Effect of Omalizumab in Patients With Severe Persistent Non-atopic Uncontrolled Asthma

A 16-week Treatment, Multicenter, Randomized, Double Blind, Placebo-controlled, Parallel-group Study to Assess the Effect of Omalizumab on the Expression of FcεRI Receptors of Blood Basophils and Dendritic Cells in Patients With Severe Persistent Non-atopic Asthma, Uncontrolled Despite Optimal Therapy

Status

Completed

Phases

Phase 3

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT01007149

Acronym

NATAIR

Enrollment

Registered

2009-11-03

Start date

2009-09-30

Completion date

2011-02-28

Last updated

2012-07-20

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Asthma

Keywords

Severe asthma,, non-atopic,, omalizumab

Brief summary

This study will assess the change in the expression of FcεRI receptors of blood basophils and dendritic cells after 16 weeks of treatment with omalizumab as compared with placebo, in adult patients with non-atopic severe persistent asthma, uncontrolled despite optimal therapy.

Interventions

DRUGomalizumab

Omalizumab was supplied in 5mL vials with solution for subcutaneous injection.

DRUGPlacebo

Placebo was supplied in vials with solution for subcutaneous injection.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

BASIC_SCIENCE

Masking

TRIPLE (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

18 Years to 70 Years

Healthy volunteers

Inclusion criteria

Severe persistent asthma with the following characteristics: * Uncontrolled according to Global Initiative for Asthma (GINA) 2007 guidelines and at least 2 exacerbations having required systemic corticosteroid and/or at least 1 hospitalization or emergency room visit in the past year. * Treated with high-dose inhaled corticosteroid (i.e. \> 1,000 µg beclometasone dipropionate equivalent per day) plus inhaled long-acting β2 agonist (with or without maintenance oral corticosteroid). * Non-atopic, i.e. negative blood multiallergic testing and negative Aspergillus-specific IgE-radio allergosorbent blood test and negative skin prick tests to a battery of common aeroallergens

Exclusion criteria

* Current smokers or smoking history stopped for less than 3 years or \> 10 pack years. * Asthma exacerbation during the 4 weeks prior to randomization. * Active lung disease other than non-atopic asthma. * Patients with an active cancer, a suspicion of cancer or any history of cancer with less than 5 disease free years. * Pregnant or nursing (lactating) women. * Treatment with omalizumab. Other protocol-defined inclusion/

Design outcomes

Primary

Measure	Time frame	Description
Change From Baseline in the Expression of FcεRI Receptors of Blood Basophils	Baseline and 16 weeks	Venous blood samples were collected at screening and at Week 16. Flow cytometry analysis determined the FcεRI receptors expression of blood basophils (mean fluorescence intensity(MFI)). Relative change in mean fluorescence intensity at the end of study was expressed as a percentage of baseline value.
Change From Baseline in the Expression of FcεRI Receptors of Dendritic Cells	Baseline and 16 weeks	Venous blood samples were collected at screening and at Week 16. Flow cytometry analysis determined the FcεRI receptors expression of dendritic cells (mean fluorescence intensity (MFI)). Relative change in mean fluorescence intensity at the end of study was expressed as a percentage of baseline value.

Secondary

Measure	Time frame	Description
Change From Baseline in Induced Sputum Eosinophil Count	Baseline and 16 weeks	The induced sputum eosinophil count was measured in a subset of patients in selected centers. Sputum samples were collected at screening and Week 16. Sputum eosinophil count was expressed as a percentage of total nonsquamous cells. Absolute change in sputum eosinophil count was expressed versus baseline value.
Change From Baseline in Score of the Shortened Version of the Asthma Control Questionnaire (Symptoms Plus Short-acting β2-agonist)	Baseline and 16 weeks	The shortened version of the asthma control questionnaire (symptoms plus β2-agonist) consists of 6 subscores (nighttime waking, symptoms on waking, activity limitation, shortness of breath, wheeze and rescue short-acting β2-agonist use) between 0 and 6 (0 = no impairment; 6 = maximum impairment) and a total score between 0 and 6 (subscores mean value). Absolute change in total score and subscores count was expressed versus baseline value. A decrease in score indicates improvement.
Change in Fractional Exhaled Nitric Oxide (FeNO)	Baseline and 4, 8, 12 and 16 weeks	FeNO was measured at baseline, and after 4, 8, 12 and 16 weeks of treatment. Absolute change in FeNO was expressed at each time point versus baseline value.
Physician and Patient Global Evaluation of Treatment Effectiveness	16 weeks	The GETE is an assessment of asthma symptoms controlled in response to asthma treatment. The evaluation was performed independently by both investigator and patient using the same 5 point scale. The scale points are: excellent, good, moderate, poor and worsening. A good or excellent response is suggested as a means of defining a patient who has responded to treatment.
Change in Forced Expiratory Volume in 1 Second (FEV1) From Baseline to 16 Weeks	Baseline and 16 weeks	Spirometry was conducted according to internationally accepted standards. At least three maneuvers were performed at each sampling timepoint. The FEV1 recorded was taken from the maneuver obtained from the single best test curve. The best test curve was defined as the spirogram that gave the largest FEV1.
Change From Baseline in Nasal Symptom Global Score and Individual Components	Baseline and 16 weeks	Nasal symptom score calculated from six scales assessing the nasal symptom severity (sneezing, runny nose, congestion, itchy nose, postnasal drip and nasal symptoms overall). These six scores were rated on a scale from 1 to 7, with 7 being the worst rating. Absolute changes in these six scores were expressed versus baseline values. A negative change indicates improvement. The range of the global score was from 1 to 7, since this is the mean value of all the subscores.
Number of Patients With at Least One Asthma-related Event Over 16 Weeks	16 weeks	Asthma-related events were: unscheduled medical visits, emergency room visits and hospitalizations. Details of exacerbations requiring oral or IV corticosteroids were recorded at each visit.

Countries

France

Participant flow

Pre-assignment details

79 patients were screened. 41 patients received study medication.

Participants by arm

Arm	Count
Omalizumab Participants received subcutaneous injections of omalizumab every 2 weeks or every 4 weeks; dosage dependent on IgE level and body weight.	20
Placebo Participants received subcutaneous injections of placebo to omalizumab every 2 weeks or every 4 weeks.	21
Total	41

Withdrawals & dropouts

Period	Reason	FG000	FG001
Overall Study	Administrative problems	0	1

Baseline characteristics

Characteristic	Omalizumab	Placebo	Total
Age Continuous	55.0 years STANDARD_DEVIATION 9.67	54.6 years STANDARD_DEVIATION 12.78	54.8 years STANDARD_DEVIATION 11.23
Sex: Female, Male Female	13 Participants	13 Participants	26 Participants
Sex: Female, Male Male	7 Participants	8 Participants	15 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	— / —	— / —
other Total, other adverse events	16 / 20	16 / 21
serious Total, serious adverse events	2 / 20	1 / 21

Outcome results

Primary

Change From Baseline in the Expression of FcεRI Receptors of Blood Basophils

Venous blood samples were collected at screening and at Week 16. Flow cytometry analysis determined the FcεRI receptors expression of blood basophils (mean fluorescence intensity(MFI)). Relative change in mean fluorescence intensity at the end of study was expressed as a percentage of baseline value.