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Development of Cockroach Immunotherapy by the Inner-City Asthma Consortium

Primary Purpose

Asthma, Perennial Allergic Rhinitis

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
German cockroach (Blattella germanica) allergenic extract
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Asthma focused on measuring Cockroach, Immunotherapy, Subcutaneous immunotherapy, Inner city asthma

Eligibility Criteria

18 Years - 55 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Have a history of perennial allergic rhinitis, asthma, or both, for a minimum of 1 year before study entry. For those with asthma:

    • a diagnosis of asthma will be defined as a report by the participant that they have had a clinical diagnosis of asthma made by a physician over a year ago
    • the participant's asthma must be well controlled as defined by:
    • a forced expiratory volume at one second (FEV1) greater than or equal to 80% predicted value with or without controller medication
    • albuterol use for no more than 3 days per week in each of the previous 2 weeks for asthma symptoms (not including exercise prophylaxis)
  • Are sensitive to German cockroach (Blattella germanica) as documented by a positive (>= 3 mm greater than negative control) skin prick test result and detectable German cockroach specific IgE (>=0.35 kUA/L)
  • Have no known contraindications to therapy with glycerinated German (Blattella germanica) cockroach allergenic extract
  • Are willing to sign the written Informed Consent prior to initiation of any study procedure

Exclusion Criteria:

  • Are pregnant or lactating. Females must be abstinent or use a medically acceptable birth control method throughout the study (e.g. oral, subcutaneous, mechanical, or surgical contraception)
  • Are unable to perform spirometry at screening
  • Have an asthma severity classification at recruitment of severe persistent, using the National Asthma Education and Prevention Program (NAEPP) classification, as evidenced by at least one of the following:

    • requires a dose of greater than 500 mcg of fluticasone per day or the equivalent of another inhaled corticosteroid
    • have received more than 2 courses of oral or parenteral corticosteroids within the last 12 months
    • have been treated with depot steroids within the last 12 months
    • have been hospitalized for asthma within the 6 months prior to recruitment
    • have had a life-threatening asthma exacerbation that required intubation, mechanical ventilation, or that resulted in a hypoxic seizure within 2 years prior to recruitment
  • Do not have access to a phone (needed for scheduling appointments)
  • Have received allergen immunotherapy (SLIT or SCIT) in the last 12 months prior to recruitment or who plan to initiate or resume allergen immunotherapy during the study. Subjects who only received placebo therapy in the BioCSI protocol (A Biomarker-based Pilot Study of Cockroach Sublingual Immunotherapy in Cockroach Sensitive Adults With Asthma and/or Perennial Allergic Rhinitis, ICAC-12, NCT00829985) are eligible to participate in this study
  • Have previously been treated with anti-IgE therapy within 1 year of recruitment
  • Have received an investigational drug in the 30 days prior to recruitment or who plan to use an investigational drug during the study
  • Refuse to sign the Epinephrine Auto-injector Training Form
  • Do not primarily speak English
  • Plan to move from the area during the study period
  • Have a history of idiopathic anaphylaxis or anaphylaxis grade 2 or higher as defined in the protocol
  • Have unstable angina, significant arrhythmia, uncontrolled hypertension, history of autoimmune disease, or other chronic or immunological diseases that in the opinion of the investigator might interfere with the evaluation of the investigational agent or pose additional risk to the participant
  • Are using tricyclic antidepressants or beta-adrenergic blocker drugs (either oral or topical route[s] of administration)

Sites / Locations

  • Johns Hopkins University School of Medicine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

German cockroach allergenic extract

Arm Description

Participants will receive weekly escalating doses of glycerinated German cockroach allergenic extract administered via the subcutaneous route up to a Maximum Study Dose of 0.6 mL of extract at a concentration of 1:20 wt/vol.

Outcomes

Primary Outcome Measures

Number of Reported Treatment-related Adverse Events (AEs)
Number of non-serious adverse events reported as possibly related, probably related, or definitely related to study participation.
Number of Reported Treatment-related Serious Adverse Events (SAEs)
Number of SAEs reported as possibly related, probably related, or definitely related to study participation.

Secondary Outcome Measures

Change in German Cockroach-Specific Serum IgE Over Time
Outcome is the ratio of geometric means for baseline German cockroach-specific serum Immunoglobulin E (IgE) vs. post-baseline German cockroach-specific serum IgE. Numerator is geometric mean post-baseline IgE; denominator is baseline IgE. This result is an indicator of immune modulation over time, however its clinical significance is unclear.
Change in German Cockroach-Specific Serum IgG Over Time
Outcome is the ratio of geometric means for baseline German cockroach-specific serum Immunoglobulin G (IgG) vs. post-baseline German cockroach-specific serum IgG. Numerator is geometric mean post-baseline IgG; denominator is baseline IgG.This result is an indicator of immune modulation over time, however its clinical significance is unclear.
Change in German Cockroach-Specific Serum IgG4 Over Time
Outcome is the ratio of geometric means for baseline German cockroach-specific serum Immunoglobulin subclass 4 (IgG4) vs. post-baseline German cockroach-specific serum IgG4. Numerator is geometric mean post-baseline IgG4; denominator is baseline IgG4. This result is an indicator of immune modulation over time, however its clinical significance is unclear.
Change in IgE Fragment Antibody Binding (FAB) Activity (10 Micrograms/mL Cockroach Allergen Extract)
Outcome is the change in mean IgE fragment antibody binding (FAB) activity, baseline to post-baseline. Serum from cockroach subcutaneous immunotherapy (SCIT)-treated participants were analyzed to determine if treatment inhibits the in-vitro cockroach antigen binding to B-cells after 6-months of treatment with cockroach SCIT, using the per protocol allergenic extract doses. This result is an indicator of immune modulation over time, however its clinical significance is unclear.

Full Information

First Posted
October 13, 2010
Last Updated
June 5, 2014
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Inner-City Asthma Consortium
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1. Study Identification

Unique Protocol Identification Number
NCT01221285
Brief Title
Development of Cockroach Immunotherapy by the Inner-City Asthma Consortium
Official Title
A Biomarker-Based Pilot Study of Cockroach Subcutaneous Immunotherapy in Cockroach Sensitive Adults With Asthma and/or Perennial Allergic Rhinitis (ICAC-18)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2014
Overall Recruitment Status
Completed
Study Start Date
September 2010 (undefined)
Primary Completion Date
October 2011 (Actual)
Study Completion Date
October 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Inner-City Asthma Consortium

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This trial is a biomarker-based pilot study of the safety of Cockroach Subcutaneous Immunotherapy in Cockroach-sensitive Adults (SCITCO) who have a history of perennial allergic rhinitis, asthma, or both.
Detailed Description
Scientific evidence has shown that, over the past two decades, the combination of cockroach allergy and cockroach exposure is one of the most important factors contributing to the dramatic increase in asthma morbidity seen in inner city children with asthma. Therefore, a major goal of the Inner City Asthma Consortium (ICAC) is to evaluate the efficacy of cockroach immunotherapy in inner city asthma.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Asthma, Perennial Allergic Rhinitis
Keywords
Cockroach, Immunotherapy, Subcutaneous immunotherapy, Inner city asthma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
11 (Actual)

8. Arms, Groups, and Interventions

Arm Title
German cockroach allergenic extract
Arm Type
Experimental
Arm Description
Participants will receive weekly escalating doses of glycerinated German cockroach allergenic extract administered via the subcutaneous route up to a Maximum Study Dose of 0.6 mL of extract at a concentration of 1:20 wt/vol.
Intervention Type
Biological
Intervention Name(s)
German cockroach (Blattella germanica) allergenic extract
Intervention Description
Participants received weekly escalating doses of glycerinated German cockroach allergenic extract administered via the subcutaneous route up to a Maximum Study Dose of 0.6 mL of extract at a concentration of 1:20 wt/vol.
Primary Outcome Measure Information:
Title
Number of Reported Treatment-related Adverse Events (AEs)
Description
Number of non-serious adverse events reported as possibly related, probably related, or definitely related to study participation.
Time Frame
Baseline through 6-months of treatment
Title
Number of Reported Treatment-related Serious Adverse Events (SAEs)
Description
Number of SAEs reported as possibly related, probably related, or definitely related to study participation.
Time Frame
Baseline through 6-months of treatment
Secondary Outcome Measure Information:
Title
Change in German Cockroach-Specific Serum IgE Over Time
Description
Outcome is the ratio of geometric means for baseline German cockroach-specific serum Immunoglobulin E (IgE) vs. post-baseline German cockroach-specific serum IgE. Numerator is geometric mean post-baseline IgE; denominator is baseline IgE. This result is an indicator of immune modulation over time, however its clinical significance is unclear.
Time Frame
Baseline through 6-months of treatment
Title
Change in German Cockroach-Specific Serum IgG Over Time
Description
Outcome is the ratio of geometric means for baseline German cockroach-specific serum Immunoglobulin G (IgG) vs. post-baseline German cockroach-specific serum IgG. Numerator is geometric mean post-baseline IgG; denominator is baseline IgG.This result is an indicator of immune modulation over time, however its clinical significance is unclear.
Time Frame
Baseline through 6-months of treatment
Title
Change in German Cockroach-Specific Serum IgG4 Over Time
Description
Outcome is the ratio of geometric means for baseline German cockroach-specific serum Immunoglobulin subclass 4 (IgG4) vs. post-baseline German cockroach-specific serum IgG4. Numerator is geometric mean post-baseline IgG4; denominator is baseline IgG4. This result is an indicator of immune modulation over time, however its clinical significance is unclear.
Time Frame
Baseline through 6-months of treatment
Title
Change in IgE Fragment Antibody Binding (FAB) Activity (10 Micrograms/mL Cockroach Allergen Extract)
Description
Outcome is the change in mean IgE fragment antibody binding (FAB) activity, baseline to post-baseline. Serum from cockroach subcutaneous immunotherapy (SCIT)-treated participants were analyzed to determine if treatment inhibits the in-vitro cockroach antigen binding to B-cells after 6-months of treatment with cockroach SCIT, using the per protocol allergenic extract doses. This result is an indicator of immune modulation over time, however its clinical significance is unclear.
Time Frame
Baseline through 6-months of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Have a history of perennial allergic rhinitis, asthma, or both, for a minimum of 1 year before study entry. For those with asthma: a diagnosis of asthma will be defined as a report by the participant that they have had a clinical diagnosis of asthma made by a physician over a year ago the participant's asthma must be well controlled as defined by: a forced expiratory volume at one second (FEV1) greater than or equal to 80% predicted value with or without controller medication albuterol use for no more than 3 days per week in each of the previous 2 weeks for asthma symptoms (not including exercise prophylaxis) Are sensitive to German cockroach (Blattella germanica) as documented by a positive (>= 3 mm greater than negative control) skin prick test result and detectable German cockroach specific IgE (>=0.35 kUA/L) Have no known contraindications to therapy with glycerinated German (Blattella germanica) cockroach allergenic extract Are willing to sign the written Informed Consent prior to initiation of any study procedure Exclusion Criteria: Are pregnant or lactating. Females must be abstinent or use a medically acceptable birth control method throughout the study (e.g. oral, subcutaneous, mechanical, or surgical contraception) Are unable to perform spirometry at screening Have an asthma severity classification at recruitment of severe persistent, using the National Asthma Education and Prevention Program (NAEPP) classification, as evidenced by at least one of the following: requires a dose of greater than 500 mcg of fluticasone per day or the equivalent of another inhaled corticosteroid have received more than 2 courses of oral or parenteral corticosteroids within the last 12 months have been treated with depot steroids within the last 12 months have been hospitalized for asthma within the 6 months prior to recruitment have had a life-threatening asthma exacerbation that required intubation, mechanical ventilation, or that resulted in a hypoxic seizure within 2 years prior to recruitment Do not have access to a phone (needed for scheduling appointments) Have received allergen immunotherapy (SLIT or SCIT) in the last 12 months prior to recruitment or who plan to initiate or resume allergen immunotherapy during the study. Subjects who only received placebo therapy in the BioCSI protocol (A Biomarker-based Pilot Study of Cockroach Sublingual Immunotherapy in Cockroach Sensitive Adults With Asthma and/or Perennial Allergic Rhinitis, ICAC-12, NCT00829985) are eligible to participate in this study Have previously been treated with anti-IgE therapy within 1 year of recruitment Have received an investigational drug in the 30 days prior to recruitment or who plan to use an investigational drug during the study Refuse to sign the Epinephrine Auto-injector Training Form Do not primarily speak English Plan to move from the area during the study period Have a history of idiopathic anaphylaxis or anaphylaxis grade 2 or higher as defined in the protocol Have unstable angina, significant arrhythmia, uncontrolled hypertension, history of autoimmune disease, or other chronic or immunological diseases that in the opinion of the investigator might interfere with the evaluation of the investigational agent or pose additional risk to the participant Are using tricyclic antidepressants or beta-adrenergic blocker drugs (either oral or topical route[s] of administration)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Wood, MD
Organizational Affiliation
Johns Hopkins University
Official's Role
Study Chair
Facility Information:
Facility Name
Johns Hopkins University School of Medicine
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
24184147
Citation
Wood RA, Togias A, Wildfire J, Visness CM, Matsui EC, Gruchalla R, Hershey G, Liu AH, O'Connor GT, Pongracic JA, Zoratti E, Little F, Granada M, Kennedy S, Durham SR, Shamji MH, Busse WW. Development of cockroach immunotherapy by the Inner-City Asthma Consortium. J Allergy Clin Immunol. 2014 Mar;133(3):846-52.e6. doi: 10.1016/j.jaci.2013.08.047. Epub 2013 Nov 1.
Results Reference
result

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Development of Cockroach Immunotherapy by the Inner-City Asthma Consortium

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