Venous Thromboembolism
Conditions
Brief summary
The aim of the study is to investigate the safety and tolerability of dabigatran etexilate solution in children aged less than 1 year, to demonstrate comparable PK/PD relationship to older children and adults and to confirm dabigatran etexilate dosing algorithm for children aged less than 1 year.
Detailed description
Purpose:
Interventions
Experimental dose chosen based on age and weight
Sponsors
Study design
Eligibility
Inclusion criteria
* Neonates and infants with aged \< 12 months at Visit 1 * Objective diagnosis of VTE * End of planned treatment course with anticoagulant therapy as per standard of care at the investigator site. * Written informed consent provided by the patient's parent(s) (or legal guardian) according to local regulations at Visit 1.
Exclusion criteria
* Weight less than 3 kg at Visit 1 * Conditions associated with an increased risk of bleeding * renal dysfunction * hepatic disease * Anemia or thrombocytopenia at screening
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Central Measurement: The Mean of dTT Ratio at 2h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1 | Central measurement: The mean of dTT (AntiFactor IIa activity) ratio at 2 h and 12 h (±2 h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation. dTT ratio= dTT(post dose)/dTT(baseline). The mean of dTT ratio is presented. |
| Plasma Concentrations of Total Dabigatran, 2h and 12 h (+/-2h) Post Administration of Dabigatran Etexilate | 2 hours (h) and 12h after drug administration on day 1 | Plasma concentrations of total dabigatran, 2h and 12 h (+/-2h) post administration of dabigatran etexilate. |
| Central Measurement: The Mean aPTT Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | 2 h, and 12 h after dosing on day 1 | Central measurement: The mean activated partial thromboplastin time (aPTT) coagulation time at 2 h and 12 h (±2 h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation. |
| Central Measurement: The Mean of ECT Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | 2 h, and 12 h after dosing on day 1 | Central measurement: The mean of Ecarin Clotting Time (ECT) coagulation time at 2 h and 12h (+/-2h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation. |
| Central Measurement: The Mean of Diluted Thrombin Time (dTT) Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | 2 h, and 12 h after dosing on day 1 | Central measurement: The mean of dTT (AntiFactor IIa activity) coagulation time at 2 h and 12h (+/-2h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation. |
| Central Measurement: The Mean aPTT Ratio at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1 | Central measurement: The mean aPTT (activated partial thromboplastin time) ratio at 2 h and 12 h (±2 h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation. aPTT ratio= aPTT (post dose)/aPTT (baseline). The mean of aPTT ratio is presented. |
| Central Measurement: The Mean ECT Ratio at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1 | Central measurement: The mean Ecarin Clotting Time (ECT) ratio at 2 h and 12h (+/-2h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation. ECT ratio= ECT(Post dose)/ECT(baseline), The mean of ECT ratio is presented. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PK-PD Relationship: Relationship Between Total Dabigatran Plasma Concentration and Coagulation Parameters ECT Values. | baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1 | Linear regression models were used for modeling the relationship between total dabigatran plasma concentration and coagulation parameters ECT values. For our simple regression model, R-squared is equal to the square of Pearson's coefficient of correlation. The R-squared can be between 0 and 1. R-squared =1 means a perfect fit. |
| PK-PD Relationship: Relationship Between Total Dabigatran Plasma Concentration and Coagulation Parameters dTT Values. | baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1 | Linear regression models were used for modeling the relationship between total dabigatran plasma concentration and coagulation parameters dTT (AntiFactor IIa activity) values. For our simple regression model, R-squared is equal to the square of Pearson's coefficient of correlation. The R-squared can be between 0 and 1. R-squared =1 means a perfect fit. |
| Incidence of All Bleeding Events (Major, CRNM and Minor) During the Treatment Period. | Within two days after the administration of trial medication, up to 3 days | Percentage of patients with Incidence of all bleeding events(major, clinically relevant non-major (CRNM) & minor) during the treatment period (including the residual effect period).Bleeding events were classified as follow: Major bleeding: 1) Fatal bleeding 2) Clinically overt bleeding associated with decrease in haemoglobin of at least 2 g/dL (20 g/L) in 24-h-period 3) Bleeding that was retroperitoneal, pulmonary, intracranial, or otherwise involved the central nervous system 4) Bleeding that required surgical intervention in an operating suite. CRNM bleeding: 1) Overt bleeding for which a blood product was administered & which was not directly attributable to the patient's underlying medical condition 2) Bleeding that required medical or surgical intervention to restore haemostasis, other than in an operating suite. Minor bleeding defined as any overt or macroscopic evidence of bleeding that did not fulfil the criteria for either major bleeding or CRNM bleeding. |
| Incidence of All AEs During the Treatment Period | Within two days after the administration of trial medication, up to 3 days | Percentage of patients with all adverse events (AEs) during the treatment period (including REP). |
| Global Assessment of Acceptability and Tolerability of Study Medication | Day 1 (immediately after dosing) | The investigator was to provide a global clinical assessment of tolerability and acceptability of study medication by the patient.This assessment was based on 5-point scale (good, satisfactory, not satisfactory, bad, not assessable). |
| PK-PD Relationship: Relationship Between Total Dabigatran Plasma Concentration and Coagulation Parameters APTT Values. | baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1 | Linear regression models were used for modeling the relationship between total dabigatran plasma concentration and coagulation parameters APTT values. For our simple regression model, R-squared is equal to the square of Pearson's coefficient of correlation. The R-squared can be between 0 and 1. R-squared =1 means a perfect fit. |
Countries
Canada, France, Russia
Participant flow
Pre-assignment details
This was an open-label, multicentre, multinational, non-randomised, uncontrolled, single dose, single arm Phase IIa study.
Participants by arm
| Arm | Count |
|---|---|
| Dabigatran Etexilate The patients were orally administered a single dose of liquid formulation of dabigatran etexilate. The dose were adjusted based on an age and weight (equivalent to a 150 mg dose in adults). In case the patient could not take the full dose at once, the assigned dose could have been given as divided doses. | 8 |
| Total | 8 |
Baseline characteristics
| Characteristic | Dabigatran Etexilate |
|---|---|
| Age, Continuous | 2.912 Months STANDARD_DEVIATION 1.694 |
| Sex: Female, Male Female | 5 Participants |
| Sex: Female, Male Male | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 8 |
| serious Total, serious adverse events | 0 / 8 |
Outcome results
Central Measurement: The Mean aPTT Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate.
Central measurement: The mean activated partial thromboplastin time (aPTT) coagulation time at 2 h and 12 h (±2 h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation.
Time frame: 2 h, and 12 h after dosing on day 1
Population: PKS
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Dabigatran Etexilate | Central Measurement: The Mean aPTT Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | E2 | 78.9 second | Standard Deviation 26.7 |
| Dabigatran Etexilate | Central Measurement: The Mean aPTT Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | E12 | 62.8 second | Standard Deviation 27.7 |
Central Measurement: The Mean aPTT Ratio at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate.
Central measurement: The mean aPTT (activated partial thromboplastin time) ratio at 2 h and 12 h (±2 h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation. aPTT ratio= aPTT (post dose)/aPTT (baseline). The mean of aPTT ratio is presented.
Time frame: baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1
Population: PKS
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Dabigatran Etexilate | Central Measurement: The Mean aPTT Ratio at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | ER2 | 1.86 ratio | Standard Deviation 19.5 |
| Dabigatran Etexilate | Central Measurement: The Mean aPTT Ratio at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | ER12 | 1.47 ratio | Standard Deviation 17.7 |
Central Measurement: The Mean ECT Ratio at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate.
Central measurement: The mean Ecarin Clotting Time (ECT) ratio at 2 h and 12h (+/-2h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation. ECT ratio= ECT(Post dose)/ECT(baseline), The mean of ECT ratio is presented.
Time frame: baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1
Population: PKS
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Dabigatran Etexilate | Central Measurement: The Mean ECT Ratio at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | ER2 | 2.42 Ratio | Standard Deviation 34.2 |
| Dabigatran Etexilate | Central Measurement: The Mean ECT Ratio at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | ER12 | 1.63 Ratio | Standard Deviation 13.8 |
Central Measurement: The Mean of Diluted Thrombin Time (dTT) Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate.
Central measurement: The mean of dTT (AntiFactor IIa activity) coagulation time at 2 h and 12h (+/-2h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation.
Time frame: 2 h, and 12 h after dosing on day 1
Population: PKS
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Dabigatran Etexilate | Central Measurement: The Mean of Diluted Thrombin Time (dTT) Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | E2 | 48.7 second | Standard Deviation 24 |
| Dabigatran Etexilate | Central Measurement: The Mean of Diluted Thrombin Time (dTT) Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | E12 | 38.6 second | Standard Deviation 8.12 |
Central Measurement: The Mean of dTT Ratio at 2h and 12h (+/-2h) Post Administration of Dabigatran Etexilate.
Central measurement: The mean of dTT (AntiFactor IIa activity) ratio at 2 h and 12 h (±2 h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation. dTT ratio= dTT(post dose)/dTT(baseline). The mean of dTT ratio is presented.
Time frame: baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1
Population: PKS
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Dabigatran Etexilate | Central Measurement: The Mean of dTT Ratio at 2h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | ER12 | 1.26 ratio | Standard Deviation 5.67 |
| Dabigatran Etexilate | Central Measurement: The Mean of dTT Ratio at 2h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | ER2 | 1.59 ratio | Standard Deviation 25.4 |
Central Measurement: The Mean of ECT Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate.
Central measurement: The mean of Ecarin Clotting Time (ECT) coagulation time at 2 h and 12h (+/-2h) post administration of dabigatran etexilate. Standard deviation is actually the Coefficient of Variation.
Time frame: 2 h, and 12 h after dosing on day 1
Population: PKS
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Dabigatran Etexilate | Central Measurement: The Mean of ECT Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | E2 | 101 second | Standard Deviation 44.3 |
| Dabigatran Etexilate | Central Measurement: The Mean of ECT Coagulation Time at 2 h and 12h (+/-2h) Post Administration of Dabigatran Etexilate. | E12 | 66.9 second | Standard Deviation 23.5 |
Plasma Concentrations of Total Dabigatran, 2h and 12 h (+/-2h) Post Administration of Dabigatran Etexilate
Plasma concentrations of total dabigatran, 2h and 12 h (+/-2h) post administration of dabigatran etexilate.
Time frame: 2 hours (h) and 12h after drug administration on day 1
Population: Pharmacokinetic set (PKS): This patient set included all treated patients who provided at least 1 PK/PD observation and had no important Protocol violations (PVs) with respect to statistical analysis of Pharmacokinetic (PK) or Pharmacodynamic (PD ) endpoints.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Dabigatran Etexilate | Plasma Concentrations of Total Dabigatran, 2h and 12 h (+/-2h) Post Administration of Dabigatran Etexilate | 12h | 60.4 ng/mL | Geometric Coefficient of Variation 30 |
| Dabigatran Etexilate | Plasma Concentrations of Total Dabigatran, 2h and 12 h (+/-2h) Post Administration of Dabigatran Etexilate | 2h | 120.0 ng/mL | Geometric Coefficient of Variation 62.1 |
Global Assessment of Acceptability and Tolerability of Study Medication
The investigator was to provide a global clinical assessment of tolerability and acceptability of study medication by the patient.This assessment was based on 5-point scale (good, satisfactory, not satisfactory, bad, not assessable).
Time frame: Day 1 (immediately after dosing)
Population: Treated set
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Dabigatran Etexilate | Global Assessment of Acceptability and Tolerability of Study Medication | Good | 75.0 percentage of participants |
| Dabigatran Etexilate | Global Assessment of Acceptability and Tolerability of Study Medication | Satisfactory | 12.5 percentage of participants |
| Dabigatran Etexilate | Global Assessment of Acceptability and Tolerability of Study Medication | Not satisfactory | 0.0 percentage of participants |
| Dabigatran Etexilate | Global Assessment of Acceptability and Tolerability of Study Medication | Bad | 12.5 percentage of participants |
| Dabigatran Etexilate | Global Assessment of Acceptability and Tolerability of Study Medication | Not assessable | 0.0 percentage of participants |
Incidence of All AEs During the Treatment Period
Percentage of patients with all adverse events (AEs) during the treatment period (including REP).
Time frame: Within two days after the administration of trial medication, up to 3 days
Population: Treated set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dabigatran Etexilate | Incidence of All AEs During the Treatment Period | 0.0 percentage of participants |
Incidence of All Bleeding Events (Major, CRNM and Minor) During the Treatment Period.
Percentage of patients with Incidence of all bleeding events(major, clinically relevant non-major (CRNM) & minor) during the treatment period (including the residual effect period).Bleeding events were classified as follow: Major bleeding: 1) Fatal bleeding 2) Clinically overt bleeding associated with decrease in haemoglobin of at least 2 g/dL (20 g/L) in 24-h-period 3) Bleeding that was retroperitoneal, pulmonary, intracranial, or otherwise involved the central nervous system 4) Bleeding that required surgical intervention in an operating suite. CRNM bleeding: 1) Overt bleeding for which a blood product was administered & which was not directly attributable to the patient's underlying medical condition 2) Bleeding that required medical or surgical intervention to restore haemostasis, other than in an operating suite. Minor bleeding defined as any overt or macroscopic evidence of bleeding that did not fulfil the criteria for either major bleeding or CRNM bleeding.
Time frame: Within two days after the administration of trial medication, up to 3 days
Population: Treated set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dabigatran Etexilate | Incidence of All Bleeding Events (Major, CRNM and Minor) During the Treatment Period. | 0.0 Percentage of participants |
PK-PD Relationship: Relationship Between Total Dabigatran Plasma Concentration and Coagulation Parameters APTT Values.
Linear regression models were used for modeling the relationship between total dabigatran plasma concentration and coagulation parameters APTT values. For our simple regression model, R-squared is equal to the square of Pearson's coefficient of correlation. The R-squared can be between 0 and 1. R-squared =1 means a perfect fit.
Time frame: baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1
Population: PKS
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dabigatran Etexilate | PK-PD Relationship: Relationship Between Total Dabigatran Plasma Concentration and Coagulation Parameters APTT Values. | 0.752 R-Square |
PK-PD Relationship: Relationship Between Total Dabigatran Plasma Concentration and Coagulation Parameters dTT Values.
Linear regression models were used for modeling the relationship between total dabigatran plasma concentration and coagulation parameters dTT (AntiFactor IIa activity) values. For our simple regression model, R-squared is equal to the square of Pearson's coefficient of correlation. The R-squared can be between 0 and 1. R-squared =1 means a perfect fit.
Time frame: baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1
Population: PKS
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dabigatran Etexilate | PK-PD Relationship: Relationship Between Total Dabigatran Plasma Concentration and Coagulation Parameters dTT Values. | 0.920 R-Square |
PK-PD Relationship: Relationship Between Total Dabigatran Plasma Concentration and Coagulation Parameters ECT Values.
Linear regression models were used for modeling the relationship between total dabigatran plasma concentration and coagulation parameters ECT values. For our simple regression model, R-squared is equal to the square of Pearson's coefficient of correlation. The R-squared can be between 0 and 1. R-squared =1 means a perfect fit.
Time frame: baseline (0.5 h before intake of study medication), 2 h, and 12 h after dosing on day 1
Population: PKS
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dabigatran Etexilate | PK-PD Relationship: Relationship Between Total Dabigatran Plasma Concentration and Coagulation Parameters ECT Values. | 0.858 R-Square |