Study of Two Doses of Crizanlizumab Versus Placebo in Adolescent and Adult Sickle Cell Disease Patients
Condition: Sickle Cell Disease (SCD)
MeSH terms: Anemia, Sickle Cell
Intervention: Crizanlizumab (SEG101); Placebo
Intervention description: Crizanlizumab was supplied in single use 10 mL glass vials at a concentration of 10 mg/mL. One vial contains 100 mg of crizanlizumab. This is a concentrate for solution for infusion.
IV.; Placebo was supplied in single use 10 mL glass vials at a concentration of 0 mg/mL. This is a concentrate for solution for infusion IV.
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking description: Double-blind Study
Enrollment: 252.0
Sex: All
Minimum age: 12 Years
Healthy volunteers: No
Keywords: Sickle Cell Disease; SCD; SEG101; Crizanlizumab; Hydroxyurea/ Hydroxycarbamide Therapy; Vaso-Occlusive Crises; SCA; blood disorders; hemoglobin; red blood cells; sickle-like shape; mutation in hemoglobin gene; sickle-cell trait; sickle-cell crisis

Summary:

      The purpose of this study is to compare the efficacy and safety of 2 doses of crizanlizumab
      (5.0 mg/kg and 7.5 mg/kg) versus placebo in adolescent and adult sickle cell disease (SCD)
      patients with history of vaso-occlusive crisis (VOC) leading to healthcare visit.
    

Eligibility criteria:

        Key Inclusion Criteria:

          1. Written informed consent must be obtained prior to any screening procedures

          2. Male or female patients aged 12 years and older on the day of signing informed
             consent. Adolescent include patients aged 12 to 17 years old and adults ≥ 18 years

          3. Confirmed diagnosis of SCD by hemoglobin electrophoresis or high performance liquid
             chromatography (HPLC) [performed locally]. All SCD genotypes are eligible, genotyping
             is not required for study entry

          4. Experienced at least 2 VOCs leading to healthcare visit within the 12 months prior to
             screening visit as determined by medical history. Prior VOC leading to healthcare
             visit must resolve at least 7 days prior to Week 1 Day 1 and must include:

               1. Pain crisis defined as an acute onset of pain for which there is no other
                  medically determined explanation other than vaso- occlusion -

               2. which requires a visit to a medical facility and/or healthcare professional,

               3. and receipt of oral/parenteral opioids or parenteral nonsteroidal
                  anti-inflammatory drug (NSAID) analgesia Acute chest syndrome (ACS), priapism and
                  hepatic or splenic sequestration will be considered VOC in this study

          5. If receiving HU/HC or L-glutamine (local HA approved medicinal product), must have
             been receiving the drug for at least 6 months and at a stable dose for at least 3
             months prior to Screening visit and plan to continue taking it at the same dose and
             schedule until the subject has reached one year of study treatment. Patients who have
             not been receiving such drug must not have received it for at least 6 months prior to
             Screening visit to be included. Patients must have evidence of insufficient control of
             acute pain, such as at least one VOC leading to healthcare visit while on HU/HC or
             L-Glutamine treatment. If receiving erythropoietin stimulating agent, must have been
             receiving the drug for at least 6 months prior to Screening visit and plan to continue
             taking the treatment to maintain stable Hb levels at least until the subject has
             reached one year of study treatment

          6. Patients must meet the following central laboratory values prior to Week 1 Day 1:

               -  Absolute Neutrophil Count ≥1.0 x 109/L

               -  Platelet count ≥75 x 109/L

               -  Hemoglobin: for adults (Hb) ≥4.0 g/dL and for adolescents (Hb) ≥5.5 g/dL

               -  Glomerular filtration rate ≥ 45 mL/min/1.73 m2 using CKD-EPI formula in adults,
                  and Shwartz formula in adolescents

               -  Direct (conjugated) bilirubin < 2.0 x ULN

               -  Alanine transaminase (ALT) < 3.0 x ULN

          7. ECOG performance status ≤2.0 for adults and Karnofsky ≥ 50% for adolescents

        Key Exclusion Criteria:

          1. History of stem cell transplant.

          2. Participating in a chronic transfusion program (pre-planned series of transfusions for
             prophylactic purposes) and/or planning on undergoing an exchange transfusion during
             the duration of the study; episodic transfusion in response to worsened anemia or VOC
             is permitted.

          3. Contraindication or hypersensitivity to any drug or metabolites from similar class as
             study drug or to any excipients of the study drug formulation. History of severe
             hypersensitivity reaction to other monoclonal antibodies, which in the opinion of the
             investigator may pose an increased risk of serious infusion reaction.

          4. Received active treatment on another investigational trial within 30 days (or 5
             half-lives of that agent, whichever is greater) prior to Screening visit or plans to
             participate in another investigational drug trial.

          5. Women of child-bearing potential, defined as all women physiologically capable of
             becoming pregnant unless they are using highly effective methods of contraception
             during dosing and for 15 weeks after stopping treatment.

          6. Concurrent severe and/or uncontrolled medical conditions which, in the opinion of the
             Investigator, could cause unacceptable safety risks or compromise participation in the
             study.

          7. History or current diagnosis of ECG abnormalities indicating significant risk of
             safety such as:

               -  Concomitant clinically significant cardiac arrhythmias (e.g ventricular
                  tachycardia), and clinically significant second or third degree AV block without
                  a pacemaker

               -  History of familial long QT syndrome or know family history of Torsades de
                  Pointes

          8. Not able to understand and to comply with study instructions and requirements.

          9. Received prior treatment with crizanlizumab or other selectin targeting agent