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Effects of p38 Inhibitor AZD7624 in Corticosteroid Resistant Asthma

Primary Purpose

Corticosteroid Resistant (CR) Asthmatics

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
AZD7624
prednisone
Placebo
Sponsored by
National Jewish Health
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Corticosteroid Resistant (CR) Asthmatics

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

Asthmatic Subjects

  • Males and women of non-childbearing potential aged 18-65 of any racial or ethnic background, who are physically and mentally able to cooperate with the proposed tests and procedures and who are able to give informed consent.
  • Asthma defined by symptoms and/or a doctor's diagnosis compatible with asthma as per 2014 GINA Guidelines.
  • Symptomatic patients (ACQ>1.25) with FEV1 % predicted 80%, currently taking ICS or ICS/LABA. Patients should demonstrate normal bronchodilator response, i.e. there must be equal or greater than 12% or 200ml improvement in FEV1 post-bronchodilator (albuterol).
  • Females must have a negative pregnancy test at Visit 1, must not be lactating and must be of non-childbearing potential, by fulfilling one of the following criteria:

    • Postmenopausal defined as amenorrhoea for at least 12 months or more following cessation of all possible exogenous hormonal treatments and luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels in the postmenopausal range (at Visit 1)
    • Documentation of irreversible surgical sterilisation by hysterectomy, bilateral oophorectomy or bilateral salpingectomy but not tubal ligation
  • Males must be surgically sterile or agree to use an acceptable method of contraception (defined as barrier methods in conjunction with spermicides) for the duration of the study (from the time they sign consent) and for 3 months after the last dose of investigational product to prevent pregnancy in a partner.
  • A weight of ≥50 kg (measured at Visit 1)

Healthy Controls

  • Subjects must be 18 to 65 years old, who are physically and mentally able to cooperate with the proposed tests and procedures and who are able to give informed consent.
  • They must have no respiratory or cardiac symptoms (cough, phlegm, wheeze, dyspnea) and no physician diagnosed cardiac or respiratory disease.
  • No allergic history.
  • FEV1≥ 80%
  • Females must have a negative pregnancy test at Visit 1, must not be lactating and must be of non-childbearing potential, by fulfilling one of the following criteria:

    • Postmenopausal defined as amenorrhoea for at least 12 months or more following cessation of all possible exogenous hormonal treatments and luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels in the postmenopausal range (at Visit 1)
    • Documentation of irreversible surgical sterilisation by hysterectomy, bilateral oophorectomy or bilateral salpingectomy but not tubal ligation
  • A weight of ≥50 kg (measured at Visit 1)

Exclusion Criteria:

  • An FEVl <60% predicted post albuterol bronchodilator.
  • Oral steroid use within the past 6 weeks.
  • Acute respiratory illness within 6 weeks of the study.
  • Another pulmonary disease expected to affect participation in the study or the measurements to be examined.
  • Pregnancy.
  • Smoking in last year or prior smoking history of more than 10 pack years.
  • Previous randomization to treatment in the present study (at Visit 1)
  • Participation in another clinical study with any novel investigational medicine product within 3 months before the first dose of investigational product in this study (at Visit 4)
  • Previously intake of any p38 inhibitor (same class as AZD7624)
  • Significant disease or disorder other than asthma (e.g. cardiovascular; pulmonary as e.g. tuberculosis and cystic fibrosis; gastrointestinal, liver; neurological; musculoskeletal; endocrine; metabolic; malignant; psychiatric; major physical impairment) which, in the opinion of the investigator, may either put the patient at risk because of participation in the study, or influence the results of the study, or the patient's ability to participate in the study (at Visit 1)
  • Any clinically relevant abnormal findings in clinical chemistry, haematology and urinalysis, which, in the opinion of the investigator, may put the patient at risk because of participation in the study (for CR patients only at Visit 3a)
  • Any clinically relevant abnormal findings in physical examination, pulse or blood pressure which, in the opinion of the investigator, may put the patient at risk because of participation in the study (at Visit 1)
  • History or family history of muscle diseases (at Visit 1)
  • Abnormal vital signs, after 10 minutes supine rest, defined as any of the following (CR patients, at Visit 3a):

    • Systolic blood pressure (SBP) above 140 mmHg if <60 years of age and above 150 mmHg if ≥60 years of age
    • Diastolic blood pressure (DBP) above 90 mmHg
    • Pulse <50 or >100 bpm
  • Unstable angina pectoris or stable angina pectoris classified higher than Canadian Cardiovascular Society (CSS) class 2. History of hospitalization within 12 months caused by heart failure or a diagnosis of heart failure higher than New York Heart Association (NYHA) class II. Acute myocardial infarction within 6 months of screening (CR patients, Visit 3a).
  • Treatment with strong CYP3A inhibitors (like erythromycin and itraconazole), within 4 weeks prior to randomization (CVR patients, Visit 4). Patients on anticoagulation treatment.

Healthy Controls

  • Evidence on history, physical examination, or screening spirometry of Lung disease or other disease that will affect participation in the study or the measurements to be examined.
  • Smoking in the last year or prior smoking history of more than 10 pack years.

Sites / Locations

  • National Jewish Health

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

No Intervention

Other

Active Comparator

Placebo Comparator

Arm Label

Normal control

Corticosteroid sensitive (CS) asthmatics

Corticosteroid resistant (CR) asthmatics active

Corticosteroid resistant (CR) asthmatics placebo

Arm Description

Health volunteers will be recruited as an additional control group.

After the initial visit, asthmatics will be given oral prednisone for 1 week and patients will return for the spirometer assessment. Patients will be defined as CR if <10% improvement in FEV1 % predicted is observed and as CS in >12% improvement in FEV1% predicted is observed.

The study will have a 1 week oral corticosteroid (OSC) run-in period. Subjects unresponsive to OCS will be defined as corticosteroid resistant (CR) and randomized to two crossover treatment sequences consisting of 4 weeks of inhaled AZD7624 or placebo, followed by 4 weeks of a washout period, and another 4 weeks of placebo or ASD7624

The study will have a 1 week oral corticosteroid (OSC) run-in period. Subjects unresponsive to OCS will be defined as corticosteroid resistant (CR) and randomized to two crossover treatment sequences consisting of 4 weeks of inhaled AZD7624 or placebo, followed by 4 weeks of a washout period, and another 4 weeks of placebo or ASD7624

Outcomes

Primary Outcome Measures

P38 MAPK activation (as measured by phosphorylation) in the whole blood samples by flow cytometry.
P38 MAPK activation in the whole blood samples by flow cytometry and p38 MAPK expression in BAL and induced sputum macrophages by immunostaining and microscopy imaging before and after p38 inhibitor treatment vs placebo in CR asthma patients
Evaluate MAPK activation in the whole blood samples by flow cytometry and pMAPK expression in BAL and induced sputum macrophages by immunostaining and microscopy imaging before and after p38 inhibitor AZD7624 treatment vs placebo.

Secondary Outcome Measures

Full Information

First Posted
April 18, 2016
Last Updated
August 19, 2019
Sponsor
National Jewish Health
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1. Study Identification

Unique Protocol Identification Number
NCT02753764
Brief Title
Effects of p38 Inhibitor AZD7624 in Corticosteroid Resistant Asthma
Official Title
Effects of p38 Inhibitor AZD7624 in Corticosteroid Resistant Asthma
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Completed
Study Start Date
January 2017 (undefined)
Primary Completion Date
February 25, 2019 (Actual)
Study Completion Date
February 25, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
National Jewish Health

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a double-blind, placebo controlled 4 week crossover study to investigate the efficacy and safety of AZD7624 (an inhaled p38 inhibitor) in corticosteroid resistant (CR) asthmatics. For the purpose of this study 10 symptomatic CR asthma patients with a FEV1% predicted <80% and normal bronchodilator response, 10 CS asthmatics and 10 healthy controls will be recruited.
Detailed Description
In Part A of the study, p38 MAPK activation will be measured in CR asthmatics and compared to CS asthmatics. Assessment of p38 MAPK activation in whole blood samples from 5 CR and 5 CS asthma patients will be performed. After fulfilling all enrollment criteria blood samples will be collected from asthma patients at Visit 1 for the whole blood evaluation of MAPK activation by flow cytometry. After the initial visit, asthmatics will be given oral prednisone for 1 week and patients will return for the spirometry assessment. Patients will be defined as CR if <10% improvement in FEV1 % predicted is observed and as CS if >12% improvement in FEV1 % predicted is observed. If at least 2 fold increase in p-p38 MAPK expression in CD14+ cells of CR asthma patients is demonstrated when compared to CS asthmatics, Part B will be triggered. If no difference in p38 MAPK phosphorylation will be observed in monocytes of CR and CS asthmatics by flow cytometry assessment, the study will be terminated. In Part B of the study, CR asthmatics will be randomized for treatment with AZD7624 or placebo for one month in a cross over design; the ability of AZD7624 to inhibit p38 MAPK activity will be assessed in CR patients. Five CR asthma patients from Part A may also take part in Part B. Additional CR (n=10 total patients required) and CS asthmatics (n=5) will be recruited in part B. Baseline levels of p38 MAPK and other biomarkers will also be assessed in CR asthmatics and compared to both CS asthmatics and healthy volunteers. Patients will be enrolled and assessed for baseline p38 MAPK activation as above in peripheral blood. Patients will be re-defined as CR or CS as above based on changes in the lung function after 1 week of oral prednisone burst as above. Levels of p38 MAPK activity and other biomarkers will be compared between CR and CS patients (n=10 in each group based on recruitment for Part A and Part B) and also compared to healthy volunteers (n=10). After 1 week following oral prednisone burst, CR patients will return to undergo bronchoscopy with the collection of BAL and bronchial epithelial brushes. Blood samples will be collected for evaluation of p38 MAPK activation. CS patients will not undergo bronchoscopy, but will give a blood sample one week after oral prednisone burst for the analysis of p38 MAPK activation. Blood samples will also be collected from healthy controls during the initial visit to assess p38 MAPK activation. CR patients will be randomized for treatment with p38 inhibitor AZD7624 or placebo (5 patients per group). After 4 weeks of treatment with AZD7624 or placebo, CR patients will undergo additional bronchoscopy with the collection of BAL, brushes and blood. Patients will be monitored for adverse events during the trial. After completion of first block of cross over treatment, CR patients will undergo a 1 month wash-out period, after which, they will return for induced sputum and blood collection, and then undergo the second crossover period with AZD7624 or placebo. After the second 4 week treatment block, patients will come for sputum induction and blood collection. In CR asthma patients assessment of lung function, asthma control, airway hyperreactivity, p38 MAPK activation in peripheral blood, BAL, induced sputum samples and cellular responsiveness to corticosteroids before and after treatment with AZD7624 will be performed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Corticosteroid Resistant (CR) Asthmatics

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Normal control
Arm Type
No Intervention
Arm Description
Health volunteers will be recruited as an additional control group.
Arm Title
Corticosteroid sensitive (CS) asthmatics
Arm Type
Other
Arm Description
After the initial visit, asthmatics will be given oral prednisone for 1 week and patients will return for the spirometer assessment. Patients will be defined as CR if <10% improvement in FEV1 % predicted is observed and as CS in >12% improvement in FEV1% predicted is observed.
Arm Title
Corticosteroid resistant (CR) asthmatics active
Arm Type
Active Comparator
Arm Description
The study will have a 1 week oral corticosteroid (OSC) run-in period. Subjects unresponsive to OCS will be defined as corticosteroid resistant (CR) and randomized to two crossover treatment sequences consisting of 4 weeks of inhaled AZD7624 or placebo, followed by 4 weeks of a washout period, and another 4 weeks of placebo or ASD7624
Arm Title
Corticosteroid resistant (CR) asthmatics placebo
Arm Type
Placebo Comparator
Arm Description
The study will have a 1 week oral corticosteroid (OSC) run-in period. Subjects unresponsive to OCS will be defined as corticosteroid resistant (CR) and randomized to two crossover treatment sequences consisting of 4 weeks of inhaled AZD7624 or placebo, followed by 4 weeks of a washout period, and another 4 weeks of placebo or ASD7624
Intervention Type
Drug
Intervention Name(s)
AZD7624
Intervention Type
Drug
Intervention Name(s)
prednisone
Intervention Description
oral prednisone 20 mg bid for one week
Intervention Type
Drug
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
P38 MAPK activation (as measured by phosphorylation) in the whole blood samples by flow cytometry.
Time Frame
4 months
Title
P38 MAPK activation in the whole blood samples by flow cytometry and p38 MAPK expression in BAL and induced sputum macrophages by immunostaining and microscopy imaging before and after p38 inhibitor treatment vs placebo in CR asthma patients
Description
Evaluate MAPK activation in the whole blood samples by flow cytometry and pMAPK expression in BAL and induced sputum macrophages by immunostaining and microscopy imaging before and after p38 inhibitor AZD7624 treatment vs placebo.
Time Frame
4 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Asthmatic Subjects Males and women of non-childbearing potential aged 18-65 of any racial or ethnic background, who are physically and mentally able to cooperate with the proposed tests and procedures and who are able to give informed consent. Asthma defined by symptoms and/or a doctor's diagnosis compatible with asthma as per 2014 GINA Guidelines. Symptomatic patients (ACQ>1.25) with FEV1 % predicted 80%, currently taking ICS or ICS/LABA. Patients should demonstrate normal bronchodilator response, i.e. there must be equal or greater than 12% or 200ml improvement in FEV1 post-bronchodilator (albuterol). Females must have a negative pregnancy test at Visit 1, must not be lactating and must be of non-childbearing potential, by fulfilling one of the following criteria: Postmenopausal defined as amenorrhoea for at least 12 months or more following cessation of all possible exogenous hormonal treatments and luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels in the postmenopausal range (at Visit 1) Documentation of irreversible surgical sterilisation by hysterectomy, bilateral oophorectomy or bilateral salpingectomy but not tubal ligation Males must be surgically sterile or agree to use an acceptable method of contraception (defined as barrier methods in conjunction with spermicides) for the duration of the study (from the time they sign consent) and for 3 months after the last dose of investigational product to prevent pregnancy in a partner. A weight of ≥50 kg (measured at Visit 1) Healthy Controls Subjects must be 18 to 65 years old, who are physically and mentally able to cooperate with the proposed tests and procedures and who are able to give informed consent. They must have no respiratory or cardiac symptoms (cough, phlegm, wheeze, dyspnea) and no physician diagnosed cardiac or respiratory disease. No allergic history. FEV1≥ 80% Females must have a negative pregnancy test at Visit 1, must not be lactating and must be of non-childbearing potential, by fulfilling one of the following criteria: Postmenopausal defined as amenorrhoea for at least 12 months or more following cessation of all possible exogenous hormonal treatments and luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels in the postmenopausal range (at Visit 1) Documentation of irreversible surgical sterilisation by hysterectomy, bilateral oophorectomy or bilateral salpingectomy but not tubal ligation A weight of ≥50 kg (measured at Visit 1) Exclusion Criteria: An FEVl <60% predicted post albuterol bronchodilator. Oral steroid use within the past 6 weeks. Acute respiratory illness within 6 weeks of the study. Another pulmonary disease expected to affect participation in the study or the measurements to be examined. Pregnancy. Smoking in last year or prior smoking history of more than 10 pack years. Previous randomization to treatment in the present study (at Visit 1) Participation in another clinical study with any novel investigational medicine product within 3 months before the first dose of investigational product in this study (at Visit 4) Previously intake of any p38 inhibitor (same class as AZD7624) Significant disease or disorder other than asthma (e.g. cardiovascular; pulmonary as e.g. tuberculosis and cystic fibrosis; gastrointestinal, liver; neurological; musculoskeletal; endocrine; metabolic; malignant; psychiatric; major physical impairment) which, in the opinion of the investigator, may either put the patient at risk because of participation in the study, or influence the results of the study, or the patient's ability to participate in the study (at Visit 1) Any clinically relevant abnormal findings in clinical chemistry, haematology and urinalysis, which, in the opinion of the investigator, may put the patient at risk because of participation in the study (for CR patients only at Visit 3a) Any clinically relevant abnormal findings in physical examination, pulse or blood pressure which, in the opinion of the investigator, may put the patient at risk because of participation in the study (at Visit 1) History or family history of muscle diseases (at Visit 1) Abnormal vital signs, after 10 minutes supine rest, defined as any of the following (CR patients, at Visit 3a): Systolic blood pressure (SBP) above 140 mmHg if <60 years of age and above 150 mmHg if ≥60 years of age Diastolic blood pressure (DBP) above 90 mmHg Pulse <50 or >100 bpm Unstable angina pectoris or stable angina pectoris classified higher than Canadian Cardiovascular Society (CSS) class 2. History of hospitalization within 12 months caused by heart failure or a diagnosis of heart failure higher than New York Heart Association (NYHA) class II. Acute myocardial infarction within 6 months of screening (CR patients, Visit 3a). Treatment with strong CYP3A inhibitors (like erythromycin and itraconazole), within 4 weeks prior to randomization (CVR patients, Visit 4). Patients on anticoagulation treatment. Healthy Controls Evidence on history, physical examination, or screening spirometry of Lung disease or other disease that will affect participation in the study or the measurements to be examined. Smoking in the last year or prior smoking history of more than 10 pack years.
Facility Information:
Facility Name
National Jewish Health
City
Denver
State/Province
Colorado
ZIP/Postal Code
80206
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Effects of p38 Inhibitor AZD7624 in Corticosteroid Resistant Asthma

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