Effect of Mepolizumab in Severe Bilateral Nasal Polyps
Condition: Nasal Polyps
MeSH terms: Nasal Polyps; Polyps
Intervention: Mepolizumab; Placebo; Mometasone furoate
Intervention description: Mepolizumab injection 100 mg/millilitre (mL) is a clear to opalescent, colorless to pale yellow to pale brown sterile solution for SC injection in a single-use, safety syringe.; Placebo is a clear to opalescent, colorless sterile solution for SC injection in a single-use, safety syringe.; All participants will receive mometasone furoate usually 400 micrograms (mcg), 2 actuations (50 mcg/actuation) in each nostril twice daily. Intolerant participants will use 200g (2 actuations [50 g/actuation] in each nostril once daily).
Intervention MeSH terms: Mometasone Furoate
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Enrollment: 414.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: SB240563; Nasal Polyps; Mepolizumab; Phase 3; Parallel group; Efficacy

Summary:

      Nasal polyps (NP) has long been known as chronic inflammatory disease of the nasal mucosa.
      This disease is characterized by the presence of polyps in the upper nasal cavity,
      originating from within the ostiomeatal complex. The presence of polyps can cause long-term
      symptoms such as prominent nasal obstruction, post-nasal drip, loss of smell, and discharge.

      Mepolizumab (SB240563) is an Immunoglobulin G 1 [IgG1], kappa humanized monoclonal antibody
      (mAB) that blocks human interleukin-5 (hIL-5) from binding to the interleukin-5 (IL-5)
      receptor complex expressed on the eosinophil cell surface and thus inhibits signaling.
      Neutralization of IL-5 with mepolizumab has been shown to reduce blood, sputum and tissue
      eosinophils and hence is assumed to be a treatment option in a number of eosinophilic
      diseases including NP.

      The aim of this randomized, double-blind, parallel group, phase 3 (PhIII) study is to assess
      the clinical efficacy and safety of 100 milligram (mg) subcutaneous (SC) mepolizumab as an
      add on to maintenance treatment in adults with severe bilateral NP. The study will include a
      4-week run in period followed by randomization to a 52-week treatment period. Participants
      will receive mepolizumab 100 mg or placebo SC by the investigator or delegate via a
      pre-filled safety syringe every 4 weeks for 52 weeks. Throughout the entire study period (run
      in + treatment period + follow up), participants will receive a standard of care (SoC) for NP
      which consists of daily mometasone furorate (MF) nasal spray, and if required, saline nasal
      douching, occasional short courses of high dose oral corticosteroids (OCS) and/or
      antibiotics. The treatment period will consist of thirteen, 4-weekly doses of mepolizumab or
      placebo. In addition, up to the first 200 randomized participants will be followed up every
      other month for up to a further 6 months after the Visit 15 (7 months post last dose) in
      order to assess maintenance of response and to validate a physiological model derived from
      the previous Phase 2 study. Approximately 400 participants will be randomized (200
      participants per treatment arm) in to the study. Total duration of the study will be 76 weeks
      for first 200 randomized participants and 52 weeks for remainder of participants who are not
      participating in the 6 months no treatment follow up.
    

Eligibility criteria:

        Inclusion Criteria

          -  18 years of age and older inclusive, at the time of signing the informed consent.

          -  Body weight greater or equal to 40 kilogram (kg).

          -  Male or female participants (with appropriate contraceptive methods) to be eligible
             for entry into the study. To be eligible for entry into the study, woman of
             childbearing potential (WOCBP) must commit to consistent and correct use of an
             acceptable method of birth control from the time of consent, for the duration of the
             trial, and for 105 days after last study drug administration.

          -  Participants who have had at least one previous surgery in the previous 10 years for
             the removal of NP. NP Surgery is defined as any procedure involving instruments with
             resulting incision (cutting open) and removal of polyp tissue from the nasal cavity
             (polypectomy). For the purpose of inclusion into this study, any procedure involving
             instrumentation in the nasal cavity resulting in dilatation of the nasal passage such
             as balloon sinuplasty, insertion of coated stents or direct injection of steroids or
             other medication without any removal of NP tissue is not accepted.

          -  Participants with bilateral NP as diagnosed by endoscopy or computed tomography (CT)
             scan.

          -  Presence of at least two of the following symptoms one of which should be either nasal
             blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip) and
             either nasal discharge (anterior/posterior nasal drip); facial pain/pressure;
             reduction or loss of smell for at least 12 weeks prior to screening.

          -  Participants with severe NP symptoms defined as an obstruction VAS symptom score of
             >5.

          -  Severity consistent with a need for surgery as described by:

               1. Participants with an overall VAS symptom score >7,

               2. Participants with an endoscopic bilateral NP score of at least 5 out of a maximum
                  score of 8 (with a minimum score of 2 in each nasal cavity).

          -  Treatment with intranasal corticosteroids (INCS) for at least 8 weeks prior to
             screening.

          -  Capable of giving signed informed consent Exclusion Criteria

          -  As a result of medical interview, physical examination, or screening investigation,
             the physician responsible considers the participant unfit for the study.

          -  Cystic fibrosis

          -  Eosinophilic granulomatosis with polyangiitis (also known as churg strauss syndrome),
             young's, kartagener's or dyskinetic ciliary syndromes.

          -  Antrochoanal polyps

          -  Nasal septal deviation occluding one nostril

          -  Acute sinusitis or upper respiratory track infection (URTI) at screening or in 2 weeks
             prior to screening

          -  Ongoing rhinitis medicamentosa (rebound or chemical induced rhinitis)

          -  Participants who have had an asthma exacerbation requiring admission to hospital
             within 4 weeks of Screening.

          -  Participants who have undergone any intranasal and/or sinus surgery (for example
             polypectomy, balloon dilatation or nasal stent insertion) within 6 months prior Visit
             1.

          -  Participants where NP surgery is contraindicated in the opinion of the Investigator.

          -  Participants with a known medical history of human immunodeficiency virus (HIV)
             infection.

          -  Participants with a known, pre-existing parasitic infestation within 6 months prior to
             Visit 1.

          -  Participants who are currently receiving, or have received within 3 months (or 5 half
             lives - whatever is the longest) prior to first mepolizumab dose, chemotherapy,
             radiotherapy or investigational medications/therapies.

          -  Participants with a history of sensitivity to any of the study medications, or
             components thereof or a history of drug or other allergy that, in the opinion of the
             investigator or GSK medical monitor, contraindicates their participation.
             Aspirin-sensitive participants are acceptable.

          -  Participants with a history of allergic reaction to anti-IL-5 or other monoclonal
             antibody therapy.

          -  Participants on a waiting list for NP surgery while at screening

          -  Participants that have taken part in previous mepolizumab, reslizumab, dupilumab or
             benralizumab studies.

          -  Use of systemic corticosteroids (including oral corticosteroids) or corticosteroid
             nasal solution (intranasal corticosteroid is accepted) within 4 weeks prior to
             Screening or planned use of such medications during the double-blind period.

          -  INCS dose changes within 1 month prior to screening.

          -  Treatments with biological or immunosuppressive treatment (other than omalizumab)
             treatment within 5 terminal phase half lives of Visit 1.

          -  Omalizumab treatment in the 130 days prior to Visit 1.

          -  Commencement of leukotriene antagonist treatment less than 30 days prior to Visit 1.

          -  Allergen immunotherapy within the previous 3 months.

          -  Women who are pregnant or lactating or are planning on becoming pregnant during the
             study.

          -  Participants who currently smoke or have smoked in the last 6 months.

          -  Any participant who is considered unlikely to survive the duration of the study period
             or has any rapidly progressing disease or immediate life-threatening illness (e.g.
             cancer). In addition, any participant who has any other condition (e.g. neurological
             condition) that is likely to affect respiratory function should not be included in the
             study.

          -  Participants who have known, pre-existing, clinically significant endocrine,
             autoimmune, cardiovascular, metabolic, neurological, renal, gastrointestinal, hepatic,
             hematological or any other system abnormalities that are uncontrolled with standard
             treatment.

          -  Immunocompromized, other than that explained by the use of corticosteroids taken as
             therapy.

          -  A current malignancy or previous history of cancer in remission for less than 12
             months prior to Screening. Participants with successfully treated basal cell
             carcinoma, squamous cell carcinoma of the skin, or cervical carcinoma in situ, with no
             evidence of recurrence may participate in the study.

          -  Current active liver or biliary disease (with the exception of gilbert's syndrome or
             asymptomatic gallstones or otherwise stable chronic liver disease per investigator
             assessment).

          -  Corrected QT interval (QTc) >450 milliseconds (msec) or QTc >480 msec in participants
             with bundle branch block at visit 1.

          -  A known or suspected history of alcohol or drug abuse within 2 years prior to
             Screening (Visit 1) that in the opinion of the investigator would prevent the
             participant from completing the study procedures.

          -  An investigator, sub-investigator, study coordinator, employee of a participating
             investigator or study site, or immediate family member of the aforementioned that is
             involved in this study.

          -  In the opinion of the investigator, any participant who is unable to read and/or would
             not be able to complete a questionnaire.