| Protocol No: | ECCT/22/04/01 | Date of Protocol: | 30-03-2021 |
| Study Title: |
An Open-Label Extension Study to Evaluate the Long-Term Safety of Inclacumab Administered to Participants with Sickle Cell Disease Who Have Participated in an Inclacumab Clinical Trial
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| Study Objectives: |
Main Objective
The primary objective of this study is to:
1. evaluate the long-term safety of every 12 week dosing of inclacumab in participants with sickle cell disease (SCD) that have completed a prior inclacumab clinical trial.
The secondary Objective
Additional objectives are to:
1.Evaluate the incidence of vaso-occlusive crises (VOCs), hospitalizations, missed work/school days, red blood cell (RBC)
transfusions, and quality of life (QoL) with long-term use of inclacumab
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| Laymans Summary: |
Sickle cell disease (SCD) is a genetic condition where red blood cells are shaped like a crescent moon (sickle cells). Compared to round (normal) red blood cells, these sickled red blood cells do not carry oxygen well around the body. SCD leads to problems like anemia (low number of red blood cells), pain attacks (also called vaso-occlusive crisis or VOC), extreme tiredness, and more frequent infections. SCD lasts a lifetime and can shorten a person’s lifespan.
What is inclacumab?
Inclacumab, also known as PF-07940370, is a medicine given into a vein through a needle (also called intravenous or IV).
Researchers thought that inclacumab might help reduce the number of VOCs in people with SCD. One of the causes of painful VOCs is obstruction (blockage) in
the blood vessels. Inclacumab is designed to prevent such blockage from happening so that blood flows normally.
The use of inclacumab in people with SCD in this study is investigational, which means it is not approved for use outside of research studies.
What was the purpose of this study?
The main goal of this study was to find out if participants with SCD from earlier inclacumab studies can safely take (tolerate) inclacumab for a long time.
Researchers wanted to know:
Can participants with SCD safely tolerate inclacumab for a long time?
This study was stopped early because the results from an earlier inclacumab study did not show that it reduced the number of VOCs in participants with SCD. This
decision was not because of safety reasons or requests from any health authorities.
What happened during the study?
How was the study done?
Researchers tested inclacumab in participants with SCD who had completed an earlier inclacumab study to find out if participants could safely take inclacumab
for a long time.
Participants received inclacumab 30 milligram per kilogram (mg/kg) in this study. This means that for every kilogram of body weight, the participant received 30 mg
of inclacumab. Participants were to receive inclacumab every 12 weeks (about 3 months) in this study until study was stopped or they could get inclacumab from
another source (like buying it).
Participants and researchers knew that all participants received inclacumab in this study. This is called an “open-label” study.
During the study, researchers checked the participants’ health and asked how they were feeling and what medications they were taking.
Where did this study take place?
The Sponsor ran this study at 41 locations in 10 countries in North and South America, East and West Africa, and Western and Southwest Asia.
When did this study take place?
It began on 29 March 2022 and ended on 07 November 2025.
Who participated in this study?
The study included participants with SCD who had completed an earlier inclacumab study. A total of 241 participants received at least 1 dose of
inclacumab.
• A total of 119 men and 122 women participated.
• All participants were between the ages of 16 years and 50 years.
None of the participants finished the study. The most common reason was because the Sponsor stopped the study early.
How long did the study last?
The entire study ran for about 3 years and 7 months until it stopped early. This was because the results from an earlier inclacumab study did not show that it
reduced the number of VOCs in participants with SCD. The decision to stop the study was not because of safety reasons or requests from any health authorities.
When the study ended in November 2025, the Sponsor began reviewing the information collected. The Sponsor then created a report of the results. This is a
summary of that report.
What were the results of the study?
Can participants with SCD safely tolerate inclacumab for a long time?
To answer this question, researchers looked at all the information collected on the participants’ health throughout the study.
Based on the data collected until the study stopped early, researchers found that inclacumab was safe and well tolerated in
participants with SCD. No new safety concerns were found in this study compared to earlier studies of inclacumab.
What medical problems did participants have during the study?
The researchers recorded any medical problems the participants had during the study. Participants could have had medical problems for reasons not related to
the study (for example, caused by an underlying disease or by chance). Or, medical problems could also have been caused by a study treatment or by
another medicine the participant was taking. Sometimes the cause of a medical problem is unknown. By comparing medical problems across many treatment
groups in many studies, doctors try to understand what effects a study medicine might have on a participant.
A total of 211 out of 241 participants (88%) in this study had at least 1 medical problem. The most common medical problems – those reported by at least 10%
of participants – were:
• Malaria, a disease caused by a bite of a mosquito that was infected with a
parasite, in 69 out of 241 participants (29%)
• SCD with pain attack in 68 out of 241 participants (28%)
• Low number of red blood cells in 49 out of 241 participants (20%)
• Headache in 42 out of 241 participants (17%)
• Nose and throat infection in 42 out of 241 participants (17%)
• Urinary tract infection or UTI in 29 out of 241 participants (12%)
• Joint pain in 26 out of 241 participants (11%)
A total of 19 out of 241 participants (8%) had medical problems that caused them
to stop receiving inclacumab.
Did study participants have any serious medical problems?
A medical problem is considered “serious” when it is life-threatening, needs hospital care, or causes lasting problems.
A total of 97 out of 241 participants (40%) in this study had serious medical problems. The most common serious medical problem – reported by more than
10% of participants – was low number of red blood cells in 35 out of 241 participants (15%).
Seventeen (17) out of 241 participants (7%) died during the study. None of the
deaths were reported to be related to inclacumab by researchers.
Where can I learn more about this study?
If you have questions about the results of your study, please speak with the doctor or staff at your study site.
For more details on your study protocol, please visit: www.pfizer.com/research/ research_clinical_trials/trial_results
Use the protocol number: C5361003 (or GBT2104-133)
The full scientific report of this study is available online at: www.clinicaltrials.gov
Use the study identifier: NCT05348915
https://euclinicaltrials.eu : Use the study identifier: 2020-005289-32
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| Abstract of Study: | Introduction Sickle cell disease is one of the most commonly inherited blood disorders in the world characterized by vaso-occlusive crises, anemia, stroke and multiple organ damage. Vaso-occlusive crises are the most common presentation of sickle cell disease. Vaso-occlusive crises are caused by activation of the endothelial cells, neutrophils, monocytes and platelets by the sickled red blood cells. The activation of these cells leads to their expression of the p-selectin molecule promoting the aggregation and adhesion of these cells to one another and to the endothelial cells leading to clot formation and blockage of the microvascular channels. There is only one known cure of sickle cell disease, which is a hematopoietic stem cell transplant (HSCT). Unfortunately, this intervention is not easily accessible to most patients due to its cost and unavailability in the country. Most patients with sickle cell disease are therefore mainly on supportive treatment. These reasons inform the need for more affordable and accessible treatments. The study participants will have completed a study of inclacumab (originating study) and will receive inclacumab intravenous infusion in this open-label study. They will receive the intravenous treatment every 12 weeks. The mechanism of action of inclacumab is to prevent the action of p-selectin molecule, which reduces adhesion of molecules and leads to a reduction in the episodes of vaso-occlusive crises. The study aims to assess the safety of long-term administration of inclacumab in participants with SCD that have completed an inclacumab clinical trial. During the study period, participants can receive standard of care treatment except for crizanlizumab.
Methodology
Study setting
The study will be carried out in up to 150 global clinical sites with a sample size of 520 participants. There will be approximately 5 sites in Kenya. We have three study sites in different parts of Nairobi, one in Siaya and the last one in Eldoret.
Study design
This study is an open-label extension study to evaluate the safety of long-term treatment with inclacumab in participants with SCD. The study will be available to eligible participants who were enrolled in a prior GBT-Sponsored inclacumab clinical study (originating study). Eligible participants, who continue to receive clinical benefit that outweighs risk, will receive inclacumab every 12 weeks until the participant has access to inclacumab from an alternative source. Given the long half-life of inclacumab (terminal half-life of 21 to 28 days) at the dose to be evaluated in this study, the majority of participants receiving active study drug are expected to maintain target concentrations as required throughout the study period.
INTRODUCTION & JUSTIFICATION
Sickle cell disease is one of the most commonly inherited blood disorders worldwide (Sj et al., 2017). It is estimated that approximately 300,000 children are born with sickle cell disease in the world annually, 75% of whom are from Sub-Saharan Africa (Makani et al., 2013). As there is no systematic neonatal screening program in most public and private facilities, there is no national prevalence data. However, it is estimated that 4% of children born in Western Kenya have sickle cell disease(Wanjiku et al., 2019). The study is being conducted in Kenya due to the high incidence of sickle cell disease in the country.
Sickle cell disease (SCD) is an autosomal recessive disease characterized by chronic haemolysis, inflammation and vaso-occlusion presenting as recurrent pain episodes (variously termed sickle cell-related pain crises or VOCs), multi-organ dysfunction, and early death (Kato, 2018).
vaso-occlusion in SCD is driven by a series of complex and often redundant receptor–ligand interactions involved in the adhesion of circulating cells to the damaged endothelium and exposed sub-endothelium. Extensive research demonstrates that P-selectin mediated cellular interactions with sickled red blood cells (RBCs), leukocytes and platelets play a crucial role in the pathophysiology of vaso-occlusion in SCD. Blocking P-selectin-mediated cellular interactions reduces vaso-occlusion in animal models. Taken together, these data led to the hypothesis that blocking P-selectin could reduce the risk of VOCs in SCD patients.
Results from a randomized, placebo-controlled Phase 2b trial of crizanlizumab, a humanized monoclonal antibody in SCD, bolstered the hypothesis that blocking the interaction of P-selectin with its receptors could prevent vaso-occlusion and VOCs (Ataga, 2017). In summary, there is a high unmet need for treatment options in SCD and there is a scientific rationale, supported by clinical data, that p-selectin inhibition has the potential to reduce the risk for acute vaso-occlusions.
JUSTIFICATION/RATIONALE
Allogeneic HSCT remains the only curative therapy for sickle cell disease. It is however unavailable for most patients due to its high cost and it being available only in high income countries. It is also associated with various transplant complications (Kassim and Sharma 2017). Three therapies, hydroxyurea (HU [DROXIA®, 2017]; (also known as hydroxycarbamide), L-glutamine (ENDARI, 2017) and crizanlizumab (ADAKVEO®, 2019), have been approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to reduce VOCs in patients with SCD (Charache, 1995; Niihara, 2018; Ataga, 2017). The effectiveness of HU is impaired by low compliance rates and frequent discontinuations in treatment (Shah, 2019) while L-glutamine provides a modest 25% reduction in annual VOC rates (Niihara, 2018).
Crizanlizumab is a monoclonal antibody directed against human P-Selectin and is administered as an infusion every 4 weeks whereas inclacumab is to be administered every 12 weeks. The 4-week administration of crizanlizumab is a potential barrier to continued adherence to lifelong therapy because patients need to travel more frequently to an infusion centre to receive treatment. This regimen extracts a higher cost on patient and caregiver productivity and frequent intravenous infusions generally attract extra costs Version No: * Date of Protocol * Study Drug* Route(s) of Administration * Disease condition being investigated * Product Type * Name of manufacturer Manufacturing site address Phone Email Manufacturing activities at site If others, specify Country of manufacture to the patient. (Saini, 2009; Richter, 2003). It has also been shown that less frequent dosing results in better adherence to medication (Saini, 2009; Richter, 2003).
Inclacumab has a similar mechanism of action as crizanlizumab. Previous studies on inhibition of p-selectin through crizanlizumab, have demonstrated it to be efficacious and safe for use in SCD patients. Additionally, the dose selected is 30mg/kg every 12 weeks and from previous studies, population PK simulations project that the inclacumab dose regimen of 30 mg/kg Q12W will maintain concentrations above 10 μg/mL throughout the study period in the majority of participants, thereby maximizing the pharmacology required for effective reduction of VOC in the SCD population. The 12-week dosing for inclacumab offers a potential benefit over the 4-week dosing of crizanlizumab and this could increase patient adherence to treatment, reduce the costs of patient and caregiver productivity, leading to a reduction in the overall health costs. Treatments with stable standard of care are allowed except for crizanlizumab because it has a similar mechanism of action as the study drug and would confound the interpretation of this data.
In summary, despite the recent availability of new options to treat VOCs, an unmet medical need exists to further reduce the frequency of VOCs while reducing patient burden and enhancing patient adherence to therapy.
NULL HYPOTHESIS
There is no null hypothesis.
OBJECTIVES
Primary objective
1. To evaluate the long-term safety of every 12-week dosing of inclacumab in participants with SCD that have completed a prior inclacumab clinical trial.
Additional objectives
2.To evaluate the incidence of VOCs, hospitalizations, missed work/school days, RBC transfusions, and quality of life (QoL) with long-term use of inclacumab.
STUDY DESIGN
This study is a multicenter,global,open-label extention,designed to assess the safety of long-term treatment with inclacumab in participants with SCD.
Participants must have completed participation in their originating clinical study and must meet the entry criteria for this study to be eligible for enrolment. Eligible participants will receive Inclacumab 30 mg/kg administered IV Q12W; if they continue to receive clinical benefit that outweighs the risk, until the participant has access to inclacumab from an alternative source (e.g., through commercialization or a managed-access program).
All participants will undergo safety and outcome assessments at Baseline (Day 1), Week 6, and every 12 weeks thereafter. Visits to the clinical site for infusion of study drug will occur at Baseline (Day 1) and every 12 weeks (Weeks 12, 24, 36, 48, etc.).
Despite this being an open-label study, Investigators, study site staff, the Sponsor’s study staff, the Sponsor’s clinical CRO, and study participants will remain blinded to the randomized treatment assignments, as applicable, from the originating GBT-Sponsored inclacumab study. During the study, access to participants’ treatment assignment from the originating study will be limited to DMC members and service providers supporting DMC reviews, including the independent Data Coordinating Centre, until the database from the originating study is locked and primary endpoint analysis is complete. If a need arises for unblinding of the originating GBT-Sponsored inclacumab study, the instruction for unblinding as outlined in the originating study protocol will be followed.
A Data Monitoring Committee (DMC) will regularly review the totality of accumulated safety data from all ongoing inclacumab studies on an ongoing, unblinded basis with additional emphasis on adolescent participants. DMC review will continue until the originating studies have been completed and the randomization assignments are unblinded. Details will be provided in the DMC Charter.
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