A Trial Investigating Safety and Efficacy of Treatment With BAY94-9027 in Severe Hemophilia A (PROTECT-VIII)

November 3, 2023 updated by: Bayer

A Phase II/III, Multicenter, Partially Randomized, Open Label Trial Investigating Safety and Efficacy of On-demand and Prophylactic Treatment With BAY94-9027 in Severe Hemophilia A

Haemophilia A is an inherited disorder in which one of the proteins, Factor VIII, needed to form blood clots is missing or not present in sufficient levels. In a person with haemophilia A, the clotting process is slowed and the person experiences bleeds that can result in serious problems and potential disability.

The current standard treatment for severe haemophilia A is regularly scheduled infusion of FVIII to keep levels high enough to prevent bleeding. Due to the short half-life of FVIII, prophylaxis may require treatment as often as every other day.

In this trial safety and efficacy of a long-acting recombinant factor VIII molecule is evaluated in subjects with severe Hemophilia A.

120-140 patients will receive open label treatment with long-acting rFVIII either on-demand to treat bleeds or prophylactically for 36 weeks in the main trial plus an optional extension to continue treatment for at least 100 total exposure days (ED). Patients on prophylactic treatment will receive study drug at dosing intervals between once and twice a week depending on their observed bleeding. Patients will attend the treatment centre for routine blood samples and be required to keep an electronic diary.

Male patients aged 12-65, with severe hemophilia A, previously treated with FVIII for at least 50 exposure days may be eligible for this study.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Subjects in prophylactic treatment arms will undergo clinical evaluation at 10 weeks. Those with adequate control of bleeding will undergo randomization to every 5 or 7 day infusion. Those with continued bleeding will remain in treatment arm and have an increase in dose.

Part B-major surgery - optional sub study included to collect information on efficacy of BAY94-9027 in major surgical setting. Due to rarity of surgery in this population, enrollment to this sub-study may be independent of participation in main study.

Study Type

Interventional

Enrollment (Actual)

145

Phase

  • Phase 2
  • 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

      • Wien, Austria, 1090
      • Brugge, Belgium, 8000
    • Ontario
      • London, Ontario, Canada, N6A 5W9
    • Antioquia
      • Medellin, Antioquia, Colombia, 050030
    • Atlántico
      • Baranquilla, Atlántico, Colombia, 080020
      • Aarhus N, Denmark, 8200
      • BRON cedex, France, 69677
      • Marseille, France, 13005
      • Reims Cedex, France, 51092
      • Rennes Cedex, France, 35033
    • Baden-Württemberg
      • Heidelberg, Baden-Württemberg, Germany, 69004
    • Nordrhein-Westfalen
      • Bonn, Nordrhein-Westfalen, Germany, 53127
      • Ramat Gan, Israel, 5262000
    • Campania
      • Napoli, Campania, Italy, 80131
    • Lazio
      • Roma, Lazio, Italy, 00161
    • Lombardia
      • Milano, Lombardia, Italy, 20122
    • Piemonte
      • Torino, Piemonte, Italy, 10126
      • Hiroshima, Japan, 734-8551
    • Aichi
      • Nagoya, Aichi, Japan, 466-8560
    • Hyogo
      • Nishinomiya, Hyogo, Japan, 663-8501
    • Nara
      • Kashihara, Nara, Japan, 634-8522
    • Tokyo
      • Shinjuku-ku, Tokyo, Japan, 160-0023
      • Suginami, Tokyo, Japan, 167-0035
      • Daejeon, Korea, Republic of, 35233
      • Seoul, Korea, Republic of, 05278
      • Seoul, Korea, Republic of, 03722
    • Busan Gwang''yeogsi
      • Busan, Busan Gwang''yeogsi, Korea, Republic of, 49241
      • Amsterdam, Netherlands, 1105 AZ
      • Den Haag, Netherlands, 2545 CH
      • Groningen, Netherlands, 9713 GZ
      • Maastricht, Netherlands, 6229 HX
      • Oslo, Norway, 0372
      • Wroclaw, Poland, 50-367
      • Timisoara, Romania, 300011
      • Singapore, Singapore, 119228
      • Singapore, Singapore, 169608
      • Singapore, Singapore, 229 899
      • Changhua, Taiwan, 50006
      • Taipei, Taiwan, 100
      • Taipei, Taiwan, 11217
      • Ankara, Turkey, 06100
      • Izmir, Turkey, 35100
      • London, United Kingdom, SE1 7EH
      • Sheffield, United Kingdom, S10 2JF
    • Vale Of Glamorgan, The
      • Newcastle Upon Tyne, Vale Of Glamorgan, The, United Kingdom, NE1 4LP
    • Arizona
      • Tucson, Arizona, United States, 85724-5024
    • California
      • Sacramento, California, United States, 95817
      • San Diego, California, United States, 92103-8651
    • Florida
      • Jacksonville, Florida, United States, 32207
      • Miami, Florida, United States, 33136
    • Illinois
      • Chicago, Illinois, United States, 60612
    • Michigan
      • Detroit, Michigan, United States, 48202
    • Minnesota
      • Minneapolis, Minnesota, United States, 55455
    • New York
      • Syracuse, New York, United States, 13210
    • Ohio
      • Cincinnati, Ohio, United States, 45229-3039
      • Cleveland, Ohio, United States, 44106-6007
      • Columbus, Ohio, United States, 43205
    • Pennsylvania
      • Hershey, Pennsylvania, United States, 17033
    • Virginia
      • Richmond, Virginia, United States, 23298-0155

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

12 years to 65 years (Child, Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Male; 12-65 years of age
  • Subjects with severe hemophilia A
  • Previously treated with factor VIII for a minimum of 150 exposure days

Exclusion Criteria:

  • Inhibitors to FVIII (current evidence or history)
  • Any other inherited or acquired bleeding disorder in addition to Hemophilia A
  • Platelet count < 100,000/mm3
  • Creatinine > 2x upper limit of normal or AST/ALT (aspartate aminotransferase/alanine aminotransferase) > 5x upper limit of normal

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
Experimental: Arm 1
On-demand treatment of BAY94-9027 at individual dose and number of infusions based upon location and severity of bleeds
Intravenous infusion of BAY94-9027
Experimental: Arm 2
Prophylaxis treatment of BAY94-9027; 2 infusions per week over 10 weeks followed by 2 infusions per week over 26 weeks in the main trial; and at least 1 day per week in the extension for at least 100 ED
Intravenous infusion of BAY94-9027
Experimental: Arm 3
Prophylaxis treatment of BAY94-9027; 2 infusions per week over 10 weeks followed by infusion every 5 days over 26 weeks in the main trial; and at least 1 day per week in the extension for at least 100 ED
Intravenous infusion of BAY94-9027
Experimental: Arm 4
Prophylaxis treatment of BAY94-9027; 2 infusions per week over 10 weeks followed by infusion every 7 days over 26 weeks in the main trial; and at least 1 day per week in the extension for at least 100 ED
Intravenous infusion of BAY94-9027

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Annualized Number of Total Bleeds in On-demand Treatment Arm (Weeks 0 -36) and in Each Prophylaxis Arm (Weeks 10 - 36, Excluding Rescue Bleeds) - Part A, Main Trial
Time Frame: On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A
Annualized number of total bleeds was defined as the annualized sum of spontaneous bleeds and trauma bleeds. A participant who had the one-time increase in dose frequency was regarded as rescued. A rescue bleed was a bleed that occured after the dose frequency was increased. Rescue bleeds and periods were not considered for the annualized bleeding rate (ABR).
On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Annualized Number of Joint Bleeds, Trauma, Spontaneous Bleeds in On-demand Treatment Arm (Weeks 0 -36) and in Each Prophylaxis Arm (Weeks 10 - 36, Excluding Rescue Bleeds) - Part A
Time Frame: On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A
A participant who had the one-time increase in dose frequency was regarded as rescued. A rescue bleed was a bleed that occured after the dose frequency was increased. Rescue bleeds and periods were not considered for the ABR.
On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A
Annualized Number of Total Bleeds in On-demand Treatment Arm and in Each Prophylaxis Arm, Part A, Extension
Time Frame: at least 100 total exposure days acquired, median time 3.9 years up to 7 years maximum
Annualized number of total bleeds was defined as the annualized sum of spontaneous bleeds and trauma bleeds.
at least 100 total exposure days acquired, median time 3.9 years up to 7 years maximum
Number of Participants Developed Human Coagulation Factor VIII (FVIII) Inhibitor - Part A
Time Frame: Weeks 0 to 36 during Part A
FVIII inhibitor testing was done according to the Nijmegen modified Bethesda assay. A positive inhibitor test was defined with a threshold of ≥0.6 Bethesda unit (BU) at the central laboratory.
Weeks 0 to 36 during Part A
Number of Bleeds Requiring 1, 2 or >= 3 Infusions to Control the Bleed - Part A
Time Frame: Weeks 0 to 36
Number of bleeds requiring 1, 2 or >= 3 infusions to control the bleeding
Weeks 0 to 36
Number of Bleeds According to Locations - Part A
Time Frame: Weeks 0 -36
Bleed locations were categorised as joint, muscle, skin/mucosa, internal, others and missing.
Weeks 0 -36
Number of Bleeds Over Time Since Previous Prophylaxis Infusion - Part A
Time Frame: Weeks 0 to 36
Weeks 0 to 36
Number of Bleeds According to Participant's Assessment of Response to Treatment - Part A
Time Frame: Weeks 0 to 36 during Part A
Response to treatment was assessed by participant as excellent, good, moderate, poor or missing during Part A of the study.
Weeks 0 to 36 during Part A
Recombinant Human Factor VIII (rFVIII) Usage Expressed as Total Dose Per Kilogram Per Year - Part A
Time Frame: On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A
For prophylaxis patients, the dose is related to all infusions.
On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A
Recombinant Human Factor VIII (rFVIII) Usage Expressed as Dose Per Kilogram Per Infusion - Part A
Time Frame: On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A
For prophylaxis patients, the dose per infusion related to prophylaxis infusion.
On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A
Number of Participants Requiring an Increase in Dose Frequency, or Dose Increase, During Weeks 10 to 36 - Part A
Time Frame: Weeks 10 to 36 during Part A
Weeks 10 to 36 during Part A
Number of Surgeries According to Physician's Assessment of Adequacy of Hemostasis in Major Surgery - Part B
Time Frame: Day of surgery
Major surgery was defined as any surgical or invasive procedure (elective or emergent) in which the overall bleeding risk was excessive, required a general anesthetic in an individual without a bleeding disorder, penetrated or exposed a major body cavity, resulted in substantial impairment of physical or physiological functions, or required special anatomic knowledge or manipulative skill. Adequacy of hemostasis was assessed as excellent, good, moderate or poor, by the surgeon or interventionalist during Part B of the study.
Day of surgery
Recombinant Human Factor VIII (rFVIII) Usage Expressed as Dose Per Kilogram Per Infusion for Major Surgery - Part B
Time Frame: Up to 3 weeks post-surgery during Part B
Major surgery was defined as any surgical or invasive procedure (elective or emergent) in which the overall bleeding risk was excessive, required a general anesthetic in an individual without a bleeding disorder, penetrated or exposed a major body cavity, resulted in substantial impairment of physical or physiological functions, or required special anatomic knowledge or manipulative skill. Total dose per kilogram per Infusion was expressed in international units per kilogram per infusion (IU/kg/infusion).
Up to 3 weeks post-surgery during Part B
Recombinant Human Factor VIII (rFVIII) Usage Expressed as Number of Infusions for Major Surgery - Part B
Time Frame: Up to 3 weeks post-surgery during Part B
Major surgery was defined as any surgical or invasive procedure (elective or emergent) in which the overall bleeding risk was excessive, required a general anesthetic in an individual without a bleeding disorder, penetrated or exposed a major body cavity, resulted in substantial impairment of physical or physiological functions, or required special anatomic knowledge or manipulative skill.rFVIII usage expressed as number of infusions and IU/kg per year, as well as IU/kg per event (surgery) was assessed by investigator.
Up to 3 weeks post-surgery during Part B
Maximum Drug Plasma Concentration (Cmax) Following Single and Multiple Doses of BAY94-9027, Chromogenic Assay - Part A
Time Frame: Weeks 0 and 36: pre-infusion (0 hours), post-infusion 15, 30 minutes, 1, 3, 6, 8, 24, 48, 72, 96 hours
Cmax: Maximum observed drug concentration following an infusion of 60 IU/kg
Weeks 0 and 36: pre-infusion (0 hours), post-infusion 15, 30 minutes, 1, 3, 6, 8, 24, 48, 72, 96 hours
Area Under the Plasma Concentration Versus Time Curve From Zero to Infinity (AUC) Following Single and Multiple Doses of BAY94-9027, Chromogenic Assay - Part A
Time Frame: Weeks 0 and 36: pre-infusion (0 hours), post-infusion 15, 30 minutes, 1, 3, 6, 8, 24, 48, 72, 96 hours
AUC: The total area under the plasma concentration versus time curve following an infusion of 60 IU/kg .
Weeks 0 and 36: pre-infusion (0 hours), post-infusion 15, 30 minutes, 1, 3, 6, 8, 24, 48, 72, 96 hours
Terminal Elimination Half Life (t1/2) Following Single and Multiple Doses of BAY94-9027, Chromogenic Assay - Part A
Time Frame: Weeks 0 and 36: pre-infusion (0 hours), post-infusion 15, 30 minutes, 1, 3, 6, 8, 24, 48, 72, 96 hours
t1/2: Terminal half-life is the time the plasma concentration during terminal phase is halved following an infusion of 60 IU/kg .
Weeks 0 and 36: pre-infusion (0 hours), post-infusion 15, 30 minutes, 1, 3, 6, 8, 24, 48, 72, 96 hours
Overall Human Coagulation Factor VIII (FVIII) Recovery Value by Chromogenic Assay - Part A
Time Frame: Weeks 0 to 36 during Part A
Recovery was calculated by the following formula: Recovery = (post-infusion FVIII activity - pre-infusion FVIII activity ) * weight / dose (in IU). Recovery is the increase of FVIII activity after the injection normalized by dose: IU/dl per IU/kg = kg/dL
Weeks 0 to 36 during Part A
Change From Baseline in Quality of Life by Hemophilia Specific Quality of Life Instrument or Questionnaire for Adults (Haemo-QoL-A) Overall Score at Week 36 - Part A
Time Frame: Week 0 (baseline) and Week 36 during Part A
Quality of life (QoL) was measured by the Haemo-QoL-A overall score, which ranged from 0 (the worst condition) to 100 (the best condition).
Week 0 (baseline) and Week 36 during Part A

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change From Baseline in Overall Pain Severity and Interference Due to Pain at Week 36 - Part A
Time Frame: Week 0 (baseline) and Week 36 during Part A
Brief Pain Inventory (BPI) - Short Form (BPI-SF) was a 15-item, self-administered, validated tool developed to assess pain used in the study for patient reported outcomes. Scores ranged from 0 to 10 and a higher score indicates a higher level of pain/interference.
Week 0 (baseline) and Week 36 during Part A
Change From Baseline in Work Productivity and Activity Impairment (WPAI) Questionnaire at Week 36 - Part A
Time Frame: Week 0 (baseline) and Week 36 during Part A
The WPAI is a validated instrument to assess the effect of hemophilia on ability to work, attend classes, and perform regular daily activities in participants aged 12 and above. The WPAI also contained classroom impairment questions (CIQ). The questionnaire was self-administered and comprised of nine questions that elicited information on work, classroom, and daily activity impairment during the previous seven days. WPAI outcomes that are overall work and activity impairment, transformed to impairment percentages (range from 0 to 100), with higher numbers indicating greater impairment and less productivity.
Week 0 (baseline) and Week 36 during Part A
Recombinant Human Factor VIII (rFVIII) Usage Expressed as Number of Infusions- Part A
Time Frame: On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A
For prophylaxis patients, the dose is related to all infusions.
On-demand: Weeks 0 -36 and Prophylaxis: Weeks 10 - 36 during Part A
Recombinant Human Factor VIII (rFVIII) Usage Expressed as Dose Per Kilogram With Prophylaxis Treatment - Part A
Time Frame: Weeks 10 - 36 during Part A
For prophylaxis patients, the dose per kilogram is related to prophylaxis infusions.
Weeks 10 - 36 during Part A
Number of Minor Surgeries According to Physician's Assessment of Adequacy of Hemostasis - Part A
Time Frame: Weeks 0 to 36 during Part A
Minor surgery was defined as any surgical procedure that did not meet the definition of major, and included simple dental extractions, incision and drainage of abscesses, or simple excisions.
Weeks 0 to 36 during Part A
Number of Surgeries According to Physician's Assessment of Response to Hemostasis, Post-surgery - Part B Main Trial
Time Frame: Up to 3 weeks post-surgery during Part B
Response to treatment during surgery was assessed by investigator/surgeon as excellent, good, moderate, poor or missing during Part B of the study.
Up to 3 weeks post-surgery during Part B
Number of Participants With Change/Drop in Hemoglobin/Hematocrit Laboratory Assessments - Part B
Time Frame: Up to 3 weeks post-surgery during Part B
Hematocrit is defined as the volume percentage (%) of red blood cells in blood.
Up to 3 weeks post-surgery during Part B
Maximum Blood Loss During Major Surgery - Part B
Time Frame: day of surgery
Major surgery was defined as any surgical or invasive procedure (elective or emergent) in which the overall bleeding risk was excessive, required a general anesthetic in an individual without a bleeding disorder, penetrated or exposed a major body cavity, resulted in substantial impairment of physical or physiological functions, or required special anatomic knowledge or manipulative skill.
day of surgery
Number of Participants Who Took Anti-fibrinolytic Medications During Major Surgery - Part B
Time Frame: Up to 3 weeks post-surgery during Part B
Major surgery was defined as any surgical or invasive procedure (elective or emergent) in which the overall bleeding risk was excessive, required a general anesthetic in an individual without a bleeding disorder, penetrated or exposed a major body cavity, resulted in substantial impairment of physical or physiological functions, or required special anatomic knowledge or manipulative skill.
Up to 3 weeks post-surgery during Part B
Volume of Blood Transfused in Major Surgery - Part B
Time Frame: Up to 3 weeks post-surgery during Part B
Major surgery was defined as any surgical or invasive procedure (elective or emergent) in which the overall bleeding risk was excessive, required a general anesthetic in an individual without a bleeding disorder, penetrated or exposed a major body cavity, resulted in substantial impairment of physical or physiological functions, or required special anatomic knowledge or manipulative skill.
Up to 3 weeks post-surgery during Part B

Collaborators and Investigators

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

Sponsor

Investigators

  • Study Director: Bayer Study Director, Bayer

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)

April 23, 2012

Primary Completion (Actual)

June 13, 2014

Study Completion (Actual)

November 21, 2019

Study Registration Dates

First Submitted

March 28, 2012

First Submitted That Met QC Criteria

April 18, 2012

First Posted (Estimated)

April 19, 2012

Study Record Updates

Last Update Posted (Actual)

November 7, 2023

Last Update Submitted That Met QC Criteria

November 3, 2023

Last Verified

November 1, 2023

More Information

Terms related to this study

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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