A Phase 1/2 interventional study of Glycerinated peanut allergenic extract and Placebo for peanut extract (glycerin) in Food Hypersensitivity, Hypersensitivity and Immediate Hypersensitivity, sponsored by National Institute of Allergy and Infectious Diseases (NIAID). Completed at 5 sites in United States. Open to participants aged 12 Years to 40 Years. Per ClinicalTrials.gov, last updated 2019-08-21.
Sponsored by National Institute of Allergy and Infectious Diseases (NIAID) · Phase 1/2, Interventional, and Treatment
The purpose of this study is to evaluate the safety and immune response to daily sublingual (under the tongue) immunotherapy (SLIT) with peanut extract in adults and children with peanut allergies.
Peanut allergy is a common ailment in the United States. Research suggests that the prevalence of peanut allergy in the United States has doubled over the last 5 years. Currently, the only effective treatment for peanut allergy is a peanut-free diet and quick access to self-injectable epinephrine in the event of peanut exposure. The sublingual route is a potential method to administer immunotherapy for the treatment of food allergies. The intent of this study is to induce desensitization and eventually tolerance to peanut protein and evaluate the safety and immunologic effects of daily sublingual immunotherapy (SLIT) for individuals with peanut allergy. The trial will enroll 40 participants. After the first 10 participants between the ages of 18 and 40 are enrolled, safety information will be reviewed. If there are no safety concerns, the study will continue to enroll the remaining participants between the ages of 12 and 40.
This clinical trial will last 172 to 216 weeks. Participants will be randomly assigned to receive peanut SLIT or placebo SLIT. All participants will have an entry oral food challenge (OFC). The treatment group will receive gradual dosing escalations of peanut SLIT and maintenance therapy over a 44-week period, followed by another OFC. Following the OFC, participants will be unblinded, and the placebo group will receive peanut SLIT escalated to a higher maximum dose than the first treatment group. Maintenance therapy will continue for both groups for more than 2 years.
Study visits will occur every 2 weeks during dosing escalations of peanut SLIT, followed by visits gradually spacing out during maintenance to every 12 weeks. At selected visits, a physical examination, skin prick tests, blood and urine collection, and atopic dermatitis and asthma evaluations will occur. Approximately 6 OFCs will be administered to each participant throughout the course of the study. Additionally, 10 participants will be enrolled as control participants who will not receive any study therapy and will only have blood drawn at 3 visits throughout the course of the trial.
166 studies on the registry are indexed under Peanut Hypersensitivity; 27 are open to participants now.
This study's enrollment of 40 is below the median of 50 across 127 interventional studies indexed under Peanut Hypersensitivity.
Browse Peanut Hypersensitivity studies →National Institute of Allergy and Infectious Diseases (NIAID) is the lead sponsor of 2,446 studies on the registry; 179 are open to participants now.
Of its 405 completed or terminated interventional studies of FDA-regulated products, 302 (75%) have results posted.
Compared within Peanut Hypersensitivity, this study's primary condition as ClinicalTrials.gg classifies it; the registry's first condition term is Food Hypersensitivity. The counts are of registry records indexed under each term, refreshed daily. How we classify →
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
A drug or device being studied in a clinical trial.
It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.
Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.
Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.
Contraception
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Investigational drug or device
A drug or device being studied in a clinical trial.
It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Corticosteroids (steroids)
Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.
Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Subjects ingest peanut protein (glycerinated peanut allergenic extract) daily starting with 0.000165 mcg, followed by a build-up phase (escalating peanut doses every 2 weeks, achieving maintenance dose by 36 weeks). Thereafter, subjects are on a maximally tolerated maintenance dose (165 mcg to 1,386 mcg) for \>= 8 weeks. After Week 44, subjects are given a 5,000 mg Oral Food Challenge (OFC) using peanut powder. Subjects/study staff are unblinded following this OFC and continue on an open label peanut protein maintenance dose of 1,386 mcg/day or may attempt escalation up to this dose. Subjects who at the Week 116 OFC are unable to consume \>= 5,000 mg peanut powder or 10-fold the amount of peanut powder compared to the baseline OFC will discontinue study therapy. SLIT=Sublingual Immunotherapy.
Drug: Glycerinated peanut allergenic extract
Subjects ingest placebo (glycerin) daily beginning with a dose of 0.000165 mcg, followed by a build-up phase (escalating placebo doses every 2 weeks, achieving a maintenance dose by 36 weeks). Thereafter, subjects are on a maximally tolerated maintenance dose (165 mcg to 1,386 mcg) for \>= 8 weeks. After Week 44, subjects are given a 5,000 mg Oral Food Challenge (OFC) using peanut powder. Subjects/study staff are unblinded following this OFC and subjects no longer receive placebo dosing but are crossed over and receive open label high dose peanut SLIT; the study procedures and schedule are the same as for the Low Dose Peanut SLIT group, the only difference is the maximum maintenance dose is almost 3-fold higher at 3,696 mcg/day. DB=Double Blind, SLIT=Sublingual Immunotherapy, OL=Open Label.
Drug: Placebo for peanut extract (glycerin)
Glycerinated peanut extract delivered sublingually.
Also known as: Peanut SLIT
Placebo (glycerin) delivered sublingually.
Also known as: Placebo
Percent of Participants Who Successfully Consumed 5,000 mg of Peanut Powder or at Least a 10-fold Increase in the Amount of Peanut Powder Compared to Their Baseline Oral Food Challenge
Desensitization Assessment: Participants who successfully consumed without dose-limiting symptoms 5,000 mg of peanut powder or at least a 10-fold increase in the amount of peanut powder compared to their baseline oral food challenge during a double-blind placebo-controlled oral food challenge were counted as successes.
Time frame: Week 44 (Double Blind Period)
Percent of Participants Who Achieved a Maintenance Dose of 1,386 mcg
During the build-up phase, escalation was to occur every 2 weeks until the 1,386 mcg maintenance dose was reached. The maximum time allowed for the build-up phase was 36 weeks; the dose achieved by 36 weeks was considered the maintenance dose.
Time frame: Week 44 (Double Blind Period)
Percent of Crossover Participants Who Successfully Consumed 5,000 mg of Peanut Powder or at Least a 10-fold Increase in the Amount of Peanut Powder Compared to Their Baseline Oral Food Challenge After 44 Weeks of Open Label Peanut Protein Consumption
Desensitization Assessment: Participants who successfully consumed without dose-limiting symptoms 5,000 mg of peanut powder or at least a 10-fold increase in the amount of peanut powder compared to their baseline oral food challenge during a double-blind placebo-controlled oral food challenge were counted as successes.
Time frame: Week 44 after initiating crossover open label peanut protein consumption
Percent of Crossover Participants Who Achieved an Open Label Peanut Protein Consumption Maintenance Dose of 3,696 mcg
During the build-up phase, escalation was to occur every 2 weeks until the 3,696 mcg maintenance dose was reached. The maximum time allowed for the build-up phase was 36 weeks; the dose achieved by 36 weeks was considered the maintenance dose.
Time frame: Week 44 after initiating crossover open label peanut protein consumption
Number of Participants With Serious Adverse Events (SAEs)
This study graded the severity of Adverse Events experienced by participants according to the criteria set forth in the National Cancer Institute's Common Terminology Criteria for Adverse Events Version 3.
Time frame: Baseline through Week 44 (Double Blind Period)
Number of Crossover Participants With Serious Adverse Events (SAEs) During 44 Weeks of Open Label Peanut Protein Consumption
All subjects who were in the Placebo group during the double-blind phase of the study who initiated crossover peanut sublingual immunotherapy during the open label phase of the study will be included.
Time frame: Initiation of open label peanut protein study therapy through Week 44 of open label peanut protein consumption
Percent of Participants Who Successfully Consumed 10,000 mg of Peanut Powder
Tolerance Assessment: Participants who successfully consumed without dose-limiting symptoms 10,000 mg of peanut powder during a double-blind placebo-controlled oral food challenge were then given an open feeding of peanut butter and those who successfully consumed the open feeding were counted as successes.
Time frame: Approximately 8 weeks after discontinuing study therapy after 3 years on maintenance study therapy
Recruitment took place at five university-based medical centers in the United States (Mt. Sinai School of Medicine, Johns Hopkins University, Duke University, National Jewish Medical Center, University of Arkansas Children's Hospital from April 2008 to January 2010.
| Milestone | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) |
|---|---|---|
| Started | 20 | 20 |
| Had week 44 oral food challenge | 18 | 19 |
| Completed | 20 | 20 |
| Not completed | 0 | 0 |
| Milestone | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) |
|---|---|---|
| Started | 18 | 17 |
| Had week 44 oral food challenge | 0 | 12 |
| Had week 68 oral food challenge | 15 | 12 |
| Had week 116 oral food challenge | 13 | 6 |
| Had week 164 oral food challenge | 9 | 5 |
| Had week 172 oral food challenge | 2 | 2 |
| Completed | 9 | 5 |
| Not completed | 9 | 12 |
| Withdrew: Lack of efficacy at week 116 ofc | 2 | 1 |
| Withdrew: Withdrawal by subject | 4 | 6 |
| Withdrew: Dosing symptoms | 0 | 1 |
| Withdrew: Lost to follow-up | 0 | 1 |
| Withdrew: Pregnancy | 0 | 1 |
| Withdrew: Non-compliance | 2 | 0 |
| Withdrew: Physician decision | 1 | 1 |
| Withdrew: Needed prohibited medication | 0 | 1 |
Desensitization Assessment: Participants who successfully consumed without dose-limiting symptoms 5,000 mg of peanut powder or at least a 10-fold increase in the amount of peanut powder compared to their baseline oral food challenge during a double-blind placebo-controlled oral food challenge were counted as successes.
| Percentage of participants | Low Dose Peanut SLIT (Double Blind) | Placebo (Double Blind) |
|---|---|---|
| Percent of Participants Who Successfully Consumed 5,000 mg of Peanut Powder or at Least a 10-fold Increase in the Amount of Peanut Powder Compared to Their Baseline Oral Food Challenge | 70 | 15 |
During the build-up phase, escalation was to occur every 2 weeks until the 1,386 mcg maintenance dose was reached. The maximum time allowed for the build-up phase was 36 weeks; the dose achieved by 36 weeks was considered the maintenance dose.
| Percentage of participants | Low Dose Peanut SLIT (Double Blind) | Placebo (Double Blind) |
|---|---|---|
| Percent of Participants Who Achieved a Maintenance Dose of 1,386 mcg | 85.0 | 95.0 |
Desensitization Assessment: Participants who successfully consumed without dose-limiting symptoms 5,000 mg of peanut powder or at least a 10-fold increase in the amount of peanut powder compared to their baseline oral food challenge during a double-blind placebo-controlled oral food challenge were counted as successes.
| Percentage of participants | High Dose Peanut SLIT Crossover (Open Label) |
|---|---|
| Percent of Crossover Participants Who Successfully Consumed 5,000 mg of Peanut Powder or at Least a 10-fold Increase in the Amount of Peanut Powder Compared to Their Baseline Oral Food Challenge After 44 Weeks of Open Label Peanut Protein Consumption | 43.8 |
During the build-up phase, escalation was to occur every 2 weeks until the 3,696 mcg maintenance dose was reached. The maximum time allowed for the build-up phase was 36 weeks; the dose achieved by 36 weeks was considered the maintenance dose.
| Percentage of participants | High Dose Peanut SLIT Crossover (Open Label) |
|---|---|
| Percent of Crossover Participants Who Achieved an Open Label Peanut Protein Consumption Maintenance Dose of 3,696 mcg | 88.2 |
This study graded the severity of Adverse Events experienced by participants according to the criteria set forth in the National Cancer Institute's Common Terminology Criteria for Adverse Events Version 3.
| participants | Low Dose Peanut SLIT (Double Blind) | Placebo (Double Blind) |
|---|---|---|
| Number of Participants With Serious Adverse Events (SAEs) | 1 | 0 |
All subjects who were in the Placebo group during the double-blind phase of the study who initiated crossover peanut sublingual immunotherapy during the open label phase of the study will be included.
| participants | High Dose Peanut SLIT Crossover (Open Label) |
|---|---|
| Number of Crossover Participants With Serious Adverse Events (SAEs) During 44 Weeks of Open Label Peanut Protein Consumption | 0 |
Tolerance Assessment: Participants who successfully consumed without dose-limiting symptoms 10,000 mg of peanut powder during a double-blind placebo-controlled oral food challenge were then given an open feeding of peanut butter and those who successfully consumed the open feeding were counted as successes.
| percentage of participants | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) |
|---|---|---|
| Percent of Participants Who Successfully Consumed 10,000 mg of Peanut Powder | 10.0 | 11.8 |
Collected over Baseline through 44 weeks of study therapy. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Low Dose Peanut SLIT Before Week 44 OFC (Double Blind) | — | 1/20 (5%) | 19/20 (95%) |
| Placebo Before Week 44 OFC (Double Blind) | — | 0/20 (0%) | 20/20 (100%) |
| High Dose Peanut SLIT Crossover Before Wk44 Crossover OFC (OL) | — | 0/17 (0%) | 17/17 (100%) |
| Low Dose Peanut SLIT (Double Blind to Open Label) | — | 1/18 (5.6%) | 17/18 (94.4%) |
| Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) | — | 0/17 (0%) | 15/17 (88.2%) |
| Event | Low Dose Peanut SLIT Before Week 44 OFC (Double Blind) | Placebo Before Week 44 OFC (Double Blind) | High Dose Peanut SLIT Crossover Before Wk44 Crossover OFC (OL) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) |
|---|---|---|---|---|---|
| Anaphylactic ReactionImmune system disorders | 0/20 | 0/20 | 0/17 | 1/18 | 0/17 |
| UrticariaSkin and subcutaneous tissue disorders | 1/20 | 0/20 | 0/17 | 0/18 | 0/17 |
| Event | Low Dose Peanut SLIT Before Week 44 OFC (Double Blind) | Placebo Before Week 44 OFC (Double Blind) | High Dose Peanut SLIT Crossover Before Wk44 Crossover OFC (OL) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) |
|---|---|---|---|---|---|
| Oral disorderGastrointestinal disorders | 17/20 | 6/20 | 16/17 | 14/18 | 8/14 |
| Oropharyngeal discomfortRespiratory, thoracic and mediastinal disorders | 9/20 | 3/20 | 6/17 | 3/18 | 1/14 |
| Abdominal discomfortGastrointestinal disorders | 7/20 | 1/20 | 6/17 | 2/18 | 2/14 |
| UrticariaSkin and subcutaneous tissue disorders | 7/20 | 1/20 | 6/17 | 5/18 | 3/14 |
| PruritusSkin and subcutaneous tissue disorders | 7/20 | 3/20 | 2/17 | 1/18 | 2/14 |
| NasopharyngitisInfections and infestations | 4/20 | 5/20 | 3/17 | 3/18 | 1/17 |
| SinusitisInfections and infestations | 4/20 | 2/20 | 3/17 | 3/18 | 4/17 |
| Upper respiratory tract congestionRespiratory, thoracic and mediastinal disorders | 0/20 | 1/20 | 4/17 | 0/18 | 0/17 |
| SneezingRespiratory, thoracic and mediastinal disorders | 2/20 | 1/20 | 3/17 | 0/18 | 3/14 |
| Upper respiratory tract infectionInfections and infestations | 4/20 | 4/20 | 3/17 | 3/18 | 3/17 |
| Age, Categorical(Participants) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) | Total |
|---|---|---|---|
| <=18 years | 15 | 15 | 30 |
| Between 18 and 65 years | 5 | 5 | 10 |
| >=65 years | 0 | 0 | 0 |
| Age, Continuous(years) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) | Total |
|---|---|---|---|
| Mean | 17.2 ± 7.6 | 16.5 ± 3.5 | 16.8 ± 5.8 |
| Sex: Female, Male(Participants) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) | Total |
|---|---|---|---|
| Female | 7 | 6 | 13 |
| Male | 13 | 14 | 27 |
| Ethnicity (NIH/OMB)(Participants) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) | Total |
|---|---|---|---|
| Hispanic or Latino | 0 | 0 | 0 |
| Not Hispanic or Latino | 20 | 20 | 40 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 2 | 1 | 3 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 1 | 0 | 1 |
| White | 17 | 19 | 36 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Region of Enrollment(participants) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) | Total |
|---|---|---|---|
| United States | 20 | 20 | 40 |
| Atopic Dermatitis Total Score(Scores on a scale) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) | Total |
|---|---|---|---|
| Mean | 1.1 ± 1.7 | 0.9 ± 1.6 | 1.0 ± 1.6 |
| Total IgE(kU/L) | Low Dose Peanut SLIT (Double Blind to Open Label) | Placebo (DB) Crossed Over to High Dose Peanut SLIT (OL) | Total |
|---|---|---|---|
| Mean | 407.8 ± 254.1 | 330.5 ± 305.0 | 369.1 ± 279.9 |
3 further baseline measures are reported on the registry.
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