A Study to Investigate the Safety, Pharmacodynamics and Efficacy Against Allergic Reactivity of Repeat Intranasal Administration of the TLR7 Agonist GSK2245035 in Subjects With Respiratory Allergies

This study has been completed.
Sponsor:
Collaborator:
PATH
Information provided by (Responsible Party):
GlaxoSmithKline
ClinicalTrials.gov Identifier:
NCT01607372
First received: March 29, 2012
Last updated: October 10, 2013
Last verified: October 2013
  Purpose

GSK2245035 is a highly selective Toll-like receptor 7 (TLR7) agonist that stimulates preferentially the induction of type I interferons. Intranasal (i.n.) administration of GSK2245035 in humans causes immune changes in the upper airways milieu that may alter bystander immune responsiveness to aeroallergens and contribute to reduction of allergic reactivity in subjects with respiratory allergies. The purpose of this study is to examine the safety and pharmacodynamics of repeat dosing with i.n. GSK2245035 in subjects with respiratory allergies and to determine the potential to modulate immune reactivity to aeroallergens. The study will be conducted in two parts: In Part 1, the safety and pharmacodynamic response of four weekly administrations of escalating doses of i.n. GSK2245035 will be investigated and the maximum tolerated dose will be established. Subsequently, the safety and pharmacodynamic response of administering the maximum well tolerated dose of i.n. GSK2245035 more frequently (twice a week) will be explored if the previous findings support it. Part 1 of the study will be conducted in patients with pollen-driven allergic rhinitis and mild asthma. In Part 2, the safety of administering i.n. GSK2245035 eight times and the potential to prevent the development of allergic reactivity in response to allergen chamber exposure will be investigated in subjects with active pollen-driven respiratory allergies. The duration of any preventative effect will also be assessed. Part 2 of the study will be initiated after the safety of repeat dosing with i.n. GSK2245035 is confirmed in Part 1 and the most appropriate dosing regimen is selected.


Condition Intervention Phase
Asthma and Rhinitis
Drug: GSK2245035
Device: Type 1 amber glass bottle
Other: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A Randomised, Double Blind, Placebo-controlled Study to Investigate the Safety, Pharmacodynamics and Efficacy Against Allergic Reactivity of Repeat Intranasal Administration of the TLR7 Agonist GSK2245035 in Subjects With Respiratory Allergies

Resource links provided by NLM:


Further study details as provided by GlaxoSmithKline:

Primary Outcome Measures:
  • To evaluate the safety and tolerability of repeat doses of i.n. GSK2245035 administered once per week or every 4 days [ Time Frame: 4 weeks (Part 1); 8 weeks (Part 2) ] [ Designated as safety issue: No ]
    General safety endpoints, including AE, vital signs, body temperature, 12-lead ECG and clinical laboratory parameters. Nasal tolerability endpoints, including nasal examination and assessment of nasal symptoms

  • To evaluate the effect of treatment with 8 doses of i.n. GSK2245035 on total and individual nasal symptoms elicited by the allergen challenge exposure compared to placebo [ Time Frame: 8 weeks (Part 2) ] [ Designated as safety issue: No ]
    Total nasal symptoms score (TNSS) elicited by allergen challenge exposure. Individual nasal symptoms, including nasal congestion, rhinorrhea, sneezing and nasal itch, elicited by allergen challenge exposure

  • To evaluate the duration of a positive treatment effect with 8 doses of i.n. GSK2245035 on total and individual nasal symptoms elicited by allergen challenge exposure compared to placebo [ Time Frame: 8 weeks (Part 2) ] [ Designated as safety issue: No ]
    Total nasal symptoms score (TNSS) elicited by allergen challenge exposure. Individual nasal symptoms, including nasal congestion, rhinorrhea, sneezing and nasal itch, elicited by allergen challenge exposure


Secondary Outcome Measures:
  • FEV1 assessment [ Time Frame: 4 weeks (Part 1) ] [ Designated as safety issue: No ]
    To evaluate the effect of four repeat doses of i.n. GSK2245035 administered once per week or every four days on lung function, as measured by FEV1

  • TLR7-induced blood PD biomarkers, including TLR7-induced cytokines [ Time Frame: 4 weeks (Part 1); 8 weeks (Part 2) ] [ Designated as safety issue: No ]
    To evaluate the induction of TLR7-associated blood PD biomarkers following administration of i.n. GSK2245035 once per week or every four days

  • TLR7-induced nasal PD biomarkers, including but not limited to IP-10, in nasal lavage fluid [ Time Frame: 4 weeks (Part 1); 8 weeks (Part 2) ] [ Designated as safety issue: No ]
    To evaluate the induction of TLR7-associated nasal PD biomarkers following administration of repeat doses of i.n. GSK2245035 once per week or every four days

  • Daily rhinitis symptoms and use of medication diaries during the study period [ Time Frame: 4 weeks (Part 1); 8 weeks (Part 2) ] [ Designated as safety issue: No ]
  • Daily asthma symptoms and use of medication diaries during the study period [ Time Frame: 4 weeks (Part 1) ] [ Designated as safety issue: No ]
  • Daily morning peak expiratory flow (PEF) during the study period [ Time Frame: 4 weeks (Part 1) ] [ Designated as safety issue: No ]
  • Exhaled NO assessment in Part 1, exhaled NO following allergen challenge exposure in Part 2 [ Time Frame: 4 weeks (Part 1); 8 weeks (Part 2) ] [ Designated as safety issue: No ]
  • Cell counts and differential in nasal lavage [ Time Frame: 4 weeks (Part 1); 8 weeks (Part 2) ] [ Designated as safety issue: No ]
  • Exploratory allergic biomarkers including but not limited to immunoglobulins and cytokines in blood and nasal lavage fluid and tissue [ Time Frame: 4 weeks (Part 1) ] [ Designated as safety issue: No ]
  • Allergic blood biomarkers including but not limited to immunoglobulins [ Time Frame: 8 weeks (Part 2) ] [ Designated as safety issue: No ]
  • Weight of nasal secretions elicited during allergen challenge exposure [ Time Frame: 8 weeks (Part 2) ] [ Designated as safety issue: No ]
  • Assessment of nasal flow following allergen challenge exposure [ Time Frame: 8 weeks (Part 2) ] [ Designated as safety issue: No ]
  • Allergic nasal biomarkers including but not limited to cytokines, chemokines and immunoglobulins in nasal fluid and/or tissue following allergen challenge exposure [ Time Frame: 8 weeks (Part 2) ] [ Designated as safety issue: No ]
  • Plasma GSK2245035 concentrations [ Time Frame: 4 weeks (Part 1); 8 weeks (Part 2) ] [ Designated as safety issue: No ]

Enrollment: 18
Study Start Date: April 2012
Study Completion Date: July 2013
Primary Completion Date: July 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Cohort 1 (Part 1)
GSK2245035 - 40 ng or placebo once per week
Drug: GSK2245035
GSK2245035 nasal spray solution. A solution formulation in saline, preserved with Benzalkonium Chloride and Disodium Edetate
Device: Type 1 amber glass bottle
fitted with a metered Valios VP7 pump
Other: Placebo
As for GSK2245035 nasal spray solution except for omission of the active ingredient
Experimental: Cohort 2 (Part 1)
GSK2245035 - 80 ng or placebo once per week
Drug: GSK2245035
GSK2245035 nasal spray solution. A solution formulation in saline, preserved with Benzalkonium Chloride and Disodium Edetate
Device: Type 1 amber glass bottle
fitted with a metered Valios VP7 pump
Other: Placebo
As for GSK2245035 nasal spray solution except for omission of the active ingredient
Experimental: Cohort 3 (Part 1)
GSK2245035 - 100 ng or placebo once per week may be considered after completion of the previous cohorts if thorough review of all safety and PD data, by the GSK core study team and the investigator, indicate this will be safe and appropriate.
Drug: GSK2245035
GSK2245035 nasal spray solution. A solution formulation in saline, preserved with Benzalkonium Chloride and Disodium Edetate
Device: Type 1 amber glass bottle
fitted with a metered Valios VP7 pump
Other: Placebo
As for GSK2245035 nasal spray solution except for omission of the active ingredient
Experimental: Part 2
Dose to be decided from Part 1. Subjects to receive 8 doses of GSK 2245035
Drug: GSK2245035
GSK2245035 nasal spray solution. A solution formulation in saline, preserved with Benzalkonium Chloride and Disodium Edetate
Device: Type 1 amber glass bottle
fitted with a metered Valios VP7 pump
Other: Placebo
As for GSK2245035 nasal spray solution except for omission of the active ingredient

  Eligibility

Ages Eligible for Study:   18 Years to 62 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

All subjects (Part 1 and 2):

  • Good general health, as determined by a responsible and experienced physician, based on a medical evaluation, including medical history, physical examination, laboratory tests and cardiac monitoring. A subject with a clinical abnormality or laboratory parameters outside the reference range for the population being studied may be included only if the investigator agrees that the finding is unlikely to introduce additional risk factors and will not interfere with the study procedures.
  • Males between 18 and 62 years of age inclusive. - Male subjects with female partners of child-bearing potential must agree to use one of the contraception methods listed in the protocol. This criterion must be followed from the time of the first dose of study medication until four days after the last dosing.
  • Females between 18 and 62 years of age inclusive, if they are of non-childbearing potential, defined as pre-menopausal females with a documented tubal ligation or hysterectomy, or postmenopausal, defined as 12 months of spontaneous amenorrhea (in questionable cases a blood sample with simultaneous follicle stimulating hormone (FSH) greater than 40 MlU/ml and estradiol less than 40 pg/ml (less than 147 pmol/L) is confirmatory). Females on hormone replacement therapy (HRT) and whose menopausal status is in doubt will be required to use one of the contraception methods in the protocol if they wish to continue their HRT during the study. Otherwise, they must discontinue HRT to allow confirmation of post-menopausal status prior to study enrollment. For most forms of HRT, at least 2-4 weeks should elapse between the cessation of therapy and the blood draw; this interval depends on the type and dosage of HRT. Following confirmation of their post-menopausal status, they can resume use of HRT during the study without use of a contraceptive method.
  • Body weight greater than and equal to 50 kg and body mass index (BMI) within the range 19 - 29.9 kg/m2 (inclusive).
  • Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form.
  • Available to complete all required study measurements. Patients with pollen driven seasonal respiratory allergy (Part 1): Documented history of symptomatic pollen-driven allergic rhinitis and mild asthma, that does not require regular use of inhaled steroids, for more than 3 years; Positive skin allergy test (wheal greater than and equal to 3 mm) or Radio Allergosorbent Test (RAST) (greater than and equal to class 2) for pollen allergen; Subjects have asthma and rhinitis symptoms developed during the current pollen season. Patients with seasonal ragweed pollen respiratory allergy only (Part 2): Documented history of symptomatic seasonal allergic rhinitis to ragweed pollen for more than 3 years; Positive skin allergy test (wheal greater than and equal 3 mm) or RAST (greater than and equal class 2) for ragweed pollen allergen; TNSS in response to screening allergen chamber exposure of greater than and equal 5 (on a 12 point scale).

Exclusion Criteria:

All subjects (Parts 1 and 2)

  • History of immunological disorders or other diseases (including, but not limited to, malignancy, cardiovascular, gastro-intestinal, hepatic, renal, haematological, neurological, endocrine or pulmonary disease) that in the opinion of the investigator and GSK medical monitor may pose additional risk factors
  • Nasal conditions that according to the opinion of the investigator may affect the outcome of the study, i.e. nasal septal perforation, nasal polyps, other nasal malformations or history of frequent nosebleeds.
  • Respiratory tract infection within 4 weeks prior to the first dosing.
  • A positive pre-study Hepatitis B surface antigen or positive Hepatitis C antibody result within 3 months of screening - A positive test for HIV antibody
  • A positive screening or pre-dose drug/alcohol screen - History of regular alcohol consumption within 6 months of the study defined as: an average weekly intake of greater than 14 drinks for males or greater than 7 drinks for females. One drink is equivalent to 12 g of alcohol: 12 ounces (360 ml) of beer, 5 ounces (150 ml) of wine or 1.5 ounces (45 ml) of 80 proof distilled spirits.
  • Participation in a clinical trial with receipt of an investigational product within 3 months prior to the first dosing day.
  • Exposure to more than four new chemical entities within 6 months prior to the first dosing day.
  • History of drug or other allergy that, in the opinion of the investigator or GSK medical monitor, contraindicates participation in this study.
  • Donation of blood or blood products in excess of 500 mL within a 56-day period.
  • History of sensitivity to heparin or heparin-induced thrombocytopenia
  • Unwillingness or inability to follow the procedures outlined in the protocol.
  • Subject is mentally or legally incapacitated. Patients with pollen driven respiratory allergy (Part 1): History of severe asthma; Serious asthma exacerbation requiring hospital visit and/ or treatment with oral steroids or high doses of inhaled steroids within 6 weeks prior to screening; Pre-bronchodilator FEV1 less than and equal to 70% of predicted at screening; Use of prescription or non-prescription drugs, including vitamins, herbal and dietary supplements (including St John's Wort) within 7 days (or 14 days if the drug is a potential enzyme inducer) or 5 half-lives (whichever is longer) prior to first dosing, unless in the opinion of the investigator and GSK medical monitor the medication will not interfere with the study procedures or compromise subject safety. Paracetamol is an exception and will be permitted at daily doses of up to 4 g from screening to follow-up. During the dosing visits Paracetamol can be used, if needed, only if the investigator allows it.
  • Subjects using steroid treatment for allergic rhinitis and/or asthma may participate in the study if they can remain free of medication throughout the study period starting from the following periods of time prior to first dosing: Nasal steroids: 4 weeks; Oral steroids: 12 weeks; Inhaled steroids: 4 weeks
  • Subjects using other medications for their allergic rhinitis and/or asthma on an as needed basis may participate in the study if they can abstain from: Xanthines (including theophylline, but not including caffeine), anticholinergics, cromoglycates, leukotriene antagonists, 5-lipoxygenase inhibitors and longacting inhaled beta-agonists from 1 week prior to screening and throughout the studyNa; Nasal antihistamines: 48 hours prior each dosing; Oral antihistamines: 76 hours prior each dosing; Nasal decongestants: 24 hours prior each dosing; Oral decongestants: 24 hours prior each dosing; Short acting inhaled beta-agonists: 48 hours prior each dosing
  • Patients with seasonal ragweed pollen respiratory allergy (Part 2): Documented history of asthma; History of treatment with allergen-specific immunotherapy; Use of prescription or non-prescription drugs, including vitamins, herbal and dietary supplements (including St John's Wort) within 7 days (or 14 days if the drug is a potential enzyme inducer) or 5 half-lives (whichever is longer) prior to first dosing and throughout the treatment period unless in the opinion of the investigator and GSK medical monitor the medication will not interfere with the study procedures or compromise subject safety. Paracetamol is an exception and will be permitted at daily doses of up to 4 g from screening to follow-up; Subjects using oral steroids may participate in the study if they can remain free of medication from 12 weeks prior to screening, throughout the treatment period and up to the last scheduled allergen chamber exposure; Subjects using the medications below for allergic rhinitis may participate in the study if they can abstain from: Anticholinergics, cromoglycates, leukotriene antagonists and 5-lipoxygenase inhibitors from 1 week prior to screening and throughout the treatment period up to 1 month after the end of the treatment period. Thereafter, for 2 weeks prior each allergen challenge visit in the clinic; Nasal antihistamines: 48 hours prior each visit in the clinic: Oral antihistamine: 7 days prior each visit in the clinic; Nasal decongestants: 24 hours prior each visit in the clinic; Oral decongestants: 24 hours prior each visit in the clinic; Nasal steroids: 4 weeks prior each visit in the clinic (screening, dosing visits, allergen challenge visits and PD assessment visits included)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01607372

Locations
Canada, Ontario
GSK Investigational Site
Toronto, Ontario, Canada, M5V 2T3
Sponsors and Collaborators
GlaxoSmithKline
PATH
Investigators
Study Director: GSK Clinical Trials GlaxoSmithKline
  More Information

No publications provided

Responsible Party: GlaxoSmithKline
ClinicalTrials.gov Identifier: NCT01607372     History of Changes
Other Study ID Numbers: 116392
Study First Received: March 29, 2012
Last Updated: October 10, 2013
Health Authority: Canada: Health Canada

Keywords provided by GlaxoSmithKline:
TLR7 agonist, Respiratory Allergies, Allergic Rhinitis, Mild Allergic Asthma, Repeat Dose Safety, Reduction of Allergic Reactivity

Additional relevant MeSH terms:
Asthma
Rhinitis
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Lung Diseases
Respiratory Hypersensitivity
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases
Nose Diseases
Respiratory Tract Infections
Otorhinolaryngologic Diseases

ClinicalTrials.gov processed this record on July 10, 2014