Efficacy and Safety of Tozorakimab in Symptomatic Chronic Obstructive Pulmonary Disease With a History of Exacerbations

AstraZeneca1,454 enrolled

Overview

The purpose of this Phase III study is to evaluate the efficacy and safety of tozorakimab administered subcutaneously (SC) in adult participants with symptomatic COPD with a history of ≥ 2 moderate or ≥ 1 severe exacerbations of COPD in the 12 months prior to enrolment. Participants should be receiving optimised treatment with inhaled maintenance therapy (ICS/LABA/LAMA triple therapy, or dual therapy if triple is not considered appropriate) throughout at least the last 3 months prior to enrolment.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

1,454

Conditions

Chronic Obstructive Pulmonary Disease (COPD)

Interventions

PlaceboDRUG

Placebo administered subcutaneously, equivalent volume to tozorakimab throughout the study.

TozorakimabDRUG

Administered subcutaneously tozorakimab and placebo throughout the study.

Eligibility

Sex: ALLMin age: 40 YearsMax age: 130 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Participant must be ≥ 40 years of age and capable of giving signed informed consent. 2. Documented diagnosis of COPD for at least one year prior to enrolment. 3. Post BD FEV1/FVC \< 0.70 and post-BD FEV1 \>20% of predicted normal value 4. Documented history of ≥ 2 moderate or ≥ 1 severe COPD exacerbations within 12 months prior to enrolment. 5. Documented optimised inhaled dual or triple therapy for at least 3 months prior to enrolment. 6. Smoking history of ≥ 10 pack-years. 7. CAT total score ≥ 10, with each of the phlegm (sputum) and cough items with a score ≥ 2 Exclusion Criteria: 1. Clinically important pulmonary disease other than COPD. 2. Radiological findings suggestive of a respiratory disease other than COPD that is significantly contributing to the participant's respiratory symptoms. Radiological findings of pulmonary nodules suspicious for lung cancer, as per applicable guidances, without appropriate follow up prior to randomisation. Radiological findings suggestive of acute infection. 3. Current diagnosis of asthma, prior history of asthma, or asthma-COPD overlap. Childhood history of asthma is allowed and defined as asthma diagnosed and resolved before the age of 18 4. Any unstable disorder, including, but not limited to, cardiovascular, gastrointestinal, hepatic, renal, neurological, musculoskeletal, infectious, endocrine, metabolic, haematological, psychiatric disorder, major physical and/or cognitive impairment that could affect safety, study findings or participants ability to complete the study. 5. COPD exacerbation, within 2 weeks prior to randomization, that was treated with systemic corticosteroids and/or antibiotics, and/or led to hospitalization. 6. Active significant infection within the 4 weeks prior to randomization, pneumonia within 6 weeks prior to randomization, or medical condition that predisposes the participant to infection. 7. Suspicion of, or confirmed, ongoing SARS-CoV-2 infection. 8. Significant COVID-19 illness within the 6 months prior to enrolment. 9. Unstable cardiovascular disorder. 10. Diagnosis of cor pulmonale, pulmonary arterial hypertension and/or right ventricular failure. 11. History of active severe inflammatory bowel disease or colitis within one year prior to enrolment, or unexplained diarrhoea within the 4 weeks prior to randomisation. 12. History of known immunodeficiency disorder, including a positive test for HIV-1 or HIV 2. 13. History of positive test or treatment for hepatitis B or hepatitis C (except for cured hepatitis C) 14. Evidence of active liver disease, including jaundice during screening. 15. Malignancy, current or within the past 5 years, except for adequately treated non-invasive basal cell and squamous cell carcinoma of the skin and cervical carcinoma-in-situ treated with apparent success more than one year prior to enrolment. Suspected malignancy or undefined neoplasms. 16. Participants who have evidence of active TB. 17. History of partial or total lung resection. 18. Scheduled major surgical procedure during the course of the study. 19. Participants that have previously received tozorakimab. 20. Any clinically significant abnormal findings in physical examination, vital signs, ECG, or laboratory testing during the screening period, which in the opinion of the investigator may put the participant at risk because of their participation in the study, or may influence the results of the study, or the participant's ability to complete the entire duration of the study.

Locations (368)

Outcomes

Primary Outcomes

Annualized rate of moderate to severe COPD exacerbations in participants who are former smokers.

The primary endpoint will be assessed in the primary population (former smokers with symptomatic COPD and a history of exacerbations, on optimised treatment with maintenance inhaled therapy \[triple therapy, or dual therapy if triple is not considered appropriate\]).

Time frame: Over 52 weeks

Secondary Outcomes

Annualized rate of moderate to severe COPD exacerbations in former or current smokers.

The annualized rate will be assessed in the overall population of participants including current and former smokers with symptomatic COPD and history of exacerbations, on optimised treatment with maintenance inhaled therapy.

Time frame: Over 52 weeks

Change from baseline in SGRQ total score from in former smokers

Difference in mean change from baseline in SGRQ total score in former smokers.

Time frame: Over 52 weeks

Change from baseline in SGRQ total score from in the overall population of current and former smokers.

Difference in mean change from baseline in SGRQ total score in the overall population of current and former smokers.

Time frame: Over 52 weeks

Annualized rate of severe COPD exacerbations in former smokers

The rate ratio of severe COPD exacerbations will be assessed in former smokers.

Time frame: Variable duration period up to study completion, approximately 3 years

Annualized rate of severe COPD exacerbations in former or current smokers

The rate ratio of severe COPD exacerbations will be assessed in the overall population of current and former smokers.

Data from ClinicalTrials.gov

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Research Site

Birmingham, Alabama, United States

Research Site

Decatur, Alabama, United States

Research Site

Sheffield, Alabama, United States

Research Site

Phoenix, Arizona, United States

Research Site

Tucson, Arizona, United States

Research Site

Yuma, Arizona, United States

Research Site

Los Angeles, California, United States

Research Site

Newport Beach, California, United States

Research Site

San Francisco, California, United States

Research Site

Westminster, California, United States

...and 358 more locations

Time frame: Variable duration period up to study completion, approximately 3 years

Change from baseline in E-RS:COPD total score in former smokers

Difference in mean change in E-RS:COPD total score from baseline in former smokers.

Time frame: Over 52 weeks

Change from baseline in E-RS:COPD total score in former or current smokers

Difference in mean change in E-RS:COPD total score from baseline in the overall population of current and former smokers.

Time frame: Over 52 weeks

Change from baseline in pre-bronchodilator, pre dose trough FEV1 (mL) in former smokers

Change from baseline in pre-bronchodilator, pre dose trough FEV1 (mL) in former smokers.

Time frame: Over 52 weeks

Change from baseline in pre-bronchodilator, pre dose trough FEV1 (mL) in former or current smokers

Change from baseline in pre-bronchodilator, pre dose trough FEV1 (mL) in the overall population of current and former smokers.

Time frame: Over 52 weeks

Change from baseline in post-bronchodilator FEV1 (mL) in former smokers

Change from baseline in post-bronchodilator FEV1 (mL) in former smokers.

Time frame: Week 52

Change from baseline in post-bronchodilator FEV1 (mL) in former smokers or current smokers

Change from baseline in post-bronchodilator FEV1 (mL) in former smokers or current smokers.

Time frame: Week 52

Annualised rate of COPD exacerbations requiring hospitalisations and/or Emergency Room (ER)/Emergency Department (ED) visits in former smokers

The rate ratio of COPD exacerbations requiring hospitalisations and/or Emergency Room (ER)/Emergency Department (ED) visits in former smokers.

Time frame: Variable duration period up to study completion, approximately 3 years

Annualised rate of COPD exacerbations requiring hospitalisations and/or Emergency Room (ER)/Emergency Department (ED) visits in former or current smokers

The rate ratio of COPD exacerbations requiring hospitalisations and/or Emergency Room (ER)/Emergency Department (ED) visits in former or current smokers.

Time frame: Variable duration period up to study completion, approximately 3 years

Change from baseline in pre-BD, pre-dose trough FEV1 (mL)

Change from baseline in pre-BD, pre-dose trough FEV1 (mL).

Time frame: 52 weeks

Change from baseline in post-BD FEV1 (mL)

Change from baseline in post-BD FEV1 (mL).

Time frame: Over 52 weeks

Time to first moderate to severe COPD exacerbation

Time to first moderate to severe COPD exacerbation compared with placebo.

Time frame: Over 52 weeks

Time to first severe COPD exacerbation

Time to first severe COPD exacerbation compared with placebo.

Time frame: Variable duration period up to study completion, approximately 3 years

Change from baseline in CAT total score

Change from baseline in CAT total score compared with placebo.

Time frame: Week 52

Proportion of participants achieving MCID in CAT score

Proportion of participants achieving MCID in CAT score (percentage of participants with a decrease in CAT total score of ≥ 2 points from baseline).

Time frame: Week 52

Proportion of participants achieving MCID in SGRQ total score

Proportion of participants achieving MCID in SGRQ score (percentage of participants with a decrease in SGRQ total score of ≥ 4 points from baseline).

Time frame: Week 52

Proportion of participants achieving MCID in E-RS:COPD total score

Proportion of participants achieving MCID in E-RS:COPD total score (percentage of participants with a decrease in E-RS:COPD total score of ≥ 2 points from baseline).

Time frame: Week 52

Annualized rate of healthcare resource utilization

Annualized rate of healthcare resource utilization.

Time frame: Variable duration period up to study completion, approximately 3 years

Change from baseline in rescue medication

Change from baseline (difference in mean number of puffs/day) in rescue medication use.

Time frame: Over 52 weeks

Trough serum concentrations of tozorakimab

Pharmacokinetics: concentrations of tozorakimab in trough serum.

Time frame: Over 52 weeks

Presence of anti-drug antibodies

Immunogenicity: presence of tozorakimab anti-drug antibodies in blood serum.

Time frame: Over 52 weeks

Time to death

Time to death (all-cause mortality)

Time frame: Variable duration period up to study completion, approximately 3 years