Pharmacokinetics (PK) and Safety of Subgam-VF in Primary Immunodeficiency Diseases
Condition: Primary Immune Deficiency Disorders; Common Variable Immunodeficiency; X-linked Agammaglobulinaemia; Hyperimmunoglobulin M Syndrome
MeSH terms: Agammaglobulinemia; Hyper-IgM Immunodeficiency Syndrome; Primary Immunodeficiency Diseases; Immunologic Deficiency Syndromes; Common Variable Immunodeficiency
Intervention: Subgam
Intervention description: Subgam-VF dose will be given as 1.37 of the established IGIV dose (expressed in mg/kg/week) for 26 weeks (26 infusions) beginning one week after the last IGIV infusion. Dose of Subgam-VF will then be adjusted based on the ratio of the Immunoglobulin G (IgG) average concentration achieved with Subgam-VF compared to IGIV.
Phase: Phase 3
Study type: Interventional
Primary purpose: Other
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 38.0
Sex: All
Minimum age: 2 Years
Maximum age: 75 Years
Healthy volunteers: No
Keywords: Primary Immune Deficiency Disorders; Common Variable Immunodeficiency; X-linked agammaglobulinaemia; Hyper-IgM Syndrome; Subcutaneous; Immunoglobulins

Summary:

      The main objective of the study is to determine the pharmacokinetics profile of Subgam-VF.
      The secondary objectives are to assess the safety of Subgam-VF and refine the dose adjustment
      coefficient for Subgam-VF needed for subjects switching from prior intravenous immunoglobulin
      (IGIV) therapy.
    

Eligibility criteria:

        Inclusion criteria:

          1. Aged between 2 and 75 years (at time of initial consent).

          2. Body Mass Index (BMI) < 46 for adults (aged 16 years & older), & BMI < 28 for
             children.

          3. Diagnosed with primary immunodeficiency disease e.g. common variable immunodeficiency,
             X-linked & autosomal forms of agammaglobulinaemia, hyper-IgM syndrome, Wiskott-Aldrich
             syndrome.

          4. Currently receiving a licensed (or investigational stage III, IIIb) IGIV or SCIG and

               1. IGIV dose is between 300 and 800 mg/kg/month. SCIG dose is between 110 & 300
                  mg/kg/week;

               2. Dose is stable for at least the past three months (i.e. consistent mg/kg +/- 5%);

               3. The infusion interval is every 21 or 28 days for IGIV & seven days for SCIG;

               4. Has a documented trough level of ≥ 6 g/L (600 mg/dL) on current IgG therapy. If
                  not available can be obtained at the screening visit, Visit 1 (Week 0).

          5. Female subjects who are (or become) sexually active must practice contraception by
             using a method of proven reliability for the duration of the study.

          6. Females of child-bearing potential, (defined from the onset of menstruation to one
             year post menopause), must have a negative result on a urine HCG-based pregnancy test.

          7. Willing to comply with all aspects of the protocol, including blood sampling, for the
             duration of the study.

          8. Signed an informed consent form. In the case of subjects under the legal age the
             parent/guardian will sign an informed consent form & where appropriate the subject
             will sign an assent form.

        Exclusion Criteria:

          1. Has a history of any severe anaphylactic reaction to blood or any blood-derived
             product.

          2. Has selective IgA deficiency or has a history of antibodies to IgA.

          3. Has clinically significant impairment of cellular or innate immunity at the discretion
             of the Investigator

          4. Has evidence of an active infection at the time of enrolment (i.e. on day of first
             infusion). Subjects who are asymptomatic but have not completed their course of
             antibiotics are eligible.

          5. Has previously completed or withdrawn from this study.

          6. Is currently receiving, or has received, any investigational agent within the prior
             three months, unless it is an investigational stage III, IIIb IGIV or SCIG.

          7. Is pregnant (confirmed by a positive result on an HCG-based pregnancy test) or is
             nursing.

          8. Is positive for any of the following at screening:

             • Serological test for HIV 1&2, HCV, or HBsAg

          9. Has levels at screening greater than 2.5 times the upper limit of normal as defined at
             the central laboratory of any of the following:

               -  Alanine transaminase (ALT)

               -  Aspartate transaminase (AST)

         10. Has severe renal impairment (defined as serum creatinine greater than two times the
             upper limit of normal or BUN greater than two times the upper limit of normal for the
             range of the laboratory doing the analysis); the subject is on dialysis; or has a
             history of acute renal failure.

         11. Is known to abuse alcohol, opiates, psychotropic agents, or other chemicals or drugs,
             or has done so within the past 12 months.

         12. Has a history of DVT, or thrombotic complications of IgG therapy, or a prior diagnosis
             of thrombophilia.

         13. Suffers from any acute or chronic medical condition, (e.g. renal disease or
             predisposing conditions for renal disease, coronary artery disease, or protein losing
             state, proteinuria) that the Investigator feels may interfere with the conduct of the
             study.

         14. Has an acquired medical condition, such as chronic lymphocytic leukemia, lymphoma,
             multiple myeloma, chronic or recurrent neutropenia (ANC < 1 x 109/L).

         15. Is receiving the following medication:

               -  Steroids (long-term daily, > 0.15 mg of prednisone equivalent/kg/day).
                  Requirement for short or intermittent courses of > 0.15mg/kg/day would not
                  exclude a subject.

               -  Immunosuppressive drugs

               -  Immunomodulatory drugs

         16. If ≥ 18 years of age, has non-controlled arterial hypertension (systolic blood
             pressure > 160 mmHg &/or diastolic blood pressure > 100 mmHg). For younger subjects
             refer to current guidelines for diagnosis of blood pressure1.

         17. Has anemia (hemoglobin < 10 g/dL) at screening.

         18. Has severe dermatitis that would preclude sites for safe product administration.