Asthma
Conditions
Keywords
Asthma, QAW039
Brief summary
This study aimed to determine the efficacy and safety of QAW039 and QAW039 450 mg compared to placebo, when added to GINA (Global Initiative for Asthma) steps 4 and 5 standard-of- care (SoC) asthma therapy (GINA 2016) in the following two populations: * patient with inadequately controlled severe asthma and high eosinophil counts (eosinophil count at Visit 1 ≥250 cells/ µl) (sub-population) * patients with inadequately controlled severe asthma (overall study population) Inadequate control is defined as partly controlled or uncontrolled asthma (GINA 2016)
Detailed description
This study used a randomized, multicenter, double-blind, placebo-controlled parallel-group design in which QAW039 (150 mg and 450 mg) or placebo was added to GINA steps 4 and 5 asthma therapy. The study included: * Screening period of up to 2 weeks to assess eligibility; * Run-in period of approximately 2 weeks and a maximum of 6 weeks on placebo to collect baseline data for efficacy variables and compliance with the Electronic Peak Flow/ eDiary device. Upon completion of the run-in period, all patients who met the eligibility criteria were randomized to one of three treatments: QAW039 150 mg or QAW039 450 mg or placebo once daily in a ratio of 1:1:1. * Treatment period of 52 weeks (assessment period for all Primary and Secondary Outcome Measures). Clinic visits were scheduled approximately 4 weeks after randomization and then at approximately 8-week intervals during the active-treatment period. Phone calls occurred at specified time points between visits occurring at 8-week intervals. Patients who had successfully completed 52 weeks of treatment in this study were offered an optional participation in a safety study (CQAW039A2315). * Follow-up period of 4 weeks, investigational and drug-free, following the last dose of study drug. A follow-up visit occurred approximately 4 weeks (i.e., approximately 30 days) following the last dose of study therapy to complete safety assessments and pregnancy testing (if applicable). The follow-up period applied to all patients except those patients who had entered the optional safety study (CQAW039A2315) directly after the Week 52 study visit
Interventions
QAW039 150 mg once daily
Placebo once daily
Sponsors
Study design
Eligibility
Inclusion criteria
* Written informed consent. * Male and female patients aged ≥12 years. * A diagnosis of severe asthma, uncontrolled on GINA 4/5 asthma medication. * Evidence of airway reversibility or airway hyper- reactivity. * FEV1 ≤80% of the predicted normal value for patients aged ≥18 years; FEV1 of ≤90% for patients aged 12 to \<18 years * An ACQ score ≥1.5 * A history of 2 or more asthma exacerbations within the 12 months prior to entering the study.
Exclusion criteria
* Use of other investigational drugs within 5 half-lives of study entry, or within 30 days, whichever is longer. * Subjects who have participated in another trial of QAW039. * A QTcF (Fridericia) ≥450 msec (male) or ≥460 msec (female). * History of malignancy with the exception of local basal cell carcinoma of the skin. * Pregnant or nursing (lactating) women. * Serious co-morbidities. * Patients on \>20 mg of simvastatin, \> 40 mg of atorvastatin, \>40 mg of pravastatin, or \>2 mg of pitavastatin.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in High Eosinophils Subpopulation | 52 weeks | A severe asthma exacerbation is defined as treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days and hospitalization; or treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days and emergency department visit (greater than 24 hours\*); or death due to asthma. A moderate asthma exacerbation is defined as treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days either as an outpatient or in emergency department visits (Emergency department visit less than or equal to 24 hours). The high eosinophils subpopulation consists of all patients with blood eosinophil count ≥ 250 cells/μL at baseline. |
| Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in Overall Population | 52 weeks | A severe asthma exacerbation is defined as treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days and hospitalization; or treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days and emergency department visit (greater than 24 hours\*); or death due to asthma. A moderate asthma exacerbation is defined as treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days either as an outpatient or in emergency department visits (Emergency department visit less than or equal to 24 hours). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in High Eosinophils Subpopulation | Baseline, Week 52 | Forced Expiratory Volume in one second (FEV1) is calculated as the volume of air forcibly exhaled in one second as measured by a spirometer. Baseline is defined as the last available FEV1 measurement taken prior to the first dose of randomized study drug. The high eosinophils subpopulation consists of all patients with blood eosinophil count ≥ 250 cells/μL at baseline. |
| Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in Overall Population | Baseline, Week 52 | AQLQ is a 32-item instrument administered as a self-assessment. AQLQ+12 is a modified version of AQLQ developed to measure functional impairments of participants aged 12-70 years. It is divided into 4 domains: activity limitation, symptoms, emotional function, and environmental stimuli. Participants were asked to recall their experiences during the last 2 weeks and respond to each question on a 7-point scale (1=severe impairment, 7=no impairment), where higher scores indicated better quality of life. Overall AQLQ+12 score is the mean of all 32 responses. |
| Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in High Eosinophils Subpopulation | Baseline, Week 52 | AQLQ is a 32-item instrument administered as a self-assessment. AQLQ+12 is a modified version of AQLQ developed to measure functional impairments of participants aged 12-70 years. It is divided into 4 domains: activity limitation, symptoms, emotional function, and environmental stimuli. Participants were asked to recall their experiences during the last 2 weeks and respond to each question on a 7-point scale (1=severe impairment, 7=no impairment), where higher scores indicated better quality of life. Overall AQLQ+12 score is the mean of all 32 responses. The high eosinophils subpopulation consists of all patients with blood eosinophil count ≥ 250 cells/μL at baseline. |
| Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in Overall Population | Baseline, Week 52 | Forced Expiratory Volume in one second (FEV1) is calculated as the volume of air forcibly exhaled in one second as measured by a spirometer. Baseline is defined as the last available FEV1 measurement taken prior to the first dose of randomized study drug. |
| Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in Overall Population | Baseline, Week 52 | The ACQ-5 is a five-item, self-completed questionnaire, which is used as a measure of asthma control of a participant. The five questions (concerning nocturnal awakening, waking in the morning, activity limitation, shortness of breath and wheeze) enquire about the frequency and/or severity of symptoms over the previous week. The response options for all these questions range from zero (no impairment/limitation) to six (total impairment/ limitation) scale. The ACQ-5 score is the average of the individual item scores and ranges from 0 to 6. Higher scores indicates worsening of condition. |
| Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in High Eosinophils Subpopulation | Baseline, Week 52 | The ACQ-5 is a five-item, self-completed questionnaire, which is used as a measure of asthma control of a participant. The five questions (concerning nocturnal awakening, waking in the morning, activity limitation, shortness of breath and wheeze) enquire about the frequency and/or severity of symptoms over the previous week. The response options for all these questions range from zero (no impairment/limitation) to six (total impairment/ limitation) scale. The ACQ-5 score is the average of the individual item scores and ranges from 0 to 6. Higher scores indicates worsening of condition. The high eosinophils subpopulation consists of all patients with blood eosinophil count ≥ 250 cells/μL at baseline. |
Countries
Argentina, Canada, Czechia, Greece, India, Israel, Italy, Japan, Lebanon, Malaysia, Mexico, Netherlands, Russia, Serbia, Slovakia, South Africa, Spain, Taiwan, United States
Participant flow
Recruitment details
Participants were recruited from centers in Argentina (18), Canada (5), Czech Republic (7), Greece (6), India (12), Israel (5), Italy (22), Japan (16), Lebanon (3), Malaysia (4), Mexico (3), Netherlands (4), Russian Federation (11), Serbia (4), Slovakia (11), South Africa (3), Spain (13), Taiwan (3) and the United States (19).
Pre-assignment details
The study included a Screening period of up to 2 weeks and a Placebo Run-in period of 2 to 6 weeks, during which eligibility for randomization was determined
Participants by arm
| Arm | Count |
|---|---|
| QAW039 150 mg QAW039 150 mg once daily | 296 |
| QAW039 450 mg QAW039 450 mg once daily | 294 |
| Placebo Placebo once daily | 287 |
| Total | 877 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 2 | 1 | 0 |
| Overall Study | Death | 0 | 1 | 1 |
| Overall Study | Death post Treatment/safety period | 1 | 0 | 0 |
| Overall Study | Lack of Efficacy | 1 | 0 | 0 |
| Overall Study | Lost to Follow-up | 1 | 2 | 0 |
| Overall Study | Physician Decision | 0 | 1 | 3 |
| Overall Study | Subject/guardian decision | 14 | 20 | 16 |
| Overall Study | Technical problems | 0 | 1 | 0 |
Baseline characteristics
| Characteristic | QAW039 150 mg | QAW039 450 mg | Placebo | Total |
|---|---|---|---|---|
| Age, Continuous | 49.8 years STANDARD_DEVIATION 14.6 | 49.6 years STANDARD_DEVIATION 15.25 | 50.9 years STANDARD_DEVIATION 14.16 | 50.1 years STANDARD_DEVIATION 14.68 |
| Race/Ethnicity, Customized Asian | 44 Participants | 41 Participants | 41 Participants | 126 Participants |
| Race/Ethnicity, Customized Black | 6 Participants | 4 Participants | 1 Participants | 11 Participants |
| Race/Ethnicity, Customized Caucasian | 234 Participants | 235 Participants | 227 Participants | 696 Participants |
| Race/Ethnicity, Customized Native American | 2 Participants | 2 Participants | 4 Participants | 8 Participants |
| Race/Ethnicity, Customized Other | 8 Participants | 10 Participants | 11 Participants | 29 Participants |
| Race/Ethnicity, Customized Unknown | 2 Participants | 2 Participants | 3 Participants | 7 Participants |
| Sex: Female, Male Female | 165 Participants | 178 Participants | 177 Participants | 520 Participants |
| Sex: Female, Male Male | 131 Participants | 116 Participants | 110 Participants | 357 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 296 | 1 / 293 | 1 / 287 |
| other Total, other adverse events | 181 / 296 | 183 / 293 | 180 / 287 |
| serious Total, serious adverse events | 20 / 296 | 20 / 293 | 18 / 287 |
Outcome results
Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in High Eosinophils Subpopulation
A severe asthma exacerbation is defined as treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days and hospitalization; or treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days and emergency department visit (greater than 24 hours\*); or death due to asthma. A moderate asthma exacerbation is defined as treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days either as an outpatient or in emergency department visits (Emergency department visit less than or equal to 24 hours). The high eosinophils subpopulation consists of all patients with blood eosinophil count ≥ 250 cells/μL at baseline.
Time frame: 52 weeks
Population: Full Analysis Set (FAS) in high eosinophils subpopulation (count ≥ 250 cells/μL)
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| QAW039 150 mg | Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in High Eosinophils Subpopulation | 0.73 Events/year |
| QAW039 450 mg | Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in High Eosinophils Subpopulation | 0.76 Events/year |
| Placebo | Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in High Eosinophils Subpopulation | 1.06 Events/year |
Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in Overall Population
A severe asthma exacerbation is defined as treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days and hospitalization; or treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days and emergency department visit (greater than 24 hours\*); or death due to asthma. A moderate asthma exacerbation is defined as treatment with 'rescue' systemic corticosteroids for greater than or equal to 3 days either as an outpatient or in emergency department visits (Emergency department visit less than or equal to 24 hours).
Time frame: 52 weeks
Population: Full Analysis Set (FAS), including all randomized patients who received at least one dose of study drug.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| QAW039 150 mg | Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in Overall Population | 0.76 Events/year |
| QAW039 450 mg | Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in Overall Population | 0.70 Events/year |
| Placebo | Rate of Moderate-to-severe Asthma Exacerbations During the 52-week Treatment Period in Overall Population | 0.93 Events/year |
Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in High Eosinophils Subpopulation
The ACQ-5 is a five-item, self-completed questionnaire, which is used as a measure of asthma control of a participant. The five questions (concerning nocturnal awakening, waking in the morning, activity limitation, shortness of breath and wheeze) enquire about the frequency and/or severity of symptoms over the previous week. The response options for all these questions range from zero (no impairment/limitation) to six (total impairment/ limitation) scale. The ACQ-5 score is the average of the individual item scores and ranges from 0 to 6. Higher scores indicates worsening of condition. The high eosinophils subpopulation consists of all patients with blood eosinophil count ≥ 250 cells/μL at baseline.
Time frame: Baseline, Week 52
Population: Full Analysis Set (FAS) in high eosinophils subpopulation (count ≥ 250 cells/μL)
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| QAW039 150 mg | Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in High Eosinophils Subpopulation | -0.92 units on a scale | Standard Error 0.067 |
| QAW039 450 mg | Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in High Eosinophils Subpopulation | -0.84 units on a scale | Standard Error 0.068 |
| Placebo | Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in High Eosinophils Subpopulation | -0.75 units on a scale | Standard Error 0.069 |
Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in Overall Population
The ACQ-5 is a five-item, self-completed questionnaire, which is used as a measure of asthma control of a participant. The five questions (concerning nocturnal awakening, waking in the morning, activity limitation, shortness of breath and wheeze) enquire about the frequency and/or severity of symptoms over the previous week. The response options for all these questions range from zero (no impairment/limitation) to six (total impairment/ limitation) scale. The ACQ-5 score is the average of the individual item scores and ranges from 0 to 6. Higher scores indicates worsening of condition.
Time frame: Baseline, Week 52
Population: Full Analysis Set (FAS), including all randomized patients who received at least one dose of study drug.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| QAW039 150 mg | Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in Overall Population | -0.83 units on a scale | Standard Error 0.055 |
| QAW039 450 mg | Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in Overall Population | -0.77 units on a scale | Standard Error 0.055 |
| Placebo | Change From Baseline to Week 52 in Asthma Control Questionnaire-5 (ACQ-5) Score in Overall Population | -0.70 units on a scale | Standard Error 0.055 |
Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in High Eosinophils Subpopulation
AQLQ is a 32-item instrument administered as a self-assessment. AQLQ+12 is a modified version of AQLQ developed to measure functional impairments of participants aged 12-70 years. It is divided into 4 domains: activity limitation, symptoms, emotional function, and environmental stimuli. Participants were asked to recall their experiences during the last 2 weeks and respond to each question on a 7-point scale (1=severe impairment, 7=no impairment), where higher scores indicated better quality of life. Overall AQLQ+12 score is the mean of all 32 responses. The high eosinophils subpopulation consists of all patients with blood eosinophil count ≥ 250 cells/μL at baseline.
Time frame: Baseline, Week 52
Population: Full Analysis Set (FAS) in high eosinophils subpopulation (count ≥ 250 cells/μL)
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| QAW039 150 mg | Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in High Eosinophils Subpopulation | 0.73 units on a scale | Standard Error 0.061 |
| QAW039 450 mg | Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in High Eosinophils Subpopulation | 0.71 units on a scale | Standard Error 0.062 |
| Placebo | Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in High Eosinophils Subpopulation | 0.58 units on a scale | Standard Error 0.062 |
Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in Overall Population
AQLQ is a 32-item instrument administered as a self-assessment. AQLQ+12 is a modified version of AQLQ developed to measure functional impairments of participants aged 12-70 years. It is divided into 4 domains: activity limitation, symptoms, emotional function, and environmental stimuli. Participants were asked to recall their experiences during the last 2 weeks and respond to each question on a 7-point scale (1=severe impairment, 7=no impairment), where higher scores indicated better quality of life. Overall AQLQ+12 score is the mean of all 32 responses.
Time frame: Baseline, Week 52
Population: Full Analysis Set (FAS), including all randomized patients who received at least one dose of study drug.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| QAW039 150 mg | Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in Overall Population | 0.62 units on a scale | Standard Error 0.05 |
| QAW039 450 mg | Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in Overall Population | 0.67 units on a scale | Standard Error 0.05 |
| Placebo | Change From Baseline to Week 52 in Asthma Quality of Life Questionnaire for Participants 12 Years and Older (AQLQ+12) Score in Overall Population | 0.55 units on a scale | Standard Error 0.051 |
Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in High Eosinophils Subpopulation
Forced Expiratory Volume in one second (FEV1) is calculated as the volume of air forcibly exhaled in one second as measured by a spirometer. Baseline is defined as the last available FEV1 measurement taken prior to the first dose of randomized study drug. The high eosinophils subpopulation consists of all patients with blood eosinophil count ≥ 250 cells/μL at baseline.
Time frame: Baseline, Week 52
Population: Full Analysis Set (FAS) in high eosinophils subpopulation (count ≥ 250 cells/μL)
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| QAW039 150 mg | Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in High Eosinophils Subpopulation | 0.192 Liter | Standard Error 0.0306 |
| QAW039 450 mg | Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in High Eosinophils Subpopulation | 0.162 Liter | Standard Error 0.0311 |
| Placebo | Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in High Eosinophils Subpopulation | 0.124 Liter | Standard Error 0.0313 |
Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in Overall Population
Forced Expiratory Volume in one second (FEV1) is calculated as the volume of air forcibly exhaled in one second as measured by a spirometer. Baseline is defined as the last available FEV1 measurement taken prior to the first dose of randomized study drug.
Time frame: Baseline, Week 52
Population: Full Analysis Set (FAS), including all randomized patients who received at least one dose of study drug.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| QAW039 150 mg | Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in Overall Population | 0.153 Liter | Standard Error 0.0247 |
| QAW039 450 mg | Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in Overall Population | 0.164 Liter | Standard Error 0.0249 |
| Placebo | Change From Baseline to Week 52 in Pre-dose Forced Expiratory Volume in 1 Second (FEV1) in Overall Population | 0.103 Liter | Standard Error 0.025 |
All Collected Deaths
Total Deaths are presented from first dose of study treatment until discontinuation of trial, up to maximum duration of 56 weeks. Deaths on-treatment are presented from first dose of study treatment until last dose of study treatment plus 30 days, up to maximum duration of 56 weeks.
Time frame: up to 56 weeks
Population: Safety Set (SAF), including all randomized patients who received at least one dose of study drug
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| QAW039 150 mg | All Collected Deaths | Total Deaths | 1 Participants |
| QAW039 150 mg | All Collected Deaths | Deaths on-treatment | 0 Participants |
| QAW039 450 mg | All Collected Deaths | Total Deaths | 1 Participants |
| QAW039 450 mg | All Collected Deaths | Deaths on-treatment | 1 Participants |
| Placebo | All Collected Deaths | Total Deaths | 1 Participants |
| Placebo | All Collected Deaths | Deaths on-treatment | 1 Participants |