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Eltrombopag in Combination With Rabbit Anti-thymocyte Globulin/Cyclosporine A in Naive Aplastic Anemia (AA) Subjects

Information source: GlaxoSmithKline
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Cytopaenia

Intervention: Eltrombopag (Biological); Rabbit ATG (Biological); CsA (Biological)

Phase: Phase 2

Status: Recruiting

Sponsored by: GlaxoSmithKline

Official(s) and/or principal investigator(s):
GSK Clinical Trials, Study Director, Affiliation: GlaxoSmithKline

Overall contact:
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com

Summary

This is an open label, non-randomized, phase II study of eltrombopag in combination with rabbit ATG/CsA in subjects with moderate or more severe AA who have not received prior ATG/ALG-based immunosuppressive therapy. The objective is to assess additive effects of eltorombopag on overall response rate (ORR) at 6 months (Week 26) of treatment with ATG/CsA. Subjects will be assessed at least weekly for safety during the period from the start of ATG/CsA to 4 weeks after the start of administration of eltrombopag. After that, subjects will visit every 2 weeks until Week 26. Subjects in whom the treatment is assessed as effective at Week 26 may continue treatment with eltrombopag after 6 months when clinically indicated at the discretion of the investigator. There are five follow-up visits: at discontinuation of the treatment of eltrombopag, and Weeks 1, 2, 3, 4 and 26 after treatment discontinuation. As this study is the first Japanese phase II study in which this product is administered in combination with ATG/CsA to subjects with naive moderate or more severe AA, the subject number of this study is determined to be 10 based on the feasibility survey.

Clinical Details

Official title: A Non-randomized, Phase II Study of Eltrombopag in Combination With Rabbit Anti-thymocyte Globulin/Cyclosporine A (ATG/CsA) in Subjects With Moderate or More Severe Aplastic Anemia Who Have Not Received Prior ATG/Anti-lymphocyte Globulin (ALG)-Based Immunosuppressive Therapy

Study design: Allocation: Non-Randomized, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: ORR at 6 months

Secondary outcome:

ORR at 3 months

Complete Response (CR), and Partial Response (PR) rate at 3 months and 6 months

CR rate based on the criteria used in NIH 12-H-0150 study at 6 months

Changes in hematology parameters in the absence of platelet transfusion

Frequency of platelet and red blood cells (RBC) transfusions

Volume of platelet and RBC transfusions

The proportion of subjects whose transfusion unit (or volume) are decreased or who became transfusion (platelet, RBC) independent

Duration of hospitalization

Time to onset of CR and PR

Duration of CR or PR

Degree of exposure to eltrombopag

Number of participants with adverse events

Composite of laboratory parameters assessment as a safety measure.

Vital signs as a measure of safety and tolerability

12-lead electrocardiogram (ECG) as measure of safety and tolerability

The trough concentrations of eltrombopag following repeat doses of at 75 mg, 50 mg and 25 mg

The concentration after 4 hours of dose of eltrombopag 75 mg

Eligibility

Minimum age: 18 Years. Maximum age: 75 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Japanese subjects aged >=18 and <71 years at the time of informed consent. Note:

subjects aged >=71 and <75 may be eligible when clinically indicated at the discretion of the investigator by mutual agreement with GSK medical monitor.

- Diagnosed with moderate or more severe AA according to the diagnostic criteria of AA.

The severity classification is: Stage I - Mild - Other than the stages below; Stage

II - Moderate - At least two of the following conditions are met: Reticulocyte

<60,000/microliter, Neutrophil <1,000/microliter, Platelet <50,000/microliter; Stage

III - Moderately severe - At least two of the following conditions are met and

regular red blood cell transfusion (a need for transfusion of >=2 units per month) is required: Reticulocyte <60,000/microliter, Neutrophil <1,000/microliter, Platelet

<50,000/microliter; Stage IV - Severe - At least two of the following conditions are

met: Reticulocyte <20,000/microliter, Neutrophil <500/microliter, Platelet

<20,000/microliter; Stage V - Very severe - At least one of the following conditions

is met in addition to neutrophil <200/microliter: Reticulocyte <20,000/microliter, Platelet <20,000/microliter.

- Subjects who are considered an indication for the treatment with rabbit ATG and CsA.

- Adequate baseline organ function defined by the following criteria: Alanine

aminotransferase (ALT), aspartate aminotransferase (AST)<=3 × local upper limit of normal (ULN) Creatinine, total bilirubin, and alkaline phosphatase (ALP) <1. 5 × local ULN (total bilirubin <2. 5 × local ULN with Gilbert's Syndrome)

- Eastern Cooperative Oncology Group (ECOG) Performance Status (PS): 0 or 1

- Subjects with QTcF<450 millisecond (msec) or QTcF<480 msec with branch block: QTc is

QT interval corrected by Fridericia formula (QTcF), machine ,or manual overread. QTcF is based on single or averaged QTc value of triplicate ECG.

- Subjects are able to understand and comply with protocol requirements and

instructions.

- Subjects have signed and dated informed consent.

- Subjects who meet one of the following conditions: Male subjects who have a female

partner of childbearing potential must either have a prior vasectomy or agree to use an acceptable method of contraception from time of enrollment in the study until 16 weeks after the last dose of eltrombopag (based upon the lifecycle of sperm). Female subjects of non-childbearing potential (who are physiologically unable to become pregnant) defined as: Premenopausal women with documented bilateral oophorectomy, bilateral tubal ligation, or hysterectomy; or postmenopausal women after at least 12 months of natural amenorrhea [if uncertain, postmenopausal state should be confirmed by hematology result of follicle stimulating hormone (FSH) >40 milli-international units (mIU)/milliliter (mL) or estradiol <40 picogram (pg)/mL (<140 picomoles (pmol)/L)]. Female subjects of childbearing potential: Defined as those not meeting the definition of non-childbearing potential. Female subjects of childbearing potential must have a negative serum human chorionic gonadotropin (hCG) or urine pregnancy test within 7 days prior to the first dose of ATG/CsA. It is recommended that the pregnancy test should be performed as close as possible to the first dose of ATG/CsA. Female subjects with a positive pregnancy test must be excluded from the study. Subjects with a negative pregnancy test must use acceptable contraception including abstinence after the pregnancy test. Subjects must agree to use the acceptable contraception including abstinence from 14 days prior to the first dose of ATG/CsA until 28 days after the last dose of eltrombopag. Exclusion Criteria:

- Diagnosis of congenital AA (e. g. Fanconi anemia or Dyskeratosis congenital).

- Subjects who have a sibling donor with matched human leukocyte antigen (HLA) or who

underwent hematopoietic stem cell transplantation (HSCT) previously. However, such subjects may be enrolled if HSCT is not indicated, or the subject does not want to undergo HSCT.

- Subjects with abnormal chromosome (monosomy 7 detected by fluorescence in situ

hybridization (FISH), or other aberrations detected by G-band staining). Note: Subjects with abnormal chromosome which is not adopted into the clone definition of An International System for Human Cytogenetic Nomenclature (ISCN) may be enrolled after consulting with medical monitor.

- Previous ATG/ALG-based immunosuppressive therapy or steroid pulse therapy for AA.

- Treatment with CsA within 6 months before administration of ATG.

- Subjects with a paroxysmal nocturnal hemoglobinuria (PNH) clone size in granulocytes

of >50% by flow cytometric analysis.

- Pre-existing cardiac disease (congestive heart failure New York Heart Association

(NYHA) Grade II/III/IV), or arrhythmias known to involve the risk of thromboembolic events (e. g. atrial fibrillation)

- Past history of thromboembolic event (including anti-phospholipid antibody syndrome)

and current use of anticoagulants.

- Subjects with past or current malignancy. Note : Subjects who have a history of

completely resected malignant tumor and have been disease-free for 5 years are eligible.

- Subjects who test positive for hepatitis B surface (HBs) antigen, hepatitis C virus

(HCV) antibody, or human immunodeficiency virus (HIV) antibody at screening.

- Infection not adequately responding to appropriate therapy.

- Subject with liver cirrhosis

- Subjects with any clinically significant severe cardiac, renal, or hepatic medical

condition.

- Pregnant women (a positive serum or urine pregnancy test within 7 days prior to the

first dose of ATG/CsA or lactating women) Note: Female subjects who are lactating are eligible to participate if they discontinue nursing prior to the first dose of ATG/CsA and refrain from nursing until 5 days after the completion of treatment with eltrombopag.

- Known hypersensitivity, intolerance or allergy to rabbit ATG, cyclosporine A,

eltrombopag or any of their excipients.

- Current alcohol or drug abuse.

- Treatment with an investigational drug within 30 days or 5 half-lives (whichever is

longer) proceeding the first dose of ATG/CsA.

- Subjects who is not candidates for ATG.

- Subjects who is not candidates for CsA.

- History of treatment with eltrombopag, romiplostim or other thrombopoietin-receptor

(TPO-R) agonists.

Locations and Contacts

US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Aichi 453-8511, Japan; Not yet recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Aichi 460-0001, Japan; Not yet recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Ibaraki 305-8576, Japan; Recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Ishikawa 920-8641, Japan; Not yet recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Miyagi 981-1293, Japan; Not yet recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Okayama 700-0962, Japan; Not yet recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Osaka 530-0012, Japan; Not yet recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Osaka 543-8555, Japan; Not yet recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Osaka 565-0871, Japan; Not yet recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

GSK Investigational Site, Tokyo 141-8625, Japan; Not yet recruiting
US GSK Clinical Trials Call Center, Phone: 877-379-3718, Email: GSKClinicalSupportHD@gsk.com
EU GSK Clinical Trials Call Center, Phone: +44 (0) 20 8990 4466, Email: GSKClinicalSupportHD@gsk.com

Additional Information

Starting date: May 2015
Last updated: August 13, 2015

Page last updated: August 23, 2015

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