Efficacy/Safety of Human Plasminogen Eye Drop in Ligneous Conjunctivitis Patients

A Historically Controlled Phase II/III Study to Evaluate Efficacy and Safety of Kedrion Human Plasminogen Eye Drop Preparation in Patients Diagnosed With Ligneous Conjunctivitis

Kedrion Human Plasminogen, a sterile human plasma-derived plasminogen preparation for topical ocular use will be evaluated for the indication of treatment of ligneous conjunctivitis.

KB046 will be an open-label, historically controlled clinical trial. At least 10 subjects with ligneous conjunctivitis, for approximately 20 eyes, will be treated and assessed. All subjects will receive the investigational medicinal product (IMP) for 12 to 48 weeks, with a possibility for extended treatment (Continuation segment)

Study Overview

• Status: Completed
• Conditions: Ligneous Conjunctivitis
• Intervention / Treatment: Biological: Human Plasminogen

Detailed Description

Kedrion Human Plasminogen, a sterile human plasma-derived plasminogen preparation for topical ocular use will be evaluated for the indication of treatment of ligneous conjunctivitis.

KB046 will be an open-label, historically controlled clinical trial. At least 10 subjects with ligneous conjunctivitis, for approximately 20 eyes, will be treated and assessed. All subjects will receive the investigational medicinal product (IMP) for 12 to 48 weeks, with a possibility for extended treatment (Continuation segment).

The study will be divided into 3 segments: segments 1 and 2 for assessment of efficacy and safety and segment 3 (continuation segment) assessing long-term safety. For each enrolled patient, both eyes will be treated regardless of unilateral or bilateral involvement. Treatment of the unaffected eyes provided data for the safety assessment. To assess efficacy, comparisons will be made against individual patient historical data.

• Study Type: Interventional
• Enrollment (Actual): 12
• Phase: Phase 2; Phase 3

Contacts and Locations

Study Locations

• Italy
  • Florence, Italy
    • Meyer Children's Hospital
  • Padova, Italy
    • AOU Padova
• United States
  • Indiana
    • Indianapolis, Indiana, United States, 46260
      • Indiana Hemophilia & Thrombosis center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Subjects should be diagnosed with ligneous conjunctivitis associated with Type I plasminogen deficiency, confirmed by the central laboratory and documented at pre-enrollment screening. The concomitant presence of other ligneous pseudomembranes at different sites will not constitute an exclusion criterion.
• Subjects should have documented historical records of disease course available for a period of at least 6 months surrounding an episode of LC, even if asymptomatic in the past for a newly diagnosed subject , including but not limited to age of LC onset, diagnosis of Plasminogen 1 deficiency, history of pseudomembrane lesions, disease duration, past treatment for LC, response to treatment and/or surgery (including regression and recurrence), before study entrance. If more history than 6 months surrounding an LC episode is available it will be included.
• Subjects, or their legally authorized representative, in the case of study participants < 18 years of age, should have been informed of the nature of the study, agreed to its provision, signed and dated the informed consent approved by the investigational review board (IRB) or ethics committee (EC).
• Subjects available for the duration of the study will be included. The Investigator will make sure that there is no plan for the subject to leave the area of the study site before the end of the study period. If they come from another center, they must agree to be compliant with the protocol mandated study visits and return for follow-up.

Exclusion Criteria:

• Subjects presenting ligneous conjunctivitis not associated with Type 1 plasminogen deficiency.
• Subjects with no history of LC lesions for Group 2, for Group 1 the entry lesions could be the first and included as history.
• Subject presenting antibodies against plasminogen at screening.
• Subjects with any condition which, in the opinion of the Investigator, might interfere with the evaluation of the study objectives, or participation in this trial.
• Subjects unwilling to give written informed consent or assent to participation.
• Subjects who have participated in another clinical trial within 1 month before study initiation, i.e. they have received any test drug within 30 days prior the study.
• Females of childbearing potential who are either pregnant or not using an adequate method of birth control
• Females who are breastfeeding.
• Subjects being treated with FFP or Laboratory Grade Plasminogen will undergo a washout period of at least 15 days before being considered for this study. This information will be disseminated to subjects ahead of their Screening Visit and will only occur following signing of the Informed Consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Human Plasminogen; Human Plasminogen Eye Drop treatment	Biological: Human Plasminogen; Eye Drops

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Success to Prevent Pseudomembranes Relapse	The primary endpoint (prevention of pseudomembrane relapse) was presented descriptively based on the predefined success levels: complete success (defined as no relapse by the end of Segment 2), partial success(defined as relapse appearing 2 weeks or longer after the start of Segment 2, or if following the 3 rd cycle of Segment 2 for Group 1A no relapse occurred while maintaining the higher dose) or failure (defined as relapse within 2 weeks of the start of Segment 2 or if at repeat cycles of Segment 1 for Group 1A, the pseudomembranes did not regress after Segment 1). Ninety-five percent confidence intervals for the relapse rate (complete success, and complete plus partial success) were calculated on the assumption of a binomial distribution. The responses were tabulated for the mITT and Per Protocol populations.	The prevention of pseudomembranes relapse was assessed during Segment 2, after initial total regression at the end of Segment 1 (Group 1A) or after surgical excision (Group 1B) up to 21 weeks from the study start.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Eyes With Regression in Surface Area of Existing Ligneous Pseudomembranes	The secondary endpoint was presented descriptively based on the predefined success levels: complete success (defined as regression of PSAs >90%), partial success (defined as regression of PSAs between 20% and 90%) or failure (defined as regression of PSAs <20%). The responses were tabulated for the mITT and the Per Protocol populations.	Regression of pseudomembranes surface area (PSA) was assessed from baseline to the end of Segment 1, up to 5 weeks (one subject was assessed after 9 weeks due to the occurrence of a not related SAE - Varicella - between Visit 0 and Visit 1)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Subjects Who Experience Signs and Symptoms of Sensitization.	The safety parameters were presented descriptively and tabulated for the Group 1A, Group 1B and Continuation Segment safety population.	Signs and symptoms of sensitization were evaluated during the Part 1 and Part 2 of the study up to 7 years
Number of Subjects Who Experience Adverse Events.	The safety parameters were presented descriptively and tabulated for the Group 1A, Group 1B and Continuation Segment safety population.	AEs were collected from the screening visit and throughout the study up to 7 years
Number of Subjects Who Develop Antibodies Against Bovine Aprotinin.	The safety parameters were presented descriptively and tabulated for the Group 1A, Group 1B and Continuation Segment safety population.	The antibody development was detected during Part 1 and Part 2 of the study up to 7 years
Number of Subjects Who Develop Antibodies Against Human Plasminogen.	The safety parameters were presented descriptively and tabulated for the Group 1A, Group 1B and Continuation Segment safety population.	The antibody development was detected during the Part 1 and Part 2 of the study, up to 7 years

Collaborators and Investigators

• Sponsor: Kedrion S.p.A.

Publications and helpful links

General Publications

• Caputo R, Shapiro AD, Sartori MT, Leonardi A, Jeng BH, Nakar C, Di Pasquale I, Price FW Jr, Thukral N, Suffredini AL, Pino L, Crea R, Mathew P, Calcinai M. Treatment of Ligneous Conjunctivitis with Plasminogen Eyedrops. Ophthalmology. 2022 Aug;129(8):955-957. doi: 10.1016/j.ophtha.2022.03.019. Epub 2022 Mar 26. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): May 22, 2013
• Primary Completion (Actual): April 25, 2014
• Study Completion (Actual): December 4, 2020

Study Registration Dates

• First Submitted: December 20, 2011
• First Submitted That Met QC Criteria: March 13, 2012
• First Posted (Estimate): March 15, 2012

Study Record Updates

• Last Update Posted (Estimate): January 24, 2023
• Last Update Submitted That Met QC Criteria: January 2, 2023
• Last Verified: June 1, 2022

More Information

Terms related to this study

• Keywords: Plasminogen; Plasminogen Deficiency; Ligneous Conjunctivitis; Ligneous Conjunctivitis in Plasminogen Deficient Patients
• Additional Relevant MeSH Terms: Skin Diseases; Eye Diseases; Genetic Diseases, Inborn; Conjunctival Diseases; Conjunctivitis; Skin Diseases, Genetic; Molecular Mechanisms of Pharmacological Action; Fibrinolytic Agents; Fibrin Modulating Agents; Plasminogen
• Other Study ID Numbers: KB046