search
Back to results

REVErsing Airway Remodelling With Tezepelumab (REVERT)

Primary Purpose

Airway Remodelling, Asthmatic

Status
Recruiting
Phase
Phase 3
Locations
France
Study Type
Interventional
Intervention
Tezepelumab
placebo
Sponsored by
University Hospital, Montpellier
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Airway Remodelling, Asthmatic focused on measuring exacerbating asthma, Severe asthma, Airway Remodelling

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Admitted to screening visit: Minimum age: 18 Maximum age: 85 Able to perform an inspiratory and expiratory thoracic computed tomography (CT) scan, plus a nasal CT Physician-diagnosed asthma according to GINA criteria Disease with clinical impact: at least 1 severe or 2 moderate exacerbations in the previous 12 months despite treatment according to the best standards of care Maximal inhaled therapy comprising high dose ICS and at least a second controller according to GINA Based on results of screening visit and run-in: Post-bronchodilator forced expiratory volume in 1 second (FEV1) predicted values must be at 25-90% Asthma Control Questionnaire 6 (ACQ6) > 1.5 Oral corticosteroid maintenance therapy (if used) ≤7.5 mg/day In stable condition for the 4-week before randomization On CT scan, the average percentage wall area index at the B1 and B8 bronchi (generation 3, 4, 5) is >65% Exclusion Criteria: CT abnormalities evocative of any respiratory condition other than asthma Treatment regimen discordant with best practices Pulmonary disease other than asthma requiring treatment during the previous 12 months A smoking history of >20 pack years Receipt of any marketed or investigational biologic agent§ within 3 months or 5 halflives (whichever is longer) prior to randomization or receipt of any investigational non biologic agent within 30 days or 5 half-lives (whichever is longest) prior to randomization or receipt of live attenuated vaccines 30 days prior to the date of randomization. Participants enrolled in current or previous tezepelumab studies will not be included. Participants on previous biologics treatment are allowed to enter the study provided the appropriate washout period is fulfilled. Absence of signed consent Non-beneficiary of the French social security, single-payer health insurance system Presence of any condition (physical, psychological or other) that might, in the investigator's opinion, hinder study performance The patient is unavailable or unwilling to participate in future visits Potential interference from other studies Protected populations according to the French public health code Male or female patients seeking to conceive a child Women of childbearing potential and fertile men not using birth control method Pregnant, breastfeeding or lactating women History of a clinically significant infection, including upper (URTI) or lower respiratory tract infection (LRTI), requiring treatment with antibiotics or antiviral medications finalised < 2 weeks before randomization. Patients with preexisting serious infections should be treated before initiating therapy with tezepelumab. A helminth parasitic infection diagnosed within 6 months prior to Visit 1 that has not been treated with, or has failed to respond to, standard of care therapy. Patients using vaping products, including electronic cigarettes (because may induce abnormality at CT scan). Bronchial thermoplasty in the last 12 months prior to Visit 1. History of documented immune complex disease (Type III hypersensitivity reactions) following any biologic therapy. History of known immunodeficiency disorder including a positive human immunodeficiency virus test or the participant taking antiretroviral medications as determined by medical history and/or participant's verbal report. Receipt of the T2 cytokine inhibitor Suplatast tosilate within 15 days prior to randomization. Treatment with systemic immunosuppressive/immunomodulating drugs (eg, methotrexate, cyclosporine, etc.), except for OCS used in the treatment of asthma/asthma exacerbations, within the last 12 weeks or 5 half-lives (whichever is longer) prior to randomization. Receipt of immunoglobulin or blood products within 30 days prior to randomization. Receipt of allergen immunotherapy not stable within 30 days prior to randomization or with anticipated change during the treatment period.

Sites / Locations

  • CHU DijonRecruiting
  • CHU Grenoble Alpes La TroncheRecruiting
  • APHP BicêtreRecruiting
  • CHRU Lille
  • Hôpital de la Croix RousseRecruiting
  • Hôpital Nord MarseilleRecruiting
  • CHU de MontpelierRecruiting
  • APHP BichatRecruiting
  • Hôpital FochRecruiting
  • Hôpital Haut-LévêqueRecruiting
  • CHRU StrasbourgRecruiting
  • CHU ToulouseRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Placebo / Tezepelumab

Tezepelumab / Tezepelumab

Tezepelumab / Placebo

Arm Description

After 6-months of treatment, patients initially receiving placebo will switch to Tezepelumab for an additional 6 months. For 6 months of treatment, six subcutaneous (injections in accessorized pre-filled syringes (APFS)) are performed every 4 weeks. Each subcutaneous injection corresponds to 210 mg of Tezepelumab or analogous placebo.

After 6-months of treatment, patients receiving Tezepelumab will continue Tezepelumab for an additional 6 months. For 6 months of treatment, six subcutaneous (injections in accessorized pre-filled syringes (APFS)) are performed every 4 weeks.Each subcutaneous injection corresponds to 210 mg of Tezepelumab.

After 6-months of treatment, patients receiving Tezepelumab will be switched to a placebo for an additional 6 months. For 6 months of treatment, six subcutaneous (injections in accessorized pre-filled syringes (APFS)) are performed every 4 weeks. Each subcutaneous injection corresponds to 210 mg of Tezepelumab or analogous placebo.

Outcomes

Primary Outcome Measures

Comparaison on CT-scan in the change in mean percentage bronchial wall area (%WA) at the B1 and B8 bronchi, generations 3, 4 and 5
%WA = (wall area (mm²)/ (wall area (mm²) + lumen area (mm²)))×100) at bronchial levels likely to be affected.

Secondary Outcome Measures

compare on CT-scan the change in mean %WA between arms
%WA = (wall area (mm2)/ (wall area (mm2) + lumen area (mm2)))×100) at bronchial levels likely to be affected.
Comparaison on CT-scan in the average percentage bronchia wall thickness index (%WT) at the B1 and B8 bronchi, generations 3, 4 and 5
%WT = (wall thickness (mm) / airway diameter (mm))×100
Comparaison on CT-scan in the average percentage bronchia wall thickness index (%WT) at the B1 and B8 bronchi, generations 3, 4 and 5
%WT = (wall thickness (mm) / airway diameter (mm))×100
compare on CT-scan the change in wall area at the B1 and B8 bronchi, generations 3, 4 and 5
lumen area (mm²)
compare on CT-scan the change in lumen area at the B1 and B8 bronchi, generations 3, 4 and 5
lumen area (mm²)
compare on CT-scan the change in ratio wall area (WA) / lumen area(LM) at the B1 and B8 bronchi, generations 3, 4 and 5
WA/LA = WA(mm²)/LA(mm²)
compare on CT-scan the change in lumen diameter at the B1 and B8 bronchi, generations 3, 4 and 5
lumen diameter (mm)
compare on CT-scan the change in lumen circularity at the B1 and B8 bronchi, generations 3, 4 and 5
lumen circularity (4pi x area x perimeter-²)
Comparaison on CT-scan in the average percentage bronchial wall area(%WA) corrected by body surface area(BSA) at the B1 and B8 bronchi, generations 3, 4 and 5
%WA/BSA = (wall area (mm²)/ (wall area (mm²) + lumen area (mm²))×100)/(0.007184 x weight (kg)^0.425 x height (cm) ^0.725)
Comparaison on CT-scan in the average percentage bronchial wall thickness (%WT) corrected by body surface area(BSA) at the B1 and B8 bronchi, generations 3, 4 and 5
%WT/BSA = ((wall thickness (mm) / airway diameter (mm))×100)/(0.007184 x weight (kg)^0.425 x height (cm) ^0.725)
Change in the expiratory to inspiration ratio of mean lung density (MLDe/i),
expiratory-to-inspiratory ratios of mean lung density (MLDe/i)
Quantitative computed tomography measurements to evaluate airflow obstruction
Mucus plugging score (MPS)
Change in Total small Airway Count (TAC)
Total small Airway Count (TAC) mesured with Quantitative computed tomography
Change in Total small Airway Count (TAC)
Total small Airway Count (TAC) mesured with Quantitative computed tomography
Change in Lund Mackay score
Each sinus group (maxillary, anterior ethmoids, posterior ethmoids, sphenoid, frontal, ostiomeatal complex) is graded between 0 and 2 (0: no abnormality; 1: partial opacification; 2: total opacification). The ostiomeatal complex is scored as "0" (not obstructed) or "2" (obstructed). A total score of 0-24 is possible, and each side can be considered separately (0-12)
Change in Lund Mackay score
Each sinus group (maxillary, anterior ethmoids, posterior ethmoids, sphenoid, frontal, ostiomeatal complex) is graded between 0 and 2 (0: no abnormality; 1: partial opacification; 2: total opacification). The ostiomeatal complex is scored as "0" (not obstructed) or "2" (obstructed). A total score of 0-24 is possible, and each side can be considered separately (0-12)
Change in Presence/absence of nasal polyposis
Nasal brushing
Change in Presence/absence of nasal polyposis
Nasal brushing
Change in Annualized exacerbation rates
The patient journal will cover exacerbations and hospitalizations.Exacerbations will be further characterized according to severity as defined by GINA. Episode data (hospitalizations, and exacerbations) will be characterized by their beginning and end dates; These data will be used to estimate annualized exacerbation rates.
Change in Days alive and not exacerbating
The patient journal will cover exacerbations and hospitalizations. Exacerbations will be further characterized according to severity as defined by GINA. Episode data (hospitalizations, and exacerbations) will be characterized by their beginning and end dates; These data will be used to estimate days alive and not exacerbating.
Change in Days alive and not hospitalized
The patient journal will cover exacerbations and hospitalizations. Episode data (hospitalizations, and exacerbations) will be characterized by their beginning and end dates; These data will be used to estimate days alive and not hospitalized (total, and for each GINA type of exacerbation).
Change in forced expiratory volume in 1 second
Pre- and post-bronchodilator spirometry (FEV1; litres and percent predicted)
Change in forced expiratory volume in 1 second
Pre- and post-bronchodilator spirometry (FEV1; litres and percent predicted)
Change in forced vital capacity
Pre- and post-bronchodilator spirometry (FVC; litres and percent predicted)
Change in forced vital capacity
Pre- and post-bronchodilator spirometry (FVC; litres and percent predicted)
Change in forced expiratory volume in 1 second / forced vital capacity Ratio
Pre- and post-bronchodilator spirometry ( FEV1/FVC ratio (litres/litres)))
Change in forced expiratory volume in 1 second / forced vital capacity Ratio
Pre- and post-bronchodilator spirometry ( FEV1/FVC ratio (litres/litres)))
Change in total lung capacity
Pre-bronchodilator plethysmography (TLC(total lung capacity ); litres and percent predicted)
Change in total lung capacity
Pre-bronchodilator plethysmography (TLC(total lung capacity ); litres and percent predicted)
Change in residual volume
Pre-bronchodilator plethysmography (RV (residual volume ); litres and percent predicted)
Change in residual volume
Pre-bronchodilator plethysmography (RV (residual volume ); litres and percent predicted)
Change in total lung capacity (TLC)/ residual volume(RV) ratio
Pre-bronchodilator plethysmography : total lung capacity (TLC)/ residual volume(RV) ratio (litres/litres)
Change in total lung capacity (TLC)/ residual volume(RV) ratio
Pre-bronchodilator plethysmography : total lung capacity (TLC)/ residual volume(RV) ratio (litres/litres)
Change in mean ACQ (Asthma Control Questionnaire)-6 score
The ACQ6 is a shortened version of the ACQ((Asthma Control Questionnaire) that assesses asthma symptoms (night-time waking, symptoms on waking, activity limitation, shortness of breath, wheezing, and SABA use) omitting the FEV1 measurement from the original ACQ score. Patients are asked to recall how their asthma has been during the previous week by responding to one bronchodilator use question and 5 symptom questions. Questions are weighted equally and scored from 0 (totally controlled) to 6 (severely uncontrolled). The mean ACQ-6 score is the mean of the responses. Mean scores of ≤0.75 indicate well-controlled asthma, scores between 0.75 and <1.5 indicate partly controlled asthma, and a score ≥1.5 indicates not well controlled asthma (Juniper et al. 2006). Individual changes of at least 0.5 are considered to be clinically meaningful.
Change in mean ACQ (Asthma Control Questionnaire)-6 score
The ACQ6 is a shortened version of the ACQ((Asthma Control Questionnaire) that assesses asthma symptoms (night-time waking, symptoms on waking, activity limitation, shortness of breath, wheezing, and SABA use) omitting the FEV1 measurement from the original ACQ score. Patients are asked to recall how their asthma has been during the previous week by responding to one bronchodilator use question and 5 symptom questions. Questions are weighted equally and scored from 0 (totally controlled) to 6 (severely uncontrolled). The mean ACQ-6 score is the mean of the responses. Mean scores of ≤0.75 indicate well-controlled asthma, scores between 0.75 and <1.5 indicate partly controlled asthma, and a score ≥1.5 indicates not well controlled asthma (Juniper et al. 2006). Individual changes of at least 0.5 are considered to be clinically meaningful.
Change in Breathlessness, Cough and Sputum Scale (BCSS)
The Breathlessness, Cough and Sputum Scale (BCSS) has undergone a vigorous validation process and is designed to assess patients' daily respiratory symptoms. Symptoms are evaluated on a 5-point Likert-type scale ranging from 0 to 4, with higher scores indicating more severe symptoms. A mean change in BCSS total score > 1.0 represents substantial symptomatic improvement, changes of approximately 0.6 can be interpreted as moderate, and changes of 0.3 can be considered small (DeVries et al. 2016; Leidy et al. 2003).
Change in Breathlessness, Cough and Sputum Scale (BCSS)
The Breathlessness, Cough and Sputum Scale (BCSS) has undergone a vigorous validation process and is designed to assess patients' daily respiratory symptoms. Symptoms are evaluated on a 5-point Likert-type scale ranging from 0 to 4, with higher scores indicating more severe symptoms. A mean change in BCSS total score > 1.0 represents substantial symptomatic improvement, changes of approximately 0.6 can be interpreted as moderate, and changes of 0.3 can be considered small (DeVries et al. 2016; Leidy et al. 2003).
Change in Sino Nasal Outcome Test 22
The SNOT-22 is a further modification of the SNOT-20 (Piccirillo et al. 2002), where the scoring has been simplified by removing the importance rating. In addition to the normal 20-item version of the SNOT, 2 additional items were measured, nasal blockage, and loss of sense of taste and smell. The 22-question SNOT-22 is scored as 0 (no problem) to 5 (problem as bad as it can be) with a total range from 0 to 110 (higher scores indicate poorer outcomes); a MCID of 8.90 has been established.
Change in Sino Nasal Outcome Test 22
The SNOT-22 is a further modification of the SNOT-20 (Piccirillo et al. 2002), where the scoring has been simplified by removing the importance rating. In addition to the normal 20-item version of the SNOT, 2 additional items were measured, nasal blockage, and loss of sense of taste and smell. The 22-question SNOT-22 is scored as 0 (no problem) to 5 (problem as bad as it can be) with a total range from 0 to 110 (higher scores indicate poorer outcomes); a MCID of 8.90 has been established.
Change in St George Respiratory Questionnaire (SGRQ)
The SGRQ is a 50-item patient-reported instrument developed to measure the health status of patients with obstructive airway diseases. The questionnaire is divided into 2 parts: part 1 consists of 8 items pertaining to the severity of respiratory symptoms in the preceding 4 weeks; part 2 consists of 42 items related to the daily activity and psychosocial impacts of the individual's respiratory condition. The total score indicates the impact of disease on overall health status. This total score is expressed as a percentage of overall impairment, in which 100 represents the worst possible health status and 0 indicates the best possible health status.
Change in St George Respiratory Questionnaire (SGRQ)
The SGRQ is a 50-item patient-reported instrument developed to measure the health status of patients with obstructive airway diseases. The questionnaire is divided into 2 parts: part 1 consists of 8 items pertaining to the severity of respiratory symptoms in the preceding 4 weeks; part 2 consists of 42 items related to the daily activity and psychosocial impacts of the individual's respiratory condition. The total score indicates the impact of disease on overall health status. This total score is expressed as a percentage of overall impairment, in which 100 represents the worst possible health status and 0 indicates the best possible health status.
Change in ECRHS III Main Questionnaire
The European Community Respiratory Health Survey (ECRHS) III Main questionnaire is a survey used to track changing respiratory situations within the general population for epidemiological purposes. The questionnaire is composed of 32 pages and 105 questions. For the purposes of the present study, only the questions 21-28 will be used. Each selected question will be used as a stand-alone variable. The advantage of using these questions is that study distributions and longitudinal change in results can be compared to previously published epidemiological results for the general population
Change in ECRHS III Main Questionnaire
The European Community Respiratory Health Survey (ECRHS) III Main questionnaire is a survey used to track changing respiratory situations within the general population for epidemiological purposes. The questionnaire is composed of 32 pages and 105 questions. For the purposes of the present study, only the questions 21-28 will be used. Each selected question will be used as a stand-alone variable. The advantage of using these questions is that study distributions and longitudinal change in results can be compared to previously published epidemiological results for the general population
Changes in serum Club cell secretory protein (CCSP)
Changes in serum Club cell secretory protein (CCSP), an emerging blood marker associated with pulmonary function and cellular cross-talk
Changes in serum Club cell secretory protein (CCSP)
Changes in serum Club cell secretory protein (CCSP), an emerging blood marker associated with pulmonary function and cellular cross-talk
Number of adverse event between arms

Full Information

First Posted
December 7, 2022
Last Updated
July 25, 2023
Sponsor
University Hospital, Montpellier
search

1. Study Identification

Unique Protocol Identification Number
NCT05651841
Brief Title
REVErsing Airway Remodelling With Tezepelumab
Acronym
REVERT
Official Title
REVErsing Airway Remodelling With Tezepelumab : a Protocol for a Double-blind Randomized Controlled Trial for Patients With Asthma
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 27, 2023 (Actual)
Primary Completion Date
March 1, 2025 (Anticipated)
Study Completion Date
March 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Hospital, Montpellier

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 protocol is to perform a first randomized controlled trial evaluating how Tezepelumab affects the bronchial morphology (and computed tomographic variables in general) of asthmatic patients. In parallel, the investigators also hope to reproduce clinical benefits and perform a transcriptomic study that will juxtapose changes in genetic expression with changes in bronchial morphology and inflammatory signatures. The general hypothesis is that tezepelumab treatment is capable of at least partially reversing bronchial remodelling as detected on computed-tomographic (CT) scans. The investigators also expect such reversal to occur within a unique physiological repair environment that will be reflected by transcriptomic profiles
Detailed Description
Tezepelumab is a human IgG2l monoclonal antibody (mAb) directed against TSLP. Double-blind, randomized controlled trials comparing Tezepelumab treatment against placebo demonstrate net positive benefits in asthma patients. Animal research currently indicates that blocking TSLP can prevent bronchial remodelling in murine models (Chen et al. 2013), but no such observations have been attempted in humans. Within this context, the aim of this protocol is to perform a first randomized controlled trial evaluating how Tezepelumab affects the bronchial morphology (and computed tomographic variables in general) of asthmatic patients. In parallel, the investigators also hope to reproduce clinical benefits and perform a transcriptomic study that will juxtapose changes in genetic expression with changes in bronchial morphology and inflammatory signatures. The general hypothesis is that tezepelumab treatment is capable of at least partially reversing bronchial remodelling as detected on computed-tomographic (CT) scans. The investigators also expect such reversal to occur within a unique physiological repair environment that will be reflected by transcriptomic profiles. The primary objective of this protocol is therefore to compare the change-from-baseline in the average percentage bronchial wall area (%WA = (wall area (mm2)/ (wall area (mm2) + lumen area (mm2)))×100) for patients with asthma and undergoing 6 months of tezepelumab treatment with a similar population treated via placebo. Secondarily, continued treatment effects associated with longer treatment (12 months) or remanence after treatment stopping at 6 months will also be quantified. Study arms will additionally be compared in terms of: Changes in radiomics (CT-scan data); Changes in exacerbation rates and lung function; Changes in serum club cell secretory protein (CCSP); Changes in nasal single-cell transcriptomic signatures. This study also has an exploratory component designed to characterize the physiological repair environment. In depth radiomic and transcriptomic (including single-cell analyses) profiling will be performed. Finally, the capacity of baseline data to predict the response to tezepelumab will also be explored.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Airway Remodelling, Asthmatic
Keywords
exacerbating asthma, Severe asthma, Airway Remodelling

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
90 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Placebo / Tezepelumab
Arm Type
Experimental
Arm Description
After 6-months of treatment, patients initially receiving placebo will switch to Tezepelumab for an additional 6 months. For 6 months of treatment, six subcutaneous (injections in accessorized pre-filled syringes (APFS)) are performed every 4 weeks. Each subcutaneous injection corresponds to 210 mg of Tezepelumab or analogous placebo.
Arm Title
Tezepelumab / Tezepelumab
Arm Type
Experimental
Arm Description
After 6-months of treatment, patients receiving Tezepelumab will continue Tezepelumab for an additional 6 months. For 6 months of treatment, six subcutaneous (injections in accessorized pre-filled syringes (APFS)) are performed every 4 weeks.Each subcutaneous injection corresponds to 210 mg of Tezepelumab.
Arm Title
Tezepelumab / Placebo
Arm Type
Experimental
Arm Description
After 6-months of treatment, patients receiving Tezepelumab will be switched to a placebo for an additional 6 months. For 6 months of treatment, six subcutaneous (injections in accessorized pre-filled syringes (APFS)) are performed every 4 weeks. Each subcutaneous injection corresponds to 210 mg of Tezepelumab or analogous placebo.
Intervention Type
Drug
Intervention Name(s)
Tezepelumab
Intervention Description
Tezepelumab is supplied as a sterile, single-use, preservation-free, clear, colourless to slightly yellow liquid for subcutaneous administration in accessorized pre-filled syringes (APFS). Injections will be performed by study staff (doctors or nurses) during face-to-face study visits in participating centres. Subcutaneous injections are performed in a different body-part following the suggested rotation diagram.
Intervention Type
Other
Intervention Name(s)
placebo
Intervention Description
APFS containing analogous placebo identical in appearance: Injections will be performed by study staff (doctors or nurses) during face-to-face study visits in participating centres. Subcutaneous injections are performed in a different body-part following the suggested rotation diagram.
Primary Outcome Measure Information:
Title
Comparaison on CT-scan in the change in mean percentage bronchial wall area (%WA) at the B1 and B8 bronchi, generations 3, 4 and 5
Description
%WA = (wall area (mm²)/ (wall area (mm²) + lumen area (mm²)))×100) at bronchial levels likely to be affected.
Time Frame
Between baseline and 6 months
Secondary Outcome Measure Information:
Title
compare on CT-scan the change in mean %WA between arms
Description
%WA = (wall area (mm2)/ (wall area (mm2) + lumen area (mm2)))×100) at bronchial levels likely to be affected.
Time Frame
Between baseline and 12 months
Title
Comparaison on CT-scan in the average percentage bronchia wall thickness index (%WT) at the B1 and B8 bronchi, generations 3, 4 and 5
Description
%WT = (wall thickness (mm) / airway diameter (mm))×100
Time Frame
Between baseline and 6 months
Title
Comparaison on CT-scan in the average percentage bronchia wall thickness index (%WT) at the B1 and B8 bronchi, generations 3, 4 and 5
Description
%WT = (wall thickness (mm) / airway diameter (mm))×100
Time Frame
Between baseline and 12 months
Title
compare on CT-scan the change in wall area at the B1 and B8 bronchi, generations 3, 4 and 5
Description
lumen area (mm²)
Time Frame
Between baseline and 6 months
Title
compare on CT-scan the change in lumen area at the B1 and B8 bronchi, generations 3, 4 and 5
Description
lumen area (mm²)
Time Frame
Between baseline and 6 months
Title
compare on CT-scan the change in ratio wall area (WA) / lumen area(LM) at the B1 and B8 bronchi, generations 3, 4 and 5
Description
WA/LA = WA(mm²)/LA(mm²)
Time Frame
Between baseline and 6 months
Title
compare on CT-scan the change in lumen diameter at the B1 and B8 bronchi, generations 3, 4 and 5
Description
lumen diameter (mm)
Time Frame
Between baseline and 6 months
Title
compare on CT-scan the change in lumen circularity at the B1 and B8 bronchi, generations 3, 4 and 5
Description
lumen circularity (4pi x area x perimeter-²)
Time Frame
Between baseline and 6 months
Title
Comparaison on CT-scan in the average percentage bronchial wall area(%WA) corrected by body surface area(BSA) at the B1 and B8 bronchi, generations 3, 4 and 5
Description
%WA/BSA = (wall area (mm²)/ (wall area (mm²) + lumen area (mm²))×100)/(0.007184 x weight (kg)^0.425 x height (cm) ^0.725)
Time Frame
Between baseline and 6 months
Title
Comparaison on CT-scan in the average percentage bronchial wall thickness (%WT) corrected by body surface area(BSA) at the B1 and B8 bronchi, generations 3, 4 and 5
Description
%WT/BSA = ((wall thickness (mm) / airway diameter (mm))×100)/(0.007184 x weight (kg)^0.425 x height (cm) ^0.725)
Time Frame
Between baseline and 6 months
Title
Change in the expiratory to inspiration ratio of mean lung density (MLDe/i),
Description
expiratory-to-inspiratory ratios of mean lung density (MLDe/i)
Time Frame
At Baseline, 6 months and 12 months
Title
Quantitative computed tomography measurements to evaluate airflow obstruction
Description
Mucus plugging score (MPS)
Time Frame
At Baseline, 6 months and 12 months
Title
Change in Total small Airway Count (TAC)
Description
Total small Airway Count (TAC) mesured with Quantitative computed tomography
Time Frame
Between Baseline and 6 months
Title
Change in Total small Airway Count (TAC)
Description
Total small Airway Count (TAC) mesured with Quantitative computed tomography
Time Frame
Between Baseline and 12 months
Title
Change in Lund Mackay score
Description
Each sinus group (maxillary, anterior ethmoids, posterior ethmoids, sphenoid, frontal, ostiomeatal complex) is graded between 0 and 2 (0: no abnormality; 1: partial opacification; 2: total opacification). The ostiomeatal complex is scored as "0" (not obstructed) or "2" (obstructed). A total score of 0-24 is possible, and each side can be considered separately (0-12)
Time Frame
Between Baseline and 6 months
Title
Change in Lund Mackay score
Description
Each sinus group (maxillary, anterior ethmoids, posterior ethmoids, sphenoid, frontal, ostiomeatal complex) is graded between 0 and 2 (0: no abnormality; 1: partial opacification; 2: total opacification). The ostiomeatal complex is scored as "0" (not obstructed) or "2" (obstructed). A total score of 0-24 is possible, and each side can be considered separately (0-12)
Time Frame
Between Baseline and 12 months
Title
Change in Presence/absence of nasal polyposis
Description
Nasal brushing
Time Frame
Between Baseline and 6 months
Title
Change in Presence/absence of nasal polyposis
Description
Nasal brushing
Time Frame
Between Baseline and 12 months
Title
Change in Annualized exacerbation rates
Description
The patient journal will cover exacerbations and hospitalizations.Exacerbations will be further characterized according to severity as defined by GINA. Episode data (hospitalizations, and exacerbations) will be characterized by their beginning and end dates; These data will be used to estimate annualized exacerbation rates.
Time Frame
Between Baseline and 12 months
Title
Change in Days alive and not exacerbating
Description
The patient journal will cover exacerbations and hospitalizations. Exacerbations will be further characterized according to severity as defined by GINA. Episode data (hospitalizations, and exacerbations) will be characterized by their beginning and end dates; These data will be used to estimate days alive and not exacerbating.
Time Frame
Between Baseline and 12 months
Title
Change in Days alive and not hospitalized
Description
The patient journal will cover exacerbations and hospitalizations. Episode data (hospitalizations, and exacerbations) will be characterized by their beginning and end dates; These data will be used to estimate days alive and not hospitalized (total, and for each GINA type of exacerbation).
Time Frame
Between Baseline and 12 months
Title
Change in forced expiratory volume in 1 second
Description
Pre- and post-bronchodilator spirometry (FEV1; litres and percent predicted)
Time Frame
Between Baseline and 6 months
Title
Change in forced expiratory volume in 1 second
Description
Pre- and post-bronchodilator spirometry (FEV1; litres and percent predicted)
Time Frame
Between Baseline and 12 months
Title
Change in forced vital capacity
Description
Pre- and post-bronchodilator spirometry (FVC; litres and percent predicted)
Time Frame
Between Baseline and 6 months
Title
Change in forced vital capacity
Description
Pre- and post-bronchodilator spirometry (FVC; litres and percent predicted)
Time Frame
Between Baseline and 12 months
Title
Change in forced expiratory volume in 1 second / forced vital capacity Ratio
Description
Pre- and post-bronchodilator spirometry ( FEV1/FVC ratio (litres/litres)))
Time Frame
Between Baseline and 6 months
Title
Change in forced expiratory volume in 1 second / forced vital capacity Ratio
Description
Pre- and post-bronchodilator spirometry ( FEV1/FVC ratio (litres/litres)))
Time Frame
Between Baseline and 12 months
Title
Change in total lung capacity
Description
Pre-bronchodilator plethysmography (TLC(total lung capacity ); litres and percent predicted)
Time Frame
Between Baseline and 6 months
Title
Change in total lung capacity
Description
Pre-bronchodilator plethysmography (TLC(total lung capacity ); litres and percent predicted)
Time Frame
Between Baseline and 12 months
Title
Change in residual volume
Description
Pre-bronchodilator plethysmography (RV (residual volume ); litres and percent predicted)
Time Frame
Between Baseline and 6 months
Title
Change in residual volume
Description
Pre-bronchodilator plethysmography (RV (residual volume ); litres and percent predicted)
Time Frame
Between Baseline and 12 months
Title
Change in total lung capacity (TLC)/ residual volume(RV) ratio
Description
Pre-bronchodilator plethysmography : total lung capacity (TLC)/ residual volume(RV) ratio (litres/litres)
Time Frame
Between Baseline and 6 months
Title
Change in total lung capacity (TLC)/ residual volume(RV) ratio
Description
Pre-bronchodilator plethysmography : total lung capacity (TLC)/ residual volume(RV) ratio (litres/litres)
Time Frame
Between Baseline and 12 months
Title
Change in mean ACQ (Asthma Control Questionnaire)-6 score
Description
The ACQ6 is a shortened version of the ACQ((Asthma Control Questionnaire) that assesses asthma symptoms (night-time waking, symptoms on waking, activity limitation, shortness of breath, wheezing, and SABA use) omitting the FEV1 measurement from the original ACQ score. Patients are asked to recall how their asthma has been during the previous week by responding to one bronchodilator use question and 5 symptom questions. Questions are weighted equally and scored from 0 (totally controlled) to 6 (severely uncontrolled). The mean ACQ-6 score is the mean of the responses. Mean scores of ≤0.75 indicate well-controlled asthma, scores between 0.75 and <1.5 indicate partly controlled asthma, and a score ≥1.5 indicates not well controlled asthma (Juniper et al. 2006). Individual changes of at least 0.5 are considered to be clinically meaningful.
Time Frame
Between Baseline and 6 months
Title
Change in mean ACQ (Asthma Control Questionnaire)-6 score
Description
The ACQ6 is a shortened version of the ACQ((Asthma Control Questionnaire) that assesses asthma symptoms (night-time waking, symptoms on waking, activity limitation, shortness of breath, wheezing, and SABA use) omitting the FEV1 measurement from the original ACQ score. Patients are asked to recall how their asthma has been during the previous week by responding to one bronchodilator use question and 5 symptom questions. Questions are weighted equally and scored from 0 (totally controlled) to 6 (severely uncontrolled). The mean ACQ-6 score is the mean of the responses. Mean scores of ≤0.75 indicate well-controlled asthma, scores between 0.75 and <1.5 indicate partly controlled asthma, and a score ≥1.5 indicates not well controlled asthma (Juniper et al. 2006). Individual changes of at least 0.5 are considered to be clinically meaningful.
Time Frame
Between Baseline and 12 months
Title
Change in Breathlessness, Cough and Sputum Scale (BCSS)
Description
The Breathlessness, Cough and Sputum Scale (BCSS) has undergone a vigorous validation process and is designed to assess patients' daily respiratory symptoms. Symptoms are evaluated on a 5-point Likert-type scale ranging from 0 to 4, with higher scores indicating more severe symptoms. A mean change in BCSS total score > 1.0 represents substantial symptomatic improvement, changes of approximately 0.6 can be interpreted as moderate, and changes of 0.3 can be considered small (DeVries et al. 2016; Leidy et al. 2003).
Time Frame
Between Baseline and 6 months
Title
Change in Breathlessness, Cough and Sputum Scale (BCSS)
Description
The Breathlessness, Cough and Sputum Scale (BCSS) has undergone a vigorous validation process and is designed to assess patients' daily respiratory symptoms. Symptoms are evaluated on a 5-point Likert-type scale ranging from 0 to 4, with higher scores indicating more severe symptoms. A mean change in BCSS total score > 1.0 represents substantial symptomatic improvement, changes of approximately 0.6 can be interpreted as moderate, and changes of 0.3 can be considered small (DeVries et al. 2016; Leidy et al. 2003).
Time Frame
Between Baseline and 12 months
Title
Change in Sino Nasal Outcome Test 22
Description
The SNOT-22 is a further modification of the SNOT-20 (Piccirillo et al. 2002), where the scoring has been simplified by removing the importance rating. In addition to the normal 20-item version of the SNOT, 2 additional items were measured, nasal blockage, and loss of sense of taste and smell. The 22-question SNOT-22 is scored as 0 (no problem) to 5 (problem as bad as it can be) with a total range from 0 to 110 (higher scores indicate poorer outcomes); a MCID of 8.90 has been established.
Time Frame
Between Baseline and 6 months
Title
Change in Sino Nasal Outcome Test 22
Description
The SNOT-22 is a further modification of the SNOT-20 (Piccirillo et al. 2002), where the scoring has been simplified by removing the importance rating. In addition to the normal 20-item version of the SNOT, 2 additional items were measured, nasal blockage, and loss of sense of taste and smell. The 22-question SNOT-22 is scored as 0 (no problem) to 5 (problem as bad as it can be) with a total range from 0 to 110 (higher scores indicate poorer outcomes); a MCID of 8.90 has been established.
Time Frame
Between Baseline and 12 months
Title
Change in St George Respiratory Questionnaire (SGRQ)
Description
The SGRQ is a 50-item patient-reported instrument developed to measure the health status of patients with obstructive airway diseases. The questionnaire is divided into 2 parts: part 1 consists of 8 items pertaining to the severity of respiratory symptoms in the preceding 4 weeks; part 2 consists of 42 items related to the daily activity and psychosocial impacts of the individual's respiratory condition. The total score indicates the impact of disease on overall health status. This total score is expressed as a percentage of overall impairment, in which 100 represents the worst possible health status and 0 indicates the best possible health status.
Time Frame
Between Baseline and 6 months
Title
Change in St George Respiratory Questionnaire (SGRQ)
Description
The SGRQ is a 50-item patient-reported instrument developed to measure the health status of patients with obstructive airway diseases. The questionnaire is divided into 2 parts: part 1 consists of 8 items pertaining to the severity of respiratory symptoms in the preceding 4 weeks; part 2 consists of 42 items related to the daily activity and psychosocial impacts of the individual's respiratory condition. The total score indicates the impact of disease on overall health status. This total score is expressed as a percentage of overall impairment, in which 100 represents the worst possible health status and 0 indicates the best possible health status.
Time Frame
Between Baseline and 12 months
Title
Change in ECRHS III Main Questionnaire
Description
The European Community Respiratory Health Survey (ECRHS) III Main questionnaire is a survey used to track changing respiratory situations within the general population for epidemiological purposes. The questionnaire is composed of 32 pages and 105 questions. For the purposes of the present study, only the questions 21-28 will be used. Each selected question will be used as a stand-alone variable. The advantage of using these questions is that study distributions and longitudinal change in results can be compared to previously published epidemiological results for the general population
Time Frame
Between Baseline and 6 months
Title
Change in ECRHS III Main Questionnaire
Description
The European Community Respiratory Health Survey (ECRHS) III Main questionnaire is a survey used to track changing respiratory situations within the general population for epidemiological purposes. The questionnaire is composed of 32 pages and 105 questions. For the purposes of the present study, only the questions 21-28 will be used. Each selected question will be used as a stand-alone variable. The advantage of using these questions is that study distributions and longitudinal change in results can be compared to previously published epidemiological results for the general population
Time Frame
Between Baseline and 12 months
Title
Changes in serum Club cell secretory protein (CCSP)
Description
Changes in serum Club cell secretory protein (CCSP), an emerging blood marker associated with pulmonary function and cellular cross-talk
Time Frame
Between baseline and 6 months
Title
Changes in serum Club cell secretory protein (CCSP)
Description
Changes in serum Club cell secretory protein (CCSP), an emerging blood marker associated with pulmonary function and cellular cross-talk
Time Frame
Between baseline and 12 months
Title
Number of adverse event between arms
Time Frame
Between baseline and 6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Admitted to screening visit: Minimum age: 18 Maximum age: 85 Able to perform an inspiratory and expiratory thoracic computed tomography (CT) scan, plus a nasal CT Physician-diagnosed asthma according to GINA criteria Disease with clinical impact: at least 1 severe or 2 moderate exacerbations in the previous 12 months despite treatment according to the best standards of care Maximal inhaled therapy comprising high dose ICS and at least a second controller according to GINA Based on results of screening visit and run-in: Post-bronchodilator forced expiratory volume in 1 second (FEV1) predicted values must be at 25-90% Asthma Control Questionnaire 6 (ACQ6) > 1.5 Oral corticosteroid maintenance therapy (if used) ≤7.5 mg/day In stable condition for the 4-week before randomization On CT scan, the average percentage wall area index at the B1 and B8 bronchi (generation 3, 4, 5) is >65% Exclusion Criteria: CT abnormalities evocative of any respiratory condition other than asthma Treatment regimen discordant with best practices Pulmonary disease other than asthma requiring treatment during the previous 12 months A smoking history of >20 pack years Receipt of any marketed or investigational biologic agent§ within 3 months or 5 halflives (whichever is longer) prior to randomization or receipt of any investigational non biologic agent within 30 days or 5 half-lives (whichever is longest) prior to randomization or receipt of live attenuated vaccines 30 days prior to the date of randomization. Participants enrolled in current or previous tezepelumab studies will not be included. Participants on previous biologics treatment are allowed to enter the study provided the appropriate washout period is fulfilled. Absence of signed consent Non-beneficiary of the French social security, single-payer health insurance system Presence of any condition (physical, psychological or other) that might, in the investigator's opinion, hinder study performance The patient is unavailable or unwilling to participate in future visits Potential interference from other studies Protected populations according to the French public health code Male or female patients seeking to conceive a child Women of childbearing potential and fertile men not using birth control method Pregnant, breastfeeding or lactating women History of a clinically significant infection, including upper (URTI) or lower respiratory tract infection (LRTI), requiring treatment with antibiotics or antiviral medications finalised < 2 weeks before randomization. Patients with preexisting serious infections should be treated before initiating therapy with tezepelumab. A helminth parasitic infection diagnosed within 6 months prior to Visit 1 that has not been treated with, or has failed to respond to, standard of care therapy. Patients using vaping products, including electronic cigarettes (because may induce abnormality at CT scan). Bronchial thermoplasty in the last 12 months prior to Visit 1. History of documented immune complex disease (Type III hypersensitivity reactions) following any biologic therapy. History of known immunodeficiency disorder including a positive human immunodeficiency virus test or the participant taking antiretroviral medications as determined by medical history and/or participant's verbal report. Receipt of the T2 cytokine inhibitor Suplatast tosilate within 15 days prior to randomization. Treatment with systemic immunosuppressive/immunomodulating drugs (eg, methotrexate, cyclosporine, etc.), except for OCS used in the treatment of asthma/asthma exacerbations, within the last 12 weeks or 5 half-lives (whichever is longer) prior to randomization. Receipt of immunoglobulin or blood products within 30 days prior to randomization. Receipt of allergen immunotherapy not stable within 30 days prior to randomization or with anticipated change during the treatment period.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Arnaud Bourdin, MD
Phone
+33467336126
Email
a-bourdin@chu-montpellier.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Fanny Cardon
Phone
+33467330824
Email
depotac@chu-montpellier.fr
Facility Information:
Facility Name
CHU Dijon
City
Dijon
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Philippe BONNIAUD, Dr
Facility Name
CHU Grenoble Alpes La Tronche
City
Grenoble
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Christel SAINT-RAYMOND, Dr
First Name & Middle Initial & Last Name & Degree
Amandine BRIAULT, Dr
First Name & Middle Initial & Last Name & Degree
Wassila MARNAS, Dr
First Name & Middle Initial & Last Name & Degree
Ami Marie BOCOUM, Dr
First Name & Middle Initial & Last Name & Degree
Bruno DEGANO, Dr
Facility Name
APHP Bicêtre
City
le Kremlin-Bicêtre
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Antoine BEURNIER, Dr
First Name & Middle Initial & Last Name & Degree
Marc HUMBERT, Dr
First Name & Middle Initial & Last Name & Degree
Sophia KEDDACHE, Dr
First Name & Middle Initial & Last Name & Degree
Caroline SATTLER, Dr
Facility Name
CHRU Lille
City
Lille
Country
France
Individual Site Status
Withdrawn
Facility Name
Hôpital de la Croix Rousse
City
Lyon
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gilles DEVOUASSOUX, Dr
Facility Name
Hôpital Nord Marseille
City
Marseille
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pascal CHANEZ, Dr
First Name & Middle Initial & Last Name & Degree
Marion GOUITAA, Dr
First Name & Middle Initial & Last Name & Degree
Celine TUMMINO, Dr
Facility Name
CHU de Montpelier
City
Montpellier
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Arnaud BOURDIN, Pr
First Name & Middle Initial & Last Name & Degree
Arnaud BOURDIN, Pr
Facility Name
APHP Bichat
City
Paris
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Camille Taille, Dr
First Name & Middle Initial & Last Name & Degree
Clairelyne DUPIN, Dr
First Name & Middle Initial & Last Name & Degree
Loubna Alavoine, Dr
Facility Name
Hôpital Foch
City
Paris
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Colas TCHERAKIAN, Dr
Facility Name
Hôpital Haut-Lévêque
City
Pessac
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Patrick BERGER, Pr
First Name & Middle Initial & Last Name & Degree
Pierre-Olivier GIRODET, Dr
First Name & Middle Initial & Last Name & Degree
Pietro ROSELLINI, Dr
Facility Name
CHRU Strasbourg
City
Strasbourg
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Naji KHAYATH, Dr
First Name & Middle Initial & Last Name & Degree
Nicolas MIGUERES, Dr
First Name & Middle Initial & Last Name & Degree
Christophe MARCOT, Dr
Facility Name
CHU Toulouse
City
Toulouse
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Laurent GUILLEMINAULT, Dr
First Name & Middle Initial & Last Name & Degree
Alain Didier, Dr

12. IPD Sharing Statement

Plan to Share IPD
Undecided

Learn more about this trial

REVErsing Airway Remodelling With Tezepelumab

We'll reach out to this number within 24 hrs