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A Phase 3 Study to Evaluate the Efficacy and Safety of Benralizumab in Patients With Hypereosinophilic Syndrome (HES) (NATRON)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT04191304
Recruitment Status : Not yet recruiting
First Posted : December 9, 2019
Last Update Posted : December 9, 2019
Information provided by (Responsible Party):

Brief Summary:
This is a multicentre, randomised, double-blind (DB), parallel-group, placebo-controlled, 24-week Phase 3 study to compare the efficacy and safety of benralizumab versus placebo administered by SC injection Q4W in patients with hypereosinophilic syndrome (HES). This study comprises 2 distinct periods (together defined as the 'main study'): A 24-week, DB treatment period, during which patients will be randomised to receive either benralizumab or placebo, in addition to prior stable HES background therapy, and an open-label (OLE) treatment period, during which all patients will receive benralizumab. The primary database lock (DBL) will occur when at least 47 patients have had their first HES worsening/flare event and all randomised patients have been followed up for the 24-week DB treatment period. The target patient population is male and female patients 12 years of age and older with symptomatic active HES. Approximately 120 eligible patients will be randomised at a 1:1 ratio to receive either benralizumab or matching placebo.

Condition or disease Intervention/treatment Phase
Hypereosinophilic Syndrome Biological: Benralizumab Biological: Placebo Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 120 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description:

All eligible patients will be centrally randomly assigned in a 1:1 ratio to receive either benralizumab or placebo. Randomisation will be done using an IWRS/IVRS.

Benralizumab and placebo will not be visually distinct from each other. All packaging and labelling of the IP will be done in such a way as to ensure blinding for all Sponsor and investigational site staff. Neither the patient nor any of the Investigators or Sponsor staff who are involved in the treatment, clinical evaluation, and monitoring of the patients will be aware of the treatment received. Since benralizumab and placebo are not visually distinct, IP will be handled by an appropriately qualified member of the study team (e.g., pharmacist, Investigator, or designee) at the site.

Primary Purpose: Treatment
Official Title: A Multicentre, Randomised, Double-blind, Parallel-group, Placebo-controlled, 24-week Phase 3 Study With an Open-label Extension to Evaluate the Efficacy and Safety of Benralizumab in Patients With Hypereosinophilic Syndrome (HES)
Estimated Study Start Date : January 6, 2020
Estimated Primary Completion Date : June 26, 2022
Estimated Study Completion Date : July 23, 2023

Arm Intervention/treatment
Experimental: Benralizumab arm
1x Benralizumab SC injection
Biological: Benralizumab
Benralizumab solution for injection in an accessorised prefilled syringe (APFS) will be administered subcutaneously (SC) every 4 weeks

Placebo Comparator: Placebo arm
1x Benralizumab matching placebo SC injection
Biological: Placebo
Matching placebo solution for injection in an APFS will be administered SC every 4 weeks

Primary Outcome Measures :
  1. Time to first HES worsening/flare [ Time Frame: Up to 24 weeks ]
    An HES worsening or flare is defined as HES clinical manifestations or lab abnormalities that result in an increase/burst of OCS ≥10 mg/day for at least 2 days, OR in increase or addition of new cytotoxic and/or immunosuppressive therapy, OR hospitalisation

Secondary Outcome Measures :
  1. Time to first haematologic relapse [ Time Frame: Up to 24 weeks ]
    A haematologic relapse is defined as AEC ≥1000 cells/μL

  2. Proportion of patients who experience HES worsening/flare [ Time Frame: Up to 24 weeks ]
  3. Proportion of patients who have haematologic relapse [ Time Frame: Up to 24 weeks ]
  4. Proportion of patients who have AEC<500 cells/µL for 24 weeks [ Time Frame: Up to 24 weeks ]
  5. Proportion of patients who require an increase in corticosteroid dose [ Time Frame: Up to 24 weeks ]
  6. Change from baseline in fatigue [ Time Frame: Up to 24 weeks ]
    The PROMIS Fatigue Short Form 7a will be used which contains 7 questions assessing a range of patient-reported symptoms, from mild subjective feelings of tiredness to an overwhelming, debilitating, and sustained sense of exhaustion that likely decreases one's ability to execute daily activities and function normally in family or social roles

  7. Change from baseline in HRQoL [ Time Frame: Up to 24 weeks ]
    Derived from the SF-36v2 questionnaires which contains 36 questions measuring patients' general functional health and well-being, both physically and mentally

  8. PGIS [ Time Frame: Up to 24 weeks ]
    The PGIS is a single question evaluating patients' perception of overall symptom severity

  9. PGIC [ Time Frame: Up to 24 weeks ]
    The PGIC is a single question evaluating whether there has been an improvement or decline in patients' overall health status after start of treatment.

  10. Serum benralizumab concentration as a measure of pharmacokinetics [ Time Frame: Up to 24 weeks ]
  11. Anti-drug antibodies (ADA) titers and neutralizing antibodies (nAb) testing for all ADA-positive samples as measure of immunogenicity [ Time Frame: Up to 24 weeks ]
  12. Percentage of participants with Adverse Events (AEs) and Serious Adverse Events (SAEs) [ Time Frame: Up to 24 weeks ]
  13. Change from baseline in systolic and diastolic blood pressure [ Time Frame: Up to 24 weeks ]
  14. Change from baseline in pulse rate [ Time Frame: Up to 24 weeks ]
  15. Change from baseline in respiratory rate [ Time Frame: Up to 24 weeks ]
  16. Change from baseline in hematology parameters of hemoglobin, leukocytes, lymphocytes, monocytes, basophils, eosinophils, neutrophils, and platelets [ Time Frame: Up to 24 weeks ]
  17. Change from baseline in clinical chemistry parameters of Alanine Aminotransferase (ALT), alkaline phosphatase, Aspartate Aminotransferase (AST), creatinine kinase, direct, indirect and total bilirubin, uric acid, albumin, creatinine and glucose [ Time Frame: Up to 24 weeks ]

Information from the National Library of Medicine

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, Learn About Clinical Studies.

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Ages Eligible for Study:   12 Years to 130 Years   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria

  1. Provision of the signed and dated written informed consent of the patient or the patient's legally authorised representative, and informed assent from the patient (per local regulations) prior to any mandatory study-specific procedures, sampling, and analyses.
  2. Males and females 12 years of age and older at the time of signing the ICF.
  3. Documented diagnosis of HES (history of persistent eosinophilia >1500 cells/μL without secondary cause on 2 examinations [interval ≥1 month; Valent et al 2012] and evidence of end organ manifestations attributable to the eosinophilia).
  4. Documented negative testing for the FIP1L1-PDGFRA fusion tyrosine kinase gene translocation.
  5. Stable HES treatment dose(s) and regimen for ≥4 weeks at the time of Visit 1
  6. Signs or symptoms of HES worsening/flare and/or laboratory abnormalities indicative of HES worsening/flare (other than isolated eosinophilia) at Visit 1.
  7. AEC ≥1000 cells/μL at Visit 1 (assessed by local laboratory).
  8. Corticosteroid responsiveness defined as an AEC <1000 cells/μL after a 2-day course of OCS 1 mg/kg/day at Visit 2 (assessed by local laboratory).
  9. Women of childbearing potential (WOCBP) must agree to use a highly effective method of birth control (confirmed by the Investigator) from enrolment, throughout the study duration, and within 16 weeks (5 half-lives) after last dose of IP and have a negative urine dipstick pregnancy test result on Visit 1

Exclusion Criteria

  1. Life-threatening HES and/or HES complication(s) as judged by the Investigator:

    1. Medical intervention for HES-related life-threatening event(s) within 12 weeks prior to randomisation OR
    2. History of thrombotic complications, stroke, or significant cardiac damage related to HES, OR
    3. Disease severity that, in the opinion of the Investigator, makes the patient inappropriate for inclusion in the study.
  2. Presence of FIP1L1-PDGFRA fusion tyrosine kinase gene translocation or other known imatinib-sensitive mutation.
  3. Clinical diagnosis of eosinophilic granulomatosis with polyangiitis.
  4. Known, pre-existing, clinically significant endocrine, autoimmune, metabolic, neurological, renal, gastrointestinal, hepatic, haematological, respiratory, or any other system abnormalities that are not associated with HES and are uncontrolled with standard treatment which, in the opinion of the Investigator, may put the patient at risk because of his/her participation in the study, or may influence the results of the study, or the patient's ability to complete the entire duration of the study.
  5. Hypereosinophilia of unknown significance.
  6. Cardiovascular: Documented history of any clinically significant cardiac damage prior to Visit 1 that, in the opinion of the Investigator, would impact the patient's participation during the study and/or clinically significant echocardiography findings within 12 months prior to Visit 1, if available
  7. Known currently active liver disease.

    1. Chronic stable hepatitis B and C (including positive testing for hepatitis B surface antigen or hepatitis C antibody) or other stable chronic liver disease are acceptable if patient otherwise meets eligibility criteria. Stable chronic liver disease should generally be defined by the absence of ascites, encephalopathy, coagulopathy, hypoalbuminemia, oesophageal or gastric varices, or persistent jaundice, or cirrhosis.
    2. Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level ≥3× the upper limit of normal (ULN) during the screening period (AST or ALT >5×ULN if documented HES with liver manifestations). Transient increase of AST/ALT level that resolves by the time of randomisation is acceptable if, in the Investigator's opinion, the patient does not have an active liver disease and meets other eligibility criteria.
  8. Current malignancy, or history of malignancy, except:

    1. Patients who have had basal cell carcinoma, localised squamous cell carcinoma of the skin, or in situ carcinoma of the cervix are eligible provided the patient is in remission and curative therapy was completed at least 12 months prior to the date that informed consent, and assent when applicable, was obtained.
    2. Patients who have had other malignancies are eligible provided the patient is in remission and curative therapy was completed at least 5 years prior to the date informed consent, and assent when applicable, was obtained.
  9. Diagnosis of systemic mastocytosis.
  10. Chronic or ongoing active infections requiring systemic treatment, as well as clinically significant viral, bacterial, or fungal infection within 4 weeks prior to Visit 1.

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 identifier (NCT number): NCT04191304

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Contact: AstraZeneca Clinical Study Information Center 1-877-240-9479

Sponsors and Collaborators
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Responsible Party: AstraZeneca Identifier: NCT04191304    
Other Study ID Numbers: D3254C00001
2019-002039-27 ( EudraCT Number )
First Posted: December 9, 2019    Key Record Dates
Last Update Posted: December 9, 2019
Last Verified: December 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by AstraZeneca:
Hypereosinophilic Syndrome (HES)
Additional relevant MeSH terms:
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Hypereosinophilic Syndrome
Pathologic Processes
Leukocyte Disorders
Hematologic Diseases
Anti-Asthmatic Agents
Respiratory System Agents