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NCT01736475

Study Investigating a PEGylated Recombinant Factor VIII (BAX 855) for Hemophilia A (PROLONG-ATE Study)

Completed Phase 2, PHASE3 Results posted Last updated 20 May 2021
What this trial tests

Phase 2, PHASE3 trial testing Antihemophilic Factor (Recombinant) - Plasma/Albumin Free Method in Hemophilia A in 159 participants. Completed in 17 July 2014.

Timeline
31 January 2013
Primary endpoint
17 July 2014
17 July 2014

Quick facts

Lead sponsorBaxalta now part of Shire
PhasePhase 2, PHASE3
StatusCompleted
Study typeINTERVENTIONAL
Allocationnon randomized
Designparallel
Maskingnone
Primary purposeprevention
Enrollment159
Start date31 January 2013
Primary completion17 July 2014
Estimated completion17 July 2014
Sites72 locations across Japan, Malaysia, Taiwan, Poland, South Korea, Netherlands, Sweden, Lithuania

Drugs / interventions tested

Conditions studied

Sponsor

Baxalta now part of Shire — full company profile →

Who can join

Adults 12 to 65, male only, with Hemophilia A. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Annualized Bleeding Rate (ABR) Primary · 9 months

Comparisons between prophylactic and on-demand treatment were based on ABR estimates from a negative binomial regression model, taking into account the treatment regimen, target joints and age at screening, and duration of the observation period for efficacy.

GroupValue95% CI
Prophylaxis4.33.4 – 5.5
On-demand43.425.2 – 74.8
Rate of Success of BAX 855 for Treatment of Bleeding Episodes Secondary · At least 50 exposure days or 6 months (±2 weeks), whichever occurs last, for the prophylaxis arm and 6 months (± 2 weeks) for the on-demand arm.

Success in the control of bleeding was defined as a rating of excellent or good using the Efficacy Rating Scale for Treatment of Bleeding Episodes measured 24 hours after initiation of treatment for the bleeding episode. EXCELLENT: Full relief of pain and cessation of objective signs of bleeding (eg, swelling, tenderness, and decreased range of motion in the case of musculoskeletal hemorrhage) after a single infusion. No additional infusion is required for the control of bleeding. Administration of further infusions to maintain hemostasis would not affect this scoring. GOOD: Definite pain reli

GroupValue95% CI
Participants With a Bleeding Episode0.960.91 – 0.98
Average Number of BAX 855 Infusions Needed for the Treatment of Bleeding Episodes Secondary · From first exposure to BAX 855 until the end of the study, [at least 50 exposure days or 6 months (±2 weeks), whichever occurs last, for the prophylaxis arm; and 6 months (± 2 weeks) for the on-demand arm].
GroupValue95% CI
Prophylaxis1.37± 0.80
On-demand1.21± 0.35
Number of Participants With ≤1, 2, 3, 4, 5, 6, or >6 Month Time Intervals Between Bleeding Episodes or no Bleeding Episodes Secondary · From first exposure to BAX 855 until the end of the study, [at least 50 exposure days or 6 months (±2 weeks), whichever occurs last, for the prophylaxis arm; and 6 months (± 2 weeks) for the on-demand arm].

Interval between Bleeds in months was calculated as: Observation period for efficacy (in days)/(number of bleeds)\*(12/365.2425)

No bleed
GroupValue95% CI
Prophylaxis45
On-demand0
>6 Months
GroupValue95% CI
Prophylaxis5
On-demand0
6 Months
GroupValue95% CI
Prophylaxis20
On-demand0
5 Months
GroupValue95% CI
Prophylaxis3
On-demand0
4 Months
GroupValue95% CI
Prophylaxis0
On-demand0
3 Months
GroupValue95% CI
Prophylaxis11
On-demand0
2 Months
GroupValue95% CI
Prophylaxis16
On-demand0
≤1 Month
GroupValue95% CI
Prophylaxis20
On-demand17
Weight-adjusted Consumption of BAX 855 - Per Prophylactic Infusion and Pharmacokinetic (PK) Infusion Secondary · Prophylactic Infusion: ≥50 exposure days or 6 months (±2 weeks), whichever occurs last. PK Infusion: PK #1 Pre-infusion within 30 minutes; Post-infusion 10 min, and 0.5, 1, 3, 6, 24, 32, 48, 56 hours (h). PK #2 also at Post-infusion 96h
Per Prophylactic Infusion (N= 5941 Infusions)
GroupValue95% CI
All Study Participants44.51± 4.556
Per PK Infusion (N= 50 Infusions)
GroupValue95% CI
All Study Participants45.48± 2.592
Weight-adjusted Consumption of BAX 855 - Per Treatment of Bleeding Episode (BE) and Per BE for Maintenance of Hemostasis Secondary · Treatment of Bleeding Episode (BE): Minor/Moderate BE every 12 to 24 hours until bleeding is resolved; Major BE every 8 to 12 hours until bleeding is resolved. Per BE for Maintenance of Hemostasis: within 48 hours after bleeding episode resolution.

Infusions per bleeding episode for maintenance of hemostasis only includes infusions following the resolution of a bleed to maintain hemostasis.

Per Treatment of BE (N= 592 bleeds)
GroupValue95% CI
All Study Participants37.44± 28.105
Per BE for Maintenance of Hemostasis (N=34 bleeds)
GroupValue95% CI
All Study Participants39.29± 34.206
Percentage of Participants With Adverse Events Secondary · From first exposure to BAX 855 until the end of the study, [at least 50 exposure days or 6 months (±2 weeks), whichever occurs last, for the prophylaxis arm; and 6 months (± 2 weeks) for the on-demand arm].

Adverse Events (AEs) and Serious Adverse Events (SAEs)

SAE, Moderate, Unrelated
GroupValue95% CI
All Study Participants0.7
SAE, Severe, Unrelated
GroupValue95% CI
All Study Participants2.9
nSAE, Mild, Unrelated
GroupValue95% CI
All Study Participants40.1
nSAE, Mild, Related
GroupValue95% CI
All Study Participants3.6
nSAE, Moderate, Unrelated
GroupValue95% CI
All Study Participants19.0
nSAE, Moderate, Related
GroupValue95% CI
All Study Participants1.5
nSAE, Unknown Severity, Unrelated
GroupValue95% CI
All Study Participants0.7
nSAE, Severe, Unrelated
GroupValue95% CI
All Study Participants1.5
Immunogenicity - Number of Participants With Positive Inhibitory Antibodies to FVIII, Binding Antibodies to FVIII, PEG-VIII, PEG and Anti-CHO Antibodies at Study Completion/Termination Secondary · From first exposure to BAX 855 until the end of the study, [at least 50 exposure days or 6 months (±2 weeks), whichever occurs last, for the prophylaxis arm; and 6 months (± 2 weeks) for the on-demand arm].

Number of participants who received BAX855, with immunogenicity data from study completion/termination visit. FVIII = factor VIII; PEG-VIII = polyethylene glycol-factor VIII; Anti-CHO = Anti-Chinese hamster ovary

Inhibitory Antibodies to FVIII (N= 112, 14)
GroupValue95% CI
Prophylaxis0
On-demand0
IgG: Binding Antibodies FVIII (N= 117, 15)
GroupValue95% CI
Prophylaxis0
On-demand0
IgM: Binding Antibodies FVIII (N= 117, 15)
GroupValue95% CI
Prophylaxis0
On-demand0
IgG: Binding Antibodies PEG (N= 117, 15)
GroupValue95% CI
Prophylaxis0
On-demand0
IgM: Binding Antibodies PEG (N= 117, 15)
GroupValue95% CI
Prophylaxis0
On-demand0
IgG: Binding Antibodies PEG-FVIII (N= 117, 15)
GroupValue95% CI
Prophylaxis0
On-demand1
IgM: Binding Antibodies PEG-FVIII (N= 117, 15)
GroupValue95% CI
Prophylaxis0
On-demand0
CHO-Protein Antibodies (N= 117, 15)
GroupValue95% CI
Prophylaxis0
On-demand0
Patient Reported Outcomes: Haemo-SYM Questionnaire, Change in Score From Baseline to End of Study Secondary · Baseline; and end of study visit [at least 50 exposure days or 6 months (±2 weeks), whichever occurs last, for the prophylaxis arm and 6 months (± 2 weeks) for the on-demand arm].

The HAEMO-SYM has two subscales: pain and bleeds. HAEMO-SYM subscale scores are calculated by taking the mean of the items in each subscale and transforming them to a 0 (none or absent) to 100 (very severe) scale. Given that higher scores indicate more severe symptoms on the Haemo-SYM and that the change scores were calculated as the value at study completion minus the value at baseline, a negative change score indicates an improvement (reduction in symptoms). Conversely, a positive change score indicates worsening symptoms.

Bleed Severity Total Score
GroupValue95% CI
Prophylaxis-4.17± 17.05
On-demand-4.24± 15.71
Pain Severity Total Score
GroupValue95% CI
Prophylaxis-1.22± 12.50
On-demand-0.17± 11.88
Patient Reported Outcomes - Short Form (SF)-36, Change From Baseline to End of Study Secondary · Baseline; and end of study visit [at least 50 exposure days or 6 months (±2 weeks), whichever occurs last, for the prophylaxis arm and 6 months (± 2 weeks) for the on-demand arm]

Change from Baseline to End of Study for SF-36 Questionnaire is provided. Scores for individual SF-36 categories range from 0 to 100 with higher scores representing better health. Given that higher scores indicate better health-related quality of life (HRQoL) and that the change scores were calculated as the value at study completion minus the value at baseline, a negative change score indicates a worsening of HRQoL.

Physical Functioning (N= 97, 12)
GroupValue95% CI
Prophylaxis0.49± 5.27
On-demand-2.46± 4.29
Role-physical (N= 97, 12)
GroupValue95% CI
Prophylaxis1.31± 7.36
On-demand-3.67± 9.01
Bodily Pain (N= 97, 12)
GroupValue95% CI
Prophylaxis2.08± 8.19
On-demand0.60± 4.44
General Health (N= 96, 12)
GroupValue95% CI
Prophylaxis0.40± 6.43
On-demand-0.28± 9.04
Vitality (N= 96, 12)
GroupValue95% CI
Prophylaxis-0.38± 7.43
On-demand0.26± 9.36
Social Functioning (N= 97, 12)
GroupValue95% CI
Prophylaxis0.90± 7.54
On-demand-3.18± 6.35
Role Emotional (N= 97, 12)
GroupValue95% CI
Prophylaxis-0.20± 8.46
On-demand0.65± 7.92
Mental Health (N= 96, 12)
GroupValue95% CI
Prophylaxis0.09± 7.26
On-demand-3.29± 7.95
Pharmacokinetics (Pk) - Plasma Half-life (One-stage Clotting Assay) Secondary · Within 30 minutes prior to start of infusion; and post-infusion at 10, 30 minutes, and 1, 3, 6, 9, 24, 32, 48, 56, 72 (PK2 and PK3 only), and 96 hours (PK2 and PK3 only).

Terminal half-life calculated as log\_e2/λz where λz is the terminal elimination rate constant. Participants in the pharmacokinetic full analysis set (PKFAS) analysis set received an initial infusion of ADVATE for pharmacokinetic analysis (PK-1) followed by a washout period and an infusion of BAX 855 for a second pharmacokinetic analysis (PK-2). After at least 50 EDs of BAX 855, participants in the PK subgroup received another infusion of BAX 855 for pharmacokinetic analysis (PK-3).

PK-1: ADVATE
GroupValue95% CI
Pharmacokinetic Analysis Participants10.40± 2.244
PK-2: BAX 855
GroupValue95% CI
Pharmacokinetic Analysis Participants14.30± 3.838
PK-3: BAX 855, After ≥50 Exposure Days (N=22)
GroupValue95% CI
Pharmacokinetic Analysis Participants16.02± 4.922
Pharmacokinetics (Pk) - Mean Residence Time (One-stage Clotting Assay) Secondary · Within 30 minutes prior to start of infusion; and post-infusion at 10, 30 minutes, and 1, 3, 6, 9, 24, 32, 48, 56, 72 (PK2 and PK3 only), and 96 hours (PK2 and PK3 only).

The mean residence time (MRT) w as calculated as total area under the moment curve divided by the total area under the curve starting from the begin of infusion (or the end of infusion if start time is not available). Participants in the pharmacokinetic full analysis set (PKFAS) analysis set received an initial infusion of ADVATE for pharmacokinetic analysis (PK-1) followed by a washout period and an infusion of BAX 855 for a second pharmacokinetic analysis (PK-2). After at least 50 EDs of BAX 855, participants in the PK subgroup received another infusion of BAX 855 for pharmacokinetic analysi

PK-1: ADVATE
GroupValue95% CI
Pharmacokinetic Analysis Participants12.86± 3.044
PK-2: BAX 855
GroupValue95% CI
Pharmacokinetic Analysis Participants19.56± 5.315
PK-3: BAX 855, After ≥50 Exposure Days (N=22)
GroupValue95% CI
Pharmacokinetic Analysis Participants20.65± 4.821

Adverse events — posted to ClinicalTrials.gov

Time frame: From first exposure to BAX 855 until the end of the study, [at least 50 exposure days or 6 months (±2 weeks), whichever occurs last, for the prophylaxis arm; and 6 months (± 2 weeks) for the on-demand arm].. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

All Study Participants
Serious: 5/137 (4%)
Deaths:

Serious adverse events (5 terms)

ReactionSystemAll Study Participants
HERPES ZOSTER INFECTION NEUROLOGICALInfections and infestations
HUMERUS FRACTUREInjury, poisoning and procedural complications
MUSCLE HAEMORRHAGEMusculoskeletal and connective tissue disorders
OSTEOARTHRITISMusculoskeletal and connective tissue disorders
NEUROENDOCRINE CARCINOMANeoplasms benign, malignant and unspecified (incl cysts and polyps)
Other adverse events (3 terms — click to expand)

ReactionSystemAll Study Participants
NasopharyngitisInfections and infestations
Upper respiratory tract infectionInfections and infestations
HeadacheNervous system disorders

Most-reported serious reactions: HERPES ZOSTER INFECTION NEUROLOGICAL, HUMERUS FRACTURE, MUSCLE HAEMORRHAGE, OSTEOARTHRITIS, NEUROENDOCRINE CARCINOMA.

Data from ClinicalTrials.gov NCT01736475 adverse events section.

Sponsor's own description

To assess efficacy and safety, including immunogenicity of BAX 855 administered as prophylaxis and as on-demand therapy in adult and adolescent (12-65 years) previously treated patients (PTPs) with severe hemophilia A To determine the pharmacokinetic (PK) parameters of BAX 855.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Pegylated, full-length, recombinant factor VIII for prophylactic and on-demand treatment of severe hemophilia A.
    Konkle BA, Stasyshyn O, Chowdary P, Bevan DH, et al · · 2015 · cited 192× · PMID 26157075 · DOI 10.1182/blood-2015-03-630897
  2. Outcome of Clinical Trials with New Extended Half-Life FVIII/IX Concentrates.
    Mancuso ME, Santagostino E. · · 2017 · cited 72× · PMID 28350322 · DOI 10.3390/jcm6040039
  3. Rurioctocog alfa pegol PK-guided prophylaxis in hemophilia A: results from the phase 3 PROPEL study.
    Klamroth R, Windyga J, Radulescu V, Collins PW, et al · · 2021 · cited 61× · PMID 33150384 · DOI 10.1182/blood.2020005673
  4. Safety of PEGylated recombinant human full-length coagulation factor VIII (BAX 855) in the overall context of PEG and PEG conjugates.
    Stidl R, Fuchs S, Bossard M, Siekmann J, et al · · 2016 · cited 48× · PMID 26219204 · DOI 10.1111/hae.12762
  5. Potential role of a new PEGylated recombinant factor VIII for hemophilia A.
    Wynn TT, Gumuscu B. · · 2016 · cited 17× · PMID 27382347 · DOI 10.2147/jbm.s82457
  6. Clinical studies of extended-half-life recombinant FVIII products for prophylaxis in adults and children: A critical review from the physician's perspective.
    Hermans C, Reding MT, Astermark J, Klamroth R, et al · · 2022 · cited 13× · PMID 35390452 · DOI 10.1016/j.critrevonc.2022.103678
  7. A Retrospective Observational Study of Rurioctocog Alfa Pegol in Clinical Practice in the United States.
    Aledort L, Milligan S, Watt M, Booth J. · · 2020 · cited 10× · PMID 32223610 · DOI 10.18553/jmcp.2020.26.4.492
  8. Efficacy, safety, and immunogenicity of rurioctocog alfa pegol for prophylactic treatment in previously treated patients with severe hemophilia A: a systematic review and meta-analysis of clinical trials.
    Witarto BS, Visuddho V, Witarto AP, Sutanto H, et al · · 2021 · cited 5× · PMID 35136579 · DOI 10.12688/f1000research.73884.3

Verify or expand the search:

Other trials of Antihemophilic Factor (Recombinant) - Plasma/Albumin Free Method

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