The von Willebrand factor-binding aptamer rondaptivon pegol as a treatment for severe and nonsevere hemophilia A.

Abstract

Factor VIII (FVIII) circulates in a noncovalent complex with von Willebrand Factor (VWF), the latter determining FVIII half-life. The VWF-binding aptamer rondaptivon pegol (BT200) increases plasma levels of VWF/FVIII in healthy volunteers. This trial assessed its safety, pharmacokinetics, and pharmacodynamics in hemophilia A. Nineteen adult patients (ages 20-62 years, 4 women) with hemophilia A (8 mild, 2 moderate, and 9 severe) received subcutaneous injections of rondaptivon pegol. After an initial fixed dose of 3 mg on days 0 and 4, patients received weekly doses of 2 to 9 mg until day 28. Severe hemophilia A patients underwent sparse-sampling population pharmacokinetics individual profiling after the final dose of rondaptivon pegol. Adverse events, pharmacokinetics, and pharmacodynamics were assessed. FVIII activity and VWF levels were measured. All patients tolerated rondaptivon pegol well. The geometric mean half-life of rondaptivon pegol was 5.4 days and rondaptivon pegol significantly increased VWF levels. In severe hemophilia A, 6 doses of rondaptivon pegol increased the half-lives of 5 different FVIII products from a median of 10.4 hours to 31.1 hours (range, 20.8-56.0 hours). Median FVIII increased from 22% to 48% in mild hemophilia A and from 3% to 7.5% in moderate hemophilia A. Rondaptivon pegol is a first-in-class prohemostatic molecule that extended the half-life of substituted FVIII approximately 3-fold and increased endogenous FVIII levels approximately 2-fold in hemophilia patients. This trial was registered at www.clinicaltrials.gov as #NCT04677803.

• Authors: Cihan Ay, Katarina D Kovacevic, Daniel Kraemmer, Christian Schoergenhofer, Georg Gelbenegger, Christa Firbas, Peter Quehenberger, Petra Jilma-Stohlawetz, James C Gilbert, Shuhao Zhu, Martin Beliveau, Franz Koenig, Alfonso Iorio, Bernd Jilma, Ulla Derhaschnig, Ingrid Pabinger
• Journal: Blood (Blood) Vol. 141 Issue 10 Pg. 1147-1158 (03 09 2023) ISSN: 1528-0020 [Electronic] United States
• PMID: 36108308 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

Chemical References

• von Willebrand Factor
• Factor VIII
• Hemostatics

Topics

• Adult
• Humans
• Female
• Young Adult
• Middle Aged
• von Willebrand Factor (therapeutic use)
• Hemophilia A (drug therapy)
• Factor VIII
• Hemostatics (therapeutic use)
• Half-Life