AzTrials
AzTrials

Inherited Platelet DisorderPhase 2NCT02422394

Eltrombopag for Inherited Thrombocytopenias

A Phase 2 study testing Eltrombopag in people with Inherited Platelet Disorder, run by Fondazione IRCCS Policlinico San Matteo di Pavia at 3 sites in Italy.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Inherited thrombocytopenias (ITs) are a heterogeneous group of disorders characterized by a reduced number of blood platelets and a consequent bleeding tendency that ranges from mild to life-threatening. Read more about this study

Who is it for?
Ages 16 to 70 years
Conditions the study is for
Inherited Platelet Disorder
What is being tested?
Eltrombopag
Could I receive a placebo?
No, everyone receives an active treatment
How many people
24 participants
Where
3 sitesItaly
Study dates
Apr 2015to Mar 2018
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 to 70 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Phase 1:
  • Patients with the following forms of inherited thrombocytopenias will be considered for enrolment:
  • MYH9-related disorders (OMIM 155100, 605249, 153640, 153650)
  • Bernard-Soulier Syndrome (OMIM 231200) deriving from monoallelic mutations (at variance with biallelic classical BSS, monoallelic form does not present defective platelet function)
  • Wiskott-Aldrich syndrome (OMIM 301000).
  • X-linked thrombocytopenia (OMIM 313900).
Show all 21Show fewer
  • X-linked thrombocytopenia with thalassemia (OMIM 314050).
  • Dyserythropoietic anemia with thrombocytopenia (OMIM 300367).
  • ITGA2B/ITGB3-related thrombocytopenia (OMIM not available).
  • ANKRD26-related thrombocytopenia (OMIM 188000).
  • TUBB1-related thrombocytopenia (OMIM not available)
  • ACTN1-related thrombocytopenia (OMIM not available)
  • GFI1B-related thrombocytopenia (OMIM not available)
  • CYCS-related thrombocytopenia (OMIM 612004)
  • SLFN14-related thrombocytopenia (OMIM not available)
  • Patients will have to fulfill all the following criteria:
  • Age ≥ 16 years and ≤ 70 years
  • Average platelet count during the previous year less than 80 x109/L
  • Written informed consent
  • Phase 2
  • Patients with clinically relevant chronic or recurrent bleedings at baseline (grade 2-4 of the WHO bleeding scale) who: (i) completed the phase 1 without severe side effects and (ii) obtained reduction or remission of bleeding by Eltrombopag administration.

Who cannot join

  • Phases 1 and 2
  • Hypersensitivity to Eltrombopag or one of the excipients.
  • History of thromboembolic events.
  • Treatment with anti-platelet drugs or other drugs affecting platelet function and/or with anticoagulants.
  • Concurrent diseases or conditions that significantly increase the risk of thromboembolic events.
  • Moderate to severe liver failure (Child-Pugh score ≥ 5).
Show all 12Show fewer
  • Altered renal function as defined by creatinine ≥ 2 mg/dL
  • Previous or concurrent clonal disorders of the myeloid series (acute myeloid leukemias and myelodysplastic syndromes).
  • Females who are pregnant or nursing (a negative pregnancy test is required before enrolment of fertile women).
  • Formal refusal of any recommendations for a safe contraception.
  • Alcohol or drug addiction.
  • Any other disease or condition that by the advice of the responsible physician would make the treatment dangerous for the patient or would make the patient ineligible for this study, including physical, psychiatric, social and behavioral problems.

Trial locations and contacts

3 sites in 1 country.

Italy3 sites
  • Department of Internal Medicine, Hospital of Padova

    Padova, 35128

  • Unit of Internal Medicine 3, IRCCS Policlinico San Matteo Foundation

    Pavia, 27100

  • Section of Internal and Cardiovascular Medicine, Department of Medicine, University Hospital of Perugia

    Perugia, 06126

Other trials in Italy

About this study

Inherited thrombocytopenias (ITs) are a heterogeneous group of disorders characterized by a reduced number of blood platelets and a consequent bleeding tendency that ranges from mild to life-threatening. Thrombocytopenia is caused by genetic mutations and therefore is present throughout life and can be transmitted to the progeny. Some patients with severely reduced platelet count present spontaneous bleeding, which represents a major clinical problem: in fact, bleeding diathesis exposes these subjects to the risk of severe hemorrhages, affects their quality of life and often requires hospitalization and/or transfusions. Conversely, other patients with ITs have absent or mild spontaneous bleeding tendency. However, even these patients are at risk of major bleeding on the occasion of surgery or other invasive procedures. Therefore, the potential for hemorrhages on the occasion of invasive procedures represent a clinical problem for all patients affected by ITs.

Eltrombopag is a drug, available in tablets, which stimulates the production of platelets by the bone marrow. A previous study demonstrated that a short course of eltrombopag was effective in increasing platelet count in most patients with the MYH9-related disease (MYH9-RD), the most frequent form of IT. Eltrombopag was given for 3 to 6 weeks to 12 patients with MYH9-RD and platelet counts lower than 50 x10e9/L. Eleven patients responded to the drug and 8 of them obtained platelet counts higher than 100 x10e9/L or three times the baseline value. Remission of spontaneous bleeding was achieved by 8 of 10 patients and treatment was well tolerated in all the cases. Based on these findings, short-term eltrombopag courses have been successfully used for preparing for major surgery two patients with MYH9-RD and less than 20 x10e9 platelets/L.

Read more

The present study has two main objectives. - To verify if eltrombopag is effective in transiently increasing platelet count over 100 x 10e9/L and abolishing bleeding tendency in patients with different forms of IT.

To this end, eltrombopag will be given for 3-6 weeks to patients with different forms of IT. Eltrombopag will be administered at the dose of 50 mg/day for 3 weeks. After 3 weeks of treatment, the patients who will obtain a platelet count higher than 100 x10e9/L and complete remission of bleeding tendency will stop therapy. In the other cases, patients will be treated with eltrombopag at a higher dose (75 mg/day) for 3 additional weeks. This treatment schedule is called "Phase 1" of the study.

If the study will achieve this goal, short-term eltrombopag could be potentially used in the future to prepare these patients for surgery or other invasive procedures

  • To verify if eltrombopag can be used to stably reduce spontaneous bleeding tendency for long periods of time in patients with clinically significant spontaneous hemorrhages.

To this end, patients with clinically significant spontaneous bleedings at baseline and who had their bleeding tendency reduced during the Phase 1 of the study without severe side effects, will be admitted to the "Phase 2" of the study.

During the Phase 2, patients will be treated with eltrombopag for 16 weeks. In order to determine the lowest dose of eltrombopag that is able to reduce or abolish their bleeding tendency, patients will start treatment with eltrombopag 25 mg/day for 4 weeks. Then, every 4 weeks, patients will be re-evaluated and the dosage of eltrombopag will be adjusted according to bleeding tendency and platelet count. The dosages of eltrombopag that can be used in the Phase 2 range from 12.5 to 75 mg/day.

Other objectives of the study are:

  • to evaluate safety and tolerability of Eltrombopag in patients affected with ITs.
  • to identify the dosages of Eltrombopag required for achieving the primary endpoints of Phases 1 and 2.
  • to study the effects of Phase 2 treatment on patients' health-related quality of life (HR-QoL);
  • to study the effects of treatment on some laboratory parameters related to platelet production and function.

All patients will be undergo a follow-up visit 30 days after completion of treatment.

Patients will be treated as outpatients. The evaluation of patients at enrollment and at each subsequent on-treatment and post-treatment visits includes: medical history; physical examination; evaluation of bleeding tendency according to WHO bleeding scale; CBC and differential; platelet count by phase-contrast microscopy; peripheral blood smear examination; plasma transaminases, bilirubin, and creatinine; urine analysis; ophthalmic assessment (only at some visits); measurement of serum thrombopoietin level; evaluation of HR-QoL (only at baseline and during Phase 2); evaluation of in vitro platelet aggregation in response to ADP, collagen and ristocetin whenever platelet count is over 100 x 10e9/L.

Being tested
Eltrombopag

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EltrombopagDrug

Study groups in NCT02422394
Study groupRoleWhat they receive
EltrombopagExperimentalPhase 1: Eltrombopag 50 mg/day for 3 weeks. At the end of these 3 weeks of treatment: platelet count higher than 100 x10e9/L and no spontaneous bleeding, end therapy. In the other cases, treatment with eltrombopag 75 mg/day for 3 additional weeks. Phase 2: Eltrombopag will be administered for 16 weeks. Eltrombopag will be initially given at 25 mg/day for 4 weeks. Every 4 weeks, the dosage will be modified as follows. (1) Bleeding score (WHO bleeding scale) 0-1 and platelet count between 30 and 100 x10e9/L: continue at the current dose; (2) Bleeding score 0-1 and platelet count higher than 100 x10e9/L: switch to the next lower dose; (3) Bleeding score 2-4 or platelet count lower than 30 x 10e9/L: switch to the next higher dose. The following dosages of eltrombopag are considered: 12.5 mg/day; 25 mg/day; 50 mg/day; 75 mg/day.
Receives: Drug: Eltrombopag

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. platelet count

    Phase 1: major response is defined by increase of platelet count over 100 x10e9/L and no bleeding tendency (grade 0 of the WHO bleeding scale) during the last week of treatment. Minor response is defined by a platelet at least two-fold increased with respect to baseline value without reaching the criteris for major response.

    Measured: 3 or 6 weeks (Phase 1)

  2. bleeding tendency according to the WHO bleeding scale

    Phase 1: major response is defined by increase of platelet count over 100 x10e9/L and no bleeding tendency (grade 0 of the WHO bleeding scale) during the last week of treatment.

    Phase 2: Major response is defined as a complete remission of hemorrhages. Minor response is defined as a reduction of bleeding according to the WHO bleeding scale without reaching the criteria for major response.

    Measured: 3 or 6 weeks (Phase 1); 16 weeks (Phase 2)

Secondary outcomes (3)
  1. Daily dose of eltrombopag (in milligrams) required for achievement of the primary endpoints

    Measured: 3 or 6 weeks (Phase 1); 16 weeks (Phase 2)

  2. number and severity of adverse events as a measure of safety and tolerability.

    Measured: 7 or 10 weeks (Phase 1); 20 weeks (Phase 2)

  3. patients' health-related quality of life as a result of reduction of spontaneous bleeding tendency.

    Measured: 20 weeks (Phase 2)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Apr 2015 (estimated)
  2. Study startApr 2015
  3. Primary completionMar 2018
  4. Study completionMar 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
24 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02422394
Sponsor's protocol ID
Eltrombo-IT-2014
Status last verified
Aug 2018
First submitted
14 Apr 2015
Last updated
21 Aug 2018
Results posted
No
Data monitoring committee
No

Publications

  • Balduini CL, Pecci A, Noris P. Diagnosis and management of inherited thrombocytopenias. Semin Thromb Hemost. 2013 Mar;39(2):161-71. doi: 10.1055/s-0032-1333540. Epub 2013 Feb 8.

    PubMed 23397552
  • Pecci A. Pathogenesis and management of inherited thrombocytopenias: rationale for the use of thrombopoietin-receptor agonists. Int J Hematol. 2013 Jul;98(1):34-47. doi: 10.1007/s12185-013-1351-7. Epub 2013 May 1.

    PubMed 23636669
  • Pecci A, Gresele P, Klersy C, Savoia A, Noris P, Fierro T, Bozzi V, Mezzasoma AM, Melazzini F, Balduini CL. Eltrombopag for the treatment of the inherited thrombocytopenia deriving from MYH9 mutations. Blood. 2010 Dec 23;116(26):5832-7. doi: 10.1182/blood-2010-08-304725. Epub 2010 Sep 15.

    PubMed 20844233
  • Pecci A, Barozzi S, d'Amico S, Balduini CL. Short-term eltrombopag for surgical preparation of a patient with inherited thrombocytopenia deriving from MYH9 mutation. Thromb Haemost. 2012 Jun;107(6):1188-9. doi: 10.1160/TH12-01-0005. Epub 2012 Mar 8. No abstract available.

    PubMed 22398565
  • Favier R, Feriel J, Favier M, Denoyelle F, Martignetti JA. First successful use of eltrombopag before surgery in a child with MYH9-related thrombocytopenia. Pediatrics. 2013 Sep;132(3):e793-5. doi: 10.1542/peds.2012-3807. Epub 2013 Aug 12.

    PubMed 23940247
  • Zaninetti C, Gresele P, Bertomoro A, Klersy C, De Candia E, Veneri D, Barozzi S, Fierro T, Alberelli MA, Musella V, Noris P, Fabris F, Balduini CL, Pecci A. Eltrombopag for the treatment of inherited thrombocytopenias: a phase II clinical trial. Haematologica. 2020 Mar;105(3):820-828. doi: 10.3324/haematol.2019.223966. Epub 2019 Jul 4.

    PubMed 31273088

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Eltrombopag in people with Inherited Platelet Disorder, run by Fondazione IRCCS Policlinico San Matteo di Pavia at 3 sites in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 21 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Aug 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

platelet count (time frame: 3 or 6 weeks (Phase 1)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02422394, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Aug 2018.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in