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717 Clinical Outcomes over 3 Years of Once-Weekly Efanesoctocog Alfa Treatment in Adults and Adolescents with Severe Hemophilia A: Second Interim Analysis from the Phase 3 XTEND-ed Long-Term Extension Study

Program: Oral and Poster Abstracts
Type: Oral
Session: 322. Hemophilia A and B: Clinical and Epidemiological: Impact of Novel Therapies on Outcomes, Including Long-Term
Hematology Disease Topics & Pathways:
Research, Clinical trials, Bleeding and Clotting, Hemophilia, Clinical Research, Diseases
Monday, December 9, 2024: 11:00 AM

Robert Klamroth, MD1*, Stephanie P'ng2*, Sophie Susen3*, Davide Matino, MD, MSc4*, Pratima Chowdary5*, Angela C Weyand, MD6, Toshko Lissitchkov7*, Young-Shil Park8*, María Teresa Alvarez-Román, PhD, MD9*, Liqi Feng10*, Helena Palmborg11*, Jennifer Dumont12, Elena Santagostino13, Lara Mamikonian12* and Keiji Nogami14*

1Vivantes Klinikum, Friedrichshain, Berlin, Germany
2The Haemophilia and Haemostasis Centre, Fiona Stanley Hospital, Murdoch, Australia
3Centre Hospitalier Universitaire de Lille, Université de Lille, Lille, France
4Division of Hematology & Thromboembolism, Department of Medicine, McMaster University, Ontario, Canada
5Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, United Kingdom
6Division of Hematology/Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
7Specialized Hospital for Active Treatment of Hematological Diseases, Department of Chemotherapy, Hemotherapy and Hereditary Blood Diseases at Clinical Hematology Clinic, Sofia, Bulgaria
8Department of Pediatrics, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea, Republic of (South)
9Department of Hematology, University Hospital La Paz, Autonoma University of Madrid, Madrid, Spain
10Sanofi, Shanghai, China
11Sobi, Stockholm, Sweden
12Sanofi, Cambridge, MA
13Sobi, Basel, Switzerland
14Nara Medical University, Nara, Japan

Introduction

Efanesoctocog alfa (formerly BIVV001) is a first-in-class high-sustained factor VIII (FVIII) replacement therapy designed to decouple FVIII from endogenous von Willebrand factor. In the Phase 3 XTEND-1 study (NCT04161495), once-weekly efanesoctocog alfa demonstrated superior bleed protection over prior FVIII prophylaxis, was well tolerated, and provided FVIII activity within the normal to near-normal (>40%) range for most of the week. Here we present data from the second interim analysis of the long-term safety and efficacy of efanesoctocog alfa in adults and adolescents with severe hemophilia A in the XTEND-ed study (NCT04644575).

Methods

Previously treated patients (≥12 years) who completed XTEND-1 could continue efanesoctocog alfa (50 IU/kg, once-weekly) prophylaxis in the multicenter, open-label, long-term XTEND-ed study (Arm A). The primary endpoint is incidence of FVIII inhibitor development (determined by the Nijmegen modified Bethesda assay). Secondary endpoints include annualized bleed rates (ABRs), efficacy for bleed treatment, patient-reported quality of life (QoL) outcomes, and safety. XTEND-ed was approved by local ethics committees; participants provided informed consent. Data cut: February 22, 2024.

Results

A total of 146 participants (including 1 female) rolled over from XTEND-1 to Arm A of XTEND-ed (age: 12–17 years, n=21; 18–64 years, n=120; ≥65 years, n=5). The median (range) treatment duration in XTEND-ed was 120.6 (14.1–140.6) weeks comprising a median (range) of 121.5 (14–147) exposure days (EDs). The median (range) cumulative treatment duration from XTEND-1 baseline was 170.5 (46.3–192.6) weeks with median (range) 171.5 (47–201) EDs. FVIII inhibitors were not detected. During XTEND-ed, the mean (standard deviation [SD]) ABRs for Day 1–Month 6 (n=146) was 0.63 (1.6), Months 6–12 (n=144) was 0.77 (1.54), Months 12–18 (n=139) was 0.65 (1.67), and Months 18–24 (n=138) was 0.58 (1.64). The number of participants with zero bleeds for Day 1–Month 6 was 116 of 146 (79.5%), Months 6–12 was 107 of 144 (74.3%), Months 12–18 was 109 of 139 (78.4%), and Months 18–24 was 111 of 138 (80.4%). The mean (95% confidence interval) model-based ABR for the whole efficacy period was 0.64 (0.50; 0.82). Of 205 treated bleeding episodes, 194 (94.6%) resolved with 1 injection of efanesoctocog alfa; participants rated the response as excellent/good for 139/160 (86.9%) bleeds. The median (range) total weekly efanesoctocog alfa consumption was 51.6 (39.4–61.0) IU/kg. The Haem-A-QoL total score and physical health score, analyzed in 102 participants (age: ≥17 years), showed an improvement with mean (SD) change from baseline (XTEND-1) to XTEND-ed Month 24 of -5.8 (13.35) and -7.5 (20.05), respectively.

Overall, 117 (80.1%) participants experienced ≥1 treatment-emergent adverse event (TEAE), the most commonly reported being COVID-19 (25.3%), arthralgia (15.1%), and nasopharyngitis (12.3%). Twenty-two participants (15.1%) experienced ≥1 serious TEAE including 2 participants with thromboembolic events: one was a deep vein thrombosis following corrective surgery for a femur fracture (in the setting of treatment with another FVIII product), the other was a cerebral infarction in a participant with pre-existing atrial fibrillation and other risk factors; neither event was related to efanesoctocog alfa treatment.

Conclusion

Long-term results in adults and adolescents in XTEND-ed shows that once-weekly efanesoctocog alfa continues to provide high efficacy and is well tolerated. No inhibitors were detected and ABRs remained low, with continued improvement observed for overall QoL.

Disclosures: Klamroth: Bayer, BioMarin, BioTest, CSL Behring, Grifols, Kedrion, LFB, Novo Nordisk, Octapharma, Pfizer, Roche/Chugai, Sanofi, Sobi, and Takeda: Honoraria, Other: Grant/research support, Research Funding. P'ng: Sanofi: Honoraria; Novo Nordisk: Honoraria; Roche: Honoraria; CSL: Honoraria; Pfizer: Honoraria. Susen: CSL Behring: Consultancy, Honoraria, Research Funding; Roche/Chugai: Consultancy, Honoraria, Research Funding; Stago: Research Funding; Siemens Healthiners: Consultancy, Honoraria, Research Funding; Biomarin: Consultancy, Honoraria; Bioverativ: Consultancy, Honoraria; Hemosonics: Consultancy, Honoraria; LFB: Consultancy, Honoraria; Novo Nordisk: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Shire/Takeda: Consultancy, Honoraria; Sobi: Consultancy, Honoraria. Matino: Bayer: Consultancy, Honoraria, Other: Scientific Advisory Board, Research Funding, Speakers Bureau; Roche: Research Funding; Pfizer: Consultancy, Honoraria, Other: Scientific Advisory Board, Research Funding, Speakers Bureau; Novo Nordisk: Honoraria, Other: Scientific Advisory Board, Research Funding, Speakers Bureau; Sanofi: Honoraria, Other: Scientific Advisory Board, Research Funding, Speakers Bureau; Spark: Research Funding; Octapharma: Honoraria, Other: Scientific Advisory Board, Research Funding, Speakers Bureau; Sobi: Honoraria, Other: Scientific Advisory Board, Speakers Bureau. Chowdary: Bayer: Other: Advisor; Boehringer Ingelheim: Other: Advisor; Apcintex: Other: Advisor; CSL Behring: Other: Advisor; Chugai: Other: Advisor; Freeline: Other: Advisor; Novo Nordisk: Other: Advisor; Pfizer: Other: Advisor; Roche: Other: Advisor; Sanofi: Other: Advisor; Spark: Other: Advisor; Sobi: Other: Advisor; Takeda: Other: Advisor. Weyand: Bayer: Honoraria; Genentech: Honoraria; Takeda: Consultancy, Honoraria, Research Funding; Pfizer: Research Funding; Novo Nordisk: Honoraria, Research Funding; Biomarin: Honoraria; Sanofi: Consultancy, Honoraria, Research Funding; Hemab: Consultancy; Octapharma: Honoraria. Lissitchkov: Sobi: Other: Principal investigator of clinical trial; Sanofi: Other: Principal investigator of clinical trial. Park: BioMarin: Other: principal investigator, Research Funding; CSL Behring: Other: principal investigator, Research Funding; Novo Nordisk: Other: principal investigator, Research Funding; Sanofi: Other: principal investigator, Research Funding; Takeda: Other: principal investigator, Research Funding; Pfizer: Other: principal investigator, Research Funding; Chugai: Other: principal investigator, Research Funding. Alvarez-Román: Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Sponsored symposia , Speakers Bureau; Takeda: Membership on an entity's Board of Directors or advisory committees, Other: Sponsored symposia , Speakers Bureau; Grifols: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees, Other: Sponsored symposia , Speakers Bureau; CSL Behring: Membership on an entity's Board of Directors or advisory committees, Other: Sponsored symposia , Speakers Bureau; Octapharma: Membership on an entity's Board of Directors or advisory committees, Other: Sponsored symposia , Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Other: Sponsored symposia , Speakers Bureau; Sobi: Membership on an entity's Board of Directors or advisory committees, Other: Sponsored symposia , Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Other: Sponsored symposia , Research Funding, Speakers Bureau; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees, Other: Sponsored symposia , Speakers Bureau. Feng: Sanofi: Current Employment. Palmborg: Sobi: Current Employment. Dumont: Sanofi: Current Employment. Santagostino: Sobi: Current Employment. Mamikonian: Sanofi: Current Employment. Nogami: Bayer AG.: Consultancy, Other, Research Funding; Novo Nordisk A/S: Consultancy, Other: principal investigator, Research Funding; CSL Behring Co.: Consultancy, Other: principal investigator, Research Funding; Sanofi S.A.: Consultancy, Other: principal investigator, Research Funding; Bioverativ: Other: principal investigator, Research Funding; Fujimoto Pharmaceutical Co.: Consultancy, Other, Research Funding; KM Biologics Co.: Consultancy, Other: principal investigator, Research Funding; Sekisui medical: Consultancy, Other: principal investigator, Research Funding; Sysmex Co.: Consultancy, Other, Research Funding; Chugai Pharmaceutical Co.: Consultancy, Other: principal investigator, Research Funding.

*signifies non-member of ASH