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C1 esterase inhibitor

Phase 3

Hereditary Angioedema | Small molecule | Immunology |Takeda Pharmaceutical Company Limited|Trials Updated: Dec 27, 2024

C1 esterase inhibitor target and mechanism

ModalitySmall molecule

Also known as C1 esterase inhibitor [human] (C1INH-nf), C1 Esterase Inhibitor (Human), C1 Esterase Inhibitor Injection [Cinryze]

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindCONTROLLEDDMC
Total Trials7
Total Enrollment541

FDA Designations

No designations recorded

C1 esterase inhibitor clinical trials

C1 esterase inhibitor · 7 trials · 3 indications

Phase 3 4Phase 2 2Phase 1 1
NCT00438815Open-Label C1 Esterase Inhibitor (C1INH-nf) for the Treatment of Acute Hereditary Angioedema (HAE) AttacksHereditary Angioedema
COMPLETED113 Analytics
NCT00462709Open-Label C1 Esterase Inhibitor (C1INH-nf) for the Prevention of Acute Hereditary Angioedema (HAE) AttacksHereditary Angioedema
COMPLETED146 Analytics
NCT00289211C1 Esterase Inhibitor (C1INH-nf) for the Treatment of Acute Hereditary Angioedema (HAE) AttacksHereditary Angioedema
COMPLETED83 Analytics
NCT01005888C1 Esterase Inhibitor (C1INH-nf) for the Prevention of Acute Hereditary Angioedema (HAE) AttacksHereditary Angioedema
COMPLETED26 Analytics
PHASE3COMPLETED
Open-Label C1 Esterase Inhibitor (C1INH-nf) for the Treatment of Acute Hereditary Angioedema (HAE) Attacks
Hereditary AngioedemaUnlock trial analytics
PHASE3COMPLETED
Open-Label C1 Esterase Inhibitor (C1INH-nf) for the Prevention of Acute Hereditary Angioedema (HAE) Attacks
Hereditary AngioedemaUnlock trial analytics
PHASE3COMPLETED
C1 Esterase Inhibitor (C1INH-nf) for the Treatment of Acute Hereditary Angioedema (HAE) Attacks
Hereditary AngioedemaUnlock trial analytics
PHASE3COMPLETED
C1 Esterase Inhibitor (C1INH-nf) for the Prevention of Acute Hereditary Angioedema (HAE) Attacks
Hereditary AngioedemaUnlock trial analytics

Study Endpoints

Primary Endpoints

Number of Hereditary Angioedema (HAE) Attacks Treated With C1INH-nf
Duration of the study (2.5 years)
Percent of HAE Attacks With Substantial Relief of the Defining Symptom
Within 4 hours after initial treatment

Subjects were to assess their symptoms every 15 minutes up to 4 hours after the initial dose or until substantial relief of the defining symptom was achieved. The conservative analysis defined substantial relief as 3 consecutive assessments of improvement of the defining symptom; any attack that did not have 3 consecutive documented reports of improvement was considered a treatment failure. In the less conservative analysis, attacks also were considered to have responded if clinical improvement of the defining symptom occurred but data were incomplete due to cessation of symptom assessments.

Frequency of All HAE Attacks
Duration of the study

A hereditary angioedema (HAE) attack was defined as a discrete episode during which the subject progressed from no angioedema to symptoms of angioedema.

Time to Beginning of Substantial Relief of the Defining Symptom
Within 4 hours after initial treatment

Randomized subjects assessed their symptoms every 15 minutes up to 4 hours after the initial dose of blinded study drug or until substantial relief of the defining symptom was achieved. Substantial relief was defined as 3 consecutive assessments of improvement of the defining symptom. Beginning of substantial relief was considered the first of the 3 consecutive assessments.

Number of Hereditary Angioedema (HAE) Attacks During Each Prophylactic Therapy Period
12 weeks

An HAE attack was defined as the subject-reported indication of swelling at any location following a report of no swelling on the previous day. Analyses include observed attack counts and normalized attack counts (i.e., the number of attacks observed during each therapy period, normalized for the number of days the subject participated in that period).

Number of participants with delayed cerebral ischemia (DCI)
To be determined between day 4 and day 14 of admission

Defined as either a new focal neurological impairment, or a decrease of at least 2 points on the Glasgow Coma Scale. This should last for at least 1 hour, is not apparent immediately after aneurysm occlusion, and cannot be attributed to other causes by means of clinical assessment, CT or MRI scanning of the brain, and appropriate laboratory studies.

Number of participants with complications during hospitalization.
Up to 1 year after admission

Complication rate during hospitalization

Change From Baseline in Histopathology Endpoints
Within 72 hours prior to first dose of study drug, Day 20

The protocol-specified Day 20 (post-treatment) biopsy was compared to the qualifying biopsy to assess changes in histopathology for light and immunofluorescence microscopy. The Central Pathologist provided the following categorical information from the qualifying biopsy in an AMR Scorecard: C4d Score (0-100), Margination Score (0-100) Glomerulitis Score (0-100), Vasculitis Score (0-100), Glomerulosclerosis Score (0-100), Chronic Glomerulopathy Score (0-100), Interstitial Fibrosis Score (0-100), and the Chronic Vasculitis Score (0-100), with 0 being absence of abnormal histopathology. The "qualifying" renal allograft biopsy was performed as standard of care (SOC) within 12 months after transplant and prior to screening for this study. The first dose of study drug (Day 1) was administered within 72 hours after qualifying biopsy. A negative change from baseline indicates that histopathology has improved. Endpoint includes subjects with both Qualifying and Day 20 Biopsies.

PK will be analyzed by means of incremental recovery, in vivo half-life, area under the curve, clearance, and mean residence time.
1 week
C1 inhibitor (functional and antigenic) and C4 antigen serum levels will be measured at a United States Clinical Laboratory Improvement Amendments-certified laboratory and the research division of Sanquin Blood Supply Foundation.
1 week

Secondary Endpoints

Time to Beginning of Substantial Relief of the Defining Symptom
Within 4 hours after initial treatment
Time to Beginning of Substantial Relief of the Defining Symptom for Subjects Who Received Multiple Treatments
Within 4 hours after initial treatment
Antigenic C1 Inhibitor (C1INH) Serum Levels
Pre-infusion to 1 hour post-infusion
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Study Design & Arms

AllocationNA
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Open-label C1INH-nfEXPERIMENTAL1,000 Units (U) of C1INH-nf administered intravenously. If there was no response to treatment 60 minutes after the first dose, a second 1,000 U dose could be administered.
C1INH-nfEXPERIMENTAL1,000 Units (U) of C1INH-nf administered intravenously (IV). If there was no response to treatment 60 minutes after the first dose, a second 1,000 U dose could be administered.
PlaceboPLACEBO_COMPARATORMatching placebo (saline) administered IV. If there was no response to treatment 60 minutes after the first dose, a second placebo (saline) dose could be administered.
C1INH-nf First, then PlaceboEXPERIMENTAL1,000 Units (U) of C1INH-nf administered intravenously (IV) every 3 to 4 days (approximately twice weekly) for 12 weeks, followed by matching placebo (saline) administered IV every 3 to 4 days for 12 weeks.
Placebo First, then C1INH-nfEXPERIMENTALMatching placebo (saline) administered IV every 3 to 4 days (approximately twice weekly) for 12 weeks, followed by 1,000 U of C1INH-nf administered IV every 3 to 4 days for 12 weeks.
C1-esterase inhibitor (Cinryze)EXPERIMENTALOne group receiving study medication (C1-esterase inhibitor Cinryze)
C1 Esterase Inhibitor (Human)EXPERIMENTALSubjects were to receive C1 esterase inhibitor intravenously at a rate of approximately 1 mL per minute as tolerated. Subjects were to receive a total of 7 doses over a 2-week period: an initial IV infusion of 5000 U (not to exceed 100 U/kg) on Day 1, followed by 2500 U (not to exceed 50 U/kg) IV on Days 3, 5, 7, 9, 11, and 13
Normal SalinePLACEBO_COMPARATORplacebo infused as above
Single DoseEXPERIMENTAL1,000 Units (U) of C1INH-nf administered intravenously (IV).
First Dose Followed by Second DoseEXPERIMENTAL1,000 U of C1INH-nf administered IV, followed by a second 1,000 U dose 60 minutes later.

Interventions

NameTypeDescription
C1 esterase inhibitor [human] (C1INH-nf)BIOLOGICAL -
Placebo (saline)DRUG -
C1 Esterase Inhibitor Injection [Cinryze]DRUGC1 Esterase Inhibitor Injection \[Cinryze\]
PlaceboDRUGSodium Chloride /physiological saline (0.9%) in equal volume dosed intravenous
C1 Esterase Inhibitor (Human)BIOLOGICAL -
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Eligibility Criteria

Age Range1 Year to N/A
SexALL
Healthy VolunteersNo
Study Sites30

Inclusion Criteria: This study was open to all subjects who: * Completed participation in LEVP2005-1/A (NCT00289211) and were not participating in LEVP2005-1/B (NCT01005888), any time after the 3-day telephone follow-up * Completed participation in LEVP2005-1/B any time after the final prophylacti...

Countries:United StatesNetherlandsGermany
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Frequently asked questions about C1 esterase inhibitor

What is C1 esterase inhibitor used for?

C1 esterase inhibitor is being studied in hereditary angioedema, antibody-mediated graft rejection, and aneurysmal subarachnoid hemorrhage. It is an investigational therapy developed by Takeda Pharmaceutical Company Limited. Across its clinical program, trials have enrolled 395 participants in conditions spanning immunology and acute neurological injury.

Who makes C1 esterase inhibitor?

C1 esterase inhibitor is developed by Takeda Pharmaceutical Company Limited, which trades under the ticker TAK. Takeda is the sponsor behind the clinical program evaluating the therapy across hereditary angioedema, graft rejection, and aneurysmal subarachnoid hemorrhage.

What phase is C1 esterase inhibitor in?

C1 esterase inhibitor is in Phase 2 development overall, though individual trials have been conducted at Phase 3. It is investigational and has not been approved by the FDA. Five trials have been completed and one Phase 2 study is currently recruiting.

What clinical trials is C1 esterase inhibitor in?

The active trial is NCT06359782, a Phase 2 study of complement inhibition in aneurysmal subarachnoid hemorrhage, recruiting 128 patients in the Netherlands. Completed trials include NCT01147302 in graft rejection, plus NCT01005888 and NCT00462709 in hereditary angioedema prevention.

Is C1 esterase inhibitor the same as C1INH-nf or Cinryze?

Yes. C1 esterase inhibitor is also known as C1 esterase inhibitor [human] (C1INH-nf), C1 Esterase Inhibitor (Human), and C1 Esterase Inhibitor Injection [Cinryze]. These names refer to the same therapy evaluated across the hereditary angioedema, graft rejection, and subarachnoid hemorrhage trials.

How many patients have been enrolled in C1 esterase inhibitor trials?

C1 esterase inhibitor trials have enrolled a total of 395 participants. The studies are randomized, double-blind, and placebo-controlled. Enrollment ranges from 18 patients in the graft rejection pilot to 146 in a hereditary angioedema prevention study.