Nasal Polyps
Conditions
Brief summary
To evaluate the efficacy of an anti-inflammatory agent compared with placebo in relieving signs and symptoms of disease in patients with sinusitis.
Detailed description
This is a Phase 2a, single-center, randomized, placebo-controlled, double-blind study that includes 12 weeks of treatment with experimental drug anti-inflammatory agent or placebo TID administered orally. All subjects will be ≥18 years, have sinusitis with persistent symptoms despite standard of care treatment, and have failed a course of steroids in the past.
Interventions
40 mg three times daily po for 12 weeks
collection of biomarkers for analysis of nasal disease
QD Nasal Spray
looks like AZ compound, made by same company, double blind. 40 mg three times daily po for 12 weeks
Sponsors
Study design
Eligibility
Inclusion criteria
1\. Females must have a negative urine pregnancy test at screening unless documented to have a hysterectomy or be postmenopausal.
Exclusion criteria
1. Inability or unwillingness of a participant to give written informed consent or comply with study protocol 2. Use of any investigational drugs within 30 days of screening. 3. Acute infection needing antibiotic treatment at screening.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| TOTAL POLYP SCORE (TPS) | Baseline and Week 12 | Measure Description: Measurement of Primary outcome- 0-4 scale in each nostril, total is 8. The total polyp score is the sum of the right and left nasal polyp score. Maximum is 8, minimum is 0. Higher score indicates worse disease. 0 =No polyps 1=Small polyps in the middle meatus not reaching below the inferior border of the middle turbinate 2=Polyps reaching the lower border of the middle turbinate or polyp medial to the middle turbinate 3 = Large polyps reaching the lower border of the inferior turbinate 4 =Large polyps causing complete obstruction. The primary outcome measured change in polyp size and secondary outcomes included change in radiographic severity of sinus disease, quality of life, and nasal symptoms as measured by Sino Nasal Outcome Test-22 (SNOT-22) and sense of smell by Brief Smell Identification Test (B-SIT) at 12 weeks in the AZD1981 group vs. the placebo. These were done at the baseline visit and the Week 12 visit. |
| Sinus CT Scan Scores by Lund-Mackay Scores | Baseline and Week 12 | Measurement of secondary outcome: sinus CT scan scores by Lund-Mckay scores. We measured sinus radiographic severity with Lund-Mackay scores of 0 to 24. 0 was the least severe and 24 was the most severe. This secondary outcomes included change in radiographic severity of sinus disease, as measured by sinus CT scan scores at baseline and 12 weeks in the AZD1981 group vs. the placebo group. |
| BSIT (Brief Smell Identification Test) | Baseline and Week 12 | Measurement of secondary outcome- BSIT (brief smell identification test) is a 12-item test measuring sense of smell. This is a multiple choice test with one correct answer out of four possible answer choices. This test features distinct types of smells. Minimum score: 0/12, which indicates that none of the correct answers were chosen on the 12-item test. Maximum score: 12/12, which indicates that all of the correct answers were chosen on the 12-item test. The higher the score, the better the outcome. Only one out of the four possible answer choices for each multiple choice question is correct. There are no subscales. This secondary outcome measures sense of smell by Brief Smell Identification Test (B-SIT) at baseline (visit 1) and 12 weeks (visit 5) in the AZD1981 group vs. the placebo group. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| SNOT-22 (Sino-Nasal Outcome Test-22) Score | Baseline and Week 12 | Measurement of secondary outcome- the SNOT-22 test contains 22 items regarding patient-reported outcomes of sino-nasal symptom severity on a 0-5 scale for each item. 0 is no problem and 5 is problem as bad as it can be, so higher values represent a worse outcome than lower values. The subscale is 0 - 5 of each of the 22 items and the total score is the sum of the subscales of all 22 items. The minimum total score is 0/110. The maximum total score is 110/110. This secondary outcome measured change in patient-reported outcomes of nasal symptoms as measured by Sino Nasal Outcome Test-22 (SNOT-22) over 12 weeks in the AZD1981 group vs. the placebo group. |
| Visual Analog Scale (VAS) | Baseline and Week 12 | Measurement of secondary outcome- 0 to 10 scale bilaterally that measures how subjective sinus symptom severity, with 0 being the least troublesome to 10 being the most troublesome over 12 weeks in the AZD1981 group vs. the placebo group. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| AZD + INCS AZD1981 40 mg 3 times a day orally, added to 2 sprays daily of intranasal corticosteroid (INCS) spray for 12 weeks. | 22 |
| PLACEBO + INCS Placebo 3 times a day orally added to 2 sprays daily of intranasal corticosteroid (INCS) spray for 12 weeks. | 21 |
| Total | 43 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 3 | 5 |
Baseline characteristics
| Characteristic | PLACEBO + INCS | Total | AZD + INCS |
|---|---|---|---|
| Age, Continuous | 47 years STANDARD_DEVIATION 12 | 46 years STANDARD_DEVIATION 13 | 45 years STANDARD_DEVIATION 13 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 9 Participants | 6 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants | 4 Participants | 0 Participants |
| Race (NIH/OMB) White | 14 Participants | 30 Participants | 16 Participants |
| Sex: Female, Male Female | 13 Participants | 21 Participants | 8 Participants |
| Sex: Female, Male Male | 8 Participants | 22 Participants | 14 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 22 | 0 / 21 |
| other Total, other adverse events | 1 / 22 | 0 / 21 |
| serious Total, serious adverse events | 1 / 22 | 1 / 21 |
Outcome results
BSIT (Brief Smell Identification Test)
Measurement of secondary outcome- BSIT (brief smell identification test) is a 12-item test measuring sense of smell. This is a multiple choice test with one correct answer out of four possible answer choices. This test features distinct types of smells. Minimum score: 0/12, which indicates that none of the correct answers were chosen on the 12-item test. Maximum score: 12/12, which indicates that all of the correct answers were chosen on the 12-item test. The higher the score, the better the outcome. Only one out of the four possible answer choices for each multiple choice question is correct. There are no subscales. This secondary outcome measures sense of smell by Brief Smell Identification Test (B-SIT) at baseline (visit 1) and 12 weeks (visit 5) in the AZD1981 group vs. the placebo group.
Time frame: Baseline and Week 12
Population: The secondary outcome was the mean change from baseline to 12 weeks of BSIT scores in the AZD1981 treated group compared to the placebo-treated group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AZD + INCS | BSIT (Brief Smell Identification Test) | Visit 1 (Baseline) | 5.75 units on a scale | Standard Error 0.81 |
| AZD + INCS | BSIT (Brief Smell Identification Test) | Visit 5 (12 weeks) | 6.92 units on a scale | Standard Error 1.12 |
| PLACEBO + INCS | BSIT (Brief Smell Identification Test) | Visit 1 (Baseline) | 5.20 units on a scale | Standard Error 0.88 |
| PLACEBO + INCS | BSIT (Brief Smell Identification Test) | Visit 5 (12 weeks) | 5.80 units on a scale | Standard Error 1.22 |
Sinus CT Scan Scores by Lund-Mackay Scores
Measurement of secondary outcome: sinus CT scan scores by Lund-Mckay scores. We measured sinus radiographic severity with Lund-Mackay scores of 0 to 24. 0 was the least severe and 24 was the most severe. This secondary outcomes included change in radiographic severity of sinus disease, as measured by sinus CT scan scores at baseline and 12 weeks in the AZD1981 group vs. the placebo group.
Time frame: Baseline and Week 12
Population: The secondary outcome was the mean change in Lund-Mackay scores of sinus CT scans from baseline to 12 weeks in the AZD1981 treated group compared to the placebo-treated group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AZD + INCS | Sinus CT Scan Scores by Lund-Mackay Scores | Visit 1 (Baseline) | 17.44 units on a scale | Standard Error 1.38 |
| AZD + INCS | Sinus CT Scan Scores by Lund-Mackay Scores | Visit 5 (12 weeks) | 18.25 units on a scale | Standard Error 1.1 |
| PLACEBO + INCS | Sinus CT Scan Scores by Lund-Mackay Scores | Visit 1 (Baseline) | 15.53 units on a scale | Standard Error 1.43 |
| PLACEBO + INCS | Sinus CT Scan Scores by Lund-Mackay Scores | Visit 5 (12 weeks) | 16.33 units on a scale | Standard Error 1.14 |
TOTAL POLYP SCORE (TPS)
Measure Description: Measurement of Primary outcome- 0-4 scale in each nostril, total is 8. The total polyp score is the sum of the right and left nasal polyp score. Maximum is 8, minimum is 0. Higher score indicates worse disease. 0 =No polyps 1=Small polyps in the middle meatus not reaching below the inferior border of the middle turbinate 2=Polyps reaching the lower border of the middle turbinate or polyp medial to the middle turbinate 3 = Large polyps reaching the lower border of the inferior turbinate 4 =Large polyps causing complete obstruction. The primary outcome measured change in polyp size and secondary outcomes included change in radiographic severity of sinus disease, quality of life, and nasal symptoms as measured by Sino Nasal Outcome Test-22 (SNOT-22) and sense of smell by Brief Smell Identification Test (B-SIT) at 12 weeks in the AZD1981 group vs. the placebo. These were done at the baseline visit and the Week 12 visit.
Time frame: Baseline and Week 12
Population: The primary outcome was the mean change from baseline to 12 weeks in the size of nasal polyps as measured by the total polyp score in the AZD1981 treated group compared to the placebo-treated group.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| AZD + INCS | TOTAL POLYP SCORE (TPS) | 4.67 units on a scale | Standard Error 0.38 |
| PLACEBO + INCS | TOTAL POLYP SCORE (TPS) | 5.24 units on a scale | Standard Error 0.36 |
SNOT-22 (Sino-Nasal Outcome Test-22) Score
Measurement of secondary outcome- the SNOT-22 test contains 22 items regarding patient-reported outcomes of sino-nasal symptom severity on a 0-5 scale for each item. 0 is no problem and 5 is problem as bad as it can be, so higher values represent a worse outcome than lower values. The subscale is 0 - 5 of each of the 22 items and the total score is the sum of the subscales of all 22 items. The minimum total score is 0/110. The maximum total score is 110/110. This secondary outcome measured change in patient-reported outcomes of nasal symptoms as measured by Sino Nasal Outcome Test-22 (SNOT-22) over 12 weeks in the AZD1981 group vs. the placebo group.
Time frame: Baseline and Week 12
Population: This secondary outcome was the mean change from baseline to 12 weeks in sinonasal symptoms detailed in the SNOT-22 as measured by the total polyp score in the AZD1981 treated group compared to the placebo-treated group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AZD + INCS | SNOT-22 (Sino-Nasal Outcome Test-22) Score | Visit 1 (baseline) | 33.73 units on a scale | Standard Error 5.17 |
| AZD + INCS | SNOT-22 (Sino-Nasal Outcome Test-22) Score | Visit 5 (12 weeks) | 26.07 units on a scale | Standard Error 4.94 |
| PLACEBO + INCS | SNOT-22 (Sino-Nasal Outcome Test-22) Score | Visit 1 (baseline) | 40.41 units on a scale | Standard Error 5.01 |
| PLACEBO + INCS | SNOT-22 (Sino-Nasal Outcome Test-22) Score | Visit 5 (12 weeks) | 36.13 units on a scale | Standard Error 4.78 |
Visual Analog Scale (VAS)
Measurement of secondary outcome- 0 to 10 scale bilaterally that measures how subjective sinus symptom severity, with 0 being the least troublesome to 10 being the most troublesome over 12 weeks in the AZD1981 group vs. the placebo group.
Time frame: Baseline and Week 12
Population: The secondary outcome was the mean change from baseline (visit 1) to 12 weeks (visit 5) of the VAS scores in the AZD1981 treated group compared to the placebo-treated group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AZD + INCS | Visual Analog Scale (VAS) | Visit 1 | 5.57 units on a scale | Standard Error 2.59 |
| AZD + INCS | Visual Analog Scale (VAS) | Visit 5 | 4.75 units on a scale | Standard Error 2.66 |
| PLACEBO + INCS | Visual Analog Scale (VAS) | Visit 1 | 5.70 units on a scale | Standard Error 2.6 |
| PLACEBO + INCS | Visual Analog Scale (VAS) | Visit 5 | 4.74 units on a scale | Standard Error 2.66 |