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Phase II, Safety and Efficacy Study of Kamada-alpha-1-antitrypsin (AAT) for Inhalation"

Primary Purpose

Alpha-1 Antitrypsin Deficiency

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Kamada-AAT for Inhalation, 80mg
Placebo
Kamada-AAT for Inhalation, 160mg
Sponsored by
Kamada, Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alpha-1 Antitrypsin Deficiency

Eligibility Criteria

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

Inclusion Criteria:

  • Male or female patients between 18 and 65 years of age (inclusive).
  • Able and willing to sign informed consent.
  • Males, and non-pregnant, non-lactating females whose screening pregnancy test is negative and who are using contraceptive methods deemed reliable by the investigator or who are post-menopausal or surgically sterilized.
  • Diagnosis of alpha1-antitrypsin deficiency [only individuals with a ZZ or Z null classification].
  • Forced expiratory volume in one second (FEV1) ≥ 50% of predicted post bronchodilator
  • No respiratory exacerbations within 6 weeks of baseline. Subjects can be re-screened if exacerbations exist at the time of enrollment.
  • No signs of chronic and/or acute Hepatitis A, Hepatitis B, Hepatitis C, HIV infection and Parvovirus B19, by NAT (for Parvovirus B19, nucleic acid testing (NAT) result must be < 10^4 IU/mL).
  • No significant abnormalities in serum hematology, serum chemistry, serum inflammatory / immunogenic markers and urinalysis.
  • No significant abnormalities in ECG.
  • Not on intravenous augmentation therapy for at least 8 weeks prior to initial dosing with study drug/placebo and willing to forego intravenous augmentation therapy for the duration of the study.

Exclusion Criteria:

  • Clinically significant intercurrent illnesses (except for respiratory or liver disease secondary to AAT deficiency), including: cardiac, hepatic, renal, endocrine, neurological, hematological, neoplastic, immunological, skeletal or other) that in the opinion of the investigator, could interfere with the safety, compliance or other aspects of this study. Patients with well-controlled, chronic diseases could possibly be included after consultation with the treating physician and the sponsor.
  • History of life threatening allergy, anaphylactic reaction, or systemic response to human plasma derived products.
  • History of life threatening transfusion reactions.
  • History of lung transplant.
  • Current or previous (up to 8 weeks from baseline) use of AAT augmentation therapy or by any other route
  • Current use of oral or parenteral glucocorticoids in doses exceeding 10mg of prednisone daily or equivalent generics (substance and dose).
  • Any lung surgery within the past two years.
  • On any thoracic surgery waiting list.
  • Active smoking during the last 12 months from screening date.
  • Pregnancy or lactation.
  • Woman of child-bearing potential not taking adequate contraception deemed reliable by the investigator.
  • Presence of psychiatric/ mental disorder or any other medical disorder which might impair the patient's ability to give informed consent or to comply with the requirements of the study protocol.
  • Evidence of alcohol abuse or history of alcohol abuse or illegal and/or legally prescribed drugs.
  • Immunoglobulin A (IgA) Deficiency.
  • Inability to undergo bronchoscopy.
  • Allergy to lidocaine or any other medicines used in the bronchoscopy process
  • Exacerbation of chronic obstructive pulmonary disease (COPD) in the previous 6 weeks.
  • Participation in another clinical trial involving investigational medication or interventional treatment within 30 days prior to baseline visit.
  • Participation in observational clinical trial which involves any invasive procedure scheduled to occur during the AAT inhaled study period. If participating in an observational clinical trial that already completed all diagnostic procedures (e.g. liver biopsy), any adverse events (AEs) experienced must have returned to baseline within 30 days prior to baseline visit.
  • Inability to attend scheduled clinic visits and/or comply with the study protocol.
  • Any other factor that, in the opinion of the investigator, would prevent the patient form complying with the requirements of the protocol.

Sites / Locations

  • University of Florida, Pulmonary, Critical Care & Sleep Medicine
  • The University of Texas Health Science Center at Tyler Center for Clinical Research

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Placebo Comparator

Experimental

Arm Label

Kamada-AAT for Inhalation, 80mg

Placebo

Kamada-AAT for Inhalation, 160mg

Arm Description

Daily inhalation of Kamada-AAT for Inhalation, 80mg

Placebo administered by inhalation daily

Daily inhalation of Kamada-AAT for Inhalation, 160mg

Outcomes

Primary Outcome Measures

Change From Baseline in the Concentration of Antigenic Alpha-1 Antitrypsin (AAT) in the Lung Epithelial Lining Fluid (ELF)
Patients underwent bronchoalveolar lavage (BAL) prior to initiation of drug and then again after 3 months. Concentration of AAT in the BAL was measured by an enzyme linked immunosorbent assay (ELISA) specific for the normal form of AAT (piM). Urea was also measured in order to determine the dilution factor of the BAL fluid and calculate the concentration of AAT in the ELF.
Change From Baseline to 12 Weeks in the Concentration of Functional AAT (Alpha-1 Antitrypsin) in ELF
ITT population with baseline and 12 week values. Patients underwent bronchoalveolar lavage (BAL) prior to initiation of drug and then again after 3 months. Concentration of AAT in the BAL was measured by an antineutrophil elastase capacity (ANEC) assay. Urea was also measured in order to determine the dilution factor of the BAL fluid and calculate the concentration of AAT in the ELF.

Secondary Outcome Measures

Change From Baseline in Levels of M Specific AAT in Plasma (PiM)
Intention to treat (ITT) population with baseline and 12 week values.The median change from baseline to Week 12 in the levels of M-specific AAT (piM) in plasma was measured using a specific ELISA assay for M-specific AAT (piM)
Change From Baseline in AAT-neutrophil Elastase (NE) Complexes in ELF
Patients underwent a BAL procedure at baseline and 12 weeks and the fluid was analyzed to calculate the change from baseline in the concentration of complexes between AAT and neutrophil elastase in the ELF

Full Information

First Posted
November 24, 2013
Last Updated
December 31, 2019
Sponsor
Kamada, Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT02001688
Brief Title
Phase II, Safety and Efficacy Study of Kamada-alpha-1-antitrypsin (AAT) for Inhalation"
Official Title
Phase II, Double-Blind, Placebo-Controlled Study to Explore the ELF and Plasma Concentration as Well as Safety of Inhaled Alpha-1 Antitrypsin in Alpha-1 Antitrypsin Deficiency Subjects
Study Type
Interventional

2. Study Status

Record Verification Date
December 2019
Overall Recruitment Status
Completed
Study Start Date
April 2014 (undefined)
Primary Completion Date
February 2016 (Actual)
Study Completion Date
May 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Kamada, Ltd.

4. Oversight

5. Study Description

Brief Summary
To evaluate different doses of "Kamada-AAT for Inhalation" on the levels of alpha 1-proteinase inhibitor and other analytes in epithelial lining fluid (ELF) and serum and to assess the safety of the treatment in subjects with AAT Deficiency.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alpha-1 Antitrypsin Deficiency

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
36 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Kamada-AAT for Inhalation, 80mg
Arm Type
Experimental
Arm Description
Daily inhalation of Kamada-AAT for Inhalation, 80mg
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo administered by inhalation daily
Arm Title
Kamada-AAT for Inhalation, 160mg
Arm Type
Experimental
Arm Description
Daily inhalation of Kamada-AAT for Inhalation, 160mg
Intervention Type
Drug
Intervention Name(s)
Kamada-AAT for Inhalation, 80mg
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Type
Drug
Intervention Name(s)
Kamada-AAT for Inhalation, 160mg
Primary Outcome Measure Information:
Title
Change From Baseline in the Concentration of Antigenic Alpha-1 Antitrypsin (AAT) in the Lung Epithelial Lining Fluid (ELF)
Description
Patients underwent bronchoalveolar lavage (BAL) prior to initiation of drug and then again after 3 months. Concentration of AAT in the BAL was measured by an enzyme linked immunosorbent assay (ELISA) specific for the normal form of AAT (piM). Urea was also measured in order to determine the dilution factor of the BAL fluid and calculate the concentration of AAT in the ELF.
Time Frame
12 weeks from initiation of study drug
Title
Change From Baseline to 12 Weeks in the Concentration of Functional AAT (Alpha-1 Antitrypsin) in ELF
Description
ITT population with baseline and 12 week values. Patients underwent bronchoalveolar lavage (BAL) prior to initiation of drug and then again after 3 months. Concentration of AAT in the BAL was measured by an antineutrophil elastase capacity (ANEC) assay. Urea was also measured in order to determine the dilution factor of the BAL fluid and calculate the concentration of AAT in the ELF.
Time Frame
12 weeks from initiation of study drug
Secondary Outcome Measure Information:
Title
Change From Baseline in Levels of M Specific AAT in Plasma (PiM)
Description
Intention to treat (ITT) population with baseline and 12 week values.The median change from baseline to Week 12 in the levels of M-specific AAT (piM) in plasma was measured using a specific ELISA assay for M-specific AAT (piM)
Time Frame
12 weeks from initiation of study drug
Title
Change From Baseline in AAT-neutrophil Elastase (NE) Complexes in ELF
Description
Patients underwent a BAL procedure at baseline and 12 weeks and the fluid was analyzed to calculate the change from baseline in the concentration of complexes between AAT and neutrophil elastase in the ELF
Time Frame
12 weeks from initiation of study drug

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients between 18 and 65 years of age (inclusive). Able and willing to sign informed consent. Males, and non-pregnant, non-lactating females whose screening pregnancy test is negative and who are using contraceptive methods deemed reliable by the investigator or who are post-menopausal or surgically sterilized. Diagnosis of alpha1-antitrypsin deficiency [only individuals with a ZZ or Z null classification]. Forced expiratory volume in one second (FEV1) ≥ 50% of predicted post bronchodilator No respiratory exacerbations within 6 weeks of baseline. Subjects can be re-screened if exacerbations exist at the time of enrollment. No signs of chronic and/or acute Hepatitis A, Hepatitis B, Hepatitis C, HIV infection and Parvovirus B19, by NAT (for Parvovirus B19, nucleic acid testing (NAT) result must be < 10^4 IU/mL). No significant abnormalities in serum hematology, serum chemistry, serum inflammatory / immunogenic markers and urinalysis. No significant abnormalities in ECG. Not on intravenous augmentation therapy for at least 8 weeks prior to initial dosing with study drug/placebo and willing to forego intravenous augmentation therapy for the duration of the study. Exclusion Criteria: Clinically significant intercurrent illnesses (except for respiratory or liver disease secondary to AAT deficiency), including: cardiac, hepatic, renal, endocrine, neurological, hematological, neoplastic, immunological, skeletal or other) that in the opinion of the investigator, could interfere with the safety, compliance or other aspects of this study. Patients with well-controlled, chronic diseases could possibly be included after consultation with the treating physician and the sponsor. History of life threatening allergy, anaphylactic reaction, or systemic response to human plasma derived products. History of life threatening transfusion reactions. History of lung transplant. Current or previous (up to 8 weeks from baseline) use of AAT augmentation therapy or by any other route Current use of oral or parenteral glucocorticoids in doses exceeding 10mg of prednisone daily or equivalent generics (substance and dose). Any lung surgery within the past two years. On any thoracic surgery waiting list. Active smoking during the last 12 months from screening date. Pregnancy or lactation. Woman of child-bearing potential not taking adequate contraception deemed reliable by the investigator. Presence of psychiatric/ mental disorder or any other medical disorder which might impair the patient's ability to give informed consent or to comply with the requirements of the study protocol. Evidence of alcohol abuse or history of alcohol abuse or illegal and/or legally prescribed drugs. Immunoglobulin A (IgA) Deficiency. Inability to undergo bronchoscopy. Allergy to lidocaine or any other medicines used in the bronchoscopy process Exacerbation of chronic obstructive pulmonary disease (COPD) in the previous 6 weeks. Participation in another clinical trial involving investigational medication or interventional treatment within 30 days prior to baseline visit. Participation in observational clinical trial which involves any invasive procedure scheduled to occur during the AAT inhaled study period. If participating in an observational clinical trial that already completed all diagnostic procedures (e.g. liver biopsy), any adverse events (AEs) experienced must have returned to baseline within 30 days prior to baseline visit. Inability to attend scheduled clinic visits and/or comply with the study protocol. Any other factor that, in the opinion of the investigator, would prevent the patient form complying with the requirements of the protocol.
Facility Information:
Facility Name
University of Florida, Pulmonary, Critical Care & Sleep Medicine
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32610
Country
United States
Facility Name
The University of Texas Health Science Center at Tyler Center for Clinical Research
City
Tyler
State/Province
Texas
ZIP/Postal Code
75708
Country
United States

12. IPD Sharing Statement

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Phase II, Safety and Efficacy Study of Kamada-alpha-1-antitrypsin (AAT) for Inhalation"

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