TAVNEOS for Otolaryngologic Manifestations of Granulomatosis With Polyangiitis

Not Applicable

Not yet recruiting

• Conditions: Granulomatosis With Polyangiitis; Wegener's; GPA
• Interventions: Drug: Avacopan; Drug: Placebo

• Registration Number: NCT07176546
• Lead Sponsor: Robert Spiera, MD

Brief Summary

This is a single center double-blind placebo-controlled study. Patients with GPA and active ears, nose, and throat (ENT) disease in at least two ENT domains, as defined after endoscopic visualization of the upper airway and audiometric evaluation, if applicable, by a single otolaryngologist using a validated GPA ENT disease activity score, will be eligible for inclusion. Patients will be treated with standard of care (SOC) treatment as determined by their treating rheumatologist. In addition to SOC, patients will be randomized to receive TAVNEOS 30mg BID or placebo. Patients will be followed for 52 weeks with standardized ENT assessment along with rheumatologic evaluation of overall disease activity with BVAS.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2025-08-18
• Status Verified: 2025-09
• Study First Submitted QC: 2025-09-09
• Last Update Submitted: 2025-09-15
• Study First Posted: 2025-09-16
• Last Update Posted: 2025-09-19
• Study Start: 2026-07-01
• Primary Completion: 2030-07
• Study Completion: 2030-10-01

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 30

Inclusion Criteria

• GPA diagnosis defined by score of ≥5 on 2022 ACR/EULAR Classification Criteria for GPA

• Active GPA (both newly diagnosed and relapsing disease) in the ENT domain within 1 month prior to screening, where the active disease is defined as a score of ≥2 on a GPA ENT disease activity score (7 items scored as 1= present 0= absent) performed by direct endoscopic visualization of the upper airway and audiometric evaluation, if applicable, by a single expert otolaryngologist. Items included in the GPA ENT disease activity score are:

  • Bloody rhinorrhea (Daily blood stained nasal discharge)
  • Objective stridor (Stridor assessed by doctor)
  • Inflammation on nasal examination (Ulcers, granulation, friable mucosa on rigid nasal endoscopy. Excluding crusting)
  • Inflammation on flexible laryngoscopy (Ulcers, granulation, friable mucosa in the larynx)
  • Inflamed TM*/middle ear (Persistent inflammation or granulation tissue in tympanic membrane/middle ear)
  • Sudden sensorineural hearing loss (30db drop in 3 frequencies within 72 hours)

• Other ENT/upper airway manifestations of active GPA observed during structured ENT exam including but not limited to lacrimal gland dacryocystitis and endobronchial disease

• Age 18 and older

• Willing and able to comply with treatment and follow-up procedures

• Men and women of reproductive potential must agree to use an acceptable method of birth control during treatment and for twelve months after completion of treatment.

• Willing and able to provide written informed consent

• Adequate liver function as defined by AST or ALT <2x Upper Limit of Normal

Exclusion Criteria

• Creatinine >4.0mg/dl or GFR <15 at baseline or dependence on dialysis
• Respiratory failure requiring mechanical ventilatory support or had experienced alveolar hemorrhage requiring invasive pulmonary ventilation support anticipated to last beyond the screening period of the study
• Previous treatment with TAVNEOS within 6 months of screening
• Inability to comply with study and/or follow-up procedures at investigator discretion.
• Intravenous glucocorticoids in the 4 weeks prior to screening except as premedication prior to infusion of rituximab
• Pregnant or breast-feeding
• Any other known multi-system autoimmune disease including eosinophilic granulomatosis with polyangiitis (Churg-Strauss), systemic lupus erythematosus, IgA vasculitis (Henoch-Schonlein), rheumatoid vasculitis, Sjogren's syndrome, anti-glomerular basement membrane disease, or cryoglobulinemic vasculitis
• Required dialysis or plasma exchange within 12 weeks prior to screening
• Have had a kidney transplant
• Any of the following within 12 weeks prior to screening: symptomatic congestive heart failure requiring prescription medication, unstable angina (unless successfully treated with stent or bypass surgery), clinically significant cardiac arrhythmia, myocardial infarction or stroke
• History or presence of any form of cancer within the 5 years prior to screening, with the exception of excised basal cell or squamous cell carcinoma of the skin, or carcinoma in situ such as cervical or breast carcinoma in situ that has been excised or resected completely and is without evidence of local recurrence or metastasis
• Evidence of tuberculosis based on interferon gamma release assay (IGRA), tuberculin purified protein derivative (PPD) skin test, or chest radiography (X rays or CT scan) done at screening or within 6 weeks prior to screening
• HBV, HCV, or HIV viral screening test showing evidence of active or chronic viral infection done at screening or within 6 weeks prior to screening
• Received a live vaccine within 4 weeks prior to screening
• WBC count less than 3500/uL, or neutrophil count less than 1500/uL, or lymphocyte count less than 500/uL before start of dosing
• Evidence of hepatic disease: AST, ALT, alkaline phosphatase, or bilirubin >3 times the upper limit of normal before start of dosing
• Known hypersensitivity to avacopan or inactive ingredients of the TAVNEOS capsules
• Participated in any clinical study of an investigational product within 30 days prior to screening or within 5 half-lives after taking the last dose
• Participated previously in an TAVNEOS study
• Concurrent use of strong inducers of the CYP450 ie. carbamazepine, phenobarbital, phenytoin, rifampin, or St. John's wort
• Known hypersensitivity to avacopan or inactive ingredients of the avacopan capsules (including gelatin, polyethylene glycol, or Cremophor)
• History or presence of any medical condition or disease which, in the opinion of the Investigator, may place the patient at unacceptable risk for study participation

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
TAVNEOS	Avacopan	BID dose of 30 mg TAVNEOS
Placebo	Placebo	BID dose of 30 mg TAVNEOS-matching placebo

Primary Outcome Measures

Name	Time	Method
Proportion of patients in ENT remission without relapse	Week 52	The proportion of patients in ENT remission without relapse in each treatment group at week 52 with no glucocorticoid (GC) exposure 4 weeks prior to week 52, where ENT remission is defined as a score of 0 on GPA ENT disease activity score

Secondary Outcome Measures

Name	Time	Method
Mean ENT disease activity score	Week 52	Comparison of mean ENT disease activity scores between treatment groups at week 52
Change in ENT disease activity score	Between week 26 and week 52	Change in ENT GPA disease activity score between week 26 and week 52
Duration of steroid-free remission	Through study completion, an average of 60 weeks
ANCA-Associated Vasculitis Patient-Reported Outcome (AAV-PRO)	Through study completion, an average of 60 weeks	Scale 0-119 (Higher score equals worse outcome)
Number of surgical procedures in the ENT domain required	Through study completion, an average of 60 weeks	Number of surgical procedures in the ENT domain required during the study period
Number of ENT flares	Through study completion, an average of 60 weeks	Number of ENT flares as measured by the rise in GPA ENT DAS (defined by an increase of ≥1 point on the GPA ENT DAS)
Proportion of patients in ENT remission with BVAS 0 at week 52 and sustained remission	Week 52	Proportion of patients in remission with BVAS 0 at week 52 and sustained remission from week 26 to week 52 with BVAS 0 and no glucocorticoids for 4 weeks prior to assessment
Cumulative steroid dose	Through study completion, an average of 60 weeks
Change in Vasculitis Damage Index (VDI)	Week 52	Change in VDI in the ENT domain at week 52
Sino-nasal Outcome Test (SNOT-22)	Through study completion, an average of 60 weeks	Scale 0-110 (Higher score equals worse outcome)
Time to ENT relapse	Through study completion, an average of 60 weeks
Number of GPA flares	Through study completion, an average of 60 weeks	Number of GPA flares as measured by Birmingham Vasculitis Activity Score for Wegener's Granulomatosis (BVAS-WG)

Trial Locations

Locations (2)

Hackensack Meridian School of Medicine - Advanced Lung and Airway Center; 🇺🇸 Edison, New Jersey, United States

Hospital for Special Surgery; 🇺🇸 New York, New York, United States