Study to Evaluate the Effect of Omalizumab on Improving the Tolerability of Specific Immunotherapy in Patients With Persistent Allergic Asthma

Novartis

Status and phase: Completed; Phase 4

Conditions: Allergic Asthma

Treatments: Drug: Immunotherapy; Drug: Omalizumab; Drug: Placebo

Study type: Interventional

Funder types: Industry

Identifiers

NCT00267202

CIGE025AUS23

Details and patient eligibility

About

This study is designed to investigate the use of omalizumab as a pretreatment for patients with persistent allergic asthma who are candidates for allergen immunotherapy (ie, allergy shots) and will test the hypothesis that omalizumab may reduce the rate of systemic reactions to immunotherapy in patients with persistent allergic asthma.

Enrollment: 275 patients

Sex: All

Ages: 18 to 55 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Patients were eligible for inclusion if they met all of the following criteria:

Informed Consent

• Patients who were informed of the study procedures and medications and provided their written informed consent

Demographics

• Male or female
• Any race
• Ages 18 - 55 years
• Body weight >=20 kg and <=150 kg
• Total serum IgE concentration >=30 and <=700 IU/mL at Visit 0

Disease Definitions/Medications

• History of at least moderate persistent allergic asthma (consistent with Global Initiative for Asthma [GINA] guidelines of >=1 year in duration
• On a stable asthma treatment regimen including inhaled corticosteroids for the preceding 4 weeks
• An FEV1 while withholding short-acting beta-agonists for at least 6 hours and long-acting beta-agonists for at least 12 hours, of >=75% of the predicted value at Visit 0
• Evidence of reversible airway obstruction, as defined by an increase in FEV1 of >=12% between 20 to 30 minutes after 4 puffs (or less at the discretion of the investigator) of inhaled short-acting beta-agonist administration at Visit 0 or within the preceding year
• Documented sensitivity to perennial aeroallergens, as evidenced by a positive skin test (wheal >=5mm greater than saline control) to at least 1 of 3 perennial aeroallergens (house dust mite, cat, or dog) at Visit 0 or within the preceding year
• Average PEFR variability <=20% (calculated as [(PM PEF - AM PEF)/(PM PEF + AM PEF)/2 x 100) during the 2-week screening period
• Pre-specified level of nocturnal asthma symptoms (i.e., a mean nocturnal asthma score of >0 and <=0.5) and a mean combined clinical symptom score (nocturnal, morning, and daytime) of >0 and <=3 during the screening period
• Non-smoker for at least 1 year prior to Visit 1, with a smoking history of no more than 10 pack-years (i.e., 1 pack [20 cigarettes] per day for 10 years)
• Judged to be in good physical and mental health (except for his/her asthma), based on medical history, physical examination, and routine laboratory data, and appeared to be able to successfully complete this trial

Exclusion criteria

Patients were to be excluded from participation if they met any of the following criteria:

Pulmonary

• History of intubation for asthma
• Asthma exacerbation requiring treatment with systemic steroids within the preceding 3 months
• Asthma exacerbation requiring treatment in an emergency department or a hospital admission in the preceding 6 months
• Upper respiratory tract infection or sinusitis within the preceding 4 weeks
• History of an anaphylactic allergic reaction (except to stinging insects, foods, or drugs other than omalizumab)
• History of treatment with immunotherapy to any allergen within past 3 years
• History of aspirin or non steroidal anti-inflammatory drug (NSAID)-related asthma; patients could have been included in NSAIDs use was avoided for the duration of the study

General Medical

• History of or current malignancy
• Any clinically significant uncontrolled systemic disease or a history of such disease (e.g., infectious, hematologic, renal, hepatic, endocrinologic, gastrointestinal, or cardiovascular disease) within the previous 3 months
• Clinically significant laboratory abnormalities at Visit 1
• Platelet levels <=130 x 10 9/L at visit 1
• Women of childbearing potential who were not practicing a medically approved contraception method (e.g., oral, subcutaneous, mechanical, or surgical contraception), as well as women who were pregnant or nursing
• History of hypersensitivity to any ingredients, including excipients (sucrose, histidine, or polysorbate 20) of the study medication or drugs related to omalizumab (e.g., monoclonal anti-bodies or polyclonal gammaglobulin)
• Severe medical condition(s) that, in the view of the investigator, prohibited participation in the study
• Previous treatment with omalizumab within 1 year of screening
• Considered by the investigator to be potentially unreliable or who may not have reliably attended study visits
• History of drug or alcohol abuse

Procedural

• Unable to perform acceptable, reproducible spirometry, or PEFR measurements
• Unable or unwilling to comply with the study procedures as determined during the screening phase, including adequate completion of the diary

Medications

Patient took the following medications before Visit 0. These medications were not permitted during the trial unless otherwise specified:

• Oral, intravenous, intramuscular, or intra-articular corticosteroids within 4 weeks
• Beta-adrenergic antagonists (including ocular preparations) within 1 week
• Antihistamines within 1 week; after skin testing was completed (Visit 0), antihistamines could be used as needed for the remainder of the study
• Intravenous gammaglobulin or immunosuppressants within 4 weeks
• Tricyclic antidepressants within 1 week
• Investigational drugs within 4 weeks

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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275 participants in 2 patient groups, including a placebo group

Placebo

Placebo Comparator group

Description:

The dose of placebo was determined according to the omalizumab US product label using a dosing table nomogram that ensures patients receive at least 0.016 mg/kg/IgE (IU/ml) per 4 weeks. The study drug was administered by subcutaneous injection every 2 or 4 weeks according to the dosing table nomogram.

Treatment:

Drug: Placebo

Drug: Immunotherapy

Drug: Immunotherapy

Omalizumab

Experimental group

Description:

The dose of omalizumab was determined according to the omalizumab US product label using a dosing table nomogram that ensures patients receive at least 0.016 mg/kg/IgE (IU/ml) per 4 weeks. The study drug was administered by subcutaneous injection every 2 or 4 weeks according to the dosing table nomogram.

Treatment:

Drug: Immunotherapy

Drug: Immunotherapy

Drug: Omalizumab