Allergic Bronchopulmonary AspergillosisPhase 3PICANCT06174922
A Randomized Trial of Prednisolone, Itraconazole, or Their Combination in Allergic Bronchopulmonary Aspergillosis
A Phase 3 study testing Prednisolone and Itraconazole in people with Allergic Bronchopulmonary Aspergillosis, run by Post Graduate Institute of Medical Education and Research, Chandigarh at 1 site in India.
Trial summary
The investigators hypothesize that a combination of prednisolone and itraconazole would significantly reduce the exacerbation rate at one-year of patients with acute allergic bronchopulmonary aspergillosis (ABPA) compared to itraconazole or prednisolone monotherapy. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Allergic Bronchopulmonary Aspergillosis
- What is being tested?
- Prednisolone and Itraconazole
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 300 participants
- Where
- 1 siteIndia
- Study dates
- 1 Dec 2023to Jun 2026
- Phase
- Phase 3
- Are there results?
- Not yet: the study is under way
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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Consecutive subjects of acute stage allergic bronchopulmonary aspergillosis (ABPA) complicating asthma per the revised ISHAM-ABPA working group criteria
- newly diagnosed subjects with uncontrolled asthma or symptoms or radiology suggesting active lesions attributable to ABPA and meeting the diagnostic criteria of ABPA
- those previously meeting the diagnostic criteria for ABPA and presenting with sustained (≥2 weeks) clinical or radiological worsening; and increase in serum total IgE by ≥50% of the last recorded IgE value during clinical stability.
Who cannot join
- occurrence of ≥3 ABPA exacerbations in the last 18 months before enrollment
- contraindications to the use of either prednisolone or itraconazole
- subjects who have received oral prednisolone (or equivalent) ≥30 mg for ≥2 weeks or itraconazole (or voriconazole or posaconazole or isavuconazole) for more than 2 weeks, in the last 3 months
- chronic medical illnesses, including uncontrolled diabetes mellitus, chronic renal failure, chronic liver failure, chronic heart failure, and others
- patient on immunosuppressive drugs
- pregnancy
Show all 11Show fewer
- enrollment in another trial of ABPA
- failure to provide informed consent
- asthma exacerbation: worsening respiratory symptoms for at least 24 hours without immunological or radiological deterioration of ABPA
- infective/bronchiectasis exacerbation: clinical deterioration for at least 24 hours with increase in cough; breathlessness; sputum volume or consistency; sputum purulence; fatigue, malaise, or fever; and hemoptysis without immunological or radiological deterioration of ABPA
- serologic ABPA
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
India1 site, 1 recruiting
- Recruiting
Chest Clinic, Dept. of Pulmonary Medicine
Chandigarh, Chandigarh, 160012
Ritesh Agarwal, MD, DM, 00911722756825, agarwal.ritesh@outlook.in
Valliappan Muthu, MD, DM, 00911722756820, valliappa@gmail.com
About this study
Official title: A Randomized Trial Comparing the Role of Prednisolone, Itraconazole, or Their Combination in Patients with Acute Stage of Allergic Bronchopulmonary Aspergillosis
The investigators hypothesize that a combination of prednisolone and itraconazole would significantly reduce the exacerbation rate at one-year of patients with acute allergic bronchopulmonary aspergillosis (ABPA) compared to itraconazole or prednisolone monotherapy.
In this study, 300 subjects aged ≥18 years with acute ABPA will be randomized to treatment with either prednisolone, itraconazole, or prednisolone plus itraconazole, all for four months each. After collecting baseline demographic, immunologic, and imaging data, the investigators will follow the patients every 2 months for the first two visits and then every four months for three visits. The primary outcome will be the proportion of subjects experiencing exacerbation (asthma or ABPA) 12 months after treatment completion.
Read the detailed description
The principles of treating ABPA include using glucocorticoids to control the immunologic activity and antifungal agents to attenuate the fungal burden in the airways.4 Glucocorticoids are the first line treatment in acute stages of ABPA, although there are no placebo-controlled trials of glucocorticoids in ABPA. However, their effectiveness in ABPA is so well established that it might be considered unethical to conduct placebo-controlled trials. In one study, 92 subjects were randomized to receive high-dose (n=44) or low-dose (n=48) prednisolone. The numbers of subjects with exacerbation after one year (high-dose: 40.9% vs. medium-dose: 50%, p=0.59) were similar in the two groups. Although the composite response rates were significantly higher in the high-dose group, the improvement in lung function and the time to first exacerbation were similar in the two groups. [Eur Respir J. 2016;47(2):490-498] Specific antifungal agents in ABPA can modify the immune response by removing or reducing the antigenic stimulus consequent to a decreased fungal burden. Two randomized trials have recently shown that itraconazole and voriconazole monotherapies are as effective as prednisolone in treating acute-stage ABPA. [Chest. 2018;153(3):656-664|Eur Respir J. 2018;52(3):1801159] In the first randomized trial, 131 ABPA patients were randomized to receive either oral itraconazole (400 mg/day, [n=68]) or prednisolone (n=63) for four months. The proportion of subjects responding at six weeks was significantly higher in the prednisolone arm (100% vs. 88%; p=0.007). However, the number of subjects with exacerbations after one and two years of treatment was similar in the two groups. The time to first exacerbation was also similar in the two groups. The occurrence of adverse reactions was significantly higher in the glucocorticoid arm. Although prednisolone was more effective than itraconazole in inducing a response in acute-stage ABPA, itraconazole with fewer side effects is an acceptable alternative for treating acute-stage ABPA.[Chest. 2018;153(3):656-664] In the second trial, 50 ABPA patients were randomized to receive prednisolone (n=25) or voriconazole (n=25).[Eur Respir J. 2018;52(3):1801159] The response to treatment after six weeks and three months was similar in the two groups. The numbers of subjects with exacerbations after one year and two years were similar in the two groups. More recently, acute-stage ABPA subjects were randomized to receive either prednisolone (n=94) or prednisolone-itraconazole combination (n=97). The one-year exacerbation rate was 33% and 20.6% in the prednisolone and the prednisolone-itraconazole arms, respectively (p=0.054).[Eur Respir J. 2022;59(4):2101787] However, the study did not have a comparator arm of itraconazole monotherapy. Thus, it is unclear whether combination therapy is better than itraconazole or prednisolone monotherapy in reducing the occurrence of ABPA exacerbations.
The investigators hypothesize that the combination of prednisolone and itraconazole would significantly reduce the exacerbation rate at one-year than monotherapy. This study will compare the efficacy of prednisolone, itraconazole, or their combination in patients with acute stages of ABPA.
- Conditions
- Allergic Bronchopulmonary Aspergillosis
- Being tested
- Prednisolone, Itraconazole
- Medical subject headings
- Aspergillosis, Allergic Bronchopulmonary
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
PrednisoloneDrug
Prednisolone for 4 months
ItraconazoleDrug
SUBA-itraconazole for 4 months
| Study group | Role | What they receive |
|---|---|---|
| Prednisolone | Active comparator | Oral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper 5 mg every 4 weeks and discontinue by 4 months. After breakfast, oral prednisolone will be administered as a morning dose (8-10 am). Receives: Drug: Prednisolone |
| Itraconazole | Active comparator | Oral SUBA-itraconazole 65 mg 2 capsules BD for 4 months. Oral itraconazole will be given twice daily (9 am and 9 pm) spaced one hour with meals. We will perform therapeutic drug monitoring for itraconazole at two weeks and two months. We will increase the itraconazole dose to a maximum of 390 mg/day (six 65 mg capsules) in those with trough itraconazole levels <0.5 µg/mL. Receives: Drug: Itraconazole |
| Prednisolone plus itraconazole | Experimental | Oral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper 5 mg every 4 weeks and discontinue by 4 months. After breakfast, oral prednisolone will be administered as a morning dose (8-10 am); and, Oral SUBA-itraconazole 65 mg 2 capsules BD for 4 months. Oral itraconazole will be given twice daily (9 am and 9 pm) spaced one hour with meals. We will perform therapeutic drug monitoring for itraconazole at two weeks and two months. We will increase the itraconazole dose to a maximum of 390 mg/day (six 65 mg capsules) in those with trough itraconazole levels <0.5 µg/mL. Receives: Drug: Prednisolone; Drug: Itraconazole |
What is being measured
The primary outcome is the main question the study is designed to answer.
Asthma or ABPA exacerbations
Proportion of subjects experiencing exacerbation (asthma or ABPA) 12 months after treatment completion
Measured: 12 months after treatment completion
Secondary outcomes (8)
Composite response
Proportion of subjects experiencing composite response defined as symptomatic improvement by at least 50%; and, major radiological improvement, and a decline in serum total IgE by at least 20% of baseline
Measured: 8 weeks
IgE decline
Percentage decline in IgE (baseline IgE minus IgE after eight weeks/baseline IgE
Measured: 8 weeks
Time to first ABPA exacerbation
Time to first ABPA exacerbation in days
Measured: 12 months after treatment completion
Time to first asthma exacerbation
Time to first asthma exacerbation in days
Measured: 12 months after treatment completion
Weight gain
Treatment-related adverse effects
Measured: Two months
Hyperglycemia
Treatment-related adverse effects
Measured: Two months
Cushingoid habitus
Treatment-related adverse effects
Measured: Two months
Transaminitis
Treatment-related adverse effects
Measured: Two months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted18 Dec 2023
- Study start1 Dec 2023
- Primary completionJun 2026 (estimated)
- Study completionJun 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Allergic Bronchopulmonary AspergillosisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- None (open label)
- Enrolment
- 300 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Post Graduate Institute of Medical Education and Research, Chandigarh
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ritesh Agarwal, Post Graduate Institute of Medical Education and Research, Chandigarh
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06174922
- Sponsor's protocol ID
- Int/IEC/2023/SPL-1026A
- Acronym
- PICA
- Status last verified
- Feb 2025
- First submitted
- 24 Nov 2023
- Last updated
- 28 Feb 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 28 Feb 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Trial Comparing the Role of Prednisolone, Itraconazole, or Their Combination in Patients with Acute Stage of Allergic Bronchopulmonary Aspergillosis
- ClinicalTrials.gov ID
- NCT06174922
- Acronym / sponsor ID
- PICA / Int/IEC/2023/SPL-1026A
- Conditions
- Allergic Bronchopulmonary Aspergillosis
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 300 participants (estimated)
- Lead sponsor
- Post Graduate Institute of Medical Education and Research, ChandigarhUniversity, hospital or other
- Study start
- 1 Dec 2023 (actual)
- Primary completion
- Jun 2026 (estimated)
- Study completion
- Jun 2026 (estimated)
- First posted
- 18 Dec 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The investigators hypothesize that a combination of prednisolone and itraconazole would significantly reduce the exacerbation rate at one-year of patients with acute allergic bronchopulmonary aspergillosis (ABPA) compared to itraconazole or prednisolone monotherapy.
In this study, 300 subjects aged ≥18 years with acute ABPA will be randomized to treatment with either prednisolone, itraconazole, or prednisolone plus itraconazole, all for four months each. After collecting baseline demographic, immunologic, and imaging data, the investigators will follow the patients every 2 months for the first two visits and then every four months for three visits. The primary outcome will be the proportion of subjects experiencing exacerbation (asthma or ABPA) 12 months after treatment completion.
Detailed description
The principles of treating ABPA include using glucocorticoids to control the immunologic activity and antifungal agents to attenuate the fungal burden in the airways.4 Glucocorticoids are the first line treatment in acute stages of ABPA, although there are no placebo-controlled trials of glucocorticoids in ABPA. However, their effectiveness in ABPA is so well established that it might be considered unethical to conduct placebo-controlled trials. In one study, 92 subjects were randomized to receive high-dose (n=44) or low-dose (n=48) prednisolone. The numbers of subjects with exacerbation after one year (high-dose: 40.9% vs. medium-dose: 50%, p=0.59) were similar in the two groups. Although the composite response rates were significantly higher in the high-dose group, the improvement in lung function and the time to first exacerbation were similar in the two groups. [Eur Respir J. 2016;47(2):490-498] Specific antifungal agents in ABPA can modify the immune response by removing or reducing the antigenic stimulus consequent to a decreased fungal burden. Two randomized trials have recently shown that itraconazole and voriconazole monotherapies are as effective as prednisolone in treating acute-stage ABPA. [Chest. 2018;153(3):656-664|Eur Respir J. 2018;52(3):1801159] In the first randomized trial, 131 ABPA patients were randomized to receive either oral itraconazole (400 mg/day, [n=68]) or prednisolone (n=63) for four months. The proportion of subjects responding at six weeks was significantly higher in the prednisolone arm (100% vs. 88%; p=0.007). However, the number of subjects with exacerbations after one and two years of treatment was similar in the two groups. The time to first exacerbation was also similar in the two groups. The occurrence of adverse reactions was significantly higher in the glucocorticoid arm. Although prednisolone was more effective than itraconazole in inducing a response in acute-stage ABPA, itraconazole with fewer side effects is an acceptable alternative for treating acute-stage ABPA.[Chest. 2018;153(3):656-664] In the second trial, 50 ABPA patients were randomized to receive prednisolone (n=25) or voriconazole (n=25).[Eur Respir J. 2018;52(3):1801159] The response to treatment after six weeks and three months was similar in the two groups. The numbers of subjects with exacerbations after one year and two years were similar in the two groups. More recently, acute-stage ABPA subjects were randomized to receive either prednisolone (n=94) or prednisolone-itraconazole combination (n=97). The one-year exacerbation rate was 33% and 20.6% in the prednisolone and the prednisolone-itraconazole arms, respectively (p=0.054).[Eur Respir J. 2022;59(4):2101787] However, the study did not have a comparator arm of itraconazole monotherapy. Thus, it is unclear whether combination therapy is better than itraconazole or prednisolone monotherapy in reducing the occurrence of ABPA exacerbations.
The investigators hypothesize that the combination of prednisolone and itraconazole would significantly reduce the exacerbation rate at one-year than monotherapy. This study will compare the efficacy of prednisolone, itraconazole, or their combination in patients with acute stages of ABPA.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Prednisolone | Active comparator | Drug: PrednisoloneOral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper 5 mg every 4 weeks and discontinue by 4 months. After breakfast, oral prednisolone will be administered as a morning dose (8-10 am). |
| Itraconazole | Active comparator | Drug: ItraconazoleOral SUBA-itraconazole 65 mg 2 capsules BD for 4 months. Oral itraconazole will be given twice daily (9 am and 9 pm) spaced one hour with meals. We will perform therapeutic drug monitoring for itraconazole at two weeks and two months. We will increase the itraconazole dose to a maximum of 390 mg/day (six 65 mg capsules) in those with trough itraconazole levels <0.5 µg/mL. |
| Prednisolone plus itraconazole | Experimental | Drug: Prednisolone, Drug: ItraconazoleOral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper 5 mg every 4 weeks and discontinue by 4 months. After breakfast, oral prednisolone will be administered as a morning dose (8-10 am); and, Oral SUBA-itraconazole 65 mg 2 capsules BD for 4 months. Oral itraconazole will be given twice daily (9 am and 9 pm) spaced one hour with meals. We will perform therapeutic drug monitoring for itraconazole at two weeks and two months. We will increase the itraconazole dose to a maximum of 390 mg/day (six 65 mg capsules) in those with trough itraconazole levels <0.5 µg/mL. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Consecutive subjects of acute stage allergic bronchopulmonary aspergillosis (ABPA) complicating asthma per the revised ISHAM-ABPA working group criteria
- newly diagnosed subjects with uncontrolled asthma or symptoms or radiology suggesting active lesions attributable to ABPA and meeting the diagnostic criteria of ABPA
- those previously meeting the diagnostic criteria for ABPA and presenting with sustained (≥2 weeks) clinical or radiological worsening; and increase in serum total IgE by ≥50% of the last recorded IgE value during clinical stability.
Key exclusion criteria (11 listed)
- occurrence of ≥3 ABPA exacerbations in the last 18 months before enrollment
- contraindications to the use of either prednisolone or itraconazole
- subjects who have received oral prednisolone (or equivalent) ≥30 mg for ≥2 weeks or itraconazole (or voriconazole or posaconazole or isavuconazole) for more than 2 weeks, in the last 3 months
- chronic medical illnesses, including uncontrolled diabetes mellitus, chronic renal failure, chronic liver failure, chronic heart failure, and others
- patient on immunosuppressive drugs
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| PrednisolonePrednisolone for 4 months | Drug | Prednisolone, Prednisolone plus itraconazole |
| ItraconazoleSUBA-itraconazole for 4 months | Drug | Itraconazole, Prednisolone plus itraconazole |
Primary outcome
Asthma or ABPA exacerbations
Time frame: 12 months after treatment completion
Proportion of subjects experiencing exacerbation (asthma or ABPA) 12 months after treatment completion
8 secondary outcomes
Composite response
Time frame: 8 weeks
IgE decline
Time frame: 8 weeks
Time to first ABPA exacerbation
Time frame: 12 months after treatment completion
Time to first asthma exacerbation
Time frame: 12 months after treatment completion
Weight gain
Time frame: Two months
Hyperglycemia
Time frame: Two months
Cushingoid habitus
Time frame: Two months
Transaminitis
Time frame: Two months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Feb 2025.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Prednisolone and Itraconazole in people with Allergic Bronchopulmonary Aspergillosis, run by Post Graduate Institute of Medical Education and Research, Chandigarh at 1 site in India.
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 3 inclusion and 11 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: looking for participants now, as of the sponsor's last update on 28 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in India. 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. 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?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Asthma or ABPA exacerbations (time frame: 12 months after treatment completion). 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 28 Feb 2025.