A Phase 2 interventional study of Ravulizumab in Paroxysmal Nocturnal Hemoglobinuria and PNH, sponsored by Alexion Pharmaceuticals, Inc.. Completed at 16 sites in 7 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2023-01-04.
Sponsored by Alexion Pharmaceuticals, Inc. · Phase 2, Interventional, and Treatment
The primary purpose of this study is to evaluate the safety, tolerability, and efficacy of multiple intravenous (IV) doses of ravulizumab administered to complement inhibitor treatment-naïve participants with PNH.
The study consisted of a screening period of up to 30 days and a Treatment Period of up to 253 days for Cohorts 1-3 and 281 days for Cohort 4. After completion of the Treatment Period, all participants had the opportunity to enter the Extension Period, wherein participants continue to receive ravulizumab for up to 5 years. The first dose in the Extension Period occurred on Day 253 for Cohorts 1-3 and on Day 281 for Cohort 4.
The data presented includes the Primary Completion date of the study for the Treatment Period. The results for the Extension Period will be reported after study completion.
Exclusion Criteria:
During the Treatment Period, participants were administered ravulizumab 1400 milligram (mg) on Day 1, ravulizumab 1000 mg on Day 15 and Day 29, and then ravulizumab 1000 mg every 4 weeks for 7 doses. In the Extension Period, participants initially continued to receive their dose. During the second year of the study, participants were administered weight-based doses of ravulizumab every 8 weeks for up to 5 years: 3000 mg for participants weighing 40 to less than 60 kilograms (kg), 3300 mg for participants weighing 60 to less than 100 kg, and 3600 mg for participants weighing 100 kg or more.
Biological: Ravulizumab
During the Treatment Period, participants were administered ravulizumab 2000 mg on Day 1, ravulizumab 1600 mg on Day 22 and Day 43, and then ravulizumab 1600 mg every 6 weeks for 4 doses. In the Extension Period, participants initially continued to receive their dose. During the second year of the study, participants were administered weight-based doses of ravulizumab every 8 weeks for up to 5 years: 3000 mg for participants weighing 40 to less than 60 kg, 3300 mg for participants weighing 60 to less than 100 kg, and 3600 mg for participants weighing 100 kg or more.
Biological: Ravulizumab
During the Treatment Period, participants were administered ravulizumab 1600 mg on Day 1 and Day 15, ravulizumab 2400 mg on Day 29, and then ravulizumab 2400 mg every 8 weeks for 3 doses. In the Extension Period, participants initially continued to receive their dose. During the second year of the study, participants were administered weight-based doses of ravulizumab every 8 weeks for up to 5 years: 3000 mg for participants weighing 40 to less than 60 kg, 3300 mg for participants weighing 60 to less than 100 kg, and 3600 mg for participants weighing 100 kg or more.
Biological: Ravulizumab
During the Treatment Period, participants were administered ravulizumab 3000 mg on Day 1, ravulizumab 5400 mg on Day 29, and then ravulizumab 5400 mg every 12 weeks for 2 doses. During the Extension Period, participants were administered ravulizumab 5400 mg every 12 weeks for up to 5 years.
Biological: Ravulizumab
All treatments were given as IV infusions.
Also known as: ALXN1210, Ultomiris
Percent Change In LDH Levels From Baseline To Day 253 And Day 281
The percent change in LDH levels was assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
Time frame: Baseline, Day 253 (Cohorts 1 to 4) and Day 281 (Cohort 4)
Percent Change In Free Hemoglobin Levels From Baseline To Day 253 And Day 281
The percent change in free hemoglobin levels was assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
Time frame: Baseline, Day 253 (Cohorts 1 to 4) and Day 281 (Cohort 4)
Percent Change In Haptoglobin Levels From Baseline To Day 253 And Day 281
The percent change in haptoglobin levels was assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
Time frame: Baseline, Day 253 (Cohorts 1 to 4) and Day 281 (Cohort 4)
Percent Change In Reticulocyte/Erythrocyte Count From Baseline To Day 253 And Day 281
The percent change in reticulocyte/erythrocyte count levels was assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
Time frame: Baseline, Day 253 (Cohorts 1 to 4) and Day 281 (Cohort 4)
Percent Change In PNH RBC Types II And III Clone Size From Baseline To Day 253
The percent change in paroxysmal nocturnal hemoglobinuria (PNH) red blood cell (RBC), summed types II and III, clone size levels were assessed from Baseline to Day 253 for Cohorts 1 to 4.
Time frame: Baseline, Day 253 (Cohorts 1 to 4)
Percent Change In D-dimer From Baseline To Day 253 And Day 281
The percent change in D-dimer levels were assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
Time frame: Baseline to Day 253 (Cohorts 1 to 4) and Day 281 (Cohort 4)
Change In Clinical Manifestations Of PNH From Baseline To Day 253 And Day 281
Clinical manifestations were assessed from Baseline to Day 253 for Cohorts 1 to 3 and from Baseline to Day 281 for Cohort 4 only. Clinical manifestations were defined as fatigue, abdominal pain, dyspnea, dysphagia, chest pain, and erectile dysfunction (male participants only). Improvement was defined as present at Baseline and absent at Day endpoint. Worsening was defined as absent at Baseline and present at Day endpoint. No Change was defined as no change from Baseline and time point of endpoint.
Time frame: Baseline, Day 253 (Cohorts 1 to 3) and Day 281 (Cohort 4)
| Milestone | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Started | 6 | 6 | 7 | 7 |
| Received at least 1 dose of study drug | 6 | 6 | 7 | 7 |
| Completed | 6 | 6 | 7 | 7 |
| Not completed | 0 | 0 | 0 | 0 |
| Milestone | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Started | 6 | 6 | 7 | 7 |
| Received at least 1 dose of study drug | 6 | 6 | 7 | 7 |
| Completed | 6 | 6 | 6 | 7 |
| Not completed | 0 | 0 | 1 | 0 |
| Withdrew: Participant underwent bone marrow transplantation due to chronic myelomonocytic leukemia | 0 | 0 | 1 | 0 |
The percent change in LDH levels was assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
| Percent Change | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Day 253 | -72.85 ± 12.082 | -78.12 ± 6.635 | -84.96 ± 4.423 | -87.63 ± 6.923 |
| Day 281 | — | — | — | -89.89 ± 2.885 |
The percent change in free hemoglobin levels was assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
| Percent Change | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Day 253 | 14.07 ± 124.755 | -12.32 ± 57.213 | -22.14 ± 94.388 | -40.80 ± 27.474 |
| Day 281 | — | — | — | -45.64 ± 28.938 |
The percent change in haptoglobin levels was assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
| Percent Change | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Day 253 | 21.67 ± 53.072 | 81.67 ± 200.042 | 4.29 ± 11.339 | 34.29 ± 74.578 |
| Day 281 | — | — | — | 27.14 ± 56.188 |
The percent change in reticulocyte/erythrocyte count levels was assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
| Percent Change | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Day 253 | -1.27 ± 43.019 | -5.05 ± 35.691 | 10.46 ± 59.510 | 14.66 ± 81.390 |
| Day 281 | — | — | — | -4.66 ± 68.502 |
The percent change in paroxysmal nocturnal hemoglobinuria (PNH) red blood cell (RBC), summed types II and III, clone size levels were assessed from Baseline to Day 253 for Cohorts 1 to 4.
| Percent Change | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Percent Change In PNH RBC Types II And III Clone Size From Baseline To Day 253 | 6.65 ± 24.101 | 5.47 ± 21.940 | 54.14 ± 98.713 | 88.21 ± 138.290 |
The percent change in D-dimer levels were assessed from Baseline to Day 253 for Cohorts 1 to 4 and from Baseline to Day 281 for Cohort 4 only.
| Percent Change | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Day 253 | -24.80 ± 32.436 | -29.47 ± 26.547 | -10.90 ± 41.032 | -16.08 ± 34.783 |
| Day 281 | — | — | — | -27.05 ± 27.663 |
Clinical manifestations were assessed from Baseline to Day 253 for Cohorts 1 to 3 and from Baseline to Day 281 for Cohort 4 only. Clinical manifestations were defined as fatigue, abdominal pain, dyspnea, dysphagia, chest pain, and erectile dysfunction (male participants only). Improvement was defined as present at Baseline and absent at Day endpoint. Worsening was defined as absent at Baseline and present at Day endpoint. No Change was defined as no change from Baseline and time point of endpoint.
| Participants | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Fatigue at Day 253 — Improved from Baseline | 4 | 2 | 3 | 3 |
| Fatigue at Day 253 — Worsened from Baseline | 0 | 0 | 0 | 0 |
| Fatigue at Day 253 — No Change | 2 | 4 | 4 | 4 |
| Fatigue at Day 253 — Not Applicable | 0 | 0 | 0 | 0 |
| Fatigue at Day 281 — Improved from Baseline | — | — | — | 4 |
| Fatigue at Day 281 — Worsened from Baseline | — | — | — | 0 |
| Fatigue at Day 281 — No Change | — | — | — | 3 |
| Fatigue at Day 281 — Not Applicable | — | — | — | 0 |
| Abdominal Pain at Day 253 — Improved from Baseline | 1 | 1 | 1 | 0 |
| Abdominal Pain at Day 253 — Worsened from Baseline | 0 | 0 | 0 | 0 |
| Abdominal Pain at Day 253 — No Change | 5 | 5 | 6 | 7 |
| Abdominal Pain at Day 253 — Not Applicable | 0 | 0 | 0 | 0 |
| Abdominal Pain at Day 281 — Improved from Baseline | — | — | — | 0 |
| Abdominal Pain at Day 281 — Worsened from Baseline | — | — | — | 0 |
| Abdominal Pain at Day 281 — No Change | — | — | — | 7 |
| Abdominal Pain at Day 281 — Not Applicable | — | — | — | 0 |
| Dyspnea at Day 253 — Improved from Baseline | 1 | 1 | 4 | 2 |
| Dyspnea at Day 253 — Worsened from Baseline | 0 | 0 | 0 | 0 |
| Dyspnea at Day 253 — No Change | 5 | 5 | 3 | 5 |
| Dyspnea at Day 253 — Not Applicable | 0 | 0 | 0 | 0 |
| Dyspnea at Day 281 — Improved from Baseline | — | — | — | 2 |
| Dyspnea at Day 281 — Worsened from Baseline | — | — | — | 0 |
| Dyspnea at Day 281 — No Change | — | — | — | 5 |
| Dyspnea at Day 281 — Not Applicable | — | — | — | 0 |
| Dysphagia at Day 253 — Improved from Baseline | 0 | 1 | 1 | 1 |
| Dysphagia at Day 253 — Worsened from Baseline | 0 | 0 | 0 | 0 |
| Dysphagia at Day 253 — No Change | 6 | 5 | 6 | 6 |
| Dysphagia at Day 253 — Not Applicable | 0 | 0 | 0 | 0 |
| Dysphagia at Day 281 — Improved from Baseline | — | — | — | 1 |
| Dysphagia at Day 281 — Worsened from Baseline | — | — | — | 0 |
| Dysphagia at Day 281 — No Change | — | — | — | 6 |
| Dysphagia at Day 281 — Not Applicable | — | — | — | 0 |
| Chest Pain at Day 253 — Improved from Baseline | 1 | 0 | 2 | 0 |
| Chest Pain at Day 253 — Worsened from Baseline | 0 | 0 | 0 | 0 |
| Chest Pain at Day 253 — No Change | 5 | 6 | 5 | 7 |
| Chest Pain at Day 253 — Not Applicable | 0 | 0 | 0 | 0 |
| Chest Pain at Day 281 — Improved from Baseline | — | — | — | 0 |
| Chest Pain at Day 281 — Worsened from Baseline | — | — | — | 0 |
| Chest Pain at Day 281 — No Change | — | — | — | 7 |
| Chest Pain at Day 281 — Not Applicable | — | — | — | 0 |
| Erectile Dysfunction at Day 253 — Improved from Baseline | 2 | 0 | 1 | 1 |
| Erectile Dysfunction at Day 253 — Worsened from Baseline | 0 | 0 | 0 | 0 |
| Erectile Dysfunction at Day 253 — No Change | 2 | 5 | 5 | 4 |
| Erectile Dysfunction at Day 253 — Not Applicable | 2 | 1 | 1 | 2 |
| Erectile Dysfunction at Day 281 — Improved from Baseline | — | — | — | 1 |
| Erectile Dysfunction at Day 281 — Worsened from Baseline | — | — | — | 0 |
| Erectile Dysfunction at Day 281 — No Change | — | — | — | 4 |
| Erectile Dysfunction at Day 281 — Not Applicable | — | — | — | 2 |
Collected over Adverse events were monitored continuously from Screening to Day 253 (for Cohorts 1, 2, and 3) and Day 281 (for Cohort 4) (Treatment Period) and up to Day 2157 (Extension Period).. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Cohort 1 | 0/6 (0%) | 3/6 (50%) | 6/6 (100%) |
| Cohort 2 | 0/6 (0%) | 3/6 (50%) | 6/6 (100%) |
| Cohort 3 | 0/7 (0%) | 4/7 (57.1%) | 7/7 (100%) |
| Cohort 4 | 0/7 (0%) | 1/7 (14.3%) | 7/7 (100%) |
| Event | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| Febrile neutropeniaBlood and lymphatic system disorders | 1/6 | 1/6 | 0/7 | 0/7 |
| PyrexiaGeneral disorders | 1/6 | 0/6 | 0/7 | 0/7 |
| Meningococcal infectionInfections and infestations | 0/6 | 1/6 | 0/7 | 0/7 |
| Urinary tract infectionInfections and infestations | 0/6 | 1/6 | 0/7 | 0/7 |
| Femoral neck fractureInjury, poisoning and procedural complications | 0/6 | 1/6 | 0/7 | 0/7 |
| InfectionInfections and infestations | 0/6 | 1/6 | 0/7 | 0/7 |
| Klebsiella bacteraemiaInfections and infestations | 0/6 | 1/6 | 0/7 | 0/7 |
| Enterobacter bacteraemiaInfections and infestations | 0/6 | 1/6 | 0/7 | 0/7 |
| Enterobacter sepsisInfections and infestations | 0/6 | 1/6 | 0/7 | 0/7 |
| Escherichia urinary tract infectionInfections and infestations | 0/6 | 1/6 | 0/7 | 0/7 |
| Event | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 |
|---|---|---|---|---|
| HeadacheNervous system disorders | 3/6 | 5/6 | 4/7 | 3/7 |
| Upper respiratory tract infectionInfections and infestations | 2/6 | 1/6 | 5/7 | 4/7 |
| NasopharyngitisInfections and infestations | 4/6 | 2/6 | 3/7 | 2/7 |
| Back painMusculoskeletal and connective tissue disorders | 4/6 | 0/6 | 2/7 | 1/7 |
| FatigueGeneral disorders | 3/6 | 2/6 | 0/7 | 0/7 |
| ArthralgiaMusculoskeletal and connective tissue disorders | 3/6 | 0/6 | 0/7 | 2/7 |
| DyspnoeaRespiratory, thoracic and mediastinal disorders | 3/6 | 0/6 | 0/7 | 1/7 |
| Abdominal painGastrointestinal disorders | 3/6 | 0/6 | 1/7 | 2/7 |
| DizzinessNervous system disorders | 1/6 | 0/6 | 3/7 | 0/7 |
| DiarrhoeaGastrointestinal disorders | 0/6 | 1/6 | 3/7 | 0/7 |
Safety set: All participants who received at least 1 dose of ravulizumab.
| Age, Continuous(years) | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 | Total |
|---|---|---|---|---|---|
| Mean | 43.1 ± 14.57 | 48.6 ± 23.48 | 37.3 ± 14.03 | 48.5 ± 13.43 | 44.3 ± 16.33 |
| Sex: Female, Male(Participants) | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 | Total |
|---|---|---|---|---|---|
| Female | 2 | 1 | 1 | 2 | 6 |
| Male | 4 | 5 | 6 | 5 | 20 |
| Ethnicity (NIH/OMB)(Participants) | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 | Total |
|---|---|---|---|---|---|
| Hispanic or Latino | 1 | 0 | 0 | 0 | 1 |
| Not Hispanic or Latino | 4 | 4 | 7 | 7 | 22 |
| Unknown or Not Reported | 1 | 2 | 0 | 0 | 3 |
| Race/Ethnicity, Customized(Participants) | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 | Total |
|---|---|---|---|---|---|
| White | 5 | 4 | 3 | 3 | 15 |
| Asian | 0 | 0 | 4 | 3 | 7 |
| Not Reported | 1 | 2 | 0 | 0 | 3 |
| Other | 0 | 0 | 0 | 1 | 1 |
| Lactate Dehydrogenase (LDH) Levels(units/liter (U/L)) | Cohort 1 | Cohort 2 | Cohort 3 | Cohort 4 | Total |
|---|---|---|---|---|---|
| Mean | 1026.88 ± 547.843 | 1223.55 ± 149.693 | 2127.57 ± 815.875 | 2142.24 ± 366.511 | 1668.90 ± 724.341 |
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Alexion Pharmaceuticals, Inc.