Iron Overload Due to Repeated Red Blood Cell Transfusions
Conditions
Brief summary
The purpose of this extension study is to evaluate SSP-004184AQ in patients with transfusional iron overload and to provide data on long term safety and efficacy. SSP-004184AQ is an iron chelator under development for chronic daily oral administration to patients with transfusional iron overload
Interventions
DRUGSSP-004184AQ
Long term extension study of 8-75 mg/kg/d of SSP-004184AQ (equivalent to 7-68 mg/kg/d free acid or active form)
Sponsors
Shire
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
6 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Subjects and/or parents willing and able to sign the approved informed consent/and assent (based on institutional guidelines). * An understanding, ability, and willingness to fully comply with study procedures and restrictions. * Has either completed a previous SSP-004184AQ study or prematurely discontinued from (with agreement from the Investigator and Shire physician) from one of the SSP-004184AQ studies. * If applicable, female subjects should be either: 1. Post-menopausal (12 consecutive months of spontaneous amenorrhea), or 2. Surgically sterile, or 3. Females of child-bearing potential must have a negative urine pregnancy test at the Qualification and Enrollment Visit prior to dosing on Day 1. Females of child-bearing potential must agree to abstain from sexual activity that could result in pregnancy or agree to use acceptable methods of contraception. For subjects that did not transition directly from their feeder protocol and have initiated treatment with a chelator other than SSP-004184AQ: * Willing to discontinue all existing iron chelation therapies for a minimum period of 1 to 5 days prior to first dose of SSP-004184AQ. (Note: This inclusion criterion is also applicable for subjects that were receiving chelators other than SSP-004184AQ in their feeder protocol.) * Serum ferritin greater than 500 ng/mL at the Qualification and Enrollment Visit. * Liver iron concentration (LIC) greater than or equal to 2.0 mg iron per g (equivalent dry weight, liver) determined by FerriScan® R2 MRI at the Qualification and Enrollment Visit (Day -28 to Day -8). (Note: Younger subjects for whom MRI is not feasible will be considered iron overloaded on the basis of serum ferritin only.) - Mean of the previous 3 pre-transfusion hemoglobin concentrations greater than or equal to 7.5 g/dL. Exclusion: * Unwilling to remain off all other existing chelation therapies during SSP-004184AQ dosing and for up to 24 hours from last dose. * A history of non-compliance in a prior FerroKin/Shire-sponsored SSP-004184AQ study (excluding dose suspensions that were medically warranted). * Cardiac MRI T2\* less than 10.0 milliseconds at the Qualification and Enrollment Visit. * Cardiac left ventricular ejection fraction less than 50% at the Qualification and Enrollment Visit by MRI or below the locally determined normal range by echocardiography if MRI information is not available. * Evidence of clinically relevant oral, cardiovascular, gastrointestinal, endocrine, pulmonary, neurologic, psychiatric, immunologic, bone marrow, dermatologic, hepatic, biliary, or renal dysfunction where, in the opinion of the Investigator or the Shire Study Physician, treatment with SSP-004184AQ is relatively contraindicated. * Platelet count below 100,000/µL or absolute neutrophil count less than 1500/mm3 at the Qualification and Enrollment Visit. * Known sensitivity to any ingredient in the SSP-004184AQ formulation. * Pregnant or lactating females. For subjects that did not transition directly from their feeder protocol and have initiated treatment with a chelator other than SSP-004184AQ: * In younger subjects for whom MRI is not feasible, evidence of severe cardiac dysfunction, as assessed by the Investigator. * Non-elective hospitalization within the 30 days prior to receiving the first dose of SSP 004184AQ. * For subjects greater than or equal to 18 years old: ALT greater than 200 IU/L at the Qualification and Enrollment Visit. OR For subjects less than 18 years old: ALT greater than 180 IU/L at the Qualification and Enrollment Visit. \- For subjects greater than or equal to 18 years old: Evidence of severe renal insufficiency, eg, serum creatinine 1.5X above the upper limit of normal or proteinuria greater than 1 gm per day or a calculated glomerular filtration rate less than 40 mL/min. OR For subjects less than 18 years old: Evidence of significant renal insufficiency, eg, serum creatinine above the upper limit of normal or proteinuria greater than 1 gm per day. * Use of any investigational agent within the 30 days prior to receiving the first dose of SSP-004184AQ. * Cardiac left ventricular ejection fraction below the locally determined normal range in the 12 months prior to Screening by echocardiography or MRI or less than 50% at Baseline testing by MRI (Echocardiograph is acceptable for LVEF if MRI information is not available).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 2) | Baseline, Week 24 (Cycle 2) | Efficacy of SSP-004184 was assessed by determining LIC. Abdominal MRI data were collected by using FerriScan R2 standard procedures and used to determine LIC. A negative change from baseline indicates that LIC decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. |
| Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 1) | Baseline, Week 24 (Cycle 1) | Efficacy of SSP-004184 was assessed by determining LIC. Abdominal magnetic resonance imaging (MRI) data were collected by using FerriScan R2 standard procedures and used to determine LIC. A negative change from baseline indicates that LIC decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. |
| Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 48 (Cycle 1) | Baseline, Week 48 (Cycle 1) | Efficacy of SSP-004184 was assessed by determining LIC. Abdominal MRI data were collected by using FerriScan R2 standard procedures and used to determine LIC. A negative change from baseline indicates that LIC decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. |
| Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 2) | Baseline, Week 24 (Cycle 2) | The efficacy of SSP-004184 was assessed by determining cardiac iron load. Cardiac MRI data were collected by using T2\* standard procedures and used to determine iron load. A negative change from baseline indicates that iron load increased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. |
| Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 1) | Baseline, Week 24 (Cycle 1) | The efficacy of SSP-004184 was assessed by determining cardiac iron load. Cardiac MRI data were collected by using T2\* standard procedures and used to determine iron load. A negative change from baseline indicates that iron load increased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. |
| Change From Baseline in Cardiac T2* Values at Week 48 (Cycle 1) | Baseline, Week 48 (Cycle 1) | The efficacy of SSP-004184 was assessed by determining cardiac iron load. Cardiac MRI data were collected by using T2\* standard procedures and used to determine iron load. A negative change from baseline indicates that iron load increased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Serum Ferritin Values at Specified Visits | Baseline, Weeks 24 and 48 of Cycle 1, Week 24 of Cycle 2 | A negative change from baseline indicates that serum ferritin decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. |
Countries
Canada, Italy, Thailand, United Kingdom, United States
Participant flow
Pre-assignment details
A total of 30 participants were enrolled to this open-label extension study (24 participants transferred directly from feeder studies SPD602-201 \[NCT01186419\], SPD602-202 \[NCT01363908\], and SPD602-203 \[NCT01604941\] and 6 participants did not transfer directly and received a chelator other than SSP-004184 after discontinuation from a feeder study).
Participants by arm
| Arm | Count |
|---|---|
| SSP-004184AQ Participants received SSP-004184AQ (magnesium salt of free acid or active form, that is, SSP-004184 \[SPD602, FBS0701\]) capsules orally at a total daily dose of 8-75 mg/kg/day (equivalent to SSP-004184 7-68 mg/kg/day) either once daily or twice daily at the discretion of investigator for up to a maximum of 3 years or until the sponsor decided to stop the study. | 30 |
| Total | 30 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 2 |
| Overall Study | Lack of Efficacy | 1 |
| Overall Study | Other | 24 |
| Overall Study | Physician Decision | 1 |
| Overall Study | Withdrawal by Subject | 2 |
Baseline characteristics
| Characteristic | SSP-004184AQ |
|---|---|
| Age, Continuous | 25.5 years STANDARD_DEVIATION 11.38 |
| Sex: Female, Male Female | 17 Participants |
| Sex: Female, Male Male | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 25 / 30 |
| serious Total, serious adverse events | 2 / 30 |
Outcome results
Primary
Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 1)
The efficacy of SSP-004184 was assessed by determining cardiac iron load. Cardiac MRI data were collected by using T2\* standard procedures and used to determine iron load. A negative change from baseline indicates that iron load increased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study.
Time frame: Baseline, Week 24 (Cycle 1)
Population: FAS. Here, 'n' signifies the number of FAS participants evaluable for the respective time points.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| SSP-004184AQ | Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 1) | Baseline (n=23) | 35.14 milliseconds | Standard Deviation 12.242 |
| SSP-004184AQ | Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 1) | Change at Week 24 (Cycle 1) (n=14) | -0.41 milliseconds | Standard Deviation 8.069 |
p-value: 0.8061paired t-test
Primary
Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 2)
The efficacy of SSP-004184 was assessed by determining cardiac iron load. Cardiac MRI data were collected by using T2\* standard procedures and used to determine iron load. A negative change from baseline indicates that iron load increased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study.
Time frame: Baseline, Week 24 (Cycle 2)
Population: FAS participants evaluable for this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SSP-004184AQ | Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 2) | -3.91 milliseconds | Standard Deviation 5.551 |
p-value: 0.1248paired t-test
Primary
Change From Baseline in Cardiac T2* Values at Week 48 (Cycle 1)
The efficacy of SSP-004184 was assessed by determining cardiac iron load. Cardiac MRI data were collected by using T2\* standard procedures and used to determine iron load. A negative change from baseline indicates that iron load increased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study.
Time frame: Baseline, Week 48 (Cycle 1)
Population: FAS participants evaluable for this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SSP-004184AQ | Change From Baseline in Cardiac T2* Values at Week 48 (Cycle 1) | -3.47 milliseconds | Standard Deviation 9.619 |
p-value: 0.2297paired t-test
Primary
Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 1)
Efficacy of SSP-004184 was assessed by determining LIC. Abdominal magnetic resonance imaging (MRI) data were collected by using FerriScan R2 standard procedures and used to determine LIC. A negative change from baseline indicates that LIC decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study.
Time frame: Baseline, Week 24 (Cycle 1)
Population: Full analysis set (FAS) included all participants in the Safety set who had at least 1 post-baseline primary efficacy assessment. Here, 'n' signifies the number of FAS participants evaluable for the respective time points.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| SSP-004184AQ | Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 1) | Baseline (n=23) | 9.9 milligram per gram (mg/g) dry tissue | Standard Deviation 8.1 |
| SSP-004184AQ | Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 1) | Change at Week 24 (Cycle 1) (n=13) | -1.1 milligram per gram (mg/g) dry tissue | Standard Deviation 1.86 |
p-value: 0.056paired t-test
Primary
Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 2)
Efficacy of SSP-004184 was assessed by determining LIC. Abdominal MRI data were collected by using FerriScan R2 standard procedures and used to determine LIC. A negative change from baseline indicates that LIC decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study.
Time frame: Baseline, Week 24 (Cycle 2)
Population: FAS participants evaluable for this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SSP-004184AQ | Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 2) | -1.5 mg/g dry tissue | Standard Deviation 2.23 |
p-value: 0.1319paired t-test
Primary
Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 48 (Cycle 1)
Efficacy of SSP-004184 was assessed by determining LIC. Abdominal MRI data were collected by using FerriScan R2 standard procedures and used to determine LIC. A negative change from baseline indicates that LIC decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study.
Time frame: Baseline, Week 48 (Cycle 1)
Population: FAS participants evaluable for this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SSP-004184AQ | Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 48 (Cycle 1) | -1.0 mg/g dry tissue | Standard Deviation 1.68 |
p-value: 0.1232paired t-test
Secondary
Change From Baseline in Serum Ferritin Values at Specified Visits
A negative change from baseline indicates that serum ferritin decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study.
Time frame: Baseline, Weeks 24 and 48 of Cycle 1, Week 24 of Cycle 2
Population: FAS. Here, 'n' signifies the number of FAS participants evaluable for the respective time points.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| SSP-004184AQ | Change From Baseline in Serum Ferritin Values at Specified Visits | Baseline (n=23) | 5353.38 nanogram per milliliter | Standard Deviation 4588.423 |
| SSP-004184AQ | Change From Baseline in Serum Ferritin Values at Specified Visits | Change at Week 24 (Cycle 1) (n=12) | -395.82 nanogram per milliliter | Standard Deviation 569.305 |
| SSP-004184AQ | Change From Baseline in Serum Ferritin Values at Specified Visits | Change at Week 48 (Cycle 1) (n=9) | -250.87 nanogram per milliliter | Standard Deviation 452.327 |
| SSP-004184AQ | Change From Baseline in Serum Ferritin Values at Specified Visits | Change at Week 24 (Cycle 2) (n=7) | -384.03 nanogram per milliliter | Standard Deviation 649.99 |