Phase 2, Pharmacokinetics Study of Eltrombopag in Japanese Thrombocytopenic Subjects With Chronic Liver Disease

TPL111913, a Multi-centre, Open Label, Dose Ranging Phase II Study to Assess Efficacy, Safety and Pharmacokinetics of Eltrombopag in Japanese Thrombocytopenic Subjects With Chronic Liver Disease

This is an open label, multi-centre, dose ranging study to assess efficacy, safety and pharmacokinetics of eltrombopag in thrombocytopenic subjects with chronic liver disease.

Study Overview

• Status: Completed
• Conditions: Liver Diseases
• Intervention / Treatment: Drug: eltrombopag 12.5 milligrams (mg) tablet; Drug: eltrombopag 25 mg tablet

• Study Type: Interventional
• Enrollment (Actual): 38
• Phase: Phase 2

Contacts and Locations

Study Locations

• Japan
  • Fukuoka, Japan, 814-0180
    • GSK Investigational Site
  • Fukuoka, Japan, 810-8563
    • GSK Investigational Site
  • Fukuoka, Japan, 815-8555
    • GSK Investigational Site
  • Fukuoka, Japan, 830-0011
    • GSK Investigational Site
  • Fukuoka, Japan, 839-0863
    • GSK Investigational Site
  • Kagoshima, Japan, 890-8520
    • GSK Investigational Site
  • Kumamoto, Japan, 860-8556
    • GSK Investigational Site
  • Kumamoto, Japan, 862-8655
    • GSK Investigational Site
  • Nagasaki, Japan, 856-8562
    • GSK Investigational Site
  • Oita, Japan, 879-5593
    • GSK Investigational 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:

• Subject who agree to comply with protocol requirements and instructions and who provide signed and dated written informed consent.
• Male and female subjects, ≥20 years of age (at the time of informed consent) with chronic liver disease.
• Child-Pugh score <=9.
• A baseline platelet count <50,000/mcL.
• A baseline serum sodium level >130 mEq/L.
• Haemoglobin concentration >8 g/dL, stable for at least 4 weeks.
• A female is eligible to enter and participate in the study if she is of:

Non-childbearing potential (i.e., physiologically incapable of becoming pregnant) including any female who:

• Has had a hysterectomy
• Has had a bilateral oophorectomy (ovariectomy)
• Has had a bilateral tubal ligation
• Is post-menopausal (demonstrate total cessation of menses for longer than one year)

Childbearing potential, has a negative urine and/or serum pregnancy test at screening, and within the 24 hour period prior to the first dose of investigational product and uses one of the following acceptable methods of contraception:

• Complete abstinence from intercourse.
• Any intrauterine device (IUD) with a documented failure rate of less than 1% per year.
• Double-barrier contraception (condom with spermicidal jelly, or diaphragm with spermicide).
• Male partner who is sterile (diagnosed by a qualified medical professional) prior to the female subject's study entry and is the sole sexual partner for that female.
• Oral contraceptive (combined).
• Subject has no physical limitation to ingest and retain oral medication.

Exclusion Criteria:

• Subjects with known or suspected hypersensitivity, intolerance or allergy to any of the ingredients in eltrombopag tablets.
• Evidence of portal vein thrombosis on abdominal imaging (ultrasound with Doppler or appropriate magnetic resonance imaging/computed tomography (MRI/CT) imaging techniques) within 3 months before the start of the study.
• History of arterial or venous thrombosis (including Budd-Chiari Syndrome),

AND ≥ two of the following risk factors:

• hereditary thrombophilic disorders (e.g. antithrombinIII (ATIII) deficiency, etc.)
• hormone replacement therapy
• systemic contraception therapy (containing oestrogen)
• smoking
• diabetes
• hypercholesterolemia
• medication for hypertension or cancer
• Human Immunodeficiency Virus (HIV) infection.
• History of drug/alcohol abuse or dependence within 1 year prior to screening.
• Any disease condition associated with current active World Health Organization (WHO) Grade 3 or 4 bleeding.
• Active infection requiring systemic antibiotic therapy.
• Pregnant, nursing mothers, women who may be pregnant, or women who plan to become pregnant during the time of study participation.
• Treatment with platelet transfusion within 2 weeks prior to Day 1.
• Treatment with interferon within 4 weeks prior to Day 1.
• Treatment with an investigational drug within 30 days or five half-lives (whichever is longer) preceding the first dose of study medication.
• History of platelet agglutination abnormality.
• History of porphyria.
• Subjects who are deemed unsuitable for the study by the investigator (or subinvestigator).

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

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: low dose; eltrombopag 12.5 mg/day	Drug: eltrombopag 12.5 milligrams (mg) tablet; eltrombopag 12.5 mg tablet once a day
Experimental: middle dose; eltrombopag 25 mg/day	Drug: eltrombopag 25 mg tablet; eltrombopag 25 mg tablet once a day
Experimental: high dose; eltrombopag 37.5 mg/day	Drug: eltrombopag 12.5 milligrams (mg) tablet; eltrombopag 12.5 mg tablet once a day; Drug: eltrombopag 25 mg tablet; eltrombopag 25 mg tablet once a day

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Platelet Counts on Day 15	Platelet counts were measured by blood draw. Change from Baseline was calculated as the Day 15 value minus the Baseline value.	Baseline, Day 15

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Analysis of Covariance for Three Patterns of Dose Response Using the Change From Baseline in Platelet Counts (Baseline Platelet Counts as Covariate)	Exploratory analysis was conducted to see a dose response/trend when a dose goes high with the changes from baseline in platelet counts (12.5 mg, 25 mg, and 37.5 mg) on Day 15 of each subject. The data were analyzed with baseline of platelet counts as covariate for the following dose response pattern using contrast: (1) linearity, (2) saturation at the medium dose, (3) onset of response at the high dose.	Baseline, Day 15
Analysis of Covariance for Three Patterns of Dose Response Using the Change From Baseline in Platelet Counts (Baseline of Platelet Counts and Child-Pugh Class as Covariates)	Exploratory analysis was conducted to see a dose response/trend when a dose goes high with the changes from baseline in platelet counts (12.5 mg, 25 mg, and 37.5 mg) on Day 15 of each subject. The data were analyzed with baseline of platelet counts and Child-Pugh class as covariate for the following dose response pattern using contrast: (1) linearity, (2) saturation at the medium dose, (3) onset of response at the high dose.	Baseline, Day 15
Percent Change From Baseline in Platelet Counts on Day 15	Platelet counts were measured by blood draw. Change from Baseline was calculated as the Day 15 value minus the Baseline value.	Baseline, Day 15
Platelet Counts by Treatment Visit	Platelet counts were measured by blood draw. The Final Assessment Point is the last visit during the treatment period, which is Day 15 or Day 22.	Day 1 (Baseline), Day 8, Day 15, and Final Assessment Point (Day 15 or Day 22)
Platelet Counts by Post-Treatment Visit	Platelet counts were measured by blood draw.	4 days post-treatment, 8 days post-treatment, and 15 days post-treatment
Platelet Counts at Day 22	Platelet counts were measured by blood draw. The Final Assessment Point is the last visit during the treatment period, which is Day 15 or Day 22.	Day 22
Change From Baseline in Platelet Counts by Treatment Visit	Platelet counts were measured by blood draw. The Final Assessment Point is the last visit during the treatment period, which is Day 15 or Day 22. Change from Baseline was calculated as the value at each visit minus the Baseline value.	Baseline, Day 8, Day 15, and Final Assessment Point (Day 15 or Day 22)
Change From Baseline in Platelet Counts by Post-Treatment Visit	Platelet counts were measured by blood draw. Change from Baseline was calculated as the value at each visit minus the Baseline value.	4 days post-treatment, 8 days post-treatment, and 15 days post-treatment
Percentage of Responders on Day 15	A responder was defined as a participant with a platelet count within the target range (>=80 x 10^9/Liter) on Day 15.	Day 15
Percentage of Responders on Day 22	A responder was defined as a participant with a platelet count within the target range (>=80 x 10^9/Liter) on Day 22 after receiving eltrombopag for an additional week from Day 15, on which his or her platelet count was <80 x 10^9/Liter.	Day 22
Change From Baseline in Platelet Counts on Day 15 by Child-Pugh Class	Change from Baseline was calculated as the Day 15 value minus the Baseline value. The Child-Pugh (CP) score (ranging from 5 to 15, with 5 being mild and 15 being severe), calculated based on total bilirubin, serum albumin, international normalized ratio, ascites, and hepatic encephalopathy, is used to assess the severity of liver disease. A CP score of 5 or 6 is classified as Class A (mild), a score of 7-9 is classified as Class B (moderate), and a score >=10 is classified as Class C (severe). Participants with a CP score <10 were enrolled in the study.	Baseline, Day 15
Change From Baseline in Platelet Counts on Day 15 by Sex	Change from Baseline was calculated as the Day 15 value minus the Baseline value. The numbers of females and males in each treatment group are illustrated by the "n's" in the category titles.	Baseline, Day 15
Change From Baseline in Platelet Counts on Day 15 by Age	Change from Baseline was calculated as the Day 15 value minus the Baseline value. The numbers of participants in each age category are illustrated by the "n's" in the category titles.	Baseline, Day 15
Log-transformed Cmax on Days 14 and 15 in Participants Receiving Eltrombopag 12.5 mg	Serial PK samples were collected over a 24-hour (h) period on Days 14 and 15 in participants receiving eltrombopag 12.5 mg. A total of 8 blood samples (3 milliliters per sample) were collected at pre-dose, and at 1 h, 2 h, 4 h, 6 h, 8 h, 10 h, and 24 h post-dose. Cmax=maximum drug concentration.	Day 14, Day 15
Log-transformed Tmax on Days 14 and 15 in Participants Receiving Eltrombopag 12.5 mg	Serial PK samples were collected over a 24-hour (h) period on Days 14 and 15 in participants receiving eltrombopag 12.5 mg. A total of 8 blood samples (3 milliliters per sample) were collected at pre-dose, and at 1 h, 2 h, 4 h, 6 h, 8 h, 10 h, and 24 h post-dose. Tmax=maximum drug concentration time.	Day 14, Day 15
Log-transformed AUC(0-t) and AUC(0-24) on Days 14 and 15 in Participants Receiving Eltrombopag 12.5 mg	Serial PK samples were collected over a 24-hour (h) period on Days 14 and 15 in participants receiving eltrombopag 12.5 mg. A total of 8 blood samples (3 milliliters per sample) were collected at pre-dose, and at 1 h, 2 h, 4 h, 6 h, 8 h, 10 h, and 24 h post-dose. AUC(0-t)=area under the concentration-time curve from time zero (pre-dose) to last time of quantifiable concentration, and AUC(0-24)=area under the concentration-time curve from 0 (pre-dose) to 24 hours.	Day 14, Day 15

Collaborators and Investigators

• Sponsor: GlaxoSmithKline

Publications and helpful links

General Publications

• Kawaguchi T, Komori A, Seike M, Fujiyama S, Watanabe H, Tanaka M, Sakisaka S, Nakamuta M, Sasaki Y, Oketani M, Hattori T, Katsura K, Sata M. Efficacy and safety of eltrombopag in Japanese patients with chronic liver disease and thrombocytopenia: a randomized, open-label, phase II study. J Gastroenterol. 2012 Dec;47(12):1342-51. doi: 10.1007/s00535-012-0600-5. Epub 2012 Jun 8.

Study record dates

Study Major Dates

• Study Start: January 1, 2009
• Primary Completion (Actual): August 1, 2009
• Study Completion (Actual): August 1, 2009

Study Registration Dates

• First Submitted: March 5, 2009
• First Submitted That Met QC Criteria: March 12, 2009
• First Posted (Estimate): March 13, 2009

Study Record Updates

• Last Update Posted (Estimate): May 12, 2015
• Last Update Submitted That Met QC Criteria: April 23, 2015
• Last Verified: February 1, 2011

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Liver Diseases
• Other Study ID Numbers: 111913