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Minimize Menorrhagia in Women With Type 1 Von Willebrand Disease (VWDMin)

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ClinicalTrials.gov Identifier: NCT02606045
Recruitment Status : Recruiting
First Posted : November 17, 2015
Last Update Posted : March 11, 2019
Sponsor:
Collaborators:
University of North Carolina
Duke University
Information provided by (Responsible Party):
Margaret Ragni, University of Pittsburgh

Brief Summary:
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 type 1 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.

Condition or disease Intervention/treatment Phase
Type 1 Von Willebrand Disease Drug: recombinant von Willebrand factor Drug: tranexamic acid Phase 3

Detailed Description:

In this study, women age 18-45 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 16 or more 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.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Prospective, Randomized, Crossover Trial Comparing Recombinant Von Willebrand Factor (rVWF) vs. Tranexamic Acid (TA) to Minimize Menorrhagia in Women With Type 1 Von Willebrand Disease: The VWD Minimize Study
Actual Study Start Date : February 7, 2019
Estimated Primary Completion Date : August 15, 2022
Estimated Study Completion Date : August 15, 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Menstruation

Arm Intervention/treatment
Active Comparator: Group I
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

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.

Other Names:
  • vonicog alfa
  • Vonvendi

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.

Other Name: Lysteda®

Active Comparator: Group II
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

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.

Other Names:
  • vonicog alfa
  • Vonvendi

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.

Other Name: Lysteda®




Primary Outcome Measures :
  1. Menstrual Bleeding Severity [ Time Frame: 24 weeks ]
    Bleeding severity measured by pictorial bleeding assessment chart (PBAC).


Secondary Outcome Measures :
  1. Menstrual bleeding unresponsive to study drugs [ Time Frame: 24 weeks ]
    Menorrhagia cycle severity rating by patient diary, cycle length by PBAC, drug logs

  2. Quality of life including depression, wellness, activity [ Time Frame: 24 weeks ]
    Quality of life questionnaires (HRQoL): Rand Short Form 36-Question Health Survey (SF-36), Ruta Menorrhagia Score, Center for Disease Control Health-Related Quality of Life 14 Questions (CDC-HRQoL-14), and Center for Epidemiology Studies Depression Scale (CES-D), and Satisfaction Survey

  3. von Willebrand assays, genotype [ Time Frame: 24 weeks ]
    von Willebrand assays: VWF ristocetin cofactor (VWF:RCo), VWF antigen ( VWF:Ag), VIII:C, multimers; VWF genotype



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 45 Years   (Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Adult females18-45 years of age.
  2. Mild or moderate von Willebrand disease (VWF:RCo <0.50 IU/ml, normal multimers, past bleeding)
  3. Menorrhagia defined as PBAC >100 in at least one of the last two menstrual cycles.
  4. Regular menses, at least every 21-35 days.
  5. Willingness to have blood drawn
  6. No prior history of an allergic reaction or anaphylaxis to rVWF or TA.
  7. Willingness to avoid aspirin (ASA) and nonsteroidal anti-inflammatory agents (NSAIDS) during the study.
  8. Willingness to comply with randomization to rVWF or TA study arms.
  9. Willingness to keep a personal diary of menorrhagia bleeding frequency duration and severity by pictorial blood assessment chart, and any drugs or hemostatic agents taken.
  10. Willingness to make 4 visits and undergo blood sampling for coagulation studies, and accept randomization of two therapies for each of four consecutive menstrual cycles, including an end-of-study visit.
  11. Willingness to use "double-barrier" method of contraception during the study.

Exclusion Criteria:

  1. Any bleeding disorder other than von Willebrand disease; or past thrombotic disease
  2. Pregnant or lactating, or use of hormones or oral contraceptives or contraceptive implant in past 3 months
  3. Platelet count < 100,000/ul.
  4. Use of immunomodulatory or experimental drugs.
  5. Surgery within the past 8 weeks.
  6. Concomitant use of antiplatelet drugs, anticoagulants, dextran, aspirin or NSAIDs.
  7. Treatment with DDAVP, cryoprecipitate, whole blood, plasma and plasma derivatives containing VWF within 5 days of study.
  8. Inability to comply with study requirements.
  9. Hypothyroidism as defined by elevated TSH.
  10. Iron deficiency as defined by low serum ferritin, unless iron replacement has been initiated.
  11. History of renal disease

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02606045


Contacts
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Contact: Margaret V Ragni, MD, MPH 412-209-7288 ragni@pitt.edu
Contact: Katarina Gray, BS 412-209-7563 KGray2@itxm.org

Locations
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United States, Pennsylvania
University of Pittsburgh and Hemophilia Center Western PA Recruiting
Pittsburgh, Pennsylvania, United States, 15213
Contact: Katarina Gray, BS    412-209-7563    kgray2@itxm.org   
Contact: Amy Steele, RN    412-209-7292    asteele@itxm.org   
Principal Investigator: Margaret V Ragni, MD MPH         
Sub-Investigator: Craig D Seaman, MD MS         
Sponsors and Collaborators
Margaret Ragni
University of North Carolina
Duke University
Investigators
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Principal Investigator: Margaret V Ragni, MD, MPH University of Pittsburgh
  Study Documents (Full-Text)

Documents provided by Margaret Ragni, University of Pittsburgh:

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Responsible Party: Margaret Ragni, Professor of Medicine, University of Pittsburgh
ClinicalTrials.gov Identifier: NCT02606045     History of Changes
Other Study ID Numbers: PRO15070638
First Posted: November 17, 2015    Key Record Dates
Last Update Posted: March 11, 2019
Last Verified: March 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: 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 Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
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.

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Margaret Ragni, University of Pittsburgh:
menorrhagia
VWD

Additional relevant MeSH terms:
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Von Willebrand Diseases
Von Willebrand Disease, Type 1
Uterine Hemorrhage
Uterine Diseases
Genital Diseases, Female
Hemorrhage
Blood Coagulation Disorders, Inherited
Blood Coagulation Disorders
Hematologic Diseases
Coagulation Protein Disorders
Blood Platelet Disorders
Hemorrhagic Disorders
Genetic Diseases, Inborn
Menorrhagia
Pathologic Processes
Menstruation Disturbances
Tranexamic Acid
Antifibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Hemostatics
Coagulants