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    Clinical Trial Results:
    A randomized, open label, parallel-group, international, multicenter study evaluating persistency of response to omalizumab during 32 weeks treatment given as add on to optimized asthma therapy in adult and adolescent patients with severe allergic asthma, who remain inadequately controlled despite GINA (2004) Step 4 therapy

    Summary
    EudraCT number
    2005-001099-11
    Trial protocol
    GB   NO   IE   ES   DK   SE   DE   HU   PT   IT   BE   GR  
    Global end of trial date
    23 Sep 2008

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Jul 2016
    First version publication date
    15 Aug 2015
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CIGE025A2425
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00264849
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Novartis Pharma AG
    Sponsor organisation address
    CH-4002, Basel, Switzerland,
    Public contact
    Clinical Disclosure Office, Novartis Pharma AG, +41 613241111,
    Scientific contact
    Clinical Disclosure Office, Novartis Pharma AG, +41 613241111,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    23 Sep 2008
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    23 Sep 2008
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective was to evaluate persistency in treatment responder classification between assessments at 16 and 32 weeks after starting omalizumab therapy given as add on to optimized asthma therapy in patients who remained uncontrolled despite GINA (2004) Step 4 therapy. Treatment response was defined by at least marked improvement of overall asthma control as assessed by physician Global Evaluation of Treatment Effectiveness.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and the International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines. All the local regulatory requirements pertinent to safety of trial subjects were also followed during the conduct of the trial. The subjects were treated with β-2 agonist (salbutamol or terbutaline) for rescue medication from symptoms of intercurrent bronchospasm or during asthma exacerbation, inhaled via any device e.g. MDI Accuhaler, Rotacaps, Turbuhaler and Ventidisks. If rescue medication was taken prior to a spirometric assessment, the investigator was notified by the subject. Home use of nebulized β-2 agonist (salbutamol 2.5-5 milligram (mg) or terbutaline 5-10 mg) was allowed for treatment. Symptomatic subjects despite nebulization contacted trial personnel immediately for further evaluation, each nebulization was recorded on subject’s diary/note book.
    Background therapy
    Subjects were receiving any of the following background therapies (Oral and/or inhaled corticosteroids (ICS),Long-acting inhaled β-2 agonists (LABA), Fixed dose combinations of ICS and LABA) at least 3 months prior to screening with doses adjusted according to best clinical practice during the 32 weeks treatment: 1. Oral and ICS: Subjects inhaled moderate to high dose of corticosteroids more than or equal to (≥)800 microgram (mcg) beclomethasone dipropionate (BDP) or equivalent prior to the 2 qualifying asthma exacerbations, required treatment with systemic corticosteroids for at least 3 months prior to screening . Doses of ICS more than (>)1000 mcg BDP or equivalent, were taken for at least the last 4 weeks of the run-in period. 2. LABA: Subjects were to have taken LABA at least 3 months prior to screening and remain on unchanged dose during the last 4 weeks of run-in. Subjects were not allowed LABA medication within 12 hours prior to visit for reversibility and spirometric assessment. 3. Fixed dose combinations of ICS and LABA: Subjects were allowed with fixed combination (budesonide/formoterol and fluticasone/salmeterol) with a dose of ICS ≥ 800 mcg BDP or equivalent. Doses of inhaled corticosteroid (ICS) more than (>)1000 mcg BDP or equivalent, were taken for at least the last 4 weeks of the run-in period. Fixed dose combination medication should have been taken after spirometry measurements. Additional medications for treatment of the patient's allergic asthma exacerbations already established prior to the final 4 weeks of the run in period were allowed in this study
    Evidence for comparator
    -
    Actual start date of recruitment
    22 Nov 2005
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Norway: 1
    Country: Number of subjects enrolled
    Spain: 39
    Country: Number of subjects enrolled
    Sweden: 8
    Country: Number of subjects enrolled
    United Kingdom: 36
    Country: Number of subjects enrolled
    Belgium: 21
    Country: Number of subjects enrolled
    Denmark: 9
    Country: Number of subjects enrolled
    Germany: 48
    Country: Number of subjects enrolled
    Hungary: 30
    Country: Number of subjects enrolled
    Italy: 99
    Country: Number of subjects enrolled
    Canada: 15
    Country: Number of subjects enrolled
    Israel: 16
    Country: Number of subjects enrolled
    Poland: 40
    Country: Number of subjects enrolled
    Switzerland: 3
    Country: Number of subjects enrolled
    Turkey: 35
    Worldwide total number of subjects
    400
    EEA total number of subjects
    331
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    5
    Adults (18-64 years)
    368
    From 65 to 84 years
    27
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted at 106 centres in 14 countries.

    Pre-assignment
    Screening details
    A total of 768 subjects were screened, out of which 406 were provided with treatment. Out of 406 treated subjects, 2 subjects treated with optimized asthma treatment (OAT) + omalizumab were non-randomised and discontinued due to administrative problems.

    Pre-assignment period milestones
    Number of subjects started
    404 [1]
    Number of subjects completed
    400

    Pre-assignment subject non-completion reasons
    Reason: Number of subjects
    Consent withdrawn by subject: 2
    Reason: Number of subjects
    Protocol deviation: 1
    Reason: Number of subjects
    lost to follow up: 1
    Notes
    [1] - The number of subjects reported to have started the pre-assignment period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: Out of 406 treated subjects, 2 subjects treated with optimized asthma treatment (OAT) + omalizumab were nonrandomised and discontinued due to administrative problems.
    Period 1
    Period 1 title
    Randomized patients (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    The study was open label, hence no blinding was performed.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Optimized Asthma Treatment (OAT) + Omalizumab
    Arm description
    Subjects received omalizaumab (150 mg; 225 mg; 300 mg or 375 mg) through subcutaneous (s.c) route for 2-4 weeks based on their body weight and immunoglobulin E (IgE) levels. Subjects with body­ weight between 90-150 kilograms (kg), received 300 mg of omalizumab for omalizumab for 4 weeks (if pre­treatment IgE level was between 30­100 international units per milliliter [IU/mL]) and for 2 weeks (if pre­treatment IgE level was between 200­300 IU/mL).
    Arm type
    Experimental

    Investigational medicinal product name
    Omalizumab
    Investigational medicinal product code
    IGE025
    Other name
    Pharmaceutical forms
    Powder for solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Omalizumab 150 mg administered s.c. after reconstitution with 1.4 ml Sterile Water for Injection. The dose administered was individualized for each subject based on the body weight.

    Arm title
    Optimized Asthma Treatment (OAT)
    Arm description
    During the 32 weeks treatment phase , subjects continued to receive OAT were evaluated and optimized according to GINA guidelines established during the run-in period of the study. The subjects were treated with moderate to high dose ICS (BDP 1000 mcg or equivalent dose), regular LABA, or fixed combination of ICS and LABA.
    Arm type
    No intervention

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Started
    272
    128
    Completed
    253
    106
    Not completed
    19
    22
         Adverse event, serious fatal
    -
    1
         Consent withdrawn by subject
    7
    9
         Adverse event, non-fatal
    7
    2
         Unsatisfactory therapeutic effect
    1
    6
         Lost to follow-up
    -
    1
         Protocol deviation
    4
    3

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Optimized Asthma Treatment (OAT) + Omalizumab
    Reporting group description
    Subjects received omalizaumab (150 mg; 225 mg; 300 mg or 375 mg) through subcutaneous (s.c) route for 2-4 weeks based on their body weight and immunoglobulin E (IgE) levels. Subjects with body­ weight between 90-150 kilograms (kg), received 300 mg of omalizumab for omalizumab for 4 weeks (if pre­treatment IgE level was between 30­100 international units per milliliter [IU/mL]) and for 2 weeks (if pre­treatment IgE level was between 200­300 IU/mL).

    Reporting group title
    Optimized Asthma Treatment (OAT)
    Reporting group description
    During the 32 weeks treatment phase , subjects continued to receive OAT were evaluated and optimized according to GINA guidelines established during the run-in period of the study. The subjects were treated with moderate to high dose ICS (BDP 1000 mcg or equivalent dose), regular LABA, or fixed combination of ICS and LABA.

    Reporting group values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT) Total
    Number of subjects
    272 128 400
    Age categorical
    Units: Subjects
        12-17 years
    5 0 5
        18-54 years
    189 92 281
        55-64 years
    61 26 87
        65-75 years
    17 10 27
    Age continuous
    Mod ITT
    Units: years
        arithmetic mean (standard deviation)
    45.6 ( 13.04 ) 45.7 ( 12.57 ) -
    Gender categorical
    Units: Subjects
        Female
    183 76 259
        Male
    89 52 141

    End points

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    End points reporting groups
    Reporting group title
    Optimized Asthma Treatment (OAT) + Omalizumab
    Reporting group description
    Subjects received omalizaumab (150 mg; 225 mg; 300 mg or 375 mg) through subcutaneous (s.c) route for 2-4 weeks based on their body weight and immunoglobulin E (IgE) levels. Subjects with body­ weight between 90-150 kilograms (kg), received 300 mg of omalizumab for omalizumab for 4 weeks (if pre­treatment IgE level was between 30­100 international units per milliliter [IU/mL]) and for 2 weeks (if pre­treatment IgE level was between 200­300 IU/mL).

    Reporting group title
    Optimized Asthma Treatment (OAT)
    Reporting group description
    During the 32 weeks treatment phase , subjects continued to receive OAT were evaluated and optimized according to GINA guidelines established during the run-in period of the study. The subjects were treated with moderate to high dose ICS (BDP 1000 mcg or equivalent dose), regular LABA, or fixed combination of ICS and LABA.

    Primary: Persistency rate of response and non-response, as based on investigator's Global Evaluation of Treatment Effectiveness

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    End point title
    Persistency rate of response and non-response, as based on investigator's Global Evaluation of Treatment Effectiveness [1]
    End point description
    Treatment response of omalizumab was assessed by investigator based on GETE, a five point scale that evaluated change in asthma control/symptoms (1: excellent for complete control of asthma, 2: good for marked improvement of asthma, 3: moderate for discernible, but limited improvement of asthma, 4: poor for no appreciable change, and 5: worsening of asthma). Responders were defined as subjects scaling excellent or good and non-responders as moderate, poor or worsening assessed at 16 weeks and 32 weeks. The primary analysis was performed in the modified intent to treat (ITT) population, defined as all randomized subjects with at least one post-baseline efficacy assessment. Here, "Number of subjects analysed" were subjects assessed for persistency of response if they were responders at Week 16 and had a second GETE obtained ≥ 4 weeks after the Week 16 assessment or discontinued prematurely for unsatisfactory therapeutic effect ≥ 4 weeks after the Week 16 assessment.
    End point type
    Primary
    End point timeframe
    Week 16, Week 32
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The statistics for this end point was planned for selected arm only.
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    187
    28
    Units: Percentage of subjects
        number (confidence interval 95%)
    91.4 (87.4 to 95.5)
    64.3 (46.5 to 82)
    No statistical analyses for this end point

    Secondary: Number of subjects by Investigator's Global Evaluation of Treatment Effectiveness (GETE) category at Week 16 and Week 32

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    End point title
    Number of subjects by Investigator's Global Evaluation of Treatment Effectiveness (GETE) category at Week 16 and Week 32
    End point description
    Responders were defined as subjects scaling excellent or good at 16 weeks and still at 32 weeks. Response for subjects were assessed by investigator based on completion of a GETE, which was a five point scale that evaluates change in asthma control/symptoms (excellent for complete control of asthma, good for marked improvement of asthma, moderate for discernible, but limited improvement of asthma, poor for no appreciable change, and worsening for asthma). The analysis was performed in the modified ITT population.
    End point type
    Secondary
    End point timeframe
    Week 16, Week 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    272
    128
    Units: Number of subjects
        Week 16: Excellent
    35
    1
        Week 16: Good
    155
    28
        Week 16: Moderate
    57
    24
        Week 16: Poor
    13
    34
        Week 16: Worsening
    1
    6
        Week 16: Missing
    11
    35
        Week 32: Excellent
    73
    1
        Week 32: Good
    126
    24
        Week 32: Moderate
    45
    31
        Week 32: Poor
    13
    39
        Week 32: Worsening
    2
    9
        Week 32: Missing
    13
    24
    No statistical analyses for this end point

    Secondary: Number of subjects by Subject's Global Evaluation of Treatment Effectiveness (GETE) category at Week 16 and Week 32

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    End point title
    Number of subjects by Subject's Global Evaluation of Treatment Effectiveness (GETE) category at Week 16 and Week 32
    End point description
    Responders were defined as subjects scaling excellent or good at 16 weeks and still at 32 weeks. Response for subjects were evaluated by subjects based on completion of a GETE, which was a five point scale that evaluates change in asthma control/symptoms (excellent for complete control of asthma, good for marked improvement of asthma, moderate for discernible, but limited improvement of asthma, poor for no appreciable change, and worsening for asthma). The analysis was performed in the modified ITT population.
    End point type
    Secondary
    End point timeframe
    Week 16, Week 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    272
    128
    Units: Number of subjects
        Week 16: Excellent
    54
    4
        Week 16: Good
    139
    29
        Week 16: Moderate
    53
    23
        Week 16: Poor
    15
    33
        Week 16: Worsening
    1
    5
        Week 16: Missing
    10
    34
        Week 32: Excellent
    80
    2
        Week 32: Good
    127
    27
        Week 32: Moderate
    38
    28
        Week 32: Poor
    12
    38
        Week 32: Worsening
    2
    8
        Week 32: Missing
    13
    25
    No statistical analyses for this end point

    Secondary: Percentage of persistent treatment non-responders based on Investigator’s Global Evaluation of Treatment Effectiveness (GETE) score at both Week 16 and Week 32

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    End point title
    Percentage of persistent treatment non-responders based on Investigator’s Global Evaluation of Treatment Effectiveness (GETE) score at both Week 16 and Week 32
    End point description
    Treatment response was assessed by investigator based on GETE, a five point scale that evaluated change in asthma control/symptoms (1: excellent for complete control of asthma, 2: good for marked improvement of asthma, 3: moderate for discernible, but limited improvement of asthma, 4: poor for no appreciable change, and 5: worsening for asthma). Non-responders were defined as moderate, poor or worsening assessed at 16 weeks and 32 weeks. The analysis was performed in the modified ITT population. Here, "Number of subjects analysed" were subjects assessed for persistency of non-response if they were non-responders at Week 16 and had second GETE obtained ≥ 4 weeks after the week 16 assessment or discontinued prematurely for unsatisfactory therapeutic effect ≥ 4 weeks after the week 16 assessment.
    End point type
    Secondary
    End point timeframe
    Week 16, Week 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    71
    63
    Units: Percentage of subjects
        number (confidence interval 95%)
    62 (50.7 to 73.3)
    90.5 (83.2 to 97.7)
    No statistical analyses for this end point

    Secondary: Percent Predicted Forced Expiratory Volume for 1 Second (FEV1)

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    End point title
    Percent Predicted Forced Expiratory Volume for 1 Second (FEV1)
    End point description
    FEV1 was defined as the amount of air which can be forcibly exhaled from the lungs in the first second of a forced exhalation, measured through spirometry testing. The subject’s predicted FEV1 value was calculated according to Crapo standards (Males: Predicted FEV1 = 0.0414*height – 0.0244*age – 2.190 and Females: Predicted FEV1 = 0.0342*height – 0.0255*age – 1.578, where height was in cm). The analysis was performed in modified ITT population. Here, 'n' signifies those subjects evaluable for this measure at specified time points for each group, respectively.
    End point type
    Secondary
    End point timeframe
    Weeks 16, Week 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    272
    128
    Units: Percent predicted FEV1
    least squares mean (confidence interval 95%)
        Week 16 (n= 258, 106)
    68.4 (66.2 to 70.5)
    64.8 (61.8 to 67.8)
        Week 32 (n= 266, 121)
    68.1 (65.8 to 70.5)
    63.7 (60.6 to 66.8)
    No statistical analyses for this end point

    Secondary: Change from baseline in Asthma Control Questionnaire (ACQ) overall score at Week 16 and Week 32

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    End point title
    Change from baseline in Asthma Control Questionnaire (ACQ) overall score at Week 16 and Week 32
    End point description
    Asthma Control Questionnaire (ACQ), has 7 questions, each with a 7 point scale (0 – good control, 6 – poor control). The average score will be calculated as the total of all 7 questions divided by 7 (or the number of questions that were answered at the time point as long as there are at least 4 questions answered). A negative change in score indicated improvement in symptoms. The analysis was performed in modified ITT population. Here 'n' signifies those subjects with valid ACQ measurements at specified time points for each group, respectively.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 16, Week 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    272
    128
    Units: Units on a scale
    least squares mean (confidence interval 95%)
        Week 16 (n= 249, 104)
    -0.78 (-0.92 to -0.63)
    -0.11 (-0.31 to 0.1)
        Week 32 (n= 238, 104)
    -0.91 (-1.07 to -0.76)
    -0.04 (-0.26 to 0.17)
    No statistical analyses for this end point

    Secondary: Percentage of subjects with clinically significant asthma exacerbations during the 32 week treatment period

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    End point title
    Percentage of subjects with clinically significant asthma exacerbations during the 32 week treatment period
    End point description
    A clinically significant asthma exacerbation was defined as a worsening of asthma requiring treatment with rescue systemic (oral or IV) corticosteroids. The initiation of the rescue systemic corticosteroids was marked as the start of asthma exacerbation and cessation of the rescue systemic corticosteroids was marked as the end. Duplicated, or overlapped by at least one day with another episode, or nested within another exacerbation episode,were considered as single exacerbation. The analysis was performed in the modified ITT population.
    End point type
    Secondary
    End point timeframe
    Day 1 up to Weeks 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    272
    128
    Units: Percentage of subjects
    number (not applicable)
        0 asthma exacerbation
    67.3
    50
        1 asthma exacerbation
    21.3
    27.3
        2 asthma exacerbation
    6.6
    13.3
        3 asthma exacerbation
    3.3
    4.7
        >= 4 asthma exacerbation
    1.5
    4.7
    No statistical analyses for this end point

    Secondary: Percentage of subjects with severe asthma exacerbations during the 32 week treatment period

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    End point title
    Percentage of subjects with severe asthma exacerbations during the 32 week treatment period
    End point description
    Subjects with clinically significant severe asthma exacerbation fulfilled any of the following criteria: required treatment with rescue systemic (oral or IV) corticosteroids, or resulted in hospitalization or required an emergency department visit, or resulted in >30% fall from personal best in peak expiratory flow for two successive days. The analysis was performed in the modified ITT population.
    End point type
    Secondary
    End point timeframe
    Day 1 up to Week 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    272
    128
    Units: Percentage of subjects
    number (not applicable)
        0 asthma exacerbations severe
    84.6
    77.3
        1 asthma exacerbations severe
    11.8
    13.3
        2 asthma exacerbations severe
    1.8
    5.5
        3 asthma exacerbations severe
    0.7
    1.6
        >= 4 asthma exacerbations severe
    1.1
    2.3
    No statistical analyses for this end point

    Secondary: Percentage of subjects with hospital admissions, emergency room visits and unscheduled clinical visits due to asthma exacerbations

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    End point title
    Percentage of subjects with hospital admissions, emergency room visits and unscheduled clinical visits due to asthma exacerbations
    End point description
    Combined total of unscheduled visits was determined for each subject as the total number of hospital admissions, emergency room visits and unscheduled outpatient clinical visits due to asthma exacerbations. Only the most serious type of asthma exacerbation was included for multiple type of visit on same day, while all visits were counted when visits occurred on different dates for single asthma exacerbation. The analysis was performed in the modified ITT population.
    End point type
    Secondary
    End point timeframe
    Day 1 up to Week 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    272
    128
    Units: Percentage of subjects
    number (not applicable)
        0 combined unscheduled visits
    83.1
    67.2
        1 combined unscheduled visits
    9.6
    9.4
        2 combined unscheduled visits
    3.7
    13.3
        3 combined unscheduled visits
    1.5
    6.3
        >= 4 combined unscheduled visits
    2.2
    3.9
    No statistical analyses for this end point

    Secondary: Percentage change from baseline in oral steroid dose at Weeks 16 and Week 32

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    End point title
    Percentage change from baseline in oral steroid dose at Weeks 16 and Week 32
    End point description
    The dose of oral steroid measured was the maintenance dose of the subjects and not the dose to treat an asthma exacerbation. A negative change from baseline indicated improvement. The analysis was performed in the modified ITT population. Here, "Number of subjects analysed" were subjects evaluable for change from baseline in oral steroid dose at week 16 and week 32, for each arm. The 'n' signifies those subjects evaluable for this measure at specified time points for each group, respectively.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 16, Week 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    59
    23
    Units: Prednisolone equivalent mg/day
    arithmetic mean (standard deviation)
        Week 16 (n= 56, 19)
    -20.1 ( 63.08 )
    36.8 ( 212.03 )
        Week 32 (n= 59, 23)
    -45 ( 50.22 )
    18.3 ( 85.13 )
    No statistical analyses for this end point

    Secondary: Percentage of subjects by type of dose change for systemic steroids at Weeks 16 and Week 32

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    End point title
    Percentage of subjects by type of dose change for systemic steroids at Weeks 16 and Week 32
    End point description
    Subjects with systemic steroids were defined as those who used systemic steroids throughout the entire treatment period (Weeks 16 and Week 32). Dose of systemic steroids was expressed in prednisolone equivalent mg/day. Removed subjects were defined as subjects who removed from systemic steroids during treatment period and not provided with dose, maintained as subjects with unchanged or increased dose and decreased as subjects with decreased dose. The analysis was performed in the modified ITT population.Here, "Number of subjects analysed" were subjects evaluable for change from baseline in oral steroid dose at week 16 and week 32, for each arm. The 'n' signifies those subjects evaluable for this measure at specified time points for each group, respectively.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 16, Week 32
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    59
    23
    Units: Percentage of subjects
    number (not applicable)
        Week 16 - Removed systemic steroids (n= 56, 19)
    17.9
    10.5
        Week 32 - Removed systemic steroids (n= 59, 23)
    32.2
    13
    No statistical analyses for this end point

    Secondary: Change from baseline in Asthma Quality of Life Questionnaire (AQLQ) overall score at Week 15 and Week 31

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    End point title
    Change from baseline in Asthma Quality of Life Questionnaire (AQLQ) overall score at Week 15 and Week 31
    End point description
    Asthma Quality of Life Questionnaire (AQLQ) was 32 item questionnaire defined in 4 domains (symptoms, activity limitation, emotional function and environmental exposure). Each question was answered on a 7 point scale (1–totally limited/problems all the time to 7–not at all limited/no problems). The overall AQLQ score was the mean of all 32 responses (a minimum domain / overall score of 1 = Severely impaired whereas a maximum domain / overall score of 7 = not impaired at all). A positive change from baseline score indicated improvement. The analysis was performed in the modified ITT population. The 'n' signifies those subjects evaluable for this measure at specified time points for each group, respectively.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 15, Week 31
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    272
    128
    Units: Units on a scale
    least squares mean (confidence interval 95%)
        Overall Score: Week 15 (n= 214, 92)
    0.9 (0.73 to 1.07)
    0.03 (-0.2 to 0.27)
        Overall Score: Week 31 (n= 224, 97)
    1.06 (0.88 to 1.24)
    -0.07 (-0.31 to 0.17)
    No statistical analyses for this end point

    Secondary: Change from baseline in EuroQual 5-Dimension health status questionnaire (EQ-5D) utility index and health state assessment at Week 15 and Week 31

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    End point title
    Change from baseline in EuroQual 5-Dimension health status questionnaire (EQ-5D) utility index and health state assessment at Week 15 and Week 31
    End point description
    The utility-based EQ-5D questionnaire was in two parts and provides a generic measure of health for clinical and economic appraisal. The health state classification part contains 5 questions each with 3 categories (no problem, moderate problem, severe problems). The visual analogue scale was measured from 0 (worst imaginable health state) to 100 (best imaginable health state). A positive change from baseline score indicated improvement.The analysis was performed in the modified ITT population. Here 'n' signifies those subjects evaluable for this measure at specified time points for each group, respectively.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 15, Week 31
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    272
    128
    Units: Units on a scale
    least squares mean (confidence interval 95%)
        EQ-5D Utility Index Score: Week 15 (n= 212 ,90)
    0.071 (0.038 to 0.105)
    0.002 (-0.044 to 0.049)
        EQ-5D Utility Index Score: Week 31 (n= 194, 81)
    0.091 (0.051 to 0.132)
    0.064 (0.008 to 0.121)
        Health State Assessment: Week 15 (n= 211, 89)
    8.2 (4.7 to 11.8)
    -0.4 (-5.4 to 4.6)
        Health State Assessment: Week 31 (n= 194, 80)
    9.3 (5.2 to 13.4)
    -2.8 (-8.5 to 3)
    No statistical analyses for this end point

    Secondary: Change from baseline in percent overall Work Impairment due to asthma symptoms at Week 31

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    End point title
    Change from baseline in percent overall Work Impairment due to asthma symptoms at Week 31
    End point description
    Work Productivity and Activity Impairment-Allergic Asthma (WPAI-AA) questionnaire, covered 6 questions relating to hours missed from work and work productivity in the previous 7 days. Overall work impairment due to asthma problems was derived from the proportion of hours missed from work due to asthma and the degree to which asthma problems affected productivity while working. A negative change indicated improvement. The analysis was performed in the modified ITT population. Here, "Number of subjects analysed" were subjects evaluable for this measure at specified time points for each group, respectively.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 31
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    79
    34
    Units: Percent impairment
        arithmetic mean (standard deviation)
    -21.4 ( 26.79 )
    0 ( 29.89 )
    No statistical analyses for this end point

    Secondary: Change from baseline in percent Activity Impairment due to asthma symptoms at Week 31

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    End point title
    Change from baseline in percent Activity Impairment due to asthma symptoms at Week 31
    End point description
    Work Productivity and Activity Impairment-Allergic Asthma (WPAI-AA) questionnaire, covered 6 questions relating to hours missed from work and work productivity in the previous 7 days. Activity impairment due to asthma problems was derived from the subjects assessment of the degree to which asthma problems affected regular activities. A negative change indicated improvement. The analysis was performed in the modified ITT population. Here, "Number of subjects analysed" were subjects evaluable for this measure at specified time points for each group, respectively.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 31
    End point values
    Optimized Asthma Treatment (OAT) + Omalizumab Optimized Asthma Treatment (OAT)
    Number of subjects analysed
    193
    80
    Units: Percent impairment
        arithmetic mean (standard deviation)
    -17.2 ( 24.36 )
    -0.1 ( 24.05 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events are collected from First Patient First Visit (FPFV) until Last Patient Last Visit (LPLV).  All Adverse events are reported in this record from First Patient First Treatment until Last Patient Last Visit.
    Adverse event reporting additional description
    Consistent with EudraCT disclosure specifications, Novartis has reported under the Serious adverse events field “number of deaths resulting from adverse events” all those deaths, resulting from serious adverse events that are deemed to be causally related to treatment by the investigator.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    11.1
    Reporting groups
    Reporting group title
    Optimized Asthma Treatment
    Reporting group description
    Optimized Asthma Treatment

    Reporting group title
    Optimized Asthma Treatment + Omalizumab
    Reporting group description
    Optimized Asthma Treatment + Omalizumab

    Serious adverse events
    Optimized Asthma Treatment Optimized Asthma Treatment + Omalizumab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    17 / 128 (13.28%)
    29 / 274 (10.58%)
         number of deaths (all causes)
    1
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Breast neoplasm
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Fibroadenoma of breast
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Haematoma
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    Intra-uterine death
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pregnancy
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Polyp
         subjects affected / exposed
    1 / 128 (0.78%)
    0 / 274 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Oedema peripheral
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    Drug hypersensitivity
         subjects affected / exposed
    1 / 128 (0.78%)
    0 / 274 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    14 / 128 (10.94%)
    15 / 274 (5.47%)
         occurrences causally related to treatment / all
    0 / 14
    0 / 15
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pleuritic pain
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Status asthmaticus
         subjects affected / exposed
    1 / 128 (0.78%)
    0 / 274 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Psychiatric disorders
    Depression
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Chest injury
         subjects affected / exposed
    0 / 128 (0.00%)
    2 / 274 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Contusion
         subjects affected / exposed
    0 / 128 (0.00%)
    2 / 274 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Fractured coccyx
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Facial bones fracture
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Road traffic accident
         subjects affected / exposed
    0 / 128 (0.00%)
    3 / 274 (1.09%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Upper limb fracture
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac arrest
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Headache
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Melaena
         subjects affected / exposed
    1 / 128 (0.78%)
    0 / 274 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Angioedema
         subjects affected / exposed
    1 / 128 (0.78%)
    0 / 274 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urticaria
         subjects affected / exposed
    1 / 128 (0.78%)
    0 / 274 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal failure acute
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Endocrine disorders
    Goitre
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyperparathyroidism
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    1 / 128 (0.78%)
    0 / 274 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Foot deformity
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intervertebral disc protrusion
         subjects affected / exposed
    1 / 128 (0.78%)
    0 / 274 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    2 / 128 (1.56%)
    0 / 274 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 128 (0.78%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Orchitis
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory tract infection viral
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urosepsis
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    0 / 128 (0.00%)
    1 / 274 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Optimized Asthma Treatment Optimized Asthma Treatment + Omalizumab
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    66 / 128 (51.56%)
    151 / 274 (55.11%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    9 / 128 (7.03%)
    33 / 274 (12.04%)
         occurrences all number
    26
    92
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    51 / 128 (39.84%)
    82 / 274 (29.93%)
         occurrences all number
    52
    85
    Cough
         subjects affected / exposed
    4 / 128 (3.13%)
    14 / 274 (5.11%)
         occurrences all number
    6
    19
    Oropharyngeal pain
         subjects affected / exposed
    1 / 128 (0.78%)
    14 / 274 (5.11%)
         occurrences all number
    1
    15
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 128 (0.00%)
    14 / 274 (5.11%)
         occurrences all number
    0
    19
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    7 / 128 (5.47%)
    13 / 274 (4.74%)
         occurrences all number
    10
    14
    Influenza
         subjects affected / exposed
    4 / 128 (3.13%)
    18 / 274 (6.57%)
         occurrences all number
    4
    22
    Nasopharyngitis
         subjects affected / exposed
    9 / 128 (7.03%)
    38 / 274 (13.87%)
         occurrences all number
    14
    52
    Lower respiratory tract infection
         subjects affected / exposed
    8 / 128 (6.25%)
    16 / 274 (5.84%)
         occurrences all number
    14
    20
    Upper respiratory tract infection
         subjects affected / exposed
    6 / 128 (4.69%)
    17 / 274 (6.20%)
         occurrences all number
    7
    20
    Sinusitis
         subjects affected / exposed
    7 / 128 (5.47%)
    10 / 274 (3.65%)
         occurrences all number
    12
    18

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    23 Jun 2006
    • The secondary objective to further evaluate the best individual or combination of clinical measures for evaluating treatment response to omalizumab treatment was introduced • The dose of omalizumab to be given every 4-weeks for a body weight >30-40 and baseline IgE >200-300 international units per millilitre(IU/ml) to 225 mg, was introduced to be consistent with the approved dosing schedule • Total IgE measurement at randomisation visit was added

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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