Clinical trial NCT05582993: A Study of Vonicog Alfa (rVWF) in Children With Severe Von Willebrand Disease (vWD)
Official title: A Phase 3, Prospective, Open-label, Uncontrolled, Multicenter Study on Efficacy and Safety of Prophylaxis With Vonicog Alfa (rVWF) in Children Diagnosed With Severe Von Willebrand Disease
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE3
Conditions: Von Willebrand Disease (VWD)
Lead sponsor: Takeda
Sponsor class: INDUSTRY
First posted: 2022-10-17
Enrollment: 24
Sex: ALL
Maximum age (years): 17
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The main aim of the study is to evaluate the effectiveness of prophylaxis with vonicog alfa (recombinant von Willebrand factor \[rVWF\]) in children. This study will enroll those participants who have been previously treated with VWF product or with a plasma-derived VWF (pdVWF) product. In this study, participants will be treated with vonicog alfa (rVWF) for 12 months.

During the study, participants will visit the study clinic 5 times after treatment initiation.


Eligibility criteria: 1. The participant has a documented diagnosis of severe VWD (baseline von Willebrand factor ristocetin cofactor activity \[VWF:RCo\] \<20 international units per deciliter \[IU/dL\]) with a history of replacement therapy with VWF concentrate required to control bleeding and a diagnosis of VWD type 1, type 2 (2A, 2B, 2M, 2N), or type 3. Diagnosis is confirmed, as applicable, by genetic testing and/or by multimer analysis, which may be documented in participant's history or at screening.
2. The participant is \<18 years of age at the time of screening.
3. Prescreening treatment requirements:

   1. The participant has been receiving OD therapy with VWF products for at least 12 months (for participants \>=2 years of age) prior to screening, has experienced at least 1 VWF-treated bleeding event during (excluding menorrhagia/heavy menstrual bleeding \[HMB\], as applicable) in the last 12 months, and prophylactic treatment is recommended by the investigator (Prior OD participants); or
   2. The participant has been receiving prophylactic treatment with pdVWF products for at least 12 months prior to screening (for participants \>=2 years of age) and switching to prophylaxis with vonicog alfa (rVWF) is recommended by the investigator (Switch participants).
   3. For participants \<2 years of age, the required duration for prior OD therapy with VWF products or for prior prophylactic treatment with pdVWF products is at least 6 months. Prior OD participants \<2 years of age should have experienced at least 1 VWF-treated bleeding event during the last 6 months based on medical records and be recommended to receive prophylactic treatment by the investigator.
4. For participants \>=2 years of age, the participant has available records that reliably evaluate type, frequency, severity, and treatment of BEs for at least 12 months preceding enrollment. For participants \<2 years of age, the participant has available records that reliably evaluate type, frequency, severity and treatment of BEs for at least 6 months preceding enrollment.
5. If \>=12 years old at the time of screening, the participant has a body mass index (BMI) \>=15 but \<40 kilogram per square meter (kg/m\^2). If \>=2 to \<12 years old at the time of screening, the participant has a BMI of \>=5th and \<95th percentile (per Centers for Disease Control and Prevention \[CDC\] clinical charts). For younger participants who are \<2 years old, the "weight-for-age" clinical charts (5th to 95th percentile) provided by the CDC should be utilized to ensure the participant has a body weight of \>=5th and \<95th percentile based on gender (for clinical charts provided by CDC, refer to: https://www.cdc.gov/growthcharts/clinical_charts.htm).
6. Female participants of childbearing potential (that is, had onset of menses/reached puberty) must have a negative blood/urine pregnancy test result at screening and agree to employ highly effective birth control measures for the duration of their participation in the study.
7. The participant has voluntarily provided assent (if appropriate) and the legally authorized representative(s) has provided informed consent.
8. The participant and/or legally authorized representative is willing and able to comply with the requirements of the protocol, which should also be confirmed based on a prescreening evaluation held between the investigator and the sponsor to ensure no eminent risk is present that could challenge the participant's compliance with the study requirements.

Exclusion Criteria:

1. The participant has been diagnosed with pseudo VWD or another hereditary or acquired coagulation disorder other than VWD (example, qualitative and quantitative platelet disorders or elevated prothrombin time/international normalized ratio 1.4).
2. The participant has a history or presence of a VWF inhibitor at screening.
3. The participant has a history or presence of an factor VIII (FVIII) inhibitor with a titer \>=0.6 Bethesda units per milliliter (/mL).
4. The participant has a known hypersensitivity to any of the components of the study drugs, such as mouse or hamster proteins.
5. The participant has a medical history of immunological disorders, excluding seasonal allergic rhinitis/conjunctivitis, mild asthma, food allergies, or animal allergies.
6. The participant has a medical history of a thromboembolic event.
7. The participant is human immunodeficiency virus (HIV)-positive with an absolute helper T cell (CD4) count \<200 per cubic millimeter or microliter (/mm\^3).
8. The participant has been diagnosed with significant liver disease per the 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 (ULN), hypoalbuminemia, portal vein hypertension (example, presence of otherwise unexplained splenomegaly, history of esophageal varices), or liver cirrhosis classified as Child-Pugh class B or C.
9. The participant has been diagnosed with renal disease, with a serum creatinine level \>=2.5 milligram per deciliter (mg/dL).
10. The participant has a platelet count \<100,000/mL at screening (because participants with type 2B VWD are considered eligible for this study, for participants with type 2B VWD, platelet count\[s\] at screening will be evaluated in consultation with the sponsor, taking into consideration historical trends in platelet counts and the investigator's medical assessment of the participants condition).
11. The participant has been treated with an immunomodulatory drug, excluding topical treatment (example, ointments, nasal sprays), within 30 days prior to signing the informed consent (or assent, if appropriate).
12. The participant is pregnant or lactating at the time of enrollment.
13. The participant has cervical or uterine conditions causing menorrhagia or metrorrhagia (including infection, dysplasia).
14. The participant has participated in another clinical study involving another 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.
15. The participant has not received OD or prophylactic treatment with a VWF product prior to this study.
16. The participant has a progressive fatal disease and/or life expectancy of less than 15 months.
17. The participant is unable to complete screening procedures and/or comply with the requirements of the protocol in the opinion of the investigator, based on the joint prescreening evaluation held between the investigator and the sponsor.
18. 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.
19. The participant is member of the study team or in a dependent relationship with one of the study team members, which includes close relatives (that is, children, partner/spouse, siblings, and parents) as well as employees.

Primary outcomes:
measure: Annualized Bleeding Rate (ABR) for Spontaneous or Traumatic Bleeding Episodes as Assessed by Investigator During Prophylactic Treatment With Vonicog Alfa (rVWF)
timeFrame: 12 months
Secondary outcomes:
measure: Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)
timeFrame: 12 months
measure: Number of Participants With TEAEs by Severity
timeFrame: 12 months
measure: Number of Participants With TEAEs and SAEs by Causality
timeFrame: 12 months
measure: Number of Participants With Thromboembolic Events, Hypersensitivity Reactions and Infusion-Related Reactions (IRR)
timeFrame: 12 months
measure: Number of Participants Who Develop Neutralizing Antibodies to VWF and Factor VIII (FVIII)
timeFrame: 12 months
measure: Number of Participants Who Develop Binding Antibodies to VWF and FVIII
timeFrame: 12 months
measure: Number of Participants With Clinically Significant Change From Baseline Values in Vital Sign Parameters
timeFrame: 12 months
measure: Number of Participants With Clinically Significant Change From Baseline Values in Laboratory Parameters
timeFrame: 12 months
measure: Number of Participants With Categorized ABR
timeFrame: 12 months
measure: Number of Participants Previously Receiving On-demand Treatment who will Achieve ABR Percent Reduction Success
timeFrame: 12 months
measure: Number of pdVWF Switch Participants With Spontaneous ABR Preservation Success
timeFrame: 12 months
measure: Number of Spontaneous ABR Historically and While on Prophylactic Treatment With Vonicog Alfa (rVWF) by Location of Bleeding
timeFrame: 12 months
measure: ABR for Bleeding Episodes by Bleeding Cause Historically and While on Prophylactic Treatment With Vonicog Alfa (rVWF)
timeFrame: 12 months
measure: Total Number of Infusions Administered Per Week During Prophylactic Treatment With Vonicog Alfa (rVWF)
timeFrame: 12 months
measure: Average Number of Infusions Per Week During Prophylactic Treatment With Vonicog Alfa (rVWF)
timeFrame: 12 months
measure: Total Weight Adjusted Consumption of Vonicog Alfa (rVWF) Per Month During Prophylactic Treatment
timeFrame: 12 months
measure: Overall Hemostatic Efficacy Rating of Breakthrough Bleed Treatment at Resolution of the Bleeding Episode
timeFrame: 12 months
measure: Number of Infusions of rVWF and ADVATE (rFVIII, octocog alfa) per Bleeding Episode
timeFrame: 12 months
measure: Weight-adjusted Consumption of Vonicog Alfa (rVWF) and ADVATE per Bleeding Episode
timeFrame: 12 months
measure: Plasma Level of Vonicog Alfa (rVWF) based on Von Willebrand Factor: Ristocetin Cofactor (VWF:Rco)
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Plasma Level of Vonicog Alfa (rVWF) based on Von Willebrand Factor Antigen (VWF:Ag)
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Plasma Level of Vonicog alfa (rVWF) based on Von Willebrand Factor Collagen Binding (VWF:CB)
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Plasma Level of Vonicog alfa (rVWF) based on Von Willebrand Factor Glycoprotein 1b Binding (VWF:GP1bM)
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Plasma Level of Factor VIII Clotting (FVIII:C)
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Incremental Recovery Based on VWF:Rco
timeFrame: 12 months
measure: Incremental Recovery Based on VWF:Ag
timeFrame: 12 months
measure: Incremental Recovery Based on VWF:CB
timeFrame: 12 months
measure: Incremental Recovery Based on VWF:GP1bM
timeFrame: 12 months
measure: Ratio of Area Under the Plasma Level Versus Time Curve From Time 0 to End of the Partial Dosing Interval (AUC0- Tau;ss) and Area Under the Level Versus Time Curve From 0 to 96 Hours (AUC0-96; ss) for VWF:Rco
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Terminal Half-life (T1/2) for VWF:Rco
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Maximum Plasma Level During the Partial Dosing Interval at Steady State (Cmax;ss) for VWF:Rco
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Minimum Time to Reach the Maximum Plasma Level at Steady State (Tmax;ss) for VWF:Rco
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Volume of Distribution at Steady State (Vss) for VWF:Rco
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Clearance (CL) for VWF:Rco
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Maximum Plasma Level During the Partial Dosing Interval at Steady State (Cmax;ss) for FVIII:C
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Minimum Time to Reach the Maximum Plasma Level at Steady State (Tmax;ss) for FVIII:C
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Ratio of Area Under the Plasma Level Versus Time Curve From Time 0 to End of the Partial Dosing Interval (AUC0- Tau;ss) and Area Under the Level Versus Time Curve From 0 to 96 Hours (AUC0-96; ss) for FVIII:C
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
measure: Area Under the Level Versus Time Curve From 0 to 96 Hours (AUC0-96; ss) for FVIII:C
timeFrame: Within 30 minutes pre-infusion and at multiple timepoints (up to 96 hours) post-infusion
Other outcomes:
Locations:
city: Detroit
country: United States
facility: Childrens Hospital of Michigan
state: Michigan
city: Minneapolis
country: United States
facility: Children's Health Care d/b/a Children's Minnesota
state: Minnesota
city: New York
country: United States
facility: New York - Presbyterian/Weill Cornell Medical Center
state: New York
city: Charleston
country: United States
facility: Medical University of South Carolina (MUSC)
state: South Carolina
city: Lille
country: France
facility: Hemostase Clinique - Institut Cœur-Poumons (4eme étage aile est) Bureau 419
city: Lyon
country: France
facility: Hopital Edouard Herriot - CHU Lyon
city: Dublin
country: Ireland
facility: Children's Health Ireland
city: Napoli
country: Italy
facility: Azienda Ospedaliera Pediatrica Santobono Pausillipon
city: Turin (Torino)
country: Italy
facility: Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino
city: Kashihara
country: Japan
facility: Nara Medical University Hospital
Study officials:
affiliation: Takeda
name: Study Director
role: STUDY_DIRECTOR
References: