Pomalidomide for the Treatment of Bleeding in HHT
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 have anemia and/or 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.
Pomalidomide for the Treatment of Bleeding in Hereditary Hemorrhagic Telangiectasia
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 have anemia and/or 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 4 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.
Telangiectasia, Hereditary Hemorrhagic Epistaxis pomalidomide blood transfusion Telangiectasis Pomalidomide Oral Product
You can join if…
Open to people ages 18 years and up
- A clinical diagnosis of HHT as defined by the Curacao criteria
- Age > 18 years
- Platelet count ≥ 100,000/µl
- WBC ≥ 2,500/µl
- INR ≤ 1.4 and normal ± 2 sec activated partial thromboplastin time (aPTT or PTT per local laboratory designation) by local laboratory criteria (except for patients on a stable dose of warfarin or direct oral anticoagulants)
- Epistaxis severity score ≥ 3 measured over the preceding three months, measured at the screening visit
- A requirement for anemia, as determined by local laboratory hemoglobin assessment and normal ranges, and/or parenteral infusion of at least 250 mg of iron or transfusion of 1 unit of blood over the 24 weeks preceding the screening visit
- 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.
- Ability to understand and sign informed consent
- . 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...
- Women currently breast feeding
- Renal insufficiency, serum creatinine > 2.0 mg/dl
- Hepatic insufficiency, bilirubin > 2.0 (or >4.0 in the setting of a prior clinical or genetic diagnosis of Gilbert's syndrome) or transaminases > 3.0x normal
- Prior treatment with thalidomide or other imid drugs within previous 6 months
- Prior treatment with bevacizumab (systemic or nasal) within previous 6 weeks*
- Prior treatment with pazopanib within previous 6 weeks*
- The use of octreotide or oral estrogens within the previous month*
- History of prior unprovoked thromboembolism confirmed by venous ultrasound or other imaging modalities
- Peripheral neuropathy, confirmed by neurologic consultation
- . Known underlying hypoproliferative anemia (i.e. myelodysplasia, aplastic anemia)
- . Currently enrolled in other interventional trials
- . Known hypersensitivity to thalidomide or lenalidomide.
- . The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
- . Known SMAD-4 mutation, unless there has been a colonoscopy with normal (negative) results, or in which the patient has had no more than 5 small (in the opinion of the gastroenterologist) colonic polyps completely removed within the preceding 18 months
- . Anything that in the investigator's opinion is likely to interfere with completion of the study
- Use of these treatments is not permitted during study participation.
- UCSD Hemophilia and Thrombosis Treatment Center
accepting new patients
San Diego California 92121 United States
- UCSF HHT Center
accepting new patients
San Francisco California 94107 United States
Lead Scientist at UCSD
- Jenny Zhou, MD
Assistant Clinical Professor, Medicine, Vc-health Sciences-schools
- accepting new patients
- Start Date
- Completion Date
- The Cleveland Clinic
- Phase 2 research study
- Study Type
- Expecting 159 study participants
- Last Updated
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