A 16-Week Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Multicenter Study Evaluating the Efficacy and Safety of Intranasal Administration of 100, 200, and 400 μg of Fluticasone Propionate Twice a Day (BID) Using a Novel Bi Directional Device in Subjects With Bilateral Nasal Polyposis Followed by an 8-Week Open-Label Extension Phase to Assess Safety
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 入组人数
- 323
- 试验地点
- 33
- 主要终点
- Change in 7-day Average Instantaneous Morning Diary Congestion/Obstruction Symptoms
研究概览
简要总结
The primary objective of this study is to compare the efficacy of intranasal administration of 100, 200, and 400 μg of fluticasone propionate twice a day delivered by the OptiNose device with placebo in subjects with bilateral nasal polyposis. Two co-primary endpoints will be used in the study: reduction of nasal congestion/obstruction symptoms at the end of Week 4 of the double-blind treatment phase measured by the 7 day average instantaneous AM diary symptom scores, and reduction in total polyp grade (sum of scores from both nasal cavities) over the 16 weeks of the double-blind treatment phase as determined by the Lildholdt scale score measured by nasoendoscopy.
详细描述
This was a randomized, double-blind, placebo-controlled, parallel-group, multicenter study designed to assess the efficacy and safety of intranasal administration of 3 doses of OPN-375 (100, 200, and 400 µg bid) in subjects with bilateral nasal polyposis and nasal congestion.
This study consisted of 3 phases. After signing informed consent, subjects who met eligibility criteria at Visit 1 (screening) entered the study.
- Pretreatment phase (single-blind, placebo, run-in): 7 to up to 14 days duration, to determine disease status eligibility and to ensure the subject was able to comply with study procedures prior to randomization and enrolment in the double-blind treatment phase.
- Double-blind treatment phase: 16 weeks duration with 6 scheduled visits starting with Visit 2, Day 1 (baseline) when eligible subjects were randomized by balance allocation to 1 of 4 treatment groups and ending at Visit 7 (Week 16).
- Open-label extension phase: 8 weeks duration with 1 scheduled visit (Visit 8 [Week 24]).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Investigator)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men or women aged 18 years and older
- •Women must
- •be practicing an effective method of birth control (eg,prescription oral contraceptives, contraceptive injections, contraceptive patch, intrauterine device, double-barrier method [eg, condoms, diaphragm, or cervical cap with spermicidal foam, cream, or gel], or male partner sterilization) before entry and throughout the study, or
- •be surgically sterile (have had a hysterectomy or bilateral oophorectomy, or tubal ligation at least 1 year before screening) or otherwise be incapable of pregnancy, or
- •be postmenopausal (spontaneous amenorrhea for at least 1 year).
- •Women of child-bearing potential must have a negative serum beta-human chorionic gonadotropin (B-hCG) or urine pregnancy test (depending on local regulations) at the screening visit
- •Must have bilateral nasal polyposis with a grade of 1 to 3 in each of the nasal cavities as determined by the Lildholdt scale score measured by nasoendoscopy at both screening and baseline visits
- •Must have at least moderate symptoms of nasal congestion/obstruction as reported by the subject for the 7 day period preceding the screening visit
- •At the baseline visit (Day 1), must have a morning score of at least 2 (moderate) on nasal congestion/obstruction recorded on the subject diary for at least 5 of the last 7 days of the 7 to up to 14 day run-in period
- •Must demonstrate an ability to correctly complete the daily diary during the run-in period to be eligible for randomization
- •Subjects with comorbid asthma or COPD must be stable with no exacerbations (eg, no emergency room visits, hospitalizations, or oral or parenteral steroid use) within the 3 months before the screening visit. Inhaled corticosteroid use must be limited to stable doses of no more than 1,000 μg/day of beclomethasone (or equivalent) for at least 3 months before screening with plans to continue use throughout the study.
- •Must be able to cease treatment with intranasal medications including, but not limited to, intranasal steroids, intranasal sodium cromolyn, nasal atropine, nasal ipratropium bromide, inhaled corticosteroids (except permitted doses listed above for comorbid asthma and COPD) at the screening visit
- •Must be able to cease treatment with oral and nasal decongestants and antihistamines at the screening visit
- •Must be able to use the OptiNose device correctly; all subjects will be required to demonstrate correct use of the placebo device at screening, Visit
- •Must be capable, in the opinion of the investigator, of providing informed consent to participate in the study. Subjects must sign an informed consent document indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study.
排除标准
- •Women who are pregnant or lactating
- •Have complete or near-complete obstruction of the nasal cavities
- •Inability to achieve bilateral nasal airflow for any reason including nasal septum deviation
- •Inability to have each nasal cavity examined for any reason including nasal septum deviation
- •Nasal septum perforation
- •Has had more than 1 episode of epistaxis with frank bleeding in the month before the screening visit
- •Have evidence of significant baseline mucosal injury, ulceration or erosion (eg, exposed cartilage, perforation) on baseline nasal examination/nasal endoscopy
- •History of more than 5 sinonasal surgeries for either nasal polyps or nasal/sinus inflammation (lifetime)
- •History of sinus or nasal surgery within 6 months before the screening visit
- •History of any surgical procedure that prevents the ability to accurately grade polyps
- •Have symptoms of seasonal allergic rhinitis at screening or baseline and/or, based on time of year, would anticipate onset of symptoms within 4 weeks of randomization
- •Current, ongoing rhinitis medicamentosa (rebound rhinitis)
- •Have significant oral structural abnormalities, eg, a cleft palate
- •Diagnosis of cystic fibrosis
- •History of Churg-Strauss syndrome or dyskinetic ciliary syndromes
- •Purulent nasal infection, acute sinusitis, or upper respiratory tract infection within 2 weeks before the screening visit. Potential subjects presenting with any of these infections may be rescreened 4 weeks after symptom resolution Note: Subjects who are taking prophylactic antibiotics will be allowed to enter the study as long as they intend to continue the antibiotics for the duration of the study.
- •Planned sinonasal surgery during the period of the study
- •Allergy, hypersensitivity, or contraindication to corticosteroids or steroids
- •Allergy or hypersensitivity to any excipients in study drug
- •Exposure to any glucocorticoid treatment with potential for systemic effects (eg, oral, parenteral, intra-articular, or epidural steroids, high dose topical steroids) within 1 month before the screening visit; except as noted in inclusion criteria for subjects with comorbid asthma or COPD
- •Have nasal candidiasis
- •Have taken a potent CYP3A4 inhibitor within 14 days before the screening visit.
- •History or current diagnosis of any form of glaucoma or ocular hypertension (ie, >21 mmHg)
- •History of intraocular pressure elevation on any form of steroid therapy
- •History or current diagnosis of the presence (in either eye) of a cataract
- •Any serious or unstable concurrent disease, psychiatric disorder, or any significant condition that, in the opinion of the investigator could confound the results of the study or could interfere with the subject's participation or compliance in the study
- •A recent (within 1 year of the screening visit) clinically significant history of drug or alcohol use, abuse, or dependence that, in the opinion of the investigator could interfere with the subject's participation or compliance in the study
- •Positive urine drug screen at screening visit for drugs of abuse, with the exception of prescribed medications for legitimate medical conditions
- •Have participated in an investigational drug clinical trial within 30 days of the screening visit
- •Employees of the investigator or study center, with direct involvement in the proposed study or other studies under the direction of that investigator or study center, as well as family members of the employees or the investigator
研究组 & 干预措施
OPN-375 100 μg BID
Double-Blind Treatment Phase: OPN-375 100 μg BID x 16 weeks
Open-Label Extension Phase: OPN-375 400 μg BID x 8 weeks
干预措施: Fluticasone Propionate (Drug)
Placebo
Double-Blind Treatment Phase: Matching Placebo BID x 16 weeks
Open-Label Extension Phase: OPN-375 400 μg BID x 8 weeks
干预措施: Fluticasone Propionate (Drug)
OPN-375 200 μg BID
Double-Blind Treatment Phase: OPN-375 200 μg BID x 16 weeks
Open-Label Extension Phase: OPN-375 400 μg BID x 8 weeks
干预措施: Fluticasone Propionate (Drug)
OPN-375 400 μg BID
Double-Blind Treatment Phase: OPN-375 400 μg BID x 16 weeks
Open-Label Extension Phase: OPN-375 400 μg BID x 8 weeks
干预措施: Fluticasone Propionate (Drug)
结局指标
主要结局
Change in 7-day Average Instantaneous Morning Diary Congestion/Obstruction Symptoms
时间窗: Baseline, Week 4 of the double-blind treatment phase
Subjects reported nasal symptoms using the electronic diary twice daily immediately before dosing. 0: None 1. Mild, symptoms clearly present, but minimal awareness, and easily tolerated 2. Moderate, definite awareness of symptoms that is bothersome but tolerable 3. Severe, symptoms that are hard to tolerate, cause interference with activities or daily living The change from baseline in instantaneous morning diary symptom scores averaged over 7 days prior to the Week 4 Visit of the double-blind treatment phase
Change in Total Polyp Grade
时间窗: Baseline, Week 16 of the double-blind treatment phase
Polyp grading of each nasal cavity was determined by a nasal polyp grading scale score measured by nasoendoscopy. A summary of the changes from baseline to Week 16 in total polyp grade. 0: No polyps 1. Mild polyposis: polyps not reaching below the inferior border of the middle turbinate 2. Moderate polyposis: polyps reaching below the inferior border of the middle concha, but not the inferior border of the inferior turbinate 3. Severe polyposis large polyps reaching below the lower inferior border of the inferior turbinate Reduction in total polyp grade (sum of scores from both nasal cavities) at Week 16 of double-blind treatment phase; Included patients with nasal polyps at baseline
次要结局
- Hyposmia Score (7-day Instantaneous Morning)(Baseline, Week 16 of the double-blind treatment phase)
- Change in Rhinorrhea Score (7-day Instantaneous Morning)(Baseline, Week 16 of the double-blind treatment phase)
- MOS Sleep-R Score(Baseline, Week 16 of the double-blind treatment phase)
- Rhinosinusitis Disability Index (RSDI) Total Score(Baseline, Week 16 of the double-blind treatment phase)
- Congestion/Obstruction Scores (7-day Instantaneous Morning)(Baseline, Week 16 of the double-blind treatment phase)
- SF-36v2 - Mental Component(Baseline, Week 16 of the double-blind treatment phase, Week 24 of the end of open-label treatment phase)
- Patient Global Impression of Change (PGIC) Score(Week 16 of the double-blind treatment phase, Week 24 of the end of open-label treatment phase)
- Polyp Grade of 0 in at Least One Nostril(Baseline, Week 16 of the double-blind treatment phase, Week 24 of the end of open-label treatment phase)
- Nasal Polyp Surgery Eligilbilty(Baseline, Week 16 of the double-blind treatment phase, Week 24 of the open-label extension phase)
- Facial Pain or Pressure Score (7-day Instantaneous Morning)(Baseline, Week 16 of the double-blind treatment phase)
- Sinonasal Outcome Test 22 (SNOT-22) Total Score(Baseline, Week 16 of the double-blind treatment phase, Week 24 of the end of open-label treatment phase)
- SF-36v2 - Physical Component(Baseline, Week 16 of the double-blind treatment phase, Week 24 of the end of open-label treatment phase)
- Peak Nasal Inspiratory Flow (PNIF)(Baseline, Week 16 of the double-blind treatment phase, Week 24 of the open-label treatment phase)