Mepolizumab Treatment for Rhinovirus-induced Asthma Exacerbations (MATERIAL)
The Efficacy of Mepolizumab Treatment on Rhinovirus Induced Asthma Exacerbations
Asthma is a chronic inflammatory disorder of the airways characterized by lower respiratory tract (LRT) symptoms such as wheeze, cough and airway obstruction. Patients with asthma frequently suffer from exacerbations, which can be triggered by allergens and, in particular, viral respiratory infections. It has recently been shown that mepolizumab, a humanized monoclonal antibody that neutralizes interleukin(IL)-5, markedly reduces the exacerbation rate in asthma patients with eosinophilic airway inflammation. Previous studies have indicated that in a mixed population (eosinophilic and non eosinophilic) of mild asthma patients, mepolizumab did not have an impact on lung function and asthma symptom scores upon allergen provocation, although it did on markers such as sputum and blood eosinophils. Together, these observations led to the hypothesis that mepolizumab treatment reduces the exacerbation rate by limiting virus-induced asthma exacerbations.
The investigators hypothesize that neutralization of IL-5 during virus infection in patients with allergic asthma:
- Reduces virus-induced bronchial inflammation
- Attenuates virus-induced asthma symptoms, airflow limitation and bronchial hyperresponsiveness.
- Enhances cellular immune responses to the virus.
The aims of this study are to:
- To investigate whether IL-5 neutralization reduces the inflammatory response to viral airway infections in allergic asthma patients
- To investigate whether IL-5 neutralization prevents or reduces asthma symptoms during virus-induced asthma exacerbations
- To investigate whether IL-5 neutralization affects the cellular immune response to viral airway infections in allergic asthma patients
調査の概要
詳細な説明
研究の種類
入学 (予想される)
段階
- フェーズ 3
連絡先と場所
研究場所
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Amsterdam、オランダ、1105 AZ
- 募集
- Academic Medical Center
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主任研究者:
- René Lutter, PhD
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Age between 18 - 50 years
- History of episodic chest tightness and wheezing
- Intermittent or mild persistent asthma according to the criteria by the Global Initiative for Asthma
- Non-smoking or stopped smoking more than 12 months ago and ≤ 5 pack years (PY)
- Clinically stable, no history of exacerbations within the last 6 weeks prior to the study
- Steroid-naïve or those patients who are currently not on corticosteroids and have not taken any corticosteroids by any dosing-routes within 2 weeks prior to the study. Occasional usage of inhaled short-acting beta2-agonists as rescue medication is allowed, prior and during the study
- Baseline FEV1 > 80% of predicted
- Airway hyperresponsiveness, indicated by a positive acetyl-ß-methylcholine bromide (MeBr) challenge with PC20 < 9.8 mg/ml
- Positive skin prick test (SPT) to one or more of the 12 common aeroallergen extracts, defined as a wheal with an average diameter of > 3mm
- No other clinically significant abnormality on medical history and clinical examination
Exclusion Criteria:
- Presence of antibodies directed against RV16 in serum (titer > 4), measured at visit 1
- History of clinical significant hypotensive episodes or symptoms of fainting, dizziness, or light-headedness
- Women who are pregnant, lactating or who have a positive urine pregnancy test at visit 1
- Chronic use of any other medication for treatment of lung disease other than short-acting beta2-agonists
- Participation in any clinical investigational drug treatment protocol within the preceding 3 months
- Ongoing use of tobacco products of any kind or previous usage with ≥ 6 total PY
- Concomitant disease or condition which could interfere with the conduct of the study, or for which the treatment might interfere with the conduct of the study, or which would, in the opinion of the investigator, pose an unacceptable risk to the patient
- People with young children (< 2 years)
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:防止
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:トリプル
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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プラセボコンパレーター:生理食塩水
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3 monthly intravenous infusions with saline
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実験的:Mepolizumab
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3 monthly intravenous infusions of 750 mg
他の名前:
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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FEV1
時間枠:1 day prior and 6 days after RV16 challenge
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Change in pre-bronchodilator FEV1 between day 70 and day 77, i.e. 1 day prior and 6 days after RV16 challenge.
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1 day prior and 6 days after RV16 challenge
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Questionnaire to score asthma and common cold complaints
時間枠:During 14 days following viral infection
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During 14 days following viral infection
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Viral load
時間枠:Day 6 after viral infection
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Viral load in nasal swab and bronchial brushes
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Day 6 after viral infection
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Sputum eosinophils
時間枠:Before and after mepolizumab infusion
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Change in sputum eosinophils
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Before and after mepolizumab infusion
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Cell influx in bronchoalveolar lavage fluid
時間枠:6 days after viral infection
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Influx of neutrophils, eosinophils, macrophages, monocytes, T en B lymphocytes into the lungs
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6 days after viral infection
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Pro-inflammatory cytokines in bronchoalveolar lavage fluid
時間枠:6 days after viral infection
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Measurement of IL-6, IL-8 and IFN-y in bronchoaveolar lavage fluid
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6 days after viral infection
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Antibody production
時間枠:6 weeks after infection
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Anti RV-16 antibodies are measured in serum
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6 weeks after infection
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協力者と研究者
捜査官
- 主任研究者:René Lutter, PhD、Academic Medical Center, Respiratory Medicine
- スタディディレクター:Elisabeth H Bel, MD, PhD、Academic Medical Center, Respiratory Medicine
- スタディディレクター:Peter J Sterk, PhD、Academic Medical Center, Respiratory Medicine
出版物と役立つリンク
一般刊行物
- Haldar P, Brightling CE, Hargadon B, Gupta S, Monteiro W, Sousa A, Marshall RP, Bradding P, Green RH, Wardlaw AJ, Pavord ID. Mepolizumab and exacerbations of refractory eosinophilic asthma. N Engl J Med. 2009 Mar 5;360(10):973-84. doi: 10.1056/NEJMoa0808991. Erratum In: N Engl J Med. 2011 Feb 10;364(6):588.
- Nair P, Pizzichini MM, Kjarsgaard M, Inman MD, Efthimiadis A, Pizzichini E, Hargreave FE, O'Byrne PM. Mepolizumab for prednisone-dependent asthma with sputum eosinophilia. N Engl J Med. 2009 Mar 5;360(10):985-93. doi: 10.1056/NEJMoa0805435.
- Leckie MJ, ten Brinke A, Khan J, Diamant Z, O'Connor BJ, Walls CM, Mathur AK, Cowley HC, Chung KF, Djukanovic R, Hansel TT, Holgate ST, Sterk PJ, Barnes PJ. Effects of an interleukin-5 blocking monoclonal antibody on eosinophils, airway hyper-responsiveness, and the late asthmatic response. Lancet. 2000 Dec 23-30;356(9248):2144-8. doi: 10.1016/s0140-6736(00)03496-6.
- Message SD, Laza-Stanca V, Mallia P, Parker HL, Zhu J, Kebadze T, Contoli M, Sanderson G, Kon OM, Papi A, Jeffery PK, Stanciu LA, Johnston SL. Rhinovirus-induced lower respiratory illness is increased in asthma and related to virus load and Th1/2 cytokine and IL-10 production. Proc Natl Acad Sci U S A. 2008 Sep 9;105(36):13562-7. doi: 10.1073/pnas.0804181105. Epub 2008 Sep 3.
研究記録日
主要日程の研究
研究開始
一次修了 (予想される)
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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