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Uncontrolled AsthmaPhase 3ASTHMIRINENCT02906761

Aspirin for Uncontrolled Asthma

A Phase 3 study testing Aspirin in people with Uncontrolled Asthma, run by Assistance Publique - Hôpitaux de Paris at 9 sites in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Asthma is characterized by changes in eicosanoids metabolism, especially high production of bronchoconstrictive cysteinyl leukotrienes (CystLTBs) and leukotriene B4 (LTB4). Recent studies have also demonstrated a relative low production of lipoxin A4, an endogenous lipid mediator resulting from lipo-oxygenase action… Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Uncontrolled Asthma
What is being tested?
Aspirin
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
24 participants
Where
9 sitesFrance
Study dates
15 Jan 2019to 17 Jun 2021
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age : 18 to 75 years old
  • Patients receiving inhaled steroids (>1000 µg/d beclomethasone or equivalent) combined with long acting beta agonist at a stable dose for at least 1 month and montelukast for at least 2 weeks.
  • Patients receiving Proton Pump Inhibitors for at least 2 weeks
  • Uncontrolled asthma defined by an ACQ 6 score≥1.5 at baseline
  • Recurrent chronic rhinosinusitis with nasal polyposis diagnosed by nasal endoscopy by an otorhinolaryngologist
  • Evidence of reversibility of airway obstruction defined as an increase of FEV1 of 12% or greater and at least 200 ml after Short Acting Beta Agonists (SABA) administration OR after oral corticoid test or an increase of CVF of 12% or greater and at least 200 ml after Short Acting Beta Agonists (SABA) administration or after oral corticoid test OR a variation in FEV1 of more than 200 ml and 12% between 2 follow-up visits OR variation of the Peak Expiratory Flow Rate (PEF) with a delta PEF over the day / average PEF over 2 weeks > 10% OR a positive methacholine bronchial challenge test: decrease in FEV1 by more than 20% for a dose < 1600 µg documented once during medical history
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  • FEV1>1.5l and 60% of predicted value at inclusion
  • Never smoked or non-smoker for at least 6 months, with a smoking history of no more than 10 pack-years
  • Written informed consent
  • Efficient contraception, other than an intrauterine device (IUD), for women of reproductive age

Who cannot join

  • Evidence of another clinically significant, active pulmonary disorder (bronchiectasis, chronic obstructive pulmonary disease (COPD), …) that could influence asthma control evaluation
  • Patient treated regularly with aspirin or NSAID for another pathology
  • Hypersensitive response to lansoprazole
  • treatment by nelfinavir or other HIV protease inhibitors for which absorption depends on gastric pH (atazanavir...)
  • Asthma exacerbation within the 4 weeks prior to inclusion (as defined by an oral corticotherapy for more than 48h or a 2-fold increase of oral corticoid intake )
  • Pregnancy or breast feeding
Show all 18Show fewer
  • Recent myocardial infarction within the 6 months prior to inclusion
  • immunodeficiency
  • Patients receiving bet-blockers
  • Contra-indication for aspirin : history of gastro-intestinal or cerebral bleeding, active gastric or duodenal ulcer, major surgery within the 4 weeks prior to inclusion, treatment with methotrexate, probenecid, selective serotonin re-uptake inhibitor, diuretic, angiotensin-converting-enzyme inhibitor, angiotensin receptor inhibitor or anti-platelet drug, ,any hemorrhagic risk according to the investigator, heart, liver or kidney failure, hyperuricemia, phenylketonuria.
  • Major surgery planned during the 6 month study period
  • under security or legal protection measures
  • patient intolerant to lactose or other excipient
  • Patient with intra-uterine device
  • patient who has not given written consent
  • Non affiliation to a social security scheme (beneficiary or assignee)
  • Secondary exclusion criteria :
  • -Patients who will require epinephrine injection or transfer to ICU or patients who do not reach the maximum dose of 600mg during aspirin challenge-desensitization will stop the study and not be randomized

Trial locations and contacts

9 sites in 1 country.

9 sites in 1 country

France9 sites
  • Service de pneumologie - CHU Besançon

    Besançon

  • Service de Pneumologie - Hôpital François Mitterrand - CHU Dijon

    Dijon, 21000

  • Service de Pneumologie - Hôpital Bicêtre

    Le Kremlin-Bicêtre, 94270

  • Service de pneumologie - Hôpital Calmette - CHRU Lille

    Lille, 59037

  • Service de Pneumologie - La Croix Rousse

    Lyon, 69004

  • CIC - Hôpital Bichat

    Paris, 75018

  • Service de pneumologie - Hôpital Charles Nicolle - CHU Rouen

    Rouen

  • Service de pneumologie - Nouvel Hopital Civil - CHU strasbourg

    Strasbourg

  • Service de pneumologie - Hôpital Larrey

    Toulouse, 31009

Other trials in France

About this study

Official title: Aspirin for Uncontrolled Asthma : a Randomized Controlled Study

Asthma is characterized by changes in eicosanoids metabolism, especially high production of bronchoconstrictive cysteinyl leukotrienes (CystLTBs) and leukotriene B4 (LTB4). Recent studies have also demonstrated a relative low production of lipoxin A4, an endogenous lipid mediator resulting from lipo-oxygenase action, distinct from CystLTBs, with anti-inflammatory properties, in bronchial epithelial cells and lung macrophages of severe asthma patients, leading to imbalance between pro-resolving and pro-inflammatory eicosanoids production in airways. Such data suggest that aspirin, that induces lipoxins production, could restore lipoxins deficit in severe asthma. Interest for aspirin is also supported by data obtained in asthma patients with aspirin intolerance (Aspirin induced asthma, AIA) : in this particular group of patients, aspirin treatment significantly improves nasal symptoms, quality of life, asthma and rhinitis scores, and reduces need for hospitalizations, nasal surgery and oral steroids use. Potential effect of aspirin in patients with uncontrolled asthma without aspirin intolerance, who presented changes in arachidonic acid pathway close to those observed in AIA, is not established.

The aim of the study is to assess whether long term aspirin treatment could improve asthma control, compared to placebo, in patients with uncontrolled disease and nasal polyposis, whatever their aspirin tolerance level.

Read the detailed description

Asthma concerns about 7% of the French adult population. About 10% of them have uncontrolled disease, despite high doses of inhaled steroids combined with long acting beta 2 agonists and adequate management of aggravating factors. They account for considerable asthma morbidity, mortality and costs. New treatments are needed for these patients.

Asthma is characterized by changes in eicosanoids metabolism, especially high production of bronchoconstrictive cysteinyl leukotrienes and LTB4. Recent studies have also demonstrated a relative low production of lipoxin A4, an endogenous lipid mediator resulting from lipo-oxygenase action, distinct from CystLTBs, with anti-inflammatory properties, in bronchial epithelial cells and lung macrophages of severe asthma patients, leading to imbalance between pro-resolving and pro-inflammatory eicosanoids production in airways. Such data suggest that aspirin, that induces lipoxins production, could restore lipoxins deficit in severe asthma, as demonstrated in other models.

Interest for aspirin is also supported by data obtained in asthma patients with aspirin intolerance (Aspirin induced asthma, AIA), who are characterized by a severe difficult-to-treat respiratory disease frequently associated with nasal polyposis, overproduction of leukotrienes and increased expression of leukotriene receptors. In this particular group of patients, aspirin treatment significantly improves nasal symptoms, quality of life, asthma and rhinitis scores, and reduces need for hospitalizations and nasal surgery. A reduction in oral steroids use was observed in most series. In this group of patients, aspirin also induced a decrease in interleukin 4 (IL-4) and Matrix metallopeptidase 9 (MMP-9) levels in sputum in asthma patients thus providing another explanation for anti inflammatory effect of aspirin in asthma. Patients treated with higher doses of aspirin (650 mg BID) had more favorable courses than those treated with lower doses.Aspirin desensitization is considered as a cost-effective therapeutic intervention in patients with moderate-to-severe AIA However, some of these studies, coming mostly from the same team, can be criticized for methodological reasons, low evidence, small series, and weak asthma characterization.

Potential effect of aspirin in patients with uncontrolled asthma without aspirin intolerance, who presented changes in arachidonic acid pathway close to those observed in AIA, is not established. Because similar changes in eicosanoid metabolism are described in nasal polyps mucosa, a pathology frequently associated with asthma, we hypothesize that patients with nasal polyps and asthma could be a specific target for aspirin treatment.

Aspirin is a cheap treatment, compared with biotherapies developed for severe asthma.

Hypothesis The investigators propose to compare the effect aspirin (600 mg twice daily) versus placebo, given during six months, on asthma control in patients with uncontrolled asthma and nasal polyposis, whatever their aspirin level of tolerance, in a randomized, double blind, placebo-controlled trial.

Study objectives Primary objective To assess whether long term aspirin treatment could improve asthma control, compared to placebo, in patients with uncontrolled disease and nasal polyposis, whatever their aspirin tolerance level.

Secondary objectives

To assess the effect of long term aspirin treatment compared to placebo, in patients with uncontrolled disease and nasal polyposis, on the following criteria:

  • lung function
  • number of exacerbations
  • time to the first exacerbation
  • oral and inhaled steroid use and doses
  • Nasal symptoms
  • Nasal sinus symptoms severity
  • quality of life
  • Lipoxin A4, cysteinyl leukotrienes (cystLT) and LTB4 levels in sputum
  • Reactions during oral aspirin challenge
  • Gastro-intestinal and other bleedings

Study design This is a multicentric, randomized, placebo-controlled, double-blinded phase III clinical trial.

Being tested
Aspirin, Placebo
Keywords
asthma, aspirin
Medical subject headings
Asthma

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AspirinDrug

    Also called acetylsalicylic acid

    Aspirin 600 mg (2 tablets of 300 mg) twice daily for 6 months

  • PlaceboDrug

    Placebo (2 tablets) twice daily for 6 months

Study groups in NCT02906761
Study groupRoleWhat they receive
AspirinExperimentalAspirin 600 mg (2 tablets of 300 mg) twice daily for 6 months
Receives: Drug: Aspirin
PlaceboPlacebo comparatorPlacebo (2 tablets) twice daily for 6 months
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in asthma Control Questionnaire (ACQ 6) score between baseline and 6 months

    Patients will fill in ACQ6 at each visit (day 0, 1 month, 3 months and 6 months)

    Measured: 6 months

Secondary outcomes (14)
  1. Forced expired volume in 1 second (FEV1) variation between baseline and 6 months

    A spirometry will be done at each visit (day 0, 1 month, 3 months and 6 months)

    Measured: 6 months

  2. number of exacerbations

    The number of exacerbations will be assessed at each visit (day 0, 1 month, 3 months and 6 months)

    Measured: 6 months

  3. Time to first exacerbation

    Time to first exacerbation will be assessed at each visit (day 0, 1 month, 3 months and 6 months)

    Measured: 6 months

  4. number of hospitalization

    number of hospitalization

    Measured: 6 months

  5. oral steroid use

    oral steroid use

    Measured: 6 months

  6. inhaled steroid doses

    inhaled steroid doses

    Measured: 6 months

  7. nasal sinus symptoms severity at baseline and 6 months

    Patients will fill in Sino-Nasal Outcome Test 16 (SNOT 16) questionnaire at each visit .The SNOT-16 is a quality of life, self-administered questionnaire comprising 16 questions.

    Responses are scored as: 0 = no bother, 1 = mild or minor bother, 2 = moderate bother, 3 = severe bother. Patients are also asked to check to five items which are most important to them personally. Scores range (sum of each question) from 0 (no functional bother) to 48 (maximal functional bother) (day 0, 1 months, 3 months and 6 months)

    Measured: 6 months

  8. measure of quality of life: AQLQ

    Patients will fill in Asthma Quality of Life Questionnaire (AQLQ) at each visit (day 0, 1 months, 3 months and 6 months). There are 32 questions in the AQLQ and they are in 4 domains (symptoms, activity limitation, emotional function and environmental stimuli). The activity domain contains 5 'patient-specific' questions. This allows patients to select 5 activities in which they are most limited and these activities will be assessed at each follow-up. Patients are asked to think about how they have been during the previous two weeks and to respond to each of the 32 questions on a 7-point scale (7 = not impaired at all - 1 = severely impaired). The overall AQLQ score is the mean of all 32 responses and the individual domain scores are the means of the items in those domains.

    Measured: 6 months

  9. Lipoxin A4 (LXA4) levels in sputum

    LXA4 levels at day 0 and 6 months will be measured by ELISA kit

    Measured: 6 months

  10. Cyst-LT levels in sputum

    Cyst-LT levels at day 0 and 6 months will be measured by ELISA kit

    Measured: 6 months

  11. LTB4 levels in sputum

    LTB4 levels at day 0 and 6 months will be measured by ELISA kit

    Measured: 6 months

  12. Reactions during oral aspirin challenge test

    Occurrence of intolerance symptom : angioedema, bronchospasm, rhinitis, urticaria...

    Measured: 3 to 4 days

  13. Digestive tolerance during treatment

    Medical examination, patient interview

    Measured: 6 months

  14. gastro-intestinal bleedings during treatment

    Occurence by bleedings during treatment, patient interview

    Measured: 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Sep 2016 (estimated)
  2. Study start15 Jan 2019
  3. Primary completion17 Jun 2021
  4. Study completion17 Jun 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
24 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02906761
Sponsor's protocol ID
P130954
Other IDs
2016-000739-42, 2016
Acronym
ASTHMIRINE
Status last verified
Sep 2022
First submitted
1 Sep 2016
Last updated
8 Sep 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Aspirin in people with Uncontrolled Asthma, run by Assistance Publique - Hôpitaux de Paris at 9 sites in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 Sep 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 9 sites in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in asthma Control Questionnaire (ACQ 6) score between baseline and 6 months (time frame: 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Sep 2022.

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