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En undersøgelse for at evaluere effektiviteten og sikkerheden af ​​Mitapivat hos pædiatriske deltagere med pyruvatkinase-mangel (PKD), som regelmæssigt transfunderes efterfulgt af en 5-årig forlængelsesperiode (ACTIVATE-KidsT)

27. oktober 2026 opdateret af: Agios Pharmaceuticals, Inc.

En fase 3, multicenter, randomiseret, dobbeltblind, placebokontrolleret undersøgelse for at evaluere effektiviteten og sikkerheden af ​​Mitapivat hos pædiatriske forsøgspersoner med pyruvatkinase-mangel, som regelmæssigt får transfusion efterfulgt af en 5-årig åben forlængelsesperiode

ACTIVATE-KidsT (AG348-C-022) is a multicenter study designed to evaluate the efficacy and safety of treatment with mitapivat compared with placebo in pediatric participants with pyruvate kinase deficiency (PK deficiency) who are regularly receiving blood transfusions. Participants will be randomized 2:1 to receive either mitapivat or matching placebo. Randomization will be stratified by age (1 to < 6 years, 6 to < 12 years, 12 to < 18 years) and splenectomy status. Participants will be dosed by age and weight during a double-blind period consisting of an 8-week dose titration period followed by a 24-week fixed-dose period. Participants who complete the double-blind period will be eligible to receive mitapivat in the open-label extension (OLE) period.

Studieoversigt

Status

Aktiv, ikke rekrutterende

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

49

Fase

  • Fase 3

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

    • Ontario
      • Ottawa, Ontario, Canada, K1H 5B2
        • Comprehensive Hemophilia Care Clinic at CHEO (Children's Hospital Eastern Ontario)
      • Copenhagen, Danmark, 2100
        • Rigshospitalet
    • Central Jutland
      • Aarhus, Central Jutland, Danmark, 8200
        • Aarhus University Hospital
      • London, Det Forenede Kongerige, SE5 9RS
        • King's College Hospital NHS
    • Arizona
      • Phoenix, Arizona, Forenede Stater, 85016
        • Phoenix Children's Hospital
    • California
      • Palo Alto, California, Forenede Stater, 94304
        • Stanford Medicine
    • Georgia
      • Atlanta, Georgia, Forenede Stater, 30322
        • Children's Healthcare of Atlanta - Emory
    • Massachusetts
      • Boston, Massachusetts, Forenede Stater, 02115
        • Boston Children's Hospital
    • Nevada
      • Las Vegas, Nevada, Forenede Stater, 89135
        • Cure 4 the Kids Foundation, A Division of Roseman University of Health Sciences
    • New York
      • New York, New York, Forenede Stater, 10065
        • Weill Cornell Medical College
    • Pennsylvania
      • Philadelphia, Pennsylvania, Forenede Stater, 19104
        • Children's Hospital of Philadelphia
    • Texas
      • Dallas, Texas, Forenede Stater, 75390
        • UT Southwestern Medical Center
      • Houston, Texas, Forenede Stater, 77030
        • Texas Children's Hospital
      • Utrecht, Holland, 3584 CX
        • Universitair Medisch Centrum Utrecht
    • Canton of Bern
      • Lausanne, Canton of Bern, Schweiz
        • CHUV University Hospital of Lausanne
      • Barcelona, Spanien, 08035
        • Hospital Universitario Vall d'Hebron
      • Madrid, Spanien, 30120
        • Hospital Clinico Universitario Virgen de la Arrixaca
      • Olomouc, Tjekkiet, 779 00
        • Fakultní Nemocnice Olomouc
      • Ankara, Tyrkiet (Türkiye)
        • Hacettepe University
      • Istanbul, Tyrkiet (Türkiye), 34093
        • İstanbul Üniversitesi Tıp Fakültesi [Istanbul University Faculty of Medicine] Çocuk Sağlığı Enstitüsü [Institute of Child Health]
    • Adana
      • Izmir, Adana, Tyrkiet (Türkiye)
        • Ege University Faculty of Medicine
      • Berlin, Tyskland, 13353
        • Charite - UB - CVK - Medizinische Klinik

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

1 år til 17 år (Barn)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Written informed consent from the participant, or the participant's legally authorized representative, parent(s), or legal guardian, and the participant's assent, where applicable (informed consent/assent) must be obtained before any study-related procedures are conducted, and participants must be willing to comply with all study procedures for the duration of the study;
  • Aged 1 to <18 years. Participants between 12 and 24 months of age must weigh a minimum of 7 kilograms (kg);
  • Clinical laboratory confirmation of pyruvate kinase deficiency (PKD), defined as documented presence of at least 2 mutant alleles in the pyruvate kinase L/R (PKLR) gene, of which at least 1 is a missense mutation, as determined per the genotyping performed by the study central genotyping laboratory;
  • Six to 26 transfusion episodes in the 52-week period before providing informed consent/assent;
  • Have complete records of transfusion history for the 52 weeks before providing informed consent/assent, defined as having all the following available: (1) all the transfusion dates, (2) the RBC transfusion volume (milliliters and/or number of units) for all the transfusions, and (3) hemoglobin concentrations within 1 week before transfusion for at least 80% of the transfusions;
  • Receiving folic acid supplementation as part of routine clinical care for at least 21 days before administration of the first dose of study drug, to be continued during study participation;
  • Female participants who have attained menarche and/or breast development in Tanner Stage 2 must be abstinent of sexual activities that may induce pregnancy as part of their usual lifestyle, or agree to use 2 forms of contraception, 1 of which must be considered highly effective, from the time of informed consent/assent, throughout the study, and for 28 days after the last dose of study drug (including the time required to dose taper). The second form of contraception can include an acceptable barrier method.

Exclusion Criteria:

  • Pregnant or breastfeeding;

  • Homozygous for the R479H mutation or have 2 nonmissense mutations, without the presence of another missense mutation, in the PKLR gene as determined per the genotyping performed by the study central genotyping laboratory;

  • History of malignancy;

  • History of active and/or uncontrolled cardiac or pulmonary disease or clinically relevant QT prolongation within 6 months before providing informed consent/assent;

  • Hepatobiliary disorders including, but not limited to:

    • Liver disease with histopathological evidence of cirrhosis or severe fibrosis;
    • Clinically symptomatic cholelithiasis or cholecystitis (participants with prior cholecystectomy are eligible);
    • History of drug-induced cholestatic hepatitis;
    • Aspartate aminotransferase >2.5×upper limit of normal (ULN) (unless due to hemolysis and/or hepatic iron deposition) and alanine aminotransferase >2.5×ULN (unless due to hepatic iron deposition);
  • Renal dysfunction as defined by an estimated glomerular filtration rate <60 milliliters per minute (mL/min)/1.73 m^2;

  • Nonfasting triglycerides >440 milligrams per deciliter (mg/dL) (5 millimoles per liter [mmol/L]);

  • Active uncontrolled infection requiring systemic antimicrobial therapy;

  • Participants with known active hepatitis B or hepatitis C virus infection;

  • Participants with known human immunodeficiency virus (HIV) infection;

  • History of major surgery (including splenectomy) ≤6 months before providing informed consent/assent and/or planning on undergoing a major surgical procedure during the screening or double-blind period;

  • Current enrollment or past participation (within 90 days before the first dose of study drug or a time frame equivalent to 5 half-lives of the investigational study drug, whichever is longer) in any other clinical study involving an investigational study drug or device;

  • Prior exposure to gene therapy, or bone marrow or stem cell transplantation;

  • Currently receiving hematopoietic stimulating agents; the last dose must have been administered at least 28 days or a time frame equivalent to 5 half-lives (whichever is longer) before randomization;

  • Receiving products that are strong inhibitors of CYP3A4/5 that have not been stopped for ≥5 days or a time frame equivalent to 5 half-lives (whichever is longer), or strong inducers of CYP3A4 that have not been stopped for ≥28 days or a time frame equivalent to 5 half-lives (whichever is longer), before randomization;

  • Receiving anabolic steroids, including testosterone preparations, that have not been stopped for at least 28 days before randomization;

  • Known allergy, or other contraindication, to mitapivat or its excipients (microcrystalline cellulose, croscarmellose sodium, sodium stearyl fumarate, mannitol, Opadry® II Blue [hypromellose, titanium dioxide, lactose monohydrate, triacetin, and Food, Drug, and Cosmetics blue dye number 2 (FD&C Blue #2)], Opadry® II White [hypromellose, titanium dioxide, lactose monohydrate, and triacetin], and magnesium stearate);

  • Any medical, hematologic, psychological, or behavioral condition(s) or prior or current therapy that, in the opinion of the Investigator, may confer an unacceptable risk to participating in the study and/or could confound the interpretation of the study data; also included are:

    • Participants who are institutionalized by regulatory or court order.
    • Participants with any condition(s) that could create undue influence (including but not limited to incarceration, involuntary psychiatric confinement, and financial or familial affiliation with the Investigator or Sponsor).
  • Receiving a pyruvate kinase activator that has not been stopped for ≥52 weeks before providing informed consent/assent.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Firedobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Mitapivat

For participants randomized to receive mitapivat, dosing occurs orally twice daily (BID), and is based on age and weight. Dosing is optimized through 2 potential sequential increases in dose levels (1-5 mg, 4-20 mg and 10-50 mg) at Week 4 and Week 8, and aims to achieve the adult-equivalent exposure at 5, 20, and 50 mg. Following titration, participants remain on their individually optimized dose during the remainder of the Double-blind (DB) Period for 24 weeks. After the DB period, participants will enter an Open-label Extension (OLE) Period. To preserve blinding of treatment allocation, participants will continue mitapivat at their optimized dose and undergo mock titration with placebo for 8 weeks. At the conclusion of 8 weeks, participants may continue receiving mitapivat in the OLE Period for up to 262 weeks (including up to 2 weeks of dose taper).

Tablets or granules

Andre navne:
  • AG-348
  • AG-348 sulfathydrat
  • Mitapivat sulfat

Tablets or granules

Placebo komparator: Placebo

For participants randomized to receive matched placebo, dosing is identical to that described above for mitapivat. Following the initial dose titration period, participants remain on their individually optimized dose during the remainder of the DB period for 32 weeks. After the DB period, participants will enter an OLE period. To preserve blinding of treatment allocation, participants will continue placebo at their optimized dose and undergo mitapivat dose optimization through 2 potential sequential increases in dose levels (1-5 mg, 4-20 mg and 10-50 mg) at Week 4 and Week 8 of the OLE Period, and aims to achieve the adult-equivalent exposure at 5, 20, and 50 mg. At the conclusion of 8 weeks, participants may continue receiving mitapivat in the OLE Period for up to 262 weeks (including up to 2 weeks of dose taper).

Tablets or granules

Andre navne:
  • AG-348
  • AG-348 sulfathydrat
  • Mitapivat sulfat

Tablets or granules

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Percentage of Participants Achieving Transfusion Reduction Response (TRR)
Tidsramme: Week 9 to Week 32

TRR is defined as ≥33% reduction in total red blood cell (RBC) transfusion volume from Week 9 through Week 32 of the double-blind period, normalized by weight and actual study drug duration compared with the historical transfusion volume, standardized by weight, and to 24 weeks.

Week 9 to Week 32

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Populationsfarmakokinetisk (PK) modelparameterestimat: Maksimal plasmakoncentration (Cmax) af Mitapivat
Tidsramme: Uge 2, 8, 12 og 16
Uge 2, 8, 12 og 16
Population PK Model Parameter Estimation: Areal under koncentrationstidskurven (AUC) afledt fra plasmakoncentrationer af Mitapivat
Tidsramme: Uge 2, 8, 12 og 16
Uge 2, 8, 12 og 16
Koncentration ved Steady State (Css) af Mitapivat
Tidsramme: Uge 16: 6 og 8 timer efter dosis
Uge 16: 6 og 8 timer efter dosis
Trugkoncentration (Ctrough) af Mitapivat
Tidsramme: Uge 8: ≤30 minutter forud for dosis; Uge 12: ≤30 minutter forud for dosis
Uge 8: ≤30 minutter forud for dosis; Uge 12: ≤30 minutter forud for dosis
Ændring fra baseline i østradiolkoncentration
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i estronkoncentration
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i total testosteronkoncentration
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i koncentrationen af ​​fri testosteron hos deltagere ≥7 år eller garvestadie ≥2 (alt efter hvad der indtræffer først)
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i luteiniserende hormonkoncentration hos deltagere ≥6 år
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Procentdel antal kvindelige deltagere med udvikling af ovariecyster
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i størrelsen af ​​ovariecyster hos kvindelige deltagere
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i højde-for-alder Z-score
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i vægt-for-alder Z-score
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i Body Mass Index (BMI) for alders Z-score
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i knoglemineraltæthed (BMD) Z-score
Tidsramme: Baseline op til uge 298
Baseline op til uge 298
Ændring fra baseline i serumjernkoncentration
Tidsramme: Baseline op til uge 292
Baseline op til uge 292
Ændring fra baseline i serumferritinkoncentration
Tidsramme: Baseline op til uge 292
Baseline op til uge 292
Ændring fra baseline i total jernbindende kapacitet
Tidsramme: Baseline op til uge 292
Baseline op til uge 292
Ændring fra baseline i transferrin/transferrinmætning
Tidsramme: Baseline op til uge 292
Baseline op til uge 292
Percentage of Participants With Transfusion-free Response
Tidsramme: Week 9 to Week 32

Transfusion-free response is defined as achievement of 0 transfusions administered from Week 9 through Week 32 of the double-blind period.

Week 9 to Week 32
Change in the Number of Transfusion Episodes
Tidsramme: Week 9 to Week 32

The change in the number of transfusion episodes from Week 9 through Week 32 of the double-blind period compared with the historical number of transfusion episodes standardized to 24 weeks.

Week 9 to Week 32
Percentage Change in Weight-normalized and Study Treatment Duration-normalized Total Transfusion Volume
Tidsramme: Week 9 to Week 32

The percentage change in weight-normalized and study treatment duration-normalized total transfusion volume from Week 9 through Week 32 of the double-blind period will be compared with the historical transfusion volume standardized by weight and to 24 weeks.

Week 9 to Week 32
Percentage of Participants With Normal Hemoglobin (Hb) Response
Tidsramme: Week 9 to Week 32

Normal Hb response is defined as achievement of Hb concentrations in the normal range at least once, 8 weeks or more after a transfusion during Week 9 through Week 32 of the double-blind period.

Week 9 to Week 32
Change From Baseline in Sexual Maturity Rating with Tanner Stage
Tidsramme: Baseline up to Week 298

Tanner Stage 1 corresponds to the prepubertal form, with progression to Tanner Stage 5, the final adult form.

Baseline up to Week 298
Change from Baseline in Pediatric Quality of Life (PedsQL) Multidimensional Fatigue Scale
Tidsramme: Baseline up to Week 292

The PedsQL multidimensional fatigue scale yields a total score from age-appropriate validated questionnaire that asks for perceived fatigue within the domains of 'General', 'Sleep/Rest' and 'Cognitive'. Each domain consists of 6 questions that are rated from 0 to 4 (therefore total score can range from 0 to 72). A higher total score indicates greater fatigue (i.e., worse outcome).

Baseline up to Week 292
Change from Baseline in PedsQL Generic Core Scale (GCS)
Tidsramme: Baseline up to Week 292

PedsQL GCS is designed to measure health-related quality of life in pediatric participants and adolescents (2 to 18 years of age). It encompasses 4 dimensions of functioning (physical [8 items], emotional [5 items], social [5 items], school [3 items]). Age groups: Toddler (2-4 years), Young pediatric (5-7 years), Pediatric (8-12 years), and Teens (13-17 years). Depending on the participant's age, the questionnaire may be completed by parent/caregiver as appropriate. For the Toddler group, the PedsQL GCS consist of 21 items, using a 5-point Likert scale (0 to 4); for all other groups, the PedsQL GCS consist of 23 items, with a 3-point Likert scale (0, 2, 4) for the young pediatric, and a 5-point Likert scale for the pediatric and teens groups. Scores are transformed on a scale from 0 to 100 where 0=100, 1=75, 2=50, 3=25, and 4=0. Higher scores indicate improved quality of life.

Baseline up to Week 292

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Efterforskere

  • Studiestol: Medical Affairs, Agios Pharmaceuticals, Inc.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

8. juni 2022

Primær færdiggørelse (Faktiske)

3. maj 2024

Studieafslutning (Anslået)

1. juni 2029

Datoer for studieregistrering

Først indsendt

22. november 2021

Først indsendt, der opfyldte QC-kriterier

22. november 2021

Først opslået (Faktiske)

3. december 2021

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

28. oktober 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

27. oktober 2026

Sidst verificeret

1. oktober 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • AG348-C-022
  • 2021-003265-36 (EudraCT nummer)
  • 2024-515024-37-00 (Ctis)

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ja

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .