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 |
Allergy to peanuts or peanut-containing foods |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
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 demonstrate the efficacy of AR101, a pharmaceutical-grade peanut allergen formulation, through reduction in clinical reactivity to limited amounts of peanut allergen in peanut-allergic children and adolescents (ages 4 to 17 years, inclusive). |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives are to demonstrate the safety of AR101 as measured by the incidence of adverse events (AEs), including serious adverse events (SAEs) and to evaluate the immunological effects of peanut OIT therapy. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Age 4 through 17 years (inclusive)
• Clinical history of allergy to peanuts or peanut-containing foods
• Serum IgE to peanut ≥ 0.35 kUA/L, inclusive (as determined by UniCAP™ within the past 12 months) and/or a peanut SPT wheal diameter ≥ 3 mm compared to control
• Experience dose-limiting symptoms at or before the 300 mg (444 mg cumulative) challenge dose of peanut protein (measured as 600 mg of peanut flour) on Screening DBPCFC conducted in accordance with PRACTALL (Practical Issues in Allergology, Joint United States/European Union Initiative) guidelines
• Written informed consent from subject or parent/guardian for all subjects
• Written assent from minor subjects as appropriate (e.g., above the age of 7 years or the applicable age per local regulatory requirements)
• Use of effective birth control by female subjects of child-bearing potential |
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E.4 | Principal exclusion criteria |
• History of hemodynamically significant cardiovascular disease, including uncontrolled or inadequately controlled hypertension (Section 5.10)
• History of severe or life-threatening episode of anaphylaxis or anaphylactic shock within 60 days of Screening DBPCFC
• History of chronic disease (other than asthma, atopic dermatitis, or allergic rhinitis) that is, or is at significant risk of, becoming unstable or requiring a change in chronic therapeutic regimen including autoimmune diseases and malignancies (including malignancies occurring in the 5 years prior to Screening)
• History of eosinophilic esophagitis (EoE), other eosinophilic GI disease, chronic, recurrent, or severe gastroesophageal reflux disease (GERD), symptoms of dysphagia (eg, difficulty swallowing, food “getting stuck”), or recurrent GI symptoms of undiagnosed etiology
• Current participation in any other interventional study and/or participation in another interventional clinical study within 30 days or 5 half-lives of the IP, whichever is longer, prior to randomization
• Participation in, and having received active treatment in, any previous clinical study of AR101 CODIT™
• Currently receiving, or having received in the 5 years prior to Screening, any type of peanut or any other food immunotherapy (including subcutaneous, sublingual, oral, or epicutaneous)
• Subject is in “build-up phase” of immunotherapy to another allergen (ie, has not reached maintenance dosing)
• Severe asthma (2007 NHLBI Criteria Steps 5 or 6, Appendix 2)
• Mild or moderate asthma (2007 NHLBI Criteria Steps 1-4), if uncontrolled or difficult to control as defined by any of the following:
o Forced expiratory volume in 1 second (FEV1) < 80% of predicted, with or without controller medications (only for age 6 years or greater and able to do spirometry); or
o Inhaled corticosteroid (ICS) dosing of > 500 mcg daily fluticasone (or equivalent ICS based on NHLBI dosing chart); or
o 1 hospitalization in the past year prior to Screening for asthma; or
o Emergency room (ER) visit for asthma within 6 months prior to Screening
• History of high-dose corticosteroid use (eg, 1 to 2 mg/kg of prednisone or the equivalent for > 3 days) by any route of administration in any of the following manners:
o history of daily corticosteroid dosing for > 1 month during the past year; or
o 1 corticosteroid course in the past 3 months; or
o > 2 corticosteroid courses in the past year ≥ 1 week in duration
• Inability to discontinue antihistamines 5 half-lives before the initial day of escalation, SPT, or Screening DBPCFC
• Lack of an available palatable vehicle food to which the subject is not allergic
• Use of any therapeutic antibody (eg, omalizumab, mepolizumab, reslizumab, dupilumab, etc.) or any other immunomodulatory therapy excluding aeroallergen or venom immunotherapy, or corticosteroids within the past 6 months (Section 5.10)
• Use of beta blockers (oral), angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARB), calcium channel blockers, or tricyclic antidepressants (Section 5.10)
• Pregnancy or lactation
• Residing at the same address as another subject in this or any peanut OIT study
• Developing DLS(s) in reaction to the placebo part of the Screening DBPCFC
• History of a mast cell disorder, including mastocytosis, urticaria pigmentosa, and hereditary or idiopathic angioedema, and chronic spontaneous urticaria or other physician-diagnosed physical urticaria syndrome
• Allergy to oat
• Hypersensitivity to epinephrine or any of the excipients in the IP
• Any other condition that, in the opinion of the investigator, precludes participation for reasons of safety
• Inability to follow the protocol requirements
• Patients being in any relationship or dependency with the sponsor and/or investigator
• Subjects with a history of alcohol, medication or drug abuse |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary clinical efficacy endpoint is the proportion of subjects who tolerate at least 2043 mg cumulative of peanut protein with no more than mild symptoms at the Exit DBPCFC. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
After approximately 56 weeks of treatment including up to 16 weeks at maintenance dose of 300mg/day. |
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E.5.2 | Secondary end point(s) |
Key Secondary Efficacy Endpoints
• The proportion of subjects who tolerate at least 600 mg as a single dose (1043 mg cumulative) of peanut protein with no more than mild symptoms at the Exit DBPCFC
• The proportion of subjects who tolerate at least 300 mg as a single dose (443 mg cumulative) of peanut protein with no more than mild symptoms at the Exit DBPCFC
• The maximum severity of symptoms occurring following ingestion of peanut protein during the Exit DBPCFC
Other Secondary Efficacy Endpoints
• Maximum tolerated dose (MTD) with no more than mild symptoms at Exit DBPCFC
• Change from baseline in MTD of peanut protein at Exit DBPCFC
• Use of epinephrine as a rescue medication at Exit DBPCFC and comparison to its use at Screening DBPCFC
• Changes in serum peanut- and peanut component-specific IgE, total IgE, and peanut-specific IgG4 levels
• Changes in peanut skin prick test (SPT) mean wheal diameter
• Quality of life assessment using the food allergy quality of life questionnaire (FAQLQ), and the food allergy independent measure (FAIM) questionnaire |
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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 | 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) | 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 | 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) | 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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 25 |
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 | |
E.8.9.1 | In the Member State concerned months | 18 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 18 |