A Pilot Study In Adults And Adolescents With Irritant (Non-Allergic) Rhinitis
Condition: Rhinitis, Allergic, Perennial
MeSH terms: Rhinitis; Rhinitis, Allergic; Rhinitis, Allergic, Perennial
Intervention: Fluticasone Furoate Nasal Spray; Placebo Nasal Spray
Intervention description: Fluticasone furoate nasal spray 110mcg intranasally once daily for 4 weeks; Matching placebo nasal spray intranasally once daily for 4 weeks
Intervention MeSH terms: Fluticasone; Xhance
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Enrollment: 102.0
Sex: All
Minimum age: 12 Years
Healthy volunteers: No
Keywords: Adolescents; Irritant(non-allergic)rhinitis; Adults; GW685698; Air Pollution

Summary:

      The purpose of this pilot study is to compare the effects (effectiveness and safety)of an
      intranasal corticosteroid (fluticasone furoate nasal spray [FFNS]) with a placebo nasal spray
      for the treatment of irritant (non-allergic) rhinitis.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Informed consent: Subject is willing and able to provide consent to participate in the
             study. For subjects who are under 18 years of age, an appropriately signed and dated
             assent must be obtained from the parents or guardian.

          -  Outpatient: Subject is treatable on an outpatient basis.

          -  Age: 12 years of age or older at Visit 2.

          -  Gender: Male or eligible female

        To be eligible for entry into the study, females of childbearing potential must commit to
        the 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,
             or

          -  Females of childbearing potential who are not sexually active must commit to complete
             abstinence from intercourse for two weeks before exposure to the study drug,
             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).

        Female subjects should not be enrolled if they plan to become pregnant during the time of
        study participation. A urine pregnancy test will be performed at the screening visit (Visit
        1), the randomisation visit (Visit 2) and at the final visit (Visit 6 or Early Withdrawal).

          -  Clinical history: Diagnosis or evidence of air pollution triggers as the predominant
             irritant trigger for their rhinitis symptoms to include ALL of the following:

               -  A two year clinical history of irritant (non-allergic) rhinitis triggered
                  predominantly by air pollution exposure (written or verbal confirmation) in the
                  opinion of the investigator and evidence of symptoms such as rhinorrhea, nasal
                  congestion and postnasal drip relating to concentration of air particulates, air
                  quality and levels of exposure.

               -  Based on the trigger questionnaire, subjects must indicate that air pollution is
                  the predominant trigger that makes their rhinitis symptoms worse completed at
                  Visit 1.

               -  Negative skin test (by prick method) response to seasonal allergens (including
                  tree, grass and weed pollens) and perennial allergens (including animal dander,
                  house dust mites, cockroach and mould) relevant to the geographical area
                  completed at Visit 1.

        A negative response for allergen skin prick testing is defined as a wheal <3 mm than the
        diluent control.

          -  Positive response to a histamine skin test (prick method) completed at Visit 1. A
             positive response for histamine skin prick testing is defined as a wheal ≥3 mm larger
             than the diluent control.

          -  Normal sinus radiograph (Waters view) to rule out sinusitis (presence of mucosal
             thickening of ≥6 mm at the point of maximal thickening or an air fluid level or
             opacification). The sinus radiograph will be scheduled at Visit 1.

               -  Ability to comply with study procedures: Subject understands and is willing, able
                  and likely to comply with study procedures and restrictions.

               -  Literate: Subject must be able to read, comprehend, and record information in
                  English or native language.

        Randomization Criteria

          -  Average of the last 8, reflective, total nasal symptom score (rTNSS) assessments (4
             morning [AM] assessments, 4 evening [PM] assessments) over the four 24-hour periods
             prior to randomisation must be greater than/equal to 4.5.

          -  Average of the last 8 reflective nasal symptom assessments for congestion (4 AM
             assessments, 4 PM assessments) over the four 24-hour periods prior to randomisation
             must be greater than/equal to 2.

          -  A subject must have completed 80% of assessments on the screening symptom diary card.

        Exclusion Criteria:

          -  Significant concomitant medical conditions, defined as but not limited to:

               -  a historical or current evidence of clinically significant uncontrolled disease
                  of any body system (e.g., tuberculosis, psychological disorders, eczema).
                  Significant is defined as any disease that, in the opinion of the investigator,
                  would put the safety of the subject at risk through study participation or which
                  would confound the interpretation of the study results if the disease/condition
                  exacerbated during the study.

               -  a severe physical obstruction of the nose (e.g., deviated septum or nasal polyp)
                  or nasal septal perforation that could affect the deposition of double blind
                  intranasal study drug

               -  nasal (e.g., nasal septum) or ocular injury/surgery in the last 3 months

               -  asthma, with the exception of mild intermittent asthma [Global Initiative for
                  Asthma (GINA), 2006]. NOTE: Subjects will be allowed to use short-acting inhaled
                  beta2 agonists ONLY on an as needed basis.

               -  rhinitis medicamentosa

               -  bacterial or viral infection (e.g., common cold) of the upper respiratory tract
                  within two weeks of Visit 1 or during the screening period

               -  documented evidence of acute or significant chronic sinusitis, as determined by a
                  sinus radiograph (Waters view) done at Visit 1

               -  current or history of glaucoma and/or current cataract or ocular herpes simplex

               -  physical impairment that would affect the subject's ability to participate in the
                  study

               -  clinical evidence of a Candida infection of the nose or oropharynx

               -  history of psychiatric disease, intellectual deficiency, poor motivation,
                  substance abuse (including drug and alcohol) or other conditions that will limit
                  the validity of informed consent or that would confound the interpretation of the
                  study results

               -  history of or current use of cocaine

               -  history of adrenal insufficiency

               -  Chickenpox or measles within 3 weeks of Visit 1. A subject is not eligible if
                  he/she currently has chickenpox or measles, or has been exposed to chickenpox or
                  measles during the last 3 weeks and is non-immune. If a subject develops
                  chickenpox or measles during the study, he/she will be withdrawn from the study.
                  If a non-immune subject is exposed to chickenpox or measles during the study,
                  his/her continuation in the study will be at the discretion of the investigator,
                  taking into consideration the likelihood of developing active disease.

          -  Use of corticosteroids, defined as:

               -  Intranasal corticosteroid within 4 weeks prior to Visit 1.

               -  Inhaled, oral, intramuscular, intravenous, ocular, and/or dermatological
                  corticosteroid (with the exception of hydrocortisone cream/ointment, 1% or less,
                  or equivalent) within 8 weeks prior to Visit 1.

          -  Use of other allergy medications within the timeframe indicated relative to Visit 1

               -  Intranasal or ocular cromolyn within 14 days prior to Visit 1

               -  Short-acting prescription and over the counter (OTC) antihistamines, including
                  ocular preparations and antihistamines contained in insomnia and 'nighttime' pain
                  formulations taken for insomnia, within 7 days prior to Visit 1

               -  Long-acting antihistamines within 10 days prior to Visit 1: loratadine,
                  desloratadine, fexofenadine, cetirizine

               -  Long-acting antihistamine, astemizole, within 12 weeks prior to Visit 1

               -  Intranasal antihistamines (e.g. Astelin) within 2 weeks prior to Visit 1

               -  Oral or intranasal decongestants within 3 days prior to Visit 1

               -  Intranasal, oral, or inhaled anticholinergics within 3 days prior to Visit 1

               -  Oral antileukotrienes within 3 days prior to Visit 1

               -  Subcutaneous omalizumab (Xolair) within 5 months of Visit 1

               -  Use of any medications that significantly inhibit the cytochrome P450 subfamily
                  enzyme CYP3A4, including ritonavir and ketoconazole.

               -  Ocular antihistamines, artificial tears, eyewashes/nasal irrigation solutions,
                  homeopathic preparations, lubricants, sympathomimetic or vasoconstrictor
                  preparations during the screening or treatment periods. No exclusion period prior
                  to screening (Visit 1) is required for these treatments.

               -  Throat treatments (e.g., cough lozenges, throat sprays) during the screening and
                  treatment periods. No exclusion period prior to screening (Visit 1) is required
                  for these treatments.

          -  Use of other medications that may affect irritant rhinitis or its symptoms

               -  Chronic use of concomitant medications, such as tricyclic antidepressants, that
                  would affect assessment of the effectiveness of the study drug.

               -  Chronic use of long-acting beta-agonists (e.g., salmeterol).

               -  Chronic use of other intranasally administered medications (e.g.,
                  calcitonin-salmon).

               -  Use of face masks (e.g, general face masks that are used for protection from air
                  pollution, and C-PAP face masks or pillows), saline nasal sprays and lavages, eye
                  drops, and local, herbal and homeopathic treatments.

          -  Chronic use of medications that could cause drug-induced rhinitis including:

               -  ACE inhibitors, reserpine, guanethidine, methyldopa, hydralazine, beta-blockers,
                  alpha-adrenoceptor antagonists (e.g., Prazosin), phentolamine, chlorpromazine,
                  aspirin, and non-steroidal anti-inflammatory medications (NSAIDS).

        NOTE: Subjects taking aspirin and/or NSAIDs on a chronic basis may be considered for
        inclusion in the study if the investigator can evaluate and document the subject's irritant
        rhinitis symptoms are not caused by these medications.

          -  Use of immunosuppressive medications 8 weeks prior to screening and during the study

          -  Immunotherapy

          -  Allergy/Intolerance

             • Known hypersensitivity to corticosteroids, or any excipients in the product

          -  Clinical trial/experimental medication experience

               -  Exposure to an investigational study drug within 30 days prior to Visit 1

               -  Participation in a previous or current fluticasone furoate nasal spray
                  (GW685698X) clinical study

          -  Positive or inconclusive pregnancy test or female who is breastfeeding

             • Has a positive or inconclusive pregnancy test at Visit 1 or Visit 2

          -  Tobacco use

             • Subjects who currently use or have used within the past year smoking products
             including cigarettes, cigars and pipes, or smokeless products such as chewing tobacco.

          -  Findings of a clinically significant, abnormal electrocardiogram (ECG)

          -  Findings of a clinically significant laboratory abnormality