Active, not recruiting
Phase 3
Long-term Safety and Efficacy of Odevixibat in Patients With Alagille Syndrome
Condition(s) studied
Alagille Syndrome
Investigational drug(s) / intervention(s)
Odevixibat
Odevixibat: Odevixibat is a small molecule and selective inhibitor of IBAT.
Study summary
The purpose of this study is to assess the long-term safety and effectiveness of odevixibat in participants with Alagille syndrome (ALGS).
The participants of this study will have ALGS a rare genetic disorder that can affect multiple organ systems of the body including the liver, heart, skeleton, eyes and kidneys. Common symptoms, which often develop during the first three months of life, include blockage of the flow of bile from the liver (cholestasis), yellowing of the skin and mucous membranes (jaundice), poor weight gain and growth and severe itching (pruritis).
The drug used for the study is odevixibat and was authorized for the treatment of cholestatic pruritus in infants with ALGS over 12 months of age by the United States Food and Drug Administration on 13 June 2023.
Eligibility
Inclusion Criteria:
Cohort 1 :
1. Completion of the 24-week Treatment Period of Study A4250-012
2. Signed informed consent and assent as appropriate. Patients who turn 18 years of age (or legal age per country) during the study will be required to re-consent to remain on the study
3. Caregivers (and age-appropriate patients) must be willing and able to use an electronic diary (eDiary) device as required by the study
4. Sexually active males and females must agree to use a reliable contraceptive method with ≤1% failure rate (such as hormonal contraception, intra-uterine device, or complete abstinence) from signed informed consent through 90 days after last dose of study drug.
Cohort 2 :
1. Infant with clinically confirmed ALGS , ≤11 months of age at Study Day 1
2. Body weight ≥2 kg at Study Day 1
3. Gestational age ≥36 weeks. For children born with gestational age between 32 and 36 weeks, a postmenstrual age of ≥36 weeks is required .
4. Signed parent/legal guardian informed consent.
Exclusion Criteria:
Cohort 1 :
1. Decompensated liver disease, history or presence of clinically significant ascites, variceal hemorrhage, and/or encephalopathy
2. Patients who were not compliant with study drug treatment or procedures in Study A4250-012
3. Any other conditions or abnormalities which, in the opinion of the investigator, may compromise the safety of the patient, or interfere with the patient participating in or completing the study
4. Known hypersensitivity to any components of odevixibat
Cohort 2 :
1. Patient with past medical history or ongoing presence of other types of liver disease including, but not limited to, the following:
1. Biliary atresia of any kind
2. Progressive familial intrahepatic cholestasis (PFIC)
3. Benign recurrent intrahepatic cholestasis
2. Patient with a past medical history or ongoing presence of any other disease or condition known to interfere with the absorption, distribution, metabolism (specifically bile acid metabolism), or excretion of drugs in the intestine, including but not limited to, inflammatory bowel disease
3. Patient with past medical history or ongoing chronic diarrhea requiring intravenous fluid or nutritional intervention for treatment of the diarrhea and/or its sequelae
4. Patient has a confirmed past diagnosis of infection with human immunodeficiency virus or other present and active, clinically significant chronic infection
5. Recent infection requiring hospitalization or treatment with parenteral anti-infective within 4 weeks of Study Day 1 or completion of oral anti-infective treatment within 2 weeks prior to the Screening Visit
6. Cancer diagnosis (except for basal cell carcinoma)
7. Chronic kidney disease with an impaired renal function and a glomerular filtration rate \<70 mL/min/1.73 m2
8. Patient with surgical history of disruption of the enterohepatic circulation (biliary diversion surgery) within 6 months prior to the Screening Visit
9. Patient has had a liver transplant, or a liver transplant is planned within 6 months of Study Day 1
10. Decompensated liver disease, history or presence of clinically significant ascites, variceal hemorrhage, and/or encephalopathy
11. International normalized ratio (INR) \>1.4 (the patient may be treated with Vitamin K, and if INR is ≤1.4 at resampling the patient may be enrolled)
12. Serum alanine aminotransferase (ALT) \>10 × upper limit of normal (ULN) at Screening
13. Serum ALT \>15 × ULN at any time point during the last 6 months unless an alternate etiology was confirmed for the elevation
14. Total bilirubin \>15 × ULN at Screening
15. Patient suffers from uncontrolled, recalcitrant pruritic condition other than ALGS. Examples include, but not limited to, refractory atopic dermatitis or other primary pruritic skin diseases.
16. Patient exposed to alcohol or substance abuse in utero
17. Bile acid or lipid binding resins and medications that slow gastrointestinal motility
18. Patient has had investigational exposure to a drug, biologic agent, or medical device within 30 days prior to the Screening Visit, or 5 half-lives of the study agent, whichever is longer
19. Any other conditions or abnormalities which, in the opinion of the investigator may compromise the safety of the patient, or interfere with the patient participating in or completing the study
Primary outcome measure(s)
- Change from baseline in pruritus — Baseline to week 72 (cohort 1).
Assessed as change in scratching score as measured by measured by the Albireo Observer-Reported Outcome Caregiver Instrument.
- Percentage of participants with Treatment Emergent Adverse Event (TEAEs) and Serious Adverse Events (SAEs) — Baseline to week 12 (cohort 2).
An Adverse event (AE) is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. A serious adverse event (SAE) is an AE that results in any of following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged inpatient hospitalization; congenital anomaly/birth defect or was otherwise considered medically important. Treatment-emergent adverse events. TEAEs included both Serious TEAEs and non-serious TEAEs.
- Percentage of participants with clinically significant changes from baseline in Physical Examination — Baseline to week 12 (cohort 2).
The clinical significance will be graded by the investigator.
- Percentage of participants with clinically significant changes in Laboratory Parameters — Baseline to week 12 (cohort 2).
The following laboratory parameters will be reported: blood chemistry, hematology and coagulation. The clinical significance will be graded by the investigator.
- Percentage of participants with clinically significant changes from baseline in Vital Signs. — Baseline to week 12 (cohort 2).
The clinical significance will be graded by the investigator.
- Change from baseline in concomitant medications. — Baseline to week 12 (cohort 2).
- Change from baseline in fat-soluble vitamin levels. — Baseline to week 12 (cohort 2).
Trial sites (35)
| Facility | City | Region | Status |
| Rady Children's Hospital |
San Diego |
California |
|
| UCSF |
San Francisco |
California |
|
| Children's Healthcare of Atlanta |
Atlanta |
Georgia |
|
| Riley Hospital for Children at IU Health |
Indianapolis |
Indiana |
|
| Johns Hopkins Hospital |
Baltimore |
Maryland |
|
| Boston Children's Hospital |
Boston |
Massachusetts |
|
| Children's Mercy Hospital and Clinics |
Kansas City |
Missouri |
|
| Northwell Health System |
New Hyde Park |
New York |
|
| Hassenfeld Children's Hospital at NYU Langone |
New York |
New York |
|
| New York-Presbyterian / Columbia University Irving Medical Center |
New York |
New York |
|
| The Childrens Hospital at Montefiore Albert Einstein School of Medicine |
The Bronx |
New York |
|
| Atrium Health Carolinas Medical |
Durham |
North Carolina |
|
| Cincinnati Children's Hospital |
Cincinnati |
Ohio |
|
| Oregon Health Science University School of Medicine |
Portland |
Oregon |
|
| Monroe Carell Jr. Childrens Hospital at Vanderbilt |
Nashville |
Tennessee |
|
| Childrens Medical Center of Dallas University of Texas Southwestern |
Dallas |
Texas |
|
| Texas Children's Hospital |
Houston |
Texas |
|
| Texas Liver Institute |
San Antonio |
Texas |
|
| Cliniques Universitaires Saint-Luc Bruxelles |
Brussels |
Belgium |
|
| Hôpital Femme Mère Enfant de Lyon |
Bron |
France |
|
| Antenne pediatrique du CIC-Hopital Jeanne De Flandre |
Lille |
France |
|
| Hopital Necker Enfants Malades |
Paris |
France |
|
| Charité - Universitätsmedizin Berlin |
Berlin |
Germany |
|
| Medizinische Hochschul |
Hanover |
Germany |
|
| Universitatsklinik fur Kinder-und Jugendmedizin Tubingen |
Tübingen |
Germany |
|
| AOU Meyer |
Florence |
Italy |
|
| Azienda Ospedale University |
Padova |
Italy |
|
| Ospedale Pediatrico Bambino Gesu |
Rome |
Italy |
|
| University of Malaya Medical Center |
Kuala Lumpur |
Malaysia |
|
| Universitair Medisch Centrum Groningen |
Groningen |
Netherlands |
|
| Wilhelmina Children's Hospital UMCU Utrecht |
Utrecht |
Netherlands |
|
| Instytut Pomnik-Centrum Zdrowia Dzieck |
Warsaw |
Poland |
|
| Istanbul University Istanbul Medical Faculty Hospital |
Istanbul |
Turkey (Türkiye) |
|
| Birmingham Women's and Children's NHS Foundation Trust |
Birmingham |
United Kingdom |
|
| King's College Hospital NHS Foundation Trust King's College Hospital Paediatric Research |
London |
United Kingdom |
|