Dupilumab in Eosinophilic Gastritis
Primary Purpose
Eosinophilic Gastritis, Eosinophilic Gastroenteritis
Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Dupilumab (blinded)
Placebo (blinded)
Dupilumab (open-label)
Sponsored by
About this trial
This is an interventional treatment trial for Eosinophilic Gastritis
Eligibility Criteria
Inclusion Criteria:
- Participant and/or parent guardian must be able to understand and provide informed consent and/or assent.
- Willing and able to comply with study visits and activities
- Age ≥ 12 and < 71 years at study enrollment
- Histologically active EG at time of screening, with a peak gastric count of ≥ 30 eos/hpf in at least 5 hpfs in the gastric antrum and/or body.
- History (by patient report) of moderate to severe EG symptoms
- Stable medical management of EG.
- Willing to maintain current dietary regimen throughout the course of the study. Diet must have been stable for 8 weeks prior to baseline endoscopy.
- If have asthma and/or any other chronic allergic conditions they must be willing to maintain their pretrial medications until the end of study. Medication dose can be increased if there is a deterioration in the condition.
- Score on Asthma Control Test (ACTTM) ≥ 20
Exclusion Criteria:
- Inability or unwillingness of a participant to give written informed consent or comply with study protocol.
- Current active H. pylori infection.
- Systemic gastrointestinal disorders such as Crohn's disease, inflammatory bowel disease, or Celiac disease.
- Known or suspected active colitis in the Principal Investigator's opinion or by biopsy.
- Hypereosinophilic syndrome.
- History of cancer
- Current or recent use of biological agents.
- Leukocyte count has not returned to the relevant lower limit of normal after discontinuing cell depleting biological agents.
- Current or recent use of any investigational drug.
- Current use of systemic steroids with daily dose > 10 mg for any reason or steroid burst for > 3 days within 1 month of screening.
- Prior exposure to dupilumab.
- History of anaphylaxis to any biologic therapy.
- Current pregnancy or breastfeeding.
- Ocular disorder.
- Individuals who have required use of a systemic corticosteroid for asthma.
- Received live vaccine 30 days prior to screening or planning on receiving a live vaccine during the time period that he/she is participating in the study.
- Any esophageal stricture unable to be passed with a standard, diagnostic upper endoscope.
- History of bleeding disorders or esophageal varices.
- Active parasitic infection.
- History of alcohol or drug abuse within 6 months prior to screening.
- Participant or his/her immediate family is a member of the investigational team.
- Planned or anticipated major surgical procedure during the study.
- Initiation, discontinuation or addition of allergens to subcutaneous immunotherapy (SCIT) within 12 months prior to screening.
- Treatment with sublingual immunotherapy (SLIT) within 6 months prior to screening.
- Treatment with oral immunotherapy (OIT) within 6 months prior to screening.
- Chronic or acute infection requiring treatment with systemic antibiotics, antivirals or antifungals within 2 weeks before the baseline visit
- Known or suspected immunodeficiency disorder, including human immunodeficiency disorder (HIV).
- Planned or anticipated use of any prohibited medications and procedures during the study.
- Initiation, discontinuation or change in the dosage regimen of the following Proton pump inhibitors (PPIs) Leukotriene inhibitors Nasal and/or inhaled corticosteroids
- Women of childbearing potential who are unwilling to practice highly effective contraception.
Sites / Locations
- Children's Hospital ColoradoRecruiting
- University of Colorado Denver and HospitalRecruiting
- Northwestern Medicine Digestive Health CenterRecruiting
- Riley Children's HospitalRecruiting
- Tufts Medical Center
- Icahn School of Medicine at Mount SinaiRecruiting
- University of North Carolina School of MedicineRecruiting
- Cincinnati Children's Hospital Medical CenterRecruiting
- The Children's Hospital of PhiladelphiaRecruiting
- University of PennsylvaniaRecruiting
- Texas Children's HospitalRecruiting
- University of Utah HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
Dupilumab
Placebo
Arm Description
Outcomes
Primary Outcome Measures
Relative change of peak eosinophil counts in the stomach
We will determine the Relative change from baseline of the peak eosinophil counts in the 5 most eosinophil dense HPFs in the gastric antrum and/or body between drug vs placebo at 12 weeks will be the primary measurement endpoint.
Secondary Outcome Measures
Induction of disease remission
We will use the 30 eosinophils/hpf threshold, which is the study inclusion level. Comparison between drug vs placebo at week 12 will be the measurement endpoint.
Change in histologic score of gastric mucosa
Change in histologic score from pre- to post-treatment with dupilumab or placebo as measured by the Eosinophilic Gastritis Biopsy Evaluation Form. The EG Biopsy Evaluation Form assesses 11 different types of histological features, each one rated from 0-2 (0 = absent, 1 = mild/moderate, 2 = marked), with a maximum score of 22 (most severe) and a minimum score of 0 (normal).
Changes in endoscopic score before and after treatment with dupilumab
Change in endoscopic score from pre- to post-treatment with dupilumab or placebo as measured by Eosinophilic Gastritis Endoscopic Assessment. The Eosinophilic Gastritis Endoscopy Assessment captures 6 endoscopic features of the stomach, each scored from 0-6, varying by endoscopic feature. The maximum score is 43 (most severe), and the minimum is 0 (normal).
Changes in clinical symptoms as measured by the Severity of Dyspepsia Assessment tool.
Change in symptoms from pre- to post-treatment with dupilumab or placebo as measured by the Severity of Dyspepsia Assessment (SoDA) tool. The SoDA measures 3 domains: Pain Intensity (scored from 2-47, with 47 being the most severe), Non-pain symptoms (scored from 7-35, with 35 being the most severe), and SoDA satisfaction (scored from 2-23, with 23 being the most satisfied). Each domain is assessed independently; they are not summed or averaged.
Change in blood eosinophil counts
Change in blood eosinophil count before and after treatment with dupilumab or placebo as measured by CBC with differential.
Assessment of the value of baseline blood and esophageal biomarkers in predicting responsiveness to dupilumab.
The baseline values of blood biomarkers (primarily cytokine levels) as well as esophageal transcripts will be assessed before and after treatment. We will determine if baseline values correlate with drug responsiveness.
Full Information
NCT ID
NCT03678545
First Posted
August 6, 2018
Last Updated
September 1, 2023
Sponsor
Children's Hospital Medical Center, Cincinnati
Collaborators
Regeneron Pharmaceuticals, National Institutes of Health (NIH)
1. Study Identification
Unique Protocol Identification Number
NCT03678545
Brief Title
Dupilumab in Eosinophilic Gastritis
Official Title
A Randomized, Double-blind, Placebo-controlled Clinical Trial to Evaluate the Efficacy of Dupilumab (Anti-IL4a) in Subjects With Eosinophilic Gastritis
Study Type
Interventional
2. Study Status
Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
May 15, 2021 (Actual)
Primary Completion Date
October 1, 2023 (Anticipated)
Study Completion Date
April 1, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Children's Hospital Medical Center, Cincinnati
Collaborators
Regeneron Pharmaceuticals, National Institutes of Health (NIH)
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
40 participants with Eosinophilic Gastritis 12-70 years of age will be randomly assigned with dupilumab or placebo subcutaneous injections every two weeks for a total of 12 weeks. Study subjects who complete the 12-week treatment phase, may continue into an open label extension study, where dupilumab will be administered every two weeks for a total of 24 weeks.
Detailed Description
This is a phase 2, multi-center, randomized, double-blind, placebo-controlled trial testing the efficacy of dupilumab vs. placebo in EG. Qualifying subjects will be randomized 1:1 to either study drug (dupilumab) or placebo, and will receive 600 mg once followed by 300 mg doses every two weeks of study treatment for a total of 6 injections. After the 6th injection subjects may continue into an open-label treatment phase in which dupilumab will be administered every two weeks for a total of 24 weeks.
Approximately 14 sites associated with the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) will take part in the study.
The primary objective of this study is to assess the efficacy of repeat subcutaneous (SC) doses of dupilumab, compared with placebo, to reduce eosinophilic inflammation in the gastrointestinal tract of patients with EG.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Eosinophilic Gastritis, Eosinophilic Gastroenteritis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Participants are assigned to either drug or placebo, followed by an open label extension
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
40 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Dupilumab
Arm Type
Active Comparator
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Dupilumab (blinded)
Intervention Description
Subcutaneous injection every two weeks as follows: 600 mg initial dose, and 300 mg subsequent doses for a total of 6 injections.
Intervention Type
Drug
Intervention Name(s)
Placebo (blinded)
Intervention Description
Placebo is matched to the active drug (dupilumab), and is given in the same manner: a subcutaneous injection every two weeks for a total of 6 injections.
Intervention Type
Drug
Intervention Name(s)
Dupilumab (open-label)
Intervention Description
After completing 6 doses of blinded study drug (dupilumab or placebo), participants can continue into the open-label portion of the study, in which all subjects will receive 12 doses (every 2 weeks for 24 weeks) of dupilumab.
Primary Outcome Measure Information:
Title
Relative change of peak eosinophil counts in the stomach
Description
We will determine the Relative change from baseline of the peak eosinophil counts in the 5 most eosinophil dense HPFs in the gastric antrum and/or body between drug vs placebo at 12 weeks will be the primary measurement endpoint.
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Induction of disease remission
Description
We will use the 30 eosinophils/hpf threshold, which is the study inclusion level. Comparison between drug vs placebo at week 12 will be the measurement endpoint.
Time Frame
12 weeks
Title
Change in histologic score of gastric mucosa
Description
Change in histologic score from pre- to post-treatment with dupilumab or placebo as measured by the Eosinophilic Gastritis Biopsy Evaluation Form. The EG Biopsy Evaluation Form assesses 11 different types of histological features, each one rated from 0-2 (0 = absent, 1 = mild/moderate, 2 = marked), with a maximum score of 22 (most severe) and a minimum score of 0 (normal).
Time Frame
12 weeks
Title
Changes in endoscopic score before and after treatment with dupilumab
Description
Change in endoscopic score from pre- to post-treatment with dupilumab or placebo as measured by Eosinophilic Gastritis Endoscopic Assessment. The Eosinophilic Gastritis Endoscopy Assessment captures 6 endoscopic features of the stomach, each scored from 0-6, varying by endoscopic feature. The maximum score is 43 (most severe), and the minimum is 0 (normal).
Time Frame
12 weeks
Title
Changes in clinical symptoms as measured by the Severity of Dyspepsia Assessment tool.
Description
Change in symptoms from pre- to post-treatment with dupilumab or placebo as measured by the Severity of Dyspepsia Assessment (SoDA) tool. The SoDA measures 3 domains: Pain Intensity (scored from 2-47, with 47 being the most severe), Non-pain symptoms (scored from 7-35, with 35 being the most severe), and SoDA satisfaction (scored from 2-23, with 23 being the most satisfied). Each domain is assessed independently; they are not summed or averaged.
Time Frame
12 weeks
Title
Change in blood eosinophil counts
Description
Change in blood eosinophil count before and after treatment with dupilumab or placebo as measured by CBC with differential.
Time Frame
12 weeks
Title
Assessment of the value of baseline blood and esophageal biomarkers in predicting responsiveness to dupilumab.
Description
The baseline values of blood biomarkers (primarily cytokine levels) as well as esophageal transcripts will be assessed before and after treatment. We will determine if baseline values correlate with drug responsiveness.
Time Frame
12 weeks
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:
Participant and/or parent guardian must be able to understand and provide informed consent and/or assent.
Willing and able to comply with study visits and activities
Age ≥ 12 and < 71 years at study enrollment
Histologically active EG at time of screening, with a peak gastric count of ≥ 30 eos/hpf in at least 5 hpfs in the gastric antrum and/or body.
History (by patient report) of moderate to severe EG symptoms
Stable medical management of EG.
Willing to maintain current dietary regimen throughout the course of the study. Diet must have been stable for 8 weeks prior to baseline endoscopy.
If have asthma and/or any other chronic allergic conditions they must be willing to maintain their pretrial medications until the end of study. Medication dose can be increased if there is a deterioration in the condition.
Score on Asthma Control Test (ACTTM) ≥ 20
Exclusion Criteria:
Inability or unwillingness of a participant to give written informed consent or comply with study protocol.
Current active H. pylori infection.
Systemic gastrointestinal disorders such as Crohn's disease, inflammatory bowel disease, or Celiac disease.
Known or suspected active colitis in the Principal Investigator's opinion or by biopsy.
Hypereosinophilic syndrome.
History of cancer
Current or recent use of biological agents.
Leukocyte count has not returned to the relevant lower limit of normal after discontinuing cell depleting biological agents.
Current or recent use of any investigational drug.
Current use of systemic steroids with daily dose > 10 mg for any reason or steroid burst for > 3 days within 1 month of screening.
Prior exposure to dupilumab.
History of anaphylaxis to any biologic therapy.
Current pregnancy or breastfeeding.
Ocular disorder.
Individuals who have required use of a systemic corticosteroid for asthma.
Received live vaccine 30 days prior to screening or planning on receiving a live vaccine during the time period that he/she is participating in the study.
Any esophageal stricture unable to be passed with a standard, diagnostic upper endoscope.
History of bleeding disorders or esophageal varices.
Active parasitic infection.
History of alcohol or drug abuse within 6 months prior to screening.
Participant or his/her immediate family is a member of the investigational team.
Planned or anticipated major surgical procedure during the study.
Initiation, discontinuation or addition of allergens to subcutaneous immunotherapy (SCIT) within 12 months prior to screening.
Treatment with sublingual immunotherapy (SLIT) within 6 months prior to screening.
Treatment with oral immunotherapy (OIT) within 6 months prior to screening.
Chronic or acute infection requiring treatment with systemic antibiotics, antivirals or antifungals within 2 weeks before the baseline visit
Known or suspected immunodeficiency disorder, including human immunodeficiency disorder (HIV).
Planned or anticipated use of any prohibited medications and procedures during the study.
Initiation, discontinuation or change in the dosage regimen of the following Proton pump inhibitors (PPIs) Leukotriene inhibitors Nasal and/or inhaled corticosteroids
Women of childbearing potential who are unwilling to practice highly effective contraception.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Regina Yearout
Phone
513-517-2108
Email
regina.yearout@cchmc.org
First Name & Middle Initial & Last Name or Official Title & Degree
Kara Kliewer
Email
kara.kliewer@cchmc.org
Facility Information:
Facility Name
Children's Hospital Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rachel Andrews
Phone
720-777-1994
Email
rachel.andrews@childrenscolorado.org
First Name & Middle Initial & Last Name & Degree
Calies Menard-Katcher, MD
Facility Name
University of Colorado Denver and Hospital
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jonathon Cahoon
Phone
303-724-8974
Email
jonathon.cahoon@cuanscnutz.edu
First Name & Middle Initial & Last Name & Degree
Paul Menard-Katcher, MD
Facility Name
Northwestern Medicine Digestive Health Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amanda Jarosik
Phone
312-695-4054
Email
amanda.jarosik@northwestern.edu
First Name & Middle Initial & Last Name & Degree
Nirmala Gonsalves, MD
Facility Name
Riley Children's Hospital
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gail Waltz
Phone
317-944-9656
Email
gwaltz@iu.edu
First Name & Middle Initial & Last Name & Degree
Sandeep Gupta, MD
Facility Name
Tufts Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02111
Country
United States
Individual Site Status
Completed
Facility Name
Icahn School of Medicine at Mount Sinai
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jennifer Diaz
Phone
212-241-8780
First Name & Middle Initial & Last Name & Degree
Mirna Chehade, MD
Facility Name
University of North Carolina School of Medicine
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sean LaFata
Phone
919-843-7684
Email
sean_lafata@med.unc.edu
First Name & Middle Initial & Last Name & Degree
Evan Dellon, MD
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Regina Yearout
Phone
513-517-2108
Email
Regina.Yearout@cchmc.org
First Name & Middle Initial & Last Name & Degree
Kara Kliewer, PhD
Email
Kara.Kliewer@cchmc.org
First Name & Middle Initial & Last Name & Degree
Marc E Rothenberg, M.D., PhD
Facility Name
The Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Susan Lee
Phone
215-528-7314
Email
Leess@chop.edu
First Name & Middle Initial & Last Name & Degree
Jonathan Spergel, MD, PhD
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Maureen DeMarshall
Phone
215-349-8546
Email
demarshm@pennmedicine.upenn.edu
First Name & Middle Initial & Last Name & Degree
Gary Falk, MD
Facility Name
Texas Children's Hospital
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amanda Vega
Phone
832-824-0939
Email
amandav@bcm.edu
First Name & Middle Initial & Last Name & Degree
Carla Davis, MD
Facility Name
University of Utah Hospital
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Brinnlie Harward
Phone
801-585-0894
Email
brinnlie.harward@hsc.utah.edu
First Name & Middle Initial & Last Name & Degree
Kathryn Peterson, MD
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
data will be collected from 14 different sites and kept in a secure electronic database supported by the NIH: Rare Diseases Data Management and Coordinating Center. Information such as test results, eligibility and patient reported outcomes can be accessed by authorized personnel from each site. staff from each site will only have access to the data collect by that site. The main site, CCHMC, will have full access to all data collected from all sites.
Learn more about this trial
Dupilumab in Eosinophilic Gastritis
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