A Phase 1 interventional study of Pegcetacoplan in Paroxysmal Nocturnal Hemoglobinuria, sponsored by Apellis Pharmaceuticals, Inc.. Completed at 7 sites in 4 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-01-11.
Sponsored by Apellis Pharmaceuticals, Inc. · Phase 1, Interventional, and Treatment
The objectives of the study are to assess the safety, tolerability, preliminary efficacy and PK of multiple subcutaneous (SC) doses of pegcetacoplan in subjects with paroxysmal nocturnal hemoglobinuria (PNH) who have not received treatment with eculizumab in the past.
An exploratory objective of the study is to assess the pharmacodynamics (PD) of multiple SC doses of pegcetacoplan when administered to PNH patients.
This is a Phase Ib, open-label, multiple ascending dose, pilot study in patients with PNH who have not received eculizumab (Soliris)® in the past. Two cohorts of 3 subjects are planned for evaluation.
Safety will be assessed throughout the study; serial blood and urine samples will be collected for these assessments. Blood samples will be collected for the assessment of pegcetacoplan PK. Additional samples for assessment of PD will also be collected.
The study will consist of four parts;
Subjects will be entered into Part 1 of the study on Day 1 at a time designated by the PI. During Part 1, the first 3 daily SC doses of pegcetacoplan (Day 1 to 3) as well as doses on Day 8, 15 and 22 will be administered at the clinical site. From Day 4 to Day 28 daily doses of pegcetacoplan will be administered off-site by a trained study nurse at the subject's home, workplace, or other location convenient to the subject with the exception of those days where dosing is at the clinical site. Following ongoing review of available safety, PK and PD data by the investigator and sponsor, subjects showing evidence of perceived clinical benefit may progress to Part 2A and then to Part 2B of the study and continue to receive daily doses of pegcetacoplan until Day 84 and then until Day 364.
Cohort 2 will not be initiated until all subjects in Cohort 1 have reached the Day 29 visit and the SMC has reviewed emerging safety and efficacy data and determined that, at the initial dose, pegcetacoplan has an acceptable safety and tolerability profile.
The planned length of participation in the study for each subject in Cohort 2 is approximately 444 days (14.5 months) from Day 30 through completion of the Day 414 Exit visit procedures).
The study is planned to take place over approximately 24 months (from screening of Cohort 1 through completion of Cohort 2).
This time period may change in the event that the study is terminated early, additional cohorts are enrolled, additional time is required to review safety between cohorts, or extended safety and PK sampling is added for a cohort.
107 studies on the registry are indexed under Hemoglobinuria; 10 are open to participants now.
This study's enrollment of 23 is below the median of 27 across 89 interventional studies indexed under Hemoglobinuria.
Browse Hemoglobinuria studies →Apellis Pharmaceuticals, Inc. is the lead sponsor of 28 studies on the registry; 3 are open to participants now.
Of its 18 completed or terminated interventional studies of FDA-regulated products, 14 (78%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
180 mg pegcetacoplan/day
Drug: Pegcetacoplan
270 mg pegcetacoplan/day
Drug: Pegcetacoplan
Complement (C3) Inhibitor
Also known as: APL-2
Number of Subjects With Treatment Emergent Adverse Events (TEAEs) Including by Severity
TEAEs were defined as adverse events (AEs) that occurred after dosing on Day 1 and up to 30 days after the last dose of study drug. A treatment-related TEAE is defined as a TEAE with a relationship to study drug of probably, possibly, unlikely, or unrelated. A serious adverse event (SAE) is defined as any AE that resulted in death; was life-threatening; required hospitalization or prolongation of existing hospitalization; resulted in persistent or significant incapacity or substantial disruption of ability to conduct normal life functions; was a congenital anomaly or birth defect. TEAEs were graded according to Common Terminology Criteria for Adverse Events v4.03 based on: Grade 1: Mild; Grade 2: Moderate; Grade 3: Severe; Grade 4: Life-threatening; Grade 5: Death related to AE.
Time frame: From first dose of study drug (Day 1) up to 30 days after the last dose of study drug, up to approximately 563 days.
Mean Change From Baseline in Lactate Dehydrogenase (LDH) at Day 365
Serum chemistry assessments of LDH were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. LDH results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Percentage Change From Baseline in LDH at Day 365
Serum chemistry assessments of LDH were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. LDH results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Change From Baseline in Haptoglobin at Day 365
Serum chemistry assessments of haptoglobin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. Haptoglobin results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Percentage Change From Baseline in Haptoglobin at Day 365
Serum chemistry assessments of haptoglobin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. Haptoglobin results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Change From Baseline in Hemoglobin at Day 365
Hematology assessments of hemoglobin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. Hemoglobin results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Percentage Change From Baseline in Hemoglobin at Day 365
Hematology assessments of hemoglobin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. Hemoglobin results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Score at Day 365
The FACIT-Fatigue Scale is a 13 item Likert scaled instrument where the subject was presented with 13 statements and asked to indicate their response as it applied to the past 7 days. The 5 possible responses were 'Not at all' (0), 'A little bit (1), 'Somewhat' (2), 'Quite a bit' (3) and 'Very much' (4). There are 13 statements with the total score ranging from 0 to 52 and higher scores indicating better quality of life. The FACIT-Fatigue Scale results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Change From Baseline in Absolute Reticulocyte Count (ARC) at Day 365
Hematology assessments of ARC were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. ARC results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Percentage Change From Baseline in ARC at Day 365
Hematology assessments of ARC were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. ARC results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Change From Baseline in Total Bilirubin at Day 365
Serum chemistry assessments of total bilirubin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the 3 parts of the treatment period. Total bilirubin results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Mean Percentage Change From Baseline in Total Bilirubin at Day 365
Serum chemistry assessments of total bilirubin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the 3 parts of the treatment period. Total bilirubin results were summarized for Cohort 2 only.
Time frame: Baseline (Day 1) and Day 365.
Number of Subjects Receiving Red Blood Cell (RBC) Transfusions
The number of on-study RBC transfusions were monitored throughout the treatment period.
Time frame: From Day 1 up to Day 533.
This Phase 1b, pilot study was conducted at 9 sites in 5 countries (Hong Kong, Malaysia, New Zealand, Thailand and United States) in subjects with paroxysmal nocturnal hemoglobinuria (PNH) who had not received treatment with eculizumab (Soliris®) in the past, between 01 December 2015 and 26 August 2019. A total of 22 subjects were enrolled.
| Milestone | Cohort 1 | Cohort 2 |
|---|---|---|
| Started | 3 | 20 |
| Completed | 2 | 20 |
| Not completed | 1 | 0 |
| Withdrew: Withdrawal by subject | 1 | 0 |
| Milestone | Cohort 1 | Cohort 2 |
|---|---|---|
| Started | 0 | 20 |
| Completed | 0 | 18 |
| Not completed | 0 | 2 |
| Withdrew: Physician decision | 0 | 1 |
| Withdrew: Withdrawal by subject | 0 | 1 |
| Milestone | Cohort 1 | Cohort 2 |
|---|---|---|
| Started | 0 | 18 |
| Completed | 0 | 17 |
| Not completed | 0 | 1 |
| Withdrew: Adverse event | 0 | 1 |
| Milestone | Cohort 1 | Cohort 2 |
|---|---|---|
| Started | 0 | 14 |
| Completed | 0 | 12 |
| Not completed | 0 | 2 |
| Withdrew: Adverse event | 0 | 1 |
| Withdrew: Withdrawal by subject | 0 | 1 |
| Milestone | Cohort 1 | Cohort 2 |
|---|---|---|
| Started | 3 | 4 |
| Completed | 3 | 2 |
| Not completed | 0 | 2 |
| Withdrew: Other | 0 | 2 |
TEAEs were defined as adverse events (AEs) that occurred after dosing on Day 1 and up to 30 days after the last dose of study drug. A treatment-related TEAE is defined as a TEAE with a relationship to study drug of probably, possibly, unlikely, or unrelated. A serious adverse event (SAE) is defined as any AE that resulted in death; was life-threatening; required hospitalization or prolongation of existing hospitalization; resulted in persistent or significant incapacity or substantial disruption of ability to conduct normal life functions; was a congenital anomaly or birth defect. TEAEs were graded according to Common Terminology Criteria for Adverse Events v4.03 based on: Grade 1: Mild; Grade 2: Moderate; Grade 3: Severe; Grade 4: Life-threatening; Grade 5: Death related to AE.
| Participants | Cohort 1 | Cohort 2 |
|---|---|---|
| All TEAEs | 2 | 18 |
| Treatment related TEAEs | 2 | 9 |
| Serious AEs | 1 | 6 |
| TEAEs leading to study drug discontinuation | 1 | 2 |
| TEAEs leading to death | 0 | 1 |
| TEAEs with mild intensity | 0 | 3 |
| TEAEs with moderate intensity | 2 | 8 |
| TEAEs with severe intensity | 0 | 5 |
| TEAEs with life threatening intensity | 0 | 1 |
Serum chemistry assessments of LDH were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. LDH results were summarized for Cohort 2 only.
| units per liter (U/L) | Cohort 2 |
|---|---|
| Mean Change From Baseline in Lactate Dehydrogenase (LDH) at Day 365 | -2105.2 ± 1078.79 |
Serum chemistry assessments of LDH were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. LDH results were summarized for Cohort 2 only.
| percent change | Cohort 2 |
|---|---|
| Mean Percentage Change From Baseline in LDH at Day 365 | -84.8 ± 14.04 |
Serum chemistry assessments of haptoglobin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. Haptoglobin results were summarized for Cohort 2 only.
| gram per liter (g/L) | Cohort 2 |
|---|---|
| Mean Change From Baseline in Haptoglobin at Day 365 | 0.066 ± 0.1245 |
Serum chemistry assessments of haptoglobin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. Haptoglobin results were summarized for Cohort 2 only.
| percent change | Cohort 2 |
|---|---|
| Mean Percentage Change From Baseline in Haptoglobin at Day 365 | 166.176 ± 311.3656 |
Hematology assessments of hemoglobin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. Hemoglobin results were summarized for Cohort 2 only.
| g/L | Cohort 2 |
|---|---|
| Mean Change From Baseline in Hemoglobin at Day 365 | 3.68 ± 2.690 |
Hematology assessments of hemoglobin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. Hemoglobin results were summarized for Cohort 2 only.
| percent change | Cohort 2 |
|---|---|
| Mean Percentage Change From Baseline in Hemoglobin at Day 365 | 49.86 ± 43.254 |
The FACIT-Fatigue Scale is a 13 item Likert scaled instrument where the subject was presented with 13 statements and asked to indicate their response as it applied to the past 7 days. The 5 possible responses were 'Not at all' (0), 'A little bit (1), 'Somewhat' (2), 'Quite a bit' (3) and 'Very much' (4). There are 13 statements with the total score ranging from 0 to 52 and higher scores indicating better quality of life. The FACIT-Fatigue Scale results were summarized for Cohort 2 only.
| score on a scale | Cohort 2 |
|---|---|
| Mean Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Score at Day 365 | 7.1 ± 11.09 |
Hematology assessments of ARC were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. ARC results were summarized for Cohort 2 only.
| 10^9 cells/L | Cohort 2 |
|---|---|
| Mean Change From Baseline in Absolute Reticulocyte Count (ARC) at Day 365 | -105.9 ± 70.28 |
Hematology assessments of ARC were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the different parts of the treatment period. ARC results were summarized for Cohort 2 only.
| percent change | Cohort 2 |
|---|---|
| Mean Percentage Change From Baseline in ARC at Day 365 | -47.5 ± 26.86 |
Serum chemistry assessments of total bilirubin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the 3 parts of the treatment period. Total bilirubin results were summarized for Cohort 2 only.
| micromole per liter (umol/L) | Cohort 2 |
|---|---|
| Mean Change From Baseline in Total Bilirubin at Day 365 | -29.9 ± 24.34 |
Serum chemistry assessments of total bilirubin were made at the last measurement prior to the first dose of pegcetacoplan (baseline) and periodically throughout the 3 parts of the treatment period. Total bilirubin results were summarized for Cohort 2 only.
| percent change | Cohort 2 |
|---|---|
| Mean Percentage Change From Baseline in Total Bilirubin at Day 365 | -60.9 ± 19.00 |
The number of on-study RBC transfusions were monitored throughout the treatment period.
| Participants | Cohort 1 | Cohort 2 |
|---|---|---|
| Number of Subjects Receiving Red Blood Cell (RBC) Transfusions | 1 | 7 |
Collected over TEAE data is reported from first dose of study drug (Day 1) up to 30 days after the last dose of study drug, up to approximately 563 days.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Cohort 1 | 0/3 (0%) | 1/3 (33.3%) | 2/3 (66.7%) |
| Cohort 2 | 1/20 (5%) | 6/20 (30%) | 17/20 (85%) |
| Event | Cohort 1 | Cohort 2 |
|---|---|---|
| HypersensitivityImmune system disorders | 1/3 | 0/20 |
| HaemolysisBlood and lymphatic system disorders | 0/3 | 2/20 |
| Abdominal neoplasmNeoplasms benign, malignant and unspecified (incl cysts and polyps) | 0/3 | 1/20 |
| Aplastic anaemiaBlood and lymphatic system disorders | 0/3 | 1/20 |
| Intravascular haemolysisBlood and lymphatic system disorders | 0/3 | 1/20 |
| Acute kidney injuryRenal and urinary disorders | 0/3 | 1/20 |
| Joint dislocationInjury, poisoning and procedural complications | 0/3 | 1/20 |
| PneumonitisRespiratory, thoracic and mediastinal disorders | 0/3 | 1/20 |
| Paroxysmal nocturnal haemoglobinuriaBlood and lymphatic system disorders | 0/3 | 1/20 |
| Cholecystitis acuteHepatobiliary disorders | 0/3 | 1/20 |
| Event | Cohort 1 | Cohort 2 |
|---|---|---|
| Urinary tract infectionInfections and infestations | 1/3 | 0/20 |
| Injection site erythemaGeneral disorders | 1/3 | 4/20 |
| Upper respiratory tract infectionInfections and infestations | 0/3 | 5/20 |
| HypokalaemiaMetabolism and nutrition disorders | 0/3 | 4/20 |
| EpistaxisRespiratory, thoracic and mediastinal disorders | 0/3 | 3/20 |
| Electrocardiogram QT prolongedInvestigations | 0/3 | 3/20 |
| NeutropeniaBlood and lymphatic system disorders | 0/3 | 3/20 |
| PharyngitisInfections and infestations | 0/3 | 2/20 |
| PyrexiaGeneral disorders | 0/3 | 2/20 |
| Rash maculo-papularSkin and subcutaneous tissue disorders | 0/3 | 2/20 |
The Intent-To-Treat (ITT) population set included all subjects eligible to receive study drug and who received ≥1 dose of study drug. In this study, subjects could participate in more than 1 cohort. Overall, 2 cohorts of 22 unique subjects were evaluated as one subject participated in cohorts 1 and 2.
| Age, Categorical(Participants) | Cohort 1 | Cohort 2 | Total |
|---|---|---|---|
| <=18 years | 0 | 0 | 0 |
| Between 18 and 65 years | 3 | 19 | 22 |
| >=65 years | 0 | 1 | 1 |
| Sex: Female, Male(Participants) | Cohort 1 | Cohort 2 | Total |
|---|---|---|---|
| Female | 1 | 9 | 10 |
| Male | 2 | 11 | 13 |
| Race/Ethnicity, Customized(Participants) | Cohort 1 | Cohort 2 | Total |
|---|---|---|---|
| White | 3 | 1 | 4 |
| Asian | 0 | 15 | 15 |
| Native Hawaiian or Other Pacific Islander | 0 | 1 | 1 |
| Maori | 0 | 1 | 1 |
| Other | 0 | 2 | 2 |
| Race/Ethnicity, Customized(Participants) | Cohort 1 | Cohort 2 | Total |
|---|---|---|---|
| Not Hispanic or Latino | 3 | 19 | 22 |
| Unknown | 0 | 1 | 1 |
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Apellis Pharmaceuticals, Inc.