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Menzies-Gow A, Wechsler ME, Brightling CE, Korn S, Corren J, Israel E, Chupp G, Bednarczyk A, Ponnarambil S, Caveney S, Almqvist G, Gołąbek M, Simonsson L, Lawson K, Bowen K, Colice G, Fiterman J, Souza Machado A, Antila MA, Lima MA, Minamoto SET, Blanco DC, Bezerra PGDM, Houle PA, Lemiere C, Melenka LS, Leigh R, Mitchell P, Anees S, Pek B, Chouinard G, Cheema AS, Yang WHC, Philteos G, Chanez P, Bourdin A, Devouassoux G, Taille C, De Blay F, Leroyer C, Beurnier A, Garcia G, Girodet PO, Blanc FX, Magnan A, Wanin S, Just J, Linde R, Zielen S, Förster K, Geßner C, Jandl M, Buhl RO, Korn S, Kornmann MO, Linnhoff A, Ludwig-Sengpiel A, Ehlers M, Schmoller T, Steffen H, Hoffmann M, Kirschner J, Schmidt O, Welte T, Temme H, Wand O, Bar-Shai A, Izbicki G, Berkman N, Fink G, Shitrit D, Adir Y, Kuna P, Rewerska B, Pisarczyk-Bogacka E, Kurbacheva O, Mikhailov SL, Vasilev M, Emelyanov A, Wali S, Albanna A, van Zyl-Smit R, Abdullah I, Abdullah I, Bernhardi D, Hoosen F, Irusen E, Kalla I, Lakha D, Mitha E, Naidoo V, Nell H, Padayachee T, Reddy J, Petrick F, van der Walt E, Vawda ZFA, Park HS, Lee SH, Kim MK, Park JW, Cho YS, Lee BJ, Chang YS, Park CS, Lee KH, Lee SY, Yoon H, Sohn KH, Park MJ, Min KH, Cho YJ, Park HK, Lee Y, Lee J, Sheu CC, Tu CY, Lee KY, Bavbek S, Gemicioglu B, Ediger D, Kalkan IK, Makieieva N, Ostrovskyy M, Dytyatkovs'ka Y, Mostovoy YM, Lebed K, Yakovenko O, Adams A, Mooring T, Torres Jr L, Sexton M, Thompson E, Bernstein JA, Lisi P, Chappel CM, Cole J, Greenwald GI, Jones C, Klein RM, Pham DN, Spangenthal S, Weinstein SF, Windom HH, Kao NL, Leong MA, Mehta V, Moore WC, Bhat S, Aish B, Meltzer SM, Corren J, Moss MH, Kerwin EM, Delgado JP, Lucksinger GH, Thompson CA, Chupp G, Alpizar SA, Vadgama SV, Zafar Z, Jacobs JS, Lugogo NJ, Jain N, Sher LD, Andrawis NS, Fuentes D, Boren EJ, Gonzalez EG, Talreja N, Durrani SS, Israel E, Sekhsaria S, DeLeon S, Shukla M, Totszollosy Tarpay MM, Fakih F, Hudes G, Tillinghast JP, Korenblat PE, Shenoy K, Que L, Kureishy SA, Umeh FC, Nguyen VN, Chu HT, Nguyen TTD. Long-term safety and efficacy of tezepelumab in people with severe, uncontrolled asthma (DESTINATION): a randomised, placebo-controlled extension study. Lancet Respir Med 2023; 11:425-438. [PMID: 36702146 DOI: 10.1016/s2213-2600(22)00492-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Tezepelumab is a human monoclonal antibody that blocks thymic stromal lymphopoietin. The drug has been tested previously in the phase 3 NAVIGATOR (NCT03347279) and SOURCE (NCT03406078) studies, and was subsequently approved as a treatment for severe asthma. This extension study recruited from NAVIGATOR and SOURCE and aimed to evaluate the long-term safety and efficacy of tezepelumab in individuals with severe, uncontrolled asthma. METHODS DESTINATION was a phase 3, multicentre, randomised, double-blind, placebo-controlled, long-term extension study. The study was done across 182 sites (including hospitals, clinics, medical centres, clinical trial centres, and private practices) in 18 countries. Participants (aged 12-80 years) were required to have good treatment compliance in the parent study. Randomisation was stratified by the parent study and all participants were re-randomised. Those who were previously randomised to receive tezepelumab in either parent study continued treatment of subcutaneous tezepelumab (210 mg every 4 weeks); those who were previously randomised to receive placebo in either parent study were re-randomised 1:1 to receive either subcutaneous tezepelumab (210 mg every 4 weeks) or placebo (every 4 weeks) using a randomisation list prepared by a computerised system. Total treatment duration (including the parent studies) was 104 weeks for all groups. Participants, investigators, and site staff were masked to treatment assignment. The primary endpoints were exposure-adjusted incidence of adverse events and serious adverse events and the secondary endpoint was the annualised asthma exacerbation rate; these were assessed from week 0 of the parent studies to week 104 of DESTINATION in all participants who were randomised and who received at least one dose of tezepelumab or placebo in either of the parent studies. The trial is registered with ClinicalTrials.gov, NCT03706079, and is closed to new participants. FINDINGS Participants were recruited between Jan 7, 2019, and Oct 15, 2020. For individuals who initially received tezepelumab (n=528) in NAVIGATOR, incidence of adverse events over 104 weeks was 49·62 (95% CI 45·16 to 54·39) per 100 patient-years, compared with 62·66 (56·93 to 68·81) for those receiving placebo (n=531; difference -13·04, 95% CI -17·83 to -8·18). For serious adverse events, incidence was 7·85 (6·14 to 9·89) per 100 patient-years for individuals who initially received tezepelumab and 12·45 (9·97 to 15·35) for those who received placebo (difference -4·59, -7·69 to -1·65). In SOURCE, incidence of adverse events was 47·15 (36·06 to 60·56) per 100 patient-years for those who initially received tezepelumab (n=74) and 69·97 (54·54 to 88·40) for those who received placebo (n=76; difference -22·82, -34·77 to -10·01). For serious adverse events, incidence was 13·14 (7·65 to 21·04) per 100 patient-years for those who initially received tezepelumab and 17·99 (10·66 to 28·44) for those who received placebo (difference -4·85, -14·88 to 4·53). Tezepelumab reduced the annualised asthma exacerbation rate over 104 weeks compared with placebo. In participants initially from NAVIGATOR, the annualised asthma exacerbation rate ratio over 104 weeks was 0·42 (95% CI 0·35 to 0·51); in those initially from SOURCE, the ratio over 104 weeks was 0·61 (0·38 to 0·96). INTERPRETATION Tezepelumab treatment was well tolerated for up to 2 years and resulted in sustained, clinically meaningful reductions in asthma exacerbations in individuals with severe, uncontrolled asthma. These findings are consistent with previous randomised, placebo-controlled studies and show the long-term safety and sustained efficacy of tezepelumab in individuals with severe, uncontrolled asthma. FUNDING AstraZeneca and Amgen.
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Affiliation(s)
- Andrew Menzies-Gow
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospitals, School of Immunology and Microbial Sciences, King's College London, London, UK.
| | | | - Christopher E Brightling
- Institute for Lung Health, National Institute for Health and Care Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Stephanie Korn
- Pulmonary Department, Institute für klinische Forschung, Pneumologie Mainz, Mainz, Germany; Pulmonary Department, Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Jonathan Corren
- Department of Medicine and Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Geoffrey Chupp
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Artur Bednarczyk
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca Warsaw, Poland
| | - Sandhia Ponnarambil
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Scott Caveney
- Global Development, Inflammation, Research and Development, Amgen, Thousand Oaks, CA, USA
| | - Gun Almqvist
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Monika Gołąbek
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca Warsaw, Poland
| | - Linda Simonsson
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Kaitlyn Lawson
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, MD, USA; Cytel, Cambridge, MA, USA
| | - Karin Bowen
- Biometrics, Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Gene Colice
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, MD, USA
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