.
Transfusion of Red Blood Cells	Red blood cells were packed red blood cells (PRBCs).	From the start of infusion until 24 h after the start of infusion
Use of Other Blood Products and Hemostatic Agents	Other blood products and hemostatic agents containing coagulation factors (such as whole blood, plasma, albumin, platelets) not including PRBCs.	From the start of infusion until 24 h after the start of infusion
45-Day All-cause Mortality		Until Day 45
Overall Treatment-emergent Adverse Events (TEAEs)	Number of participants with TEAEs. Treatment-related AEs were defined as events whose relationship to study treatment was definitely related, probably related, or possibly related in the opinion of the investigator. AEs with missing relationship were considered related to treatment. Serious TEAEs were treatment-emergent SAEs. Deaths reported up to and including Day 45; one additional Beriplex death occurred after Day 45.	From the start of infusion up to the allowed time window of the Day 10 visit for non-serious AEs and from the start of infusion up to the allowed time window of the Day 45 visit for SAEs.

Collaborators and Investigators

• Sponsor: CSL Behring

Publications and helpful links

General Publications

• Sarode R, Milling TJ Jr, Refaai MA, Mangione A, Schneider A, Durn BL, Goldstein JN. Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation. 2013 Sep 10;128(11):1234-43. doi: 10.1161/CIRCULATIONAHA.113.002283. Epub 2013 Aug 9.

Study record dates

Study Major Dates

• Study Start: June 1, 2008
• Primary Completion (Actual): November 1, 2010
• Study Completion (Actual): November 1, 2010

Study Registration Dates

• First Submitted: July 1, 2008
• First Submitted That Met QC Criteria: July 1, 2008
• First Posted (Estimate): July 2, 2008

Study Record Updates

• Last Update Posted (Estimate): February 3, 2014
• Last Update Submitted That Met QC Criteria: January 1, 2014
• Last Verified: September 1, 2013

More Information

Terms related to this study

• Keywords: Complex; Coagulopathy; Anticoagulant reversal; Prothrombin; Concentrate; induced by; coumarin; derivatives; Kcentra
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Hematologic Diseases; Hemorrhagic Disorders; Hemostatic Disorders; Blood Coagulation Disorders; Hemorrhage; Molecular Mechanisms of Pharmacological Action; Fibrinolytic Agents; Fibrin Modulating Agents; Anticoagulants; Protein C; Protein S
• Other Study ID Numbers: BE1116_3002; 1462 (Other Identifier: CSL Behring); 2007-007861-19 (EudraCT Number)