Study to Evaluate the Efficacy and Safety of APL-2 in Patients With Paroxysmal Nocturnal Hemoglobinuria (PNH)

March 1, 2022 updated by: Apellis Pharmaceuticals, Inc.

A Phase III, Randomized, Multi-Center, Open-Label, Active-Comparator Controlled Study to Evaluate the Efficacy and Safety of APL-2 in Patients With Paroxysmal Nocturnal Hemoglobinuria (PNH)

Evaluation of the Efficacy and Safety of APL-2 in Patients with Paroxysmal Nocturnal Hemoglobinuria

Study Overview

Status

Completed

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

80

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

    • Victoria
      • Melbourne, Victoria, Australia, 3000
        • Royal Melbourne Hospital
    • Vlaams-Brabant
      • Woluwe-Saint-Lambert, Vlaams-Brabant, Belgium, 1200
        • Cliniques Universitaires Saint-Luc
    • West-Vlaanderen
      • Roeselare, West-Vlaanderen, Belgium, 8800
        • AZ Delta Campus Wilgenstraat
    • Alberta
      • Edmonton, Alberta, Canada, T6G 2G3
        • University of Alberta
    • Ontario
      • Toronto, Ontario, Canada, M9A1G2
        • Toronto General Hospital
      • Annecy, France, 74374
        • Centre Hospitalier Annecy Genevois
      • Chalon-sur-Saône, France, 71100
        • Centre Hospitalier William Morey
      • Lille, France, 59037
        • Centre Hospitalier Universitaire de Lille
      • Marseille, France, 13009
        • Institut Paoli-Calmettes Marseille
      • Paris, France, 75010
        • Hôpital Saint-Louis
      • Pierre-Bénite, France, 69495
        • Centre Hospitalier Lyon Sud
      • Saint-Quentin, France, 02321
        • Centre Hospitalier de Saint-Quentin
      • Toulouse, France, 31059
        • Institut Universitaire Du Cancer Toulouse - Oncopole
      • Hamburg, Germany, 20246
        • Universitätsklinikum Hamburg Eppendorf
    • Baden-Württemberg
      • Ulm, Baden-Württemberg, Germany, 89081
        • Universitätsklinikum Ulm
    • North Rhine-Westphalia
      • Aachen, North Rhine-Westphalia, Germany, 52074
        • Uniklinik RWTH Aachen
      • Essen, North Rhine-Westphalia, Germany, 45147
        • Universitätsklinikum Essen
    • Aichi
      • Nagoya, Aichi, Japan, 453-8511
        • Japanese Red Cross Nagoya Daiichi Hospital
      • Showa-ku, Aichi, Japan, 453-8650
        • Japanese Red Cross Nagoya Daini Hospital
    • Ibaraki
      • Tsukuba, Ibaraki, Japan, 305-8576
        • University of tsukuba hospital
    • Nagano
      • Matsumoto, Nagano, Japan, 390-8621
        • Shinshu University Hospital
    • Okayama
      • Okayama-shi, Okayama, Japan, 700-8558
        • Okayama University Hospital
    • Tokyo
      • Bunkyo-ku, Tokyo, Japan, 113-8421
        • Juntendo University Hospital
      • Shinagawa-ku, Tokyo, Japan, 141-8625
        • NTT Medical Center Tokyo
    • Wakayama
      • Tanabe, Wakayama, Japan, 646-8588
        • Kinan Hospital
      • Bucheon, Korea, Republic of, 14584
        • Soonchunhyang University Bucheon Hospital
      • Daejeon, Korea, Republic of, 35015
        • Chungnam National University Hospital
      • Seoul, Korea, Republic of, 06351
        • Samsung Medical Center
      • Saint Petersburg, Russian Federation, 197022
        • Pavlov First Saint Petersburg State Medical University
      • Saint Petersburg, Russian Federation, 197022
        • Pavlov First Saint Petersburg State Medical University of Russian Ministry of Health
      • Tyumen, Russian Federation, 625023
        • Institution of Health Care of Tyumen Region
      • Las Palmas De Gran Canaria, Spain, 35010
        • Hospital Universitario de Gran Canaria Dr. Negrin
      • Valencia, Spain, 46026
        • Hospital Universitario Politecnico La Fe
      • Leeds, United Kingdom, LS9 7TF
        • St. James' Institute of Oncology, Leeds Teaching Hospitals
    • California
      • Los Angeles, California, United States, 90033
        • University of Southern California
      • Santa Monica, California, United States, 90403
        • Sarcoma Oncology Research Center
    • Colorado
      • Denver, Colorado, United States, 80204
        • Denver Health
    • District of Columbia
      • Washington, District of Columbia, United States, 20057
        • Georgetown University Hospital
    • Florida
      • Jacksonville, Florida, United States, 32256
        • Cancer Specialists of North Florida
      • Miami Lakes, Florida, United States, 33014
        • Lakes Research
      • Orange City, Florida, United States, 32763
        • Mid Florida Hematology and Oncology
    • Georgia
      • Atlanta, Georgia, United States, 30322
        • Winship Cancer Institute of Emory University
    • Illinois
      • Chicago, Illinois, United States, 60611
        • Northwestern University
    • Indiana
      • Indianapolis, Indiana, United States, 46260
        • Investigative Clinical Research of Indiana
    • Michigan
      • Grand Rapids, Michigan, United States, 49503
        • Cancer & Hematology Centers of Western Michigan
    • New York
      • Bronx, New York, United States, 10469
        • New York Cancer & Blood Specialists
      • Buffalo, New York, United States, 14263
        • Roswell Park Cancer Institute
      • East Setauket, New York, United States, 11733
        • New York Cancer & Blood Specialists
    • North Carolina
      • Durham, North Carolina, United States, 27710
        • Duke University Medical Center
    • Oregon
      • Corvallis, Oregon, United States, 97330
        • Good Samaritan Hospital
    • Tennessee
      • Knoxville, Tennessee, United States, 37920
        • University of Tennessee Medical Center
      • Memphis, Tennessee, United States, 38120
        • Baptist Cancer Center
    • Texas
      • Tyler, Texas, United States, 75701
        • HOPE Cancer Center of East Texas

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

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • At least 18 years of age
  • Primary diagnosis of PNH confirmed by high-sensitivity flow cytometry
  • On treatment with eculizumab. Dose of eculizumab must have been stable for at least 3 months prior to the Screening Visit
  • Hb <10.5 g/dL at the Screening Visit
  • Absolute reticulocyte count > 1.0x ULN at the Screening Visit
  • Platelet count of >50,000/mm3 at the Screening Visit
  • Absolute neutrophil count >500/mm3 at the Screening Visit
  • Vaccination against Neisseria meningitides types A, C, W, Y and B, Streptococcus pneumoniae and Haemophilus influenzae Type B (Hib) either within 2 years prior to Day 1 dosing, or within 14 days after starting treatment with APL-2. Unless documented evidence exists that subjects are non-responders to vaccination as evidenced by titers or display titer levels within acceptable local limits
  • Women of child-bearing potential (WOCBP) must have a negative pregnancy test at the Screening and Day -28 Visit (Run-in Period) and must agree to use protocol defined methods of contraception for the duration of the study and 90 days after their last dose of study drug
  • Males must agree to use protocol defined methods of contraception and agree to refrain from donating sperm for the duration of the study and 90 days after their last dose of study drug
  • Willing and able to give informed consent
  • Willing and able to self-administer APL-2 (administration by caregiver will be allowed)
  • Have a body mass index (BMI) ≤35.0 kg/m2

Exclusion Criteria:

  • Active bacterial infection that has not resolved within 14 week of Day -28 (first dose of APL-2)
  • Receiving iron, folic acid, vitamin B12 and EPO, unless the dose is stable, in the 4 weeks prior to Screening
  • Hereditary complement deficiency
  • History of bone marrow transplantation
  • History or presence of hypersensitivity or idiosyncratic reaction to compounds related to the investigational product or SC administration
  • Participation in any other investigational drug trial or exposure to other investigational agent within 30 days or 5 half-lives (whichever is longer)
  • Currently breast-feeding women
  • Inability to cooperate or any condition that, in the opinion of the investigator, could increase the subject's risk of participating in the study or confound the outcome of the study

This study includes cardiac safety evaluations. The following cardiac eligibility criteria are necessary to avoid confounding the cardiac safety outcomes:

  • History or family history of Long QT Syndrome or torsade de pointes, unexplained syncope, syncope from an uncorrected cardiac etiology, or family history of sudden death
  • Myocardial infarction, CABG, coronary or cerebral artery stenting and /or angioplasty, stroke, cardiac surgery, or hospitalization for congestive heart failure within 3 months or greater than Class 2 Angina Pectoris or NYHA Heart Failure Class >2
  • QTcF > 470 ms, PR > 280 ms
  • Mobitz II 2nd degree AV Block, 2:1 AV Block, High Grade AV Block, or Complete Heart Block unless the patient has an implanted pacemaker or implantable cardiac defibrillator (ICD) with backup pacing capabilities
  • Receiving Class 1 or Class 3 antiarrhythmic agents, or arsenic, methadone, ondansetron or pentamidine at screening
  • Receiving any other QTc-prolonging drugs (see Appendix 4 in Section 19.4), at a stable dose for less than 3 weeks prior to dosing
  • Receiving prophylactic ciprofloxacin, erythromycin or azithromycin for less than one week prior to the first dose of study medication (must have a repeat screening ECG after one week of prophylactic antibiotics with QTcF < 470 ms)

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: Crossover Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Pegcetacoplan
1080 mg pegcetacoplan administered subcutaneously twice-weekly or every three days.
Complement (C3) Inhibitor
Other Names:
  • APL-2
Complement (C5) Inhibitor
Active Comparator: Eculizumab
Complement (C5) Inhibitor.
Complement (C3) Inhibitor
Other Names:
  • APL-2
Complement (C5) Inhibitor

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Least Squares (LS) Mean Change From Baseline to Week 16 in Hemoglobin (Hb) Level During the RCP
Time Frame: Baseline and Week 16
Baseline was the average of measurements recorded before taking the first dose of pegcetacoplan, which included local and central laboratory values during the screening period. Analysis excluded data before the RCP and was censored for transfusions.
Baseline and Week 16

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percentage of Subjects Who Did Not Require a Transfusion (Transfusion Avoidance) During the RCP
Time Frame: Day 1 to Week 16
Subjects who experienced more than 1 transfusion during the RCP are only counted once. Subjects who did not have a transfusion but withdrew before Week 16 were considered as having a transfusion in the analysis of transfusion avoidance.
Day 1 to Week 16
LS Mean Change From Baseline to Week 16 in Absolute Reticulocyte Count (ARC) During the RCP
Time Frame: Baseline and Week 16
Baseline was the average of available measurements recorded from central laboratory before taking the first dose of pegcetacoplan. Analysis excluded data before the RCP and was censored for transfusions.
Baseline and Week 16
LS Mean Change From Baseline to Week 16 in Lactate Dehydrogenase (LDH) Level During the RCP
Time Frame: Baseline and Week 16
Baseline was the average of available measurements recorded from central laboratory before taking the first dose of pegcetacoplan. Analysis excluded data before the RCP and was censored for transfusions.
Baseline and Week 16
LS Mean Change From Baseline to Week 16 in Functional Assessment of Chronic Illness Therapy (FACIT) - Fatigue Scale Score During the RCP
Time Frame: Baseline and Week 16
The FACIT-fatigue scale version 4 is a 13-item Likert scaled instrument where the subject was presented with 13 statements and asked to indicate their response as it applied to the past 7 days. The 5 possible responses were 'Not at all' (0), 'A little bit (1), 'Somewhat' (2), 'Quite a bit' (3) and 'Very much' (4). With 13 statements the total score had a range of 0 to 52. A higher score corresponds to a higher quality of life (QoL). Baseline was the last available, nonmissing observation before taking the first dose of pegcetacoplan. Data collected after transfusion is excluded from analysis.
Baseline and Week 16
Percentage of Subjects Who Achieved a Hb Response in the Absence of Transfusions at Week 16
Time Frame: Baseline and Week 16
Hb response was defined as an increase of at least 1 g/dL in Hb from Baseline at Week 16. Baseline was the average of measurements recorded before taking the first dose of pegcetacoplan, which included local and central laboratory values during the screening period. Analysis excluded data before the RCP and was censored for transfusions.
Baseline and Week 16
Percentage of Subjects Who Achieved Reticulocyte Normalization in the Absence of Transfusions at Week 16
Time Frame: Week 16
Reticulocyte normalization was defined as the ARC being below the upper limit of the gender-specific normal range at Week 16, censored for transfusions. Subjects who received a transfusion between Day 1 and Week 16 or withdrew without providing efficacy data at Week 16 were classified as nonresponders.
Week 16
Percentage of Subjects Who Achieved Hb Normalization in the Absence of Transfusions at Week 16
Time Frame: Week 16
Hb normalization was defined as the Hb level being above the lower limit of the normal range at Week 16, censored for transfusions. Subjects who received a transfusion between Day 1 and Week 16 or withdrew without providing efficacy data at Week 16 are classified as nonnormalization.
Week 16
LS Mean Change From Baseline to Week 16 in Indirect Bilirubin Level During the RCP
Time Frame: Baseline and Week 16
Baseline was the average of available measurements recorded from central laboratory before taking the first dose of pegcetacoplan. Analysis excluded data before the RCP and was censored for transfusions.
Baseline and Week 16
LS Mean Change From Baseline to Week 16 in Haptoglobin Level During the RCP
Time Frame: Baseline and Week 16
Baseline was the average of available measurements recorded from central laboratory before taking the first dose of pegcetacoplan. Analysis excluded data before the RCP and was censored for transfusions.
Baseline and Week 16
LS Mean Change From Baseline to Week 16 in Linear Analog Scale Assessment (LASA) Scores During the RCP
Time Frame: Baseline and Week 16
The LASA consists of 3 items, where the respondents were asked to rate their perceived level of functioning. Specific domains included activity level, ability to carry out daily activities, and an item for overall QoL. Their level of functioning was reported on a 0 to 100 scale with 0 indicates "As low as could be" and 100 indicates "As high as could be". The combined score ranged from 0 to 300, with higher scores corresponding to a higher QoL.
Baseline and Week 16
LS Mean Change From Baseline to Week 16 in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire - Core 30 Scale (QLQ-C30) Scores During the RCP
Time Frame: Baseline and Week 16
The EORTC QLQ-C30 questionnaire (version 3.0) consists of 30 questions comprised of both multi-item scales and single-item measures to assess overall QoL in subjects. Questions are designated by functional scales, symptom scales, and global subject QoL/overall perceived health status. For the first 28 questions the 4 possible responses are "Not at all' (1), 'A little' (2), 'Quite a bit' (3) and 'Very much' (4). For the remaining 2 questions the response is requested on a 7-point scale from 1 ('Very poor') to 7 ('Excellent'). The raw scale scores were linear transformed, producing scale scores that ranged from 0% to 100%. A high scale score represents a higher response level. Hence for the functional scales and the global health status a higher score indicates a better QoL, whilst for the symptom scale scores this is implied by a lower score.
Baseline and Week 16
Total Number of PRBC Units Transfused During the RCP
Time Frame: Day 1 to Week 16
Subjects who withdrew during the RCP before Week 16 will have their number of units of PRBC estimated from the duration they were in the study.
Day 1 to Week 16
Mean Change From Baseline to Week 48 in Hb Level During the Treatment Period
Time Frame: Baseline and Week 48
Baseline was the average of measurements recorded before taking the first dose of pegcetacoplan, which included local and central laboratory values during the screening period. Analysis excluded data before the RCP and was censored for transfusions.
Baseline and Week 48
Mean Change From Week 17 to Week 48 in Hb Level During the Open-label Period
Time Frame: Week 17 and Week 48
Baseline was the average of measurements recorded before taking the first dose of pegcetacoplan, which included local and central laboratory values during the screening period. Analysis excluded data before the RCP and was censored for transfusions.
Week 17 and Week 48
Mean Change From Baseline to Week 48 in ARC During the Treatment Period
Time Frame: Baseline and Week 48
Baseline was the average of available measurements recorded from central laboratory before taking the first dose of pegcetacoplan. Analysis excluded data before the RCP and was censored for transfusions.
Baseline and Week 48
Mean Change From Week 17 to Week 48 in ARC During the Open-label Period
Time Frame: Week 17 and Week 48
Baseline was the average of available measurements recorded from central laboratory before taking the first dose of pegcetacoplan. Analysis excluded data before the RCP and was censored for transfusions.
Week 17 and Week 48
Mean Change From Baseline to Week 48 in LDH Level During the Treatment Period
Time Frame: Baseline and Week 48
Baseline was the average of available measurements recorded from central laboratory before taking the first dose of pegcetacoplan. Analysis excluded data before the RCP and was censored for transfusions.
Baseline and Week 48
Mean Change From Week 17 to Week 48 in LDH Level During the Open-label Period
Time Frame: Week 17 and Week 48
Baseline was the average of available measurements recorded from central laboratory before taking the first dose of pegcetacoplan. Analysis excluded data before the RCP and was censored for transfusions.
Week 17 and Week 48
Mean Change From Baseline to Week 48 in FACIT-Fatigue Scale Score During the Treatment Period
Time Frame: Baseline and Week 48
The FACIT-fatigue scale version 4 is a 13-item Likert scaled instrument where the subject was presented with 13 statements and asked to indicate their response as it applied to the past 7 days. The 5 possible responses were 'Not at all' (0), 'A little bit (1), 'Somewhat' (2), 'Quite a bit' (3) and 'Very much' (4). With 13 statements the total score had a range of 0 to 52. A higher score corresponds to a higher QoL. Baseline was the last available, nonmissing observation before taking the first dose of pegcetacoplan. Data collected after transfusion is excluded from analysis.
Baseline and Week 48
Mean Change From Week 17 to Week 48 in FACIT-Fatigue Scale Score During the Open-label Period
Time Frame: Week 17 and Week 48
The FACIT-fatigue scale is a 13 item Likert scaled instrument where the subject was presented with 13 statements and asked to indicate their response as it applied to the past 7 days. The 5 possible responses were 'Not at all' (0), 'A little bit (1), 'Somewhat' (2), 'Quite a bit' (3) and 'Very much' (4). With 13 statements the total score had a range of 0 to 52. Higher score corresponds to a higher QoL.
Week 17 and Week 48
Mean Change From Baseline to Week 48 in LASA Scores During the Treatment Period
Time Frame: Baseline and Week 48
The LASA consists of 3 items, where the respondents were asked to rate their perceived level of functioning. Specific domains included activity level, ability to carry out daily activities, and an item for overall QoL. Their level of functioning was reported on a 0 to 100 scale with 0 indicates "As low as could be" and 100 indicates "As high as could be". The combined score ranged from 0 to 300, with higher scores corresponding to a higher QoL.
Baseline and Week 48
Mean Change From Week 17 to Week 48 in LASA Scores During the Open-label Period
Time Frame: Week 17 and Week 48
The FACIT-fatigue scale is a 13 item Likert scaled instrument where the subject was presented with 13 statements and asked to indicate their response as it applied to the past 7 days. The 5 possible responses were 'Not at all' (0), 'A little bit (1), 'Somewhat' (2), 'Quite a bit' (3) and 'Very much' (4). With 13 statements the total score had a range of 0 to 52. Higher score corresponds to a higher QoL.
Week 17 and Week 48
Mean Change From Baseline to Week 48 in QLQ-C30 Scores During the Treatment Period
Time Frame: Baseline and Week 48
The EORTC QLQ-C30 questionnaire (version 3.0) consists of 30 questions comprised of both multi-item scales and single-item measures to assess overall QoL in subjects. Questions are designated by functional scales, symptom scales, and global subject QoL/overall perceived health status. For the first 28 questions the 4 possible responses are 'Not at all' (1), 'A little' (2), 'Quite a bit' (3) and 'Very much' (4). For the remaining 2 questions the response is requested on a 7-point scale from 1 ('Very poor') to 7 ('Excellent'). The raw scale scores were linear transformed, producing scale scores that ranged from 0% to 100%. A high scale score represents a higher response level. Hence for the functional scales and the global health status a higher score indicates a better QoL, whilst for the symptom scale scores this is implied by a lower score.
Baseline and Week 48
Mean Change From Week 17 to Week 48 in QLQ-C30 Scores During the Open-label Period
Time Frame: Week 17 and Week 48
The EORTC QLQ-C30 questionnaire (version 3.0) consists of 30 questions comprised of both multi-item scales and single-item measures to assess overall QoL in subjects. Questions are designated by functional scales, symptom scales, and global subject QoL/overall perceived health status. For the first 28 questions the 4 possible responses are 'Not at all' (1), 'A little' (2), 'Quite a bit' (3) and 'Very much' (4). For the remaining 2 questions the response is requested on a 7-point scale from 1 ('Very poor') to 7 ('Excellent'). The raw scale scores were linear transformed, producing scale scores that ranged from 0% to 100%. A high scale score represents a higher response level. Hence for the functional scales and the global health status a higher score indicates a better QoL, whilst for the symptom scale scores this is implied by a lower score.
Week 17 and Week 48
Total Number of PRBC Units Transfused During the Open-Label Period
Time Frame: Week 17 to Week 48
Number of units of PRBC transfused to subjects in the open-label period are reported.
Week 17 to Week 48

Collaborators and Investigators

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

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.

General Publications

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)

June 14, 2018

Primary Completion (Actual)

November 14, 2019

Study Completion (Actual)

August 13, 2020

Study Registration Dates

First Submitted

April 10, 2018

First Submitted That Met QC Criteria

April 10, 2018

First Posted (Actual)

April 18, 2018

Study Record Updates

Last Update Posted (Actual)

March 25, 2022

Last Update Submitted That Met QC Criteria

March 1, 2022

Last Verified

March 1, 2022

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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