A Study of AG-348 in Adult Participants With Pyruvate Kinase (PK) Deficiency

• ClinicalTrials.gov Identifier: NCT02476916
• Recruitment Status: Active, not recruiting
• First Posted: June 22, 2015
• Results First Posted: June 11, 2020
• Last Update Posted: June 13, 2022
• Sponsor: Agios Pharmaceuticals, Inc.
• Information provided by (Responsible Party): Agios Pharmaceuticals, Inc.

Study Description

Brief Summary:

Study AG348-C-003 is a multicenter study designed to evaluate the safety and efficacy of different dose levels of AG-348 (mitapivat) in participants with PK deficiency.

Condition or disease	Intervention/treatment	Phase
Pyruvate Kinase Deficiency	Drug: AG-348	Phase 2

Detailed Description:

This is a Phase 2, open label, two arm, multicenter, randomized, dose-ranging study during which adult participants with PK deficiency will receive multiple doses of AG-348 for up to 24 weeks (Core Period); eligible participants may enter an Extension Period to receive AG-348 for up to 8 additional years. Data will be reviewed on a regular basis and study design, dose and schedule will be adapted based on these reviews. The study will evaluate the safety and tolerability of multiple doses of AG-348, pharmacokinetic and pharmacodynamic (PD) profile of AG-348 and early indicators of clinical efficacy.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 52 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 2, Open Label, Randomized, Dose Ranging, Safety, Efficacy, Pharmacokinetic and Pharmacodynamic Study of AG-348 in Adult Patients With Pyruvate Kinase Deficiency
• Actual Study Start Date: June 26, 2015
• Actual Primary Completion Date: May 8, 2017
• Estimated Study Completion Date: May 2025

Arms and Interventions

Arm	Intervention/treatment
Experimental: AG-348 50 mg BID; Participants with PK deficiency received AG-348, 50 milligrams (mg), as initial dose, twice daily (BID) for the Core Period (Week 24).	Drug: AG-348; Participants with PK deficiency were randomized to either receive AG-348, 50 or 300 mg, as initial doses, BID for the Core Period (Week 24). At the Week 24 visit, Core Period participants who had safely tolerated AG-348 and demonstrated clinical activity in response to AG-348 were potentially eligible to immediately roll over to the Extension Period for continued treatment. Participants were assigned to initial doses, however, over the course of the core period were treated across a range of doses due to treatment emergent adverse events (AEs) and hemoglobin (Hb) levels exceeding mid-point of sex-adjusted ranges.; Other Name: Mitapivat
Experimental: AG-348 300 mg BID; Participants with PK deficiency received AG-348, 300 mg, as initial dose, BID for the Core Period (Week 24).	Drug: AG-348; Participants with PK deficiency were randomized to either receive AG-348, 50 or 300 mg, as initial doses, BID for the Core Period (Week 24). At the Week 24 visit, Core Period participants who had safely tolerated AG-348 and demonstrated clinical activity in response to AG-348 were potentially eligible to immediately roll over to the Extension Period for continued treatment. Participants were assigned to initial doses, however, over the course of the core period were treated across a range of doses due to treatment emergent adverse events (AEs) and hemoglobin (Hb) levels exceeding mid-point of sex-adjusted ranges.; Other Name: Mitapivat

Outcome Measures

Primary Outcome Measures :

1. Percentage of Participants Experiencing at Least One Adverse Event (AEs) in the Core Period [ Time Frame: Up to Week 24 ]
   An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not considered study drug-related.

Secondary Outcome Measures :

1. Change From Baseline in Hemoglobin (Hb) Value at Week 24 [ Time Frame: Baseline and Week 24 ]
   Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Increased Hb values indicate improvement.
2. Change From Baseline in Hematocrit at Week 24 [ Time Frame: Baseline and Week 24 ]
   Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Increased hematocrit values indicate improvement.
3. Change From Baseline in Reticulocyte Count at Week 24 [ Time Frame: Baseline and Week 24 ]
   Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Decreased reticulocyte count values indicate improvement.
4. Change From Baseline in Haptoglobin at Week 24 [ Time Frame: Baseline and Week 24 ]
   Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Increased haptoglobin values indicate improvement.
5. Change From Baseline in Carbon Monoxide at Week 24 [ Time Frame: Baseline and Week 24 ]
   Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Decreased carbon monoxide values indicate improvement.
6. Change From Baseline in Lactate Dehydrogenase (LDH) at Week 24 [ Time Frame: Baseline and Week 24 ]
   Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Decreased LDH values indicate improvement.
7. Change From Baseline in Total Bilirubin at Week 24 [ Time Frame: Baseline and Week 24 ]
   Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Decreased total bilirubin values indicate improvement.
8. Change From Baseline in Indirect Bilirubin at Week 24 [ Time Frame: Baseline and Week 24 ]
   Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Decreased indirect bilirubin values indicate improvement.
9. Change From Baseline in Erythropoietin (EPO) at Week 24 [ Time Frame: Baseline and Week 24 ]
   Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Decreased EPO values indicate improvement.
10. Change From Baseline in Hepcidin at Week 24 [ Time Frame: Baseline and Week 24 ]
    Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Decreased hepcidin values indicate improvement.
11. Change From Baseline in Ferritin at Week 24 [ Time Frame: Baseline and Week 24 ]
    Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Decreased ferritin values indicate improvement.
12. Change From Baseline in Transferrin Saturation at Week 24 [ Time Frame: Baseline and Week 24 ]
    Transferrin saturation is the ratio of serum iron to iron-binding capacity. Change (absolute change) from baseline was calculated as post-baseline value - baseline value. Decreased transferrin saturation values indicate improvement.
13. Area Under the Concentration-time Curve From Time Zero to the Last Non-zero Concentration (AUC0-t) for AG-348 and Its Metabolite AGI-8702 [ Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15 ]
    Pre-dose pharmacokinetic concentrations, if any, were excluded from the pharmacokinetic analyses.
14. Maximum Plasma Concentration (Cmax) for AG-348 and Its Metabolite AGI-8702 [ Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15 ]
    Pre-dose pharmacokinetic concentrations, if any, were excluded from the pharmacokinetic analyses.
15. Time to Reach Peak Plasma Concentration (Tmax) for AG-348 and Its Metabolite AGI-8702 [ Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15 ]
    Pre-dose pharmacokinetic concentrations, if any, were excluded from the pharmacokinetic analyses.
16. Apparent Clearance at Steady-State (Clss/F) for AG-348 and Its Metabolite AGI-8702 [ Time Frame: pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15 ]
    Pre-dose pharmacokinetic concentrations, if any, were excluded from the pharmacokinetic analyses.
17. Maximum Change From Baseline Response Value Over 12 Hours Post-dose (BRmax) for Adenosine Triphosphate (ATP) [ Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15 ]
    Pre-dose concentration observed on Day 1 was used as Baseline for calculation of change from baseline.
18. Maximum Change From Baseline Response Value Over 12 Hours Post-dose (BRmax) for 2,3 - Diphosphoglycerate (2,3-DPG) [ Time Frame: pre-dose, 0.5, 1, 2, 4, 8, 12 hours post-dose Day 1 and pre-dose, 0.5, 1, 2, 4, 8 hours post-dose Day 15 ]
    Pre-dose concentration observed on Day 1 was used as Baseline for calculation of change from baseline.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Informed consent
2. Male or female, aged 18 years and older
3. Known medical history of PK deficiency
4. PK deficiency confirmed by enzymatic assay at Screening
5. Genotypic characterization of PKR gene at Screening
6. Genotypic characterization of uridine-5'-diphosphate-glucuronyltransferase-A1 (UGTA1) gene to document underlying Gilbert's disease (Gilbert's disease patients are eligible)
7. Males Hb ≤ 12.0 g/dL, females Hb ≤ 11 g/dL
8. Transfusion independent, defined as no more than 3 units of red blood cells (RBC) transfused in 12 months prior to the first day of study dosing and no transfusions within 4 months of first day of study dosing
9. Splenectomized patients must have had the procedure at least 6 months prior to Screening and must be up-to-date in recommended vaccinations
10. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
11. Must be taking at least 1 mg folic acid daily in the 21 days prior to screening
12. Adequate organ function defined by liver function, kidney function, platelet count and coagulation assessments
13. Agreement to use approved contraceptive measures

14. Women must not be breastfeeding

    For entry into the Extension Period, patients must meet criteria # 15-16:

15. Must have completed 24 weeks of treatment during the Core Period and tolerated AG-348
16. The treating Investigator agrees that there is a potential for clinical benefit to continued treatment and recommends participation in the Extension Period and the Medical Monitor approves

Exclusion criteria

1. Hb ˃ 12.0 g/dL if male, Hb ˃11.0 g/dL if female
2. Additional diagnosis of other congenital or acquired blood disorder
3. Iron overload sufficiently severe to result in cardiac, hepatic or pancreatic insufficiency
4. Bone marrow or stem cell transplant
5. Clinically symptomatic cholelithiasis or cholecystitis
6. Currently enrolled in any other investigational trial. Participation in the PK Deficiency Natural History Study (NCT02053480) is permitted
7. Exposure to any investigational drug, device or procedure within 28 days prior to screening or during trial participation
8. Concurrent medical condition such as poorly controlled hypertension, heart failure, active infection, frequent post-splenectomy sepsis, Hepatitis B or C, Human Immunodeficiency Virus type 1 (HIV1) or Human Immunodeficiency Virus type 2 (HIV2) infection, poorly controlled diabetes mellitus, history of primary malignancy with the exception of curatively treated nonmelanomatous skin cancer, cervical cancer of breast cancer in situ
9. Major surgery in the last 6 months
10. Psychiatric disorder that could compromise the ability of the patient to cooperate with the study
11. Serum bilirubin higher to the upper limit of normal attributable to factors other than hemolysis or Gilbert's Syndrome
12. Use of restricted products known to strongly inhibit cytochrome P450 (CYP) 3A4 metabolism within 5 days prior to Prior Day 1 dosing, or to strongly induce cytochrome P450 3A4 (CYP3A4) metabolism within 28 days prior to Day 1 dosing, or to strongly inhibit P-glycoprotein transporter within 5 days prior to Day 1 dosing, or digoxin within 5 days prior to Day 1 dosing.
13. Heart-rate corrected QT interval - Fridericia's method (QTcF) interval ˃ 450 ms in male, QTcF > 470 ms in female, with the exception of patients with a left Bundle Branch Block
14. Cardiac arrhythmias that are clinically significant or treated with drugs that are substrates of CYP3A4
15. Allergy to sulfonamides if characterized by acute hemolytic anemia, anaphylaxis, rash of erythema multiforme type or Stevens-Johnson Syndrome
16. Any other medical or psychological condition deemed by the Investigator to be likely to interfere with a patient's ability to participate in the study
17. Patients will not be permitted to enter the Extension Period if: The patient experienced AEs during the Core Period that are considered by the treating Investigator or the Sponsor's designated Medical Monitor to pose a significant safety risk to the patient if treatment were to be extended

Contacts and Locations

Locations

United States, California

Stanford University

Palo Alto, California, United States, 94304

United States, Massachusetts

Boston Children's Hospital

Boston, Massachusetts, United States, 02215

United States, Michigan

Wayne State University School of Medicine - Children's Hospital of Michigan

Detroit, Michigan, United States, 48201

United States, New York

New York Presbyterian Hospital- Weil Cornell Medical College

New York, New York, United States, 10065

United States, Pennsylvania

Central Pennsylvania Clinic

Belleville, Pennsylvania, United States, 17004

Children Hospital of Philadelphia (CHOP)

Philadelphia, Pennsylvania, United States, 19104

United States, Utah

University of Utah

Salt Lake City, Utah, United States, 84113

Canada, Ontario

University Health Network

Toronto, Ontario, Canada, M5G 2C4

France

Hôpital Henri Mondor

Créteil, Ile-de-France, France, 94010

Hôpital Saint-Vincent de Paul

Lille, Nord, France, 59000

Italy

UOC Oncoematologia Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

Milano, Italy, 20122

Netherlands

Universitair Medisch Centrum Utrecht

Utrecht, Netherlands, 3584 CX

United Kingdom

Hammersmith Hospital

London, United Kingdom, W12 0NN

Sponsors and Collaborators

Agios Pharmaceuticals, Inc.

  Study Documents (Full-Text)

Documents provided by Agios Pharmaceuticals, Inc.:

Study Protocol  [PDF] June 30, 2017

Statistical Analysis Plan  [PDF] June 15, 2017

More Information

Publications of Results:

Grace RF, Rose C, Layton DM, Galactéros F, Barcellini W, Morton DH, van Beers EJ, Yaish H, Ravindranath Y, Kuo KHM, Sheth S, Kwiatkowski JL, Barbier AJ, Bodie S, Silver B, Hua L, Kung C, Hawkins P, Jouvin MH, Bowden C, Glader B. Safety and Efficacy of Mitapivat in Pyruvate Kinase Deficiency. N Engl J Med. 2019 Sep 5;381(10):933-944. doi: 10.1056/NEJMoa1902678.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Rab MAE, Van Oirschot BA, Kosinski PA, Hixon J, Johnson K, Chubukov V, Dang L, Pasterkamp G, Van Straaten S, Van Solinge WW, Van Beers EJ, Kung C, Van Wijk R. AG-348 (Mitapivat), an allosteric activator of red blood cell pyruvate kinase, increases enzymatic activity, protein stability, and ATP levels over a broad range of PKLR genotypes. Haematologica. 2021 Jan 1;106(1):238-249. doi: 10.3324/haematol.2019.238865.

• Responsible Party: Agios Pharmaceuticals, Inc.
• ClinicalTrials.gov Identifier: NCT02476916
• Other Study ID Numbers: AG348-C-003; 2015-000484-13 ( EudraCT Number )
• First Posted: June 22, 2015
• Results First Posted: June 11, 2020
• Last Update Posted: June 13, 2022
• Last Verified: June 2022

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Agios Pharmaceuticals, Inc.:

Pyruvate Kinase Deficiency; Hemolytic anemia; Pyruvate Kinase Isoform R (PKR); Drive PK

Additional relevant MeSH terms:

Anemia, Hemolytic, Congenital Nonspherocytic; Pyruvate Metabolism, Inborn Errors; Anemia, Hemolytic, Congenital; Anemia, Hemolytic; Anemia; Hematologic Diseases; Genetic Diseases, Inborn; Carbohydrate Metabolism, Inborn Errors; Metabolism, Inborn Errors; Metabolic Diseases