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Assessment Of Disease Pathology And Key Therapeutic Targets In Severe Asthma

Primary Purpose

Asthma

Status
Terminated
Phase
Phase 1
Locations
United Kingdom
Study Type
Interventional
Intervention
Prednisolone
Bronchoscopy
Sponsored by
GlaxoSmithKline
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Asthma focused on measuring bronchoscopy, Sputum induction, Prednisolone, Asthma, biomarkers

Eligibility Criteria

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

Inclusion criteria: History of asthma with exclusion of other significant pulmonary disease. Body Mass Index between 19-31 kg.m-2. Subjects will be assigned to group 1(mild to moderate) or Group 2 (severe asthmatics) depending on their Lung Function test results. Exclusion criteria: As a result of medical interview, physical examination or screening investigation the physician responsible considers the subject unfit for the study. History of drug or other allergy, which, in the opinion of the responsible physician, contra-indicates their participation. Subject is female who is pregnant or lactating. Currently or planning to take during the study regular medication (including over-the-counter) except for medication allowed in inclusion criteria. Having participated within 30 days or 5 half-lives, whichever is longer of the first dose in a study using new molecular entity, or the first dose in any other study investigating drugs or having participated within one month of the first dose in a study with invasive procedures. History or current evidence of an upper or lower respiratory infection or symptoms (including common cold) within 2 weeks of baseline assessments. History of abnormal bruising or bleeding. History of alcohol or drug abuse. Doing night-shift work within at least 5 days prior to dosing until completion of the study. Anticoagulants except low dose of Aspirin (80 mg per day) (for bronchoscopy). Beta blockers except for low dose Atenolol (25 mg/day) or Metoprolol (50 mg/day) (for bronchoscopy). Use of Cytochrome P450 inhibitors. History of hypersensitivity to any of the following medications: Lidocaine, Fentanyl, Versed, Demerol, Midazolam, Epinephrine, Flumazenil and Naloxone. History of hypersensitivity to bronchodilator (such as Albuterol). In addition, the following additional exclusion criteria must apply to mild to moderate persistent asthmatics on regular inhaled steroids: Changed asthma medication within the 4 weeks prior to screening. Has had an asthma exacerbation in the previous month. Known sensitivity or allergy to prednisolone. Current use or use within the previous 3 months of oral corticosteroids. Current use of Methotrexate, cyclosporine and PDE inhibitors History of tuberculosis, diabetes mellitus, osteoporosis, severe hypertension, glaucoma , severe affective disorder and peptic ulceration. In addition, the following additional exclusion criteria must apply to severe persistent asthmatics with clinical controlled asthma symptoms: Changed asthma medication within the 4 weeks prior to screening. Has had an asthma exacerbation in the previous month. sensitivity or allergy to prednisolone. History of tuberculosis, diabetes mellitus, osteoporosis, hypertension, glaucoma, severe affective disorder and peptic ulceration. Current use or use within the previous 4 weeks of oral prednisolone or equivalent of greater than 20mg daily. Current use of Methotrexate, cyclosporin.

Sites / Locations

  • GSK Investigational Site

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

Intermittent mild steroid-naïve asthmatic group

Mild to moderate persistent asthmatic group

Severe asthma group

Healthy subjects group

Arm Description

Asymptomatic subjects receiving only beta-agonist inhaler with predicted FEV1 >=80% and normal peak expiratory flow between attacks will be included.

Subjects with mild to moderate persistent asthma on low to moderate dose of inhaled corticosteroid (200-500 microgram fluticasone propionate daily or equivalent), an FEV1 >= 80% predicted (post-bronchodilator), and less than 20% variability in peak expiratory flow.

Subjects with severe persistent asthma. They will be on either: high inhaled corticosteroid (CS >=1000 microgram fluticasone daily or equivalent) or on high dose inhaled CS plus oral CS (no more than 20 milligrams predisolone a day). The subjects should have at least one ( if on oral steroids) or two (if only on inhaled steroids) of the following: 1) FEV1<80% and FEV1/FVC ratio <70% 2) more than 25% variability in peak expiratory flow 3) daily symptoms ± nocturnal symptoms 4) severe exacerbations of >= twice a year in at least one of the last two years.

Non-asthmatic and non-smokers with FEV1 > 85% predicted, on no regular medication.

Outcomes

Primary Outcome Measures

Airway pathology endpoints Target Validation endpoints Biomarker endpoints Clinical endpoints
biomarkers, vital signs, ECG

Secondary Outcome Measures

Expression of airway and systemic biomarkers. Relationship between changes in target expression and clinical measures of disease activity. Relationship between steady state plasma exposure of prednisolone and pharmacodynamic biomarkers.
biomarkers

Full Information

First Posted
May 17, 2006
Last Updated
August 2, 2017
Sponsor
GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT00327197
Brief Title
Assessment Of Disease Pathology And Key Therapeutic Targets In Severe Asthma
Official Title
A Study to Assess Disease Pathology and Key Therapeutic Targets in Severe Asthma
Study Type
Interventional

2. Study Status

Record Verification Date
August 2017
Overall Recruitment Status
Terminated
Why Stopped
The study was truncated due to the long period of enrollment and the collection of a sufficient amount of data that allowed the scientific objectives to be met
Study Start Date
August 2, 2005 (Actual)
Primary Completion Date
June 6, 2011 (Actual)
Study Completion Date
June 6, 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
GlaxoSmithKline

4. Oversight

5. Study Description

Brief Summary
To evaluate and compare the expression and change in expression of key severe asthma targets at baseline in mile to moderate asthmatics vs. severe asthmatic subjects. To evaluate and compare the airway pathology at baseline and changes in airway pathology in relation to asthma severity.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Asthma
Keywords
bronchoscopy, Sputum induction, Prednisolone, Asthma, biomarkers

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
47 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intermittent mild steroid-naïve asthmatic group
Arm Type
Experimental
Arm Description
Asymptomatic subjects receiving only beta-agonist inhaler with predicted FEV1 >=80% and normal peak expiratory flow between attacks will be included.
Arm Title
Mild to moderate persistent asthmatic group
Arm Type
Experimental
Arm Description
Subjects with mild to moderate persistent asthma on low to moderate dose of inhaled corticosteroid (200-500 microgram fluticasone propionate daily or equivalent), an FEV1 >= 80% predicted (post-bronchodilator), and less than 20% variability in peak expiratory flow.
Arm Title
Severe asthma group
Arm Type
Experimental
Arm Description
Subjects with severe persistent asthma. They will be on either: high inhaled corticosteroid (CS >=1000 microgram fluticasone daily or equivalent) or on high dose inhaled CS plus oral CS (no more than 20 milligrams predisolone a day). The subjects should have at least one ( if on oral steroids) or two (if only on inhaled steroids) of the following: 1) FEV1<80% and FEV1/FVC ratio <70% 2) more than 25% variability in peak expiratory flow 3) daily symptoms ± nocturnal symptoms 4) severe exacerbations of >= twice a year in at least one of the last two years.
Arm Title
Healthy subjects group
Arm Type
Placebo Comparator
Arm Description
Non-asthmatic and non-smokers with FEV1 > 85% predicted, on no regular medication.
Intervention Type
Drug
Intervention Name(s)
Prednisolone
Intervention Description
Subjects will be administered oral prednisolone at a dose of 0.5 mg/kg, up to a maximum of 40 mg per day for 14 days.
Intervention Type
Procedure
Intervention Name(s)
Bronchoscopy
Intervention Description
All subjects will undergo bronchoscopy assessments which will involve insertion of a standard bronchoscope.
Primary Outcome Measure Information:
Title
Airway pathology endpoints Target Validation endpoints Biomarker endpoints Clinical endpoints
Description
biomarkers, vital signs, ECG
Time Frame
Through 2 weeks of Prednisolone dosing
Secondary Outcome Measure Information:
Title
Expression of airway and systemic biomarkers. Relationship between changes in target expression and clinical measures of disease activity. Relationship between steady state plasma exposure of prednisolone and pharmacodynamic biomarkers.
Description
biomarkers
Time Frame
Through 2 weeks of prednisolone dosing.

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: History of asthma with exclusion of other significant pulmonary disease. Body Mass Index between 19-31 kg.m-2. Subjects will be assigned to group 1(mild to moderate) or Group 2 (severe asthmatics) depending on their Lung Function test results. Exclusion criteria: As a result of medical interview, physical examination or screening investigation the physician responsible considers the subject unfit for the study. History of drug or other allergy, which, in the opinion of the responsible physician, contra-indicates their participation. Subject is female who is pregnant or lactating. Currently or planning to take during the study regular medication (including over-the-counter) except for medication allowed in inclusion criteria. Having participated within 30 days or 5 half-lives, whichever is longer of the first dose in a study using new molecular entity, or the first dose in any other study investigating drugs or having participated within one month of the first dose in a study with invasive procedures. History or current evidence of an upper or lower respiratory infection or symptoms (including common cold) within 2 weeks of baseline assessments. History of abnormal bruising or bleeding. History of alcohol or drug abuse. Doing night-shift work within at least 5 days prior to dosing until completion of the study. Anticoagulants except low dose of Aspirin (80 mg per day) (for bronchoscopy). Beta blockers except for low dose Atenolol (25 mg/day) or Metoprolol (50 mg/day) (for bronchoscopy). Use of Cytochrome P450 inhibitors. History of hypersensitivity to any of the following medications: Lidocaine, Fentanyl, Versed, Demerol, Midazolam, Epinephrine, Flumazenil and Naloxone. History of hypersensitivity to bronchodilator (such as Albuterol). In addition, the following additional exclusion criteria must apply to mild to moderate persistent asthmatics on regular inhaled steroids: Changed asthma medication within the 4 weeks prior to screening. Has had an asthma exacerbation in the previous month. Known sensitivity or allergy to prednisolone. Current use or use within the previous 3 months of oral corticosteroids. Current use of Methotrexate, cyclosporine and PDE inhibitors History of tuberculosis, diabetes mellitus, osteoporosis, severe hypertension, glaucoma , severe affective disorder and peptic ulceration. In addition, the following additional exclusion criteria must apply to severe persistent asthmatics with clinical controlled asthma symptoms: Changed asthma medication within the 4 weeks prior to screening. Has had an asthma exacerbation in the previous month. sensitivity or allergy to prednisolone. History of tuberculosis, diabetes mellitus, osteoporosis, hypertension, glaucoma, severe affective disorder and peptic ulceration. Current use or use within the previous 4 weeks of oral prednisolone or equivalent of greater than 20mg daily. Current use of Methotrexate, cyclosporin.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
GSK Clinical Trials
Organizational Affiliation
GlaxoSmithKline
Official's Role
Study Director
Facility Information:
Facility Name
GSK Investigational Site
City
Leicester
State/Province
Leicestershire
ZIP/Postal Code
LE3 9QP
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
29550052
Citation
Siddiqui S, Shikotra A, Richardson M, Doran E, Choy D, Bell A, Austin CD, Eastham-Anderson J, Hargadon B, Arron JR, Wardlaw A, Brightling CE, Heaney LG, Bradding P. Airway pathological heterogeneity in asthma: Visualization of disease microclusters using topological data analysis. J Allergy Clin Immunol. 2018 Nov;142(5):1457-1468. doi: 10.1016/j.jaci.2017.12.982. Epub 2018 Mar 14.
Results Reference
derived

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Assessment Of Disease Pathology And Key Therapeutic Targets In Severe Asthma

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