Efficacy and Safety of Rivipansel (GMI-1070) in the Treatment of Vaso-Occlusive Crisis in Hospitalized Subjects With Sickle Cell Disease

Time to readiness-for-discharge from hospital was defined as the difference (in hours) between the time and date when all criteria for readiness-for-discharge were met and the start time and date of the first infusion (loading dose) of study drug. Criteria for readiness-for-discharge were met when all of the applicable 6 criteria (in relation to treatment of VOC and complications related to the VOC) were documented to have occurred. The six criteria were: 1) only oral pain medication was required, 2) acute complications related to the VOC (such as acute chest syndrome, stroke, priapism) had resolved to the extent that management could be in an outpatient setting, 3) IV opioids had been discontinued, 4) IV hydration had been discontinued, 5) IV antibiotics had been discontinued and 6) red blood cell (RBC) transfusion was no longer required for treatment of this VOC.

Time to discharge from hospital was defined as the difference (in hours) between the time and date of the hospital discharge order from a qualified healthcare provider and the start time and date of the first infusion (loading dose) of study drug.

Cumulative IV opioid consumption was reported as cumulative IV opioid use (standardized using morphine equivalent units [MEU]), from the start of the first infusion (loading dose) of study drug until hospital discharge.

Time to discontinuation of IV opioids was defined as the difference (in hours) between the stop time and date of the latest IV opioid dose and the start time and date of the first infusion (loading dose) of study drug.

Cumulative IV opioid consumption (standardized using MEU) was reported as IV opioid use in the first 24 hours from the start time of the first IV infusion (loading dose) of study drug.

Percentage of participants who were re-hospitalized for a vaso-occlusive crisis (VOC) within 3 days of discharge from hospital are reported.

AE: any untoward medical occurrence in a participant who received investigational product without regard to possibility of a causal relationship. SAE: an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly; medically important events. An adverse event was considered a treatment-emergent adverse event (TEAE) if the event started during the effective duration of treatment (all events that started on or after the first dosing). AEs included both serious and non-serious adverse events.

Participants with AEs and SAEs were categorized by genotype categories. Category 1= participants with hemoglobin SS, hemoglobin S beta0 thalassemia and hemoglobin SD; category 2= participants with hemoglobin SC, hemoglobin S beta+ thalassemia and hemoglobin S-Variant (other than HbSD).

AE: any untoward medical occurrence in a participant who received investigational product without regard to possibility of a causal relationship. AEs were classified according to the severity in 3 categories a) mild - AEs did not interfere with participant's usual function, b) moderate - AEs interfered to some extent with participant's usual function, c) severe - AEs interfered significantly with participant's usual function.

Hematology: hemoglobin, hematocrit, erythrocytes <0.8*lower limit of normal (LLN), reticulocytes <0.5*LLN >1.5*ULN, platelets<0.5*LLN>1.75*upper limit of normal (ULN), reticulocytes/erythrocytes<0.5*LLN>1.5*ULN, leukocytes <0.6*LLN >1.5*ULN, lymphocytes, lymphocytes/leukocytes, neutrophils, neutrophils/leukocytes <0.8*LLN >1.2*ULN, basophils, basophils/leukocytes, eosinophils, eosinophils/leukocytes, monocytes monocytes/leukocytes >1.2*ULN. Clinical chemistry: bilirubin, direct, bilirubin, indirect bilirubin>1.5*ULN, aspartate aminotransferase (AT), alanine AT, lactate dehydrogenase, alkaline phosphatase>3.0*ULN, urea nitrogen, urea, creatinine >1.3*ULN, sodium<0.95*LLN>1.05*ULN, potassium, chloride, bicarbonate<0.9*LLN>1.1*ULN, glucose<0.6*LLN>1.5*ULN, estimated glomerular filtration rate <=60. Urinalysis: urine glucose, ketones, urine protein, urine hemoglobin, nitrite, leukocyte esterase >=1.

Hemoglobin(grade [G] 0:>11g/dl,G1:>9-11g/dl,G2:>7-9g/dl,G3:5-7g/dl,G4:<5g/dl),reticulocytes count(G0:<1%,G1:1-5%,G2:>5-10%,G3:>10-20%,G4:>20%),leukocytes(G0:<=upper limit of normal [ULN],G1:>ULN-15,000/mm^3,G2:>15,000- 20,000/mm^3,G3:>20,000- 50,000/mm^, G4:>50,000/mm^3),neutrophils(G0:>=LLN, G1:<LLN-1,500/mm^3, G2:<1,500-1,000/mm^3, G3:<1,000-500/mm^3, G4:<500/mm^3),blood urea nitrogen, creatinine(G0:<=ULN, G1:>ULN-1.5*UL, G2:>1.5-3.0*ULN, G3:>3.0*ULN, G4:>6.0*ULN), lactate dehydrogenase, alanine transaminase, aspartate aminotransferase(G0:<=ULN, G1:>ULN-3.0*ULN, G2:>3.0-5.0*ULN, G3:>5.0-20.0*ULN, G4:>20.0*ULN), bilirubin(G0:<=ULN, G1:>ULN-1.5*ULN, G2:>1.5-3.0*ULN, G3:>3.0-10.0*ULN, G4:>10.0*ULN), urine protein(G0:0-15mg/dL, G1:>15-30mg/dL, G2:>30-100mg/dL, G3:>100-300mg/dL, G4:>300mg/dL), platelet(G0:>=150K, G1:>=100K-<150K, G2:>=50K <100K, G3:<50K), eGFR (G0:>=90 mL/min/1.73m^2, G1:>=60-<90mL/min/1.73m^2, G2:>=30-<60mL/min/1.73m^2, G3:>=15-<30mL/min/1.73m^2, G4:<15 mL/min/1.73m^2)

Physical examination included assessment of the general appearance and the skin, head, ears, eyes, nose, mouth, throat, spine, neck, thyroid, chest, extremities, lymph nodes and abdomen (including liver and kidneys) plus the respiratory, cardiovascular, musculoskeletal, neurological and genitourinary systems. Clinical significance was assessed by the Investigator.

Vital signs included temperature, respiratory rate, pulse rate and systolic and diastolic blood pressure. Relatedness to treatment was assessed by the Investigator.

Investigator reported events of Acute Chest Syndrome (ACS) and other reported respiratory events were sent for adjudication by the Acute Chest Syndrome Safety Endpoint Adjudication Committee. The committee, which consisted of physicians with relevant SCD expertise, evaluated these events and determined whether they were consistent with cases of ACS.

Investigator reported cutaneous events were sent for adjudication by the Cutaneous Manifestations Safety Endpoint Adjudication Committee. The committee, which consisted of dermatologists, evaluated these events and determined whether they were cases of severe and/or generalized cutaneous manifestations and specifically whether any event was consistent with Acute Generalized Exanthematous Pustulosis.

Percentage of participants re-hospitalized for VOC within 7, 14 and 30 days of hospital discharge.