E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Chronic Spontaneous Urticaria |
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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] - Skin and Connective Tissue Diseases [C17] |
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 | 10072757 |
E.1.2 | Term | Chronic spontaneous urticaria |
E.1.2 | System Organ Class | 10040785 - Skin and subcutaneous tissue 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 demonstrate therapeutic equivalence between BP11 and Xolair in patients with chronic spontaneous urticaria (CSU) with an inadequate response to H1 antihistamine (H1AH) treatment |
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E.2.2 | Secondary objectives of the trial |
- To assess and compare other efficacy parameters between BP11 and Xolair over time;
- To assess and compare safety and tolerability between BP11 and Xolair over the entire study period;
- To assess and compare immunogenicity between BP11 and Xolair over the study;
- To assess and compare the PK between BP11 and Xolair over the study;
- To assess and compare the PD between BP11 and Xolair. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Male or female patients 18 to 75 years of age (inclusive) willing and able to provide informed consent
- A diagnosis of CSU for at least 6 months before randomization
- A diagnosis of CSU refractory to H1AH treatment as defined in the protocol
- Able to provide patient e-diary entries (without missing data) for the last 7 consecutive days before randomization
- Patient must be willing to complete e-diary twice daily (morning and evening). Able to provide e-diary entries for at least 4 consecutive days
out of 7 days before randomization.
- Females of childbearing potential (FOCBP) and males with a female partner of childbearing potential must be willing to use reliable
contraceptive precautions (refer to Appendix 1 for details) throughout the study until 6 months after the last study treatment dose.
- If the patient is an FOCBP, they should have a negative pregnancy test result at the Screening and Baseline visits |
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E.4 | Principal exclusion criteria |
- Known history of hypersensitivity or allergic reactions to omalizumab or any of its excipients
- Previous exposure to omalizumab (Xolair or biosimilar omalizumab)
- Clearly defined underlying etiology for chronic urticarias other than CSU. This includes solar, cholinergic, heat, cold, aquagenic, delayed pressure, or contact urticarias
- Any of the following diseases, which may have symptoms of urticaria and/or angioedema: urticarial vasculitis, urticaria pigmentosa, erythema multiforme, mastocytosis, hereditary or acquired angioedema, lymphoma, leukemia, or generalized cancer
- History of and/or current disease as defined in the protocol
- History of and/or current disease as defined in the protocol
- Proof of a COVID-19 vaccination within the 2 weeks before randomization
- History of and/or an ongoing use of medications as defined in the protocol
- History of and/or an ongoing use of medications as defined in the protocol
- Any contraindication to use of diphenhydramine
- Diagnosed with parasitic diseases or colonization on stool evaluation for ova and parasites
- Current or history of drug or alcohol abuse within the past year based on the investigator’s judgment
- Contraindication to background therapy and/or rescue therapy with H1AHs or contraindication to epinephrine or other components of these agents as per the investigator’s discretion
- To ensure complete systemic elimination of the study drug, any female who is currently pregnant or breastfeeding or plans to become pregnant or breastfeed for 6 months after the last dose of assigned study treatment or any male who is planning to father a child or
donate sperm during the study period or for 6 months after the last dose of assigned study treatment
- Presence of clinically significant cardiovascular, neurological, psychiatric, metabolic, hepatic, or other pathological conditions that could interfere with the interpretation of the study results and/or compromise the safety of the patients in the opinion of the investigator
- Inability to comply with the study and follow-up procedures
- History of and/or concomitant immune complex disease (including allergic reaction type III), hyperimmunoglobulin E syndrome,
autoimmune disease (which impact the study objectives at the discretion of investigator), or bronchopulmonary aspergillosis.
- Active infection requiring treatment 4 weeks before Screening. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Change from Baseline in weekly Itch Severity Score (ISS7) at Week 12 |
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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) |
Change from Baseline in ISS7 at Weeks 2, 4, 8, 16, 20, and 24
Change from Baseline in weekly Urticaria Activity Score (UAS7) at
Weeks 2, 4, 8, 12, 16, 20, and 24
Percentage of patients with UAS7 of ≤6 at Weeks 2, 4, 8, 12, 16, 20, and 24
Percentage of complete responders (UAS7 = 0) in UAS7 at Weeks 2, 4, 8, 12, 16, 20, and 24
Change from Baseline in weekly Hives Severity Score (HSS7) at Weeks 2, 4, 8, 12, 16, 20, and 24
Change from Baseline in the overall Dermatology Life Quality Index (DLQI) score at Weeks 4, 8, 12, 16, 20, and 24
Use of rescue medication up to scheduled efficacy time points and over the study (at Weeks 2, 4, 8, and 12, and by treatment period)
Incidence, nature, and severity of adverse events (AEs) including adverse drug reactions graded according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.0 as defined by treatment-emergent AEs (TEAEs), serious AEs (SAEs), AEs of special interest (AESIs), related TEAEs, and related SAEs during Treatment Period 1 (TP1) and Treatment Period 2 (TP2)
Injection-site and hypersensitivity reactions at Baseline (Week 0 after first study drug dose) and at Weeks 4, 8, 12, 16, and 20, and throughout the study
Physical examinations, vital signs, and 12-lead electrocardiograms (ECGs) throughout the study
Laboratory parameters (hematology, serum chemistry, and urinalysis)
throughout the study
Incidence of antidrug antibodies (ADAs) and neutralizing antibodies
(NAbs) and ADA titers to omalizumab measured during TP1 at Baseline
(Week 0) and at Weeks 4 and 12
Incidence of ADAs and NAbs and ADA titers to omalizumab measured during TP2 at Weeks 20, 24, and 40
Trough serum concentration (Ctrough) of omalizumab during TP1 at Baseline and at Weeks 4 and 12
Trough serum concentration (Ctrough) of omalizumab during TP2 at Weeks 20, 24, and 40
Total IgE and free IgE levels in serum during TP1 at Baseline (Week 0) and at Weeks 4 and 12
Total IgE and free IgE levels in serum during TP2 at Weeks 20, 24, and 40
Incidence, nature, and severity of AEs including adverse drug reactions graded according to the NCI CTCAE v5.0 as defined by TEAEs, SAEs, AESIs, related TEAEs, and related SAEs during TP2 for patients who switch treatment
Injection-site and hypersensitivity reactions during TP2 for patients who switch treatment
Physical examinations, vital signs, and 12-lead ECGs during TP2 for patients who switch treatment
Laboratory parameters (hematology, clinical chemistry, and urinalysis)
during TP2 for patients who switch treatment
Incidence of ADAs and NAbs and ADA titers to omalizumab measured during TP2 for patients who switch treatment |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
As specified within the list of endpoints |
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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 | Yes |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
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 |
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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 | 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) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 4 |
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 | 24 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 70 |
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 |
Georgia |
India |
Bulgaria |
Czechia |
Hungary |
Latvia |
Lithuania |
Poland |
Slovakia |
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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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | 11 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 7 |
E.8.9.2 | In all countries concerned by the trial days | 11 |