201832: A Randomised, Double-Blind, Double-Dummy, Crossover Comparison of Fluticasone Furoate/Vilanterol 100/25 mcg Once Daily Versus Fluticasone Propionate 250 mcg Twice Daily in Adolescent and Adult Subjects With Asthma and Exercise-Induced Bronchoconstriction
Overview
- Phase
- Phase 4
- Status
- Completed
- Sponsor
- GlaxoSmithKline
- Enrollment
- 75
- Locations
- 1
- Primary Endpoint
- Maximal Percent Decrease in Forced Expiratory Volume in One Second (FEV1) Following Exercise Challenge at 12 Hours (Hrs) Post Evening Dose From Pre-exercise FEV1.
Overview
Brief Summary
This is a multicenter, randomized, double-blind, double-dummy, crossover study with two 2-week treatment periods separated by a 2-week wash-out period. Subjects will participate in up to eight study visits and have a follow up phone call approximately a week after the last clinic visit. Visits 1, 2, 3, 5 and 6 are evening visits that will be conducted between 5PM and 11PM. Visit 4 and Visit 7 are also evening visits that will begin between 5PM and 11PM and continue over a period of approximately 24 hours. Subjects will be required to attend three clinic visits during this 24-hour period. An exercise challenge (using a treadmill) will be conducted at Visit 2, Visit 3 and Visit 6 (after 23 hours of the first treatment dose in each Treatment Period); and at 12 and 23 hours post evening dose at Visits 4 and 7. Spirometry will be conducted at specified visits and prior to and after each exercise challenge.
Subjects with symptomatic allergic rhinitis at Visit 1 (screening) may be treated for up to four weeks with intranasal corticosteroids followed by a repeat screening visit to determine eligibility prior to entry into the study.
Eligible subjects at visit 1 will complete a 4-week single blind run-in on FP 250 microgram (mcg) twice daily (BID), followed by 2-week double-blind Treatment Period 1 on randomized treatment, a 2-week single blind washout period on FP 250 mcg BID, 2-week double-blind Treatment Period 2 receiving the alternative treatment, and follow-up contact approximately 7-days after completing Treatment Period 2. The total duration of study participation is approximately 11 weeks; and up to 15 weeks for subjects with Symptomatic Allergic Rhinitis.
The primary objective of the study is to evaluate the protective effect of fluticasone furoate/vilanterol (FF/VI) 100/25 mcg once-daily compared with fluticasone propionate (FP) 250 mcg twice-daily against exercise-induced bronchoconstriction in adolescent and adult subjects aged 12 to 50 with persistent asthma.
ELLIPTA, ACCUHALER, and DISKUS are registered trademarks of the GlaxoSmithKline group of companies.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Crossover
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Investigator)
Eligibility Criteria
- Ages
- 12 Years to 50 Years (Child, Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Informed consent: Subjects must give their signed and dated written informed consent to participate prior to commencing any study related activities.
- •Age Range: 12 to 50 years of age, inclusive, at Visit 1 (Screening).
- •Diagnosis: A diagnosis of asthma, as defined by the National Institutes of Health for at least 12 weeks prior to Visit
- •Asthma Severity: Subjects must have a pre-bronchodilator FEV1 of \>=70 percent of the predicted normal value. Predicted values will be based upon Global Lung Function Initiative equations for spirometry reference values.
- •Evidence of EIB: Subjects must answer "Yes" to at least 2 of the following 3 questions reflecting on the previous 12 months:
- •Are you short of breath during exercise or other physical exertion?
- •Do you wheeze after exercise or other physical exertion?
- •Do you cough after exercise or other physical exertion?
- •Concurrent Anti-Asthma Therapy: Subjects must be taking low- to moderate dose inhaled steroids for 12 weeks prior to Visit 1 in order to participate with no change in dose for the 4 weeks prior to Visit
- •Gender: Subjects may be male or an eligible female. A female is eligible to enter and participate in the study if she is of: Non-child bearing potential (i.e., physiologically incapable of becoming pregnant, including any female who is post-menopausal or surgically sterile).Surgically sterile females are defined as those with a documented hysterectomy and/or bilateral oophorectomy or tubal ligation. Post-menopausal females are defined as being amenorrhoeic for greater than 1 year with an appropriate clinical profile, e.g., age appropriate, \> 45 years, in the absence of hormone replacement therapy.
Exclusion Criteria
- •Intermittent Asthma, Seasonal Asthma, or Exercise-Induced Bronchoconstriction Only: Subjects with only intermittent or seasonal asthma or only exercise-induced asthma are excluded from participation in this study.
- •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 within the last 10 years.
- •Asthma Exacerbation: Any asthma exacerbation requiring oral corticosteroids within 12 weeks of Visit 1 or that resulted in an overnight hospitalization requiring additional treatment for asthma within 6 months prior to Visit
- •Symptomatic Allergic Rhinitis: Subjects with symptomatic allergic rhinitis at Visit 1 may be treated for up to four weeks with intranasal corticosteroids followed by a repeat screening visit to determine eligibility prior to entry into the study. Subjects that continue to be symptomatic after up to four weeks of treatment will be excluded.
- •12-Lead Electrocardiogram (ECG): A subject is not eligible if he/she has an abnormal, clinically significant ECG as determined by the investigator at the Screening Visit.
- •Pregnancy: Women who are pregnant or lactating or are planning on becoming pregnant during the study.
- •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.
- •Concurrent Respiratory Disease: A subject must not have current evidence of:
- •Atelectasis
- •Bronchopulmonary dysplasia
Arms & Interventions
FF/VI 100/25 mcg + Placebo DISKUS®/ ACCUHALER®
Randomised subjects will receive FF/VI 100/25 mcg once daily via ELLIPTA inhaler and placebo twice daily via DISKUS / ACCUHALER for 2 weeks in Period 1. There will be a washout period of 2 weeks between treatment periods in which subjects will receive FP 250 mcg twice daily. Subjects will receive FP 250 mcg twice daily via DISKUS inhaler and placebo once daily via ELLIPTA inhaler for 2 weeks in Period 2.
Intervention: Fluticasone furoate/ Vilanterol 100 mcg/25 mcg (Drug)
FF/VI 100/25 mcg + Placebo DISKUS®/ ACCUHALER®
Randomised subjects will receive FF/VI 100/25 mcg once daily via ELLIPTA inhaler and placebo twice daily via DISKUS / ACCUHALER for 2 weeks in Period 1. There will be a washout period of 2 weeks between treatment periods in which subjects will receive FP 250 mcg twice daily. Subjects will receive FP 250 mcg twice daily via DISKUS inhaler and placebo once daily via ELLIPTA inhaler for 2 weeks in Period 2.
Intervention: Placebo via DISKUS / ACCUHALER (Drug)
FP 250 mcg + Placebo ELLIPTA®
Randomised subjects will receive FP 250 mcg twice daily via DISKUS inhaler and placebo once daily via ELLIPTA inhaler for 2 weeks in Period 1. There will be a washout period of 2 weeks between treatment periods in which subjects will receive FP 250 mcg twice daily. Subjects will receive FF/VI 100/25 mcg once daily via ELLIPTA inhaler and placebo twice daily via DISKUS inhaler for 2 weeks in Period 2.
Intervention: Fluticasone propionate 250 mcg (Drug)
FP 250 mcg + Placebo ELLIPTA®
Randomised subjects will receive FP 250 mcg twice daily via DISKUS inhaler and placebo once daily via ELLIPTA inhaler for 2 weeks in Period 1. There will be a washout period of 2 weeks between treatment periods in which subjects will receive FP 250 mcg twice daily. Subjects will receive FF/VI 100/25 mcg once daily via ELLIPTA inhaler and placebo twice daily via DISKUS inhaler for 2 weeks in Period 2.
Intervention: Placebo via ELLIPTA inhaler (Drug)
Outcomes
Primary Outcomes
Maximal Percent Decrease in Forced Expiratory Volume in One Second (FEV1) Following Exercise Challenge at 12 Hours (Hrs) Post Evening Dose From Pre-exercise FEV1.
Time Frame: At Week 2 of treatment period 1 and 2
The exercise challenge test is a stepped challenge on a treadmill. It was performed at 12 hrs post evening dose at the end of the 2-week treatment period, wherein the participants exercised sufficiently to reach a heart rate between 80 to 95 percent of their predicted maximum within 4 minutes (min) and maintained the heart rate with exercise for an additional 6 min followed immediately by serial assessments of FEV1 at 5, 10, 15, 30, 45 and 60 min post-exercise. Maximal percent decrease was calculated as pre-exercise FEV1 minus minimum post exercise FEV1 (smallest FEV1 value collected within one hr following exercise challenge) divided by pre-exercise FEV1 multiplied by 100. Pre-exercise FEV1 was defined as the FEV1 collected prior to the exercise challenge test at 12 hr post dose. ITT Population comprised of all participants randomized to treatment and who received at least one dose of study medication.
Secondary Outcomes
- Weighted Mean 0-60 Min for Percentage Decrease From Pre-exercise FEV1 Following Exercise Challenge at 12 Hrs and 23 Hrs Post Evening Dose.(At Week 2 of treatment period 1 and 2)
- Maximal Percent Decrease in FEV1 Following Exercise Challenge at 23 Hrs Post Evening Dose From Pre-exercise FEV1.(At Week 2 of treatment period 1 and 2)
- Proportion of Participants With a 30 Min Post-challenge FEV1 no More Than 5 Percent Lower Than Pre-exercise FEV1 Following the Exercise Challenge at 12 Hrs and 23 Hrs Post Evening Dose.(At Week 2 of treatment period 1 and 2)