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Study to Assess the Efficacy and Safety of Omalizumab Treatment on ICS Reduction for Severe IgE-mediated Asthma (MEXIC)

Primary Purpose

Severe IgE-mediated Asthma

Status
Terminated
Phase
Phase 4
Locations
Mexico
Study Type
Interventional
Intervention
Omalizumab
Budesonide
Formoterol
Budesonide
Formoterol
Sponsored by
Novartis Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Severe IgE-mediated Asthma

Eligibility Criteria

6 Years - 55 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria

  • Male and female between 6 and 55 years old. If female, participant of childbearing potential must use a safe and efficacious birth control method.
  • Asthma is considered as not well-controlled if participant has 3 or more of the following conditions:

    1. Persistent day symptoms with current therapy twice at week or more, (siblings, dyspnea, cough, chest pain, thoracic oppression).
    2. One or more night-time awakenings over the last 4 weeks.
    3. Any limitation of age-appropriated habitual activities.
    4. Need of rescue medication (short acting β2 agonist) for two or more occasions per week during the last 4 weeks before screening and 2 consecutive weeks within the 4 weeks before selection.
    5. Peak expiratory flow (PEF) or VEF1 <80% predicted or personal best (if known) this is not mandatory for pediatric participants (under 18 years old).
  • Despite continuous treatment with high-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) (CSO≥ 1 mg/kg/day) with or without controllers (As per GINA 2012 definition), the subject is receiving high doses of ICS (budesonide or its equivalent) and a long-acting β2-agonists(LABA) (formoterol) for the past 12 weeks at visit 0.
  • At last one documented asthma exacerbation (defined as increase asthma symptoms requiring systemic corticosteroid rescue therapy) that requires visits to the emergency room or to be hospitalized in the past 12 months. It is also considered asthma exacerbation a non-planned visit that required rescue medication (β2-agonists and/or steroid nebulization every 20 minutes or β2-agonists inhaler shots every 20 minutes).
  • Positive skin test or in vitro reactivity to a perennial aeroallergen, documented during the 12 months previous screening.
  • IgE total concentration ranging from 30 to 1500 UI/ml.
  • Body weight between 20 to 150 kg Exclusion Criteria
  • Pregnant or lactating female or without safe and efficacious birth control method if of childbearing potential.
  • Currently smokers or history of smoking 10 or more packs per year.
  • Ex-smokers with a history of more than 10 years of smoking. As an exception, a participant with this criterion will be considered as eligible if the FEV1 reversibility of the first spirometry reaches 12%.
  • Active lung disease other than asthma.
  • Use of methotrexate, gold salts, troleandomycin, cyclosporine, immunosuppressants, gammaglobulin or any other type of monoclonal antibody used during the 6 months prior to the initial visit.
  • Use of omalizumab during the 4 months prior to de screening visit.
  • History of renal disease, cardiovascular disease, metabolic disease, hematologic disease, gastrointestinal disease, as well as immunodeficiency or cerebrovascular disease currently under treatment but not-controlled.
  • History of hepatic, neurologic, oncologic or autoimmune disease.
  • Participant under suspicion of having cancer.
  • Participants with history of hypersensitivity to sucrose, histidine, polysorbate 20 as well as to monoclonal antibodies or gammaglobulin.
  • Hypersensitivity to omalizumab or its excipients.
  • Abnormal values of the blood chemistry laboratory tests, over 2 times the upper limit normal, that are considered clinically significant.
  • Underage participant or any participant under vulnerable conditions who does not live with their parents or legal guardian.

Sites / Locations

  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Omalizumab + budesonide and formoterol

Budesonide and formoterol

Arm Description

Participants will receive Omalizumab every 2 or 4 weeks depending on IgE level and body weight and will also receive budesonide and formoterol according to maximum daily dose.

Participants will receive budesonide and formoterol according to maximum daily dose.

Outcomes

Primary Outcome Measures

The Mean Prescribed Budesonide Dose (μg) at Baseline
prescribed budesonide dose (in μg) at Baseline in intention to treat population and in intention to treat population

Secondary Outcome Measures

Number of Hospital Admissions Due to Asthma Exacerbation
A hospital admission is defined as admissions to hospital involving a stay of at least 24 hours.
Days Missed in School/Work Due to Asthma Exacerbation Episodes
Participants /parent/legal guarding reported number of missed days of school or work at each study visit via diaries.
Control of Asthma Symptoms- Daytime Symptoms
The clinical control of asthma was defined according to the following criteria (GINA 2012): 1-Daytime symptoms: none or less than twice a week 2-Limitations of daily activities: none 3-Nocturnal symptoms or awakening because of asthma: none 4-Need of relief or rescue medication: none or less than twice a week 5-Lung function (PEF or FEV1) without administration of bronchodilator: normal
Control of Asthma Symptoms
The clinical control of asthma was defined according to the following criteria (GINA 2012): 1-Daytime symptoms: none or less than twice a week 2-Limitations of daily activities: none 3-Nocturnal symptoms or awakening because of asthma: none 4-Need of relief or rescue medication: none or less than twice a week 5-Lung function (PEF or FEV1) without administration of bronchodilator: normal
Control of Asthma Symptoms- Rescue Medication Use
The clinical control of asthma was defined according to the following criteria (GINA 2012): 1-Daytime symptoms: none or less than twice a week 2-Limitations of daily activities: none 3-Nocturnal symptoms or awakening because of asthma: none 4-Need of relief or rescue medication: none or less than twice a week 5-Lung function (PEF or FEV1) without administration of bronchodilator: normal
Participants Requiring Oral Systemic Corticosteroids During the 12 Month Study Duration
Number of days of concomitant medications use reported by participants at all visits via diaries.
Asthma Control Questionnaire (ACQ) at Baseline
The Asthma Control Questionnaire (ACQ) has six questions to be answered by the participants, each with a 7 point scale (0-good control, 6-poor control), and one question where the actual pre-bronchodilator Forced expiratory volume in 1 second (FEV1) value expressed in % of predicted FEV1 was classified to scores from 0 (> 95% of predicted) to 6 (< 50% of predicted). The overall score is the average of the 7 questions; a minimum overall score of 0 = good control of asthma whereas a maximum overall score of 6 = poor control of asthma.
Asthma Quality of Life Questionnaire (AQLQ) at Baseline
The quality of life will be measured by the standardized version of the Asthma Quality of Life Questionnaire (AQLQ[S]) score for adults and the pediatric version of the AQLQ(S) for pediatric participants (PAQLQ[S]) . The AQLQ(S) and PAQLQ(S0 contain 4 domains (activity limitations, symptoms, emotional function, and environmental stimuli), with a total of 32 items; each item is measured in a 7-point Likert scale of 1 to 7 (1 = severe impairment, 7 = no impairment). All items are weighted equally. Mean score is calculated across all items within each domain and the overall score is the mean score of the 32 items.

Full Information

First Posted
July 29, 2013
Last Updated
June 24, 2019
Sponsor
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT01912872
Brief Title
Study to Assess the Efficacy and Safety of Omalizumab Treatment on ICS Reduction for Severe IgE-mediated Asthma
Acronym
MEXIC
Official Title
Multicentric, Open-label, Randomized, Parallel--group Study to Evaluate the Efficacy and Safety of Omalizumab in a 12- Month Period, in Patients With Severe IgE-mediated Asthma Inadequately Controlled With High Doses of Corticosteroids.
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Terminated
Why Stopped
Termination was due to identified errors in data management handling after an internal audit by the sponsor performed by third party.
Study Start Date
November 11, 2013 (Actual)
Primary Completion Date
August 6, 2015 (Actual)
Study Completion Date
January 8, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis Pharmaceuticals

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Assess efficacy and safety of omalizumab treatment during 12 months in order to reduce the use of inhaled corticosteroid (ICS) in pediatric and adult participants with severe Immunoglobulin E (IgE)-mediated asthma inadequately controlled with high doses of corticosteroids.
Detailed Description
This was a multicentric, open label, randomized, parallel-group study with a 12-month treatment period. Participants were assigned to one of the 2 treatment groups, omalizumab plus budesonide/formoterol or budesonide/formoterol alone. The study comprised 4 phases: During the 4-week run-in phase adult participants received budesonide 800 mg and formoterol 24 mg. If a participant complied with all inclusion and exclusion criteria and had received the according-to-age run-in proposed doses during the last month, the participant continued to the stable-steroid phase. During the 16-week stable-steroid phase, adult and pediatric eligible participants were randomized to one of the two treatment groups. During the 8-week steroid-reduction phase, adult and pediatric participants reduced 25% of the budesonide baseline dose every 2 weeks, depending of the asthma control, until they reached a 100% reduction of the baseline dose. The clinical control of asthma was defined according to criteria (GINA 2012).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Severe IgE-mediated Asthma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
112 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Omalizumab + budesonide and formoterol
Arm Type
Experimental
Arm Description
Participants will receive Omalizumab every 2 or 4 weeks depending on IgE level and body weight and will also receive budesonide and formoterol according to maximum daily dose.
Arm Title
Budesonide and formoterol
Arm Type
Active Comparator
Arm Description
Participants will receive budesonide and formoterol according to maximum daily dose.
Intervention Type
Drug
Intervention Name(s)
Omalizumab
Intervention Description
Subcutaneous injection dose according to the IgE level and body weight.
Intervention Type
Drug
Intervention Name(s)
Budesonide
Intervention Description
Budesonide (400 μg, 200 μg or 100 μg) tablets taken orally according to maximum daily dose.
Intervention Type
Drug
Intervention Name(s)
Formoterol
Intervention Description
Formoterol 12ug tablets taken orally according to maximum daily dose.
Intervention Type
Drug
Intervention Name(s)
Budesonide
Intervention Description
Budesonide (400 μg, 200 μg or 100 μg). Patients were instructed to take the inhaled budesonide doses every 12 hours following the specific administration instructions as per the manufactures' prescription information.
Intervention Type
Drug
Intervention Name(s)
Formoterol
Intervention Description
Formoterol 12ug. Patients were instructed to take the inhaled formoterol doses every 12 hours following the specific administration instructions as per the manufactures' prescription information.
Primary Outcome Measure Information:
Title
The Mean Prescribed Budesonide Dose (μg) at Baseline
Description
prescribed budesonide dose (in μg) at Baseline in intention to treat population and in intention to treat population
Time Frame
Baseline
Secondary Outcome Measure Information:
Title
Number of Hospital Admissions Due to Asthma Exacerbation
Description
A hospital admission is defined as admissions to hospital involving a stay of at least 24 hours.
Time Frame
12 month treatment duration
Title
Days Missed in School/Work Due to Asthma Exacerbation Episodes
Description
Participants /parent/legal guarding reported number of missed days of school or work at each study visit via diaries.
Time Frame
12 month treatment duration
Title
Control of Asthma Symptoms- Daytime Symptoms
Description
The clinical control of asthma was defined according to the following criteria (GINA 2012): 1-Daytime symptoms: none or less than twice a week 2-Limitations of daily activities: none 3-Nocturnal symptoms or awakening because of asthma: none 4-Need of relief or rescue medication: none or less than twice a week 5-Lung function (PEF or FEV1) without administration of bronchodilator: normal
Time Frame
12 month treatment duration
Title
Control of Asthma Symptoms
Description
The clinical control of asthma was defined according to the following criteria (GINA 2012): 1-Daytime symptoms: none or less than twice a week 2-Limitations of daily activities: none 3-Nocturnal symptoms or awakening because of asthma: none 4-Need of relief or rescue medication: none or less than twice a week 5-Lung function (PEF or FEV1) without administration of bronchodilator: normal
Time Frame
12 month treatment duration
Title
Control of Asthma Symptoms- Rescue Medication Use
Description
The clinical control of asthma was defined according to the following criteria (GINA 2012): 1-Daytime symptoms: none or less than twice a week 2-Limitations of daily activities: none 3-Nocturnal symptoms or awakening because of asthma: none 4-Need of relief or rescue medication: none or less than twice a week 5-Lung function (PEF or FEV1) without administration of bronchodilator: normal
Time Frame
12 month treatment duration
Title
Participants Requiring Oral Systemic Corticosteroids During the 12 Month Study Duration
Description
Number of days of concomitant medications use reported by participants at all visits via diaries.
Time Frame
12 month treatment duration
Title
Asthma Control Questionnaire (ACQ) at Baseline
Description
The Asthma Control Questionnaire (ACQ) has six questions to be answered by the participants, each with a 7 point scale (0-good control, 6-poor control), and one question where the actual pre-bronchodilator Forced expiratory volume in 1 second (FEV1) value expressed in % of predicted FEV1 was classified to scores from 0 (> 95% of predicted) to 6 (< 50% of predicted). The overall score is the average of the 7 questions; a minimum overall score of 0 = good control of asthma whereas a maximum overall score of 6 = poor control of asthma.
Time Frame
Baseline
Title
Asthma Quality of Life Questionnaire (AQLQ) at Baseline
Description
The quality of life will be measured by the standardized version of the Asthma Quality of Life Questionnaire (AQLQ[S]) score for adults and the pediatric version of the AQLQ(S) for pediatric participants (PAQLQ[S]) . The AQLQ(S) and PAQLQ(S0 contain 4 domains (activity limitations, symptoms, emotional function, and environmental stimuli), with a total of 32 items; each item is measured in a 7-point Likert scale of 1 to 7 (1 = severe impairment, 7 = no impairment). All items are weighted equally. Mean score is calculated across all items within each domain and the overall score is the mean score of the 32 items.
Time Frame
Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Male and female between 6 and 55 years old. If female, participant of childbearing potential must use a safe and efficacious birth control method. Asthma is considered as not well-controlled if participant has 3 or more of the following conditions: Persistent day symptoms with current therapy twice at week or more, (siblings, dyspnea, cough, chest pain, thoracic oppression). One or more night-time awakenings over the last 4 weeks. Any limitation of age-appropriated habitual activities. Need of rescue medication (short acting β2 agonist) for two or more occasions per week during the last 4 weeks before screening and 2 consecutive weeks within the 4 weeks before selection. Peak expiratory flow (PEF) or VEF1 <80% predicted or personal best (if known) this is not mandatory for pediatric participants (under 18 years old). Despite continuous treatment with high-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) (CSO≥ 1 mg/kg/day) with or without controllers (As per GINA 2012 definition), the subject is receiving high doses of ICS (budesonide or its equivalent) and a long-acting β2-agonists(LABA) (formoterol) for the past 12 weeks at visit 0. At last one documented asthma exacerbation (defined as increase asthma symptoms requiring systemic corticosteroid rescue therapy) that requires visits to the emergency room or to be hospitalized in the past 12 months. It is also considered asthma exacerbation a non-planned visit that required rescue medication (β2-agonists and/or steroid nebulization every 20 minutes or β2-agonists inhaler shots every 20 minutes). Positive skin test or in vitro reactivity to a perennial aeroallergen, documented during the 12 months previous screening. IgE total concentration ranging from 30 to 1500 UI/ml. Body weight between 20 to 150 kg Exclusion Criteria Pregnant or lactating female or without safe and efficacious birth control method if of childbearing potential. Currently smokers or history of smoking 10 or more packs per year. Ex-smokers with a history of more than 10 years of smoking. As an exception, a participant with this criterion will be considered as eligible if the FEV1 reversibility of the first spirometry reaches 12%. Active lung disease other than asthma. Use of methotrexate, gold salts, troleandomycin, cyclosporine, immunosuppressants, gammaglobulin or any other type of monoclonal antibody used during the 6 months prior to the initial visit. Use of omalizumab during the 4 months prior to de screening visit. History of renal disease, cardiovascular disease, metabolic disease, hematologic disease, gastrointestinal disease, as well as immunodeficiency or cerebrovascular disease currently under treatment but not-controlled. History of hepatic, neurologic, oncologic or autoimmune disease. Participant under suspicion of having cancer. Participants with history of hypersensitivity to sucrose, histidine, polysorbate 20 as well as to monoclonal antibodies or gammaglobulin. Hypersensitivity to omalizumab or its excipients. Abnormal values of the blood chemistry laboratory tests, over 2 times the upper limit normal, that are considered clinically significant. Underage participant or any participant under vulnerable conditions who does not live with their parents or legal guardian.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Novartis Pharmaceuticals
Organizational Affiliation
Novartis Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Novartis Investigative Site
City
Tuxtla Gutierrez
State/Province
Chiapas
ZIP/Postal Code
29030
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mexico City
State/Province
Distrito Federal
ZIP/Postal Code
14000
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mexico
State/Province
Distrito Federal
ZIP/Postal Code
03020
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mexico
State/Province
Distrito Federal
ZIP/Postal Code
03100
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mexico
State/Province
Distrito Federal
ZIP/Postal Code
04700
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mexico
State/Province
Distrito Federal
ZIP/Postal Code
04980
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mexico
State/Province
Distrito Federal
ZIP/Postal Code
06090
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mexico
State/Province
Distrito Federal
ZIP/Postal Code
06760
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mexico
State/Province
Distrito Federal
ZIP/Postal Code
14050
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mexico
State/Province
Edo. De México
ZIP/Postal Code
53910
Country
Mexico
Facility Name
Novartis Investigative Site
City
Nezahualcoyotl
State/Province
Estado De Mexico
ZIP/Postal Code
57730
Country
Mexico
Facility Name
Novartis Investigative Site
City
Pachuca de Soto
State/Province
Hidalgo
ZIP/Postal Code
42090
Country
Mexico
Facility Name
Novartis Investigative Site
City
Guadalajara
State/Province
Jalisco
ZIP/Postal Code
44500
Country
Mexico
Facility Name
Novartis Investigative Site
City
Guadalajara
State/Province
Jalisco
ZIP/Postal Code
44600
Country
Mexico
Facility Name
Novartis Investigative Site
City
Guadalajara
State/Province
Jalisco
ZIP/Postal Code
44620
Country
Mexico
Facility Name
Novartis Investigative Site
City
Guadalajara
State/Province
Jalisco
ZIP/Postal Code
44690
Country
Mexico
Facility Name
Novartis Investigative Site
City
Guadaljara
State/Province
Jalisco
ZIP/Postal Code
44500
Country
Mexico
Facility Name
Novartis Investigative Site
City
Tepic
State/Province
Nayarit
ZIP/Postal Code
63000
Country
Mexico
Facility Name
Novartis Investigative Site
City
Monterrey
State/Province
Nuevo León
ZIP/Postal Code
64020
Country
Mexico
Facility Name
Novartis Investigative Site
City
Monterrey
State/Province
Nuevo León
ZIP/Postal Code
64718
Country
Mexico
Facility Name
Novartis Investigative Site
City
Mérida
State/Province
Yucatán
ZIP/Postal Code
97070
Country
Mexico

12. IPD Sharing Statement

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Study to Assess the Efficacy and Safety of Omalizumab Treatment on ICS Reduction for Severe IgE-mediated Asthma

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