A Phase 2, Open Label, Randomized, Dose Ranging, Safety, Efficacy, Pharmacokinetic and Pharmacodynamic Study of AG-348 in Adult Patients with Pyruvate Kinase Deficiency

• Register: EUCTR
• Last refreshed on: 9 November 2020
• Main ID: EUCTR2015-000484-13-GB
• Date of registration: 18/05/2015
• Prospective Registration: Yes
• Primary sponsor: Agios Pharmaceuticals Inc
• Public title: A Phase 2, Open Label, Randomized, Dose Ranging, Safety, Efficacy, Pharmacokinetic and Pharmacodynamic Study of AG-348 in Adult Patients with Pyruvate Kinase Deficiency
• Scientific title: A Phase 2, Open Label, Randomized, Dose Ranging, Safety, Efficacy, Pharmacokinetic and Pharmacodynamic Study of AG-348 in Adult Patients with Pyruvate Kinase Deficiency
• Date of first enrolment: 10/07/2015
• Target sample size: 75
• Recruitment status: Authorised-recruitment may be ongoing or finished
• URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:2015-000484-13
• Study type: Interventional clinical trial of medicinal product
• Study design: Controlled: no Randomised: yes Open: yes Single blind: no Double blind: no Parallel group: no Cross over: no Other: no If controlled, specify comparator, Other Medicinial Product: no Placebo: no Other: no Number of treatment arms in the trial: 2
• Phase: Human pharmacology (Phase I): no Therapeutic exploratory (Phase II): yes Therapeutic confirmatory - (Phase III): no Therapeutic use (Phase IV): no

Countries of recruitment

Canada, France, Italy, Netherlands, United Kingdom, United States

Contacts

• Name: Director, Scientific Communications
• Affiliation: Agios Pharmaceuticals, Inc.

• Name: Director, Scientific Communications
• Affiliation: Agios Pharmaceuticals, Inc.

Key inclusion & exclusion criteria

Inclusion criteria:
Core period:
1.Signed written informed consent obtained prior to performing any study procedure, including screening procedures
2.M/F, aged .18 yrs
3.Known medical history of PKD
4.Patients must have documented clinical laboratory confirmation of PKD by RBC PK enzymatic assay performed at Screening or by any participating investigative site's local hematology laboratory. Patients with prior documentation of PKD by RBC enzymatic assay will have a reconfirmation of this result during Screening as a condition of enrollment
a.In the event that a patient's screening PK enzymatic assay is negative, the patient will be eligible for enrollment if the genotyping shows a mutant genotype that has been previously documented in the literature to be associated with PKD. If the genotyping shows a previously undescribed mutation in the PKR gene, then the eligibility for enrollment will be determined on a case-by-case basis. If no mutation is defined, then the patient will not be eligible
5.Patients must have genotypic characterization of the mutant PKR gene performed at Screening.Patients whose genotype has already been determined by another laboratory may be enrolled on the basis of that report, with the approval of the Medical Monitor.
6.Patients must have genotypic characterization of the UGT1A1 gene performed to document whether they may have underlying Gilbert's Disease. Patients with Gilbert's Disease are eligible to enroll
7.Males must have Hb . 12.0 g/dL; females must have Hb . 11.0 g/dL
8.Patients must be considered transfusion independent as defined by: no greater than 3 units of RBCs transfused in the 12-month period up to the first day of study dosing and no transfusions within 4 months of first day of study dosing. Patients who have received more transfusion support than described above will evaluated for eligibility on a case-by-case basis
9. Eligible patients may still have their spleens in place, or may have undergone prior splenectomy
Splenectomized patients:
a.Must have undergone their procedure at least 6 months prior to Screening
b.Must be current in their vaccinations for Pneumococcal Conjugate (PCV13), Pneumococcal Polysaccharide (PPSV23), Quadrivalent Meningococcal vaccine, and Haemophilus influenzae type b (Hib) Any missing vaccinations may be administered starting with the Screening Period and during the trial following the initiation of AG-348 dosing as necessary according to recommended vaccination guidance.
10. ECOG Performance Status = 2
11.Patients must be taking at least 1 mg of folic acid daily for at least 21 days prior to first dose and continued daily during study participation
12.Adequate organ function, defined as:
a.Serum AST and ALT = 2.5 × upper limit of normal (ULN) (unless the increased AST is assessed by the Investigator as due to hemolysis)
b.Normal or elevated levels of serum bilirubin. In patients with serum bilirubin > ULN, the elevation must be attributed to hemolysis with or without Gilbert's syndrome and must not be choledocholithiasis, cholecystitis, biliary obstruction, or hepatocellular disease
c.Serum creatinine = 1.25 × ULN. If serum creatinine > 1.25 × ULN, then 24 hour measured or calculated (Cockcroft-Gault) glomerular filtration rate (GFR) = 60 mL/min
d.Absolute neutrophil count (ANC) > 1.0 × 109/L
e.Platelet count = 100 × 109/L
f.Activated partial thromboplastin time (aPTT) and international normalized ratio (INR) = 1.25 × ULN, unless the patient is receiving therapeutic anticoagulants
13.WOC
Exclusion criteria:
Core Period:
1.Hemoglobin level > 12.0 g/dL if male; Hb > 11.0 g/dL if female.
2.Additional diagnosis of any other congenital or acquired blood
disorder, including glucose-6-phosphate-dehydrogenase (G6PD)
deficiency, or any other hemolytic anemia process except for mild
alloimmunization
as a consequence of transfusion therapy.
3.Iron overload (hemosiderosis or concurrent hemochromatosis)
sufficiently severe to result in a clinical diagnosis by the Investigator of
cardiac, hepatic, or pancreatic insufficiency.
4.Prior bone marrow or stem cell transplant.
5.Clinically symptomatic cholelithiasis or cholecystitis. (Prior
cholecystectomy is not exclusionary. Patients with symptomatic
cholelithiasis or cholecystitis may be rescreened once the disorder has
been treated and clinical symptoms have resolved.)
6.Currently enrolled in another therapeutic clinical trial involving
ongoing
therapy with any investigational or marketed product or placebo.
Concurrent participation in the Pyruvate Kinase Deficiency Natural
History Study (NCT02053480) is permitted.
7.Exposure to any investigational drug, device, or procedure within 28
days prior to Screening or trial participation.
8.Concurrent medical condition that could compromise participation in
the study such as:
a.Poorly controlled hypertension (defined as systolic blood pressure (BP)
> 150 mm Hg or diastolic BP > 90 mm Hg) refractory to medical
management.
b.History of recent (within < 6 months from Screening date) congestive
heart failure; myocardial infarction or unstable angina pectoris; or
hemorrhagic, embolic, or thrombotic stroke; deep venous thrombosis; or pulmonary or arterial embolism.
c.Currently active infection requiring the use of parenteral anti-microbial
agents or that is . Grade 3 (CTCAEv4.03) within 6 months of first dose.
d.A pattern or frequency of post-splenectomy sepsis that in the
assessment of the Investigator could reasonably be expected to interfere
with the ability of the patient to complete the 24 week Core Period study
participation.
e.Positive test for hepatitis B surface antigen (HBsAg) or hepatitis C
virus (HCV) antibody with signs of active Hepatitis B or C virus infection.
f.Positive test for human immunodeficiency virus (HIV) 1 or 2 antibody.
g.Diabetes mellitus judged to be in poor control by the Investigator or
requiring > 3 anti-diabetic agents counting insulin; use of insulin per se
is not exclusionary.
h.History of any primary malignancy with the exception of: curatively
treated non-melanomatous skin cancer; curatively treated cervical or
breast carcinoma in situ; or other primary tumor treated with curative
intent and no known active disease present and no treatment
administered during the last 3 years.
9.Undergone major surgery within 6 months of first dose.
10.Current or recent history of psychiatric disorder that in the opinion of
the Investigator or Medical Monitor could compromise the ability of the
patient to cooperate with study visits and procedures.
11.Use of any of the restricted list of products known to strongly inhibit
CYP3A4 metabolism (Appendix 15.3, Table 7) within 5 days prior to Day
1 dosing; or to strongly induce CYP3A4 metabolism (Appendix 15.3,
Table 8) within 28 days prior to Day 1 dosing; or to strongly inhibit P-gp
transporter (Appendix 15.3, Table 9) within 5 days prior to Day 1 dosing;
or digoxin within 5 days prior to Day 1 dosing.
12.Serum bilirubin > ULN attributable to factors other than hemolysis
and/or Gilbert's syndrome.
13.M

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

Health Condition(s) or Problem(s) studied

Pyruvate Kinase Deficiency
MedDRA version: 21.1 Level: PT Classification code 10037682 Term: Pyruvate kinase deficiency anaemia System Organ Class: 10010331 - Congenital, familial and genetic disorders

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

Intervention(s)

Product Name: AG-348 sulfate hydrate
Product Code: AG-348
Pharmaceutical Form: Capsule
INN or Proposed INN: Mitapivat
CAS Number: 2151847-10-6
Current Sponsor code: AG-348 sulfate hydrate
Other descriptive name: AGI-1480, AGX-0841, AG-348, AG-348 hemisulfate
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 5-
INN or Proposed INN: Mitapivat
CAS Number: 2151847-10-6
Current Sponsor code: AG-348 sulfate hydrate
Other descriptive name: AGI-1480, AGX-0841, AG-348, AG-348 hemisulfate
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 25-
INN or Proposed INN: Mitapivat
CAS Number: 2151847-10-6
Current Sponsor code: AG-348 sulfate hydrate
Other descriptive name: AGI-1480, AGX-0841, AG-348, AG-348 hemisulfate
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 100-

Product Name: AG-348 sulfate hydrate
Product Code: AG-348
Pharmaceutical Form: Tablet
INN or Proposed INN: Mitapivat
CAS Number: 2151847-10-6
Current Sponsor code: AG-348 sulfate hydrate
Other descriptive name: AGI-1480, AGX-0841, AG-348, AG-348 hemisulfate
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 5-
INN or Proposed INN: Mitapivat
CAS Number: 2151847-10-6
Current Sponsor code: AG-348 sulfate hydrate
Other descriptive name: AGI-1480, AGX-0841, AG-348, AG-348 hemisulfate
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 20-
INN or Proposed INN: Mitapivat
CAS Number: 2151847-10-6
Current Sponsor code: AG-348 sulfate hydrate
Other descriptive name: AGI-1480, AGX-0841, AG-348, AG-348 hemisulfate
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 50-

Primary Outcome(s)

Primary end point(s): The primary outcome measure for the study is the description of safety and tolerability: AEs, including SAEs, AESIs and AEs leading to discontinuation; safety laboratory parameters (hematology, chemistry, urinalysis, coagulation); physical examination findings; vital signs (VS); 12 lead electrocardiograms (ECGs); and DXA scans. Adverse events will be graded using Common Toxicity Criteria for Adverse Events (CTCAE), Version 4.03. Serum sex hormone levels (testosterone [total and free], , estrone, and estradiol), bone turnover markers (serum osteocalcin-N-mid and serum C-terminal telopeptide [CTX]), 25-hydroxy vitamin D2 and D3 total cholesterol, high-density lipoprotein-cholestero (HDL-C), and triglycerides. Menstruating female patients will also keep a paper-based menstrual cycle diary throughout the core and extension periods.

Secondary Objective: Core:
•Evaluate PK of AG-348 and metabolite AGI-8702.
•Evaluate PD response of ATP and 2,3 DPG after admin. of AG-348.
•Evaluate indicators of clinical activity of AG-348 in patients with PK deficiency, inc. changes in hemoglobin (Hb), HCT, reticulocyte count, haptoglobin (Hp), carboxyhemoglobin (COHb), end tidal carbon monoxide (ETCO), lactate dehydrogenase (LDH), total/indirect bilirubin, erythropoietin (EPO),hepcidin, ferritin, transferrin saturation (serum iron/iron binding capacity).

Extension:
•Evaluate indicators of clinical activity of AG-348 in patients with PK deficiency including changes in Hb, HCT, reticulocyte count, Hp, COHb, LDH, total/indirect bilirubin, EPO, hepcidin, ferritin, transferrin saturation (serum iron/iron binding capacity).
•Evaluate optimal maintenance dose of AG-348 for each individual subject during the extension period

Main Objective: Core Period:
•Evaluate the safety and tolerability of up to 24 weeks of AG 348 administration in patients with PK deficiency.

Extension Period

• Evaluate the long term safety and tolerability of up to 30 months of AG-348 administration in patients with PK
deficiency.

Timepoint(s) of evaluation of this end point: The DRT (Data Review Team) will monitor safety on an on-going basis and meet at regular intervals (approximately every 6 weeks), or ad hoc as necessary, for as long as any patients are still in the Core Period, to review AEs, VS, clinical laboratory assessments (hematology, clinical chemistry, coagulation, and urinalysis), and ECGs . The DRT will also review available PK/PD data and indicators of clinical activity (e.g., changes from baseline in Hb). These DRT meetings will also include data review for all patients that may be under treatment in the Extension Period.

Secondary Outcome(s)

Secondary end point(s): The PK and PD profile of AG-348 will be evaluated by:
• Approximately the first 10 patients treated, contingent on clinical site feasibility, will undergo extensive PK sampling as detailed in Appendix 15.1, Table 5. The remainder of treated patients will undergo limited PK sampling as detailed in Appendix 15.1, Table 6. Serial blood sampling for determination of concentration-time profiles of AG-348 and its metabolite AGI-8702 will be conducted following the first dose and the morning Day 15 dose, and additional trough levels of AG-348 and AGI-8702 will be obtained.

• Pharmacodynamic assessments will include 2,3-DPG, ATP (secondary objectives), and PKR activity assay, PKR protein, and glycolytic flux assay (exploratory objectives). The PKR Flux assay and PKR activity assay will only be conducted in clinical sites able to perform these assessments. Approximately the first 10 patients treated will undergo extensive PD sampling as detailed in Appendix 15.1, Table 5.

Clinical Activity will be evaluated by
• Monitoring of potential indicators of clinical activity will include evaluating changes in Hb, HCT, reticulocyte count, Hp, COHb, LDH, total and indirect bilirubin, EPO, ferritin, and transferrin saturation.

Timepoint(s) of evaluation of this end point: The DRT will also review (approximately every 6 weeks) available PK/PD data and indicators of clinical activity. PK and PD Observations: including changes in 2,3 DPG and ATP; Indicators of Clinical Activity: including changes in Hb, HCT, reticulocyte count, Hp, COHb, LDH, EPO, total and indirect bilirubin, ferritin, and transferrin saturation.

Secondary ID(s)

AG-348-C-003

Source(s) of Monetary Support

Agios Pharmaceuticals Inc.

Ethics review

Status: Approved
Approval date: 02/06/2015
Contact: