Individualized Titration of Biologics in Severe Asthma

Study Overview
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Brief Summary
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OPTIMAL is a non-inferiority, open label randomized clinical trial thats investigates a titration algorithm for anti IL 5 biologics in severe asthma.

Official Title
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OPTIMAL - Individualized Titration of Biologics in Severe Asthma

Conditions
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Asthma

Intervention / Treatment
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* Biological: OPTIMAL algorithm


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Informed written consent Age > 18 years Correct asthma diagnosis as judged by (sub)-investigator Treatment with anti-IL5/IL5r for 12 months or longer Treatment with the same biologic drug in the last 12 months No exacerbations requiring OCS in the last 12 months Blood eosinophils < 0.30 in the last 12 months No daily OCS for more than 3 days in the last 12 months with asthma as indication Correct inhalation technique for using regular inhalers Acceptable adherence to ICS (according to FMK as judged by (sub)-investigator) Exclusion Criteria: - Pregnant or breastfeeding females Lack of effective contraception in women of childbearing potential who are sexually active with a non-sterilized male partner. Women of childbearing potential are defined as those who are not surgically sterile (e.g. bilateral tubal ligation, bilateral oophorectomy, complete hysterectomy) or postmenopausal (defined as 12 months with no menses without an alternative medical cause). Effective contraception is defined as intrauterine device (hormonal or non-hormonal), sexual abstinence, bilateral tubal occlusion, combined (estrogen and progesterone) hormonal contraception (oral, intravaginal and transdermal) and progesterone-only hormonal contraception (oral, injectable and implantable). Previous medical history or evidence of an uncontrolled intercurrent illness such as but not limited to (e.g. Autoimmune disease, immunodeficiency, immunosuppression, malignant neoplastic conditions with current relevance) that in the opinion of the investigator may compromise the safety of the subject in the study or interfere with evaluation of the algorithm or reduce the subject's ability to participate in the study. Subjects with well-controlled comorbid disease (eg, hypertension, hyperlipidaemia, gastroesophageal reflux disease) on a stable treatment regimen for 15 days prior to inclusion are eligible. Any concomitant respiratory disease that in the opinion of the investigator and/or medical monitor will interfere with the evaluation of the algorithm or interpretation of subject safety or study results (eg. chronic obstructive pulmonary disease, cystic fibrosis, pulmonary fibrosis, bronchiectasis, allergic bronchopulmonary aspergillosis, eosinophilic granulomatosis polyangitiis, alpha-1-antitrypsin deficiency, Wegeners granulomatosis, Sarcoidosis). Any clinically relevant abnormal findings in haematology or clinical chemistry (laboratory results from Visit 0), physical examination, vital signs during the screening, which in the opinion of the investigator, may put the subject at risk because of his/her participation in the study, or may influence the results of the study, or the subject's ability to participate in the study. Unwillingness or inability to follow the procedures outlined in the protocol. History of chronic alcohol- or drug abuse 12 months prior to inclusion Concurrent enrolment in another clinical study involving an investigational treatment. Use of immunosuppressive medication (eg, methotrexate, troleandomycin, oral gold, cyclosporine, azathioprine, intramuscular long-acting depot corticosteroids or any experimental anti-inflammatory therapy) within 3 months prior to inclusion and during the study.

Ages Eligible for Study
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Minimum Age: 18 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
Interventional Model Description: One group will have their biological treatment titrated via the OPTIMAL algorithm and a control group will continue their biological treatment unchanged.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: OPTIMAL group<br>This group will have their anti IL 5 biologics titrated by OPTIMAL algorithm | Biological: OPTIMAL algorithm<br>* The OPTIMAL algorithm titrates anti IL 5 treatment by addjusting the intervals between injections by FEV1, blood eosinophils and exacerbations.<br>|
| No Intervention: Control group<br>This group will continue their treatment with anti IL 5 biologics unchanged | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of proportions of patients with exacerbations aften one year in each group |  | one year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients on reduced dose of biologics at the end of trial |  | One year |