CClinicalTrials.gg
CompletedNCT01151423TITANUpdated Apr 4, 2023Results posted

Study to Assess Efficacy and Safety of Anti-von Willebrand Factor (vWF) Nanobody in Patients With Acquired Thrombotic Thrombocytopenic Purpura (aTTP)

A Phase 2 interventional study of Caplacizumab and Placebo in Acquired Thrombotic Thrombocytopenic Purpura, sponsored by Ablynx, a Sanofi company. Completed at 51 sites in 13 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2023-04-04.

Sponsored by Ablynx, a Sanofi company · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
75
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This study was a Phase II, single-blind, randomized, placebo-controlled trial to determine whether anti-vWF Nanobody is safe and effective as adjunctive treatment in patients with aTTP.

Patients received either placebo or anti-vWF Nanobody as adjunctive therapy to plasma exchange (PE).

02

Conditions studied

  • Acquired Thrombotic Thrombocytopenic Purpura
03

In context

Purpura

263 studies on the registry are indexed under Purpura; 27 are open to participants now.

This study's enrollment of 75 is above the median of 50 across 171 interventional studies indexed under Purpura.

Browse Purpura studies →

Lead sponsor

Ablynx, a Sanofi company is the lead sponsor of 24 studies on the registry; none are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • 18 years of age or older (adults) or aged 12 to \< 18 years (adolescents)
  • Male or female subject, willing to accept an acceptable contraceptive regimen
  • Subject with a clinical diagnosis of TTP
  • Requiring PE (one single PE session prior to randomization into the study was allowed)
  • Subject accessible to follow-up
  • Subject able to provide signed and dated informed consent and assent (if applicable, for adolescents)

Exclusion criteria

Exclusion Criteria:

  • Platelet count ≥ 100,000/µL
  • Severe active infection indicated by sepsis (requirement for pressors with or without positive blood cultures)
  • Clinical evidence of enteric infection with Escherichia coli 0157 or related organism
  • Anti-phospholipid syndrome
  • Diagnosis of disseminated intravascular coagulation (DIC)
  • Pregnancy or breast-feeding
  • Hematopoietic stem cell or bone marrow transplantation-associated thrombotic microangiopathy
  • Known with congenital TTP
  • Active bleeding or high risk of bleeding
  • Uncontrolled arterial hypertension
  • Known chronic treatment with anticoagulant treatment that cannot be stopped safely, including but not limited to:

    • vitamin K antagonists
    • heparin or low molecular weight heparin (LMWH)
    • non-acetyl salicylic acid non-steroidal anti-inflammatory molecules
  • Severe or life threatening clinical condition other than TTP that would impair participation in the study
  • Subjects with malignancies resulting in a life expectation of less than 3 months
  • Subjects with known or suspected bone marrow carcinosis
  • Subjects who cannot comply with study protocol requirements and procedures
  • Known hypersensitivity to the active substance or to excipients of the study drug
  • Severe liver impairment, corresponding to grade 3 toxicity defined by the CTCAE scale. For the key liver parameters, this is defined as follows:

    • bilirubin > 3 x upper limit of normal (ULN) (needed to differentiate isolated increase in indirect bilirubin due to hemolysis, this was not an exclusion parameter but disease-related)
    • alanine transaminase (ALT)/ aspartate transaminase (AST) > 5 x ULN
    • alkaline phosphatase (ALP) > 5 x ULN
    • gamma-glutamyl transpeptidase (GGT) > 5 x ULN
  • Severe chronic renal impairment, as defined by glomerular filtration rate \< 30 mL/min

Note that the use of another investigational drug or device within 30 days prior to screening was not allowed. Participation in non-interventional/observational studies and registries during the study period was allowed. Participation in another clinical study was not allowed until the end of the follow-up period or within 30 days after the last study treatment in case of early subject withdrawal from the study. Subjects who had already participated in the current study and had either completed the study per protocol or had discontinued prematurely, were not allowed to be re-included.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Participant)
Enrollment
75 participants (actual)

Study arms

  • Experimental
    Caplacizumab

    Caplacizumab 10 mg once daily

    Biological: Caplacizumab

  • Placebo comparator
    Placebo

    Placebo once daily

    Biological: Placebo

Interventions

  • BiologicalCaplacizumab

    * Subjects received a first intravenous (i.v.) bolus of 10 mg (filled at 5 mg/mL) caplacizumab via push injection within 6 hours to 15 minutes prior to the first PE on study. The first PE on study could either be the very first PE session for the current episode of aTTP (if the subject was randomized prior to the initiation of PE) or the second PE session (if the subject was randomized after a single PE session). * The first PE on study was followed by subcutaneous (s.c.) administration of 10 mg study drug within 30 minutes after the end of the PE procedure. * All subsequent study drug administrations were daily s.c. injections within 30 minutes after the end of the PE procedure (if applicable) or within 24 hours of the previous dose. * Subjects received caplacizumab up to 30 days after the last PE session.

    Also known as: anti-vWF Nanobody, ALX-0081

  • BiologicalPlacebo

    * Subjects received a first i.v. bolus of placebo via push injection within 6 hours to 15 minutes prior to the first PE on study. The first PE on study could either be the very first PE session for the current episode of aTTP (if the subject was randomized prior to the initiation of PE) or the second PE session (if the subject was randomized after a single PE session). * The first PE on study was followed by s.c. administration of placebo within 30 minutes after the end of the PE procedure. * All subsequent study drug administrations were daily s.c. injections within 30 minutes after the end of the PE procedure (if applicable) or within 24 hours of the previous dose. * Subjects received placebo up to 30 days after the last PE session.

06

What researchers measure

Primary outcomes

  1. Time-to-response of Treatment Defined by a Confirmed Recovery of Platelets ≥ 150,000/µL

    Time-to-response, defined by the achievement of platelet count response, confirmed at 48 hours after the initial reporting of this response. Platelet response was defined as recovery of platelets ≥ 150,000/µL. This response had to be confirmed at 48 hours after the initial reporting of platelet recovery ≥ 150,000/µL by a de novo measure of platelets ≥ 150,000/µL and lactate dehydrogenase (LDH) ≤ 2x upper limit of normal (ULN) (i.e., 'confirmed platelet response').

    Time frame: From the day of first study drug administration up to 30 days after first study drug administration

Secondary outcomes

  1. Number and Percentage of Subjects With Complete Remission Following Initial Daily Plasma Exchange (PE)

    Number and percentage of subjects with complete remission (defined as confirmed platelet count response and absence of exacerbation) following initial daily PE.

    Time frame: From the day of first study drug administration up to 30 days after first study drug administration

  2. Number and Percentage of Subjects With Exacerbations of TTP

    Number and percentage of subjects with exacerbations of TTP (defined as recurrent thrombocytopenia following a confirmed platelet count response and requiring a re-initiation of daily PE treatment after ≥ 1 day but ≤ 30 days of end of daily PE treatment. Time to first exacerbation of TTP was also examined as part of this end point analysis; the median time to first exacerbation could not be determined because of the small number of events.

    Time frame: Within 30 days of last day of initial daily PE

  3. Number and Percentage of Subjects With Relapse of TTP

    Number and percentage of subjects with relapse of TTP (defined as de novo TTP event that occurred later than 30 days after the last daily PE) was evaluated.

    Time frame: Later than 30 days after the last daily PE

  4. Number of Daily PE Sessions During the Initial Daily PE Period

    Number of daily PE sessions during the initial daily PE period which could include more than 1 PE per day was evaluated.

    Time frame: During the initial daily PE period, with a median (min, max) duration of exposure to study drug of 6 (2, 36) days

  5. Total Volume of Plasma Administered During the Initial Daily PE Period

    The total volume of plasma administered during the initial daily PE period was measured.

    Time frame: During the initial daily PE period, with a median (min, max) duration of exposure to study drug of 6 (2, 36) days

  6. Number of Days With at Least One PE Administration During the Total Course of the Study

    Number of days for PE was evaluated. This implies the number of days with at least one PE administration during the total course of the study.

    Time frame: During the total course of the study (from Screening till the 12-month follow-up [FU] visit)

  7. The Maximum Number of Consecutive Days Per Subject Where There Was no Interruption of PE During the Initial Daily PE Period

    The maximum number of consecutive days per subject where there was no interruption of PE during the initial daily PE period.

    Time frame: During the initial daily PE period, with a median (min, max) duration of exposure to study drug of 6 (2, 36) days

  8. Resolution of Non-focal Neurological Symptoms

    Resolution of non-focal neurological symptoms as defined by neurocognitive function at complete remission, measured by a Computerised Neuropsychological Test Battery(CNTB) (adults only). The CNTB included 6 modules: word list learning and selective reminding (WLL/SR), choice reaction time (CRT), visual memory (VMEM), simple reaction time (SRT), working memory (WMEM), and word list learning and delayed recall (WLL/DR). The 6 tasks are rated as a percentage correct (for CRT and SRT, the percentage correct corresponds to the percentage hits) and the mean score from these provides the CNTB summary score (range: 0-100). A higher CNTB summary score indicates better neuropsychological functioning.

    Time frame: From Baseline till the 12-month FU visit

  9. Number of Participants With Resolution of TTP-related Signs or Symptoms

    Resolution or improvement (improvement of ≥ 1 grade in the Common Terminology Criteria for Adverse Events \[CTCAE\] v4.0 scale) of TTP-related signs and symptoms as captured on physical examination and as adverse events. This endpoint was only evaluated for "resolution".

    Time frame: End of daily PE treatment period (median [min, max] duration of exposure to study drug of 6 [2, 36] days), end of study treatment period (median [min, max] duration of exposure to study drug of 36.5 [2, 90] days) and at 1 month follow-up

  10. Mortality

    Total mortality up to 1 month follow-up.

    Time frame: From the start of the study up to 1 month follow-up

  11. Number of PE Related Adverse Events

    Number of PE treatment-related adverse events (AEs).

    Time frame: From the start of the study up to 1 month follow-up

  12. Number and Percentage of Subjects With PE Related AEs

    Number and percentage of subjects with PE related AEs.

    Time frame: From the start of the study up to 1 month follow-up

  13. Number of Treatment-emergent Adverse Events (TEAEs) by Severity

    Number and severity of TEAEs were evaluated. The severity grades of AEs were defined as: mild, moderate, and severe. Note: the numbers listed do not include the TEAEs with missing severity.

    Time frame: From the start of the study up to 1 month follow-up

  14. Number and Percentage of Subjects With TEAEs by Severity

    Number and percentage of subjects with TEAEs by severity. The severity grades of AEs were defined as: mild, moderate, and severe.

    Time frame: From the start of the study up to 1 month follow-up

  15. Number of TEAEs and Their Relationship to Study Drug

    Number of TEAEs and their relationship to study drug were evaluated. Relationship of AEs to study drug was: related, possibly related, and unlikely/not related.

    Time frame: From the start of the study up to 1 month follow-up

  16. Number of Participants Who Developed Treatment-emergent Anti-Drug Antibodies (ADA)

    The development of anti-drug antibodies (ADA) was monitored from the start of the study until last follow-up visit.

    Time frame: From the start of the study until last follow-up visit

  17. Plasma Concentrations of Caplacizumab

    The concentration of caplacizumab in plasma was determined at different time points. pharmacokinetics (PK) Population: the PK Population consisted of all subjects who received the study drug and for whom the primary PK data are considered to be sufficient and interpretable.

    Time frame: From the start of the study up to 1 month follow-up (i.e., at Baseline, Days 1 and 2 of daily PE, last day of daily PE, Day 1 after daily PE, Weeks 1, 2, 3, and 4 after daily PE, Days 3 and 7 of FU and at the 1-month FU visit).

  18. Pharmacodynamics (PD): Ristocetin Cofactor (RICO) Activity Over Time

    The change from baseline in RICO activity was measured at different time points.

    Time frame: From the start of the study up to 1 month follow-up (i.e., at Baseline, Days 1 and 2 of daily PE, last day of daily PE, Day 1 after daily PE, Weeks 1, 2, 3, and 4 after daily PE, Days 3 and 7 of FU and at the 1-month FU visit).

  19. Pharmacodynamics: Von Willebrand Factor Antigen (vWF:Ag) Over Time

    The change from baseline in vWF:Ag concentration was measured at different time points.

    Time frame: From the start of the study drug up to 1 month follow-up (i.e., at Baseline, Days 1 and 2 of daily PE, last day of daily PE, Day 1 after daily PE, Weeks 1, 2, 3, and 4 after daily PE, Days 3 and 7 of FU and at the 1-month FU visit).

  20. PD: Coagulation Factor VIII Clotting Activity (FVIII:C) Over Time

    The change from baseline in FVIII:C concentration was measured at different ime points.

    Time frame: From the start of the study up to 1 month follow-up (i.e., at Baseline, Days 1 and 2 of daily PE, last day of daily PE, Day 1 after daily PE, Weeks 1, 2, 3, and 4 after daily PE, Days 3 and 7 of FU and at the 1-month FU visit).

07

Results

Posted May 29, 2019
Limitations and caveats
The study was stopped prematurely before meeting its enrollment target. The study is not considered to have been terminated as sites were requested to perform the assessments until 1-month follow-up if they had subjects in the study.

Participant flow

Subjects with aTTP were recruited from 11 countries in Europe, Australia, Asia and United States (US). Only adults were recruited; no adolescent patients were enrolled, although the trial was open for adolescent patients. A total of 75 patients were included in the trial.

Participant flow — Overall Study
MilestoneCaplacizumabPlacebo
Started3639
Received study drug3537
Completed2021
Not completed1618
Withdrew: Study terminated by sponsor910
Withdrew: Protocol violation01
Withdrew: Physician decision11
Withdrew: Pregnancy01
Withdrew: Death01
Withdrew: Adverse event30
Withdrew: Withdrawal by subject13
Withdrew: Lost to follow-up10
Withdrew: Diagnosed as non-ttp patient01
Withdrew: Participated in other clinical trial10

Outcome measures

PrimaryTime-to-response of Treatment Defined by a Confirmed Recovery of Platelets ≥ 150,000/µL

Time-to-response, defined by the achievement of platelet count response, confirmed at 48 hours after the initial reporting of this response. Platelet response was defined as recovery of platelets ≥ 150,000/µL. This response had to be confirmed at 48 hours after the initial reporting of platelet recovery ≥ 150,000/µL by a de novo measure of platelets ≥ 150,000/µL and lactate dehydrogenase (LDH) ≤ 2x upper limit of normal (ULN) (i.e., 'confirmed platelet response').

Time frame:
From the day of first study drug administration up to 30 days after first study drug administration
Reported as:
Median · days
Time-to-response of Treatment Defined by a Confirmed Recovery of Platelets ≥ 150,000/µL
daysCaplacizumabPlacebo
YES - One PE session prior to randomization2.4 (1.9 to 3)4.3 (2.9 to 5.7)
NO - No PE session prior to randomization3 (2.7 to 3.9)4.9 (3.2 to 6.6)
Statistical analysis
  • Caplacizumab vs Placebo · Stratified log-rank test · p = = 0.005 (Caplacizumab was compared to placebo using a one-sided log-rank test in order to assess superiority at 2.5% significance level.) · Hazard ratio (hr): 2.2 · 95% CI 1.28 to 3.78The HR was estimated from a Cox proportional Hazards regression model with presence (yes) / absence (no) of 1 PE session prior to randomization as covariate.
SecondaryNumber and Percentage of Subjects With Complete Remission Following Initial Daily Plasma Exchange (PE)

Number and percentage of subjects with complete remission (defined as confirmed platelet count response and absence of exacerbation) following initial daily PE.

Time frame:
From the day of first study drug administration up to 30 days after first study drug administration
Reported as:
Count of participants · Participants
Number and Percentage of Subjects With Complete Remission Following Initial Daily Plasma Exchange (PE)
ParticipantsCaplacizumabPlacebo
Number and Percentage of Subjects With Complete Remission Following Initial Daily Plasma Exchange (PE)2918
SecondaryNumber and Percentage of Subjects With Exacerbations of TTP

Number and percentage of subjects with exacerbations of TTP (defined as recurrent thrombocytopenia following a confirmed platelet count response and requiring a re-initiation of daily PE treatment after ≥ 1 day but ≤ 30 days of end of daily PE treatment. Time to first exacerbation of TTP was also examined as part of this end point analysis; the median time to first exacerbation could not be determined because of the small number of events.

Time frame:
Within 30 days of last day of initial daily PE
Reported as:
Count of participants · Participants
Number and Percentage of Subjects With Exacerbations of TTP
ParticipantsCaplacizumabPlacebo
Number and Percentage of Subjects With Exacerbations of TTP311
SecondaryNumber and Percentage of Subjects With Relapse of TTP

Number and percentage of subjects with relapse of TTP (defined as de novo TTP event that occurred later than 30 days after the last daily PE) was evaluated.

Time frame:
Later than 30 days after the last daily PE
Reported as:
Count of participants · Participants
Number and Percentage of Subjects With Relapse of TTP
ParticipantsCaplacizumabPlacebo
Number and Percentage of Subjects With Relapse of TTP113
SecondaryNumber of Daily PE Sessions During the Initial Daily PE Period

Number of daily PE sessions during the initial daily PE period which could include more than 1 PE per day was evaluated.

Time frame:
During the initial daily PE period, with a median (min, max) duration of exposure to study drug of 6 (2, 36) days
Reported as:
Mean · PE sessions
Number of Daily PE Sessions During the Initial Daily PE Period
PE sessionsCaplacizumabPlacebo
Number of Daily PE Sessions During the Initial Daily PE Period6.7 ± 3.698.4 ± 6.74
SecondaryTotal Volume of Plasma Administered During the Initial Daily PE Period

The total volume of plasma administered during the initial daily PE period was measured.

Time frame:
During the initial daily PE period, with a median (min, max) duration of exposure to study drug of 6 (2, 36) days
Reported as:
Mean · mL
Total Volume of Plasma Administered During the Initial Daily PE Period
mLCaplacizumabPlacebo
Total Volume of Plasma Administered During the Initial Daily PE Period22481.8 ± 15914.8528358.4 ± 21344.16
SecondaryNumber of Days With at Least One PE Administration During the Total Course of the Study

Number of days for PE was evaluated. This implies the number of days with at least one PE administration during the total course of the study.

Time frame:
During the total course of the study (from Screening till the 12-month follow-up [FU] visit)
Reported as:
Mean · days
Number of Days With at Least One PE Administration During the Total Course of the Study
daysCaplacizumabPlacebo
Number of Days With at Least One PE Administration During the Total Course of the Study11.8 ± 7.4312.6 ± 9.15
SecondaryThe Maximum Number of Consecutive Days Per Subject Where There Was no Interruption of PE During the Initial Daily PE Period

The maximum number of consecutive days per subject where there was no interruption of PE during the initial daily PE period.

Time frame:
During the initial daily PE period, with a median (min, max) duration of exposure to study drug of 6 (2, 36) days
Reported as:
Mean · days
The Maximum Number of Consecutive Days Per Subject Where There Was no Interruption of PE During the Initial Daily PE Period
daysCaplacizumabPlacebo
The Maximum Number of Consecutive Days Per Subject Where There Was no Interruption of PE During the Initial Daily PE Period6.6 ± 3.358.1 ± 6.46
SecondaryResolution of Non-focal Neurological Symptoms

Resolution of non-focal neurological symptoms as defined by neurocognitive function at complete remission, measured by a Computerised Neuropsychological Test Battery(CNTB) (adults only). The CNTB included 6 modules: word list learning and selective reminding (WLL/SR), choice reaction time (CRT), visual memory (VMEM), simple reaction time (SRT), working memory (WMEM), and word list learning and delayed recall (WLL/DR). The 6 tasks are rated as a percentage correct (for CRT and SRT, the percentage correct corresponds to the percentage hits) and the mean score from these provides the CNTB summary score (range: 0-100). A higher CNTB summary score indicates better neuropsychological functioning.

Time frame:
From Baseline till the 12-month FU visit
Reported as:
Mean · score on a scale
Resolution of Non-focal Neurological Symptoms
score on a scaleCaplacizumabPlacebo
Baseline66.76 ± 11.8849.62 ± 12.91
12 months post discharge62.10 ± 12.0658.36 ± 10.23
SecondaryNumber of Participants With Resolution of TTP-related Signs or Symptoms

Resolution or improvement (improvement of ≥ 1 grade in the Common Terminology Criteria for Adverse Events \[CTCAE\] v4.0 scale) of TTP-related signs and symptoms as captured on physical examination and as adverse events. This endpoint was only evaluated for "resolution".

Time frame:
End of daily PE treatment period (median [min, max] duration of exposure to study drug of 6 [2, 36] days), end of study treatment period (median [min, max] duration of exposure to study drug of 36.5 [2, 90] days) and at 1 month follow-up
Reported as:
Count of participants · Participants
Number of Participants With Resolution of TTP-related Signs or Symptoms
ParticipantsCaplacizumabPlacebo
End of daily PE treatment period2929
End of study treatment period3033
At 1 month follow-up3127
SecondaryMortality

Total mortality up to 1 month follow-up.

Time frame:
From the start of the study up to 1 month follow-up
Reported as:
Count of participants · Participants
Mortality
ParticipantsCaplacizumabPlacebo
Mortality02
SecondaryNumber of PE Related Adverse Events

Number of PE treatment-related adverse events (AEs).

Time frame:
From the start of the study up to 1 month follow-up
Reported as:
Number · adverse events
Number of PE Related Adverse Events
adverse eventsCaplacizumabPlacebo
Number of PE Related Adverse Events7244
SecondaryNumber and Percentage of Subjects With PE Related AEs

Number and percentage of subjects with PE related AEs.

Time frame:
From the start of the study up to 1 month follow-up
Reported as:
Count of participants · Participants
Number and Percentage of Subjects With PE Related AEs
ParticipantsCaplacizumabPlacebo
Number and Percentage of Subjects With PE Related AEs2020
SecondaryNumber of Treatment-emergent Adverse Events (TEAEs) by Severity

Number and severity of TEAEs were evaluated. The severity grades of AEs were defined as: mild, moderate, and severe. Note: the numbers listed do not include the TEAEs with missing severity.

Time frame:
From the start of the study up to 1 month follow-up
Reported as:
Number · adverse events
Number of Treatment-emergent Adverse Events (TEAEs) by Severity
adverse eventsCaplacizumabPlacebo
Mild348299
Moderate154173
Severe3723
SecondaryNumber and Percentage of Subjects With TEAEs by Severity

Number and percentage of subjects with TEAEs by severity. The severity grades of AEs were defined as: mild, moderate, and severe.

Time frame:
From the start of the study up to 1 month follow-up
Reported as:
Count of participants · Participants
Number and Percentage of Subjects With TEAEs by Severity
ParticipantsCaplacizumabPlacebo
Mild3136
Moderate2731
Severe1814
SecondaryNumber of TEAEs and Their Relationship to Study Drug

Number of TEAEs and their relationship to study drug were evaluated. Relationship of AEs to study drug was: related, possibly related, and unlikely/not related.

Time frame:
From the start of the study up to 1 month follow-up
Reported as:
Number · adverse events
Number of TEAEs and Their Relationship to Study Drug
adverse eventsCaplacizumabPlacebo
Related126
Possibly related599
Unlikely/not related486524
SecondaryNumber of Participants Who Developed Treatment-emergent Anti-Drug Antibodies (ADA)

The development of anti-drug antibodies (ADA) was monitored from the start of the study until last follow-up visit.

Time frame:
From the start of the study until last follow-up visit
Reported as:
Count of participants · Participants
Number of Participants Who Developed Treatment-emergent Anti-Drug Antibodies (ADA)
ParticipantsCaplacizumabPlacebo
Number of Participants Who Developed Treatment-emergent Anti-Drug Antibodies (ADA)30
SecondaryPlasma Concentrations of Caplacizumab

The concentration of caplacizumab in plasma was determined at different time points. pharmacokinetics (PK) Population: the PK Population consisted of all subjects who received the study drug and for whom the primary PK data are considered to be sufficient and interpretable.

Time frame:
From the start of the study up to 1 month follow-up (i.e., at Baseline, Days 1 and 2 of daily PE, last day of daily PE, Day 1 after daily PE, Weeks 1, 2, 3, and 4 after daily PE, Days 3 and 7 of FU and at the 1-month FU visit).
Reported as:
Mean · ng/mL
Plasma Concentrations of Caplacizumab
ng/mLCaplacizumabPlacebo
Baseline100 ± 0—
Day 1 of daily PE, 5 - 10 min postdose1765.9 ± 185.04—
Day 1 of daily PE, 3 - 6 hours postdose450.4 ± 36.15—
Day 1 of daily PE, 8 - 24 hours postdose562 ± 36.8—
Day 2 of daily PE, predose288 ± 24.05—
Day 2 of daily PE, 1 - 6 hours postdose415.8 ± 24.75—
Day 2 of daily PE, 6 - 12 hours postdose570.7 ± 52.22—
Day 2 of daily PE, 18 - 24 hours postdose489.3 ± 32.54—
Last day of daily PE, predose348.4 ± 38.32—
Day 1 after daily PE521.9 ± 31.52—
Week 1 after daily PE490.6 ± 36.11—
Week 2 after daily PE524.9 ± 39.37—
Week 3 after daily PE499.6 ± 35.1—
Week 4 after daily PE503.4 ± 31.21—
Day 3 of follow-up period346.7 ± 25.43—
Day 7 of follow-up period162.3 ± 20.2—
1 month follow-up100 ± 0—
SecondaryPharmacodynamics (PD): Ristocetin Cofactor (RICO) Activity Over Time

The change from baseline in RICO activity was measured at different time points.

Time frame:
From the start of the study up to 1 month follow-up (i.e., at Baseline, Days 1 and 2 of daily PE, last day of daily PE, Day 1 after daily PE, Weeks 1, 2, 3, and 4 after daily PE, Days 3 and 7 of FU and at the 1-month FU visit).
Reported as:
Mean · percentage of RICO activity
Pharmacodynamics (PD): Ristocetin Cofactor (RICO) Activity Over Time
percentage of RICO activityCaplacizumabPlacebo
Baseline76.2 ± 4.9582.1 ± 3.76
Day 1 of daily PE, post dose16.2 ± 0.7284.4 ± 6.09
Day 2 of daily PE, post dose21.4 ± 3.6494.4 ± 3.69
Last day of daily PE, post dose15.4 ± 0.39118.2 ± 1.78
Day 1 after daily PE19.2 ± 3.94105.2 ± 4.31
Week 1 after daily PE15 ± 0107.3 ± 3.05
Week 2 after daily PE18.9 ± 2.87109.2 ± 2.8
Week 3 after daily PE17.4 ± 2.34104 ± 3.46
Week 4 after daily PE15.1 ± 0.07105.5 ± 3.59
Day 3 of follow-up period42.3 ± 6.3399.1 ± 4.56
Day 7 of follow-up period88.3 ± 4.9999.7 ± 4.06
1 month follow-up94.6 ± 3.7894.7 ± 5.35
SecondaryPharmacodynamics: Von Willebrand Factor Antigen (vWF:Ag) Over Time

The change from baseline in vWF:Ag concentration was measured at different time points.

Time frame:
From the start of the study drug up to 1 month follow-up (i.e., at Baseline, Days 1 and 2 of daily PE, last day of daily PE, Day 1 after daily PE, Weeks 1, 2, 3, and 4 after daily PE, Days 3 and 7 of FU and at the 1-month FU visit).
Reported as:
Mean · Percentage of vWF:Ag
Pharmacodynamics: Von Willebrand Factor Antigen (vWF:Ag) Over Time
Percentage of vWF:AgCaplacizumabPlacebo
Baseline185.1 ± 15.09204.4 ± 14.52
Day 1 of daily PE, post dose120.6 ± 7.98166.6 ± 9.24
Day 2 of daily PE, post dose94.6 ± 4.83140.2 ± 6.16
Last day of daily PE, post dose93.6 ± 6.01151.2 ± 14.25
Day 1 after daily PE86.2 ± 6.15166 ± 10.05
Week 1 after daily PE93.4 ± 6.4234.9 ± 20.91
Week 2 after daily PE115.9 ± 12.42242.6 ± 19.43
Week 3 after daily PE102.4 ± 6.45224.2 ± 18.62
Week 4 after daily PE100.1 ± 5204.3 ± 17.08
Day 3 of follow-up period137.8 ± 9.32184.1 ± 13.89
Day 7 of follow-up period190.2 ± 12.9190.3 ± 14.81
1 month follow-up176.3 ± 15.63167.2 ± 15.46
SecondaryPD: Coagulation Factor VIII Clotting Activity (FVIII:C) Over Time

The change from baseline in FVIII:C concentration was measured at different ime points.

Time frame:
From the start of the study up to 1 month follow-up (i.e., at Baseline, Days 1 and 2 of daily PE, last day of daily PE, Day 1 after daily PE, Weeks 1, 2, 3, and 4 after daily PE, Days 3 and 7 of FU and at the 1-month FU visit).
Reported as:
Mean · Percentage of FVIII:C activity
PD: Coagulation Factor VIII Clotting Activity (FVIII:C) Over Time
Percentage of FVIII:C activityCaplacizumabPlacebo
Baseline144.18 ± 11.14156.8 ± 12.54
Day 1 of daily PE, post dose104 ± 6.95149 ± 9.16
Day 2 of daily PE, post dose90.7 ± 5.49152.9 ± 9.41
Last day of daily PE, post dose102.4 ± 10.91169.5 ± 17.79
Day 1 after daily PE116.3 ± 13.33234.2 ± 16.05
Week 1 after daily PE116.4 ± 11.73296.8 ± 26.07
Week 2 after daily PE125.2 ± 16.88291.1 ± 18.25
Week 3 after daily PE106.3 ± 9.7273.1 ± 20.35
Week 4 after daily PE95.8 ± 6.09249.1 ± 18.27
Day 3 of follow-up period146.3 ± 12.59227.7 ± 17.32
Day 7 of follow-up period208.6 ± 15.54237.5 ± 15.65
1 month follow-up212.2 ± 17.33200.1 ± 17.11

Adverse events

Collected over From time of the first study drug administration up to the last follow-up visit (12 months). Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Caplacizumab0/35 (0%)20/35 (57.1%)33/35 (94.3%)
Placebo2/37 (5.4%)19/37 (51.4%)37/37 (100%)
Most frequent serious events
Showing 10 of 42
Most frequent serious events
EventCaplacizumabPlacebo
Thrombotic thrombocytopenic purpuraBlood and lymphatic system disorders13/3513/37
DizzinessNervous system disorders2/350/37
AnemiaBlood and lymphatic system disorders1/350/37
Retinal hemorrhageEye disorders1/350/37
HypertransaminasemiaHepatobiliary disorders1/350/37
Bacterial infectionInfections and infestations1/350/37
Muscle abscessInfections and infestations1/350/37
SepsisInfections and infestations1/350/37
Urinary tract infectionInfections and infestations1/350/37
Alanine aminotransferase increasedInvestigations1/350/37
Most frequent other events
Showing 10 of 98
Most frequent other events
EventCaplacizumabPlacebo
HeadacheNervous system disorders11/3510/37
EpistaxisRespiratory, thoracic and mediastinal disorders11/354/37
NauseaGastrointestinal disorders10/3510/37
ConstipationGastrointestinal disorders7/3510/37
HypokalemiaMetabolism and nutrition disorders9/358/37
AnemiaBlood and lymphatic system disorders2/358/37
ArthralgiaMusculoskeletal and connective tissue disorders3/358/37
ParaesthesiaNervous system disorders7/358/37
VomitingGastrointestinal disorders7/357/37
MyalgiaMusculoskeletal and connective tissue disorders7/351/37

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)CaplacizumabPlaceboTotal
<=18 years000
Between 18 and 65 years353873
>=65 years112
Age, Continuous
Age, Continuous(years)CaplacizumabPlaceboTotal
Mean40.6 ± 12.742.5 ± 13.1841.6 ± 12.9
Sex: Female, Male
Sex: Female, Male(Participants)CaplacizumabPlaceboTotal
Female242044
Male121931
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)CaplacizumabPlaceboTotal
Race/Ethnicity — Caucasian323466
Race/Ethnicity — Black459
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Study locations

51 sites
  • Investigator Site
    Los Angeles, California 90033, United States
  • Investigator Site
    Washington, District of Columbia, United States
  • Investigator Site
    Atlanta, Georgia 30322, United States
  • Investigator Site
    Saint Louis, Missouri 63110, United States
  • Investigator Site
    New York, New York 10021, United States
  • Investigator Site
    Rochester, New York 14642, United States
  • Investigator Site
    Valhalla, New York 10595, United States
  • Investigator Site
    Durham, North Carolina 27710, United States
  • Investigator Site
    Winston-Salem, North Carolina 27157, United States
  • Investigator Site
    Columbus, Ohio 43210, United States
  • Investigator Site
    Pittsburgh, Pennsylvania 15224, United States
  • Investigator Site
    Dallas, Texas, United States
  • Investigator Site
    Salt Lake City, Utah 84132, United States
  • Investigator Site
    Garran, Australian Capital Territory, Australia
  • Investigator Site
    Liverpool, Australia
  • Investigator Site
    Melbourne, Australia
  • Investigator Site
    Woolloongabba, Australia
  • Investigator Site
    Graz, Austria
  • Investigator Site
    Vienna, Austria
  • Investigator Site
    Antwerp, Belgium
  • Investigator Site
    Brussels, Belgium
  • Investigator Site
    Leuven, Belgium
  • Investigator Site
    Namur, Belgium
  • Investigator Site
    Sofia, Bulgaria
  • Investigator Site
    Caen, France
  • Investigator Site
    Ulm, Baden-Wuerttemberg, Germany
  • Investigator Site
    Aachen, Germany
  • Investigator Site
    Berlin, Germany
  • Investigator Site
    Dortmund, Germany
  • Investigator Site
    Hannover, Germany
  • Investigator Site
    Köln, Germany
  • Investigator Site
    Mainz, Germany
  • Investigator Site
    Mannheim, Germany
  • Investigator Site
    Munchen, Germany
  • Investigator Site
    Haifa, Israel
  • Investigator Site
    Jerusalem, Israel
  • Investigator Site
    Petach Tikva, Israel
  • Investigator Site
    Catania, Italy
  • Investigator Site
    Foggia, Italy
  • Investigator Site
    Milan, Italy
  • Investigator Site
    Reggio Emilia, Italy
  • Investigator Site
    Rome, Italy
  • Investigator Site
    Bucharest, Romania
  • Investigator Site
    Badalona, Spain
  • Investigator Site
    Sevilla, Spain
  • Investigator Site
    Valencia, Spain
  • Investigator Site
    Bern, Switzerland
  • Investigator Site
    Lausanne, Switzerland
  • Investigator Site
    Zurich, Switzerland
  • Investigator Site
    Liverpool, United Kingdom
  • Investigator Site
    London, United Kingdom
09

References and documents

Publications

  • Peyvandi F, Cataland S, Scully M, Coppo P, Knoebl P, Kremer Hovinga JA, Metjian A, de la Rubia J, Pavenski K, Minkue Mi Edou J, De Winter H, Callewaert F. Caplacizumab prevents refractoriness and mortality in acquired thrombotic thrombocytopenic purpura: integrated analysis. Blood Adv. 2021 Apr 27;5(8):2137-2141. doi: 10.1182/bloodadvances.2020001834. PubMed 33881463 ↗
  • Peyvandi F, Scully M, Kremer Hovinga JA, Cataland S, Knobl P, Wu H, Artoni A, Westwood JP, Mansouri Taleghani M, Jilma B, Callewaert F, Ulrichts H, Duby C, Tersago D; TITAN Investigators. Caplacizumab for Acquired Thrombotic Thrombocytopenic Purpura. N Engl J Med. 2016 Feb 11;374(6):511-22. doi: 10.1056/NEJMoa1505533. PubMed 26863353 ↗
  • Holz JB. The TITAN trial--assessing the efficacy and safety of an anti-von Willebrand factor Nanobody in patients with acquired thrombotic thrombocytopenic purpura. Transfus Apher Sci. 2012 Jun;46(3):343-6. doi: 10.1016/j.transci.2012.03.027. Epub 2012 Apr 3. PubMed 22475545 ↗

Study documents

  • Study protocol · Jun 24, 2013
  • Statistical analysis plan · Dec 9, 2013

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Yes — Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Apr 4, 2023, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT01151423
Lead sponsor
Ablynx, a Sanofi company
Responsible party
Sponsor
First posted
Jun 28, 2010
Start date
Jan 2011
Primary completion
Mar 2014
Completion
Mar 2014
Results posted
May 29, 2019
Last update
Apr 4, 2023

Study contacts

Medical Monitor
study director · Ablynx NV

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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