An Efficacy and Safety Study of Luspatercept (ACE-536) Versus Placebo in Subjects With Myeloproliferative Neoplasm-Associated Myelofibrosis on Concomitant JAK2 Inhibitor Therapy and Who Require Red Blood Cell Transfusions (INDEPENDENCE)

STATUS

Recruiting
End date

Aug 23, 2025
participants needed

309
sponsor

Celgene

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Updated on 10 April 2023

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Summary

The purpose of this Phase 3 study is to evaluate the efficacy and safety of Luspatercept compared with placebo in subjects with myeloproliferative neoplasm (MPN)-associated Myelofibrosis (MF) and anemia on concomitant Janus kinase 2 (JAK2) inhibitor therapy and who require red blood cell count (RBC) transfusions.

The study is divided into Screening Period, a Treatment Phase (consisting of a Blinded Core Treatment Period, a Day 169 Response Assessment, a Blinded Extension Treatment Period, and an Open-label Extension Treatment Period), and a Posttreatment Follow-up Period.

Description

Permitted Concomitant Medications and Procedures

Subjects are receiving a JAK2 inhibitor for the treatment of MPN-associated MF that is approved in the country where the study is being conducted. JAK2 inhibitors are to be used according to their respective label and as prescribed as part of the subject's standard-of-care therapy as prescribed by their physician prior to study entry.
Best supportive care (BSC) includes, but is not limited to, treatment with transfusions (eg, RBC, platelet, whole blood), ICTs, antibiotic, antiviral and/or antifungal therapy, and nutritional support as needed.
Granulocyte colony-stimulating factors (ie, G-CSF, granulocyte macrophage colony-stimulating factor [GM-CSF]) are allowed only in cases of neutropenic fever or as clinically indicated per product label.
Prophylactic antithrombotic therapy is permitted.
Thrombopoietin and platelet transfusions are permitted.
Treatment with systemic corticosteroids is permitted for nonhematological conditions providing the subject is receiving a constant dose equivalent to ≤ 10 mg prednisone during the study.
Administration of attenuated vaccines (eg, influenza vaccine) is allowed if clinically indicated per Investigator discretion.
Iron chelation therapy (ICT) is to be used according to the product label. If the label permits, the ICT dose should be stable during at least the first 24 weeks of IP. Initiation of ICT while within the first 24 weeks of IP should be clinically indicated to treat an AE.

Prohibited Concomitant Medications

The following concomitant medications are specifically excluded during the course of study

treatment

Cytotoxic, chemotherapeutic, targeted, or investigational agents/therapies (excluding JAK2 inhibitor therapy)
Azacitidine, decitabine, or other hypomethylating agents
Lenalidomide, thalidomide, and pomalidomide
Erythropoietin stimulating agents (ESAs) and other RBC hematopoietic growth factors (eg, IL-3)
Hydroxyurea or other alkylating agents
Androgens (unless given to treat hypogonadism)
Oral retinoids (topical retinoids are permitted)
Arsenic trioxide
Interferon
Anagrelide
Systemic corticosteroids at a dose equivalent to > 10 mg prednisone
Investigational products for the treatment of MPN-associated MF

Details

Condition	Myeloproliferative Disorders, Myelofibrosis, Primary Myelofibrosis, Post-Polycythemia Vera Myelofibrosis, Anemia
Treatment	Placebo, ACE-536
Clinical Study Identifier	NCT04717414
Sponsor	Celgene
Last Modified on	10 April 2023

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Eligibility		Yes	No	Not Sure
Inclusion Criteria
	Subjects must satisfy the following criteria to be randomized in the study
	Subject is ≥18 years of age at the time of signing the ICF
	Subject has a diagnosis of PMF according to the 2016 World Health Organization (WHO) criteria or diagnosis of post-ET or post-PV MF according to the IWG-MRT 2007 criteria , confirmed by the most recent local pathology report
	Subject is requiring RBC transfusions as defined as
	Average RBC-transfusion frequency: 4 to 12 RBC units/12 weeks immediately up to randomization. There must be no interval > 6 weeks (42 days) without ≥ 1 RBC transfusion
	RBC transfusions are scored in determining eligibility when given for treatment of
	Symptomatic (ie, fatigue or shortness of breath) anemia with a pretransfusion Hgb ≤ 9.5 g/dL or
	Asymptomatic anemia with a pretransfusion Hgb ≤ 7 g/dL c. RBC transfusions given for worsening of anemia due to bleeding or infections are not scored in determining eligibility
	Subjects on continuous (eg, absent of dose interruptions lasting ≥ 2 consecutive
	weeks) JAK2 inhibitor therapy as approved in the country of the study site for
	A female of childbearing potential (FCBP) for this study is defined as a female who
	the treatment for MPN-associated MF as part of their standard-of-care therapy
	has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (eg, has had menses at any time in the preceding 24 consecutive months). Females of childbearing potential (FCBP)participating in the study must
	for at least 32 weeks, on stable daily dose for at least 16 weeks immediately
	Have 2 negative pregnancy tests as verified by the Investigator prior to starting study therapy. She must agree to ongoing pregnancy testing during the study, and after end of IP. This applies even if the subject practices true abstinence from heterosexual contact
	up to the date of randomization and anticipated to be on a stable daily dose
	Either commit to true abstinence _from heterosexual contact (which must be reviewed on a monthly basis and source documented) or agree to use, and be able to comply with, effective contraception_ without interruption, 28 days prior to starting IP, during the study therapy (including dose interruptions), and for 12 weeks (approximately 5 times the mean terminal half-life of IP based on multiple-dose PK data) after discontinuation of study therapy
	of that JAK2 inhibitor for at least 24 weeks after randomization
	Subject has an Eastern Cooperative Oncology Group (ECOG) performance score of ≤ 2
	True abstinence is acceptable when it is in line with the preferred and usual lifestyle of the subject. [Periodic abstinence (eg, calendar, ovulation, symptothermal, postovulation methods) and withdrawal are not acceptable methods of contraception.]
	Agreement to use highly effective methods of contraception that alone or in
	Male subjects must: Practice true abstinence _(which must be reviewed on a monthly
	basis) or agree to use a condom during sexual contact with a pregnant female
	or a female of childbearing potential_ while participating in the study
	during dose interruptions and for at least 12 weeks (approximately 5 times the
	mean terminal half-life of IP based on multiple-dose PK data) following IP
	discontinuation, even if he has undergone a successful vasectomy
	combination result in a failure rate of a Pearl index of less than 1% per year when
	used consistently and correctly throughout the course of the study. Such methods
	include: Combined (estrogen and progestogen containing) hormonal contraception: Oral
	Intravaginal, Transdermal; Progestogen-only hormonal contraception associated with
	inhibition of ovulation: Oral, Injectable hormonal contraception, Implantable hormonal
	contraception; Placement of an intrauterine device (IUD); Placement of an intrauterine
	hormone-releasing system (IUS); Bilateral tubal occlusion; Vasectomized partner
	Sexual Abstinence
	Subject must understand and voluntarily sign an ICF prior to any study-related
	assessments/procedures being conducted
	Subject is willing and able to adhere to the study visit schedule and other protocol
	requirements including the use of the electronic patient reported outcomes device
Exclusion Criteria
	randomization
	Subject with any of the following laboratory abnormalities at screening
	The presence of any of the following will exclude a subject from randomization
	Subject with anemia from cause other than MPN-associated MForJAK2 inhibitor therapy
	Peripheral blood myeloblasts:> 5%
	(eg, iron deficiency, vitamin B12 and/or folate deficiencies, autoimmune or hemolytic
	anemia, infection, or any type of known clinically significant bleeding or
	sequestration)
	Subject use of hydroxyurea, immunomodulatory compounds such as pomalidomide
	thalidomide, ESAs, androgenic steroids or other drugs with potential effects on
	hematopoiesis ≤ 8 weeks immediately up to the date of randomization
	Systemic corticosteroids are permitted for nonhematological conditions providing
	Basal or squamous cell carcinoma of the skin
	the subject is receiving a constant dose equivalent to ≤ 10 mg prednisone for the
	Carcinoma in situ of the cervix
	weeks immediately up to randomization
	Carcinoma in situ of the breast
	Iron chelation therapy (ICT) is permitted providing the subject is receiving a
	stable dose for the 8 weeks immediately up to randomization
	Neutrophils: < 1 x 10^9/L
	White blood count (WBC): > 100 x 10^9/L
	Platelets: the lowest allowable level as approved for the concomitant JAK2
	inhibitor but not < 25 x 10^9/L or > 1000 x 10^9/L
	Estimated glomerular filtration rate:< 30 mL/min/1.73 m2 (via the 4-variable
	modification of diet in renal disease [MDRD] formula) or nephrotic subjects (eg
	urine albumin-to-creatinine ratio > 3500 mg/g)
	Aspartate aminotransferase (AST) or alanine aminotransferase (ALT):> 3.0 x upper
	limit of normal (ULN)
	Direct bilirubin: ≥ 2 x ULN
	Higher levels are acceptable if these can be attributed to active red blood
	cell precursor destruction within the bone marrow (eg, ineffective
	erythropoiesis)
	Subject with uncontrolled hypertension, defined as repeated elevations of systolic
	blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, that is not resolved
	at the time of randomization
	Subject with prior history of malignancies, other than disease under study, unless the
	subject has been free of the disease for ≥ 3 years. However, subject with the
	following history/concurrent conditions is allowed
	Incidental histologic finding of prostate cancer (T1a or T1b using the tumor
	nodes, metastasis [TNM] clinical staging system)
	Subject with prior hematopoietic cell transplant or subject anticipated to receive a
	hematopoietic cell transplant during the 24 weeks from the date of randomization. 7
	Subject with stroke, myocardial infarction, deep venous thrombosis, pulmonary or
	arterial embolism within 6 months immediately up to the date of randomization
	Subject with major surgery within 2 months up to the date of randomization. Subject must
	have completely recovered from any previous surgery immediately up to the date of
	Subject with a major bleeding event (defined as symptomatic bleeding in a critical area
	or organ and/or bleeding causing a decrease in Hgb of ≥ 2 g/dL or leading to transfusion of
	≥ 2 units of packed red cells) in the last 6 months prior to the date of randomization
	Subject with inadequately controlled heart disease and/or have a known left ventricular
	ejection fraction < 35%
	Subject with uncontrolled systemic fungal, bacterial, or viral infection (defined as
	ongoing signs/symptoms related to the infection without improvement despite appropriate
	antibiotics, antiviral therapy, and/or other treatment)
	Subject with known human immunodeficiency virus (HIV), evidence of active Hepatitis B
	(HepB) as demonstrated by the presence of Hepatitis B surface antigen (HBsAg) and/or
	positive for Hepatitis B virus DNA (HBVDNA-positive), and/or evidence of active Hepatitis C
	(HepC) as demonstrated by a positive Hepatitis C virus RNA (HCV-RNA) test of sufficient
	sensitivity
	Subject with prior therapy of luspatercept or sotatercept. 14.Subject with history of
	severe allergic or anaphylactic reactions or hypersensitivity to recombinant proteins or
	excipients in the investigational product
	Pregnant or breastfeeding females. 16.Subject participation in any other clinical
	protocol or investigational trial that involves use of experimental therapy (including
	investigational agents) and/or therapeutic devices within 30 days or for investigational
	agents within five half-lives, whichever comes later, immediately up to the date of
	randomization
	Subject with any significant medical condition, laboratory abnormality, psychiatric
	illness, or is considered vulnerable by local regulations (eg, imprisoned or
	institutionalized) that would prevent the subject from participating in the study or places
	the subject at unacceptable risk if he/she were to participate in the study. 18.Subject
	with any condition or concomitant medication that confounds the ability to interpret data
	from the study

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An Efficacy and Safety Study of Luspatercept (ACE-536) Versus Placebo in Subjects With Myeloproliferative Neoplasm-Associated Myelofibrosis on Concomitant JAK2 Inhibitor Therapy and Who Require Red Blood Cell Transfusions (INDEPENDENCE)