Hemophilia Inhibitor Clinical Trials (INHIBIT) Platform

Overview

This study will evaluate if Eloctate is superior to Emicizumab in reducing inhibitors in children with severe hemophilia when given before the first bleed (preemptive) and continued weekly to prevent bleeds (prophylaxis); and whether Eloctate immune tolerance induction (ITI) plus emicizumab is superior to Eloctate ITI alone in eradicating inhibitor formation in children and adults with severe hemophilia A.

Full Title of Study: “Phase III INHIBIT Platform: Prevention Trial, Eloctate vs Emicizumab to Prevent Inhibitors; Eradication Trial: Eloctate Immune Tolerance (ITI) Plus Emicizumab vs vs Eloctate ITI Alone to Eradicate Inhibitors in Severe Hemophilia A”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: July 2027

Detailed Description

This is a multi-center, randomized Phase III Clinical Trials Platform (INHIBIT) in which hemostatic agents will be compared using adaptive design to prevent and eradicate inhibitors in patients with severe hemophilia A. This adaptive design is necessary as randomized trials in rare diseases are otherwise not possible. The INHIBIT Trial Platform includes one Inhibitor Prevention Trial and one Inhibitor Eradication Trial that will be conducted at up to 41 U.S. hemophilia treatment centers (HTCs) affiliated with universities. The Inhibitor Prevention Trial is a 48-week randomized phase III trial in which 66 previously untreated patients (PUPs) (children < 6 yr) with severe hemophilia A will be enrolled and randomized to preemptive weekly Eloctate vs. Emicizumab to prevent inhibitor formation, defined as anti-FVIII > 5.0 BU. The Inhibitor Eradication Trial is a 48-week randomized phase III trial in which 90 previously-treated patients (PTPs) with severe hemophilia A and high-responding inhibitors (anti-VIII >5.0 B.U.), including subjects developing inhibitors during the Prevention Trials and adults or children of any age at the same HTCs refractory to or never previously tolerated, will be enrolled and randomized to Eloctate ITI god plus weekly Emicizumab vs. Eloctate ITI alone to eradicate inhibitor formation, defined as anti-FVIII<0.6 B.U. Blood draws will be minimized to 6 timepoints, pre, 4, 12, 24, 36, and 48 weeks, and validated for small volumes, 3.8 cc (¾ tsp) each. The Inhibit Trials Platform is considered greater than minimal risk as study drug is given before the first bleed and special inhibitor studies are obtained.

Interventions

  • Drug: Eloctate Prophylaxis
    • Prevention Trial, Arm A: Eloctate (65 IU/kg) will be administered weekly by intravenous infusion for up to 48 weeks in previously untreated children with severe hemophilia A beginning before the first bleed.
  • Drug: Emicizumab Prophylaxis
    • Prevention Trial, Arm B: Emicizumab (1.5 mg/kg) will be administered weekly by subcutaneous injection for up to 48 weeks in previously untreated children with severe hemophilia A.
  • Drug: Eloctate ITI plus Emicizumab
    • Eradication Trial, Arm A: Eloctate (100 IU/kg) ITI every other day by intravenous infusion plus Emicizumab (1.5 mg/kg) weekly by subcutaneous injection will be administered for up to 48 weeks as immune tolerance in children and adults with severe hemophilia A and high-titer inhibitors.
  • Drug: Eloctate ITI
    • Eradication Trial, Arm A: Eloctate (100 IU/kg) ITI every other day by intravenous infusion will be administered for up to 48 weeks as immune tolerance in children and adults with severe hemophilia A and high-titer inhibitors.

Arms, Groups and Cohorts

  • Experimental: Eloctate Prophylaxis
    • Prevention Trial, Arm A: rFVIIIFc (Eloctate) 65 IU/kg weekly will be administered by intravenous infusion in previously untreated children with severe hemophilia A beginning before the first bleed and continued for up to 48 weeks.
  • Experimental: Emicizumab Prophylaxis
    • Prevention Trial, Arm B: Emicizumab 1.5 mg/kg weekly (following 4-wk induction at 3 mg/kg weekly) will be administered by subcutaneous injection in previously untreated children with severe hemophilia A beginning before the first bleed and continued for up to 48 weeks.
  • Experimental: Eloctate ITI plus Emicizumab
    • Eradication Trial, Arm A: Eloctate 100 IU/kg every other day will be administered by intravenous infusion as immune tolerance plus Emicizumab 1.5 mg/kg weekly by subcutaneous injection in previously treated children and adults with severe hemophilia A and high-titer inhibitors and continued for up to 48 weeks.
  • Active Comparator: Eloctate ITI Alone
    • Eradication Trial, Arm B: Eloctate 100 IU/kg every other day will be administered by intravenous infusion as immune tolerance alone in previously treated children and adults with severe hemophilia A and high-titer inhibitors and continued for up to 48 weeks.

Clinical Trial Outcome Measures

Primary Measures

  • Prevention Trial: Time to inhibitor formation
    • Time Frame: Up to 48 weeks
    • Inhibitor formation is defined as anti-FVIII > / = 5.0 B.U. by chromogenic Nijmegen-modified Bethesda assay, performed on plasma, repeated for confirmation.
  • Eradication Trial: Time to inhibitor eradication
    • Time Frame: Up to 48 weeks
    • Inhibitor eradication is defined as anti-FVIII < 0.6 B.U. by chromogenic Nijmegen Bethesda assay, performed on plasma, repeated for confirmation.

Secondary Measures

  • Prevention & Eradication Trials: Bleeding events including hematoma, joint, central nervous system, other
    • Time Frame: Up to 48 weeks
    • Number of bleeding events
  • Prevention & Eradication Trials: Factor VIII trough activity by chromogenic assay
    • Time Frame: Up to 48 weeks
    • FVIII activity
  • Prevention & Eradication Trials: HLA type and factor VIII genotype
    • Time Frame: Up to 48 weeks
    • HLA haplotype and FVIII mutation

Participating in This Clinical Trial

Prevention Trial, Inclusion Criteria:

  • Male children >/= 4 months of age. – Severe hemophilia A (FVIII < 0.01 U/ml) – No previous bleed or surgery requiring treatment (except circumcision) – No previous factor VIII product (except for circumcision) – Willingness to comply with weekly prophylaxis for 48 weeks – Willingness of parent/caregiver to keep a personal diary of bleeding frequency and factor treatment. – Willingness to make monthly visits and coagulation testing at weeks 4, 12, 24, 36, and 48 (end of study) Prevention Trial, Exclusion Criteria:

  • Acquired hemophilia. – Any bleeding disorder other than hemophilia A. – Treatment with clotting factor previously, other than circumcision. – Presence of an inhibitor to factor VIII. – Use of an experimental drug(s). – Surgery anticipated in the next 48 weeks. – Life expectancy less than 5 years. – Inability to comply with study requirements. Eradication Trial, Inclusion Criteria:

  • Male adults or children with no age limitation. – Severe hemophilia A (FVIII <0.01 U/ml). – Presence of an inhibitor to FVIII (anti-FVIII > 5.0 B.U.) – Willingness to comply with study drugs for up to 48 weeks. – Willingness to keep a personal diary of bleed frequency and drug treatment. – Willingness to make monthly visits and coagulation testing at weeks 4, 12, 24, 36, and 48 (end of study). Eradication Trial, Exclusion Criteria:

  • Acquired hemophilia. – Any bleeding disorder other than hemophilia A. – Current use of Emicizumab, or if used, > 8 weeks since last treatment. – Use of an experimental drug(s). – Surgery anticipated in the next 48 weeks. – Life expectancy less than 5 years. – Inability to copy with study requirements.

Gender Eligibility: Male

Minimum Age: 4 Months

Maximum Age: 99 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Margaret Ragni
  • Provider of Information About this Clinical Study
    • Sponsor-Investigator: Margaret Ragni, Professor of Medicine – University of Pittsburgh
  • Overall Official(s)
    • Margaret V Ragni, MD, MPH, Principal Investigator, University of Pittsburgh

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