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Safety and Efficacy Study of Romiplostim to Treat Immune Thrombocytopenia (ITP) in Pediatric Patients

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ClinicalTrials.gov Identifier: NCT01444417
Recruitment Status : Completed
First Posted : September 30, 2011
Results First Posted : January 19, 2017
Last Update Posted : February 9, 2017
Information provided by (Responsible Party):

Brief Summary:
The purpose of this study is to evaluate the efficacy of romiplostim in the treatment of thrombocytopenia in pediatric patients with Immune thrombocytopenia purpura (ITP) as measured by durable platelet response.

Condition or disease Intervention/treatment Phase
Idiopathic Thrombocytopenic Purpura Thrombocytopenia Thrombocytopenia in Pediatric Subjects With Immune (Idiopathic) Thrombocytopenic Purpura (ITP) Thrombocytopenia in Subjects With Immune (Idiopathic) Thrombocytopenic Purpura (ITP) Thrombocytopenic Purpura Immune Thrombocytopenia Drug: Romiplostim Drug: Placebo Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 62 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase 3 Randomized, Double Blind, Placebo Controlled Study to Determine the Safety and Efficacy of Romiplostim in Thrombocytopenic Pediatric Subjects With Immune Thrombocytopenia (ITP)
Study Start Date : January 2012
Actual Primary Completion Date : February 2015
Actual Study Completion Date : February 2015

Arm Intervention/treatment
Experimental: Romiplostim
Participants received once weekly subcutaneous romiplostim for 24 weeks at a starting dose of 1 µg/kg; weekly dose increases continued in increments of 1 µg/kg/week to a maximum dose of 10 µg/kg in an attempt to reach a target platelet count of ≥ 50 x 10^9/L.
Drug: Romiplostim
The starting dose of romiplostim is 1 µg/kg administered weekly by subcutaneous injection. Participants will return to the clinic weekly to provide platelet counts and undergo dose titrations under the supervision of the treating physician. Weekly dose increases will continue in increments of 1 µg/kg up to a maximum dose of 10 µg/kg in an attempt to reach a target platelet count of ≥ 50 x 10^9/L. Dose adjustment will be allowed during the treatment period to maintain a platelet count between ≥ 50 x 10^9/L and ≤ 200 x 10^9/L.
Other Names:
  • AMG 531
  • Nplate®

Placebo Comparator: Placebo
Participants received weekly subcutaneous placebo for 24 weeks.
Drug: Placebo
Matching placebo administered by subcutaneous injection

Primary Outcome Measures :
  1. Percentage of Participants With a Durable Platelet Response [ Time Frame: Week 18 to week 25 ]
    A participant with durable platelet response was defined as achieving at least 6 weekly platelet counts of ≥ 50 x 10^9/L during the last 8 weeks of treatment (platelet counts obtained from week 18 to week 25). If a platelet count from a participant was not available (missing) in a certain week, that week was imputed as non-response for that participant. Platelet counts were not deemed as a positive response for 4 weeks after the administration of rescue medication.

Secondary Outcome Measures :
  1. Percentage of Participants With an Overall Platelet Response [ Time Frame: Week 2 to week 25 ]

    Overall platelet response is defined as either a durable platelet response or transient platelet response.

    Durable platelet response was defined as weekly platelet count ≥ 50 x 10^9/L for 6 or more times during week 18 to week 25 measurements. Participants may not have had a weekly response within 4 weeks after receiving any rescue medication.

    Transient platelet response was defined as weekly platelet count ≥ 50 x 10^9/L for 4 or more times during week 2 to week 25 measurements but without durable platelet response. Participants may not have had a weekly response within 4 weeks after receiving any rescue medications.

  2. Number of Weeks With Platelet Response [ Time Frame: Week 2 to week 25 ]
    Number of weeks with platelet counts ≥ 50 x 10^9/L during week 2 to week 25 measurements. Participants may not have had a weekly response within 4 weeks after receiving any rescue medications.

  3. Percentage of Participants Who Received Rescue Medication During the Treatment Period [ Time Frame: 24 weeks ]
    Rescue medication is any medication (other than excluded medications) that is intended to increase platelet counts or prevent bleeding.

  4. Total Number of Composite Bleeding Episodes [ Time Frame: Week 2 to week 25 ]
    A composite bleeding episode was defined as clinically significant bleeding events or the use of a rescue medication to prevent a clinical significant bleeding event during weeks 2 through 25 of the treatment period. A clinically significant bleeding event was defined as a Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 grade ≥ 2 bleeding event.

  5. Number of Participants With Adverse Events [ Time Frame: From the first dose of study drug until 4 weeks after last dose; 28 weeks. ]

    A serious adverse event is defined as an adverse event that meets at least 1 of the following serious criteria:

    • fatal,
    • life threatening (places the subject at immediate risk of death),
    • requires in-patient hospitalization or prolongation of existing hospitalization,
    • results in persistent or significant disability/incapacity,
    • congenital anomaly/birth defect, and/or
    • other significant medical hazard. Adverse events were graded for severity according to the CTCAE version 3.0 grading scale, where Grade 3 = moderate, Grade 4 = life-threatening and Grade 5 = fatal.

    Treatment-related adverse events (TRAEs) were those assessed by the investigator as possibly related to study drug. This relationship was determined by a "yes" or "no" response to the question: "Is there a reasonable possibility that the event may have been caused by study drug?"

Information from the National Library of Medicine

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Ages Eligible for Study:   1 Year to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Diagnosis of primary ITP according to the American Society of Hematology (ASH) guidelines at least 6 months prior to screening, regardless of splenectomy status
  • Subject must be refractory to a prior ITP therapy, having relapsed after at least 1 prior ITP therapy, or ineligible for other ITP therapies; prior therapy includes first-line therapies
  • Age ≥ 1 year and < 18 years at the time of providing informed consent
  • The mean of 2 platelet counts taken during the screening period must be ≤ 30 x 10^9/L with neither count > 35 x 10^9/L
  • A serum creatinine concentration ≤ 1.5 times the laboratory normal range (for each age category) during the screening period
  • Adequate liver function; serum bilirubin ≤ 1.5 times the laboratory normal range during the screening period; aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3.0 times the laboratory normal range during the screening period
  • Hemoglobin > 10.0 g/dL during the screening period
  • Subject and/or subject's legally acceptable representative has provided informed consent prior to any study-specific procedure; subject has provided assent, where required

Exclusion Criteria:

  • Known history of a bone marrow stem cell disorder; any abnormal bone marrow findings other than those typical of ITP must be approved by Amgen before a subject may be enrolled in the study
  • Known active or prior malignancy except adequately treated basal cell carcinoma
  • Known history of congenital thrombocytopenia
  • Known history of hepatitis B, hepatitis C, or human immunodeficiency virus (HIV)
  • Known history of H. pylori by urea breath test or stool antigen test within 6 months of enrollment or successfully treated with no evidence of infection
  • Known history of systemic lupus erythematosus, evans syndrome, or autoimmune neutropenia
  • Known history of antiphospholipid antibody syndrome or positive for lupus anticoagulant
  • Known history of disseminated intravascular coagulation, hemolytic uremic syndrome, or thrombotic thrombocytopenic purpura
  • Previous history of venous thromboembolism or thrombotic events
  • Previous use of romiplostim, pegylated recombinant human megakaryocyte growth and development factor (PEG-rHuMGDF), Eltrombopag, recombinant human thrombopoietin (rHuTPO) or any platelet producing agent
  • Rituximab (for any indication) or 6-mercaptopurine (6-MP) within 14 weeks before the screening visit, or anticipated use during the time of the proposed study
  • Splenectomy within 4 weeks of the screening visit
  • All hematopoietic growth factors including interleukin-11 (IL-11) (oprelvekin) within 4 weeks before the screening visit
  • Alkylating agents within 8 weeks before the screening visit or anticipated use during the time of the proposed study
  • Vaccinations known to decrease platelet counts within 8 weeks before the screening visit
  • Known hypersensitivity to any recombinant E coli-derived product (eg, Infergen, Neupogen, Somatropin, and Actimmune)
  • Other criteria may apply

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01444417

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United States, California
Research Site
Orange, California, United States, 92868
Research Site
San Diego, California, United States, 92123
United States, District of Columbia
Research Site
Washington, District of Columbia, United States, 20010
United States, Georgia
Research Site
Atlanta, Georgia, United States, 30322
United States, Illinois
Research Site
Chicago, Illinois, United States, 60611
Research Site
Peoria, Illinois, United States, 61615
United States, Indiana
Research Site
Indianapolis, Indiana, United States, 46260
United States, Iowa
Research Site
Iowa City, Iowa, United States, 52242
United States, Kentucky
Research Site
Louisville, Kentucky, United States, 40202
United States, Louisiana
Research Site
New Orleans, Louisiana, United States, 70118
United States, Michigan
Research Site
Detroit, Michigan, United States, 48201
United States, Missouri
Research Site
Kansas City, Missouri, United States, 64108
United States, Nebraska
Research Site
Omaha, Nebraska, United States, 68114
United States, Nevada
Research Site
Las Vegas, Nevada, United States, 89109
United States, New Jersey
Research Site
New Brunswick, New Jersey, United States, 08901
United States, New York
Research Site
New York, New York, United States, 10016
Research Site
New York, New York, United States, 10021
United States, Ohio
Research Site
Cincinnati, Ohio, United States, 45229
Research Site
Columbus, Ohio, United States, 43205
United States, Pennsylvania
Research Site
Philadelphia, Pennsylvania, United States, 19104
Research Site
Pittsburgh, Pennsylvania, United States, 15224
United States, Tennessee
Research Site
Nashville, Tennessee, United States, 37232
United States, Texas
Research Site
Fort Worth, Texas, United States, 76104
Research Site
Houston, Texas, United States, 77030
United States, Wisconsin
Research Site
La Crosse, Wisconsin, United States, 54601
Australia, New South Wales
Research Site
Randwick, New South Wales, Australia, 2031
Australia, Queensland
Research Site
Herston, Queensland, Australia, 4029
Australia, Victoria
Research Site
Parkville, Victoria, Australia, 3052
Canada, Ontario
Research Site
Hamilton, Ontario, Canada, L8S 4K1
Research Site
Toronto, Ontario, Canada, M5G 1X8
Canada, Quebec
Research Site
Montreal, Quebec, Canada, H3H 1P3
Research Site
Montreal, Quebec, Canada, H3T 1C5
Research Site
Quebec City, Quebec, Canada, G1V 4G2
Sponsors and Collaborators
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Study Director: MD Amgen
Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Amgen
ClinicalTrials.gov Identifier: NCT01444417    
Other Study ID Numbers: 20080279
2010-018426-39 ( EudraCT Number )
First Posted: September 30, 2011    Key Record Dates
Results First Posted: January 19, 2017
Last Update Posted: February 9, 2017
Last Verified: February 2017
Keywords provided by Amgen:
Immune (Idiopathic) Thrombocytopenic Purpura
Pediatric Immune (Idiopathic) Thrombocytopenic Purpura
Immune Thrombocytopenia
Additional relevant MeSH terms:
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Purpura, Thrombocytopenic, Idiopathic
Purpura, Thrombocytopenic
Blood Platelet Disorders
Hematologic Diseases
Blood Coagulation Disorders
Pathologic Processes
Skin Manifestations
Thrombotic Microangiopathies
Hemorrhagic Disorders
Autoimmune Diseases
Immune System Diseases