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Benralizumab for Eosinophilic Gastritis (ANTI-IL5RA)

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ClinicalTrials.gov Identifier: NCT03473977
Recruitment Status : Recruiting
First Posted : March 22, 2018
Last Update Posted : April 17, 2018
Sponsor:
Collaborator:
AstraZeneca
Information provided by (Responsible Party):
Children's Hospital Medical Center, Cincinnati

Brief Summary:
A Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Evaluate the Efficacy of Benralizumab (Anti-IL5RA) in Subjects With Eosinophilic Gastritis.

Condition or disease Intervention/treatment Phase
Eosinophilic Gastritis or Gastroenteritis Biological: Benralizumab Biological: Placebo Phase 1 Phase 2

Detailed Description:

Primary Objective:

To assess the efficacy of repeat subcutaneous (SC) doses of benralizumab, compared with placebo, to reduce eosinophilic inflammation in the gastrointestinal tract of patients with EG Secondary Objectives: To assess changes in endoscopic score/histological features/blood and biopsy eosinophil counts/clinical symptoms/esophageal, gastric, and duodenal tissue transcriptome changes/ before and after treatment with benralizumab.

26 subjects are planned to be enrolled into the study at Cincinnati Children's Hospital Medical Center.

Qualifying Subjects will receive 3 monthly sub-coetaneous injections of benralizumab/Placebo, followed by an option six month Open Label Extension period.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 26 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Participants will receive 3 doses of drug or placebo. An optional OLE will also be available following the double blind period.
Masking: Triple (Participant, Care Provider, Investigator)
Masking Description: The study is double blind. Randomization will be performed by external investigational pharmacy staff, which the dispenser of the drug/placebo at CCHMC.
Primary Purpose: Treatment
Official Title: A Double-Blind, Placebo-controlled Clinical Trial to Evaluate Efficacy of Benralizumab in Subjects With Eosinophilic Gastritis
Actual Study Start Date : March 30, 2018
Estimated Primary Completion Date : March 30, 2020
Estimated Study Completion Date : March 30, 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Benralizumab
This Arm is a subcutaneous dose of 30 mg of Benralizumab
Biological: Benralizumab
Monoclonal antibody originally developed for the treatment of asthma. It is directed against the alpha-chain of the interleukin-5 receptor (CD125). Either Benralizumab or Placebo will be injected in 3 monthly doses of 30 mg, to examine the decrease in blood and tissue eosinophil counts in subjects with Eosinophilic Gastritis. This will be followed by an optional OLE period.
Other Name: Fasenra

Placebo Comparator: Placebo
This Arm is a subcutaneous dose of 30 mg of Placebo
Biological: Placebo
Placebo will be injected in 3 monthly doses of 30 mg, as a comparator to injection with Benralizumab to examine the decrease in blood and tissue eosinophil counts in subjects with Eosinophilic Gastritis.




Primary Outcome Measures :
  1. Induction of disease remission [ Time Frame: 3 years ]
    Will be defined by the percentage of patients that achieve histological remission in the stomach as defined by peak eosinophil counts less than 30/hpf. Comparison between drug vs placebo will be the primary measurement endpoint.


Secondary Outcome Measures :
  1. changes in endoscopic features before and after treatment with benralizumab [ Time Frame: 3 years ]
    Change in endoscopic score from pre- to post-treatment with benralizumab or placebo as measured by standardized endoscopy scoring systems.

  2. changes in histologic features before and after treatment with benralizumab [ Time Frame: 3 years ]
    Change in histologic score from pre- to post-treatment with benralizumab or placebo as measured by standardized histology forms specific to the diseases of interest.

  3. changes in blood eosinophil counts before and after treatment with benralizumab [ Time Frame: 3 years ]
    Change in blood eosinophil count before and after treatment with benralizumab or placebo as measured by CBC with differential.

  4. evaluate esophageal, gastric, and duodenal tissue transcriptome changes following benralizumab treatment. [ Time Frame: 3 years ]
    Baseline predictors and changes in expression of genes as assessed by whole genome RNA sequencing

  5. changes in peak eosinophil counts in biopsies before and after treatment with benralizumab [ Time Frame: 3 years ]
    Change in peak eosinophil count in biopsies (esophageal, gastric, and/or duodenal, as applicable) pre- vs. post-treatment with benralizumab or placebo

  6. changes in clinical symptoms before and after treatment with benralizumab for EG [ Time Frame: 3 years ]
    Change in symptoms from pre- to post-treatment with benralizumab or placebo as measured by patient-reported outcome measures.

  7. changes in quality of life before and after treatment with benralizumab for adult EoE [ Time Frame: 3 years ]
    Quality of life for pediatric EoE measured by the EoE-Quality of Life Scale A (range 0-96, with 96 being the most impaired)

  8. Assessment of Adverse Events and Serious Adverse Events to determine safety and tolerability of Benralizumab in subjects with EG [ Time Frame: 3 years ]
    Incidence and rate of severity of Adverse Events and Serious Adverse Events

  9. Physical exam to evaluate the safety and tolerability of Benralizumab in subjects with EG [ Time Frame: 3 years ]
    incidence of clinically significant findings



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Ages Eligible for Study:   12 Years to 60 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Informed Consent: Able to give written informed consent prior to participation in the study, which will include the ability to comply with the requirements and restrictions listed in the consent form. Subjects must be able to read, comprehend, and write at a level sufficient to complete study related materials.
  • Males and females between the ages of 12-60 years with confirmed diagnosis of EG involving stomach; involvement of eosinophilic inflammation in other gastrointestinal segments will be allowed but not required or sufficient.
  • Histologically active EG at time of screening, with a peak Gastric count of ≥ 30 eos/hpf in at least 5 hpfs.
  • Must be symptomatic (defined as having experienced symptoms within 4 weeks prior to enrollment)
  • Blood eosinophilia (defined as having an absolute eosinophil count > 500 cells per mcL of blood ) at least once during the 6 months prior to enrollment.
  • Must be on baseline anti-EG/EGE therapy as long as there is agreement to not change their dosage unless medically indicated.
  • Clinical symptoms (i.e., abdominal pain, bloating, vomiting, diarrhea) severe enough to impact daily life (e.g., school/work attendance, social activities) ≥ 2 days/week for 3 of the 4 weeks prior to enrollment despite treatment (such as diet, proton pump inhibitors or corticosteroids). See addendum number 1, page 55.
  • Female subjects: Women of childbearing potential (WOCBP) must use an effective form of birth control (confirmed by the Investigator). Effective forms of birth control include: true sexual abstinence, a vasectomized sexual partner, Implanon, female sterilization by tubal occlusion, any effective IUD intrauterine device/IUS levonogestrel Intrauterine system, Depo-Provera(tm) injections, oral contraceptive, and Evra Patch(tm) or Nuvaring(tm). WOCBP must agree to use effective method of birth control, as defined above, from enrollment, throughout the study duration and within 16 weeks after last dose of IP, and have negative serum pregnancy test result on Visit 0.
  • Women not of childbearing potential are defined as women who are either permanently sterilized (hysterectomy, bilateral oophorectomy, or bilateral salpingectomy), or who are postmenopausal. Women will be considered postmenopausal if they have been amenorrheic for 12 months prior to the planned date of visit -1 without an alternative medical cause. The following age-specific requirements apply:
  • Women <50 years old would be considered postmenopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatment and follicle stimulating hormone (FSH) levels in the postmenopausal range.
  • Women ≥50 years old would be considered postmenopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatment.
  • All male subjects who are sexually active must agree to use an acceptable method of contraception (condom with or without spermicide, vasectomy) from Visit 0 until 16 weeks after their last dose.

Exclusion Criteria:

  • Concurrent H. pylori gastritis or parasitic infection
  • Other gastrointestinal disorders such as Crohn's disease, inflammatory bowel disease, or Celiac disease
  • Esophageal stricture that prevents the easy passage of a standard endoscope
  • Use of any investigational biologic drug within 6 months prior to screening
  • Hypereosinophilic syndrome, defined by multiple organ involvement (with the exception of atopic disease or EGID) and persistent blood absolute eosinophil count ≥1500/mcL.
  • A diagnosis of celiac disease, inflammatory bowel disease, eosinophilic granulomatosis with polyangiitis (EGPA), drug hypersensitivity or connective tissue rheumatological disorders,
  • History of cancer: Subjects who have had basal cell carcinoma, localized squamous cell carcinoma of the skin, or in situ carcinoma of the cervix are eligible provided that the subject is in remission and curative therapy was completed at least 12 months prior to the date informed consent, and assent when applicable was obtained. Subjects who have had other malignancies are eligible provided that the subject is in remission and curative therapy was completed at least 5 years prior to the date informed consent, and assent when applicable, was obtained.
  • A helminth parasitic infection diagnosed within 24 weeks prior to the date informed consent is obtained that has not been treated with, or has failed to respond to standard of care therapy.
  • Pregnant or nursing
  • Receipt of any investigational non-biologic within 30 days or 5 half-lives prior to visit 0, whichever is longer.
  • A history of known immunodeficiency disorder including a positive human immunodeficiency virus (HIV) test.
  • Any other medical illness that precludes study involvement
  • Positive hepatitis B surface antigen, or hepatitis C virus antibody serology, or a positive medical history for hepatitis B or C. Subjects with a history of hepatitis B vaccination without history of hepatitis B are allowed to be enrolled.
  • Patients who are currently receiving or have previously received benralizumab or any other type of anti-interleukin therapy (i.e. mepolizumab, reslizumab, lebrikizumab etc.) within the last 6 months or 5 half-lives whichever is longer.
  • History of anaphylaxis to any biologic therapy or vaccine.
  • Receipt of immunoglobulin or blood products within 30 days prior to the date informed consent is obtained.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03473977


Contacts
Contact: Tal Cohen, MS 5135171074 tal.cohen@cchmc.org
Contact: Lauren DiTommaso 5138035446 lauren.DiTommaso@cchmc.org

Locations
United States, Ohio
Cincinnati Children's Hospital Medical Center Recruiting
Cincinnati, Ohio, United States, 45229
Contact    513-636-4200      
Sponsors and Collaborators
Children's Hospital Medical Center, Cincinnati
AstraZeneca
Investigators
Principal Investigator: marc E Rothenberg, MD, PhD Children's Hospital Medical Center, Cincinnati

Responsible Party: Children's Hospital Medical Center, Cincinnati
ClinicalTrials.gov Identifier: NCT03473977     History of Changes
Other Study ID Numbers: CIN_"Benralizumab"_001
First Posted: March 22, 2018    Key Record Dates
Last Update Posted: April 17, 2018
Last Verified: April 2018

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

Additional relevant MeSH terms:
Gastroenteritis
Gastritis
Eosinophilic Esophagitis
Enteritis
Eosinophilia
Gastrointestinal Diseases
Digestive System Diseases
Stomach Diseases
Esophagitis
Esophageal Diseases
Leukocyte Disorders
Hematologic Diseases
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases
Intestinal Diseases