A Study to Assess Subcutaneous Lirentelimab (AK002) in Chronic Spontaneous Urticaria (MAVERICK)

A Phase 2, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Lirentelimab in Adult Subjects With H-1 Antihistamine Refractory Chronic Spontaneous Urticaria

This is a Phase 2, multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of subcutaneous lirentelimab (AK002) in adult subjects with H-1 antihistamine refractory chronic spontaneous urticaria. Subjects who complete the randomized, double-blind, placebo-controlled treatment period may have the option to enroll in an open-label extension period and receive up to 6 doses of subcutaneous lirentelimab.

Study Overview

• Status: Terminated
• Conditions: Chronic Spontaneous Urticaria
• Intervention / Treatment: Other: Placebo; Drug: Lirentelimab (AK002)

• Study Type: Interventional
• Enrollment (Actual): 127
• Phase: Phase 2

Contacts and Locations

Study Locations

• Germany
  • Augsburg, Germany, 86179
    • Allakos Investigational Site 227-204
  • Berlin, Germany, 12203
    • Allakos Investigational Site 227-201
  • Buxtehude, Germany, 21614
    • Allakos Investigational Site 227-214
  • Darmstadt, Germany, 64297
    • Allakos Investigational Site 227-205
  • Erlangen, Germany, 91054
    • Allakos Investigational Site 227-209
  • Frankfurt, Germany, 60590
    • Allakos Investigational Site 227-208
  • Langenau, Germany, 89129
    • Allakos Investigational Site 227-207
  • Leipzig, Germany, 04103
    • Allakos Investigational Site 227-203
  • Mainz, Germany, 55128
    • Allakos Investigational Site 227-210
  • Mainz, Germany, 55131
    • Allakos Investigational Site 227-202
  • Munich, Germany, 80802
    • Allakos Investigational Site 227-211
  • Osnabrück, Germany, 49074
    • Allakos Investigational Site 227-206
• Poland
  • Lublin, Poland
    • Allakos Investigational Site 227-303
  • Zabrze, Poland
    • Allakos Investigational Site 227-301
  • Łódź, Poland
    • Allakos Investigational Site 227-302
  • Łódź, Poland
    • Allakos Investigational Site 227-304
• United States
  • Alabama
    • Birmingham, Alabama, United States, 35209
      • Allakos Investigational Site 227-024
    • Cullman, Alabama, United States, 35058
      • Allakos Investigational Site 227-068
  • Arizona
    • Phoenix, Arizona, United States, 85021
      • Allakos Investigational Site 227-014
    • Scottsdale, Arizona, United States, 85251
      • Allakos Investigational Site 227-023
  • California
    • Bakersfield, California, United States, 93301
      • Allakos Investigational Site 227-058
    • Los Angeles, California, United States, 90025
      • Allakos Investigational Site 227-026
    • Los Angeles, California, United States, 90045
      • Allakos Investigational Site 227-009
    • Mission Viejo, California, United States, 92691
      • Allakos Investigational Site 227-011
    • Santa Monica, California, United States, 90404
      • Allakos Investigational Site 227-021
    • Upland, California, United States, 91786
      • Allakos Investigational Site 227-031
  • Colorado
    • Colorado Springs, Colorado, United States, 80907
      • Allakos Investigational Site 227-006
  • Florida
    • Jacksonville, Florida, United States, 32256
      • Allakos Investigational Site 227-036
    • Miami, Florida, United States, 33135
      • Allakos Investigational Site 227-062
    • Sarasota, Florida, United States, 34239
      • Allakos Investigational Site 227-041
    • Tampa, Florida, United States, 33607
      • Allakos Investigational Site 227-067
    • Tampa, Florida, United States, 33613
      • Allakos Investigational Site 227-005
  • Georgia
    • Columbus, Georgia, United States, 31904
      • Allakos Investigational Site 227-018
  • Idaho
    • Boise, Idaho, United States, 83706
      • Allakos Investigational Site 227-045
  • Illinois
    • Normal, Illinois, United States, 61761
      • Allakos Investigational Site 227-045
    • River Forest, Illinois, United States, 60305
      • Allakos Investigational Site 227-057
  • Indiana
    • Plainfield, Indiana, United States, 46168
      • Allakos Investigational Site 227-074
  • Kansas
    • Overland Park, Kansas, United States, 66211
      • Allakos Investigational Site 227-047
  • Kentucky
    • Lexington, Kentucky, United States, 40509
      • Allakos Investigational Site 227-051
  • Maryland
    • Baltimore, Maryland, United States, 21224
      • Allakos Investigational Site 227-019
    • Towson, Maryland, United States, 21204
      • Allakos Investigational Site 227-012
    • White Marsh, Maryland, United States, 21162
      • Allakos Investigational Site 227-063
  • Massachusetts
    • Boston, Massachusetts, United States, 02111
      • Allakos Investigational Site 227-016
  • Michigan
    • Ann Arbor, Michigan, United States, 48106
      • Allakos Investigational Site 227-034
    • Detroit, Michigan, United States, 48202
      • Allakos Investigational Site 227-032
    • Farmington Hills, Michigan, United States, 48346
      • Allakos Investigational Site 227-070
  • Minnesota
    • Dilworth, Minnesota, United States, 56529
      • Allakos Investigational Site 227-073
    • Rochester, Minnesota, United States, 55905
      • Allakos Investigational Site 227-052
  • Missouri
    • Saint Louis, Missouri, United States, 63141
      • Allakos Investigational Site 227-008
  • Montana
    • Missoula, Montana, United States, 59808
      • Allakos Investigational Site 227-059
  • New York
    • Brooklyn, New York, United States, 11203
      • Allakos Investigational Site 227-022
    • Great Neck, New York, United States, 11021
      • Allakos Investigational Site 227-007
  • North Carolina
    • Asheville, North Carolina, United States, 28801
      • Allakos Investigational Site 227-002
  • Ohio
    • Cincinnati, Ohio, United States, 45229
      • Allakos Investigational Site 227-013
    • Cincinnati, Ohio, United States, 45236
      • Allakos Investigational Site 227-029
    • Columbus, Ohio, United States, 43235
      • Allakos Investigational Site 227-043
    • Toledo, Ohio, United States, 43617
      • Allakos Investigational Site 227-064
  • Oklahoma
    • Oklahoma City, Oklahoma, United States, 73170
      • Allakos Investigational Site 227-060
  • Oregon
    • Portland, Oregon, United States, 97223
      • Allakos Investigational Site 227-027
  • Pennsylvania
    • Hershey, Pennsylvania, United States, 17033
      • Allakos Investigational Site 227-028
    • Philadelphia, Pennsylvania, United States, 19103
      • Allakos Investigational Site 227-040
  • South Carolina
    • North Charleston, South Carolina, United States, 29420
      • Allakos Investigational Site 227-066
  • Texas
    • Austin, Texas, United States, 78759
      • Allakos Investigational Site 227-055
    • El Paso, Texas, United States, 79903
      • Allakos Investigational Site 227-049
  • Utah
    • Murray, Utah, United States, 84107
      • Allakos Investigational Site 227-039
    • Murray, Utah, United States, 84107
      • Allakos Investigational Site 227-071
  • Wisconsin
    • Greenfield, Wisconsin, United States, 53228
      • Allakos Investigational Site 227-033

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Key Inclusion Criteria:

1. Subject is able to understand the information on the study, has the capacity to consent, and has provided written informed consent.
2. Male and female subjects ≥18 years of age at the time of screening.
3. CSU diagnosis for ≥6 months.
4. Diagnosis of moderate-severe CSU refractory to H1-antihistamine (H1-AH) at a minimum of the licensed dose at the licensed frequency at the time of randomization as defined by the following: presence of hives and itch for ≥6 consecutive weeks prior to Screening Visit 1; UAS7 score (range 0-42) ≥16 and HSS7 score (range 0-21) ≥8 during the 7 days prior to randomization.
5. Subjects that are omalizumab-naïve or omalizumab-exposed.
6. Subjects must be on stable dose of H1-AH, between 1x and 4x of the licensed dose and at the licensed frequency, for treatment of CSU for at least 1 week prior to screening and willing to remain on a stable dose throughout the study.
7. Able and compliant with completing a daily symptom eDiary for the duration of the study and adherent to the study visit schedules.

Key Exclusion Criteria:

1. History of hypersensitivity to the study drugs or their excipients or to drugs of similar chemical classes (i.e., murine, chimeric or human antibodies).
2. Current use of biologics for any indication.
3. Demonstrated lack of primary response to treatment with a biologic therapy (e.g., omalizumab) for the treatment of CSU.
4. Use of any of the following treatments within 4 weeks prior to the baseline visit or any condition that in the opinion of the Investigator is likely to require such treatment(s) during the first 4 weeks of study treatment: (i) immunosuppressive or immunomodulatory drugs, including but not limited to systemic calcineurin inhibitors (e.g., cyclosporin, tacrolimus), mTOR inhibitors (e.g., sirolimus, everolimus), anti-metabolites (e.g., azathioprine, methotrexate, 6-mercaptopurine, leflunomide, mycophenolate mofetil), alkylating agents (e.g., cyclophosphamide), TNF inhibitors (e.g., infliximab, adalimumab), and eosinophil-depleting drugs (e.g., benralizumab, pramipexole); (ii) routine (daily or every other day during 5 or more consecutive days) doses of systemic hydroxychloroquine; (iii) intravenous immunoglobulin (IVIG); (iv) plasmapheresis.
5. Use of oral Janus kinase (JAK) inhibitors within 8 weeks of the baseline visit.
6. Use of any of the following treatments within 3 weeks prior to the baseline visit: (i) H2 antihistamines (H2-AH); (ii) routine (daily or every other day during 5 or more consecutive days) doses of systemic corticosteroids; (iii) regular (daily or every other day) doxepin (oral); (iv) leukotriene receptor antagonists (LTRA) (e.g., montelukast, zafirlukast).
7. H1-AH use at greater than approved doses or greater than local CSU guideline recommended doses after Screening Visit 1.
8. Previous treatment with biologics: (i) any cell-depleting agents including but not limited to rituximab within 6 months prior to the baseline visit or until lymphocyte count returns to normal, whichever is longer; (ii) other biologics, including investigational biologics (e.g., dupilumab, omalizumab, benralizumab, etc) within 5 half-lives if known or 8 weeks prior to the baseline visit, whichever is longer.
9. Planned or anticipated use of any prohibited medication.
10. Subjects having causes other than CSU for their urticaria including symptomatic dermographism, cholinergic urticaria, or any inducible urticaria.
11. Subjects with known or suspected urticarial vasculitis.
12. Subjects with known or suspected hereditary angioedema.
13. Any other skin disease associated with chronic itch, including atopic dermatitis, that in the Investigator's opinion might influence study outcome and subject's interpretation of symptoms caused by CSU.
14. A helminth parasitic infection diagnosed within 6 months prior to the date that informed consent is obtained and has not been treated with or has failed to respond to standard-of-care therapy.
15. Participation in a concurrent interventional study with the last intervention occurring within 30 days prior to study drug administration (or 90 days or 5 half-lives, whichever is longer, for biologic products).
16. Vaccination with live attenuated vaccines within 30 days prior to initiation of treatment in the study, during the treatment period, or vaccination expected within 5 half-lives (4 months) of study drug administration. This exclusion criterion does not apply to all types and formulations of vaccines (including live attenuated vaccines) currently authorized/approved by FDA or other regulatory authority for the prevention of COVID-19, which may be administered before, during, or after the study. The vaccine should not be administered within 3 days before and within 3 days after the administration of lirentelimab so that any side effects caused by either of the 2 medications can more easily be determined.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Other: Placebo; Placebo
Experimental: Lirentelimab (AK002); Subjects in this arm will receive lirentelimab (AK002) administered subcutaneously.	Drug: Lirentelimab (AK002); Lirentelimab (AK002) is a humanized non-fucosylated immunoglobulin G1 (IgG1) monoclonal antibody directed against Siglec-8; Other Names: AK002

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Absolute Change in Weekly Urticaria Assessment Score (UAS7) From Baseline at Week 12	The UAS7 is the sum for 7 days of the daily Hives Severity Score (HSS) and the daily Itch Severity Score (ISS). The daily HSS is recorded on a scale of 0 (none) to 3 (>50 hives) and the daily ISS is recorded on a scale of 0 (none) to 3 (severe). Therefore, the possible range of the weekly UAS7 score is 0-42, with 42 being the most severe.	Baseline to Week 12

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Absolute Change in Hives Severity Score (HSS7) From Baseline at Week 12	The severity of hives will be recorded by all subjects once daily on a scale of 0 (none) to 3 (> 50 hives). A weekly HSS score (HSS7) is derived by adding the average daily scores of the 7 days preceding the visit. Therefore, the possible range of the weekly score is 0 - 21.	Baseline to Week 12
Absolute Change in Itch Severity Score (ISS7) From Baseline at Week 12	The severity of itching will be recorded by all subjects once daily on a scale of 0 (none) to 3 (severe). A weekly ISS score (ISS7) is derived by adding the average daily scores of the 7 days preceding the visit. Therefore, the possible range of the weekly score is 0 - 21.	Baseline to Week 12
Proportion of Subjects Achieving Weekly Urticaria Assessment Score (UAS7)=0 at Week 12	The UAS7 is the sum for 7 days of the daily Hives Severity Score (HSS) and the daily Itch Severity Score (ISS). The possible range of the UAS7 is 0-42.	At Week 12

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety and Tolerability of up to 6 Doses of Open-label AK002 in Subjects With Chronic Spontaneous Urticaria in the Open-label Extension Period	Adverse events were assessed throughout the open-label extension period.	Through study completion, up to 34 weeks (open-label extension period)

Collaborators and Investigators

• Sponsor: Allakos Inc.
• Investigators: Study Director: Chin Lee, MD, MPH, Allakos Inc.

Study record dates

Study Major Dates

• Study Start (Actual): October 26, 2022
• Primary Completion (Actual): December 27, 2023
• Study Completion (Actual): April 18, 2024

Study Registration Dates

• First Submitted: September 1, 2022
• First Submitted That Met QC Criteria: September 1, 2022
• First Posted (Actual): September 6, 2022

Study Record Updates

• Last Update Posted (Actual): September 27, 2024
• Last Update Submitted That Met QC Criteria: September 24, 2024
• Last Verified: September 1, 2024

More Information

Terms related to this study

• Keywords: Urticaria; Chronic Urticaria; Chronic Idiopathic Urticaria; Chronic Spontaneous Urticaria; Chronic Autoimmune Urticaria; Idiopathic Chronic Urticaria; Autoimmune Urticaria
• Additional Relevant MeSH Terms: Pathologic Processes; Skin Diseases; Immune System Diseases; Hypersensitivity, Immediate; Disease Attributes; Skin Diseases, Vascular; Hypersensitivity; Chronic Disease; Urticaria; Chronic Urticaria
• Other Study ID Numbers: AK002-027

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No