Efficacy and Safety Study of Eltrombopag in Pediatric Patients With Thrombocytopenia From Chronic Idiopathic Thrombocytopenic Purpura (ITP)
Diagnosis: Pediatric Hematology/Blood Related
NCT ID: NCT00908037
(View complete trial on ClinicalTrials.gov)
DFCI Protocol ID:
Phase II, multi-center, 3 part, staggered cohort, open-label and double blind, randomized, placebo controlled study involving 3 age-determined cohorts (Cohort 1: between 12 and 17 years old; Cohort 2: between 6 and 11 years old; Cohort 3: between 1 and 5 years old). Daily dosing with eltrombopag will begin with 5 patients in the oldest age cohort in an open label fashion, and a review of safety, pharmacokinetic and platelet count data will be performed regularly. If no safety concerns are identified after 12 weeks, 18 additional patients will be randomised to placebo or eltrombopag (2:1 randomisation). After 7 weeks of randomized treatment, all patients will receive eltrombopag in an open label fashion. The total duration of treatment with eltrombopag will be 24 weeks. If at the time of the aforementioned 12 week review of the first 5 patients no safety issues are identified, dosing will begin in the next lower age cohort with an initial group of 5 patients. The same procedure will be followed in terms of safety review and subsequent enrolment and randomisation of the additional patients. Initiation of the younger age cohort will take place once data from the previous has been evaluated. Doses will be adjusted according to platelet counts and tolerability. The study will include a review of the safety data by a Data Safety Monitoring Board.
Children's Hospital Boston, Dana-Farber Cancer Institute
Ellis Neufeld, MD, PhD,
Brigham and Women's Hospital
Dana-Farber Cancer Institute:
Childrens Hospital Pediatric Clinical Translation Investigation Program CTIP,
- Subjects between 1 year and <18 years of age at Day 1.
- Written informed consent from subject's guardian and accompanying informed assent
from subject (for children over 6 years old).
- Confirmed diagnosis of chronic ITP, according to the American Society of Hematology /
British Committee for Standards in Haematology (ASH/BCSH) guidelines [George, 1996;
BCSH, 2003]. In addition, a peripheral blood smear or bone marrow examination should
support the diagnosis of ITP with no evidence of other causes of thrombocytopenia.
- Subjects who are refractory or have relapsed after at least one prior ITP therapy or
are not eligible, for a medical reason, for other treatments.
- Day 1 (or within 48 hours prior) platelet count <30 Gi/L.
- Previous therapy for ITP with immunoglobulins (IVIg and anti-D) must have been
completed at least 2 weeks prior to Day 1 or have been clearly ineffective.
- Subjects treated with concomitant ITP medication (e.g. corticosteroids or
azathioprine) must be receiving a dose that has been stable for at least 4 weeks
prior to Day 1.
- Previous treatment for ITP with splenectomy, rituximab and cyclophosphamide must have
been completed at least 4 weeks prior to Day 1 or have clearly been ineffective.
- Subjects must have prothrombin time (PT/INR) and activated partial thromboplastin
time (aPTT) within 80 to 120% of the normal range.
- Subjects must have a complete blood count (CBC) not suggestive of another
- The following clinical chemistries for the subjects MUST NOT exceed the upper limit
of normal (ULN) reference range by more than 20%: creatinine, alanine
aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and
alkaline phosphatase. In addition, total albumin must not be below the lower limit of
normal (LLN) by more than 10%.
- For subjects of child-bearing potential (after menarche): subject must not be
sexually active or is practicing an acceptable method of contraception (documented in
chart). Female subjects (or female partners of male subjects) must use one of the
following highly effective methods of contraception (i.e., Pearl Index <1.0%) from
two weeks prior to administration of study medication, throughout the study, and 28
days after completion or premature discontinuation from the study:
- Complete abstinence from intercourse;
- Intrauterine device (IUD);
- Two forms of barrier contraception (diaphragm plus spermicide, and for males condom
- Systemic contraceptives (combined or progesterone only).
- Any clinically relevant abnormality, other than ITP, identified on the screening
examination or any other medical condition or circumstance, which in the opinion of
the investigator makes the subject unsuitable for participation in the study or
suggests another primary diagnosis (e.g. thrombocytopenia is secondary to another
- Concurrent or past malignant disease, including myeloproliferative disorder.
- Subjects who are not suitable for continuation of their current therapy for at least
7 additional additional weeks.
- Treatment with an investigational drug within 30 days or 5 half-lives (whichever is
longer) preceding Day 1.
- History of platelet agglutination abnormality that prevents reliable measurement of
- Diagnosis of secondary immune thrombocytopenia, including those with laboratory or
clinical evidence of HIV infection, anti-phospholipid antibody syndrome, chronic
hepatitis B infection, hepatitis C virus infection, or any evidence of active
hepatitis at the time of subject screening.
- Subject with Evans syndrome (autoimmune thrombocytopenia and autoimmune hemolysis).
- Subjects with known inherited thrombocytopenia (e.g. MYH-9 disorders)
- Subjects treated with drugs that affect platelet function (including but not limited
to aspirin, clopidogrel and/or NSAIDs) or anti-coagulants for >3 consecutive days
within 2 weeks of Day 1.
- Subjects who have previously received eltrombopag or any other thrombopoietin
- For female subjects who have reached menarche status, an inability or unwillingness
to provide a blood or urine specimen for pregnancy testing.
- Female subjects who are pregnant or lactating.