This is a multicentre, randomised, open-label, parallel-group, active-controlled, phase IV study to assess the reduction of daily Symbicort® maintenance to anti-inflammatory reliever treatment only in participants with severe eosinophilic asthma on Fasenra® treatment, while maintaining asthma control.
This study will be conducted at 24 study sites in 3-5 countries. The study duration for each participant will be approximately 52-56 weeks. Approximately 240 participants with severe eosinophilic asthma taking high-dose Inhaled corticosteroids/ long-acting β2-agonist (ICS/LABA) who have been treated for severe eosinophilic asthma with at least 3 consecutive doses of Fasenra® and have clinically responded since the start of Fasenra® treatment (defined for the purpose of this study as an Asthma control questionnaire-5 item (ACQ-5 score) \<1.5 at Visit 1 and Visit 2b) will be enrolled into this open-label study. The study consists of a Screening Visit (Visit 1) and 4- to 8-week screening and run-in period (to align the randomisation study visit with the next Fasenra® injection), a reduction period of 32 weeks, and a 16-week maintenance period.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
170
Participants will receive Budesonide 400 μg/formoterol fumarate 12 μg per inhalation or Budesonide 200 μg/formoterol fumarate 6 μg per inhalation.
Participants will receive Benralizumab 30 mg/mL, 1 mL fill volume via subcutaneous injection every 4 weeks for first 3 doses (prior to study inclusion), every 8 weeks thereafter.
Participants will receive Salbutamol sulfate 100 μg per inhalation as needed.
Research Site
Brest, France
Research Site
Dijon, France
Proportion of Patients Who Reduced Their Symbicort® Maintenance Dose at the End of the Reduction Period
Proportion of patients with non-missing Week 32 dose who reduced their Symbicort® maintenance dose at the end of the reduction period (Week 32) to: a) Medium-dose Symbicort® maintenance and reliever therapy (SMART), or b) Low-dose SMART, or c) Symbicort® anti-inflammatory reliever only.
Time frame: At Week 32
Change From Baseline in Asthma Control Questionnaire-5 Item (ACQ-5) Score at the End of the Reduction Period
Change from baseline in the ACQ-5 patient reported outcome. This instrument contains 5 asthma symptom questions, rated from 0 (total control) to 6 (severely uncontrolled). The ACQ-5 score is the mean of the responses. Mean scores ≤0.75 indicate well controlled, scores between \>0.75 and \<1.5 indicate partly controlled, ≥1.5 indicate not well controlled asthma, and individual changes of ≥0.5 are considered to be clinically meaningful. ACQ-5 deterioration is defined as at least a 0.5 unit increase in ACQ-5 score from baseline, and a decrease of at least 0.5 units from baseline indicates improved asthma control.
Time frame: Week 0 (baseline) and at Week 32
Change From Baseline in Standardised Asthma Quality of Life Questionnaire for 12 Years and Older (AQLQ(S)+12) at the End of the Reduction Period
The AQLQ(S)+12 is a Patient-Reported Outcome (PRO) that measures the health-related quality of life experienced by asthma patients. The questionnaire comprises 4 separate domains (symptoms, activity limitations, emotional function, and environmental stimuli). Patients are asked to recall their experiences during the previous 2 weeks before each visit and to score each of the questions on a 7-point scale ranging from 7 (no impairment) to 1 (severe impairment). Range of Total Score = 0 - 7 as it is an average of responses to the individual questions. High score = better quality of life, and low score = poor quality of life. Change of \>0.5 from baseline is considered a meaningful improvement in score.
Time frame: Week 0 (baseline) and at Week 32
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Research Site
Le Kremlin-Bicêtre, France
Research Site
Lille, France
Research Site
Lyon, France
Research Site
Pessac, France
Research Site
Berlin, Germany
Research Site
Bonn, Germany
Research Site
Cottbus, Germany
Research Site
Hamburg, Germany
...and 13 more locations
Number of Patients With no Deterioration in AQLQ(S)+12 at the End of the Reduction Period
The AQLQ(S)+12 is a PRO that measures the health-related quality of life experienced by asthma patients. The questionnaire comprises 4 separate domains (symptoms, activity limitations, emotional function, and environmental stimuli). Patients are asked to recall their experiences during the previous 2 weeks before each visit and to score each of the questions on a 7-point scale ranging from 7 (no impairment) to 1 (severe impairment). AQLQ(S)+12 deterioration was defined as at least a 0.5 unit decrease in AQLQ(S)+12 total score from baseline. Patients with no deterioration include patients with improvement or no change.
Time frame: At Week 32
Number of Patients With no Deterioration in ACQ-5 at the End of the Reduction Period
Change from baseline in the ACQ-5 patient reported outcome. This instrument contains 5 asthma symptom questions, rated from 0 (total control) to 6 (severely uncontrolled). The ACQ-5 score is the mean of the responses. Mean scores ≤0.75 indicate well controlled, scores between \>0.75 and \<1.5 indicate partly controlled, ≥1.5 indicate not well controlled asthma, and individual changes of ≥0.5 are considered to be clinically meaningful. ACQ-5 deterioration is defined as at least a 0.5 units increase in ACQ-5 score from baseline, and a decrease of at least 0.5 units from baseline indicates improved asthma control.
Time frame: At Week 32
Change From Baseline in Pre-bronchodilator Forced Expiratory Volume in 1 Second (FEV1) During the Study Period
The potential for benralizumab-treated patients to maintain lung function while stepping down Symbicort® maintenance treatment was assessed. The FEV1 is the maximal volume of air exhaled in the first second of a forced expiration from a position of full inspiration, expressed in liters. Change from baseline pre-bronchodilator FEV1 calculated as post-baseline pre-bronchodilator FEV1 (L) minus baseline pre-bronchodilator FEV1 (L) for all post-baseline measurement points.
Time frame: At Week 0 (baseline), and at Weeks 8, 16, 24, 32, 40, and 48
Annualised Asthma Exacerbation Rate During the Study Period
Asthma exacerbation rate was assessed. An asthma exacerbation was defined as a worsening of asthma symptoms that led to any of the following: a) Temporary bolus/burst of systemic corticosteroids (≥3 consecutive days); b) Single depo-injectable dose of corticosteroids (equivalent to a 3-day bolus/burst); c) Visit to emergency room/urgent care (treatment \<24 hours) requiring systemic corticosteroids; d) Hospitalization (admission/evaluation ≥24 hours) due to asthma.
Time frame: From Week 0 up to Week 48
Cumulative Total Daily Inhaled Corticosteroids (ICS) Dose, by Period
The cumulative total daily ICS dose (maintenance +reliever) for: a) reduction period; b) maintenance period; c) study period was assessed.
Time frame: Reduction period (From Week 0 up to Week 32); maintenance period (From Week 32 up to Week 48); Study period (Week 0 up to end of maintenance period/ end of study)
Total Daily ICS Dose (Maintenance + Reliever) at the End of the Reduction Period
The mean total daily ICS dose (maintenance + reliever) during the 8 weeks prior to end of the reduction period was assessed.
Time frame: At Week 32
Proportion of Participants Using the Same Symbicort® Daily Dose at the End of the Maintenance Period (Week 48) That They Achieved at the End of the Reduction Period (Week 32)
Proportion of patients using the same Symbicort daily dose at the end of the maintenance period that they achieved at the end of the reduction period. Proportions were based on patients with non-missing Week 32 and Week 48 Symbicort doses.
Time frame: At Week 48
Number of Patients With at Least 1 Exacerbation Occurring From End of the Reduction Period to End of the Maintenance Period
Number of patients with at least 1 exacerbation occurring from end of the reduction period to end of the maintenance period.
Time frame: From Week 32 to Week 48
Total Daily ICS Dose From the End of the Reduction Period to the End of the Maintenance Period
Total daily ICS dose from the end of the reduction period to the end of the maintenance period.
Time frame: Week 32, Week 40, and Week 48
Change in ACQ-5 From the End of the Reduction Period to the End of the Maintenance Period
Change in ACQ-5 score from end of reduction to end of maintenance is reported. This instrument contains 5 asthma symptom questions, rated from 0 (total control) to 6 (severely uncontrolled). The ACQ-5 score is the mean of the responses. Mean scores ≤0.75 indicate well controlled, scores between \>0.75 and \<1.5 indicate partly controlled, ≥1.5 indicate not well controlled asthma, and individual changes of ≥0.5 are considered to be clinically meaningful. ACQ-5 deterioration is defined as at least a 0.5 unit increase in ACQ-5 score from baseline, and a decrease of at least 0.5 units from baseline indicates improved asthma control.
Time frame: From Week 32 to Week 48
Change in AQLQ(S)+12 From the End of the Reduction Period to the End of the Maintenance Period
Change in AQLQ(S)+12 from the end of the reduction period to the end of the maintenance period is reported. The AQLQ(S)+12 is a Patient-Reported Outcome (PRO) that measures the health-related quality of life experienced by asthma patients. The questionnaire comprises 4 separate domains (symptoms, activity limitations, emotional function, and environmental stimuli). Patients are asked to recall their experiences during the previous 2 weeks before each visit and to score each of the questions on a 7-point scale ranging from 7 (no impairment) to 1 (severe impairment). Range of Total Score = 0 - 7 as it is an average of responses to the individual questions. High score = better quality of life, and low score = poor quality of life. Change of \>0.5 from baseline is considered a meaningful improvement in score.
Time frame: From Week 32 to Week 48
Change in FEV1 From the End of the Reduction Period to the End of the Maintenance Period
The change from the end of the reduction period to the end of the maintenance period for pre-bronchodilator Forced Expiratory Volume in 1 second (FEV1) was calculated as Week 48 pre-bronchodilator FEV1 (Liter \[L\]) minus the maintenance period baseline pre-bronchodilator FEV1 (L). The FEV1 is the maximal volume of air exhaled in the first second of a forced expiration from a position of full inspiration, expressed in liters.
Time frame: From Week 32 to Week 48
Number of Patients That Met Each Composite Endpoint Defining Clinical Remission
The number of patients meeting each individual component of the composite endpoint defining clinical remission (zero exacerbations, ACQ-5 \< 1.5, or ACQ-5 \<= 0.75, \< 10% FEV1 deterioration) at the end of reduction and maintenance periods were assessed.
Time frame: At Week 32 and Week 48
Number of Patients That Met 0, 1, 2, and All 3 Composite Remission Endpoints
Clinical remission in patients at end of the reduction and maintenance periods was assessed. A remission score, assigning 1 point for each clinical remission component achieved at week 32 or week 48,was calculated for patients who met 0, 1, 2, and all 3 remission criteria (zero exacerbations,ACQ-5 \< 1.5, or ACQ-5 \<= 0.75,\< 10% FEV1 deterioration). Total remission score ranges from 0 to 3. The higher the score, the more components of remission the patient achieved.
Time frame: At Week 32 and Week 48
Number of Patients With Adverse Events or Serious Adverse Events
The safety and tolerability of benralizumab in patients with severe asthma, while stepping down Symbicort® maintenance treatment and maintaining asthma symptom control was assessed.
Time frame: From Week 0 (randomization) to Week 48 or end of treatment (total period of study is 2.5 years)