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    Clinical Trial Results:
    Multicenter double- blinded, placebo- controlled randomized cross-over (2x2) trial, to assess efficacy and safety of a new indication for Omalizumab (Xolair®, Novartis) in autoimmune and no autoimmune chronic urticaria.

    Summary
    EudraCT number
    2010-024113-31
    Trial protocol
    ES  
    Global end of trial date
    13 May 2014

    Results information
    Results version number
    v1(current)
    This version publication date
    19 Sep 2021
    First version publication date
    19 Sep 2021
    Other versions
    Summary report(s)
    FINAL REPORT (SPANISH)

    Trial information

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    Trial identification
    Sponsor protocol code
    CUN-OMAL-CU-2010
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01713725
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Clínica Universidad de Navarra
    Sponsor organisation address
    Avda. Pío XII, 36, Pamplona, Spain, 31008
    Public contact
    UCICEC, Clínica Universidad de Navarra, 34 948 255 400, ucicec@unav.es
    Scientific contact
    UCICEC, Clínica Universidad de Navara, 34 948 255 400, ucicec@unav.es
    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?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    01 Mar 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    13 May 2014
    Global end of trial reached?
    Yes
    Global end of trial date
    13 May 2014
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    1.To evaluate the efficacy of omalizumab in a new indication: patients with chronic urticaria. 2.To evaluate the safety of omalizumab in a new indication: patients with chronic urticaria. 3.To evaluate whether the efficacy and safety of omalizumab is different in patients with autoimmune and non-autoimmune chronic urticaria.
    Protection of trial subjects
    NA
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    17 Apr 2012
    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
    Spain: 20
    Worldwide total number of subjects
    20
    EEA total number of subjects
    20
    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)
    0
    Adults (18-64 years)
    20
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Patients with autoimmune and non-autoimmune chronic urticaria who do not respond to approved doses of antihistamines will be included. These patients will be invited to participate in the allergology departments of the participating hospitals.

    Pre-assignment
    Screening details
    Adult patients of both sexes, with UAS 7 Severity Scale greater than or equal to 28.

    Period 1
    Period 1 title
    Treatment period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    No

    Arm title
    Arm A (treatment group)
    Arm description
    This is a crossover design in which there are two groups of patients. Group I patients start in arm A, administered 5 doses of Omalizumab, and after a 4-week washout period, move to arm B, where they are administered 5 doses of placebo. Group II patients start in arm B (5 doses of placebo) and after a 4-week washout period move to arm A (5 doses of Omalizumab).
    Arm type
    Experimental

    Investigational medicinal product name
    Omalizumab
    Investigational medicinal product code
    R03DX05
    Other name
    Pharmaceutical forms
    Solution for injection in pre-filled injector
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    It is administered subcutaneously in the deltoid region of the arm. The dose is 300mg. It is administered as two subcutaneous injections of 150mg in 1ml each. A total of 5 doses are administered. The first two doses are administered every 2 weeks and the next 3 doses every 4 weeks. This is followed by a 4-week washout period.

    Arm title
    Arm B (placebo group)
    Arm description
    This is a crossover design in which there are two groups of patients. Group I patients start in arm A, administered 5 doses of Omalizumab, and after a 4-week washout period, move to arm B, where they are administered 5 doses of placebo. Group II patients start in arm B (5 doses of placebo) and after a 4-week washout period move to arm A (5 doses of Omalizumab).
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection in pre-filled injector
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    2ml of Physiological Saline is administered as two injections of 1ml each, subcutaneously in the deoltoid region of the upper arm. The volume to be administered is the same as that of the active treatment. A total of 5 doses are administered. The first two doses are administered every 2 weeks and the next 3 doses every 4 weeks.

    Number of subjects in period 1
    Arm A (treatment group) Arm B (placebo group)
    Started
    10
    10
    Completed
    7
    10
    Not completed
    3
    0
         Protocol deviation
    3
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Treatment period
    Reporting group description
    -

    Reporting group values
    Treatment period Total
    Number of subjects
    20 20
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    20 20
    Gender categorical
    Units: Subjects
        Female
    10 10
        Male
    10 10

    End points

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    End points reporting groups
    Reporting group title
    Arm A (treatment group)
    Reporting group description
    This is a crossover design in which there are two groups of patients. Group I patients start in arm A, administered 5 doses of Omalizumab, and after a 4-week washout period, move to arm B, where they are administered 5 doses of placebo. Group II patients start in arm B (5 doses of placebo) and after a 4-week washout period move to arm A (5 doses of Omalizumab).

    Reporting group title
    Arm B (placebo group)
    Reporting group description
    This is a crossover design in which there are two groups of patients. Group I patients start in arm A, administered 5 doses of Omalizumab, and after a 4-week washout period, move to arm B, where they are administered 5 doses of placebo. Group II patients start in arm B (5 doses of placebo) and after a 4-week washout period move to arm A (5 doses of Omalizumab).

    Primary: Efficacy of Omalizumab

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    End point title
    Efficacy of Omalizumab
    End point description
    Effectiveness is evaluated by the difference between basal mean values of Urticaria Activity Score scale (UAS), life questionary CU-Q2oL and Visual Activity Scale (VAS) and post-treatment and post-placebo mean values of these three scales. The basal values in UAS scale are 3(2;6) and the basal values in VAS scale are 60 (25;75), values expressed as a median (25 percentile; 75 percentile). On the UAS scale, a statistically significant difference is found when comparing baseline to post-treatment values. No significant difference is found when comparing baseline to post-placebo values. The same is observed when comparing the values of the CU-Q2oL scale and VAS scale. There are no statistically significant differences between patients with an autoimmune mechanism and those without.
    End point type
    Primary
    End point timeframe
    Effectiveness is assessed in each study visit.
    End point values
    Arm A (treatment group) Arm B (placebo group)
    Number of subjects analysed
    7
    10
    Units: NA
    median (inter-quartile range (Q1-Q3))
        Urticaria Activity Score scale (UAS)
    0 (0 to 2)
    2 (0 to 3)
        Visual Activity Scale (VAS)
    10 (1 to 29)
    27 (4 to 60)
    Statistical analysis title
    Comparison of means
    Comparison groups
    Arm A (treatment group) v Arm B (placebo group)
    Number of subjects included in analysis
    17
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    ≤ 0.05
    Method
    t-test, 2-sided
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Serious unexpected adverse reactions are reported within 15 days of knowledge of the reaction or within 7 days if death or life threatening has occurred. Patient who develops an adverse event will be followed until resolution.
    Adverse event reporting additional description
    None of the patients included had AEs and 12 of them had 139 AEs, of which 77% were of mild intensity and the rest of moderate intensity. Of the 139 AEs, 8 of them (5.8%) showed a possible relationship with the drug administered, 1 (0.7%) showed a probable relationship, 10 (7.2%) showed a remote relationship and 93 (66.9%) had no relationship.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTM
    Dictionary version
    NA
    Reporting groups
    Reporting group title
    All the patients
    Reporting group description
    Adverse effects are assessed and monitored for all trial participants.

    Serious adverse events
    All the patients
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 20 (0.00%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    All the patients
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    12 / 20 (60.00%)
    Nervous system disorders
    vasovagal syncope
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    General disorders and administration site conditions
    Headache
         subjects affected / exposed
    2 / 20 (10.00%)
         occurrences all number
    13
    aphonia
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    fever
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Ear and labyrinth disorders
    ear infection
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Eye disorders
    Rhinoconjunctivitis
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    2
    Eye oedema
         subjects affected / exposed
    2 / 20 (10.00%)
         occurrences all number
    10
    eye angioedema
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    5
    Social circumstances
    bad night´s rest
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Gastrointestinal disorders
    diarrhea
         subjects affected / exposed
    2 / 20 (10.00%)
         occurrences all number
    1
    Nausea
         subjects affected / exposed
    2 / 20 (10.00%)
         occurrences all number
    4
    Respiratory, thoracic and mediastinal disorders
    Rhinitis
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    8
    Rhinorrea
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    2
    dyspnea with wheezing
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Asthma
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    6
    breathlessness
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    11
    cold
         subjects affected / exposed
    3 / 20 (15.00%)
         occurrences all number
    5
    Skin and subcutaneous tissue disorders
    nasal pruritus
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    tonge angioedema
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Lip oedema
         subjects affected / exposed
    4 / 20 (20.00%)
         occurrences all number
    11
    lip angioedema
         subjects affected / exposed
    2 / 20 (10.00%)
         occurrences all number
    3
    facial oedema
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    3
    tongue sores
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Skin hyperpigmentation
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Dermatitis
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    odontalgia
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Psychiatric disorders
    Anxiety disorder
         subjects affected / exposed
    2 / 20 (10.00%)
         occurrences all number
    2
    Musculoskeletal and connective tissue disorders
    cervical pain
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    7
    Costodorsal pain
         subjects affected / exposed
    2 / 20 (10.00%)
         occurrences all number
    2
    Muscular pain
         subjects affected / exposed
    3 / 20 (15.00%)
         occurrences all number
    4
    artritis
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Arthritis
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1
    Fatigue
         subjects affected / exposed
    2 / 20 (10.00%)
         occurrences all number
    8
    Asthenia
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    12
    Infections and infestations
    amygdalitis
         subjects affected / exposed
    1 / 20 (5.00%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    26 Sep 2011
    Change from single-blinded design with blinded evaluator to double-blinded.
    02 Mar 2012
    Add two more blood draws, one after each period.
    20 Jun 2012
    Change of promoter Addition of an inclusion criterion Changes to clarify procedures Change in permitted medication Changes in the calendar Correction of errors
    26 Jul 2013
    Decrease in n Sample donation Biobank

    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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