A Study Evaluating the Effects of Lebrikizumab on Airway Eosinophilic Inflammation in Participants With Uncontrolled Asthma

Study Overview
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Brief Summary
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This Phase II, randomized, double-blind, placebo-controlled, multicenter study will evaluate the effects of lebrikizumab on airway eosinophilic inflammation in participants with uncontrolled asthma who are using inhaled corticosteroid (ICS) treatment and a second controller medication. Enrolled participants will undergo a 3-week screening period during which assessments, including a bronchoscopy procedure, will be made. Participants will subsequently be randomized to receive lebrikizumab or placebo by subcutaneous (SC) injection on Day 1, Day 8, Week 4, and Week 8. Participants will continue their standard of care therapy throughout the study. End of treatment assessments will be taken at Week 12. Total study period, including screening and follow-up, is expected to last 23 weeks.

Official Title
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A Phase II, Randomized, Double-Blind, Placebo-Controlled Bronchoscopy Study to Evaluate the Effects of Lebrikizumab on Airway Eosinophilic Inflammation in Patients With Uncontrolled Asthma on Inhaled Corticosteroids and a Second Controller Medication

Conditions
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Asthma

Intervention / Treatment
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* Drug: Lebrikizumab
* Drug: Placebo
* Drug: Inhaled corticposteroids (ICS)
* Drug: Second Asthma Controller Medication


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Asthma diagnosis for greater than or equal to (>/=) 12 months prior to Visit 1 Bronchodilator response demonstrated within the 12 months before Visit 1 or at Visit 1, 2, or 3 of screening Pre-bronchodilator FEV1 of 40 percent (%) - 80% predicted at both Visits 2 and 3 On ICS therapy at a total daily dose of 500-2000 mcg of fluticasone propionate dry powder inhaler (DPI) or equivalent for >/= 6 months prior to Visit 1, with no changes within 4 weeks prior to Visit 1, and no anticipated changes throughout the study On an eligible second controller medication (long-acting Beta-agonist [LABA), leukotriene receptor antagonist [LTRA], long-acting muscarinic antagonists [LAMAs] or theophylline) for 6 months prior to Visit 1, with no changes within 4 weeks prior to Visit 1, and no anticipated changes throughout the study Uncontrolled asthma at Visit 1 and/or 2 and at Visit 3 Chest X-ray or computed tomography (CT) scan within 12 months prior to Visit 1 or chest X-ray during the screening period (prior to Visit 3) that confirms the absence of other clinically significant lung disease Demonstrated adherence with controller medication during the screening period Exclusion Criteria: Maintenance oral corticosteroid therapy, defined as daily alternate-day oral corticosteroid maintenance therapy within 3 months prior to Visit 1 Treatment with systemic corticosteroids within 4 weeks prior to Visit 1 or during the screening period for any reason, including an acute exacerbation event Any infection requiring hospital, intravenous (IV) or intramuscular (IM) antibiotic treatment or any respiratory infection within 4 weeks prior to Visit 1 or during screening. Any infection requiring oral antibiotic treatment with 2 weeks prior to Visit 1 or during screening, or any parasitic infection within 6 months prior to Visit 1 or during screening Active tuberculosis requiring treatment within 12 months prior to Visit 1 Known immunodeficiency, including, but not limited to, human immunodeficiency virus (HIV) infection History of interstitial lung disease, chronic obstructive pulmonary disease (COPD), or other clinically significant lung disease other than asthma Known current malignancy or current evaluation for a potential malignancy Unable to safely undergo elective flexible fiberoptic bronchoscopy Clinically significant medical disease that is uncontrolled despite treatment, that is likely, in the opinion of the investigator, to impact the participant's ability to participate in the study, or to impact the study assessments History of alcohol or drug abuse that would impair or risk the participant's full participation in the study, in the opinion of the investigator Current smoker or history of smoking (greater than [>] 10 pack-years), or unwillingness to abstain from smoking for the duration of the study Past and/or current use of any anti-interleukin (IL)-13 or anti-IL-4/IL-13 therapy, including lebrikizumab Use of a licensed or investigational monoclonal antibody other than anti-IL-13, or anti IL-4/IL-13, including, but not limited to, omalizumab, anti-IL-5, or anti-IL-17, within 6 months or 5 drug half-lives prior to Visit 1 (whichever is longer) or during screening Use of a systemic immunomodulatory or immunosuppressive therapy within 3 months or 5 drug half-lives prior to Visit 1 (whichever is longer) or during screening Use of other investigational therapy within 4 weeks or 5 drug half-lives prior to Visit 1 (whichever is longer) or during screening Initiation of or increase in allergen immunotherapy within 3 months prior to Visit 1 or during screening Body mass index >38 kilograms per square meter (kg/m^2) Body weight <40 kilograms (kg) History of bronchial thermoplasty

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lebrikizumab<br>Participants with uncontrolled asthma on ICS therapy (not specified in the protocol) and a second controller medication, will receive SC injection of lebrikizumab on Days 1 and 8, and on Weeks 4 and 8. | Drug: Lebrikizumab<br>* Lebrikizumab will be administered by SC injection on Day 1, Day 8, Week 4, and Week 8.<br>* Other names: RO5490255;Drug: Inhaled corticposteroids (ICS)<br>* Participants will continue their ICS controller therapy, as they are receiving prior to screening, throughout the study. Protocol does not specify any particular ICS.<br>Drug: Second Asthma Controller Medication<br>* Participants will continue their asthma controller therapy, as they are receiving prior to screening, throughout the study.<br>|
| Placebo Comparator: Placebo<br>Participants with uncontrolled asthma on ICS therapy (not specified in the protocol) and a second controller medication, will receive SC injection of lebrikizumab matching placebo on Days 1 and 8, and on Weeks 4 and 8. | Drug: Placebo<br>* Lebrikizumab matching placebo will be administered by SC injection on Day 1, Day 8, Week 4, and Week 8.<br>Drug: Inhaled corticposteroids (ICS)<br>* Participants will continue their ICS controller therapy, as they are receiving prior to screening, throughout the study. Protocol does not specify any particular ICS.<br>Drug: Second Asthma Controller Medication<br>* Participants will continue their asthma controller therapy, as they are receiving prior to screening, throughout the study.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Relative Change From Baseline in the Number of Airway Submucosal Eosinophils per Surface Area of Basal Lamina (Cells per Square Millimeter [Cells/mm^2]) |  | From Baseline to Week 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Absolute Change From Baseline in Number of Airway Submucosal Eosinophils per Surface Area of Basal Lamina (Cells/mm^2) |  | From Baseline to Week 12 | 
| Relative Change From Baseline in the Number of Airway Epithelial Eosinophils per Surface Area of Basal Lamina (Cells/mm^2) |  | From Baseline to Week 12 | 
| Absolute Change From Baseline in Number of Airway Epithelial Eosinophils per Surface Area of Basal Lamina (Cells/mm^2) |  | From Baseline to Week 12 | 
| Relative Change From Baseline in Number of Airway Submucosal Eosinophils per Volume of Submucosa (Cells per Cubic Millimeter [Cells/mm^3]) |  | From Baseline to Week 12 | 
| Absolute Change From Baseline in Number of Airway Submucosal Eosinophils per Volume of Submucosa (Cells/mm^3) |  | From Baseline to Week 12 | 
| Relative Change From Baseline in Number of Airway Epithelial Eosinophils per Volume of Epithelium (Cells/mm^3) |  | From Baseline to Week 12 | 
| Absolute Change From Baseline in Number of Airway Epithelial Eosinophils per Volume of Epithelium (Cells/mm^3) |  | Form Baseline to Week 12 | 
| Change From Baseline in Blood Eosinophil Count |  | From Baseline to Week 12 | 
| Change From Baseline in Immunoglobulin E (IgE) Levels |  | From Baseline to Week 12 | 
| Change From Baseline in Serum Periostin Levels |  | From Baseline to Week 12 | 
| Change From Baseline in Chemokine Ligand (CCL)-13 Levels |  | From Baseline to Week 12 | 
| Change From Baseline in CCL-17 Levels |  | From Baseline to Week 12 | 
| Change From Baseline in Lung Epithelial Cell Chloride Channel Accessory 1 (CLCA1) Gene Expression |  | From Baseline to Week 12 | 
| Change From Baseline in Lung Epithelial Cell SerpinB2 Gene Expression at Week 12 |  | From Baseline to Week 12 | 
| Change From Baseline in Lung Epithelial Cell CCL-26 Gene Expression |  | From Baseline to Week 12 | 
| Change From Baseline in Lung Epithelial Cell Nitric Oxide Synthase 2 (NOS2) Gene Expression |  | From Baseline to Week 12 | 
| Change From Baseline in Lung Epithelial Cell Periostin (POSTN) Gene Expression |  | From Baseline to Week 12 | 
| Relative Change From Baseline in Fractional Exhaled Nitric Oxide (FeNO) |  | From Baseline to Week 12 | 
| Relative Change From Baseline in Forced Expiratory Volume in 1 Second (FEV1) |  | From Baseline to Week 12 | 
| Percentage of Participants With Treatment-Emergent Adverse Events |  | From Baseline to Week 20 | 
| Percentage of Participants With Anti-Therapeutic Antibodies (ATAs) to Lebrikizumab |  | Baseline up to Week 20 (assessed at Baseline, Weeks 8 and 20/dosing termination or early termination) | 
| Serum Lebrikizumab Concentration at Week 12 |  | Predose (Hour 0) at Week 12 |