Safety & Efficacy of BPL's High Purity FACTOR X in Treatment of Factor X Deficient Subjects Undergoing Surgery (Ten03)
To primary efficacy variable is to assess the presence or absence of excessive blood loss during and after surgery.
The secondary efficacy endpoints are as follows:
- A subjective overall assessment by the investigator of FACTOR X in the control of bleeding during surgery.
- The incidence of bleeding episodes during treatment with FACTOR X while the subject is at risk of post-operative bleeding, including location and duration.
- Incremental recovery of FX:C and FX:Ag after the pre-surgery bolus infusion.
- Assessment of FX:C and FX:Ag levels on each day post-surgery.
- Assessment of the cumulative weight-adjusted doses of FACTOR X as measured by FX:C (IU/kg body weight) administered to each subject to maintain haemostasis.
- Assessment of the cumulative doses of FACTOR X as measured by FX:C (IU) administered to each subject to maintain haemostasis.
- Amount of weight-adjusted FACTOR X as measured by FX:C (IU/kg body weight) administered daily (day of surgery and each post-operative day) to maintain haemostasis.
|Study Design:||Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Phase III Open, Multicentre Study to Investigate the Safety and Efficacy of BPL's High Purity FACTOR X in the Treatment of Factor X Deficient Subjects Undergoing Surgery|
- Clinical Estimation of Volume of Blood Loss During Surgery [ Time Frame: Blood loss is measured during and after surgery, the overall assessment is made after the last dose of FACTOR X. ] [ Designated as safety issue: Yes ]
As soon as possible after wound closure, the investigator estimated the volume of blood loss during surgery and made a clinical assessment against the volume of blood loss typically expected in a normal patient (i.e. one without a bleeding disorder and undergoing the same surgical procedure). The assessment may have been supported by a swab and pad count.
The clinical assessment was rated as follows:
- Blood loss less than expected
- Blood loss as expected
- Blood loss more than expected
- Blood loss excessive (defined as more than twice the pre defined amount that would be expected in a normal patient for this type of surgery)
- Clinical Assessment of Blood Loss During Surgery Against the Volume of Blood Loss Expected in Patients Without a Bleeding Disorder. [ Time Frame: After wound closure ] [ Designated as safety issue: Yes ]The investigator's estimation of the volume of blood loss during surgery compared to the volume of blood loss expected in patients without a bleeding disorder undergoing the same surgical procedure and reported as greater than, equal to or less than.
- Requirement for Blood Transfusion [ Time Frame: during and after surgery ] [ Designated as safety issue: Yes ]Number of blood transfusions required (units of packed red blood cells or units of whole blood) or infusion of autologous red cells during and after surgery
- Number of Post Operative Bleeding Episodes (See Table Below) [ Time Frame: End of surgery till end of study ] [ Designated as safety issue: Yes ]Bleeding was assessed at least once each day by the investigator, more frequently if indicated by the severity of the operation or the subject's response. This included all bleeding episodes from the end of the surgical procedure until the subject was no longer at risk of bleeding due to surgery
- Change of Haemoglobin From Pre-surgery Till End of Treatment [ Time Frame: 2 hrs pre-operatively till end of treatment ] [ Designated as safety issue: Yes ]The subject's haemoglobin was measured pre operatively, within 2 hours post operatively and at the End of Treatment Assessment. Changes in the subject's haemoglobin from pre to post operatively and from post operatively to the End of Treatment Assessment were assessed, taking into account the volume of fluid infused into the subject during the intervening periods, any blood transfusions in the intervening periods, the subject's haematocrit at the same time points and the subject's pre dose serum ferritin
- Number of Participants With Degree of Bleeding Control Rated as Excellent. [ Time Frame: During and till end of treatment ] [ Designated as safety issue: No ]
Investigators made an overall assessment of FACTOR X in controlling bleeding at the End of Treatment Assessment. The degree of bleeding control was rated as excellent, good, poor or unassessable, in accordance with the following criteria listed below:
- Excellent -Parameters were similar to those in subjects without a bleeding disorder.
- Good -Parameters were inferior to those in subjects without a bleeding disorder, but no other factor X containing agents were required to restore haemostasis.
- Poor - Blood loss was excessive (defined as more than twice the pre defined amount that would be expected in a subject without a bleeding disorder for this type of surgery) and/or Haemostasis was not achieved and/or Additional factor X containing agents were required to restore haemostasis.
- Unassessable -Efficacy was not possible to assess, or Additional factor X containing agents (excluding blood transfusions) were required before efficacy of FACTOR X could be assessed.
- Incremental Recovery After Bolus Dose of FACTOR X [ Time Frame: incremental recovery was assessed at approximately 30 minutes after the pre surgery bolus ] [ Designated as safety issue: Yes ]
Incremental Recovery of FX:C after the Pre surgery Bolus Infusion The factor X increment is calculated by subtracting the pre-infusion factor X level from the post-dose value.
Incremental recovery is calculated by FX increment (IU/dL)/ FX dose (IU/kg)
- Dose Per Infusion (IU/kg) [ Time Frame: before surgery, during the post operative period ] [ Designated as safety issue: No ]weight adjusted dose per infusion until a subject was no longer at risk of bleeding due to surgery
|Study Start Date:||March 2011|
|Study Completion Date:||January 2014|
|Primary Completion Date:||January 2014 (Final data collection date for primary outcome measure)|
Experimental: FACTOR X
Human Coagulation Factor X
Biological: FACTOR X
Presurgery loading dose- The FX level of 70%-90% should be achieved.This will be calculated based on the patients weight on day of surgery and the required rise. Initial dose should not exceed 60IU/kg.
Post surgery- FX trough levels of 50% should be achieved.
Intravenous infusion of factor X is given at a suggested rate of 10mL/min but not exceeding more than 20mL/min.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01086852
|United States, Texas|
|University Of Texas Health Science Center, Gulf States Hemophilia and Thrombophilia Center 6655 Travis St|
|Houston, Texas, United States, 77030|
|Unidad Coagulopatías, Congenitas, Edificio Dotacional, 1ra Planta Hospital Universito La Paz|
|Madrid, Spain, 28046|
|Ege University School of Medicine, Departmant of Pediatric Hematology|
|Bornova, Izmir, Turkey, 35100|
|Istanbul University Cerrahpasa Medicine Faculty Department of Pediatric Hematology|
|Istanbul, Turkey, 34098|
|Department of Hematology, Royal Cornwall Hospital,|
|Truro, Cornwall, United Kingdom, TR1 3LJ|
|The Katherine Dormandy Haemophilia Centre and Thrombosis Unit, The Royal Free Hospital,Pond Street|
|Hampstead, London, United Kingdom, NW3 2QG|
|London, United Kingdom, W12 0NN|
|Principal Investigator:||Tim Aldwinckle||Bio Products Laboratory|