The Launch of Two Sub-Studies of the Peak Registry, a Global, Longitudinal Study of Pyruvate Kinase Deficiency

Background: Pyruvate kinase (PK) deficiency is a rare, glycolytic enzymopathy caused by autosomal recessive mutations in the PKLR gene, which leads to lifelong hemolytic anemia and potentially serious complications such as extramedullary hematopoiesis, pulmonary hypertension, and iron overload. The Peak Registry (NCT03481738) was initiated in 2018 as a global, retrospective and prospective, observational study of pediatric and adult patients with a genetically confirmed diagnosis of PK deficiency to better understand the natural history, treatment patterns, and burden of disease. The registry aims to enroll 500 patients at approximately 60 sites in up to 20 countries over 7 years, with at least 2 and up to 9 years of follow-up. In 2021, two sub-studies were initiated to obtain additional information on the patient experience with PK deficiency, with a specific focus on 1) patient-reported health-related quality of life, including impact on work productivity and activity impairment (NCT04964323) and 2) the impact of PK deficiency on cognitive performance (NCT04995315). Unlike the core registry where data reporting is managed by sites via electronic case report forms, the sub-studies utilize an innovative decentralized design. The core registry and both sub-studies are currently open for enrollment.

Methods: The design of the core registry has been previously described¹. Both sub-studies are managed via a decentralized model using a web-based portal (N of 1 Health Research Platform; Digital Infuzion, Inc.). The patient-reported outcomes sub-study is open to adult (≥18 years) Peak participants in the US, Netherlands, Italy, Spain, and the UK with a target enrollment of 75 patients. Assessments include the PK Deficiency Diary (PKDD), PK Deficiency Impact Assessment (PKDIA), Functional Assessment of Cancer Therapy-Anemia (FACT-An, anemia subscale only), and the Work Productivity and Activity Impairment (WPAI) questionnaire. All assessments are completed electronically (computer, tablet, or mobile phone) at baseline and every 3 months thereafter (every 6 months for PKDD) over a 24-month period. The cognition sub-study is open to adult Peak participants in the US, Netherlands, and Italy with a target enrollment of 33 patients. Participants are required to use a desktop computer or laptop to complete a battery of self-administered cognitive assessments of psychomotor speed, attention, visual learning, and working memory utilizing the Cogstate Brief Battery (CBB). The assessments are completed at baseline and Day 90. Eligible patients can opt into sub-study participation through the platform's online Peak Patient Community Portal and begin the informed consent form (ICF) process which is managed by regional coordinating centers in each respective country. Once the ICF process has been completed, participants have access to the study surveys via the online portal. Data collected from both sub-studies will be summarized descriptively. Ethics approval has been received from all participating countries, and all stored data is de-identified.

Results: Sites in the US were approved for sub-study enrollment on a rolling basis between July 2021 and May 2022, and had enrolled 5 patients as of 07Jul2022. Enrollment opened in Spain in April 2022, the Netherlands in May 2022, and in Italy and the UK in July 2022. As of 07Jul2022, 252 patients had enrolled in the core registry, of whom approximately 100 are adults in countries participating in the sub-studies and thus potentially eligible for sub-study participation.

Summary: The Peak Registry provides a unique and impactful opportunity to enhance our understanding of PK deficiency. Two complementary sub-studies on health-related quality of life and cognition have recently been developed to obtain additional information on the patient experience with PK deficiency that has not been systematically captured or reported elsewhere. Further information is available at https://peakregistry.com and www.clinicaltrials.gov, and from medinfo@agios.com.

¹Grace RF et al. Blood (2019) 134 (Supplement_1): 2223.

Lander:Agios Pharmaceuticals, Inc.: Other: PK Deficiency Patient Advocacy Advisory Council patient representative. Grace:Agios Pharmaceuticals: Consultancy, Research Funding; Novartis: Research Funding; Sanofi: Consultancy; Sobi: Membership on an entity's Board of Directors or advisory committees, Research Funding. van Beers:Global Blood Therapeutics: Consultancy; Agios Pharmaceuticals, Inc.: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding; Pfizer: Research Funding; RR Mechatronics: Research Funding; Sobi: Research Funding; Sanofi: Consultancy. Glader:Agios: Consultancy. Kuo:Bioverativ/Sanofi/Sangamo: Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria; Pfizer: Consultancy, Research Funding; Celgene/BMS: Consultancy; bluebird bio: Consultancy; Apellis: Consultancy; Alexion: Consultancy, Honoraria; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees. Glenthøj:Celgene: Consultancy; Sanofi: Research Funding; Saniona: Research Funding; Pharmacosmos: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees; bluebird bio: Consultancy, Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees. Layton:Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Cerus: Membership on an entity's Board of Directors or advisory committees. Boscoe:Agios Pharmaceuticals, Inc.: Current Employment, Current holder of stock options in a privately-held company. Smith:Agios Pharmaceuticals, Inc.: Current Employment, Current holder of stock options in a privately-held company. McGee:Agios Pharmaceuticals, Inc.: Current Employment, Current holder of stock options in a privately-held company. Bianchi:Agios Pharmaceuticals, Inc.: Other: Scientific advisor.