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Subcutaneous Immunotherapy With BM41 in Patients With Allergic Rhino-conjunctivitis Caused by Birch Pollen (BM41)

Primary Purpose

Birch Pollen Allergy, Allergic Rhinoconjunctivitis

Status
Completed
Phase
Phase 1
Locations
Denmark
Study Type
Interventional
Intervention
BM41
Placebo
ALK Alutard SQ Betula verrucosa
Sponsored by
Odense University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Birch Pollen Allergy

Eligibility Criteria

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

Inclusion Criteria:

  1. Signed informed consent
  2. Age ≥18 ≤ 65 years
  3. Moderate to severe birch-pollen-induced allergic rhinitis/rhinoconjunctivitis of at least 2 years according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (Appendix 1, see the manual of procedures) with or without concomitant mild to moderate persistent asthma
  4. Forced expiratory volume (FEV1) >70% for patients with a history of asthma, FEV1>70% or peak flow (PEF) >80% for patients without a history of asthma
  5. A positive skin prick test (SPT) (mean wheal diameter ≥ 3mm compared to negative control and negative control should be negative) for birch pollen assessed within 1 year before randomization
  6. Specific IgE against birch pollen extract ≥ 0.7 kU/L and against Bet v 1 ≥ 0.35 kU/L as determined by ImmunoCAP

Exclusion Criteria:

  1. Chronic asthma with an FEV1<70 % of predicted value.
  2. History of allergen immunotherapy (AIT) (subcutaneous (SCIT) or sublingual (SLIT)) with birch pollen or tree pollen mix including birch pollen within the past 5 years
  3. Ongoing AIT (SCIT or SLIT) with any allergen(s) during the study period
  4. Vaccination within one week before or during the treatment phase.
  5. Immunosuppressive or biological medication (e.g. IL-5, anti-IgE therapy) within the last six months prior to inclusion and up to end of trial (EoT).
  6. Severe immune disorders (including auto-immune diseases) and/or diseases requiring immunosuppressive drugs.
  7. Uncontrolled asthma or other active respiratory diseases.
  8. Active malignancies or any malignant disease during the previous 5 years.
  9. Severe uncontrolled diseases that could increase the risk for patients participating in the study, including but not limited to: cardiovascular insufficiency, any severe or unstable lung diseases, endocrine diseases, clinically significant renal or hepatic diseases, or haematological disorders.
  10. Renal insufficiency
  11. Active inflammation or infection of the target organs (nose, eyes or lower airways) at the start of the study.
  12. Diseases with a contraindication for the use of adrenaline (e.g. hyperthyroidism, glaucoma).
  13. Use of systemic steroids within 4 weeks before start of the study and during the study.
  14. Treatment with systemic and local β-blockers.
  15. Known allergy towards constituents of the vaccine
  16. Pregnancy, lactation or inadequate contraceptive measures for women of child-bearing age (adequate contraceptive measures will be intrauterine device or hormonal contraception (birth control pill, implant, transdermal patch, vaginal ring or depot injection). It is also accepted, if the female patient is permanently sterile or infertile, if her sole partner is permanently sterile, or if they use both condom and diaphragm, The definition of sterile or infertile is surgically sterilized (vasectomy/bilateral salpingectomy, hysterectomy and/or bilateral ovariectomy) or post menopause defined as a non-menstrual period of at least 12 months before inclusion in the study.
  17. Alcohol, drug or medication abuse within the past year.
  18. Any clinically significant abnormal laboratory parameter at screening.
  19. Lack of cooperation or compliance.
  20. Any physical or mental condition that precludes administration of SCIT, compliance or participation in a clinical trial.
  21. Patients who are students or employees of the institution or 1st grade relatives or partners of the investigators
  22. Participation in a clinical trial within 3 months prior to the current trial.

Sites / Locations

  • Odense Research Center for Anaphylaxis, Odense University Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Placebo Comparator

Active Comparator

Arm Label

BM41

Placebo

Alutard

Arm Description

9 treatment visits where subcutaneous injections with BM41 (adsorbed to aluminium hydroxide) will be given in a blinded fashion starting with 12.5 nanogram increasing to 20 microgram which is maintenance dose. Subsequently 3 maintenance doses will be given.

Placebo consisting of only aluminium hydroxide will be administered blinded in amounts according to BM41.

Alutard SQ (ALK) will serve as the comparator and administration is open. Up-dosing is performed according to the official cluster scheme, reaching maintenance of 100.000 SQ-E

Outcomes

Primary Outcome Measures

Incidence of adverse events with emphasis on allergic reactions. Safety/tolerability of subcutaneous treatment with BM41 compared to placebo (double-blind) and to a conventional standardized birch pollen extract in patients with birch pollen allergy
Safety/tolerability of subcutaneous treatment with BM41 compared to placebo (double-blind) and to a conventional standardized birch pollen extract. Number and character of all adverse events will be evaluated.

Secondary Outcome Measures

Changes in serum immunoglobulin E (IgE), immunoglobulin G (IgG) and immunoglobulin G4 (IgG4) levels.
Evaluation of immunological responses during subcutaneous allergen immunotherapy (SCIT) with BM41 compared to placebo and to a conventional, standardized and registered birch pollen extract (Alutard SQ).The evaluation will be done by monitoring changes in serum immunoglobulin E (IgE), immunoglobulin G (IgG) and immunoglobulin G4 (IgG4) levels against recombinant Bet v 1 (rBet v 1), BM41 and birch pollen extract. Serum will also be used in a so-called IgE facilitated allergen-binding assay (FAB) and in a rat basophilic leukemia cell (RBL)-based histamine release test, to monitor the functional blocking antibody capacity of induced IgG/IgG4 antibodies.
Epigenetic changes induced by BM41 and Alutard compared to placebo
DNA will be isolated from a blood sample.
Changes in wheal sizes upon titrated skin prick test with BM41.
Evaluation of hypo-allergenicity before first exposure but also during repeated exposure to BM41.
Changes in the capacity to block IgE facilitated allergen binding and histamine release.
It will be evaluated in an IgE facilitated allergen binding (FAB) assay and in a rat basophilic leukemia cell (RBL)-based histamine release test.

Full Information

First Posted
May 24, 2021
Last Updated
May 27, 2021
Sponsor
Odense University Hospital
Collaborators
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA), Biomay AG, European Commission, University of Salzburg
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1. Study Identification

Unique Protocol Identification Number
NCT04912076
Brief Title
Subcutaneous Immunotherapy With BM41 in Patients With Allergic Rhino-conjunctivitis Caused by Birch Pollen
Acronym
BM41
Official Title
A Randomized, Double-blind, Placebo-controlled Study to Determine the Safety, Tolerability and Immunological Effects of BM41 Compared to Placebo and to Treatment With Standard Subcutaneous Immunotherapy (as Open Comparator) in Patients With Moderate to Severe Allergic Rhinitis/ Rhino-conjunctivitis Caused by Birch Pollen
Study Type
Interventional

2. Study Status

Record Verification Date
May 2021
Overall Recruitment Status
Completed
Study Start Date
September 17, 2018 (Actual)
Primary Completion Date
March 22, 2019 (Actual)
Study Completion Date
March 22, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Odense University Hospital
Collaborators
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA), Biomay AG, European Commission, University of Salzburg

4. Oversight

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

5. Study Description

Brief Summary
The aim of this clinical phase I single centre, randomized, double-blind, placebo-controlled study with open comparator is to investigate tolerability and safety as well as the immunological effects of BM41 in comparison to placebo (double blind) and to a standard subcutaneous immunotherapy Alutard SQ (open) in birch allergic patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Birch Pollen Allergy, Allergic Rhinoconjunctivitis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Model Description
A randomized, double-blind, placebo-controlled, single centre Phase I study with an open comparator group
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
47 (Actual)

8. Arms, Groups, and Interventions

Arm Title
BM41
Arm Type
Experimental
Arm Description
9 treatment visits where subcutaneous injections with BM41 (adsorbed to aluminium hydroxide) will be given in a blinded fashion starting with 12.5 nanogram increasing to 20 microgram which is maintenance dose. Subsequently 3 maintenance doses will be given.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo consisting of only aluminium hydroxide will be administered blinded in amounts according to BM41.
Arm Title
Alutard
Arm Type
Active Comparator
Arm Description
Alutard SQ (ALK) will serve as the comparator and administration is open. Up-dosing is performed according to the official cluster scheme, reaching maintenance of 100.000 SQ-E
Intervention Type
Drug
Intervention Name(s)
BM41
Intervention Description
Subcutaneous injection of increasing doses of BM41
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Subcutaneous injections of placebo containing aluminium hydroxide.
Intervention Type
Drug
Intervention Name(s)
ALK Alutard SQ Betula verrucosa
Intervention Description
Subcutaneous injections with increasing doses of Alutard according to cluster up-dosing scheme.
Primary Outcome Measure Information:
Title
Incidence of adverse events with emphasis on allergic reactions. Safety/tolerability of subcutaneous treatment with BM41 compared to placebo (double-blind) and to a conventional standardized birch pollen extract in patients with birch pollen allergy
Description
Safety/tolerability of subcutaneous treatment with BM41 compared to placebo (double-blind) and to a conventional standardized birch pollen extract. Number and character of all adverse events will be evaluated.
Time Frame
Through study completion, an average of 4 months
Secondary Outcome Measure Information:
Title
Changes in serum immunoglobulin E (IgE), immunoglobulin G (IgG) and immunoglobulin G4 (IgG4) levels.
Description
Evaluation of immunological responses during subcutaneous allergen immunotherapy (SCIT) with BM41 compared to placebo and to a conventional, standardized and registered birch pollen extract (Alutard SQ).The evaluation will be done by monitoring changes in serum immunoglobulin E (IgE), immunoglobulin G (IgG) and immunoglobulin G4 (IgG4) levels against recombinant Bet v 1 (rBet v 1), BM41 and birch pollen extract. Serum will also be used in a so-called IgE facilitated allergen-binding assay (FAB) and in a rat basophilic leukemia cell (RBL)-based histamine release test, to monitor the functional blocking antibody capacity of induced IgG/IgG4 antibodies.
Time Frame
Day 7, 42 and 126
Title
Epigenetic changes induced by BM41 and Alutard compared to placebo
Description
DNA will be isolated from a blood sample.
Time Frame
Day 7, 42 and 126
Title
Changes in wheal sizes upon titrated skin prick test with BM41.
Description
Evaluation of hypo-allergenicity before first exposure but also during repeated exposure to BM41.
Time Frame
Day 7, 42 and 112
Title
Changes in the capacity to block IgE facilitated allergen binding and histamine release.
Description
It will be evaluated in an IgE facilitated allergen binding (FAB) assay and in a rat basophilic leukemia cell (RBL)-based histamine release test.
Time Frame
Day 7, 42 and 126

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: Signed informed consent Age ≥18 ≤ 65 years Moderate to severe birch-pollen-induced allergic rhinitis/rhinoconjunctivitis of at least 2 years according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (Appendix 1, see the manual of procedures) with or without concomitant mild to moderate persistent asthma Forced expiratory volume (FEV1) >70% for patients with a history of asthma, FEV1>70% or peak flow (PEF) >80% for patients without a history of asthma A positive skin prick test (SPT) (mean wheal diameter ≥ 3mm compared to negative control and negative control should be negative) for birch pollen assessed within 1 year before randomization Specific IgE against birch pollen extract ≥ 0.7 kU/L and against Bet v 1 ≥ 0.35 kU/L as determined by ImmunoCAP Exclusion Criteria: Chronic asthma with an FEV1<70 % of predicted value. History of allergen immunotherapy (AIT) (subcutaneous (SCIT) or sublingual (SLIT)) with birch pollen or tree pollen mix including birch pollen within the past 5 years Ongoing AIT (SCIT or SLIT) with any allergen(s) during the study period Vaccination within one week before or during the treatment phase. Immunosuppressive or biological medication (e.g. IL-5, anti-IgE therapy) within the last six months prior to inclusion and up to end of trial (EoT). Severe immune disorders (including auto-immune diseases) and/or diseases requiring immunosuppressive drugs. Uncontrolled asthma or other active respiratory diseases. Active malignancies or any malignant disease during the previous 5 years. Severe uncontrolled diseases that could increase the risk for patients participating in the study, including but not limited to: cardiovascular insufficiency, any severe or unstable lung diseases, endocrine diseases, clinically significant renal or hepatic diseases, or haematological disorders. Renal insufficiency Active inflammation or infection of the target organs (nose, eyes or lower airways) at the start of the study. Diseases with a contraindication for the use of adrenaline (e.g. hyperthyroidism, glaucoma). Use of systemic steroids within 4 weeks before start of the study and during the study. Treatment with systemic and local β-blockers. Known allergy towards constituents of the vaccine Pregnancy, lactation or inadequate contraceptive measures for women of child-bearing age (adequate contraceptive measures will be intrauterine device or hormonal contraception (birth control pill, implant, transdermal patch, vaginal ring or depot injection). It is also accepted, if the female patient is permanently sterile or infertile, if her sole partner is permanently sterile, or if they use both condom and diaphragm, The definition of sterile or infertile is surgically sterilized (vasectomy/bilateral salpingectomy, hysterectomy and/or bilateral ovariectomy) or post menopause defined as a non-menstrual period of at least 12 months before inclusion in the study. Alcohol, drug or medication abuse within the past year. Any clinically significant abnormal laboratory parameter at screening. Lack of cooperation or compliance. Any physical or mental condition that precludes administration of SCIT, compliance or participation in a clinical trial. Patients who are students or employees of the institution or 1st grade relatives or partners of the investigators Participation in a clinical trial within 3 months prior to the current trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Carsten Bindslev-Jensen, Professor
Organizational Affiliation
Odense research Center for Anaphylaxis, Odense University Hospital, Denmark
Official's Role
Principal Investigator
Facility Information:
Facility Name
Odense Research Center for Anaphylaxis, Odense University Hospital
City
Odense
ZIP/Postal Code
5000
Country
Denmark

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Subcutaneous Immunotherapy With BM41 in Patients With Allergic Rhino-conjunctivitis Caused by Birch Pollen

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