This was an open label, non-randomized, phase II study of eltrombopag in combination with rabbit ATG/CsA in subjects with moderate or more severe AA who did not received prior ATG/ALG-based immunosuppressive therapy. The objective was to assess additive effects of eltorombopag on overall response rate (ORR) at 6 months (Week 26) of treatment with ATG/CsA. Subjects were assessed at least weekly for safety during the period from the start of ATG/CsA to 4 weeks after the start of administration of eltrombopag. After that, subjects had visits every 2 weeks until Week 26. Subjects in whom the treatment was assessed as effective at Week 26 could continued treatment with eltrombopag after 6 months when clinically indicated at the discretion of the investigator. There were five follow-up visits: at discontinuation of the treatment of eltrombopag, and Weeks 1, 2, 3, 4 and 26 after treatment discontinuation. As this study was the first Japanese phase II study in which this product was administered in combination with ATG/CsA to subjects with naive moderate or more severe AA, the subject number of this study was determined to be 10 based on the feasibility survey.
Study Type
INTERVENTIONAL
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Eltrombopag was provided as white round film-coated tablets containing 12.5 mg or 25 mg of eltrombopag free acid (SB-497115-GR, eltrombopag).
Rabbit ATG, as an intravenous drip infusion, diluted by 500 mL of saline or 5% glucose injection was administered at a dose of 2.5 to 3.75 mg per kg per day as a slow intravenous infusion over 6 hours.
CsA as capsules, oral solution, or fine granule, was administered at a dose of 3 mg per kg twice a day.
Novartis Investigative Site
Aichi, Japan
Novartis Investigative Site
Aichi, Japan
Novartis Investigative Site
Ibaraki, Japan
Novartis Investigative Site
Ishikawa, Japan
Novartis Investigative Site
Miyagi, Japan
Novartis Investigative Site
Okayama, Japan
Novartis Investigative Site
Osaka, Japan
Novartis Investigative Site
Osaka, Japan
Novartis Investigative Site
Osaka, Japan
Novartis Investigative Site
Tochigi, Japan
...and 1 more locations
ORR at 6 Months: Overall Response Rate (ORR) Defined as the Number of Participants Who Met the Criteria of Either Complete Response (CR) or Partial Response (PR) at Week 26
ORR will be calculated after 6 months of eltrombopag administration by measuring platelet, reticulocyte, neutrophil and transfusion independence. ORR includes Complete Response (CR) and Partial Response (PR) Rate.
Time frame: Week 26
ORR at 3 Months
ORR will be calculated after 3 months of eltrombopag administration by measuring platelet, reticulocyte, neutrophil and transfusion independence.
Time frame: Week 14
Complete Response (CR), and Partial Response (PR) Rate at 3 Months
CR and PR will be calculated after 3 months of eltrombopag administration by measuring platelet, reticulocyte, neutrophil and transfusion independence.
Time frame: Week 14
CR Rate Based on the Criteria Used in NIH 12-H-0150 Study at 6 Months
CR criteria used in NIH 12-H-150 study is as follows: Hemoglobin \>10 gram (g)/ deciliter (dL), and Absolute neutrophil count (ANC) \>1,000/microliter, and Platelets \>100,000/microliter.
Time frame: Week 26
Changes in Hematology Parameters (Haemoglobin) in the Absence of Platelet Transfusion
The change in hematology values ( haemoglobin) were evaluated.
Time frame: Week 26 and week 104
Changes in Hematology Parameters in the Absence of Platelet Transfusion
The change in hematology values from baseline for platelets, neutrophils and reticulocytes were evaluated.
Time frame: Week 26 and week 104
Frequency of Platelet and Red Blood Cells (RBC) Transfusions
RBC transfusion dependency defined as at least one RBC transfusion within 8 weeks prior to D1. Platelet or RBC transfusions will be based on physician's subjective judgement. Platelet transfusion will be done if the platelet count is less than 10×10\^9/liter (L) with significant bleeding tendency or the platelet count is less than 20×10\^9/L with pyrexia. RBC transfusion will be done to keep the hemoglobin concentration at over 7 g/dL or in the presence of clinical symptoms such as dyspnea.
Time frame: Baseline, Week 26
Volume of Platelet and RBC Transfusions
Platelet or RBC transfusions will be based on physician's subjective judgement. Platelet transfusion will be done if the platelet count is less than 10×10\^9/L with significant bleeding tendency or the platelet count is less than 20×10\^9/L with pyrexia. RBC transfusion will be done to keep the hemoglobin concentration at over 7 g/dL or in the presence of clinical symptoms such as dyspnea.
Time frame: Baseline, Week 26
The Proportion of Subjects Whose Transfusion Unit (or Volume) Are Decreased or Who Became Transfusion (Platelet, RBC) Independent
The proportions of the subjects for whom the amount of blood transfusion (platelets and RBC) decreased or the proportions of the subjects for whom blood transfusion (platelets and RBC) became unnecessary. Platelet transfusion will be done if the platelet count is less than 10×10\^9/L with significant bleeding tendency or the platelet count is less than 20×10\^9/L with pyrexia. RBC transfusion will be done to keep the hemoglobin concentration at over 7 g/dL or in the presence of clinical symptoms such as dyspnea.
Time frame: Week 26
Duration of Hospitalization
Duration of hospitalization is the time period from the administration of ATG up to discharge.
Time frame: Week 26
Time to Onset of CR and PR
The time to onset of CR and PR will be determined by measuring platelet, reticulocyte, neutrophil and transfusion independence.
Time frame: Week 26
Duration of CR or PR
Duration for CR or PR will be determined by measuring platelet, reticulocyte, neutrophil and transfusion independence.
Time frame: Week 104
Degree of Exposure to Eltrombopag : Average Daily Dose
Time frame: Week 104
Degree of Exposure to Eltrombopag : Cumulative Dose
The cumulative dose of drug administered to the subject will be calculated.
Time frame: Week 104
Degree of Exposure to Eltrombopag : Days on Study
Time frame: Week 104
Number of Participants With Adverse Events
Adverse events will be collected from the start of study treatment until the approval.
Time frame: though study completion , approximately 2 years
Vital Signs (Blood Pressure) as a Measure of Safety and Tolerability
Vital sign measurements : blood pressure
Time frame: baseline and Week 26
12-lead Electrocardiogram (ECG) as Measure of Safety and Tolerability
Triplicate 12-lead ECGs will be obtained at designated time points during the study using an ECG machine that calculates the heart rate and measures PR, QRS, QT, and QT interval corrected by Fridericia formula (QTcF) intervals.
Time frame: Baseline, Week 26
The Trough Concentrations of Eltrombopag Following Repeat Doses of at 75 mg, 50 mg and 25 mg
Blood samples will be collected after repeat (14 days) doses of eltrombopag 75, 50, 25 mg to determine the plasma eltrombopag concentration prior to the next dose.
Time frame: day 15
The Concentration After 4 Hours of Dose of Eltrombopag 75 mg
Blood sample will be collected at 4 hours after repeat (14 days) dose of eltrombopag 75 mg
Time frame: day 15
Composite of Laboratory Parameters Assessment as a Safety Measure (Haemoglobin and Albumin).
The laboratory test values (haemoglobin and albumin) were calculated at each time point of evaluation.
Time frame: Baseline, Week 26
Composite of Laboratory Parameters Assessment as a Safety Measure (Lymphocytes and Neutrophils).
The laboratory test values (lymphocytes and neutrophils) were calculated at each time point of evaluation.
Time frame: Baseline, Week 26
Composite of Laboratory Parameters Assessment as a Safety Measure (Alcaline Phosphatase and Aspartate Amino Transferase) .
The laboratory test values (Alcaline Phosphatase and Aspartate Amino Transferase) were calculated at each time point of evaluation.
Time frame: Baseline, Week 26
Composite of Laboratory Parameters Assessment as a Safety Measure.
The laboratory test values (hematological /biochemical examinations) were calculated at each time point of evaluation.
Time frame: Baseline, Week 26
Vital Signs (Temperature) as a Measure of Safety and Tolerability
Vital sign measurements : temperature
Time frame: baseline and Week 26
Vital Signs (Pulse Rate) as a Measure of Safety and Tolerability
Vital sign measurements : pulse rate.
Time frame: baseline and Week 26
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