Aplastic Anemia
Conditions
Keywords
Severe Aplastic Anemia, Eltrombopag, ETB115, Chinese subject, Chinese refractory or relapsed SAA subjects, refractory severe aplastic anemia, relapsed severe aplastic anemia
Brief summary
This was a non-randomized, open-label, phase II study to assess the efficacy and safety of eltrombopag in Chinese subjects with refractory or relapsed severe aplastic anemia (SAA). Treatment with eltrombopag was started at 25 mg/day and increased by 25 mg/day every 2 weeks according to the platelet count up to 150 mg/day. The hematological response rate was assessed at 3, 6 months and 1 year after starting the study treatment (Week 13, 26 and 52).
Detailed description
This was a bridging study to support China registration. An estimation strategy rather than a formal hypothesis testing was pursued. Twenty subjects were enrolled into the study. Treatment with eltrombopag started at 25 mg/day and increased by 25 mg/day every 2 weeks according to the platelet count, up to 150 mg/day. Hematological response rate was assessed at 3, 6 months and 1 year (Week 13, 26 and 52) after starting the study treatment. Subjects in whom the treatment was found to be effective at 6 months continued to receive the treatment. Eltrombopag was discontinued if the treatment was ineffective at 6 months. Subjects discontinued eltrombopag before 6 months if any of the treatment discontinuation criteria was met. Analysis set for the primary endpoint was Full Analysis Set (FAS) and subjects who discontinue from the study before Week 26 were treated as non-responders in the response analysis. Eltrombopag treatment was provided to subjects who were considered to require continued treatment at Week 26. After Week 26, if all of the hematologic response criteria (i.e., platelet count \> 50×109/L, hemoglobin level \> 100 g/L without transfusion, and neutrophil count \> 1.0×109/L) remained fulfilled for more than 8 weeks, the dose of eltrombopag was decreased by half. If the response continued for further 8 weeks even at the decreased dose, the treatment was discontinued. If a decrease in any of the hematologic values (i.e., platelet count \< 30×109/L, hemoglobin \< 90 g/L, or neutrophil count \< 0.5×109/L) was found after dose reduction, the dose was increased to the previous level. Furthermore, after treatment interruption, the treatment was restarted if any of the hematologic values decreased to the above-mentioned levels. The response assessment and safety evaluation were performed at Week 52. The Extension part of this study started 1 year (Week 52) after the initiation of study treatment. This part was included in the study with an ethical consideration for subjects who required continued treatment. The continued treatment was provided up to the launch of eltrombopag after approval. Follow-up visit was performed 30 days after the discontinuation of eltrombopag treatment. To better understand the pharmacokinetics (PK) characteristics of eltrombopag in Chinese severe aplastic anemia (SAA) patient population, intensive PK blood samples were collected only in the initial 12 Chinese subjects receiving 25 mg/day dose after reaching steady-state, to provide evaluable full PK profiles. Steady-state trough concentrations were collected at other dose levels and in other subjects.
Interventions
Eltrombopag are film-coated tablets containing 25 mg of eltrombopag free acid in each tablet.
Sponsors
Study design
Eligibility
Inclusion criteria
* Chinese patients aged greater than or equal to 18 years old. * Patient with a previous diagnosis of severe aplastic anemia and had insufficient response following at least one treatment course in the period time of \> 6 months of immunosuppression with a regimen containing anti-thymocyte globulin (ATG), anti-lymphocyte globulin (ALG), and/or cyclophosphamide, or alemtuzumab. * Platelet count ≤ 30 × 10\^9/L at screening. * Patient must not currently have the option of stem cell transplantation. * Patient has an Eastern Cooperative Oncology Group (ECOG) performance status 0-2. * Patient with QTcF (Fridericia's QT correction formula) at screening \<450 msec, or \<480 msec with bundle branch block, as determined via the mean of a triplicate ECG and assessed at site.
Exclusion criteria
* Treatment with ATG/ALG, cyclophosphamide or alemtuzumab in the past 6 months. * Congenital aplastic anemia * AST or ALT ≥3 times the upper limit of normal. * Creatinine, total bilirubin, and alkaline phosphatase (ALP) ≥ 1.5× local ULN (total bilirubin ≥ 2.5 × local ULN with Gilbert's Syndrome). * Paroxysmal nocturnal hemoglobinuria (PNH) granulocyte clone size determined by flow cytometry ≥ 50%. * Presence of chromosomal aberration (-7/7q- detected by fluorescence in situ hybridization (FISH), or other aberrations detected by G-band staining). * Evidence of a clonal hematologic bone marrow disorder on cytogenetics. * Past medical history of thromboembolism within 6 months or current use of anticoagulants. * Have any concomitant malignancies and must be fully recovered from treatment for any other malignancy and have been disease-free for 5 years. * Patient with clinically significant (of such severity that it would preclude the patient's ability to consent, be compliant with study procedures, tolerate protocol therapy) bacterial, fungal, mycobacterial, parasitic or viral infection (Patient with acute bacterial infections requiring antibiotic use should delay Screening/enrollment until the course of antibiotic therapy has been completed). * Patient with known hepatocellular disease * Presences of hepatitis B surface antigen (HBsAg), positive hepatitis C antibody test result at screening. * Cardiac disorder (NYHA) functional classification Grade II/III/IV * Past medical history of immediate or delayed hypersensitivity to compounds chemically similar to eltrombopag or their excipients. * Treatment with another investigational product within 30 days. * Prior treatment with eltrombopag, romiplostim, or any other TPO (thrombopoietin) receptor agonist. * Positive result for HIV (Human Immunodeficiency Virus) antibody test. * Pregnant or nursing (lactating) woman. * Woman of child-bearing potential.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hematologic Response Rate at 6 Months (Week 26) by Investigator | 6 months (Week 26) | Hematologic response rate: percentage of subjects who met any of the International Working Group criteria: Platelet count: If platelet transfusion independent at baseline (BL): Transfusion independent and increase from BL by 20×10\^9/L or more; If platelet transfusion dependent at BL: No platelet transfusion requirement for 8 weeks; Hemoglobin: If red blood cells (RBC) transfusion independent at BL: transfusion independent and increase from BL by 15 g/L or more; If RBC transfusion dependent at BL: A decrease of at least 4 units in RBC transfusions in the post-treatment 8-week period (1 unit = RBC derived from 200 mL blood) or no RBC transfusion requirement for 8 weeks; Neutrophil count: In the absence of granulocyte colony stimulating factor (G-CSF) taken within 21 days preceding the blood sample collection: Increase from BL by 0.5×10\^9/L or more, or (if \< 0.5×10\^9/L at BL) increase by 100% or more. Patients who discontinued from the trial before week 26 were treated as non-responders. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hematologic Response Rate by Investigator | Week (Wk) 13, Week 52 | Hematologic response rate: percentage of subjects who met any of the International Working Group criteria: Platelet count: If platelet transfusion independent at baseline (BL): Transfusion independent and increase from BL by 20×10\^9/L or more; If platelet transfusion dependent at BL: No platelet transfusion requirement for 8 wks; Hemoglobin: If red blood cells (RBC) transfusion independent at BL: transfusion independent and increase from BL by 15 g/L or more; If RBC transfusion dependent at BL: A decrease of at least 4 units in RBC transfusions in the post-treatment 8-week period (1 unit =RBC derived from 200 mL blood) or no RBC transfusion requirement for 8 wks; Neutrophil count: In the absence of granulocyte colony stimulating factor (G-CSF) taken within 21 days preceding the blood sample collection: Increase from BL by 0.5×10\^9/L or more, or (if \< 0.5×10\^9/L at BL) increase by 100% or more. Patients who discontinued from the trial before wks 13 & 26 were treated as non-responders. |
| Change From Baseline in Hemoglobin Levels | Baseline, Week 13, Week 26 and Week 52 | Change (increase from baseline) in hemoglobin (in the absence of red blood cell (RBC) transfusion) were calculated according to the lab test results entered into the CRF that were summarized at each visit using descriptive statistics. Hemoglobin level (g/L) was assessed in hematology test. |
| Change From Baseline in Neutrophil Count | Baseline, Week 13, Week 26 and Week 52 | Change (increase from baseline) in neutrophil count (in the absence of granulocyte colony stimulating factor (G-CSF) and calculated according to the lab test results entered into the CRF that were summarized at each visit using descriptive statistics). Neutrophil count (×109/L) was assessed in hematology test. |
| Time to Hematologic Response by Investigator | Baseline to Week 26 | Time to hematological response was defined as the time from the date of first study drug administration to the first hematological response. If a participant did not meet hematological response before or at the cutoff date, censoring was performed using the date of last assessment. |
| Duration of Hematologic Response by Investigator | up to approx. 3.5 years | Duration of hematologic response (any response according to the response criteria for the primary endpoint). For subjects who responded, duration of response was defined as the number of weeks from the first date of hematological response until the first date of relapse or death. Only participants with at least two response assessments were included for the duration of hematologic response assessment. |
| Frequency of Platelets Transfusion | Baseline, Week 13, Week 26 and Week 52 | For subjects receiving transfusion (platelets) at baseline, the frequency of platelet transfusion in each period (Baseline: 4 weeks before Day 1; Week 13, 26, 52: 4 weeks before each visit day) was summarized using descriptive statistics. |
| Amount of Platelets Transfusion | Baseline, Week 13, Week 26 and Week 52 | The amount of transfusion was defined as the sum of transfusion multiplied by the volume of transfusion. |
| Change From Baseline in Platelet Count | Baseline, Week 13, Week 26, Week 52 | Change (increase from baseline) in platelet count (in the absence of platelet transfusion) were calculated according to the lab test results entered into the case report form (CRF) that were summarized at each visit using descriptive statistics. Platelet Count (×109/L) was assessed in hematology test. |
| Amount of Red Blood Cells (RBC) Transfusion | Baseline, Week 13, Week 26 and Week 52 | The amount of RBC transfusion was defined as the sum of transfusion multiplied by the volume of transfusion. |
| Plasma PK Parameters of Eltrombopag: Cmax | pre-dose, and 1, 2, 4, 6, 8 and 24 hours post-dose on Day 14 | Cmax is the maximum (peak) observed plasma drug concentration after single dose administration (mass\*volume-1). Blood samples were collected from patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state. |
| Plasma PK Parameters of Eltrombopag: Tmax | pre-dose, and 1, 2, 4, 6, 8 and 24 hours post-dose on Day 14 | Tmax is the time to reach maximum (peak) plasma drug concentration after single dose administration (time). Blood samples were collected from all patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state. |
| Plasma PK Parameters of Eltrombopag: AUCtau & AUClast | pre-dose, and 1, 2, 4, 6, 8 and 24 hours post-dose on Day 14 | AUCtau is the area under the curve calculated to the end of a dosing interval (tau) at steady-state (amount\*time\*volume-1). AUClast is the AUC calculated from time 0 to the time of the last quantifiable concentration. Blood samples were collected from patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state. |
| Plasma PK Parameters of Eltrombopag: CLss/F | pre-dose, and 1, 2, 4, 6, 8 and 24 hours post-dose on Day 14 | Steady State (CLss/F) is the apparent systemic (or total body) clearance at steady state from plasma (volume/time) following drug administration. Blood samples were collected from patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state. |
| Plasma Trough Concentration of Eltrombopag | Pre-dose sample on the 15th day after each new dose level was started | Ctrough is the pre-dose concentration at the end of dose interval (mass\*volume-1). Blood samples were collected from patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state. Sparse PK blood samples were collected for the other doses and in the rest of the patients for Ctrough assessment. |
| Number of Participants With Clonal Evolution | From Baseline up to approx. 2.9 years | Number of participants with clonal evolution with a normal karyotype at baseline including clonal evolution to PNH (Paroxysmal Nocturnal Hemoglobinuria), evolution to AML (Acute Myeloid Leukemia) or MDS (Myelodysplastic Syndromes). |
| Frequency of Red Blood Cells (RBC) Transfusion | Baseline, Week 13, Week 26 and Week 52 | For subjects receiving transfusion (RBC (Red Blood Cell)) at baseline, the frequency of RBC transfusion in each period (Baseline: 8 weeks before Day 1; Week 13, 26, 52: 8 weeks before each visit day) was summarized using descriptive statistics. |
Countries
China
Participant flow
Recruitment details
The study enrolled all 20 participants from 5 sites in China.
Pre-assignment details
One of the main criteria for enrollment was for Chinese patients aged ≥ 18 years, previously diagnosed with SAA and who had insufficient response following at least one treatment course in the period time of \> 6 months of immunosuppression with a regimen containing anti-thymocyte globulin (ATG), anti-lymphocyte Immunoglobulin (ALG), and/or cyclophosphamide, or alemtuzumab.
Participants by arm
| Arm | Count |
|---|---|
| Eltrombopag Participants started eltrombopag treatment at 25 mg/day from Day 1 and increased by 25 mg/day every 2 weeks according to the platelet count up to 150 mg/day. | 20 |
| Total | 20 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
| Overall Study | Death | 1 |
| Overall Study | Lost to Follow-up | 1 |
| Overall Study | Withdrawal by Subject | 3 |
Baseline characteristics
| Characteristic | Eltrombopag |
|---|---|
| Age, Continuous | 39.0 years STANDARD_DEVIATION 13.25 |
| Race/Ethnicity, Customized Asian | 20 Participants |
| Sex: Female, Male Female | 5 Participants |
| Sex: Female, Male Male | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 20 | 1 / 20 |
| other Total, other adverse events | 19 / 20 | 0 / 0 |
| serious Total, serious adverse events | 8 / 20 | 0 / 0 |
Outcome results
Hematologic Response Rate at 6 Months (Week 26) by Investigator
Hematologic response rate: percentage of subjects who met any of the International Working Group criteria: Platelet count: If platelet transfusion independent at baseline (BL): Transfusion independent and increase from BL by 20×10\^9/L or more; If platelet transfusion dependent at BL: No platelet transfusion requirement for 8 weeks; Hemoglobin: If red blood cells (RBC) transfusion independent at BL: transfusion independent and increase from BL by 15 g/L or more; If RBC transfusion dependent at BL: A decrease of at least 4 units in RBC transfusions in the post-treatment 8-week period (1 unit = RBC derived from 200 mL blood) or no RBC transfusion requirement for 8 weeks; Neutrophil count: In the absence of granulocyte colony stimulating factor (G-CSF) taken within 21 days preceding the blood sample collection: Increase from BL by 0.5×10\^9/L or more, or (if \< 0.5×10\^9/L at BL) increase by 100% or more. Patients who discontinued from the trial before week 26 were treated as non-responders.
Time frame: 6 months (Week 26)
Population: The Full Analysis Set (FAS) comprised all patients to whom study treatment had been assigned and received one dose of study treatment. The patients who discontinued from the trial before Week 26 were treated as non-responders.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Eltrombopag | Hematologic Response Rate at 6 Months (Week 26) by Investigator | 70.0 Percentage of participants |
Amount of Platelets Transfusion
The amount of transfusion was defined as the sum of transfusion multiplied by the volume of transfusion.
Time frame: Baseline, Week 13, Week 26 and Week 52
Population: Participants in the FAS who were platelet transfusion dependent at baseline and who did not discontinue prior to the corresponding visit date (Week 13, 26 and 52).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Eltrombopag | Amount of Platelets Transfusion | Baseline | 3.7 Units | Standard Deviation 3.63 |
| Eltrombopag | Amount of Platelets Transfusion | Week 13 | 0.4 Units | Standard Deviation 0.88 |
| Eltrombopag | Amount of Platelets Transfusion | Week 26 | 0.1 Units | Standard Deviation 0.35 |
| Eltrombopag | Amount of Platelets Transfusion | Week 52 | 0.0 Units | Standard Deviation 0 |
Amount of Red Blood Cells (RBC) Transfusion
The amount of RBC transfusion was defined as the sum of transfusion multiplied by the volume of transfusion.
Time frame: Baseline, Week 13, Week 26 and Week 52
Population: Participants in the FAS who were RBC transfusion dependent at baseline and who did not discontinue prior to the corresponding visit date (Week 13, 26 and 52).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Eltrombopag | Amount of Red Blood Cells (RBC) Transfusion | Baseline | 6.6 Units | Standard Deviation 4.16 |
| Eltrombopag | Amount of Red Blood Cells (RBC) Transfusion | Week 13 | 3.8 Units | Standard Deviation 6.18 |
| Eltrombopag | Amount of Red Blood Cells (RBC) Transfusion | Week 25 | 3.0 Units | Standard Deviation 4.02 |
| Eltrombopag | Amount of Red Blood Cells (RBC) Transfusion | Week 52 | 1.4 Units | Standard Deviation 1.9 |
Change From Baseline in Hemoglobin Levels
Change (increase from baseline) in hemoglobin (in the absence of red blood cell (RBC) transfusion) were calculated according to the lab test results entered into the CRF that were summarized at each visit using descriptive statistics. Hemoglobin level (g/L) was assessed in hematology test.
Time frame: Baseline, Week 13, Week 26 and Week 52
Population: The Full Analysis Set (FAS) comprised all patients to whom study treatment had been assigned and received one dose of study treatment. These were the patients in FAS with a valid assessment for the outcome measure at baseline and at Weeks 13, 26 and 52.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Eltrombopag | Change From Baseline in Hemoglobin Levels | Baseline | 66.9 gram/liter | Standard Deviation 19.9 |
| Eltrombopag | Change From Baseline in Hemoglobin Levels | Change from BL at Week 13/Day92 | 22.4 gram/liter | Standard Deviation 23.47 |
| Eltrombopag | Change From Baseline in Hemoglobin Levels | Change from baseline at Week 26/Day 183 | 31.9 gram/liter | Standard Deviation 29.2 |
| Eltrombopag | Change From Baseline in Hemoglobin Levels | Change from BL at Week 52/Day 365 | 32.9 gram/liter | Standard Deviation 33.21 |
Change From Baseline in Neutrophil Count
Change (increase from baseline) in neutrophil count (in the absence of granulocyte colony stimulating factor (G-CSF) and calculated according to the lab test results entered into the CRF that were summarized at each visit using descriptive statistics). Neutrophil count (×109/L) was assessed in hematology test.
Time frame: Baseline, Week 13, Week 26 and Week 52
Population: The Full Analysis Set (FAS) comprised all patients to whom study treatment had been assigned and received one dose of study treatment. These were the patients in FAS with a valid assessment for the outcome measure at baseline and at Weeks 13, 26 and 52.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Eltrombopag | Change From Baseline in Neutrophil Count | Baseline | 1.199 10^9 neutrophils/liter | Standard Deviation 1.3483 |
| Eltrombopag | Change From Baseline in Neutrophil Count | Change from BL at Week 13/Day 92 (n = 16) | -0.160 10^9 neutrophils/liter | Standard Deviation 1.4141 |
| Eltrombopag | Change From Baseline in Neutrophil Count | Change from baseline at Week 26/Day 183 (n = 14) | 0.196 10^9 neutrophils/liter | Standard Deviation 1.6822 |
| Eltrombopag | Change From Baseline in Neutrophil Count | Change from BL at Week 52/Day 365 (n = 14) | 0.447 10^9 neutrophils/liter | Standard Deviation 1.5764 |
Change From Baseline in Platelet Count
Change (increase from baseline) in platelet count (in the absence of platelet transfusion) were calculated according to the lab test results entered into the case report form (CRF) that were summarized at each visit using descriptive statistics. Platelet Count (×109/L) was assessed in hematology test.
Time frame: Baseline, Week 13, Week 26, Week 52
Population: The Full Analysis Set (FAS) comprised all patients to whom study treatment had been assigned and received one dose of study treatment.~These were the patients in FAS with a valid assessment for the outcome measure at baseline and at Weeks 13, 26 and 52.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Eltrombopag | Change From Baseline in Platelet Count | Baseline (BL) | 10.725 10^9 platelets/liter | Standard Deviation 7.8731 |
| Eltrombopag | Change From Baseline in Platelet Count | Change from BL at Week 13/Day92 | 10.265 10^9 platelets/liter | Standard Deviation 14.1456 |
| Eltrombopag | Change From Baseline in Platelet Count | Change from BL at Week 26/Day 183 | 26.933 10^9 platelets/liter | Standard Deviation 30.5304 |
| Eltrombopag | Change From Baseline in Platelet Count | Change from BL at Week 52/Day 365 | 41.071 10^9 platelets/liter | Standard Deviation 56.6816 |
Duration of Hematologic Response by Investigator
Duration of hematologic response (any response according to the response criteria for the primary endpoint). For subjects who responded, duration of response was defined as the number of weeks from the first date of hematological response until the first date of relapse or death. Only participants with at least two response assessments were included for the duration of hematologic response assessment.
Time frame: up to approx. 3.5 years
Population: Participants in the FAS who achieved a hematologic response. The Full Analysis Set (FAS) comprised all patients to whom study treatment had been assigned and received one dose of study treatment and achieved a hematologic response.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Eltrombopag | Duration of Hematologic Response by Investigator | NA Weeks |
Frequency of Platelets Transfusion
For subjects receiving transfusion (platelets) at baseline, the frequency of platelet transfusion in each period (Baseline: 4 weeks before Day 1; Week 13, 26, 52: 4 weeks before each visit day) was summarized using descriptive statistics.
Time frame: Baseline, Week 13, Week 26 and Week 52
Population: Participants in the FAS who were platelet transfusion dependent at baseline and who did not discontinue prior to the corresponding visit date (Week 13, 26 and 52).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Eltrombopag | Frequency of Platelets Transfusion | Baseline | 1.8 occurrences | Standard Deviation 1.32 |
| Eltrombopag | Frequency of Platelets Transfusion | Week 13 | 0.4 occurrences | Standard Deviation 0.88 |
| Eltrombopag | Frequency of Platelets Transfusion | Week 26 | 0.1 occurrences | Standard Deviation 0.35 |
| Eltrombopag | Frequency of Platelets Transfusion | Week 52 | 0.0 occurrences | Standard Deviation 0 |
Frequency of Red Blood Cells (RBC) Transfusion
For subjects receiving transfusion (RBC (Red Blood Cell)) at baseline, the frequency of RBC transfusion in each period (Baseline: 8 weeks before Day 1; Week 13, 26, 52: 8 weeks before each visit day) was summarized using descriptive statistics.
Time frame: Baseline, Week 13, Week 26 and Week 52
Population: Participants in the FAS who were RBC transfusion dependent at baseline and who did not discontinue prior to the corresponding visit date (Week 13, 26 and 52).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Eltrombopag | Frequency of Red Blood Cells (RBC) Transfusion | Baseline | 3.0 occurrences | Standard Deviation 2.04 |
| Eltrombopag | Frequency of Red Blood Cells (RBC) Transfusion | Week 13 | 1.8 occurrences | Standard Deviation 2.83 |
| Eltrombopag | Frequency of Red Blood Cells (RBC) Transfusion | Week 26 | 1.5 occurrences | Standard Deviation 2.02 |
| Eltrombopag | Frequency of Red Blood Cells (RBC) Transfusion | Week 52 | 0.5 occurrences | Standard Deviation 0.71 |
Hematologic Response Rate by Investigator
Hematologic response rate: percentage of subjects who met any of the International Working Group criteria: Platelet count: If platelet transfusion independent at baseline (BL): Transfusion independent and increase from BL by 20×10\^9/L or more; If platelet transfusion dependent at BL: No platelet transfusion requirement for 8 wks; Hemoglobin: If red blood cells (RBC) transfusion independent at BL: transfusion independent and increase from BL by 15 g/L or more; If RBC transfusion dependent at BL: A decrease of at least 4 units in RBC transfusions in the post-treatment 8-week period (1 unit =RBC derived from 200 mL blood) or no RBC transfusion requirement for 8 wks; Neutrophil count: In the absence of granulocyte colony stimulating factor (G-CSF) taken within 21 days preceding the blood sample collection: Increase from BL by 0.5×10\^9/L or more, or (if \< 0.5×10\^9/L at BL) increase by 100% or more. Patients who discontinued from the trial before wks 13 & 26 were treated as non-responders.
Time frame: Week (Wk) 13, Week 52
Population: The Full Analysis Set (FAS) comprised all patients to whom study treatment had been assigned and received one dose of study treatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Eltrombopag | Hematologic Response Rate by Investigator | Week 13 | 65.0 Percentage of participants |
| Eltrombopag | Hematologic Response Rate by Investigator | Week 52 | 65.0 Percentage of participants |
Number of Participants With Clonal Evolution
Number of participants with clonal evolution with a normal karyotype at baseline including clonal evolution to PNH (Paroxysmal Nocturnal Hemoglobinuria), evolution to AML (Acute Myeloid Leukemia) or MDS (Myelodysplastic Syndromes).
Time frame: From Baseline up to approx. 2.9 years
Population: The Full Analysis Set (FAS) comprised all patients to whom study treatment had been assigned.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Eltrombopag | Number of Participants With Clonal Evolution | 2 Participants |
Plasma PK Parameters of Eltrombopag: AUCtau & AUClast
AUCtau is the area under the curve calculated to the end of a dosing interval (tau) at steady-state (amount\*time\*volume-1). AUClast is the AUC calculated from time 0 to the time of the last quantifiable concentration. Blood samples were collected from patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state.
Time frame: pre-dose, and 1, 2, 4, 6, 8 and 24 hours post-dose on Day 14
Population: Participants in the pharmacokinetic analysis set (PAS) who had an evaluable pharmacokinetic (PK) profile at steady state.~The pharmacokinetic analysis set (PAS) included all patients who received at least one dose of eltrombopag and who had at least one evaluable PK sample.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Eltrombopag | Plasma PK Parameters of Eltrombopag: AUCtau & AUClast | AUCtau | 67900 h*ng/mL | Standard Deviation 31400 |
| Eltrombopag | Plasma PK Parameters of Eltrombopag: AUCtau & AUClast | AUClast | 62700 h*ng/mL | Standard Deviation 33200 |
Plasma PK Parameters of Eltrombopag: CLss/F
Steady State (CLss/F) is the apparent systemic (or total body) clearance at steady state from plasma (volume/time) following drug administration. Blood samples were collected from patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state.
Time frame: pre-dose, and 1, 2, 4, 6, 8 and 24 hours post-dose on Day 14
Population: Participants in the pharmacokinetic analysis set (PAS) who had an evaluable PK profile at steady state and who had a valid value for the outcome measure. The PAS included all patients who received at least one dose of eltrombopag and who had at least one evaluable PK sample.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Eltrombopag | Plasma PK Parameters of Eltrombopag: CLss/F | 0.441 L/h | Standard Deviation 0.178 |
Plasma PK Parameters of Eltrombopag: Cmax
Cmax is the maximum (peak) observed plasma drug concentration after single dose administration (mass\*volume-1). Blood samples were collected from patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state.
Time frame: pre-dose, and 1, 2, 4, 6, 8 and 24 hours post-dose on Day 14
Population: Participants in the pharmacokinetic analysis set (PAS) who had an evaluable pharmacokinetic (PK) profile at steady state.~The pharmacokinetic analysis set (PAS) included all patients who received at least one dose of eltrombopag and who had at least one evaluable PK sample.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Eltrombopag | Plasma PK Parameters of Eltrombopag: Cmax | 3450 ng/mL | Standard Deviation 1900 |
Plasma PK Parameters of Eltrombopag: Tmax
Tmax is the time to reach maximum (peak) plasma drug concentration after single dose administration (time). Blood samples were collected from all patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state.
Time frame: pre-dose, and 1, 2, 4, 6, 8 and 24 hours post-dose on Day 14
Population: Participants in the pharmacokinetic analysis set (PAS) who had an evaluable pharmacokinetic (PK) profile at steady state.~The pharmacokinetic analysis set (PAS) included all patients who received at least one dose of eltrombopag and who had at least one evaluable PK sample.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Eltrombopag | Plasma PK Parameters of Eltrombopag: Tmax | 3.73 hour |
Plasma Trough Concentration of Eltrombopag
Ctrough is the pre-dose concentration at the end of dose interval (mass\*volume-1). Blood samples were collected from patients to assess the plasma concentrations of eltrombopag. The plasma concentrations were used to determine the PK characteristics of eltrombopag. Serial intensive PK blood samples were collected for the initial 25 mg/day dose to provide at least 12 participants with evaluable PK profiles at steady state. Sparse PK blood samples were collected for the other doses and in the rest of the patients for Ctrough assessment.
Time frame: Pre-dose sample on the 15th day after each new dose level was started
Population: The pharmacokinetic analysis set (PAS) included all patients who received at least one dose of eltrombopag and who had at least one evaluable PK sample.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Eltrombopag | Plasma Trough Concentration of Eltrombopag | concentration at 25 mg | 2180 ng/mL | Standard Deviation 1490 |
| Eltrombopag | Plasma Trough Concentration of Eltrombopag | concentration at 50 mg | 5180 ng/mL | Standard Deviation 3320 |
| Eltrombopag | Plasma Trough Concentration of Eltrombopag | concentration at 75 mg | 11300 ng/mL | Standard Deviation 6000 |
| Eltrombopag | Plasma Trough Concentration of Eltrombopag | concentration at 100 mg | 14700 ng/mL | Standard Deviation 8070 |
| Eltrombopag | Plasma Trough Concentration of Eltrombopag | concentration at 125 mg | 20300 ng/mL | Standard Deviation 11300 |
| Eltrombopag | Plasma Trough Concentration of Eltrombopag | concentration at 150 mg | 23800 ng/mL | Standard Deviation 13700 |
Time to Hematologic Response by Investigator
Time to hematological response was defined as the time from the date of first study drug administration to the first hematological response. If a participant did not meet hematological response before or at the cutoff date, censoring was performed using the date of last assessment.
Time frame: Baseline to Week 26
Population: The Full Analysis Set (FAS) comprised all patients to whom study treatment had been assigned and received one dose of study treatment and achieved a hematologic response.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Eltrombopag | Time to Hematologic Response by Investigator | 10.0 Weeks |
All Collected Deaths
Deaths were collected from the first dose until end of study, a maximum duration of up to 3.5 years. On-treatment deaths were collected within 30 days of the last dose, while post-treatment deaths were collected more than 30 days after the last dose for those who discontinued treatment early. Adverse events were collected from the first dose until 30 days after the last dose, also up to a maximum duration if 3.5 years. Adverse Events were not collected in the post-treatment period.
Time frame: On-treatment deaths: up to approx. 3.5 years, post-treatment deaths: up to approx. 3.5 years
Population: All enrolled participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Eltrombopag | All Collected Deaths | All Deaths | 1 Participants |
| Eltrombopag | All Collected Deaths | On-treatment deaths | 0 Participants |
| Eltrombopag | All Collected Deaths | Post-treatment deaths | 1 Participants |