Efficacy and Safety Study of Benralizumab in Patients With Uncontrolled Asthma on Medium to High Dose Inhaled Corticosteroid Plus LABA (MIRACLE)

A Multicentre, Randomised, Double-blind, Parallel Group, Placebocontrolled, Phase 3 Efficacy and Safety Study of Benralizumab (MEDI-563) Added to Medium to High-dose Inhaled Corticosteroid Plus Long-acting β2 Agonist in Patients With Uncontrolled Asthma.

This is a randomised, double-blind, parallel group, placebo-controlled study designed to evaluate the efficacy and safety of a fixed 30 mg dose of benralizumab administered subcutaneously for patients with a history of asthma exacerbations and uncontrolled asthma receiving medium to high-dose inhaled corticosteroid plus long-acting β2-agonist (ICS-LABA) with or without oral corticosteroids and additional asthma controllers.

Study Overview

• Status: Completed
• Conditions: Asthma
• Intervention / Treatment: Biological: Benralizumab; Biological: Placebo

Detailed Description

Approximately 666 patients will be randomised. Patients will be stratified by country/region, age group (adult or adolescent), and peripheral blood eosinophil count at time of Visit 1 (<300 or ≥300 cells/μL).All the patients will be randomised to either placebo or benralizumab (1:1 ratio) for a 48-weeks treatment, every 4 weeks for the first 3 doses and then every 8 weeks thereafter.

• Study Type: Interventional
• Enrollment (Actual): 695
• Phase: Phase 3

Contacts and Locations

Study Locations

• China
  • Baotou, China, 14010
    • Research Site
  • Beijing, China, 100020
    • Research Site
  • Beijing, China, 100730
    • Research Site
  • Beijing, China, 100034
    • Research Site
  • Beijing, China, 100037
    • Research Site
  • Beijing, China, 100050
    • Research Site
  • Changsha, China, 410004
    • Research Site
  • Changsha, China, 410015
    • Research Site
  • Changzhi, China, 46000
    • Research Site
  • Chengdu, China, 610041
    • Research Site
  • Chengdu, China, 611130
    • Research Site
  • Chongqing, China, 400038
    • Research Site
  • Foshan, China, 528000
    • Research Site
  • Ganzhou, China, 341000
    • Research Site
  • Guangzhou, China, 510120
    • Research Site
  • Guangzhou, China, 510150
    • Research Site
  • Guangzhou, China, 510080
    • Research Site
  • Guangzhou, China, 510180
    • Research Site
  • Guiyang, China, 550004
    • Research Site
  • Haikou, China, 570311
    • Research Site
  • Hangzhou, China, 310006
    • Research Site
  • Hangzhou, China, 310003
    • Research Site
  • Hangzhou, China, 310009
    • Research Site
  • Hangzhou, China, 310014
    • Research Site
  • Hohhot, China, 010017
    • Research Site
  • Hohhot, China, 10050
    • Research Site
  • Jining, China, 272029
    • Research Site
  • Kunming, China, 650032
    • Research Site
  • Kunming, China, 650051
    • Research Site
  • Lishui, China, 323000
    • Research Site
  • Nanchang, China, 330006
    • Research Site
  • Nanjing, China, 2100008
    • Research Site
  • Nanjing, China, 210009
    • Research Site
  • Nanjing, China, 210029
    • Research Site
  • Neijiang, China, 641000
    • Research Site
  • Qingdao, China, 110016
    • Research Site
  • Qingdao, China, 266000
    • Research Site
  • Shanghai, China, 200032
    • Research Site
  • Shanghai, China, 200433
    • Research Site
  • Shanghai, China, 200025
    • Research Site
  • Shanghai, China, 200072
    • Research Site
  • Shanghai, China, 201199
    • Research Site
  • Shenyang, China, 110001
    • Research Site
  • Shenyang, China, 110015
    • Research Site
  • Taiyuan, China, 030001
    • Research Site
  • Taizhou, China, 225300
    • Research Site
  • Wanzhou, China, 404000
    • Research Site
  • Wuhan, China, 430030
    • Research Site
  • Xiangtan, China, 411100
    • Research Site
  • Xinxiang, China, 453002
    • Research Site
  • Xuzhou, China, 221006
    • Research Site
  • Xuzhou, China, 221009
    • Research Site
  • Yangzhou, China, 225001
    • Research Site
  • Yinchuan, China, 750001
    • Research Site
  • Yinchuan, China, 750004
    • Research Site
  • Zhanjiang, China, 524001
    • Research Site
  • Zhuhai, China, 519099
    • Research Site
  • Zunyi, China, 563100
    • Research Site
• Korea, Republic of
  • Bucheon-si, Korea, Republic of, 14584
    • Research Site
  • Busan, Korea, Republic of, 49241
    • Research Site
  • Cheonan, Korea, Republic of, 330-715
    • Research Site
  • Daejeon, Korea, Republic of, 35365
    • Research Site
  • Gwangju, Korea, Republic of, 61469
    • Research Site
  • Seongnam-si, Korea, Republic of, 13620
    • Research Site
  • Seoul, Korea, Republic of, 03722
    • Research Site
  • Seoul, Korea, Republic of, 05505
    • Research Site
  • Seoul, Korea, Republic of, 03181
    • Research Site
  • Seoul, Korea, Republic of, 03312
    • Research Site
  • Seoul, Korea, Republic of, 08308
    • Research Site
  • Seoul, Korea, Republic of, 04763
    • Research Site
  • Suwon-si, Korea, Republic of, 16499
    • Research Site
  • Uijeongbu-si, Korea, Republic of, 11765
    • Research Site
  • Wonju, Korea, Republic of, 26426
    • Research Site
• Philippines
  • Iloilo City, Philippines, 5000
    • Research Site
  • Manila, Philippines, 1000
    • Research Site
• Taiwan
  • Taipei, Taiwan, 100
    • Research Site
  • Taipei, Taiwan, 112
    • Research Site
  • Taipei, Taiwan, 114
    • Research Site
  • Taoyuan City, Taiwan, 333
    • Research Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 75 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Key Inclusion Criteria:

1. 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.
2. Female and male aged 12 to 75 years, inclusively, at the time of Visit 1. For those patients, who are 17 on the day of Visit 1 but will turn 18 after this day, will be considered an adolescent for the purposes of this trial.
3. History of physician-diagnosed asthma requiring treatment with medium-to-high dose ICS (>250μg fluticasone propionate dry powder formulation equivalents total daily dose) and a LABA, for at least 6 months prior to Visit 1.
4. Additional maintenance asthma controller medications that are locally approved in a country for the treatment of asthma (e.g., leukotriene receptor antagonists (LTRAs), tiotropium, chromone, theophylline, oral corticosteroid), and have been used for at least 30 days prior to Visit 1 are allowed.
5. At least 2 documented asthma exacerbations in the 12 months prior to the date informed consent, and assent when available, during the treatment of medium-to-high dose ICS-LABA that required use of a systemic corticosteroid or a temporary increase from the patient's usual maintenance dose of oral corticosteroid. For patients who are re-screened within 30 days of their screen failure date, the calculation of the 12 month period should be done from the original informed consent, and assent when applicable date.
6. Documented post-bronchodilator (post-BD) reversibility in FEV1 of >12% and >200 mL in FEV1 within 12 months prior to Visit 1. If historical documentation is not available, reversibility must be demonstrated and documented at Visit 2.

7. Fulfilment of at least 1 of the following conditions over the 7 days prior to randomization:

   • >2 days with a daytime or night time symptoms score >1
   • Rescue Short-acting β2 agonist (SABA) use on >2 days
   • ≥1 nocturnal awakening due to asthma
8. Pre-bronchodilator (Pre-BD) FEV1 of <80% predicted (<90% predicted for patients aged 12 to 17 years) at Visit 2.
9. ACQ-6 score > = 1.5 at Visit 2.

Exclusion Criteria:

1. Known history of clinically important pulmonary disease other than asthma (e.g., active lung infection, chronic obstructive pulmonary disease (COPD), bronchiectasis, pulmonary fibrosis, cystic fibrosis, hypoventilation syndrome associated with obesity, lung cancer, alpha 1 anti-trypsin deficiency, and primary ciliary dyskinesia) or ever been diagnosed with pulmonary or systemic disease, other than asthma, that are associated with elevated peripheral eosinophil counts (e.g,. allergic bronchopulmonary aspergillosis/mycosis, Churg-Strauss syndrome, hypereosinophilic syndrome).

2. Known history of 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
   • Influence the findings of the studies or their interpretations
   • Impede the patient's ability to complete the entire duration of study.
3. Acute upper or lower respiratory infections requiring antibiotics or antiviral medication within 30 days prior to the date informed consent, and assent when applicable, is obtained or during the screening period.
4. Any clinically significant abnormal findings in physical examination, vital signs, haematology, clinical chemistry, or urinalysis during screening 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 entire duration of the study.
5. Current smokers or former smokers with a smoking history of > 10 pack-years.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo; Placebo administered subcutaneously	Biological: Placebo; Placebo subcutaneously on study week 0 until study week 40 inclusive.
Experimental: Benralizumab; Benralizumab administered subcutaneously	Biological: Benralizumab; Benralizumab subcutaneously on study week 0 until study week 40 inclusive.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Annual Asthma Exacerbation Rate in Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma for Baseline Eosinophils >=300/uL	Annual asthma exacerbation rate over the 48-week treatment period among benralizumab and placebo groups	From randomization through Study Week 48

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline at Week 48 in Pre-bronchodilator FEV1 (L) Value for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Change from baseline at Week 48 in Pre-bronchodilator FEV1 (L)	From randomization through Study Week 48
Change From Baseline at Week 48 in Total Asthma Symptom Score for for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Daytime and nighttime symptoms are reported using a response scale ranging from 0 to 3 where 0 indicates no asthma symptoms. The total asthma symptom score is the sum of the daytime and nighttime scores and ranges from 0 to 6; a decrease in score indicates symptom improvement.	From randomization through Study Week 48
Change From Baseline at Week 48 in Total Asthma Rescue Medication Use for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Change from baseline at week 48 in total rescue medication use (number of puffs/day)	From randomization through Study Week 48
Change From Baseline at Week 48 in Morning Peak Expiratory Flow (PEF) for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Change from baseline at week 48 in morning PEF	From randomization through Study Week 48
Change From Baseline at Week 48 in Evening Peak Expiratory Flow (PEF) for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Change from baseline at week 48 in evening PEF	From randomization through Study Week 48
Change From Baseline at Week 48 in the Proportion of Night Awakening Due to Asthma and Requiring Rescue Medication for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Change from baseline at Week 48 in proportion of night awakening due to asthma and requiring rescue medication	From randomization through Study Week 48
Change From Baseline at Week 48 in Asthma Control Questionnaire 6 (ACQ-6) for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	ACQ-6 contains one bronchodilator question and 5 symptom questions. Questions are rated from 0 (totally controlled) to 6 (severely uncontrolled). Mean ACQ-6 score is the average of the responses.	From randomization through Study Week 48
Time to First Asthma Exacerbation for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Time to first asthma exacerbation over 48-week treatment period	From randomization through Study Week 48
Number and Percentage of Patients With >=1 Asthma Exacerbations Among Patients Who Were on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Number and percentage of patients with at least one exacerbation over 48-week treatment period	From randomization through Study Week 48
Change From Baseline at Week 48 in Total Score of St. George's Respiratory Questionnaire (SGRQ) for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	The SGRQ is a 50-item PRO instrument developed to measure the HRQoL of patients with airway diseases. The questionnaire is divided into two parts: part 1 consists of 8 items pertaining to the severity of respiratory symptoms in the preceding 4 weeks; part 2 consists of 42 items related to the daily activity and psychosocial impacts of the individual's respiratory condition. The total score indicates the impact of disease on overall HRQoL. This total score is expressed as a percentage of overall impairment, in which 100 represents the worst possible HRQoL and 0 indicates the best possible HRQoL.	From randomization through Study Week 48
Annual Asthma Exacerbation Rate Associated With an Emergency Room/Urgent Care Visit or a Hospitalization for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Annual asthma exacerbation rate associated with an emergency room/urgent care visit or a hospitalization over 48-week treatment period	From randomization through Study Week 48
Number and Percentages of Asthma Specific Health Care Resource Utilization for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Asthma specific health care resource utilization over 48-week treatment period.	From randomization through Study Week 48
The Pharmacokinetics (PK) of Benralizumab as Assessed by Trough Concentration	PK trough concentrations at each visit	week 0, week 24, week 48
The Immunogenicity of Benralizumab as Assessed by the Presence of Anti-drug Antibodies (ADAs)	Anti-drug antibodies (ADA) responses at baseline and post baseline.	Pre-treatment until end of 48-week end of treatment
Percent Change From Baseline at Week 48 in Blood Eosinophil Levels for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils >=300/uL	Percent change from baseline at Week 48 in blood eosinophil levels	From randomization through Study Week 48

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Annual Asthma Exacerbation Rate in Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils <300/uL	Annual asthma exacerbation rate over the 48-week treatment period among benralizumab and placebo groups	From randomization through Study Week 48.
Change From Baseline at Week 48 in Pre-bronchodilator FEV1 (L) Value for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils <300/uL	Change from baseline at Week 48 in Pre-bronchodilator FEV1 (L)	From randomization through Study Week 48
Change From Baseline at Week 48 in Total Asthma Symptom Score for Patients on Medium to High-dose ICS-LABA With Uncontrolled Asthma and Baseline Eosinophils <300/uL	Daytime and nighttime symptoms are reported using a response scale ranging from 0 to 3 where 0 indicates no asthma symptoms. The total asthma symptom score is the sum of the daytime and nighttime scores and ranges from 0 to 6; a decrease in score indicates symptom improvement.	From randomization through Study Week 48

Collaborators and Investigators

• Sponsor: AstraZeneca

Publications and helpful links

Helpful Links

• Redacted CSP
• Redacted SAP
• Redacted CSR Synopsis

Study record dates

Study Major Dates

• Study Start (Actual): September 7, 2017
• Primary Completion (Actual): January 30, 2023
• Study Completion (Actual): January 30, 2023

Study Registration Dates

• First Submitted: May 19, 2017
• First Submitted That Met QC Criteria: June 12, 2017
• First Posted (Actual): June 14, 2017

Study Record Updates

• Last Update Posted (Actual): April 24, 2024
• Last Update Submitted That Met QC Criteria: March 28, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Asthma,; Bronchial Diseases,; Respiratory Tract Diseases,; Lung Diseases,; Obstructive Lung Diseases
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Immune System Diseases; Lung Diseases; Hypersensitivity, Immediate; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity; Asthma; Anti-Asthmatic Agents; Respiratory System Agents; Benralizumab
• Other Study ID Numbers: D3250C00036; 2017-000702-38 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• 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. All request will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
• IPD Sharing Time Frame: AstraZeneca will meet or exceed data availability as per the commitments made to the EFPIA Pharma Data Sharing Principles. For details of our timelines, please rerefer to our disclosure commitment at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
• IPD Sharing Access Criteria: When a request has been approved AstraZeneca will provide access to the de-identified individual patient-level data in an approved sponsored tool . Signed Data Sharing Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information. Additionally, all users will need to accept the terms and conditions of the SAS MSE to gain access. For additional details, please review the Disclosure Statements at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes