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Prospective, multinational, non-interventional post-authorisation study to collect additional clinical data and to ensure consistency in the long-term between the outcome from pre-authorisation clinical studies (in 135 previously treated paediatric and adult patients) and routine clinical practice. Besides aspects such as general product safety and efficacy, there will be a focus on immunogenicity, particularly on inhibitor development. The diagnosis of FVIII inhibitor will be based on clinical observations and confirmed by FVIII inhibitor testing in the laboratory.
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| Measure | Description | Time Frame |
|---|---|---|
| Number of Patients With FVIII Inhibitors | FVIII inhibitors will be determined based on clinical observations and confirmed by FVIII inhibitor testing in the laboratory. | Screening through to study completion (minimum 1.7 months; maximum 31.6 months) |
| Number of Patients With Adverse Drug Reactions | Adverse drug reactions (ADRs) including hypersensitivity reactions will be recorded by patients in treatment diaries which will be reviewed at each Follow-up Visit. | Recorded from screening through to study completion (minimum 1.7 months; maximum 31.6 months) |
| Measure | Description | Time Frame |
|---|---|---|
| Annualized Rate of Breakthrough Bleeds to Assess Efficacy in Prophylactic Treatment | Total number of bleeding episodes under prophylaxis treatment divided by the duration of prophylactic phase (in years) | Monitored throughout the study from screening through to study completion (minimum 3.7 months; maximum 21.2 months) |
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Inclusion Criteria:
Exclusion Criteria:
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The goal is to collect data on 200 previously treated male patients of any age with haemophilia (FVIII:C ≤ 2%). Patients from pre-authorisation studies can be followed up to at least 100 EDs. Newly enrolled patients have to be treated and followed for at least 100 EDs.
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| Name | Affiliation | Role |
|---|---|---|
| Kate Khair, PhD | Great Ormond Street Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Florida | Gainesville | Florida | 32610 | United States | ||
| Nicklaus Children's Hospital |
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| ID | Title | Description |
|---|---|---|
| FG000 | Nuwiq® (Human-cl rhFVIII) | A total of 80 patients were enrolled in this study. Of the 80 patients enrolled into the study, 2 were excluded because they had not received any treatment with Nuwiq, leaving 78 patients in the full analysis population (FAS) and safety population (SAF). Of these, 77 patients were part of the prophylactic treatment group and 2 patients were in the on-demand treatment group. One patient changed regimen from on-demand treatment to prophylactic treatment and back to on-demand treatment while in the study. Corresponding data for this patient in included in both the prophylactic and on-demand treatment groups. The treatment regimen, doses, dosing intervals and dose adjustments were determined at the discretion of the treating physician. A usual dose for long-term prophylaxis against bleeding in patients with severe hemophilia A is 20 to 40 IU of factor VIII per kg body weight at intervals of 2 to 3 days. Of the 78 total patients, 17 were excluded for the reasons summarized below. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Sep 26, 2017 | Jun 25, 2021 |
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Citrate Plasma for measuring FVIII inhibitors is recommended throughout the study.
| Assessment of the Efficacy of On-demand Treatment of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale |
At the end of a BE, treatment efficacy was to be assessed either by the patient (or the patient's parent or legal guardian) or by the treating physician in case of on-site treatment using a 4-point scale including the four items 'excellent,' 'good,' moderate,' and 'none.' Excellent result was defined as abrupt pain relief and/or unequivocal improvement in objective signs of bleeding within approximately 8 hours after a single injection. Good was definite pain relief and/or improvement in signs of bleeding within approximately 8-12 hours after an injection requiring up to 2 injections for complete resolution. Moderate was probable or slight beneficial effect within approximately 12 hours after the first injection requiring more than two injections for complete resolution. None was no improvement after 12 hours, or worsening of symptoms, requiring more than 2 injections for complete resolution. |
| Monitored throughout the study from screening through to study completion (minimum 1.7 months; maximum 31.6 months) |
| Overall Assessment of the Effectiveness of Surgical Prophylaxis by the Treating Physicians | At the end of the postoperative period, an overall assessment of the efficacy of treatment in the pre-, peri-, and postoperative periods using the 'excellent,' 'good,' moderate,' and 'none' scale will be done jointly by the surgeon and the hematologist. Based on this assessment, efficacy ratings assessed as either 'excellent' or 'good' will be considered 'successfully treated'. | From start of surgery until end of post-operative period |
| Assessment of the Efficacy of Treatment of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale | At the end of a BE, treatment efficacy was to be assessed either by the patient (or the patient's parent or legal guardian) or by the treating physician in case of on-site treatment using a 4-point scale including the four items 'excellent', 'good', 'moderate', and 'none.' Excellent result was defined as abrupt pain relief and/or unequivocal improvement in objective signs of bleeding within approximately 8 hours after a single injection. Good was definite pain relief and/or improvement in signs of bleeding within approximately 8-12 hours after an injection requiring up to 2 injections for complete resolution. Moderate was probable or slight beneficial effect within approximately 12 hours after the first injection requiring more than two injections for complete resolution. None was no improvement after 12 hours, or worsening of symptoms, requiring more than 2 injections for complete resolution. | Recorded from screening through to study completion (minimum 1.7 months; maximum 31.6 months) |
| Miami |
| Florida |
| 33155 |
| United States |
| Tulane University | New Orleans | Louisiana | 70112 | United States |
| Hemophilia Treatment Center of Nevada | Las Vegas | Nevada | 89109 | United States |
| Gulf States Hemophilia and Thrombophilia | Houston | Texas | 77030 | United States |
| Centro de Tratamiento de la Hemofilia Cordoba | Córdoba | Argentina |
| CTH Centro de Tratamiento de Hematologia y Hemoterapia Córdoba S.A. | Córdoba | Argentina |
| Fundación de Hemofilia de Salta | Salta | Argentina |
| Centro Mayo | Santiago del Estero | Argentina |
| Belarusian Research Center for Pediatric Oncology, Hematology and Immunology | Borovlyany | Belarus |
| Fakultní nemocnice Brno | Brno | Czechia |
| Blood Centre, University Hospital | Ostrava | Czechia |
| Hospital de Especialidades Teodoro Maldonado Carbo | Guayaquil | 090203 | Ecuador |
| CHU Hôtel Dieu | Nantes | France |
| Hopital Pontchaillou | Rennes | France |
| CHRU Hôpital Nord | Saint-Priest-en-Jarez | France |
| CRTH, Hopital Purpan | Toulouse | France |
| Pedias Inc. Centro Hospitalario La Paz | Guatemala City | Guatemala |
| L'Azienda Ospedaliero Universitaria Consorziale Policlinico, U.O. di Medicina Trasfusionale, Centro Emofilia e Trombosi | Bari | Italy |
| U.O.C. Ematologia, Ospedale San Giacomo Apostolo | Castelfranco Veneto | Italy |
| UOC Malattie emorragiche e della coagulazione, Azienda Ospedaliera Universitaria Careggi | Florence | Italy |
| Fondazione IRCCS Ca Granda | Milan | Italy |
| AOU Federico II - Dipartimento di Medicina Clinica e Chirurgica | Naples | Italy |
| Azienda Sanitaria Locale Napoli 1 Centro | Naples | Italy |
| Azienda Ospedaliera di Padova | Padova | Italy |
| AOU Policlinico di Palermo | Palermo | Italy |
| Ospedale ARNAS Civico | Palermo | Italy |
| Dipartimento Di Medicina dell'Universita degli Studi di Perugia | Perugia | Italy |
| Dipartimento di Biotecnologie Cellulari ed Ematologia -"Sapienza" Università di Roma | Rome | Italy |
| A.O. Città della Salute e della Scienza di Torino - Ospedale Regina Margherita | Torino | Italy |
| S.C. Ematologia U, A.O.U. Città della Salute e della Scienza di Torino | Torino | Italy |
| Vilnius University Hospital, Santariskiu Klinikos-Children's Hospital | Vilnius | Lithuania |
| Oslo University Hospital | Oslo | Norway |
| Centro Hospitalar Cova da Beira | Covilha | Portugal |
| National Haemophilia Center | Bratislava | Slovakia |
| Great Ormond Street Hospital (GOSH) | London | United Kingdom |
| St. Thomas' Hospital | London | United Kingdom |
| The Royal London Hospital | London | United Kingdom |
| Nottingham University Hospitals NHS Trust | Nottingham | United Kingdom |
| FAS Population |
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| SAF Population |
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| Prophylactic Treatment Group |
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| On Demand Treatment Group |
|
| SURG Population |
|
| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Nuwiq® (Human-cl rhFVIII) SAF Population | The safety (SAF) population consist of all patients who received at least one infusion of Human-cl rhFVIII (n=78) |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | Count of Participants | Participants |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
| |||||||||||||||||||||||
| Race/Ethnicity, Customized | Count of Participants | Participants |
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| Height | Mean | Standard Deviation | centimeters |
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| Weight | Mean | Standard Deviation | kilograms |
| ||||||||||||||||||||||
| BMI | Mean | Standard Deviation | kg/m^2 |
| ||||||||||||||||||||||
| Severity of Haemophilia A | Moderate Hemophilia was defined as the patient having a FVIII activity level of between 1-2%. Severe Hemophilia was defined as the patient having a FVIII activity level below 1%. | Count of Participants | Participants |
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| Family history of Haemophilia | Count of Participants | Participants |
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| Factor VIII Inhibitor History | Count of Participants | Participants |
| |||||||||||||||||||||||
| Factor VIII gene defect | Count of Participants | Participants |
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| 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 | Number of Patients With FVIII Inhibitors | FVIII inhibitors will be determined based on clinical observations and confirmed by FVIII inhibitor testing in the laboratory. | FVIII inhibitor testing could be carried out at any time at the physician's discretion. Patients were checked for clinical symptoms suggesting FVIII inhibitor development, any suspicion of inhibitor formation was to be investigated by FVIII inhibitor testing. No symptoms led to suspicion of inhibitor formation in any patient treated with Nuwiq®. Within the FAS population, inhibitor levels were tested in 40 patients at screening, 44 between screening and completion and 21 at study completion. | Posted | Count of Participants | Participants | Screening through to study completion (minimum 1.7 months; maximum 31.6 months) |
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| Primary | Number of Patients With Adverse Drug Reactions | Adverse drug reactions (ADRs) including hypersensitivity reactions will be recorded by patients in treatment diaries which will be reviewed at each Follow-up Visit. | Posted | Count of Participants | Participants | Recorded from screening through to study completion (minimum 1.7 months; maximum 31.6 months) |
|
| ||||||||||||||||||||||||||||||||||
| Secondary | Annualized Rate of Breakthrough Bleeds to Assess Efficacy in Prophylactic Treatment | Total number of bleeding episodes under prophylaxis treatment divided by the duration of prophylactic phase (in years) | Of the 77 participants within the prophylactic treatment group, 74 patients had at least 3 months under a prophylactic regimen and had at least one bleeding episode and were analyzed. | Posted | Median | Inter-Quartile Range | Number of bleeding episodes per year | Monitored throughout the study from screening through to study completion (minimum 3.7 months; maximum 21.2 months) | Number of bleeding episodes | Number of bleeding episodes |
|
| ||||||||||||||||||||||||||||||
| Secondary | Assessment of the Efficacy of On-demand Treatment of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale | At the end of a BE, treatment efficacy was to be assessed either by the patient (or the patient's parent or legal guardian) or by the treating physician in case of on-site treatment using a 4-point scale including the four items 'excellent,' 'good,' moderate,' and 'none.' Excellent result was defined as abrupt pain relief and/or unequivocal improvement in objective signs of bleeding within approximately 8 hours after a single injection. Good was definite pain relief and/or improvement in signs of bleeding within approximately 8-12 hours after an injection requiring up to 2 injections for complete resolution. Moderate was probable or slight beneficial effect within approximately 12 hours after the first injection requiring more than two injections for complete resolution. None was no improvement after 12 hours, or worsening of symptoms, requiring more than 2 injections for complete resolution. | Posted | Number | Number of Bleeding episodes | Monitored throughout the study from screening through to study completion (minimum 1.7 months; maximum 31.6 months) | Number of bleeding episodes | Number of bleeding episodes |
|
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| Secondary | Overall Assessment of the Effectiveness of Surgical Prophylaxis by the Treating Physicians | At the end of the postoperative period, an overall assessment of the efficacy of treatment in the pre-, peri-, and postoperative periods using the 'excellent,' 'good,' moderate,' and 'none' scale will be done jointly by the surgeon and the hematologist. Based on this assessment, efficacy ratings assessed as either 'excellent' or 'good' will be considered 'successfully treated'. | A total of 4 patients had 6 surgeries that were treated with Nuwiq®. Two of these surgeries were minor and 4 were major. Five surgeries had an overall efficacy assessment performed jointly by the hematologist and surgeon. One of the six surgeries was treated pre-op with another FVIII product and post-op with Nuwiq® and therefore an assessment of Nuwiq® efficacy could not be performed | Posted | Number | Surgeries | From start of surgery until end of post-operative period | Surgeries | Surgeries |
|
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| Secondary | Assessment of the Efficacy of Treatment of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale | At the end of a BE, treatment efficacy was to be assessed either by the patient (or the patient's parent or legal guardian) or by the treating physician in case of on-site treatment using a 4-point scale including the four items 'excellent', 'good', 'moderate', and 'none.' Excellent result was defined as abrupt pain relief and/or unequivocal improvement in objective signs of bleeding within approximately 8 hours after a single injection. Good was definite pain relief and/or improvement in signs of bleeding within approximately 8-12 hours after an injection requiring up to 2 injections for complete resolution. Moderate was probable or slight beneficial effect within approximately 12 hours after the first injection requiring more than two injections for complete resolution. None was no improvement after 12 hours, or worsening of symptoms, requiring more than 2 injections for complete resolution. | Analysis was only performed on patients in the prophylactic treatment group who experienced bleeding episode that required treatment with Nuwiq. Of the 77 patients in the prophylactic treatment group, 48 patients experienced a BE that required treatment with Nuwiq and were assessed using the 4-point efficacy scale | Posted | Number | Bleeding episodes | Recorded from screening through to study completion (minimum 1.7 months; maximum 31.6 months) | Number of treated Bleeding episodes | Number of treated Bleeding episodes |
|
Adverse drug reactions were monitored throughout the study from first treatment through to study completion (minimum 1.7 months; maximum 31.6 months)
One death was recorded during the study. The patient was reported as having died due to a possible intentional/unintentional overdose of prescribed medications (not Nuwiq®). The investigator reported no suspected relationship between Nuwiq® and the death of the patient and the event was deemed unrelated to Nuwiq®.
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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 | Nuwiq® (Human-cl rhFVIII) SAF Population | Adverse events were reported for the SAF population which consist of all patients who received at least one infusion of Human-cl rhFVIII (n=78). Due to no reported adverse events related to treatment with Nuwiq, AEs were not reported separately for prophylactic or on-demand interventions. | 1 | 78 | 0 | 78 | 0 | 78 |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Sigurd Knaub, Senior VP CR&D Haematology | Octapharma | 01554512141 | Sigurd.Knaub@octapharma.com |
| Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Oct 30, 2020 | Aug 27, 2021 | SAP_001.pdf |
| ID | Term |
|---|---|
| D006467 | Hemophilia A |
| ID | Term |
|---|---|
| D025861 | Blood Coagulation Disorders, Inherited |
| D001778 | Blood Coagulation Disorders |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D020147 | Coagulation Protein Disorders |
| D006474 | Hemorrhagic Disorders |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
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| Unknown or Not Reported |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Other |
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| >18 yrs |
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| >18 yrs |
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| >18 yrs |
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| Small Deletion/Insertion |
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| Stop-Mutation |
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| Nonsense Mutation |
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| Missense Mutation |
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| Other |
|
| Unknown |
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| Number of bleeding episodes |
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| Number of bleeding episodes |
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| Surgeries |
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