Anti-IgE Monoclonal Antibody Treatment in Patients With Allergic Asthma.

• ClinicalTrials.gov Identifier: NCT03468790
• Recruitment Status: Enrolling by invitation
• First Posted: March 19, 2018
• Last Update Posted: March 18, 2020
• Sponsor: Shanghai Biomabs Pharmaceutical Co., Ltd.
• Information provided by (Responsible Party): Shanghai Biomabs Pharmaceutical Co., Ltd.

Study Description

Brief Summary:

This is a multi-centre, randomized, double-blind，placebo parallel-controlled phase III study to evaluate the efficacy and safety of CMAB007 (recombinant humanized anti-immunoglobulin E(IgE) monoclonal antibody for injection) to treat asthma patients who remain not adequately controlled despite Med/high ICS plus LABA in China. Following a screening period of up to 2 weeks and run-in period of 4 weeks, randomized patients will enter a 24-week treatment period with CMAB007 or placebo. Efficacy and safety will be assessed at 4-week intervals during the treatment period.

Condition or disease	Intervention/treatment	Phase
Asthma, Allergic	Drug: CMAB007; Drug: Symbicort; Drug: Seretide; Drug: Ventolin; Drug: placebo	Phase 3

Detailed Description:

Approximately 400 asthma patients with an increased serum total IgE level(60-1500 international unit(IU)/ml) and uncontrolled receiving medium to high dose inhaled corticosteroid (ICS) plus long-acting β2-agonist(LABA) will be randomised in about 43 sites in China. They will be administered CMAB007 or placebo at a ratio of 2:1 for 24 weeks. During the whole study, all subjects will be on regularly fixed combination of med/high ICS and LABA (budesonide and formoterol fumarate powder for inhalation or salmeterol xinafoate and fluticasone propionate powder for inhalation). They should complete PEF measurement and patient diary daily and be assessed every 4 weeks. Spirometry, questionnaires, laboratory tests and so on will be performed. At selected sites, about 45 patients will be enrolled in a sub-study to assess the pharmacokinetic and pharmacodynamic characterises of CMAB007. Anti-drug antibody (ADA) will be sampled at V1, V2 and V7 too.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 400 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: placebo parallel-controlled
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Masking Description: double-blind
• Primary Purpose: Treatment
• Official Title: A Multi-centre, Randomized, Double-blind, Placebo-controlled Phase III Study to Evaluate the Efficacy and Safety of Anti-IgE Monoclonal Antibody to Treat Allergic Asthma Patients Not Adequately Controlled Despite Med/High ICS/LABA.
• Actual Study Start Date: May 9, 2018
• Estimated Primary Completion Date: November 30, 2020
• Estimated Study Completion Date: November 30, 2020

Arms and Interventions

Arm	Intervention/treatment
Experimental: CMAB007 + Seretide/Symbicort + Ventolin; CMAB007(recombinant humanized anti-IgE monoclonal antibody for injection ) will be at a fixed dose determined by the subjects' total IgE and weight at V0. All the subjects will be treated subcutaneously for 24 weeks. The 4-week total dose is 0.016mg/kg/IgE(IU/ml), administered every 2 or 4 weeks, for the subjects with total IgE level 60-700IU/ml. If the total IgE level is 700-1500IU/ml, they will be administered 375mg every 2 weeks. Symbicort(Budesonide and formoterol fumarate powder for inhalation) or Seretide (salmeterol xinafoate and fluticasone propionate powder for inhalation) will be used 1/2 inhalations bid as asthma-controlled drug during the whole study. Ventolin (Salbutamol sulphate aerosol) will be used as asthma rescue drug.	Drug: CMAB007; the study drug; Other Name: recombinant humanized anti-IgE monoclonal antibody; Drug: Symbicort; asthma-controlled drug; Other Name: budesonide and formoterol fumarate powder for inhalation; Drug: Seretide; asthma-controlled drug; Other Name: salmeterol xinafoate and fluticasone propionate; Drug: Ventolin; asthma rescue drug; Other Name: Salbutamol sulphate aerosol
Placebo Comparator: Placebo + Seretide/Symbicort + Ventolin; Placebo is without active components of the study drug and used as same as the study drug.	Drug: Symbicort; asthma-controlled drug; Other Name: budesonide and formoterol fumarate powder for inhalation; Drug: Seretide; asthma-controlled drug; Other Name: salmeterol xinafoate and fluticasone propionate; Drug: Ventolin; asthma rescue drug; Other Name: Salbutamol sulphate aerosol; Drug: placebo; No active components

Outcome Measures

Primary Outcome Measures :

1. the mean number of asthma exacerbations per patient during the 24-week treatment period [ Time Frame: from baseline(0 week) to 24 weeks ]
   Asthma exacerbation is defined by a worsening of asthma symptoms resulting in: 1.out-planned outpatient visit; 2.use of systemic and/or nebulized inhaled corticosteroids; 3.emergency room visit; 4. hospitalization.

Secondary Outcome Measures :

1. the proportion of patients with asthma exacerbations during the 24-week treatment period [ Time Frame: from baseline(0 week) to 24 weeks ]
   the number of patients with at least one exacerbations divided by the total number of patients.
2. time to the first asthma exacerbation during treatment period [ Time Frame: from baseline(0 week) to 24 weeks ]
   the time from baseline to the first asthma exacerbation
3. change from baseline in asthma symptom scores(daytime, nocturnal and total) over the 24-week treatment period [ Time Frame: from baseline(0 week) to 24 weeks ]
   mean asthma symptom scores(daytime, nocturnal and total): (pre-treatment - post-treatment)/pre-treatment *100%
4. change from baseline in Asthma Control Test(ACT) over the 24-week treatment period [ Time Frame: from baseline(0 week) to 24 weeks ]
   ACT total score: (pre-treatment - post-treatment)/pre-treatment *100%
5. change from baseline in Asthma Quality of Life Questionnaire(AQLQ) over the 24-week treatment period [ Time Frame: from baseline(0 week) to 24 weeks ]
   AQLQ total score and threshold score: (pre-treatment - post-treatment)/pre-treatment *100%
6. investigator's and patient's Global Evaluation of Treatment Effectiveness(GETE) over 16 and 24-week treatment period [ Time Frame: from baseline(0 week) to 16 and 24 weeks ]
   GETE score at week 16 and 24
7. change from baseline in rescue medication use over the 24-week treatment period [ Time Frame: from baseline(0 week) to 24 weeks ]
   mean rescue medication use(puff/day): (pre-treatment - post-treatment)/pre-treatment *100%
8. change from baseline in lung function parameters(FEV1,FVC and FEV1/FVC) over the 24-week treatment period [ Time Frame: from baseline(0 week) to 24 weeks ]
   FEV1,FVC and FEV1/FVC values: (post-treatment - pre-treatment)/pre-treatment *100%
9. change from baseline in mean peak expiratory flow(PEF) over the 24-week treatment period [ Time Frame: from baseline(0 week) to 24 weeks ]
   mean PEF value: (post-treatment - pre-treatment)/pre-treatment *100%

Eligibility Criteria

• Ages Eligible for Study: 15 Years to 75 Years (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Signed and dated informed consent prior to any study assessment;
2. Age 15-75 years inclusive, female or male;
3. Diagnosed as asthma according to the guideline for the prevention and treatment of bronchial asthma in China (version 2016), with duration for more than 1 years;
4. Have had at least one severe asthma exacerbations(requiring systemic steroid use) in the previous one year;
5. At screening, serum total IgE level 60-1500IU/ml and body weight 20-150kg.
6. Receiving seretide(fluticasone>250ug/day) or symbicort(budesonide>400ug/day) for at least 3 months and stable dose for at least 4 weeks prior to screening. Asthma symptom control level is still partly controlled or uncontrolled. Detailed drugs and usage are one of the following: Seretide 50/250ug 1 inhalation bid；Seretide 50/500ug 1 inhalation bid；Symbicort 160/4.5ug 2 inhalations bid or Symbicort 320/9ug 1 inhalation bid.
7. None of other asthma controller medications other than seretide or symbicort including systemic steroid, leukotriene modifiers, theophylline, histamine1 receptor blockers, anticholinergic drugs, traditional Chinese medicine and so on have been used 2 weeks prior to screening.
8. At screening, FEV1 < 80% of the predicted normal value.
9. At screening, laboratory tests results should meet all of the following: hemoglobin≥80g/l；3*10^9/l≤white blood cell≤10*10^9/l；platelet≥75*10^9/l；liver function(glutamic-pyruvic transaminase, glutamic-oxalacetic transaminase and total bilirubin)≤2*upper limit of normal value；renal function≤1.5*upper limit of normal value.
10. At screening, pregnant test is negative,or not lactating, for women of child-bearing potential. Effective methods of contraception will be maintained throughout the study and 6 months after the study.
11. Can understand and complete questionnaires correctly, complete PEF and patient diary correctly, and be followed up according to scheduled table.

Exclusion Criteria:

1. History of critical asthma exacerbations，such as tracheal intubation or intensive care unit admission.
2. Currently smoker, or a former smoker with a smoking history > 10 pack-years(defined as the number of packs of 20 cigarettes smoked per day multiplied by number of years the patient smoked).
3. Have elevated serum IgE levels for other causes other than allergens, such as parasite infections, allergic bronchopulmonary aspergillosis, Churg-Strauss syndrome and so on.
4. Desensitization therapy or immunosuppressant agents such as cyclosporine, methotrexate and gold preparation during 3 months prior to screening.
5. Biological agents such as monoclonal antibody including investigational biological drugs during 6 months prior to screening.
6. Vaccinated live/attenuated virus or bacterial vaccines, or intravenous used immunoglobulin G, during 4 weeks prior to screening.
7. History of bronchial thermoplasty for asthma during 12 months prior to screening.
8. Use of any anti-IgE monoclonal antibody including Xolair for asthma during 12 months prior to screening.
9. Respiratory infections（such as pneumonia,upper respiratory tract infection，etc）or large surgeries during 4 weeks prior to screening.
10. Combined with other pulmonary diseases, such as chronic obstructive pulmonary disease, bronchiectasis, pulmonary interstitial fibrosis, etc.
11. History of malignancies other than squamous cell carcinoma or basal cell carcinoma of the skin and carcinoma in situs of cervix with complete excision and no evidence of recurrences.
12. Acquired immune deficiency syndrome or human immunodeficiency virus infection patients.
13. History of malignant or proliferative diseases of the lymphatic system such as lymphoma, or there are symptoms and signs indicating lymphatic proliferative diseases, or splenomegaly (≥2cm under the ribs).
14. With uncontrolled hypertension(systolic pressure ≥160 or diastolic pressure ≥100 in millimeters of mercury) at screening.
15. With severe, progressive or uncontrolled hepatic, renal, gastrointestinal, cardio-cerebral vascular, hematopoietic，genitourinary, endocrine, nervous and immunological medical conditions, or other conditions that investigators think the patient not suitable for this study.
16. Have a history of drug or alcohol abuse or poor compliance of drugs.
17. With known hypersensitivity to human immunoglobulin, anti-IgE monoclonal antibody for injection or components.
18. Have attended other clinical trials of investigational drugs, or within 30 days or 5 half-lives of enrollment, whichever is longer.

Contacts and Locations

Locations

China, Guangdong

The First Affiliated Hospital of Guangzhou Medical University

Guangzhou, Guangdong, China, 510030

China, Zhejiang

The First Affiliated Hospital of Wenzhou Medical University

Wenzhou, Zhejiang, China, 325000

Sponsors and Collaborators

Shanghai Biomabs Pharmaceutical Co., Ltd.

Investigators

• Principal Investigator: Nanshan Zhong, M.D.; The First Affiliated Hospital of Guangzhou Medical University

More Information

• Responsible Party: Shanghai Biomabs Pharmaceutical Co., Ltd.
• ClinicalTrials.gov Identifier: NCT03468790
• Other Study ID Numbers: C007AAIII
• First Posted: March 19, 2018
• Last Update Posted: March 18, 2020
• Last Verified: March 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Asthma; Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases; Fluticasone; Budesonide; Albuterol; Formoterol Fumarate; Salmeterol Xinafoate; Fluticasone-Salmeterol Drug Combination; Budesonide, Formoterol Fumarate Drug Combination; Physiological Effects of Drugs; Anti-Inflammatory Agents; Bronchodilator Agents; Autonomic Agents; Peripheral Nervous System Agents; Anti-Asthmatic Agents; Respiratory System Agents; Dermatologic Agents; Anti-Allergic Agents; Glucocorticoids; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Adrenergic beta-2 Receptor Agonists; Adrenergic beta-Agonists