Efficacy, Safety, and Pharmacokinetic Study of Prophylactic Emicizumab Versus No Prophylaxis in Hemophilia A Participants

NCT03315455 | Completed Phase 3 Results

• 1 other identifier: YO39309
• Study Type: interventional
• Target: 85
• Locations: 4 countries
• Sites: 13

Brief Summary

This multicenter, open-label, Phase 3 study with randomized and non-randomized arms is designed to investigate the efficacy, safety, and pharmacokinetics of emicizumab in participants with hemophilia A regardless of factor VIII (FVIII) inhibitor status. Participants greater than or equal to (≥)12 years old who received episodic therapy with FVIII or bypassing agents prior to study entry and experienced at least 5 bleeds over the prior 24 weeks will be randomized in a 2:2:1 ratio to the following regimens: Arm A: Emicizumab prophylaxis at 3 milligrams per kilogram (mg/kg) once every week (QW) subcutaneously (SC) for 4 weeks, followed by 1.5 mg/kg QW SC; Arm B: Emicizumab prophylaxis at 3 mg/kg QW SC for 4 weeks, followed by 6 mg/kg once every 4 weeks (Q4W) SC; and Arm C: No prophylaxis (control arm). In addition, pediatric participants less than (\<)12 years old with hemophilia A and FVIII inhibitors who received episodic therapy with bypassing agents prior to study entry will be enrolled to Arm D: Emicizumab prophylaxis at 3 mg/kg QW SC for 4 weeks, followed by 1.5 mg/kg QW SC.

Conditions

Hemophilia A

Outcome Measures

Primary Outcomes (3)

• Model-Based Annualized Bleeding Rate for Treated Bleeds

  The number of treated bleeds over the efficacy period was estimated as an annualized bleeding rate (ABR) using a negative binomial regression model, which accounts for different follow-up times. A treated bleed was defined as a bleed that was directly followed by a hemophilia medication reported to be a "treatment for bleed". The 72-hour rule was implemented: two bleeds of the same type and at the same anatomical location were counted as one bleed if the second bleed occurred within 72 hours from the last treatment for the first bleed. Bleeds due to surgery/procedure were excluded.

  From Baseline to at least 24 weeks

• Mean Calculated Annualized Bleeding Rate for Treated Bleeds

  The number of treated bleeds over the efficacy period is presented here as a calculated annualized bleeding rate (ABR) that was annualized for each participant using the following formula: ABR = (number of bleeds/number of days during the efficacy period) x 365.25. A treated bleed was defined as a bleed that was directly followed by a hemophilia medication reported to be a "treatment for bleed". The 72-hour rule was implemented: two bleeds of the same type and at the same anatomical location were counted as one bleed if the second bleed occurred within 72 hours from the last treatment for the first bleed. Bleeds due to surgery/procedure were excluded.

  From Baseline to at least 24 weeks

• Median Calculated Annualized Bleeding Rate for Treated Bleeds

  The number of treated bleeds over the efficacy period is presented here as a calculated annualized bleeding rate (ABR) that was annualized for each participant using the following formula: ABR = (number of bleeds/number of days during the efficacy period) x 365.25. A treated bleed was defined as a bleed that was directly followed by a hemophilia medication reported to be a "treatment for bleed". The 72-hour rule was implemented: two bleeds of the same type and at the same anatomical location were counted as one bleed if the second bleed occurred within 72 hours from the last treatment for the first bleed. Bleeds due to surgery/procedure were excluded.

  From Baseline to at least 24 weeks

Secondary Outcomes (41)

• Model-Based Annualized Bleeding Rate for All Bleeds

  From Baseline to at least 24 weeks

• Mean Calculated Annualized Bleeding Rate for All Bleeds

  From Baseline to at least 24 weeks

• Median Calculated Annualized Bleeding Rate for All Bleeds

  From Baseline to at least 24 weeks

• Model-Based Annualized Bleeding Rate for Treated Spontaneous Bleeds

  From Baseline to at least 24 weeks

• Mean Calculated Annualized Bleeding Rate for Treated Spontaneous Bleeds

  From Baseline to at least 24 weeks

Study Arms (4)

Arm C (Control): No Prophylaxis, Then Emicizumab

ACTIVE COMPARATOR

Participants ≥12 years old with hemophilia A (with or without FVIII inhibitors) who are randomized to Arm C will not receive any prophylactic treatment for at least 24 weeks. After 24 weeks, participants will have the opportunity to switch to receive emicizumab prophylaxis at 3 mg/kg QW via SC injection for 4 weeks, followed by 6 mg/kg Q4W until marketing authorization as part of this study or a separate extension study, as long as they derive clinical benefit. Participants will continue to receive standard-of-care treatments on an episodic basis for the treatment of breakthrough bleeds during the study.

Drug: Emicizumab

Arm A: Emicizumab Prophylaxis at 1.5 mg/kg QW

EXPERIMENTAL

Participants ≥12 years old with hemophilia A (with or without FVIII inhibitors) who are randomized to Arm A will receive prophylactic emicizumab at a dose of 3 mg/kg via SC injection QW for first 4 weeks, followed by 1.5 mg/kg via SC injection Q4W for at least 24 weeks. After 24 weeks treatment, participants will be allowed to continue emicizumab until marketing authorization as part of this study or a separate extension study, as long as they derive clinical benefit. Participants will continue to receive standard-of-care treatments on an episodic basis for the treatment of breakthrough bleeds during the study.

Drug: Emicizumab

Arm B: Emicizumab Prophylaxis at 6 mg/kg Q4W

EXPERIMENTAL

Participants ≥12 years old with hemophilia A (with or without FVIII inhibitors) who are randomized to Arm B will receive prophylactic emicizumab at a dose of 3 mg/kg via SC injection QW for first 4 weeks, followed by 6 mg/kg via SC injection Q4W for at least 24 weeks. After 24 weeks treatment, participants will be allowed to continue emicizumab until marketing authorization as part of this study or a separate extension study, as long as they derive clinical benefit. Participants will continue to receive standard-of-care treatments on an episodic basis for the treatment of breakthrough bleeds during the study.

Drug: Emicizumab

Arm D: Emicizumab Prophylaxis at 1.5 mg/kg QW

EXPERIMENTAL

Participants \<12 years old with hemophilia A and FVIII inhibitors who are enrolled to Arm D will receive prophylactic emicizumab at a dose of 3 mg/kg via SC injection QW for first 4 weeks, followed by 1.5 mg/kg via SC injection QW for at least 24 weeks. After 24 weeks treatment, participants will be allowed to continue emicizumab until marketing authorization as part of this study or a separate extension study, as long as they derive clinical benefit. Participants will continue to receive standard-of-care treatments on an episodic basis for the treatment of breakthrough bleeds during the study.

Drug: Emicizumab

Interventions

Emicizumab DRUG

Emicizumab will be administered via subcutaneous (SC) injection, as described for each treatment arm.

Also known as: Hemlibra, RO5534262, RG6013, ACE910

Arm A: Emicizumab Prophylaxis at 1.5 mg/kg QW; Arm B: Emicizumab Prophylaxis at 6 mg/kg Q4W; Arm C (Control): No Prophylaxis, Then Emicizumab; Arm D: Emicizumab Prophylaxis at 1.5 mg/kg QW

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosis of severe congenital hemophilia A or hemophilia A with FVIII inhibitors
• Aged 12 years or older at the time of informed consent
• Body weight ≥40 kilograms (kg) at the time of screening
• Participants without FVIII inhibitors (\<0.6 Bethesda unit per milliliter \[BU/mL\]) who completed successful immune tolerance induction (ITI) must have done so at least 5 years before screening and have no evidence of inhibitor recurrence (permanent or temporary)
• Documentation of the details of episodic therapy (FVIII or bypassing agents) and of number of bleeding episodes for at least the last 24 weeks and ≥5 bleeds in the last 24 weeks prior to study entry
• Adequate hematologic, hepatic, and renal function
• For women of child bearing potential: agreement to remain abstinent or use a protocol defined contraceptive measure during the treatment period and for at least 5 elimination half-lives (24 weeks) after the last dose of study drug
• Diagnosis of congenital hemophilia A of any severity and documented history of high-titer inhibitor (i.e., ≥5 BU/mL)
• Children \<12 years old at time of informed consent
• Body weight \>3 kg at time of informed consent
• Requires treatment with bypassing agents
• Adequate hematologic, hepatic, and renal function
• For female participants who are of childbearing potential, follow the same contraception criteria as listed above for Arms A, B, and C

You may not qualify if:

• Inherited or acquired bleeding disorder other than hemophilia A
• At high risk for thrombotic microangiopathy, in the investigator's judgment
• History of illicit drug or alcohol abuse within 48 weeks prior to screening, in the investigator's judgment
• Previous (in the past 12 months) or current treatment for thromboembolic disease (with the exception of previous catheter-associated thrombosis for which anti-thrombotic treatment is not currently ongoing) or signs of thromboembolic disease
• Other conditions that may increase risk of bleeding or thrombosis
• History of clinically significant hypersensitivity associated with monoclonal antibody therapies or components of the emicizumab injection
• Known human immuno-deficiency virus (HIV) infection with cluster of differentiation 4 (CD4) count \<200 cells/microliter (cells/mcL) within 24 weeks prior to screening. Participants with HIV infection who have CD4 \>200 cells/mcL and meet all other criteria are eligible
• Use of systemic immunomodulators at enrollment or planned use during the study, with the exception of anti-retroviral therapy
• Concurrent disease, treatment, or abnormality in clinical laboratory tests that could interfere with the conduct of the study, may pose additional risk, or would, in the opinion of the investigator, preclude the participant's safe participation in and completion of the study
• Planned surgery (excluding minor procedures such as tooth extraction or incision and drainage) during the study
• Receipt of: Emicizumab in a prior investigational study; An investigational drug to treat or reduce the risk of hemophilic bleeds within 5 half-lives of last drug administration; A non-hemophilia-related investigational drug concurrently, within last 30 days or 5 half-lives, whichever is shorter
• Pregnant or lactating, or intending to become pregnant during the study
• Inherited or acquired bleeding disorder other than hemophilia A
• Ongoing (or plan to receive during the study) ITI therapy or prophylaxis treatment with FVIII
• Previous (in the past 12 months) or current treatment for thromboembolic disease (with the exception of previous catheter-associated thrombosis for which anti-thrombotic treatment is not currently ongoing) or signs of thromboembolic disease

Sponsors & Collaborators

• Hoffmann-La Roche: lead

Study Sites (13)

Beijing Children's Hospital, Capital Medical University

Beijing, 100045, China

Location

Peking Union Medical College Hospital

Beijing, 100730, China

Location

Xiangya Hospital of Centre-South University

Changsha, 410008, China

Location

Southern Medical University Nanfang Hospital

Guangdong Province Guangzhou City, 510515, China

Location

Ruijin Hospital Shanghai Jiaotong University School of Medicine

Shanghai, 200025, China

Location

Tianjin Institute of Hematology & Blood Diseases Hospital

Tianjin, 300020, China

Location

Xiehe Hospital, Tongji Medical College Huazhong University of Science & Technology

Wuhan, 430022, China

Location

Tongji Hosp, Tongji Med. Col, Huazhong Univ. of Sci. & Tech

Wuhan, 430030, China

Location

Queen Mary Hospital

Hong Kong, Hong Kong

Location

Prince of Wales Hospital

Shatin, Hong Kong

Location

Penang General Hospital

George Town, Pulau Pinang, 10990, Malaysia

Location

Queen Elizabeth Hospital

Sabah, Sabah, 88586, Malaysia

Location

Ramathibodi Hospital

Bangkok, 10400, Thailand

Location

MeSH Terms

Conditions

Hemophilia A

Interventions

emicizumab

Condition Hierarchy (Ancestors)

Blood Coagulation Disorders, Inherited; Blood Coagulation Disorders; Hematologic Diseases; Hemic and Lymphatic Diseases; Coagulation Protein Disorders; Hemorrhagic Disorders; Genetic Diseases, Inborn; Congenital, Hereditary, and Neonatal Diseases and Abnormalities

Results Point of Contact

• Title: Medical Communications
• Organization: Hoffmann-La Roche

genentech@druginfo.com

800-821-8590

Study Officials

• Clinical Trials

  Hoffmann-La Roche

  STUDY DIRECTOR

Publication Agreements

• PI is Sponsor Employee: No
• Restriction Type: OTHER
• Restrictive Agreement: Yes

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 17, 2017
• First Posted: October 20, 2017
• Study Start: April 26, 2018
• Primary Completion: August 3, 2022
• Study Completion: August 29, 2025
• Last Updated: April 1, 2026
• Results First Posted: March 6, 2024

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will share

Locations

CN (8); MY (2); TH (1); HK (2)