Clinical trial NCT03879135: A Study of Recombinant Von Willebrand Factor (rVWF) in Pediatric and Adult Participants With Severe Von Willebrand Disease (VWD)
Official title: 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)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Von Willebrand Disease (VWD)
Lead sponsor: Takeda
Sponsor class: INDUSTRY
Collaborators: name: Takeda Development Center Americas, Inc.
First posted: 2019-03-18
Enrollment: 38
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: 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.


Eligibility criteria: 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).

Primary outcomes:
measure: Spontaneous Annualized Bleeding Rate (ABR)
timeFrame: First 12 months of treatment
Secondary outcomes:
measure: Adverse Events (AEs)/Serious Adverse Events (SAEs)
timeFrame: Throughout the study participation period, up to 3 years
measure: Thromboembolic Events
timeFrame: Throughout the study participation period, up to 3 years
measure: Hypersensitivity Reactions
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants who Develop Neutralizing Antibodies to von Willebrand factor (VWF)
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants who Develop Neutralizing Antibodies to Factor VIII (FVIII)
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants who Develop Total Binding Antibodies to von Willebrand factor (VWF)
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants who Develop Total Binding Antibodies to Factor VIII (FVIII)
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants who Develop Binding Antibodies to Chinese hamster ovary (CHO) proteins
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants who Develop Binding Antibodies to Mouse Immunoglobulin G (IgG)
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants who Develop Binding Antibodies to recombinant Furin (rFurin)
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants With Clinically Significant Changes in Vital Signs
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants With Clinically Significant Changes in Laboratory Parameters
timeFrame: Throughout the study participation period, up to 3 years
measure: Spontaneous Annualized Bleeding Rate (ABR) Under Prophylactic Treatment
timeFrame: Throughout the study participation period, up to 3 years
measure: Categorized Weekly Number of Infusions
timeFrame: Throughout the study participation period, up to 3 years
measure: Categorized Spontaneous Annualized Bleeding Rate (ABR)
timeFrame: Throughout the study participation period, up to 3 years
measure: Time to First Bleeding Event
timeFrame: Throughout the study participation period, up to 3 years
measure: Spontaneous Annualized Bleeding Rate (ABR) by Location of Bleeding
timeFrame: Throughout the study participation period, up to 3 years
measure: Total Number of Infusions
timeFrame: Throughout the study participation period, up to 3 years
measure: Average Number of Infusions
timeFrame: Throughout the study participation period, up to 3 years
measure: Total Weight Adjusted Consumption of recombinant von Willebrand factor (rVWF) (vonicog alfa)
timeFrame: Throughout the study participation period, up to 3 years
measure: Number of Participants who Achieve Transfusion-free Maintenance of Hemoglobin Levels
timeFrame: Throughout the study participation period, up to 3 years
measure: Ferritin Levels Over Time
timeFrame: Throughout the study participation period, up to 3 years
measure: Overall Hemostatic Efficacy Rating
timeFrame: Initial 12 months of study
measure: Number of Infusions
timeFrame: Throughout the study participation period, up to 3 years
measure: Weight-adjusted Consumption
timeFrame: Throughout the study participation period, up to 3 years
Other outcomes:
Locations:
city: Little Rock
country: United States
facility: Arkansas Children's Hospital Research Institute
state: Arkansas
city: Aurora
country: United States
facility: University of Colorado Health
state: Colorado
city: Gainesville
country: United States
facility: University of Florida College of Medicine
state: Florida
city: Indianapolis
country: United States
facility: Indiana Hemophilia and Thrombosis Center
state: Indiana
city: Cincinnati
country: United States
facility: Cincinnati Children's Hospital Medical Center
state: Ohio
city: Cleveland
country: United States
facility: Rainbow Babies and Children's Hospital
state: Ohio
city: Columbus
country: United States
facility: Nationwide Children's Hospital
state: Ohio
city: Charleston
country: United States
facility: Medical University of South Carolina (MUSC)
state: South Carolina
city: Vienna
country: Austria
facility: AKH - Medizinische Universität Wien
city: Lille Cedex
country: France
facility: Hopital Cardiologique - CHU Lille
state: Nord
city: Paris cedex 15
country: France
facility: Hôpital Necker - Enfants Malades
state: Paris
city: Bron cedex
country: France
facility: Groupement Hospitalier Est- Hôpital Louis Pradel
city: Gironde
country: France
facility: Groupe Hospitalier Pellegrin - Hôpital Pellegrin
city: Le Kremlin Bicêtre cedex
country: France
facility: Groupement Hospitalier Sud - Hôpital Bicêtre
city: Frankfurt
country: Germany
facility: Klinikum der Johann Wolfgang Goethe-Universitaet
city: Hannover
country: Germany
facility: Werlhof-Institut GmbH
city: Firenze
country: Italy
facility: Azienda Ospedaliera Universitaria Careggi
city: Milano
country: Italy
facility: Fondazione IRCCS CA' Granda Ospedale Maggiore Policlinico
city: Napoli
country: Italy
facility: Azienda Ospedaliera Pediatrica Santobono Pausillipon
city: Roma
country: Italy
facility: Fondazione Policlinico Universitario Agostino Gemelli IRCCS
city: Roma
country: Italy
facility: Azienda Ospedaliera Universitaria Policlinico Umberto I - Università di Roma La Sapienza
city: Roma
country: Italy
facility: Ospedale Pediatrico Bambino Gesù
city: Rotterdam
country: Netherlands
facility: Erasmus Medisch Centrum
city: Rotterdam
country: Netherlands
facility: Erasmus Medisch Centrum
city: Kemerovo
country: Russian Federation
facility: SAIH "Kemerovo Regional Clinical Hospital"
city: Kirov
country: Russian Federation
facility: FSBI of Science "Kirov Scientific and Research Institute of Hematology and Blood Transfusion of FMBA
city: Alicante
country: Spain
facility: Hospital General Universitario de Alicante
city: Madrid
country: Spain
facility: Hospital Universitario La Paz
city: Valencia
country: Spain
facility: Hospital Universitari i Politecnic La Fe
city: Istanbul
country: Turkey
facility: Istanbul University Oncology Institute
city: Izmir
country: Turkey
facility: Ege University Medical Faculty
city: Izmir
country: Turkey
facility: Ege University Medical Faculty
city: Samsun
country: Turkey
facility: Ondokuz Mayis Univ. Med. Fac.
Study officials:
affiliation: Takeda
name: Study Director
role: STUDY_DIRECTOR
References: