Étude SAFE : innocuité de l'aPCC après la prophylaxie par l'emicizumab (SAFE)
Étude sur l'innocuité de l'aPCC et de l'emicizumab chez les patients atteints d'hémophilie congénitale A avec inhibiteurs (Étude SAFE : innocuité de l'aPCC après la prophylaxie par l'emicizumab)
The purpose of the aPCC-emicizumab safety study is to investigate the hemostatic efficacy as measured by thrombin generation, of a low personalized dose of aPCC (FEIBA) in children and adults with hemophilia A and inhibitors on emicizumab prophylaxis.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Hemophilia A (HA) is a congenital bleeding disorder caused by deficient or dysfunctional factor VIII (FVIII) which leads to bleeding correlated with factor deficiency severity. Patients with HA develop recurrent bleeds into joints and soft tissues that culminate into debilitating arthropathy and long-term morbidity.
The previous standard of care for high titer antibody eradication in hemophilia A (HA) included a labor-intensive, immune tolerance induction (ITI) regimen administered with concomitant bypassing agent (BPA) prophylaxis, either daily recombinant activated factor VII (rFVIIa) or at least 3 non-consecutive days of activated prothrombin complex concentrate (aPCC) given intravenously (IV) each week.
The overall objective is to determine whether the thrombin generation assay can be used to personalize a dose of aPCC that could be used in a future study during an acute bleeding event and peri-surgical prophylaxis in children and adults with hemophilia A and inhibitors on emicizumab primary prophylaxis.
Type d'étude
Phase
- Phase 3
Contacts et emplacements
Lieux d'étude
-
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Georgia
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Atlanta, Georgia, États-Unis, 30322
- Emory University Hospital
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Atlanta, Georgia, États-Unis, 30322
- Children's Healthcare of Atlanta
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-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Moderately severe hemophilia A, defined as FVIII level <0.05 IU/mL before development of an inhibitor
- Age ≥6 years of age at time of informed consent
- Documented on 2 occasions a high titer inhibitor (>5 BU/mL) with a 72-hour washout within 2 years of enrollment
- Parent/guardian (Legally Authorized Representative) or the patient has provided written informed consent
- Adequate hematologic function (Hgb >8 g/dL and platelet count >100,000 µL)
- Adequate hepatic function (total bilirubin ≤1.5 x ULN and both AST/ALT ≤3x ULN at screening (excluding known Gilbert's)
- Adequate renal function (≤2.5 x ULN and CrCl ≥30 mL/min)
Exclusion Criteria:
- Inherited or acquired bleeding disorder other than hemophilia A excluding low VWF (>30% VWF:RCo or VWF:GP1bm)
- Had an active bleed requiring factor therapy at screening
- Previous or current treatment for thromboembolic disease or signs of thromboembolic disease (excluding previously resolved line-associated thrombosis)
- Had a surgical procedure 14 days before screening
- Conditions that may increase the risk of bleeding or thrombosis
- If the patient is treated with rFVIIa or aPCC seven days before screening
- History of clinically significant hypersensitivity associated with monoclonal antibody therapies or components of the emicizumab injection
- Had current use of any medication other than emicizumab that could affect the coagulation system.
- Known HIV infection with CD4 count <200 cells/µL within 24 weeks before screening. Testing is not required if <35 years of age.
- Use of systemic immunomodulators at enrollment or planned use during the study
- Participants who are at high risk for TMA (for example, have a previous medical/family history of TMA), in the investigator's judgment
- Concurrent disease, treatment, or abnormality in clinical laboratory tests that could interfere with the conduct of the study, may pose an additional risk, or would, in the opinion of the investigator, preclude the participant's safe participation in and completion of the study
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: N / A
- Modèle interventionnel: Affectation à un seul groupe
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: Experimental treatment
Participants will have a first/baseline thrombin generation assay (TGA) sample (to be processed within 60 minutes), followed by an infusion at 15 U/kg dose of aPCC, and provide a second TGA sample 15-30 minutes after to be processed within 60 minutes. If required, a subsequent TGA sample will be obtained upon a 25 U/kg dose of aPCC to be processed within 60-90 minutes. |
HEMLIBRA® is a bispecific factor IXa- and factor X-directed antibody indicated for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adult and pediatric patients ages newborn and older with hemophilia A (congenital factor VIII deficiency) with or without factor VIII inhibitors.
Autres noms:
FEIBA™ is an Anti-Inhibitor Coagulant Complex indicated for use in hemophilia patients with inhibitors for: control and prevention of bleeding episodes, perioperative management, and routine prophylaxis to prevent or reduce the frequency of bleeding episodes. The max dose allowed for aPCC will be 50 U/kg dose given at a single visit.
Autres noms:
rFVIIa is a coagulation factor VIIa concentrate indicated for the treatment and control of bleeding episodes occurring in adults and adolescents with hemophilia with inhibitors.
Autres noms:
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Thrombin generation capacity after aPCC (FEIBA) infusion
Délai: Baseline and up to 30 minutes after infusion
|
Thrombin generation capacity from up to two escalating doses of aPCC will be measured using a thrombin generation assay at baseline and up to 30 minutes after FEIBA infusion. |
Baseline and up to 30 minutes after infusion
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Number of serious adverse events
Délai: up to 1 year
|
Number of serious adverse events will be recorded |
up to 1 year
|
|
Number of serious bleeding episodes
Délai: up to 1 year
|
Number of serious bleeding episodes will be recorded |
up to 1 year
|
|
Number of episodes of thrombotic events including thrombotic microangiopathy (TMA)
Délai: up to 1 year
|
Number of episodes of thrombotic events including thrombotic microangiopathy (TMA) will be recorded |
up to 1 year
|
Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Robert Sidonio, MD, Emory University
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Estimé)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
- Maladies génétiques, innées
- Maladies hématologiques
- Troubles de la coagulation sanguine
- Troubles hémorragiques
- Maladies génétiques liées à l'X
- Troubles de la coagulation sanguine, héréditaires
- Troubles des protéines de la coagulation
- Maladies et anomalies congénitales, héréditaires et néonatales
- Maladies hémiques et lymphatiques
- Hémophilie A
- Hémophilie B
- émizumab
- FVIIA recombinant
- complexe de coagulant anti-inhibiteur
Autres numéros d'identification d'étude
- STUDY00000804
- 2025P010684 (Autre identifiant: Emory Insight Humans IRB)
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Description du régime IPD
All of the individual participant data collected during the trial, after de-identification, will be available
Type d'informations de prise en charge du partage d'IPD
- PROTOCOLE D'ÉTUDE
- SÈVE
- CIF
Informations sur les médicaments et les dispositifs, documents d'étude
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produit fabriqué et exporté des États-Unis.
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