Mepo for EoE Study

• ClinicalTrials.gov Identifier: NCT03656380
• Recruitment Status: Completed
• First Posted: September 4, 2018
• Last Update Posted: December 21, 2022
• Sponsor: University of North Carolina, Chapel Hill
• Collaborators: GlaxoSmithKline; University of Utah; Northwestern University; MNGI Digestive Health, P.A.
• Information provided by (Responsible Party): University of North Carolina, Chapel Hill

Study Description

Brief Summary:

Multi-center, randomized, double blind, parallel-arm, placebo controlled trial to determine whether mepolizumab is more effective than placebo for improving symptoms of dysphagia and decreasing esophageal eosinophil counts in adults and adolescents with active eosinophilic esophagitis after an initial 3 month treatment course, and will also assess the impact of an additional 3 months of treatment.

Condition or disease	Intervention/treatment	Phase
EoE; Eosinophilic Esophagitis	Drug: Mepolizumab 300 mg; Drug: Mepolizumab 100 mg; Other: Placebo	Phase 2

Detailed Description:

This is a multi-center, randomized, double blind, parallel-arm, placebo controlled trial of mepolizumab. After the first 3 month blinded phase, there will be a second 3 month blinded phase where all patients receive active medication, but the dose will be lower in the subjects initially randomized to the placebo arm.

In the first arm, subjects will receive mepolizumab 300 mg SQ monthly for 3 months. In the second arm, subjects will receive a placebo SQ injection monthly for 3 months. Both groups will have the injection administered under direct observation in a Clinical & Translational Research Center (CTRC) or other clinic to ensure proper administration and compliance. Each visit will also provide an opportunity for symptom questionnaires to be completed and for blood samples to be drawn. After 3 months (the time point where the primary outcome is assessed), all subjects initially randomized to active treatment will continue with mepolizumab dosing 300 mg SQ monthly, and will remain blinded. All subjects initially randomized to placebo will receive mepolizumab 100mg SQ monthly, and will remain blinded. Of note, no dietary changes, changes in baseline Proton Pump Inhibitor (PPI) medication dose, changes in inhaled or intranasal steroid doses, or administration or oral, topical/swallowed, or systemic steroids will be allowed during the study period. Subjects will undergo endoscopy after the first blinded phase (at 3 months) and after the second blinded phase (after 6 months).

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 66 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Triple (Participant, Care Provider, Investigator)
• Primary Purpose: Treatment
• Official Title: A Multi-center, Randomized, Double Blind, Parallel-arm, Placebo Controlled Trial of Mepolizumab for Treatment of Adults and Adolescents With Active Eosinophilic Esophagitis and Dysphagia-predominant Symptoms
• Actual Study Start Date: March 20, 2019
• Actual Primary Completion Date: June 6, 2022
• Actual Study Completion Date: December 9, 2022

Arms and Interventions

Arm	Intervention/treatment
Experimental: Mepolizumab 300 mg; Subjects will receive Mepolizumab 300 mg subcutaneously (SQ) monthly for 6 months	Drug: Mepolizumab 300 mg; Mepolizumab 300 mg subcutaneous injection; Other Name: Nucala
Placebo, followed by Mepolizumab 100 mg; This arm will receive placebo, followed by Mepolizumab 100 mg. Subjects will receive placebo subcutaneously (SQ) monthly for 3 months, followed by Mepolizumab 100 mg subcutaneously (SQ) monthly for 3 months. Mepolizumab will be administered with 2 SQ injections of placebo and 1 SQ injection of Mepolizumab 100 mg to maintain blinding.	Drug: Mepolizumab 100 mg; Mepolizumab 100 mg subcutaneous injection; Other Name: Nucala; Other: Placebo; Saline subcutaneous injection; Other Name: Saline

Outcome Measures

Primary Outcome Measures :

1. Mean Change in Dysphagia from Baseline to 3 months Post-treatment [ Time Frame: Baseline, Month 3 Post-Treatment ]
   Dysphagia will be assessed by the Eosinophilic Esophagitis Symptom Activity Index (EEsAI) which measures dysphagia frequency, dysphagia severity, and food avoidance/modification behaviors. EEsAI scores range from 0 to 100, with higher scores indicating more severe symptoms. A decrease of ≥ 20 points is felt to be a meaningful clinical response and scores ≤ 20 representing clinical remission.

Secondary Outcome Measures :

1. Proportion of Participants with a Clinical Remission (EEsAI Score of ≤ 20 points) after 3 months of treatment [ Time Frame: After 3 months of treatment ]
   The EEsAI measures dysphagia frequency, dysphagia severity, and food avoidance/modification behaviors. EEsAI scores range from 0 to 100, with higher scores indicating more severe symptoms. A decrease of ≥ 20 points is felt to be a meaningful clinical response and scores ≤ 20 representing clinical remission.
2. Proportion of Participants with a Clinical Response (EEsAI Score Decrease of ≥ 20 points) after 3 months of treatment [ Time Frame: After 3 months of treatment ]
   The EEsAI measures dysphagia frequency, dysphagia severity, and food avoidance/modification behaviors. EEsAI scores range from 0 to 100, with higher scores indicating more severe symptoms. A decrease of ≥ 20 points is felt to be a meaningful clinical response and scores ≤ 20 representing clinical remission.
3. Absolute Peak Eosinophil count (measured in eos/hpf) after 3 months of treatment [ Time Frame: After 3 months of treatment ]
   Absolute peak eosinophil count (measured in EOS/hpf) after 3 months of treatment.
4. Histologic Response Levels after 3 Treatment Months [ Time Frame: After 3 months of treatment ]
   Histologic levels for <15, ≤ 6, and ≤ 1 EOS/hpf.
5. Mean Change in EoE Endoscopic Reference Score (EREFS) from Baseline to 3 months Post-treatment [ Time Frame: Baseline, 3 months post-treatment ]
   Mean change in severity of endoscopic findings as measured by the EoE Endoscopic Reference Score (EREFS). The EREFS, measures features of EoE including esophageal edema, rings, exudate, furrows, and strictures. The instrument grades edema and furrows as absent (0) or present (1); rings as absent (0), mild (1, subtle circumferential ridges), moderate (2, distinct rings) and severe (3, rings that impair passage of a standard adult diagnostic endoscope); exudates as absent (0), mild (1, less than 10% of the esophageal surface area) or severe (2, greater or equal to 10% of the esophageal surface area); and strictures as absent (0) or present (1) with an estimation of the minimal luminal diameter. Higher scores indicate more severe disease (range 0 - 9).
6. Mean change in the Straumann Dysphagia Instrument (SDI) Score from Baseline to 3 months Post-treatment [ Time Frame: Baseline, 3 months post-treatment ]
   The Straumann Dysphagia Instrument (SDI) is a direct measure of dysphagia frequency and severity which is completed by participants and reported over the previous week. The score ranges from 0-9, with higher scores indicating more severe dysphagia.

Eligibility Criteria

• Ages Eligible for Study: 16 Years to 75 Years (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Age 16-75
• Diagnosis of EoE as per consensus guidelines (including PPI non-response)*
• Active eosinophilia on esophageal biopsy, with a peak count of least 15 EOS/hpf from at least one esophageal level.
• Biopsies from the stomach and duodenum that have ruled out alternative etiologies in all children and in adults with abnormal endoscopic findings or when other gastric or small intestinal conditions are clinical possibilities. If these samples have been obtained during a previous endoscopic evaluation and in the judgement of the site-Investigator the patient has not had a clinically significant change that would merit repeat gastric/duodenal biopsies, then prior normal gastric and duodenal biopsies are acceptable to exclude alternate etiologies.
• Active symptoms of dysphagia with more than 3 episodes of dysphagia over a period of 2 weeks during the screening period, and an Eosinophilic Esophagitis Symptom Activity Index (EEsAI; see below for details) score of ≥ 27 at baseline.
• Able to read, comprehend, and sign consent form.
• Have maintained a stable diet for 6 weeks prior to enrollment.
• Able to maintain a stable diet throughout the duration of the study period.

• Female subjects of childbearing potential who have had their first menses agree to use a highly effective method of birth control during the study and for 30 days after the last dose of study drug. Female subjects with reproductive potential who are using systemic contraceptives (e.g., oral contraceptives, injectable contraceptives, implantable/insertable hormonal contraceptive products, or transdermal patches) to prevent pregnancy must have stable use for ≥28 days prior to screening.

  • PPI non-response is defined as >15 eos/hpf after at least 6 weeks of high dose administration (40mg total per day or higher) of any approved PPI medication or documented evidence of intolerance or allergy to PPIs. The length of the PPI trial period or documented intolerance/allergy will be determined according to the local clinical standard of care.

Exclusion Criteria:

• Esophageal dilation within 8 weeks of the screening endoscopy.
• Inability to pass a standard upper endoscope (8-10mm) due to esophageal narrowing or stricturing.
• Swallowed/topical steroids for EoE within 4 weeks of the screening endoscopy, or a course of systemic corticosteroids within 8 weeks of the screening endoscopy.
• Not having maintained a stable diet for at least 6 weeks preceding the screening endoscopy.
• Initiation, discontinuation, or change of dose regimen of PPIs; leukotriene inhibitors; or nasal, inhaled, and/or orally administered topical corticosteroids for any condition (such as gastroesophageal reflux disease, asthma, or allergic rhinitis) within the 8 weeks prior to the qualifying esophagogastroduodenoscopy (EGD).
• Presence of concomitant eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), eosinophilic colitis (EC), Crohn's disease, ulcerative colitis, or celiac disease.
• History of malignancy within 5 years prior to screening, except completely treated in situ carcinoma of the cervix and completely treated non-metastatic squamous or basal cell carcinoma of the skin.
• History of achalasia.
• Prior esophageal surgery.
• History of bleeding disorder or esophageal varices.
• Active parasitic infection or suspicion of an active parasitic infection, which, in the opinion of the site-Investigator, has not been previously evaluated or treated. Subjects presenting with signs of active parasitic infection or suspicion of active parasitic infection as assessed by current diarrhea and/or blood or mucus in stool will be referred to their clinical physician for further testing to rule out parasitic infection.
• Any other active infections judged at the discretion of the site-Investigator.
• Any other medical or psychological condition that, in the opinion of the site-investigator, may present an unreasonable risk to the study patient as a result of his/her participation in this clinical trial, may make patient's participation unreliable, or may interfere with study assessments. The specific justification for patients excluded under this criterion will be noted in study documents.
• Patient or his/her immediate family is a member of the investigational team.
• Pregnancy or breastfeeding.
• Women of children bearing potential who are not on highly-effective contraception.

Contacts and Locations

Locations

United States, Illinois

Northwestern University

Chicago, Illinois, United States, 60611

United States, Minnesota

MNGI Digestive Health, P.A.

Minneapolis, Minnesota, United States, 55446

United States, North Carolina

University of North Carolina at Chapel Hill

Chapel Hill, North Carolina, United States, 27599

United States, Utah

University of Utah

Salt Lake City, Utah, United States, 84112

Sponsors and Collaborators

University of North Carolina, Chapel Hill

GlaxoSmithKline

University of Utah

Northwestern University

MNGI Digestive Health, P.A.

Investigators

• Principal Investigator: Evan S Dellon, MD, MPH; UNC Chapel Hill

More Information

• Responsible Party: University of North Carolina, Chapel Hill
• ClinicalTrials.gov Identifier: NCT03656380
• Other Study ID Numbers: 18-0431
• First Posted: September 4, 2018
• Last Update Posted: December 21, 2022
• Last Verified: December 2022

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

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

Additional relevant MeSH terms:

Esophagitis; Eosinophilic Esophagitis; Esophageal Diseases; Gastrointestinal Diseases; Digestive System Diseases; Gastroenteritis; Eosinophilia; Leukocyte Disorders; Hematologic Diseases; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases