Pomalidomide for the Treatment of Bleeding in HHT

a study on Hereditary Hemorrhagic Telangiectasia

Summary

Eligibility
for people ages 18-99 (full criteria)
Location
at San Francisco, California and other locations
Dates
study started
estimated completion
Principal Investigator
by Miles Conrad, MD
Photo of Miles Conrad
Miles Conrad

Description

Summary

This is a Phase II placebo-controlled double-blind study of pomalidomide in patients with hereditary hemorrhagic telangiectasia (HHT) with moderate to severe epistaxis who require parenteral iron infusions or blood transfusions. A total of 159 patients will be randomized 2:1 to treatment with oral pomalidomide or matching placebo for 24 weeks. Mean change from baseline to 24 weeks in the Epistaxis Severity Score (ESS) will be compared between treatment groups to determine pomalidomide efficacy.

Official Title

Pomalidomide for the Treatment of Bleeding in Hereditary Hemorrhagic Telangiectasia

Details

HHT is associated with substantial morbidity, leading to a reduced quality of life, decreased rate of employment and a high incidence of depression. There currently exists no medical therapy recognized as consistently efficacious in HHT. Reports of the efficacy of thalidomide in HHT, as well as interim results of a pilot trial of pomalidomide in HHT provide evidence of efficacy with minimal toxicity. The favorable efficacy:toxicity ratio of pomalidomide suggest that it may benefit patients with HHT. This study is designed as a Phase II placebo-controlled double-blind study of pomalidomide in HHT patients with moderate to severe epistaxis who require parenteral iron infusions or blood transfusions. A total of 159 patients will be randomized 2:1 to treatment with oral pomalidomide or matching placebo for 24 weeks. Primary Objective: To determine efficacy of pomalidomide compared to placebo for the reduction in severity of epistaxis after 24 weeks of treatment. Secondary Objectives: To determine the safety and tolerability of pomalidomide for the treatment of HHT; to determine if pomalidomide treatment improves quality of life in HHT; to determine whether a continued response to pomalidomide is evident 12 weeks after treatment discontinuation; to develop a biorepository for future studies to define biomarkers predictive of pomalidomide response and allow investigations into the biology of HHT and mechanisms of pomalidomide.

Keywords

Telangiectasia, Hereditary Hemorrhagic Epistaxis pomalidomide blood transfusion Telangiectasis Pomalidomide Oral Product

Eligibility

You can join if…

Open to people ages 18-99

  1. A clinical diagnosis of HHT as defined by the Curacao criteria
  2. Age > 18 years
  3. Platelet count ≥ 100,000/µl
  4. WBC ≥ 2,500/µl
  5. INR ≤ 1.4 and normal activated partial thromboplastin time by local laboratory criteria (aPTT)
  6. Epistaxis severity score ≥ 3 measured over the preceding three months, measured at the screening visit
  7. A requirement for parenteral infusion of at least 250 mg of iron or transfusion of 1 unit of blood over the preceding 24 weeks
  8. Females of childbearing potential (FCBP) must adhere to the scheduled pregnancy testing (once very two weeks) as required in the POMALYST REMS program. FCBP must a negative serum pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of prescribing pomalidomide and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking pomalidomide. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a vasectomy.
  9. Ability to understand and sign informed consent
  10. . All study participants must agree to be registered into the FDA mandated POMALYST REMS program, and be willing and able to comply with the requirements of the POMALYST REMS program

You CAN'T join if...

  1. Women currently breast feeding
  2. Renal insufficiency, serum creatinine > 2.0 mg/dl
  3. GI bleeding thought to be related to hepatic insufficiency, bilirubin > 2.0 or transaminases > 3.0x normal
  4. Prior treatment with thalidomide or other imid drugs within previous 6 months
  5. Prior treatment with bevacizumab (systemic or nasal) within previous 8 weeks
  6. The use of octreotide or estrogens within the previous month
  7. History of prior thromboembolism confirmed by venous ultrasound or other imaging modalities
  8. Peripheral neuropathy, confirmed by neurologic consultation
  9. Known underlying hypoproliferative anemia (i.e. myelodysplasia, aplastic anemia)
  10. . Currently enrolled in other interventional trials
  11. . Known hypersensitivity to thalidomide or lenalidomide.
  12. . The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
  13. . Known SMAD-4 mutation
  14. . Anything that in the investigator's opinion is likely to interfere with completion of the study

Locations

  • UCSF HHT Center accepting new patients
    San Francisco California 94107 United States
  • University of Utah Healthcare accepting new patients
    Salt Lake City Utah 84132 United States

Lead Scientist at UCSF

  • Miles Conrad, MD
    Miles Conrad, MD, MPH is a Clinical Professor in the Department of Radiology at the University of California, San Francisco. In 2001, Dr. Conrad received his MD from Dartmouth Medical School in Hanover, New Hampshire, and in 2002 he obtained his MPH in Quantitative Methods from Harvard School of Public Heath in Boston.

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
The Cleveland Clinic
ID
NCT03910244
Phase
Phase 2
Study Type
Interventional
Last Updated
Contact us about this trial