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Investigating Dupilumab's Effect in Asthma by Genotype (IDEA)

Primary Purpose

Asthma

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Dupilumab
Placebo
Sponsored by
Boston Children's Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Asthma

Eligibility Criteria

12 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Ages 12 years and older
  2. Ability to provide informed consent
  3. Ability to perform pulmonary function tests
  4. Female participants of childbearing potential must have a negative urine pregnancy test upon study entry
  5. Female participants with reproductive potential must agree to use FDA-approved methods of birth control for the duration of the study2
  6. Participant-reported physician or licensed medical practitioner diagnosis of asthma
  7. Treatment with medium to high dose ICS (400 mcg to maximum of 2000 mcg per day of fluticasone propionate or equivalent) for at least 3 months with a stable dose ≥1 month prior to screening OR used a biologic medication for asthma within the past 8 weeks
  8. History of asthma exacerbation in the past year

An exacerbation is an asthma attack for which a clinician prescribed a course of systemic (oral, IV, IM) steroids whether or not the patient took the steroids OR An increase of >50% of baseline inhaled corticosteroid dose for ≥3 days OR An unscheduled visit for acute asthma attack (licensed medical practitioner/nurse office, urgent care intervention, emergency department, or hospitalization)

Exclusion Criteria:

  1. Chronic lung disease other than asthma, which may impair lung function
  2. Current smoker or cessation of smoking ≤6 months prior to Visit 0 screening
  3. Current use of any electronic (e) "vaping" device (e.g., e-cigarette, e-cig, mod, vape pen, JUUL, e-cigar, e-hookah, e-pipe, vape pods) or cessation ≤ 6 months prior to screening
  4. Pregnant or breast feeding
  5. Any other condition or abnormality that, in the opinion of the Principal Investigator, would compromise the safety of the patient or quality of data
  6. Evidence that the participant or family may be unreliable or poorly adherent to their asthma treatment or study procedures
  7. Planning to relocate away from the clinical center area before study completion
  8. Currently participating in an investigational drug trial or participated in one within 30 days before screening
  9. Currently being treated with immunosuppressive/immunomodulatory or other investigational agents or biologics for conditions other than asthma, or used a biologic for a non-asthma indication within the past 6 months
  10. History of respiratory illness requiring antibiotics or systemic corticosteroids, including asthma exacerbations, within the past 4 weeks (evaluated at time of screening visit)
  11. History of alcohol or illicit substance abuse within 6 months of screening
  12. Neutropenia (<1,000/mm3) or thrombocytopenia (<100,000/mm3) or hemoglobin < 100 g/L (10 g/dL) or blood eosinophils > 1500/mm3 at screening
  13. Administration of a live vaccine within 4 weeks of screening
  14. Currently receiving allergen immunotherapy (food or aeroallergen) other than an established maintenance regimen implemented continuously for a minimum of 2 months. Individuals receiving aeroallergen immunotherapy must be willing to stay on it for the duration of the study.

Sites / Locations

  • Boston Children's HospitalRecruiting
  • Brigham and Women's HospitalRecruiting
  • Henry Ford Health SystemRecruiting
  • Atlantic Health SystemRecruiting
  • Montefiore Einstein Clinical Research CenterRecruiting
  • MetroHealth SystemRecruiting
  • University of PennsylvaniaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Treatment group

Placebo group

Arm Description

Dupilumab (Dupixent®) administered subcutaneously every two weeks. An initial dose of 600 mg (two 300 mg injections) followed by 300 mg given every other week.

Placebo (preparation, administration, packaging, and labeling all equivalent to the treatment) administered subcutaneously every two weeks.

Outcomes

Primary Outcome Measures

The rate of asthma exacerbations
An exacerbation is an asthma attack for which a clinician prescribed a course of systemic steroids, whether or not the patient took the steroids.

Secondary Outcome Measures

Change in pre-bronchodilator lung function
the change in pre-bronchodilator FEV1% predicted from baseline
Change in CASI score
The change in CASI score from baseline

Full Information

First Posted
October 1, 2018
Last Updated
May 26, 2023
Sponsor
Boston Children's Hospital
Collaborators
National Institute of Allergy and Infectious Diseases (NIAID), Regeneron Pharmaceuticals, HealthBeacon Plc, Merck Sharp & Dohme LLC, Sanofi
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1. Study Identification

Unique Protocol Identification Number
NCT03694158
Brief Title
Investigating Dupilumab's Effect in Asthma by Genotype
Acronym
IDEA
Official Title
Effect of IL-4RαR576 Polymorphism on Response to Dupilumab in Asthma, a Genotype-stratified, Randomized, Placebo- Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 8, 2021 (Actual)
Primary Completion Date
September 2023 (Anticipated)
Study Completion Date
March 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Boston Children's Hospital
Collaborators
National Institute of Allergy and Infectious Diseases (NIAID), Regeneron Pharmaceuticals, HealthBeacon Plc, Merck Sharp & Dohme LLC, Sanofi

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The Goal of this study is to investigate if individuals ages 12 years and older, carrying the IL-4RαR576 gene variant, will have a greater response to therapy acting directly on the anti-IL-4R. This will be conducted by examining the effect of a 48 week therapy with dupilumab on the rate of asthma exacerbations.
Detailed Description
This is a double-blind, randomized, placebo-controlled parallel-group phase 4 clinical trial. Patients will be genotyped and categorized as those with: 1) the wild type allele (Q576/Q576), 2) heterozygous allele (Q576/R576), or 3) homozygous mutant allele (R576/R576); the genotype associated with more severe disease. After a run-in period of 2-12 weeks to determine asthma control, subjects who fulfill all inclusion/exclusion criteria will be randomized to receive either subcutaneous Dupilumab or placebo (1:1 randomization allocation ratio). This study addresses fundamental mechanisms by which the IL-4Rα-R576 variant drives the TH2/TH17 disease endotype and the influence of this variant on response to Dupilumab therapy. It brings together individuals with deep clinical and scientific expertise in allergic diseases, including epidemiology, genetics, inflammation, and tolerance mechanisms to investigate, in a coordinated strategy, the hypothesis that the IL-4Rα-R576 variant drives TH2/TH17 cell inflammation by subverting allergen-specific iTreg cells into TH17 cells. Asthmatics bearing this endotype will be particularly likely to favorably respond to Dupilumab therapy by virtue of its prevention of iTreg cell reprogramming into TH17-like cells, potentially leading to their long-term stability and potential for sustained immune tolerance.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Asthma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
This is a genotype stratified, double-blind, randomized, placebo-controlled, parallel-group, phase IV clinical trial
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double blind, placebo controlled.
Allocation
Randomized
Enrollment
150 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment group
Arm Type
Experimental
Arm Description
Dupilumab (Dupixent®) administered subcutaneously every two weeks. An initial dose of 600 mg (two 300 mg injections) followed by 300 mg given every other week.
Arm Title
Placebo group
Arm Type
Placebo Comparator
Arm Description
Placebo (preparation, administration, packaging, and labeling all equivalent to the treatment) administered subcutaneously every two weeks.
Intervention Type
Drug
Intervention Name(s)
Dupilumab
Other Intervention Name(s)
Dupixent®
Intervention Description
anti-IL4 receptor antagonist
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo for Dupilumab (packaged/administered the same as the active drug)
Primary Outcome Measure Information:
Title
The rate of asthma exacerbations
Description
An exacerbation is an asthma attack for which a clinician prescribed a course of systemic steroids, whether or not the patient took the steroids.
Time Frame
48 week treatment period
Secondary Outcome Measure Information:
Title
Change in pre-bronchodilator lung function
Description
the change in pre-bronchodilator FEV1% predicted from baseline
Time Frame
average of week 4,12, 24,36 and 48 week
Title
Change in CASI score
Description
The change in CASI score from baseline
Time Frame
average of 4,12, 24, 36, and 48 week

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ages 12 years and older Ability to provide informed consent Ability to perform pulmonary function tests Female participants of childbearing potential must have a negative urine pregnancy test upon study entry Female participants with reproductive potential must agree to use FDA-approved methods of birth control for the duration of the study2 Participant-reported physician or licensed medical practitioner diagnosis of asthma Treatment with medium to high dose ICS (400 mcg to maximum of 2000 mcg per day of fluticasone propionate or equivalent) for at least 3 months with a stable dose ≥1 month prior to screening OR used a biologic medication for asthma within the past 8 weeks History of asthma exacerbation in the past year An exacerbation is an asthma attack for which a clinician prescribed a course of systemic (oral, IV, IM) steroids whether or not the patient took the steroids OR An increase of >50% of baseline inhaled corticosteroid dose for ≥3 days OR An unscheduled visit for acute asthma attack (licensed medical practitioner/nurse office, urgent care intervention, emergency department, or hospitalization) Exclusion Criteria: Chronic lung disease other than asthma, which may impair lung function Current smoker or cessation of smoking ≤6 months prior to Visit 0 screening Current use of any electronic (e) "vaping" device (e.g., e-cigarette, e-cig, mod, vape pen, JUUL, e-cigar, e-hookah, e-pipe, vape pods) or cessation ≤ 6 months prior to screening Pregnant or breast feeding Any other condition or abnormality that, in the opinion of the Principal Investigator, would compromise the safety of the patient or quality of data Evidence that the participant or family may be unreliable or poorly adherent to their asthma treatment or study procedures Planning to relocate away from the clinical center area before study completion Currently participating in an investigational drug trial or participated in one within 30 days before screening Currently being treated with immunosuppressive/immunomodulatory or other investigational agents or biologics for conditions other than asthma, or used a biologic for a non-asthma indication within the past 6 months History of respiratory illness requiring antibiotics or systemic corticosteroids, including asthma exacerbations, within the past 4 weeks (evaluated at time of screening visit) History of alcohol or illicit substance abuse within 6 months of screening Neutropenia (<1,000/mm3) or thrombocytopenia (<100,000/mm3) or hemoglobin < 100 g/L (10 g/dL) or blood eosinophils > 1500/mm3 at screening Administration of a live vaccine within 4 weeks of screening Currently receiving allergen immunotherapy (food or aeroallergen) other than an established maintenance regimen implemented continuously for a minimum of 2 months. Individuals receiving aeroallergen immunotherapy must be willing to stay on it for the duration of the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Wanda Phipatanakul, MD, MS
Phone
857-218-5336
Email
Wanda.Phipatanakul@childrens.harvard.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Claudina Luna
Email
asthma@childrens.harvard.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wanda Phipatanakul
Organizational Affiliation
Boston Children's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Boston Children's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Claudina Luna, MD. MPH.
Phone
857-218-5336
Email
asthma@childrens.harvard.edu
First Name & Middle Initial & Last Name & Degree
Wanda Phipatanakul, MD.MS.
Facility Name
Brigham and Women's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Angeles Cinelli
Email
mcinelli@bwh.harvard.edu
First Name & Middle Initial & Last Name & Degree
Eliot Israel, MD
Facility Name
Henry Ford Health System
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48202
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sherae Hereford, RN
Phone
313-207-2453
Email
sherefo3@hfhs.org
First Name & Middle Initial & Last Name & Degree
Haejin Kim, MD.
Facility Name
Atlantic Health System
City
Cedar Knolls
State/Province
New Jersey
ZIP/Postal Code
07927
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Juliana Colecchia
Phone
908-934-0555
Ext
78625
Email
Juliana.colecchia@atlantichealth.org
First Name & Middle Initial & Last Name & Degree
John Oppenheimer, MD
Facility Name
Montefiore Einstein Clinical Research Center
City
Bronx
State/Province
New York
ZIP/Postal Code
10467
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Samuel Green
Phone
718-920-7777
Email
sagreen@montefiore.org
First Name & Middle Initial & Last Name & Degree
Sunit Jariwala, MD
Phone
609-937-1023
Email
SJARIWAL@montefiore.org
First Name & Middle Initial & Last Name & Degree
Sunit Jariwala, MD.
Facility Name
MetroHealth System
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44109
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
David Kaelber, MD.PHD. MPH.
Phone
216-780-3722
Email
dkaelber@metrohealth.org
First Name & Middle Initial & Last Name & Degree
Kimberly Schach
Phone
216-778-7992
Email
kschach@metrohealth.org
First Name & Middle Initial & Last Name & Degree
David Kaelber, MD.PHD.MPH.
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Elizabeth Beothy
Phone
215-549-5023
Email
eabeothy@pennmedicine.upenn.edu
First Name & Middle Initial & Last Name & Degree
Audreesh Banerjee, MD
Phone
215-549-5023
Email
Audreesh.Banerjee@pennmedicine.upenn.edu
First Name & Middle Initial & Last Name & Degree
Audreesh Banerjee, MD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
28943468
Citation
Lai PS, Massoud AH, Xia M, Petty CR, Cunningham A, Chatila TA, Phipatanakul W. Gene-environment interaction between an IL4R variant and school endotoxin exposure contributes to asthma symptoms in inner-city children. J Allergy Clin Immunol. 2018 Feb;141(2):794-796.e3. doi: 10.1016/j.jaci.2017.08.023. Epub 2017 Sep 21. No abstract available.
Results Reference
background
PubMed Identifier
27479084
Citation
Massoud AH, Charbonnier LM, Lopez D, Pellegrini M, Phipatanakul W, Chatila TA. An asthma-associated IL4R variant exacerbates airway inflammation by promoting conversion of regulatory T cells to TH17-like cells. Nat Med. 2016 Sep;22(9):1013-22. doi: 10.1038/nm.4147. Epub 2016 Aug 1.
Results Reference
background

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Investigating Dupilumab's Effect in Asthma by Genotype

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