A Study to Evaluate Overall Health, Physical Activity, and Joint Outcomes in Participants With Severe or Moderate Hemophilia A Without Factor VIII Inhibitors on Emicizumab Prophylaxis (NCT05181618) — UK Trial Details

Condition(s) studied

Severe Hemophilia AModerate Hemophilia A

Investigational drug(s) / intervention(s)

Emicizumab

Emicizumab: The emicizumab dosing regimen will be 3 milligrams per kilogram of body weight (mg/kg) subcutaneously (SC) once a week (QW) for 4 weeks followed by participant preference of one of the following maintenance regimens: 1.5 mg/kg QW, 3 mg/kg once every 2 weeks (Q2W), or 6 mg/kg once every 4 weeks (Q4W) in agreement with the investigator.

Study summary

Study MO42623 is a Phase IV, multicenter, open-label, three cohort study designed to evaluate the impact of emicizumab prophylaxis on overall health, physical activity, and joint outcomes in participants aged ≥13 and \<70 years with severe hemophilia A without factor VIII (FVIII) inhibitors or moderate hemophilia A without FVIII inhibitors who are receiving FVIII prophylaxis and who will start emicizumab treatment as part of this study.

Eligibility

Sex

ALL

Min age

13 Years

Max age

69 Years

Healthy volunteers

No

Inclusion Criteria: * Diagnosis of severe congenital hemophilia A (intrinsic factor VIII \[FVIII\] level \<1%) or moderate congenital hemophilia A (intrinsic FVIII level ≤5%) if previously prescribed prophylaxis * A negative test for FVIII inhibitor (i.e., \<0.6 Bethesda Units) during screening period * No history of FVIII inhibitory antibodies (\<0.6 BU/mL using the Bethesda assay) in the last 5 years. Participants who completed successful immune tolerance induction (ITI) at least 5 years before screening are eligible, provided they have had no evidence of inhibitor recurrence (permanent or temporary) as may be indicated by detection of an inhibitor, FVIII half-life \<6 hours, or FVIII recovery \<66% since completing ITI * Participants who were on standard FVIII prophylaxis, defined as the regular administration of FVIII to prevent bleeding, for at least the last 24 weeks, can be enrolled regardless of the number of bleeds during this period * Adequate hematologic, hepatic and renal function * For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraception during the treatment period and for at least 24 weeks after the final dose of emicizumab Exclusion Criteria: * Inherited or acquired bleeding disorder other than severe congenital hemophilia A (intrinsic FVIII level \<1%) or moderate congenital hemophilia A (intrinsic FVIII level ≤5%) without FVIII inhibitors who were previously prescribed prophylaxis for at least 24 weeks * Participants who have previously received emicizumab prophylaxis * Participants that plan to have joint replacement, joint procedure, synovectomy or synoviorthesis at screening * Participants who had joint replacement, joint procedure, synovectomy or synoviorthesis: Less than 2 years ago; OR, More than 3 years ago and are still experiencing pain in the joint. For participants who had joint replacement, joint procedure, synovectomy or synoviorthesis more than 2 years ago who are not experiencing pain in the joint(s), the participant may be enrolled but the specific joint(s) in which the procedure was conducted will be excluded from the study * Participants who have conditions other than hemophilia A that can affect joint health and structure (e.g., osteoarthritis) or with severely impaired mobility due to conditions other than hemophilia A * Participants with known reduced bone mineral density defined as clinically relevant vitamin D deficiency * Participants with pre-existing uncontrolled or unstable cardiovascular disease not receiving targeted medication or in a stable condition * Participants not eligible for MRI * History of illicit drug or alcohol abuse within 48 weeks prior to screening in the investigator's judgement * Participants who are at high risk for thrombotic microangiopathy (TMA) * Previous (within the last 12 months) or current treatment for thromboembolic disease (with the exception of previous catheter-associated thrombosis for which anti-thrombotic treatment is not currently ongoing) or signs of thromboembolic disease * Other conditions (e.g., certain autoimmune diseases) that may currently increase the risk of bleeding or thrombosis * History of clinically significant hypersensitivity associated with monoclonal antibody therapies or components of the emicizumab injection * Planned surgery during the emicizumab loading dose phase * Known HIV infection not controlled by medication * Concomitant disease, condition, significant abnormality on screening evaluation or laboratory tests, or treatment that could interfere with the conduct of the study, or that would in the opinion of the investigator, pose an additional unacceptable risk in administering study drug to the participant * Receipt of any of the following: An investigational drug to treat or reduce the risk of hemophilic bleeds within 5 half-lives of last drug administration at screening; A non-hemophilia-related investigational drug within last 30 days or 5 half-lives at screening, whichever is shorter; or, Any other investigational drug currently being administered or planned to be administered * Inability to comply with the study protocol * Pregnant or breastfeeding, or intending to become pregnant during the study

Primary outcome measure(s)

Joint Status at 6 Months, Based on Centrally Reviewed Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) Scores with a Specific Focus on the Synovitis Score in Participants with Synovitis — 6 Months
Joint Status at 12 Months, Based on Centrally Reviewed Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) Scores with a Specific Focus on the Synovitis Score in Participants with Synovitis — 12 Months
Joint Status at 24 Months, Based on Centrally Reviewed Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) Scores with a Specific Focus on the Synovitis Score in Participants with Synovitis — 24 Months
Joint Status at 36 Months, Based on Centrally Reviewed Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) Scores with a Specific Focus on the Synovitis Score in Participants with Synovitis — 36 Months
Clinical Joint Status at 6 Months, Based on the Hemophilia Joint Health Score (HJHS v2.1) Excluding Gait Assessment — 6 Months
Clinical Joint Status at 12 Months, Based on the Hemophilia Joint Health Score (HJHS v2.1) Excluding Gait Assessment — 12 Months
Clinical Joint Status at 24 Months, Based on the Hemophilia Joint Health Score (HJHS v2.1) Excluding Gait Assessment — 24 Months
Clinical Joint Status at 36 Months, Based on the Hemophilia Joint Health Score (HJHS v2.1) Excluding Gait Assessment — 36 Months
Joint Status at 36 Months, Based on Centrally Reviewed International Prophylaxis Study Group (IPSG) Score (with MRI) — 36 Months
Number of Problem Joints at 6 Months — 6 Months
Problem joints are defined as joints having chronic joint pain and/or limited range of movement due to compromised joint integrity (i.e., chronic synovitis and/or hemophilic arthropathy) with or without persistent bleeding.
Number of Problem Joints at 12 Months — 12 Months
Problem joints are defined as joints having chronic joint pain and/or limited range of movement due to compromised joint integrity (i.e., chronic synovitis and/or hemophilic arthropathy) with or without persistent bleeding.
Number of Problem Joints at 24 Months — 24 Months
Problem joints are defined as joints having chronic joint pain and/or limited range of movement due to compromised joint integrity (i.e., chronic synovitis and/or hemophilic arthropathy) with or without persistent bleeding.
Number of Problem Joints at 36 Months — 36 Months
Problem joints are defined as joints having chronic joint pain and/or limited range of movement due to compromised joint integrity (i.e., chronic synovitis and/or hemophilic arthropathy) with or without persistent bleeding.
Percentage of Joints That are Problem Joints at 6 Months — 6 Months
Percentage of Joints That are Problem Joints at 12 Months — 12 Months
Percentage of Joints That are Problem Joints at 24 Months — 24 Months
Percentage of Joints That are Problem Joints at 36 Months — 36 Months
Change from Baseline in the CATCH Domain Scores Over Time, as Assessed with the Comprehensive Assessment Tool of Challenges in Hemophilia (CATCH) Questionnaire for Adult Participants — At Baseline (Day 1), Months 3, 6, 9, 12, 18, 24, 30, and 36
Change from Baseline in the CATCH Domain Scores Over Time, as Assessed with the CATCH Questionnaire for Pediatric Participants — At Baseline (Day 1), Months 3, 6, 9, 12, 18, 24, 30, and 36
Change from Baseline in the Average Daily Time Spent Doing Physical Activities by Intensity Level Over Time, as Assessed by Participant Responses to the International Physical Activity Questionnaire Short Format (IPAQ-SF) — At Baseline (Day 1), Months 3, 6, 9, 12, 18, 24, 30, and 36
Daily Step Count Over Time, as Measured with a Wearable Activity Tracker — From Baseline until end of treatment period (up to 36 months)
Daily Metabolic Equivalents of Tasks (METs) Over Time, as Measured with a Wearable Activity Tracker — From Baseline until end of treatment period (up to 36 months)
Daily Time Spent in Moderate to Vigorous Physical Activity (MVPA) Over Time, as per the Activity Tracker Default Categorization — From Baseline until end of treatment period (up to 36 months)
Daily Active Minutes of Physical Activity Over Time, as Measured with a Wearable Activity Tracker — From Baseline until end of treatment period (up to 36 months)
Model-Based Annualized Bleed Rates for All Bleeds, Treated Bleeds, Spontaneous Bleeds, Joint Bleeds, Treated Joint Bleeds, and Target Joint Bleeds — From Baseline until end of treatment period (up to 36 months)
Mean Calculated Annualized Bleed Rates for All Bleeds, Treated Bleeds, Spontaneous Bleeds, Joint Bleeds, Treated Joint Bleeds, and Target Joint Bleeds — From Baseline until end of treatment period (up to 36 months)
Median Calculated Annualized Bleed Rates for All Bleeds, Treated Bleeds, Spontaneous Bleeds, Joint Bleeds, Treated Joint Bleeds, and Target Joint Bleeds — From Baseline until end of treatment period (up to 36 months)
Number of Participants who Prefer Emicizumab SC Treatment, Their Previous Hemophilia IV Treatment, or Have No Preference, as Assessed Through Use of the Emicizumab Preference Survey at Month 6 — At Month 6

Trial sites (28)

Facility	City	Region
Orthopaedic Institute for Children	Los Angeles	California
University of Miami Medical Center	Miami	Florida
Oklahoma Children's Hospital ? Jimmy Everest Center	Oklahoma City	Oklahoma
Hospital das Clinicas - UNICAMP	Campinas	São Paulo
Hospital das Clínicas Faculdades Médicas de Ribeirão Preto	Ribeirão Preto	São Paulo
Hamilton Health Sciences Corporation	Hamilton	Ontario
Charité Universitätsklinikum Berlin	Berlin	Germany
Universitätsklinikum Bonn	Bonn	Germany
Észak-Pesti Centrumkórház - Honvédkórház	Budapest	Hungary
AOU Federico II	Naples	Campania
Policlinico Univ. A. Gemelli	Rome	Lazio
IRCCS Ca' Granda Ospedale Maggiore Policlinico	Milan	Lombardy
AOU Careggi	Florence	Tuscany
Hôpital d'enfants de Rabat - Service d'hémato-oncologie pédiatrique	Rabat	Morocco
University Clinical Centre of Serbia	Belgrade	Serbia
Complejo Hospitalario Universitario A Coruña (CHUAC)	A Coruña	Spain
Hospital de la Santa Creu i Sant Pau	Barcelona	Spain
Hospital Universitario Vall de Hebron	Barcelona	Spain
Hospital Universitario la Paz	Madrid	Spain
Hospital Regional Universitario Carlos Haya	Málaga	Spain
CHU Farhat Hached	Sousse	Tunisia
Aziza Othmana Hospital	Tunis	Tunisia
Gazi Universitesi Tip Fakultesi	Ankara	Turkey (Türkiye)
Akdeniz Uni School of Medicine	Antalya	Turkey (Türkiye)
Istanbul University Cerrahpasa Medical Faculty	Istanbul	Turkey (Türkiye)
Ege Uni Medical School	Izmir	Turkey (Türkiye)
St Thomas Westminster	London	United Kingdom
Manchester University NHS Foundation Trust (MFT)	Manchester	United Kingdom

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