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The purpose of this study is to evaluate the efficacy and safety of DX-88 (ecallantide) versus placebo in the treatment of moderate to severe acute attacks of hereditary angioedema.
This is a randomized placebo-controlled trial.
The study is designed to assess the efficacy and safety of 30 mg subcutaneous ecallantide versus placebo in the treatment of moderate to severe acute attacks of hereditary angioedema. This study is conducted under Special Protocol Assessment with the FDA and is designed to provide pivotal efficacy data on ecallantide. These data are intended to support the marketing authorization of ecallantide in the treatment of acute attacks of hereditary angioedema. Efficacy and safety of ecallantide will be evaluated in this study.
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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 | Placebo, 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 |
|---|---|---|
| Change From Baseline in Mean Symptom Complex Severity (MSCS) Score at 4 Hours Post-dose | 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 |
| 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; best value]to significant worsening [-100; worst value]). Clinically meaningful improvement was indicated by a TOS of 30 or higher. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Study Director | Takeda | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aaron J. Davis | Scottsdale | Arizona | 85251 | United States | ||
| Arkansas Children's Hospital |
| 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 HAE attack but were randomized only upon attack.
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| ID | Title | Description |
|---|---|---|
| FG000 | KALBITOR (Ecallantide) | KALBITOR (ecallantide, DX-88) 30 mg given as three 10 mg/mL subcutaneous injections. |
| FG001 | Placebo | Placebo, Phosphate Buffer Saline (PBS), pH 7.0 given as 3 subcutaneous injections. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Phosphate Buffer Saline (PBS), pH 7.0 | Drug | given as three 1mL subcutaneous injections. |
|
| 4 hours post-dose |
| Patients With Significant Improvement in Overall Response | Patients were to be asked to perform an overall response assessment at intervals during the first 4 hours post-dose. Assessments were to be made relative to baseline (ie, immediately before initial dosing) using a 5-category scale. Categories were: significant improvement = "a lot better or resolved"; improvement = "a little better"; same = response unchanged; worsening = "a little worse"; significant worsening = "a lot worse". Significant improvement is the first time that a patient responded to the overall response assessment as "a lot better or resolved." | 4 hours post-dose |
| Patients With a Successful Response at 4 Hours Post-dosing, Based on the Change From Baseline in the MSCS Score | A successful response was defined as improvement in existing laryngeal symptom complex,stabilization of an existing peripheral symptom complex, or a change from baseline in the MSCS score at 4 hours of at least -1.0. | baseline, 4 hours post-dosing |
| Proportion of Patients Maintaining a Significant Improvement in Overall Response Through 24 Hours | Maintenance of significant improvement was defined as achieving and maintaining a significant improvement in overall response through 24 hours after dosing. Patient response categories were: significant improvement = "a lot better or resolved"; improvement = "a little better"; same = response unchanged; worsening = "a little worse"; significant worsening = "a lot worse". | 24 hours post-dosing |
| Little Rock |
| Arkansas |
| 72202 |
| United States |
| Little Rock Allergy & Asthma Clinic | Little Rock | Arkansas | 72205 | United States |
| Alta Bates Comprehensive Cancer Center | Berkeley | California | 94704 | United States |
| Pacific Coast Allergy | Crescent City | California | 95531 | United States |
| Jacob Offenberger | Granada Hills | California | 91344 | United States |
| UCLA David Geffen School of Medicine, Department of Medicine | Los Angeles | California | 90095-1680 | United States |
| Asthma and Allergy Associates, P.C. | Colorado Springs | Colorado | 80907 | United States |
| Christiana Hospital | Newark | Delaware | 19718 | United States |
| Georgetown University Hospital | Washington D.C. | District of Columbia | 20007 | United States |
| University of Miami, General Clinical Research Center | Miami | Florida | 33136 | United States |
| University of South Florida | Tampa | Florida | 33613 | United States |
| Roberson Allergy and Asthma | West Palm Beach | Florida | 33401 | United States |
| Family Allergy & Asthma Center, PC | Atlanta | Georgia | 30342 | United States |
| Allergy Center of Brookstone | Columbus | Georgia | 31904 | United States |
| University Consultants in Allergy and Immunology | Chicago | Illinois | 60612 | United States |
| Muncie Allergy Center | Muncie | Indiana | 47304 | United States |
| Kansas City Allergy & Asthma | Overland Park | Kansas | 66210 | United States |
| Institute for Asthma and Allergy | Wheaton | Maryland | 20902 | United States |
| Brigham and Women's Hospital | Chestnut Hill | Massachusetts | 02467 | United States |
| Asthma and Allergy Institute of Michigan | Clinton Township | Michigan | 48038 | United States |
| Respiratory Medicine Research Institute of Michigan, PLC | Ypsilanti | Michigan | 48197 | United States |
| Nevada Access to Research and Education Society | Las Vegas | Nevada | 89102 | United States |
| University of Nevada School of Medicine | Reno | Nevada | 89503 | United States |
| UMDNJ-New Jersey Medical School | Newark | New Jersey | 07103 | United States |
| Allergy Partners of Albuquerque | Albuquerque | New Mexico | 87109 | United States |
| Winthrop University Hospital | Mineola | New York | 11501 | United States |
| Allergy Partners of Western North Carolina | Asheville | North Carolina | 28801 | United States |
| University of Cincinnati | Cincinnati | Ohio | 45267 | United States |
| Optimed Research, LLC | Columbus | Ohio | 43235 | United States |
| Valley Clinical Research Center | Easton | Pennsylvania | 18045 | United States |
| Penn State Milton S. Hershey Medical Center | Hershey | Pennsylvania | 17033 | United States |
| Asthma Allergy and Pulmonary Associates | Philadelphia | Pennsylvania | 19107 | United States |
| Childrens Hospital of Pittsburgh | Pittsburgh | Pennsylvania | 15213 | United States |
| Highlands Allergy and Asthma Center, PC | Bristol | Tennessee | 37620 | United States |
| The Paull Allergy and Asthma Clinic, P.A. | Bryan | Texas | 77802 | United States |
| AARA Research Center | Dallas | Texas | 75231 | United States |
| University of Texas Medical School | Galveston | Texas | 77555-1083 | United States |
| Baylor Clinic, Baylor College of Medicine | Houston | Texas | 77030 | United States |
| University of Utah | Salt Lake City | Utah | 84132-2409 | United States |
| Clinical Research Associates of Tidewater | Norfolk | Virginia | 23507 | United States |
| Puget Sound Allergy, Asthma, & Immunology | Tacoma | Washington | 98405 | United States |
| Allergy and Asthma Research Center | Ottawa | Ontario | K1Y 4G2 | Canada |
| University of Toronto | Toronto | Ontario | M4V 1R2 | Canada |
| Jordan University Hospital | Amman | 1194 | Jordan |
| 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. |
| 23548526 | Derived | Li HH, Campion M, Craig TJ, Soteres DF, Riedl M, Lumry WR, MacGinnitie AJ, Shea EP, Bernstein JA. Analysis of hereditary angioedema attacks requiring a second dose of ecallantide. Ann Allergy Asthma Immunol. 2013 Mar;110(3):168-72. doi: 10.1016/j.anai.2012.12.004. Epub 2013 Jan 8. |
| 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. |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | KALBITOR (Ecallantide) | KALBITOR (ecallantide, DX-88) 30 mg given as three 10 mg/mL subcutaneous injections. |
| BG001 | Placebo | Placebo, Phosphate Buffer Saline (PBS), pH 7.0 given as 3 subcutaneous injections. |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||
| Region of Enrollment | Count of Participants | Participants |
| ||||||||||||||||
| Symptom Complexes at Baseline | More than one baseline symptom complex could be reported per patient; hence the number of complexes is greater than the number of patients in each group. Patient were to have at least one symptom complex that was moderate or severe. The total number of symptom complexes was 155. | Number | symptom complexes |
|
| 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 | Change From Baseline in Mean Symptom Complex Severity (MSCS) Score at 4 Hours Post-dose | 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. | Patients were excluded from the analysis if they did not have data for the endpoint being analyzed. Reasons for patients being excluded are for ecallantide: 1 patient treated for severe upper airway compromise; for placebo: 3 patient treated for severe upper airway compromise and 3 patients with missing 4-hour data. Best score=0.0; worst score=3.0. | Posted | Mean | Standard Deviation | units on a scale | baseline, 4 hours post-dose |
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| Secondary | 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; best value]to significant worsening [-100; worst value]). Clinically meaningful improvement was indicated by a TOS of 30 or higher. | Patients were excluded from this analysis if they did not have data for the endpoint being analyzed. The reasons for patients being excluded from this analysis are for ecallantide: 1 patient treated for severe upper airway compromise and for placebo: 3 patient treated for severe upper airway compromise and 3 patients with missing 4-hour data. | Posted | Mean | Standard Deviation | units on a scale | 4 hours post-dose |
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| Secondary | Patients With Significant Improvement in Overall Response | Patients were to be asked to perform an overall response assessment at intervals during the first 4 hours post-dose. Assessments were to be made relative to baseline (ie, immediately before initial dosing) using a 5-category scale. Categories were: significant improvement = "a lot better or resolved"; improvement = "a little better"; same = response unchanged; worsening = "a little worse"; significant worsening = "a lot worse". Significant improvement is the first time that a patient responded to the overall response assessment as "a lot better or resolved." | The time to significant improvement is not provided in this display as the estimated median times were not reached by 240 minutes. Instead, the number of patients with significant improvement is provided per treatment arm. | Posted | Number | participants | 4 hours post-dose |
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| Secondary | Patients With a Successful Response at 4 Hours Post-dosing, Based on the Change From Baseline in the MSCS Score | A successful response was defined as improvement in existing laryngeal symptom complex,stabilization of an existing peripheral symptom complex, or a change from baseline in the MSCS score at 4 hours of at least -1.0. | Diary information was not available for 1 patient in the placebo arm. This patient was considered not evaluable and excluded from the analysis. | Posted | Number | participants | baseline, 4 hours post-dosing |
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| Secondary | Proportion of Patients Maintaining a Significant Improvement in Overall Response Through 24 Hours | Maintenance of significant improvement was defined as achieving and maintaining a significant improvement in overall response through 24 hours after dosing. Patient response categories were: significant improvement = "a lot better or resolved"; improvement = "a little better"; same = response unchanged; worsening = "a little worse"; significant worsening = "a lot worse". | Diary information was not available for 1 patient in the placebo arm. This patient was considered not evaluable and excluded from the analysis. | Posted | Number | participants | 24 hours post-dosing |
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up to 7 days post-dose
For patients that were given an open-label dose of ecallantide for severe upper airway compromise or failed or incomplete response, or relapse, all adverse events occurring prior to open-label dosing are included in the following tables where all patients are presented in the double-blind, randomized treatment groups.
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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 | KALBITOR (Ecallantide) | KALBITOR (ecallantide, DX-88) 30 mg given as three 10 mg/mL subcutaneous injections. | 0 | 48 | 5 | 48 | ||
| EG001 | Placebo | Placebo, Phosphate Buffer Saline (PBS), pH 7.0 given as 3 subcutaneous injections. | 3 | 48 | 9 | 48 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hereditary angioedema | Congenital, familial and genetic disorders | MedDRA 10.0 | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Diarrhoea | Gastrointestinal disorders | MedDRA 10.0 | Systematic Assessment |
| |
| Headache | Nervous system disorders | MedDRA 10.0 | Systematic Assessment |
| |
| Nausea | Gastrointestinal disorders | MedDRA 10.0 | Systematic Assessment |
| |
| Vomiting | Gastrointestinal disorders | MedDRA 10.0 | Systematic Assessment |
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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.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Study Director | Shire | +1 866 842 5335 | ClinicalTransparency@shire.com |
| ID | Term |
|---|---|
| D054179 | Angioedemas, Hereditary |
| ID | Term |
|---|---|
| D000799 | Angioedema |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D000081208 | Hereditary Complement Deficiency Diseases |
| 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 |
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| ID | Term |
|---|---|
| C511194 | ecallantide |
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| Male |
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| Canada |
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| Stomach/GI |
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| Genital/Buttocks |
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| External Head/Neck |
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| Cutaneous |
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| Change from baseline in MSCS at 4 hours post-dose |
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| Participants |
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