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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/ct2/show/NCT00851721
Registration number
NCT00851721
Ethics application status
Date submitted
25/02/2009
Date registered
26/02/2009
Date last updated
19/05/2021
Titles & IDs
Public title
Efficacy and Safety Study of Prophylactic Versus On-Demand Treatment With Feiba NF in Subjects With Hemophilia A or B and a High Titer Inhibitor
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Scientific title
FEIBA NF: A Prospective, Open-label, Randomized, Parallel Study to Evaluate the Efficacy and Safety of Prophylactic Versus On-Demand Treatment in Subjects With Hemophilia A or B and a High Titer Inhibitor
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Secondary ID [1]
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2008-003855-65
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Secondary ID [2]
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090701
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Hemophilia A or B With Inhibitors
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Hemophilia A
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Hemophilia B
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Condition category
Condition code
Blood
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0
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Clotting disorders
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Human Genetics and Inherited Disorders
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Other human genetics and inherited disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Other interventions - Factor VIII Inhibitor Bypassing Activity (nanofiltered, vapor heat-treated)
Other interventions - Factor VIII Inhibitor Bypassing Activity (nanofiltered, vapor heat-treated)
Experimental: Prophylaxis arm -
Active Comparator: On-demand arm -
Other interventions: Factor VIII Inhibitor Bypassing Activity (nanofiltered, vapor heat-treated)
85 ± 15 U/kg of FEIBA NF every other day during the 12-month prophylactic period
Other interventions: Factor VIII Inhibitor Bypassing Activity (nanofiltered, vapor heat-treated)
FEIBA NF dose and dosing interval as prescribed by the treating physician
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Intervention code [1]
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Other interventions
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Reduction in Annualized Bleeding Episode Rate (ABR) Among Participants Receiving Prophylactic Treatment as Compared to Those Treated On-demand
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Assessment method [1]
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Participants were Randomized to Receive 1 of the 2 Following Treatment Regimens: 1.On-Demand: FEIBA NF dose & dosing interval as prescribed by treating physician 2.Prophylaxis: 85 ± 15 U/kg of FEIBA NF every other day during 12-month prophylactic period Annualized rate of bleeding episodes was calculated as: (Number of bleeding episodes/observed treatment period in days) * 365.25
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Timepoint [1]
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12 months ± 14 days
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Secondary outcome [1]
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Annualized Bleeding Rate by Treatment Regimen, Bleeding Etiology, and Bleed Type
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Assessment method [1]
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Spontaneous includes unknown/undermined etiology
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Timepoint [1]
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12 months ± 14 days
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Secondary outcome [2]
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Differences in Mean Transformed Annualized Bleeding Rate Between On-Demand and Prophylaxis Treatment Regimens by Bleeding Etiology, and Bleeding Type
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Assessment method [2]
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Annualized bleed rates were transformed using the square root of the number of bleeding episodes observed (X bleeds/year), X' = v(X + 0.5). This transformation was performed to stabilize the variance and align the sample distribution with the assumption of normality inherent in using the t-test. The difference in mean transformed ABRs was used to perform statistical tests and generate p-values at a significance level of 5% Participants were Randomized to Receive 1 of the 2 Following Treatment Regimens: 1.On-Demand: FEIBA NF dose & dosing interval as prescribed by treating physician 2.Prophylaxis: 85 ± 15 U/kg of FEIBA NF every other day during 12-month prophylactic period
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Timepoint [2]
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12 months ± 14 days
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Secondary outcome [3]
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Annualized Bleeding Rate for New Target Joints
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Assessment method [3]
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Target joints are =4 bleeds/6 months in any one of the following joints: ankles, knees, elbows, and hips; a target joint bleeding episode refers to an individual anatomical location.
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Timepoint [3]
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12 months ± 14 days
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Secondary outcome [4]
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Differences in Mean Transformed Annualized Bleeding Rate Between On-Demand and Prophylaxis Treatment Regimens: New Target Joints
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Assessment method [4]
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Annualized bleed rates (ABRs) were transformed using the square root of the number of bleeding episodes observed (X bleeds/year), X' = v(X + 0.5). This transformation was performed to stabilize the variance and align the sample distribution with the assumption of normality inherent in using a two-sample, two-sided t-test. The difference in mean transformed ABRs was used to perform statistical tests and generate p-values at a significance level of 5%
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Timepoint [4]
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12 months ± 14 days
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Secondary outcome [5]
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Number of New Target Joints
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Assessment method [5]
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Target Joints are defined as =4 bleeds/6 months in any one of the following joints: ankles, knees, elbows and hips
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Timepoint [5]
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12 months ± 14 days
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Secondary outcome [6]
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Assessment of Objective Clinical Symptoms- Visual Analog Scale (VAS): Pain in Adolescents and Adults (=12 Years Old)
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Assessment method [6]
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Pain caused by a bleeding episode in adolescents and adults (=12 years old) was measured at pre-infusion (pre-inf) and at 6 ± 0.5 hours (h) and 24 ± 1 h post-infusion (post-inf) (after the last infusion given to treat a bleeding episode) on the VAS pain scale in millimeters from 0 (no pain) to 100 (worst possible pain). For analysis purposes, if short acting analgesics (duration of activity approximately 6 ± 0.5 h) were used, pain was assigned the highest possible score (100). Pain assessment occurred after each infusion related to single bleeding episodes. In case participants required an additional infusion within 24h, pain was assessed 6 ± 0.5 h and 24 ±1 h following the subsequent infusion. Change in VAS scores at 6 ± 0.5 h and 24 ±1 h post-infusion were also compared relative to pre-infusion VAS scores (ie, (pre-infusion VAS score) - (post-infusion VAS score)).
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Timepoint [6]
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Throughout the study period, 12 months ± 14 days
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Secondary outcome [7]
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Assessment of Clinical Symptoms - Visual Analog Scale (VAS): Pain in Pediatrics (<12 Years Old)
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Assessment method [7]
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Pain caused by a bleeding episode (BE) in pediatric participants (<12 years old) was measured at pre-infusion (pre-inf) and at 6 ± 0.5 h and 24 ± 1 h post-infusion (post-inf) (after the last infusion given to treat a bleeding episode) using the children's VAS pain scale (a facial expression scale with one end marked as no pain and the opposite end marked as the worst possible pain). For analysis purposes, if short acting analgesics (duration of activity approximately 6 ± 0.5 h) were used, pain was assigned the highest possible score (worst possible pain). Scores on the children's VAS scale are presented as: -No Pain -Mild Pain -Moderate pain -Severe pain -Very severe pain
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Timepoint [7]
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12 months ± 14 days
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Secondary outcome [8]
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Assessment of Clinical Symptoms - Range of Motion (ROM)
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Assessment method [8]
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ROM was measured using a goniometer for 3 key joints (ie, ankles, knees, and elbows) at screening, month 6, and termination (end of study visit)
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Timepoint [8]
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12 months ± 14 days
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Secondary outcome [9]
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Assessment of Hemostasis for Treatment of Bleeding Episodes- Overall Efficacy Rating at 6 Hours
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Assessment method [9]
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Number of rAHF-PFM-treated bleeding episodes with an assessment of hemostasis (4-point ordinal scale): Excellent: Full pain relief & bleeding cessation within ~6 hours of 1 infusion. Additional infusions may have been given to maintain hemostasis; Good: Definite pain relief and/or improvement in bleeding within ~6 hours after infusion. Possibly requires >1 infusion for complete resolution; Fair: Probable or slight relief of pain & slight improvement in bleeding within ~6 hours after infusion. Requires >1 infusion for complete resolution; None: No improvement or condition worsens
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Timepoint [9]
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6 h ± 30 min post-infusion
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Secondary outcome [10]
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Assessment of Hemostasis for Treatment of Bleeding Episodes- Overall Efficacy Rating at 24 Hours
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Assessment method [10]
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Number of rAHF-PFM-treated bleeding episodes with an assessment of hemostasis (4-point ordinal scale): Excellent: Full pain relief & bleeding cessation within ~24 hours of 1 infusion. Additional infusions may have been given to maintain hemostasis; Good: Definite pain relief and/or improvement in bleeding within ~24 hours after infusion. Possibly requires >1 infusion for complete resolution; Fair: Probable or slight relief of pain & slight improvement in bleeding within ~24 hours after infusion. Requires >1 infusion for complete resolution; None: No improvement or condition worsens
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Timepoint [10]
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24 ± 1 h post-infusion
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Secondary outcome [11]
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Total Weight Adjusted Dose to Control a Bleeding Episode
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Assessment method [11]
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Timepoint [11]
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12 months ± 14 days
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Secondary outcome [12]
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The Number of Bleeding Episode (BE) Which Required 1, 2, 3, or =4 Infusions to Control Bleeding
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Assessment method [12]
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Timepoint [12]
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12 months ± 14 days
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Secondary outcome [13]
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Abnormal Activated Partial Thromboplastin Time (aPTT) Assay Results
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Assessment method [13]
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The normal reference range of values for aPTT is 22.8 - 31 seconds.
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Timepoint [13]
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Screening visit, Month 3, Month 6, Month 9, and Termination visit
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Secondary outcome [14]
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Abnormal D-Dimer Assay Results
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Assessment method [14]
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The normal reference range of values for D-dimers is <500 ng/mL.
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Timepoint [14]
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Screening visit, Month 3, Month 6, Month 9, and Termination visit
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Secondary outcome [15]
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Abnormal Fibrinogen Assay Results
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Assessment method [15]
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The normal reference range of values for fibrinogen is 200-400 mg/dL.
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Timepoint [15]
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Screening visit, Month 3, Month 6, Month 9, and Termination visit
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Secondary outcome [16]
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Abnormal Fibrin Degradation Products (FDP) Assay Results
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Assessment method [16]
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The normal reference range of values for FDP is 0-5 ug/mL.
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Timepoint [16]
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Screening visit, Month 3, Month 6, Month 9, and Termination visit
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Secondary outcome [17]
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Abnormal Prothrombin Fragment F 1.2 Assay Results
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Assessment method [17]
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The normal reference range of values for prothrombin fragment F 1.2 is 69-229 pmol/L.
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Timepoint [17]
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Screening visit, Month 3, Month 6, Month 9, and Termination visit
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Secondary outcome [18]
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Abnormal Prothrombin Time Assay Results
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Assessment method [18]
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The normal reference range of values for PT is 9.7-12.3 sec.
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Timepoint [18]
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Screening visit, Month 3, Month 6, Month 9, and Termination visit
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Secondary outcome [19]
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Abnormal Thrombin-Antithrombin III (TAT) Assay Results
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Assessment method [19]
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The normal reference range of values for TAT is 1-4.1 ug/L.
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Timepoint [19]
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Screening visit, Month 3, Month 6, Month 9, and Termination visit
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Secondary outcome [20]
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Viral Serology From Screening Visit and Study Termination Visit: Hepatitis A, Hepatitis B, and Hepatitis C
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Assessment method [20]
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-Hepatitis A Virus Antibody (HAV Ab) -Hepatitis B Virus Core Antibody (HBcAb) -Hepatitis B Virus Surface Antibody (HBsAb) -Hepatitis B Virus Surface Antigen (HBsAg) -Hepatitis C Virus (HCV)
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Timepoint [20]
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12 months ± 14 days
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Secondary outcome [21]
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Viral Serology From Screening Visit and Study Termination Visit: HIV-1/2 Antibody (Ab)
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Assessment method [21]
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Timepoint [21]
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12 months ± 14 days
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Secondary outcome [22]
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Viral Serology From Screening Visit and Study Termination Visit: Parvovirus B19 IgG Antibody [IV]
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Assessment method [22]
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Normal range (0 - 0.89 IV); High (> 0.89 IV) - Parvovirus B19 IgG Antibody [IV] (Parvo IgG Ab)
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Timepoint [22]
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12 months ± 14 days
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Secondary outcome [23]
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Viral Serology From Screening Visit and Study Termination Visit: Parvovirus B19 IgM Antibody [IV]
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Assessment method [23]
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Normal range (0 - 0.89 IV); High (> 0.89 IV) - Parvovirus B19 IgM Antibody [IV] (Parvo IgM Ab)
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Timepoint [23]
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12 months ± 14 days
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Secondary outcome [24]
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Rate of Related Adverse Events (AEs) Per Year
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Assessment method [24]
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Timepoint [24]
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12 months ± 14 days
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Secondary outcome [25]
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Rate of Related Adverse Events (AEs) During or Within 1 Hour of Infusion Per Year
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Assessment method [25]
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Timepoint [25]
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12 months ± 14 days
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Secondary outcome [26]
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Number of Related Thromboembolic Adverse Events (AEs)
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Assessment method [26]
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Timepoint [26]
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12 months ± 14 days
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Secondary outcome [27]
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Absolute Changes in Inhibitor Titer of Hemophilia A Participants With Shifts in Factor VIII (FVIII) Inhibitor Titer Levels
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Assessment method [27]
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Absolute Changes in Inhibitor Titer (or no change in low or high titer status): -Inhibitor Titer went from Low (=5 BU) to Low (=5 BU) -Inhibitor Titer went from Low (=5 BU) to High (>5 BU) -Inhibitor Titer went from High (>5 BU) to Low (=5 BU) -Inhibitor Titer went from High (>5 BU) to High (>5 BU)
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Timepoint [27]
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12 months ± 14 days
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Secondary outcome [28]
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Absolute Changes in Inhibitor Titer of Hemophilia B Participants With Shifts in Factor IX (FIX) Inhibitor Titer Levels
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Assessment method [28]
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Absolute Changes in Inhibitor Titer (or no change in low or high titer status): -Inhibitor Titer went from Low (=5 BU) to Low (=5 BU) -Inhibitor Titer went from Low (=5 BU) to High (>5 BU) -Inhibitor Titer went from High (>5 BU) to Low (=5 BU) -Inhibitor Titer went from High (>5 BU) to High (>5 BU)
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Timepoint [28]
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12 months ± 14 days
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Secondary outcome [29]
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Pharmacoeconomics: Annual Days Lost Due to Bleeding (Work or School)
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Assessment method [29]
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Timepoint [29]
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12 months ± 14 days
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Secondary outcome [30]
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Pharmacoeconomics: Annual Number of Hospitalizations for Bleeding
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Assessment method [30]
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Timepoint [30]
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12 months ± 14 days
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Secondary outcome [31]
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Pharmacoeconomics: Annual Number of Hospitalizations for Indwelling Line
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Assessment method [31]
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Timepoint [31]
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12 months ± 14 days
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Secondary outcome [32]
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Pharmacoeconomics: Annual Number of Emergency Room Visits
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Assessment method [32]
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Timepoint [32]
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12 months ± 14 days
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Secondary outcome [33]
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Pharmacoeconomics: Annual Number of Physician's Office Visits
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Assessment method [33]
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Timepoint [33]
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12 months ± 14 days
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Secondary outcome [34]
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Pharmacoeconomics: Annual Total Length of Hospitalization for Bleeding
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Assessment method [34]
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Timepoint [34]
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12 months ± 14 days
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Secondary outcome [35]
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Pharmacoeconomics: Annual Total Length of Hospitalization for Indwelling Line
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Assessment method [35]
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Timepoint [35]
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12 months ± 14 days
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Secondary outcome [36]
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Pharmacoeconomics: Annual Total Number of Days Lost (Work or School)
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Assessment method [36]
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Timepoint [36]
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12 months ± 14 days
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Secondary outcome [37]
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Health-Related Quality of Life (HRQoL): EuroQoL (Quality of Life)-5 Dimensions (EQ-5D) Index Scores
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Assessment method [37]
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EQ-5D is a participant answered questionnaire scoring 5 dimensions - mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The EQ-5D total score ranges from 0 (worst health state) to 1 (perfect health state) and 1 reflects the best outcome. EQ-5D Index scores based on EQ-5D questionnaire were calculated for participants =14 years of age, at screening, 6 months, and at termination visit. Changes in scores at 6 months and termination were also calculated. A relatively higher score represents better quality of life.
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Timepoint [37]
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12 months ± 14 days
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Secondary outcome [38]
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Hemophilia-specific Quality of Life Questionnaire for Adults (Haem-A-QoL) = 16 Years Old
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Assessment method [38]
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The Haem-A-QoL instrument has been developed and used in Hemophilia A patients. As a hemophilia-specific instrument, this measure assesses very specific aspects of dealing with hemophilia. The areas covered by this instrument are: Physical Health (PH), Sports & Leisure (S&L), School & Work (W&S), Dealing with Hemophilia (Dealing), Family Planning (FP), Feeling, Relationships (R'ships), Treatment, View, and Outlook for the Future (Future). A Haem-A-QoL Total Score (Total) was also calculated. For the Haem-A-QoL, higher scores indicate a worse quality of life. Scores on a scale range between 0 and 100. Haem-A-QoL scores at screening, 6 months, and at termination visit were collected. Changes in scores at 6 months and termination were also calculated.
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Timepoint [38]
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12 months ± 14 days
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Secondary outcome [39]
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Hemophilia-specific Quality of Life Questionnaire for Children and Adolescents < 16 Years Old (Haemo-QoL) - Parent's Evaluation
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Assessment method [39]
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The Haemo-QoL is a quality of life (QoL) assessment instrument for children and adolescents with haemophilia. As a hemophilia-specific instrument, this measure assesses very specific aspects of dealing with hemophilia. The areas covered by this instrument are: Physical Health (PH), Sports & School (S&S), Dealing with Hemophilia (Dealing), Family, Feeling, Relationships (R'ships), Treatment, View, Outlook for the Future (Future), Friends, Others, and Support. A Haemo-QoL Total Score (Total) was also calculated. For the Haemo-QoL, higher scores indicate a worse quality of life. Scores on a scale range between 0 and 100. Haemo-QoL scores at screening, 6 months, and at termination visit were collected. Changes in scores at 6 months and termination were also calculated.
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Timepoint [39]
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12 months ± 14 days
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Secondary outcome [40]
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Hemophilia-specific Quality of Life Questionnaire for Children and Adolescents < 16 Years Old (Haemo-QoL) - Child's Evaluation
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Assessment method [40]
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The Haemo-QoL is a quality of life (QoL) assessment instrument for children and adolescents with haemophilia. As a hemophilia-specific instrument, this measure assesses very specific aspects of dealing with hemophilia. The areas covered by this instrument are: Physical Health (PH), Sports & School (S&S), Dealing with Hemophilia (Dealing), Family, Feeling, Relationships (R'ships), Treatment, View, Outlook for the Future (Future), Friends, Others, and Support. A Haemo-QoL Total Score (Total) was also calculated. For the Haemo-QoL, higher scores indicate a worse quality of life. Scores on a scale range between 0 and 100. Haemo-QoL scores at screening, 6 months, and at termination visit were collected. Changes in scores at 6 months and termination were also calculated.
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Timepoint [40]
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12 months ± 14 days
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Secondary outcome [41]
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Health-Related Quality of Life (HRQoL) - General Pain Assessment Using a Visual Analogue Scale (VAS) in Adults and Adolescents =12 Years Old
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Assessment method [41]
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General pain was assessed using a VAS pain scale at screening, 6 months, and at termination. Unlike the VAS pain assessment for pain of bleeding episodes (Outcome above), this general pain assessment did not take use of analgesics into account. For the pain scale, a higher number indicates worse pain. The visual analog scale ranges from 0 to 100 where the endpoints are labeled 'Worst imaginable health state' (=0) and 'Best imaginable health state' (=100). A positive change from baseline indicates improvement. Change in VAS scores at 6 months and study termination were also compared relative to Baseline/Screening scores (ie, (Baseline/Screening VAS score) - (VAS score at 6 months and study termination).
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Timepoint [41]
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Baseline, 6 months and 12 months ± 14 days
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Secondary outcome [42]
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Health-Related Quality of Life (HRQoL) - General Pain Assessment Using a Visual Analogue Scale (VAS) in Pediatrics <12 Years Old
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Assessment method [42]
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General pain was assessed using the children's VAS pain scale (a facial expression scale with one end marked as no pain and the opposite end marked as the worst possible pain). Assessments were done at the screening, 6 months, and termination visits. Scores on the children's VAS scale are presented as: -No Pain -Mild Pain -Moderate pain -Severe pain -Very severe pain Unlike the VAS pain assessment for pain of bleeding episodes (Outcome above), this general pain assessment did not take use of analgesics into account. Change in VAS scores at 6 months and study termination were also compared relative to Baseline/Screening scores (ie, (Baseline/Screening VAS score) - (VAS score at 6 months and study termination).
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Timepoint [42]
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Baseline, 6 months and 12 months ± 14 days
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Eligibility
Key inclusion criteria
- Signed and dated informed consent form by the participant or the participant's legally
authorized representative
- The participant is = 4 to = 65 years of age
- The participant has a Karnofsky performance score of = 60
- Hemophilia A and B of any severity, with documented history of high-titer inhibitor (>
5 Bethesda unit (BU)) for at least 12 months; or, if inhibitor titer is = 5 BU, and
the participant is refractory with increased dosing of either factor VIII (FVIII) or
factor IX (FIX), as demonstrated from the participant's medical history
- Currently being treated on an on-demand basis for treatment of bleeding episodes
- Adequate venous access, with or without central venous device
- = 12 bleeding episodes requiring treatment with by-passing agents in the past 12
months, based on medical history
- Competent in-home treatment and infusion therapy
- Currently using bypassing agents (activated prothrombin complex concentrate (APCC) or
recombinant activated factor VII (rFVIIa)) for treatment of bleeding episodes
- HCV-, either by antibody testing or polymerase chain reaction (PCR); or HCV+ with
stable hepatic disease
- HIV-, or HIV+ with stable disease and CD4 count > 200 cells/mm3 at screening
- Female participant of childbearing potential, presents with a negative serum pregnancy
test, and agrees to employ adequate birth control measures for the duration of the
study
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Minimum age
4
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
- Currently receiving immune tolerance induction (ITI)
- Currently on regular prophylactic therapy to prevent bleeding episodes
- Clinically symptomatic liver disease (e.g. diagnosis of cirrhosis [confirmed by liver
biopsy], portal vein hypertension, ascites, prothrombin time (PT) 5 seconds above
upper limit of normal)
- Platelet count < 100,000/ml
- Planned elective surgery during participation in this study
- Participant is currently participating in another clinical study and has received an
investigational product or device within 30 days prior to study entry
- Planned use of pegylated or non-pegylated alpha-interferon with or without ribavirin
for HCV infected participants or planned use of a protease inhibitor for HIV infected
participants. Participants currently taking any of these medications for a 30-day
course are eligible.
- Clinically significant increase in D-dimer levels from historical baseline and/or
associated with chronic liver disease or clinically evident thromboembolic event
- Known hypersensitivity to anti-inhibitor coagulant complexes (AICCs)
- Currently treated with a systemic immunomodulating drug
- Prior history of thromboembolic event: acute myocardial infarction, deep vein
thrombosis, or pulmonary embolism
- Diagnosis of advanced atherosclerosis, malignancy and/or other diseases that may
increase the participant's risk of thromboembolic complications
- Clinically significant medical, psychiatric, or cognitive illness, or recreational
drug/alcohol use that, in the opinion of the investigator, would affect participant
safety or compliance
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
31/03/2009
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
17/10/2012
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Sample size
Target
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Accrual to date
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Final
52
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Recruitment in Australia
Recruitment state(s)
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Recruitment outside Australia
Country [1]
0
0
United States of America
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State/province [1]
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0
Illinois
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Brazil
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RJ
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Brazil
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SP
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Bulgaria
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Sofia
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Croatia
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Zagreb
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Japan
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Kanagawa
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Japan
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Nara
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Wellington
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Poland
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Krakow
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Poland
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Warsaw
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Romania
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Bucharest
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Romania
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Timisoara
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Russian Federation
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Ekaterinburg
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Russian Federation
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Kirov
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Russian Federation
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Moscow
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Ukraine
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Lviv
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Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
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Name
Baxalta now part of Shire
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Summary
Brief summary
The purpose of the study was to determine the efficacy, safety, and health-related quality of
life benefits with FEIBA NF prophylactic treatment as compared with on-demand treatment.
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Trial website
https://clinicaltrials.gov/ct2/show/NCT00851721
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Contacts
Principal investigator
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Study Director
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Takeda
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Summary Results
For IPD and results data, please see
https://clinicaltrials.gov/ct2/show/NCT00851721
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