Traumatic Injury
Conditions
Brief summary
This is a prospective, multicenter, randomized, double-blind, placebo-controlled, parallel-group, large simple trial to investigate the efficacy and safety of a single intravenous (IV) infusion of BE1116 in subjects who have traumatic injury, with confirmed or suspected acute major bleeding and / or predicted to receive a large volume blood product transfusion.
Interventions
4-Factor Prothrombin Complex administered by intravenous (IV) infusion
Administered by IV infusion
Sponsors
Study design
Eligibility
Inclusion criteria
* (a) Estimated age ≥ 15 years. Older minimum age is required in some locations. FOR United Kingdom: Estimated or actual age ≥ 16 years FOR Australia: Estimated or actual age ≥ 18 years AND (b) Estimated or actual weight ≥ 50 kg (110 lbs). * Traumatic injury with confirmed or suspected acute major bleeding and/or Revised Assessment of Bleeding and Transfusion (RABT) score ≥ 2 * Activation of massive transfusion protocol
Exclusion criteria
* Healthcare professional cardiopulmonary resuscitation including chest compressions for ≥ 5 consecutive minutes at any time before randomization * Isolated penetrating or blunt cranial injury, or exposed brain matter * Isolated burns estimated to be \> 20% total body surface area or suspected inhalational injury * Known anticoagulation treatment or a history of a TEE, within the past 3 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Participants With All-cause 6-hour Mortality | Up to 6 hours after randomization | Here, the percentage of participants with all-cause mortality has been reported. Percentages were rounded off if the second digit after the decimal point is equal to or more than five. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Participants With All-cause In-hospital Mortality Up to 30 Days After Randomization | Up to 30 days after randomization | In-hospital mortality was recorded and assessed for the primary hospitalization only. Here, the percentage of participants with all-cause in hospital mortality has been reported. Percentages were rounded off if the second digit after the decimal point is equal to or more than five. |
| Proportion of Participants Who Underwent Surgical or Interventional Radiological Procedures to Stop Bleeding Related to the Primary Injury | Up to 24 hours after randomization | Here, the percentage of participants with who underwent surgical or interventional radiological procedures to stop bleeding related to the primary injury has been reported. Percentages were rounded off if the second digit after the decimal point is equal to or more than five. |
| Number of Participants With Treatment-Emergent Serious Adverse Events (SAEs) | Up to 30 days after randomization | The number of participants with treatment-emergent SAEs considered related to IP that occurred during primary hospitalization within the 30 days after randomization are summarized by treatment arm. |
| Proportion of Participants With All-cause 24-hour In-hospital Mortality | Up to 24 hours after randomization | In-hospital mortality up to 24 hours after randomization was recorded and assessed for the primary hospitalization only. Here, the percentage of participants with all-cause in hospital mortality has been reported. Percentages were rounded off if the second digit after the decimal point is equal to or more than five. |
| Number of Participants With Acute Respiratory Distress Syndrome (ARDS) | Up to 30 days after randomization | ARDS will be assessed using the Berlin definition based on four criteria: timing, chest imaging, origin of edema, oxygenation (mild, moderate or severe) and high-flow nasal oxygen. |
| Number of Participants With Multiple Organ Failure | Up to 30 days after randomization | Multiple organ failure will be assessed using the Denver post injury multiple organ failure score. The Denver score rates the dysfunction of 4 organ systems (pulmonary, renal, hepatic, and cardiac), which are each graded on a scale from 0 to 3, where 0 represents mild and 3 was severe. Multiple organ failure is defined as a score \> 3. |
| Number of Participants With Acute Kidney Injury (AKI) Requiring Renal Replacement Therapy | Up to 30 days after randomization | Renal replacement therapy included dialysis, hemofiltration, or hemodiafiltration. AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines is diagnosed if any one of the following happens: • Serum creatinine increases by ≥ 0.3 mg/dL (≥ 26.5 μmol/L) within 48 hours • Serum creatinine increases to ≥ 1.5 times the baseline level, within the past 7 days • Urine levels drops to less than 0.5 mL/kg/hour for 6 hours |
| Number of Participants With In-hospital Overall and Related Thromboembolic Events (TEEs) | Up to 30 days after randomization | The TEEs may be symptomatic or asymptomatic, and arterial or venous (eg, deep vein thrombosis, pulmonary embolism, ischemic stroke \[including thromboembolic stroke\], myocardial infarction). The observed in-hospital overall and related to IP TEEs are reported here. |
Countries
Australia, United Kingdom, United States
Participant flow
Recruitment details
This study was conducted from 28 Mar 2023 to 29 October 2024 .
Pre-assignment details
A total of 1366 participants were enrolled in this study. Of these, 1245 participants were treated as per their assigned treatment, either BE1116 or placebo.
Participants by arm
| Arm | Count |
|---|---|
| BE1116 Participants received a single administration of BE1116 via IV administration on Day 1. | 689 |
| Placebo Participants received IV administration of placebo matched to BE1116. | 677 |
| Total | 1,366 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | No IP Administered/Subject Excluded | 1 | 4 |
| Overall Study | Physician Decision | 1 | 0 |
| Overall Study | Protocol Deviation | 2 | 1 |
| Overall Study | Withdrawal by Parent/Guardian | 10 | 14 |
| Overall Study | Withdrawal by Subject/Legally Authorized Representative | 47 | 53 |
Baseline characteristics
| Characteristic | Placebo | Total | BE1116 |
|---|---|---|---|
| Age, Continuous | 39.8 years STANDARD_DEVIATION 17.65 | 40.2 years STANDARD_DEVIATION 17.33 | 40.7 years STANDARD_DEVIATION 17 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 87 Participants | 184 Participants | 97 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 493 Participants | 983 Participants | 490 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 97 Participants | 199 Participants | 102 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 12 Participants | 21 Participants | 9 Participants |
| Race (NIH/OMB) Asian | 21 Participants | 34 Participants | 13 Participants |
| Race (NIH/OMB) Black or African American | 210 Participants | 411 Participants | 201 Participants |
| Race (NIH/OMB) More than one race | 5 Participants | 10 Participants | 5 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 4 Participants | 3 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 93 Participants | 201 Participants | 108 Participants |
| Race (NIH/OMB) White | 335 Participants | 685 Participants | 350 Participants |
| Sex: Female, Male Female | 141 Participants | 304 Participants | 163 Participants |
| Sex: Female, Male Male | 536 Participants | 1062 Participants | 526 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 146 / 689 | 114 / 677 |
| other Total, other adverse events | 32 / 618 | 39 / 627 |
| serious Total, serious adverse events | 203 / 618 | 168 / 627 |
Outcome results
Proportion of Participants With All-cause 6-hour Mortality
Here, the percentage of participants with all-cause mortality has been reported. Percentages were rounded off if the second digit after the decimal point is equal to or more than five.
Time frame: Up to 6 hours after randomization
Population: Analysis was performed on the ITT and modified ITT (mITT) population. The ITT population included all the randomized participants. The mITT population included all participants from ITT population who received at least one complete or partial dose of the investigational product (IP) (BE1116 or placebo). It also included participants with a missing or non-testable Glasgow Coma Score, or a score less than 15, as well as those who received blood product transfusions prior to randomization.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| BE1116 | Proportion of Participants With All-cause 6-hour Mortality | All-cause Mortality in ITT Analysis Set | 7.3 Percentage of participants |
| BE1116 | Proportion of Participants With All-cause 6-hour Mortality | All-cause Mortality in mITT Analysis Set | 7.2 Percentage of participants |
| Placebo | Proportion of Participants With All-cause 6-hour Mortality | All-cause Mortality in ITT Analysis Set | 4.6 Percentage of participants |
| Placebo | Proportion of Participants With All-cause 6-hour Mortality | All-cause Mortality in mITT Analysis Set | 4.1 Percentage of participants |
Number of Participants With Acute Kidney Injury (AKI) Requiring Renal Replacement Therapy
Renal replacement therapy included dialysis, hemofiltration, or hemodiafiltration. AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines is diagnosed if any one of the following happens: • Serum creatinine increases by ≥ 0.3 mg/dL (≥ 26.5 μmol/L) within 48 hours • Serum creatinine increases to ≥ 1.5 times the baseline level, within the past 7 days • Urine levels drops to less than 0.5 mL/kg/hour for 6 hours
Time frame: Up to 30 days after randomization
Population: Analysis was performed on the safety population. The safety population included of all the participants from ITT population who received at least one complete or partial dose of BE1116 or placebo, based on the treatment actually received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BE1116 | Number of Participants With Acute Kidney Injury (AKI) Requiring Renal Replacement Therapy | 52 Count of participants |
| Placebo | Number of Participants With Acute Kidney Injury (AKI) Requiring Renal Replacement Therapy | 29 Count of participants |
Number of Participants With Acute Respiratory Distress Syndrome (ARDS)
ARDS will be assessed using the Berlin definition based on four criteria: timing, chest imaging, origin of edema, oxygenation (mild, moderate or severe) and high-flow nasal oxygen.
Time frame: Up to 30 days after randomization
Population: Analysis was performed on the safety population. The safety population included of all the participants from ITT population who received at least one complete or partial dose of BE1116 or placebo, based on the treatment actually received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BE1116 | Number of Participants With Acute Respiratory Distress Syndrome (ARDS) | 31 Count of participants |
| Placebo | Number of Participants With Acute Respiratory Distress Syndrome (ARDS) | 28 Count of participants |
Number of Participants With In-hospital Overall and Related Thromboembolic Events (TEEs)
The TEEs may be symptomatic or asymptomatic, and arterial or venous (eg, deep vein thrombosis, pulmonary embolism, ischemic stroke \[including thromboembolic stroke\], myocardial infarction). The observed in-hospital overall and related to IP TEEs are reported here.
Time frame: Up to 30 days after randomization
Population: Analysis was performed on the safety population. The safety population included of all the participants from ITT population who received at least one complete or partial dose of BE1116 or placebo, based on the treatment actually received.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| BE1116 | Number of Participants With In-hospital Overall and Related Thromboembolic Events (TEEs) | Overall TEEs | 133 Count of participants |
| BE1116 | Number of Participants With In-hospital Overall and Related Thromboembolic Events (TEEs) | Related TEEs | 46 Count of participants |
| Placebo | Number of Participants With In-hospital Overall and Related Thromboembolic Events (TEEs) | Overall TEEs | 139 Count of participants |
| Placebo | Number of Participants With In-hospital Overall and Related Thromboembolic Events (TEEs) | Related TEEs | 51 Count of participants |
Number of Participants With Multiple Organ Failure
Multiple organ failure will be assessed using the Denver post injury multiple organ failure score. The Denver score rates the dysfunction of 4 organ systems (pulmonary, renal, hepatic, and cardiac), which are each graded on a scale from 0 to 3, where 0 represents mild and 3 was severe. Multiple organ failure is defined as a score \> 3.
Time frame: Up to 30 days after randomization
Population: Analysis was performed on the safety population. The safety population included of all the participants from ITT population who received at least one complete or partial dose of BE1116 or placebo, based on the treatment actually received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BE1116 | Number of Participants With Multiple Organ Failure | 59 Count of participants |
| Placebo | Number of Participants With Multiple Organ Failure | 53 Count of participants |
Number of Participants With Treatment-Emergent Serious Adverse Events (SAEs)
The number of participants with treatment-emergent SAEs considered related to IP that occurred during primary hospitalization within the 30 days after randomization are summarized by treatment arm.
Time frame: Up to 30 days after randomization
Population: Analysis was performed on the safety population. The safety population included of all the participants from ITT population who received at least one complete or partial dose of BE1116 or placebo, based on the treatment actually received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BE1116 | Number of Participants With Treatment-Emergent Serious Adverse Events (SAEs) | 34 Count of participants |
| Placebo | Number of Participants With Treatment-Emergent Serious Adverse Events (SAEs) | 46 Count of participants |
Proportion of Participants Who Underwent Surgical or Interventional Radiological Procedures to Stop Bleeding Related to the Primary Injury
Here, the percentage of participants with who underwent surgical or interventional radiological procedures to stop bleeding related to the primary injury has been reported. Percentages were rounded off if the second digit after the decimal point is equal to or more than five.
Time frame: Up to 24 hours after randomization
Population: As planned, analysis was performed on the mITT population. The mITT population included all participants from ITT population who received at least one complete or partial dose of BE1116 or placebo. It also included participants with a missing or non-testable Glasgow Coma Score, or a score less than 15, as well as those who received blood product transfusions prior to randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BE1116 | Proportion of Participants Who Underwent Surgical or Interventional Radiological Procedures to Stop Bleeding Related to the Primary Injury | 78.0 Percentage of participants |
| Placebo | Proportion of Participants Who Underwent Surgical or Interventional Radiological Procedures to Stop Bleeding Related to the Primary Injury | 75.5 Percentage of participants |
Proportion of Participants With All-cause 24-hour In-hospital Mortality
In-hospital mortality up to 24 hours after randomization was recorded and assessed for the primary hospitalization only. Here, the percentage of participants with all-cause in hospital mortality has been reported. Percentages were rounded off if the second digit after the decimal point is equal to or more than five.
Time frame: Up to 24 hours after randomization
Population: As planned, analysis was performed on the mITT population. The mITT population included all participants from ITT population who received at least one complete or partial dose of BE1116 or placebo. It also included participants with a missing or non-testable Glasgow Coma Score, or a score less than 15, as well as those who received blood product transfusions prior to randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BE1116 | Proportion of Participants With All-cause 24-hour In-hospital Mortality | 11.1 Percentage of participants |
| Placebo | Proportion of Participants With All-cause 24-hour In-hospital Mortality | 7.3 Percentage of participants |
Proportion of Participants With All-cause In-hospital Mortality Up to 30 Days After Randomization
In-hospital mortality was recorded and assessed for the primary hospitalization only. Here, the percentage of participants with all-cause in hospital mortality has been reported. Percentages were rounded off if the second digit after the decimal point is equal to or more than five.
Time frame: Up to 30 days after randomization
Population: As planned, analysis was performed on the mITT population. The mITT population included all participants from ITT population who received at least one complete or partial dose of BE1116 or placebo. It also included participants with a missing or non-testable Glasgow Coma Score, or a score less than 15, as well as those who received blood product transfusions prior to randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BE1116 | Proportion of Participants With All-cause In-hospital Mortality Up to 30 Days After Randomization | 24.8 Percentage of participants |
| Placebo | Proportion of Participants With All-cause In-hospital Mortality Up to 30 Days After Randomization | 18.6 Percentage of participants |