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Deferasirox

Phase 3

Beta-thalassemia | Small molecule | Hematology |Novartis AG|Last Updated: Aug 16, 2021

Success Probability

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Market & Valuation

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Trial Design

UNCONTROLLED
Total Trials3
Total Enrollment457

FDA Designations

No designations recorded

Clinical trial landscape

Deferasirox · 22 trials · 29 indications

Phase 3 5Phase 2 12Phase 1 5
NCT02720536Extended Evaluation of Deferasirox Film-coated Tablet (FCT) FormulationChronic Iron Overload
COMPLETED53 Analytics
NCT00235391Expanded Access of Deferasirox to Patients With Congenital Disorders of Red Blood Cells and Chronic Iron OverloadThalassemia
COMPLETED1,683 Analytics
NCT00171821A Study Assessing the Efficacy and Safety of Deferasirox in Patients With Transfusion-dependent Iron OverloadTransfusion-dependent Iron Overload
COMPLETED1,784 Analytics
NCT00171210An Extension Study of Iron Chelation Therapy With Deferasirox (ICL670) in β-thalassemia Patients With Transfusional Iron OverloadTransfusional Iron Overload in β-thalassemia
COMPLETED506 Analytics
NCT00171171A Study of Long-term Treatment With Deferasirox in Patients With Beta-thalassemia and Transfusional HemosiderosisBeta-Thalassemia
COMPLETED252 Analytics
PHASE3COMPLETED
Extended Evaluation of Deferasirox Film-coated Tablet (FCT) Formulation
Chronic Iron OverloadUnlock trial analytics
PHASE3COMPLETED
Expanded Access of Deferasirox to Patients With Congenital Disorders of Red Blood Cells and Chronic Iron Overload
ThalassemiaUnlock trial analytics
PHASE3COMPLETED
A Study Assessing the Efficacy and Safety of Deferasirox in Patients With Transfusion-dependent Iron Overload
Transfusion-dependent Iron OverloadUnlock trial analytics
PHASE3COMPLETED
An Extension Study of Iron Chelation Therapy With Deferasirox (ICL670) in β-thalassemia Patients With Transfusional Iron Overload
Transfusional Iron Overload in β-thalassemiaUnlock trial analytics
PHASE3COMPLETED
A Study of Long-term Treatment With Deferasirox in Patients With Beta-thalassemia and Transfusional Hemosiderosis
Beta-ThalassemiaUnlock trial analytics

Study Endpoints

Primary Endpoints

Overview of Number of Participants With Adverse Events
Baseline up to approximately 25 months

Numbers represent counts of participants within the categories. An adverse event (AE) was defined as treatment emergent if its onset date is on or after (≥) the first administration of study treatment within this study or events present prior to start of study treatment but increased in severity on or after (≥) the first administration of study treatment within this study but not later than 30 days after the last study treatment in this study

Change From Baseline Red Blood Cells (RBC) (10^12 Cells/L) at Month 6 and Month 12
Baseline, 6 and 12 months

The change from baseline at each time point is calculated only for subjects with a value at baseline and the particular time point. Post = Post baseline, Change = Post - Baseline

Change From Baseline White Blood Cells (WBC) (10^9 Cells/L) at Month 6 and Month 12
Baseline, 6 and 12 months

The change from baseline at each time point is calculated only for subjects with a value at baseline and the particular time point. Post = Post baseline, Change = Post - Baseline

Change From Baseline Platelets (10^9 Cells/L) at Month 6 and Month 12
Baseline, 6 and 12 months

The change from baseline at each time point is calculated only for subjects with a value at baseline and the particular time point. Post = Post baseline, Change = Post - Baseline

Change From Baseline Serum Creatinine (Umol/L) at Month 6 and Month 12
Baseline, 6 and 12 months

The change from baseline at each time point is calculated only for subjects with a value at baseline and the particular time point. Post = Post baseline, Change = Post - Baseline

Change From Baseline Creatinine Clearance (mL/Min) at Month 6 and Month 12
Baseline, 6 and 12 months

The change from baseline at each time point is calculated only for subjects with a value at baseline and the particular time point. Post = Post baseline, Change = Post - Baseline

Change From Baseline Alanine Aminotransferase/Serum Glutamic Pyruvic Transaminase (ALT/SGPT) (U/L) at Month 6 and Month 12
Baseline, 6 and 12 months

The change from baseline at each time point is calculated only for subjects with a value at baseline and the particular time point. Post = Post baseline, Change = Post - Baseline

Change From Baseline Aspartate Aminotransferase/Serum Glutamic Oxaloacetic Transaminase (AST/SGOT) (U/L) at Month 6 and Month 12
Baseline, 6 and 12 months

The change from baseline at each time point is calculated only for subjects with a value at baseline and the particular time point. Post = Post baseline, Change = Post - Baseline

Safety Profile of Deferasirox Based Upon Drug Administration and Reporting of Serious Adverse Events
Baseline to end of study (Median exposure time to drug was approximately 30 weeks; Maximum exposure was 104 weeks)

Safety as assessed by the number of participants with death, serious adverse events (SAE), and/or Adverse Events (AEs) leading to study drug interruption or discontinuation. Note: only treatment emergent AEs are summarized.

To evaluate if fixed starting doses of ICL670, based on transfusion history and subsequent dose titration can provide clinically acceptable chelation as measured by serum ferritin
at baseline and at 52 weeks
Long Term Safety and Tolerability Profile of ICL670 Based on the Number of Participants Who Experienced Any Adverse Event
up to 5 years

Adverse events results are based on preferred terms with at least 7% of participants in any group.

Liver Iron Concentration (as measured by biopsy)
at baseline and after 1 yeor of ICL670 treatment
Event-free Survival
Day 1 to end of treatment period, approx. 7 years

Event-free survival was defined as the time from the date of randomization to the date of the first documented non-fatal event (worsening cardiac function, hospitalization for congestive heart failure, liver function impairment, liver cirrhosis, transformation to AML, as defined in the protocol), or death, whichever occurred first. Participants who did not experience a non-fatal event as of the time of data cut-off (end of study), as well as participants who did not experience a non-fatal event and stopped study participation before the data cut-off, were censored as specified in the protocol.

Change from baseline in cardiac T2* value
52 weeks

Unsatisfactory response is a monthly MRI T2\* improvement lower than 3% versus baseline.

Core Study: Change in Liver Iron Concentration (LIC) From Baseline to Week 52
Baseline, Week 52

LIC was measured by magnetic resonance imaging technique at baseline and Week 52. Estimates were obtained from an Analysis of Covariance (ANCOVA) model for change in LIC between baseline and Week 52 with treatment as factor and baseline LIC as covariate.

Extension Study: Percentage of Participants Reaching a Liver Iron Concentration (LIC) < 5 mg Fe/g dw From Core Baseline to End of Extension Study
Core Baseline to End of Extension Study (up to 24 months)

Liver iron concentration was measured at Core Baseline and at the end of the Extension Study. Magnetic Resonance Imaging (MRI) scans were analyzed at a central laboratory to determine the LIC value. The percentage of participants with LIC \< 5 mgFe/g dw (milligram iron/gram dry weight) change from Baseline at the end of the Extension Study is reported.

Absolute Change From Baseline in Liver Iron Concentration (LIC) to Year 1
From the Baseline, Year 1 (End of core study)

Liver iron concentration (LIC), a predictor of iron burden, was measured using relaxation rate magnetic resonance imaging (R2-MRI) technique. Relaxation rate was determined as R2 = 1/relaxation time (T2). The baseline value of LIC of participants was categorized as \< 7, ≥ 7 to \< 15, and ≥ 15 milligram of iron/tissue dry weight (mg Fe/g dw). A negative change from baseline favored study treatment in reducing LIC.

Magnetic Resonance Imaging (MRI) T2* and Absolute Change From Baseline in MRI T2*
From Baseline to 25, 49, 77 Week

Cardiac T2\* was measured in the short axis plane at the widest point of a 4-chamber localizer using custom breath-hold R2\* gradient echo sequences modeled after techniques used by Anderson et al (2001) and Westwood et al (2003).

Number of Participants Reporting Adverse Events
up to 53 Weeks

Any untoward or unfavorable medical occurrence in a participant, including any abnormal sign (for example, abnormal physical exam or laboratory finding), symptom, or disease, temporally associated with the participant's participation in the study, whether or not considered related to the participant's participation in the study. Serious Adverse Events include adverse events that result in either of death, a life-threatening adverse event, inpatient hospitalization or prolongation of existing hospitalization, a persistent or significant incapacity or substantial disruption of the ability to conduct normal functions, or a congenital anomaly/birth defect.

The Number of Participants With Adverse Events (AEs) in the First 24 Weeks of Treatment
24 Weeks

The number of participants with Adverse Events (AEs) overall and according to Medical Dictionary for Regulatory Activities (MedDRA) preferred term greater than or equal to 5% participants in any group by treatment in the first 24 weeks.

The Number of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs) or Deaths
Core study Baseline to the end of the study (up to 60 months)

Safety was assessed using reports of adverse events of all participants in this study. Serious adverse events are those events that resulted in death, were life threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, or was a congenital anomaly/birth defect.

Participants With Adverse Events by Primary System Organ Class (SOC)
4 year extension + core 1 year

Safety parameters were measured by the number and type of adverse events (AEs). An adverse event is any untoward medical occurence in a patient administered a medicinal product that does not necessarily have a causal relationship with the treatment. An adverse event can therefore be any unfavorable and unintended sign ( for example, an abnormal laboratory finding), symptom or disease temporally associated with the use of the medicinal product, whether or not this is associated with the use of this medicinal product.

Change in Liver Iron Concentration (LIC)
Baseline of Core Study to End of Extension Study, up to 5 years.

Change in Liver Iron Concentration \[LIC\] measured by means of SQUID (Superconducting Quantum Interference Device). LIC is expressed in milligrams of iron per gram of liver dry weight (mg Fe/g dw)

To evaluate the effects of treatment on the liver iron content(LIC)
The Relative Change From Baseline in Liver Iron Content (LIC) After Prolonged Use of Deferasirox
Baseline to 7 Years

The mean percentage change in liver iron content (LIC) as assessed by superconducting quantum interference device (SQUID) was evaluated by comparing the LIC at the start of Deferasirox treatment to the LIC at the end of the 5 year extension study for participants who were treated with Deferasirox for more than 3.5 years. LIC is expressed in milligrams of iron per gram of liver dry weight (mgFe/g dw). Relative change = 1- (Change in LIC from Baseline/Baseline level) x 100.

Long-term safety and tolerability of ICL670, at 3, 4, and 5 years treatment
at 3, 4, 5 years
Effect of deferasirox on renal hemodynamics in patients with β-thalassemia and transfusional iron overload.
Once a month
Evaluate the effect of rifampicin on pharmacokinetics after single dose administration of deferasirox
Pharmacokinetics of deferasirox and its metabolites
at FPFV and at LPLV
Absolute Change of Serum Ferritin From Baseline to the End of Extension, by Dose Cohort (Extension Per-protocol Population)
0 to 48 weeks

Mean absolute change in serum ferritin from baseline to the end of the extension study.

To assess the effect of deferasirox on the pharmacokinetics of midazolam

Secondary Endpoints

Change From Baseline of Serum Ferritin Level (ug/L) at Month 6 and 12
Baseline, 6 and 12 months
Percentage Relative Change From Baseline of Serum Ferritin (%) at Month 6 and 12
Baseline, 6 and 12 months
The Change in Serum Ferritin Values From Baseline Through Completion of the Study
Baseline to end of study (Median exposure time to drug was approximately 30 weeks; Maximum exposure was 104 weeks)
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Study Design & Arms

AllocationNA
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
DeferasiroxEXPERIMENTALTreatment will be administered daily for up to 24 months. For each patient the daily dose is calculated based on the patient's actual body weight.
ICL670 (Deferasirox)EXPERIMENTAL -
PlaceboPLACEBO_COMPARATOR10 mg/kg/day (once daily) for the first 2 weeks of treatment, followed by 20 mg/kg/day (once daily) from Week 2 to End of Treatment. After 3 months of treatment at 20 mg/kg/day, the dose was allowed to be adjusted by 5 or 10 mg/kg/day up to 40 mg/kg/day based on serum ferritin responses. When a target serum ferritin level was reached (usually between 500 and 1000 µg/L), the dose could be reduced by 50% to maintain the serum ferritin within the target range.
5 mg/kg/day deferasiroxEXPERIMENTALParticipants received a starting dose of 5 mg/kg/day deferasirox tablets orally each day in the morning for 52 weeks. After 24 weeks of treatment Liver Iron Concentration (LIC) was assessed. Based on the LIC and change from baseline in LIC participants were eligible for dose escalation. In the Extension Study participants received deferasirox once daily (dose based on LIC) for 52 weeks.
10 mg/kg/day deferasiroxEXPERIMENTALParticipants received a starting dose of 10 mg/kg/day deferasirox tablets orally each day in the morning for 52 weeks. After 24 weeks of treatment Liver Iron Concentration (LIC) was assessed. Based on the LIC and change from baseline in LIC participants were eligible for dose escalation. In the Extension Study participants received deferasirox once daily (dose based on LIC) for 52 weeks.
5 mg/kg/day placeboPLACEBO_COMPARATORPlacebo tablet matching 5 mg/kg/day orally in the morning each day for 52 weeks. After 24 weeks of treatment Liver Iron Concentration (LIC) was assessed. Based on the LIC and change from baseline in LIC participants were eligible for dose escalation. In the Extension Study participants received deferasirox once daily (dose based on LIC) for 52 weeks.
10 mg/kg/day placeboPLACEBO_COMPARATORPlacebo tablet matching 10 mg/kg/day orally in the morning each day for 52 weeks. After 24 weeks of treatment Liver Iron Concentration (LIC) was assessed. Based on the LIC and change from baseline in LIC participants were eligible for dose escalation. In the Extension Study participants received deferasirox once daily (dose based on LIC) for 52 weeks.
deferasirox every day for 77 weeksEXPERIMENTALParticipants received Deferasirox 30 milligrams per kilogram per day (mg/kg/day) orally once daily (OD), 30 minutes before breakfast, preferably around the same time every morning if possible. Deferasirox tablets were dropped into water or orange juice, or apple juice and stirred until completely dispersed. For doses less than 1 gram (g), tablets were dissolved in at least 100 milliliter (mL) of liquid; for doses of 1 to 3 g, tablets were dissolved in at least 200 mL. After tablets were fully disintegrated, the liquid was promptly consumed.
ICL670EXPERIMENTALEvaluate the safety and tolerability of deferasirox 20 mg/kg/day over one year in patients with MDS
Deferasirox (ICL670)EXPERIMENTALDeferasirox (ICL670) 20 mg/kg orally once daily for 104 weeks.
Deferoxamine (DFO) then ICL670EXPERIMENTALDeferoxamine (DFO) subcutaneously for a weekly dose of 175 mg/kg for 24 weeks then crossed over to receive Deferasirox (ICL670) orally 20 mg/kg for a total of 104 weeks on therapy.
Deferasirox CrossoverEXPERIMENTALDeferasirox Crossover group consists of participants who were initially randomized to 40 mg/kg/day deferoxamine (DFO)subcutaneously in the main study and comparative prolongation study and crossed over to 5mg/kg/day to 30 mg/kg/day deferasirox orally daily at the beginning of the 5-year non-comparative extension study
Arm 1EXPERIMENTAL -
Mild hepatic impairedEXPERIMENTAL -
Moderate hepatic impairedEXPERIMENTAL -
Severe hepatic impairedEXPERIMENTAL -
Healthy volunteersEXPERIMENTALControlled group

Interventions

NameTypeDescription
DeferasiroxDRUGDeferasirox FCT will be provided as 90 mg, 180 mg and 360 mg film-coated tablets for oral use.
PlaceboDRUGInactive ingredients used as a placebo comparator, provided as 125 mg, 250 mg, and 500 mg dispersible tablets for oral use
Deferasirox (ICL670)DRUGThe recommended initial daily dose of Deferasirox is 20 mg/kg body weight.
Deferoxamine (DFO)DRUGDeferoxamine was supplied in vials of 500 mg and 2000 mg administered subcutaneously for a weekly dose of 175 mg/kg.
RifampicinDRUG -
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Eligibility Criteria

Age Range10 Years to N/A
SexALL
Healthy VolunteersNo
Study Sites14

Key Inclusion Criteria for subjects: * Completed 24-weeks of study treatment as described in the core protocol (CICL670F2201). * Were deemed to have tolerated deferasirox treatment by the investigator. * Provided written informed consent/assent before any study-specific procedures were performed. F...

Countries:AustriaGreeceItalyUnited StatesBelgiumCanadaGermanyNetherlandsSpainTaiwanThailandTurkey (Türkiye)United KingdomAustraliaChinaDenmarkEgyptFranceHong KongIsraelLebanonMalaysiaSouth AfricaSouth KoreaSwitzerlandArgentinaBrazilTunisiaOmanSaudi ArabiaSyriaBulgariaMexicoNew ZealandRussiaJapanPolandSingapore
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Frequently asked questions about Deferasirox

What is Deferasirox used for?

Deferasirox is an oral iron chelator used to treat transfusional iron overload in beta-thalassemia and other chronic anemias, including sickle cell disease and myelodysplastic syndromes. It is also studied for cardiac iron overload. The drug binds excess iron in the body, allowing its excretion, thereby reducing iron-related organ damage.

What does Deferasirox target?

Deferasirox targets iron by binding free and labile plasma iron to form a stable complex that is excreted primarily through the feces. This reduces total body iron stores in patients with transfusional iron overload. It is a small molecule iron chelator, not a conventional molecular target like a receptor or enzyme.

Who makes Deferasirox?

Deferasirox is developed by Novartis AG, a multinational pharmaceutical company headquartered in Basel, Switzerland. Novartis trades on the New York Stock Exchange under the ticker symbol NVS. The drug is also known by the brand name Exjade or Jadenu in some markets.

What phase is Deferasirox in?

Deferasirox is in Phase 2 clinical development for myelodysplastic syndromes, according to the trial NCT00940602. However, it has completed Phase 3 trials for beta-thalassemia and transfusional iron overload. The drug is investigational for these indications and not yet approved in the studied settings.

What clinical trials is Deferasirox in?

Deferasirox has been studied in several completed trials. NCT00171210 evaluated iron chelation in beta-thalassemia patients with transfusional iron overload. NCT00171821 assessed efficacy and safety in transfusion-dependent iron overload. NCT00940602 is a Phase 2 study in myelodysplastic syndromes. All trials are completed.

Is Deferasirox the same as Exjade?

Yes, Deferasirox is the same as Exjade, a brand name used by Novartis. It is also marketed as Jadenu in some regions. The generic name is deferasirox, and it is an oral iron chelator used to treat chronic iron overload from blood transfusions.