Primary Immunodeficiency Disease
Conditions
Brief summary
This Phase III clinical study is to test efficacy, safety and pharmacokinetics of BT595 in treating patients with Primary Immunodeficiency (PID)
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
Criteria for inclusion: 1. Written informed consent/assent obtained from subjects/subjects' parent(s) or legally acceptable representative indicating that they understood the purpose of, and procedures required for the study and are willing to participate in it. 2. Male or female, aged 2 through 75 years, inclusive. 3. Diagnosis of PID with impaired antibody production, ie: \- Diagnosis of common variable immunodeficiency (CVID) as defined by the European Society for Immunodeficiencies (ESID)/Pan American Group for Immunodeficiency (PAGID) diagnostic criteria. Or \- X-linked agammaglobulinaemia (XLA) as defined by ESID/PAGID diagnostic criteria. 4. Established replacement therapy with any immunoglobulin for intravenous administration (IVIg) reference preparation during the previous 6 months, including documentation of IgG trough levels. 5. Established replacement therapy with a single IVIg reference preparation for ≥3 months prior to treatment start with BT595 at a 3 week (Q3W) or 4 week (Q4W) schedule with a constant IVIg dose that did not change by ±20% of the mean dose, regular dosage intervals, and at least 1 IgG trough level of ≥5 g/L during the previous 3 months. Criteria for exclusion: 1. Pregnancy or unreliable contraceptive measures or lactation period (females only). 2. Known intolerance to immunoglobulins or comparable substances (eg, vaccination reaction). 3. Known intolerance to proteins of human origin or known allergic reactions to components of the study product. 4. Participation in another clinical study within 30 days before entering the study or during the study and/or previous participation in this study. 5. Employee or direct relative of an employee of the contract research organization, the study site, or Biotest. 6. Acquired medical conditions known to cause secondary immune deficiency, such as chronic lymphatic leukemia, lymphoma, multiple myeloma, as well as protein losing enteropathies and hypoalbuminemia. 7. Other medical condition, laboratory finding, or physical examination finding that precludes participation. 8. Recent febrile illness that precludes or delays participation. 9. Active infection and receiving antibiotic therapy for the treatment of this infection at the time of screening. Note: if the subject was deemed to be a screen failure due to a nonserious active infection requiring antibiotic therapy, the subject may have been rescreened after the initial screening. 10. Therapy with systemic steroids or other immunosuppressant drugs at the time of enrollment (current daily use of corticosteroids, ie, \>10 mg prednisone equivalent/day for \>30 days. Intermittent corticosteroid use during the study was allowable, if medically necessary). 11. History of thrombotic events (including myocardial infarction, cerebral vascular accident \[including stroke\], pulmonary embolism, and deep vein thrombosis) within the 6 months before treatment start with BT595 or the presence of significant risk factors for thrombotic events. 12. Therapy with live-attenuated virus vaccines within 3 months before start of the study. 13. Selective, absolute immunoglobulin A (IgA) deficiency or known antibodies to IgA. 14. Positive diagnosis of hepatitis B or hepatitis C. 15. Positive human immunodeficiency virus (HIV) test. 16. History of drug or alcohol abuse within the 12 months before treatment start with BT595. 17. Inability or lacking motivation to participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Acute Serious Bacterial Infections | approx. 12 month treatment period | The primary efficacy endpoint was the rate of acute serious bacterial infections, ie, the mean number of acute serious bacterial infections \[SBIs as defined by EMA and FDA\] per subject-year. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| IgG Trough Levels (Total IgG) Before Each Infusion | approx. 12 month treatment period | Total IgG levels \[g/L\] before each infusion, mean (SD) |
| Rate of Any Infections | approx. 12 month treatment period | The annual rate of infections was calculated as the number of all infections (serious plus nonserious) per subject-year |
| Rate of Nonserious Infections | approx. 12 month treatment period | The annual rate of nonserious infections was calculated as the number of nonserious infections per subject-year |
| Time to Resolution of Infections | approx. 12 month treatment period | Time to resolution of infections (days) was calculated as infection stop date - infection start date +1. |
| Antibiotic Treatment Information | approx. 12 month treatment period | Median (min-max) number of days on antibiotics treatment per subject |
| Rate of Time Lost From School/Work Due to Infections | approx. 12 month treatment period | Annual rates of the number of days subjects are not able to attend school/work due to infections and their treatment will be calculated per subject-year. |
| Hospitalization / Hospitalization Due to Infection | approx. 12 month treatment period | Annual rates of the number of days of hospitalization (any hospitalization/ hospitalization due to infection) will be calculated per subject-year. |
| Fever Episodes | approx. 12 month treatment period | The number of days with episodes of fever will be calculated as the number of fever episodes per subject-year. Fever is defined as a body temperature ≥38°C (≥100.4°F). |
Countries
Germany, Hungary, Russia, Spain, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| BT595 Subjects received BT595 (100 mg/mL human normal immunoglobulin) at doses between 0.2 and 0.8 g per kg body weight (bw) (2 to 8 mL/kg bw), either at a Q3W or Q4W schedule. The initial doses and dosage interval had to be consistent with the subject's prestudy IVIg treatment. | 67 |
| Total | 67 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 3 |
| Overall Study | Screen Failures | 14 |
| Overall Study | Withdrawal by Subject | 4 |
Baseline characteristics
| Characteristic | BT595 |
|---|---|
| Age, Categorical <=18 years | 18 Participants |
| Age, Categorical >=65 years | 5 Participants |
| Age, Categorical Between 18 and 65 years | 44 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 66 Participants |
| Region of Enrollment Germany | 4 Participants |
| Region of Enrollment Hungary | 28 Participants |
| Region of Enrollment Russia | 11 Participants |
| Region of Enrollment Spain | 3 Participants |
| Region of Enrollment United States | 21 Participants |
| Sex: Female, Male Female | 30 Participants |
| Sex: Female, Male Male | 37 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 67 |
| other Total, other adverse events | 63 / 67 |
| serious Total, serious adverse events | 9 / 67 |
Outcome results
Rate of Acute Serious Bacterial Infections
The primary efficacy endpoint was the rate of acute serious bacterial infections, ie, the mean number of acute serious bacterial infections \[SBIs as defined by EMA and FDA\] per subject-year.
Time frame: approx. 12 month treatment period
Population: The primary analysis intended to demonstrate that the SBI rate (upper limit of the 1-sided 99% CI) was \<1.0 per subject-year in the overall FAS
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BT595 | Rate of Acute Serious Bacterial Infections | 0.015 SBI rate per subject-year |
Antibiotic Treatment Information
Median (min-max) number of days on antibiotics treatment per subject
Time frame: approx. 12 month treatment period
Population: Full analysis set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| BT595 | Antibiotic Treatment Information | 6.0 days |
Fever Episodes
The number of days with episodes of fever will be calculated as the number of fever episodes per subject-year. Fever is defined as a body temperature ≥38°C (≥100.4°F).
Time frame: approx. 12 month treatment period
Population: Full analysis set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BT595 | Fever Episodes | 1.69 days per subject-year |
Hospitalization / Hospitalization Due to Infection
Annual rates of the number of days of hospitalization (any hospitalization/ hospitalization due to infection) will be calculated per subject-year.
Time frame: approx. 12 month treatment period
Population: Full analysis set
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| BT595 | Hospitalization / Hospitalization Due to Infection | Any Hospitalization | 0.70 days per subject-year |
| BT595 | Hospitalization / Hospitalization Due to Infection | Hospitalization due to Infection | 0.36 days per subject-year |
IgG Trough Levels (Total IgG) Before Each Infusion
Total IgG levels \[g/L\] before each infusion, mean (SD)
Time frame: approx. 12 month treatment period
Population: Full analysis set
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Screening, Q4W | 8.467 g/L | Standard Deviation 3.4562 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 7 (Week 18), Q3W | 10.032 g/L | Standard Deviation 2.2755 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Baseline, Q4W | 7.824 g/L | Standard Deviation 2.7705 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 1 (Week 0), Q4W | 7.824 g/L | Standard Deviation 2.7705 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 2 (Week 4), Q4W | 8.278 g/L | Standard Deviation 2.5919 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 3 (Week 8), Q4W | 8.246 g/L | Standard Deviation 2.397 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 4 (Week 12), Q4W | 8.410 g/L | Standard Deviation 2.2998 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 5 (Week 16), Q4W | 8.634 g/L | Standard Deviation 3.4997 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 6 (Week 20), Q4W | 8.203 g/L | Standard Deviation 2.2912 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 7 (Week 24), Q4W | 8.298 g/L | Standard Deviation 2.3822 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 8 (Week 28), Q4W | 8.308 g/L | Standard Deviation 2.1087 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 9 (Week 32), Q4W | 8.410 g/L | Standard Deviation 2.2353 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 10 (Week 36), Q4W | 8.264 g/L | Standard Deviation 2.2994 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 11 (Week 40), Q4W | 8.181 g/L | Standard Deviation 2.1706 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 12 (Week 44), Q4W | 8.336 g/L | Standard Deviation 2.0893 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 13 (Week 48), Q4W | 8.479 g/L | Standard Deviation 2.3571 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 14 (Week 52), Q4W | 8.437 g/L | Standard Deviation 2.1703 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 15 (extra dose administered), Q4W | 8.950 g/L | Standard Deviation 0.6608 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Follow-up, Q4W | 8.461 g/L | Standard Deviation 2.2248 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Screening, Q3W | 10.238 g/L | Standard Deviation 2.47 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Baseline, Q3W | 10.064 g/L | Standard Deviation 2.6829 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 1 (Week 0), Q3W | 10.261 g/L | Standard Deviation 2.7216 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 2 (Week 3), Q3W | 10.422 g/L | Standard Deviation 2.9521 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 3 (Week 6), Q3W | 10.509 g/L | Standard Deviation 2.9857 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 4 (Week 9), Q3W | 10.050 g/L | Standard Deviation 3.0155 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 5 (Week 12), Q3W | 10.267 g/L | Standard Deviation 3.2398 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 6 (Week 15), Q3W | 10.026 g/L | Standard Deviation 3.2135 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 8 (Week 21), Q3W | 10.268 g/L | Standard Deviation 2.7719 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 9 (Week 24), Q3W | 9.889 g/L | Standard Deviation 2.1752 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 10 (Week 27), Q3W | 10.343 g/L | Standard Deviation 2.2324 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 11 (Week 30), Q3W | 10.188 g/L | Standard Deviation 2.6981 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 12 (Week 33), Q3W | 10.427 g/L | Standard Deviation 2.732 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 13 (Week 36), Q3W | 10.087 g/L | Standard Deviation 2.6267 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 14 (Week 39), Q3W | 10.245 g/L | Standard Deviation 2.4434 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 15 (Week 42), Q3W | 10.539 g/L | Standard Deviation 2.249 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 16 (Week 45), Q3W | 10.045 g/L | Standard Deviation 2.7147 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 17 (Week 48), Q3W | 9.877 g/L | Standard Deviation 2.019 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Infusion 18 (Week 51), Q3W | 10.412 g/L | Standard Deviation 2.4921 |
| BT595 | IgG Trough Levels (Total IgG) Before Each Infusion | Follow-up, Q3W | 10.415 g/L | Standard Deviation 2.6176 |
Rate of Any Infections
The annual rate of infections was calculated as the number of all infections (serious plus nonserious) per subject-year
Time frame: approx. 12 month treatment period
Population: Full analysis set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BT595 | Rate of Any Infections | 2.80 infections per subject-year |
Rate of Nonserious Infections
The annual rate of nonserious infections was calculated as the number of nonserious infections per subject-year
Time frame: approx. 12 month treatment period
Population: Full analysis set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BT595 | Rate of Nonserious Infections | 2.74 infections per subject-year |
Rate of Time Lost From School/Work Due to Infections
Annual rates of the number of days subjects are not able to attend school/work due to infections and their treatment will be calculated per subject-year.
Time frame: approx. 12 month treatment period
Population: Full analysis set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BT595 | Rate of Time Lost From School/Work Due to Infections | 4.32 days per subject-year |
Time to Resolution of Infections
Time to resolution of infections (days) was calculated as infection stop date - infection start date +1.
Time frame: approx. 12 month treatment period
Population: Full analysis set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| BT595 | Time to Resolution of Infections | 7.0 days |