- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03921294
HemLibra Prophylaxis in Patients With Hemophilic Pseudotumor
Prospective, Single-arm, Open-label Use of Hemlibra (Emicizumab) to Treat Hemophilic Pseudotumor
Study Overview
Detailed Description
This is a single arm, phase 4, prospective, open-label, United States single-center study to assess the hemostatic efficacy and safety of Hemlibra (emicizumab) for hemostatic control of hemophilia A patients, (baseline FVIII level <40%), children and adults, with and without inhibitors with hemophilic pseudotumors; secondary outcomes will assess changes in quality of life and activity level in treated patients.
Hemlibra (emicizumab) will be administered as primary weekly prophylaxis after the enrollment/screening visit is complete (approximately 7-10 days after screening, if laboratory results are available and eligibility is confirmed). If an activity monitoring device is typically utilized by the patient (eg, a Fitbit) then permission will be requested from the patient at screening to access the data for 1 month prior to screening as a baseline comparator for post-treatment activity. The use of an activity-monitoring device is not required by the study.
The enrollment period is 2 years and the study will last a maximum of 4 years; subjects will receive study medication (Hemlibra, emicizumab) for a minimum of 2 years and a maximum of 4 years based upon time of enrollment. Hemlibra (emicizumab) will be administered using the FDA-approved once-weekly dosing regimen for loading dose and prophylactic dose. Breakthrough bleeding events will be recorded and treated with locally available FVIII (eg, pdFVIII or rFVIII) in non-inhibitor subjects and inhibitor subjects with low titer inhibitors (titer<5 BU). The lowest dose of FVIII expected to achieve hemostasis will be utilized for treatment of breakthrough bleeding events in non-inhibitor and low-titer inhibitor patients. Subjects with high-titer inhibitors (titer ≥5 BU) and those with low titer inhibitors who do not respond to FVIII will be required to utilize rFVIIa as first line therapy; aPCC (<100 U/kg/day for preferably no more than 1 day) may only be used upon approval of the Study Investigator and under the supervision of a physician.
The proposed study is seeking to address the following knowledge gaps:
Does weekly prophylactic Hemlibra (emicizumab) reduce the rate of bleeding events in subjects with hemophilia A and pseudotumor, including the rate of hospitalization, anemia and transfusion? Does weekly prophylactic Hemlibra (emicizumab) control the progression of hemophilic pseudotumor? Does weekly prophylactic Hemlibra (emicizumab) result in an increase in QoL and activity level?
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
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Indiana
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Indianapolis, Indiana, United States, 46260
- Indiana Hemophila @Thrombosis Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Signed informed consent form from the subject, parent or guardian
- Diagnosis of congenital hemophilia A (baseline FVIII level <40%) with or without FVIII inhibitor, either high or low responding, regardless of titer
- Diagnosis of a hemophilic pseudotumor confirmed by radiologic assessment such as CT or MRI
- Any weight or BMI
- Medical documentation of prophylactic or episodic treatment (FVIII or bypassing agent) and the number of bleeding episodes for at least 16 weeks, and up to 6 months if available, prior to entry into the study
- Medical documentation of any need for PRBC transfusion or hospitalization for 6 months prior to entry into the study
- Subjects with a history of an inhibitor should provide documentation of the inhibitor history including date of initial diagnosis of inhibitor, peak titer, and agent utilized for hemostatic control
- Subjects with high titer inhibitors or those with low titer inhibitors who do not respond to FVIII must be willing to use rFVIIa as first line therapy for the treatment of breakthrough bleeding events
- Medical documentation of ITI therapy for subjects with a history of a FVIII inhibitor and ITI, including current FVIII inhibitor titer
Willingness to discontinue any current prophylactic hemostatic regimen (FVIII or bypassing agent) and/or FVIII ITI therapy for the duration of the study
- Subjects receiving FVIII prophylaxis must be willing to discontinue their FVIII prophylactic regimen immediately prior to their second loading dose of Hemlibra (emicizumab)
- Subjects receiving bypassing agent prophylaxis must be willing to discontinue their prophylactic regimen at least 24 hours prior to their first loading dose of Hemlibra (emicizumab)
- Subjects receiving FVIII ITI therapy must be willing to discontinue ITI immediately prior to their first loading dose of Hemlibra (emicizumab)
- Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures, including the health-related questionnaires, activity tracking, and bleed diaries, using systems provided during the study
- Adequate hepatic function, defined as total bilirubin ≤1.5 × age-adapted upper limit of normal (ULN) (excluding Gilbert's syndrome) and both AST and ALT ≤3 × age-adapted ULN at the time of screening, and no clinical signs or known laboratory/radiographic evidence consistent with cirrhosis
- Subjects must be willing to be vaccinated against HAV and HBV if not previously vaccinated, exposed or immune to HAV or HBV*
- Adequate hematologic function, defined as a platelet count ≥100,000/μL and a PT≤1.5 times the ULN at the time of screening
- Adequate renal function, defined as serum creatinine ≤2.5 × age-adapted ULN and creatinine clearance ≥30 mL/min by Cockcroft-Gault formula
- For women with hemophilia of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use highly effective contraceptive methods that result in a failure rate of <1% per year during the treatment period and for at least 5 elimination half-lives (24 weeks) after the last dose of study drug
Exclusion Criteria:
- Inherited or acquired bleeding disorder other than congenital hemophilia A
- Lack of a documented diagnosis of hemophilic pseudotumor
- Patients who are at high risk for TMA (eg, have a previous medical or family history of TMA), in the Study Investigator's judgment
- History of illicit drug or alcohol abuse within 48 weeks prior to screening, in the Study Investigator's judgment
- Previous (within the last 12 months) or current treatment for thromboembolic disease (with the exception of previous catheter-associated thrombosis for which anti-thrombotic treatment is not currently ongoing) or signs of thromboembolic disease
- Other conditions (eg, certain autoimmune diseases) that may currently increase the risk of bleeding or thrombosis
- History of clinically significant hypersensitivity associated with monoclonal antibody therapies or components of the Emicizumab injection
- Planned surgery (excluding minor procedures such as tooth extraction or incision and drainage) during the study
- Known HIV infection with CD4 counts <200 cells/μL. HIV infection with CD4 counts ≥200 cells/μL permitted
- Use of systemic immunomodulators (eg, interferon) at enrollment or planned use during the study, with the exception of anti-retroviral therapy
- Concomitant disease, condition, significant abnormality on screening evaluations or laboratory tests, or treatment that could interfere with the conduct of the study, or that would, in the opinion of the Study Investigator, pose an additional unacceptable risk in administering study drug to the patient
Receipt of any of the following:
- Hemlibra (emicizumab) in a prior investigational study
- An investigational drug to treat or reduce the risk of hemophilic bleeds within 5 half-lives of last drug administration
- A non-hemophilia-related investigational drug within last 30 days or 5 half-lives, whichever is shorter
- Any other investigational drug currently being administered or planned to be administered
- Inability to comply with the study protocol in the opinion of the Study Investigator
- Pregnancy or lactation or intention to become pregnant during the study
- Women with a positive serum pregnancy test result within 10 days prior to initiation of study drug
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Single Arm
Patients with hemophilic pseudotumor will be treated with prophylactic emicizumab and assessed for improvement.
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bispecific monoclonal antibody binding to activated Factor IX and Factor X
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hemostatic Efficacy of Prophylactic Weekly Injections of Hemlibra (Emicizumab) Based on Hemoglobin
Time Frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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Maintenance or increase of hemoglobin (g/dl) from participants' baseline level based on serial blood tests.
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Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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Hemostatic Efficacy of Prophylactic Weekly Injections of Hemlibra (Emicizumab) Based on Participants' Need for Blood Transfusions or Lack of
Time Frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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Whether or not the patient requires blood transfusions (units of RBCs) due to blood loss secondary to lack of hemostatic efficacy during the duration of study treatment duration.
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Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Breakthrough Bleeds
Time Frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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Number of breakthrough bleeding events that require hemostatic therapy in addition to Hemlibra prophylaxis
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Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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Pseudotumor Status
Time Frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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Radiologic evaluation (CT and/or MRI) to evaluate control of progression, stabilization or regression per change in size (measured in cm) of the pseudotumor
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Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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Patient Quality of Life Based on Haem-A-QOL
Time Frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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The subjective change in quality of life and activity with Hemlibra (emicizumab) prophylaxis will be evaluated during the study.
QoL and activity will be assessed using Haem-A-QoL and EQ-5D-5L.
Changes in these measures will be determined by changes from the baseline scores compared to follow-up scores.
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Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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Patient Quality of Life Based on EQ-5D-5L
Time Frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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The subjective change in quality of life and activity with Hemlibra (emicizumab) prophylaxis will be evaluated during the study.
QoL and activity will be assessed using Haem-A-QoL and EQ-5D-5L.
Changes in these measures will be determined by changes from the baseline scores compared to follow-up scores.
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Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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Adverse Events
Time Frame: Every 3 months, for the 2 years and 10 months of the patient's study participation duration.
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Number of adverse events while on HemLibra (emicizumab) prophylaxis.
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Every 3 months, for the 2 years and 10 months of the patient's study participation duration.
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Serious Adverse Events
Time Frame: Every 3 months, for the 2 years and 10 months of the patient's study participation duration.
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Number of SAEs while on HemLibra (emicizumab) prophylaxis
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Every 3 months, for the 2 years and 10 months of the patient's study participation duration.
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Number of Participants With Adverse Events
Time Frame: Every 3 months, for the 2 years and 10 months of the patient's study participation duration.
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Number of participants with adverse events while on HemLibra (emicizumab) prophylaxis
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Every 3 months, for the 2 years and 10 months of the patient's study participation duration.
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Anti-Drug Antibodies (ADA)
Time Frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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Development of emicizumab anti-drug antibodies using the ADA assay
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Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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ADA and Activated Partial Thromboplastin Time (APTT)
Time Frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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If the patient develops an ADA: the ADA's effect on the patient's APTT
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Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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ADA and Factor VIII (FVIII)
Time Frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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If the patient develops an ADA: the ADA's effecton the patient's FVIII assay
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Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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Planned or Unplanned Surgery
Time Frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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If the patient requires surgery: Whether the procedure(s) was/were planned versus unplanned
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Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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Hemostatic Agents in Surgery
Time Frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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If the patient requires surgery: Whether hemostatic agents in addition to Hemlibra were required to achieve or maintain hemostasis
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Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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Blood Loss in Surgery
Time Frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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If the patient requires surgery: Whether blood loss exceeded the estimated/predicted blood loss relative to a patient without hemophilia
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Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Amy D Shapiro, MD, Indiana Hemophilia &Thrombosis Center, Inc.
Publications and helpful links
General Publications
- Blanchette VS, Key NS, Ljung LR, Manco-Johnson MJ, van den Berg HM, Srivastava A; Subcommittee on Factor VIII, Factor IX and Rare Coagulation Disorders of the Scientific and Standardization Committee of the International Society on Thrombosis and Hemostasis. Definitions in hemophilia: communication from the SSC of the ISTH. J Thromb Haemost. 2014 Nov;12(11):1935-9. doi: 10.1111/jth.12672. Epub 2014 Sep 3. No abstract available.
- Franchini M, Mannucci PM. Hemophilia A in the third millennium. Blood Rev. 2013 Jul;27(4):179-84. doi: 10.1016/j.blre.2013.06.002. Epub 2013 Jun 28.
- Gringeri A, Leissinger C, Cortesi PA, Jo H, Fusco F, Riva S, Antmen B, Berntorp E, Biasoli C, Carpenter S, Kavakli K, Morfini M, Negrier C, Rocino A, Schramm W, Windyga J, Zulfikar B, Mantovani LG. Health-related quality of life in patients with haemophilia and inhibitors on prophylaxis with anti-inhibitor complex concentrate: results from the Pro-FEIBA study. Haemophilia. 2013 Sep;19(5):736-43. doi: 10.1111/hae.12178. Epub 2013 Jun 4.
- Ahlberg AK. On the natural history of hemophilic pseudotumor. J Bone Joint Surg Am. 1975 Dec;57(8):1133-6.
- Liu SS, White WL, Johnson PC, Gauntt C. Hemophilic pseudotumor of the spinal canal. Case report. J Neurosurg. 1988 Oct;69(4):624-7. doi: 10.3171/jns.1988.69.4.0624.
- Magallon M, Monteagudo J, Altisent C, Ibanez A, Rodriguez-Perez A, Riba J, Tusell J, Martin-Villar J. Hemophilic pseudotumor: multicenter experience over a 25-year period. Am J Hematol. 1994 Feb;45(2):103-8. doi: 10.1002/ajh.2830450202.
- Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, Street A; Treatment Guidelines Working Group on Behalf of The World Federation Of Hemophilia. Guidelines for the management of hemophilia. Haemophilia. 2013 Jan;19(1):e1-47. doi: 10.1111/j.1365-2516.2012.02909.x. Epub 2012 Jul 6.
- van Ommeren JW, Mooren DW, Veth RP, Novakova IR, van de Kaa CA. Pseudotumor occurring in hemophilia. Arch Orthop Trauma Surg. 2000;120(7-8):476-8. doi: 10.1007/s004029900087.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- RO-IIS-2018-10581
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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