A Clinical Study To Test A Nasal Spray (Fluticasone Furoate Nasal Spray) For The Treatment Of Perennial (Year-round) Allergic Rhinitis
Condition: Rhinitis, Allergic, Perennial
MeSH terms: Rhinitis; Rhinitis, Allergic; Rhinitis, Allergic, Perennial
Intervention: Fluticasone furoate nasal spray; Placebo
Intervention description: Fluticasone furoate nasal spray; Placebo
Intervention MeSH terms: Fluticasone; Xhance
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Enrollment: 315.0
Sex: All
Minimum age: 12 Years
Healthy volunteers: No
Keywords: Perennial allergic rhinitis; fluticasone furoate nasal spray

Summary:

      The purpose of this 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 perennial (year-round) allergic rhinitis.
    

Eligibility criteria:

        Inclusion Criteria:

        Subjects eligible for enrollment in the study must meet all of the following criteria:

          -  Informed consent

          -  Subject has provided an appropriately signed and dated informed consent.

          -  An appropriately signed and dated assent must be obtained from the parents or guardian
             if the subject is a child under 18 years of age.

          -  Outpatient

          -  Subject is treatable on an outpatient basis.

          -  Age

          -  ≥ 12 years at Visit 2

          -  ≥ 18 years at Visit 1 for Russia and Germany

          -  Male or eligible female. 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 for all females of childbearing potential at Visits 1, 2, 5, and Visit
             6/Early Withdrawal to determine if the subject is pregnant.

        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:

          -  Abstinence 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).

          -  Oral contraceptive (either combined estrogen/progestin or progestin only),

          -  Injectable progestogen,

          -  Implants of levonorgestrel,

          -  Percutaneous contraceptive patches,

          -  Intrauterine device (IUD) or intrauterine system (IUS) with a documented failure rate
             of less than 1% per year,

          -  Male partner who is sterile (vasectomy with documentation of azospermia) prior to the
             female subject's entry into the study and is the sole sexual partner for that female
             subject,

          -  Double barrier method-condom or occlusive cap (diaphragm or cervical /vault caps) plus
             spermicide,

          -  Estrogenic vaginal ring

          -  Diagnosis of PAR to include:

          -  A positive skin test (by prick method) response to appropriate perennial allergen
             (house dust mites, animal dander, mold, or cockroach) within last 12 months prior to
             Visit 1 or at Visit 1.

        A positive skin test is defined as a wheal ≥3mm larger than the diluent control for prick
        testing.

          -  Two year medical history and past treatment of PAR (written or verbal confirmation)
             which includes perennial, i.e., year-round, symptoms. PAR symptoms would include nasal
             congestion, rhinorrhea, nasal itching and sneezing, eye itching/burning, eye
             tearing/watering, and eye redness.

        In vitro tests for specific IgE (such as RAST, PRIST) will not be allowed for the diagnosis
        of PAR.

        NOTE: Subjects who meet the above criteria for PAR and who also have a history of allergy
        to a seasonal pollen that will be present in their geographic area during study
        participation are NOT eligible for randomization.

          -  Environment

          -  Subject must be symptomatic to appropriate perennial allergen (animal dander, house
             dust mites, cockroach, mold) and willing to maintain same environment throughout the
             study.

          -  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

        At Visit 2, the subject must meet the following criteria:

          -  Average of the last 8 rTNSS assessments (4 AM assessments, 4 PM assessments) over the
             four 24-hours periods prior to randomization must be ≥6. This includes the AM
             assessment on the morning of the randomization visit.

          -  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 randomization
             must be ≥2. This includes the AM assessment on the morning of the randomization visit.

          -  Average of the last eight rTOSS assessments (4 AM assessments, 4 PM assessments) over
             the four 24-hour periods prior to randomization must be ≥ 4. This includes the AM
             assessment on the morning of the randomization visit.

          -  The subject has demonstrated the ability to comply with the use of the daily e-diary,
             defined as completion of at least 80% of the assessments during the screening period.

        Exclusion Criteria:

        Subjects meeting any of the following criteria must not be enrolled in the study:

          -  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 [NAEPP, 2007; GINA, 2006], or
             very mild asthma (Canada) [Lemiére, 2004].

        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 eyes or 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 the
             individual investigator

          -  current or history of glaucoma and/or ocular herpes simplex

          -  current cataract

          -  physical impairment that would affect subject's ability to participate safely and
             fully in the study

          -  clinical evidence of a Candida infection of the nose

          -  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 adrenal insufficiency

          -  Use of corticosteroids, defined as:

          -  Intranasal corticosteroid within 4 weeks prior to Visit 1 (e.g., FLONASE™, VERAMYST,
             Nasonex, Rhinocort).

          -  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 (e.g., Nasalcrom,
             Crolom)

          -  Short-acting prescription and non-prescription antihistamines, including ocular
             preparations and antihistamines contained in insomnia and "night time" pain
             formulations, within 3 days prior to Visit 1 (e.g., Benadryl, Chlortrimeton, Dimetane,
             Tavist)

          -  Long-acting antihistamines within 10 days prior to Visit 1, including loratadine,
             desloratadine, fexofenadine, cetirizine, levocetirizine, terfenadine (e.g., Allegra,
             Claritin, Clarinex, Zyrtec)

          -  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 (e.g., Sudafed)

          -  Long-acting beta-agonists within 3 days prior to Visit 1 (e.g., SEREVENT™, Foradil)

          -  Intranasal, oral, or inhaled anticholinergics within 3 days prior to Visit 1 (e.g.,
             Atrovent)

          -  Histamine H2-receptor antagonists including cimetidine, ranitidine, famotidine,
             nizatidine (e.g., ZANTAC™, Tagamet, Pepcid, Axid) within 1 day prior to Visit 1

          -  Oral antileukotrienes within 3 days of Visit 1 (e.g., Singulair)

          -  Subcutaneous omalizumab (Xolair) within 5 months of Visit 1

          -  Subjects are not permitted to use any artificial tears, eyewashes/nasal irrigation
             solutions, homeopathic preparations, lubricants, sympathomimetic or vasoconstrictor
             preparations 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 allergic rhinitis or its symptoms

          -  Chronic use of concomitant medications, such as tricyclic antidepressants, that would
             affect assessment of the effectiveness of the study drug

          -  Use of other intranasally administered medications (e.g., Miacalcin)

          -  Use of immunosuppressive medications eight weeks prior to screening and during the
             study

          -  Immunotherapy Immunotherapy patients may be enrolled in the study as long as the
             immunotherapy was not initiated within 30 days of Visit 1 and if the dose has remained
             fixed over the 30 days prior to Visit 1, and the dose will remain fixed for the
             duration of the study.

          -  Use of any medications that significantly alter the pharmacokinetics of fluticasone
             furoate, including ritonavir and ketoconazole

          -  Allergy/Intolerance

          -  Known hypersensitivity to corticosteroids, or any excipients in the product

          -  Use of contact lenses

          -  Use of Nasal Continuous Positive Airway Pressure (C-PAP) device (mask or pillow)

          -  Clinical trial/experimental medication experience

          -  Participation in a clinical trial within 12 months prior to Visit 1

          -  Participation in a previous or current FFNS (GW685698X) clinical study

          -  Positive pregnancy test or female who is breastfeeding

          -  Has a positive or inconclusive pregnancy test at Visit 1 or Visit 2

          -  Affiliation with investigational site

          -  Subject is a participating investigator, sub-investigator, study co-ordinator, or
             employee of a participating investigator, or is an immediate family member of the
             aforementioned.

          -  Current tobacco use

          -  Subject currently uses, or has used within the past year, smoking products including
             cigarettes, cigars, and pipe or chewing tobacco.

          -  Chickenpox or measles

          -  A subject is not eligible if he/she currently has chickenpox or measles, or has been
             exposed to chickenpox or measles during the last three 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.

          -  Findings of a clinically significant, abnormal electrocardiogram (ECG)

          -  Findings of a clinically significant laboratory abnormality