Clinical trial NCT02175771: Long-Term Safety Study of Fluticasone Propionate (Fp) Multidose Dry Powder Inhaler (MDPI) and Fluticasone Propionate/Salmeterol (FS) MDPI in Patients With Persistent Asthma
Official title: A 26-Week Open-Label Study to Assess the Long-Term Safety of Fluticasone Propionate Multidose Dry Powder Inhaler and Fluticasone Propionate/Salmeterol Multidose Dry Powder Inhaler in Patients 12 Years of Age and Older With Persistent Asthma
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Persistent Asthma
Lead sponsor: Teva Branded Pharmaceutical Products R&D, Inc.
Sponsor class: INDUSTRY
First posted: 2014-06-26
Enrollment: 758
Sex: ALL
Minimum age (years): 12
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The primary objective of the study is to evaluate the long-term safety of fluticasone propionate (Fp) inhalation powder in 2 strengths and fluticasone propionate/salmeterol inhalation (FS) powder in 2 strengths when administered with the Teva multidose dry powder inhaler (MDPI) device over 26 weeks in patients with persistent asthma.

Detailed description: This was a stratified, randomized, open-label, active drug-controlled Phase 3 study.

Patients who met all of the inclusion criteria and none of the exclusion criteria at the screening visit completed a 14 day (±2 days) pretreatment run in period. During the run-in period, patients continued using their current asthma medications (ie, inhaled corticosteroid and/or other controller therapies) except for their SABA, which was replaced by the sponsor-provided albuterol (salbutamol) hydrofluoroalkane (HFA) inhaler to be used as needed for symptomatic relief of asthma symptoms during the run in and treatment periods.

Patients were assigned to inhaled corticosteroid (ICS) monotherapy or inhaled corticosteroid/long acting beta2 agonist (ICS/LABA) combination therapy and then to a mid- or high-treatment strength based on their current asthma maintenance therapy regimen. Patients in each strength of the ICS monotherapy cohort were randomly assigned in a 3:1 distribution to either the Fp MDPI or FLOVENT HFA treatment arm. Patients in each strength of the ICS/LABA combination cohort were randomly assigned in a 3:1 distribution to either the FS MDPI or ADVAIR DISKUS treatment arm. There was a total of 8 treatment arms following randomization.

Eligibility criteria: Inclusion Criteria:

1. Best pre-bronchodilator forced expiratory volume in 1 second (FEV1) of greater than 40% of their predicted normal value.
2. Patients must have a treatment regimen that includes a short-acting β2 agonist (SABA) (albuterol) for use as needed and either an inhaled corticosteroid (ICS) or an ICS/long-acting β2 agonist (LABA) as a preventative treatment for a minimum of 8 weeks before the SV. Patients currently taking low-dose ICS without LABA are not eligible for this study. Patients currently taking low-dose ICS/LABA may only be entered into the mid ICS strength. All patients must have been maintained on a stable dose of ICS or ICS/LABA for 4 weeks prior to the SV (or pre-SV if necessary) at 1 qualifying doses
3. To meet reversibility of disease criteria, the patient must demonstrate a ≥12% reversibility of FEV1 (and 200 mL for patients aged18 years and older) within 30 minutes following 4 inhalations of albuterol at the SV. Historic reversibility within the past 12 months of the SV may be used to meet this criterion.
4. Written informed consent/assent is obtained. For adult patients (aged 18 years and older, or as applicable per local regulations), the written informed consent form (ICF) must be signed and dated by the patient before conducting any study-related procedure. For minor patients (aged 12 to 17 years, or as applicable per local regulations), the written ICF must be signed and dated by the parent/legal guardian and the written assent form must be signed and dated by the patient (if applicable) before conducting any study-related procedure. Note: Age requirements are as specified by local regulations.
5. Outpatient \>= 12 years of age on the date of consent/assent. .
6. Asthma diagnosis: The patient has a diagnosis of asthma as defined by the National Institutes of Health (NIH). The asthma diagnosis has been present for a minimum of 3 months and has been stable (defined as no exacerbations and no changes in medication) for at least 30 days before providing informed consent.
7. The patient is able to perform acceptable and repeatable spirometry.
8. The patient is able to perform peak expiratory flow (PEF) with a handheld peak flow meter.
9. The patient is able to use a metered-dose inhaler (MDI) device without a spacer device and a MDPI device.
10. The patient is able to withhold (as judged by the investigator) his or her regimen of ICS or study drug, and rescue medication for at least 6 hours before the SV and before all treatment visits where spirometry is performed.
11. The patient/parent/legal guardian/caregiver is capable of understanding the requirements, risks, and benefits of study participation, and, as judged by the investigator, capable of giving informed consent/assent and being compliant with all study requirements.
12. SABAs: All patients must be able to replace their current SABA with albuterol/salbutamol HFA inhalation aerosol at the SV for use as needed for the duration of the study.
13. Female patients may not be pregnant, breastfeeding, or attempting to become pregnant.

    * -Other criteria may apply, please contact the investigator for more information

Exclusion Criteria:

1. The patient has a history of a life-threatening asthma exacerbation that is defined for this protocol as an asthma episode that required intubation and/or was associated with hypercapnea, respiratory arrest, or hypoxic seizures.
2. The patient is pregnant or lactating, or plans to become pregnant during the study period or for 30 days after the study.
3. The patient has participated as a randomized patient in any investigational drug study within the 30 days preceding the SV (or prescreening visit, as applicable) or plans to participate in another investigational drug study at any time during this study.
4. The patient has previously participated in an Fp MDPI or FS MDPI study.
5. The patient has a known hypersensitivity to any corticosteroid, salmeterol, or any of the excipients in the study drug or rescue medication formulation (ie, lactose).
6. The patient has been treated with any known strong cytochrome P450 (CYP) 3A4 inhibitors (eg, azole antifungals, ritonavir, or clarithromycin) within 30 days before the SV or plans to be treated with any strong CYP3A4 inhibitor during the study.
7. The patient has been treated with any of the prohibited medications during the prescribed (per protocol) washout periods before the SV.
8. The patient currently smokes or has a smoking history of 10 pack-years or more (a pack-year is defined as smoking 1 pack of cigarettes/day for 1 year). The patient may not have used tobacco products within the past year (eg, cigarettes, cigars, chewing tobacco, or pipe tobacco).
9. The patient has a culture-documented or suspected bacterial or viral infection of the upper or lower respiratory tract, sinus, or middle ear that has not resolved at least 2 weeks before the SV.
10. The patient has a history of alcohol or drug abuse within 2 years preceding the SV.
11. The patient has had an asthma exacerbation requiring systemic corticosteroids within 30 days before the SV, or has had any hospitalization for asthma within 2 months before the SV.
12. Initiation or dose escalation of immunotherapy (administered by any route) is planned during the study period. However, patients who initiated immunotherapy 90 days or more before the SV and have been on a stable (maintenance) dose for 30 days or more before the SV may be considered for inclusion.
13. The patient has used immunosuppressive medications within 4 weeks before the SV.
14. The patient is unable to tolerate or unwilling to comply with the appropriate washout periods and withholding of all applicable medications. (Patients that require continuous treatment with β-blockers, monoamine oxidase inhibitors, tricyclic antidepressants, anticholinergics, and/or systemic corticosteroids are excluded).
15. The patient has untreated oral candidiasis at the SV. Patients with clinical visual evidence of oral candidiasis who agree to receive treatment and comply with appropriate medical monitoring may enter the study.
16. The patient has a history of a positive test for human immunodeficiency virus, active hepatitis B virus, or hepatitis C infection.
17. The patient is either an employee or an immediate relative of an employee of the clinical investigational center.
18. A member of the patient's household is participating in the study at the same time. However, after the enrolled patient completes or discontinues participation in the study, another patient from the same household may be screened.
19. The patient has a disease/condition that in the medical judgment of the investigator would put the safety of the patient at risk through participation or that could affect the efficacy or safety analysis if the disease/condition worsened during the study.

    * Other criteria may apply, please contact the investigator for more information

Criteria for Randomization:

Patients were randomized into the study if they met all of the following criteria:

1. The patient continued to be in general good health, meeting the entry criteria.
2. The patient continued to have a predose/pre-albuterol FEV1 at the randomization visit (RV) that was ≥40% of predicted normal.
3. The patient had no clinically significant abnormal laboratory test results or ECG findings at the screening visit.
4. The patient had no significant changes in asthma medications during run-in, excluding the albuterol/salbutamol HFA (90 mcg ex actuator) or equivalent used as rescue medication as supplied per protocol.
5. The patient did not have a upper respiratory tract infection (URI) or lower respiratory tract infection (LRI) during the run in period. Patients who developed a URI or LRI during the run in period could be discontinued from the study and allowed to re-screen 2 weeks after resolution of symptoms.
6. The patient had no asthma exacerbation during the run in period, defined as any worsening of asthma requiring any significant treatment other than rescue albuterol/salbutamol HFA (90 mcg ex actuator) or equivalent or the patient's run-in MDPI. This included requiring the use of systemic corticosteroids and/or emergency department (ED) visit or hospitalization or an increase in the patient's regularly prescribed nonsteroidal maintenance treatment. Urgent care/ED visits where the treatment was limited to a single dose of nebulized albuterol/salbutamol did not meet the criteria of an asthma exacerbation.
7. The patient had no clinical visual evidence (on oropharyngeal examination) of oropharyngeal candidiasis.
8. The patient did not experience an adverse event that would result in failure to continue to meet selection criteria.
9. The patient did not use any of the prohibited concomitant medications during the run in period.
10. The patient complied with completion of the daily diary, defined as follows:

    * completion of AM and PM asthma symptom scores on 4 or more of the 7 days immediately preceding the RV.
    * completion of rescue medication use (whether used or not) on 4 or more of the 7 days immediately preceding the RV.
    * completion of AM peak expiratory flow (PEF) measurements on 4 or more of the 7 days immediately preceding the RV.
    * recording of AM and PM asthma inhalation therapy use on 4 or more of the 7 days immediately preceding the RV.

Primary outcomes:
measure: Participants With Treatment-Emergent Adverse Experiences (TEAE) During the Treatment Period
timeFrame: Day 1 to Week 26 of the Treatment Period
Secondary outcomes:
measure: Participants With Positive Swab Test Results for Oral Candidiasis
timeFrame: Baseline (Day 1 pre-treatment), Weeks 2, 6, 10, 14, 18, 22 26, Endpoint
measure: Participants With Potentially Clinically Significant Abnormal Vital Signs During the Treatment Period
timeFrame: Baseline (Day 1 pre-treatment), Weeks 2, 6, 10, 14, 18, 22 26, Endpoint
measure: Shifts From Baseline to Endpoint in Electrocardiogram (ECG) Findings
timeFrame: Screening (Day -14), Endpoint (week 26 if study was completed)
measure: Analysis of 24-Hour Urine Cortisol Free Over the 26-Week Treatment Period
timeFrame: Baseline (Day 1, pre-treatment), Weeks 14 and 26 and early termination visit if applicable
measure: Change From Baseline in Trough Forced Expiratory Volume in 1 Minute (FEV1) Over the 26-Week Treatment Period
timeFrame: Baseline (Day 1 pre-treatment), Weeks 2, 6, 10, 14, 18, 22 26, early termination visit if applicable
Other outcomes:
Locations:
city: Birmingham
country: United States
facility: Teva Investigational Site 12068
state: Alabama
city: Mobile
country: United States
facility: Teva Investigational Site 12112
state: Alabama
city: Pell City
country: United States
facility: Teva Investigational Site 12130
state: Alabama
city: Little Rock
country: United States
facility: Teva Investigational Site 12119
state: Alaska
city: Phoenix
country: United States
facility: Teva Investigational Site 12076
state: Arizona
city: Scottsdale
country: United States
facility: Teva Investigational Site 12135
state: Arizona
city: Tucson
country: United States
facility: Teva Investigational Site 12132
state: Arizona
city: Fountain Valley
country: United States
facility: Teva Investigational Site 12102
state: California
city: Fresno
country: United States
facility: Teva Investigational Site 12104
state: California
city: Fullerton
country: United States
facility: Teva Investigational Site 12123
state: California
city: Huntington Beach
country: United States
facility: Teva Investigational Site 12103
state: California
city: Long Beach
country: United States
facility: Teva Investigational Site 12073
state: California
city: Mission Viejo
country: United States
facility: Teva Investigational Site 12077
state: California
city: Napa
country: United States
facility: Teva Investigational Site 12098
state: California
city: Northridge
country: United States
facility: Teva Investigational Site 12149
state: California
city: Orange
country: United States
facility: Teva Investigational Site 12081
state: California
city: Rancho Mirage
country: United States
facility: Teva Investigational Site 12100
state: California
city: Riverside
country: United States
facility: Teva Investigational Site 12133
state: California
city: Riverside
country: United States
facility: Teva Investigational Site 12146
state: California
city: Rolling Hills Estates
country: United States
facility: Teva Investigational Site 12075
state: California
city: San Diego
country: United States
facility: Teva Investigational Site 12074
state: California
city: San Diego
country: United States
facility: Teva Investigational Site 12150
state: California
city: San Jose
country: United States
facility: Teva Investigational Site 12064
state: California
city: Stockton
country: United States
facility: Teva Investigational Site 12061
state: California
city: Walnut Creek
country: United States
facility: Teva Investigational Site 12141
state: California
city: Denver
country: United States
facility: Teva Investigational Site 12043
state: Colorado
city: Denver
country: United States
facility: Teva Investigational Site 12051
state: Colorado
city: Waterbury
country: United States
facility: Teva Investigational Site 12091
state: Connecticut
city: Fort Lauderdale
country: United States
facility: Teva Investigational Site 12078
state: Florida
city: Hialeah
country: United States
facility: Teva Investigational Site 12140
state: Florida
city: Kissimmee
country: United States
facility: Teva Investigational Site 12066
state: Florida
city: Miami
country: United States
facility: Teva Investigational Site 12120
state: Florida
city: Miami
country: United States
facility: Teva Investigational Site 12127
state: Florida
city: Miami
country: United States
facility: Teva Investigational Site 12148
state: Florida
city: Ocala
country: United States
facility: Teva Investigational Site 12114
state: Florida
city: Sarasota
country: United States
facility: Teva Investigational Site 12055
state: Florida
city: Tallahassee
country: United States
facility: Teva Investigational Site 12048
state: Florida
city: Tamarac
country: United States
facility: Teva Investigational Site 12122
state: Florida
city: Winter Park
country: United States
facility: Teva Investigational Site 12086
state: Florida
city: Gainesville
country: United States
facility: Teva Investigational Site 12111
state: Georgia
city: Lawrenceville
country: United States
facility: Teva Investigational Site 12070
state: Georgia
city: Marietta
country: United States
facility: Teva Investigational Site 12072
state: Georgia
city: Coeur d'Alene
country: United States
facility: Teva Investigational Site 12106
state: Idaho
city: Eagle
country: United States
facility: Teva Investigational Site 12117
state: Idaho
city: River Forest
country: United States
facility: Teva Investigational Site 12065
state: Illinois
city: Shiloh
country: United States
facility: Teva Investigational Site 12059
state: Illinois
city: Overland Park
country: United States
facility: Teva Investigational Site 12056
state: Kansas
city: Fort Mitchell
country: United States
facility: Teva Investigational Site 12138
state: Kentucky
city: Owensboro
country: United States
facility: Teva Investigational Site 12092
state: Kentucky
city: Covington
country: United States
facility: Teva Investigational Site 12087
state: Louisiana
city: Bangor
country: United States
facility: Teva Investigational Site 12095
state: Maine
city: Baltimore
country: United States
facility: Teva Investigational Site 12042
state: Maryland
city: Baltimore
country: United States
facility: Teva Investigational Site 12124
state: Maryland
city: North Dartmouth
country: United States
facility: Teva Investigational Site 12052
state: Massachusetts
city: Minneapolis
country: United States
facility: Teva Investigational Site 12139
state: Minnesota
city: Plymouth
country: United States
facility: Teva Investigational Site 12137
state: Minnesota
city: Columbia
country: United States
facility: Teva Investigational Site 12079
state: Missouri
city: Rolla
country: United States
facility: Teva Investigational Site 12067
state: Missouri
city: Saint Louis
country: United States
facility: Teva Investigational Site 12057
state: Missouri
city: Saint Louis
country: United States
facility: Teva Investigational Site 12060
state: Missouri
city: Saint Louis
country: United States
facility: Teva Investigational Site 12108
state: Missouri
city: Warrensburg
country: United States
facility: Teva Investigational Site 12128
state: Missouri
city: Bellevue
country: United States
facility: Teva Investigational Site 12136
state: Nebraska
city: Las Vegas
country: United States
facility: Teva Investigational Site 12115
state: Nevada
city: Las Vegas
country: United States
facility: Teva Investigational Site 12131
state: Nevada
city: Ocean City
country: United States
facility: Teva Investigational Site 12126
state: New Jersey
city: Verona
country: United States
facility: Teva Investigational Site 12129
state: New Jersey
city: Rochester
country: United States
facility: Teva Investigational Site 12058
state: New York
city: Rockville Centre
country: United States
facility: Teva Investigational Site 12113
state: New York
city: Charlotte
country: United States
facility: Teva Investigational Site 12047
state: North Carolina
city: Charlotte
country: United States
facility: Teva Investigational Site 12085
state: North Carolina
city: Winston-Salem
country: United States
facility: Teva Investigational Site 12144
state: North Carolina
city: Canton
country: United States
facility: Teva Investigational Site 12053
state: Ohio
city: Cincinnati
country: United States
facility: Teva Investigational Site 12094
state: Ohio
city: Cincinnati
country: United States
facility: Teva Investigational Site 12105
state: Ohio
city: Sylvania
country: United States
facility: Teva Investigational Site 12107
state: Ohio
city: Tiffin
country: United States
facility: Teva Investigational Site 12069
state: Ohio
city: Oklahoma City
country: United States
facility: Teva Investigational Site 12045
state: Oklahoma
city: Oklahoma City
country: United States
facility: Teva Investigational Site 12080
state: Oklahoma
city: Oklahoma City
country: United States
facility: Teva Investigational Site 12083
state: Oklahoma
city: Eugene
country: United States
facility: Teva Investigational Site 12062
state: Oregon
city: Medford
country: United States
facility: Teva Investigational Site 12097
state: Oregon
city: Portland
country: United States
facility: Teva Investigational Site 12049
state: Oregon
city: Bryn Mawr
country: United States
facility: Teva Investigational Site 12134
state: Pennsylvania
city: Philadelphia
country: United States
facility: Teva Investigational Site 12090
state: Pennsylvania
city: Providence
country: United States
facility: Teva Investigational Site 12089
state: Rhode Island
city: Warwick
country: United States
facility: Teva Investigational Site 12088
state: Rhode Island
city: Charleston
country: United States
facility: Teva Investigational Site 12096
state: South Carolina
city: Spartanburg
country: United States
facility: Teva Investigational Site 12147
state: South Carolina
city: Dallas
country: United States
facility: Teva Investigational Site 12121
state: Texas
city: El Paso
country: United States
facility: Teva Investigational Site 12099
state: Texas
city: Live Oak
country: United States
facility: Teva Investigational Site 12071
state: Texas
city: San Antonio
country: United States
facility: Teva Investigational Site 12054
state: Texas
city: Waco
country: United States
facility: Teva Investigational Site 12145
state: Texas
city: Murray
country: United States
facility: Teva Investigational Site 12046
state: Utah
city: South Burlington
country: United States
facility: Teva Investigational Site 12041
state: Vermont
city: Richmond
country: United States
facility: Teva Investigational Site 12125
state: Virginia
city: Seattle
country: United States
facility: Teva Investigational Site 12101
state: Washington
city: Spokane
country: United States
facility: Teva Investigational Site 12109
state: Washington
city: Tacoma
country: United States
facility: Teva Investigational Site 12044
state: Washington
city: Greenfield
country: United States
facility: Teva Investigational Site 12082
state: Wisconsin
Study officials:
affiliation: Teva Branded Pharmaceutical Products R&D, Inc.
name: Teva Medical Expert, MD
role: STUDY_DIRECTOR
References:
citation: Mansfield L, Yiu G, Sakov A, Liu S, Caracta C. A 6-month safety and efficacy study of fluticasone propionate and fluticasone propionate/salmeterol multidose dry powder inhalers in persistent asthma. Allergy Asthma Proc. 2017 Jul 24;38(4):264-276. doi: 10.2500/aap.2017.38.4061. Epub 2017 May 24.
citation: Miller DS, Yiu G, Hellriegel ET, Steinfeld J. Dose-ranging study of salmeterol using a novel fluticasone propionate/salmeterol multidose dry powder inhaler in patients with persistent asthma. Allergy Asthma Proc. 2016 Jul;37(4):291-301. doi: 10.2500/aap.2016.37.3963. Epub 2016 May 27.