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Safety and Efficacy of Exjade in the Treatment of Transfusion-dependent Iron Overload in Aplastic Anemia Patients

Open-label Study of Exjade in the Treatment of Transfusion-dependent Iron Overload in Aplastic Anemia Patients Undergoing Treatment Programs in Comparison With Control Group

Status
Terminated
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01818726
Enrollment
15
Registered
2013-03-26
Start date
2014-06-23
Completion date
2016-10-17
Last updated
2019-08-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Aplastic Anemia

Keywords

Aplastic anemia, deferasirox, ICL670, renal function, transfusion-dependent iron overload, immunosuppressive treatment, Cyclosporine A, unosuppressive treatment without chelation therapy

Brief summary

Evaluated Exjade efficacy and safety in patients with aplastic anemia and transfusion-dependent iron overload, undergoing treatment programs of immunosuppressive treatment (Cyclosporine A) , in comparison with a group of patients undergoing treatment programs of immunosuppressive treatment (Cyclosporine A) without chelation therapy.

Detailed description

The secondary endpoints that were originally planned for this study were not analyzed as the study ended prematurely.

Interventions

DRUGICL670

ICL670 was supplied in registered packages as 250mg or 500mg dispersible tablets.

DRUGChelation

Main group of patients with aplastic anemia and transfusion-dependent iron overload underwent treatment programs of standard immunosuppressive treatment (immunosupressant - Cyclosporine A) and received chelation with ICL670 (deferasirox).

DRUGNo chelation

Comparative group of patients with aplastic anemia and transfusion-dependent iron overload underwent treatment programs of standard immunosuppressive treatment ( immunosupressant -Cyclosporine A)

Sponsors

Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Main diagnosis: aplastic anemia * Absence of severe and/or uncontrolled comorbidities * Confirmed iron overload (serum ferritin ≥ 1000 mkg/L) * Serum creatinine is not higher than the upper limit of normal for the given age * Absence of severe proteinuria. Protein/Creatinine ratio should be \< 0.5 mg/mg * Liver enzymes are \< 5 ULN * Completion of a scheduled cycle of immunosuppressive treatment program, with no severe infectious or generalized hemorrhagic complications * WHO (ECOG) performance status ≤ 2

Exclusion criteria

* No signed informed consent form * Patient is under 18 years old * Severe concomitant condition * Severe infectious and generalized haemorrhagic complication following regular planned cycle of programmed immune suppressive treatment. * History of increased sensitivity to active substance and any other ingredient of the medicinal product. * Creatinine clearance (CC) \< 60 ml/min and/or creatinine concentration in blood serum is 2 or more times higher than upper limit of age normal by results of 2 tests at Visits 1 and 2. * Severe liver disorders (class C by Child-Pugh scale). * Patients with aplastic anaemia in which chelator treatment will be ineffective due to rapid progression of the disease. * Significant proteinuria basing on protein creatinine ratio \> 1.0 mg/ml in urine sample from second urination at Visits 1 and 2 (or as an alternative in 2 of 3 urine samples at screening); * Rare hereditary disorders related to galactose intolerance, severe deficit of lactase or glucose-galactose malabsorption; * Pregnancy, lactation; * Level of liver enzymes higher than 5 upper limits of age normal at Visits 1 and 2.

Design outcomes

Primary

MeasureTime frameDescription
Change in Serum Ferritin ValuesScreening, Week (Wk) 4, Wk 8, Wk 12, Wk 16, Wk 20, Wk 24, Wk 28, Wk 32, Wk 36, Wk 40, Wk 44, Wk 48, Wk 52Change from baseline was be summarized descriptively for all on-treatment study visits. Changes to the planned statistical analysis were related to significant withdrawal of patients from the Per-Protocol Analysis Set due to a large number of patients who discontinued the study (lack of assessments of iron exchange parameters at visits) and deviations from the Protocol affecting the assessment of efficacy parameters. Because of that, the additional efficacy analysis in the Per-Protocol Analysis Set was not performed.
Change in Transferrin Saturation With Iron (TSI) ValuesScreening, Week (Wk) 4, Wk 8, Wk 12, Wk 16, Wk 20, Wk 24, Wk 28, Wk 32, Wk 36, Wk 40, Wk 44, Wk 48, Wk 52Mean percentage change from baseline in transferrin saturation with iron was summarized descriptively for all on-treatment study visits.
Change in Serum Total Iron-binding Capacity (TIBC)Screening, Week (Wk) 4, Wk 8, Wk 12, Wk 16, Wk 20, Wk 24, Wk 28, Wk 32, Wk 36, Wk 40, Wk 44, Wk 48, Wk 52Mean change from baseline in serum total iron-binding capacity was summarized descriptively for all on-treatment study visits.

Countries

Russia

Participant flow

Recruitment details

Estimated number of patients was 25; the actual number of patients enrolled in the study and included in efficacy analysis was 15.

Pre-assignment details

The study enrolled adult transfusion-dependent patients with Aplastic Anaemia (AA) on programmed immune suppressive treatment.

Participants by arm

ArmCount
Serum Ferritin Level ≥ 1,000 μg/l
Transfusion-dependent adult patients with AA and serum ferritin ≥ 1000 mg/L on programmed immune suppressive treatment with cyclosporine A who were receiving chelation with Exjade (deferasirox) during the study
10
Serum Ferritin Level < 1,000 μg/l
Transfusion-dependent adult patients with AA and serum ferritin \< 1,000 mg/L on programmed immune suppressive treatment with cyclosporine A who were not receiving the investigational product
5
Total15

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdministrative reasons51
Overall StudyDecision to perform 2nd course of trtmnt10
Overall StudyWithdrawal by Subject01

Baseline characteristics

CharacteristicSerum Ferritin Level ≥ 1,000 μg/lSerum Ferritin Level < 1,000 μg/lTotal
Age, Continuous34.0 Years
STANDARD_DEVIATION 9.33
37.0 Years
STANDARD_DEVIATION 10.1
35.0 Years
STANDARD_DEVIATION 9.34
Race/Ethnicity, Customized
Caucasian
10 Participants5 Participants15 Participants
Sex: Female, Male
Female
6 Participants4 Participants10 Participants
Sex: Female, Male
Male
4 Participants1 Participants5 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 100 / 5
other
Total, other adverse events
4 / 100 / 5
serious
Total, serious adverse events
0 / 100 / 5

Outcome results

Primary

Change in Serum Ferritin Values

Change from baseline was be summarized descriptively for all on-treatment study visits. Changes to the planned statistical analysis were related to significant withdrawal of patients from the Per-Protocol Analysis Set due to a large number of patients who discontinued the study (lack of assessments of iron exchange parameters at visits) and deviations from the Protocol affecting the assessment of efficacy parameters. Because of that, the additional efficacy analysis in the Per-Protocol Analysis Set was not performed.

Time frame: Screening, Week (Wk) 4, Wk 8, Wk 12, Wk 16, Wk 20, Wk 24, Wk 28, Wk 32, Wk 36, Wk 40, Wk 44, Wk 48, Wk 52

Population: Full Analysis Set included all patients of the Safety Analysis Set with available baseline data \& data obtained at follow-up visits \&/or final visit, for evaluation of at least 1 efficacy parameter. Statistical analysis was not performed due to large number of patients discontinuing \& thus lack of assessments of iron exchange parameters at visits.

ArmMeasureGroupValue (MEAN)Dispersion
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 42089.62 ng/mlStandard Deviation 638.29
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 202054.23 ng/mlStandard Deviation 729.14
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 521288.80 ng/ml
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 241710.67 ng/mlStandard Deviation 653.13
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 82498.58 ng/mlStandard Deviation 1165.94
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 281446.07 ng/mlStandard Deviation 395.17
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 02895.62 ng/mlStandard Deviation 1245.81
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 321626.28 ng/mlStandard Deviation 689.86
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 122262.12 ng/mlStandard Deviation 916.65
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 361709.07 ng/mlStandard Deviation 1153.94
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesScreening2866.14 ng/mlStandard Deviation 1460.13
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 401897.05 ng/mlStandard Deviation 1107.95
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 162164.01 ng/mlStandard Deviation 886.93
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 441301.80 ng/mlStandard Deviation 460.31
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Ferritin ValuesWeek 481740.00 ng/mlStandard Deviation 1493.24
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 44661.13 ng/mlStandard Deviation 267.15
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 48709.50 ng/mlStandard Deviation 305.32
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 52655.07 ng/mlStandard Deviation 277.98
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesScreening769.02 ng/mlStandard Deviation 230.36
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 0727.68 ng/mlStandard Deviation 299.61
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 4640.75 ng/mlStandard Deviation 292.14
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 8623.14 ng/mlStandard Deviation 223.27
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 12653.62 ng/mlStandard Deviation 311.72
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 16647.58 ng/mlStandard Deviation 225.28
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 20646.80 ng/mlStandard Deviation 147.73
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 24680.08 ng/mlStandard Deviation 182.24
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 28526.17 ng/mlStandard Deviation 122.4
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 32687.37 ng/mlStandard Deviation 114.47
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 36699.13 ng/mlStandard Deviation 217.38
Serum Ferritin Level < 1,000 μg/lChange in Serum Ferritin ValuesWeek 40717.33 ng/mlStandard Deviation 306.63
Primary

Change in Serum Total Iron-binding Capacity (TIBC)

Mean change from baseline in serum total iron-binding capacity was summarized descriptively for all on-treatment study visits.

Time frame: Screening, Week (Wk) 4, Wk 8, Wk 12, Wk 16, Wk 20, Wk 24, Wk 28, Wk 32, Wk 36, Wk 40, Wk 44, Wk 48, Wk 52

Population: Full Analysis Set (FAS) included all patients of the Safety Analysis Set with the available baseline data, as well as data obtained at follow-up visits and/or the final visit, for evaluation of at least one efficacy parameter.

ArmMeasureGroupValue (MEAN)Dispersion
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 1283.56 μmol/lStandard Deviation 19.86
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 28101.90 μmol/lStandard Deviation 23.71
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 049.98 μmol/lStandard Deviation 10.17
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 3272.85 μmol/lStandard Deviation 25.92
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 1685.31 μmol/lStandard Deviation 23.12
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 3676.56 μmol/lStandard Deviation 19.13
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 873.90 μmol/lStandard Deviation 10.97
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 4083.50 μmol/lStandard Deviation 19.74
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 2074.34 μmol/lStandard Deviation 18.95
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 4471.56 μmol/lStandard Deviation 23.95
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 478.70 μmol/lStandard Deviation 20.93
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 4874.30 μmol/lStandard Deviation 11.61
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 2481.90 μmol/lStandard Deviation 27.17
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 5267.10 μmol/lStandard Deviation 26.87
Serum Ferritin Level ≥ 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Screening4.51 μmol/lStandard Deviation 9.34
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 5246.77 μmol/lStandard Deviation 5.39
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Screening66.68 μmol/lStandard Deviation 14.95
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 049.10 μmol/lStandard Deviation 5.73
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 449.00 μmol/lStandard Deviation 4.95
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 847.44 μmol/lStandard Deviation 5.09
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 1247.20 μmol/lStandard Deviation 4.68
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 1649.53 μmol/lStandard Deviation 8.03
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 2048.63 μmol/lStandard Deviation 4.46
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 2446.53 μmol/lStandard Deviation 5.82
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 2845.97 μmol/lStandard Deviation 4.14
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 3248.23 μmol/lStandard Deviation 2.05
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 3647.53 μmol/lStandard Deviation 2.6
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 4046.30 μmol/lStandard Deviation 4.49
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 4444.10 μmol/lStandard Deviation 4.22
Serum Ferritin Level < 1,000 μg/lChange in Serum Total Iron-binding Capacity (TIBC)Week 4845.70 μmol/lStandard Deviation 5.57
Primary

Change in Transferrin Saturation With Iron (TSI) Values

Mean percentage change from baseline in transferrin saturation with iron was summarized descriptively for all on-treatment study visits.

Time frame: Screening, Week (Wk) 4, Wk 8, Wk 12, Wk 16, Wk 20, Wk 24, Wk 28, Wk 32, Wk 36, Wk 40, Wk 44, Wk 48, Wk 52

Population: Full Analysis Set (FAS) included all patients of the Safety Analysis Set with the available baseline data, as well as data obtained at follow-up visits and/or the final visit, for evaluation of at least one efficacy parameter.

ArmMeasureGroupValue (MEAN)Dispersion
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesScreening88.80 Percentage of saturationStandard Deviation 10.01
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 087.19 Percentage of saturationStandard Deviation 10.49
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 473.37 Percentage of saturationStandard Deviation 8.55
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 872.68 Percentage of saturationStandard Deviation 9.49
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 1272.43 Percentage of saturationStandard Deviation 5.98
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 1668.60 Percentage of saturationStandard Deviation 9.21
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 2068.14 Percentage of saturationStandard Deviation 19.64
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 2474.30 Percentage of saturationStandard Deviation 11.79
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 2865.05 Percentage of saturationStandard Deviation 7.57
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 3275.75 Percentage of saturationStandard Deviation 12.98
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 3665.94 Percentage of saturationStandard Deviation 13.87
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 4066.05 Percentage of saturationStandard Deviation 9.51
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 4469.22 Percentage of saturationStandard Deviation 16.95
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 4871.07 Percentage of saturationStandard Deviation 12.87
Serum Ferritin Level ≥ 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 5283.40 Percentage of saturationStandard Deviation 11.74
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 5243.57 Percentage of saturationStandard Deviation 4.09
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesScreening53.70 Percentage of saturationStandard Deviation 10.28
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 4043.07 Percentage of saturationStandard Deviation 2.57
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 054.88 Percentage of saturationStandard Deviation 14.5
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 2852.67 Percentage of saturationStandard Deviation 12.49
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 450.10 Percentage of saturationStandard Deviation 14.14
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 4844.20 Percentage of saturationStandard Deviation 1.39
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 849.54 Percentage of saturationStandard Deviation 17.12
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 3249.90 Percentage of saturationStandard Deviation 11.96
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 1249.04 Percentage of saturationStandard Deviation 10.15
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 4433.27 Percentage of saturationStandard Deviation 9.63
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 1652.78 Percentage of saturationStandard Deviation 9.21
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 3647.83 Percentage of saturationStandard Deviation 4.91
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 2050.65 Percentage of saturationStandard Deviation 11.45
Serum Ferritin Level < 1,000 μg/lChange in Transferrin Saturation With Iron (TSI) ValuesWeek 245.90 Percentage of saturationStandard Deviation 5.59

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026