Anti-TSLP (AMG 157) Plus Antigen-Specific Immunotherapy for Induction of Tolerance in Individuals With Cat Allergy

Phase 1

Completed

Conditions: Cat Allergy
Cat Hypersensitivity

Interventions: Biological: AMG 157
Biological: Cat Immunotherapy
Biological: Cat Immunotherapy Placebo
Biological: AMG 157 Placebo

Registration Number: NCT02237196

Lead Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)

Brief Summary: This trial will test whether a novel therapeutic approach, cat immunotherapy combined with an investigational new drug called MEDI9929/AMG 157 (an anti-TSLP \[thymic stromal lymphopoietin\] antibody being co-developed by Amgen and MedImmune) can lead to lasting tolerance to cat allergen.The objective of the study is to determine whether one year of immunotherapy combined with MEDI9929/AMG 157 can induce tolerance to cat allergen.

Detailed Description: This study will implement the concept referred to as "allergen-plus," which aims to enhance the disease-modifying mechanisms of allergen-specific immunotherapy by combining it with other anti-inflammatory or immune-modulating agents. Thymic stromal lymphopoietin (TSLP) is a cytokine which appears to be instrumental in both initiating and maintaining allergic sensitivity to antigens, and Immune Tolerance Network (ITN) investigators hypothesize that blocking TSLP during the administration of cat immunotherapy will induce durable immune changes that lead to tolerance.

CATNIP will be conducted at multiple sites in the US and enroll cat-allergic adults who will be randomized to four possible treatment groups: immunotherapy plus MEDI9929/AMG 157, immunotherapy plus placebo, placebo plus MEDI9929/AMG 157, or two corresponding placebos. This study is specifically enrolling cat allergic individuals who do not live with cats in order to limit exposure to the allergen outside of the study. Treatment will be given for about one year, followed by one year off therapy.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 121

Inclusion Criteria

History of moderate-severe allergic rhinitis caused by cat exposure for at least 2 yrs
Skin prick test wheal >/=5 mm to standardized cat extract
Immunoglobulin E (IgE) >/=0.7 kU/L (class 2) to cat extract
Screening nasal allergen challenge in which:

*TNSS is </= 3 after the 0 concentration (vehicle control only) dose,
TNSS increase is </=1 from the TNSS prior to allergen administration to the TNSS after the 0 concentration (vehicle control only) dose,
- TNSS is >/=8 after the highest dose, and
- Between the first non-zero dose and 10 minutes after the highest dose,either:
>/=3 sneezes are counted or
>20% drop in PNIF is recorded
Body mass index (BMI) between 1 and 32 kg/m^2, inclusive at screening
Clinically acceptable physical examination and electrocardiogram (ECG) results (12-lead reporting RR, PR, QRS, QT and QTcF) prior to Day 0 based on the opinion of the investigator
Adequate renal function (defined by creatinine clearance >80 mL/min using the Cockcroft Gault equation)
For women of childbearing age, a willingness to use a highly effective form of contraception for five months after last dose of study medication. Highly effective methods of birth control include abstinence, vasectomy by the male partner, or a condom with spermicide in combination with either hormonal birth control, IUD or barrier methods used by the woman.
For men with female partners of childbearing potential, agreement not to donate sperm and to inform their female partner of their participation in this clinical study and use highly effective methods of birth control for five months after last dose of study medication. Highly effective methods of birth control include abstinence, vasectomy, or a condom with spermicide in combination with either hormonal birth control, Intrauterine device (IUD) or barrier methods used by the woman.
The ability to give informed consent and comply with study procedures

Exclusion Criteria

Prebronchodilator Forced Expiratory Volume at one second (FEV1) less than 0% of predicted value at screening visit
History of moderate or higher Allergic Rhinitis and its Impact on Asthma (ARIA) severity classification for allergic rhinitis in the last year due to allergens other than cat
History of asthma meeting the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 (EPR3) classification of mild-persistent or worse in the past year, other than with cat exposure, requiring regular inhaled corticosteroids for >4 weeks per year
History of serious chronic medical conditions which might interfere with treatment or assessments
History of emergency visit or hospital admission for asthma in the previous 12 months
History of chronic obstructive pulmonary disease (COPD)
History of significant recurrent acute sinusitis, defined as 2 episodes/yr for the last 2 years, all of which required antibiotic treatment
History of chronic sinusitis, defined as a sinus symptoms lasting >12 weeks that includes >/=2 major factors or 1 major factor and 2 minor factors. Major factors are defined as facial pain or pressure, nasal obstruction or blockage, purulent or discolored postnasal discharge, purulence in nasal cavity, or impaired or loss of smell. Minor factors are defined as headache, fever, halitosis, fatigue, dental pain, cough, and ear pain, pressure, or fullness.
History of systemic disease affecting the immune system such as autoimmune diseases, immune complex disease, or immunodeficiency, where, in the opinion of the study physician, participation in the trial would pose a risk or significant effect on the immune system
Diabetes (Type I or II)
Evidence of any active or suspected bacterial, viral, fungal or parasitic infection(s) within 30 days prior to randomization
High risk of parasitic disease as judged by the investigator
Positive QuantiFERON(R) tuberculin test UNLESS the potential subject has been treated with appropriate chemoprophylaxis
Exposure to an individual with active tuberculosis within six months from randomization
Subjects tested positive for HIV antibody, Hep B surface antigen, or Hep C antibody
At randomization, current symptoms of, or treatment for, upper respiratory tract infection, acute sinusitis, acute otitis media, or other relevant infectious process; serous otitis media is not an exclusion criterion. Participants may be re-evaluated for eligibility after symptoms resolve.
History of malignancy of any type, including basal cell and squamous cell cancers of the skin, within 5 years of enrollment
Tobacco smoking (ANY) within the last year or a history of >/=10 pack years
Previous immunotherapy treatment with cat allergen within the previous 10 yrs
Any history of grade 4 anaphylaxis due to any cause as defined by the CTCAE grading criteria for immunotherapy
History of bleeding disorders or treatment with anticoagulation therapy
Treatment with omalizumab within 6 months prior to randomization
Currently taking any of the following medications: beta blockers; tricyclic antidepressants; monoamine oxidase inhibitors; or anti-IgE monoclonal antibody treatment
Ongoing systemic immunosuppressive treatment
History of intolerance to the study therapy, rescue medications, or their excipients
For women of childbearing age a positive serum or urine pregnancy test with sensitivity of <50 mIU/mL within 72 hours before the start of study therapy
The use of any investigational drug within 6 months of randomization
The presence of any medical condition that the investigator deems incompatible with participation in the trial.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
AMG 157+Cat Immunotherapy Placebo	AMG 157	AMG 157 will be administered every four weeks. Placebo for Cat immunotherapy will be administered weekly.
AMG 157+Cat Immunotherapy	Cat Immunotherapy	AMG 157 will be administered every four weeks. Cat immunotherapy will be administered weekly.
AMG 157+Cat Immunotherapy	AMG 157	AMG 157 will be administered every four weeks. Cat immunotherapy will be administered weekly.
AMG 157 Placebo+Cat Immunotherapy	Cat Immunotherapy	Placebo for AMG 157 of similar appearance will be administered every four weeks. Cat immunotherapy will be administered weekly.
AMG 157+Cat Immunotherapy Placebo	Cat Immunotherapy Placebo	AMG 157 will be administered every four weeks. Placebo for Cat immunotherapy will be administered weekly.
AMG 157 Placebo+Cat Immunotherapy	AMG 157 Placebo	Placebo for AMG 157 of similar appearance will be administered every four weeks. Cat immunotherapy will be administered weekly.
Placebo-Placebo	Cat Immunotherapy Placebo	Placebo for AMG 157 will be administered every four weeks. Placebo for cat immunotherapy will be administered weekly.
Placebo-Placebo	AMG 157 Placebo	Placebo for AMG 157 will be administered every four weeks. Placebo for cat immunotherapy will be administered weekly.

Primary Outcome Measures

Name	Time	Method
Total Nasal Symptom Score (TNSS) Area Under the Curve (AUC)	0 to 1 hour of the NAC at Week 104	TNSS (0-12) is a participant rated score computed as the sum of four subscale scores (0-3) measuring nasal congestion and blockade, rhinorrhea, itching, and sneezing. Participants indicate a score on each subscale of 0, 1, 2, or 3, indicating none, mild, moderate, or severe symptoms, respectively. Higher scores indicate more severe nasal symptoms. The trapezoidal rule was used to calculate the TNSS AUC. The primary outcome compared the mean TNSS AUC from 0 to 1 hour after cat Nasal Allergen Challenge at 104 weeks by treatment group, using a longitudinal repeated measures model in the ITT sample. The model included fixed effects for treatment, time, and treatment by time interaction and included covariates for site, baseline TNSS AUC and Baseline Cat exposure (low vs high). The primary endpoint was assessed at week 104 using a contrast in least squares means between the following groups: AMG 157+Cat Immunotherapy and AMG 157 Placebo+Cat Immunotherapy.

Secondary Outcome Measures

Name	Time	Method
Skin Late Phase Response (LPR) to Intradermal Testing	6 hours status post cat allergen challenge at: Baseline (Time 0) and Weeks 26, 52 and 104	Concentrations of standardized cat hair extract were applied intradermally to the forearm. Wheal size was measured 15 minutes and 6 hours after application. The Late Phase Response (LPR) is the response measured at 6 hours after application.
Peak Total Nasal Symptom Score (TNSS): Early Phase Response (EPR)	0 to 1 hour of the NAC at: Baseline (Week 0) and Weeks 26, 52, 78 and 104	TNSS (0-12) is a participant rated score computed as the sum of four subscale scores (0-3) measuring nasal congestion and blockade, rhinorrhea, itching, and sneezing. Participants indicate a score on each subscale of 0, 1, 2, or 3, indicating none, mild, moderate, or severe symptoms, respectively. Higher scores indicate more severe nasal symptoms. Peak TNSS EPR is the highest value recorded between 0 and 1 hour inclusive.
Skin Prick Test Endpoint Titration	15 minutes after Time 0 of the skin prick titration test at: Baseline (Week 0) and Weeks 1, 4, 12, 26, 52, 78 and 104	A dilution series of standardized cat allergen extracts were applied in duplicate on the participant's upper back. Wheal size was assessed 15 minutes after application.
Skin Early Phase Response (EPR) to Intradermal Testing	15 minutes after Time 0 of the intradermal test at: Baseline (Week 0) and Weeks 26, 52, and 104	Concentrations of standardized cat hair extract were applied intradermally to the forearm. Wheal size was measured 15 minutes and 6 hours after application. The Early Phase Response (EPR) is the response measured at 15 minutes after application.
Total Nasal Symptom Score (TNSS) Early Phase Response (EPR)	0 to 1 hour of the NAC at: Baseline (Week 0) and Weeks 26, 52, 78 and 104	TNSS (0-12) is a participant rated score computed as the sum of four subscale scores (0-3) measuring nasal congestion and blockade, rhinorrhea, itching, and sneezing. Participants indicate a score on each subscale of 0, 1, 2, or 3, indicating none, mild, moderate, or severe symptoms, respectively. Higher scores indicate more severe nasal symptoms. The trapezoidal rule was used to calculate the TNSS AUC. The Early Phase Response (EPR) is the TNSS AUC from 0 to 1 hour.
Peak Nasal Inspiratory Flow (PNIF) Early Phase Response (EPR) Area Under the Curve (AUC)	0 to 1 hour of the NAC at: Baseline (Week 0) and Weeks 26, 52 and 104	PNIF is defined as the speed of inspiration of air in Liters per minute when breathing in into the lungs through the nose. Lower scores indicate less ability to breathe air into the lungs due to more severe nasal symptoms. The Early Phase Response (EPR) is the PNIF AUC from 0 to 1 hour of the NAC.
Total Nasal Symptom Score (TNSS) Late Phase Response (LPR)	Hours 5 to 6 of the NAC at: Baseline (Week 0) and Weeks 26, 52, and 104	TNSS (0-12) is a participant rated score computed as the sum of four subscale scores (0-3) measuring nasal congestion and blockade, rhinorrhea, itching, and sneezing. Participants indicate a score on each subscale of 0, 1, 2, or 3, indicating none, mild, moderate, or severe symptoms, respectively. Higher scores indicate more severe nasal symptoms. The trapezoidal rule was used to calculate the TNSS AUC. The Late Phase Response (LPR) is the TNSS AUC from 5 to 6 hours.
Peak Nasal Inspiratory Flow (PNIF) Late Phase Response (LPR) Area Under Curve AUC	Hours 5 to 6 of the NAC at: Baseline (Week 0) and Weeks 26, 52, 78, and 104	PNIF is defined as the speed of inspiration of air in Liters per minute when breathing in into the lungs through the nose. Lower scores indicate less ability to breathe air into the lungs due to more severe nasal symptoms. The Late Phase Response (LPR) is the PNIF AUC from hours 5 to 6 of the NAC.

Trial Locations

Locations (9): Vital Prospects Clinical Research Institute, P.C.
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Tulsa, Oklahoma, United States
Johns Hopkins Asthma & Allergy Center
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Baltimore, Maryland, United States
University of North Carolina, Chapel Hill
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Chapel Hill, North Carolina, United States
University of Chicago
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Chicago, Illinois, United States
Northwestern University
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Chicago, Illinois, United States
University of California, Los Angeles
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Los Angeles, California, United States
National Jewish Health
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Denver, Colorado, United States
ASTHMA Inc. Clinical Research Center
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Seattle, Washington, United States
University Wisconsin, Madison
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Madison, Wisconsin, United States