Data presented by CSL Behring at the 2012 Thrombosis and Hemostasis Summit of North America (THSNA) showed that a balanced, human 4-factor prothrombin complex concentrate (PCC) is as effective as the current standard of treatment in stopping bleeding in patients receiving vitamin K antagonist therapy (i.e., warfarin). Currently in the United States, fresh frozen plasma is the standard treatment for warfarin reversal. The data are from the first and largest randomized clinical study to demonstrate the non-inferiority of 4-factor PCC to plasma through clinical endpoints and to show superiority through bioanalytical endpoints.
The Phase IIIb study results showed that the hemostatic efficacy of 4-factor PCC was comparable to plasma at 24 hours in patients who required urgent reversal of warfarin therapy (72.4 percent and 65.4 percent, respectively). Additionally, the co-primary efficacy endpoint analysis showed that the 4-factor PCC was superior in achieving target INR correction within 30 minutes at the end of infusion as compared to plasma (62.2 percent and 9.6 percent, respectively). Four-factor PCC was also superior to plasma in rapidly and safely raising the levels of clotting factors II, VII, IX, X, and anticoagulant Proteins C and S at the same 30 minutes post-treatment time point (p values<0.0001).
"Patients on warfarin therapy are susceptible to acute and serious bleeding. For the physician, quickly stopping that bleeding is absolutely critical," said Ravindra Sarode, M.D., Director of Transfusion Medicine and Hemostasis Reference Laboratory at the University of Texas, Southwestern Medical Center, who presented the data. "This trial demonstrates that 4-factor PCC may offer healthcare professionals an important new treatment advance over plasma in managing patient outcomes in an important critical care setting."
The study also found that PCC was well-tolerated in patients and that the incidences of severe treatment-emergent adverse events, serious adverse events and deaths were generally similar between the PCC and plasma groups. Also, PCC was shown to possibly reduce the risk of transfusion-associated circulatory overload - that is, when too much fluid is transfused or transfusion is too rapid, which can lead to cardiac events - when compared to plasma (8.7 percent compared to 19.3 percent, respectively).
"We are very encouraged by the results, as this is the first and largest randomized clinical study showing 4-factor PCC is highly effective in reducing INR and increasing factor levels to support hemostatic efficacy during warfarin-induced bleeding," said Russell Basser, M.D., Senior Vice President, Global Clinical R&D, at CSL Behring. "CSL Behring is advancing our investigational 4-factor PCC through rigorous clinical study with the goal of bringing to the United States a safe, effective new treatment option for people who are at risk of major bleeding that results from warfarin use."
About Prothrombin Complex Concentrate (PCC) (Human)
Prothrombin complex concentrates (PCC) are derived from human plasma. CSL Behring's investigational PCC contains four important pro-coagulant factors in significant quantities: Factor II (prothrombin), Factor VII, Factor IX and Factor X, as well as anticoagulant Proteins C and S.
Guidelines from the American College of Chest Physicians recommend 4-factor PCC, rather than plasma, for rapid reversal of anticoagulation in patients with vitamin K antagonist associated major bleeding. The guidelines also recommend the use of vitamin K (5 to 10 mg) administered by slow intravenous (IV) infusion rather than reversal with coagulation factors alone.
About the Study
This was an open-label, randomized, multicenter Phase IIIb study to assess the efficacy, safety and tolerance of human 4-factor prothrombin complex concentrate (PCC) to plasma for rapid reversal of acute major bleeding in patients receiving warfarin therapy. The study enrolled 212 patients. The primary endpoint was hemostatic efficacy with respect to the adequacy of stopping an ongoing major bleed within 24 hours from the start of infusion. The secondary endpoints evaluated plasma levels of major clotting factors (Factors II, VII, IX, X, proteins C and S); time to INR correction; number of transfusions, amount of blood products used, and hemostatic agents; and safety and tolerability (including all-cause mortality).
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