A Phase II Study of Bermekimab (MABp1) in Patients With Moderate to Severe Atopic Dermatitis

A Phase II, Open Label, Dose Escalation Study of Bermekimab (MABp1) in Patients With Moderate to Severe Atopic Dermatitis

Status

Completed

Phases

Phase 2

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT03496974

Enrollment

Registered

2018-04-12

Start date

2018-05-21

Completion date

2018-12-11

Last updated

2021-03-12

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

Conditions

Atopic Dermatitis

Brief summary

A Phase 2 study of Bermekimab (MABp1) in patients with atopic dermatitis.

Detailed description

A Phase 2, Open Label, Dose Escalation Study of Bermekimab (MABp1) in Patients with Moderate to Severe Atopic Dermatitis. The study is multi center and will consist of two dose levels: Group A (n=9): patients will receive a total of 4 x 200mg subcutaneous injections of bermekimab. Dosing will occur weekly from visit 1 to visit 4, inclusive. Group B (n=20): patients will receive a total of 8 x 400 mg subcutaneous injections of bermedimkb. Dosing will occur weekly from visit 1 to visit 8, inclusive.

Interventions

DRUGBermekimab Monoclonal Antibody 200 mg

200 mg subcutaneous injection

DRUGBermekimab Monoclonal Antibody 400 mg

400 mg subcutaneous injection

Study design

Allocation

NON_RANDOMIZED

Intervention model

SEQUENTIAL

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

* Written informed consent provided by the patient * Age 18 years or greater * Chronic Atopic Dermatitis present for at least 3 years * Disease is not responsive to topical medications, or for whom topical treatments are not indicated or desired. * Willing and able to comply with all clinic visits and study-related procedures * EASI score ≥16 at screening and baseline visits * IGA score ≥3 at screening and baseline visits * ≥10% body surface area (BSA) of AD involvement at screening and baseline visits * Documented recent history (within 6 months before the screening visit) of inadequate response to treatment with topical medications or for whom topical treatments are otherwise medically inadvisable or undesired.

Exclusion criteria

* Treatment with an investigational drug within 8 weeks of baseline visit * Having received the following treatments within 4 weeks before the baseline visit, or any condition that, in the opinion of the investigator, is likely to require such treatment(s) during the first 4 weeks of study treatment: 1. Immunosuppressive/immunomodulating drugs (eg, systemic corticosteroids, cyclosporine, mycophenolate-mofetil, IFN-γ, Janus kinase inhibitors, azathioprine, methotrexate, etc.) 2. Phototherapy for AD * Treatment with topical corticosteroids (TCS) or topical calcineurin inhibitors (TCI) within 1 week before the baseline visit * Initiation of treatment during the screening period with prescription moisturizers or moisturizers containing additives such as ceramide, hyaluronic acid, urea, or filaggrin degradation products during the screening period (patients may continue using stable doses of such moisturizers if initiated before the screening visit) * Regular use (more than 2 visits per week) of a tanning booth/parlor within 4 weeks of the screening visit. * History of severe allergic or anaphylactic reactions to monoclonal antibodies. * Administration of any live (attenuated) vaccine within 4 weeks prior to the baseline. * Any history of dysplasia or history of malignancy (including lymphoma and leukemia) other than a successfully treated non-metastatic cutaneous squamous cell carcinoma, basal cell carcinoma or localized carcinoma in situ of the cervix * Active chronic or acute infection requiring treatment with systemic antibiotics, antivirals, antiparasitics, antiprotozoals, or antifungals within 2 weeks before the baseline visit, or superficial skin infections within 1 week before the baseline visit. NOTE: patients may be rescreened after infection resolves * Known or suspected history of immunosuppression, including history of invasive opportunistic infections (eg, tuberculosis \[TB\], histoplasmosis, listeriosis, coccidioidomycosis, pneumocystosis, aspergillosis) despite infection resolution: or unusually frequent, recurrent, or prolonged infections, per investigator judgment * History of human immunodeficiency virus (HIV) infection or positive HIV serology at screening * Positive with hepatitis B surface antigen (HBsAg) or hepatitis C antibody at the screening visit * Presence of skin comorbidities that may interfere with study assessments * Severe concomitant illness(es) that, in the investigator's judgment, would adversely affect the patient's participation in the study. Examples include, but are not limited to, patients with short life expectancy, patients with uncontrolled diabetes (HbA1c ≥ 9%), patients with cardiovascular conditions (eg, stage III or IV cardiac failure according to the New York Heart Association classification), severe renal conditions (eg, patients on dialysis), hepato-biliary conditions (eg, Child-Pugh class B or C), neurological conditions (eg, demyelinating diseases), active major autoimmune diseases (eg, lupus, inflammatory bowel disease, rheumatoid arthritis, etc.), other severe endocrinological, gastrointestinal, metabolic, pulmonary or lymphatic diseases. The specific justification for patients excluded under this criterion will be noted in study documents (chart notes, case report forms \[CRFs\], etc.) * Pregnant or breastfeeding women, or women planning to become pregnant or breastfeed during the study * Where relevant, women unwilling to use adequate birth control

Design outcomes

Primary

Measure	Time frame	Description
Number of Patients With Treatment Emergent Adverse Events (TEAEs)	From Visit 1 (Post-injection) until 7 days after the last administration of the study drug.	Safety and tolerability endpoints were evaluated by monitoring all the adverse events from clinical and laboratory reporting, vital signs, physical examinations, ECG and urinalysis. All the Adverse Events that the subjects experienced from Visit 1 Day 1 (Post-injection) until 7 days after the last administration of the study drug were captured in the clinical database. AEs are coded using medical dictionary - MedDRA Version 21.0 and the severity was assigned using CTCAE version 4.03.

Secondary

Measure	Time frame	Description
Pharmacokinetics (PK) Assessment at Week 7	Group A: Week 4; Group B: Week 7	An enzyme-linked immunosorbent assay (ELISA) has been developed to specifically measure bermekimab levels in human plasma. Blood will be drawn into a single 6 ml Na-Heparin collection tube at each PK collection time point. These samples will be collected per the study lab manual and immediately shipped to the Sponsor for PK analysis. The PK samples will also be used to test for the presence of antibodies against bermekimab. PK sample collection time points are as follows: Group A: Pre-dose at visits 1-5; visit 5 is reported Group B: Pre-dose at visit 1, visit 3, visit 5 and visit 8; visit 8 is reported
Number of Patients Achieving Investigator's Global Assessment (IGA) Response (0 or 1) at Week 7	Group A: Week 4; Group B: Week 7	IGA assesses disease severity and clinical response using a 5-point scale: 0 = clear, 1= almost clear, 2 = mild, 3 = moderate, 4 = severe. The score is determined by ranking the extent of erythema and population/infiltration. A clinical response to therapy will be an IGA score of 0 (clear) or 1 (almost clear). Patients receiving more than one treatment with additional medication for AD exacerbation during the study or who are missing IGA scores at visit 8 (week 7) will be treated as non-responders. For the 200 mg group, IGA was recorded at visits 1,3, and 5; visit 5 is reported. For the 400 mg group, IGA was recorded at visits 1-8, visit 8 was reported.
Number of Patients Achieving ≥2 IGA Score Reduction at Week 7	Group A: Week 4; Group B: Week 7	IGA assesses disease severity and clinical response using a 5-point scale: 0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe. The score is determined by ranking the extent of erythema and papulation/infiltration. A clinical response to therapy will be an IGA score of 0 (clear) or 1 (almost clear).
Change in Peak Weekly Averaged Pruritus Numerical Rating Scores (Overall Itch) From Baseline to Week 7	Group A: Baseline to Week 4; Group B: Baseline to Week 7	The NRS rating system captures the intensity of patient's itch, both maximum and average intensity over a 24-hour period. The following question was presented to patients: How would you rate your itch at the worst moment and on average during the previous 24 hours a scale of 0-10 (0=no itch and 10=worst possible itch)?
Change in Peak Weekly Averaged Pruritus Numerical Rating Scores (Worst Moment Itch) From Baseline to Week 7	Group A: Baseline to Week 4; Group B: Baseline to Week 7	The NRS rating system captures the intensity of patient's itch, both maximum and average intensity over a 24-hour period. The following question was presented to patients: How would you rate your itch at the worst moment and on average during the previous 24 hours a scale of 0-10 (0=no itch and 10=worst possible itch)?
Change in SCORing Atopic Dermatitis (SCORAD) Score From Baseline to Week 7	Group A: Baseline to Week 4; Group B: Baseline to Week 7	SCORAD was developed by the European Task Force on Atopic Dermatitis. (Severity scoring of Atopic Dermatitis: the SCORAD index), as a measure of disease severity in AD. It includes assessment of the eczema in addition to patient-reported symptoms. Total score ranges from 0 to 103 (no disease to most severe disease, respectively).
Change in Eczema Area and Severity Index (EASI) Score, From Baseline to Week 7 (or Last Visit)	Group A: Baseline to Week 4; Group B: Baseline to Week 7	EASI score will assess severity and extent of AD with respect to erythema, excoriation, infiltration and lichenification at 4 anatomic sites of the body: lower and upper extremities, trunk and head. The total EASI score shall be in a range of 0 to 72 points (from no disease to maximum disease severity, respectively). Group A: Change= (Baseline - Week 4 score); Group B: Change= (Baseline - Week 7 score)
Number of Patients Achieving 50% or Greater Reduction in SCORAD Score at Week 7	Group A: Week 4; Group B: Week 7	Calculated as per description in Outcome 8.
Change in Patient Oriented Eczema Measure (POEM) Scores From Baseline to Week 7.	Group A: Baseline to Week 4; Group B: Baseline to Week 7	POEM is a 7-item patient-reported quality of life outcome measure based on a questionnaire to determine disease symptoms, including bleeding, cracking, dryness, flaking, itching, sleep loss and weeping. The scoring range is from 0 to 28 (no disease to most severe disease, respectively).
Change in Global Individual Signs Score (GISS) From Baseline to Week 7	Group A: Baseline to Week 4; Group B: Baseline to Week 7	GISS assesses AD lesions for erythema, excoriations, lichenification and edema/papulation. Each component will be rated on a global basis (over the entire body surface rather than region) using a 4-point scale (0=none, 1=mild, 2=moderate and 3=severe) according to the EASI grading severity. Total score will range from 0 to 12 (no disease to most severe disease, respectively).
Change in Dermatology Life Quality Index (DLQI) From Baseline to Week 7	Group A: Baseline to Week 4; Group B: Baseline to Week 7	The DLQI is a 10-item, validated questionnaire used in clinical practice and clinical trials to assess the impact of AD disease symptoms and treatment on QOL. The format is a simple response (0 to 3 where 0 is not at all and 3 is very much) to 10 questions, which assess QOL over the past week, with an overall scoring system of 0 to 30; a high score is indicative of a poor QOL.
Change in HADS (Anxiety) Score From Baseline to Week 7	Group A: Baseline to Week 4; Group B: Baseline to Week 7	The HADS is a set of fourteen questions to be rated by a patient on a four point (0-3) response category so the possible scores range from 0 to 21 for anxiety and 0 to 21 for depression. Scoring is as follows: (0-7)= Normal (8-10)= Borderline Abnormal (11-21)= Abnormal
Change in HADS (Depression) Score From Baseline to Week 7	Group A: Baseline to Week 4; Group B: Baseline to Week 7	The HADS is a set of fourteen questions to be rated by a patient on a four point (0-3) response category so the possible scores range from 0 to 21 for anxiety and 0 to 21 for depression. Scoring is as follows: (0-7)= Normal (8-10)= Borderline Abnormal (11-21)= Abnormal
Number of Patients Achieving 50% or Greater Reduction in EASI Score at Week 7	Group A: Week 4; Group B: Week 7	EASI score will assess severity and extent of AD with respect to erythema, excoriation, infiltration and lichenification at 4 anatomic sites of the body: lower and upper extremities, trunk and head. The total EASI score shall be in a range of 0 to 72 points (from no disease to maximum disease severity, respectively).

Countries

United States

Participant flow

Participants by arm

Arm	Count
Group A: 200 mg Cohort Bermekimab Monoclonal Antibody 200 mg: 200 mg subcutaneous injection	10
Group B: 400 mg Cohort Bermekimab Monoclonal Antibody 400 mg: 400 mg subcutaneous injection	28
Total	38

Baseline characteristics

Characteristic	Group B: 400 mg Cohort	Total	Group A: 200 mg Cohort
Age, Categorical <=18 years	0 Participants	0 Participants	0 Participants
Age, Categorical >=65 years	6 Participants	8 Participants	2 Participants
Age, Categorical Between 18 and 65 years	22 Participants	30 Participants	8 Participants
Age, Continuous	48.54 years STANDARD_DEVIATION 19.14	47.92 years STANDARD_DEVIATION 18.35	46.2 years STANDARD_DEVIATION 16.78
Race (NIH/OMB) American Indian or Alaska Native	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Asian	0 Participants	1 Participants	1 Participants
Race (NIH/OMB) Black or African American	2 Participants	6 Participants	4 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	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) White	26 Participants	31 Participants	5 Participants
Sex: Female, Male Female	18 Participants	25 Participants	7 Participants
Sex: Female, Male Male	10 Participants	13 Participants	3 Participants
Weight	74.76 kg STANDARD_DEVIATION 16.4	75.66 kg STANDARD_DEVIATION 18.2	78.2 kg STANDARD_DEVIATION 23.34

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	0 / 10	0 / 28
other Total, other adverse events	3 / 10	6 / 28
serious Total, serious adverse events	0 / 10	0 / 28

Outcome results

Primary

Number of Patients With Treatment Emergent Adverse Events (TEAEs)

Safety and tolerability endpoints were evaluated by monitoring all the adverse events from clinical and laboratory reporting, vital signs, physical examinations, ECG and urinalysis. All the Adverse Events that the subjects experienced from Visit 1 Day 1 (Post-injection) until 7 days after the last administration of the study drug were captured in the clinical database. AEs are coded using medical dictionary - MedDRA Version 21.0 and the severity was assigned using CTCAE version 4.03.

Time frame: From Visit 1 (Post-injection) until 7 days after the last administration of the study drug.

Population: All subjects who have received at least one dose of bermekimab were included in the safety analysis.

Arm	Measure	Value (COUNT_OF_PARTICIPANTS)
Group A: 200 mg Cohort	Number of Patients With Treatment Emergent Adverse Events (TEAEs)	3 Participants
Group B: 400 mg Cohort	Number of Patients With Treatment Emergent Adverse Events (TEAEs)	6 Participants

Secondary

Change in Dermatology Life Quality Index (DLQI) From Baseline to Week 7

The DLQI is a 10-item, validated questionnaire used in clinical practice and clinical trials to assess the impact of AD disease symptoms and treatment on QOL. The format is a simple response (0 to 3 where 0 is not at all and 3 is very much) to 10 questions, which assess QOL over the past week, with an overall scoring system of 0 to 30; a high score is indicative of a poor QOL.