E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Chronic obstructive pulmonary disease |
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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 | 26.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10009033 |
E.1.2 | Term | Chronic obstructive pulmonary disease |
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 300 mg q2w in patients with moderate or severe COPD as measured by
- Annualized rate of acute moderate and severe COPD exacerbation (AECOPD)
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E.2.2 | Secondary objectives of the trial |
To evaluate the effect of dupilumab 300 mg q2w on
- Pre-bronchodilator forced expiratory volume in 1 second (FEV1) over 12 weeks compared to placebo
- Health related quality of life, assessed by the change from baseline to Week 52 in the St. George’s
Respiratory Questionnaire (SGRQ)
- Pre-bronchodilator FEV1 over 52 weeks compared to placebo |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
-Participants with a physician diagnosis of COPD who meet the following criteria at screening:
-Current or former smokers with a smoking history of ≥10 pack-years.
-Moderate-to-severe COPD (post-bronchodilator FEV1/ forced vital capacity [FVC] ratio
<0.70 and post-bronchodilator FEV1 % predicted >30% and ≤70%).
-Medical Research Council (MRC) Dyspnea Scale grade ≥2.
-Patient-reported history of signs and symptoms of chronic bronchitis (chronic productive cough) for 3 months in the year up to screening in the absence of other known causes of chronic cough.
-Documented history of high exacerbation risk defined as exacerbation history of ≥2 moderate or ≥1 severe within the year prior to inclusion. At least one exacerbation should have occurred while the patient was taking inhaled corticosteroid (ICS)/long acting beta agonist (LABA)/long acting muscarinic agonist (LAMA) (or LABA/LAMA if ICS is contraindicated). Moderate exacerbations are recorded by the investigator and defined as acute exacerbation of COPD (AECOPD) that require either systemic corticosteroids (intramuscular, intravenous, or oral) and/or antibiotics. One of the two required moderate exacerbations has to require the use of systemic corticosteriods. Severe exacerbations are recorded by the investigator and defined as AECOPD requiring hospitalization/emergency room visit or treatment for >24 hours in emergency department/urgent care facility or result in death.
-Background triple therapy (inhaled corticosteroid [ICS] + long acting beta agonist [LABA] + long acting muscarinic agonist [LAMA]) for 3 months prior to randomization with a stable dose of medication for ≥1 month prior to Visit 1; Double therapy (LABA + LAMA) allowed if ICS is contraindicated.
-Evidence of Type 2 inflammation: Patients with blood eosinophils ≥300 cells/microliter at Visit 1. |
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E.4 | Principal exclusion criteria |
- COPD diagnosis for less than 12 months prior to randomization.
- A current diagnosis of asthma or history of asthma according to the 2018 Global Initiative for Asthma (GINA) guidelines or other accepted guidelines; or a history of asthma with age of onset ≥ 40 years of age.
- Significant pulmonary disease other than COPD (e.g. lung fibrosis, sarcoidosis, interstitial lung disease, pulmonary hypertension, bronchiectasis, Churg-Strauss Syndrome etc) or another diagnosed pulmonary or systemic disease associated with elevated peripheral eosinophil counts.
- Cor pulmonale, evidence of right cardiac failure.
- Treatment with oxygen of more than 12 hours per day.
- Hypercapnia requiring Bi-level ventilation.
- AECOPD as defined in inclusion criteria within 4 weeks prior to screening, or during the screening period.
- Respiratory tract infection within 4 weeks prior to screening, or during the screening period.
- History of, or planned pneumonectomy or lung volume reduction surgery. Patients who are participating in the acute phase of a pulmonary rehabilitation program, ie, who started rehabilitation <4 weeks prior to screening (Note: patients in the maintenance phase of a rehabilitation program can be included).
- Diagnosis of α-1 anti-trypsin deficiency. |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Annual rate of acute COPD exacerbation (AECOPD) : Annualized rate of moderate or severe COPD exacerbations over the 52-week treatment period compared to placebo
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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) |
1. Change in pre-bronchodilator FEV1 : Change in pre-bronchodilator FEV1 from baseline to Week 12 compared to placebo
2. Change in SGRQ : Change from baseline to Week 52 in SGRQ total score compared to placebo
3. Improvement in SGRQ : Proportion of patients with SGRQ improvement ≥4 points at Week 52
4. Change in pre-bronchodilator FEV1 from baseline to Week 52 : Change in pre-bronchodilator FEV1 from baseline to Week 52 compared to placebo
5. Change in pre-bronchodilator FEV1 from baseline to time points up to Week 44 : Change in pre-bronchodilator FEV1 from baseline to weeks other than 12 and 52 (i.e. Weeks 2, 4, 8, 24, 36 and 44) compared to placebo
6. Change in post-bronchodilator FEV1 lung function : Change in post-bronchodilator FEV1 from baseline at Weeks 2, 4, 8, 12, 24, 36 and 52 compared to placebo
7. Change in forced expiratory flow (FEF) 25-75% : Change in FEF 25-75% from baseline to Weeks 2, 4, 8, 12, 24, 36, 44 and 52
8. Annualized rate of severe AECOPD : Annualized rate of severe COPD exacerbations compared to placebo over the 52-week treatment period
9. Time to first AECOPD : Time to first moderate or severe COPD exacerbation compared with placebo during the 52-week treatment period
10. Adverse events : Number of adverse events (AEs)/treatment-emergent adverse events (TEAEs)
11. Potentially clinically significant abnormality (PCSA) in laboratory tests : Percentage of patients with at least one incidence of PCSA
12. Anti-drug antibodies : Incidence of anti-drug antibodies against dupilumab |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1. Baseline to week 12
2. 3. 4. 8. 9. Baseline to week 52
5. Baseline to weeks 2, 4, 8, 24, 36, 44
6. Baseline to weeks 2, 4, 8, 12, 24, 36, 52
7. Baseline to weeks 2, 4, 8, 12, 24, 36, 44, 52
10. 11. 12. Baseline through week 64 |
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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 | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
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 | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 78 |
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 |
Argentina |
Chile |
Ukraine |
Canada |
China |
Israel |
Japan |
Korea, Republic of |
Mexico |
Russian Federation |
United States |
Bulgaria |
Czechia |
Denmark |
Finland |
Germany |
Hungary |
Italy |
Poland |
Romania |
Slovakia |
Spain |
Sweden |
Türkiye |
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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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Last visit of the last participant (LVLS). |
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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 | 36 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 36 |