A Study to Assess Efficacy and Safety of Eltrombopag in Combination With a Short Course of Dexamethasone in Patients With Newly Diagnosed ITP (XPAG-ITP)

Novartis

Status and phase: Completed; Phase 2

Conditions: Immune Thrombocytopenia (ITP)

Treatments: Drug: Eltrombopag; Drug: Dexamethasone

Study type: Interventional

Funder types: Industry

Identifiers

NCT04346654

2019-002658-21 (EudraCT Number)

CETB115JDE01

Details and patient eligibility

About

The purpose of this study was to compare the ability of eltrombopag in combination with a short course of high-dose dexamethasone to induce sustained response off treatment in patients with newly-diagnosed ITP versus 1-3 cycles of dexamethasone monotherapy.

The unmet clinical need and the potential for eltrombopag when added to steroids to improve the treatment outcome and the potential to induce sustained response off treatment serve as the basis for clinical investigation of eltrombopag in first-line ITP.

Full description

This is a Phase II, multicenter, 1:1 randomized, open-label study that compared the efficacy and safety of eltrombopag in combination with a short course of high-dose dexamethasone to 1-3 cycles of high-dose dexamethasone monotherapy, as first-line treatment in adult patients with newly diagnosed ITP.

Adult patients with newly diagnosed ITP who had platelet counts < 30 × 10^9/L and required treatment were screened, and if eligible, were randomized to either Arm A (eltrombopag in combination with a short course of dexamethasone) or Arm B (1-3 cycles of dexamethasone monotherapy).

The study was conducted in the following periods:

Screening Period: Patients were screened for 14 days based on the inclusion and exclusion criteria.

Treatment Period: Arm A: Patients were treated for 26 weeks during the treatment period. Patients who reached platelet counts ≥ 30 × 10^9/L and maintained counts ≥ 30 × 10^9/L during the tapering phase were eligible for treatment discontinuation. Duration of tapering before treatment discontinuation at Week 26 was 6 weeks. Arm B: Patients were treated up to 12 weeks during the treatment period. Patients who reached platelet counts ≥ 30 × 10^9/L and maintained counts ≥ 30 × 10^9/L after 1-3 cycles of dexamethasone treatment were eligible for treatment discontinuation. Patients with platelet counts < 30 × 10^9/L after 3 cycles of dexamethasone treatment were offered a course of eltrombopag treatment within the study and were discontinued from study at week 52.

Observation period: After completion of the treatment period, all patients were observed for sustained response off treatment until week 52. Only patients with sustained response at week 52 were followed for another 26 weeks.

Enrollment: 26 patients

Sex: All

Ages: 18 to 99 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Signed informed consent must be obtained prior to participation in the study.
• Men and women ≥ 18 years of age
• Newly diagnosed with primary ITP (time from diagnosis within 3 months)
• Platelet count < 30 × 109/L at screening and a need for treatment (per physician's discretion) Note: If pre-treatment is necessary, platelet count data performed directly before pre-treatment (can be used for study inclusion (screening value). Treatment-naïve patients will be included based on their platelet counts performed at screening

Exclusion criteria

• Previous history of treatment for ITP, except any ITP-directed therapy for a maximum of 3 days within 7 days before randomization
• Patients with diagnosis of secondary thrombocytopenia
• Patients who have life threatening bleeding complications per physician´s discretion
• Patients with a history of thromboembolic events in the 6 months preceding enrollment or known risk factors for thromboembolism
• Serum creatinine > 1.5 mg/dL
• Total bilirubin (TBIL) > 1.5 × upper limit of normal (ULN)
• Aspartate transaminase (AST) > 3.0 × ULN
• Alanine transaminase (ALT) > 3.0 × ULN
• Patients who are human immune deficiency virus (HIV),hepatitis C virus (HCV) or hepatitis B surface antigen (HBsAg) positive
• Patients with hepatic impairment (Child-Pugh score > 5)
• Patients with known active or uncontrolled infections not responding to appropriate therapy
• History of current diagnosis of cardiac disease or impaired cardiac function denoted
• Patients who have active malignancy
• Patients with evidence of current alcohol/drug abuse
• Any serious and/or unstable pre-existing medical, psychiatric disorder, or other conditions that could interfere with subject's safety, obtaining informed consent or compliance with the study procedures
• Female subjects who are nursing or pregnant (positive serum or urine B-human chorionic gonadotrophin (B-hCG) pregnancy test) at screening or pre-dose on Day 1
• Women of child-bearing potential and males unwilling to use adequate contraception during the study

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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26 participants in 2 patient groups

Eltrombopag + Dexamethasone

Experimental group

Description:

Patients were treated with eltrombopag in combination with a standard high-dose dexamethasone (1 cycle: 40 mg once daily (QD) from day 1-4) to induce sustained response off treatment.

Treatment:

Drug: Dexamethasone

Drug: Eltrombopag

Dexamethasone

Active Comparator group

Description:

Patients were treated with a standard high-dose dexamethasone (1-3 cycles: 40 mg QD day 1-4 at 4 weeks intervals (or at 14-28 days intervals if needed) to induce sustained response off treatment.

Treatment:

Drug: Dexamethasone