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Study Evaluating the Safety and Efficacy of MN-221 as an Adjunct to Standard Therapy in Subjects Experiencing an Acute Exacerbation of Asthma

Primary Purpose

Asthma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
MN-221
Placebo
Sponsored by
MediciNova
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Asthma focused on measuring MN-221, Asthma, Acute, Exacerbation

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Subjects meeting all of the following criteria will be considered for admission to the study:

    1. Male or female 18 to 65 years of age, inclusive;
    2. Self-reported history of physician-diagnosed and treated asthma for ≥ 3 months prior to randomization;
    3. A diagnosis of an acute exacerbation of asthma upon presentation at the ED as defined by dyspnea and evidence of bronchospasm;
    4. Received the following Standardized Treatment within a 2-hour time window and prior to obtaining the Qualifying Spirometry value(FEV1):

      • Supplemental oxygen given to maintain oxygen saturation as measured by pulse oximetry of ≥ 90% as needed;
      • Albuterol 5-15mg of albuterol via nebulizer prior to the qualifying spirometry evaluation; simultaneously with
      • Ipratropium 0.5-1.5 mg of ipratropium via nebulizer prior to the qualifying spirometry evaluation;
      • One dose of corticosteroid of at least 50 mg given orally (prednisone) or intravenously (methylprednisolone) or the equivalent dose of another corticosteroid.
    5. FEV1 of ≤ 50% of predicted; NOTE: Spirometry to measure the subject's FEV1 expressed as % of predicted within 30 minutes of completing administration of 5 mg (but not more than 15 mg) albuterol and 0.5 mg (but not more than 1.5 mg) of ipratropium..
    6. Negative urine pregnancy test for all females of child-bearing potential;
    7. ECG with no dysrhythmias (except sinus tachycardia);
    8. No clinical or electrocardiographic signs of ischemic heart disease as determined by the Investigator; and
    9. Legally effective written informed consent obtained prior to starting any mandated study procedures

Exclusion Criteria:

Subjects will be excluded if they meet any of the following criteria:

  1. Administration of a parenteral (intravenous or subcutaneous) beta agonist (e. g., albuterol, terbutaline, epinephrine) within 6 hours prior to randomization;
  2. A current or prior diagnosis or suspected diagnosis of COPD or other chronic lung disease other than asthma;
  3. Presence of pneumonia;
  4. Presence of significant other respiratory dysfunction such as pneumothorax, pneumomediastinum, or pulmonary edema;
  5. Known or suspected vocal cord dysfunction syndrome;
  6. Presence of aspirated foreign body (known or suspected);
  7. History or any current clinical evidence suggesting cardiomyopathy or congestive heart failure;
  8. History or presence of tachyarrhythmias, with the exception of sinus tachycardia;
  9. Heart rate ≥ 140 bpm;
  10. Hypokalemia, defined as subjects with serum potassium level of <2.8 mEq/L (≤2.8 mmol/L) obtained at Screening (local stat lab, blood gas analysis, or other point of care device) with the following exception:

    For the subjects using non-potassium-sparing diuretics (i.e. loop-diuretic or thiazide diuretic) without "potassium-sparing diuretics" (e.g., Triamterene or Spironolactone) OR without potassium supplementation of at least KCl 20 mEq/day whose potassium level <3.5 mEq/L (<3.5 mmol/L) at Screening.

  11. Significant cardiac, renal, hepatic, endocrine, metabolic, neurologic or other systemic disease. A significant disease will be defined as one which, in the opinion of the Investigator, may either put the subject at risk because of participation in the study, or may influence the results of the study or the subject's ability to participate in the trial;
  12. Self-reported history of greater than 20 pack-yr smoking history;
  13. Fever ≥ 102.0 ºF (38.9 ºC);
  14. Uncontrolled hypertension defined as a blood pressure ≥ 170/100 mm Hg (22.7/13.3 kPa);
  15. Need for immediate intubation, mechanical ventilation, or non-invasive positive pressure ventilation as determined by the Investigator;
  16. Pregnant or lactating females;
  17. Participated in another clinical study with an investigational drug within 30 days of randomization;
  18. Positive urine drug screen for cocaine, methamphetamine or PCP unless, in the Investigator's clinical judgment, a single positive result is explained by exposure to a non-illicit drug product (i.e., is a false positive). For example, phenylpropanolamine or methylphenidate may read positive in a methamphetamine screen; dextromethorphan in a PCP screen.
  19. Any subject with a known allergy to components of the MN-221 drug product;
  20. Any subject with a known allergy to other beta agonists;
  21. Previous exposure to MN-221; or
  22. Use of theophylline, beta blockers, digoxin, MAO inhibitors, or tricyclic antidepressants within 2 weeks prior to randomization.

Use of non-potassium-sparing diuretics (i.e. Thiazide or Loop-diuretic) without potassium-sparing diuretic OR without potassium supplementation >20 mEq/day within 2 weeks prior to randomization and if serum potassium level at Screening <3.5 mEq/L (<3.5 mmol/L).

Sites / Locations

  • Loma Linda University Medical Center
  • UCSD Medical Center - Thornton Hospital
  • UCSD Medical Center
  • Olive View - UCLA Medical Center
  • Loyola University Medical Center
  • Newton - Wellesley Hospital
  • Baystate Medical Center
  • Hennepin County Medical Center
  • Washington University School of Medicine
  • Hackensack University Medical Center
  • University of Cincinnati
  • Albert Einstein Healthcare Network
  • Rhode Island Hospital
  • University of Texas Southwestern Medical Center
  • Sentara General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

1

Placebo

Arm Description

MN-221 given i.v. 1-hour infusion a total dose of 1200 μg (40 μg/min for 15 min [600 μg] + 13.3 μg/min for 45 min [600 μg]) as an adjunct to the standard of care for acute exacerbation of asthma.

Placebo (Lot #CLO-095) was packaged in identical vials containing only excipients and administered as an i.v. 1-hour infusion with a regimen as described for MN-221.

Outcomes

Primary Outcome Measures

The primary efficacy analysis will be based on a change in FEV1, expressed as percent of predicted, at Hour 3 when compared to FEV1, expressed as percent of predicted, at the qualifying/screening timepoint.

Secondary Outcome Measures

Change from baseline FEV1 % of predicted (at time points other than Hour 3)
Change from baseline FEV1 (L)
Change from baseline PEFR (L/sec)
Change from baseline PEFR, expressed as percent (%) of predicted
Improvement in Dyspnea index scale
Percent of subjects with an improvement in FEV1 ≥ 200cc
Percent of subjects with an improvement in FEV1, % predicted ≥ 5%
Percent of subjects with and improvement in FEV1, % predicted ≥ 10%
Subjects Hospitalized ( within 24 hour from start of study drug infusion)
Admitted to ICU (within 24 hours from start of study drug infusion)
Number of albuterol treatments to achieve an increase in FEV1% of predicted ≥ 15%
Total dose or number of albuterol treatments in first 3 hours following commencement of randomized medication.
Time to achieve an increase of FEV1% of predicted ≥ 15%
Time to initial albuterol treatment following the commencement of randomized medication
Hospital length of stay

Full Information

First Posted
February 5, 2009
Last Updated
September 4, 2013
Sponsor
MediciNova
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1. Study Identification

Unique Protocol Identification Number
NCT00838591
Brief Title
Study Evaluating the Safety and Efficacy of MN-221 as an Adjunct to Standard Therapy in Subjects Experiencing an Acute Exacerbation of Asthma
Official Title
MN-221-CL-007: A Phase II, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Safety and Efficacy of MN-221 When Administered Intravenously as an Adjunct to Standard Therapy to Adults With an Acute Exacerbation of Asthma
Study Type
Interventional

2. Study Status

Record Verification Date
September 2013
Overall Recruitment Status
Completed
Study Start Date
March 2009 (undefined)
Primary Completion Date
March 2012 (Actual)
Study Completion Date
March 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
MediciNova

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of this clinical study is to examine the safety and effectiveness of intravenous MN-221 compared to placebo when administered as an adjunct to standard therapy in subjects experiencing an acute exacerbation of asthma.
Detailed Description
This is an international, randomized, double-blind, placebo-controlled, multi-center ED study. Each subject will receive MN-221 or placebo administered through a continuous intravenous infusion in addition to the standardized treatment for an acute exacerbation of asthma. Upon presentation to the ED for assessment and treatment for an acute exacerbation of asthma the patient should receive standard of care consistent with the international guidelines (e.g., Global Initiative for Asthma [GINA] or the National Asthma Education and Prevention Program [NAEPP]) and required, in part, by this protocol prior to screening procedures being performed. Prior to any study specific treatment or evaluation being performed a subject must have signed an IRB/EC/REB approved consent form. Once the subject has received the initial treatment regimen the subject will be assessed for response to the treatment including spirometry.If the subject meets all entry criteria the subject will be randomized to receive MN-221 or placebo. Throughout the screening process the subject will continue to receive standardized treatment consistent with the appropriate guidelines for the treatment of acute exacerbations of asthma. Subjects enrolled in the study will receive an intravenous 1-hour infusion of MN-221 study drug or placebo. Subjects receiving MN-221 will be administered a total dose of 1200 μg. During the study treatment period, the subject may continue to receive standardized treatment and be assessed. The study treatment period will be approximately 3 hours in length. Safety and efficacy will be monitored throughout the treatment period. PK parameters (if applicable) will be obtained from subjects at selected study sites. A blood sample for genomic evaluation will be collected during the treatment period (at participating sites) if the subject consents to the evaluation. An initial 24-hour post-randomization follow-up visit will be completed to evaluate the subject's health status as well as for safety and PK parameters (if applicable). A second follow-up contact will be completed by telephone seven days post-randomization for safety purposes and to evaluate the subject's health status. A periodic risk/benefit evaluation will be performed by the study's Data Safety Monitoring Board.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Asthma
Keywords
MN-221, Asthma, Acute, Exacerbation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
176 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
MN-221 given i.v. 1-hour infusion a total dose of 1200 μg (40 μg/min for 15 min [600 μg] + 13.3 μg/min for 45 min [600 μg]) as an adjunct to the standard of care for acute exacerbation of asthma.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo (Lot #CLO-095) was packaged in identical vials containing only excipients and administered as an i.v. 1-hour infusion with a regimen as described for MN-221.
Intervention Type
Drug
Intervention Name(s)
MN-221
Other Intervention Name(s)
bedoradrine sulfate
Intervention Description
Dose: intravenous 1-hour infusion of MN-221 (total dose 1200 μg) or matching placebo.
Intervention Type
Drug
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
The primary efficacy analysis will be based on a change in FEV1, expressed as percent of predicted, at Hour 3 when compared to FEV1, expressed as percent of predicted, at the qualifying/screening timepoint.
Time Frame
Hour 3
Secondary Outcome Measure Information:
Title
Change from baseline FEV1 % of predicted (at time points other than Hour 3)
Time Frame
Hours 1, 2, 3, and 24
Title
Change from baseline FEV1 (L)
Time Frame
Hours 1, 2, 3 and 24
Title
Change from baseline PEFR (L/sec)
Time Frame
Hours 1, 2, 3 and 24
Title
Change from baseline PEFR, expressed as percent (%) of predicted
Time Frame
Hours 1, 2, 3and 24
Title
Improvement in Dyspnea index scale
Time Frame
Hours 1, 2, 3, 24 and Day 8
Title
Percent of subjects with an improvement in FEV1 ≥ 200cc
Time Frame
Hours 1, 2, 3 and 24
Title
Percent of subjects with an improvement in FEV1, % predicted ≥ 5%
Time Frame
Hours 1, 2, 3 and 24
Title
Percent of subjects with and improvement in FEV1, % predicted ≥ 10%
Time Frame
Hours 1, 2, 3 and 24
Title
Subjects Hospitalized ( within 24 hour from start of study drug infusion)
Time Frame
Within 24 hours from start of study drug infusion.
Title
Admitted to ICU (within 24 hours from start of study drug infusion)
Time Frame
Within 24 hours from start of study drug infusion.
Title
Number of albuterol treatments to achieve an increase in FEV1% of predicted ≥ 15%
Time Frame
Hours 3
Title
Total dose or number of albuterol treatments in first 3 hours following commencement of randomized medication.
Time Frame
No specific time points
Title
Time to achieve an increase of FEV1% of predicted ≥ 15%
Time Frame
No specific time points
Title
Time to initial albuterol treatment following the commencement of randomized medication
Time Frame
No specific time points
Title
Hospital length of stay
Time Frame
No specific timepoints

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects meeting all of the following criteria will be considered for admission to the study: Male or female 18 to 65 years of age, inclusive; Self-reported history of physician-diagnosed and treated asthma for ≥ 3 months prior to randomization; A diagnosis of an acute exacerbation of asthma upon presentation at the ED as defined by dyspnea and evidence of bronchospasm; Received the following Standardized Treatment within a 2-hour time window and prior to obtaining the Qualifying Spirometry value(FEV1): Supplemental oxygen given to maintain oxygen saturation as measured by pulse oximetry of ≥ 90% as needed; Albuterol 5-15mg of albuterol via nebulizer prior to the qualifying spirometry evaluation; simultaneously with Ipratropium 0.5-1.5 mg of ipratropium via nebulizer prior to the qualifying spirometry evaluation; One dose of corticosteroid of at least 50 mg given orally (prednisone) or intravenously (methylprednisolone) or the equivalent dose of another corticosteroid. FEV1 of ≤ 50% of predicted; NOTE: Spirometry to measure the subject's FEV1 expressed as % of predicted within 30 minutes of completing administration of 5 mg (but not more than 15 mg) albuterol and 0.5 mg (but not more than 1.5 mg) of ipratropium.. Negative urine pregnancy test for all females of child-bearing potential; ECG with no dysrhythmias (except sinus tachycardia); No clinical or electrocardiographic signs of ischemic heart disease as determined by the Investigator; and Legally effective written informed consent obtained prior to starting any mandated study procedures Exclusion Criteria: Subjects will be excluded if they meet any of the following criteria: Administration of a parenteral (intravenous or subcutaneous) beta agonist (e. g., albuterol, terbutaline, epinephrine) within 6 hours prior to randomization; A current or prior diagnosis or suspected diagnosis of COPD or other chronic lung disease other than asthma; Presence of pneumonia; Presence of significant other respiratory dysfunction such as pneumothorax, pneumomediastinum, or pulmonary edema; Known or suspected vocal cord dysfunction syndrome; Presence of aspirated foreign body (known or suspected); History or any current clinical evidence suggesting cardiomyopathy or congestive heart failure; History or presence of tachyarrhythmias, with the exception of sinus tachycardia; Heart rate ≥ 140 bpm; Hypokalemia, defined as subjects with serum potassium level of <2.8 mEq/L (≤2.8 mmol/L) obtained at Screening (local stat lab, blood gas analysis, or other point of care device) with the following exception: For the subjects using non-potassium-sparing diuretics (i.e. loop-diuretic or thiazide diuretic) without "potassium-sparing diuretics" (e.g., Triamterene or Spironolactone) OR without potassium supplementation of at least KCl 20 mEq/day whose potassium level <3.5 mEq/L (<3.5 mmol/L) at Screening. Significant cardiac, renal, hepatic, endocrine, metabolic, neurologic or other systemic disease. A significant disease will be defined as one which, in the opinion of the Investigator, may either put the subject at risk because of participation in the study, or may influence the results of the study or the subject's ability to participate in the trial; Self-reported history of greater than 20 pack-yr smoking history; Fever ≥ 102.0 ºF (38.9 ºC); Uncontrolled hypertension defined as a blood pressure ≥ 170/100 mm Hg (22.7/13.3 kPa); Need for immediate intubation, mechanical ventilation, or non-invasive positive pressure ventilation as determined by the Investigator; Pregnant or lactating females; Participated in another clinical study with an investigational drug within 30 days of randomization; Positive urine drug screen for cocaine, methamphetamine or PCP unless, in the Investigator's clinical judgment, a single positive result is explained by exposure to a non-illicit drug product (i.e., is a false positive). For example, phenylpropanolamine or methylphenidate may read positive in a methamphetamine screen; dextromethorphan in a PCP screen. Any subject with a known allergy to components of the MN-221 drug product; Any subject with a known allergy to other beta agonists; Previous exposure to MN-221; or Use of theophylline, beta blockers, digoxin, MAO inhibitors, or tricyclic antidepressants within 2 weeks prior to randomization. Use of non-potassium-sparing diuretics (i.e. Thiazide or Loop-diuretic) without potassium-sparing diuretic OR without potassium supplementation >20 mEq/day within 2 weeks prior to randomization and if serum potassium level at Screening <3.5 mEq/L (<3.5 mmol/L).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kazuko Matsuda, MD
Organizational Affiliation
MediciNova
Official's Role
Study Director
Facility Information:
Facility Name
Loma Linda University Medical Center
City
Loma Linda
State/Province
California
ZIP/Postal Code
92354
Country
United States
Facility Name
UCSD Medical Center - Thornton Hospital
City
San Diego
State/Province
California
ZIP/Postal Code
92037
Country
United States
Facility Name
UCSD Medical Center
City
San Diego
State/Province
California
ZIP/Postal Code
92103
Country
United States
Facility Name
Olive View - UCLA Medical Center
City
Sylmar
State/Province
California
ZIP/Postal Code
91342
Country
United States
Facility Name
Loyola University Medical Center
City
Maywood
State/Province
Illinois
ZIP/Postal Code
60153
Country
United States
Facility Name
Newton - Wellesley Hospital
City
Newton
State/Province
Massachusetts
ZIP/Postal Code
02462
Country
United States
Facility Name
Baystate Medical Center
City
Springfield
State/Province
Massachusetts
ZIP/Postal Code
01199
Country
United States
Facility Name
Hennepin County Medical Center
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55415
Country
United States
Facility Name
Washington University School of Medicine
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Hackensack University Medical Center
City
Hackensack
State/Province
New Jersey
ZIP/Postal Code
07601
Country
United States
Facility Name
University of Cincinnati
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45267-0563
Country
United States
Facility Name
Albert Einstein Healthcare Network
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19141
Country
United States
Facility Name
Rhode Island Hospital
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02903
Country
United States
Facility Name
University of Texas Southwestern Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States
Facility Name
Sentara General Hospital
City
Norfolk
State/Province
Virginia
ZIP/Postal Code
23507
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
26324315
Citation
House SL, Matsuda K, O'Brien G, Makhay M, Iwaki Y, Ferguson I, Lovato LM, Lewis LM. Efficacy of a new intravenous beta2-adrenergic agonist (bedoradrine, MN-221) for patients with an acute exacerbation of asthma. Respir Med. 2015 Oct;109(10):1268-73. doi: 10.1016/j.rmed.2015.08.003. Epub 2015 Aug 14.
Results Reference
derived
PubMed Identifier
25087835
Citation
Schneider JE, Lewis LM, Ferguson I, House SL, Liu J, Matsuda K, Johnson K. Repeated dyspnea score and percent FEV1 are modest predictors of hospitalization/relapse in patients with acute asthma exacerbation. Respir Med. 2014 Sep;108(9):1284-91. doi: 10.1016/j.rmed.2014.06.006. Epub 2014 Jul 8.
Results Reference
derived

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Study Evaluating the Safety and Efficacy of MN-221 as an Adjunct to Standard Therapy in Subjects Experiencing an Acute Exacerbation of Asthma

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