Clinical trial NCT04840667: A Study of Replagal in Treatment-naïve Adults With Fabry Disease
Official title: A Phase 3, Open-label Study to Evaluate the Efficacy and Safety of REPLAGAL® in Treatment-naïve Subjects With Fabry Disease
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE3
Conditions: Fabry Disease
Lead sponsor: Takeda
Sponsor class: INDUSTRY
First posted: 2021-04-12
Enrollment: 17
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: In this study, adults with Fabry Disease who have not had any treatment for this condition will be treated with Replagal. The main aim of the study is to check if Replagal improves kidney function and heart structure of participants with Fabry Disease. Participants will receive one Replagal infusion every other week for up to 104 weeks. They will visit the clinic every 12 to 14 weeks during treatment with a follow-up visit 2 weeks after treatment.


Eligibility criteria: Inclusion Criteria:

* The participant must voluntarily sign an Institutional Review Board (IRB)/Independent Ethics Committee/Research Ethics Board approved informed consent form after all relevant aspects of the study have been explained and discussed with the participant.
* The participant has Fabry disease as confirmed at screening by the following criteria using a dried blood spot (DBS) assay:

  1. For male participants, Fabry disease is confirmed by a deficiency of alpha-galactosidase A (GLA) activity and a mutation in the GLA gene
  2. For female participants, Fabry disease is confirmed by a mutation in the GLA gene
* The participant is 18 to 65 years of age, inclusive.
* Female participants must have a negative pregnancy test at screening.
* Female participants of child-bearing potential must agree to use a medically acceptable method of contraception at all times during the study and for at least 14 days after the final study infusion; the methods of acceptable contraception are listed in the protocol.
* The participant is deemed, as determined by the investigator, to have adequate general health to undergo the specified protocol-related procedures and to have no safety or medical contraindications for participation.
* The participant has not received any treatment (approved or investigational) specific to Fabry disease, such as enzyme replacement therapy (ERT), chaperone therapy, or substrate reduction therapy.
* The participant must have an eGFR of 45 to 120 milliliter per minute per 1.73 square meter (mL/min/1.73 m\^2); eGFR will be calculated by a Shire-designated laboratory using the CKD-EPI formula. If the eGFR measurement at screening is not within the range, a second eGFR measurement may be completed and, if in range, used as the screening value. If a second measurement is taken, a minimum of 1 week and maximum of 30 days should separate it from the first. This inclusion criterion follows the European Guidelines for Treatment of Fabry Disease and Kidney Disease Improving Global Outcomes guidelines for classification of renal disease.
* The participant has left ventricular hypertrophy (LVH), where LVH is defined as left ventricular mass index (LVMI) greater than (\>) 50 gram per square meter (g/m\^2.7) confirmed by cardiac magnetic resonance imaging (cMRI) at screening. The cMRI value at screening will serve as the baseline value.

Exclusion Criteria:

* In the opinion of the investigator, the participant's life expectancy is less than or equal to (\<=) 5 years.
* The participant has undergone or is scheduled to undergo kidney transplantation or is currently on dialysis, or has any signs or symptoms of end stage renal disease.
* Urine protein/creatinine ratio (PCR) greater than (\>) 1.5 milligram per milligram (mg/mg).
* Participants who have clinically relevant history of allergy or signs or symptoms of severe hypersensitivity, (including hypersensitivity to the REPLAGAL active substance or any of the excipients), which in the investigator's judgment, will substantially increase the participant's risk if he or she participates in the study.
* Cardiac fibrosis involving more than 2 segments, as determined by cMRI at screening.
* In the opinion of the investigator, the participant has non-Fabry disease-related cause of end-organ (renal, cardiac, central nervous system) dysfunction/failure or is receiving medications that may affect the rate of disease progression, as assessed by cardiac and/or renal measures.
* The participant has a positive test at screening for hepatitis B surface antigen, positive test for hepatitis B core antibody, positive test for hepatitis C (HCV) antibody with confirmation by HCV-ribonucleic acid polymerase chain reaction testing, or positive test for human immunodeficiency virus antibody.
* Treatment with REPLAGAL at any time prior to the study.
* Prior treatment with any of the following medications:

  1. FABRAZYME (agalsidase beta) and its biosimilars
  2. GLYSET (miglitol)
  3. ZAVESCA (miglustat)
  4. CERDELGA (eliglustat)
  5. GALAFOLD (migalastat)
  6. Any investigational product for treatment of Fabry disease
* Treatment at any time during the study with the following medications:

  1. Chloroquine
  2. Amiodarone
  3. Monobenzone
  4. Gentamicin
* The participant is pregnant or lactating.
* The participant has a body mass index \> 39 kilogram per square meter (kg/ m\^2). (Body mass index \[BMI\] = kg/ m\^2).
* The participant is treated or has been treated with any investigational drug within 30 days of study start.
* The participant is unable to understand the nature, scope, and possible consequences of the study.
* The participant is unable to comply with the protocol, eg, uncooperative with protocol schedule, refusal to agree to all of the study procedures, inability to return for evaluations, or is otherwise unlikely to complete the study, as determined by the investigator.

Primary outcomes:
measure: Change From Baseline in Renal Function at Week 104
timeFrame: Baseline, Week 104
measure: Change From Baseline in Cardiac Structure at Week 104
timeFrame: Baseline, Week 104
Secondary outcomes:
measure: Annualized Rate of Change in Estimated Glomerular Filtration Rate (eGFR) up to Week 104
timeFrame: From Baseline up to Week 104
measure: Annualized Rate of Change in Left Ventricular Mass Index (LVMI) up to Week 104
timeFrame: From Baseline up to Week 104
measure: Change From Baseline in eGFR up to Week 104
timeFrame: From Baseline up to Week 104
measure: Change From Baseline in LVMI up to Week 104
timeFrame: From Baseline up to Week 104
measure: Change From Baseline in Proteinuria up to Week 104
timeFrame: From Baseline up to Week 104
measure: Change From Baseline in Cardiac Fibrotic Segments up to Week 104
timeFrame: From Baseline up to Week 104
measure: Change From Baseline in Interventricular Septal End-Diastolic Thickness and Posterior Wall Thickness in Diastole up to Week 104
timeFrame: From Baseline up to Week 104
measure: Change From Baseline in Plasma Globotriaosylsphingosine (Lyso-Gb3) up to Week 104
timeFrame: From Baseline up to Week 104
measure: Number of Participants With Adverse Events (AEs)
timeFrame: From start of study drug administration up to follow-up visit (i.e., up to Week 106)
measure: Number of Participants Who Will Develop Anti-drug Antibodies (ADA) to REPLAGAL
timeFrame: From Baseline up to Week 104
Other outcomes:
Locations:
city: Calgary
country: Canada
facility: M.A.G.I.C. Clinic Ltd. Metabolics and Genetics in Calgary
city: Halifax
country: Canada
facility: Queen Elizabeth II Health Sciences Center
city: Turku
country: Finland
facility: Turun Yliopistollinen Keskussairaala
city: Vaasa
country: Finland
facility: Vaasan Keskussairaala
city: Berlin
country: Germany
facility: Charité - Universitätsklinikum
city: Hochheim
country: Germany
facility: SphinCS
city: Mainz
country: Germany
facility: Universitätsmedizin der Johannes Gutenberg-Universität Mainz
city: Müllheim
country: Germany
facility: Fachinternistische Gemeinschaftspraxis
city: Wuerzburg
country: Germany
facility: Universitaetsklinikum Wuerzburg
city: Athens
country: Greece
facility: Laiko General Hospital of Athens
city: Athens
country: Greece
facility: Attikon University General Hospital
city: Heraklion
country: Greece
facility: University General Hospital of Heraklion
city: Ioannina
country: Greece
facility: University Hospital of Ioannina
city: Kallithea
country: Greece
facility: Onasseio Private Practise Hospital of Piraeus
city: Thessaloniki
country: Greece
facility: Papageorgiou General Hospital of Thessaloniki
city: Krakow
country: Poland
facility: Szpital Uniwersytecki
city: Warszawa
country: Poland
facility: Narodowy Instytut Kardiologii im Prymasa Tysiaclecia Kardynala Stefana Wyszynskiego - Instytut Badaw
city: Wroclaw
country: Poland
facility: Uniwersytecki Szpital Kliniczny im. Jana Mikulicza Radeckiego we Wroclawiu
city: Coimbra
country: Portugal
facility: Centro Hospitalar e Universitário de Coimbra EPE
city: Guimaraes
country: Portugal
facility: Hospital Senhora da Oliveira - Guimaraes, E.P.E
city: Lisboa
country: Portugal
facility: Centro Hospitalar Lisboa Norte, E.P.E. - Hospital de Santa Maria
city: Alicante
country: Spain
facility: Hospital General Universitario de Alicante
city: Almeria
country: Spain
facility: Hospital de Torrecárdenas
city: Barcelona
country: Spain
facility: Hospital Universitario Vall d'Hebrón - PPDS
city: Madrid
country: Spain
facility: Hospital Universitario La Paz
city: Sevilla
country: Spain
facility: Hospital Universitario Virgen del Rocio - PPDS
city: Zaragoza
country: Spain
facility: Hospital Quironsalud Zaragoza
city: Uppsala
country: Sweden
facility: Akademiska Sjukhuset I Uppsala
Study officials:
affiliation: Shire
name: Study Director
role: STUDY_DIRECTOR
References: