12-Month OL Intranasal Fluticasone Propionate BID Using OptiNose Device

12-Month OL Evaluating the Safety of Intranasal Administration Fluticasone BID Using OptiNose Device in Subjects With CS With or Without Nasal Polyps

Status

Completed

Phases

Phase 3

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT01623310

Enrollment

223

Registered

2012-06-19

Start date

2013-09-30

Completion date

2015-10-31

Last updated

2018-01-24

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

Conditions

Nasal Polyps

Brief summary

This is an open-label, multicenter study designed to assess the safety of intranasal administration of 400 μg of fluticasone propionate twice a day delivered by the OptiNose device in subjects with chronic sinusitis with or without nasal polyps. The study consists of an up-to-7-day pretreatment phase followed a 12-month open-label treatment phase. The duration of each subject's participation is approximately 53 weeks.

Interventions

DRUGFluticasone Propionate

Using Optinose Exhalation Delivery System

Study design

Allocation

Intervention model

SINGLE_GROUP

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

* Men or women aged 18 years and older Women must * be practicing an effective method of birth control (eg, prescription oral contraceptives, contraceptive injections, contraceptive patch, intrauterine device, double-barrier method \[eg, condoms, diaphragm, or cervical cap with spermicidal foam, cream, or gel\], or male partner sterilization) before entry and throughout the study, or * be surgically sterile (have had a hysterectomy or bilateral oophorectomy, or tubal ligation at least 1 year before screening) or otherwise be incapable of pregnancy, or * be postmenopausal (spontaneous amenorrhea for at least 1 year). * Women of child-bearing potential must have a negative serum beta-human chorionic gonadotropin (β-hCG) pregnancy test at the screening visit * Have either: a history of chronic sinusitis with bilateral nasal polyposis determined by nasoendoscopy at screening visit OR a history of chronic sinusitis (without polyps) for equal to or greater than 12 weeks and currently experiencing 2 or more of the following symptoms, one of which MUST be either nasal blockage/congestion or nasal discharge (anterior and/or posterior nasal discharge): 1. nasal blockage/congestion 2. nasal discharge (anterior and/or posterior nasal discharge) 3. facial pain or pressure 4. reduction or loss of smell * Subjects with comorbid asthma or COPD must be stable with no exacerbations (eg, no emergency room visits, hospitalizations, or oral or parenteral steroid use)within the 3 months before the screening visit. Inhaled corticosteroid use must be limited to stable doses of no more than 1,000 μg/day of beclomethasone (or equivalent; See Attachment 1) for at least 3 months before screening with plans to continue use throughout the study. * Must be able to cease treatment with intranasal steroids and inhaled corticosteroids (except permitted doses listed above for asthma and COPD) at the screening visit * Must be able to use the OptiNose device correctly; all subjects will be required to demonstrate correct use of the placebo device at the screening visit, see Section 12.1, Visit 1, screening procedures. * Must be capable, in the opinion of the investigator, of providing informed consent to participate in the study. Subjects must sign an informed consent document indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study.

Exclusion criteria

* Women who are pregnant or lactating * Inability to have each nasal cavity examined for any reason, including nasal septum deviation * Nasal septum perforation * Has had more than 1 episode of epistaxis with frank bleeding in the month before the screening visit * Have evidence of significant baseline mucosal injury, ulceration or erosion (eg, exposed cartilage, perforation) on baseline nasal examination/nasoendoscopy * History of sinus or nasal surgery within 6 months before the screening visit * Current, ongoing rhinitis medicamentosa (rebound rhinitis) * Have significant oral structural abnormalities, eg, a cleft palate * Diagnosis of cystic fibrosis * History of Churg-Strauss syndrome or dyskinetic ciliary syndromes * Purulent nasal infection, acute sinusitis, or upper respiratory tract infection within 2 weeks before the screening visit. Potential subjects presenting with any of these infections may be rescreened 4 weeks after symptom resolution * Planned sinonasal surgery during the period of the study * Allergy, hypersensitivity, or contraindication to corticosteroids or steroids * Allergy or hypersensitivity to any excipients in study drug * Exposure to any glucocorticoid treatment with potential for systemic effects (eg, oral, parenteral, intra-articular, or epidural steroids, high dose topical steroids) within 1 month before the screening visit; except as noted in inclusion criteria for subjects with comorbid asthma or COPD * Have nasal candidiasis * Have taken a potent CYP3A4 inhibitor within 14 days before the screening visit; examples of these medications can be found in Section 11.6, Concomitant Medication. * History or current diagnosis of any form of glaucoma or ocular hypertension (ie, intraocular pressure \>21 mmHg) * History of intraocular pressure elevation on any form of steroid therapy * History or current diagnosis of the presence (in either eye) of a cataract * Any serious or unstable concurrent disease, psychiatric disorder, or any significant condition that, in the opinion of the investigator could confound the results of the study or could interfere with the subject's participation or compliance in the study * A recent (within 1 year of the screening visit) clinically significant history of drug or alcohol use, abuse, or dependence that, in the opinion of the investigator could interfere with the subject's participation or compliance in the study * Positive urine drug screen at screening visit for drugs of abuse (see Section 14.5), with the exception of prescribed medications for legitimate medical conditions * Have participated in a previous clinical trial of OPTINOSE FLUTICASONE * Have participated in an investigational drug clinical trial within 30 days of the screening visit * Employees of the investigator or study center, with direct involvement in the proposed study or other studies under the direction of that investigator or study center, as well as family members of the employees or the investigator

Design outcomes

Primary

Measure	Time frame	Description
Adverse Events	12 Months	Patients with at least one Adverse Events

Secondary

Measure	Time frame	Description
Sinonasal Outcome Test 22 (SNOT-22) Total Score	Baseline, Month 3, Month 12	Change from baseline to Month 3 & Month 12 in SNOT-22 Total Score SNOT-22 is validated in large populations with chronic sinusitis with and without nasal polyps. The 22 questions are used to calculate a total score (the sum of all items) and 4 subscale scores. The 22 questions are divided among 4 subscales: Rhinologic, Ear and Facial Symptoms, Sleep Function, and Psychological Issues subscales. The total score can range from 0-110, 0 being the best and 110 being the worst. 0: No problem 1. Very mild problem 2. Mild or slight problem 3. Moderate problem 4. Severe problem 5. Problem as bad as it can be
Lund-Mackay Total Score	Baseline, Month 3, Month 12	Change from baseline to Month 3, Month 12, in Lund-Mackay Total Score Lund-Mackay Assessment of nasal cavity appearance, via nasoendoscopy, used to evaluate signs of edema, discharge, crusting, scarring/adhesions, and nasal polyps, with each sign rated on a 0 to 2 scale 0: None 2: Worse outcome
Patient Global Impression of Change (PGIC)	Baseline, Month 3, Month 12	The PGIC took less than 1 minute to complete. Subjects answered question, Since starting the study drug, how would you rate the change in your symptoms? Patients may answer very much improved, much improved, minimally improved, no change, minimally worse, much worse, or very much worse. Data listed below reports the total number of patients who answered very much improved, much improved, or minimally improved at the specified time.
Summed Bilateral Nasal Polyp Grading Scale Score	Baseline, Month 3, Month 12	In subjects with nasal polyps, polyp grading of each nasal cavity was determined by a nasal polyp grading scale score measured by nasoendoscopy. 0: No polyps 1. Mild polyposis: polyps not reaching below the inferior of the middle turbinate 2. Moderate polyposis: polyps reaching below the inferior border of the middle concha, but not the inferior border of the inferior turbinate 3. Severe polyposis: large polyps reaching below the lower inferior border of the inferior turbinate
Nasal Polyp Surgery Eligibility	Baseline, Month 3, Month 12	—

Countries

United States

Participant flow

Participants by arm

Arm	Count
OPN-375 400 μg OPN-375 400 μg BID for 12 months	223
Total	223

Withdrawals & dropouts

Period	Reason	FG000
Overall Study	Adverse Event	21
Overall Study	Became potentially child-bearing	1
Overall Study	Diagnoses of bilateral cateracts	1
Overall Study	Investigators Discretion-Noncompliant	1
Overall Study	Lack of Efficacy	6
Overall Study	Lost to Follow-up	18
Overall Study	Protocol Violation	6
Overall Study	Withdrawal by Subject	25

Baseline characteristics

Characteristic	OPN-375 400 μg
Age, Continuous	45.4 years STANDARD_DEVIATION 12.62
Lund-Mackay total score Pts Without Polyps	1.4 units on a scale STANDARD_DEVIATION 1.2
Lund-Mackay total score Pts With Polyps	1.7 units on a scale STANDARD_DEVIATION 1.51
Nasal Polyp Surgery Eligibility Pts Without Polyps	11 Participants
Nasal Polyp Surgery Eligibility Pts With Polyps	16 Participants
Previous polyp removal surgery via polypectomy only	11 Participants
Previous sinus surgery for polyp removal or sinus surgery	80 Participants
Race/Ethnicity, Customized Asian	2 Participants
Race/Ethnicity, Customized Black/African American	45 Participants
Race/Ethnicity, Customized Other	1 Participants
Race/Ethnicity, Customized White	175 Participants
Region of Enrollment United States	223 Participants
Sex: Female, Male Female	96 Participants
Sex: Female, Male Male	127 Participants
Sinonasal Outcome Test 22 (SNOT-22) Total Score Pts Without Polyps	39.7 units on a scale STANDARD_DEVIATION 21.72
Sinonasal Outcome Test 22 (SNOT-22) Total Score Pts With Polyps	41.9 units on a scale STANDARD_DEVIATION 23.27
Summed Bilateral Nasal Polyp Grading Scale Score	2.8 units on a scale STANDARD_DEVIATION 1.17
Use of ICS treatment for polyps in past 10 years	214 Participants

Adverse events

Event type	EG000 affected / at risk
deaths Total, all-cause mortality	0 / 223
other Total, other adverse events	169 / 223
serious Total, serious adverse events	0 / 223

Outcome results

Primary

Adverse Events

Patients with at least one Adverse Events

Time frame: 12 Months

Arm	Measure	Value (COUNT_OF_PARTICIPANTS)
OPN-375 400 μg	Adverse Events	169 Participants

Secondary

Lund-Mackay Total Score

Change from baseline to Month 3, Month 12, in Lund-Mackay Total Score Lund-Mackay Assessment of nasal cavity appearance, via nasoendoscopy, used to evaluate signs of edema, discharge, crusting, scarring/adhesions, and nasal polyps, with each sign rated on a 0 to 2 scale 0: None 2: Worse outcome