E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Body processes [G] - Circulatory and Respiratory Physiological Phenomena [G09] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 15.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10003553 |
E.1.2 | Term | Asthma |
E.1.2 | System Organ Class | 10038738 - Respiratory, thoracic and mediastinal disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate two SC treatment regimens of 300 mg tralokinumab compared with placebo by assessing the effect on asthma exacerbation rate over 52 weeks in adults with uncontrolled, severe asthma requiring high-dose ICS and LABA with or without additional asthma controller medications. |
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E.2.2 | Secondary objectives of the trial |
1) To evaluate the safety and tolerability of tralokinumab.
2) To evaluate the effect of tralokinumab on pulmonary function: clinic spirometry,
including pre- and post-bronchodilator FEV1, forced expiratory volume in 6 seconds
(FEV6), FVC, inspiratory capacity (IC); and PEF and FEV1 measured at home.
3) To evaluate the effect of tralokinumab on Patient Reported Outcomes: Asthma
Control Questionnaire (6-item version; ACQ-6) score, HRQoL using Asthma Quality
of Life Questionnaire Standardised Version (AQLQ[S]), and EQ-5D.
4) To evaluate the effect of tralokinumab on asthma symptoms using the Assessing
Symptoms of Moderate-to-severe Asthma (ASMA) diary and use of rescue
medication.
5) To describe the pharmacokinetics (PK) and immunogenicity of tralokinumab. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1) Age 18-75 years of age at the time of screening (Visit 1).
2) Written informed consent
3) Body mass index (BMI) between 16-40 kg/m2 at Visit 1.
4) Documented physician-diagnosed asthma for at least 12 months prior to Visit 1 and
EITHER
- Proof of postbronchodilator reversibility of FEV1 ≥ 12% and ≥ 200 mL to a SABA documented within 36 months prior to Visit 1; OR
- Proof of a positive response to a methacholine (PC20 ≤ 8 mg/mL), histamine or mannitol challenge documented within 36 months prior to Visit 1; OR
- A postbronchodilator increase in FEV1 ≥ 12% and ≥ 200 mL at Visit 1.
5) Subjects must have received an asthma controller regimen consistent with that described at Step 4 or 5 of the GINA guidelines (GINA, 2009) for at least 6 of the 12 months prior to Visit 1 and must have used physician prescribed high-dose ICS in combination with LABA for at least 30 days prior to Visit 1
6) For subjects receiving an alternative combination of ICS/LABA prior to Visit 1, a willingness to switch to fluticasone/salmeterol either as a DPI at a dose of 500/50 μg, one inhalation twice per day, or as an MDI 250 μg/25 μg (delivered dose 220 μg/21 μg), 2 inhalations twice per day, once eligibility has been confirmed at Visit 2.
7) Where applicable, the dose of other asthma controller medications (leukotriene modifiers, theophylline, secondary ICS, OCS, or cromones) must have been stable for at least 30 days prior to Visit 1.
8) Subjects must have a history of at least 2 but no more than 6 documented asthma exacerbation events within the 12 months prior to Visit 1.
9) At both Visits 1 and 4, subjects must have at least one of the following; a morning prebronchodilator FEV1 value of between 40% and 80% predicted or an ACQ-6 score for the preceding week of ≥ 1.5.
10) A chest x-ray taken during the screening period or within the 12 months before Visit 1 that, according to the investigator, is normal for an asthmatic subject and excludes significant alternative respiratory disease.
11) Females of childbearing potential who are sexually active with a nonsterilized male partner must use highly effective contraception from screening, and must agree to continue using such precautions through Week 75 of the study.
- A highly effective method of contraception is defined as one that results in a low failure rate (ie, less than 1% per year) when used consistently and correctly.
12) Nonsterilized males or sterilized males who are ≤ 1 year post-vasectomy who are sexually active with a female partner of childbearing potential must use a highly effective method of contraception (see Table 4.2.1-1) from Day 1 through Week 75. |
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E.4 | Principal exclusion criteria |
1) Employee of the clinical study site or any other individuals directly involved with the conduct of the study, or immediate family members of such individuals.
2) Pregnant or breastfeeding women.
3) Individuals who are legally institutionalized.
4) Subjects unable to demonstrate acceptable inhaler and peak flow meter/spirometry techniques as judged by the investigator.
5) Any concomitant respiratory disease that in the opinion of the investigator and/or medical monitor will interfere with the evaluation of the investigational product.
6) Concurrent enrollment in another clinical study where the subject is receiving an investigational product.
7) Previous receipt of tralokinumab.
8) Receipt of any marketed or investigational biologic agent within 4 months or 5 half-lives prior to Visit 1, whichever is longer
9) Receipt of any investigational nonbiologic agent within 3 months or 5 half-lives prior to Visit 1, whichever is longer
10) Subjects who have received a live attenuated vaccine within 4 weeks prior to Visit 1.
11) Use of systemic immunosuppressive medication within 3 months prior to Visit 1.
12) Current use of any excluded medications listed in Section 4.6.2 of protocol.
13) Occurrence of an asthma exacerbation event requiring a burst of systemic corticosteroids from 30 days prior to Visit 1, up to and including Visit 4.
14) Known history of allergy or reaction to any component of the investigational product formulation or history of anaphylaxis following any biologic therapy.
15) Known exposure to inhaled occupational agents or fumes with an established diagnosis of occupational asthma.
16) Current tobacco smoking (smoking must have stopped for ≥ 3 months prior to screening) or a history of tobacco smoking ≥ 10 pack-years.
17) Previous medical history or evidence of an uncontrolled intercurrent illness that in the opinion of the investigator and/or medical monitor may compromise the safety of the subject in the study or interfere with evaluation of the investigational product or reduce the subject’s ability to participate in the study.
18) Any clinically relevant abnormal findings in physical examination, electrocardiogram (ECG), vital signs, hematology, clinical chemistry, or urinalysis during screening/runin period, which in the opinion of the investigator or medical monitor may compromise the safety of the subject in the study or interfere with evaluation of the investigational product or reduce the subject’s ability to participate in the study.
19) Evidence of active liver disease, including jaundice or aspartate transaminase, alanine transaminase, or alkaline phosphatase greater than twice the upper limit of normal.
20) History of a clinically significant infection from 30 days prior to Visit 1, up to and including Visit 4.
21) Subjects who in the opinion of the investigator have evidence of active TB, either treated or untreated, or latent TB without completion of an appropriate course of treatment or appropriate ongoing prophylactic treatment.
22) A history of an untreated systemic helminth parasitic infestation; diagnosis of a helminth parasitic infestation within 6 months prior to Visit 1; history of living with a person known to have had a helminth parasitic infestation within 12 months prior to Visit 1.
23) History of chronic alcohol or drug abuse within 12 months of Visit 1, or any condition associated with poor compliance as judged by the investigator.
24) History of any known primary immunodeficiency disorder excluding asymptomatic selective immunoglobulin A or immunoglobulin G (IgG) subclass deficiency.
25) History of cancer, except for basal cell carcinoma or in situ carcinoma of the cervix treated with apparent success with curative therapy ≥ 12 months prior to screening or other malignancies treated with apparent success with curative therapy ≥ 5 years prior to screening.
26) Positive hepatitis B surface antigen or hepatitis C virus antibody serology. Subjects with a history of hepatitis B vaccination without history of hepatitis B are allowed to enrol.
27) A positive human immunodeficiency virus (HIV) test at screening or subject taking antiretroviral medications, as determined by medical history and/or subject’s verbal report.
28) Major surgery within 8 weeks prior to Visit 1, or planned in-patient surgery or hospitalisation during the study period. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary objective of this study is to evaluate the effect of two SC treatment regimens of
300 mg tralokinumab compared with placebo by assessing the asthma exacerbation rate over
52 weeks in adults with uncontrolled, severe asthma requiring high-dose ICS and LABA with
or without additional controller medications. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
1) To evaluate the safety and tolerability of tralokinumab.
2) To evaluate the effect of tralokinumab on pulmonary function: clinic spirometry,
including pre- and post-bronchodilator FEV1, forced expiratory volume in 6 seconds
(FEV6), FVC, inspiratory capacity (IC); and PEF and FEV1 measured at home.
3) To evaluate the effect of tralokinumab on Patient Reported Outcomes: Asthma
Control Questionnaire (6-item version; ACQ-6) score, HRQoL using Asthma Quality
of Life Questionnaire Standardised Version (AQLQ[S]), and EQ-5D.
4) To evaluate the effect of tralokinumab on asthma symptoms using the Assessing
Symptoms of Moderate-to-severe Asthma (ASMA) diary and use of rescue
medication.
5) To describe the pharmacokinetics (PK) and immunogenicity of tralokinumab. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
52 weeks. Safety follow up at 74 weeks. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 30 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Argentina |
Brazil |
Canada |
Chile |
Czech Republic |
France |
Germany |
Korea, Republic of |
Mexico |
Philippines |
Poland |
Russian Federation |
Spain |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The end of the study (“study completion”) is defined as the date of the last protocol-specified visit/assessment (including telephone contact) for the last subject in the study. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |