A Phase 3 interventional study of recombinant von Willebrand factor and tranexamic acid in Von Willebrand Diseases, sponsored by Margaret Ragni. Terminated at 19 sites in United States. Open to female participants aged 13 Years to 45 Years. Per ClinicalTrials.gov, last updated 2024-07-01.
Sponsored by Margaret Ragni · Phase 3, Interventional, and Treatment
This is an outpatient, 24-week Phase III prospective, randomized, crossover trial comparing recombinant von Willebrand factor (rVWF) and tranexamic acid (TA, Lysteda®) to minimize menorrhagia in women with von Willebrand disease (VWD). The purpose of this Phase III multicenter prospective, randomized, crossover arm trial is to compare recombinant von Willebrand factor (rVWF) to tranexamic acid (TA) in reducing the severity of menorrhagia in women with von Willebrand disease.
In this study, women age 13-45 years with mild to moderate VWD and menorrhagia will be enrolled at their hemophilia treatment centers (HTCs) and provide information on menstrual bleeding from their two past monthly cycles to establish baseline bleeding frequency. Only women with regular menses, defined as menses every 21-35 days will be enrolled. A total of 60 subjects will be recruited and enrolled at approximately 25 HTC sites. Following enrollment, subjects will be randomized to Group I or Group II for the first five days of the next four consecutive menstrual cycles. Those randomized to Group I will be treated with Arm A for menstrual bleeding in cycles 1 and 2, followed by Arm B for menstrual bleeding in cycles 3 and 4. Those randomized to Group II will be treated with Arm B for menstrual bleeding in cycles 1 and 2, followed by Arm A for menstrual bleeding in cycles 3 and 4.
Subjects randomized to Group I will receive Arm A rVWF 40 IU/kg intravenously (IV) infusion on day 1 of each of two menstrual cycles, Cycles 1 and 2. They will then be crossed over to Arm B, TA 650 mg 2 tablets orally (po) three times daily on days 1-5 of each of two menstrual cycles, Cycles 3 and 4. Subjects randomized to Group II will receive Arm B, TA 650 mg 2 tablets orally (po) three times daily on days 1-5, for each of two menstrual cycles, Cycles 1 and 2. They will then be crossed over to Arm A, rVWF 40 IU/kg intravenously (IV) infusion on day 1 on each of two menstrual cycles, Cycles 3 and 4. This regimen may be given at the HTC clinic or at home by visiting nurse. Baseline laboratory studies will be drawn at screening, including Blood Counts: hemoglobin, white count, differential, platelets; Iron Tests: iron, total iron binding capacity (TIBC), ferritin; Thyroid Test: thyroid stimulating hormone (TSH); and Von Willebrand Tests (VWF and related tests). Before initiating treatment, subjects will be trained by the HTC nurse on 1) reading urine pregnancy tests and 2) completion of the pictorial blood assessment chart (PBAC), cycle severity score (CSR), and cycle length (CL); and 3) completion of patient diary. Following randomization, subjects will administer home pregnancy tests prior to the first of each 5-day dosing cycle. On each of the four dosing cycles, Cycles 1-4, the PBAC, CSR, and CL will be recorded daily. After completion of study drug on cycle 2, the Crossover Study Visit will occur, during which subjects will be given a new supply of study drug for the study arm to which they will crossed over; subject diaries will be returned and coagulation studies and quality of life questionnaires performed. At 10-14 days after completion of study drug in Cycle 4, the End Study Visit will occur, during which subject diaries will be returned and quality of life questionnaires performed. All study visits will be within +/- 2 days of the scheduled visit. Study visits will be every 2 months, at the end of cycle 2 (cross-over) and at the end of cycle 4 (end of study) during which treatment diaries will be reviewed for bleeding frequency, side effects, and medications. Menstrual bleeding by PBAC, cycle severity, cycle duration, and health-related quality-of-life (HRQoL) questionnaires, including Rand Short Form 36-Question Health Survey (SF-36), Ruta Menorrhagia Severity Scale, Center for Disease Control Health-Related Quality of Life-14 Question Form (CDC-HRQoL14), and Center for Epidemiologic Studies Depression Scale (CES-D) will be assessed at baseline and after cycle 2 and after cycle 4. The study is innovative in the 1) evaluation of recombinant VWF, a new high purity recombinant VWF protein, to reduce menorrhagia, as compared with the current non-hormonal standard, tranexamic acid (TA); 2) investigation of the relationship of VWF to menstrual bleeding by PBAC score, by assessing VWD parameters: VWF ristocetin co-factor (VWF:RCo), VWF antigen (VWF:Ag), FVIII:C, VWF multimers, including high molecular weight multimers (HMW) by electrophoresis, and VWF genotype; 3) use of a "home treatment injection" for VWD; 4) comparison of two quality of life measures to assess treatment response on each study arm, one specific for bleeding disorders and one specific for menstrual disorders.
186 studies on the registry are indexed under Menorrhagia; 32 are open to participants now.
This study's enrollment of 39 is below the median of 100 across 137 interventional studies indexed under Menorrhagia.
Browse Menorrhagia studies →Margaret Ragni is the lead sponsor of 6 studies on the registry; none are open to participants now.
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Exclusion Criteria:
Subjects randomized to Group I will receive Arm A recombinant von Willebrand factor 40 IU/kg intravenously (IV) infusion on day 1 of each of two menstrual cycles, Cycles 1 and 2. They will then be crossed over to Arm B, tranexamic acid 650 mg 2 tablets orally (po) three times daily on days 1-5 of each of two menstrual cycles, Cycles 3 and 4.
Drug: recombinant von Willebrand factor · Drug: tranexamic acid
Group II will receive Arm B, tranexamic acid 650 mg 2 tablets orally (po) three times daily on days 1-5, for each of two menstrual cycles, Cycles 1 and 2. They will then be crossed over to Arm A, recombinant von Willebrand factor 40 IU/kg intravenously (IV) infusion on day 1 on each of two menstrual cycles, Cycles 3 and 4.
Drug: recombinant von Willebrand factor · Drug: tranexamic acid
Group I will receive Arm A recombinant von Willebrand factor 40 IU/kg intravenously (IV) infusion on day 1 of each of two menstrual cycles, Cycles 1 and 2. They will then be crossed over to Arm B, TA 650 mg 2 tablets orally (po) three times daily on days 1-5 of each of two menstrual cycles, Cycles 3 and 4. Group II will receive Arm B, TA 650 mg 2 tablets orally (po) three times daily on days 1-5, for each of two menstrual cycles, Cycles 1 and 2. They will then be crossed over to Arm A, rVWF 40 IU/kg intravenously (IV) infusion on day 1 on each of two menstrual cycles, Cycles 3 and 4.
Also known as: vonicog alfa, Vonvendi
Group I will receive Arm A recombinant von Willebrand factor 40 IU/kg intravenously (IV) infusion on day 1 of each of two menstrual cycles, Cycles 1 and 2. They will then be crossed over to Arm B, TA 650 mg 2 tablets orally (po) three times daily on days 1-5 of each of two menstrual cycles, Cycles 3 and 4. Group II will receive Arm B, TA 650 mg 2 tablets orally (po) three times daily on days 1-5, for each of two menstrual cycles, Cycles 1 and 2. They will then be crossed over to Arm A, rVWF 40 IU/kg intravenously (IV) infusion on day 1 on each of two menstrual cycles, Cycles 3 and 4.
Also known as: Lysteda®
Menstrual Bleeding Severity
As measured by Pictorial Blood Assessment Chart (PBAC), 0- no theoretical limit, higher score means greater severity
Time frame: 4 weeks.
Cycle Duration
Menorrhagia cycle length by days of bleeding (score 0 - theoretically any length)
Time frame: 4 weeks.
Ruta Menorrhagia Severity Scale
Unit measure derived from quality of life questions reported as a single score, Minimum 0 to 100 maximum, with a higher score indicating worse outcome
Time frame: 4 weeks.
Center for Epidemiology Studies Depression Scale (CES-D)
Reported by questions on depression, Minimum 0 to 60 Maximum, with higher scores indicating greater depression.
Time frame: 4 weeks.
Rand Short Form 36-Question Health Survey (SF-36)
SF-36 reported by answer to questions, Minimum 0 to Maximum 100 for each of 8 domains (1-physical functioning, 2-role limitations due to physical health, 3-role limitations due to emotional problems, 4-energy and fatigue, 5-emotional wellbeing, 6-social functioning, 7-pain, and 8-general health), with higher scores for each domain meaning greater severity of physical and mental health.
Time frame: 4 weeks
Center for Disease Control Health-Related Quality of Life 14 Questions (CDC-HRQoL-14)
Reported by answer to questions, over the past two weeks with minimum 0 to maximum 14, with higher scores indicating greater severity of physical and mental health.
Time frame: 4 weeks.
Cycle Severity
Menorrhagia cycle severity by Likert scale, with minimum 0 to maximum 3, with higher score indicating worse severity.
Time frame: 4 weeks
| Milestone | Recombinant Von Willebrand Factor, Then Tranexamic Acid | Tranexamic Acid Then Recombinant Von Willebrand Factor |
|---|---|---|
| Started | 18 | 21 |
| Completed | 17 | 19 |
| Not completed | 1 | 2 |
| Withdrew: Study closed before treament could begin | 1 | 2 |
As measured by Pictorial Blood Assessment Chart (PBAC), 0- no theoretical limit, higher score means greater severity
| score on a scale | Tranexamic Acid | Recombinant Von Willebrand Factor |
|---|---|---|
| Menstrual Bleeding Severity | 225 ± 207 | 272 ± 223 |
Menorrhagia cycle length by days of bleeding (score 0 - theoretically any length)
| days | Tranexamic Acid | Recombinant Von Willebrand Factor |
|---|---|---|
| Cycle Duration | 7.1 ± 4.5 | 7.0 ± 3.9 |
Unit measure derived from quality of life questions reported as a single score, Minimum 0 to 100 maximum, with a higher score indicating worse outcome
| units on a scale | Tranexamic Acid | Recombinant Von Willebrand Factor |
|---|---|---|
| Ruta Menorrhagia Severity Scale | 32.4 ± 13.5 | 34.8 ± 13.0 |
Reported by questions on depression, Minimum 0 to 60 Maximum, with higher scores indicating greater depression.
| score on a scale | Tranexamic Acid | Recombinant Von Willebrand Factor |
|---|---|---|
| Center for Epidemiology Studies Depression Scale (CES-D) | 13.5 ± 10.6 | 11.0 ± 10.2 |
SF-36 reported by answer to questions, Minimum 0 to Maximum 100 for each of 8 domains (1-physical functioning, 2-role limitations due to physical health, 3-role limitations due to emotional problems, 4-energy and fatigue, 5-emotional wellbeing, 6-social functioning, 7-pain, and 8-general health), with higher scores for each domain meaning greater severity of physical and mental health.
| units on a scale | Tranexamic Acid | Recombinant Von Willebrand Factor |
|---|---|---|
| Physical functioning | 84.4 ± 19.6 | 83.6 ± 20.0 |
| Role limitations of physical health | 70.1 ± 39.1 | 67.4 ± 37.7 |
| Role limitations of emotional health | 63.9 ± 41.7 | 68.5 ± 39.0 |
| Energy/fatigue | 50.3 ± 20.6 | 47.9 ± 22.8 |
| Emotional well-being | 69.2 ± 17.7 | 72.9 ± 20.0 |
| Social functioning | 76.4 ± 21.9 | 80.9 ± 20.2 |
| Pain | 71.2 ± 23.5 | 68.8 ± 34.2 |
| General health | 58.8 ± 19.9 | 59.3 ± 21.2 |
Reported by answer to questions, over the past two weeks with minimum 0 to maximum 14, with higher scores indicating greater severity of physical and mental health.
| units on a scale | Tranexamic Acid | Recombinant Von Willebrand Factor |
|---|---|---|
| Physically Unhealthy Days | 3.1 ± 4.0 | 1.9 ± 3.2 |
| Mentally Unhealthy Days | 4.7 ± 5.1 | 5.7 ± 7.0 |
Menorrhagia cycle severity by Likert scale, with minimum 0 to maximum 3, with higher score indicating worse severity.
| units on a scale | Tranexamic Acid | Recombinant Von Willebrand Factor |
|---|---|---|
| Cycle Severity | 0.96 ± 0.879 | 1.07 ± 0.738 |
Collected over Adverse Events were collected over collected a 24 week period. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Tranexamic Acid | 0/36 (0%) | 0/36 (0%) | 4/36 (11.1%) |
| Recombinant Von Willebrand Factor | 0/36 (0%) | 0/36 (0%) | 4/36 (11.1%) |
| Event | Tranexamic Acid | Recombinant Von Willebrand Factor |
|---|---|---|
| Other BleedingBlood and lymphatic system disorders | 3/36 | 2/36 |
| Mucosal BleedingBlood and lymphatic system disorders | 2/36 | 0/36 |
| HematomaBlood and lymphatic system disorders | 0/36 | 1/36 |
| Injury/ Trauma BleedingBlood and lymphatic system disorders | 0/36 | 1/36 |
| Age, Categorical(Participants) | Group I | Group II | Total |
|---|---|---|---|
| <=18 years | 0 | 4 | 4 |
| Between 18 and 65 years | 17 | 15 | 32 |
| >=65 years | 0 | 0 | 0 |
| Age, Continuous(years) | Group I | Group II | Total |
|---|---|---|---|
| Mean | 31.9 ± 6.3 | 26.7 ± 10.3 | 29.2 ± 8.9 |
| Sex: Female, Male(Participants) | Group I | Group II | Total |
|---|---|---|---|
| Female | 17 | 19 | 36 |
| Male | 0 | 0 | 0 |
| Ethnicity (NIH/OMB)(Participants) | Group I | Group II | Total |
|---|---|---|---|
| Hispanic or Latino | 2 | 5 | 7 |
| Not Hispanic or Latino | 15 | 13 | 28 |
| Unknown or Not Reported | 0 | 1 | 1 |
| Race (NIH/OMB)(Participants) | Group I | Group II | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 2 | 0 | 2 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 1 | 2 | 3 |
| White | 12 | 13 | 25 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 2 | 4 | 6 |
| Region of Enrollment(participants) | Group I | Group II | Total |
|---|---|---|---|
| United States | 17 | 19 | 36 |
| Menstrual Bleeding Severity(score on a scale) | Group I | Group II | Total |
|---|---|---|---|
| Mean | 597 ± 389 | 483 ± 270 | 537 ± 331 |
Documents are hosted by the registry — open the source record to download them.
Plan to share: Yes — The IPD to be shared include individual bleeding data (PBAC), cycle severity score (CSR), cycle length (CL), quality of life by four scales (SF-36, Ruta, CDC-HRQoL-14, CES-D), satisfaction survey, VWF assays, VWF genotype.
Supporting information: Study protocol, Statistical analysis plan, Informed consent form, Clinical study report, Analytic code
Time frame: Within 12 months of trial completion.
Access criteria: Qualified investigators will have access to data and bio specimens, consistent with data sharing policies and applicable laws, and upon receipt of a Research Materials Distribution Agreement, data will be transferred by secure transfers through the BioLINCC website.
This study is terminated, as verified in Jun 2024. You cannot join it, but the record below documents what was studied.
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Studies of the drugs tested here: Vonicog alfa · Tranexamic Acid
Margaret Ragni