Primary Objective:

To assess the long-term safety and tolerability in patients with cold agglutinin disease (CAD), after multiple doses of SAR445088

Secondary Objective:

To assess, in patients with cold agglutinin disease (CAD), after multiple doses of SAR445088:

• The long-term effect of SAR445088 on complement mediated hemolysis
• The long-term pharmacodynamics (PD) effect of SAR445088 relating to complement inhibition
• The long-term pharmacokinetic (PK) profile of SAR445088
• The long-term immunogenicity of SAR445088

The screening period for this study is up to 6 weeks. The treatment period for this study will continue for 2 years after last participant entered Part 2 (either having switched from Part 1 or as a SAR445088-naïve participant), or until SAR445088 development is discontinued, whichever comes first.

Inclusion Criteria:

• Male and female adult patients ≥18 years of age with CAD who were previously treated with SAR445088 and met criteria the below criteria for entry into Part 1:

  • met the eligibility criteria of a previous study evaluating SAR445088;
  • successfully enrolled and completed dosing in a previous study evaluating SAR445088;
  • successfully completed end of study procedures in a previous study evaluating SAR445088; and
  • per Investigator judgement, had a favorable benefit-to-risk profile after receiving SAR445088.

• OR were never treated with SAR445088 before entering Part 2, and met the below criteria to establish CAD diagnosis:

  • chronic hemolysis;
  • polyspecific direct antiglobulin test (DAT) positive status;
  • monospecific DAT strongly positive for C3d;
  • cold agglutinin [CAg] titer ≥64 at 4°C;
  • IgG DAT ≤1+;
  • hemoglobin level ≤10 g/dL;
  • elevated bilirubin not attributable to liver disease;

• Documented vaccinations against encapsulated bacterial pathogens given within five years of enrollment and at least 14 days prior to dosing (vaccinations have to be initiated at least 14 days prior to dosing and completed before Week 5 of Part 2).

• Contraception (with double contraception methods) for male and female participants; not pregnant or breastfeeding for female participants; no sperm donation for male participants.

• Having given written informed consent prior to undertaking any study-related procedure.

Exclusion Criteria:

• Cold agglutinin syndrome secondary to infection, rheumatologic disease, or known high-grade hematologic malignancy, or known solid organ tumor.
• Clinically relevant infection within 1 month of enrollment.
• Clinical diagnosis of systemic lupus erythematosus (SLE).
• Treatment with anti-CD20 monotherapy within 3 months or anti-CD20 combination therapies within 6 months prior to screening.
• Concurrent treatment with systemic immunosuppressive agents targeting B- or T-cell function and/or cytotoxic agents within 3 months prior to screening. Concurrent treatment with other systemic immunosuppressants within 5.5 half-lives of the drug prior to screening.
• Any specific complement system inhibitor other than SAR445088 (eg, eculizumab) within 3 months prior to screening.
• Concurrent treatment with systemic corticosteroids other than a stable daily dose equivalent to ≤10 mg/day prednisone within 3 months prior to screening.
• History of hypersensitivity to SAR445088 or any of its components.

The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org