A Phase 2 interventional study of Placebo Viaskin® Patch and Low-dose DBV712 Viaskin® Patch in Peanut Hypersensitivity, Food Hypersensitivity and Hypersensitivity, sponsored by National Institute of Allergy and Infectious Diseases (NIAID). Completed at 5 sites in United States. Open to participants aged 4 Years to 25 Years. Per ClinicalTrials.gov, last updated 2019-07-01.
Sponsored by National Institute of Allergy and Infectious Diseases (NIAID) · Phase 2, Interventional, and Treatment
Food allergy occurs when the immune system reacts against foods. The immune system is the part of the body that protects us from illness and germs, but it can also cause allergies. Peanut allergy occurs in 1 - 2% of people in the United States and other Western countries. There is proof that allergy to peanut is increasing. Allergic reactions to peanut can be severe and life threatening. The only way that you can prevent an allergic reaction is to avoid exposure to peanuts. However, peanut proteins are found in a variety of foods and people can be accidently exposed to peanut proteins. Treatment for accidental exposure include antihistamines (medications like Benadryl), and injectable epinephrine (adrenalin) which must be carried at all times. DBV Technologies has developed an epicutaneous delivery system, a patch that puts the peanut protein on the skin.
This study will evaluate whether peanut epicutaneous immunotherapy can protect individuals who are allergic to peanuts from having severe allergic reactions, when accidentally exposed to peanuts. The study also looks at the safety of the treatment and the effects it has on the immune system.
Exclusion Criteria:
Subjects apply placebo Viaskin® patch daily for a 52-week blinded period. Patch application duration is initially 3 hours and gradually increased to 24 hours over a 21-day graduated dosing period; subsequently patch changed every 24 hours. At Week 52, subjects complete an oral food challenge (OFC) and are unblinded. Following blinded phase, subjects who have not demonstrated sustained unresponsiveness at the Week 52 OFC crossover to active treatment (using the same 21-day graduated dosing period used in the blinded phase) and dose with a high-dose DBV712 Viaskin® patch containing 250 μg peanut protein for a total active treatment period of 30 months (130 weeks).
Biological: Placebo Viaskin® Patch
Subjects apply low-dose DBV712 Viaskin® patch containing 100 micrograms (μg) peanut protein daily for a 52-week blinded period. Patch application duration is initially 3 hours and gradually increased to 24 hours over a 21-day graduated dosing period; subsequently patch changed every 24 hours. At Week 52, subjects complete an OFC and are unblinded. Following blinded phase, subjects who have not demonstrated sustained unresponsiveness at the Week 52 OFC crossover to active treatment (using same 21-day graduated dosing period used in blinded phase for subjects 4-\<6 years old at enrollment or who had Grade 2 reaction or higher within previous 2 months) and dose with a high-dose DBV712 Viaskin® patch containing 250 μg peanut protein for a total active treatment period of 30 months (130 weeks).
Biological: Low-dose DBV712 Viaskin® Patch
Subjects apply high-dose DBV712 Viaskin® patch containing 250 micrograms (μg) peanut protein daily for a 52-week blinded period. Patch application duration is initially 3 hours and gradually increased to 24 hours over a 21-day graduated dosing period; subsequently patch changed every 24 hours. At Week 52, subjects complete an OFC and are unblinded. Following blinded phase, subjects who have not demonstrated sustained unresponsiveness at the Week 52 OFC continue active treatment with a high-dose DBV712 Viaskin® patch for a total active treatment period of 30 months (130 weeks).
Biological: High-dose DBV712 Viaskin® Patch
Placebo (e.g., no peanut) patch in an epicutaneous application for 24 hours every 24 hours.
100 microgram (µg) dose of peanut proteins in an epicutaneous application for 24 hours every 24 hours.
250 microgram (µg) dose of peanut proteins in an epicutaneous application for 24 hours every 24 hours.
Percentage of Subjects With a Successful Treatment Response
Treatment response is defined as a subject who can either (a) successfully consume a cumulative dose of peanut protein equal to or greater than 5044 mg or (b) successfully consume at least a 10-fold increase in peanut protein at the Week 52 oral food challenge (OFC), when compared to the cumulative successfully consumed dose at the baseline OFC.
Time frame: Week 52
Percentage of Subjects Desensitized to Peanut Protein
Desensitization is defined based on successfully consumed dose in mg protein at the Week 130 oral food challenge (OFC) as follows: 1) 0-44 mg at BL, \>=444 mg at Wk 130 2) \>44-\<444 mg at BL, 10-fold increase at Wk 130 3) \>=444 mg at BL, \>=5,044 mg at Wk 130. BL=Baseline, Wk 130=Week 130 (Month 30)
Time frame: Week 130 (Month 30)
Percentage of Subjects Who Can Successfully Consume 1044 mg or 5044 mg Peanut Protein
Subjects who successfully consumed without dose-limiting symptoms 1044 mg or 5044 mg peanut protein during the Week 130 oral food challenge (OFC). This is referred to as the successfully consumed dose (SCD). The maximum SCD for this OFC was 5044 mg peanut protein.
Time frame: Week 130 (Month 30)
Percentage of Desensitized Subjects in the Active Treatment Arms as Measured by 5044 mg Peanut Protein Oral Food Challenge (OFC)
Desensitization is defined based on successfully consumed dose in mg protein at the Week 52 oral food challenge (OFC) as follows: 0-44 mg at BL, \>=444 mg at Wk52 2) \>44-\<444 mg at BL, 10-fold increase at Wk 52 3) \>=444 mg at BL, \>=5,044 mg at Wk 52. BL=Baseline, Wk 52=Week 52
Time frame: Week 52
Average Successfully Consumed Dose as Measured by 5044 mg Peanut Protein Oral Food Challenge (OFC)
The successfully consumed dose (SCD) is the cumulative dose consumed during an oral food challenge without dose-limiting symptoms that led to the termination of the challenge.
Time frame: Week 52
Percentage of Subjects Who Pass an OFC to 5044 mg of Peanut Protein Followed by an Open Feeding of Peanut Butter After 8 Weeks or 20 Weeks of Discontinuation of Dosing Subsequent to Passing the Week 130 Oral Food Challenge (OFC)
Subjects who after passing the Week 130 (Month 30) discontinue dosing for 8 weeks and later 20 weeks successfully consumed 5044 mg peanut protein during an OFC followed by an open feeding of peanut butter.
Time frame: 8 and 20 weeks after the Week 130 (Month 30) OFC
Percentage of Subjects With Adverse Events Related to Therapy Through Week 52 and Through 30 Months
Adverse events (AEs) related to study therapy includes both unsolicited AEs where there was a reasonable possibility that the study product caused the event as well as solicited AEs related to dosing.
Time frame: Week 52 and Month 30 (Week 130)
Percentage of Subjects Who Successfully Complete the Dosing Regimen With no More Than Mild Symptoms Related to Peanut Patch Dosing After 30 Months of Therapy
Mild symptoms related to peanut patch dosing are defined as patch site reactions up to Grade 2 in severity or mild systemic dosing symptoms.
Time frame: Month 30 (Week 130)
Recruitment took place from September 2013 to July 2014 at the five listed university-based medical centers located in the United States.
| Milestone | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|---|
| Started | 25 | 25 | 25 |
| Completed week 52 ofc | 22 | 21 | 25 |
| Began crossover treatment | 20 | 21 | 0 |
| Completed week 130 ofc | 18 | 18 | 23 |
| Completed | 18 | 18 | 23 |
| Not completed | 7 | 7 | 2 |
| Withdrew: Withdrew before receiving dosing | 0 | 1 | 0 |
| Withdrew: Non-compliance | 1 | 0 | 0 |
| Withdrew: Anxiety about ofc/refused ofc | 2 | 0 | 0 |
| Withdrew: Patch site reactions | 1 | 1 | 0 |
| Withdrew: Increased syncope | 0 | 1 | 0 |
| Withdrew: Unrelated illness | 0 | 1 | 0 |
| Withdrew: Passed week 52 ofc | 1 | 0 | 0 |
| Withdrew: Withdrawal by subject | 1 | 2 | 0 |
| Withdrew: Participant relocated | 1 | 1 | 1 |
| Withdrew: Lost to follow-up | 0 | 0 | 1 |
Treatment response is defined as a subject who can either (a) successfully consume a cumulative dose of peanut protein equal to or greater than 5044 mg or (b) successfully consume at least a 10-fold increase in peanut protein at the Week 52 oral food challenge (OFC), when compared to the cumulative successfully consumed dose at the baseline OFC.
| percentage of participants | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|---|
| Percentage of Subjects With a Successful Treatment Response | 12.0 | 45.8 | 48.0 |
Desensitization is defined based on successfully consumed dose in mg protein at the Week 130 oral food challenge (OFC) as follows: 1) 0-44 mg at BL, \>=444 mg at Wk 130 2) \>44-\<444 mg at BL, 10-fold increase at Wk 130 3) \>=444 mg at BL, \>=5,044 mg at Wk 130. BL=Baseline, Wk 130=Week 130 (Month 30)
| percentage of participants | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|---|
| Percentage of Subjects Desensitized to Peanut Protein | 5.0 (0.1 to 24.9) | 20.8 (7.1 to 42.2) | 36.0 (18.0 to 57.5) |
Subjects who successfully consumed without dose-limiting symptoms 1044 mg or 5044 mg peanut protein during the Week 130 oral food challenge (OFC). This is referred to as the successfully consumed dose (SCD). The maximum SCD for this OFC was 5044 mg peanut protein.
| percentage of participants | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|---|
| SCD>=1044 mg peanut protein | 10.0 (1.2 to 31.7) | 16.7 (4.7 to 37.4) | 32.0 (14.9 to 53.5) |
| SCD=5044 mg peanut protein | 0.0 (0.0 to 16.8) | 0.0 (0.0 to 14.2) | 0.0 (0.0 to 13.7) |
Desensitization is defined based on successfully consumed dose in mg protein at the Week 52 oral food challenge (OFC) as follows: 0-44 mg at BL, \>=444 mg at Wk52 2) \>44-\<444 mg at BL, 10-fold increase at Wk 52 3) \>=444 mg at BL, \>=5,044 mg at Wk 52. BL=Baseline, Wk 52=Week 52
| percentage of participants | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|
| Percentage of Desensitized Subjects in the Active Treatment Arms as Measured by 5044 mg Peanut Protein Oral Food Challenge (OFC) | 12.5 | 20.0 |
The successfully consumed dose (SCD) is the cumulative dose consumed during an oral food challenge without dose-limiting symptoms that led to the termination of the challenge.
| mg protein | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|---|
| Average Successfully Consumed Dose as Measured by 5044 mg Peanut Protein Oral Food Challenge (OFC) | 14 (1 to 5044) | 144 (44 to 2044) | 144 (0 to 2044) |
Subjects who after passing the Week 130 (Month 30) discontinue dosing for 8 weeks and later 20 weeks successfully consumed 5044 mg peanut protein during an OFC followed by an open feeding of peanut butter.
No measurements were reported for this outcome.
Adverse events (AEs) related to study therapy includes both unsolicited AEs where there was a reasonable possibility that the study product caused the event as well as solicited AEs related to dosing.
| percentage of participants | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|---|
| Had AE related to study therapy through Week 52 | 88.0 | 100.0 | 100.0 |
| Had AE related to study therapy through Month 30 | 100.0 | 100.0 | 100.0 |
Mild symptoms related to peanut patch dosing are defined as patch site reactions up to Grade 2 in severity or mild systemic dosing symptoms.
| percentage of participants | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|---|
| Percentage of Subjects Who Successfully Complete the Dosing Regimen With no More Than Mild Symptoms Related to Peanut Patch Dosing After 30 Months of Therapy | 65.0 | 62.5 | 64.0 |
Collected over For the Placebo Patch group, data were collected for 52 weeks of double-blind dosing with a placebo patch and 130 weeks of open label dosing on active treatment with the DBV712 Viaskin® Patch with 250 µg peanut protein. For the 100 µg Peanut Patch group and the 250 µg Peanut Patch group, data were collected for 52 weeks of double-blind dosing and then 78 weeks of open label dosing for a total of 130 weeks of active treatment.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Placebo Patch Before Week 52 OFC (Double Blind) | 0/25 (0%) | 1/25 (4%) | 23/25 (92%) |
| Placebo Patch Crossed Over to 250 µg Peanut Patch (Open Label) | 0/20 (0%) | 0/20 (0%) | 20/20 (100%) |
| 100 µg Peanut Patch | 0/24 (0%) | 2/24 (8.3%) | 24/24 (100%) |
| 250 µg Peanut Patch | 0/25 (0%) | 0/25 (0%) | 25/25 (100%) |
| Event | Placebo Patch Before Week 52 OFC (Double Blind) | Placebo Patch Crossed Over to 250 µg Peanut Patch (Open Label) | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|---|---|
| SyncopeNervous system disorders | 0/25 | 0/20 | 1/24 | 0/25 |
| MigraineNervous system disorders | 0/25 | 0/20 | 1/24 | 0/25 |
| Abdominal PainGastrointestinal disorders | 1/25 | 0/20 | 0/24 | 0/25 |
| Event | Placebo Patch Before Week 52 OFC (Double Blind) | Placebo Patch Crossed Over to 250 µg Peanut Patch (Open Label) | 100 µg Peanut Patch | 250 µg Peanut Patch |
|---|---|---|---|---|
| Application site erythemaGeneral disorders | 19/25 | 20/20 | 24/24 | 25/25 |
| Application site extravasationGeneral disorders | 8/25 | 19/20 | 22/24 | 25/25 |
| Application site papulesGeneral disorders | 6/25 | 16/20 | 23/24 | 25/25 |
| Application site pruritusGeneral disorders | 18/25 | 20/20 | 24/24 | 25/25 |
| Upper respiratory tract infectionInfections and infestations | 5/25 | 7/20 | 11/24 | 15/25 |
| PyrexiaGeneral disorders | 5/25 | 4/20 | 6/24 | 8/25 |
| SinusitisInfections and infestations | 0/25 | 2/20 | 1/24 | 8/25 |
| Pharyngitis streptococcalInfections and infestations | 2/25 | 2/20 | 3/24 | 7/25 |
| Viral infectionInfections and infestations | 1/25 | 2/20 | 3/24 | 7/25 |
| Viral upper respiratory tract infectionInfections and infestations | 3/25 | 5/20 | 5/24 | 7/25 |
All randomized subjects who received study treatment. Note that 1 subject in the 100 µg Peanut Patch group who never received treatment was not included.
| Age, Categorical(Participants) | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch | Total |
|---|---|---|---|---|
| <=18 years | 24 | 24 | 25 | 73 |
| Between 18 and 65 years | 1 | 0 | 0 | 1 |
| >=65 years | 0 | 0 | 0 | 0 |
| Age, Continuous(years) | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch | Total |
|---|---|---|---|---|
| Mean | 10.1 ± 3.9 | 9.7 ± 3.4 | 8.8 ± 3.4 | 9.5 ± 3.6 |
| Sex: Female, Male(Participants) | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch | Total |
|---|---|---|---|---|
| Female | 9 | 10 | 9 | 28 |
| Male | 16 | 14 | 16 | 46 |
| Ethnicity (NIH/OMB)(Participants) | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch | Total |
|---|---|---|---|---|
| Hispanic or Latino | 1 | 0 | 3 | 4 |
| Not Hispanic or Latino | 24 | 24 | 22 | 70 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch | Total |
|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 |
| Asian | 1 | 1 | 0 | 2 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 |
| Black or African American | 2 | 1 | 0 | 3 |
| White | 22 | 18 | 23 | 63 |
| More than one race | 0 | 4 | 2 | 6 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 |
| Region of Enrollment(participants) | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch | Total |
|---|---|---|---|---|
| United States | 25 | 24 | 25 | 74 |
| Atopic Dermatitis Total Score(Scores on a scale) | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch | Total |
|---|---|---|---|---|
| Mean | 1.9 ± 2.6 | 1.4 ± 2.3 | 1.5 ± 2.2 | 1.6 ± 2.4 |
| Total IgE(kU/L) | Placebo Patch | 100 µg Peanut Patch | 250 µg Peanut Patch | Total |
|---|---|---|---|---|
| Mean | 751.8 ± 797.6 | 949.1 ± 1183.5 | 691.5 ± 602.3 | 795.4 ± 884.2 |
3 further baseline measures are reported on the registry.
Plan to share: Yes — The plan is to share data in ImmPort \[https://immport.niaid.nih.gov/ \], a long-term archive of clinical and mechanistic data from DAIT-funded grants and contracts.
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National Institute of Allergy and Infectious Diseases (NIAID)