Study to Evaluate how effective and safe the investigationall product, Mitapivat, is when administred to Pediatric Subjects With Pyruvate Kinase Deficiency, who are receiving regular blood transfusions, followed by a 5-Year Open-label Extension Period, where subjects will be given the option to receive mitapivat for an additional 5 years

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Agios Pharmaceuticals Inc.

Participant type

Pediatric, Patients

Age range

0-17 years

Gender

Male and Female

Therapeutic area

Diseases [C] - Hemic and Lymphatic Diseases [C15]

Trial duration

27 May 2022 → ongoing

Decision date (initial)

2024-08-13

Transition trial

Yes

Low-intervention

No

Rare-disease indication

Yes

Vulnerable population

Yes

External identifiers

EU CT number

2024-515024-37-00

EudraCT number

2021-003265-36

ClinicalTrials.gov

NCT05144256

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Efficacy, Therapy, Pharmacokinetic, Pharmacodynamic, Safety

To determine the efficacy of treatment with mitapivat compared with placebo, as assessed by the reduction in transfusion burden in pediatric subjects with pyruvate kinase deficiency (PK deficiency) who are regularly transfused

Conditions and MedDRA coding

Pyruvate Kinase Deficiency

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 7

1. Written informed consent from the subject, or the subject’s legally authorized representative, parent(s), or legal guardian, and the subject’s assent, where applicable (informed consent/assent) must be obtained before any study-related procedures are conducted, and subjects must be willing to comply with all study procedures for the duration of the study.
2. Aged 1 to <18 years. Subjects between 12 and 24 months of age must weigh a minimum of 7 kg.
3. Clinical laboratory confirmation of PK deficiency, defined as documented presence of at least 2 mutant alleles in the PKLR gene, of which at least 1 is a missense mutation, as determined per the genotyping performed by the study central genotyping laboratory
4. Six to 26 transfusion episodes in the 52-week period before providing informed consent/assent
5. Have complete records of transfusion history for the 52 weeks before providing informed consent/assent, defined as having all the following available: (1) all the transfusion dates, (2) the RBC transfusion volume (milliliters and/or number of units) for all the transfusions, and (3) Hb concentrations within 1 week before transfusion for at least 80% of the transfusions
6. Receiving folic acid supplementation as part of routine clinical care for at least 21 days before administration of the first dose of study drug, to be continued during study participation
7. Female subjects who have attained menarche and/or breast development in Tanner Stage 2 must be abstinent of sexual activities that may induce pregnancy as part of their usual lifestyle, or agree to use 2 forms of contraception, 1 of which must be considered highly effective, from the time of informed consent/assent, throughout the study, and for 28 days after the last dose of study drug (including the time required to dose taper). The second form of contraception can include an acceptable barrier method.

Exclusion criteria 19

1. Pregnant or breastfeeding
2. Homozygous for the R479H mutation or have 2 nonmissense mutations, without the presence of another missense mutation, in the PKLR gene as determined per the genotyping performed by the study central genotyping laboratory
3. History of malignancy
4. History of active and/or uncontrolled cardiac or pulmonary disease or clinically relevant QT prolongation within 6 months before providing informed consent/assent
5. Hepatobiliary disorders including but not limited to: a. Liver disease with histopathological evidence of cirrhosis or severe fibrosis b. Clinically symptomatic cholelithiasis or cholecystitis (subjects with prior cholecystectomy are eligible) c. History of drug-induced cholestatic hepatitis d. Aspartate aminotransferase >2.5× the upper limit of normal (ULN) (unless due to hemolysis and/or hepatic iron deposition) and alanine aminotransferase >2.5×ULN (unless due to hepatic iron deposition)
6. Renal dysfunction as defined by an estimated glomerular filtration rate <60 mL/min/1.73 m2 (bedside Schwartz equation)
7. Nonfasting triglycerides >440 mg/dL (5 mmol/L)
8. Active uncontrolled infection requiring systemic antimicrobial therapy
9. Subjects with known active hepatitis B or hepatitis C virus infection
10. Subjects with known HIV infection
11. History of major surgery (including splenectomy) ≤6 months before providing informed consent/assent and/or planning on undergoing a major surgical procedure during the Screening or Double-blind Period
12. Current enrollment or past participation (within 90 days before the first dose of study drug or a time frame equivalent to 5 half-lives of the investigational study drug, whichever is longer) in any other clinical study involving an investigational study drug or device
13. Prior exposure to gene therapy, or bone marrow or stem cell transplantation
14. Currently receiving hematopoietic stimulating agents; the last dose must have been administered at least 28 days or a time frame equivalent to 5 half-lives (whichever is longer) before randomization
15. Receiving products that are strong inhibitors of cytochrome P450 (CYP)3A4/5 that have not been stopped for ≥5 days or a time frame equivalent to 5 half-lives (whichever is longer), or strong inducers of CYP3A4 that have not been stopped for ≥28 days or a time frame equivalent to 5 half-lives (whichever is longer), before randomization
16. Receiving anabolic steroids, including testosterone preparations, that have not been stopped for at least 28 days before randomization
17. Known allergy, or other contraindication, to mitapivat or its excipients (microcrystalline cellulose, croscarmellose sodium, sodium stearyl fumarate, mannitol, Opadry® II Blue [hypromellose, titanium dioxide, lactose monohydrate, triacetin, and FD&C Blue #2], Opadry® II White [hypromellose, titanium dioxide, lactose monohydrate, and triacetin], and magnesium stearate)
18. Any medical, hematologic, psychological, or behavioral condition(s) or prior or current therapy that, in the opinion of the Investigator, may confer an unacceptable risk to participating in the study and/or could confound the interpretation of the study data; also included are: • Subjects who are institutionalized by regulatory or court order • Subjects with any condition(s) that could create undue influence (including but not limited to incarceration, involuntary psychiatric confinement, and financial or familial affiliation with the Investigator or Sponsor)
19. Receiving a pyruvate kinase activator that has not been stopped for ≥52 weeks before providing informed consent/assent

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. Transfusion reduction response (TRR), defined as achievement of a ≥33% reduction in the total red blood cell (RBC) transfusion volume from Week 9 through Week 32 of the Double-blind Period normalized by weight and actual study drug duration compared with the historical transfusion volume standardized by weight and to 24 weeks

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 4

Placebo 1

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Agios Pharmaceuticals Inc.

Sponsor organisation

Agios Pharmaceuticals Inc.

Address

88 Sidney Street

City

Cambridge

Postcode

02139-4137

Country

United States

Scientific contact point

Organisation

Agios Pharmaceuticals Inc.

Contact name

Director, Scientific Communications

Public contact point

Organisation

Agios Pharmaceuticals Inc.

Contact name

Director, Scientific Communications

Third parties 13

Locations

3 EU/EEA countries · 5 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 42 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

3 submissions — initial application plus substantial / non-substantial modifications