E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
severe eosinophilic asthma |
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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 | 20.0 |
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 assess the use of the combination product, mepolizumab liquid drug product in autoinjector for the subcutaneous self-administration of mepolizumab by subjects with severe eosinophilic asthma |
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E.2.2 | Secondary objectives of the trial |
To assess the use of mepolizumab liquid drug product in autoinjector outside the clinic setting |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
AGE:
1. Age: At least 12 years of age inclusive, at the time of signing the informed consent. [For those countries where local regulations permit enrolment of adults only, subject recruitment will be restricted to those who are ≥ 18 years of age]
TYPE OF SUBJECT AND DIAGNOSIS INCLUDING DISEASE SEVERITY
2. Asthma: A physician diagnosis of asthma for ≥2 years that meets the National Heart, Lung and Blood Institute guidelines [National heart, lung and blood institute (NIH), 2007] or Global Initiative for Asthma (GINA) guidelines [GINA, 2015]
3. Mepolizumab treatment:
a. Not receiving mepolizumab treatment at Visit 1
(NB: these subjects must also meet inclusion criteria 4, 5, 6 and 7).
OR
b. Receiving 100 mg SC mepolizumab administered for the treatment of
severe eosinophilic asthma every 4 weeks for at least 12 weeks prior to Visit 1.
The following inclusion criteria are only applicable to those subjects NOT receiving mepolizumab treatment at Visit 1:
4. Eosinophilic asthma: A high likelihood of eosinophilic asthma as per the required ‘Continuation to Treatment’ - Criterion 2.
5. Inhaled Corticosteroid: A well-documented requirement for regular treatment with high dose inhaled corticosteroid (ICS) in the 12 months prior to Visit 1 with or without maintenance oral corticosteroids (OCS).
For subjects ≥ 18 years old:
ICS dose must be ≥880 mcg/day fluticasone propionate (FP) (exactuator) or equivalent daily.
For ICS/long-acting-beta-2-agonist (LABA) combination preparations, the highest strength approved maintenance dose in the local country will meet this ICS criterion.
For subjects ≥12 to ≤17 years old:
ICS dose must be ≥440 mcg/day FP (ex-actuator) or equivalent daily.
For ICS/LABA combination preparations, the mid-strength approved maintenance dose in the local country will meet this ICS criterion.
(Subjects will be permitted to be enrolled without continuous high dose ICS
providing the subject was receiving continuous ICS and the Investigator attests that the subject should have been treated with high dose ICS to mitigate the risk of exacerbations but financial or tolerance issues prevented the use of high-dose ICS. Such subjects should be discussed with GSK Medical Monitor prior to enrolment)
6. Controller Medication: Current treatment with an additional controller medication, besides ICS, for at least 3 months or a documented failure in the past 12 months of an additional controller medication [e.g., long-acting beta-2-agonist (LABA), leukotriene receptor antagonist (LTRA), or theophylline] for at least 3 successive months.
7. Exacerbation history: Previously confirmed history of one or more exacerbations requiring treatment with systemic corticosteroid (CS) [intramuscular (IM), intravenous, or oral] in the 12 months prior to Visit 1, despite the use of high-dose ICS. For subjects receiving maintenance CS, the CS treatment for an exacerbation must have been a two-fold dose increase or greater.
WEIGHT
8. Body weight: A minimum ≥ 40 kg at Visit 1
SEX
9. Gender: Male or Female
Females:
A female subject is eligible to participate if she is not pregnant (as confirmed by a
negative urine human chorionic gonadotrophin (hCG) test), not planning to become pregnant during the time of study participation (and up to 16 weeks after the last dose), not lactating, and at least one of the following conditions applies:
a. Non-reproductive potential defined as:
Pre-menopausal females with one of the following:
Documented tubal ligation
Documented hysteroscopic tubal occlusion procedure with follow-up confirmation of bilateral tubal occlusion
Hysterectomy
Documented Bilateral Oophorectomy
Postmenopausal female (see Appendix 3 for specific criteria).
b. Reproductive potential and agrees to follow one of the options listed in the Modified List of Highly Effective Methods for Avoiding Pregnancy in Females of
Reproductive Potential (FRP) (see Appendix 3 of the study protocol) from 30 days prior to the first dose of study medication and until 16 weeks after the last dose of study medication and completion of the End of Study/Early Withdrawal visit.
The investigator is responsible for ensuring that subjects understand how to properly use these methods of contraception.
INFORMED CONSENT
10. Informed Consent: Capable of giving signed informed consent which includes
compliance with the requirements and restrictions listed in the consent form and in this protocol. |
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E.4 | Principal exclusion criteria |
CONCURRENT CONDITIONS/MEDICAL HISTORY (INCLUDES LIVER FUNCTION AND QTc INTERVAL)
1. Concurrent Respiratory Disease: Presence of a known pre-existing, clinically
important lung condition other than asthma. This includes current infection,
bronchiectasis, pulmonary fibrosis, bronchopulmonary aspergillosis, or diagnoses of emphysema or chronic bronchitis (chronic obstructive pulmonary disease other than asthma) or a history of lung cancer.
2. Eosinophilic Diseases: Subjects with other conditions that could lead to elevated eosinophils such as Hypereosinophilic Syndromes, including Churg-Strauss Syndrome, or Eosinophilic Esophagitis. Subjects with a known, pre-existing parasitic infestation within 6 months prior to Visit 1 are also to be excluded.
3. Malignancy: A current malignancy or previous history of cancer in remission for less than 12 months prior to screening (Subjects that had localized carcinoma of the skin which was resected for cure will not be excluded).
4. Immunodeficiency: A known immunodeficiency (e.g. human immunodeficiency
virus – HIV), other than that explained by the use of corticosteroids taken as therapy for asthma.
5. Other Concurrent Medical Conditions: Subjects who have known, pre-existing,
clinically significant cardiovascular, endocrine, autoimmune, metabolic,
neurological, renal, gastrointestinal, hepatic, haematological or any other system
abnormalities that are uncontrolled with standard treatment.
6. Liver Disease: Known, pre-existing, unstable liver disease (as defined by the
presence of ascites, encephalopathy, coagulopathy, hypoalbuminaemia, esophageal or gastric varices or persistent jaundice), cirrhosis, and known biliary abnormalities (with the exception of Gilbert’s syndrome or asymptomatic gallstones).
7. ECG Assessment: QT interval corrected for heart rate by either Fridericia’s or
Bazett’s formula QTc(F)/QTc(B) ≥450msec or QTc(F)/QTc(B) ≥480 msec for
subjects with Bundle Branch Block at Visit 1.
CONCOMITANT MEDICATIONS
8. Xolair: Subjects who have received omalizumab within 130 days of Visit 1.
9. Other Monoclonal Antibodies not including mepolizumab: Subjects who have
received any monoclonal antibody (other than Xolair) to treat inflammatory disease within 5 half-lives of Visit 1.
10. Investigational Medications: Subjects who have received treatment with an
investigational drug, other than mepolizumab within the past 30 days or five terminal phase half-lives of the drug whichever is longer, prior to visit 1 (this also includes investigational formulations of marketed products) or experimental antiinflammatory drugs (non biologicals) in the past 3 months.
11. Chemotherapy: Subjects who have received chemotherapy within 12 months prior to Visit 1.
RELEVANT HABITS
12. Alcohol/Substance Abuse: A history (or suspected history) of alcohol misuse or substance abuse within 2 years prior to Visit 1.
CONTRAINDICATIONS
13. Hypersensitivity: Subjects with hypersensitivity to mepolizumab or to any of the excipients (sodium phosphate, citric acid, sucrose, EDTA, polysorbate 80).
DIAGNOSTIC ASSESSMENTS AND OTHER CRITERIA
14. Adherence: Subjects who have known evidence of lack of adherence to controller medications and/or ability to follow physician’s recommendations. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Proportion of subjects successfully able to self-administer their observed third
dose at Week 8 |
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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) |
Proportion of subjects successfully able to self-administer their unobserved second dose outside the clinic setting at Week 4 |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | No |
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 | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Correct use of the device |
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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 | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
An open-label, single arm, repeat dose, multi-centre study |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
Will this trial be conducted at a single site globally?
| No |
E.8.4 | Will this trial be conducted at multiple sites globally? | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | Specify the countries outside of the EEA in which trial sites are planned |
Australia |
Canada |
Russian Federation |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.2 | In all countries concerned by the trial months | 9 |