A Study of Lanadelumab in Teenagers and Adults to Prevent Acute Attacks of Non-histaminergic Angioedema with Normal C1-Inhibitor (C1-INH)

JRCT ID: jRCT2061210013

Registered date:17/06/2021

Basic Information

• Recruitment status: Complete
• Health condition(s) or Problem(s) studied: Angioedema
• Date of first enrollment: 04/05/2020
• Target sample size: 77
• Countries of recruitment: United States,Japan
• Study type: Interventional

Intervention(s)

Lanadelumab
Participants will receive 300 milligrams (mg) of lanadelumab solution in a prefilled syringe (PFS) as subcutaneous (SC) injection once every 2 weeks (q2w) for 26 weeks.

Placebo
Participants will receive placebo matched to lanadelumab SC injection once q2w for 26 weeks.

Outcome(s)

Primary Outcome

1.Number of Investigator-Confirmed Angioedema Attacks During the Treatment Period of Day 0 Through Day 182
Time Frame: Day 0 through Day 182
An angioedema attack was defined as the symptoms or signs consistent with an attack in at least 1 of the following locations: peripheral angioedema (cutaneous swelling involving an extremity, the face, neck, torso, and/or genitourinary region), abdominal angioedema (abdominal pain, with or without abdominal distention, nausea, vomiting, or diarrhea), laryngeal angioedema (stridor, dyspnea, difficulty speaking, difficulty swallowing, throat tightening, or swelling of the tongue, palate, uvula, or larynx). Attack rate was calculated for each participant as the number of attacks occurring during the specified period divided by the number of days the participant contributed to the specified period multiplied by 28 days. Number of investigator-confirmed angioedema attacks during the treatment period of Day 0 through Day 182 was assessed.

Secondary Outcome

1.Number of Participants Achieving Attack-Free Status During the Treatment Period of Day 0 Through Day 182
Time Frame: Day 0 through Day 182
A participant was considered as attack free during a time period if the participant has no investigator-confirmed angioedema attacks during that time period. For participants who discontinue the study prior to completion of the analysis period, participants were classified as attack-free or not based on the observed contribution to the analysis period. Number of participants achieving attack-free status during the treatment period of day 0 through day 182 was assessed.

2.Number of Investigator-Confirmed Moderate or Severe Angioedema Attacks During the Treatment Period of Day 0 Through Day 182
Time Frame: Day 0 Through Day 182
The overall severity of the participant's angioedema attack was determined by the site using the following definitions: 1. Mild: Transient or mild discomfort; 2. Moderate: Mild to moderate limitation in activity some assistance needed; 3. Severe: Marked limitation in activity, assistance required. Number of investigator-confirmed moderate or severe angioedema attacks during the treatment period of day 0 through day 182 was assessed.

3.Number of Investigator-Confirmed Angioedema Attacks During the Presumed Steady State Period of Day 70 Through Day 182
Time Frame: Day 70 through Day 182
Number of investigator-confirmed angioedema attacks during the presumed steady state period of day 70 through day 182 was assessed.

4.Number of Participants Achieving Attack-Free Status During the Presumed Steady State Period of Day 70 Through Day 182
Time Frame: Day 70 through Day 182
Number of participants achieving attack-free status during the presumed steady state period of day 70 through day 182 was assessed.

5.Number of Participants with Maximum Attack Severity During Treatment Period of Day 0 Through Day 182
Time Frame: Day 0 through Day 182
Number of participants with maximum attack severity during treatment period of day 0 through day 182 was assessed. Angioedema attack severity was calculated per participant based on the severity categories as follows: No attack, Mild, Moderate, and Severe.

6.Number of Investigator-Confirmed Moderate or Severe Angioedema Attacks During the Presumed Steady State Period of Day 70 Through Day 182
Time Frame: Day 70 through Day 182
Number of investigator-confirmed moderate or severe angioedema attacks during the presumed steady state period of day 70 through day 182 was assessed.

7.Number of Participants with Maximum Attack Severity During Presumed Steady State Period of Day 70 Through Day 182
Time Frame: Day 70 through Day 182
Number of participants with maximum attack severity during the presumed steady state period of day 70 through day 182 was assessed.

8.Time to First Angioedema Attack After Day 0 Through Day 182
Time Frame: Day 0 Through Day 182
The time to the first angioedema attack (days) after Day 0 for the efficacy evaluation period of Day 0 through Day 182 was calculated from the date and time of the first dose of lanadelumab for the efficacy evaluation period (Day 0 through Day 182) to the date and time of the first in angioedema attack after the first dose for the efficacy evaluation period of Day 0 through Day 182.

9.Time to First Angioedema Attack After Day 70 Through Day 182
Time Frame: Day 70 through Day 182
The time to the first angioedema attack (days) after Day 0 for the efficacy evaluation period of Day 70 through Day 182 was calculated from the date and time of the first dose of lanadelumab for the efficacy evaluation period (Day 70 through Day 182) to the date and time of the first in angioedema attack after the first dose for the efficacy evaluation period of Day 70 through Day 182.

10.Number of Participants Achieving at Least 50 %, 70%, 90% and 100% Reduction in the Investigator-Confirmed Normalized Number of Attacks (NNA) per 4 Weeks during each of the Efficacy Evaluation Periods Relative to the Observation Period NNA
Time Frame: Day 0 Through Day 182
The normalized number of investigator-confirmed angioedema attacks (NNA) during each efficacy evaluation period was expressed as a monthly (28 days) angioedema attack rate. Number of participants achieving at least 50 percent (%), 70%, 90% and 100% reduction in the investigator-confirmed normalized number of attacks per 4 weeks during each of the efficacy evaluation periods relative to the observation period NNA was assessed. The percentage reduction groups are not mutually exclusive, participants may appear in more than one group as applicable based on their percentage reduction.

11.Number of Participants Achieving Normalized Number of Attacks (NNA) Less than (<)1.0 per 4 weeks During Each of the Efficacy Evaluation Periods
Time Frame: Day 0 Through Day 182, Day 70 through Day 182
The normalized number of investigator-confirmed angioedema attacks (NNA) during each efficacy evaluation period was expressed as a monthly (28 days) angioedema attack rate. Number of participants achieving normalized number of attacks < 1.0 per 4 weeks during each of the efficacy evaluation periods was assessed. The percentage reduction groups are not mutually exclusive, participants may appear in more than one category as applicable based on their percentage reduction.

12.Number of Participants with Treatment Emergent Adverse Events (TEAEs) Including Adverse Events of Special Interest (AESI) and Serious Adverse Events (SAEs)
Time Frame: From start of the study up to follow up (Day 196)
A TEAE was defined as any event emerging or manifesting at or after the initiation of treatment with an investigational product (IP) or medicinal product or any existing event that worsens in either intensity or frequency following exposure to the IP or medicinal product. A SAE is any untoward clinical manifestation of signs, symptoms or outcomes (whether considered related to investigational product or not and at any dose: results in death, is life-threatening, requires inpatient hospitalization or prolongation of hospitalization, results in persistent or significant disability/incapacity, congenital abnormality/birth defect, an important medical event. AESI included hypersensitivity reactions. Number of participants with TEAEs including AESI and SAE was assessed. As pre-specified in protocol, TEAEs, SAEs and AESIs were collected for treatment and follow up periods thus the data is reported accordingly.

13.Plasma Concentrations of Lanadelumab
Time Frame: Pre-dose and post-dose at Day 0, 4, 14, 28, 56, 84, 112, 140, 168 and 182

14.Plasma Kallikrein (pKal) Activity
Time Frame: Pre-dose and post-dose at Day 4, 14, 28, 56, 84, 112, 140, 168 and 182
Plasma Kallikrein activity was measured by biomarker cleaved high molecular weight kininogen (cHMWK) level to assess pharmacodynamics of lanadelumab.

15.Number of Participants With Neutralizing or Non-neutralizing Antidrug Antibodies (ADA) in Plasma
Time Frame: Pre-dose and post-dose at Day 28, 56, 84, 112, 140, 168 and 182
Number of participants with neutralizing or non-neutralizing antidrug antibodies in plasma was assessed.

16.Number of Participants With Change in Total Angioedema Quality of life (AE-QoL) Questionnaire Score During the Treatment Period of Day 0 Through Day 182
Time Frame: Baseline through Day 182
The AE-QoL questionnaire was a self-administered validated instrument to assess health related (HR)QoL among participants with recurrent angioedema. The AE-QoL consisted of 17 disease-specific quality-of-life items, to produce a total AEQoL score and 4 domain scores (functioning, fatigue/mood, fear/shame, and nutrition) and each of the 17 items has a five point response scale ranging from 0 (Never) to 4 (Very Often). The raw total score (mean of all item scores) was rescaled using linear transformations into final percentage scores ranging 0 to 100.

Key inclusion & exclusion criteria

• Age minimum: >= 12age old
• Age maximum: Not applicable
• Gender: Both

Include criteria

1.Males and females, 12 years of age and older for participants with non-histaminergic normal C1-INH angioedema at the time of signing of the informed consent form (ICF).
2.Documented clinical history of recurrent attacks of angioedema in the absence of wheals/urticaria.
3.Investigator-confirmed diagnosis of non-histaminergic bradykinin-mediated angioedema with normal C1-INH as documented by a history of angioedema attack(s) at screening and occurrence of attacks during the observation period:
-History of recurrent angioedema with at least an average of 1 angioedema attack per 4 weeks prior to screening and this attack rate must be confirmed during the observation period while treated with chronic high-dose antihistamine (cetirizine 40 milligram per day [mg/day] or equivalent high-dose second-generation antihistamine medication).
-Diagnostic testing results obtained during screening from a sponsor-approved central laboratory that confirm C1-INH function >=50 percent (%) of normal and C4 level not below the normalrange. With prior sponsor approval, participants may be retested during the observation period if results are incongruent with clinical history.
-Clinical history of not responding to high-dose antihistamine treatment (cetirizine 40 mg/day or equivalent high-dose second-generation antihistamine medication), which must be confirmed during the observation period with at least 1 angioedema attack per 4 weeks with chronic high-dose antihistamine treatment and no significant difference (as assessed by the investigator and in consultation with the sponsor's medical monitor, as necessary) from the historic attack rate without high-dose antihistamine treatment.
4.Agree to adhere to the protocol-defined schedule of treatments, assessments, and procedures.
5.Participants >= 18 years of age must be willing to use icatibant as the rescue medication during the observation and treatment period. During the observation period, participants need to be treated with icatibant for at least 2 angioedema attacks or at least 1 moderate or severe attack. In the opinion of the investigator, participants with no response to icatibant for acute angioedema attacks in the past medical history/screening, or no improvement or worsened attack severity 2 hours after icatibant treatment during the observation period (based on totality of assessments), will not be included. Note: For participants 12 to less than (<) 18 years of age, standard of care therapy per local protocols should be provided.
6.Males, or non-pregnant, non-lactating females who are of child-bearing potential and who agree to be abstinent or agree to comply with the applicable contraceptive requirements of this protocol for the duration of the study. Female participants of childbearing potential must have a negative serum pregnancy test at screening and must be willing to undergo pregnancy tests throughout the study. Females of non-childbearing potential are defined as surgically sterile (status post hysterectomy, bilateral oophorectomy, or bilateral tubal ligation) or post-menopausal for at least 12 months.
7.The participants (or the participant's parent/legal guardian, if applicable) has provided written informed consent approved by the institutional review board/research ethics board/ethics committee (IRB/REB/EC).
8.If the participants is an adult, be informed of the nature of the study and provide written informed consent before any study-specific procedures are performed.
OR
If the participants is a minor (i.e. < 18 years of age), have a parent/legal guardian who is informed of the nature of the study provide written informed consent (i.e. permission) for the minor to participate in the study before any study-specific procedures are performed. Assent will be obtained from minor participants.

Exclude criteria

1.Concomitant diagnosis of Type I or Type II HAE, or recurrent angioedema associated with urticaria.
2.Dosing with any investigational drug or exposure to an investigational device within 4 weeks prior to screening.
3.Exposure to angiotensin-converting enzyme (ACE) inhibitors or rituximab within 6 months prior to screening.
4.Use of any estrogen-containing medications with systemic absorption (such as oral contraceptives or hormonal replacement therapy) within 4 weeks prior to screening.
5.Response to omalizumab (prophylactic) or corticosteroid (acute/prophylactic) or epinephrine (acute) or anti-leukotrienes (prophylactic) treatments in the past.
6.Use of long-term prophylactic therapy for HAE, e.g. C1-INH, attenuated androgens (e.g. danazol, methyltestosterone, testosterone), or anti-fibrinolytics within 2 weeks prior to entering the observation period as long as the investigator determines that doing so would not place the participant at any undue safety risk, and that the participant is at least 18 years of age.
7.Any exposure to prophylactic plasma kallikrein inhibitors prior to screening.
8.Use of short-term prophylaxis for HAE within 7 days prior to entering the observation period. Short-term prophylaxis is defined as C1-INH, attenuated androgens, or anti-fibrinolytics used to avoid angioedema complications from medically indicated procedures.
9.Have any active infectious illness or fever defined as an oral temperature greater than (>) 38C (100.4F), tympanic > 38.5C (101.3F), axillary > 38C (100.4F), or rectal/core > 38.5C (101.3F) within 24 hours prior to the first dose of study drug in the treatment period. (C; degree Celsius, F; degree Fahrenheit)
10.Any of the following liver function test abnormalities: alanine aminotransferase (ALT) > 3x upper limit of normal, or aspartate aminotransferase (AST) > 3x upper limit of normal, or total bilirubin > 2x upper limit of normal (unless the bilirubin elevation is a result of Gilbert's syndrome).
11.Pregnancy or breast feeding.
12.Participant has a known hypersensitivity to the investigational product or its components.
13.Have any uncontrolled underlying medical condition which would require treatment adjustment during the study treatment period that, in the opinion of the investigator or sponsor, may confound the results of the safety assessments or may place the participant at risk. Participants with stable treatment for at least 3 months prior to screening and NOT expecting any change to their treatment regimen for 6 months during the study treatment period, will not be excluded.
14.Have any condition (surgical or medical) that, in the opinion of the investigator or sponsor, may compromise their safety or compliance, preclude the successful conduct of the study, or interfere with interpretation of the results (e.g. significant pre-existing illness or other major comorbidities that the investigator considers may confound the interpretation of study results).

Related Information

• Primary Sponsor: Nishizawa Atsushi
• Secondary ID(s): NCT04206605,2019-001703-20