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The objective of this study is to evaluate the formation of antibodies, the occurence of allergic reactions, and the risk of hypercoagulability and hypocoagulability in patients treated with KALBITOR (ecallantide).
The objective of this study is to evaluate immunogenicity and hypersensitivity upon exposure to KALBITOR, in particular:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients naive to KALBITOR | HAE patients that have not been treated with KALBITOR (ecallantide) prior to enrollment in the study |
| |
| Patients non- naive to KALBITOR | HAE patients that have been treated with KALBITOR prior to enrollment in the study |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ecallantide | Drug | 30 mg SC |
|
| Measure | Description | Time Frame |
|---|---|---|
| Occurrence of Anaphylaxis or Other Adverse Events Suggestive of Hypersensitivity | Based on medical review of multiple preferred terms for treatment emergent adverse events (TEAEs) suggestive of Type 1 hypersensitivity; terms included adverse drug reaction, anaphylaxis, anaphylactic reaction, anaphylactoid reaction, hypersensitivity, erythema, flushing, hot flush, pharyngeal edema, laryngeal edema, pruritus, pruritus generalized, rash, rash erythematous, rhinitis allergic, rhinorrhea, throat irritation, urticaria, urticaria localized, dyspnea, and wheezing. Records of patients with any of these TEAE referred terms were reviewed further to assess potential hypersensitivity reactions, considering factors such as timing of TEAEs in relationship to dose (ie, occurred within 24 hours after start of KALBITOR treatment), accompanying symptoms, Investigator causality assessment (ie, reported as possibly, probably, or definitely related to study drug), and any other available clinical information. Anaphylaxis subset determined based on criteria established by the NIAID. | 12 months after first treatment |
| Occurrence of Seroconversion to Anti-ecallantide Antibodies Upon Exposure to KALBITOR. | Seroconversion is the development of detectable specific antibodies in the blood serum. Serum was tested for development of antibodies (irrespective of immunoglobulin class) against ecallantide at screening and at all safety evaluations. Positive results were to undergo a confirmatory test. Confirmed positive samples were further titered. Patients who developed an antibody response were evaluated for the development of neutralizing antibodies. Patients also had their serum analyzed for IgE-specific antibodies to ecallantide at screening and during safety evaluations. Positive results underwent a confirmatory test. Confirmed positive samples were further titered. | 12 months after first treatment |
| Occurrence of Adverse Events Related to Disordered Coagulation (Hypercoagulability and Hypocoagulability) Upon Exposure to KALBITOR | Events of ecchymosis, hemorrhage, petechiae, spontaneous hemorrhage, hematoma, gastrointestinal bleeding, hemorrhagic stroke and any other term indicative of a bleeding event or increased tendency for bleeding were reviewed to determine the occurrence of hypocoagulability. Events of clotting, thrombosis, pulmonary embolism, vaso-occlusive stroke, myocardial infarction, and any other term indicative of a clotting event or increased risk of clotting were reviewed to determine the occurrence of hypercoagulability. |
| Measure | Description | Time Frame |
|---|---|---|
| Overall Patient Response Assessment | The Overall Response Assessment was to be completed every 30 minutes after treatment until patient discharge. Patients evaluated their response to treatment as "a lot better or resolved," "a little better," "the same," "a little worse," or "a lot worse." The data presented is based on the best response achieved following a single dose of KALBITOR (Dose A) for the first HAE treatment episode. Responses of "a lot better or resolved" and "a little better" were combined to form a category of "Better." Similarly, "a little worse" and "a lot worse" were combined to form a category of "Worse." Patients treated in a clinic (study site) could have been discharged after an hour and hence may have only had 2 post-treatment evaluations (30 and 60 minutes); response assessments may not have been consistently provided when patients were treated at an alternate site outside of the study site. |
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Inclusion Criteria:
Exclusion Criteria:
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patients with hereditary angioedema, either naive or non-naive to KALBITOR (ecallantide) prior to enrollment in the study
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| Name | Affiliation | Role |
|---|---|---|
| Study Director | Takeda | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Little Rock Allergry and Asthma Clinical Research Center | Little Rock | Arkansas | 72205 | United States | ||
Subjects were to complete screening/enrollment procedures on a separate day prior to receiving KALBITOR treatment for an acute attack of HAE. The primary and secondary endpoints were analyzed for the Safety population only (all patients who received at least 1 treatment dose of KALBITOR).
Patients indicated in the US FDA-approved product label for KALBITOR (ecallantide) who experienced an acute attack of HAE were eligible for inclusion in this trial.
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| ID | Title | Description |
|---|---|---|
| FG000 | Patients Naive to KALBITOR | HAE patients that have not been treated with KALBITOR (ecallantide) prior to enrollment in the study ecallantide: 30 mg SC |
| FG001 | Patients Non- Naive to KALBITOR |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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serum
| 12 months after first treatment |
| within 4 hours post dose |
| Sunrise Clinical Research |
| Bell Gardens |
| California |
| 90201 |
| United States |
| Allergy & Asthma Institute of the Valley | Granada Hills | California | 91344 | United States |
| Unidversity of California, Los Angeles David Geffen School of Medicine | Los Angeles | California | 90095-1680 | United States |
| 705 West LaVeta | Orange | California | 92868 | United States |
| Allergy & Asthma Clinical Research Inc. | Walnut Creek | California | 94598 | United States |
| Center for Allergy, Asthma & Immunology | Waterbury | Connecticut | 06708 | United States |
| University of South Florida Asthma | Tampa | Florida | 33613 | United States |
| Brookstone Clinical Research Center | Columbus | Georgia | 31904 | United States |
| University Consultants in Allergry and Immunology | Chicago | Illinois | 60612 | United States |
| Deaconess Clinic Downtown | Evansville | Indiana | 47713 | United States |
| Muncie Allergy Ctr | Muncie | Indiana | 47304 | United States |
| Kansas City Allergy and Asthma Associates | Overland Park | Kansas | 66210 | United States |
| Ochsner Health System - Allergy, Asthma and Immunology Department | Jefferson | Louisiana | 70121 | United States |
| Clinical Research Specialists | Metairie | Louisiana | 70006 | United States |
| Institute for Asthma and Allergy, P.C. | Chevy Chase | Maryland | 20815 | United States |
| Brigham and Women's Hospital | Chestnut Hill | Massachusetts | 02467 | United States |
| University of Michigan Health System Allergy Specialty Clinic | Ann Arbor | Michigan | 48105 | United States |
| Asthma and Allergy Institute of Michigan | Clinton Township | Michigan | 48038 | United States |
| Saint Louis University School of Medicine | St Louis | Missouri | 63104 | United States |
| Washington University School of Medicine | St Louis | Missouri | 63110 | United States |
| University of Nevada School of Medicine - Department of Pediatrics | Reno | Nevada | 89503 | United States |
| Allergy Treatment Center of New Jersey | Iselin | New Jersey | 08830 | United States |
| Winthrop University Hospital | Mineola | New York | 11501 | United States |
| Medical Research Associates of CNY | North Syracuse | New York | 13212 | United States |
| The Bronx | New York | 10465 | United States |
| Allergy Partners of Western North Carolina | Asheville | North Carolina | 28801 | United States |
| Specialty Medical Clinic And Research Center | Sanford | North Carolina | 27330 | United States |
| Department of Internal Medicine, University of Cincinnati -MSB | Cincinnati | Ohio | 45267-0563 | United States |
| Optimed Research, LTD | Columbus | Ohio | 43235 | United States |
| Reynolds Clinic | Toledo | Ohio | 43615 | United States |
| Toledo Institute of Clinical Research | Toledo | Ohio | 43617 | United States |
| Allergy Clinic of the Tulsa, Inc. | Tulsa | Oklahoma | 74133 | United States |
| Penn State University - Penn State Milton S. Hershey Medical Center | Hershey | Pennsylvania | 17033-0850 | United States |
| Children's Hospital of Pittsburgh of UPMC | Pittsburgh | Pennsylvania | 15224 | United States |
| AARA Research Center | Dallas | Texas | 75231 | United States |
| University of Utah, Department of Dermatology | Salt Lake City | Utah | 84132 | United States |
| Children's Hospital of the King's Daughters | Norfolk | Virginia | 23507 | United States |
| Virginia Beach | Virginia | 23452 | United States |
| Puget Sound Allergy, Asthma and Immunology | Tacoma | Washington | 98405 | United States |
HAE patients that have been treated with KALBITOR prior to enrollment in the study ecallantide: 30 mg SC
| Treated |
|
| COMPLETED |
|
| NOT COMPLETED |
|
|
Safety population; defined as all patients who received at least 1 treatment dose of KALBITOR
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| ID | Title | Description |
|---|---|---|
| BG000 | Patients Naive to KALBITOR | HAE patients that have not been treated with KALBITOR (ecallantide) prior to enrollment in the study ecallantide: 30 mg SC |
| BG001 | Patients Non- Naive to KALBITOR | HAE patients that have been treated with KALBITOR prior to enrollment in the study ecallantide: 30 mg SC |
| 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 |
| ||||||||||||||||
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| 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 | Occurrence of Anaphylaxis or Other Adverse Events Suggestive of Hypersensitivity | Based on medical review of multiple preferred terms for treatment emergent adverse events (TEAEs) suggestive of Type 1 hypersensitivity; terms included adverse drug reaction, anaphylaxis, anaphylactic reaction, anaphylactoid reaction, hypersensitivity, erythema, flushing, hot flush, pharyngeal edema, laryngeal edema, pruritus, pruritus generalized, rash, rash erythematous, rhinitis allergic, rhinorrhea, throat irritation, urticaria, urticaria localized, dyspnea, and wheezing. Records of patients with any of these TEAE referred terms were reviewed further to assess potential hypersensitivity reactions, considering factors such as timing of TEAEs in relationship to dose (ie, occurred within 24 hours after start of KALBITOR treatment), accompanying symptoms, Investigator causality assessment (ie, reported as possibly, probably, or definitely related to study drug), and any other available clinical information. Anaphylaxis subset determined based on criteria established by the NIAID. | Safety population; defined as all patients who received at least 1 treatment dose of KALBITOR | Posted | Number | 95% Confidence Interval | participants | 12 months after first treatment |
|
|
| ||||||||||||||||||||||||||||||||
| Primary | Occurrence of Seroconversion to Anti-ecallantide Antibodies Upon Exposure to KALBITOR. | Seroconversion is the development of detectable specific antibodies in the blood serum. Serum was tested for development of antibodies (irrespective of immunoglobulin class) against ecallantide at screening and at all safety evaluations. Positive results were to undergo a confirmatory test. Confirmed positive samples were further titered. Patients who developed an antibody response were evaluated for the development of neutralizing antibodies. Patients also had their serum analyzed for IgE-specific antibodies to ecallantide at screening and during safety evaluations. Positive results underwent a confirmatory test. Confirmed positive samples were further titered. | Based on total number of patients who were not positive for the antibody class at study entry and had at least one post-baseline antibody evaluation. N=40 evaluable patients for all immunoglobulin antibody classes; N=41 evaluable patients for IgE to ecallantide antibodies; N=41 evaluable patients for neutralizing antibodies to ecallantide. | Posted | Number | 95% Confidence Interval | participants | 12 months after first treatment |
|
| |||||||||||||||||||||||||||||||||
| Primary | Occurrence of Adverse Events Related to Disordered Coagulation (Hypercoagulability and Hypocoagulability) Upon Exposure to KALBITOR | Events of ecchymosis, hemorrhage, petechiae, spontaneous hemorrhage, hematoma, gastrointestinal bleeding, hemorrhagic stroke and any other term indicative of a bleeding event or increased tendency for bleeding were reviewed to determine the occurrence of hypocoagulability. Events of clotting, thrombosis, pulmonary embolism, vaso-occlusive stroke, myocardial infarction, and any other term indicative of a clotting event or increased risk of clotting were reviewed to determine the occurrence of hypercoagulability. | Posted | Number | 95% Confidence Interval | participants | 12 months after first treatment |
|
| ||||||||||||||||||||||||||||||||||
| Secondary | Overall Patient Response Assessment | The Overall Response Assessment was to be completed every 30 minutes after treatment until patient discharge. Patients evaluated their response to treatment as "a lot better or resolved," "a little better," "the same," "a little worse," or "a lot worse." The data presented is based on the best response achieved following a single dose of KALBITOR (Dose A) for the first HAE treatment episode. Responses of "a lot better or resolved" and "a little better" were combined to form a category of "Better." Similarly, "a little worse" and "a lot worse" were combined to form a category of "Worse." Patients treated in a clinic (study site) could have been discharged after an hour and hence may have only had 2 post-treatment evaluations (30 and 60 minutes); response assessments may not have been consistently provided when patients were treated at an alternate site outside of the study site. | Safety population; defined as all patients who received at least 1 treatment dose of KALBITOR. Analysis only includes episodes of patients who were treated at the study site. | Posted | Number | participants | within 4 hours post dose |
|
12 months after first treatment
Adverse events were to be recorded for the duration of the study. Results are presented for episode-based treatment-emergent adverse events--ie, those that occurred or worsened in severity within 24 hours after the start of treatment with KALBITOR, or were reported as related to treatment with KALBITOR regardless of time of onset post treatment.
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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 | Safety Population | Safety population; defined as all patients who received at least 1 treatment dose of KALBITOR | 6 | 44 | 14 | 44 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Dehydration | Metabolism and nutrition disorders | MedDRA (12.1) | Systematic Assessment |
| |
| Hereditary angioedema | Congenital, familial and genetic disorders | MedDRA (12.1) | Systematic Assessment |
| |
| Drug ineffective for unapproved indication | General disorders | MedDRA (12.1) | Systematic Assessment |
| |
| Anaphylactic reaction | Immune system disorders | MedDRA (12.1) | Systematic Assessment |
| |
| Erythema | Skin and subcutaneous tissue disorders | MedDRA (12.1) | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Skin test positive | Investigations | MedDRA (12.1) | Systematic Assessment |
| |
| Hereditary angioedema | Congenital, familial and genetic disorders | MedDRA (12.1) | Systematic Assessment |
| |
| Abdominal pain upper | Gastrointestinal disorders | MedDRA (12.1) | Systematic Assessment |
| |
| Nausea | Gastrointestinal disorders | MedDRA (12.1) | Systematic Assessment |
| |
| Upper respiratory tract infection | Infections and infestations | MedDRA (12.1) | Systematic Assessment |
| |
| Dehydration | Metabolism and nutrition disorders | MedDRA (12.1) | Systematic Assessment |
| |
| Erythema | Skin and subcutaneous tissue disorders | MedDRA (12.1) | Systematic Assessment |
|
44 patients (out of 200 planned) received treatment in this study. Additionally, the collection of evaluable efficacy data for the secondary endpoint was limited by a lack of response data collected for HAE attacks treated at alternate sites.
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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| Black |
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