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NCT Number: NCT06572228

Efficacy of Dupilumab Added to Medium Dose Inhaled Corticosteroid/Long-acting Beta-agonist (ICS/LABA) in Comparison to ICS Dose Escalation to High Dose ICS/LABA in Adolescent and Adult Patients With Uncontrolled Asthma

This study is researching a drug called dupilumab. The study is focused on patients who have uncontrolled asthma. Asthma is a condition where the airways narrow and swell, making it difficult to breathe. Uncontrolled asthma means that patients are still having frequent symptoms while taking their current asthma medication.

The aim of the study is to see which regimen is more effective: taking dupilumab with an inhaled asthma medication or only taking a higher dose of the inhaled asthma medication. The type of asthma medication that will be used is a combination inhaled corticosteroid and long-acting beta-agonist (referred to as an ICS/LABA). Some patients may also receive an additional asthma medication called a long-acting muscarinic antagonist (referred to as a LAMA) if they are already receiving a LAMA.

The study is also looking at:

• What side effects may happen from taking dupilumab

Active, Not Recruiting

This study is active but is not currently recruiting participants.

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Key information

Age range

12 year–80 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 4

Primary location

The Lung Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada

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About this study

This study is a Phase 3b in Canada Minors will not be enrolled in Denmark

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Key Inclusion Criteria:

  • Diagnosis of asthma for ≥12 months, based on the Global Initiative for Asthma (GINA) 2023 guidance document
  • Existing treatment with medium dose ICS/LABA (>250 to 500 μg/day of fluticasone propionate DPI or equivalent, per GINA 2023 guidance document) for at least 3 months with a stable dose ≥1 month prior to visit 1
  • Participants requiring a maximum of 3 controllers for their asthma will be considered eligible for this study
  • Pre-bronchodilator FEV1, as defined in the protocol
  • Reversibility of at least 12% and 200 mL in FEV1 after the administration of 200 to 400 μg albuterol/salbutamol at screening OR a documented history of ≥20% reduction in the FEV1, as defined in the protocol
  • Demonstrated adherence to medium dose ICS/LABA on at least 80% of days during the run-in period
  • ACQ-5 score ≥1.5 at screening (visit 1)
  • History of ≥1 severe exacerbation(s) in the previous year before visit 1, but not in the 30 days immediately preceding visit 1
  • Biomarker criteria: Baseline blood eosinophil count ≥300 cells/μL at visit 1 (~90% of population), as defined in the protocol

Key Exclusion Criteria:

  • Diagnosis of chronic obstructive pulmonary disease (COPD) or other lung diseases which may impair lung function and interfere with treatment assessments
  • Clinical evidence of lung disease(s) other than asthma or imaging (Chest X-ray, computed tomography (CT), magnetic resonance imaging [MRI]) with significant findings within 12 months of visit 1 and up to and including the baseline visit (visit 3)
  • A participant who experiences a severe asthma exacerbation at any time from 1 month prior to the screening visit (visit 1) up to and including the baseline visit (visit 3), as defined in the protocol
  • Weight is less than 30 kilograms
  • Current smoker or cessation of smoking within 6 months prior to visit 1 or previous smoker with a smoking history ≥10 pack-years
  • Severe concomitant illness(es) that, in the Investigator's judgment, would adversely affect the participant's participation in the study, as defined in the protocol
  • Participants cannot be on systemic corticosteroids at any time from 1 month prior to the screening visit (visit 1) through the duration of the run-in period

NOTE: Other protocol-defined Inclusion/Exclusion criteria apply

Treatment and study plan

Dupilumab

Drug

Administered by subcutaneous (SC) injection

Other names: Dupixent®, REGN668, SAR231893

Matching Placebo

Drug

Administered by SC injection

ICS/LABA

Drug

Administered at a blinded dose

Other names: fluticasone, propionate/salmeterol HFA, inhalation aerosol

Primary outcomes

  1. Annualized severe asthma exacerbation rate

    Time frame: Baseline through Week 52

Secondary outcomes

  1. Change in pre-bronchodilator Forced expiratory volume in the first second (FEV1)

    Time frame: Baseline to week 12

  2. Annualized cumulative dose of systemic corticosteroid exposure to treat severe asthma exacerbations

    Time frame: Baseline to week 52

  3. Change in Asthma Control Questionnaire (ACQ-5)

    Time frame: Baseline to week 12

    The ACQ-5 has 5 items that assess the most common asthma symptoms: 1. Frequency in past week awoken by asthma during the night, 2. Severity of asthma symptoms in the morning, 3. Limitation of daily activities due to asthma, 4. Shortness of breath due to asthma and 5. Wheeze. Participants are asked to recall how their asthma has been during the previous week and to respond to the symptom questions on a 7-point scale (0=no impairment, 6=maximum impairment). The ACQ-5 global score is the mean of the 5 questions and, therefore, between 0 (totally controlled) and 6 (severely uncontrolled). Higher score indicates lower asthma control.

  4. Proportion of participants achieving ACQ-5 <1.5

    Time frame: At week 12

  5. Change in pre-bronchodilator FEV1

    Time frame: Baseline up to week 52

  6. Change in percent predicted FEV1

    Time frame: Baseline up to week 52

  7. Change in peak expiratory flow (PEF)

    Time frame: Baseline up to week 52

  8. Change in forced vital capacity (FVC)

    Time frame: Baseline up to week 52

  9. Change in forced expiratory flow (FEF) 25-75%

    Time frame: Baseline up to week 52

  10. Change in FEV1: FVC ratio

    Time frame: Baseline up to week 52

  11. Change in post-bronchodilator FEV1

    Time frame: Baseline up to week 52

  12. Time to first severe exacerbation event

    Time frame: Up to week 52

  13. Proportion of participants achieving a 0.5-point improvement minimal clinically important difference (MCID) in ACQ-5

    Time frame: Up to week 52

  14. Incidence of Treatment-emergent adverse event (TEAEs)

    Time frame: Up to week 52

Sponsors and collaborators

Lead sponsor

Regeneron Pharmaceuticals

Industry

Collaborators

  • Sanofi

Registry information

Official study title

AIM4: Next Step - Asthma Uncontrolled With ICS in Medium Dose (GINA 4): Next Step; Efficacy of Dupilumab Added to Medium Dose ICS/LABA in Comparison to ICS Dose Escalation to High Dose ICS/LABA in Patients With Uncontrolled Asthma

Acronym: AIM4:Next Step

Important dates

Study start
2024
Primary completion
2027
Study completion
2027
First posted
Aug 27, 2024
Registry last updated
May 22, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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