During the Efficacy Study (Part B), the investigators will study whether Pazopanib, taken daily for 24 weeks, will reduce the severity of nose bleeds in patients with hereditary hemorrhagic telangiectasia (HHT). Patients will either be provided active drug or a placebo \[sugar - inactive pill\], and be tested for nose bleed severity throughout the trial, including particularly nose bleed duration. Investigators will also test for blood loss, as well as for safety. This study is funded by the US Department of Defense USAMRAA and FDA/OOPD.
Now that a single dose pharmacokinetics (PK) study (Part A) has been completed to properly establish similar exposure with the prior pilot 50mg tablet, a double blind, placebo controlled study will follow (Part B), which proposes to define primarily the value of low dose (150 mg) Pazopanib on nose bleed duration, in the context of assessing perceived nose bleed severity. After a patient completes Part B of the study, the patient will be invited to take part in an Extension Study (Part C) in which the patient will be provided with active drug equal to the dose they were assigned in Part B. All patients in Part C will receive active drug for 24 weeks. Part C will further assess the effects of Pazopanib on the severity of nose bleeds in patients with HHT and also support safety and efficacy elements. After the patient completes their treatment period (either Part B or Parts B and C), a 12 week follow-up period will follow to support safety and efficacy elements. Secondary endpoints will be assessed, including ongoing blood loss, use of iron and blood products, quality of life, and drug safety.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
70
gel capsule, with 25mg-similar fills
identical gel capsule without active pharmaceutical ingredient
University of California - Los Angeles
Los Angeles, California, United States
University of Colorado
Denver, Colorado, United States
Augusta University
Augusta, Georgia, United States
John Hopkins University
Baltimore, Maryland, United States
Massachusetts General Hospital
Boston, Massachusetts, United States
Mayo Clinic
Rochester, Minnesota, United States
Washington University
St Louis, Missouri, United States
University of North Carolina
Chapel Hill, North Carolina, United States
Cleveland Clinic
Cleveland, Ohio, United States
University of Texas - Southwestern
Dallas, Texas, United States
...and 1 more locations
Change in epistaxis duration in minutes
\>=50% decrease in the duration of epistaxis in the 150 mg pazopanib arm versus the placebo arm (moderate and severe cohorts combined)
Time frame: Average duration in weeks 19-24 (last 6 weeks of blinded phase) versus baseline.
Hemoglobin Response rate increase in hemoglobin
Increase in hemoglobin by ≥ 2 g/dl in the 150 mg pazopanib arm versus the placebo arm (moderate and severe cohorts combined)
Time frame: Average duration in weeks 19-24 (last 6 weeks of blinded phase) versus baseline.
Achievement of meaningful improvement in epistaxis for HHT patients
Compare patients reported being bothered by epistaxis at baseline and report not bothered at week 24
Time frame: Baseline [screening, run-in and 0 time points] and week 24.
Percent change in blood transfusion rate in the Severe Cohort
Reduction in RBC transfusion rate by at least one unit
Time frame: Baseline, and weeks 13-24
Assess the safety of up to 24 and 48 weeks of treatment of pazopanib
* AEs; absolute values and changes over time of hematology, clinical chemistry, urinalysis, blood pressure, and heart rate. * Physical exam, leg and abdominal evaluations, and CNS symptoms. * ECG parameters (PR, QRS, QT, QTc intervals) in addition to cardiac echocardiogram to evaluate LV function from pre-dose values in at-risk patients (baseline EF \<50)
Time frame: 1st dose of intervention until Weeks 24 and 48
Assess pharmacokinetics and pharmacodynamics (PK/PD) of treatment
* Cτ, data permitting * Graphical exploration of PK/PD relationships between pazopanib and selected PD endpoints
Time frame: Weeks 12, 24, 36 and 48
Establish comparability of endpoint outcomes for each hemoglobin stratification
Trends for primary endpoint in severe (hemoglobin (\<9.5 g/dl) and moderate (9.5-10.9 g/dl) groups.
Time frame: Baseline, Weeks 19-24, Week 48
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