safety and efficacy study of losmapimod (gw856553) in frequently exacerbating participants with chronic obstructive pulmonary disease (copd)

Conditions: Pulmonary Disease, Chronic Obstructive

Summary: this is a randomised, double-blind, parallel-group, multi-centre study evaluating 15 milligram (mg) twice daily/ bi-daily (bid) of losmapimod versus placebo, in addition to standard of care (soc). the primary objective of this study is to explore the therapeutic potential of losmapimod as a treatment to reduce the rate of exacerbations in the subset of participants with moderate-to-severe copd who are at high risk of exacerbation, having experienced two or more moderate/severe exacerbations in the preceding 12 months, and who have \<=2% of blood eosinophils at screening. as secondary objectives safety, effects on lung function, quality of life, pharmacokinetic (pk), biomarkers of both disease and inflammation shall be evaluated. the duration of the treatment period is variable but will be at least 26 weeks and up to a maximum of 52 weeks, with the end of study date being established once the final participant has been randomized. the purpose of the variable dosing regimen is to enable participants to remain in the study for a longer duration, as it is anticipated that this will increase the likelihood of observing exacerbation events without increasing the overall study duration. it will also enable safety data on dosing periods beyond 6 months to be generated. approximately 200 participants in a 1:1 ratio between losmapimod and placebo will be randomized to the study. sample size re-estimation will be performed during the course of the study to potentially increase the sample size up to a maximum of 600 participants.


Eligibility criteria:
inclusion criteria: * copd diagnosis and severity: participants with a clinical history of copd (established by a physician) in accordance with the following definition by the american thoracic society/european respiratory society, for at least 6 months prior to enrolment. participants must have evidence of airflow obstruction, defined as post-bronchodilator fev1 equal to or less than 80% of predicted normal value calculated using "third national health and nutrition examination survey" (nhanes iii) reference equation at visit 1 and a fev1 / fvc ratio \<=70% at screening (visit 1). note: post-bronchodilator spirometry will be performed approximately 10-15 minutes after the participants has self-administered 4 inhalations (i.e., total 400/360 \[microgram\] mcg) of salbutamol/albuterol via a metered dose inhaler (mdi) (use of spacer will be optional). the study-provided central spirometry equipment will calculate the fev1/fvc ratio and fev1 percent predicted values. * exacerbation history: a documented history (e.g., medical record verification) in the 12 months prior to visit 1 of \>=2 copd exacerbations resulting in prescription for antibiotics and/or oral corticosteroids or hospitalisation or extended observation in a hospital emergency room or outpatient centre. note: prior use of antibiotics alone does not qualify as a moderate exacerbation unless the use was specifically for the treatment of worsening symptoms of copd. * existing copd maintenance treatment: participants must be receiving daily maintenance treatment for their copd for at least 3 months prior to screening. notes: participants receiving only "pro re nata" or as needed (prn) copd medications are not eligible for inclusion in the study. all participants will continue on their current standard of care (soc) copd medications throughout the entire duration of the study. * tobacco use: participants with a current or prior history of \>=10 pack-years of cigarette smoking at screening (visit 1). former smokers are defined as those who have stopped smoking for at least 6 months prior to visit 1. one pack year =20 cigarettes smoked per day for 1 year or the equivalent. number of pack years=(number of cigarettes per day/20) x number of years smoked. * sex: male or female participants aged \>=40 years at screening (visit 1). a female participant is eligible to participate if she is of non-child bearing potential defined as pre-menopausal females with a documented tubal ligation or hysterectomy; or postmenopausal defined as 12 months of spontaneous amenorrhea \[in questionable cases a blood sample with simultaneous follicle stimulating hormone (fsh) \>40 milli-international unit/milliliter (miu/ml) and estradiol \<40 picogram/milliliter (pg/ml) (\<140 \[picomoles per liter\] pmol/l) is confirmatory\] or if of child-bearing potential is using a highly effective method for avoidance of pregnancy from 30 days before the first dose, for the duration of dosing and until 2 weeks post last-dose. * capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form. * corrected ecg qt interval (qtc)\<450 milliseconds(msec) or qtc\<480 msec for participants with bundle branch block. the qtc is the qt interval corrected for heart rate according to either bazett's formula (qtcb), fridericia's formula (qtcf), or another method, machine or manual over-read. for eligibility and withdrawal, ideally the same qt correction formula will be used for all participants. however, because this is not always possible, the same qt correction formula will be used for each individual participant to determine eligibility for and withdrawal from the study. the qtc will be based on single or averaged qtc values of triplicate ecgs obtained over a brief recording period. exclusion criteria: * eosinophils: \>2.0% blood eosinophils at screening (visit 1) * concomitant medication: copd medication: participants currently on chronic treatment with macrolides or roflumilast; long term oxygen therapy (ltot) or nocturnal oxygen therapy required for greater than 12 hours a day. oxygen prn use (i.e. \<=12 hours per day) is not exclusionary. multidrug and toxin extrusion (mate) transporter 1 (mate1) inhibitors: cimetidine, pyrimethamine, trimethoprim (short course treatment with trimethoprim is allowed). other medications: chronic maintenance therapy with anti-tumor necrosis factor (anti-tnf), anti-interleukin-1 (anti-il1), phosphodiesterase type 4 (pde4) inhibitors, or any other immunosuppressive therapy (not including steroids) within 60 days prior to dosing. any other investigational drug within 30 days or 5 half lives, whichever is longer prior to screening visit. * other respiratory disorders: participants with asthma (as primary diagnosis) lung cancer, bronchiectasis, active sarcoidosis, active lung fibrosis, cystic fibrosis, idiopathic pulmonary hypertension, active interstitial lung diseases or other active pulmonary diseases. participants with alpha-1-antitrypsin deficiency as the underlying cause of copd. * participants with clinically significant sleep apnea who require use of continuous positive airway pressure (cpap) device. * participants who require a non-invasive positive pressure ventilation (nippv) device (note: use of non invasive ventilation (niv) in hospital as part of the medical management of an acute exacerbation is permitted.) * lung resection: participants who have undergone previous lung reduction surgery (e.g. lobectomy, pneumonectomy, or lung volume reduction). * copd stability: less than 30 days prior to visit 1 have elapsed from completion of a course of antibiotics or oral corticosteroids for a recent copd exacerbation. * evidence of pneumonia or a clinically significant abnormality not believed to be due to the presence of copd on chest x-ray (posteroanterior with lateral) or computerised tomography (ct) scan (historic data up to 1 year may be used). * pulmonary rehabilitation program: participation in the acute phase of a pulmonary rehabilitation program within 4 weeks prior to visit 1. participants who are in the maintenance phase of a pulmonary rehabilitation program are not excluded. * alanine aminotransferase (alt) \>2x upper limits of normal (uln) and bilirubin \>1.5xuln (isolated bilirubin \>1.5xuln is acceptable if bilirubin is fractionated and direct bilirubin \<35%). * current or chronic history of liver disease, or known hepatic or biliary abnormalities (with the exception of gilbert's syndrome or asymptomatic gallstones). * malignancy: a current malignancy or previous history of cancer in remission for less than 12 months prior to visit 1 (participants that had localized carcinoma of the skin or cervix which was resected for cure will not be excluded). * other diseases/abnormalities: history or current evidence of clinically significant or uncontrolled cardiovascular, pulmonary, metabolic, neurological, endocrine (including uncontrolled diabetes or thyroid disease), renal, hepatic, haematological (including agranulocytosis) or gastrointestinal conditions that are uncontrolled on permitted therapy and in the opinion of the investigator and/or gsk medical monitor, places the participant at an unacceptable risk as participant in this trial or which would affect the efficacy or safety analysis if the disease/condition exacerbated during the study * viral infections: presence of hepatitis b surface antigen (hbsag), hepatitis c antibody test result at screening or within 3 months prior to first dose of study treatment. note: participants with positive hepatitis c antibody due to prior resolved disease can be enrolled, only if a confirmatory negative hepatitis c ribonucleic acid (rna) polymerase chain reaction (pcr) test is obtained. * a positive test for human immunodeficiency virus (hiv) antibody * tuberculosis (tb): participant with active tb or who have previously tested positive for latent tb and not received treatment or prophylaxis following the positive test. * vaccination: participants who have received live attenuated vaccines in the 6 weeks prior to randomization. the use of live attenuated vaccines during the treatment period and in the 4 weeks post-discontinuation of investigational product is prohibited. * drug/food allergy: participants with a history of hypersensitivity to any of the study medications (e.g., lactose, magnesium stearate). * lactating females * pregnant females (as determined by positive urine human chorionic gonadotropin (hcg) test prior to dosing). * drug/alcohol abuse: participants with a known or suspected history of alcohol or drug abuse within the last 2 years. * prior use of study medication/other investigational drugs: participants who have received an investigational drug within 30 days of entry into this study or within 5 drug half-lives of the investigational drug, whichever is longer. * affiliation with investigator site: study investigators, sub-investigators, study coordinators, employees of a participating investigator or immediate family members of the aforementioned are excluded from participating in this study. * inability to read: in the opinion of the investigator, any participant who is unable to read and/or would not be able to complete study related materials. * non-compliance: participants at risk of non-compliance, or unable to comply with the study procedures. any infirmity, disability, or geographic location that would limit compliance for scheduled visits. * questionable validity of consent: participants with a history of psychiatric disease, intellectual deficiency, poor motivation or other conditions that will limit the validity of informed consent to participate in the study.

Keywords: phase ii clinical study losmapimod exacerbations copd eosinophil sub-group