A study to evaluate the benefit and safety of Luspatercept (ACE-536) in adults with Beta-Thalassemia who require regular red blood cell tranfusions.

• Register: EUCTR
• Last refreshed on: 13 December 2021
• Main ID: EUCTR2015-003224-31-BG
• Date of registration: 17/03/2016
• Prospective Registration: Yes
• Primary sponsor: Celgene Corporation
• Public title: A study to evaluate the benefit and safety of Luspatercept (ACE-536) in adults with Beta-Thalassemia who require regular red blood cell tranfusions.
• Scientific title: A Phase 3, Double-Blind, Randomized, Placebo-Controlled, Multicenter Study to Determine the Efficacy and Safety of Luspatercept (ACE-536) Versus Placebo in Adults Who Require Regular Red Blood Cell Transfusions Due to Beta-Thalassemia - The Believe Trial
• Date of first enrolment: 12/04/2016
• Target sample size: 336
• Recruitment status: Not Recruiting
• URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:2015-003224-31
• Study type: Interventional clinical trial of medicinal product
• Study design: Controlled: yes; Randomised: yes; Open: no; Single blind: no; Double blind: yes; Parallel group: yes; Cross over: no; Other: no; If controlled, specify comparator, Other Medicinial Product: no; Placebo: yes; Other: no; Number of treatment arms in the trial: 2
• Phase: Human pharmacology (Phase I): no Therapeutic exploratory (Phase II): no Therapeutic confirmatory - (Phase III): yes Therapeutic use (Phase IV): no

Countries of recruitment

Australia, Bulgaria, Canada, France, Germany, Greece, Israel, Italy, Lebanon, Malaysia, Taiwan, Thailand, Turkey, United Kingdom, United States

Contacts

• Name: PPD Project Manager
• Affiliation: PPD

• Name: PPD Project Manager
• Affiliation: PPD

Key inclusion & exclusion criteria

Inclusion criteria:
1. Male or female, at least 18 years of age at the time of signing the informed consent document (ICF).
2. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted.
3. Subject is willing and able to adhere to the study visit schedule (eg, not scheduled to receive HSCT) and other protocol requirements.
4. Documented diagnosis of ß-thalassemia or Hemoglobin E/ß-thalassemia - (ß-thalassemia with mutation and/or multiplication of alpha globin is allowed).
5. Regularly transfused, defined as: 6-20 RBC units in the 24 weeks prior to randomization and no transfusion-free period for = 35 days during that period.
6. Performance status: Eastern Cooperative Oncology Group (ECOG) score of 0 or 1.
7. A female of childbearing potential (FCBP) for this study is defined as a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (ie, has had menses at any time in the preceding 24 consecutive months). FCBP participating in the study must:
a. Have two negative pregnancy tests as verified by the Investigator prior to starting study therapy. She must agree to ongoing pregnancy testing during the course of the study, and after end of study treatment. This applies even if the subject practices true abstinence from heterosexual contact.
b. Either commit to true abstinence from heterosexual contact (which must be reviewed on a monthly basis and source documented). If a FCBP engages in sexual activity that may result in pregnancy, she must agree to use, and be able to comply with, effective contraception without interruption, 28 days prior to starting investigational product, during the study therapy (including dose interruptions), and for 12 weeks (approximately five times the mean terminal half-life of luspatercept based on multiple-dose PK data) after discontinuation of study therapy
8. Male subjects must:
a. Practice true abstinence (which must be reviewed on a monthly basis) or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions and for at least 12 weeks (approximately five times the mean terminal half-life of luspatercept based on multiple-dose PK data) following investigational product discontinuation, even if he has undergone a successful vasectomy.

Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 335
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 1

Exclusion criteria:
1. Any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study.
2. Any condition including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study.
3. Any condition that confounds the ability to interpret data from the study.
4. A diagnosis of Hemoglobin S/ß-thalassemia or alpha (a)-thalassemia (eg, Hemoglobin H); ß-thalassemia combined with a-thalassemia is allowed.
5. Evidence of active hepatitis C (HCV) infection as demonstrated by a positive HCV-RNA test of sufficient sensitivity, or active infectious hepatitis B as demonstrated by the presence of HBsAg and/or HBVDNA- positive, or known positive human immunodeficiency virus (HIV).
6. DVT or stroke requiring medical intervention = 24 weeks prior to randomization.
7. Chronic anticoagulant therapy is excluded, unless the treatment stopped at least = 28 days prior to randomization, Anticoagulant therapies used for prophylaxis for surgery or high risk procedures as well as low- molecular-weight (LMW) heparin for superficial venous thrombosis and chronic aspirin are allowed.
8. Platelet count > 1000 x 109/L
9. Poorly controlled diabetes mellitus within 24 weeks prior to randomization as defined by short term (eg, hyperosmolar or ketoacidotic crisis) and/or history of diabetic cardiovascular complications (eg, stroke or myocardial infarction).
10. Treatment with another investigational drug or device = 28 days prior to randomization.
11. Prior exposure to sotatercept (ACE-011) or luspatercept (ACE-536).
12. Use of an erythropoiesis-stimulating agent (ESA) = 24 weeks prior to randomization.
13. Iron chelation therapy, if initiated = 24 weeks prior to randomization (allowed if initiated
> 24 weeks before or during treatment).
14. Hydroxyurea treatment = 24 weeks prior to randomization.
15. Pregnant or lactating females.
16. Uncontrolled hypertension. Controlled hypertension for this protocol is considered = Grade 1 according to NCI CTCAE version 4.0 (current active minor version).
17. Major organ damage, including:
a. Liver disease with alanine aminotransferase (ALT) > 3 x the upper limit of normal (ULN) or history of evidence of cirrhosis.
b. Heart disease, heart failure as classified by the New York Heart Association (NYHA) classification 3 or higher, or significant arrhythmia requiring treatment, or recent myocardial infarction within 6 months of randomization.
c. Lung disease, including pulmonary fibrosis or pulmonary hypertension which are clinically significant ie. = Grade 3 NCI CTCAE version 4.0 (current active minor version).
d. Creatinine clearance < 60 mL/min (per Cockroff-Gault method).
18. Proteinuria = Grade 3 according to NCI CTCAE version 4.0 (current active minor version).
19. Chronic systemic glucocorticoids = 12 weeks prior to randomization (physiologic eplacement therapy for adrenal insufficiency is allowed). Single day glucocorticoid reatment (eg, for prevention or treatment of transfusion reactions, is allowed).
20. Major surgery = 12 weeks prior to randomization (subjects must have completely recovered from any previous surgery prior to randomization).
21. History of severe allergic or anaphylactic reactions or hypersensitivity to recombinant proteins or excipients in the investigational product (see Investigator Brochure).
22. Cytotoxic agents, immunosuppressants = 28 days pri

Age minimum:
Age maximum:
Gender:
Female: yes
Male: yes

Health Condition(s) or Problem(s) studied

Adults who require regular Red Blood Cell (RBC) transfusions due to Beta-Thalassemia.
MedDRA version: 20.1 Level: LLT Classification code 10054658 Term: Thalassemia System Organ Class: 100000004850

Therapeutic area: Diseases [C] - Blood and lymphatic diseases [C15]

Intervention(s)

Product Name: Luspatercept
Product Code: ACE-536
Pharmaceutical Form: Lyophilisate for solution for injection
INN or Proposed INN: Luspatercept
CAS Number: 1373715-00-4
Current Sponsor code: ACE-536
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 37.5-
Pharmaceutical form of the placebo: Solution for injection
Route of administration of the placebo: Subcutaneous use

Product Name: Luspatercept
Product Code: ACE-536
Pharmaceutical Form: Lyophilisate for solution for injection
INN or Proposed INN: Luspatercept
CAS Number: 1373715-00-4
Current Sponsor code: ACE-536
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 87.5-
Pharmaceutical form of the placebo: Solution for injection
Route of administration of the placebo: Subcutaneous use

Primary Outcome(s)

Primary end point(s): Primary Endpoints:
1. Proportion of subjects with hematological improvement, defined as = 33% reduction from baseline in RBC transfusion burden with a reduction of at least 2 units from Week 13 to Week 24 compared to the 12-week interval prior to randomization for luspatercept plus BSC versus placebo plus BSC.

Main Objective: The primary objective of the study is:
- To determine the proportion of subjects treated with luspatercept plus BSC versus placebo plus BSC who achieved erythroid response, defined as = 33% reduction from baseline in transfusion burden (units RBCs / time) with a reduction of at least 2 units, from Week 13 to Week 24.

Secondary Objective: The key secondary objectives are:
- To evaluate the proportion of subjects who achieve = 33% reduction from baseline in transfusion burden from Week 37 to Week 48 versus placebo
- To evaluate the proportion of subjects who achieve = 50% reduction from baseline in transfusion burden from Week 13 to Week 24 versus placebo
- To evaluate the proportion of subjects who achieve = 50% reduction from baseline in transfusion burden from Week 37 and Week 48 versus placebo
- To evaluate the mean change from baseline in transfusion burden from Week 13 to Week 24
- To evaluate the mean change from baseline in liver iron concentration (LIC) versus placebo
- To evaluate the mean change from baseline in mean daily dose of iron chelation therapy (ICT) used versus placebo
- To evaluate the mean change from baseline in serum ferritin versus placebo
- To evaluate the effect of luspatercept on osteoporosis/osteopenia, total hip and lumbar spine measured by bone mineral density versus placebo

Timepoint(s) of evaluation of this end point: Primary Endpoints: Week 24

Secondary Outcome(s)

Secondary end point(s): 1. Proportion of subjects with hematological improvement, defined as = 33% reduction from baseline in RBC transfusion burden with a reduction of at least 2 units from Week 37 to Week 48 compared to the 12-week interval prior to randomization for luspatercept plus BSC versus placebo plus BSC.
2. Proportion of subjects with = 50% reduction from baseline in RBC transfusion burden with a reduction of at least 2 units from Week 13 to Week 24 compared to the 12-week interval prior to randomization for luspatercept plus BSC versus placebo plus BSC
3. Proportion of subjects = 50% reduction from baseline in RBC transfusion burden with a reduction of at least 2 units from Week 37 to Week 48 compared to the 12-week interval prior to randomization for luspatercept plus BSC versus placebo plus BSC
4. Mean change from baseline in transfusion burden (RBC units) from Week 13 to Week 24

Timepoint(s) of evaluation of this end point: 1. Week 48
2. Week 24
3. Week 48
4. Week 24

Secondary ID(s)

2015-003224-31-GB

ACE-536-B-THAL-001

Source(s) of Monetary Support

Celgene Corporation

Ethics review

Status: Approved
Approval date: 31/03/2016
Contact: