This is a randomized, double-blind, comparative, parallel-group study of the efficacy and safety of Genolar® and Xolair® in the treatment of persistent atopic bronchial asthma of moderate and severe course, whose symptoms are insufficiently controlled by the 4-step treatment GINA (2017)
There is an increasing incidence of bronchial asthma (BA) and other allergic diseases around the world. Bronchial asthma suffers from 4 to 10% of the world population, in Russian Federation, the incidence of BA across the adult population ranges from 2.2 to 5-7%, in the child population is about 10%. Severe BA is associated not only with frequent hospitalizations and increased mortality but also with high treatment costs. As to it, there is a hot button issue of developing new drugs for treating patients not to be achieved effectively with standard therapy. Considering the leading pathogenesis role of IgE-mediated allergy, the use of drugs to block IgE makes it possible to control the disease at the earliest allergic reaction phase of the development. It was shown that the IgE elimination from the mast cells and basophils surface reduced the severity of acute allergic reactions, reduced the allergen-induced late phase of the immune response and infiltration with inflammatory cells. These anti-IgE antibodies effects have been shown in various studies. Genolar® (omalizumab) (JSC "GENERIUM", the Russian Federation) is a humanized recombinant monoclonal antibody selectively binding to immunoglobulin (IgE) and is a biosimilar of Xolar® ("Novartis Pharma AG", Switzerland). This III phase study is aimed to compare the effectiveness, safety and immunogenicity of Genolar® (JSC "GENERIUM", Russia) and Xolair® to register of the drug Genolar® (JSC "GENERIUM", the Russian Federation), a lyophilizate for subcutaneous administration, in the Russian Federation. The study included patients (n = 192) aged 18 to 75 years with moderate to severe persistent atopic bronchial asthma. The diagnosis was documented for ≥1 year. The symptoms of the disease were insufficiently controlled by therapy corresponding to the 4th stage of treatment (GINA, 2017) during ≥2 months before screening. With block randomization, the patients were divided into two groups in a 2: 1 ratio: in group 1 - 127 patients received treatment with Genolar® for 52 weeks ± 3 days, in group 2 - 64 patients received treatment with Xolair® for 26 weeks ± 3 days. The study consisted of a screening period, an induction period for basic treatment standardizing with the using inhaled budesonide + formoterol, a comparative period of treatment with the studied drugs (Genolar® vs. Xolair®) for 26 weeks ± 3 days, and an additional period of continuing treatment with Genolar® for 26 ± 1 week for its long-term immunogenicity study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
192
The experimental drug dose and administration frequency were determined based on baseline IgE concentration (IU / ml) measured before treatment and current body weight (kg). Depending on the initial IgE concentration and body weight the recommended drug dose was from 75 to 600 mg once in 2 or 4 weeks. The experimental drug Genolar® and the reference drug Xolair® were administered subcutaneously for 26 weeks. Budesonide + formoterol inhalation (dosed powder for inhalation, each delivered dose contains 320 μg budesonide and formoterol fumarate dihydrate 9 μg)) 1 inhalation 2 times a day.
The experimental drug dose and administration frequency were determined based on baseline IgE concentration (IU / ml) measured before treatment and current body weight (kg). Depending on the initial IgE concentration and body weight the recommended drug dose was from 75 to 600 mg once in 2 or 4 weeks. The experimental drug Genolar® and the reference drug Xolair® were administered subcutaneously for 26 weeks. Budesonide + formoterol inhalation (dosed powder for inhalation, each delivered dose contains 320 μg budesonide and formoterol fumarate dihydrate 9 μg)) 1 inhalation 2 times a day.
Patients proportion with an investigator rating "excellent" or "good" on the Global Evaluation of Treatment Effectiveness (GETE) scale after 26 weeks of comparative treatment
Global evaluation of treatment effectiveness (GETE) is a validated tool and has been used to evaluate the clinical response to omalizumab in patients with moderate to severe allergic asthma (IgE-mediated).
Time frame: In 26 weeks after comparative treatment beginning (Genolar® vs. Xolair®)
The number of bronchial asthma exacerbations per patient for 26-week period of comparative treatment
An exacerbation is defined as the patient needs to use oral or intravenous glucocorticosteroids (prednisolone) or to increase the dose of inhaled corticosteroids ≥2 times due to an exacerbation of asthma symptoms and a fall in peak expiratory flow (PEF) or forced expectorant volume for 1 sec (FEV1) resistant to treatment with inhalation drugs
Time frame: For 26 weeks after comparative treatment start (Genolar® vs. Xolair®)
Mean PEF change in every 4 weeks compared to PEF baseline in patients treated with Genolar® and Xolar® for 26 weeks of comparative treatment
PEF measures how much air patient can breathe out using the greatest effort. It is used in the monitoring and treatment of asthma to determine treatment efficacy
Time frame: Every 4 weeks for 26 weeks of comparative treatment (Genolar® vs. Xolair®)
FEV1 changes from FEV1 baseline at each visit over 26 weeks of comparative treatment (Genolar® vs. Xolair®)
FEV1 is the amount of air that can be forcefully exhaled in one second. Clinically, the percentage of predicted FEV1 appears to be a valid marker for the degree of airway obstruction with asthma and other respiratory conditions. Together with asthma symptoms and use of inhaled short-acting beta2-agonists, FEV1 is used to classify the severity of asthma and treatment efficacy
Time frame: At the screening, for the Introductory trial period during which the basic therapeutic drug Symbicort Turbuhaler was admitted, before the comparative treatment beginning, in 8, 16, 26 weeks of comparative treatment (Genolar® vs. Xolair®)
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State Budgetary Healthcare Institution "Republican Clinical Hospital named after G.G. Kuvatov"
Ufa, Bashkortostan Republic, Russia
Limited Liability Company "MDP-Medical Group"
Odintsovo, Moscow Oblast, Russia
State Budgetary Healthcare Institution of the Perm Territory "Clinical Medical and Sanitary Unit No. 1
Perm, Perm Territory, Russia
State Budgetary Institution of Health Care of the Leningrad Region "Center for Occupational Pathology"
Saint Petersburg, Sankt-Peterburg, Russia
State Budgetary Healthcare Institution of the Arkhangelsk Region "The First City Clinical Hospital named after E.E. Volosevich"
Arkhangelsk, Russia
Regional State Budgetary Healthcare Institution "Regional Clinical Hospital"
Barnaul, Russia
State Autonomous Healthcare Institution of the Kemerovo Region "Kemerovo Regional Clinical Hospital named after S.V. Belyaev"
Kemerovo, Russia
Municipal budgetary health care institution "Krasnodar City Clinical Emergency Hospital"
Krasnodar, Russia
Joint Stock Company "Outpatient clinic" Medical Regional United System of Contracts"
Moscow, Russia
Federal State Budgetary Institution "Research Institute of Pulmonology of the Federal Medical and Biological Agency"
Moscow, Russia
...and 14 more locations
Patients proportion with an ACQ-5 Asthma Control Questionnaire score ≤0.75 after 26 weeks of treatment
ACQ is a patient-reported tool to assess asthma control in patient ≥ 6 years of age. ACQ was used to evaluate asthma control in patients and treatment efficacy
Time frame: At the screening, before the comparative treatment start, upon 26 weeks of comparative treatment (Genolar® vs. Xolair®) completion
Number of days without asthma symptoms during the 26-week period of comparison treatment (Genolar® vs. Xolair®)
A day without asthma symptoms
Time frame: For 26 weeks of comparative treatment (Genolar® vs. Xolair®)
Neutralizing antibody rate
long-term immunogenicity study of Genolar®
Time frame: Baseline, in 6, 26, 52 weeks of treatment