Pan African Clinical Trials Registry

South African Medical Research Council, South African Cochrane Centre
PO Box 19070, Tygerberg, 7505, South Africa
Telephone: +27 21 938 0506 / +27 21 938 0834 Fax: +27 21 938 0836
Email: pactradmin@mrc.ac.za Website: pactr.samrc.ac.za
Trial no.: PACTR201909828957937 Date of Approval: 18/09/2019
Trial Status: Registered in accordance with WHO and ICMJE standards
TRIAL DESCRIPTION
Public title Study of two doses of crizanlizumab versus placebo in adolescent and adult sickle cell disease patients
Official scientific title A phase III, Multicenter, Randomized, Double-blind Study to Assess Efficacy and Safety of Two Doses of Crizanlizumab versus placebo, with or without Hydroxyurea/ Hydroxycarbamide Therapy, in Adolescent and Adult Sickle Cell Disease Patients with Vaso-Occlusive Crises (STAND)
Brief summary describing the background and objectives of the trial The purpose of this study is to compare the efficacy and safety of 2 doses of crizanlizumab (5.0 mg/kg and 7.5 mg/kg) versus placebo in adolescent and adult sickle cell disease (SCD) patients with history of vaso-occlusive crisis (VOC) leading to healthcare visit. Pre-clinical data have established P-selectin as a key mediator of vaso-occlusion in SCD and suggest that its blockade could eliminate or reduce VOCs. The A2201 study (SUSTAIN) compared the mean trough percentage P-selectin inhibition obtained with crizanlizumab following administration of 2.5 mg/kg dose and 5.0 mg/kg dose and suggested that the degree of clinical benefit may be correlated with achieving a certain level of P-selectin inhibition. Since trough concentration is highly correlated with % P-selectin inhibition, 7.5 mg/kg is the proposed dose to achieve higher % P-selectin inhibition in SCD patients. The purpose of this study is to compare the efficacy and safety of 2 doses of crizanlizumab (5.0 mg/kg and 7.5 mg/kg) versus placebo in adolescent and adult SCD patients with history of VOC leading to healthcare visit. Primary Objective: To compare the efficacy of 7.5 mg/kg of crizanlizumab versus placebo on the annualized rate of VOC leading to healthcare visit, in addition to standard of care To compare the efficacy of 5.0 mg/kg of crizanlizumab versus placebo on the annualized rate of VOC leading to healthcare visit, in addition to standard of care Key Secondary Objective: To compare the efficacy of 7.5 mg/kg versus placebo on the annualized rate of all VOCs (managed at home + leading to healthcare visit) To compare the efficacy of 5.0 mg/kg versus placebo on the annualized rate of all VOCs (managed at home + leading to healthcare visit)
Type of trial RCT
Acronym (If the trial has an acronym then please provide)
Disease(s) or condition(s) being studied Haematological Disorders
Sub-Disease(s) or condition(s) being studied
Purpose of the trial Treatment: Drugs
Anticipated trial start date 02/08/2019
Actual trial start date 27/11/2019
Anticipated date of last follow up 05/11/2027
Actual Last follow-up date 31/12/2027
Anticipated target sample size (number of participants) 240
Actual target sample size (number of participants) 240
Recruitment status Recruiting
Publication URL
Secondary Ids Issuing authority/Trial register
STUDY DESIGN
Intervention assignment Allocation to intervention If randomised, describe how the allocation sequence was generated Describe how the allocation sequence/code was concealed from the person allocating the participants to the intervention arms Masking If masking / blinding was used
Parallel: different groups receive different interventions at same time during study Randomised Stratified allocation where factors such as age, gender, center, or previous treatment are used in the stratification Central randomisation by phone/fax Masking/blinding used Care giver/Provider,Outcome Assessors,Participants
INTERVENTIONS
Intervention type Intervention name Dose Duration Intervention description Group size Nature of control
Experimental Group Crizanlizumab SEG101 at 5 mg per kg Drug: Crizanlizumab (SEG101) Crizanlizumab will be supplied in single use 10 mL glass vials at a concentration of 10 mg/mL. One vial contains 100 mg of crizanlizumab. This is a concentrate for solution for infusion IV. Other Name: SEG101 Drug: Crizanlizumab (SEG101) Crizanlizumab will be supplied in single use 10 mL glass vials at a concentration of 10 mg/mL. One vial contains 100 mg of crizanlizumab. This is a concentrate for solution for infusion IV. Other Name: SEG101 This study will compare 2 doses of crizanlizumab versus placebo: 5.0 mg/kg which has shown efficacy in reducing the number of VOCs in SCD patients at the age of 16 years and over and a higher dose (7.5 mg/kg). The placebo of crizanlizumab will be used as a comparator to provide objective evidence of clinical efficacy, and safety data generated from subjects exposed to the experimental drug. 80
Control Group Placebo Comparator Placebo will be supplied in single use 10 mL glass vials at a concentration of 10 mg/mL. One vial contains 100 mg of placebo. This is a concentrate for solution for infusion IV. Following randomization, subjects will receive their first dose of investigational treatment (crizanlizumab or placebo) via IV administration on Week 1 Day 1, followed by a second dose 14 days later (Week 3 Day 1), and then investigational treatment administration will take place every 4 weeks for a total on-study treatment period of up to 5 years. This study will compare 2 doses of crizanlizumab versus placebo: 5.0 mg/kg which has shown efficacy in reducing the number of VOCs in SCD patients at the age of 16 years and over and a higher dose (7.5 mg/kg). The placebo of crizanlizumab will be used as a comparator to provide objective evidence of clinical efficacy, and safety data generated from subjects exposed to the experimental drug. 80 Placebo
Experimental Group Crizanlizumab SEG101 at 7.5 mg per kg Crizanlizumab will be supplied in single use 10 mL glass vials at a concentration of 10 mg/mL. One vial contains 100 mg of crizanlizumab. This is a concentrate for solution for infusion IV. Crizanlizumab will be supplied in single use 10 mL glass vials at a concentration of 10 mg/mL. One vial contains 100 mg of crizanlizumab. This is a concentrate for solution for infusion IV. This study will compare 2 doses of crizanlizumab versus placebo: 5.0 mg/kg which has shown efficacy in reducing the number of VOCs in SCD patients at the age of 16 years and over and a higher dose (7.5 mg/kg). The placebo of crizanlizumab will be used as a comparator to provide objective evidence of clinical efficacy, and safety data generated from subjects exposed to the experimental drug 80
ELIGIBILITY CRITERIA
List inclusion criteria List exclusion criteria Age Category Minimum age Maximum age Gender
1. Written informed consent must be obtained prior to any screening procedures 2. Male or female patients aged 12 years and older on the day of signing informed consent. Adolescent include patients aged 12 to 17 years old and adults ≥ 18 years and older 3. Confirmed diagnosis of SCD by hemoglobin electrophoresis or high performance liquid chromatography (HPLC) [performed locally]. All SCD genotypes are eligible, genotyping is not required for study entry 4. Experienced at least 2 VOCs leading to healthcare visit within the 12 months prior to screening visit as determined by medical history. Prior VOC leading to healthcare visit must include: a. Pain crisis defined as an acute onset of pain for which there is no other medically determined explanation other than vaso-occlusion, b. a visit to a medical facility and/or healthcare professional, c. and receipt of oral/parenteral opioids or parenteral nonsteroidal anti-inflammatory drug (NSAID) analgesia As well as other complicated crises, such as acute chest syndrome, priapism, and hepatic or splenic sequestration (see Section 8.3.1 for further definition) 5. If receiving HU/HC or L-glutamine or erythropoietin stimulating agent , must have been receiving the drug for at least 6 months prior to Screening visit and plan to continue taking at the same dose and schedule until the subject has reached one year of study treatment. Patients who have not been receiving such drug must not have received it for at least 6 months prior to Screening visit to be included 6. Patients must meet the following central laboratory values at the screening visit: Absolute Neutrophil Count ≥1.0 x 109/L, Platelet count ≥75 x 109/L, Hemoglobin: for adults (Hb) ≥4.0 g/dL and for adolescents (Hb) ≥5.5 g/dL, Glomerular filtration rate ≥ 45 mL/min/1.73 m2 using CKD-EPI formula in adults, and Shwartz formula in adolescents, Direct (conjugated) bilirubin < 2.0 x ULN, Alanine transaminase (ALT) < 3.0 x ULN 7. ECOG performance status ≤2.0 for adults and Karnofsky ≥ 50% for adolescents 8. Received standard age-appropriate care for SCD, including an up-to-date record of immunizations, as per local requirements 1. History of stem cell transplant 2. Received blood products within 30 days of Week 1 Day 1 dosing 3. Participating in a chronic transfusion program (pre-planned series of transfusions for prophylactic purposes) and/or planning on undergoing an exchange transfusion and/or plasmapheresis during the duration of the study; episodic transfusion in response to worsened anemia or VOC is permitted 4. Contraindication or hypersensitivity to any drug or metabolites from similar class as study drug or to any excipients of the study drug formulation. History of severe hypersensitivity reaction to other monoclonal antibodies, which in the opinion of the investigator may pose an increased risk of serious infusion reaction 5. Use of therapeutic anticoagulation or antiplatelet therapy (other than aspirin or NSAIDs) within the 10 days prior to Week 1 Day 1 dosing. Note: Prophylactic anticoagulant dose is permitted, as per local guidelines 6. Received active treatment on another investigational trial within 30 days (or 5 half-lives of that agent, whichever is greater) prior to Screening visit or plans to participate in another investigational drug trial 7. Pregnant females or females who have given birth within the past 90 days or who are breastfeeding 8. Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant unless they are using highly effective methods of contraception during dosing and for 15 weeks after stopping treatment. Highly effective contraception methods include: • Total abstinence (when this is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception • Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy, or tubal ligation at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment • Male sterilization (at least 6 months prior to screening). The vasectomized male partner should be the sole partner for that patient • Use of oral, injected or implanted hormonal methods of contraception or placement of an intrauterine device (IUD) or intrauterine system (IUS), or other forms of hormonal contraception that have comparable efficacy (failure rate <1%), for example hormone vaginal ring or transdermal hormone contraception. In case of use of oral contraception women should have been stable on the same pill for a minimum of 3 months before taking study treatment 9. Any documented history of a clinical stroke or intracranial hemorrhage, or an uninvestigated neurologic finding within the past 12 months before screening visit. Silent infarct only present on imaging is allowed 10. Clinically significant bleeding disorder 11. Planning to undergo a major surgical procedure during the duration of the study 12. Hospitalized at Screening 13. Patient with active HIV infection (detectable viral load) 14. Patients with active Hepatitis B infection (HBsAg positive) will be excluded Note: Patients with antecedent but no active Hepatitis B (i.e. anti-HBc positive, HBsAg and HBV-DNA negative) are eligible 15. Positive test for hepatitis C ribonucleic acid (HCV RNA) Note: Patients in whom HCV infection resolved spontaneously (positive HCV antibodies without detectable HCV-RNA) or those that achieved a sustained virological response after antiviral treatment and show absence of detectable HCV RNA ≥ 6 months (with the use of IFN-free regimes) or ≥ 12 months (with the use of IFN-based regimes) after cessation of antiviral treatment are eligible 16. Malignant disease. Exceptions to this exclusion include the following: malignancies that were treated curatively and have not recurred within 3 years prior to study treatment; completely resected basal cell and squamous cell skin cancers and any completely resected carcinoma in situ 17. Concurrent severe and/or uncontrolled medical conditions which, in the opinion of the Investigator, could cause unacceptable safety risks or compromise participation in the study 18. Any condition which, in the opinion of the investigator, is likely to interfere with the successful collection of the measurements required for the study 19. History or current diagnosis of ECG abnormalities indicating significant risk of safety such as: - Resting QTcF ≥470 msec at pretreatment (baseline) for both male and female or instabilityto determine QTc - Concomitant clinically significant cardiac arrhythmias (e.g ventricular tachycardia), and clinically significant second or third degree AV block without a pacemaker - History of familial long QT syndrome or know family history of Torsades de Pointe 20. Not able to understand and to comply with study instructions and requirements 21. Acute vaso-occlusive crisis ending within 7 days prior to Week 1 Day 1 dosing 80 and over: 80+ Year,Adolescent: 13 Year-18 Year,Adult: 19 Year-44 Year,Aged: 65+ Year(s),Child: 6 Year-12 Year,Middle Aged: 45 Year(s)-64 Year(s) 12 Year(s) 80 Year(s) Both
ETHICS APPROVAL
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
No 24/09/2019 Korle Bu Teaching Hospital Independent Review Board
Ethics Committee Address
Street address City Postal code Country
Guggisberg Avenue, Accra, Ghana ACCRA 0000 Ghana
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
Yes 12/08/2019 University of the Witwatersrand Human Research Ethics Committee Medical
Ethics Committee Address
Street address City Postal code Country
31 Princess of Wales Terrace, Parktown Johannesburg 2041 South Africa
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
No 27/09/2019 KEMRI Scientific Ethics Review Unit SERU
Ethics Committee Address
Street address City Postal code Country
P.O. Box, 54840-00200 Nairobi 0000 Kenya
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
No 27/09/2019 Gertrudes Institute of Child Health and Research Ethics Review Committee
Ethics Committee Address
Street address City Postal code Country
Muthaiga Road Nairobi 0000 Kenya
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
No 27/09/2019 Human Research Publication and Ethics Kwame Nkrumah University of Science and Technology
Ethics Committee Address
Street address City Postal code Country
Kumasi Kumasi 0000 Ghana
OUTCOMES
Type of outcome Outcome Timepoint(s) at which outcome measured
Primary Outcome To compare the efficacy of 7.5 mg/kg of crizanlizumab versus placebo on the annualized rate of VOC leading to healthcare visit, in addition to standard of care To compare the efficacy of 5.0 mg/kg of crizanlizumab versus placebo on the annualized rate of VOC leading to healthcare visit, in addition to standard of care Annualized rate of VOC events leading to healthcare visit in each treatment group over the first year post-randomization
Secondary Outcome Key secondary objective: To compare the efficacy of 7.5 mg/kg versus placebo on the annualized rate of all VOCs (managed at home + leading to healthcare visit) To compare the efficacy of 5.0 mg/kg versus placebo on the annualized rate of all VOCs (managed at home + leading to healthcare visit) To assess the number of days with VOC leading to healthcare visit in each group To assess rate of subjects free from VOC leading to healthcare visit in each group To assess the time to first and second VOC leading to healthcare visit in each group Healthcare resource utilization (visits to clinic, Emergency room (ER) and hospitalizations) in each group versus placebo To assess SCD-related renal damage in each group To characterize the pharmacokinetic (PK) profile of crizanlizumab at 5.0 and 7.5 mg/kg To characterize the pharmacodynamic (PD) (P-selectin inhibition) of crizanlizumab at 5.0 and 7.5 mg/kg To assess efficacy, safety and immunogenicity of crizanlizumab over the study period (treatment of 5 years + 105 days of follow-up) (taking into account potential treatment switch after primary analysis) Number and percentage of subjects free from VOCs leading to healthcare visit in each group over the first year post randomization
RECRUITMENT CENTRES
Name of recruitment centre Street address City Postal code Country
Ghana Institute Of Clinical Genetics Korle Bu Teaching Hospital Accra Ghana
Sickle Cell Office Driectorate of Chidl Health Komfo Anokye Teaching Hospital Kumasi Ghana
Malaria Research Centre Agogo Presbyterian Hospita Agogo Ghana
CREATES Strathmore University Ole Sangale Road Nairobi 0000 Kenya
International Cancer Institute Nandi Road Block 8/102 Eldoret 0000 Kenya
Gertrudes Childrens Hospital 34 Muthaiga Road Nairobi 0000 Kenya
Hemophilia Comprehensive Care Centre Charlotte Maxeke Johannesburg Academic Hospital York Road Parktown Johannesburg 2193 South Africa
FUNDING SOURCES
Name of source Street address City Postal code Country
Novartis Pharma AG Lichtstrasse 35 Basel 4056 Switzerland
SPONSORS
Sponsor level Name Street address City Postal code Country Nature of sponsor
Primary Sponsor Novartis Pharma AG Lichtstrasse 35 Basel 4056 Switzerland Commercial Sector/Industry
COLLABORATORS
Name Street address City Postal code Country
Dr Vivian Paintsill Sickle Cell Office Directorate of Child Health Komfo Anokye Teaching Hospital Kumasi 0000 Ghana
Professor Johnny Mahlangu Room 31 Green Block Charlotte Maxeke Johannesburg Academic Hospital York Road Parktown Johannesburg 2193 South Africa
Dr Yvonne Dei Adomakoh Ghana Institute of Clinical Genetics, Korle Bu Teaching Hospital, Korle Bu Accra 0000 Ghana
Professor Berhards Ogutu CREATES Strathmore University Ole Sangale Road, Madaraka Estate Nairobi 0000 Kenya
Dr Asirwa Fredrick Chite International Cancer Institute, Nandi Road Block 8/102 Eldoret 0000 Kenya
Dr Doreen Mutua Gertrudes Childrens Hospital 34 Muthaiga Road Nairobi 0000 Kenya
CONTACT PEOPLE
Role Name Email Phone Street address
Public Enquiries Clinical Disclosure Officer Clinical Disclosure Officer Trialandresults.registries@novartis.com +41613241111 Novartis Pharma AG CH-4002
City Postal code Country Position/Affiliation
Basel 4002 Switzerland Clinical Disclosure Officer
Role Name Email Phone Street address
Scientific Enquiries Clinical Disclosure Officer Clinical Disclosure Officer Trialandresults.registries@novartis.com +41613241111 Novartis Pharma AG CH-4002
City Postal code Country Position/Affiliation
Basel 4002 Switzerland Clinical Disclosure Officer
Role Name Email Phone Street address
Principal Investigator Yvonne Dei Adomakoh deiadom@yahoo.com +233243550980 Ghana Institute Of Clinical Genetics, Korle Bu Teaching Hospital
City Postal code Country Position/Affiliation
Accra 0000 Ghana Head of Department
REPORTING
Share IPD Description Additional Document Types Sharing Time Frame Key Access Criteria
Yes Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com Clinical Study Report This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations.
URL Results Available Results Summary Result Posting Date First Journal Publication Date
No
Result Upload 1: Result Upload 2: Result Upload 3: Result Upload 4: Result Upload 5:
Result URL Hyperlinks Link To Protocol
Result URL Hyperlinks
Changes to trial information