A Study of Recombinant Von Willebrand Factor (rVWF) in Pediatric and Adult Participants With Severe Von Willebrand Disease (VWD)

Study Overview
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Brief Summary
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The main aim of the study is to check effectiveness of rVWF (vonicog alfa) prophylaxis based on the annualized bleeding rate (ABR) of spontaneous (not related to trauma) bleeding episodes in pediatric and adult participants during the first 12 months on study treatment. The participants will be treated with rVWF for a maximum of 3 years. Their von Willebrand Disease will be treated according to Investigational product (IP) dosing directions.

Official Title
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A Phase 3b, Prospective, Open-Label, Uncontrolled, Multicenter Study on Long-Term Safety and Efficacy of rVWF in Pediatric and Adult Subjects With Severe Von Willebrand Disease (VWD)

Conditions
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Von Willebrand Disease (VWD)

Intervention / Treatment
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* Biological: rVWF
* Biological: rFVIII


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The participant will not be considered eligible for the study without meeting all of the criteria below. Participants who have completed Study 071301 or Study 071102 (or participants who have completed the surgery arm treatment in Study 071102 and want to continue to receive on-demand (OD) treatment) and are willing to immediately transition into this study, must meet the following 2 criteria to be eligible for this study: If female of childbearing potential, has a negative blood/urine pregnancy test at screening and agrees to employ highly effective birth control measures for the duration of the study. Participant and/or legally authorized representative is willing and able to comply with the requirements of the protocol. New participants (Cohort 4) who meet the above 2 and ALL the following additional criteria are eligible for this study: - Participant has a documented diagnosis of severe von Willebrand disease (VWD) (baseline von Willebrand factor: Ristocetin cofactor (VWF:RCo) <20 International Units per deciliter [IU/dL]) with a history of requiring substitution therapy with von Willebrand factor (vWF) concentrate to control bleeding: Type 1 (VWF:RCo <20 IU/dL) or, Type 2A (as verified by multimer pattern), Type 2B (as diagnosed by genotype), Type 2M or, Type 3 (Von Willebrand factor antigen (VWF:Ag) less than or equal to (<=) 3 IU/dL). Diagnosis is confirmed by genetic testing and multimer analysis, documented in participant history or at screening. Participant has been receiving OD therapy with VWF products for at least 12 months, and prophylactic treatment is recommended by the investigator. Participant has greater than or equal to (>=) 3 documented spontaneous bleeds (not including menorrhagia) requiring VWF treatment during the past 12 months. Participant has available records that reliably evaluate type, frequency, and treatment of bleeding episodes for at least 12 months preceding enrollment; up to 24 months of retrospective data should be collected if available. Participant is >=12 years old at the time of screening and has a body mass index >=15 but <40 kilogram per meter square (kg/m^2). Exclusion Criteria: The participant will be excluded from the study if any of the following exclusion criteria are met. The participant has been diagnosed with Type 2N VWD, pseudo VWD, or another hereditary or acquired coagulation disorder other than VWD (eg, qualitative and quantitative platelet disorders or elevated prothrombin time (PT)/international normalized ratio [INR] >1.4). The participant has a history or presence of a VWF inhibitor at screening. The participant has a history or presence of a Factor VIII (FVIII) inhibitor with a titer >=0.4 Bethesda units (BU) (by Nijmegen modified Bethesda assay) or >=0.6 BU (by Bethesda assay). The participant has a known hypersensitivity to any of the components of the study drugs, such as mouse or hamster proteins. The participant has a medical history of immunological disorders, excluding seasonal allergic rhinitis/conjunctivitis, mild asthma, food allergies, or animal allergies. The participant has a medical history of a thromboembolic event. The participant is human immunodeficiency virus (HIV) positive with an absolute Helper T cell (CD4) count <200/cubic millimeters (mm^3). The participant has been diagnosed with significant liver disease per investigator's medical assessment of the participant's current condition or medical history or as evidenced by, but not limited to any of the following: serum alanine aminotransferase (ALT) greater than 5 times the upper limit of normal; hypoalbuminemia; portal vein hypertension (eg, presence of otherwise unexplained splenomegaly, history of esophageal varices) or liver cirrhosis classified as Child-Pugh class B or C. The participant has been diagnosed with renal disease, with a serum creatinine (CR) level >=2.5 milligrams per deciliter (mg/dL). The participant has a platelet count <100,000/milliliter (mL) at screening. The participant has been treated with an immunomodulatory drug, excluding topical treatment (eg, ointments, nasal sprays), within 30 days prior to signing the informed consent (or assent, if appropriate). The participant is pregnant or lactating at the time of enrollment. The participant has cervical or uterine conditions causing menorrhagia or metrorrhagia (including infection, dysplasia). The participant has participated in another clinical study involving another investigational product (IP) or investigational device within 30 days prior to enrollment or is scheduled to participate in another clinical study involving an IP or investigational device during the course of this study. The participant has a progressive fatal disease and/or life expectancy of less than 15 months. For new OD participants, the participant is scheduled for a surgical intervention. The participant is identified by the investigator as being unable or unwilling to cooperate with study procedures. The participant has a mental condition rendering him/her unable to understand the nature, scope and possible consequences of the study and/or evidence of an uncooperative attitude. The participant is member of the study team or in a dependent relationship with one of the study team members which includes close relatives (i.e., children, partner/spouse, siblings and parents) as well as employees. Delay criteria Only for Cohort 4, if the participant presents with an acute bleeding episodes or acute illness (eg, influenza, flu-like syndrome, allergic rhinitis/conjunctivitis, and non-seasonal asthma) the screening visit will be postponed until the participant has recovered. For all other participants, end of study (EOS) visit for 071102 or 071301 will be completed per protocol and the completed EOS in Study 071102 or 071301 will also serve as the screening visit for this continuation study (SHP677-304).
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: On-Demand<br>Participants will receive recombinant von Willebrand factor (rVWF) (with or without ADVATE). | Biological: rVWF<br>* Recombinant von Willebrand factor<br>* Other names: Vonicog alfa;Biological: rFVIII<br>* Recombinant Factor VIII<br>* Other names: ADVATE;|
| Experimental: Prophylaxis<br>Participants will receive recombinant von Willebrand factor (rVWF). | Biological: rVWF<br>* Recombinant von Willebrand factor<br>* Other names: Vonicog alfa;Biological: rFVIII<br>* Recombinant Factor VIII<br>* Other names: ADVATE;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Spontaneous Annualized Bleeding Rate (ABR) | Spontaneous ABR during prophylaxis treatment with rVWF (vonicog alfa) | First 12 months of treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse Events (AEs)/Serious Adverse Events (SAEs) | AEs/ SAEs: incidence, severity, causality | Throughout the study participation period, up to 3 years | 
| Thromboembolic Events | Occurrence of thromboembolic events | Throughout the study participation period, up to 3 years | 
| Hypersensitivity Reactions | Occurrence of hypersensitivity reactions | Throughout the study participation period, up to 3 years | 
| Number of Participants who Develop Neutralizing Antibodies to von Willebrand factor (VWF) | Number of participants who develop neutralizing antibodies (inhibitors) to VWF | Throughout the study participation period, up to 3 years | 
| Number of Participants who Develop Neutralizing Antibodies to Factor VIII (FVIII) | Number of participants who develop neutralizing antibodies (inhibitors) to FVIII | Throughout the study participation period, up to 3 years | 
| Number of Participants who Develop Total Binding Antibodies to von Willebrand factor (VWF) | Number of participants who develop total binding antibodies to VWF | Throughout the study participation period, up to 3 years | 
| Number of Participants who Develop Total Binding Antibodies to Factor VIII (FVIII) | Number of participants who develop total binding antibodies to FVIII | Throughout the study participation period, up to 3 years | 
| Number of Participants who Develop Binding Antibodies to Chinese hamster ovary (CHO) proteins | Number of participants who develop binding antibodies to CHO proteins | Throughout the study participation period, up to 3 years | 
| Number of Participants who Develop Binding Antibodies to Mouse Immunoglobulin G (IgG) | Number of participants who develop binding antibodies to mouse IgG | Throughout the study participation period, up to 3 years | 
| Number of Participants who Develop Binding Antibodies to recombinant Furin (rFurin) | Number of participants who develop binding antibodies to rFurin | Throughout the study participation period, up to 3 years | 
| Number of Participants With Clinically Significant Changes in Vital Signs | Clinically significant changes in vital signs (body temperature, blood pressure, respiration and pulse) will be assessed from baseline up to 3 years | Throughout the study participation period, up to 3 years | 
| Number of Participants With Clinically Significant Changes in Laboratory Parameters | Clinically significant changes in laboratory parameters (clinical chemistry, fasting lipid panel and determination of fat-soluble vitamins, bile acids and other cholestasis biochemical markers) will be assessed from baseline up to 3 years | Throughout the study participation period, up to 3 years | 
| Spontaneous Annualized Bleeding Rate (ABR) Under Prophylactic Treatment | Spontaneous ABR under prophylactic treatment with rVWF (vonicog alfa) while enrolled in the study | Throughout the study participation period, up to 3 years | 
| Categorized Weekly Number of Infusions | Categorized as 1, 2 or >=3 during prophylactic treatment with rVWF (vonicog alfa) | Throughout the study participation period, up to 3 years | 
| Categorized Spontaneous Annualized Bleeding Rate (ABR) | Categorized as 0, 1-2, 3-5, or >5 bleeding episodes during rVWF (vonicog alfa) prophylaxis | Throughout the study participation period, up to 3 years | 
| Time to First Bleeding Event | Under each prophylaxis regimen | Throughout the study participation period, up to 3 years | 
| Spontaneous Annualized Bleeding Rate (ABR) by Location of Bleeding | Gastrointestinal [GI], epistaxis, joint bleeding, menorrhagia, oral, muscle and soft tissue, etc. while on prophylactic treatment with rVWF (vonicog alfa) | Throughout the study participation period, up to 3 years | 
| Total Number of Infusions | Total number of infusions during prophylactic treatment with rVWF (vonicog alfa) | Throughout the study participation period, up to 3 years | 
| Average Number of Infusions | Per week during prophylactic treatment with rVWF (vonicog alfa) | Throughout the study participation period, up to 3 years | 
| Total Weight Adjusted Consumption of recombinant von Willebrand factor (rVWF) (vonicog alfa) | During prophylactic treatment | Throughout the study participation period, up to 3 years | 
| Number of Participants who Achieve Transfusion-free Maintenance of Hemoglobin Levels | Transfusion free maintenance of hemoglobin levels over time | Throughout the study participation period, up to 3 years | 
| Ferritin Levels Over Time | Ferritin levels over time will be reported. | Throughout the study participation period, up to 3 years | 
| Overall Hemostatic Efficacy Rating | At the resolution of bleed with respect to the treatment of bleeding episodes for the initial 12 months of study | Initial 12 months of study | 
| Number of Infusions | Number of infusions of rVWF (vonicog alfa) and ADVATE (rFVIII, octocog alfa) utilized to treat bleeding episodes while enrolled in the study | Throughout the study participation period, up to 3 years | 
| Weight-adjusted Consumption | Weight-adjusted consumption of rVWF (vonicog alfa) and ADVATE (rFVIII, octocog alfa) per bleeding episode while enrolled in the study | Throughout the study participation period, up to 3 years |