Study to Evaluate the Efficacy and Safety of MEDI9929 (AMG 157) in Adult Subjects With Inadequately Controlled, Severe Asthma

Phase 2

Completed

Conditions: Asthma

Interventions: Drug: Placebo
Drug: MEDI9929 210 mg
Drug: MEDI9929 280 mg
Drug: MEDI9929 70 mg

Registration Number: NCT02054130

Lead Sponsor: MedImmune LLC

Brief Summary: The primary objective of the study is to evaluate the effect of 3 dose levels of MEDI9929 (AMG 157) on asthma exacerbations in adult subjects with inadequately controlled, severe asthma.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 584

Inclusion Criteria

Age 18 through 75
Body mass index (BMI) between 18-40 kg/m2 and weight greater than or equal 40 kg
Documented physician-diagnosed asthma - Subjects must have received a physician-prescribed asthma controller regimen with medium- or high-dose inhaled corticosteroids (ICS) plus long acting β2 agonist (LABA) -If on asthma controller medications in addition to ICS plus LABA, the dose of the other asthma controller medications (leukotriene receptor inhibitors, theophylline, secondary ICS, long-acting anti-muscarinics (LAMA), cromones, or maintenance oral prednisone or equivalent up to a maximum of 10 mg daily or 20 mg every other day for the maintenance treatment of asthma) must be stable. -Subjects must have a documented history of at least 2 asthma exacerbation events OR at least 1 severe asthma exacerbation resulting in hospitalization within the 12 months prior to first study visit.

Exclusion Criteria

Diagnosis of vocal cord dysfunction, reactive airways dysfunction syndrome, hyperventilation and panic attacks, or other mimics of asthma.
Current smokers or subjects with a smoking history of ≥ 10 pack years
Former smokers with < 10 pack years must have stopped for at least 1 year to be eligible.
Any concomitant respiratory disease that in the opinion of the investigator and/or medical monitor will interfere with the evaluation of the investigational product or interpretation of subject safety or study results (eg, chronic obstructive pulmonary disease, cystic fibrosis, pulmonary fibrosis, bronchiectasis, allergic bronchopulmonary aspergillosis, Churg-Strauss syndrome).
Evidence of active liver disease.
History of Cancer, except for basal cell carcinoma or insitu carcinoma of the cervix treated with apparent success with curative therapy or other malignancies are eligible provided that curative therapy was completed -Known history of active tuberculosis (TB)
History of anaphylaxis to any biologic therapy
Positive medical history for hepatitis B or C
Subject with human immunodeficiency virus (HIV) or subject taking antiretroviral medications, as determined by medical history and/or subject's verbal report.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Participants received placebo matched to MEDI9929 subcutaneously once every 2 weeks from Day 1 to Week 50.
MEDI9929 210 mg	MEDI9929 210 mg	Participants received 210 mg of MEDI9929 subcutaneously once every 4 weeks from Day 1 to Week 48 along with subcutaneous placebo once every 4 weeks from Week 2 to Week 50.
MEDI9929 280 mg	MEDI9929 280 mg	Participants received 280 mg of MEDI9929 subcutaneously once every 2 weeks from Day 1 to Week 50.
MEDI9929 70 mg	MEDI9929 70 mg	Participants received 70 milligram (mg) of MEDI9929 subcutaneously once every 4 weeks from Day 1 to Week 48 along with subcutaneous placebo once every 4 weeks from Week 2 to Week 50.

Primary Outcome Measures

Name	Time	Method
Annualized Asthma Exacerbation Rate (AER) Through Week 52	Week 0 (Day 1) up to Week 52	Asthma exacerbation is defined as worsening of asthma that leads to any of the following: use of systemic corticosteroids for at least 3 days, an emergency department visit due to asthma that required systemic corticosteroids, and an inpatient hospitalization due to asthma. The annual AER was presented as the total number of exacerbations for the treatment group divided by the total duration of person follow-up.

Secondary Outcome Measures

Name	Time	Method
Reduction in AER on Subpopulations at Week 52	Week 52	Asthma exacerbation is defined as worsening of asthma that leads to any of the following: use of systemic corticosteroids for at least 3 days, an emergency department visit due to asthma that required systemic corticosteroids, and an inpatient hospitalization due to asthma. Reduction in AER was evaluated in pre-specified subpopulations (blood eosinophil count \[eosinophilic and non-eosinophilic\], T helper cell 2 \[Th2\] status \[high and low\], Fraction of exhaled nitric oxide \[FENO\] \[high and low\], serum periostin \[high and low\], current post bronchodilator forced expiratory volume in 1 second \[Post-BD FEV1\] reversibility- yes, allergic and non-allergic) of asthma. The annual AER was presented as the total number of exacerbations for the treatment group divided by the total duration of person follow-up. Also, the high or low was determined using median value.
Rate of Severe Asthma Exacerbation Through Week 52	Week 0 (Day 1) up to Week 52	A severe asthma exacerbation is defined as an event that resulted in hospitalization. The severe AER was presented as the total number of exacerbations for the treatment group divided by the total duration of person follow-up.
Time to First Asthma Exacerbation Through Week 52	Week 0 (Day 1) through Week 52	Asthma exacerbation is defined as worsening of asthma that leads to use of systemic corticosteroids for at least 3 days, an emergency department visit due to asthma that required systemic corticosteroids, and an inpatient hospitalization due to asthma. Time to first asthma exacerbation was reported.
Time to First Severe Asthma Exacerbation Through Week 52	Week 0 (Day 1) through Week 52	Asthma exacerbation is defined as worsening of asthma that leads to use of systemic corticosteroids for at least 3 days, an emergency department visit due to asthma that required systemic corticosteroids, and an inpatient hospitalization due to asthma. Time to first severe asthma exacerbations (hospitalization) were reported.
Number of Participants With at Least One Severe Asthma Exacerbations Through Week 52	Week 0 (Day 1) through Week 52	Asthma exacerbation is defined as worsening of asthma that leads to use of systemic corticosteroids for at least 3 days, an emergency department visit due to asthma that required systemic corticosteroids, and an inpatient hospitalization due to asthma. Participants with severe asthma exacerbations (hospitalization) were reported.
Change From Baseline in Asthma Symptoms Measured by Asthma Control Questionnaire (ACQ-6) Score at Week 52	Baseline (Week 0 [Day 1]) and Week 52	The ACQ is a patient-reported questionnaire assessing asthma symptoms (ie, night-time waking, symptoms on waking, activity limitation, shortness of breath, wheezing) and daily rescue bronchodilator use and FEV1. The ACQ-6 is a shortened version of the ACQ that omits the FEV1 measurement from the original ACQ score. Questions are weighted equally and scored from 0 (totally controlled) to 6 (severely uncontrolled).
Change From Baseline in Pre-bronchodilator (Pre-BD) Forced Expiratory Volume in 1 Second (FEV1) and Forced Vital Capacity (FVC) at Week 52	Baseline (Week 0 [Day 1]) to Week 52	Forced expiratory volume in 1 second and forced vital capacity measures taken before bronchodilator use were reported.
Change From Baseline in FEV1 on Subpopulations at Week 52	Baseline and up to Week 52	Forced expiratory volume in one second (FEV1) was evaluated in pre-specified subpopulations of asthma. The data presented in the below table for this outcome measure is for pre-bronchodilator FEV1.
Change From Baseline in Post-bronchodilator (Post-BD) FEV1 and FVC at Week 52	Baseline (Week 0 [Day 1]) to Week 52	Forced expiratory volume in 1 second and forced vital capacity measures taken after bronchodilator use were reported.
Number of Participants With at Least One Asthma Exacerbations Through Week 52	Week 0 (Day 1) through Week 52	Asthma exacerbation is defined as worsening of asthma that leads to use of systemic corticosteroids for at least 3 days, an emergency department visit due to asthma that required systemic corticosteroids, and an inpatient hospitalization due to asthma.
Number of Participants With TEAEs Related to Electrocardiogram Evaluations	From the start of study drug administration upto Week 64	Adverse events observed in participants with clinically significant electrocardiogram abnormalities were assessed.
Mean Serum Concentrations of MEDI9929	Week 0 (Day 1) to Week 64	The mean serum concentrations of MEDI9929 was observed at specified timepoints.
Number of Participants With Positive Antibodies to MEDI9929	Week 0 (Day 1) to Week 64	Blood samples for immunogenicity assessment included the determination of anti-drug antibodies (ADA) for MEDI9929. The number of participants with positive serum antibodies to MEDI9929 were presented.
Change From Baseline in Overall Symptoms Score on Subpopulations at Week 52	Baseline and up to Week 52	Asthma symptoms during night time and daytime are recorded by the participant in the asthma daily diary. Overall symptom score is the average of scores of daytime severity, daytime frequency, and nighttime severity symptoms. The daytime frequency and severity items are scored from 0 to 4, where a higher score indicates greater frequency/severity and nighttime severity item is scored from 0 to 4 , where a higher score indicates greater severity. Overall symptom score ranges from 0 to 4, where lower score indicates better asthma symptom while, higher score indicates worse asthma symptom.
Change From Baseline in Asthma Symptoms Measured by Asthma Daily Diary at Week 52	Baseline (Week 0 [Day 1]) and Week 52	Asthma symptoms during night time and daytime are recorded by the participant in the asthma daily diary. Symptom score values for night time assessment is 0 (no asthma symptom) to 3 (unable to sleep because of asthma) and symptom score values for day time assessment is 0 (no asthma symptom) to 3 (unable to do normal activities due to asthma). Total asthma symptom score is the sum of the daytime and night time score (0 to 6). Lower score (0) is indicating better asthma symptom, while higher score (6) is indicating worse asthma symptom.
Change From Baseline in Asthma Quality of Life Questionnaire (Standardized Version) (AQLQ [S]) Overall Score at Week 52	Baseline (Week 0 [Day 1]) and Week 52	The AQLQ(S) +12 is a 32-item questionnaire that measures the health-related quality of life experienced by asthma participants. The questionnaire comprises 4 separate domains (symptoms, activity limitations, emotional function, and environmental stimuli) scaled on a 7-point scale ranging from 7 (no impairment) to 1 (severe impairment).
Change From Baseline in European Quality of Life-5 Dimensions 5 Level Version (EQ-5D-5L) Health State Evaluation at Week 52	Baseline (Week 0 [Day 1]) and Week 52	European Quality of Life-5 Dimensions-5 Level (EQ-5D-5L) is a standardized measure of health status of the participant. The first component is a descriptive system of the respondent's health comprised of the following 5 participant-reported dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. The responses are used to derive the health state index scores using the United Kingdom (UK) algorithm, with scores ranging from -0.594 to 1. A higher score indicates better health state. The second component is a self-perceived health score which is assessed using a visual analogue scale (VAS) that ranged from 0 to 100, where 0 indicated the worst health you can imagine and 100 indicated the best health you can imagine.
Total Amount of Study Drug Exposure	Week 0 (Day 1) through Week 52	The total amount of study drug exposure (in milligram) for the entire study period was summarized.
Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs)	Day 1 upto Week 64	An adverse event is any unfavourable and unintended signs (including abnormal laboratory findings), symptoms, or diseases temporally associated with use of medicinal product, whether or not considered related to medicinal product. Serious adverse event is any adverse event that resulted in death, life-threatening, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability or incapacity, is a congenital anomaly/birth defect in offspring of a study participant, is an important medical event that may jeopardize the participant or may require medical intervention. TEAEs are defined as events present at baseline that worsened in intensity after administration of study drug or events absent at baseline that emerged after administration of study drug, for the period until and including the follow-up period (Week 64).
Number of Participants With TEAEs Related to Vital Sign Parameters	Day 1 upto Week 64	Adverse events observed in participants with clinically significant vital signs abnormalities were assessed.
Number of Participants With TEAEs Related to Clinical Laboratory Evaluation	Day 1 upto Week 64	An abnormal laboratory finding which required an action or intervention by the investigator, or a finding judged by the investigator to represent a change beyond the range of normal physiologic fluctuation were reported as an adverse event. Laboratory evaluations of blood and urine samples were performed.