This is first-in-human phase 1/2 clinical trial to evaluate the safety, systemic and local reactogenicity of GNR-127 at the first stage in sequential cohorts of patients with allergic rhinitis with sensitization to the birch pollen, and then to determine and evaluate an effective and safe dose of the GNR-127 after five monthly administrations compared to placebo at the second stage.
Allergic rhinitis (AR) is the most common disease in both children and adults and is a global health problem that affects approximately 400 million people worldwide. AR has a significant impact on the quality of life of patients, disrupting their sleep, physical and social activity. AR is a disease characterized by IgE-mediated inflammation of the nasal mucosa (which develops under the influence of allergens) and the presence of at least two of the following symptoms that occur daily for an hour or more: nasal congestion (obstruction), nasal discharge (rhinorrhea), sneezing, itching in the nasal cavity. AR is often combined with other allergic diseases, such as allergic conjunctivitis, atopic dermatitis, and bronchial asthma. The investigational product GNR-127 is a recombinant vaccine containing the ABP antigen protein, which includes the hypoallergenic peptides Bet v 1 (major birch allergen) and Mal d 1 (apple allergen), as well as the PreS protein of the hepatitis B virus as an immunogenic carrier. The drug is intended for the prevention of allergy to birch pollen - subcutaneous allergen immunotherapy (AIT) in patients suffering from AR with sensitization to birch pollen. This study is a 'first-in-human' clinical trial and is aimed at evaluating the safety, systemic and local reactogenicity, preliminary efficacy and immunogenicity after the use of GNR-127. This study is a two-stage study that combines phase I (Stage 1) and phase II (Stage 2) of a clinical trial. Stage 1 (Phase I) is an open-label safety study of increasing doses of the investigational drug GNR-127 in patients with AR with sensitization to birch pollen. Phase 1 is to evaluate the safety of three doses of GNR-127 and to determine the dose(s) to be studied in Phase 2. Patients enrolled in Phase 1 will continue to participate in the study in the appropriate dose cohort or prematurely complete their participation in the clinical study. Phase 2 (Phase II) to be conducted as a single-blind, randomized, placebo-controlled trial. The main goal of Stage 2 is to determine the effective and safe dose of the investigational product in patients with AR with sensitization to birch pollen.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
150
GNR-127, 20 mcg in 0.5 ml administered 5 times every 4 weeks
GNR-127, 40 mcg in 0.5 ml administered 5 times every 4 weeks
GNR-127, 80 mcg in 0.5 ml administered 5 times every 4 weeks
GNR-127 placebo 0.5 ml administered 5 times every 4 weeks
National Research Center - Institute of Immunology Federal Medical-Biological Agency
Moscow, Russia
Daily Symptom Score (dSS)
According to the dSS scale, the patient will need to assess the presence and severity of 4 symptoms of AR (itchy nose, sneezing, runny nose and nasal congestion) and 2 symptoms of AK (itchy eyes/redness of the eyes and lacrimation) on a 3-point scale, where 0 - no symptoms, 1-mild symptoms (the sign/symptom is clearly present, but causes minimal anxiety; easily tolerated), 2 - moderate symptoms (definite awareness of sign/symptom that is bothersome but tolerable), 3 - severe symptoms (sign/symptom that is hard to tolerate; causes interference with activities of daily living and/or sleeping). 4 nasal and 2 conjunctival symptoms to be assessed from 0 to 3 score each. Total (dayli) symptoms score: 0-3 (max score is 3, i.e. 18 points/divided by 6 symptoms): 0 - no symptoms, 3 - severe symptoms.
Time frame: Up to 3 months after the end of treatment.
Daily Medication Score (dMS)
The use of the following medications that can be used to relieve symptoms of allergic rhinitis and allergic conjunctivitis will need to be evaluated by the patient * Non-sedative H1-antihistamines (H1A) for oral and / or topical use (eyes or nose) = 1 point; * Intranasal corticosteroids (InCS) with / without H1A = 2 points; * Oral corticosteroids with / without InKS, with / without H1A = 3 points. Points are not added up, and the maximum score is set. Thus, the minimum dMS value is 0 and means no need for medication, and the maximum dMS value is 3 and means the need for third-line medications).
Time frame: Up to 3 months after the end of treatment.
Combined Symptom and Medication Score (CSMS)
The eDP automatically calculates total dSS and dMS scores based on the patient's daily scores: * The (Total) Daily Symptoms Score (dSS) is the sum of the scores for each of the symptoms and can range from 0 to 3 points * The (Total) Daily Medication Score (dMS): 0-3 (max score is 3) СSMS= dSS (0-3) + dMS (0-3) CSMS can range from 0 to 6 points, where the minimum value is 0 points and means no symptoms and no need for medication, and the maximum value is 6 points and means the maximum severity of rhinitis symptoms, despite the use of third-line medications.
Time frame: Up to 3 months after the end of treatment.
36-Item Short Form Health Survey (36-SF)
The questionnaire reflects the overall well-being and degree of satisfaction with those aspects of a person's life that are affected by the state of health. The SF-36 consists of 36 questions, grouped into eight scales: Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health. The scores for each scale are constructed so that a higher value (from 0 to 100) indicates a more favorable health state for that particular scale.
Time frame: Day 0, week 16 (end of treatment) and up to 3 months after the end of treatment.
Severity of allergic rhinitis symptoms on a Visual-analog scale (VAS)
VAS is a horizontal graded line 10 cm long on which the patient marks with a vertical line the assessment of the effect of AR on their well - being, expressed in points from 0 to 100 (from 0 to 10 cm), where 0 is the absence of complaints and symptoms, and 100 is the most pronounced manifestations of the disease. Results from 0 to 50 points (5 cm) indicate a controlled course of allergic AR, from 50 points and above (≥5 cm) - an uncontrolled course of AR.
Time frame: Uo to 3 months after the end of therapy.
Antibody level to the Betv1, Mald1 and PreS antigens.
IgG, IgE, IgA, IgM antibody level to all three antigen will be assessed.
Time frame: Day 1, week 8, week 16 and up to 3 months after the end of treatment.
Percentage of the CD3+CD69+ T-cells
Assessment of CD3+CD69+ - percentage of cells expressing the marker and geometric mean fluorescence intensity in peripheral blood cells without in vitro activation.
Time frame: Day 1, week 8, week 16 and up to 3 months after the end of treatment.
Cytokines level
Cytokins level: IL-1β, IFNγ, IL-2, IL-4, IL-5, IL-10, IL-13 will be assessed.
Time frame: Day 1, week 8, week 16 and up th 3 months after the end of treatment.
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