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The purpose of this study is to determine if a subcutaneous dose of DX-88 (ecallantide; an investigational product) is safe and relieves symptoms of HAE in patients suffering from moderate to severe acute attacks of HAE.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| DX-88 (ecallantide) | Experimental | DX-88 (ecallantide) 30 mg given as three 10 mg/mL subcutaneous injections. |
|
| Placebo | Placebo Comparator | Phosphate Buffer Saline (PBS), pH 7.0 given as 3 subcutaneous injections. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ecallantide | Drug | dose of 30 mg (10 mg/ml) given as 3 subcutaneous injections. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Treatment Outcome Score at 4 Hours Post-Dose | Treatment Outcome Score (TOS) is a validated, comprehensive measure of symptom response to treatment. At 4 hours , patient assessment of response characterized by their change from baseline in symptom severity and collected by anatomic site of attack involvement, was recorded on a categorical scale (significant improvement [100] to significant worsening [-100]). The response at each anatomic site was weighted by baseline severity and then the weighted scores across all involved sites were averaged to calculate the TOS. Clinically meaningful improvement was indicated by a TOS of 30 or higher. | 4 hours post-dose (DOUBLE-BLIND PART) |
| Measure | Description | Time Frame |
|---|---|---|
| Change From Baseline in Mean Symptom Complex Severity (MSCS) Score at 4 Hours Post-dose | Mean Symptom Complex Severity (MSCS) score is a validated, comprehensive point-in-time measure of symptom severity. At baseline and 4 hours, patients rated the severity on a categorical scale (0 = normal, 1 = mild, 2 = moderate, 3 = severe) for symptoms at each affected anatomical location. Ratings were averaged to obtain the MSCS score. A decrease in MSCS score reflected an improvement in symptoms; clinically meaningful improvement (minimally important difference) was indicated by a reduction in the score of 0.30 or more. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Patients With Symptom Complexes of Treated Attack at Baseline(DOUBLE-BLIND PART) | Patient-reported severity of symptom complexes at baseline, by symptom complex and treatment group. Patients were to have at least one symptom complex that was moderate or severe. Patients could present with multiple symptom complexes, some of which could be mild. Mild=noticeable but do not impact daily living activities; Moderate=treatment or intervention is highly desirable and activities of daily living are impacted; Severe=require treatment or intervention due to inability to perform activities of daily living. The results are for number of patients with symptom complexes including mild, moderate and severe, provided the patients have at least one symptom complex that was moderate or severe |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Study Director | Takeda | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Institute for Asthma and Allergy | Wheaton | Maryland | 20902 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24712435 | Derived | Rubinstein E, Stolz LE, Sheffer AL, Stevens C, Bousvaros A. Abdominal attacks and treatment in hereditary angioedema with C1-inhibitor deficiency. BMC Gastroenterol. 2014 Apr 9;14:71. doi: 10.1186/1471-230X-14-71. | |
| 23878046 | Derived | MacGinnitie AJ, Davis-Lorton M, Stolz LE, Tachdjian R. Use of ecallantide in pediatric hereditary angioedema. Pediatrics. 2013 Aug;132(2):e490-7. doi: 10.1542/peds.2013-0646. Epub 2013 Jul 22. |
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Patients were screened in advance of presenting with an Hereditary Angioedema (HAE) attack but were randomized only upon attack.
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| ID | Title | Description |
|---|---|---|
| FG000 | Ecallantide / Ecallantide | Patients treated with ecallantide in the double-blind part and eligible for treatment with ecallantide in the repeat-dosing part of the study once their Follow-up Visit 1 (Day 7) in the double-blind part was completed. |
| FG001 | Placebo / Ecallantide | Patients treated with placebo in the double-blind part and eligible for treatment with ecallantide in the repeat-dosing part of the study once their Follow-up Visit 1 (Day 7) in the double-blind part was completed. |
| FG002 | Ecallantide (Repeat Dose Only) | Patients not treated in the double-blind part but treated with ecallantide in the repeat-dosing part. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Double Blind Treatment Period |
|
| ||||||||||||||||||
| Repeat Dose Treatment Period |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Ecallantide / Ecallantide | Patients treated with ecallantide in the double-blind part (ITT as treated) and eligible for treatment with ecallantide in the repeat-dosing part of the study once their Follow-up Visit 1 (Day 7) in the double-blind part was completed. |
| BG001 | Placebo / Ecallantide |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Treatment Outcome Score at 4 Hours Post-Dose | Treatment Outcome Score (TOS) is a validated, comprehensive measure of symptom response to treatment. At 4 hours , patient assessment of response characterized by their change from baseline in symptom severity and collected by anatomic site of attack involvement, was recorded on a categorical scale (significant improvement [100] to significant worsening [-100]). The response at each anatomic site was weighted by baseline severity and then the weighted scores across all involved sites were averaged to calculate the TOS. Clinically meaningful improvement was indicated by a TOS of 30 or higher. | ITT as treated: two patients randomized on the same day at the same study center were administered treatment opposite to their randomized treatment assignment. Data were analyzed based on actual treatment received. Imputation was used to account for emerging symptoms and medical intervention. Best possible score = 100; worst possible score = -100. | Posted | Mean | Standard Deviation | units on a scale | 4 hours post-dose (DOUBLE-BLIND PART) |
|
Adverse events were reported from enrollment (Study Day 1) through the conclusion of the Follow-up Visit 2 (Study Days 23-37) of each episode.
Additionally, AEs suspected to be related to study procedures were collected from the time of informed consent through enrollment and from Follow-up Visit 2 through Follow-up Visit 3 (Study Days 83-97).
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Double Blind - Ecallantide | Patients treated with ecallantide in the double-blind part only. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Anaphylactic Reaction | Immune system disorders | MedDRA (6.0) | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Diarrhoea | Gastrointestinal disorders | MedDRA (6.0) | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Study Director | Shire | +1 866 842 5335 | ClinicalTransparency@shire.com |
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| ID | Term |
|---|---|
| D054179 | Angioedemas, Hereditary |
| ID | Term |
|---|---|
| D000799 | Angioedema |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D000081208 | Hereditary Complement Deficiency Diseases |
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| ID | Term |
|---|---|
| C511194 | ecallantide |
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| Phosphate Buffer Saline (PBS), | Drug | given as three 1mL subcutaneous injections. |
|
| baseline, 4 hours post-dose (DOUBLE-BLIND PART) |
| Time to Significant Improvement in Overall Response | The overall response assessment is a patient-reported assessment of global response to therapy. Patients are asked to perform an overall response assessment at regular intervals, relative to baseline. Patients were asked "overall how are you feeling" compared to how they felt before study drug. Answer options were "a lot worse", "a little worse", "same", "a little better" or "a lot better or resolved". Significant improvement was the first time that the patient responded to the assessment as "a little better or resolved". | 4 hours post-dose (DOUBLE-BLIND PART) |
| Baseline |
| Treatment Outcome Score at 4 Hours Post-Dose Over Multiple Treatment Episodes | Treatment Outcome Score (TOS) is a validated, comprehensive measure of symptom response to treatment. At 4 hours , patient assessment of response characterized by their change from baseline in symptom severity and collected by anatomic site of attack involvement, was recorded on a categorical scale (significant improvement [100] to significant worsening [-100]). The response at each anatomic site was weighted by baseline severity and then the weighted scores across all involved sites were averaged to calculate the TOS. Clinically meaningful improvement was indicated by a TOS of 30 or higher. | 4 hours post-dose (REPEAT-DOSING PART) |
| Change From Baseline in Mean Symptom Complex Severity (MSCS) Score at 4 Hours Post-dose Over Multiple Treatment Episodes | The Mean Symptom Complex Severity (MSCS) score is a validated, comprehensive point-in-time measure of symptom severity. At baseline and 4 hours, patients rated the severity on a categorical scale (0 = normal, 1 = mild, 2 = moderate, 3 = severe) for symptoms at each affected anatomical location. Ratings were averaged to obtain the MSCS score. A decrease in MSCS score reflected an improvement in symptoms; clinically meaningful improvement was indicated by a reduction in the score of 0.30 or more. | baseline, 4 hours post-dose (REPEAT-DOSING PART) |
| Time to Significant Improvement in Overall Response Over Multiple Treatment Episodes | The overall response assessment is a patient-reported assessment of global response to therapy. Patients are asked to perform an overall response assessment at regular intervals, relative to baseline (ie,immediately before treatment) using the following 5-category scale from significant improvement (Score = 100)to significant worsening (Score = -100) | 4 hours post-dose (REPEAT-DOSING PART) |
| 23548529 | Derived | Sheffer AL, MacGinnitie AJ, Campion M, Stolz LE, Pullman WE. Outcomes after ecallantide treatment of laryngeal hereditary angioedema attacks. Ann Allergy Asthma Immunol. 2013 Mar;110(3):184-188.e2. doi: 10.1016/j.anai.2012.12.007. Epub 2013 Jan 5. |
| 22765833 | Derived | Bernstein JA, Shea EP, Koester J, Iarrobino R, Pullman WE. Assessment of rebound and relapse following ecallantide treatment for acute attacks of hereditary angioedema. Allergy. 2012 Sep;67(9):1173-80. doi: 10.1111/j.1398-9995.2012.02864.x. Epub 2012 Jul 5. |
| 21130380 | Derived | Riedl M, Campion M, Horn PT, Pullman WE. Response time for ecallantide treatment of acute hereditary angioedema attacks. Ann Allergy Asthma Immunol. 2010 Dec;105(6):430-436.e2. doi: 10.1016/j.anai.2010.09.005. Epub 2010 Oct 25. |
| 20818887 | Derived | Cicardi M, Levy RJ, McNeil DL, Li HH, Sheffer AL, Campion M, Horn PT, Pullman WE. Ecallantide for the treatment of acute attacks in hereditary angioedema. N Engl J Med. 2010 Aug 5;363(6):523-31. doi: 10.1056/NEJMoa0905079. |
|
| NOT COMPLETED |
|
|
Patients treated with placebo in the double-blind part (ITT as treated) and eligible for treatment with ecallantide in the repeat-dosing part of the study once their Follow-up Visit 1 (Day 7) in the double-blind part was completed. |
| BG002 | Ecallantide (Repeat-Dosing Part Only) | Patients not treated in the double-blind part but treated with ecallantide in the repeat-dosing part. One patient was omitted from analysis in the intent-to-treat and per-protocol populations due to the loss of the data for the 4-hour post-dose assessments during treatment episode 1. |
| BG003 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| OG000 | Ecallantide | Patients treated with ecallantide in the double-blind part. |
| OG001 | Placebo | Patients treated with placebo in the double-blind part. |
|
|
|
| Secondary | Change From Baseline in Mean Symptom Complex Severity (MSCS) Score at 4 Hours Post-dose | Mean Symptom Complex Severity (MSCS) score is a validated, comprehensive point-in-time measure of symptom severity. At baseline and 4 hours, patients rated the severity on a categorical scale (0 = normal, 1 = mild, 2 = moderate, 3 = severe) for symptoms at each affected anatomical location. Ratings were averaged to obtain the MSCS score. A decrease in MSCS score reflected an improvement in symptoms; clinically meaningful improvement (minimally important difference) was indicated by a reduction in the score of 0.30 or more. | ITT as treated: two patients randomized on the same day at the same center were administered treatment opposite to their randomized treatment assignments. Data were analyzed based on their actual treatment received. Imputation was used to account for emerging symptoms and medical intervention. Best possible score = 0.0; worst possible score = 3.0. | Posted | Mean | Standard Deviation | units on a scale | baseline, 4 hours post-dose (DOUBLE-BLIND PART) |
|
|
|
|
| Other Pre-specified | Number of Patients With Symptom Complexes of Treated Attack at Baseline(DOUBLE-BLIND PART) | Patient-reported severity of symptom complexes at baseline, by symptom complex and treatment group. Patients were to have at least one symptom complex that was moderate or severe. Patients could present with multiple symptom complexes, some of which could be mild. Mild=noticeable but do not impact daily living activities; Moderate=treatment or intervention is highly desirable and activities of daily living are impacted; Severe=require treatment or intervention due to inability to perform activities of daily living. The results are for number of patients with symptom complexes including mild, moderate and severe, provided the patients have at least one symptom complex that was moderate or severe | Posted | Number | participants | Baseline |
|
|
|
| Other Pre-specified | Treatment Outcome Score at 4 Hours Post-Dose Over Multiple Treatment Episodes | Treatment Outcome Score (TOS) is a validated, comprehensive measure of symptom response to treatment. At 4 hours , patient assessment of response characterized by their change from baseline in symptom severity and collected by anatomic site of attack involvement, was recorded on a categorical scale (significant improvement [100] to significant worsening [-100]). The response at each anatomic site was weighted by baseline severity and then the weighted scores across all involved sites were averaged to calculate the TOS. Clinically meaningful improvement was indicated by a TOS of 30 or higher. | Treatment episode 1 contains data only from those participants who were new patients in the repeat-dosing part. Treatment episode 2 and beyond contain data pooled from patients treated in the double-blind part (ecallantide or placebo) and the repeat-dosing part. Data imputation was used to account for emerging symptoms and medical intervention. | Posted | Mean | Standard Deviation | units on a scale | 4 hours post-dose (REPEAT-DOSING PART) |
|
|
|
| Other Pre-specified | Change From Baseline in Mean Symptom Complex Severity (MSCS) Score at 4 Hours Post-dose Over Multiple Treatment Episodes | The Mean Symptom Complex Severity (MSCS) score is a validated, comprehensive point-in-time measure of symptom severity. At baseline and 4 hours, patients rated the severity on a categorical scale (0 = normal, 1 = mild, 2 = moderate, 3 = severe) for symptoms at each affected anatomical location. Ratings were averaged to obtain the MSCS score. A decrease in MSCS score reflected an improvement in symptoms; clinically meaningful improvement was indicated by a reduction in the score of 0.30 or more. | Treatment episode 1 contains data only from those participants who were new patients in the repeat-dosing part. Treatment episode 2 and beyond contain data pooled from patients treated in the double-blind part (ecallantide or placebo) and the repeat-dosing part. Data imputation was used to account for emerging symptoms and medical intervention. | Posted | Mean | Standard Deviation | units on a scale | baseline, 4 hours post-dose (REPEAT-DOSING PART) |
|
|
|
| Secondary | Time to Significant Improvement in Overall Response | The overall response assessment is a patient-reported assessment of global response to therapy. Patients are asked to perform an overall response assessment at regular intervals, relative to baseline. Patients were asked "overall how are you feeling" compared to how they felt before study drug. Answer options were "a lot worse", "a little worse", "same", "a little better" or "a lot better or resolved". Significant improvement was the first time that the patient responded to the assessment as "a little better or resolved". | ITT as treated. Patients not reporting significant improvement before 4 hours were censored at 4 hours. Patients receiving additional HAE therapy within 4 hours were censored at the time of the medical intervention. The time to significant improvement is not provided in this display as the median time for placebo was not reached by 4 hours. | Posted | Number | participant | 4 hours post-dose (DOUBLE-BLIND PART) |
|
|
|
|
| Other Pre-specified | Time to Significant Improvement in Overall Response Over Multiple Treatment Episodes | The overall response assessment is a patient-reported assessment of global response to therapy. Patients are asked to perform an overall response assessment at regular intervals, relative to baseline (ie,immediately before treatment) using the following 5-category scale from significant improvement (Score = 100)to significant worsening (Score = -100) | Patients not reporting significant improvement before 4 hours were censored at 4 hours. Patients receiving additional HAE therapy within 4 hours were censored at the time of the medical intervention. The time to significant improvement is not provided in this display as the interquartile range (IQR) was not reached by 4 hours for most episodes. | Posted | Number | participants | 4 hours post-dose (REPEAT-DOSING PART) |
|
|
|
| 3 |
| 36 |
| 13 |
| 36 |
| EG001 | Double-Blind Placebo | Patients treated with placebo in the double-blind part only. | 2 | 36 | 7 | 36 |
| EG002 | Repeat-Dosing Ecallantide | All patients treated with ecallantide in the repeat-dosing part, regardless of whether they were treated previously in the double-blind part or not. All adverse events reported in all repeat-dosing episodes are included. Patients reporting more than 1 AE with the same preferred term are counted only once for that preferred term. | 7 | 67 | 22 | 67 |
| Anxiety | Psychiatric disorders | MedDRA (6.0) | Systematic Assessment |
|
| Colitis | Gastrointestinal disorders | MedDRA (6.0) | Systematic Assessment |
|
| Concussion | Injury, poisoning and procedural complications | MedDRA (6.0) | Systematic Assessment |
|
| Contusion | Skin and subcutaneous tissue disorders | MedDRA (6.0) | Systematic Assessment |
|
| Diarrhoea | Gastrointestinal disorders | MedDRA (6.0) | Systematic Assessment |
|
| Diarrhoea Infectious | Infections and infestations | MedDRA (6.0) | Systematic Assessment |
|
| Dyspnea | Respiratory, thoracic and mediastinal disorders | MedDRA (6.0) | Systematic Assessment |
|
| Hematochezia | Gastrointestinal disorders | MedDRA (6.0) | Systematic Assessment |
|
| Hereditary Angioedema | Congenital, familial and genetic disorders | MedDRA 10.0 | Systematic Assessment |
|
| Hypoxia | Respiratory, thoracic and mediastinal disorders | MedDRA (6.0) | Systematic Assessment |
|
| Lymphoproliferative disorders | Blood and lymphatic system disorders | MedDRA (6.0) | Systematic Assessment |
|
| Pharyngeal Oedema | Respiratory, thoracic and mediastinal disorders | MedDRA (6.0) | Systematic Assessment |
|
| Rash Generalized | Skin and subcutaneous tissue disorders | MedDRA (6.0) | Systematic Assessment |
|
| Skin Laceration | Injury, poisoning and procedural complications | MedDRA (6.0) | Systematic Assessment |
|
| Urinary Incontinence | Renal and urinary disorders | MedDRA (6.0) | Systematic Assessment |
|
| Vomiting | Gastrointestinal disorders | MedDRA (6.0) | Systematic Assessment |
|
| Headache | Nervous system disorders | MedDRA (6.0) | Systematic Assessment |
|
| Hereditary Angioedema | Congenital, familial and genetic disorders | MedDRA (6.0) | Systematic Assessment |
|
| Nasal Congestion | Respiratory, thoracic and mediastinal disorders | MedDRA (6.0) | Systematic Assessment |
|
| Nasopharyngitis | Infections and infestations | MedDRA (6.0) | Systematic Assessment |
|
| Nausea | Gastrointestinal disorders | MedDRA (6.0) | Systematic Assessment |
|
| Prothrombin Time Prolonged | Investigations | MedDRA (6.0) | Systematic Assessment |
|
| Pyrexia | General disorders | MedDRA (6.0) | Systematic Assessment |
|
| Tachycardia | Cardiac disorders | MedDRA (6.0) | Systematic Assessment |
|
| Upper Respiratory Tract Infection | Respiratory, thoracic and mediastinal disorders | MedDRA (6.0) | Systematic Assessment |
|
Dyax agreements vary, but Dyax will not prohibit any investigator from publishing. Dyax reviews publications prior to public release and can request deferral by up to 60 days beyond the proposed publication date if necessary to preserve its intellectual property. Dyax can request changes to publications to remove non-study-related confidential information. Dyax can also request deferral of single-center publications until after disclosure of the clinical trial's primary publication.
| D000081207 | Primary Immunodeficiency Diseases |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D014581 | Urticaria |
| D017445 | Skin Diseases, Vascular |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D006969 | Hypersensitivity, Immediate |
| D006967 | Hypersensitivity |
| D007154 | Immune System Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| Change from baseline in MSCS at 4 hours post-dose |
|
| Genital/Buttocks |
|
| External Head/Neck |
|
| Cutaneous |
|
| Title | Measurements |
|---|---|
|
| Episode 4 (n = 21) |
|
| Episode 5 (n = 11) |
|
| Episode 6 (n = 9) |
|
| Title | Measurements |
|---|---|
|
| Episode 4 (n = 21) |
|
| Episode 5 (n = 11) |
|
| Episode 6 (n = 9) |
|
| Title | Measurements |
|---|---|
|
| Episode 4 (n=21) |
|
| Episode 5 (n=11) |
|
| Episode 6 (n=9) |
|