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] - Ear, nose and throat diseases [C09] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10028756 |
E.1.2 | Term | Nasal polyps |
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 the efficacy of dupilumab compared to placebo on a background of mometasone furoate nasal spray (MFNS) in reducing nasal congestion/obstruction (NC) severity and endoscopic nasal polyp score (NPS) in patients with bilateral nasal polyposis (NP). In addition for Japan, reduction in computed tomography (CT) scan opacification of the sinuses will be also a coprimary objective. |
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E.2.2 | Secondary objectives of the trial |
-To evaluate the efficacy of dupilumab in improving total symptoms score (TSS).
-To evaluate the efficacy of dupilumab in improving sense of smell.
-To evaluate the efficacy of dupilumab in reducing CT scan opacification of the sinuses (primary objective for Japan).
-To evaluate ability of dupilumab in reducing proportion of patients requiring treatment with systemic corticosteroids or NP surgery.
-To evaluate the effect of dupilumab on patient reported outcomes and health related quality of life outcome by sinonasal outcome test-22 (SNOT-22).
-To evaluate the effect of dupilumab in the subgroups of patients with prior surgery and co-morbid asthma (including non-steroid antiinflammatory drug [NSAID] exacerbated respiratory disease [NERD]).
-To evaluate residual effect in follow up.
-To evaluate the safety of dupilumab in patients with bilateral NP.
-To evaluate functional dupilumab concentrations (systemic exposure) and incidence of treatment-emergent anti-drug antibodies. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Patients with bilateral sinonasal polyposis that despite prior treatment with systemic corticosteroids (SCS) anytime within the past 2 years; and/or have a medical contraindication / intolerance to SCS, and/or had prior surgery for NP at the screening visit, have:
-An endoscopic bilateral NPS of at least 5 out of a maximum score of 8 (with a minimum score of 2 in each nasal cavity).
-Ongoing symptoms (for at least 8 weeks prior to V1) of nasal congestion / blockage / obstruction with moderate or severe symptom severity (score 2 or 3) at V1 and a weekly average severity of greater than 1 at the time of randomization (V2), and another symptom such as loss of smell, rhinorrhea (anterior/posterior).
-Signed written informed consent. |
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E.4 | Principal exclusion criteria |
-Patients <18 years of age.
-Patient who has previously been treated in dupilumab studies.
-Patient who has taken:
-Biologic therapy/systemic immunosuppressant to treat inflammatory disease or autoimmune disease (eg, rheumatoid arthritis, inflammatory bowel disease, primary biliary cirrhosis, systemic lupus erythematosus, multiple sclerosis, etc.) within 2 months before V1 or 5 half-lives, whichever is longer.
-Any experimental monoclonal antibody (mAB) within 5 half-lives or within 6 months before V1 if the half-life is unknown.
-Anti-immunoglobulin E (IgE) therapy (omalizumab) within 130 days prior to V1.
-Patients who are receiving leukotriene antagonists/modifiers at V1 unless they are on a continuous treatment for at least 30 days prior to V1.
-Initiation of allergen immunotherapy within 3 months prior to V1 or a plan to begin therapy or change its dose during the run-in period or the randomized treatment period.
-Patients who have undergone any intranasal and/or sinus surgery (including polypectomy) within 6 months prior to V1.
-Patients who have had a sinonasal or sinus surgery changing the lateral wall structure of the nose making impossible the evaluation of NPS.
-Patients with conditions/concomitant diseases making them nonevaluable at V1 or for the primary efficacy endpoint such as:
-Antrochoanal polyps.
-Nasal septal deviation that would occlude at least one nostril.
-Acute sinusitis, nasal infection or upper respiratory infection.
-Ongoing rhinitis medicamentosa.
-Allergic granulomatous angiitis (Churg-Strauss syndrome), granulomatosis with polyangiitis (Wegener’s granulomatosis), Young’s syndrome, Kartagener’s syndrome or other dyskinetic ciliary syndromes, concomitant cystic fibrosis.
-Radiologic suspicion, or confirmed invasive or expansive fungal rhinosinusitis.
-Patients with nasal cavity malignant tumor and benign tumors (eg, papilloma, blood boil etc).
-Patients with forced expiratory volume in 1 second (FEV1) 50% or less (of predicted normal).
-Patients receiving concomitant treatment prohibited in the study.
-Treatment with a live (attenuated) vaccine within 12 weeks before the baseline visit.
-History of human immunodeficiency virus (HIV) infection or positive HIV serology at screening.
-Positive with hepatitis B surface antigen (HBsAg) or hepatitis C antibody at the screening visit.
-Active chronic or acute infection requiring systemic treatment within 2 weeks before the baseline visit.
-Known or suspected history of immunosuppression.
-Pregnant or breastfeeding women, or women planning to become pregnant or breastfeed during the study.
-Women unwilling to use adequate birth control, if of reproductive potential and sexually active. |
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E.5 End points |
E.5.1 | Primary end point(s) |
1- Change from baseline in nasal congestion/obstruction (NC)
symptom severity score based on the patient daily morning
assessment
2- Change from baseline in nasal polyposis score (NPS) as assessed by nasal endoscopy
3- Change from baseline in sinus opacifications as assessed by
computed tomography (CT) scans using Lund Mackay Score
(For Japan only) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
1-2-3: From baseline to Week 24 |
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E.5.2 | Secondary end point(s) |
1- Change from baseline in total symptom score (TSS) (composite
severity score consisting of the patient daily AM assessed NC,
decreased/loss of sense of smell, anterior/posterior rhinorrhea)
2- Change from baseline in University of Pennsylvania Smell Identification Test
3- Change from baseline in severity of decreased/loss of smell as assessed by patient daily
4- Change from baseline in sinus opacifications as assessed by CT
scans using Lund Mackay Score. (This endpoint will not be
assessed as a secondary endpoint for Japan as it is already a
co-primary endpoint).
5- Change from baseline in sinonasal outcome test-22 (SNOT-22)
6- Proportion of patients during study treatment receiving oral corticosteroid for NP and/or planned to undergo surgery for nasal polyps |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1-2-3-4-5 : From baseline to Week 24
6 : at week 24 |
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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 | Yes |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | Yes |
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) | Yes |
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 | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 47 |
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 |
Bulgaria |
Czech Republic |
France |
Germany |
Hungary |
Italy |
Netherlands |
Poland |
Romania |
Russian Federation |
Ukraine |
United Kingdom |
United States |
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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 | 1 |
E.8.9.1 | In the Member State concerned months | 3 |
E.8.9.1 | In the Member State concerned days | 13 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 3 |
E.8.9.2 | In all countries concerned by the trial days | 13 |