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Efficacy and Safety of Romiplostim Versus Eltrombopag in the Treatment of Thrombocytopenia in Patients With Wiskott-Aldrich Syndrome

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ClinicalTrials.gov Identifier: NCT04371939
Recruitment Status : Recruiting
First Posted : May 1, 2020
Last Update Posted : May 6, 2020
Sponsor:
Information provided by (Responsible Party):
Federal Research Institute of Pediatric Hematology, Oncology and Immunology

Brief Summary:
This is a prospective, open-label, randomized, two-arm clinical trial conducted to evaluate the safety and efficacy of romiplostim in comparison with eltrombopag in the treatment of thrombocytopenia in patients with Wiskott-Aldrich syndrome

Condition or disease Intervention/treatment Phase
Wiskott-Aldrich Syndrome Drug: Romiplostim Drug: Eltrombopag Phase 2

Detailed Description:

Wiskott-Aldrich syndrome (WAS) is a life-threatening primary immunodeficiency associated with bleeding of variable severity due to severe thrombocytopenia. Considering that the hemorrhagic events are a cause of death in 21% of WAS patients, management of thrombocytopenia constitutes a major challenge. Findings of defective platelet production by megakaryocytes and reduced in vitro pro-platelet formation suggested the possibility of megakaryocyte stimulation by TPO-RAs romiplostim, eltrombopag as a treatment strategy. Each of them has distinct pharmacodynamic, pharmacokinetic properties, different effects on megakaryopoiesis, and might have different efficacy in individual patients.

The aim of this study is to compare the efficacy and safety of romiplostim and another TPO-RA eltrombopag for the treatment of thrombocytopenia in patients with WAS and assess the benefit of switching these molecules in refractory subjects. The patients will be randomized in a 1:1 fashion to receive either romiplostim or eltrombopag.

After enrollment, (see detailed inclusion and exclusion criteria below) subjects under 18 years of age with a confirmed diagnosis of WAS and thrombocytopenia (platelet count of less than 70 x 109/L) will be assigned to receive romiplostim at an initial dose of 9 µg/kg subcutaneously per week or oral eltrombopag at a dose of 2-3mg/kg daily (ages 1 to 5 years) and 75 mg/daily (>6 years) for at least 1 month.

Bleeding severity will be evaluated with a modified World Health Organization (WHO) Bleeding Scale, lab tests (blood counts, biochemical analyses), ECG will be assessed after 30 days of treatment (30 +/- 7 days).

The efficacy of romiplostim/eltrombopag will be defined by the following criteria: complete response -an achievement of the platelet count >100 x 109/L, partial - platelet count at least 30 x 109/L higher than the patient's pretreatment baseline count up to to 100 x 109/L. No response will be defined as not achieving a platelet count of > 30 x 109/L from the baseline count.

Refractory patients will be switched to alternate TPO-RA agonist. Other reasons for switching that are not related to efficacy might include adverse events, active colitis, patient preference.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomized, Two-arm Single-center Phase II Clinical Trial Comparing the Efficacy and Safety of Romiplostim Versus Eltrombopag in the Treatment of Thrombocytopenia in Patients With Wiskott-Aldrich Syndrome
Actual Study Start Date : November 5, 2019
Estimated Primary Completion Date : December 2022
Estimated Study Completion Date : July 30, 2023


Arm Intervention/treatment
Experimental: I (Romiplostim)

Participants will receive romiplostim at an initial dose of 9 µg/kg subcutaneously per week for at least 1 month depending on their response to study drug.

Patients failing to achieve a complete platelet response cross over to arm II.

Drug: Romiplostim

Participants will receive romiplostim at an initial dose of 9 µg/kg subcutaneously per week for at least 1 month depending on their response to study drug.

Patients failing to achieve a complete platelet response cross over to arm II.

Other Name: Nplate

Experimental: II (Eltrombopag)

Participants will receive eltrombopag at a dose of 2-3mg/kg daily (ages 0 to 5 years) and 75 mg/daily (>6 years) for at least 1 month depending on their response to study drug.

Patients failing to achieve a complete platelet response switch to arm I.

Drug: Eltrombopag

Participants will receive eltrombopag at a dose of 2-3mg/kg daily (ages 0 to 5 years) and 75 mg/daily (>6 years) for at least 1 month depending on their response to study drug.

Patients failing to achieve a complete platelet response switch to arm I.





Primary Outcome Measures :
  1. Percentage of patients with overall platelet response (complete response + partial response) for romiplostim and eltrombopag group [ Time Frame: 1 month (30 day +/- 7 days) ]
    A complete response will be defined as a platelet count >100 x 109/L, partial - 30 x 109/L higher than the patient's pretreatment baseline count to 100 x 109/L.


Secondary Outcome Measures :
  1. Number of participants with bleeding events and severity of bleeding in romiplostim and eltrombopag group [ Time Frame: until discontinuation, from at least one month to one year ]

    The incidence and severity of bleeding events is evaluated with a modified World Health Organization (WHO) Bleeding Scale.

    (G1=Petechiae, epistaxis <30 min, G2=Mild blood loss, hematomas, epistaxis >30 min, melanotic stool G3=Gross blood loss, requiring blood transfusions, G4=Fatal bleeding).


  2. Number of participants with drug related adverse events in each treatment group [ Time Frame: until discontinuation, from at least one month to one year ]
    Adverse events are graded according to Common Terminology Criteria for Adverse Events (CTCAE).

  3. Percentage of patients with overall platelet response (complete response + partial response) after switching from one TPO-RA to another one. [ Time Frame: until discontinuation, from at least one month to one year ]


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Ages Eligible for Study:   up to 18 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Genetically verified Wiskott-Aldrich syndrome
  • Thrombocytopenia (platelet count < 70 x 109/L)
  • Age: under 18 years
  • Subject/legal representative has signed written informed consent.

Exclusion Criteria:

  • Patients, who do not meet the inclusion criteria.
  • Any prior history of arterial or venous thrombosis within the past year.
  • Arm II (eltrombopag):

    1. abnormal hepatic function -elevated AST/ALT > 1.5 times upper limit of normal within 4 weeks prior to enrollment
    2. Active colitis

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): NCT04371939


Contacts
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Contact: Anna Shcherbina, MD, PhD +7(495)2876570 ext 6299 shcher26@hotmail.com

Locations
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Russian Federation
Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology Recruiting
Moscow, Russian Federation, 117997
Contact: Anna Shcherbina, MD, PhD    +7(495)2876570 ext 6299    shcher26@hotmail.com   
Sponsors and Collaborators
Federal Research Institute of Pediatric Hematology, Oncology and Immunology
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Responsible Party: Federal Research Institute of Pediatric Hematology, Oncology and Immunology
ClinicalTrials.gov Identifier: NCT04371939    
Other Study ID Numbers: NCPHOI-2020-03
First Posted: May 1, 2020    Key Record Dates
Last Update Posted: May 6, 2020
Last Verified: May 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Federal Research Institute of Pediatric Hematology, Oncology and Immunology:
eltrombopag
romiplostim
thrombocytopenia
platelets
Additional relevant MeSH terms:
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Thrombocytopenia
Wiskott-Aldrich Syndrome
Syndrome
Disease
Pathologic Processes
Blood Platelet Disorders
Hematologic Diseases
Blood Coagulation Disorders, Inherited
Blood Coagulation Disorders
Hemorrhagic Disorders
Lymphopenia
Leukopenia
Leukocyte Disorders
Genetic Diseases, Inborn
Genetic Diseases, X-Linked
Immunologic Deficiency Syndromes
Immune System Diseases