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    Clinical Trial Results:
    A Phase 2, Randomized, Double-Blind, Placebo Controlled, Study to Evaluate Multiple Doses of AK001 in Patients With Moderate to Severe Nasal Polyposis

    Summary
    EudraCT number
    2016-000460-42
    Trial protocol
    BE   GB   ES   NL   DE  
    Global end of trial date
    05 Jan 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    20 Jan 2019
    First version publication date
    20 Jan 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    AK001-002
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Allakos, Inc.
    Sponsor organisation address
    975 Island Drive, Suite 201, Redwood City, United States, CA 94065
    Public contact
    Clinical Trials Information, Allakos, Inc., +1 6505975002, rwinger@allakos.com
    Scientific contact
    Clinical Trials Information, Allakos, Inc., +1 6505975002, rwinger@allakos.com
    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
    05 Jan 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    13 Oct 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    05 Jan 2018
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The primary objective was to evaluate the effect of each of 2 doses of AK001 separately in combination with an intranasal steroid (INS) versus the INS alone on the reduction in size of nasal polyps as evaluated by the change from Baseline to Week 12 after the start of treatment in Total Polyp Score (TPS)
    Protection of trial subjects
    A data monitoring committee was available to monitor the safety of patients over the course of the study. The intravenous (IV) infusion could be interrupted for 5 to 30 minutes and the rate could be reduced and gradually increased in 15-minute intervals if a patient experienced infusion-related reactions. Medication to treat mild or moderate infusion-reactions were ready to be used. Signs or symptoms of anaphylaxis were carefully monitored and treated according to standard of care. Emergency crash cart equipment was available at all times during the conduct of the study.
    Background therapy
    Eligible patients entered a 4-week Run-In Period to achieve a stable regimen with a common intranasal topical steroid (NASONEX [mometasone furoate monohydrate]) and discontinued any other intranasal topical steroids. Patients were instructed to self-administer 2 nasal inhalations in each nostril twice a day. Patients still eligible after the run-in period were randomized and continued treatment with NASONEX as background therapy throughout the study.
    Evidence for comparator
    -
    Actual start date of recruitment
    04 Apr 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 15
    Country: Number of subjects enrolled
    European Union: 25
    Worldwide total number of subjects
    40
    EEA total number of subjects
    0
    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)
    38
    From 65 to 84 years
    2
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Patients with moderate to severe chronic nasal polyposis and whose symptoms were resistant to treatment with intranasal steroids were recruited at a total of 15 sites in the United States and European Union (including sites in Spain, Belgium, The Netherlands, and Germany). The first informed consent form was signed on 04-Apr-2016.

    Pre-assignment
    Screening details
    After the Screening Period, eligible patients were enrolled and entered the Run-In Period to achieve a stable regimen with Nasonex and discontinued any other intranasal topical steroid. Thereafter, 40 eligible patients were randomized stratified by presence of asthma to 25mg or 250mg AK001 or placebo treatment.

    Period 1
    Period 1 title
    Overall study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst
    Blinding implementation details
    To maintain the blind, the prepared test and control IV infusion solutions were identical in appearance. Access to the randomization codes were strictly controlled via the interactive voice or web response system. Throughout the study, the blind remained unbroken until completion of the study and after the study database had been locked.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    25 mg AK001
    Arm description
    25 mg AK001 was administered as a single IV infusion through a peripheral vein on Days 0, 21, and 49.
    Arm type
    Experimental

    Investigational medicinal product name
    AK001
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    AK001 Drug Product was supplied as a sterile liquid in a single-use glass vial. For dose administration, the assigned amount of AK001 was diluted with 0.9% sodium chloride for IV injection.

    Arm title
    250 mg AK001
    Arm description
    250 mg AK001 was administered as a single IV infusion through a peripheral vein on Days 0, 21, and 49.
    Arm type
    Experimental

    Investigational medicinal product name
    AK001
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    AK001 Drug Product was supplied as a sterile liquid in a single-use glass vial. For dose administration, the assigned amount of AK001 was diluted with 0.9% sodium chloride for IV injection.

    Arm title
    Placebo
    Arm description
    Placebo was administered as a single IV infusion through a peripheral vein on Days 0, 21, and 49.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    The placebo was supplied as a sterile liquid in a single-use glass vial. The vial was indistinguishable from the AK001 active product. For dose administration, the assigned amount of placebo was diluted with 0.9% sodium chloride for IV injection.

    Number of subjects in period 1 [1]
    25 mg AK001 250 mg AK001 Placebo
    Started
    15
    14
    10
    Completed
    12
    14
    9
    Not completed
    3
    0
    1
         Consent withdrawn by subject
    2
    -
    1
         Adverse event, non-fatal
    1
    -
    -
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: One patient was randomized but never received study treatment, because it was noted that the subject did not qualify based on inclusion criteria. The patient was excluded from all analysis sets.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    25 mg AK001
    Reporting group description
    25 mg AK001 was administered as a single IV infusion through a peripheral vein on Days 0, 21, and 49.

    Reporting group title
    250 mg AK001
    Reporting group description
    250 mg AK001 was administered as a single IV infusion through a peripheral vein on Days 0, 21, and 49.

    Reporting group title
    Placebo
    Reporting group description
    Placebo was administered as a single IV infusion through a peripheral vein on Days 0, 21, and 49.

    Reporting group values
    25 mg AK001 250 mg AK001 Placebo Total
    Number of subjects
    15 14 10 39
    Age categorical
    Units: Subjects
        In utero
    0 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0 0
        Newborns (0-27 days)
    0 0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0 0
        Children (2-11 years)
    0 0 0 0
        Adolescents (12-17 years)
    0 0 0 0
        Adults (18-64 years)
    13 14 10 37
        From 65-84 years
    2 0 0 2
        85 years and over
    0 0 0 0
    Age continuous
    Units: years
        median (full range (min-max))
    48.0 (24 to 71) 46.5 (27 to 63) 45.0 (29 to 60) -
    Gender categorical
    Units: Subjects
        Female
    5 8 5 18
        Male
    10 6 5 21

    End points

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    End points reporting groups
    Reporting group title
    25 mg AK001
    Reporting group description
    25 mg AK001 was administered as a single IV infusion through a peripheral vein on Days 0, 21, and 49.

    Reporting group title
    250 mg AK001
    Reporting group description
    250 mg AK001 was administered as a single IV infusion through a peripheral vein on Days 0, 21, and 49.

    Reporting group title
    Placebo
    Reporting group description
    Placebo was administered as a single IV infusion through a peripheral vein on Days 0, 21, and 49.

    Primary: Change in total polyp score (TPS)

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    End point title
    Change in total polyp score (TPS) [1]
    End point description
    End point type
    Primary
    End point timeframe
    Change in TPS from Baseline (prior to the first dose) to Week 12 (Day 84).
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The study was terminated early because the Sponsor decided not to pursue further development of AK001 and was, consequently, underpowered for the endpoint comparison. Statistical analyses of the primary endpoint did not show statistically significant results for either the comparison of the 25 mg or the 250 mg group with placebo.
    End point values
    25 mg AK001 250 mg AK001 Placebo
    Number of subjects analysed
    15
    14
    10
    Units: score
        least squares mean (confidence interval 95%)
    -0.5 (-1.3 to 0.3)
    -0.3 (-1.1 to 0.5)
    -0.2 (-1.1 to 0.7)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From the time of study drug administration until completion of the last study-related procedure.
    Adverse event reporting additional description
    If a patient completed the study with an ongoing adverse event (AE), investigational site personnel continued to follow-up until AE resolution and the documentation thereof. If, after 30 days from the study completion date, the AE was still continuing but not assessed as serious, the outcome was recorded as ongoing.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.0
    Reporting groups
    Reporting group title
    25 mg AX001
    Reporting group description
    25 mg AX001 will be administered as a single intravenous infusion over about 1 hour through a peripheral vein on Day 0, 21, and 49.

    Reporting group title
    250 mg AX001
    Reporting group description
    250 mg AX001 will be administered as a single intravenous infusion over about 1 hour through a peripheral vein on Day 0, 21, and 49.

    Reporting group title
    Placebo
    Reporting group description
    Placebo will be administered as a single intravenous infusion over about 1 hour through a peripheral vein on Day 0, 21, and 49.

    Serious adverse events
    25 mg AX001 250 mg AX001 Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    25 mg AX001 250 mg AX001 Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    11 / 15 (73.33%)
    10 / 14 (71.43%)
    7 / 10 (70.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    0
    General disorders and administration site conditions
    Facial pain
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    0
    Fatigue
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Feeling hot
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Pain
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Pyrexia
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    0 / 15 (0.00%)
    2 / 14 (14.29%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Cough
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Dyspnoea
         subjects affected / exposed
    1 / 15 (6.67%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    1
    1
    0
    Epistaxis
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    2 / 10 (20.00%)
         occurrences all number
    0
    1
    2
    Nasal congestion
         subjects affected / exposed
    2 / 15 (13.33%)
    2 / 14 (14.29%)
    0 / 10 (0.00%)
         occurrences all number
    2
    2
    0
    Nasal discharge discolouration
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Nasal obstruction
         subjects affected / exposed
    3 / 15 (20.00%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    3
    0
    0
    Rhinorrhoea
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    0
    Throat irritation
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Wheezing
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    0
    Psychiatric disorders
    Agitation
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Insomnia
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Investigations
    Blood pressure increased
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Heart rate increased
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    2
    Weight increased
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Injury, poisoning and procedural complications
    Forearm fracture
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Upper limb fracture
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Cardiac disorders
    Ventricular extrasystoles
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    2
    Headache
         subjects affected / exposed
    2 / 15 (13.33%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    2
    1
    0
    Memory impairment
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Migraine
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    3
    0
    0
    Syncope
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Blood and lymphatic system disorders
    Lymphadenopathy
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Ear and labyrinth disorders
    Ear pain
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    0
    Gastrointestinal disorders
    Abdominal discomfort
         subjects affected / exposed
    0 / 15 (0.00%)
    2 / 14 (14.29%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Nausea
         subjects affected / exposed
    1 / 15 (6.67%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    1
    2
    0
    Toothache
         subjects affected / exposed
    1 / 15 (6.67%)
    1 / 14 (7.14%)
    1 / 10 (10.00%)
         occurrences all number
    1
    1
    1
    Skin and subcutaneous tissue disorders
    Acne
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Angioedema
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Blister
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Erythema
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Generalised erythema
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Pruritus
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    2
    0
    1
    Pruritus generalised
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Rash
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Rash maculo-papular
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Muscle fatigue
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Pain in extremity
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    3
    0
    1
    Infections and infestations
    Acute sinusitis
         subjects affected / exposed
    0 / 15 (0.00%)
    0 / 14 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Bronchitis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Gastroenteritis
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Gastroenteritis viral
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    3
    0
    Impetigo
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Influenza
         subjects affected / exposed
    0 / 15 (0.00%)
    2 / 14 (14.29%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Nasopharyngitis
         subjects affected / exposed
    4 / 15 (26.67%)
    2 / 14 (14.29%)
    1 / 10 (10.00%)
         occurrences all number
    4
    3
    2
    Otitis media acute
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Paronychia
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Rhinitis
         subjects affected / exposed
    2 / 15 (13.33%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    0
    Sinusitis
         subjects affected / exposed
    1 / 15 (6.67%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Upper respiratory tract infection
         subjects affected / exposed
    3 / 15 (20.00%)
    0 / 14 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    3
    0
    0
    Urinary tract infection
         subjects affected / exposed
    0 / 15 (0.00%)
    1 / 14 (7.14%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    27 Jul 2016
    Amendment 2: - specified that 2 doses of AK001 were being evaluated - clarified the handling of biomarker samples - corrected typographical errors - specified that dose preparation and administration were provided in a Study Manual - clarified labelling information and methods of unblinding - removed the recording of patient's initials in the eCRF.
    05 Sep 2016
    Amendment 1: - following a health authority request, inclusion criteria were changed - changed visit window of last study visit - extended the Run-In Period into the Screening period - added the assessment of clinical symptoms for rhinosinusitis by using a validated scale - removed unnecessary requirements (i.e. 2-hour fasting, assessment of vital signs before blood draw, post-dose blood draw for pharmacokinetics) - clarifications

    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.
    After 40 of the 70 patients planned were randomized in the study, enrollment was stopped as the Sponsor decided not to pursue further development of AK001. The study was not stopped for any safety concern.
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