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NCT04046939: EXHALE-1

Dexpramipexole Dose-Ranging Biomarker Study in Subjects With Eosinophilic Asthma

Completed Phase 2 Results posted Last updated 13 April 2023
What this trial tests

Phase 2 trial testing Dexpramipexole in Eosinophilic Asthma in 534 participants. Completed in 2 March 2021.

Timeline
15 August 2019
Primary endpoint
3 December 2020
2 March 2021

Quick facts

Lead sponsorKnopp Biosciences
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingtriple
Primary purposetreatment
Enrollment534
Start date15 August 2019
Primary completion3 December 2020
Estimated completion2 March 2021
Sites36 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Knopp Biosciences — full company profile →

Who can join

Adults 18 to 74, any sex, with Eosinophilic Asthma or Asthma. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Change in Blood Absolute Eosinophil Count From Baseline to Week 12 Primary · Baseline, 12 Weeks

The primary endpoint of this study was the change in AEC from Baseline to Week 12 on a ratio scale. The analysis used a mixed effects model repeated-measures (MMRM) with terms for log10 transformed baseline, GINA treatment step, treatment, visit, treatment by visit interaction, and log10 transformed baseline by visit interaction as fixed effects, and subject as a random effect. An unstructured covariance matrix was used. The response variable was the log10 transformed post-baseline value minus the log10 transformed baseline value. The estimates of Geometric LS Means and their ratios were obtai

GroupValue95% CI
Placebo BID0.8980± 1.26
37.5 mg BID Dexpramipexole0.4031± 1.28
75 mg BID Dexpramipexole0.3056± 1.27
150 mg BID Dexpramipexole0.2051± 1.25
Change in Pre-bronchodilator FEV1 (Liters) From Baseline to Week 12 Secondary · Baseline, 12 Weeks

FEV1 is defined as the amount of air that can be forcibly exhaled from the lungs in the first second of a forced exhalation.

GroupValue95% CI
Placebo BID0.0700± 0.08329
37.5 mg BID Dexpramipexole0.208± 0.08387
75 mg BID Dexpramipexole0.0557± 0.07848
150 mg BID Dexpramipexole0.247± 0.07769
Combined 150 mg BID and 75 mg BID Arms0.151± 0.05746
Change in Asthma Control Questionnaire (ACQ-6) Score From Baseline to Week 12 Secondary · Baseline, 12 Weeks

ACQ-6 is simple questionnaire to measure the adequacy of asthma control and change in asthma control which occurs either spontaneously or as a result of treatment. The 6-point self-administered scale has items measuring asthma symptoms and rescue inhaler use. The ACQ score is the mean of the questions and therefore between 0 (totally controlled) and 6 (severely uncontrolled). The original protocol planned to analyze the ACQ-7 score. As a result of FEV1 testing restrictions imposed on the study during the COVID-19 pandemic, the analysis was prospectively modified to the ACQ-6 score prior to dat

GroupValue95% CI
Placebo BID-0.391± 0.1866
37.5 mg BID Dexpramipexole-0.419± 0.1974
75 mg BID Dexpramipexole-0.437± 0.1924
150 mg BID Dexpramipexole-0.655± 0.1803
Change in Post-bronchodilator FEV1 From Baseline to Week 12 Secondary · Baseline, 12 Weeks

Post-bronchodilator FEV1 is defined as the amount of air that can be forcibly exhaled from the lungs in the first second of a forced exhalation, after treatment with inhaled albuterol.

GroupValue95% CI
Placebo BID-0.00546± 0.07208
37.5 mg BID Dexpramipexole0.0932± 0.07455
75 mg BID Dexpramipexole-0.000717± 0.06977
150 mg BID Dexpramipexole0.176± 0.07182
Change in Quality of Life, as Measured by the Asthma Quality of Life Questionnaire (AQLQ) From Baseline to Week 12 Secondary · Baseline, 12 Weeks

The AQLQ is a 32-item asthma specific questionnaire designed to measure functional impairments that are most important to patients with asthma. The 32 questions in the AQLQ are divided into four domains; activity limitations, symptoms, emotional function, and environmental stimuli. Individual questions are equally weighted. The overall AQLQ score is the mean of the responses to each of the 32 questions and ranges from 1 to 7. A score 7.0 indicates that the patient has no impairments due to asthma and score 1.0 indicates severe impairment.

GroupValue95% CI
Placebo BID0.376± 0.1999
37.5 mg BID Dexpramipexole0.531± 0.2112
75 mg BID Dexpramipexole0.312± 0.2055
150 mg BID Dexpramipexole0.584± 0.1979
Number of Participants With Potentially Clinically Significant Hematology Results by Treatment Group Post Randomization Through Week 12 Secondary · Immediately post-baseline up to Week 12

Number of Participants with Potentially Clinically Significant Hematology Results by Treatment Group. Percentages based on number of patients with at least one non-missing post-baseline value in each treatment group. Patients are only counted once per criterion per laboratory test.

Eosinophils >1.6 x 10^9/L
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Basophils >1.6 x 10^9/L
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Erythrocytes ≤3.5 x 10^12/L
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole1
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole2
Erythrocytes ≥6.4 x 10^12/L
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Hematocrit ≤32% - Females
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole2
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole1
Hematocrit ≥54% - Females
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Hematocrit ≤37% - Males
GroupValue95% CI
Placebo BID2
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole1
150 mg BID Dexpramipexole1
Hematocrit ≥60% - Males
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Number of Participants With Potentially Clinically Significant Blood Chemistry Results by Treatment Group Post Randomization Through Week 12 Secondary · Immediately post-baseline up to Week 12

Number of Participants with Potentially Clinically Significant Blood Chemistry Results by Treatment Group. Percentages based on number of patients with at least one non-missing post-baseline value in each treatment group. Patients are only counted once per criterion per laboratory test.

ALT ≥ 3 x ULN
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole1
150 mg BID Dexpramipexole0
Albumin ≤ 2.5 g/dL
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Alkaline Phosphatase ≥ 1.5 x ULN
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole1
150 mg BID Dexpramipexole1
AST ≥ 3 x ULN
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Bicarbonate ≤ 16 mEq/L
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole1
150 mg BID Dexpramipexole0
Bicarbonate ≥ 35 mEq/L
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Bilirubin > 2 X ULN and (ALT or AST ≥ 3 X ULN)
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Bilirubin ≥ 1.5 x ULN
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Number of Participants With Potentially Clinically Significant Urinalysis Results by Treatment Group Post Randomization Through Week 12 Secondary · Immediately post-baseline up to Week 12

Number of Participants with Potentially Clinically Significant Urinalysis Results (glycosuria, ketonuria, or proteinuria) by Treatment Group. Percentages based on number of patients with at least one non-missing post-baseline urinalysis value in each treatment group. Patients are only counted once per criterion per laboratory test. The number of participants with potential clinical important urinalysis findings at any post-baseline visit were reported.

glycosuria (glucose in urine ++++)
GroupValue95% CI
Placebo BID1
37.5 mg BID Dexpramipexole2
75 mg BID Dexpramipexole1
150 mg BID Dexpramipexole0
ketonuria (ketones in urine ≥ ++++)
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
proteinuria (protein in urine ≥ ++)
GroupValue95% CI
Placebo BID1
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Number of Participants With Potentially Clinically Significant Vital Signs Results by Treatment Group Post Randomization Through Week 12 Secondary · Immediately post-baseline up to Week 12

Number of Participants with Potentially Clinically Significant Vital Signs Results by Treatment Group. Percentages based on number of patients with at least one non-missing post-baseline value in each treatment group. Patients are only counted once per criterion per laboratory test.

Systolic blood pressure: >180 mmHg
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Systolic blood pressure: Increase >40 mmHg
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Systolic blood pressure: <90 mmHg
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Systolic blood pressure: Decrease >30 mmHg
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Diastolic blood pressure: >105 mmHg
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Diastolic blood pressure: Increase >30 mmHg
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole1
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Diastolic blood pressure: <50 mmHg
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Diastolic blood pressure: Decrease >20 mmHg
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Number of Participants With Potentially Clinically Significant ECG Results by Treatment Group Post Randomization Through Week 12 Secondary · Immediately post-baseline up to Week 12

Number of Participants with Potentially Clinically Significant ECG Results by Treatment Group. Percentages based on number of patients with at least one non-missing post-baseline value in each treatment group. Patients are only counted once per criterion per laboratory test.

Heart Rate >120 bpm
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Heart Rate Increase from Baseline >30 bpm
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole1
QT Interval: >450 ms
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
QT Interval: >480 ms
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
QT Interval: >500 ms
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
QT Interval: Increase from Baseline >30 ms
GroupValue95% CI
Placebo BID7
37.5 mg BID Dexpramipexole3
75 mg BID Dexpramipexole2
150 mg BID Dexpramipexole0
QT Interval: Increase from Baseline >60 ms
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
QTcF Interval: >450 ms
GroupValue95% CI
Placebo BID0
37.5 mg BID Dexpramipexole0
75 mg BID Dexpramipexole0
150 mg BID Dexpramipexole0
Change in Nasal Eosinophil Peroxidase (Presented as Ratio to Protein) From Baseline to Week 12 Secondary · Baseline, Week 12

The EPX:protein ratio was used to normalize the EPX for the quantity of sample, yielding the values in ng EPX per mg protein. The ratio of nasal Eosinophil Peroxidase to Protein is a biomarker for airway eosinophils. A lower ratio to Baseline represents a lowering in airway eosinophilia, which is a marker of successful drug therapy.

GroupValue95% CI
Placebo BID0.8330.258 – 2.99
37.5 mg BID Dexpramipexole0.6450.275 – 1.18
75 mg BID Dexpramipexole0.1740 – 0.708
150 mg BID Dexpramipexole0.1100 – 0.943
Change in Blood Absolute Blood Basophil Count From Baseline to Week 12 Secondary · Baseline, Week 12

The analysis used a mixed effects model repeated-measures MMRM with terms for baseline, GINA treatment step, treatment, visit, treatment by visit interaction, and baseline by visit interaction as fixed effects, and subject as a random effect. An unstructured covariance matrix was used. The response variable was the post-baseline value minus the baseline value. Basophils were enumerated as part of the WBC automated differential performed by the Central Laboratory.

GroupValue95% CI
Placebo BID-0.00439± 0.006323
37.5 mg BID Dexpramipexole-0.00655± 0.006674
75 mg BID Dexpramipexole-0.0250± 0.006487
150 mg BID Dexpramipexole-0.0277± 0.006082

Adverse events — posted to ClinicalTrials.gov

Time frame: Placebo Run-in Period = from enrollment to Randomization (2-4 weeks); Primary Assessment Period = from Randomization through the Week 12 visit, plus 30 days following the last dose; Eosinophil Recovery Period = all visits occurring from 30 days following the last dose through the end of study (Week 24 post-Randomization). Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Screening Period
Serious: 0/103 (0%)
Deaths: 0/103
Primary Assessment Period: Placebo BID
Serious: 0/27 (0%)
Deaths: 0/27
Primary Assessment Period: 37.5 mg BID
Serious: 0/22 (0%)
Deaths: 0/22
Primary Assessment Period: 75 mg BID
Serious: 0/26 (0%)
Deaths: 0/26
Primary Assessment Period: 150 mg BID
Serious: 0/28 (0%)
Deaths: 0/28
Eosinophil Recovery Period: Assigned to Placebo BID During Primary Assessment Period
Serious: 0/25 (0%)
Deaths: 0/25
Eosinophil Recovery Period: Assigned to 37.5 mg BID During Primary Assessment Period
Serious: 0/22 (0%)
Deaths: 0/22
Eosinophil Recovery Period: Assigned to 75 mg BID During Primary Assessment Period
Serious: 0/24 (0%)
Deaths: 0/24
Eosinophil Recovery Period: Assigned to 150 mg BID During Primary Assessment Period
Serious: 0/28 (0%)
Deaths: 0/28
Other adverse events (62 terms — click to expand)

ReactionSystemScreening PeriodPrimary Assessment Period:…Primary Assessment Period:…Primary Assessment Period:…Primary Assessment Period:…Eosinophil Recovery Period…Eosinophil Recovery Period…Eosinophil Recovery Period…Eosinophil Recovery Period…
NasopharyngitisInfections and infestations
InfluenzaInfections and infestations
Upper respiratory tract infectionInfections and infestations
Coronavirus test positiveInvestigations
Back painMusculoskeletal and connective tissue disorders
Pain in extremityMusculoskeletal and connective tissue disorders
AsthmaRespiratory, thoracic and mediastinal disorders
NauseaGastrointestinal disorders
MonocytopeniaBlood and lymphatic system disorders
NeutropeniaBlood and lymphatic system disorders
Sinus BradycardiaCongenital, familial and genetic disorders
Ear painEar and labyrinth disorders
Abdominal discomfortGastrointestinal disorders
Aphthous ulcerGastrointestinal disorders
Dry mouthGastrointestinal disorders
Gastrooesophageal reflux diseaseGastrointestinal disorders
VomitingGastrointestinal disorders
Chest discomfortGeneral disorders
FatigueGeneral disorders
Peripheral swellingGeneral disorders
CholecystitisHepatobiliary disorders
Anaphylactic reactionImmune system disorders
Acute sinusitisInfections and infestations
BronchitisInfections and infestations
Corona virus infectionInfections and infestations
Ear infection fungalInfections and infestations
Otitis externaInfections and infestations
SinusitisInfections and infestations
UrethritisInfections and infestations
Viral upper respiratory tract infectionInfections and infestations
ContusionInjury, poisoning and procedural complications
FallInjury, poisoning and procedural complications
Foreign body in earInjury, poisoning and procedural complications
ScratchInjury, poisoning and procedural complications
Skin lacerationInjury, poisoning and procedural complications
SunburnInjury, poisoning and procedural complications
Tooth fractureInjury, poisoning and procedural complications
Fluid retentionMetabolism and nutrition disorders
ArthralgiaMusculoskeletal and connective tissue disorders
Intervertebral disc protrusionMusculoskeletal and connective tissue disorders

Data from ClinicalTrials.gov NCT04046939 adverse events section.

Sponsor's own description

This is a randomized, double-blind, placebo-controlled, parallel-group, dose-ranging, multi-center study to evaluate the clinical effects of oral administration of dexpramipexole for 12 weeks on peripheral blood eosinophil count in subjects with eosinophilic asthma.

Publications & conference data

5 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Regulation of Eosinophilia in Asthma-New Therapeutic Approaches for Asthma Treatment.
    Cusack RP, Whetstone CE, Xie Y, Ranjbar M, et al · · 2021 · cited 22× · PMID 33917396 · DOI 10.3390/cells10040817
  2. Urine eosinophil-derived neurotoxin: A potential marker of activity in select eosinophilic disorders.
    Makiya MA, Khoury P, Kuang FL, Mata AD, et al · · 2023 · cited 15× · PMID 35971862 · DOI 10.1111/all.15481
  3. Recent advances in understanding the role of eosinophils.
    Constantine GM, Klion AD. · · 2022 · cited 13× · PMID 36225210 · DOI 10.12703/r/11-26
  4. Lessons learned from targeting eosinophils in human disease.
    Kuang FL, Bochner BS. · · 2021 · cited 9× · PMID 33891135 · DOI 10.1007/s00281-021-00849-w
  5. Investigational Treatments in Phase I and II Clinical Trials: A Systematic Review in Asthma.
    Calzetta L, Aiello M, Frizzelli A, Pistocchini E, et al · · 2022 · cited 7× · PMID 36140430 · DOI 10.3390/biomedicines10092330

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