STEP: Phase IIIb Study of Benralizumab to Step-down Maintenance Therapy in Patients With Severe Eosinophilic Asthma (STEP)
STEP: A Prospective, Interventional, Multicenter, Single-Arm Phase 3b Study to Evaluate the Step-Down of Maintenance Therapy in Patients With Severe Eosinophilic Asthma Treated With Benralizumab
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
The study population will be approximately 440-520 patients on MD/HD ICS/LABA with and without LTRA or LAMA or theophylline and meeting study inclusion and exclusion criteria in China. After patients sign the informed consent, they will undergo a screening visit (Visit 1, Week -1 to Week 0) to assess eligibility criteria. Patients who meet eligibility criteria and complete study baseline assessments will enter the study and receive the first dose of benralizumab at visit 2 (Week 0).
The benralizumab treatment includes 4 phases: Induction Phase (16 weeks), Reduction Phase (24 weeks), Maintenance Phase (16 weeks) and Follow-up Phase (4 weeks). After initiation of benralizumab 30 mg administered subcutaneously every 4 weeks (Q4W) for the first 3 doses (Visits 2 to 4), then every 8 weeks (Q8W) thereafter.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Contact
Study Contact
- Name: AstraZeneca Clinical Study Information Center
- Phone Number: 1-877-240-9479
- Email: information.center@astrazeneca.com
Study Locations
-
-
-
Beijing, China, 100020
- Research Site
-
Beijing, China, 100730
- Research Site
-
Beijing, China, 100029
- Research Site
-
Beijing, China, 100191
- Research Site
-
Changsha, China, 410011
- Research Site
-
Changsha, China, 410008
- Research Site
-
Changsha, China, 410005
- Research Site
-
Chengdu, China, 610041
- Research Site
-
Chengdu, China, 610072
- Research Site
-
Chengdu, China, 610014
- Research Site
-
Chengdu, China, 610021
- Research Site
-
Chongqing, China, 402260
- Research Site
-
Guangzhou, China, 510515
- Research Site
-
Guangzhou, China, 510630
- Research Site
-
Guangzhou, China, 510280
- Research Site
-
Guangzhou, China, 510163
- Research Site
-
Guilin, China, 541001
- Research Site
-
Guiyang, China, 510630
- Research Site
-
Hangzhou, China, 310006
- Research Site
-
Hangzhou, China, 310009
- Research Site
-
Hefei, China, 230601
- Research Site
-
Hefei, China, 230061
- Research Site
-
Hohhot, China, 10050
- Research Site
-
Hohhot, China, 010010
- Research Site
-
Huzhou, China, 313003
- Research Site
-
Jinan, China, 250012
- Research Site
-
Jinan, China, 250014
- Research Site
-
Jinan, China, 250030
- Research Site
-
Kunming, China, CN-650034
- Research Site
-
Lanzhou, China, 730000
- Research Site
-
Luoyang, China, 471000
- Research Site
-
Nanjing, China, 211100
- Research Site
-
Nanjing, China, 210029
- Research Site
-
Nanning, China, 530021
- Research Site
-
Ningbo, China, 315010
- Research Site
-
Qingdao, China, 266042
- Research Site
-
Shanghai, China, 200032
- Research Site
-
Shanghai, China, 200080
- Research Site
-
Shanghai, China, 200025
- Research Site
-
Shanghai, China, 200065
- Research Site
-
Shanghai, China, 200092
- Research Site
-
Shenyang, China, 110001
- Research Site
-
Shenyang, China, 110004
- Research Site
-
Shenzhen, China, 518039
- Research Site
-
Shenzhen, China, 518036
- Research Site
-
Shenzhen, China, 518101
- Research Site
-
Shenzhen, China, 518001
- Research Site
-
Shijiazhuang, China, 50051
- Research Site
-
Shijiazhuang, China, 054001
- Research Site
-
Suzhou, China, 215004
- Research Site
-
Suzhou, China, 215006
- Research Site
-
Taiyuan, China, 030001
- Research Site
-
Taiyuan, China, 030032
- Research Site
-
Tangshan, China, 63000
- Research Site
-
Tianjin, China, 300192
- Research Site
-
Tianjin, China, 300050
- Research Site
-
Tianjin, China, 300222
- Research Site
-
Weifang, China, 261000
- Research Site
-
Wenzhou, China, 325000
- Research Site
-
Wuhan, China, 430022
- Research Site
-
Wuhan, China, 430060
- Research Site
-
Wuhan, China, 430010
- Research Site
-
Wuhu, China, 241000
- Research Site
-
Xi'an, China, 710061
- Research Site
-
Xi'an, China, 710068
- Research Site
-
Xi'an, China, 710100
- Research Site
-
Xiamen, China, 361004
- Research Site
-
Xinxiang, China, 453100
- Research Site
-
Xuzhou, China, 221009
- Research Site
-
Yangzhou, China, 225001
- Research Site
-
Zhangzhou, China, 363000
- Research Site
-
Zhengzhou, China, 450052
- Research Site
-
Zhengzhou, China, 450003
- Research Site
-
Zhengzhou, China, 450007
- Research Site
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Informed Consent
1.Provision of informed consent prior to any study-specific procedures. Written informed consent, and assent when applicable for study participation must be obtained prior to any study related procedures being performed (local regulations are to be followed in determining the assent/consent requirements for children and parent[s]/guardian[s]) and according to international guidelines and/or applicable local guidelines.
Age 2. Patient must be aged 12-75 years old, inclusively, at the time of Visit 1(Week -1 to Week 0) For those patients, who are 17 on the day of Visit 1(Week -1 to Week 0) but will turn 18 after this day, will be considered an adolescent for the purposes of this study.
Type of Patient and Disease Characteristics 3. Documented history of physician-diagnosed asthma prior to Visit 1
The documentation requirements for demonstrating pulmonary function reversibility are as follows for Screening (Visit 1, Week -1 to Week 0):
For patients diagnosed with asthma ≥1 year prior to enrolment, pulmonary function reports from within 12 months prior to Visit 1 are required: i. If pre- or post-bronchodilator FEV1/FVC ≥70% in reports within 12 months prior to Visit 1: Only objective records of prior reversibility testing confirming asthma diagnosis are required. ii. If both pre- and post-bronchodilator FEV1/FVC <70% in reports within 12 months prior to Visit 1: Must provide objective documentation within 12 months prior to Visit 1 of any of the following:
- Positive bronchodilator response test, or
- Positive bronchial provocation test, or
- Positive PEF diurnal variability (≥10% for adults, ≥13% for children), or
- PEF improvement ≥20% post-bronchodilator, or
- Post-treatment FEV1 improvement ≥12% and ≥200mL after 4 weeks of therapy within 12 months prior to Visit 1, or
- Documented FEV1 variability ≥12% and ≥200mL between two stable visits (non-acute, non-infectious states).
- For patients diagnosed with bronchial asthma <1 year prior to enrollment: Require submission of objective documentation within 12 months prior to Visit 1 of any of the above reversibility criteria.
- For all enrolled patients meeting inclusion/exclusion criteria: Bronchodilator testing will be conducted during the screening period to establish baseline data for further analysis.
Prior to screening (Visit 1, Week -1 to Week 0), patients must have either a documented asthma diagnosis for >6 months or a history of ICS/LABA use for >6 months.
4. Documented diagnosis of severe eosinophilic asthma (EOS≥150 cells/μL at enrollment, and if EOS 150-<300 cells/μL at enrollment, must have EOS≥300 cells/μL at sometime within 1 year before enrollment) 5. Documented current maintenance treatment with MD/HD ICS + LABA with up to one additional controller
- Other acceptable asthma controller includes LTRA and LAMA 6. On stable MD/HD ICS(>250μg fluticasone propionate dry powder formulation equivalents total daily dose) + LABA for ≥2 months prior to enrollment (see Appendix F for medium and high daily ICS doses by formulation) 7. For patients on MD ICS/LABA, stable LTRA or LAMA (≥2 weeks) is allowed 8. Documented at least one exacerbation in the year prior to enrolment
A qualifying historical asthma exacerbation is a symptomatic worsening requiring systemic corticosteroid (i.e., oral, intravenous (IV) or intramuscular; any healthcare setting or temporary increase from a stable maintenance dose of oral corticosteroid) or that resulted in hospitalization or emergency room/urgent care visit.
- Source documentation is required for physician-diagnosed asthma, ICS-LABA use and asthma exacerbations over the prior year. A patient verbal history suggestive of asthma symptoms and/or prior asthma exacerbations, but without supporting documentation, is not sufficient to satisfy these inclusion criteria.
- Examples of acceptable documentation of the asthma disease state and prior asthma exacerbations include clinic visit (primary or specialist Health care provider (HCP)), emergency room/urgent care, or hospital records listing asthma as a current problem, plus documentation of at least 1 asthma exacerbations during the 12 months prior to ICF.
Weight 9. Weight of ≥40 kg. Sex and Contraceptive/Barrier Requirements 10. Male and/or female Contraceptive use by females should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
- Female patients:
- Females not of childbearing potential are defined as females who are either permanently sterilised (hysterectomy, bilateral oophorectomy, or bilateral salpingectomy), or who are postmenopausal. Females will be considered postmenopausal if they have been amenorrhoeic for 12 months prior to Visit 1(Week -1 to Week 0) without an alternative medical cause. The following age-specific requirements apply:
- Females < 50 years old would be considered postmenopausal if they have been amenorrhoeic for 12 months or more following cessation of exogenous hormonal treatment and FSH levels in the postmenopausal range.
- Females ≥ 50 years old would be considered postmenopausal if they have been amenorrhoeic for 12 months or more following cessation of all exogenous hormonal treatment.
- Female patients of childbearing potential must use one highly effective form of birth control. A highly effective method of contraception is defined as one that can achieve a failure rate of less than 1% per year when used consistently and correctly. Females of childbearing potential who are sexually active with a non-sterilised male partner must agree to use one highly effective method of birth control, as defined below, from enrolment throughout the study and until at least 12 weeks after last dose of study intervention. Cessation of contraception after this point should be discussed with a responsible physician.
- The following are not acceptable methods of contraception: periodic abstinence (calendar, symptothermal, post-ovulation methods), withdrawal (coitus interruptus), spermicides only, and lactational amenorrhoea. Female condom and male condom should not be used together.
- All WOCBP must have a negative serum pregnancy test result at Visit 1(Week -1 to Week 0).
- Highly effective birth control methods include: Total sexual abstinence is an acceptable method provided it is the usual lifestyle of the patient (defined as refraining from heterosexual intercourse during the entire period of risk associated with the study treatments) [(periodic abstinence eg, calendar, ovulation,symptothermal, post-ovulation methods), declaration of abstinence for the duration of exposure to study intervention, and withdrawal are not acceptable methods of contraception], a vasectomised partner, Implanon®, bilateral tubal occlusion, intrauterine device/levonorgestrel intrauterine system, Depo-Provera™ injections, oral contraceptive, and Evra Patch™, Xulane™, or NuvaRing®.
Exclusion Criteria:
Medical Conditions
- Unable to commit to the scheduled visits as required by the protocol, or unable to commit to undergoing protocol guided reductions in asthma therapy, as directed by the Investigator.
Clinically important pulmonary disease other than asthma (e.g., active lung infection, chronic obstructive pulmonary disease [COPD], bronchiectasis, pulmonary fibrosis, cystic fibrosis), or ever been diagnosed with pulmonary or systemic disease, other than asthma, that is associated with elevated peripheral eosinophil counts (e.g., allergic bronchopulmonary aspergillosis/mycosis, Churg-Strauss syndrome, hypereosinophilic syndrome).
•Within the 12 months prior to Visit 1, a CT scan is required to exclude related diseases.
- Current smokers at Visit 1 are not allowed. Former smokers with smoking history ≥ 10 pack-years at Visit 1 are not allowed; Former smokers with a smoking history of <10 pack years must have stopped for at least 6 months to be eligible.
- History of alcohol or drug abuse within 12 months prior to Visit 1(Week -1 to Week 0).
- A helminth parasitic infection diagnosed within 24 weeks prior to Visit 1(Week -1 to Week 0) that has not been treated with, or has failed to respond to, standard of care therapy.
- History of anaphylaxis to any biologic therapy.
- Known history of allergy or reaction to any component of the study treatment formulation.
- Respiratory exacerbation requiring use of Systemic corticosteroids (SCS) or acute upper/lower respiratory infection that required antibiotics or antiviral medication within 30 days prior to Visit 1(Week -1 to Week 0). An extension of the screening period up to 3 months is allowed to ensure that a patient recovering from any repiratory exacerbation or acute upper/lower respiratory infection can be included.
- A history of known immunodeficiency disorder, including human immunodeficiency virus.
Current or history of malignancy within 5 years before the screening visit with the following exceptions:
- In-situ carcinoma of the cervix where curative therapy has been completed and patients are in remission for at least 12 months prior to screening.
- Basal cell or superficial squamous skin cancer.
- Patients who have had other malignancies are eligible provided that the patient is in remission and curative therapy was completed at least 5 years prior to the date informed consent was obtained.
Exclusion for any of the following:
- Previous allogeneic bone marrow transplant.
- Non-leucocyte depleted whole blood transfusion within 120 days of genetic sample collection.
Any disorder, including, but not limited to, cardiovascular, gastrointestinal, hepatic, renal, neurological, musculoskeletal, infectious, endocrine, metabolic, haematological, psychiatric, or major physical impairment that is not stable in the opinion of the investigator and could:
- Affect the safety of the patient throughout the study,
- Confound the study results or impact the scientific validity of the data outcome, or
- Impede the patient's ability to complete the entire duration of study.
Prior/Concomitant Therapy
- Oral corticosteroid use during 4 weeks prior to Visit 1(Week -1 to Week 0).
- Use of immunosuppressive medication (including but not limited to: methotrexate, troleandomycin, cyclosporine, azathioprine, intramuscular long-acting depot corticosteroid, or any experimental anti-inflammatory therapy) within 3 months or 5 halflives (whichever is longer) prior to the date informed consent is obtained.
Receipt of any marketed or investigational biologic agent within 4 months or 5 half lives (whichever is longer) prior to Visit 1(Week -1 to Week 0) or receipt of any investigational non biologic agent within 30 days or 5 half-lives (whichever is longest) prior to Visit 1(Week -1 to Week 0). Exception:
- For marketed non-respiratory biologics, it is allowed if the patient is stable on treatment for at least 3 months prior to Visit 1(Week -1 to Week 0) and throughout the study.
- Covid-related prevention and treatment
- Receipt of live attenuated vaccines 30 days prior to the date of first dose of benralizumab.
- Intention to use any concomitant medication that is not permitted or failure to complete the required washout period for a particular prohibited medication.
- Receipt of immunoglobulin or blood products within 30 days prior to the date informed consent is obtained.
- Received bronchial thermoplasty (BT) as treatment of asthma within 12 months prior to Visit 1.
- Received treatment with traditional Chinese herbs or proprietary Chinese medicines that have anti-asthmatic effects (excluding topical Chinese herbs) within 4 weeks prior to Visit 1 (Week -1 to Week 0) Prior/Concurrent Clinical Study Experience
Concurrent participation in another clinical study with an Investigational Product or a post-authorization safety study.
Diagnostic Assessments
Any clinically significant abnormal findings in physical examination, medical history, vital signs, haematology, or clinical chemistry during the enrolment period, which in the opinion of the investigator, may put the patient at risk because of his/her participation in the study, or may influence the results of the study, or the patient's ability to complete the entire duration of the study.
Other Exclusions
- For females only - currently pregnant (confirmed with positive pregnancy test), breast-feeding, or lactating.
- Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site).
- Judgement by the investigator that the patient should not participate in the study if the patient is unlikely to comply with study procedures, restrictions, and requirements.
- Previous enrolment in the present study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Benralizumab
Severe eosinophilic asthma taking medium-high dose ICS/LABA with/without LTRAs, LAMAs will be all treated by study Drug.
|
Severe eosinophilic asthma taking medium-high dose ICS/LABA with/without LTRAs, LAMAs will be enrolled into this single arm treatment.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
To assess the potential for benralizumab treated patients to reduce their standard of care asthma controller regimen in the overall patient populationa and by subgroups of baseline background therapy
Time Frame: within 40 weeks after the first administration
|
Main outcomes: Proportion of patients with at least one controller medication category reduction at end of reduction phase
Supportive outcomes:
|
within 40 weeks after the first administration
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
To assess overall asthma exacerbation rate during the study of severe eosinophilic asthma patients treated with benralizumab in the overall patient population and by subgroups of baseline background therapy
Time Frame: within 56 weeks after first administration
|
Annualized asthma exacerbation rate Defined as Number of exacerbations×365.25/(Follow-Up Date-First Benralizumab dose date+1) |
within 56 weeks after first administration
|
|
To assess standard asthma efficacy measures for benralizumab treated patients when reducing their standard of care asthma controller regimen in the overall patient population a and by subgroups of baseline background therapy
Time Frame: From 16~40 weeks
|
|
From 16~40 weeks
|
|
To assess if reductions in background therapies achieved at end of reduction phase aremaintained until end of maintenance phase in the overall patient population a and by subgroups of baseline background therapy
Time Frame: From 32-56 weeks
|
•Proportion of patients at the end of the maintenance phase who use the same background therapy that they achieved at the end of the reduction phase
|
From 32-56 weeks
|
|
To assess standard asthma efficacy measures for benralizumab treated patients at induction phase in the overall patient population and by subgroups of baseline background therapy
Time Frame: from 0-16 weeks
|
|
from 0-16 weeks
|
|
To assess biomarkers of severe eosinophilic asthma patients treated with benralizumab in the overall patient population and by subgroups of baseline background therapy
Time Frame: from -1 week to 56 week
|
Baseline and follow-up visits, and change from baseline:
|
from -1 week to 56 week
|
|
To assess if reductions in background therapies achieved at end of reduction phase aremaintained until end of maintenance phase in the overall patient population a and by subgroups of baseline background therapy
Time Frame: From 40-56 weeks
|
•Change in ACQ-5, SGRQ and FEV1 from the end of the reduction phase to the end of the maintenance phase
|
From 40-56 weeks
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
To assess the changes in small - airway lung function indicators among patients treated with benralizumab in the overall patient populationa and by subgroups of baseline background therapy over the course of the study
Time Frame: from -1 week to 56 week
|
Change in small - airway lung function indicators from baseline to the end of the maintenance phase:
|
from -1 week to 56 week
|
|
To explore relationship between baseline characteristic and asthma control level at baseline
Time Frame: -1 week
|
Baseline characteristics and asthma control levels at baseline
|
-1 week
|
|
To assess the safety and tolerability of benralizumab during the study in patients with severe eosinophilic asthma, while reducing their standard of care asthma controller regimen and maintaining asthma symptom control
Time Frame: from -1 week to 60 week
|
Frequency of Adverse Events/Serious Adverse Events
|
from -1 week to 60 week
|
|
To assess the safety and tolerability of benralizumab during the study in patients with severe eosinophilic asthma, while reducing their standard of care asthma controller regimen and maintaining asthma symptom control
Time Frame: from -1 week to 56 week
|
Vital Signsb
|
from -1 week to 56 week
|
|
To assess the safety and tolerability of benralizumab during the study in patients with severe eosinophilic asthma, while reducing their standard of care asthma controller regimen and maintaining asthma symptom control
Time Frame: -1 week, 16 week, 40 week, 56 week
|
Laboratory variables (chemistry and hematology)
|
-1 week, 16 week, 40 week, 56 week
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Min Zhang, Professor, ShangHai First General Hospital
- Principal Investigator: HuaHao Shen, Professor, Second Affiliated Hospital, Zhejiang University, School of Medicine
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- D3250L00046
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal Vivli.org. All requests will be evaluated as per the AZ disclosure commitment:
https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. "Yes", indicates that AZ are accepting requests for IPD, but this does not mean all requests will be approved.
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.