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Evaluate Efficacy and Safety of "Kamada-AAT for Inhalation" in Patients With AATD (InnovAATe)

Primary Purpose

Alpha 1-Antitrypsin Deficiency

Status
Recruiting
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Alpha 1-Antitrypsin
Placebo
Sponsored by
Kamada, Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alpha 1-Antitrypsin Deficiency focused on measuring Inhaled Alpha 1-Antitrypsin Nebulizer

Eligibility Criteria

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

Inclusion Criteria

  1. Diagnosis of severe AAT deficiency, i.e. patients with either Pi(ZZ), Pi(Z/Null), or Pi(Null/Null) genotypes confirmed by genotype blood test documented prior to screening.
  2. Serum AAT levels ≤ 11 µM at screening.
  3. Lung disease with clinical evidence of airflow limitation (post bronchodilator FEV1/SVC ≤ 70%) at screening.
  4. 40% ≤ FEV1 ≤ 80% of predicted post-bronchodilator at screening.
  5. Patients who are either naïve or washed out of any AAT treatment for at least 8 weeks prior to randomization.
  6. Age between 18 to 65 years inclusive at screening.
  7. Able to read and sign informed consent and willing to participate in the study.
  8. Males or non-pregnant, non-lactating females whose screening pregnancy test is negative, who are using contraceptive methods deemed reliable by the investigator, who are post-menopausal, or are surgically sterilized.
  9. High compliance during run in defined as study medication use and e-Diary compliance for at least 20 out of the 28 days of run in.

Exclusion Criteria

  1. Immunoglobulin A (IgA) absolute deficiency defined as serum IgA levels < 0.05 g/L at screening.
  2. History of life-threatening transfusion reaction(s), allergy, anaphylactic reaction, or systemic response to human plasma-derived products.
  3. Two or more moderate or any severe exacerbation(s) within the year prior to the baseline visit.
  4. A moderate exacerbation within 6 weeks prior to the baseline.
  5. Use of oral or parenteral glucocorticoids in doses above 10 mg of prednisone daily or equivalent generics (substance and dose).
  6. Clinically significant inter-current illnesses (except for respiratory or liver disease secondary to AAT deficiency), including: cardiac, hepatic, renal, endocrine, neurological, hematological, neoplastic, immunological, skeletal, or other. Patients might be included after consultation with the treating physician and the sponsor if, in the opinion of the Investigator, their condition will not interfere with the safety, compliance or other aspects of this study.
  7. Hospitalization for any cause 6 weeks prior to screening.
  8. History of lung or liver transplant.
  9. On any thoracic or hepatic surgery waiting list.
  10. Any lung surgery within the past two years (including bronchoscopic lung volume reduction).
  11. Any smoking within the year prior to screening.
  12. Evidence of alcohol abuse or history of alcohol abuse, or use of illegal drugs and/or abuse of legally prescribed drugs in the last 5 years prior to screening.
  13. Acute or chronic hepatitis (hepatitis A, hepatitis B, hepatitis C), or positive human immunodeficiency virus (HIV) serology.
  14. Signs of significant abnormalities in serum hematology, serum chemistry, serum inflammatory / immunogenic markers and urinalysis per investigator judgment, taking into considerations the potential effects of the AAT deficiency.
  15. Signs of significant abnormalities in ECG per investigator judgment at screening.
  16. Presence of psychiatric/ mental disorder or any other medical disorder that might impair the patient's ability to give informed consent or to comply with the requirements of the study protocol. If, in the opinion of the Investigator, the condition will not interfere with the compliance or other aspects of this study, the patient might be included after consultation with the treating physician and the sponsor.
  17. Participation in another clinical trial involving investigational medication or interventional treatment within 30 days and/or last dose 5 half-lives prior to screening visit.
  18. Inability to attend scheduled clinic visits and/or comply with study protocol.
  19. Any other factor that, in the opinion of the investigator, would prevent the patient from complying with the requirements of the protocol.

Sites / Locations

  • University Hospital (UZ) LeuvenRecruiting
  • Tays Central HospitalRecruiting
  • Beaumont HospitalRecruiting
  • Leiden University Medical Center (LUMC)Recruiting
  • Canisius Wilhelmina Hospital (CWZ)Recruiting
  • Skåne University HospitalRecruiting
  • University Hospitals Birmingham NHS Foundation TrustRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Inhaled AAT

Placebo

Arm Description

Daily inhalation of 80 mg/day "Kamada-AAT for Inhalation" for 104 weeks

Daily inhalation of a solution of NaCl in phosphate buffer solution with 0.01% TWEEN-80

Outcomes

Primary Outcome Measures

FEV1 post bronchodilator
Change from baseline in post bronchodilator FEV1 at 104 weeks

Secondary Outcome Measures

CT densitometry whole-lung 15th percentile lung density (PD15) at total lung capacity (TLC).
Change from baseline over 104 weeks of treatment in CT densitometry whole-lung 15th percentile lung density (PD15) at total lung capacity (TLC).
FEV1 % of predicted
Change from baseline over 104 weeks of treatment in FEV1 % of predicted
FEV1/FVC %
Change from baseline over 104 weeks of treatment in FEV1/FVC %
Exacerbations
Annual rate of exacerbations by severity and duration
6 minute walk test
Change from Baseline in the distance walked in six minutes

Full Information

First Posted
December 17, 2019
Last Updated
April 30, 2023
Sponsor
Kamada, Ltd.
Collaborators
Syneos Health
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1. Study Identification

Unique Protocol Identification Number
NCT04204252
Brief Title
Evaluate Efficacy and Safety of "Kamada-AAT for Inhalation" in Patients With AATD
Acronym
InnovAATe
Official Title
A Prospective Phase III Multi-center, Placebo Controlled, Double Blind Study to Evaluate the Efficacy and Safety of "Kamada-AAT for Inhalation" 80 mg Per Day in Adult Patients With Congenital Alpha-1 Antitrypsin Deficiency With Moderate and Severe Airflow Limitation (40% ≤ FEV1 ≤ 80% of Predicted; FEV1/SVC ≤ 70%)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 25, 2019 (Actual)
Primary Completion Date
March 2027 (Anticipated)
Study Completion Date
September 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Kamada, Ltd.
Collaborators
Syneos Health

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The current study population will consist of adult patients with congenital alpha-1 antitrypsin (AAT) deficiency who have moderate or severe airflow limitation (forced expiratory volume in 1 second 40% ≤ [FEV1] ≤ 80% of predicted) and FEV1/slow vital capacity [SVC] ≤ 70% and who have not experienced two or more moderate or one or more severe exacerbations of COPD during the past year. A total of 220 patients will be recruited, and after 4 weeks practice inhaling saline with the nebulizer, will be randomized 1:1 to inhale either 80 mg/day "Kamada-AAT for Inhalation" or a placebo with identical appearance. Patients will be treated for 104 weeks and then followed up for a further 26 weeks. Over this time there will be 13 visits to the clinical site and in addition the patients will be required to fill out a daily e-diary.
Detailed Description
Individuals with a genetic deficiency of alpha-1-antitrypsin (AATD) are at a significantly increased risk (80-100%) of developing emphysema. This study is designed to administer a solution of AAT by nebulizer so that patients can inhale the drug instead of requiring infusions as in current treatment. A significant advantage of inhalation is that the AAT is directly transferred to the lungs, which is the site most in need of the protein. Previous results show that in addition to the added convenience, three times higher concentrations of AAT can be achieved in the lungs by inhalation than by intravenous infusions. To date, more than 220 patients have completed Inhalation studies for several indications.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alpha 1-Antitrypsin Deficiency
Keywords
Inhaled Alpha 1-Antitrypsin Nebulizer

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Inhaled AAT
Arm Type
Active Comparator
Arm Description
Daily inhalation of 80 mg/day "Kamada-AAT for Inhalation" for 104 weeks
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Daily inhalation of a solution of NaCl in phosphate buffer solution with 0.01% TWEEN-80
Intervention Type
Drug
Intervention Name(s)
Alpha 1-Antitrypsin
Other Intervention Name(s)
Kamada alpha 1-antitrypsin for inhalation
Intervention Description
Kamada's alpha 1-antitrypsin product given by inhalation using the eFlow® electronic nebulizer manufactured by PARI Pharma GmbH
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Preparation of NaCl in phosphate buffer solution with 0.01% TWEEN-80
Primary Outcome Measure Information:
Title
FEV1 post bronchodilator
Description
Change from baseline in post bronchodilator FEV1 at 104 weeks
Time Frame
104 weeks
Secondary Outcome Measure Information:
Title
CT densitometry whole-lung 15th percentile lung density (PD15) at total lung capacity (TLC).
Description
Change from baseline over 104 weeks of treatment in CT densitometry whole-lung 15th percentile lung density (PD15) at total lung capacity (TLC).
Time Frame
104 weeks
Title
FEV1 % of predicted
Description
Change from baseline over 104 weeks of treatment in FEV1 % of predicted
Time Frame
104 weeks
Title
FEV1/FVC %
Description
Change from baseline over 104 weeks of treatment in FEV1/FVC %
Time Frame
104 weeks
Title
Exacerbations
Description
Annual rate of exacerbations by severity and duration
Time Frame
104 weeks
Title
6 minute walk test
Description
Change from Baseline in the distance walked in six minutes
Time Frame
104 weeks
Other Pre-specified Outcome Measures:
Title
TEAEs
Description
Rate and severity of adverse events during treatment emergent adverse events (TEAEs), adverse events of special interest (AESIs) and serious adverse events (SAEs) during treatment and follow-up period [Safety Outcome]
Time Frame
130 weeks
Title
PiM
Description
Plasma M-type AAT specific (PiM) levels evaluated as function of exposure time, antibody response (positive vs. negative), and antibody titers
Time Frame
130 weeks
Title
ADA/nADA
Description
Rate and titers of binding and neutralizing AAT antibodies (ADA/nADA) in plasma [Safety Outcome]
Time Frame
130 weeks

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 Diagnosis of severe AAT deficiency, i.e. patients with either Pi(ZZ), Pi(Z/Null), or Pi(Null/Null) genotypes confirmed by genotype blood test documented prior to screening. Serum AAT levels ≤ 11 µM at screening. Lung disease with clinical evidence of airflow limitation (post bronchodilator FEV1/SVC ≤ 70%) at screening. 40% ≤ FEV1 ≤ 80% of predicted post-bronchodilator at screening. Patients who are either naïve or washed out of any AAT treatment for at least 8 weeks prior to randomization. Age between 18 to 65 years inclusive at screening. Able to read and sign informed consent and willing to participate in the study. Males or non-pregnant, non-lactating females whose screening pregnancy test is negative, who are using contraceptive methods deemed reliable by the investigator, who are post-menopausal, or are surgically sterilized. High compliance during run in defined as study medication use and e-Diary compliance for at least 20 out of the 28 days of run in. Exclusion Criteria Immunoglobulin A (IgA) absolute deficiency defined as serum IgA levels < 0.05 g/L at screening. History of life-threatening transfusion reaction(s), allergy, anaphylactic reaction, or systemic response to human plasma-derived products. Two or more moderate or any severe exacerbation(s) within the year prior to the baseline visit. A moderate exacerbation within 6 weeks prior to the baseline. Use of oral or parenteral glucocorticoids in doses above 10 mg of prednisone daily or equivalent generics (substance and dose). Clinically significant inter-current illnesses (except for respiratory or liver disease secondary to AAT deficiency), including: cardiac, hepatic, renal, endocrine, neurological, hematological, neoplastic, immunological, skeletal, or other. Patients might be included after consultation with the treating physician and the sponsor if, in the opinion of the Investigator, their condition will not interfere with the safety, compliance or other aspects of this study. Hospitalization for any cause 6 weeks prior to screening. History of lung or liver transplant. On any thoracic or hepatic surgery waiting list. Any lung surgery within the past two years (including bronchoscopic lung volume reduction). Any smoking within the year prior to screening. Evidence of alcohol abuse or history of alcohol abuse, or use of illegal drugs and/or abuse of legally prescribed drugs in the last 5 years prior to screening. Acute or chronic hepatitis (hepatitis A, hepatitis B, hepatitis C), or positive human immunodeficiency virus (HIV) serology. Signs of significant abnormalities in serum hematology, serum chemistry, serum inflammatory / immunogenic markers and urinalysis per investigator judgment, taking into considerations the potential effects of the AAT deficiency. Signs of significant abnormalities in ECG per investigator judgment at screening. Presence of psychiatric/ mental disorder or any other medical disorder that might impair the patient's ability to give informed consent or to comply with the requirements of the study protocol. If, in the opinion of the Investigator, the condition will not interfere with the compliance or other aspects of this study, the patient might be included after consultation with the treating physician and the sponsor. Participation in another clinical trial involving investigational medication or interventional treatment within 30 days and/or last dose 5 half-lives prior to screening visit. Inability to attend scheduled clinic visits and/or comply with study protocol. Any other factor that, in the opinion of the investigator, would prevent the patient from complying with the requirements of the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jan Stolk, Prof
Organizational Affiliation
LUMC
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital (UZ) Leuven
City
Leuven
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Wim Janssens
Phone
003216341966
Email
wim.janssens@uzleuven.be
First Name & Middle Initial & Last Name & Degree
Ella Demesmaeker
Phone
003216341966
Email
ella.demesmaeker@uzleuven.be
Facility Name
Tays Central Hospital
City
Tampere
Country
Finland
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Seppo Saarelainen
Phone
00358444722863
Email
Seppo.Saarelainen@pshp.fi
First Name & Middle Initial & Last Name & Degree
Minttu Kopra
Phone
00358444722863
Email
minttu.kopra@pirha.fi
Facility Name
Beaumont Hospital
City
Dublin
Country
Ireland
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gerry McElvaney
Phone
0035318093763
Email
gmcelvaney@rcsi.ie
First Name & Middle Initial & Last Name & Degree
Ann M. Collins
Phone
0035318093864
Email
annmcollins@rcsi.ie
Facility Name
Leiden University Medical Center (LUMC)
City
Leiden
State/Province
ZA
ZIP/Postal Code
2333
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Prof. Jan Stolk, MD PhD
Phone
+31 71 526 5731
Email
research-longziekten@lumc.nl
Facility Name
Canisius Wilhelmina Hospital (CWZ)
City
Nijmegen
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rob Janssen
Phone
0031243658755
Email
rob.janssen@cwz.nl
First Name & Middle Initial & Last Name & Degree
Britt Hulsen
Phone
0031243657944
Email
res.long@cwz.nl
Facility Name
Skåne University Hospital
City
Malmö
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hanan Tanash
Phone
0046040332180
Email
hanan.tanash@med.lu.se
First Name & Middle Initial & Last Name & Degree
Louise Qvist
Phone
0046040337574
Email
louise.qvist@med.lu.se
Facility Name
University Hospitals Birmingham NHS Foundation Trust
City
Birmingham
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alice Turner
Phone
004401213713885
Email
alice.turner2@uhb.nhs.uk
First Name & Middle Initial & Last Name & Degree
Anita Pye
Phone
00441213713886
Email
Anita.Pye@uhb.nhs.uk

12. IPD Sharing Statement

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Evaluate Efficacy and Safety of "Kamada-AAT for Inhalation" in Patients With AATD

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