A Randomized Study To Evaluate The Efficacy And Safety Of An Investigational Drug In Adolescent And Adult Subjects With Asthma Uncontrolled on Moderate-Dose ICS Therapy.
Condition: Asthma
MeSH terms: Asthma
Intervention: GW685698X
Intervention description: GW685698X
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Enrollment: 627.0
Sex: All
Minimum age: 12 Years
Healthy volunteers: No
Keywords: Adolescents; Adults; Asthma; Pharmacokinetics; Pharmacogenetics; GW685698X

Summary:

      This study is designed to determine if the investigational drug is effective and safe in
      individuals with asthma.
    

Eligibility criteria:

        INCLUSION CRITERIA:

        Subjects eligible for enrolment in the study must meet all of the following criteria:

          -  Type of Subject: Outpatient

          -  Age: 12 years of age or older at Visit 1. For sites in the following countries,
             subjects recruited will be ≥18 years of age: Bulgaria, Czech Republic, Germany,
             Greece, Lithuania, New Zealand, Russian Federation, Turkey and any other countries
             where local regulations or the regulatory status of study medication permit enrolment
             of adults only.

          -  3. Gender: Male or Eligible Female

          -  To be eligible for entry into the study, females of childbearing potential must commit
             to consistent and correct use of an acceptable method of birth control, as defined by
             the following:

          -  Male partner who is sterile prior to the female subject's entry into the study and is
             the sole sexual partner for that female subject

          -  Implants of levonorgestrel

          -  Injectable progestogen

          -  Oral contraceptive (either combined estrogen/progestin or progestin only)

          -  Any intrauterine device (IUD) with a documented failure rate of less than 1% per year.

          -  Females of childbearing potential who are not sexually active must commit to complete
             abstinence from intercourse throughout the clinical trial and for a period after the
             trial to account for elimination of the drug (minimum of six days).

          -  Double barrier method - spermicide plus a mechanical barrier (e.g., spermicide plus a
             male condom or a spermicide and female diaphragm).

          -  NB: For German sites, female subjects must use a method of birth control other than
             the double barrier method.

          -  The contraceptive transdermal patch, Ortho Evra (if the subject is less than 198
             pounds)

          -  Female subjects should not be enrolled if they are pregnant, lactating or plan to
             become pregnant during the time of study participation. A serum pregnancy test is
             required of all females. This test will be performed at the initial screening visit
             (Visit 1) and Visit 8. In addition, a urine pregnancy test will be performed on the
             evening of the double-blind treatment visit, prior to randomization (Visit 3) and at
             Visits 4 through 7.

          -  Asthma Diagnosis: Asthma as defined by the National Institutes of Health [National
             Institutes of Health, 2007].

          -  Severity of Disease: A best FEV1 of 40%-85% of the predicted normal value during the
             morning Visit 1 screening period or a best FEV1 of 40%-90% of the predicted normal
             value during the evening Visit 1 screening period.

          -  Reversibility of Disease: Demonstrated a ≥ 12% and ≥200mL reversibility of FEV1 within
             approximately 30-minutes following 4 inhalations of albuterol/salbutamol inhalation
             aerosol (if required, spacers are permitted for reversibility testing only) or one
             nebulized albuterol/salbutamol solution during the screening period.

        Re-screening of subjects during the Visit 1 screening period: If a subject does not meet
        the inclusion criteria based upon FEV1 percent predicted and/or reversibility, the subject
        may return to the site once within 4 days and repeat the lung function tests.

          -  Current Anti-Asthma Therapy: Subjects must have been using a inhaled corticosteroid
             for at least 8 weeks prior to Visit 1 and maintained on a stable dose of inhaled
             corticosteroids for four weeks prior to Visit 1 at one of the following doses:
             [fluticasone propionate MDI CFC/HFA >176 ≤ 440mcg exactuator or > 200 ≤500mcg ex
             valve]; [fluticasone propionate DPI > 200≤500mcg]; [beclomethasone dipropionate DPI >
             420 ≤ 840mcg exactuator or > 500 ≤ 1000mcg ex-valve]; [beclomethasone dipropionate HFA
             Qvar > 160 ≤ 480mcg exactuator or > 200 ≤ 500mcg ex-valve]; [budesonide DPI MDI >400
             ≤1200mcg]; [flunisolide > 1000 ≤ 2000mcg]; [triamcinolone acetonide >1000 ≤1600mcg];
             [mometasone furoate DPI >200 ≤ 440mcg]; [ciclesonide MDI HFA >160 mcg ≤ 320mcg
             ex-actuator dose / >200mcg ≤ 400mcg ex-valve dose}

          -  Short- Acting Beta2-Agonists: All subjects must be able to replace their current
             short-acting beta2-agonists with albuterol/salbutamol inhalation aerosol at Visit 1
             for use as needed for the duration of the study. The use of spacer devices with
             metered dose inhaler (MDI) or nebulized albuterol/salbutamol will not be allowed
             during the study with the exception of their use during reversibility testing at Visit
             1. Subjects must be able to withhold all inhaled short-acting beta sympathomimetic
             bronchodilators for at least 6 hours prior to all study visits.

          -  Informed Consent: All subjects must be able and willing to give written informed
             consent to take part in the study.

          -  Compliance: Subjects must be able to comply with completion of the Daily Diary
             (includes paper medical conditions diary).

          -  French subjects: In France, a subject will be eligible for inclusion in this study
             only if either affiliated to or a beneficiary of a social security category.

        Inclusion Criteria for Randomization

        At the end of the run-in period, a subject will be eligible to enter the treatment period
        of the study if he/she meets the following criteria at Visit 3:

          1. Evening pre-dose percent predicted FEV1 of between 40% and 90% of their predicted
             normal.

          2. Any combination of the daily asthma symptom scores (day-time plus night-time) of ≥1 or
             albuterol/salbutamol use on at least 4 of the last 7 consecutive days of the run-in
             period (immediately preceding Visit 3).

        EXCLUSION CRITERIA:

          -  History of Life-threatening asthma: Defined for this protocol as an asthma episode
             that required intubation and/or was associated with hypercapnia, respiratory arrest or
             hypoxic seizures.

          -  Respiratory Infection: Culture-documented or suspected bacterial or viral infection of
             the upper or lower respiratory tract, sinus or middle ear that is not resolved within
             4 weeks of Visit 1 and led to a change in asthma management, or in the opinion of the
             Investigator is expected to affect the subject's asthma status or the subject's
             ability to participate in the study.

          -  Asthma Exacerbation: Any asthma exacerbation requiring oral corticosteroids within 3
             months of Visit 1. A subject must not have had any hospitalization for asthma within 6
             months prior to Visit 1.

          -  Concurrent Diseases/Abnormalities: Historical or current evidence of clinically
             significant uncontrolled disease including, but not limited to: cardiovascular
             disease, hepatic disease, renal disease, hematological disease, neurological disease,
             or pulmonary disease (including, but not confined to chronic bronchitis, emphysema,
             bronchiectasis with the need of treatment, cystic fibrosis, bronchopulmonary
             dysplasia, and chronic obstructive pulmonary disease). Significant is defined as any
             disease that, in the opinion of the investigator, would put the safety of the subject
             at risk through participation, or which would affect the efficacy or safety analysis
             if the disease/condition exacerbated during the study. The list of additional excluded
             conditions/diseases includes, but is not limited to the following: congestive heart
             failure, clinically significant coronary artery disease, stroke within 3 months of
             Visit 1, poorly controlled peptic ulcer, immunologic compromise, tuberculosis (current
             or untreated), Addison's disease, uncontrolled thyroid disorder, known aortic
             aneurysm, clinically significant cardiac arrhythmia, uncontrolled hypertension,
             hematological, hepatic, or renal disease, current malignancy, cushings disease,
             uncontrolled diabetes mellitus, recent history of drug or alcohol abuse.

          -  Oropharyngeal Examination: A subject will not be eligible for the run-in if he/she has
             clinical visual evidence of oral candidiasis at Visit 1.

          -  Investigational Medications: A subject must not have participated in a study or used
             any investigational drug within 30 days prior to Visit 1.

          -  Drug Allergy: Any adverse reaction including immediate or delayed hypersensitivity to
             any beta2-agonist, sympathomimetic drug, or any intranasal, inhaled, or systemic
             corticosteroid therapy. Known or suspected sensitivity to the constituents of the
             novel dry powder inhaler or DISKUS/ACCUHALER (i.e., lactose or magnesium stearate).

          -  Milk Protein Allergy: History of severe milk protein allergy.

          -  Immunosuppressive Medications: A subject must not be using, or require use, of
             immunosuppressive medications during the study. NOTE: Immunotherapy for the treatment
             of allergies is allowed during the study provided that the treatment was initiated
             prior to Visit 1 and the subject is maintained on a stable regimen throughout the
             study period.

          -  Attendance: A subject will not be eligible if he/she or his/her parent or legal
             guardian has any infirmity, disability, or geographical location which seems likely
             (in the opinion of the Investigator) to impair compliance with any aspect of this
             study protocol or scheduled visits to the study center and non-compliant with study
             medication or procedures (e.g. completion of daily diary). Neurological or psychiatric
             disease or history of drug or alcohol abuse which in the opinion of the investigator
             could interfere with the subject's proper completion of the protocol requirements
             excludes study participation.

          -  Tobacco Use : Current smoker or a smoking history of 10 pack years or more (e.g. 20
             cigarettes/day for 10 years). A subject may not have used tobacco products within the
             past one year (i.e., cigarettes, cigars, or pipe tobacco).

          -  Affiliation with Investigator's Site: A subject will not be eligible for this study if
             he/she is an immediate family member of the participating Investigator,
             sub-Investigator, study coordinator, or employee of the participating Investigator.

          -  Corticosteroid Use: Administration of systemic, oral or depot corticosteroids within
             12 weeks of Visit 1.

          -  Potent Cytochrome P450 3A4 (CYP3A4) inhibitors: Patients who are receiving potent
             CYP3A4 inhibitors within 4 weeks of Visit 1 (e.g., ritonavir, ketoconazole,
             itraconazole).

        Exclusion Criteria for Randomization At the end of the run-in period, a subject will not be
        eligible to enter the treatment period of the study if they meet any of the following
        criteria.

          1. Clinical Laboratory Abnormalities: Clinically significant abnormal laboratory tests
             during Visit 1 which are still abnormal upon repeat analysis and are not believed to
             be due to disease(s) present. Each Investigator will use his/her own discretion in
             determining the clinical significance of the abnormality. When in doubt,
             GlaxoSmithKline, or designee, should be notified so that a joint decision can be made.

          2. Changes in asthma medication (excluding albuterol/salbutamol inhalation aerosol
             provided at Visit 1).

          3. Occurrence of a culture-documented or suspected bacterial or viral infection of the
             upper or lower respiratory tract, sinus or middle ear during the run-in period that
             led to a change in asthma management, or in the opinion of the Investigator is
             expected to affect the subject's asthma status or the subject's ability to participate
             in the study.

          4. Asthma exacerbation, defined as any worsening of asthma requiring any treatment other
             than rescue albuterol/salbutamol or regular inhaled corticosteroid use. This includes
             requiring the use of systemic corticosteroids and / or emergency room visit or
             hospitalization or a change in subject's regular inhaled corticosteroid dose.

          5. A subject will not be eligible for randomization if he/she has an abnormal visual
             oropharyngeal exam at the randomization Visit 3 (visual clinical evidence of oral
             candidiasis).

          6. Non-compliance with completion of the Daily Diary, defined as: -Completion of AM and
             PM symptom scores on less than 4 days out of the last 7 days immediately preceding
             Visit 3.

               -  Completion of AM and PM rescue use on less than 4 days out of the last 7 days
                  immediately preceding Visit 3.

               -  Completion of AM and PM PEF measurements on less than 4 days out of the last 7
                  days immediately preceding Visit 3.

               -  Recording run-in asthma medication use on less than 4 days out of the last 7 days
                  immediately preceding Visit 3.