Efficacy and Safety of Lanadelumab for Prevention Against Acute Attacks of Non-histaminergic Angioedema With Normal C1-Inhibitor (C1-INH) and Acquired Angioedema (AAE) Due to C1-INH Deficiency
a study on Angioedema
The purpose of this study is to evaluate the safety and efficacy of repeated subcutaneous (SC) administrations of lanadelumab in preventing angioedema attacks in adolescents and adults with non-histaminergic angioedema with normal C1-INH and in adults with acquired angioedema (AAE) due to C1-INH deficiency.
A Phase 3, Multicenter, Randomized, Placebo-controlled, Double-blind Study to Evaluate the Efficacy and Safety of Lanadelumab for Prevention Against Acute Attacks of Non-histaminergic Angioedema With Normal C1-Inhibitor (C1-INH) and Acquired Angioedema (AAE) Due to C1-INH Deficiency
Study consists of 2 angioedema indication cohorts based on the population-specific study entry criteria: 1. non-histaminergic normal C1-INH angioedema indication cohort with 12 years of age and above participants, 2. AAE indication cohort with 30 years and above participants. Participants will be randomized 2:1 to receive repeated SC administrations of lanadelumab or placebo in a double-blind fashion within each of the 2 angioedema indication cohorts. In the non-histaminergic normal C1-INH angioedema indication cohort, randomization will be stratified by baseline angioedema attack rate (1 to less than (<) 2 attacks/4 weeks, and greater than (>=)2 attacks/4 weeks) and in the AAE indication cohort, randomization will be stratified by baseline angioedema attack rate only (1 to < 2 attacks/4 weeks, 2 to < 3 attacks/4 weeks, and >= 3 attacks/4 weeks).
Angioedema Angioedemas, Hereditary Complement C1 Inactivator Proteins Complement C1 Inhibitor Protein Lanadelumab
You can join if…
Open to people ages 12 years and up
The Participant will not be considered eligible for the study without meeting all of the applicable population criteria below.
- Males and females, 12 years of age and older for participants with non-histaminergic normal C1-INH angioedema or 30 years of age and older for participants with AAE due to C1-INH deficiency at the time of signing of the informed consent form (ICF).
- Documented clinical history of recurrent attacks of angioedema in the absence of wheals/urticaria.
- Investigator-confirmed diagnosis of non-histaminergic bradykinin-mediated angioedema:
- non-histaminergic angioedema with normal C1-INH
- AAE due to C1-INH deficiency, as documented by a history of angioedema attacks at screening and occurrence of attack(s) during the observation period.
- Participants with non-histaminergic normal C1-INH angioedema must also meet the specific inclusion criteria below unique to this study population:
- History of recurrent angioedema with at least an average of 1 angioedema attack per 4 weeks prior to screening and this attack rate must be confirmed during the observation period while treated with chronic high-dose antihistamine (cetirizine 40 milligram per day [mg/day] or equivalent high-dose second-generation antihistamine medication).
- Diagnostic testing results obtained during screening from a sponsor-approved central laboratory that confirm C1-INH antigen and function greater than or equal to (>=) 50 percent (%) of normal and normal C4. With prior sponsor approval, participants may be retested during the observation period if results are incongruent with clinical history.
- Clinical history of not responding to high-dose antihistamine treatment (cetirizine 40 mg/day or equivalent high-dose second-generation antihistamine medication), which must be confirmed during the observation period with at least 1 angioedema attack per 4 weeks with chronic high-dose antihistamine treatment and no significant difference (as assessed by the investigator and in consultation with the sponsor's medical monitor, as necessary) from the historic attack rate without high-dose antihistamine treatment.
- Participants with AAE due to C1-INH deficiency must also meet the specific inclusion criteria below unique to this study population:
- History of recurrent angioedema with at least an average of 1 angioedema attack per 4 weeks prior to screening and this attack rate must be confirmed during the observation period.
- No family history of angioedema or C1-INH deficiency.
- Onset of angioedema symptoms and attacks after the age of 30 years.
- Diagnostic testing results obtained during screening from a sponsor-approved central laboratory that confirm C1-INH function below 50% of normal (decreased functional C1-INH) and low C4 levels (below the normal range). Participants may be retested if results are incongruent with clinical history or believed by the investigator to be confounded by recent C1-INH use.
- Agree to adhere to the protocol-defined schedule of treatments, assessments, and procedures.
- Participants >= 18 years of age must be willing to use icatibant as the rescue medication during the observation and treatment period. During the observation period, participants need to be treated with icatibant for at least 2 angioedema attacks or at least 1 moderate or severe attack. In the opinion of the investigator, participants with no response to icatibant for acute angioedema attacks in the past medical history/screening, or no improvement or worsened attack severity 2 hours after icatibant treatment during the observation period (based on totality of assessments), will not be included. Note: For participants 12 to less than (<) 18 years of age, standard of care therapy per local protocols should be provided.
- Males, or non-pregnant, non-lactating females who are of child-bearing potential and who agree to be abstinent or agree to comply with the applicable contraceptive requirements of this protocol for the duration of the study; or females of non-childbearing potential, defined as surgically sterile (status post hysterectomy, bilateral oophorectomy, or bilateral tubal ligation) or post-menopausal for at least 12 months.
- The participant (or the participant's parent/legal guardian, if applicable) has provided written informed consent approved by the institutional review board/research ethics board/ethics committee (IRB/REB/EC).
- If the participant is an adult, be informed of the nature of the study and provide written informed consent before any study-specific procedures are performed.
- If the participant is a minor (i.e. < 18 years of age), have a parent/legal guardian who is informed of the nature of the study provide written informed consent (i.e. permission) for the minor to participate in the study before any study-specific procedures are performed. Assent will be obtained from minor participants.
You CAN'T join if...
The participant will be excluded from the study if any of the following exclusion criteria are met.
- Concomitant diagnosis of Type I or Type II HAE, or recurrent angioedema associated with urticaria.
- Dosing with any investigational drug or exposure to an investigational device within 4 weeks prior to screening.
- Exposure to angiotensin-converting enzyme (ACE) inhibitors or rituximab within 6 months prior to screening.
- For participants with normal C1-INH angioedema only: use of any estrogen-containing medications with systemic absorption (such as oral contraceptives or hormonal replacement therapy) within 6 months prior to screening.
- Response to omalizumab (prophylactic) or corticosteroid (acute/prophylactic) or epinephrine (acute) or anti-leukotrienes (prophylactic) treatments in the past.
- Use of long-term prophylactic therapy for HAE, e.g. C1-INH, attenuated androgens (e.g. danazol, methyltestosterone, testosterone), or anti-fibrinolytics within 2 weeks prior to entering the observation period.
- Any exposure to prophylactic plasma kallikrein inhibitors prior to screening.
- Use of short-term prophylaxis for HAE within 7 days prior to entering the observation period. Short-term prophylaxis is defined as C1-INH, attenuated androgens, or antifibrinolytics used to avoid angioedema complications from medically indicated procedures.
- Have any active infectious illness or fever defined as an oral temperature greater than (>) 38°C (100.4°F), tympanic > 38.5°C (101.3°F), axillary > 38°C (100.4°F), or rectal/core > 38.5°C (101.3°F) within 24 hours prior to the first dose of study drug in the treatment period. Any angioedema attack must be resolved prior to the first dose in the treatment period.
- Any of the following liver function test abnormalities: alanine aminotransferase (ALT) > 3x upper limit of normal, or aspartate aminotransferase (AST) > 3x upper limit of normal, or total bilirubin > 2x upper limit of normal (unless the bilirubin elevation is a result of Gilbert's syndrome).
- Pregnancy or breast feeding.
- Participants has a known hypersensitivity to the investigational product or its components.
- Have any uncontrolled underlying medical condition which would require treatment adjustment during the study treatment period that, in the opinion of the investigator or sponsor, may confound the results of the safety assessments or may place the participant at risk. Participants with stable treatment for at least 3 months prior to screening and NOT expecting any change to their treatment regimen for 6 months during the study treatment period, will not be excluded.
- Have any condition (surgical or medical) that, in the opinion of the investigator or sponsor, may compromise their safety or compliance, preclude the successful conduct of the study, or interfere with interpretation of the results (e.g. significant pre-existing illness or other major comorbidities that the investigator considers may confound the interpretation of study results).
- UCSD Angioedema Center
San Diego California 92122 United States
- Medical Research of Arizona a division of Allergy, Asthma & Immunology Associates, LTD
Scottsdale Arizona 85251 United States
Lead Scientist at UC Health
- Alexander Kim (ucsd)
Assistant Clinical Professor, Medicine. Authored (or co-authored) 5 research publications
- not yet accepting patients
- Start Date
- Completion Date
- Phase 3
- Study Type
- Last Updated