Treatment of Post-Punch Biopsy Bleeding in Apixaban-Treated Patients Using Self-Administered BXP154B

Randomized, Double-Blind, Placebo-Controlled, 2-Way Crossover Study to Evaluate the Efficacy and Safety of BXP154B (Tranexamic Acid Sterile Topical Solution) in the Treatment of External Bleeding From Minor Wounds in Subjects on Apixaban

The goal of this clinical trial is to test if the study drug, BXP154B works to stop bleeding from a minor wound in patients that are on apixaban for anticoagulant therapy. The main questions it aims to answer are:

• How long does it take to stop bleeding after BXP154B is applied to a wound?
• How many people require the use of a rescue treatment to stop bleeding?
• Does BXP154B reduce instances of re-bleeding after the bleeding has stopped initially?
• Is BXP154B safe and well-tolerated?

Study Overview

• Status: Completed
• Conditions: Wound Bleeding
• Intervention / Treatment: Drug: Placebo; Drug: BXP154B

Detailed Description

Oral anticoagulant-related clinically relevant nonmajor bleeding (CRNMB; i.e., non-major bleeding that requires medical intervention, increased level of care, or face-to-face evaluation) and minor bleeding, often referred to as 'nuisance' bleeding, carries a high burden in terms of patient discomfort, anxiety, temporary disability, and reduced quality of life, and strain on medical and socioeconomic resources. Prolonged bleeding following minor injuries (falls, scrapes, cuts) can be life-interrupting and frequently leads patients to seek medical care, often times in an urgent care or emergency department (ED) setting. Prolonged bleeding from minor injuries is a significant challenge to daily life for people on anticoagulants, and is anything but 'minor' to the patient.

Bio 54, LLC, is developing BXP154B, a topical agent intended for self-administration (in or outside the home) to treat external bleeding from minor wounds in patients on anticoagulants. The development of BXP154B will offer patients on anticoagulants a much-needed treatment for self-management of external bleeding from minor wounds at home.

BXP154-201 is a randomized, double-blind, placebo-controlled, 2-way crossover-design study to evaluate the efficacy and safety of BXP154 (6 mL) compared with volume-matched placebo in the treatment of bleeding following punch biopsy in subjects on apixaban.

Subjects will be enrolled in this clinical trial for a total of seven days, following a screening period of up to 28 days. The study commences on Day 1 with a skin punch biopsy and administration of the investigational drug or placebo. Subsequently, follow-up assessments will be conducted on Days 2, 3, and 4. A second skin punch biopsy will be performed on Day 4, followed by additional follow-up assessments on Days 5, 6, and 7. Upon completion of the Day 7 assessments, subjects will have fulfilled their involvement in the study.

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Laura Malahias; Phone Number: 9195042821; Email: lmalahias@501ventures.com

Study Locations

• United States
  • Florida
    • DeLand, Florida, United States, 32720
      • Accel Research Sites Network - DeLand
      • Contact: Melissa Hodges
      • Principal Investigator: Bruce Rankin, DO

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Male or female ≥18 years of age on the day of signed informed consent. At least 8 subjects of each sex will be enrolled.
• Currently receiving apixaban (Eliquis®) and on a BID dosing regimen 5 mg BID (10 mg total daily dose). Subjects must have been on the same dosing regimen for at least 7 days prior to Day 1.
• Willing and able to provide informed consent prior to any study procedures and to comply with all aspects of the protocol

Exclusion Criteria:

• Allergy or sensitization to any components of BXP154B
• BMI ≥ 50 kg/m2
• Known genetic/familial hypercoagulable disorder
• Thrombocytopenia (platelets <75,000/mm3)
• Subjects using any prescribed chronic drug therapies that impact platelet function including clopidogrel (Plavix®), prasugrel (Effient®), ticagrelor (Brillinta®), dipyridamole (Aggrenox®), cilostazol (Pletal®), aspirin, or any non-steroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen, diclofenac, indomethacin, ketorolac, etc.) are excluded from participation in the study. NSAIDs or aspirin taken on an as needed (PRN) basis must be discontinued according to the following required windows prior to Day 1 (aspirin, 7 days; ibuprofen, 24 hours; all other NSAIDs, 4 days) and may not be taken for the duration of the study.
• Use of any other anticoagulant therapies other than apixaban 5mg BID
• Hypersensitivity to any local anesthetic being used by the site
• Pregnant, breastfeeding, or planning to become pregnant
• Use of any hormonal contraceptive methods (e.g., oral, injectable, vaginal ring, transdermal patch, or hormonal intrauterine device [IUD]), or any oral treatment containing estrogen or synthetic estrogen within 30 days prior to Screening or during study participation. Women of childbearing potential must agree to use effective non-hormonal contraception during study participation.
• Participation in another clinical trial for an investigational product within 30 days prior to Screening. In addition, subjects who participated in BXP154-PIL are not eligible for this study.
• Any clinically significant finding on screening assessments or other physical or neurological condition that, in the opinion of the investigator, impairs the ability of the subject to comply with protocol procedures and safely participate in the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Double

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: BXP154B/Right Leg Period 1; Placebo/Left Leg Period 2; Single topical application of BXP154B 6ml (right leg), treatment period 1; single topical application of Placebo 6ml (left leg), treatment period 2	Drug: Placebo; Placebo will be self-administered topically following wound induction; Drug: BXP154B; BXP154B will be self-administered topically following wound induction
Experimental: Placebo/Right Leg Period 1; BXP154B/Left Leg Period 2; Single topical application of Placebo 6ml (right leg), treatment period 1; single topical application of BXP154B 6ml (left leg), treatment period 2	Drug: Placebo; Placebo will be self-administered topically following wound induction; Drug: BXP154B; BXP154B will be self-administered topically following wound induction
Experimental: BXP154B/ Left Leg Period 1; Placebo/Right Leg Period 2; Single topical application of BXP154B 6ml (left leg), treatment period 1; single topical application of Placebo 6ml (right leg), treatment period 2	Drug: Placebo; Placebo will be self-administered topically following wound induction; Drug: BXP154B; BXP154B will be self-administered topically following wound induction
Experimental: Placebo/Left Leg Period 1; BXP154B/Right Leg Period 2; Single topical application of Placebo 6ml (left leg), treatment period 1; single topical application of BXP154B 6ml (right leg), treatment period 2	Drug: Placebo; Placebo will be self-administered topically following wound induction; Drug: BXP154B; BXP154B will be self-administered topically following wound induction

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to achieve hemostasis (in minutes) following start of treatment	Time to achieve hemostasis (in minutes) will be compared between active treatment and control.	60 minutes following start of treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of subjects who require rescue treatment intervention to achieve hemostasis following biopsy	Summarized as the proportion of subjects that met criteria and compared between active treatment and control.	60 minutes following start of treatment
Time to achieve hemostasis (in minutes) with no rebleeding requiring self-managed or medical intervention within 72 hours after the start of treatment	Time (in minutes) to achieve hemostasis will be compared between active treatment and control.	72 hours following start of treatment
Proportion of subjects who experience rebleeding following initial hemostasis that requires self-managed or medical intervention to re-achieve hemostasis within 24, 48, and 72 hours after the start of treatment	Summarized as the proportion of subjects that met criteria and compared between active treatment and control.	72 hours following start of treatment
Proportion of subjects who experience rebleeding following initial hemostasis that requires subsequent self-managed intervention to re-achieve hemostasis within 24, 48, and 72 hours after the start of treatment	Summarized as the proportion of subjects that met criteria and compared between active treatment and control.	72 hours following start of treatment
Proportion of subjects who experience rebleeding following initial hemostasis that requires subsequent medical intervention to re-achieve hemostasis within 24, 48, and 72 hours after the start of treatment	Summarized as the proportion of subjects that met criteria and compared between active treatment and control.	72 hours following start of treatment
Number of rebleeding episodes following initial hemostasis that require subsequent medical intervention to re-achieve hemostasis within 24, 48, and 72 hours after the start of treatment	Summarized as the number of episodes per subject compared between active treatment and control.	72 hours following start of treatment
Systolic blood pressure	Summarized as observed values and change from baseline compared between active treatment and control.	7 days
Diastolic blood pressure	Summarized as observed values and change from baseline compared between active treatment and control.	7 days
Proportion of subjects who experience adverse events including adverse skin reactions and other clinically significant findings on physical exam; clinically significant lab values; and clinically significant changes in vital signs.	Summarized as the proportion of subjects reporting adverse events compared between active treatment and control.	9 days
Proportion of subjects who achieve hemostasis within 4mins, 8mins, 12mins, 16mins, 20mins, 25mins, 30mins, 40 mins, 50mins, 60mins	Summarized as the proportion of subjects that met criteria and compared between active treatment and control.	60 minutes following start of treatment
Time to achieve hemostasis (in minutes) following the start of treatment in subjects with a bleed time of at least 10 minutes in either treatment period	Time (in minutes) to achieve hemostasis will be compared between active treatment and control.	72 hours following start of treatment

Collaborators and Investigators

• Sponsor: Bio 54, LLC

Study record dates

Study Major Dates

• Study Start (Actual): January 24, 2024
• Primary Completion (Actual): March 14, 2024
• Study Completion (Actual): March 18, 2024

Study Registration Dates

• First Submitted: January 4, 2024
• First Submitted That Met QC Criteria: January 4, 2024
• First Posted (Actual): January 16, 2024

Study Record Updates

• Last Update Posted (Actual): April 24, 2024
• Last Update Submitted That Met QC Criteria: April 23, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Anticoagulant
• Additional Relevant MeSH Terms: Pathologic Processes; Hemorrhage
• Other Study ID Numbers: BXP154-201

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No