A Phase 3 interventional study of lirentelimab (AK002) and Placebo in Eosinophilic Gastritis and Eosinophilic Duodenitis, sponsored by Allakos Inc.. Completed at 60 sites in United States. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2024-01-02.
Sponsored by Allakos Inc. · Phase 3, Interventional, and Treatment
This is a Phase 3, multi-center, randomized, double-blind, placebo-controlled study to assess the efficacy and safety of lirentelimab (AK002), given monthly for 6 doses, in patients with moderately to severely active Eosinophilic Gastritis and/or Eosinophilic Duodenitis (formerly referred to as Eosinophilic Gastroenteritis) who have an inadequate response with, lost response to, or were intolerant to standard therapies
Key Inclusion Criteria:
Key Exclusion Criteria:
Placebo
Other: Placebo
Subjects in this arm will receive 6 monthly doses of lirentelimab (AK002): a first dose of 1 mg/kg followed by 5 monthly doses of 3 mg/kg.
Drug: lirentelimab (AK002)
Lirentelimab (AK002) is a humanized non-fucosylated immunoglobulin G1 (IgG1) monoclonal antibody directed against Siglec-8.
Placebo
Proportion of Tissue Eosinophil Responders at Week 24
A tissue eosinophil responder is defined as mean eosinophil count ≤4 cells/HPF in 5 gastric HPFs for EG only patients, ≤15 cells/HPF in 3 duodenal HPFs for EoD only patients, and ≤4 cells/HPF in 5 gastric HPFs and ≤15 cells/HPF in 3 duodenal HPFs for EG+EoD patients.
Time frame: At Week 24
Change in PRO Total Symptom Score (TSS) From Baseline to Weeks 23-24
The PRO Total Symptom Score (TSS) is a patient reported outcome (PRO) questionnaire comprises the following 6 symptoms: Abdominal pain intensity, Nausea intensity, Fullness before meal intensity, Loss of appetite intensity, Bloating intensity, and Abdominal cramping intensity. TSS scores can range from 0 to 60, with a lower score indicating less-severe symptoms.
Time frame: Baseline to Weeks 23 - 24
Change in Tissue Eosinophils From Baseline to Week 24
Tissue eosinophil count obtained in biopsy specimens from the stomach and/or duodenum using esophago-gastro-duodenoscopy (EGD)
Time frame: Baseline to Week 24
Subjects Achieving Mean Eosinophil Count ≤1 Cell/Hpf in 5 Highest Gastric Hpf and/or Mean Eosinophil Count ≤1 Cell/Hpf in 3 Highest Duodenal Hpf at Week 24
Tissue eosinophil count obtained in biopsy specimens from the stomach and/or duodenum using esophago-gastro-duodenoscopy (EGD)
Time frame: At Week 24
Number of Treatment Responders
Treatment responders defined by \>30% improvement in TSS at Weeks 23-24 and eosinophil count ≤4 cells/hpf in 5 gastric hpf and/or eosinophil count ≤15 cells/hpf in 3 duodenal hpf at Week 24
Time frame: Weeks 23-24 and at Week 24, respectively
Subjects Who Achieve ≥50% Reduction in TSS From Baseline to Weeks 23-24
The PRO Total Symptom Score (TSS) is a patient reported outcome (PRO) questionnaire comprises the following 6 symptoms: Abdominal pain intensity, Nausea intensity, Fullness before meal intensity, Loss of appetite intensity, Bloating intensity, and Abdominal cramping intensity. TSS scores can range from 0 to 60, with a lower score indicating less-severe symptoms.
Time frame: At Weeks 23-24
Subjects Who Achieve ≥70% Reduction in TSS From Baseline to Weeks 23-24
The PRO Total Symptom Score (TSS) is a patient reported outcome (PRO) questionnaire comprises the following 6 symptoms: Abdominal pain intensity, Nausea intensity, Fullness before meal intensity, Loss of appetite intensity, Bloating intensity, and Abdominal cramping intensity. TSS scores can range from 0 to 60, with a lower score indicating less-severe symptoms.
Time frame: At Weeks 23-24
Percent Change in Weekly TSS Over Time Using MMRM
The PRO Total Symptom Score (TSS) is a patient reported outcome (PRO) questionnaire comprises the following 6 symptoms: Abdominal pain intensity, Nausea intensity, Fullness before meal intensity, Loss of appetite intensity, Bloating intensity, and Abdominal cramping intensity. TSS scores can range from 0 to 60, with a lower score indicating less-severe symptoms.
Time frame: Baseline to Week 24
| Milestone | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Started | 91 | 90 |
| Completed | 85 | 83 |
| Not completed | 6 | 7 |
A tissue eosinophil responder is defined as mean eosinophil count ≤4 cells/HPF in 5 gastric HPFs for EG only patients, ≤15 cells/HPF in 3 duodenal HPFs for EoD only patients, and ≤4 cells/HPF in 5 gastric HPFs and ≤15 cells/HPF in 3 duodenal HPFs for EG+EoD patients.
| Participants | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Proportion of Tissue Eosinophil Responders at Week 24 | 77 | 4 |
The PRO Total Symptom Score (TSS) is a patient reported outcome (PRO) questionnaire comprises the following 6 symptoms: Abdominal pain intensity, Nausea intensity, Fullness before meal intensity, Loss of appetite intensity, Bloating intensity, and Abdominal cramping intensity. TSS scores can range from 0 to 60, with a lower score indicating less-severe symptoms.
| Score on a scale | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Change in PRO Total Symptom Score (TSS) From Baseline to Weeks 23-24 | -10.0 ± 1.2 | -11.5 ± 1.1 |
Tissue eosinophil count obtained in biopsy specimens from the stomach and/or duodenum using esophago-gastro-duodenoscopy (EGD)
| Cells/HPF | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Change in Tissue Eosinophils From Baseline to Week 24 | -61.6 ± 46.3 | -11.7 ± 21.3 |
Tissue eosinophil count obtained in biopsy specimens from the stomach and/or duodenum using esophago-gastro-duodenoscopy (EGD)
| Participants | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Subjects Achieving Mean Eosinophil Count ≤1 Cell/Hpf in 5 Highest Gastric Hpf and/or Mean Eosinophil Count ≤1 Cell/Hpf in 3 Highest Duodenal Hpf at Week 24 | 75 | 1 |
Treatment responders defined by \>30% improvement in TSS at Weeks 23-24 and eosinophil count ≤4 cells/hpf in 5 gastric hpf and/or eosinophil count ≤15 cells/hpf in 3 duodenal hpf at Week 24
| Participants | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Number of Treatment Responders | 39 | 3 |
The PRO Total Symptom Score (TSS) is a patient reported outcome (PRO) questionnaire comprises the following 6 symptoms: Abdominal pain intensity, Nausea intensity, Fullness before meal intensity, Loss of appetite intensity, Bloating intensity, and Abdominal cramping intensity. TSS scores can range from 0 to 60, with a lower score indicating less-severe symptoms.
| Participants | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Subjects Who Achieve ≥50% Reduction in TSS From Baseline to Weeks 23-24 | 36 | 29 |
The PRO Total Symptom Score (TSS) is a patient reported outcome (PRO) questionnaire comprises the following 6 symptoms: Abdominal pain intensity, Nausea intensity, Fullness before meal intensity, Loss of appetite intensity, Bloating intensity, and Abdominal cramping intensity. TSS scores can range from 0 to 60, with a lower score indicating less-severe symptoms.
| Participants | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Subjects Who Achieve ≥70% Reduction in TSS From Baseline to Weeks 23-24 | 26 | 18 |
The PRO Total Symptom Score (TSS) is a patient reported outcome (PRO) questionnaire comprises the following 6 symptoms: Abdominal pain intensity, Nausea intensity, Fullness before meal intensity, Loss of appetite intensity, Bloating intensity, and Abdominal cramping intensity. TSS scores can range from 0 to 60, with a lower score indicating less-severe symptoms.
| Percentage of Change | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Week 2 | -18.2 ± 34.1 | -17.4 ± 31.9 |
| Week 4 | -17.7 ± 34.2 | -21.2 ± 32.8 |
| Week 6 | -29.8 ± 37.2 | -28.3 ± 37.6 |
| Week 8 | -29.8 ± 40.4 | -31.3 ± 33.6 |
| Week 10 | -34.6 ± 39.7 | -36.3 ± 39.7 |
| Week 12 | -33.1 ± 39.9 | -36.2 ± 37.3 |
| Week 14 | -36.3 ± 40.2 | -38.7 ± 36.5 |
| Week 16 | -33.1 ± 40.8 | -38.8 ± 38.8 |
| Week 18 | -42.6 ± 42.3 | -41.3 ± 37.2 |
| Week 20 | -42.1 ± 37.1 | -39.9 ± 34.9 |
| Week 22 | -41.7 ± 39.8 | -41.4 ± 37.3 |
| Week 24 | -39.4 ± 39.9 | -38.5 ± 37.2 |
Collected over Baseline up to Day 225. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| 3 mg/kg of Lirentelimab (AK002) | 0/91 (0%) | 7/91 (7.7%) | 41/91 (45.1%) |
| Placebo | 0/89 (0%) | 5/89 (5.6%) | 31/89 (34.8%) |
| Event | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| AnaemiaBlood and lymphatic system disorders | 0/91 | 1/89 |
| Biliary dyskinesiaHepatobiliary disorders | 0/91 | 1/89 |
| Femur fractureInjury, poisoning and procedural complications | 0/91 | 1/89 |
| Diabetic ketoacidosisMetabolism and nutrition disorders | 1/91 | 1/89 |
| Mental status changesPsychiatric disorders | 0/91 | 1/89 |
| Cholecystitis acuteHepatobiliary disorders | 1/91 | 0/89 |
| OsteomyelitisInfections and infestations | 1/91 | 0/89 |
| HypokalaemiaMetabolism and nutrition disorders | 1/91 | 0/89 |
| Lumbar radiculopathyNervous system disorders | 1/91 | 0/89 |
| SeizureNervous system disorders | 1/91 | 0/89 |
| Event | 3 mg/kg of Lirentelimab (AK002) | Placebo |
|---|---|---|
| Infusion related reactionInjury, poisoning and procedural complications | 31/91 | 12/89 |
| Corona virus infectionInfections and infestations | 4/91 | 6/89 |
| Coronavirus test positiveInvestigations | 3/91 | 6/89 |
| Abdominal painGastrointestinal disorders | 5/91 | 5/89 |
| NauseaGastrointestinal disorders | 2/91 | 5/89 |
| VomitingGastrointestinal disorders | 3/91 | 5/89 |
| Urinary tract infectionInfections and infestations | 3/91 | 5/89 |
| FatigueGeneral disorders | 5/91 | 1/89 |
| Age, Continuous(years) | 3 mg/kg of Lirentelimab (AK002) | Placebo | Total |
|---|---|---|---|
| Median | 43 (17 to 77) | 41 (18 to 78) | 42 (17 to 78) |
| Age, Customized(Participants) | 3 mg/kg of Lirentelimab (AK002) | Placebo | Total |
|---|---|---|---|
| <65 years | 81 | 85 | 166 |
| >=65 years | 10 | 4 | 14 |
| Sex: Female, Male(Participants) | 3 mg/kg of Lirentelimab (AK002) | Placebo | Total |
|---|---|---|---|
| Female | 56 | 61 | 117 |
| Male | 35 | 28 | 63 |
| Ethnicity (NIH/OMB)(Participants) | 3 mg/kg of Lirentelimab (AK002) | Placebo | Total |
|---|---|---|---|
| Hispanic or Latino | 14 | 10 | 24 |
| Not Hispanic or Latino | 76 | 78 | 154 |
| Unknown or Not Reported | 1 | 1 | 2 |
| Race (NIH/OMB)(Participants) | 3 mg/kg of Lirentelimab (AK002) | Placebo | Total |
|---|---|---|---|
| American Indian or Alaska Native | 2 | 0 | 2 |
| Asian | 2 | 4 | 6 |
| Native Hawaiian or Other Pacific Islander | 2 | 1 | 3 |
| Black or African American | 7 | 6 | 13 |
| White | 75 | 78 | 153 |
| More than one race | 2 | 0 | 2 |
| Unknown or Not Reported | 1 | 0 | 1 |
| Region of Enrollment(Participants) | 3 mg/kg of Lirentelimab (AK002) | Placebo | Total |
|---|---|---|---|
| United States | 91 | 89 | 180 |
| Baseline Gastric Eosinophil Count(Eosinophils/HPF) | 3 mg/kg of Lirentelimab (AK002) | Placebo | Total |
|---|---|---|---|
| Mean | 51.3 ± 57.9 | 37.0 ± 30.9 | 44.3 ± 46.9 |
| Baseline Duodenal Eosinophil Count(Eosinophils/HPF) | 3 mg/kg of Lirentelimab (AK002) | Placebo | Total |
|---|---|---|---|
| Mean | 42.4 ± 19.8 | 39.1 ± 15.6 | 40.7 ± 17.9 |
1 further baseline measures are reported on the registry.
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Allakos Inc.