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    Clinical Trial Results:
    Randomised placebo-controlled study of grass pollen allergen immunotherapy tablet (AIT) for seasonal rhinitis: time course of nasal, cutaneous and immunological outcomes

    Summary
    EudraCT number
    2013-003732-72
    Trial protocol
    GB  
    Global end of trial date
    01 Mar 2017

    Results information
    Results version number
    v2(current)
    This version publication date
    12 Oct 2019
    First version publication date
    23 Aug 2019
    Other versions
    v1
    Version creation reason
    • New data added to full data set
    • Correction of full data set
    Statistical data and minor changes needs to be corrected on the posted file

    Trial information

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    Trial identification
    Sponsor protocol code
    13IC0847
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02005627
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Imperial College London
    Sponsor organisation address
    Norfolk Place, London, United Kingdom, W2 1PG
    Public contact
    Nabila Youssouf , Imperial College London, +44 (0)2033110206, nabila.youssouf08@imperial.ac.uk
    Scientific contact
    Nabila Youssouf , Imperial College London, +44 (0)2033110206, nabila.youssouf08@imperial.ac.uk
    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
    07 Jan 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    01 Mar 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    01 Mar 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To understand the time course of clinical and immunological actions of grass pollen allergen immunotherapy tablets in the treatment of seasonal allergic rhinitis.
    Protection of trial subjects
    This trial was conducted in compliance with the protocol, current Good Clinical Practice (GCP) guidelines and all applicable regulatory requirements. All participants read, signed, and dated the consent form before participating in the study. Participant’s privacy and confidentiality were preserved by assigning a sequential identification number used to collect, store, and report participant information. Grazax sublingual immunotherapy is commonly associated with local side effects of itching and swelling in the mouth that may last up to 30 minutes after taking each tablet. Systemic side effects after Grazax are very rare and generally of mild intensity. The first Grazax® or Grazax® placebo was administered under the supervision of a trial physician and the participant observed for one hour thereafter before discharge from the clinic.
    Background therapy
    All atopic participants were provided with anti-allergic rescue medications (antihistamine tablets, topical intranasal corticosteroids, and eye-drops) throughout the pollen season.
    Evidence for comparator
    Sublingual immunotherapy tablet is a fast-dissolving tablet that is registered throughout Europe for sublingual use in patients aged 5–65 years (18–65 years in UK). The tablet is administered daily for a minimum of 2 months before and during the grass pollen season to be taken for at least 3 years. In a double-blind trial of Grazax® that included a withdrawal phase, efficacy was maintained for 2–3 years with continuous treatment and at 1 year following withdrawal.
    Actual start date of recruitment
    01 Sep 2013
    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
    United Kingdom: 46
    Worldwide total number of subjects
    46
    EEA total number of subjects
    46
    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)
    46
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Participants who were having severe allergic rhinoconjunctivitis were recruited during out of pollen season from September to March 2014. All participants were recruited from United Kingdom.

    Pre-assignment
    Screening details
    Individuals with severe grass pollen hay fever, with or without associated seasonal asthma were recruited after the 2013 grass pollen season, between December 2013 and April 2014. Screening of 94 participants was completed before 46 eligible atopic participants were randomized to one of the following two treatment arms in a 1:1 ratio.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    The active Grazax tablets and placebo were prepared as identical tablet and provided in identical packages. Throughout the study, participants, data analysist and investigators remained blinded.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Grazax
    Arm description
    The active treatment arm received active grass pollen immunotherapy tablet (AIT), Grazax Oral Lyophilisate 75,000 standardised quality units tablet (SQ-T) once daily.
    Arm type
    Active comparator

    Investigational medicinal product name
    GRAZAX
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Sublingual tablet
    Routes of administration
    Sublingual use
    Dosage and administration details
    Active Grazax Oral Lyophilisate 75,000 standardised quality units tablet (SQ-T) once daily.

    Arm title
    Grazax Placebo
    Arm description
    The placebo treatment arm received placebo tablet, Grazax placebo tablet (SQ-T) once daily.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Sublingual tablet
    Routes of administration
    Sublingual use
    Dosage and administration details
    Grazax placebo tablet (SQ-T) sublingually once daily.

    Number of subjects in period 1
    Grazax Grazax Placebo
    Started
    23
    23
    Completed
    21
    19
    Not completed
    2
    4
         Consent withdrawn by subject
    1
    2
         Lost to follow-up
    1
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Grazax
    Reporting group description
    The active treatment arm received active grass pollen immunotherapy tablet (AIT), Grazax Oral Lyophilisate 75,000 standardised quality units tablet (SQ-T) once daily.

    Reporting group title
    Grazax Placebo
    Reporting group description
    The placebo treatment arm received placebo tablet, Grazax placebo tablet (SQ-T) once daily.

    Reporting group values
    Grazax Grazax Placebo Total
    Number of subjects
    23 23 46
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    23 23 46
    Age continuous
    Units: years
        median (standard deviation)
    31.5 ± 2.12 36.9 ± 1.97 -
    Gender categorical
    Units: Subjects
        Female
    10 5 15
        Male
    13 18 31
    Specific IgE
    Units: kU/l
        median (standard deviation)
    14.4 ± 3.12 14.17 ± 2.81 -

    End points

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    End points reporting groups
    Reporting group title
    Grazax
    Reporting group description
    The active treatment arm received active grass pollen immunotherapy tablet (AIT), Grazax Oral Lyophilisate 75,000 standardised quality units tablet (SQ-T) once daily.

    Reporting group title
    Grazax Placebo
    Reporting group description
    The placebo treatment arm received placebo tablet, Grazax placebo tablet (SQ-T) once daily.

    Primary: Total nasal symptom scores mean differnce

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    End point title
    Total nasal symptom scores mean differnce
    End point description
    The total nasal symptom score at one hour after grass pollen nasal allergen challenge in active versus placebo treated participants at 12 months. Score ranges from 0-12 points. Higher score is more severe symptoms.
    End point type
    Primary
    End point timeframe
    60 minutes
    End point values
    Grazax Grazax Placebo
    Number of subjects analysed
    23
    23
    Units: Score on scale
        geometric mean (confidence interval 95%)
    3.37 (2.7 to 4.05)
    4.71 (4 to 5.4)
    Statistical analysis title
    Total symptom score
    Comparison groups
    Grazax v Grazax Placebo
    Number of subjects included in analysis
    46
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    t-test, 2-sided
    Confidence interval

    Secondary: Delta Peak nasal inspiratory flow

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    End point title
    Delta Peak nasal inspiratory flow
    End point description
    End point type
    Secondary
    End point timeframe
    60 minutes
    End point values
    Grazax Grazax Placebo
    Number of subjects analysed
    23
    23
    Units: L/min
        geometric mean (confidence interval 95%)
    -29.2 (-44.8 to -13.5)
    -72.5 (-88.8 to -56.1)
    Statistical analysis title
    Peak nasal inspiratory flow
    Comparison groups
    Grazax v Grazax Placebo
    Number of subjects included in analysis
    46
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    t-test, 2-sided
    Confidence interval

    Secondary: Early phase Intradermal test

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    End point title
    Early phase Intradermal test
    End point description
    End point type
    Secondary
    End point timeframe
    15 minutes
    End point values
    Grazax Grazax Placebo
    Number of subjects analysed
    23
    23
    Units: millimeter(s)
        geometric mean (standard error)
    15.3 ± 1.1
    20.2 ± 1.1
    No statistical analyses for this end point

    Secondary: Late phase intradermal test

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    End point title
    Late phase intradermal test
    End point description
    End point type
    Secondary
    End point timeframe
    8 hours after intradermal allergen test
    End point values
    Grazax Grazax Placebo
    Number of subjects analysed
    23
    23
    Units: millimeter(s)
        geometric mean (standard error)
    52.6 ± 3.4
    74.6 ± 3.4
    No statistical analyses for this end point

    Secondary: End of season global rhinitis symptoms

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    End point title
    End of season global rhinitis symptoms
    End point description
    End point type
    Secondary
    End point timeframe
    12 month
    End point values
    Grazax Grazax Placebo
    Number of subjects analysed
    23
    23
    Units: scale
        geometric mean (standard error)
    40.4 ± 5.18
    54.97 ± 5.43
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    1 year
    Adverse event reporting additional description
    All adverse and severe adverse events (SAEs) were recorded on the appropriate case report forms and the specific serious adverse events were to report as soon as possible and within 24 hours. Data were entered into MHRA approved clinical trial database.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4
    Reporting groups
    Reporting group title
    Grazax placebo
    Reporting group description
    PLacebo non-active treated group

    Reporting group title
    Grazax active
    Reporting group description
    -

    Serious adverse events
    Grazax placebo Grazax active
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 23 (0.00%)
    0 / 23 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Grazax placebo Grazax active
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    20 / 23 (86.96%)
    22 / 23 (95.65%)
    Immune system disorders
    Allergic reaction
         subjects affected / exposed
    3 / 23 (13.04%)
    19 / 23 (82.61%)
         occurrences all number
    3
    23
    Gastrointestinal disorders
    Dyspepsia
    Additional description: In the SLIT-tablet group more adverse events were present especially gastrointestinal system such as dyspepsia and vomiting after taking SLIT.
    alternative dictionary used: CTCAE 5
         subjects affected / exposed
    0 / 23 (0.00%)
    6 / 23 (26.09%)
         occurrences all number
    0
    8
    Abdominal pain
         subjects affected / exposed
    0 / 23 (0.00%)
    1 / 23 (4.35%)
         occurrences all number
    0
    1
    Mucositis Oral
         subjects affected / exposed
    1 / 23 (4.35%)
    1 / 23 (4.35%)
         occurrences all number
    1
    1
    Tooth Ache
         subjects affected / exposed
    0 / 23 (0.00%)
    2 / 23 (8.70%)
         occurrences all number
    0
    2
    Vomiting
         subjects affected / exposed
    0 / 23 (0.00%)
    4 / 23 (17.39%)
         occurrences all number
    0
    4

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    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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