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A Study to Evaluate Efficacy of rFVIIIFc for Immune Tolerance Induction (ITI) in Severe Hemophilia A Participants With Inhibitors Undergoing the First ITI Treatment (verITI-8 Study)

A Non-controlled, Open-Label, Multicenter, Study of Efficacy of rFVIIIFc for Immune Tolerance Induction (ITI) in Severe Hemophilia A Subjects With Inhibitors Undergoing the First ITI Treatment

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03093480
Enrollment
16
Registered
2017-03-28
Start date
2017-12-08
Completion date
2021-02-16
Last updated
2022-03-28

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

Conditions

Hemophilia A With Inhibitors

Brief summary

The primary purpose of this study was to describe the time to tolerization (i.e., ITI success) with rFVIIIFc in participants within a maximum of 48 weeks (12 months) of ITI treatment.

Interventions

BIOLOGICALrFVIIIFc

rFVIIIFc 200 IU/kg/day in ITI Period, 50 or 100 IU/kg (adjusted according to Investigator judgement) in tapering Period, and prophylactic regimen in Follow-Up period as powder for injection administered intravenously.

Sponsors

Swedish Orphan Biovitrum
CollaboratorINDUSTRY
Bioverativ, a Sanofi company
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
MALE
Healthy volunteers
No

Inclusion criteria

* Ability of the participant or his legally authorized representative (e.g., parent or legal guardian) to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information in accordance with national and local participant privacy regulations * Male participants of any age diagnosed with severe hemophilia A (as confirmed from the medical record) * Currently diagnosed with high titer inhibitors (historical peak greater than or equal to (\>=) 5 Bethesda units per milliliter (BU/mL), according to medical records) * Previously treated with any plasma-derived or recombinant conventional or Extended Half-Life FVIII

Exclusion criteria

* Other coagulation disorder(s) in addition to hemophilia A * Previous immune tolerance induction (ITI) * History of hypersensitivity or anaphylaxis associated with any factor VIII (FVIII) administration * Planned major surgery scheduled during the study unless deferred until after study completion (minor surgery such as tooth extraction or insertion/replacement of central venous access device is allowed) * Abnormal renal function (serum creatinine \>1.5 milligram per deciliter (mg/dL) or 2 × upper limit of normal (ULN) for participant age based on local laboratory range) as assessed by local laboratory * Serum alanine aminotransferase or aspartate aminotransferase \> 5 × upper limit of normal (ULN) as assessed by local laboratory

Design outcomes

Primary

MeasureTime frameDescription
Time to Tolerization With rFVIIIFcUp to 48 WeeksTime required for participants to achieve immune tolerance induction (ITI) success where ITI success is defined as achieving all 3 of the following criteria: confirmed negative titers consisting of 2 consecutive negative inhibitor assessments within 2 weeks (less than \[\<\] 0.6 Bethesda units/milliliter \[mL\] by the Nijmegen-modified Bethesda assay); incremental recovery (IR) greater than or equal to (\>=) 66 percent (%) of the expected IR in 2 consecutive assessments; half-life (t½) \>= 7 hours.

Secondary

MeasureTime frameDescription
Number of Participants Who Experienced RelapseUp to 48 weeks (16 weeks Tapering period and 32 weeks follow-up period)Number of Participants with ITI success who reaches the criteria for relapse (defined as confirmed positive inhibitor titer \>= 0.6 BU/mL or abnormal recovery after tolerance is achieved, and t½ less than \[\<\] 7 hours) evaluated during the Tapering or Follow-Up Periods
Annualized Bleeding Rates During ITI PeriodUp to 48 weeksA bleeding episode started from the first sign of a bleed and ended no more than 72 hours after the last treatment for the bleed, within which any symptoms of bleeding at the same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. Annualized bleeding rate for a patient during the ITI period is defined as the number of bleeding episodes divided by the length of the ITI period in days\* 365.25.
Annualized Bleeding Rates After ITI PeriodUp to 48 weeks (16 weeks Tapering period and 32 weeks follow-up period)A bleeding episode started from the first sign of a bleed and ended no more than 72 hours after the last treatment for the bleed, within which any symptoms of bleeding at the same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. Annualized bleeding rate for a patient after the ITT period (for tapering and follow-up period) is defined as the number of bleeding episodes divided by the length of the period after the ITI period in days\* 365.25.
Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (TESAEs) as a Measure of Safety and TolerabilityUp to 2 YearsAn AE is any untoward medical occurrence that does not necessarily have a causal relationship with this treatment. An SAE is any untoward medical occurrence that at any dose: results in death; in the view of the Investigator, places the participant at immediate risk of death (a life-threatening event); requires inpatient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; results in a congenital anomaly/birth defect; any other medically important event that, in the opinion of the Investigator, may jeopardize the participant or may require intervention to prevent one of the other outcomes listed in the definition.
Average Number of Days Missed From Work or School Per Month During ITI PeriodUp to 48 weeksAverage number of days missed from school or work per month for a period (counting in non-missing diary days) is defined as number of the missing school/work days in the period divided by number of days with data entry in the period. Number of days per month missed from school or work is reported for those who attend school or have a job.
Number of Participants With Immune Tolerance Induction (ITI) SuccessUp to 48 WeeksNumber of participants who achieve ITI success where ITI success is defined as achieving all 3 of the following criteria: confirmed negative titers consisting of 2 consecutive negative inhibitor assessments within 2 weeks (\<0.6 Bethesda units/mL by the Nijmegen-modified Bethesda assay); incremental recovery (IR) \>= 66% of the expected IR at 2 consecutive assessments; half-life (t½) \>=7 hours.
Annualized Number of Hospitalization Days During ITI PeriodUp to 48 weeksAnnualized number of hospitalization days during a period for a patient is defined as the number of hospitalization days divided by the length of the period in days \* 365.25.
Annualized Number of Hospitalization Days After ITI PeriodUp to 48 weeks (16 weeks Tapering period & 32 weeks Follow-up period)Annualized number of hospitalization days during a period for a patient is defined as the number of hospitalization days divided by the length of the period in days \* 365.25.
Adherence to Treatment Regimen Overall Study PeriodUp to 2 YearsAdherence to treatment is based on prescribed daily dose for the overall study period which is defined as the percentage of administered doses versus the prescribed doses to a patient for the entire study duration.
Annualized rFVIIIFc Consumption for Overall Study PeriodUp to 2 YearsAnnualized rFVIIIFc consumption for a treatment period is the total nominal rFVIIIFc (IU/kg) / length of period in days \* 365.25.
Average Number of Days Missed From Work or School Per Month After ITI PeriodUp to 48 weeks (16 weeks Tapering period & 32 weeks Follow-up period)Average number of days missed from school or work per month for a period (counting in non-missing diary days) is defined as number of the missing school/work days in the period divided by number of days with data entry in the period. Number of days per month missed from school or work is reported for those who attend school or have a job.

Countries

Belgium, Bulgaria, Canada, France, Germany, Italy, Japan, Spain, United Kingdom, United States

Participant flow

Recruitment details

The study was conducted at 14 active centers in 7 countries between 08-Dec-2017 to 16-Feb-2021.

Pre-assignment details

Total 16 participants were screened, enrolled and received drug.

Participants by arm

ArmCount
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)
Participants were to receive rFVIIIFc at a dose of 200 international units (IU)/kilogram (kg) as once daily injections or divided on several injections per day at the discretion of the Investigator, starting at baseline visit up to maximum of 48 Weeks in ITI Period. Participants who met the criteria for immune tolerance induction (ITI) success entered the tapering period and received rFVIIIFc at a dose adjusted according to Investigator judgment based on the FVIII activity levels and with the aim of tapering the rFVIIIFc dose to reach a prophylactic dosing regimen within 16 weeks (4 months). Follow-Up was for 32 weeks under an adjusted prophylactic regimen according to Investigator judgment.
16
Total16

Baseline characteristics

CharacteristicRecombinant Coagulation Factor VIII Fc (rFVIIIFc)
Age, Continuous3.8 years
STANDARD_DEVIATION 4.06
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
0 Participants
Race (NIH/OMB)
Black or African American
2 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
2 Participants
Race (NIH/OMB)
White
12 Participants
Sex: Female, Male
Female
NA Participants
Sex: Female, Male
Male
16 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
0 / 16
other
Total, other adverse events
15 / 16
serious
Total, serious adverse events
9 / 16

Outcome results

Primary

Time to Tolerization With rFVIIIFc

Time required for participants to achieve immune tolerance induction (ITI) success where ITI success is defined as achieving all 3 of the following criteria: confirmed negative titers consisting of 2 consecutive negative inhibitor assessments within 2 weeks (less than \[\<\] 0.6 Bethesda units/milliliter \[mL\] by the Nijmegen-modified Bethesda assay); incremental recovery (IR) greater than or equal to (\>=) 66 percent (%) of the expected IR in 2 consecutive assessments; half-life (t½) \>= 7 hours.

Time frame: Up to 48 Weeks

Population: Participants who are in ITI full analysis set (includes all participants receiving at least 1 infusion of rFVIIIFc) and achieved ITI success

ArmMeasureValue (MEDIAN)
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Time to Tolerization With rFVIIIFc11.7 weeks
Secondary

Adherence to Treatment Regimen Overall Study Period

Adherence to treatment is based on prescribed daily dose for the overall study period which is defined as the percentage of administered doses versus the prescribed doses to a patient for the entire study duration.

Time frame: Up to 2 Years

Population: ITI full analysis set

ArmMeasureValue (MEAN)Dispersion
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Adherence to Treatment Regimen Overall Study Period100.8 percentage of dosesStandard Deviation 7.76
Secondary

Annualized Bleeding Rates After ITI Period

A bleeding episode started from the first sign of a bleed and ended no more than 72 hours after the last treatment for the bleed, within which any symptoms of bleeding at the same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. Annualized bleeding rate for a patient after the ITT period (for tapering and follow-up period) is defined as the number of bleeding episodes divided by the length of the period after the ITI period in days\* 365.25.

Time frame: Up to 48 weeks (16 weeks Tapering period and 32 weeks follow-up period)

Population: Tapering period full analysis set excluding participants who were observed for less than 90 days in the period.

ArmMeasureGroupValue (MEAN)Dispersion
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Annualized Bleeding Rates After ITI PeriodTapering period1.0 episodes per participant per yearStandard Deviation 1.27
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Annualized Bleeding Rates After ITI PeriodFollow-up Period1.2 episodes per participant per yearStandard Deviation 2.91
Secondary

Annualized Bleeding Rates During ITI Period

A bleeding episode started from the first sign of a bleed and ended no more than 72 hours after the last treatment for the bleed, within which any symptoms of bleeding at the same location or injections less than or equal to 72 hours apart were considered the same bleeding episode. Annualized bleeding rate for a patient during the ITI period is defined as the number of bleeding episodes divided by the length of the ITI period in days\* 365.25.

Time frame: Up to 48 weeks

Population: ITI full analysis set which excludes participants who were observed for less than 90 days during the period

ArmMeasureValue (MEAN)Dispersion
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Annualized Bleeding Rates During ITI Period6.6 episodes per participant per yearStandard Deviation 9.5
Secondary

Annualized Number of Hospitalization Days After ITI Period

Annualized number of hospitalization days during a period for a patient is defined as the number of hospitalization days divided by the length of the period in days \* 365.25.

Time frame: Up to 48 weeks (16 weeks Tapering period & 32 weeks Follow-up period)

Population: Tapering Period Full analysis set but excluding patients who were observed for less than 90 days in the period.

ArmMeasureValue (MEAN)Dispersion
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Annualized Number of Hospitalization Days After ITI Period2.7 daysStandard Deviation 8.53
Secondary

Annualized Number of Hospitalization Days During ITI Period

Annualized number of hospitalization days during a period for a patient is defined as the number of hospitalization days divided by the length of the period in days \* 365.25.

Time frame: Up to 48 weeks

Population: ITI Full analysis set but excluding patients who were observed for less than 90 days in the period.

ArmMeasureValue (MEAN)Dispersion
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Annualized Number of Hospitalization Days During ITI Period15.4 daysStandard Deviation 32.24
Secondary

Annualized rFVIIIFc Consumption for Overall Study Period

Annualized rFVIIIFc consumption for a treatment period is the total nominal rFVIIIFc (IU/kg) / length of period in days \* 365.25.

Time frame: Up to 2 Years

Population: ITI Full analysis set

ArmMeasureValue (MEAN)Dispersion
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Annualized rFVIIIFc Consumption for Overall Study Period42713.4 international unit (IU)/kilograms (kg)Standard Deviation 20938.08
Secondary

Average Number of Days Missed From Work or School Per Month After ITI Period

Average number of days missed from school or work per month for a period (counting in non-missing diary days) is defined as number of the missing school/work days in the period divided by number of days with data entry in the period. Number of days per month missed from school or work is reported for those who attend school or have a job.

Time frame: Up to 48 weeks (16 weeks Tapering period & 32 weeks Follow-up period)

Population: Participants of Tapering full analysis set and who attended school or have a job

ArmMeasureValue (MEAN)
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Average Number of Days Missed From Work or School Per Month After ITI Period0 days
Secondary

Average Number of Days Missed From Work or School Per Month During ITI Period

Average number of days missed from school or work per month for a period (counting in non-missing diary days) is defined as number of the missing school/work days in the period divided by number of days with data entry in the period. Number of days per month missed from school or work is reported for those who attend school or have a job.

Time frame: Up to 48 weeks

Population: Participants of ITI full analysis set and who attend school or have a job

ArmMeasureValue (MEAN)Dispersion
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Average Number of Days Missed From Work or School Per Month During ITI Period2.3 daysStandard Deviation 1.21
Secondary

Number of Participants Who Experienced Relapse

Number of Participants with ITI success who reaches the criteria for relapse (defined as confirmed positive inhibitor titer \>= 0.6 BU/mL or abnormal recovery after tolerance is achieved, and t½ less than \[\<\] 7 hours) evaluated during the Tapering or Follow-Up Periods

Time frame: Up to 48 weeks (16 weeks Tapering period and 32 weeks follow-up period)

Population: Tapering Full analysis set

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Number of Participants Who Experienced Relapse0 Participants
Secondary

Number of Participants With Immune Tolerance Induction (ITI) Success

Number of participants who achieve ITI success where ITI success is defined as achieving all 3 of the following criteria: confirmed negative titers consisting of 2 consecutive negative inhibitor assessments within 2 weeks (\<0.6 Bethesda units/mL by the Nijmegen-modified Bethesda assay); incremental recovery (IR) \>= 66% of the expected IR at 2 consecutive assessments; half-life (t½) \>=7 hours.

Time frame: Up to 48 Weeks

Population: ITI full analysis set

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Number of Participants With Immune Tolerance Induction (ITI) Success10 Participants
Secondary

Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (TESAEs) as a Measure of Safety and Tolerability

An AE is any untoward medical occurrence that does not necessarily have a causal relationship with this treatment. An SAE is any untoward medical occurrence that at any dose: results in death; in the view of the Investigator, places the participant at immediate risk of death (a life-threatening event); requires inpatient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; results in a congenital anomaly/birth defect; any other medically important event that, in the opinion of the Investigator, may jeopardize the participant or may require intervention to prevent one of the other outcomes listed in the definition.

Time frame: Up to 2 Years

Population: ITI full analysis set

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (TESAEs) as a Measure of Safety and TolerabilityDeath0 Participants
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (TESAEs) as a Measure of Safety and Tolerabilitydiscontinuation of treatment and/or the study due to an AE0 Participants
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (TESAEs) as a Measure of Safety and Tolerabilityat least one TEAE16 Participants
Recombinant Coagulation Factor VIII Fc (rFVIIIFc)Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (TESAEs) as a Measure of Safety and Tolerabilityat least one TESAE9 Participants

Source: ClinicalTrials.gov · Data processed: Feb 13, 2026