Study to Evaluate Tezepelumab in Adults With Chronic Spontaneous Urticaria

Study Overview
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Brief Summary
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The primary objective of this study is to evaluate the effect of tezepelumab on improvement in the Urticaria Activity Score over 7 days (UAS7).

Official Title
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A Randomized, Double-Blind, Placebo-Controlled, Multicenter, Dose-Ranging, Phase 2b Study to Evaluate Efficacy and Safety of Tezepelumab for the Treatment of Chronic Spontaneous Urticaria

Conditions
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Chronic Spontaneous Urticaria

Intervention / Treatment
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* Biological: Tezepelumab Dose 1
* Biological: Tezepelumab Dose 2
* Biological: Omalizumab
* Biological: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed informed consent must be obtained prior to participation in the study. Male and female participants ≥ 18 years and ≤ 80 years of age at the time of screening. Chronic spontaneous urticaria (CSU) diagnosis for ≥ 6 months at the time of screening. CSU inadequately controlled by second generation H1-antihistamines (sgAH) at enrollment, as defined by all of the following: The presence of itch and hives for >= 6 consecutive weeks at any time prior to screening visit 2 Failure to respond to an sgAH (up to 4 times the approved dose) Urticaria Activity Score over 7 days (UAS7) (range 0-42) >= 16 and Hives Severity Score over 7 days (HSS7) (range 0-21) >= 8 during the 7 days prior to enrollment Participant with CSU who discontinued, is intolerant to, or was an inadequate responder to anti-IgE therapies despite being treated with omalizumab 300 mg every 4 weeks (Q4W) for 6 months or higher doses of omalizumab > 2 months or another anti-IgE therapy. Note: This criterion is only applicable for anti-IgE-experienced participants. Participant willing and able to complete a daily symptom eDiary for the duration of the study and adhere to the study visit schedules. Subject must have been on a sgAH at approved or increased doses (up to 4x the approved dose) for treatment of CSU for at least 3 consecutive days immediately prior to the day -14 screening visit (screening visit 2) and must have documented current use on the day of screening visit 1 Exclusion Criteria: Disease related, including but not limited to: Urticaria is solely due to inducible urticaria Active dermatologic diseases (or conditions) other than chronic urticaria, with urticaria wheals or angioedema symptoms such as urticarial vasculitis, erythema multiforme, cutaneous mastocytosis (urticaria pigmentosa) and hereditary or acquired angioedema (eg, due to C1 inhibitor deficiency) Any other active skin disease associated with chronic itching that might influence, in the investigator's opinion, the study evaluations and results (eg, atopic dermatitis, dermatitis herpetiformis, senile pruritus, etc.) History of a clinically significant infection within 28 days prior to day 1 that, in the opinion of the investigator or medical monitor, might compromise the safety of the participant in the study, interfere with evaluation of the investigational product, or reduce the participants ability to participate in the study. Evidence of active tuberculosis (TB) (in the opinion of the investigator), either treated or untreated, or a positive purified protein derivative (PPD) or QuantiFERON-TB Gold Plus (QFT-Plus) test for TB during screening. History of malignancy, except for basal cell carcinoma or in situ carcinoma of the cervix treated with apparent success with curative therapy ≥ 12 months prior to screening or other malignancies treated with apparent success with curative therapy ≥ 5 years prior to screening visit 1. Subject is unable to complete an electronic patient diary or complete questionnaires, or does not meet the required level of compliance with the eDiary during the 14 days sgAH stabilization period Other medical conditions History or evidence of severe depression, schizophrenia, previous suicide attempts, or suicidal ideation. Prior/concomitant therapy, including but not limited to: Treatment with any biologic products (eg, omalizumab, ligelizumab) within 4 months or 5 half-lives (whichever is longer) prior to screening visit 1 Routine (daily or every other day for 5 or more consecutive days) use of systemic corticosteroids, systemic hydroxychloroquine, methotrexate, cyclosporine A, cyclophosphamide, tacrolimus, azathioprine, and mycophenolate mofetil within 30 days prior to screening visit 1. Major surgery within 8 weeks prior to screening visit 1 or planned inpatient surgery or hospitalization during the study period. Receipt of Ig or blood products within 30 days prior to screening visit 1. Vaccination with a live or attenuated vaccine within 30 days prior to screening visit 1. Receipt of COVID-19 vaccines and inactive/killed vaccinations (eg, inactive influenza) are allowed, provided the vaccinations are not administered within 7 days before or after any study dosing visit. Known hypersensitivity, including severe hypersensitivity reactions and/or history of anaphylactic shock, to any of the products or components to be administered during dosing or to products of similar chemical classes (ie, to murine, chimeric, or human antibodies.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group 1: Omalizumab<br>Participants naive to anti-IgE therapies will receive omalizumab. | Biological: Omalizumab<br>* Subcutaneous injection.<br>* Other names: Xolair;|
| Placebo Comparator: Group 2: Placebo<br>Participants naive to anti-IgE therapies will receive a placebo. | Biological: Placebo<br>* Subcutaneous injection.<br>|
| Experimental: Group 3: Tezepelumab Dose 1<br>Participants naive to anti-IgE therapies will receive tezepelumab. | Biological: Tezepelumab Dose 1<br>* Subcutaneous injection.<br>* Other names: AMG 157;|
| Experimental: Group 4: Tezepelumab Dose 2<br>Participants naive to anti-IgE therapies will receive tezepelumab. | Biological: Tezepelumab Dose 2<br>* Subcutaneous injection.<br>* Other names: AMG 157;|
| Placebo Comparator: Group 5: Placebo<br>Participants previously treated with anti-IgE therapies will receive a placebo. | Biological: Placebo<br>* Subcutaneous injection.<br>|
| Experimental: Group 6: Tezepelumab Dose 1<br>Participants previously treated with anti-IgE therapies will receive tezepelumab. | Biological: Tezepelumab Dose 1<br>* Subcutaneous injection.<br>* Other names: AMG 157;|
| Experimental: Group 7: Tezepelumab Dose 2<br>Participants previously treated with anti-IgE therapies will receive tezepelumab. | Biological: Tezepelumab Dose 2<br>* Subcutaneous injection.<br>* Other names: AMG 157;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Urticaria Activity Score over 7 days (UAS7) |  | Baseline to Week 16 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants with a Complete Response in Urticaria Activity Score over 7 Days (UAS7) | Complete response is defined as having a UAS7 score of 0 at week 16. | Week 16 | 
| Change from Baseline in Itch Severity Score over 7 Days (ISS7) |  | Baseline to Week 16 | 
| Change from Baseline in Hives Severity Score over 7 Days (HSS7) |  | Baseline to Week 16 | 
| Number of Participants with a Urticaria Activity Score over 7 days (UAS7) Score of 6 or Below |  | Week 16 | 
| Number of Participants with a Change from Baseline in Urticaria Activity Score over 7 days (UAS7) of ≤ -10 |  | Baseline to Week 16 | 
| Number of Participants with a Complete Resolution of Itch using the Itch Severity Score over 7 Days (ISS7) | Complete resolution of itch is defined as having a ISS7 score of 0 at week 16. | Week 16 | 
| Number of Participants with a Change from Baseline in Itch Severity Score over 7 days (ISS7) of ≤ -5 |  | Baseline to Week 16 | 
| Number of Participants with a Complete Resolution of Hives using the Hives Severity Score over 7 Days (HSS7) | Complete resolution of hives is defined as a HSS7 score of 0 at week 16. | Week 16 | 
| Number of Participants with a Change from Baseline in Hives Severity Score over 7 Days (HSS7) of ≤ -5.5 |  | Baseline to Week 16 | 
| Change from Baseline in Sleep Interference Score |  | Baseline to Week 16 | 
| Change from Baseline in Sleep Quality Diary Items |  | Baseline to Week 16 | 
| Change from Baseline in Urticaria Control Test (UCT) Score |  | Baseline to Week 16 | 
| Change from Baseline in Angioedema Activity Score over 7 Days (AAS7) |  | Baseline to Week 16 | 
| Number of Cumulative Weeks that Participants are Angioedema Occurrence-free using the Angioedema Activity Score over 7 Days (AAS7) |  | Baseline to Week 16 | 
| Change from Baseline in Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) Score |  | Baseline to Week 16 | 
| Change from Baseline in Dermatology Life Quality Index (DLQI) Score |  | Baseline to Week 16 | 
| Change from Baseline in Angioedema Quality of Life Questionnaire (AE-QoL) Score |  | Baseline to Week 16 | 
| Change from Baseline in Angioedema Control Test (AECT) Score |  | Baseline to Week 16 | 
| Number of Participants with Complete Control in Angioedema Control Test (AECT) | Complete control is defined as having an AECT score of 16 at week 16. | Week 16 | 
| Change from Baseline in Work Productivity and Activity Impairment Questionnaire: Chronic Urticaria (WPAI-CU) Score |  | Baseline to Week 16 | 
| Total Number of H1-antihistamine Rescue Medication Uses |  | Baseline to Week 16 | 
| Maximum Observed Concentration of Tezepelumab in Serum (Cmax) |  | Baseline to Week 16 | 
| Number of Participants who Experience an Adverse Event (AE) |  | Baseline to Week 32 | 
| Number of Participants who Experience a Serious Adverse Event (SAE) |  | Baseline to Week 32 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CSU