Efficacy, Safety, and Pharmacokinetics of APT-1011 in Subjects With Eosinophilic Esophagitis (EoE) (FLUTE)
Primary Purpose
Eosinophilic Esophagitis
Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
APT-1011
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Eosinophilic Esophagitis focused on measuring Esophagitis, Eosinophilic Esophagitis, Fluticasone, Dysphagia, Safety, Efficacy, Pharmacokinetics, Esophageal Diseases, Gastrointestinal Diseases, Digestive System Diseases, Glucocorticoids, Orally Disintegrating Tablet
Eligibility Criteria
Inclusion Criteria:
- Male or female between ≥18 and ≤75 years of age at the time of informed consent
- Signed informed consent
- Evidence of EoE defined by ≥15 peak eosinophils per HPF as measured from proximal and distal biopsies
- Subject-reported history of ≥3 episodes of dysphagia in the 7 days prior to Screening
- 7-day Global EoE Symptom Score >3 at baseline and at screening
- Willing and able to adhere to study-related treatment regimens, procedures, and visit schedule
Exclusion Criteria:
- Have known contraindication, hypersensitivity, or intolerance to corticosteroids;
- Have any physical, mental, or social condition or history of illness or laboratory abnormality that in the Investigator's judgment might interfere with study procedures or the ability of the subject to adhere to and complete the study;
- Presence of oral or esophageal mucosal infection of any type;
- Have any mouth or dental condition that prevents normal eating;
- Have any condition affecting the esophageal mucosa or altering esophageal motility other than EoE;
- Use of systemic corticosteroids within 60 days prior to Screening, use of inhaled/swallowed corticosteroids within 30 days prior to Screening, or extended use of high-potency dermal topical corticosteroids within 30 days prior to Screening;
- Initiation of an elimination diet or elemental diet within 30 days before Screening (diet must remain stable after signing ICF);
- Morning serum cortisol level ≤5 μg/dL (138 nmol/L);
- Use of biologic immunomodulators in the 24 weeks prior to Screening;
- Use of calcineurin inhibitors or purine analogues, or potent cytochrome P450 (CYP) 3A4 inhibitors in the 12 weeks prior to Screening;
- Have a contraindication to or factors that substantially increase the risk of EGD or esophageal biopsy or have narrowing of the esophagus that precludes EGD with a standard 9 mm endoscope;
- Have a history of an esophageal stricture requiring dilatation within the previous 12 weeks prior to Screening;
- Have initiated, discontinued or changed dosage regimen of PPIs, H2 antagonists, antacids or antihistamines for any condition such as GERD or allergic rhinitis within 4 weeks prior to qualifying endoscopy. These drugs must remain constant throughout the study.
- A serum cortisol level <18 μg/dL (497 nmol/L) at 60 minutes with adrenocorticotropic hormone (ACTH) stimulation test using 250 μg cosyntropin (i.e., a positive result on the ACTH stimulation test).
Sites / Locations
- Del Sol Research Management, LLC
- Del Sol Research Management, LLC
- Arkansas Gastroenterology, P.A.
- Hope Clinical Research
- TriWest Research Associates, LLC
- SC Clinical Research, Inc.
- Beverly Hills Center for Digestive Health
- Focilmed
- Precision Research Institute, LLC
- Medical Associates Research Group, Inc.
- Care Access Research LLC
- Stanford University School of Medicine
- St. Jude Healthcare
- Western Connecticut Health Network
- Medical Research Center of Connecticut, LLC
- Eastern Research, Inc.
- Nature Coast Clinical Research, LLC
- Sunrise Medical Research
- DBC Research, Corp
- Northwestern Medical Faculty Foundation
- Southwest Gastroenterology
- Rockford Gastroenterology Associates, Ltd.
- MediSphere Medical Research Center, an AMR affiliate
- Cotton-O'Neil Clinical Research Center, Digestive Health
- Gastroenterology Associates
- Clinical Trials of America, Inc.
- Henry Ford Medical Center
- Metro Health
- St. Louis Center for Clinical Research
- Long Island Gastrointestinal Research Group, LLP
- Weill Cornell Medical College
- University of North Carolina at Chapel Hill
- Research Institute of the Carolinas, PLC
- Carolina's GI Research, LLC
- Wake Research Associates, LLC
- PMG Research of Salisbury, LLC
- Bernstein Clinical Research Center, LLC
- Aventiv Research Inc.
- Unity Clinical Research
- Allergy and Asthma Center of South Oregon
- University of Pennsylvania
- Digestive Disease Associates, Ltd.
- Rapid City Medical Center, LLP
- Advanced Gastroenterology
- Avant Research Associates, LLC - Austin
- Avant Research Associates, LLC
- DHAT Research Institute
- Advanced Research Institute
- University of Utah
- Care Access Research LLC
- Verity Research Inc
- AZ Sint-Lucas
- Universitair Ziekenhuis Gent
- AZ Groeninge - Kennedylaan
- UZ Leuven
- (G.I.R.I.) GI Research Institute
- Viable Clinical Research
- Viable Clinical Research
- London Health Science Centre
- Taunton Surgical Centre
- Klinikum rechts der Isar der TU Muenchen
- Staedisches Klinikum Brandenburg
- Praxis am Germania
- Universitaetsklinikum Leipzig AoeR
- Universitaetsklinikum Schleswig-Holstein
- Hospital General de Tomelloso
- Hospital General Universitario de Alicante
- Hospital de la Santa Creu i Sant Pau
- Hospital Universitari Vall d'Hebron
- Hospital Universitario de La Princesa
- Hospital Universitario Virgen del Rocio
- Hospital Clinico Universitario de Valencia
- Hospital Clinico Universitario Lozano Blesa
- Hospital Universitario Miguel Servet
- Centre Hospitalier Universitaire Vaudois
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm Type
Experimental
Experimental
Experimental
Experimental
Placebo Comparator
Arm Label
APT-1011 1.5 mg HS
APT-1011 1.5 mg BID
APT-1011 3 mg HS
APT-1011 3 mg BID
Placebo BID
Arm Description
Placebo after breakfast, APT-1011 1.5 mg HS
APT-1011 1.5 mg after breakfast, APT-1011 1.5 mg HS
Placebo after breakfast, APT-1011 3 mg HS
APT-1011 3 mg after breakfast, APT-1011 3 mg HS
Placebo 30 minutes after breakfast and HS
Outcomes
Primary Outcome Measures
Percentage of Subjects With ≤6 Peak Eosinophils/High-power Field (HPF)
Histology (eosinophils per high power field [HPF]): percentage of subjects with ≤6 PEAK eosinophils/HPF after assessing at least 5-6 biopsies from the proximal and distal esophagus (~3 each) where the HPF area is 235 square microns (40 magnification lens with a 22 mm ocular).
Secondary Outcome Measures
Percentage of Subjects Who Met the Primary Endpoint at Week 12 and Maintained the Primary Endpoint at Weeks 26 and 52
Percentage of subjects who entered Part 2 - Maintenance and met the primary endpoint (histology) at Week 12 and maintained the primary endpoint at Week 26 and Week 52.
Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect percentage of subjects who met the primary endpoint following 12 or 38 weeks of treatment.
Change From Baseline Eosinophilic Esophagitis Endoscopic Reference Score (EREFs) at Week 12, 26, and 52
Endoscopic changes will be assessed as per the EREFs evaluation based on the following endoscopic features: edema [Grade {Gr} 0 (absent) or Gr 1 (present)], strictures [Gr 0 (absent) or Gr 1 (present)], rings [Gr 0 (none), Gr 1 (mild), Gr 2 (moderate), Gr 3 (severe)], exudates [Gr 0 (none), Gr 1 (mild), Gr (severe)], furrows [Gr 0 (none), Gr 1 (mild), Gr 2 (severe)], crepe paper esophagus [Gr 0 (absent) or Gr 1 (present)], narrow caliber esophagus [Gr 0 (absent) or Gr 1 (present)], and esophageal erosions [Normal (0), Gr A (1), Gr B (2), Gr C (3), or Gr D (4)].
EREFs: 0 (best) to 15 (worst) based on the sum of the subscores listed above.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3 mg BID and results reflect EREF evaluation following 12 or 38 weeks of treatment.
Percentage of Subjects With a Peak Eosinophils/HPF Number <1 and <15
Percentage of subjects with a peak eosinophils/HPF <1 and <15 at Week 12, 26 and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect peak eosinophils/HPF following 12 or 38 weeks of treatment.
Change From Baseline Global EoE Symptom Score
Change from baseline global EOE symptom score assessed prior to randomization to scores for 7-day recall at Week 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52 visits.
Global Eosinophilic Esophagitis Symptom Score: On a scale from 0 (no symptoms) to 10 (most severe symptoms), how severe were your EoE symptoms over the past 7 days? Patients were asked to think of all their symptoms due to EoE and make an overall statement by selecting a number.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline global EOE symptom score following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Change in the Number of Dysphagia Episodes
Change in the number of dysphagia episodes at baseline (14-day period prior to randomization) compared with the 14-day period prior to the time point of interest.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect the change in the number of dysphagia episodes following 12 or 38 weeks of treatment.
Change From Baseline 7-Day Eosinophilic Esophagitis Activity Index (EEsAI) Total Score
Change from Baseline 7-Day EEsAI total score assessed prior to randomization and those assessed at Weeks 12, 26 and 52 (Total score 100).
Eosinophilic Esophagitis Activity Index Total Score: 0 (best) to 100 (worst) based on the sum of the categorized subscores for frequency of trouble swallowing [never (0), 1-3x (15) or 4-6x (27) per week]; duration of trouble swallowing [≤5 min (0), >5 min (6)]; pain when swallowing [no (0), yes (15)]; Visual Dysphagia Question score [0 (best),12,19, 21, or 23 (worst)]; avoidance modification and slow eating score [0 (best), 9, or 25 (worst)].
A higher score means a worse outcome.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect the change from baseline 7-day EEs
Change From Baseline 7-Day Eosinophilic Esophagitis Activity Index (EEsAI) Subscores
The Avoidance, Modification and Slow Eating (AMS) Score and Visual Dysphagia Question (VDQ) Score are components of the EEsAI.
AMS: Answers to three items determining the pattern of behavioral adaptation were scored for each food consistency consumed by the subject (avoidance, modification, and eating slowly). The AMS score ranges from 0 (best) to 25 (worst).
VDG: The degree of perceived difficulty when eating 8 different food consistencies was assessed. The VDQ score ranges from 0 (best) to 23 (worst).
A higher score for either subscore means a worse outcome. Negative change from baseline represents a worsening in quality of life for the total score or subscore.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline.
Percentage of Subjects With Mean 7-day EEsAI Total Score <20
Percentage of subjects with mean 7-day EEsAI total score <20 to those assessed at Weeks 12, 26 and 52.
Eosinophilic Esophagitis Activity Index Total Score: 0 (best) to 100 (worst) based on the sum of the categorized subscores for frequency of trouble swallowing [never (0), 1-3x (15) or 4-6x (27) per week]; duration of trouble swallowing [<= 5 min (0), >5 min (6)]; pain when swallowing [no (0), yes (15)]; Visual Dysphagia Question score [0 (best),12,19,21, or 23 (worst)]; avoidance modification and slow eating score [0 (best), 9, or 25 (worst)].
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline global EOE symptom score following 12 or 38 weeks of treatment
Change From Baseline Patient Global Impression of Severity (PGIS) for EoE Symptoms as Assessed Prior to Randomization Post-Baseline Visit
Change From Baseline PGIS for EoE Symptoms as Assessed Prior to Randomization at Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline global EOE symptoms following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Change From Baseline PGIS for Difficulty With Food or Pills Going Down as Assessed Prior to Randomization Post-Baseline Visit
Change From Baseline PGIS for Difficulty with Food or Pills Going Down as Assessed Prior to Randomization at Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline PGIS for difficulty with food or pills going down following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Change From Baseline Patient Global Impression of Change (PGIC) for EoE Symptoms as Assessed Prior to Randomization Post-Baseline Visit
Change From Baseline PGIC for EoE Symptoms as Assessed Prior to Randomization at Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline PGIC for EoE symptoms following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Change From Baseline PGIC of Difficulty With Food or Pills as Assessed Prior to Randomization Post-Baseline Visit
Change From Baseline PGIC of Difficulty with Food or Pills as Assessed Prior to Randomization at Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline PGIC of difficulty with food or pills following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Percentage of Histologic Non-responders by Dose at Weeks 12, 26, and 52
Percentage of histologic non-responders by dose at Weeks 12, 26, and 52.
Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect non-response following 12 or 38 weeks of treatment.
Percentage of Subjects Requiring Emergency Endoscopic Food Dis-impaction
Percentage of subjects requiring emergency endoscopic food dis-impaction by dose before Week 14, between Week 14 and Week 28, and between Week 28 and Week 52.
Note: There were no patients in the placebo group after Week 14.
Percentage of Subjects Requiring Esophageal Dilation
Percentage of subjects requiring esophageal dilation by dosing group and part of the study.
Note: There were no patients in the placebo group after Week 14.
Full Information
NCT ID
NCT03191864
First Posted
June 15, 2017
Last Updated
April 4, 2023
Sponsor
Adare Pharmaceuticals, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT03191864
Brief Title
Efficacy, Safety, and Pharmacokinetics of APT-1011 in Subjects With Eosinophilic Esophagitis (EoE)
Acronym
FLUTE
Official Title
FLUTicasone in Eosinophilic Esophagitis (FLUTE): A Randomized, Double-blind, Placebo-controlled, Dose-ranging, and Maintenance Study of APT-1011 in Subjects With Eosinophilic Esophagitis
Study Type
Interventional
2. Study Status
Record Verification Date
April 2023
Overall Recruitment Status
Completed
Study Start Date
June 22, 2017 (Actual)
Primary Completion Date
January 3, 2019 (Actual)
Study Completion Date
October 23, 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Adare Pharmaceuticals, Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus, characterized by eosinophilic infiltration and gastrointestinal symptoms. Swallowed, topically acting corticosteroids, such as fluticasone, appear to be effective in resolving acute clinical and pathological features of EoE.
APT-1011 is an orally disintegrating tablet (ODT) formulation of fluticasone propionate. This study is designed to compare the efficacy and safety of APT-1011 with placebo in adults with EoE for an initial 12-week treatment period, followed by an additional 40-week maintenance treatment phase. Histologic response, pharmacokinetics, and dysphagia will be assessed.
Detailed Description
FLUTE is a phase 2b randomized, double-blind, placebo-controlled dose-ranging clinical trial of APT-1011 versus placebo in 100 adult subjects (≥18 years of age) diagnosed with EoE. Efficacy (including histologic, endoscopic, and symptomatic response), safety, and PK of APT-1011 will be examined. Participants will be given an electronic diary to record symptoms and medication intake daily.
FLUTE will be conducted in several parts (Screening [4 weeks], followed by a 4-week Baseline Symptom Assessment, and 2 treatment parts [Part 1: 14-week Induction and Part 2: 38-week Maintenance]), with a follow-up visit to occur 2 weeks after the final dose of study drug.
In Part 1 of the study, approximately 100 subjects will be randomized 1:1:1:1:1 to receive placebo or one of 4 active doses of APT-1011. All subjects will receive one tablet 30 minutes after breakfast and one tablet at bedtime (HS). The dosing groups include: 1.5 mg HS APT-1011, 1.5 mg twice daily (BID) (total daily dose of 3 mg) APT-1011, 3 mg HS APT-1011, and 3 mg BID (total daily dose of 6 mg) APT-1011, and placebo BID.
In Part 2, all subjects classified as histologic responders at Week 12 will continue to be treated according to the dosing group to which they were randomized, and non-responders will receive single-blind 3 mg BID. All subjects who are histologic non-responders at Week 26 will stop treatment at Week 28 and enter the 2-week follow-up and exit the study. Histologic responders at Week 26 will continue on the same dose until end-of-study at Week 52.
Subjects will complete a follow-up visit 2 weeks after the final dose of study drug. All subjects must have a final EGD within 3 weeks prior to completing the Follow-up Visit unless the subject withdraws consent or has a contraindication to EGD.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Eosinophilic Esophagitis
Keywords
Esophagitis, Eosinophilic Esophagitis, Fluticasone, Dysphagia, Safety, Efficacy, Pharmacokinetics, Esophageal Diseases, Gastrointestinal Diseases, Digestive System Diseases, Glucocorticoids, Orally Disintegrating Tablet
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double Blind
Allocation
Randomized
Enrollment
106 (Actual)
8. Arms, Groups, and Interventions
Arm Title
APT-1011 1.5 mg HS
Arm Type
Experimental
Arm Description
Placebo after breakfast, APT-1011 1.5 mg HS
Arm Title
APT-1011 1.5 mg BID
Arm Type
Experimental
Arm Description
APT-1011 1.5 mg after breakfast, APT-1011 1.5 mg HS
Arm Title
APT-1011 3 mg HS
Arm Type
Experimental
Arm Description
Placebo after breakfast, APT-1011 3 mg HS
Arm Title
APT-1011 3 mg BID
Arm Type
Experimental
Arm Description
APT-1011 3 mg after breakfast, APT-1011 3 mg HS
Arm Title
Placebo BID
Arm Type
Placebo Comparator
Arm Description
Placebo 30 minutes after breakfast and HS
Intervention Type
Drug
Intervention Name(s)
APT-1011
Other Intervention Name(s)
Fluticasone propionate ODT
Intervention Description
APT-1011 is an orally disintegrating tablet formulation of fluticasone propionate
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Matching placebo dose
Intervention Description
Placebo tablets are identical in composition to APT-1011 except they exclude the active ingredient.
Primary Outcome Measure Information:
Title
Percentage of Subjects With ≤6 Peak Eosinophils/High-power Field (HPF)
Description
Histology (eosinophils per high power field [HPF]): percentage of subjects with ≤6 PEAK eosinophils/HPF after assessing at least 5-6 biopsies from the proximal and distal esophagus (~3 each) where the HPF area is 235 square microns (40 magnification lens with a 22 mm ocular).
Time Frame
Week 12
Secondary Outcome Measure Information:
Title
Percentage of Subjects Who Met the Primary Endpoint at Week 12 and Maintained the Primary Endpoint at Weeks 26 and 52
Description
Percentage of subjects who entered Part 2 - Maintenance and met the primary endpoint (histology) at Week 12 and maintained the primary endpoint at Week 26 and Week 52.
Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect percentage of subjects who met the primary endpoint following 12 or 38 weeks of treatment.
Time Frame
Week 26, and Week 52
Title
Change From Baseline Eosinophilic Esophagitis Endoscopic Reference Score (EREFs) at Week 12, 26, and 52
Description
Endoscopic changes will be assessed as per the EREFs evaluation based on the following endoscopic features: edema [Grade {Gr} 0 (absent) or Gr 1 (present)], strictures [Gr 0 (absent) or Gr 1 (present)], rings [Gr 0 (none), Gr 1 (mild), Gr 2 (moderate), Gr 3 (severe)], exudates [Gr 0 (none), Gr 1 (mild), Gr (severe)], furrows [Gr 0 (none), Gr 1 (mild), Gr 2 (severe)], crepe paper esophagus [Gr 0 (absent) or Gr 1 (present)], narrow caliber esophagus [Gr 0 (absent) or Gr 1 (present)], and esophageal erosions [Normal (0), Gr A (1), Gr B (2), Gr C (3), or Gr D (4)].
EREFs: 0 (best) to 15 (worst) based on the sum of the subscores listed above.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3 mg BID and results reflect EREF evaluation following 12 or 38 weeks of treatment.
Time Frame
Week 12, Week 26, and Week 52
Title
Percentage of Subjects With a Peak Eosinophils/HPF Number <1 and <15
Description
Percentage of subjects with a peak eosinophils/HPF <1 and <15 at Week 12, 26 and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect peak eosinophils/HPF following 12 or 38 weeks of treatment.
Time Frame
Week 12, Week 26, and Week 52
Title
Change From Baseline Global EoE Symptom Score
Description
Change from baseline global EOE symptom score assessed prior to randomization to scores for 7-day recall at Week 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52 visits.
Global Eosinophilic Esophagitis Symptom Score: On a scale from 0 (no symptoms) to 10 (most severe symptoms), how severe were your EoE symptoms over the past 7 days? Patients were asked to think of all their symptoms due to EoE and make an overall statement by selecting a number.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline global EOE symptom score following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Time Frame
Week 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52
Title
Change in the Number of Dysphagia Episodes
Description
Change in the number of dysphagia episodes at baseline (14-day period prior to randomization) compared with the 14-day period prior to the time point of interest.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect the change in the number of dysphagia episodes following 12 or 38 weeks of treatment.
Time Frame
Week 12, Week 26 and Week 52
Title
Change From Baseline 7-Day Eosinophilic Esophagitis Activity Index (EEsAI) Total Score
Description
Change from Baseline 7-Day EEsAI total score assessed prior to randomization and those assessed at Weeks 12, 26 and 52 (Total score 100).
Eosinophilic Esophagitis Activity Index Total Score: 0 (best) to 100 (worst) based on the sum of the categorized subscores for frequency of trouble swallowing [never (0), 1-3x (15) or 4-6x (27) per week]; duration of trouble swallowing [≤5 min (0), >5 min (6)]; pain when swallowing [no (0), yes (15)]; Visual Dysphagia Question score [0 (best),12,19, 21, or 23 (worst)]; avoidance modification and slow eating score [0 (best), 9, or 25 (worst)].
A higher score means a worse outcome.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect the change from baseline 7-day EEs
Time Frame
Weeks 12, 26 and 52
Title
Change From Baseline 7-Day Eosinophilic Esophagitis Activity Index (EEsAI) Subscores
Description
The Avoidance, Modification and Slow Eating (AMS) Score and Visual Dysphagia Question (VDQ) Score are components of the EEsAI.
AMS: Answers to three items determining the pattern of behavioral adaptation were scored for each food consistency consumed by the subject (avoidance, modification, and eating slowly). The AMS score ranges from 0 (best) to 25 (worst).
VDG: The degree of perceived difficulty when eating 8 different food consistencies was assessed. The VDQ score ranges from 0 (best) to 23 (worst).
A higher score for either subscore means a worse outcome. Negative change from baseline represents a worsening in quality of life for the total score or subscore.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline.
Time Frame
Weeks 12, 26 and 52
Title
Percentage of Subjects With Mean 7-day EEsAI Total Score <20
Description
Percentage of subjects with mean 7-day EEsAI total score <20 to those assessed at Weeks 12, 26 and 52.
Eosinophilic Esophagitis Activity Index Total Score: 0 (best) to 100 (worst) based on the sum of the categorized subscores for frequency of trouble swallowing [never (0), 1-3x (15) or 4-6x (27) per week]; duration of trouble swallowing [<= 5 min (0), >5 min (6)]; pain when swallowing [no (0), yes (15)]; Visual Dysphagia Question score [0 (best),12,19,21, or 23 (worst)]; avoidance modification and slow eating score [0 (best), 9, or 25 (worst)].
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline global EOE symptom score following 12 or 38 weeks of treatment
Time Frame
Weeks 12, 26, and 52
Title
Change From Baseline Patient Global Impression of Severity (PGIS) for EoE Symptoms as Assessed Prior to Randomization Post-Baseline Visit
Description
Change From Baseline PGIS for EoE Symptoms as Assessed Prior to Randomization at Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline global EOE symptoms following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Time Frame
Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52
Title
Change From Baseline PGIS for Difficulty With Food or Pills Going Down as Assessed Prior to Randomization Post-Baseline Visit
Description
Change From Baseline PGIS for Difficulty with Food or Pills Going Down as Assessed Prior to Randomization at Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline PGIS for difficulty with food or pills going down following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Time Frame
Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52
Title
Change From Baseline Patient Global Impression of Change (PGIC) for EoE Symptoms as Assessed Prior to Randomization Post-Baseline Visit
Description
Change From Baseline PGIC for EoE Symptoms as Assessed Prior to Randomization at Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline PGIC for EoE symptoms following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Time Frame
Weeks 4, 8, 12, 14, 18, 22, 26, 36, 44, and 52
Title
Change From Baseline PGIC of Difficulty With Food or Pills as Assessed Prior to Randomization Post-Baseline Visit
Description
Change From Baseline PGIC of Difficulty with Food or Pills as Assessed Prior to Randomization at Weeks 4, 8, 12, 14, 18, 22, 26, 28, 36, 44, and 52.
Population used are those who entered Part 1 - Induction. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint. Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect change from baseline PGIC of difficulty with food or pills following 4, 8, 12, 14, 22, 30 or 38 weeks of treatment.
Time Frame
Weeks 4, 8, 12, 14, 18, 22, 26, 36, 44, and 52
Title
Percentage of Histologic Non-responders by Dose at Weeks 12, 26, and 52
Description
Percentage of histologic non-responders by dose at Weeks 12, 26, and 52.
Note: Following Week 14, all patients in the placebo group were given APT-1011 3mg BID and results reflect non-response following 12 or 38 weeks of treatment.
Time Frame
Weeks 12, 26 and 52
Title
Percentage of Subjects Requiring Emergency Endoscopic Food Dis-impaction
Description
Percentage of subjects requiring emergency endoscopic food dis-impaction by dose before Week 14, between Week 14 and Week 28, and between Week 28 and Week 52.
Note: There were no patients in the placebo group after Week 14.
Time Frame
before Week 14, between Week 14 and Week 28, between Week 28 and Week 52
Title
Percentage of Subjects Requiring Esophageal Dilation
Description
Percentage of subjects requiring esophageal dilation by dosing group and part of the study.
Note: There were no patients in the placebo group after Week 14.
Time Frame
baseline to Week 52
Other Pre-specified Outcome Measures:
Title
Number of Subjects Discontinuing Due to HPA Axis Suppression
Description
Number of subjects discontinuing due to HPA axis suppression.
Note: There were no patients in the placebo group after Week 14.
Time Frame
baseline to Week 52
Title
Number of Subjects With Oral and Esophageal Candidiasis
Description
Frequency of oral and esophageal candidiasis.
Note: There were no patients in the placebo group after Week 14.
Time Frame
baseline to Week 52
Title
Number of Subjects With Treatment-Emergent Adverse Events Leading to Study Discontinuation in Part 1
Description
Number of Subjects With Treatment-Emergent Adverse Events (TEAEs) Leading to Study Discontinuation in Part 1.
Time Frame
baseline to Week 12
Title
Number of Subjects With Treatment-Emergent Adverse Events Leading to Study Discontinuation in Part 2
Description
Number of Subjects With Treatment-Emergent Adverse Events (TEAEs) Leading to Study Discontinuation in Part 2.
Time Frame
Week 12 to 52
Title
Percentage of Subjects With Serum Cortisol Level ≤5 μg/dL or Abnormal Adrenocorticotropic Hormone (ACTH) Stimulation Test
Description
Percentage of subjects with serum cortisol level ≤5 μg/dL (≤138 nmol/L) or abnormal adrenocorticotropic hormone (ACTH) stimulation test (serum cortisol <16 μg/dL [≤440 nmol/L] at 60 minutes).
Population used are those who entered Part 2 - Maintenance. The number of participants analyzed for each timepoint reflect the actual number of participants with data at that timepoint.
Time Frame
Week 12 to 52
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or female between ≥18 and ≤75 years of age at the time of informed consent
Signed informed consent
Evidence of EoE defined by ≥15 peak eosinophils per HPF as measured from proximal and distal biopsies
Subject-reported history of ≥3 episodes of dysphagia in the 7 days prior to Screening
7-day Global EoE Symptom Score >3 at baseline and at screening
Willing and able to adhere to study-related treatment regimens, procedures, and visit schedule
Exclusion Criteria:
Have known contraindication, hypersensitivity, or intolerance to corticosteroids;
Have any physical, mental, or social condition or history of illness or laboratory abnormality that in the Investigator's judgment might interfere with study procedures or the ability of the subject to adhere to and complete the study;
Presence of oral or esophageal mucosal infection of any type;
Have any mouth or dental condition that prevents normal eating;
Have any condition affecting the esophageal mucosa or altering esophageal motility other than EoE;
Use of systemic corticosteroids within 60 days prior to Screening, use of inhaled/swallowed corticosteroids within 30 days prior to Screening, or extended use of high-potency dermal topical corticosteroids within 30 days prior to Screening;
Initiation of an elimination diet or elemental diet within 30 days before Screening (diet must remain stable after signing ICF);
Morning serum cortisol level ≤5 μg/dL (138 nmol/L);
Use of biologic immunomodulators in the 24 weeks prior to Screening;
Use of calcineurin inhibitors or purine analogues, or potent cytochrome P450 (CYP) 3A4 inhibitors in the 12 weeks prior to Screening;
Have a contraindication to or factors that substantially increase the risk of EGD or esophageal biopsy or have narrowing of the esophagus that precludes EGD with a standard 9 mm endoscope;
Have a history of an esophageal stricture requiring dilatation within the previous 12 weeks prior to Screening;
Have initiated, discontinued or changed dosage regimen of PPIs, H2 antagonists, antacids or antihistamines for any condition such as GERD or allergic rhinitis within 4 weeks prior to qualifying endoscopy. These drugs must remain constant throughout the study.
A serum cortisol level <18 μg/dL (497 nmol/L) at 60 minutes with adrenocorticotropic hormone (ACTH) stimulation test using 250 μg cosyntropin (i.e., a positive result on the ACTH stimulation test).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Peter C Richardson
Organizational Affiliation
Adare Pharmaceuticals, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Del Sol Research Management, LLC
City
Chandler
State/Province
Arizona
ZIP/Postal Code
85224
Country
United States
Facility Name
Del Sol Research Management, LLC
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85710
Country
United States
Facility Name
Arkansas Gastroenterology, P.A.
City
Sherwood
State/Province
Arkansas
ZIP/Postal Code
72120
Country
United States
Facility Name
Hope Clinical Research
City
Canoga Park
State/Province
California
ZIP/Postal Code
91303
Country
United States
Facility Name
TriWest Research Associates, LLC
City
El Cajon
State/Province
California
ZIP/Postal Code
92020-4124
Country
United States
Facility Name
SC Clinical Research, Inc.
City
Garden Grove
State/Province
California
ZIP/Postal Code
92844
Country
United States
Facility Name
Beverly Hills Center for Digestive Health
City
Los Angeles
State/Province
California
ZIP/Postal Code
90048
Country
United States
Facility Name
Focilmed
City
Oxnard
State/Province
California
ZIP/Postal Code
93030
Country
United States
Facility Name
Precision Research Institute, LLC
City
San Diego
State/Province
California
ZIP/Postal Code
92114
Country
United States
Facility Name
Medical Associates Research Group, Inc.
City
San Diego
State/Province
California
ZIP/Postal Code
92123
Country
United States
Facility Name
Care Access Research LLC
City
San Pablo
State/Province
California
ZIP/Postal Code
94806
Country
United States
Facility Name
Stanford University School of Medicine
City
Stanford
State/Province
California
ZIP/Postal Code
94305-2200
Country
United States
Facility Name
St. Jude Healthcare
City
Yorba Linda
State/Province
California
ZIP/Postal Code
92886
Country
United States
Facility Name
Western Connecticut Health Network
City
Danbury
State/Province
Connecticut
ZIP/Postal Code
06810
Country
United States
Facility Name
Medical Research Center of Connecticut, LLC
City
Hamden
State/Province
Connecticut
ZIP/Postal Code
06518
Country
United States
Facility Name
Eastern Research, Inc.
City
Hialeah
State/Province
Florida
ZIP/Postal Code
33013
Country
United States
Facility Name
Nature Coast Clinical Research, LLC
City
Inverness
State/Province
Florida
ZIP/Postal Code
34452
Country
United States
Facility Name
Sunrise Medical Research
City
Lauderdale Lakes
State/Province
Florida
ZIP/Postal Code
33319
Country
United States
Facility Name
DBC Research, Corp
City
Pembroke Pines
State/Province
Florida
ZIP/Postal Code
33029
Country
United States
Facility Name
Northwestern Medical Faculty Foundation
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Southwest Gastroenterology
City
Oak Lawn
State/Province
Illinois
ZIP/Postal Code
60453-3767
Country
United States
Facility Name
Rockford Gastroenterology Associates, Ltd.
City
Rockford
State/Province
Illinois
ZIP/Postal Code
61107
Country
United States
Facility Name
MediSphere Medical Research Center, an AMR affiliate
City
Evansville
State/Province
Indiana
ZIP/Postal Code
47714
Country
United States
Facility Name
Cotton-O'Neil Clinical Research Center, Digestive Health
City
Topeka
State/Province
Kansas
ZIP/Postal Code
66606
Country
United States
Facility Name
Gastroenterology Associates
City
Hazard
State/Province
Kentucky
ZIP/Postal Code
41701
Country
United States
Facility Name
Clinical Trials of America, Inc.
City
West Monroe
State/Province
Louisiana
ZIP/Postal Code
71291
Country
United States
Facility Name
Henry Ford Medical Center
City
Novi
State/Province
Michigan
ZIP/Postal Code
48377-3600
Country
United States
Facility Name
Metro Health
City
Wyoming
State/Province
Michigan
ZIP/Postal Code
49519
Country
United States
Facility Name
St. Louis Center for Clinical Research
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63128
Country
United States
Facility Name
Long Island Gastrointestinal Research Group, LLP
City
Great Neck
State/Province
New York
ZIP/Postal Code
11023
Country
United States
Facility Name
Weill Cornell Medical College
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Facility Name
University of North Carolina at Chapel Hill
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27514
Country
United States
Facility Name
Research Institute of the Carolinas, PLC
City
Mooresville
State/Province
North Carolina
ZIP/Postal Code
28117
Country
United States
Facility Name
Carolina's GI Research, LLC
City
Raleigh
State/Province
North Carolina
ZIP/Postal Code
27607
Country
United States
Facility Name
Wake Research Associates, LLC
City
Raleigh
State/Province
North Carolina
ZIP/Postal Code
27612
Country
United States
Facility Name
PMG Research of Salisbury, LLC
City
Salisbury
State/Province
North Carolina
ZIP/Postal Code
28144
Country
United States
Facility Name
Bernstein Clinical Research Center, LLC
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45231
Country
United States
Facility Name
Aventiv Research Inc.
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43231
Country
United States
Facility Name
Unity Clinical Research
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73118
Country
United States
Facility Name
Allergy and Asthma Center of South Oregon
City
Medford
State/Province
Oregon
ZIP/Postal Code
97504
Country
United States
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Digestive Disease Associates, Ltd.
City
Wyomissing
State/Province
Pennsylvania
ZIP/Postal Code
19610
Country
United States
Facility Name
Rapid City Medical Center, LLP
City
Rapid City
State/Province
South Dakota
ZIP/Postal Code
57701
Country
United States
Facility Name
Advanced Gastroenterology
City
Union City
State/Province
Tennessee
ZIP/Postal Code
38261
Country
United States
Facility Name
Avant Research Associates, LLC - Austin
City
Austin
State/Province
Texas
ZIP/Postal Code
78704
Country
United States
Facility Name
Avant Research Associates, LLC
City
Beaumont
State/Province
Texas
ZIP/Postal Code
77702
Country
United States
Facility Name
DHAT Research Institute
City
Richardson
State/Province
Texas
ZIP/Postal Code
75082
Country
United States
Facility Name
Advanced Research Institute
City
Ogden
State/Province
Utah
ZIP/Postal Code
84405
Country
United States
Facility Name
University of Utah
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84108
Country
United States
Facility Name
Care Access Research LLC
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84124
Country
United States
Facility Name
Verity Research Inc
City
Fairfax
State/Province
Virginia
ZIP/Postal Code
22031
Country
United States
Facility Name
AZ Sint-Lucas
City
Brugge
ZIP/Postal Code
8310
Country
Belgium
Facility Name
Universitair Ziekenhuis Gent
City
Gent
ZIP/Postal Code
9000
Country
Belgium
Facility Name
AZ Groeninge - Kennedylaan
City
Kortrijk
ZIP/Postal Code
8500
Country
Belgium
Facility Name
UZ Leuven
City
Leuven
ZIP/Postal Code
3000
Country
Belgium
Facility Name
(G.I.R.I.) GI Research Institute
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V6Z 2K5
Country
Canada
Facility Name
Viable Clinical Research
City
Bridgewater
State/Province
Nova Scotia
ZIP/Postal Code
B4V 3N2
Country
Canada
Facility Name
Viable Clinical Research
City
Lindsay
State/Province
Ontario
ZIP/Postal Code
K9V 5G6
Country
Canada
Facility Name
London Health Science Centre
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 5A5
Country
Canada
Facility Name
Taunton Surgical Centre
City
Oshawa
State/Province
Ontario
ZIP/Postal Code
L1H 7K4
Country
Canada
Facility Name
Klinikum rechts der Isar der TU Muenchen
City
Muenchen
State/Province
Bayern
ZIP/Postal Code
81675
Country
Germany
Facility Name
Staedisches Klinikum Brandenburg
City
Brandenburg an der Havel
State/Province
Brandenburg
ZIP/Postal Code
14770
Country
Germany
Facility Name
Praxis am Germania
City
Muenster
State/Province
Nordrhein Westfalen
ZIP/Postal Code
48159
Country
Germany
Facility Name
Universitaetsklinikum Leipzig AoeR
City
Leipzig
State/Province
Sachsen
ZIP/Postal Code
4103
Country
Germany
Facility Name
Universitaetsklinikum Schleswig-Holstein
City
Kiel
State/Province
Schleswig Holstein
ZIP/Postal Code
24105
Country
Germany
Facility Name
Hospital General de Tomelloso
City
Tomelloso
State/Province
Ciudad Real
ZIP/Postal Code
13700
Country
Spain
Facility Name
Hospital General Universitario de Alicante
City
Alicante
ZIP/Postal Code
3010
Country
Spain
Facility Name
Hospital de la Santa Creu i Sant Pau
City
Barcelona
ZIP/Postal Code
08025
Country
Spain
Facility Name
Hospital Universitari Vall d'Hebron
City
Barcelona
Country
Spain
Facility Name
Hospital Universitario de La Princesa
City
Madrid
ZIP/Postal Code
28006
Country
Spain
Facility Name
Hospital Universitario Virgen del Rocio
City
Sevilla
ZIP/Postal Code
41013
Country
Spain
Facility Name
Hospital Clinico Universitario de Valencia
City
Valencia
ZIP/Postal Code
46010
Country
Spain
Facility Name
Hospital Clinico Universitario Lozano Blesa
City
Zaragoza
ZIP/Postal Code
50009
Country
Spain
Facility Name
Hospital Universitario Miguel Servet
City
Zaragoza
ZIP/Postal Code
50009
Country
Spain
Facility Name
Centre Hospitalier Universitaire Vaudois
City
Lausanne
ZIP/Postal Code
1011
Country
Switzerland
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
35181572
Citation
Dellon ES, Lucendo AJ, Schlag C, Schoepfer AM, Falk GW, Eagle G, Nezamis J, Comer GM, Knoop K, Hirano I. Fluticasone Propionate Orally Disintegrating Tablet (APT-1011) for Eosinophilic Esophagitis: Randomized Controlled Trial. Clin Gastroenterol Hepatol. 2022 Nov;20(11):2485-2494.e15. doi: 10.1016/j.cgh.2022.02.013. Epub 2022 Feb 16.
Results Reference
derived
Learn more about this trial
Efficacy, Safety, and Pharmacokinetics of APT-1011 in Subjects With Eosinophilic Esophagitis (EoE)
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