Conjunctivitis, Rhinitis, Allergic
Conditions
Brief summary
This study will evaluate the efficacy and safety of ragweed sublingual tablet (SCH 39641/MK-3641/Amb a 1-U) compared with placebo in participants with ragweed-induced rhinoconjunctivitis over a one-year period. It is expected that ragweed allergic participants on one of the active arms of the trial will have decreased allergic rhinoconjunctivitis symptoms and require less allergy rescue medications during ragweed pollen season.
Interventions
BIOLOGICALAmbrosia artemisiifolia allergen extract (Amb a 1-U)
Rapidly dissolving tablet administered sublingually once daily, at a dose of 1.5, 6 or 12 units.
BIOLOGICALPlacebo
Placebo matching Ambrosia artemisiifolia allergen extract rapidly dissolving tablet, administered sublingually once daily
Sponsors
ALK-Abelló A/S
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Must have a clinical history of significant ragweed-induced allergic rhinoconjunctivitis of at least 2 years duration, with or without asthma and have received treatment during the previous ragweed season (RS). * Must have a positive skin prick test response to Ambrosia artemisiifolia at Screening Visit. * Must be positive for specific immunoglobulin E (IgE) against Ambrosia artemisiifolia at Screening Visit. * Must have an forced expiratory volume in one second (FEV1) of at least 70% of predicted at Screening Visit. * Safety laboratory tests and vital signs conducted at the Screening Visit must be within normal limits or clinically acceptable to the investigator/sponsor. * Must be willing to give written informed consent and be able to adhere to dose and visit schedules. * Female participants of childbearing potential must be using a medically acceptable and adequate form of birth control. These include: hormonal contraceptives as prescribed by a physician (oral, hormonal vaginal ring, hormonal implant or depot injectable); medically prescribed intra-uterine device; medically prescribed topically-applied transdermal contraceptive patch; double-barrier method (eg, condom in combination with a spermicide). * Female participants of childbearing potential should be counseled in the appropriate use of birth control while in the study. Female participants who are not currently sexually active must and consent to use one of the above-mentioned methods if she becomes sexually active during the study. * Female participants of childbearing potential must have a negative urine pregnancy test at Screening Visit. Women who have been surgically sterilized or at least 1 year postmenopausal are not considered to be of childbearing potential.
Exclusion criteria
* Clinical history of symptomatic seasonal allergic rhinitis and/or asthma having received regular medication, due to another during or potentially overlapping the RS. * Clinical history of significant symptomatic perennial allergic rhinitis and/or asthma due to an allergen to which the participant is regularly exposed. * Receipt of an immunosuppressive treatment within 3 months prior to the Screening Visit (except steroids for allergic and asthma symptoms). * Clinical history of severe asthma. * Asthma requiring medium or high dose inhaled corticosteroids (ICS). * History of anaphylaxis with cardiorespiratory symptoms. * History of chronic urticaria and angioedema. * Clinical history of chronic sinusitis 2 years prior to the Screening Visit. * Current severe atopic dermatitis. * Breast-feeding, pregnancy, or intending to become pregnant. * Had previous treatment by immunotherapy with ragweed allergen or any other allergen 5 years prior to Screening Visit. * History of allergy, hypersensitivity or intolerance to the ingredients of the investigational medicinal products (except for Ambrosia artemisiifolia), rescue medications, or self-injectable epinephrine. * Any clinically significant condition or situation, other than the condition being studied that, in the opinion of the investigator, would interfere with the study evaluations or optimal participation in the study. * Use of any investigational drugs within 30 days of Screening Visit. * Participation in any other clinical study. * Being a family member of the study staff. * Inability to meet medication washout requirements. * Unlikely to be able to complete the trial, or likely to travel for an extended time during the RS. * Clinically significant abnormal vital sign or lab value. * Participation in this same study at another site. * Randomized into this study more than once. * Inability to or will not comply with the use of self-injectable epinephrine. * Greater risk of developing adverse reactions after epinephrine administration. * History of self-injectable epinephrine use
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Combined (Sum of) Rhinoconjunctivitis Daily Symptom Score (DSS) and Daily Medication Score (DMS) Averaged Over the Peak Ragweed Season (RS) | The 15-day period during the ragweed season with the highest moving pollen average | The total combined score is a composite endpoint that combines the rhinoconjuntivitis DSS and the rhinoconjunctivitis DMS. The rhinoconjunctivitis DSS consisted of a total of 6 symptoms (runny nose, blocked nose, sneezing, itchy nose, gritty feeling/red/itchy eyes and watery eyes) that were measured on a scale of 0 to 3 (0=no symptoms, 3=severe symptoms; score range: 0-18), with a lower score indicating less rhinoconjunctivitis symptoms. Rhinoconjunctivitis DMS was based on use of specific study-provided rescue medication, with different rescue medications being assigned different scores/dose unit (score range: 0-36), with a lower score indicating less rhinconjunctivitis medication use. The sum of the rhinoconjunctivitis DSS+DMS could range from 0 to 54, with a lower score indicating less rhinoconjuntivitis symptoms and medication use. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average Combined Rhinoconjunctivitis DSS and DMS Over the Entire RS | Approximately 5 weeks | The total combined score is a composite endpoint that combines the rhinoconjuntivitis DSS and the rhinoconjunctivitis DMS. The rhinoconjunctivitis DSS consisted of a total of 6 symptoms (runny nose, blocked nose, sneezing, itchy nose, gritty feeling/red/itchy eyes and watery eyes) that were measured on a scale of 0 to 3 (0=no symptoms, 3=severe symptoms; score range: 0-18), with a lower score indicating less rhinoconjunctivitis symptoms. Rhinoconjunctivitis DMS was based on use of specific study-provided rescue medication, with different rescue medications being assigned different scores/dose unit (score range: 0-36), with a lower score indicating less rhinconjunctivitis medication use. The sum of the rhinoconjunctivitis DSS+DMS could range from 0 to 54, with a lower score indicating less rhinoconjuntivitis symptoms and medication use. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects. |
| Average Rhinoconjunctivitis DSS for the Peak RS | The 15-day period during the ragweed season with the highest moving pollen average | The rhinoconjunctivitis DSS consisted of a total of 6 symptoms (runny nose, blocked nose, sneezing, itchy nose, gritty feeling/red/itchy eyes and watery eyes) that were measured on a scale of 0 to 3 (0=no symptoms, 3=severe symptoms; score range: 0-18), with a lower score indicating less rhinoconjunctivitis symptoms. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects. |
| Average Rhinoconjunctivitis DSS for the Entire RS | Approximately 5 weeks | The rhinoconjunctivitis DSS consisted of a total of 6 symptoms (runny nose, blocked nose, sneezing, itchy nose, gritty feeling/red/itchy eyes and watery eyes) that were measured on a scale of 0 to 3 (0=no symptoms, 3=severe symptoms; score range: 0-18), with a lower score indicating less rhinoconjunctivitis symptoms. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects. |
| Average Rhinoconjunctivitis DMS for the Peak RS | The 15-day period during the ragweed season with the highest moving pollen average | Rhinoconjunctivitis DMS was based on participant use of specific study-provided rescue medication, with different rescue medications being assigned different scores/dose unit (score range: 0-36), with a lower score indicating less rhinconjunctivitis medication use. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| SCH 39641 1.5 Amb a 1-U Participants receive Ambrosia artemisiifolia allergan extract (SCH 39641 1.5 Amb a 1-U) rapidly dissolving sublingual tablets, administered once daily for approximately 52 weeks | 197 |
| SCH 39641 6 Amb a 1-U Participants receive Ambrosia artemisiifolia allergan extract (SCH 39641 6 Amb a 1-U) rapidly dissolving sublingual tablets, administered once daily for approximately 52 weeks | 195 |
| SCH 39641 12 Amb a 1-U Participants receive Ambrosia artemisiifolia allergan extract (SCH 39641 12 Amb a 1-U) rapidly dissolving sublingual tablets, administered once daily for approximately 52 weeks | 194 |
| Placebo Participants receive placebo matching Ambrosia artemisiifolia allergan extract rapidly dissolving sublingual tablets, administered once daily for approximately 52 weeks | 198 |
| Total | 784 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 11 | 17 | 16 | 6 |
| Overall Study | Lost to Follow-up | 9 | 5 | 10 | 3 |
| Overall Study | Noncompliance with Protocol | 7 | 4 | 7 | 9 |
| Overall Study | Withdrawal by Subject | 13 | 17 | 24 | 20 |
Baseline characteristics
| Characteristic | SCH 39641 1.5 Amb a 1-U | SCH 39641 6 Amb a 1-U | SCH 39641 12 Amb a 1-U | Placebo | Total |
|---|---|---|---|---|---|
| Age, Continuous | 36.2 years STANDARD_DEVIATION 8.83 | 36.9 years STANDARD_DEVIATION 8.8 | 35.6 years STANDARD_DEVIATION 8.75 | 36.7 years STANDARD_DEVIATION 8.54 | 36.4 years STANDARD_DEVIATION 8.73 |
| Gender Female | 110 Participants | 103 Participants | 91 Participants | 96 Participants | 400 Participants |
| Gender Male | 87 Participants | 92 Participants | 103 Participants | 102 Participants | 384 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 105 / 196 | 108 / 195 | 125 / 194 | 78 / 198 |
| serious Total, serious adverse events | 5 / 196 | 4 / 195 | 4 / 194 | 1 / 198 |
Outcome results
Primary
Combined (Sum of) Rhinoconjunctivitis Daily Symptom Score (DSS) and Daily Medication Score (DMS) Averaged Over the Peak Ragweed Season (RS)
The total combined score is a composite endpoint that combines the rhinoconjuntivitis DSS and the rhinoconjunctivitis DMS. The rhinoconjunctivitis DSS consisted of a total of 6 symptoms (runny nose, blocked nose, sneezing, itchy nose, gritty feeling/red/itchy eyes and watery eyes) that were measured on a scale of 0 to 3 (0=no symptoms, 3=severe symptoms; score range: 0-18), with a lower score indicating less rhinoconjunctivitis symptoms. Rhinoconjunctivitis DMS was based on use of specific study-provided rescue medication, with different rescue medications being assigned different scores/dose unit (score range: 0-36), with a lower score indicating less rhinconjunctivitis medication use. The sum of the rhinoconjunctivitis DSS+DMS could range from 0 to 54, with a lower score indicating less rhinoconjuntivitis symptoms and medication use. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects.
Time frame: The 15-day period during the ragweed season with the highest moving pollen average
Population: The Full Analysis Set (FAS) population consisted of all randomized participants who took at least one dose of study medication and had at least one post-randomization efficacy measurement.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SCH 39641 1.5 Amb a 1-U | Combined (Sum of) Rhinoconjunctivitis Daily Symptom Score (DSS) and Daily Medication Score (DMS) Averaged Over the Peak Ragweed Season (RS) | 7.70 score on a scale | Standard Error 0.517 |
| SCH 39641 6 Amb a 1-U | Combined (Sum of) Rhinoconjunctivitis Daily Symptom Score (DSS) and Daily Medication Score (DMS) Averaged Over the Peak Ragweed Season (RS) | 6.88 score on a scale | Standard Error 0.526 |
| SCH 39641 12 Amb a 1-U | Combined (Sum of) Rhinoconjunctivitis Daily Symptom Score (DSS) and Daily Medication Score (DMS) Averaged Over the Peak Ragweed Season (RS) | 6.41 score on a scale | Standard Error 0.534 |
| Placebo | Combined (Sum of) Rhinoconjunctivitis Daily Symptom Score (DSS) and Daily Medication Score (DMS) Averaged Over the Peak Ragweed Season (RS) | 8.46 score on a scale | Standard Error 0.535 |
p-value: 0.219295% CI: [-1.98, 0.45]ANOVA
p-value: 0.011395% CI: [-2.8, -0.36]ANOVA
p-value: 0.001595% CI: [-3.3, -0.79]ANOVA
Secondary
Average Combined Rhinoconjunctivitis DSS and DMS Over the Entire RS
The total combined score is a composite endpoint that combines the rhinoconjuntivitis DSS and the rhinoconjunctivitis DMS. The rhinoconjunctivitis DSS consisted of a total of 6 symptoms (runny nose, blocked nose, sneezing, itchy nose, gritty feeling/red/itchy eyes and watery eyes) that were measured on a scale of 0 to 3 (0=no symptoms, 3=severe symptoms; score range: 0-18), with a lower score indicating less rhinoconjunctivitis symptoms. Rhinoconjunctivitis DMS was based on use of specific study-provided rescue medication, with different rescue medications being assigned different scores/dose unit (score range: 0-36), with a lower score indicating less rhinconjunctivitis medication use. The sum of the rhinoconjunctivitis DSS+DMS could range from 0 to 54, with a lower score indicating less rhinoconjuntivitis symptoms and medication use. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects.
Time frame: Approximately 5 weeks
Population: The FAS population consisted of all randomized participants who took at least one dose of study medication and had at least one post-randomization efficacy measurement.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SCH 39641 1.5 Amb a 1-U | Average Combined Rhinoconjunctivitis DSS and DMS Over the Entire RS | 6.22 score on a scale | Standard Error 0.432 |
| SCH 39641 6 Amb a 1-U | Average Combined Rhinoconjunctivitis DSS and DMS Over the Entire RS | 5.81 score on a scale | Standard Error 0.433 |
| SCH 39641 12 Amb a 1-U | Average Combined Rhinoconjunctivitis DSS and DMS Over the Entire RS | 5.18 score on a scale | Standard Error 0.439 |
| Placebo | Average Combined Rhinoconjunctivitis DSS and DMS Over the Entire RS | 7.09 score on a scale | Standard Error 0.441 |
p-value: 0.087895% CI: [-1.88, 0.13]ANOVA
p-value: 0.012595% CI: [-2.29, -0.28]ANOVA
p-value: 0.000395% CI: [-2.95, -0.88]ANOVA
Secondary
Average Rhinoconjunctivitis DMS for the Peak RS
Rhinoconjunctivitis DMS was based on participant use of specific study-provided rescue medication, with different rescue medications being assigned different scores/dose unit (score range: 0-36), with a lower score indicating less rhinconjunctivitis medication use. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects.
Time frame: The 15-day period during the ragweed season with the highest moving pollen average
Population: The FAS population consisted of all randomized participants who took at least one dose of study medication and had at least one post-randomization efficacy measurement.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SCH 39641 1.5 Amb a 1-U | Average Rhinoconjunctivitis DMS for the Peak RS | 2.58 score on a scale | Standard Error 0.322 |
| SCH 39641 6 Amb a 1-U | Average Rhinoconjunctivitis DMS for the Peak RS | 2.01 score on a scale | Standard Error 0.328 |
| SCH 39641 12 Amb a 1-U | Average Rhinoconjunctivitis DMS for the Peak RS | 1.99 score on a scale | Standard Error 0.333 |
| Placebo | Average Rhinoconjunctivitis DMS for the Peak RS | 3.09 score on a scale | Standard Error 0.333 |
p-value: 0.1995% CI: [-1.26, 0.25]ANOVA
p-value: 0.005395% CI: [-1.84, -0.32]ANOVA
p-value: 0.005895% CI: [-1.89, -0.32]ANOVA
Secondary
Average Rhinoconjunctivitis DSS for the Entire RS
The rhinoconjunctivitis DSS consisted of a total of 6 symptoms (runny nose, blocked nose, sneezing, itchy nose, gritty feeling/red/itchy eyes and watery eyes) that were measured on a scale of 0 to 3 (0=no symptoms, 3=severe symptoms; score range: 0-18), with a lower score indicating less rhinoconjunctivitis symptoms. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects.
Time frame: Approximately 5 weeks
Population: The FAS population consisted of all randomized participants who took at least one dose of study medication and had at least one post-randomization efficacy measurement.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SCH 39641 1.5 Amb a 1-U | Average Rhinoconjunctivitis DSS for the Entire RS | 4.24 score on a scale | Standard Error 0.255 |
| SCH 39641 6 Amb a 1-U | Average Rhinoconjunctivitis DSS for the Entire RS | 4.19 score on a scale | Standard Error 0.256 |
| SCH 39641 12 Amb a 1-U | Average Rhinoconjunctivitis DSS for the Entire RS | 3.62 score on a scale | Standard Error 0.259 |
| Placebo | Average Rhinoconjunctivitis DSS for the Entire RS | 4.58 score on a scale | Standard Error 0.261 |
p-value: 0.262295% CI: [-0.93, 0.25]ANOVA
p-value: 0.191495% CI: [-0.99, 0.2]ANOVA
p-value: 0.002195% CI: [-1.57, -0.35]ANOVA
Secondary
Average Rhinoconjunctivitis DSS for the Peak RS
The rhinoconjunctivitis DSS consisted of a total of 6 symptoms (runny nose, blocked nose, sneezing, itchy nose, gritty feeling/red/itchy eyes and watery eyes) that were measured on a scale of 0 to 3 (0=no symptoms, 3=severe symptoms; score range: 0-18), with a lower score indicating less rhinoconjunctivitis symptoms. Raw means were converted to adjusted means using an ANOVA model with baseline asthmatic condition, pollen region and treatment group as fixed effects.
Time frame: The 15-day period during the ragweed season with the highest moving pollen average
Population: The FAS population consisted of all randomized participants who took at least one dose of study medication and had at least one post-randomization efficacy measurement.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SCH 39641 1.5 Amb a 1-U | Average Rhinoconjunctivitis DSS for the Peak RS | 5.11 score on a scale | Standard Error 0.301 |
| SCH 39641 6 Amb a 1-U | Average Rhinoconjunctivitis DSS for the Peak RS | 4.87 score on a scale | Standard Error 0.306 |
| SCH 39641 12 Amb a 1-U | Average Rhinoconjunctivitis DSS for the Peak RS | 4.43 score on a scale | Standard Error 0.311 |
| Placebo | Average Rhinoconjunctivitis DSS for the Peak RS | 5.37 score on a scale | Standard Error 0.311 |
p-value: 0.478195% CI: [-0.96, 0.45]ANOVA
p-value: 0.169595% CI: [-1.21, 0.21]ANOVA
p-value: 0.011895% CI: [-1.67, -0.21]ANOVA