The purpose of this multicentre, randomized, double blinded, single dose, two-way cross-over study, is to compare the pharmacokinetics (PK) of biosimilar eptacog alfa (activated) with Novoseven in 24 patients, adult and children (\>12 years), not bleeding, with inherited coagulation factor VII (FVII) deficiency (FVII \<1%). Patients will be randomized to receive either a single dose of eptacog alfa biosimilar 30 μg/kg and one single dose of NovoSeven 30 μg/kg, or vice versa, with doses separated by a washout period. All patients will be followed 12 months and will receive biosimilar eptacog alfa, on demand, for every bleeding episode that should occur - or - for prophylaxis, with the aim of monitoring of inhibiting antibody formation, lack of efficacy and collection of safety data.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
24
Either a single dose of eptacog alfa biosimilar 30 μg/kg and one single dose of NovoSeven 30 μg/kg, or vice versa, with doses separated by a washout period. Then, in an open follow up phase of 12 months, for every bleeding episode eptacog alfa biosimilar 30 μg/kg, on demand, for one of more days until resolution of bleeding, based on the Investigator's decision - or - prophylaxis with eptacog alfa biosimilar, with dose, frequency, and duration of treatment based on the Investigator's decision. The modality of treatment (on demand or prophylaxis) will be decided by the Investigator.
Either a single dose of eptacog alfa biosimilar 30 μg/kg and one single dose of NovoSeven 30 μg/kg, or vice versa, with doses separated by a washout period.
Hemophilia Center - Hematology & Oncology Dept. Shiraz University of Medical Science
Shiraz, Iran
Comprehensive Hemophilia Care Center
Tehran, Iran
Area under the plasma activity-time curve from time 0 to last quantifiable activity (AUClast)
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\],
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
Maximum plasma concentration of the factor VII activity (Cmax).
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\],
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
Area under the plasma concentration-time curve from time 0 to infinity (AUCinf)
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\]
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
Time of Cmax (tmax)
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\]
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
Fraction of the total AUCinf that was derived by extrapolation beyond tlast (AUCextra)
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\]
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
First order rate constant associated with the terminal (log-linear) portion of the curve (λz)
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\]
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
Elimination half-life (t½)
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\]
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
Mean residence time (MRT)
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\]
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
Clearance (CL)
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\]
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
Volume of distribution (Vss)
Measurement of plasma level of factor VII clotting activity (FVII:C) \[one-stage clotting method using recombinant tissue factor preparation (STA-Deficient and STA-Neoplastin R; Diagnostica Stago, France)\]
Time frame: Ten min before injection and 10 min, 20 min, 1h, 3h, 6h, 8h, 12h, 24h and 30h after injection, for both drug administered in the PK phase
Clinical response in controlling acute bleeding.
Rated by the treating physician using a 4 point scale (Excellent, Good, Moderate, None).
Time frame: 2, 6 and 12 hours post infusion (last dose of Eptacog alfa Biosimilar)
Immunogenicity
The modified Nijmegen method of the Bethesda assay
Time frame: On plasma samples obtained at screening visit, before the second dose/second drug administration, and then every 3 months for a year.
Adverse Events
Time frame: Adverse events (AEs) will be monitored throughout the trial, from the first dose administered up to 12 months follow-up.
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