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 | Diseases [C] - Respiratory Tract Diseases [C08] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10039776 |
E.1.2 | Term | Seasonal allergic rhinitis |
E.1.2 | System Organ Class | 100000004855 |
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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 |
The primary objective is to determine if pre-seasonal low dose intradermal grass pollen allergen immunotherapy (either 7 or 8 two-weekly injections of 10 Biological Units (33.333 SQ-U)) reduces symptoms and requirements for anti-allergic drugs in seasonal allergic rhinitis during the 2013 grass pollen season compared to the control intervention (histamine only). |
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E.2.2 | Secondary objectives of the trial |
1) Determine if this intervention is associated with improvement in quality of life compared to the control intervention, as assessed during the 2013 grass pollen season.
2) Evaluate if this is a safe and well-tolerated form of treatment.
3) Investigate immunological mechanisms associated with this form of treatment, by examining humoral and cellular responses, both in peripheral blood and in tissue.
4) Explore if the intradermal desensitisation effect is long-lived i.e. persists following cessation of intradermal injections.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1) Adults aged 18 to 65 years.
2) A clinical history of grass pollen-induced allergic rhinoconjunctivitis for at least 2 years with peak symptoms in May, June, or July.
3) A clinical history of moderate-severe persistent rhinoconjunctivitis symptoms interfering with usual daily activities or with sleep.
4) A clinical history of rhinoconjunctivitis that remains troublesome despite treatment with either antihistamines or nasal corticosteroids during the grass pollen season.
5) Positive skin prick test response, defined as wheal diameter greater than or equal to 3 mm, to Phleum pratense.
6) Positive specific IgE, defined as greater than or equal to IgE class 2, against Phleum pratense.
7) For women of childbearing age, a willingness to use an effective form of contraception for the duration of intradermal injections.
8) The ability to give informed consent and comply with study procedures.
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E.4 | Principal exclusion criteria |
1) Pre-bronchodilator FEV1 less than 70% of predicted value at screening visit.
2) A history of seasonal grass pollen-induced asthma requiring regular treatment with salbutamol or inhaled corticosteroids. Patients with mild seasonal grass pollen-induced asthma may be included, provided symptoms are satisfactorily controlled with occasional salbutamol only.
3) A clinical history of symptomatic seasonal allergic rhinitis and/or asthma due to tree pollen or weed pollen near or overlapping the grass pollen season, although patients with mild intermittent symptoms requiring only occasional antihistamines may be included.
4) A clinical history of symptomatic allergic rhinitis and/or asthma caused by a perennial allergen to which the participant is regularly exposed, although patients with mild intermittent symptoms requiring only occasional antihistamines may be included.
5) Emergency department visit or hospital admission for asthma in the previous 12 months.
6) History of chronic obstructive pulmonary disease.
7) History of significant recurrent acute sinusitis, defined as 2 episodes per year for the last 2 years, all of which required antibiotic treatment.
8) History of chronic sinusitis, defined as a sinus symptoms lasting greater than 12 weeks outside the grass pollen season, that includes 2 or more major factors or 1 major factor and 2 minor factors. Major factors are defined as facial pain or pressure, nasal obstruction or blockage, nasal discharge or purulence or discoloured postnasal discharge, purulence in nasal cavity, or impaired or loss of smell. Minor factors are defined as headache, fever, halitosis, fatigue, dental pain, cough, and ear pain, pressure, or fullness.
9) At randomisation, current symptoms of, or treatment for, upper respiratory tract infection, acute sinusitis, acute otitis media, or other relevant infectious process; serous otitis media is not an exclusion criterion. Participants may be re-evaluated for eligibility after symptoms resolve.
10) Current smokers or a history of greater than or equal to 5 pack years.
11) Previous treatment by immunotherapy with grass pollen allergen within the previous 5 years.
12) History of life-threatening anaphylaxis or angioedema.
13) Ongoing systemic immunosuppressive treatment.
14) History of intolerance of grass pollen immunotherapy, rescue medications or their excipients.
15) For females of childbearing age a positive serum or urine pregnancy test with sensitivity of less than 50 mIU/mL within 72 hours of first administration of study therapy.
16) Lactating females.
17) The use of any investigational drug within 30 days of the screening visit.
18) Ongoing treatment with leukotriene receptor antagonists, beta-blockers, calcium channel blockers, tricyclic antidepressants, monoamine oxidase inhibitors or anti-IgE monoclonal antibody.
19) The presence of any medical condition that the investigator deems incompatible with participation in the trial.
20) Individuals with insufficient understanding of the trial.
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E.5 End points |
E.5.1 | Primary end point(s) |
A combined symptom and medication score during the grass pollen season period of mid May-August 2013 |
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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) Symptom score during 2013 grass pollen season.
2) Medication score during 2013 grass pollen season.
3) Rhinoconjunctivitis Quality of Life Questionnaire scores during 2013 grass pollen season.
4) Visual Analogue Score during 2013 grass pollen season.
5) A global evaluation of symptoms at the end of 2013 grass pollen season.
6) Frequency of adverse events
7) Health Related Quality of Life Questionnaire (EQ-5D-5L) scores during 2013 grass pollen season.
8) Number of GP visits for hay fever during summer 2013
9) Combined symptom and medication score during the peak of the 2013 grass pollen season.
10) Number of medication free days covering the grass pollen season period of 13th May-end August 2013 will be compared in active and control groups.
11) Number of symptom free days covering the grass pollen season period of 13th May-end August 2013 will be compared in active and control groups.
12) Individual symptoms scores (AUC) for each organ: nose, mouth, eyes and lungs.
13) Total number of days during which prednisolone used between 13th May-end August 2013
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Daily diary cards will be used to record symptoms for Approximately 16 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 | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
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 | No |
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) | Yes |
E.8.2.2 | Placebo | No |
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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
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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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 | 0 |
E.8.9.1 | In the Member State concerned days | 0 |