Asthma
Conditions
Keywords
asthma, asthma control, allergy, atopic, IgE, double-blind, placebo, omalizumab
Brief summary
This study assessed the effect on asthma control of different dose levels and regimens of QGE031 in asthma patients that are inadequately controlled with inhaled steroid and beta-2 agonist medication. Safety was assessed also. Comparison was to placebo and omalizumab. Information from this study was planned to support the design of future studies.
Interventions
QGE031 was supplied as 120 mg liquid in vial per 1 mL
Omalizumab was supplied as 150 mg lyophilisate in vial
Placebo to QGE031 and Omalizumab was supplied as QGE031 0 mg in vial per 1 mL
Sponsors
Study design
Eligibility
Inclusion criteria
Key Inclusion Criteria: * A diagnosis of allergic asthma , uncontrolled on current medication. * History of at least 1 asthma exacerbation during the last 1 year * Forced Expiratory Volume in one second (FEV1) of ≥ 40% and ≤ 80% of the predicted normal value; reversibility following administration of bronchodilator must also be demonstrated (historical positive reversibility or bronchoprovocation result can be used). Key
Exclusion criteria
* Baseline IgE levels or body weight outside the omalizumab dosing table. * Use of tobacco products within the previous 6 months (Social occasional smokers may be included). * Recent asthma attack/exacerbation or asthma worsening/ respiratory infection.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of QGE031 Participants With Clinically Important Improvement of <= -0.5 in the Asthma Control Questionnaire 7 (ACQ-7) Score Compared to Placebo | Week 16 | The ACQ-7 measures asthma symptom control and consisted of 7 items: 5 on symptom assessment, 1 on rescue bronchodilator use and 1 on airway caliber (FEV1 % predicted). All 7 questions of the ACQ were equally weighted. Items 1-6 scored along a 7-point response scale, where 0 = good controlled and 6 = poor controlled. The 7th item on % predicted FEV1 (pre-bronchodilator) was scored by clinic staff on a 7-point scale (0 - \> 95%; 1 - 90-95%; 2 - 80-89%; 3 - 70-79%; 4 - 60-69%; 5 - 50-59%; 6 - \< 50%). The average score of the 7 questions was calculated as the sum of scores divided by the number of questions that were answered by the participants, as long as there were at least 6 questions answered and the missing items were neither question 1 nor question 7. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With a Change From Baseline in ACQ-7 Score Less Than -1.1 | Week 16 | The ACQ-7 measures asthma symptom control and consisted of 7 items: 5 on symptom assessment, 1 on rescue bronchodilator use and 1 on airway caliber (FEV1 % predicted). All 7 questions of the ACQ were equally weighted. Items 1-6 scored along a 7-point response scale, where 0 = good controlled and 6 = poor controlled. The 7th item on % predicted FEV1 (pre-bronchodilator) was scored by clinic staff on a 7-point scale (0 - \> 95%; 1 - 90-95%; 2 - 80-89%; 3 - 70-79%; 4 - 60-69%; 5 - 50-59%; 6 - \< 50%). The average score of the 7 questions was calculated as the sum of scores divided by the number of questions that were answered by the participants, as long as there were at least 6 questions answered and the missing items were neither question 1 nor question 7. |
| Change From Baseline in Asthma Quality of Life Questionnaire (AQLQ) Score | Baseline, Week 16, Week 28 | The AQLQ is a 32-item disease specific questionnaire designed to measure functional impairments that are most important to participants with asthma. The 32 items in the AQLQ were divided into four domain-specific scores and a total score as follows: Activity limitations = Mean of Items 1, 2, 3, 4, 5, 11, 19, 25, 28, 31, 32 (11 items); Symptoms = Mean of Items 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 29, 30 (12 items); Emotional function = Mean of Items 7, 13, 15, 21, 27 (5 items); Environmental stimuli = Mean of Items 9, 17, 23, 26 (4 items); and Overall Score = Mean of Items 1 to 32 (32 items). Each item of the AQLQ was equally weighted and scored along a 7-point scale, where 1 indicates maximal impairment and 7 indicates no impairment. Thus, higher scores indicate better asthma-related quality of life. The mean overall score ranged from 1 to 7. A positive change from baseline indicates improvement. |
| Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Baseline, Week 16 | Participants recorded their use of rescue medication into an electronic diary (eDiary). A negative change from baseline indicates improvement. |
| Change From Baseline in ACQ-7 Score | Baseline, Weeks 4, 8, 12, 16 and 28 | The ACQ-7 measures asthma symptom control and consisted of 7 items: 5 on symptom assessment, 1 on rescue bronchodilator use and 1 on airway caliber (FEV1 % predicted). All 7 questions of the ACQ were equally weighted. Items 1-6 scored along a 7-point response scale, where 0 = good controlled and 6 = poor controlled. The 7th item on % predicted FEV1 (pre-bronchodilator) was scored by clinic staff on a 7-point scale (0 - \> 95%; 1 - 90-95%; 2 - 80-89%; 3 - 70-79%; 4 - 60-69%; 5 - 50-59%; 6 - \< 50%). The average score of the 7 questions was calculated as the sum of scores divided by the number of questions that were answered by the participants, as long as there were at least 6 questions answered and the missing items were neither question 1 nor question 7. A negative change from baseline indicates improvement. |
Countries
Argentina, Canada, Czechia, Finland, France, Germany, Guatemala, Hungary, India, Israel, Italy, Mexico, Panama, Poland, Portugal, Romania, Russia, Singapore, Slovakia, South Africa, South Korea, Turkey (Türkiye), United Kingdom, United States
Participant flow
Recruitment details
A total of 471 participants were randomized to one of the 14 treatment groups. Of these, 5 participants did not receive study treatment. Therefore, the full analysis set (FAS) and safety set included 466 participants.
Pre-assignment details
The treatment arms for QGE031 and placebo were pooled into high dose QGE031 (240 mg q2w, 240 mg q4w, 180 mg q2w and 120 q2w), low dose QGE031 (36 mg q2w and 18 mg 2qw) and Placebo Total (all QGE031 placebo and Omalizumab placebo arms).
Participants by arm
| Arm | Count |
|---|---|
| QGE031 High Dose Participants received QGE031 240 mg q2w, 240 mg q4w, 180 mg q2w or 120 mg q2w. | 199 |
| QGE031 Low Dose Participants received QGE031 36 mg q2w or 18 mg q2w. | 40 |
| Omalizumab Participants received omalizumab as per locally approved dosing table q2w or q4w. | 135 |
| Placebo Total Participants received matching placebo to QGE031 or Omalizumab. | 97 |
| Total | 471 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 4 | 2 | 2 | 1 |
| Overall Study | Death | 0 | 0 | 0 | 1 |
| Overall Study | Lost to Follow-up | 1 | 0 | 0 | 1 |
| Overall Study | Non-compliance with study treatment | 0 | 0 | 1 | 0 |
| Overall Study | Physician Decision | 1 | 0 | 0 | 0 |
| Overall Study | Protocol deviation | 0 | 2 | 7 | 2 |
| Overall Study | Withdrawal by Subject | 5 | 0 | 4 | 3 |
Baseline characteristics
| Characteristic | QGE031 High Dose | QGE031 Low Dose | Omalizumab | Placebo Total | Total |
|---|---|---|---|---|---|
| Age, Continuous | 47.6 Years STANDARD_DEVIATION 13.86 | 46.0 Years STANDARD_DEVIATION 12.38 | 46.8 Years STANDARD_DEVIATION 13.35 | 48.6 Years STANDARD_DEVIATION 12.8 | 47.4 Years STANDARD_DEVIATION 13.36 |
| Sex: Female, Male Female | 113 Participants | 20 Participants | 92 Participants | 63 Participants | 288 Participants |
| Sex: Female, Male Male | 86 Participants | 20 Participants | 43 Participants | 34 Participants | 183 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 | 91 / 199 | 17 / 40 | 43 / 131 | 35 / 96 |
| serious Total, serious adverse events | 9 / 199 | 3 / 40 | 1 / 131 | 5 / 96 |
Outcome results
Percentage of QGE031 Participants With Clinically Important Improvement of <= -0.5 in the Asthma Control Questionnaire 7 (ACQ-7) Score Compared to Placebo
The ACQ-7 measures asthma symptom control and consisted of 7 items: 5 on symptom assessment, 1 on rescue bronchodilator use and 1 on airway caliber (FEV1 % predicted). All 7 questions of the ACQ were equally weighted. Items 1-6 scored along a 7-point response scale, where 0 = good controlled and 6 = poor controlled. The 7th item on % predicted FEV1 (pre-bronchodilator) was scored by clinic staff on a 7-point scale (0 - \> 95%; 1 - 90-95%; 2 - 80-89%; 3 - 70-79%; 4 - 60-69%; 5 - 50-59%; 6 - \< 50%). The average score of the 7 questions was calculated as the sum of scores divided by the number of questions that were answered by the participants, as long as there were at least 6 questions answered and the missing items were neither question 1 nor question 7.
Time frame: Week 16
Population: The full analysis set (FAS) for the QGE031 240 mg q2w, placebo to QGE031 240 mg q2w and Omalizumab groups (n=120,49,131) was considered for the analysis. Only participants who had week 16 values were analyzed. The FAS included randomized participants who received at least one dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| QGE031 240 mg q2w | Percentage of QGE031 Participants With Clinically Important Improvement of <= -0.5 in the Asthma Control Questionnaire 7 (ACQ-7) Score Compared to Placebo | 63.16 Percentage of participants |
| Placebo to QGE031 240 mg q2w | Percentage of QGE031 Participants With Clinically Important Improvement of <= -0.5 in the Asthma Control Questionnaire 7 (ACQ-7) Score Compared to Placebo | 70.21 Percentage of participants |
| Omalizumab | Percentage of QGE031 Participants With Clinically Important Improvement of <= -0.5 in the Asthma Control Questionnaire 7 (ACQ-7) Score Compared to Placebo | 69.17 Percentage of participants |
Change From Baseline in ACQ-7 Score
The ACQ-7 measures asthma symptom control and consisted of 7 items: 5 on symptom assessment, 1 on rescue bronchodilator use and 1 on airway caliber (FEV1 % predicted). All 7 questions of the ACQ were equally weighted. Items 1-6 scored along a 7-point response scale, where 0 = good controlled and 6 = poor controlled. The 7th item on % predicted FEV1 (pre-bronchodilator) was scored by clinic staff on a 7-point scale (0 - \> 95%; 1 - 90-95%; 2 - 80-89%; 3 - 70-79%; 4 - 60-69%; 5 - 50-59%; 6 - \< 50%). The average score of the 7 questions was calculated as the sum of scores divided by the number of questions that were answered by the participants, as long as there were at least 6 questions answered and the missing items were neither question 1 nor question 7. A negative change from baseline indicates improvement.
Time frame: Baseline, Weeks 4, 8, 12, 16 and 28
Population: The FAS for the QGE031 240 mg q2w, placebo to QGE031 240 mg q2w and Omalizumab groups (n=120,49,131) was considered for the analysis. Participants who had values at both baseline and the post baseline time point were analyzed for that post baseline time point. The FAS included randomized participants who received at least one dose of study drug.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 4 (n=115,46,122) | -0.51 Score on a scale | Standard Deviation 0.709 |
| QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 8 (n=110,46,122) | -0.68 Score on a scale | Standard Deviation 0.678 |
| QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 12 (n=110,46,118) | -0.78 Score on a scale | Standard Deviation 0.738 |
| QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 28 (n112,47,115) | -0.62 Score on a scale | Standard Deviation 0.81 |
| QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 16 (n=114,48,120) | -0.75 Score on a scale | Standard Deviation 0.817 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 8 (n=110,46,122) | -0.62 Score on a scale | Standard Deviation 0.735 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 16 (n=114,48,120) | -0.79 Score on a scale | Standard Deviation 0.733 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 12 (n=110,46,118) | -0.71 Score on a scale | Standard Deviation 0.724 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 28 (n112,47,115) | -0.63 Score on a scale | Standard Deviation 0.744 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in ACQ-7 Score | Week 4 (n=115,46,122) | -0.48 Score on a scale | Standard Deviation 0.834 |
| Omalizumab | Change From Baseline in ACQ-7 Score | Week 28 (n112,47,115) | -0.59 Score on a scale | Standard Deviation 0.842 |
| Omalizumab | Change From Baseline in ACQ-7 Score | Week 12 (n=110,46,118) | -0.83 Score on a scale | Standard Deviation 0.737 |
| Omalizumab | Change From Baseline in ACQ-7 Score | Week 8 (n=110,46,122) | -0.78 Score on a scale | Standard Deviation 0.687 |
| Omalizumab | Change From Baseline in ACQ-7 Score | Week 16 (n=114,48,120) | -0.89 Score on a scale | Standard Deviation 0.734 |
| Omalizumab | Change From Baseline in ACQ-7 Score | Week 4 (n=115,46,122) | -0.60 Score on a scale | Standard Deviation 0.705 |
Change From Baseline in Asthma Quality of Life Questionnaire (AQLQ) Score
The AQLQ is a 32-item disease specific questionnaire designed to measure functional impairments that are most important to participants with asthma. The 32 items in the AQLQ were divided into four domain-specific scores and a total score as follows: Activity limitations = Mean of Items 1, 2, 3, 4, 5, 11, 19, 25, 28, 31, 32 (11 items); Symptoms = Mean of Items 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 29, 30 (12 items); Emotional function = Mean of Items 7, 13, 15, 21, 27 (5 items); Environmental stimuli = Mean of Items 9, 17, 23, 26 (4 items); and Overall Score = Mean of Items 1 to 32 (32 items). Each item of the AQLQ was equally weighted and scored along a 7-point scale, where 1 indicates maximal impairment and 7 indicates no impairment. Thus, higher scores indicate better asthma-related quality of life. The mean overall score ranged from 1 to 7. A positive change from baseline indicates improvement.
Time frame: Baseline, Week 16, Week 28
Population: The FAS for the QGE031 240 mg q2w, placebo to QGE031 240 mg q2w and Omalizumab groups (n=120,49,131) was considered for the analysis. Participants who had values at both baseline and the post baseline time point were analyzed for that post baseline time point. The FAS included randomized participants who received at least one dose of study drug.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| QGE031 240 mg q2w | Change From Baseline in Asthma Quality of Life Questionnaire (AQLQ) Score | Week 16 (n=114,48,122) | 0.53 Score on a scale | Standard Deviation 0.878 |
| QGE031 240 mg q2w | Change From Baseline in Asthma Quality of Life Questionnaire (AQLQ) Score | Week 28 (n=114,47,121) | 0.44 Score on a scale | Standard Deviation 0.899 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in Asthma Quality of Life Questionnaire (AQLQ) Score | Week 16 (n=114,48,122) | 0.66 Score on a scale | Standard Deviation 0.624 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in Asthma Quality of Life Questionnaire (AQLQ) Score | Week 28 (n=114,47,121) | 0.63 Score on a scale | Standard Deviation 0.826 |
| Omalizumab | Change From Baseline in Asthma Quality of Life Questionnaire (AQLQ) Score | Week 16 (n=114,48,122) | 0.79 Score on a scale | Standard Deviation 0.853 |
| Omalizumab | Change From Baseline in Asthma Quality of Life Questionnaire (AQLQ) Score | Week 28 (n=114,47,121) | 0.48 Score on a scale | Standard Deviation 0.871 |
Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication
Participants recorded their use of rescue medication into an electronic diary (eDiary). A negative change from baseline indicates improvement.
Time frame: Baseline, Week 16
Population: The full analysis set (FAS) for the QGE031 240 mg q2w, placebo to QGE031 240 mg q2w and Omalizumab groups (n=120,49,131) was considered for the analysis. Only participants who had both baseline and week 16 values were analyzed. The FAS included randomized participants who received at least one dose of study drug.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| QGE031 240 mg q2w | Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Overall | -0.56 Number of puffs | Standard Error 0.145 |
| QGE031 240 mg q2w | Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Evening | -0.31 Number of puffs | Standard Error 0.082 |
| QGE031 240 mg q2w | Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Morning | -0.28 Number of puffs | Standard Error 0.072 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Evening | -0.33 Number of puffs | Standard Error 0.126 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Morning | -0.34 Number of puffs | Standard Error 0.113 |
| Placebo to QGE031 240 mg q2w | Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Overall | -0.64 Number of puffs | Standard Error 0.226 |
| Omalizumab | Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Morning | -0.39 Number of puffs | Standard Error 0.073 |
| Omalizumab | Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Overall | -0.73 Number of puffs | Standard Error 0.148 |
| Omalizumab | Change From Baseline in Mean Number of Puffs of Morning, Evening and Total Daily Asthma Rescue Medication | Evening | -0.33 Number of puffs | Standard Error 0.084 |
Percentage of Participants With a Change From Baseline in ACQ-7 Score Less Than -1.1
The ACQ-7 measures asthma symptom control and consisted of 7 items: 5 on symptom assessment, 1 on rescue bronchodilator use and 1 on airway caliber (FEV1 % predicted). All 7 questions of the ACQ were equally weighted. Items 1-6 scored along a 7-point response scale, where 0 = good controlled and 6 = poor controlled. The 7th item on % predicted FEV1 (pre-bronchodilator) was scored by clinic staff on a 7-point scale (0 - \> 95%; 1 - 90-95%; 2 - 80-89%; 3 - 70-79%; 4 - 60-69%; 5 - 50-59%; 6 - \< 50%). The average score of the 7 questions was calculated as the sum of scores divided by the number of questions that were answered by the participants, as long as there were at least 6 questions answered and the missing items were neither question 1 nor question 7.
Time frame: Week 16
Population: The full analysis set (FAS) for the QGE031 240 mg q2w, placebo to QGE031 240 mg q2w and Omalizumab groups (n=120,49,131) was considered for the analysis. Only participants who had week 16 values were analyzed. The FAS included randomized participants who received at least one dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| QGE031 240 mg q2w | Percentage of Participants With a Change From Baseline in ACQ-7 Score Less Than -1.1 | 40.35 Percentage of participants |
| Placebo to QGE031 240 mg q2w | Percentage of Participants With a Change From Baseline in ACQ-7 Score Less Than -1.1 | 34.04 Percentage of participants |
| Omalizumab | Percentage of Participants With a Change From Baseline in ACQ-7 Score Less Than -1.1 | 36.67 Percentage of participants |