Chronic Obstructive Pulmonary Disease
Conditions
Keywords
QAW039, Chronic obstructive pulmonary disease, COPD, sputum, eosinophillic, eosinophilia, prostaglandin D2 receptor, DP2, CRTh2, fevipiprant
Brief summary
This was an exploratory, randomized, subject- and investigator-blind, placebo-controlled, parallel group, proof-of-mechanism study of multiple oral doses of fevipiprant (QAW039) in chronic obstructive pulmonary disease (COPD) patients with eosinophilia.
Detailed description
This was an exploratory, randomized, subject- and investigator-blind, placebo-controlled, parallel group, proof-of-mechanism study in COPD subjects with eosinophilia, on standard of care therapy. Standard of care (SoC) treatment in subjects with COPD typically includes a regimen of inhaled corticosteroid (ICS) plus one or more long acting bronchodilator (long-acting beta2-agonist (LABA) or long-acting antimuscarinic antagonist (LAMA)). The study consisted of a screening period (including an optional pre-screen visit) during which the subject's phenotype and eligibility for the study were assessed. All subjects who met the eligibility criteria after the screening visit were to undergo induction of their sputum to examine the baseline sputum cell counts. Subjects were required to demonstrate both blood and sputum eosinophilia to be eligible for participation in the study. Eligible subjects were randomized 3:2 to active (fevipiprant 450 mg oral daily) vs. placebo arms. Randomization was stratified by current smoking status (current vs. ex-smoker). Subjects were to continue their COPD standard of care and other medications during the entire course of the study. Subjects were to receive multiple doses of fevipiprant or placebo for six weeks. Sputum induction was to be repeated at the end of the treatment period and at the end of the study (approximately 4 weeks after the last dose). The primary purpose of the proof-of-mechanism study was to determine whether fevipiprant (QAW039), when administered to COPD patients with eosinophilic airway inflammation on standard of care therapy, reduced the burden of sputum eosinophilia. Data from other trials did not confirm efficacy of fevipiprant and did not warrant the continuation of treatment in this study. As a result, this study was terminated early.
Interventions
DRUGQAW039
QAW039 (fevipiprant) 450 mg once daily for 6 weeks administered orally as a tablet + Standard of Care
DRUGPlacebo
Placebo once daily for 6 weeks administered orally as a tablet + Standard of Care
Sponsors
Novartis Pharmaceuticals
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Masking description
This was a subject and investigator-blinded study. Subjects, investigators and all site staff remained blinded to study treatment throughout the study. The identity of the treatments was concealed by the use of study drugs that were all identical in packaging, labeling, schedule of administration, appearance, and odor. The sponsor could be unblinded to the study treatment at any time, especially in case of a safety concern.
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Acceptable and reproducible spirometry with post-bronchodilator FEV1/FVC \< 0.7 and post-bronchodilator FEV1≥ 30 and ≤ 80% of predicted at the screening and baseline visits (GOLD stage II or III COPD). 2. Patients with a physician-diagnosed history of COPD for at least 1 year prior to screening visit, and a documented history of at least one COPD exacerbation within the year prior to screening visit and on a stable therapy regimen for COPD for at least 4 weeks prior to screening visit with inhaled glucocorticoid + one or more long acting bronchodilator. 3. Current or ex-smokers who have a smoking history of at least 10 pack-years (10 pack-years are defined as 20 cigarettes a day for 10 years, or 10 cigarettes a day for 20 years, or equivalent). 4. Circulating eosinophils ≥ 300 cells/µL blood AND sputum eosinophils ≥ 3% of total cell count during screening period.
Exclusion criteria
1. Patients with a past or current medical history of asthma. 2. Patients with a past or current medical history of conditions other than COPD or allergic rhinitis that could result in elevated sputum eosinophils (e.g., asthma, hypereosinophilic syndrome, Churg-Strauss Syndrome). Patients with known parasitic infestation within 6 months prior to screening are also excluded. 3. Patients who have had a respiratory tract infection or COPD worsening or systemic steroid use within 4 weeks prior to screening visit or between screening and randomization visits. 4. Patients with history of concomitant chronic or severe pulmonary disease (e.g., sarcoidosis, interstitial lung disease, cystic fibrosis, tuberculosis). Exception: patients with concomitant mild or moderate pulmonary hypertension or bronchiectasis are permitted to participate. 5. Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using effective contraception (also called basic contraception)methods during the study. 6. Patients on any statin therapy with a CK level \> 2 X ULN at screening. 7. Patients who have a clinically significant laboratory abnormality at the screening visit including (but not limited to): * Total white blood cell count \<2500 cells/uL * AST or ALT \> 2.0 X ULN or total bilirubin \> 1.3 X ULN * Estimated Glomerular Filtration Rate (eGFR) by the Modification of Diet in Renal Disease (MDRD) equation or Bedside Schwartz equation \<55 mL/minute/1.73 m2. 8. Patients with any of the following cardiac related concerns: * A resting QTcF (Fridericia) ≥450 msec (male) or ≥460 msec (female) at screening visit * A history of familial long QT syndrome or known family history of Torsades de Pointe * Receiving any medications or other agents known to prolong the QT interval * patients with a history of moderate or severe uncontrolled tachyarrhythmias * History of a clinically significant cardiovascular event within 1 year prior to the screening visit, such as acute myocardial infarction, congestive heart failure, unstable arrhythmia * Patients who, in the judgment of the investigator have a clinically significant ECG abnormality such as (but not limited to) sustained ventricular tachycardia, or clinically significant second or third degree AV block without a pacemaker
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Sputum Eosinophil Percentage Based on Log-10 Transformed Scale at Week 6 | Baseline, Week 6 | Sputum eosinophil percentage of the total cell count was obtained from induced sputum samples. Sputum was processed to include preparation of slides for differential cellular count. As sputum eosinophil percentage has been found to follow a log-normal distribution, the analysis of this outcome measure was based on log10-transformed scale. The baseline measurement was defined as sputum eosinophil percentage prior to the first dosing (on log10-transformed scale). |
Countries
Germany, United Kingdom
Participant flow
Recruitment details
Participants took part in 4 investigative sites in 2 countries (Germany and United Kingdom).
Pre-assignment details
Participants were randomized 3:2 to active (QAW039 450 mg orally daily) vs. placebo arms. Randomization was stratified by current smoking status (current vs. ex-smoker).
Participants by arm
| Arm | Count |
|---|---|
| QAW039 450 mg QAW039 (fevipiprant) 450 mg once daily for 6 weeks administered orally as a tablet. | 6 |
| Placebo Placebo once daily for 6 weeks administered orally as a tablet. | 3 |
| Total | 9 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Study terminated by Sponsor | 2 | 1 |
Baseline characteristics
| Characteristic | Placebo | Total | QAW039 450 mg |
|---|---|---|---|
| Age, Continuous | 67.3 Years STANDARD_DEVIATION 6.35 | 64.8 Years STANDARD_DEVIATION 8.53 | 63.5 Years STANDARD_DEVIATION 9.71 |
| Race/Ethnicity, Customized Asian | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 2 Participants | 8 Participants | 6 Participants |
| Sex: Female, Male Female | 1 Participants | 2 Participants | 1 Participants |
| Sex: Female, Male Male | 2 Participants | 7 Participants | 5 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 6 | 0 / 3 | 0 / 9 |
| other Total, other adverse events | 4 / 6 | 2 / 3 | 6 / 9 |
| serious Total, serious adverse events | 0 / 6 | 0 / 3 | 0 / 9 |
Outcome results
Primary
Change From Baseline in Sputum Eosinophil Percentage Based on Log-10 Transformed Scale at Week 6
Sputum eosinophil percentage of the total cell count was obtained from induced sputum samples. Sputum was processed to include preparation of slides for differential cellular count. As sputum eosinophil percentage has been found to follow a log-normal distribution, the analysis of this outcome measure was based on log10-transformed scale. The baseline measurement was defined as sputum eosinophil percentage prior to the first dosing (on log10-transformed scale).
Time frame: Baseline, Week 6
Population: All subjects with available data and no protocol deviations with relevant impact on data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| QAW039 450 mg | Change From Baseline in Sputum Eosinophil Percentage Based on Log-10 Transformed Scale at Week 6 | -0.43373 Percentage | Standard Deviation 0.3974 |
| Placebo | Change From Baseline in Sputum Eosinophil Percentage Based on Log-10 Transformed Scale at Week 6 | -0.06689 Percentage | Standard Deviation 0.43094 |