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Depigoid Birch 5000 Longterm Study in Adults and Adolescents

Primary Purpose

Allergic Rhinitis/Rhinoconjunctivitis +-Intermittent Asthma, Sensitization Against Betula Alba (Birch) Pollen

Status
Completed
Phase
Phase 3
Locations
Germany
Study Type
Interventional
Intervention
s.c. injection
Sponsored by
Leti Pharma GmbH
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Allergic Rhinitis/Rhinoconjunctivitis +-Intermittent Asthma focused on measuring Allergic rhinitis, Allergic rhinoconjunctivitis, Allergy induced asthma, Birch (Betula alba), Hayfever, Immunotherapy

Eligibility Criteria

12 Years - 70 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Availability of an appropriately signed and dated informed consent before any study specific examination,
  • Clinical history of at least 2 years of seasonal allergic rhinitis and/or rhinoconjunctivitis with or without intermittent asthma due to birch pollen allergy that has required repeated use of symptomatic treatment,
  • Patients must have a minimum level of perception of symptoms from previous seasons defined as at least a moderate symptom level (i.e. a score of 2 on the 4-point-Likert scale) in at least 2 symptom categories prior to randomization,
  • Lung function ≥ 80% of the predicted normal value,
  • IgE-mediated sensitization has to be verified by:

    • suggestive medical history, and
    • specific IgE reactivity to birch pollen (CAP-RAST ≥ 2), and
    • a positive SPT to birch pollen at screening or within 1 months prior to the screening visit. An SPT is considered positive if it results in a wheal diameter of at least 3.0 mm
  • Internet access so that patients can complete the eDiary daily via internet during all 5 pollen seasons covered by the study protocol.

Exclusion Criteria:

  • History of significant clinical manifestations of allergy as a result of sensitization against co-allergies, particularly-but not limited to-grass or weed pollen and perennial allergens (e.g. house dust mites, cat or dog).
  • History of anaphylactic reaction.
  • Moderate or severe persistent asthma (GINA 3 or 4).
  • Mild persistent asthma (GINA 2), according to the Global Initiative for Asthma Guidelines, necessitating treatment with inhaled glucocorticoids at a daily dose level of > 400 µg budesonide dose equivalents.
  • Lung function < 80% of the predicted normal value (for PEF: highest result of 3 measurements).
  • Acute or chronic inflammatory or infectious airway diseases including recurrent acute or chronic sinusitis.
  • Chronic structural diseases of the affected organs (e.g. eye, nose, lung).
  • History or presence of confirmed or potential diseases of the immune system including autoimmune diseases and immune deficiencies of actual clinical relevance.
  • Any disease that prohibits the use of adrenaline (e.g. hyperthyroidism).
  • Atopic dermatitis with SCORAD >30 in the past or at screening.
  • Ongoing or past full courses of SIT against birch pollen within the last 5 years.
  • Topical and systemic treatment with β-blockers.
  • Concomitant treatment with substances interfering with the immune system beginning 1 week prior to start of treatment.
  • Use of systemic corticosteroids within 3 months prior to Visit 1-1.
  • Immunization with vaccines within 7 days prior to Visit 1-1.
  • Treatment with antihistamines for any reason other than allergic symptoms due to birch pollen allergy.
  • Changed residence between geographical regions since the last birch pollen season or not staying in the geographical region during the pre-determined birch pollen season.
  • Nursing (lactating) women or women with a positive pregnancy test at the screening visit. Women of childbearing potential must be using highly effective contraception during participation in this clinical study. A highly effective method of birth control is defined as one that results in a low failure rate (i.e. less than 1% per year) when used consistently and correctly, such as implants, injectables, combined oral contraceptives, some IUDs, sexual abstinence, or vasectomised partner.

Sites / Locations

  • Hautarztpraxis
  • Klinik und Poliklinik für Dermatologie und Allergologie der Universität

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Depigoid Birch 5.000 DPP/ml

Placebo

Arm Description

Suspension for s.c. injection. Treatment schedule: Build-up phase (1 day: 0,2 ml+0,3 ml at interval of 30 minutes) Maintenance phase (3 years: 0,5 ml at intervals of 4-6 weeks)

Suspension for s.c. injection. Treatment schedule: Build-up phase (1 day: 0,2 ml+0,3 ml at interval of 30 minutes) Maintenance phase (3 years: 0,5 ml at intervals of 4-6 weeks)

Outcomes

Primary Outcome Measures

Proof of efficacy (superiority vs. placebo) by means of the combined Symptom and Medication Score (SMS).
For the primary outcome the SMS of nasal and ocular symptoms and their respective Rescue Medication score is used to assess efficacy of the perennial treatment regimen of Depigoid Birch 5000 DPP/mL versus placebo after 5 years (comprising 3 years of treatment plus 2 years treatment-free follow-up). An interim analysis will be conducted after 2 years. Data are captured via eDiary to be completed by the patients during each of the 5 pollen seasons within the duration of the study, starting prior to onset of pollen flight until after the end of the pollen seasons.

Secondary Outcome Measures

Symptom score (SS) during the 1st, 3rd, and 4th pollen seasons.
Differences between treatment groups also including pulmonary symptoms and for asthmatic/non-asthmatic patients. Data are captured via eDiary to be completed by the patients during each of the 5 pollen seasons within the duration of the study, starting prior to onset of pollen flight until after the end of the pollen seasons.
Rescue Medication Score (RMS) during the 1st, 3rd, and 4th pollen season (futility and interim analyses).
Differences between treatment groups also including pulmonary symptoms and for asthmatic/non-asthmatic patients. Data are captured via eDiary to be completed by the patients during each of the 5 pollen seasons within the duration of the study, starting prior to onset of pollen flight until afte the end of the pollen seasons.
combined Symptoms and Rescue Medication Score (SMS) during the 1st, 3rd, and 4th pollen season including pulmonary symptoms.
Differences between treatment groups, during all 5 pollen seasons also including pulmonary symptoms and for asthmatic/non-asthmatic patients. Data are captured via eDiary to be completed by the patients during each of the 5 pollen seasons within the duration of the study, starting prior to onset of pollen flight until after the end of the pollen seasons.
Rhinitis Quality of Life Questionnaire (RQLQ) resp. RQLQ for adolescent patients (AdolRQLQ)
Changes to baseline and difference between treatment groups during all 5 pollen seasons
Immunology parameters (Total IgE, specific IgE, specific IgG1 and IgG4)
Differences within patients and between treatment groups
Disease modifying effect after 5 years
Difference between treatment groups. Incidence of asthma and new sensitizations.
Clinical chemistry: Number of patients with outside range values
Differences between treatment groups
Adverse events: number of patients with AEs/SAEs
Including symptoms reported by patients in eDiary. Differences between treatment groups including but not limited to differences in severity levels of systemic reactions (SRs), immediate and local reaction including calculation of ratios per injection
Serum levels of Aluminium hydroxide (Pharmacokinetics)
Serum Aluminium hydroxide levels are assessed in a subgroup of 24 patients. Differences between treatment groups (adult patients only) Sampling: prior to 1st application of IMP, 4 time points after 1st, 2nd and 10th application (after 1 year). 24 hrs. urine at these 3 time points
Vitamin D3 level
Possible influence on specific immunotherapy. Exploratory evaluation
Hematology: Number of patients with outside range values
Differences between treatment groups

Full Information

First Posted
August 27, 2012
Last Updated
January 15, 2019
Sponsor
Leti Pharma GmbH
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1. Study Identification

Unique Protocol Identification Number
NCT01694836
Brief Title
Depigoid Birch 5000 Longterm Study in Adults and Adolescents
Official Title
Multicenter, Placebo-controlled, Long-term Study of Depigoid Birch 5000 in Adults and Adolescents With Allergic Rhinitis and/or Rhinoconjunctivitis With or Without Intermittent Asthma
Study Type
Interventional

2. Study Status

Record Verification Date
January 2019
Overall Recruitment Status
Completed
Study Start Date
September 17, 2012 (Actual)
Primary Completion Date
July 30, 2018 (Actual)
Study Completion Date
July 30, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Leti Pharma GmbH

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Specific immunotherapy for IgE mediated sensitization to birch pollen. Long-term study to assess safety and efficacy of Depigoid(R)Birch 5000 - a modified pollen extract of Betula alba (Birch) - versus placebo.
Detailed Description
Investigation of the long-term efficacy and safety of Depigoid Birch 5000 according to the perennial treatment regimen in comparison to placebo in adult and adolescent patients with birch pollen-induced allergic rhinitis and/or rhinoconjunctivitis to show superiority vs. placebo. As the study includes adolescent patients it is run under an approved PIP. Total study duration per patient will be 5 years: 3 years of perennial treatment (application of study medication at intervals of 4-6 weeks) followed by a treatment-free observational phase of 2 years (seasons).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Allergic Rhinitis/Rhinoconjunctivitis +-Intermittent Asthma, Sensitization Against Betula Alba (Birch) Pollen
Keywords
Allergic rhinitis, Allergic rhinoconjunctivitis, Allergy induced asthma, Birch (Betula alba), Hayfever, Immunotherapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
634 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Depigoid Birch 5.000 DPP/ml
Arm Type
Experimental
Arm Description
Suspension for s.c. injection. Treatment schedule: Build-up phase (1 day: 0,2 ml+0,3 ml at interval of 30 minutes) Maintenance phase (3 years: 0,5 ml at intervals of 4-6 weeks)
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Suspension for s.c. injection. Treatment schedule: Build-up phase (1 day: 0,2 ml+0,3 ml at interval of 30 minutes) Maintenance phase (3 years: 0,5 ml at intervals of 4-6 weeks)
Intervention Type
Biological
Intervention Name(s)
s.c. injection
Other Intervention Name(s)
Depigoid(R)Birch
Intervention Description
3 years of therapy followed by 2 years (seasons) of treatment-free observational period
Primary Outcome Measure Information:
Title
Proof of efficacy (superiority vs. placebo) by means of the combined Symptom and Medication Score (SMS).
Description
For the primary outcome the SMS of nasal and ocular symptoms and their respective Rescue Medication score is used to assess efficacy of the perennial treatment regimen of Depigoid Birch 5000 DPP/mL versus placebo after 5 years (comprising 3 years of treatment plus 2 years treatment-free follow-up). An interim analysis will be conducted after 2 years. Data are captured via eDiary to be completed by the patients during each of the 5 pollen seasons within the duration of the study, starting prior to onset of pollen flight until after the end of the pollen seasons.
Time Frame
after 5 years
Secondary Outcome Measure Information:
Title
Symptom score (SS) during the 1st, 3rd, and 4th pollen seasons.
Description
Differences between treatment groups also including pulmonary symptoms and for asthmatic/non-asthmatic patients. Data are captured via eDiary to be completed by the patients during each of the 5 pollen seasons within the duration of the study, starting prior to onset of pollen flight until after the end of the pollen seasons.
Time Frame
after 1 year, 2 years, 3 years, 4 years and 5 years
Title
Rescue Medication Score (RMS) during the 1st, 3rd, and 4th pollen season (futility and interim analyses).
Description
Differences between treatment groups also including pulmonary symptoms and for asthmatic/non-asthmatic patients. Data are captured via eDiary to be completed by the patients during each of the 5 pollen seasons within the duration of the study, starting prior to onset of pollen flight until afte the end of the pollen seasons.
Time Frame
after 1 year, 2 years, 3 years, 4 years and 5 years
Title
combined Symptoms and Rescue Medication Score (SMS) during the 1st, 3rd, and 4th pollen season including pulmonary symptoms.
Description
Differences between treatment groups, during all 5 pollen seasons also including pulmonary symptoms and for asthmatic/non-asthmatic patients. Data are captured via eDiary to be completed by the patients during each of the 5 pollen seasons within the duration of the study, starting prior to onset of pollen flight until after the end of the pollen seasons.
Time Frame
after 1 year, 2 years, 3 years and 4 years
Title
Rhinitis Quality of Life Questionnaire (RQLQ) resp. RQLQ for adolescent patients (AdolRQLQ)
Description
Changes to baseline and difference between treatment groups during all 5 pollen seasons
Time Frame
Screening and after 1 year, 2 years, 3 years, 4 years and 5 years
Title
Immunology parameters (Total IgE, specific IgE, specific IgG1 and IgG4)
Description
Differences within patients and between treatment groups
Time Frame
Screening, after years 1, 2, 3 and 5 (resp. end of study)
Title
Disease modifying effect after 5 years
Description
Difference between treatment groups. Incidence of asthma and new sensitizations.
Time Frame
after 5 years
Title
Clinical chemistry: Number of patients with outside range values
Description
Differences between treatment groups
Time Frame
Screening, after years 2, 3 and 5
Title
Adverse events: number of patients with AEs/SAEs
Description
Including symptoms reported by patients in eDiary. Differences between treatment groups including but not limited to differences in severity levels of systemic reactions (SRs), immediate and local reaction including calculation of ratios per injection
Time Frame
throughout the whole study duration
Title
Serum levels of Aluminium hydroxide (Pharmacokinetics)
Description
Serum Aluminium hydroxide levels are assessed in a subgroup of 24 patients. Differences between treatment groups (adult patients only) Sampling: prior to 1st application of IMP, 4 time points after 1st, 2nd and 10th application (after 1 year). 24 hrs. urine at these 3 time points
Time Frame
prior and after 1st and 2nd application of IMP and after 1 year
Title
Vitamin D3 level
Description
Possible influence on specific immunotherapy. Exploratory evaluation
Time Frame
baseline and end of study
Title
Hematology: Number of patients with outside range values
Description
Differences between treatment groups
Time Frame
Screening, after years 2, 3 and 5

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Availability of an appropriately signed and dated informed consent before any study specific examination, Clinical history of at least 2 years of seasonal allergic rhinitis and/or rhinoconjunctivitis with or without intermittent asthma due to birch pollen allergy that has required repeated use of symptomatic treatment, Patients must have a minimum level of perception of symptoms from previous seasons defined as at least a moderate symptom level (i.e. a score of 2 on the 4-point-Likert scale) in at least 2 symptom categories prior to randomization, Lung function ≥ 80% of the predicted normal value, IgE-mediated sensitization has to be verified by: suggestive medical history, and specific IgE reactivity to birch pollen (CAP-RAST ≥ 2), and a positive SPT to birch pollen at screening or within 1 months prior to the screening visit. An SPT is considered positive if it results in a wheal diameter of at least 3.0 mm Internet access so that patients can complete the eDiary daily via internet during all 5 pollen seasons covered by the study protocol. Exclusion Criteria: History of significant clinical manifestations of allergy as a result of sensitization against co-allergies, particularly-but not limited to-grass or weed pollen and perennial allergens (e.g. house dust mites, cat or dog). History of anaphylactic reaction. Moderate or severe persistent asthma (GINA 3 or 4). Mild persistent asthma (GINA 2), according to the Global Initiative for Asthma Guidelines, necessitating treatment with inhaled glucocorticoids at a daily dose level of > 400 µg budesonide dose equivalents. Lung function < 80% of the predicted normal value (for PEF: highest result of 3 measurements). Acute or chronic inflammatory or infectious airway diseases including recurrent acute or chronic sinusitis. Chronic structural diseases of the affected organs (e.g. eye, nose, lung). History or presence of confirmed or potential diseases of the immune system including autoimmune diseases and immune deficiencies of actual clinical relevance. Any disease that prohibits the use of adrenaline (e.g. hyperthyroidism). Atopic dermatitis with SCORAD >30 in the past or at screening. Ongoing or past full courses of SIT against birch pollen within the last 5 years. Topical and systemic treatment with β-blockers. Concomitant treatment with substances interfering with the immune system beginning 1 week prior to start of treatment. Use of systemic corticosteroids within 3 months prior to Visit 1-1. Immunization with vaccines within 7 days prior to Visit 1-1. Treatment with antihistamines for any reason other than allergic symptoms due to birch pollen allergy. Changed residence between geographical regions since the last birch pollen season or not staying in the geographical region during the pre-determined birch pollen season. Nursing (lactating) women or women with a positive pregnancy test at the screening visit. Women of childbearing potential must be using highly effective contraception during participation in this clinical study. A highly effective method of birth control is defined as one that results in a low failure rate (i.e. less than 1% per year) when used consistently and correctly, such as implants, injectables, combined oral contraceptives, some IUDs, sexual abstinence, or vasectomised partner.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Natalja Novak, Prof. Dr.
Organizational Affiliation
Klinik für Dermatologie und Allergologie der Universität Bonn
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Angelika Sager, Dr. med.
Organizational Affiliation
Leti Pharma GmbH
Official's Role
Study Director
Facility Information:
Facility Name
Hautarztpraxis
City
Berlin
ZIP/Postal Code
13057
Country
Germany
Facility Name
Klinik und Poliklinik für Dermatologie und Allergologie der Universität
City
Bonn
ZIP/Postal Code
53105
Country
Germany

12. IPD Sharing Statement

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Depigoid Birch 5000 Longterm Study in Adults and Adolescents

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