NAsal Polyps: Inflammatory & Molecular Phenotyping of Responders to Benralizumab

Nasal Polyps Clinical Trial

— NAPPREB  

Official title:

NAsal Polyps: Inflammatory & Molecular Phenotyping of Responders to Benralizumab

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04185012
• Other study ID #: NAPPREB
• Status: Recruiting
• Phase: Phase 3
• Start date: February 24, 2020
• Est. completion date: July 30, 2022

Study information

• Verified date: November 2021
• Source: Humanitas Clinical and Research Center
• Contact: Giorgio Walter Canonica, MD
• Phone: +390288247013
• Email: giorgio_walter.canonica[@]hunimed.eu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Background and rationale:

Phase III-b study.

Population and patient selection criteria: Adult patients with Chronic Rhinosinusitis with Nasal Polyps (allergic and non-allergic) requiring at least 1000 mg oral prednisone over the previous twelve months to control symptoms of rhinosinusitis, and with:

• Nasal polyps score (Meltzer et al.) ≥ 5

• Symptoms VAS scores (for nasal obstruction, hyposmia, post-nasal drip, sneezing, rhinorrea; 0-10 for each symptom) > 24 Sample size: 20 subjects.

Study design and study duration:

This is a pilot, prospective, double-blind placebo-controlled (DBPC) phase III-b trial with Benralizumab 30 mg administered subcutaneously every 4 weeks for the first 3 doses and then every 8 weeks, for a treatment-period of 16 weeks (followed up at 32 and 52 weeks) in patients with chronic rhinosinusinusitis with nasal polyps (CRSwNP).

Description of study treatment/product/intervention: Benralizumab, 30 mg subcutaneously every 4 week for the first 3 doses, and then every 8 weeks.

Objectives:

• Primary objective: To assess the clinical efficacy of Benralizumab on CRSwNP at week 24 (vs baseline) after the beginning of treatment, and to correlate the presence of baseline biomarkers with nasal polyp (NP) score improvement, in order to identify any possible predictive biomarker of response to Benralizumab.

• Secondary objective: In the follow up phase we will monitor all the biomarkers at 32 and 52 weeks , this monitoring will ascertain if any of those will predict relapse of nasal polyps and consequently when Benralizumab treatment has to be reinstalled.

• Safety objective: To evaluate the safety and tolerability of Benralizumab in patients with CRSwNP

Statistical methods, data analysis: Descriptive analysis of all collected variables at all time-points will be performed. Patients will be classified into "responders" and "non responders", for primary endopoint variable. Continuous variables will be evaluated with the normality test of Kolmogorov-Smirnov and compared with ANOVA or the Mann-Whitney test, depending on the normality of distribution. Categorical variables will be compared using Fisher's exact test.

Ethical considerations: The study will be performed in accordance with ethical principles that have their origin in the Declaration of Helsinki and are consistent with ICH/Good Clinical Practice, applicable regulatory requirements and the Sponsor policy on Bioethics and Human Biological Samples.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 20
• Est. completion date: July 30, 2022
• Est. primary completion date: March 28, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

Adult patients with Chronic Rhinosinusitis with Nasal Polyps (allergic and non-allergic) requiring at least 1000 mg oral prednisone over the previous twelve months to control symptoms of rhinosinusitis, and with:

• Nasal polyps score (Meltzer et al.) > 5

• Symptoms VAS scores (for nasal obstruction, hyposmia, post-nasal drip, sneezing, rhinorrea; 0-10 for each symptom) > 24

• Provision of informed consent prior to any study specific procedure

Exclusion Criteria:

• Patients < 18 years age

• Pregnant women

• Biologic therapy in the past 6 months (or at least a period corresponding to 5 half-life of used drugs) (eg: omalizumab, mepolizumab, reslizumab, dupilumab)

• Previous treatment with Benralizumab

• Known hypersensitivity to benralizumab or any of its excipients

• Immunosuppression other than oral steroids in the past 3 months

• Allergen immunotherapy in the past 6 months

• Serious life threatening cardiopulmonary disorders

• Systemic immunologic disorder in the last 12 months

• Positive history for malignant tumors ever in patient's life

• Patients with conditions or concomitant diseases making them non evaluable at visit 1 or for the primary efficacy endpoint:

1. Ongoing rhinitis medicamentosa

2. Nasal septal deviation occluding at least one nostril

3. Acute sinusitis, nasal infection, upper respiratory infections

4. Radiologic suspicion or confirmed invasive or expansive fungal rhinosinusitis

5. Eosinophilic Granulomatosis with Polyangiitis (previously named Churg-Strauss Syndrome)

6. Granulomatosis with Polyangiitis (previously named Wegener's granulomatosis)

7. Young's Syndrome

8. Kartagener's Syndrome

9. all ciliary dyskinesia

10. Cystic Fibrosis

• Systemic corticosteroid treatment for other chronic conditions (i.e.: autoimmune disorders, tumors,….)

• Evidence of active systemic immunedepression (i.e..: primary or secondary immunodeficiency)

• Patients with severe asthma, defined according to ERS/ATS definition

Related Conditions & MeSH terms

• Nasal Polyps
• Polyps

Intervention

Biological:
• Benralizumab
Benralizumab 30 mg administered subcutaneously Q4W for the first 3 doses and then Q8W, for a 16 weeks treatment-period
• Placebo
Placebo administered subcutaneously Q4W for the first 3 doses and then Q8W, for a 16 weeks treatment-period

Locations

Country	Name	City	State
Italy	Humanitas Clinical and Research Hospital	Rozzano	MI

Sponsors (2)

Lead Sponsor	Collaborator
Humanitas Clinical and Research Center	AstraZeneca

Country where clinical trial is conducted

Italy, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Significant reduction of the Nasal polyps Score (range: 0-8; higher values mean larger nasal polyps size)	score reduction of 1.5	at week 24 (vs baseline)
Secondary	Reduction in Lund-MacKay Score (range: 0-24; higher values mean larger nasal polyps extension)	>50% of baseline	at week 24 (vs baseline)
Secondary	Improvement of Sino-Nasal Outcome Test (SNOT-22; range: 0-110; higher values mean poorer disease-related quality of life)	>40% of baseline	at week 24 (vs baseline)
Secondary	Improvement of smell Visual Analogue Scale (VAS; range: 0-10; higher values mean worse smell)	>50% of baseline	at week 24 (vs baseline)