Subcutaneous engineered factor VIIa marzeptacog alfa (activated) in hemophilia with inhibitors: Phase 2 trial of pharmacokinetics, pharmacodynamics, efficacy, and safety.

Autor: Mahlangu J; Haemophilia Comprehensive Care Center Charlotte Maxeke Johannesburg Academic Hospital University of the Witwatersrand and NHLS Johannesburg South Africa., Levy H; Catalyst Biosciences South San Francisco CA USA., Kosinova MV; Hematology Kemerovo Regional Clinical Hospital Kemerovo Russia., Khachatryan H; R.H. Yeolyan Hemophilia and Thrombophilia Center Yerevan Republic of Armenia., Korczowski B; Institute of Medical Sciences College of Medical Sciences of the University of Rzeszow, University of Rzeszow Rzeszow Poland., Makhaldiani L; K. Eristavi National Center of Experimental and Clinical Surgery Tbilisi Georgia., Iosava G; Institute of Hematology and Transfusiology Tbilisi Georgia., Lee M; Fielding School of Public Health University of California Los Angeles Los Angeles CA USA., Del Greco F; Catalyst Biosciences South San Francisco CA USA.
Jazyk: angličtina
Zdroj: Research and practice in thrombosis and haemostasis [Res Pract Thromb Haemost] 2021 Aug 17; Vol. 5 (6), pp. e12576. Date of Electronic Publication: 2021 Aug 17 (Print Publication: 2021).
DOI: 10.1002/rth2.12576
Abstrakt: Background: Marzeptacog alfa (activated) (MarzAA), a novel recombinant activated human factor VII (FVIIa) variant, was developed to provide increased procoagulant activity, subcutaneous (SC) administration, and longer duration of action in people with hemophilia.
Objectives: To investigate if daily SC administration of MarzAA in subjects with inhibitors can provide effective prophylaxis.
Methods: This multicenter, open-label phase 2 trial (NCT03407651) enrolled men with severe congenital hemophilia with an inhibitor. All subjects had a baseline annualized bleeding rate (ABR) of ≥12 events/year. Subjects received a single 18 μg/kg intravenous dose of MarzAA to measure 24-hour pharmacokinetics (PK) and pharmacodynamics (PD), single 30 μg/kg SC dose to measure 48-hour PK/PD, then daily SC 30 μg/kg MarzAA for 50 days. If spontaneous bleeding occurred, the dose was sequentially escalated to 60, 90, or 120 μg/kg, with 50 days at the final effective dose without spontaneous bleeding to proceed to a 30-day follow-up. The primary end point was reduction in ABR. Secondary end points were safety, tolerability, and antidrug antibody (ADA) formation.
Results: In the 11 subjects, the mean ABR significantly reduced from 19.8 to 1.6, and the mean proportion of days with bleeding significantly reduced from 12.3% to 0.8%. Of a total of 517 SC doses, six injection site reactions in two subjects were reported. No ADAs were detected. One fatal unrelated serious adverse event occurred: intracerebral hemorrhage due to untreated hypertension.
Conclusions: The data demonstrated that MarzAA was highly efficacious for prophylactic treatment in patients with inhibitors by significantly decreasing bleed frequency and duration of bleeding episodes.
(© 2021 Catalyst Biosciences. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).)
Databáze: MEDLINE
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