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    Summary
    EudraCT Number:2021-003338-35
    Sponsor's Protocol Code Number:D7552C00001
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-03-04
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2021-003338-35
    A.3Full title of the trial
    A Phase 2, Randomised, Double-Blind, Placebo-Controlled Study to Assess Efficacy and Safety of Multiple Dose Levels of Atuliflapon Given Orally Once Daily for Twelve Weeks in Adults with Moderate-to-Severe Uncontrolled Asthma
    Estudio de fase 2, aleatorizado, doble ciego, controlado con placebo para evaluar la eficacia y la seguridad de distintos niveles de dosis de Atuliflapon, en administración oral una vez al día durante 12 semanas, en adultos con asma no controlada de grado moderado o severo
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to Assess the Efficacy and Safety of AZD5718 in Moderate-to-Severe Uncontrolled Asthma
    Estudio para evaluar la eficacia y la seguridad de AZD5718 en el asma no controlada de grado moderado o severo
    A.3.2Name or abbreviated title of the trial where available
    FLASH
    A.4.1Sponsor's protocol code numberD7552C00001
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT05251259
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorAstraZeneca AB
    B.1.3.4CountrySweden
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportAstraZeneca AB
    B.4.2CountrySweden
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAstraZeneca AB
    B.5.2Functional name of contact pointClinical Study Information Center
    B.5.3 Address:
    B.5.3.1Street Addressn/a
    B.5.3.2Town/ cityn/a
    B.5.3.3Post coden/a
    B.5.3.4CountryUnited States
    B.5.6E-mailInformation.Center@astrazeneca.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAtuliflapon
    D.3.2Product code AZD5718
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAtuliflapon
    D.3.9.1CAS number 2041075-86-7
    D.3.9.2Current sponsor codeAZD5718
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAtuliflapon
    D.3.2Product code AZD5718
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAtuliflapon
    D.3.9.1CAS number 2041075-86-7
    D.3.9.2Current sponsor codeAZD5718
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAtuliflapon
    D.3.2Product code AZD5718
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAtuliflapon
    D.3.9.1CAS number 2041075-86-7
    D.3.9.2Current sponsor codeAZD5718
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number125
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 3
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Moderate-to-Severe Uncontrolled Asthma
    Asma no controlada de grado moderado o severo
    E.1.1.1Medical condition in easily understood language
    Asthma (an illness that causes breathing difficulty) that is not fully controlled, so that episodes of breathing difficulty are still occurring despite the use of other available treatments
    Asma (enfermedad que causa dificultad para respirar) no completamente controlada, con episodios de dificultad respiratoria que continúan ocurriendo a pesar del uso de otros tratamientos disponibles.
    E.1.1.2Therapeutic area Diseases [C] - Respiratory Tract Diseases [C08]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10003553
    E.1.2Term Asthma
    E.1.2System Organ Class 10038738 - Respiratory, thoracic and mediastinal disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the clinical efficacy of Atuliflapon as compared to placebo in adult participants with moderate-to-severe uncontrolled asthma
    Evaluar la eficacia clínica de Atuliflapon comparado con placebo en participantes adultos con asma no controlada de grado moderado o severo
    E.2.2Secondary objectives of the trial
    - To evaluate the clinical efficacy of Atuliflapon at different dose levels in adult participants with moderate-to-severe uncontrolled asthma

    - To evaluate the clinical efficacy of Atuliflapon as compared to placebo in adult participants with moderate-to-severe uncontrolled asthma

    For further secondary objectives please refer to the protocol.
    - Evaluar la eficacia clínica de Atuliflapon a diferentes niveles de dosis en participantes adultos con asma no controlada de moderada a grave

    - Evaluar la eficacia clínica de Atuliflapon en comparación con el placebo en participantes adultos con asma no controlada de moderada a grave

    Para obtener más objetivos secundarios, consulte el protocolo.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    A PK/PD sub-study will be conducted in a sub-set of participants randomised in Part 1 and Part 2. As part of this sub-study, additional PK and PD blood samples will be collected.
    Se realizará un subestudio de farmacoquinética/farmacodinámica en un subconjunto de participantes asignados al azar en la Parte 1 y la Parte 2. Como parte de este subestudio, se recolectarán muestras de sangre adicionales para su análisis farmacoquinético/farmacodinámico
    E.3Principal inclusion criteria
    Lead-in PK Cohort - Recruitment Completed
    1.Provision of signed informed consent prior to any study-specific procedures.
    2.Participant is willing and able to follow study procedures and restrictions.
    3.18 to 55 years of age inclusive at the time of signing the ICF at Screening (Visit 1).
    4.Bodyweight 50 to 120 kg (inclusive) and BMI 18 to 32 kg/m2 (inclusive) at Screening (Visit 1).
    5.Documented asthma diagnosis >= 12 months prior to Screening (Visit 1).
    6.Able to perform acceptable lung function testing for FEV1 according to ATS/ERS 2019 acceptability criteria.
    7.Documented evidence of asthma.
    8.Morning pre-BD FEV1 >= 40% predicted at Screening (Visit 1) and Visit 2.
    9.Treated with low dose ICS-LABA or medium-high dose ICS alone or in combination with LABA at a stable dose for at least 3 months prior to Screening (Visit 1). (The ICS can be contained within an ICS-LABA fixed dose combination product)
    -Treatment with additional asthma controller therapies (eg, LAMA) at a stable dose >= 3 months prior to Screening (Visit 1) is allowed. Treatment with LTRAs or 5-LO inhibitors is not allowed (see exclusion criteria).
    10.Able and willing to comply with the requirements of the CSP including ability to read, write, be fluent in the translated language of all participants facing questionnaires used at site, and use electronic devices (eg, spirometer).
    11.Participant's influenza/pneumonia vaccination is up to date as per local guidelines prior to Visit 2.
    12.For female participants, a negative serum pregnancy test at Screening (Visit 1) and a negative urine pregnancy test prior to administration of study intervention (Visit 2).
    13.Contraceptive use by female participants should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. There are no restrictions on male participants or their female partners.

    Part 1 and Part 2

    1.Capable of giving signed informed consent.
    2.Provision of signed and dated written Optional Genetic Research Information informed consent prior to collection of samples for optional genetic research that supports Genomic Initiative.
    3.Participant is willing and able to follow study procedures and restrictions.
    4.Participant must be 18 to 80 years of age inclusive, at the time of signing the ICF.
    5.Body weight >= 40 kg and BMI < 35 kg/m2.
    6.Documented physician-diagnosed asthma >= 12 months prior to Screening (Visit 1).
    7.Able to perform acceptable lung function testing for FEV1 according to ATS/ERS 2019 acceptability criteria.
    8.Documented evidence of asthma.
    9.Morning pre-BD FEV1 between >= 40% and <= 85% predicted at Screening (Visit 1) and Visit 3.
    10.Documented history of >= 1 severe asthma exacerbation within 3 years prior to Screening (Visit 1).
    11.Treated with low dose ICS-LABA or medium-high dose ICS alone or in combination with LABA at a stable dose for at least 3 months prior to Screening (Visit 1). (The ICS can be contained within an ICS-LABA fixed
    dose combination product).
    -Treatment with additional asthma controller therapies (eg, LAMA) at a stable dose >= 3 months prior to Screening (Visit 1) is allowed. Treatment with LTRAs or 5-LO inhibitors is not allowed.
    12.An ACQ-6 score >= 1.5 at Screening (Visit 1) and at Visit 3.
    13.Able and willing to comply with the requirements of the CSP including ability to read, write, be fluent in the translated language of all participants facing questionnaires used at site, and use electronic devices, eg, eCOA device and spirometry.
    14.At least 80% compliance with usual asthma background medication during run-in period (from Visit 2 to Visit 3) based on the daily asthma ePROs.
    15. Minimum 80% compliance with daily eCOA assessments. Compliance is defined as completing the daily ePRO questions and PEF measurement at least 80% of the time during the run-in period and during the 14 days preceding Visit 3.
    16.For female participants, a negative serum pregnancy test at Screening (Visit 1) and negative urine pregnancy test at Visit 3.
    17.Contraceptive use by female participants should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. There are no restrictions on male participants or their female partners.

    Please refer to the protocol for the full list of inclusion criteria.
    Cohorte PK inicial - Reclutamiento completado
    1. Suministro de un consentimiento informado firmado antes de cualquier procedimiento específico del estudio.
    2. El participante está dispuesto y es capaz de seguir los procedimientos y restricciones del estudio.
    3. Edad de 18 a 55 años (ambas inclusive) al momento de firmar el ICF en la Selección (Visita 1).
    4.Peso corporal de 50 a 120 kg (inclusive) e IMC de 18 a 32 kg/m2 (inclusive) en la selección (visita 1).
    5.Diagnóstico de asma documentado >= 12 meses antes de la selección (visita 1).
    6. Capaz de realizar pruebas de función pulmonar aceptables para FEV1 de acuerdo con los criterios de aceptabilidad de ATS/ERS 2019.
    7. Evidencia documentada de asma.
    8. FEV1 matutino pre-BD >= 40 % previsto en la selección (visita 1) y visita 2.
    9. Tratado con dosis bajas de ICS-LABA o ICS a dosis media-alta solos o en combinación con LABA a una dosis estable durante al menos 3 meses antes de la selección (visita 1). (El ICS puede estar contenido dentro de un producto de combinación de dosis fija ICS-LABA)
    - Se permite el tratamiento con terapias adicionales para controlar el asma (p. ej., LAMA) a una dosis estable >= 3 meses antes de la selección (visita 1). No se permite el tratamiento con LTRAs o inhibidores de 5-LO (ver criterios de exclusión).
    10. Capaz y dispuesto a cumplir con los requisitos del protocolo, incluida la capacidad de leer, escribir, hablar con fluidez el idioma traducido de todos los cuestionarios para participantes utilizados en el sitio, y a utilizar dispositivos electrónicos (por ejemplo, espirómetro).
    11. La vacuna contra la gripe/neumonía del participante está actualizada según las pautas locales antes de la visita 2.
    12. Para las participantes femeninas, una prueba de embarazo en suero negativa en la Selección (Visita 1) y una prueba de embarazo en orina negativa antes de la administración de la intervención del estudio (Visita 2).
    13. El uso de anticonceptivos por parte de las mujeres participantes debe ser consistente con las regulaciones locales con respecto a los métodos anticonceptivos para quienes participan en estudios clínicos. No hay restricciones para los participantes masculinos o sus parejas femeninas.


    Parte 1 y Parte 2

    1. Capaz de dar consentimiento informado firmado.
    2. Suministro de Consentimiento Informado de Investigación Genética Opcional por escrito, firmado y fechado, antes de la recolección de muestras para la investigación genética opcional que realiza Genomic Initiative.
    3. El participante está dispuesto y es capaz de seguir los procedimientos y restricciones del estudio.
    4. El participante debe tener entre 18 y 80 años de edad, ambos inclusive, al momento de firmar el ICF.
    5. Peso corporal >= 40 kg e índice de masa corporal (IMC) < 35 kg/m2.
    6. Asma documentada diagnosticada por un médico >= 12 meses antes de la Visita 1.
    7. Capaz de realizar pruebas de función pulmonar a niveles aceptables para FEV1 según los criterios de aceptabilidad ATS/ERS 2019.
    8. Evidencia documentada de asma.
    9. FEV1 matutino pre-BD entre >=40 % y <=85 % predicho en la Visita 1 y en la Visita 3.
    10. Historial documentado de >= 1 exacerbación grave del asma en los 3 años anteriores a la Visita 1.
    11. Tratado con dosis bajas de ICS-LABA o dosis media-alta de ICS (según el Apéndice C de la tabla de equivalencia GINA 2021 ICS) solo o en combinación con LABA a una dosis estable para al menos 3 meses antes de la Visita 1.(El ICS puede estar contenido dentro de un producto de combinación de dosis fija ICS-LABA).
    - Se permite el tratamiento con terapias adicionales de control del asma (p. ej., LAMA) a una dosis estable >= 3 meses antes de la Visita 1. (No se permite el tratamiento con LTRA o inhibidores de 5-LO.
    12. Una puntuación ACQ-6 >= 1,5 en la Visita 1 y en la Visita 3.
    13. Capaz y dispuesto a cumplir con los requisitos del protocolo, incluida la capacidad de leer, escribir, hablar con fluidez el idioma traducido de todos los cuestionarios para participantes utilizados en el sitio, y a utilizar dispositivos electrónicos, por ejemplo, dispositivo eCOA y espirometría.
    14. Al menos un 80 % de cumplimiento con la medicación de base habitual para el asma durante el período de preinclusión (desde la visita 2 a la visita 3) según los ePRO (Resultados Informados por los Pacientes electrónicamente) diarios para el asma.
    15. Cumplimiento mínimo del 80 % con las evaluaciones diarias de eCOA (Evaluación de Resultádos Clínicos electrónica). El cumplimiento se define como completar las preguntas diarias de ePRO y la medición del PEF al menos el 80 % del tiempo durante el período de prueba y durante los 14 días anteriores a la visita 3.
    16. Para las participantes femeninas, una prueba de embarazo en suero negativa en la Selección (Visita 1) y una prueba de embarazo en orina negativa (Visita 3).


    Ver lista completa de criterios en el protocolo.
    E.4Principal exclusion criteria
    1. A severe asthma exacerbation within 8 weeks of randomisation Screening (Visit 1).
    2. A positive test result of an approved antigen test (confirmed by a
    positive RT-PCR) or a positive RT-PCR test for SARS-CoV-2, the
    virus responsible for COVID-19.
    3. Participants with a significant COVID-19 illness within 6 months of enrolment:
    - Participants with a diagnosis of COVID-19 pneumonia based on radiological assessment.
    - Participants with a diagnosis of COVID-19 requiring hospitalisation and/or oxygen supplementation therapy.
    4. Clinically important pulmonary disease other than asthma eg, active lung infection,
    COPD, bronchiectasis, pulmonary fibrosis, cystic fibrosis, hypoventilation syndrome
    associated with obesity, lung cancer, history or planned lung lobectomy, alpha-1
    anti-trypsin deficiency, primary ciliary dyskinesia, Churg-Strauss syndrome, allergic
    bronchopulmonary aspergillosis and hyper-eosinophilic syndrome.
    5. Any disorder, including, but not limited to, cardiovascular, gastrointestinal, hepatic, renal,
    neurological, musculoskeletal, infectious, endocrine, metabolic, haematological,
    psychiatric, or major physical impairment that is not stable in the opinion of the
    investigator and could:
    - Affect the safety of the participant throughout the study.
    - Influence the findings of the study or the interpretation.
    - Impede the participant's ability to complete the entire duration of study.
    6. Any clinically significant cardiac disease:
    - Acute coronary syndrome (acute myocardial infarction, unstable angina), coronary intervention with percutaneous coronary intervention/coronary artery bypass surgery or stroke within 6 months.
    - Heart failure NYHA II-IV.
    - Untreated high degree atrioventricular-block (>= 3:1 conduction rate/Grade III block)/
    significant sinus node dysfunction/pause or therapy requiring tachyarrhythmia.
    - History or family history of long QT-syndrome.
    - History of QT prolongation associated with other medications that required discontinuation of that medication.
    - Hypertrophic cardiomyopathy or clinically significant valvular heart disease.
    - Stroke within 3 months of Screening (Visit 1).
    7. History of severe renal disease (CKD stage 4 or 5) or history of creatinine clearance < 30 mL/min × m2 calculated using Cockcroft-Gault equation.
    8. Severe hepatic impairment (Child-Pugh class C).
    9. Previous hepatotoxicity related to zileuton or LTRAs (eg montelukast)
    10. Participants with a recent history of, or who have a positive test for, infective hepatitis or
    unexplained jaundice, or participants who have been treated for hepatitis B, hepatitis C, or
    HIV. For the hepatitis B testing (HbsAg, anti-HBs, and anti-HBc), any of the following
    would exclude the participant from the study:
    - Participants positive for HbsAg.
    - Participants positive for anti-HBc.
    11. Evidence of active or untreated latent TB:
    - Positive IGRA, or repeated indeterminate IGRAs, untreated LTBI (unable to be treated for, or declines treatment of LTBI).
    - Participants newly diagnosed with LTBI at Visit 1 could be considered for rescreening if they complete a full course of treatment for LTBI in accordance with recommended treatment guidelines prior to rescreening. In this situation, repeat IGRA test is not required after completion of treatment for LTBI.
    - Participants with an indeterminate IGRA should undergo a repeat test and if still indeterminate may be enrolled only after being treated for LTBI.
    12. Abnormal findings identified on physical examination, ECG, or
    laboratory testing include, but are not limited to:
    - ALT or AST >= 2 × ULN.
    - TBL >= 1.5 × ULN (unless due to Gilbert's disease).
    - Evidence of chronic liver disease.
    - Abnormal vital signs, after 5 minutes of supine or sitting rest (confirmed by one controlled measurement), defined as any of the following:
    o SBP < 80 mmHg or >= 150 mmHg.
    o DBP < 50 mmHg or >= 95 mmHg.
    o Pulse < 45 or > 100 beats per minute.
    - Signs of pulmonary oedema or volume overload.
    - Any clinically significant rhythm, conduction, or morphology abnormalities in the ECG including but not limited to QTcF > 450 ms.

    Please refer to the protocol for the full list of exclusion criteria.
    1. Una exacerbación grave del asma en las 8 semanas posteriores a la Sellección (Visita 1).
    2. Un resultado positivo de una prueba de antígeno aprobada (confirmado por una RT-PCR positiva) o una prueba de RT-PCR positiva para SARS-CoV-2, el virus responsable del COVID-19.
    3. Participantes con una enfermedad significativa de COVID-19 en los 6 meses posteriores a la inscripción:
    - Participantes con diagnóstico de neumonía por COVID-19 basado en evaluación radiológica.
    - Participantes con diagnóstico de COVID-19 que requieran hospitalización y/o oxigenoterapia.
    4. Enfermedad pulmonar clínicamente importante distinta del asma, por ejemplo, infección pulmonar activa,
    EPOC, bronquiectasias, fibrosis pulmonar, fibrosis quística, síndrome de hipoventilación asociado con obesidad, cáncer de pulmón, antecedentes o lobectomía pulmonar planificada, alfa-1 deficiencia de antitripsina, discinesia ciliar primaria, síndrome de Churg-Strauss, alergia aspergilosis broncopulmonar y síndrome hipereosinofílico.
    5. Cualquier trastorno, incluidos pero no limitados a, entre otros, cardiovasculares, gastrointestinales, hepáticos, renales, neurológicos, musculoesqueléticos, infecciosos, endocrinos, metabólicos, hematológicos, discapacidad psiquiátrica o física importante que no es estable en la opinión del investigador y pudiese:
    - Afectar la seguridad del participante a lo largo del estudio.
    - Influir en los hallazgos del estudio o en la interpretación.
    - Impedir la capacidad del participante para completar toda la duración del estudio.
    6. Cualquier enfermedad cardíaca clínicamente significativa:
    - Síndrome coronario agudo (infarto agudo de miocardio, angina inestable), intervención coronaria con intervención coronaria percutánea/cirugía de derivación coronaria o ictus en los 6 meses anteriores.
    - Insuficiencia cardiaca NYHA II-IV.
    - Bloqueo auriculoventricular de alto grado no tratado (tasa de conducción >= 3:1/bloqueo de grado III)/
    disfunción/pausa significativa del nodo sinusal o terapia que requiere taquiarritmia.
    - Antecedentes o antecedentes familiares de síndrome de QT largo.
    - Antecedentes de prolongación del intervalo QT asociada con otros medicamentos que requirieron la suspensión de ese medicamento.
    - Miocardiopatía hipertrófica o valvulopatía cardíaca clínicamente significativa.
    - Accidente cerebrovascular en los 3 meses posteriores a la Selección (Visita 1).
    7. Antecedentes de enfermedad renal grave (ERC estadio 4 o 5) o antecedentes de aclaramiento de creatinina < 30 ml/min × m2 calculado mediante la ecuación de Cockcroft-Gault.
    8. Insuficiencia hepática grave (Child-Pugh clase C).
    9. Hepatotoxicidad previa relacionada con zileuton o LTRA (p. ej., montelukast)
    10. Los participantes con antecedentes recientes o que tengan una prueba positiva para hepatitis infecciosa o ictericia inexplicable, o participantes que han sido tratados por hepatitis B, hepatitis C o VIH. Para la prueba de hepatitis B (HbsAg, anti-HBs y anti-HBc), cualquiera de los siguientes resultados excluiría al participante del estudio:
    - Participantes positivos para HbsAg.
    - Participantes positivos para anti-HBc.
    11. Evidencia de TB activa o latente no tratada:
    - IGRA positivo o IGRA indeterminados repetidos, sin tratamiento para LTBI (incapaz de ser tratado o rechaza el tratamiento de LTBI).
    - Los participantes recién diagnosticados con LTBI en la Visita 1 podrían ser considerados para una nueva evaluación si completan un curso completo de tratamiento para LTBI de acuerdo con las pautas de tratamiento recomendadas antes de la nueva evaluación. En esta situación, no se requiere repetir la prueba IGRA después de completar el tratamiento para LTBI.
    - Los participantes con un IGRA indeterminado deben someterse a una prueba repetida y, si todavía es indeterminado, pueden inscribirse solo después de recibir tratamiento para LTBI.
    12. Los hallazgos anormales en el examen físico, ECG, o las pruebas de laboratorio, incluyen pero no se limitan a:
    - ALT o AST >= 2 × LSN.
    - TBL >= 1,5 × ULN (a menos que se deba a la enfermedad de Gilbert).
    - Evidencia de enfermedad hepática crónica.
    - Signos vitales anormales, después de 5 minutos de reposo en decúbito supino o sentado (confirmados por una medición controlada), definidos como cualquiera de los siguientes:
    o PAS < 80 mmHg o >= 150 mmHg.
    o PAD < 50 mmHg o >= 95 mmHg.
    o Pulso < 45 o > 100 latidos por minuto.



    Consulte el protocolo para ver la lista completa de criterios de exclusión.
    E.5 End points
    E.5.1Primary end point(s)
    Time to first CompEx Asthma event
    Tiempo hasta el primer acontecimiento de CompEx Asthma
    E.5.1.1Timepoint(s) of evaluation of this end point
    Week 12
    Semana 12
    E.5.2Secondary end point(s)
    Clinical efficacy endpoints: change from baseline in:
    1 pre-BD FEV1: Baseline, Week 4, and Week 12
    2 SGRQ: Baseline, Week 4, and Week 12

    Clinical efficacy endpoints: change from baseline in:
    1 ACQ-6: Baseline, Week 4, Week 8, Week 12, and average over the 12-week treatment period
    2 average morning and average evening PEF: Baseline, Week 4, Week 8, Week 12, and average over the 12-week treatment period
    3 daily asthma symptom score (total, daytime, and night-time): Baseline, Week 4, Week 8, Week 12, and average over the 12-week treatment period

    Clinical efficacy endpoints:
    1 time to first severe asthma exacerbation
    2 event status (CompEx Asthma event yes/no)

    To evaluate the PK of Atuliflapon :
    1 Atuliflapon plasma concentrations and PK parameters
    2 Atuliflapon plasma concentrations: post-dose samples taken at Week 4
    3 Atuliflapon plasma concentrations: pre-dose samples at Baseline, Week 4, and Week 12

    Safety Endpoints:
    Safety and tolerability evaluations using AEs, vital sign measures, clinical laboratory assessments, ECG and C-SSRS

    Exploratory Endpoints:

    - Change from baseline in:
    1 Post BD FEV1: Baseline, and Week 12
    2 Percent reversibility: Baseline and Week 12
    3 Forced expiratory flow 25-75%: Baseline, Week 4, and Week 12

    - Change from baseline in FeNO: Baseline, Week 4, and Week 12

    - Change from baseline in cough VAS: Baseline, Week 4, and Week 12 and over the treatment period

    - Change from baseline in:
    1 home spirometry assessment: Baseline, Week 4 and Week 12

    - Change from baseline in:
    1 time to first CompEx Asthma event
    2 Pre-BD FEV1: Baseline, Week 4 and Week 12
    3 ACQ-6 and SGRQ: Baseline, Week 4, and Week 12
    4 FeNO: Baseline to Week 4 and Week 12

    - Blood and urine biomarker concentrations including Type 1, Type 2, and Type 17 cytokines and
    other arachidonic acid metabolites at baseline, Week 4, and Week 12

    - Endpoints:
    1 Creatinine normalised uLTE4, plasma LTE4
    2 Creatinine normalised uLTE4, plasma LTE4, plasma LTB4 (ex-vivo stimulation) at Week 4
    3 Blood and urine biomarker concentrations including LTE4, LTB4, pre-dose samples: Baseline, Week 4, and Week 12

    For full information please refer to the protocol.
    Criterios de valoración de la eficacia clínica: cambio frente al basal en:
    1 FEV1 antes de broncodilatador (pre-BD): Basal, Semana 4 y Semana 12
    2 SGRQ: Basal, Semana 4 y Semana 12

    Criterios de valoración de la eficacia clínica: cambio frente al basal en:
    1 ACQ-6: Basal, Semana 4, Semana 8, Semana 12 y promedio a lo largo del periodo de tratamiento de 12 semanas
    2 valor promedio del PEF matutino y del vespertino: Basal, Semana 4, Semana 8, Semana 12 y promedio a lo largo del periodo de tratamiento de 12 semanas
    3 puntuación diaria de los síntomas asmáticos (total, diurna y nocturna): Basal, Semana 4, Semana 8, Semana 12 y promedio a lo largo del periodo de tratamiento de 12 semanas

    Criterios de valoración de la eficacia clínica:
    1 tiempo hasta la primera crisis asmática severa
    2 estado de acontecimientos (acontecimientos de CompEx Asthma, sí/no)

    Para evaluar el PK de Atuliflapon :
    1 concentraciones plasmáticas y parámetros farmacocinéticos de Atuliflapon
    2 concentraciones plasmáticas de Atuliflapon : muestras posdosis tomadas en la Semana 4
    3 concentraciones plasmáticas de Atuliflapon : muestras predosis en Basal, Semana 4 y Semana 12

    Puntos finales de seguridad:
    evaluaciones de la seguridad y la tolerabilidad utilizando los acontecimientos adversos, valores de las constantes vitales, determinaciones de laboratorio, ECG y C-SSRS

    Criterios de valoración exploratorios:

    - Cambio frente al basal en:
    1 post BD FEV1: basal y semana 12
    2 Porcentaje de reversibilidad: basal y semana 12
    3 Flujo espiratorio forzado 25-75 %: basal , semana 4 y semana 12

    - Cambio frente al basal en FeNO: basal , semana 4 y semana 12

    - Cambio frente al basal en la EVA para la tos: basal , semana 4 y semana 12 y durante el período de tratamiento

    - Cambio frente al basal en:
    1 evaluación de espirometría en el hogar: basal , semana 4 y semana 12

    - Cambio frente al basal en:
    1 vez al primer evento de asma CompEx
    2 FEV1 Pre-BD: basal , semana 4 y semana 12
    3 ACQ-6 y SGRQ: basal , semana 4 y semana 12
    4 FeNO: basal a la semana 4 y la semana 12

    - Concentraciones de biomarcadores en sangre y orina, incluidas las citoquinas tipo 1, tipo 2 y tipo 17 y
    otros metabolitos del ácido araquidónico al inicio, semana 4 y semana 12

    - Puntos finales:
    1 Creatinina normalizada uLTE4, plasma LTE4
    2 Creatinina normalizada uLTE4, plasma LTE4, plasma LTB4 (estimulación ex vivo) en la semana 4
    3 Concentraciones de biomarcadores en sangre y orina, incluidos LTE4, LTB4, muestras previas a la dosis: línea de base, semana 4 y semana 12

    Para obtener información completa, consulte el protocolo.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Baseline, Week 4, Week 8 and Week 12
    Basal, Semana 4, Semana 8 y Semana 12
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial4
    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.8.4.1Number of sites anticipated in Member State concerned6
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA116
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Chile
    Australia
    Bulgaria
    Croatia
    France
    Germany
    Hungary
    Italy
    Japan
    Korea, Republic of
    Mexico
    Netherlands
    Poland
    Romania
    Serbia
    Slovakia
    Slovenia
    South Africa
    Spain
    Turkey
    United Kingdom
    United States
    E.8.7Trial 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
    LSLV
    Última Visita del Último Paciente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months10
    E.8.9.1In the Member State concerned days5
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months10
    E.8.9.2In all countries concerned by the trial days5
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 1011
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 253
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state57
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 430
    F.4.2.2In the whole clinical trial 1264
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-06-06
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-03-18
    P. End of Trial
    P.End of Trial StatusOngoing
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