Chronic Obstructive Pulmonary Disease
Conditions
Keywords
chronic obstructive pulmonary disease, COPD, QVA149, QAB149, NVA237, indacaterol, glycopyrronium bromide
Brief summary
The study assessed the safety and efficacy of the fixed combination product QVA149 versus the component products QAB149 and NVA237, administered concurrently, in patients that have moderate to severe chronic obstructive pulmonary disease (COPD).
Detailed description
The study assessed the safety and efficacy of the fixed combination product QVA149 versus the component products QAB149 and NVA237, administered concurrently, in patients that have moderate to severe chronic obstructive pulmonary disease (COPD).
Interventions
QVA149 110/50 ug supplied as capsules in blister packs for inhalation via SDDPI, once daily
NVA237 50 ug supplied as capsules in blister packs for inhalation via SDDPI, once daily
QAB149 150 ug supplied as capsules in blister packs for inhalation via SDDPI , once daily
Placebo capsules provided in blister packs for inhalation via SDDPI, once daily
Sponsors
Study design
Eligibility
Inclusion criteria
* Male or female adults aged ≥ 40 yrs * Smoking history of at least 10 pack years * Diagnosis of COPD (moderate to severe as classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines, 2010) * Post-bronchodilator FEV1 \< 80% and ≥ 30% of the predicted normal value and post-bronchodilator FEV1/FVC (forced vital capacity) \< 70%
Exclusion criteria
* Patients who have had a respiratory tract infection within 4 weeks prior to Visit 1 * Patients with concomitant pulmonary disease * Patients with a history of asthma * Any patient with lung cancer or a history of lung cancer * Patients with a history of certain cardiovascular co-morbid conditions * Patients with a known history and diagnosis of alpha-1 antitrypsin deficiency * Patients in the active phase of a supervised pulmonary rehabilitation program * Patients contraindicated for inhaled anticholinergic agents and β2 agonists Other protocol-defined inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Trough Forced Expiratory Volume in 1 Second (FEV1) After 28 Days of Blinded Treatment | Day 29 | Spirometry was conducted according to internationally accepted standards. Trough FEV1 is defined as the average of the 23 hour 15 minute and 23 hour 45 minute post-dose FEV1 readings measured at day 29, after 28 days of treatment. Mixed model: Trough FEV1 = treatment + baseline FEV1 + FEV1 reversibility components + baseline smoking status + baseline ICS use + country + center (country) + error. Center was included as a random effect nested within country. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4 Hours at Day 28 | 0, 5, 15, and 30 minutes; and 1, 2, 3 and 4 hours post-dose at Day 28 | Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4h at Day 28 was measured via spirometry conducted according to internationally accepted standards. Measurements were made at 0, 5, 15, and 30 minutes; and 1, 2, 3 and 4 hours post-dose. The standardized AUC FEV1 was calculated as the sum of trapezoids divided by the length of time. Mixed model used: AUC FEV1 = treatment + baseline FEV1 + FEV1 reversibility components + baseline smoking status + baseline ICS use + country + center (country) + error. Center was included as a random effect nested within country. |
| Peak Forced Expiratory Volume in 1 Second (FEV1) on Days 1 and 28 Post-dose | 5 min - 4 hr at Days 1 and 28 | Spirometry was conducted according to internationally accepted standards. Peak FEV1 is the maximum FEV1 recorded in the period between 5 minutes and 4 hours post dose. Analysis of Covariance was carried out with a mixed model that used (period) baseline, defined as the value of FEV1 measured prior to the first study drug intake in the period, as a covariate. |
| Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4 Hours at Day 1 | 0, 5, 15, and 30 minutes; and 1, 2, 3 and 4 hours post-dose at Day 1 | Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4h at Day 1 was measured via spirometry conducted according to internationally accepted standards. Measurements were made at 0, 5, 15, and 30 minutes; and 1, 2, 3 and 4 hours post-dose. The standardized AUC FEV1 was calculated as the sum of trapezoids divided by the length of time. Mixed model used: AUC FEV1 = treatment + baseline FEV1 + FEV1 reversibility components + baseline smoking status + baseline ICS use + country + center (country) + error. Center was included as a random effect nested within country. |
| Change From Baseline in the Mean Daily, (Daytime and Nighttime Combined) Number of Puffs of Rescue Medication Used Over 28 Days of Treatment | Baseline and 28 days | The number of puffs of rescue medication taken in the previous 12 hours was recorded in the Patient Diary in the morning and evening. The total number of puffs of rescue medication per day over the whole active treatment period was calculated and divided by the total number of days with non-missing rescue data to derive the mean daily number of puffs of rescue medication taken for the patient. If the number of puffs was missing for part of the day (either morning or evening) then a half day was used in the denominator. |
| Change From Baseline in Percentage of Days With 'no Daytime Symptoms' Over 28 Days of Treatment | 28 days | The mean total symptom scores and mean individual symptom scores for the patient were calculated for the whole study period. The mean change from baseline in the total scores and in the individual scores were summarized by treatment and were analyzed for the percentage of 'nights with no nighttime awakenings'. The symptom variables for the whole active treatment period was analyzed using the similar MIXED model as for the primary endpoint, with the baseline FEV1 term being replaced by the respective baseline symptom variables. |
| Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | -45 min, -15 min predose, 5 min, 30 min, 1 hr, 2hr, 3hr and 4 hr post-dose on Day 28 | Time course of Forced Expiratory Volume in 1 second (FEV1) was measured at -45 min, -15 min predose, 5 min, 30 min, 1 hr, 2hr, 3hr and 4 hr post-dose on Day 28. FEV1 is the amount of air which can be forcibly exhaled from the lungs in the first second of a forced exhalation. |
Countries
Austria, Denmark, Netherlands, Norway, Sweden
Participant flow
Recruitment details
193 patients were randomized, with 187 of those completing the study. A total of 6 patients discontinued from the study.
Pre-assignment details
Open-label, active QAB149 and NVA237 were administered during a 14-day period prior to randomization in order to stabilize patients and standardize baseline lung function. The patients were then randomized to either the fixed dose combination or free combination arms of blinded treatment in a 1:1 ratio and received study drug for 28 days.
Participants by arm
| Arm | Count |
|---|---|
| QVA149 QVA149 plus placebo once daily for 28 days. | 90 |
| QAB149 + NVA237 Indacaterol (QAB149) plus glycopyrronium bromide (NVA237) once daily for 28 days. | 103 |
| Total | 193 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Administrative problem | 2 | 1 |
| Overall Study | Adverse Event | 1 | 1 |
| Overall Study | Protocol Violation | 0 | 1 |
Baseline characteristics
| Characteristic | QVA149 | QAB149 + NVA237 | Total |
|---|---|---|---|
| Age, Continuous | 65.6 years STANDARD_DEVIATION 7.28 | 64.2 years STANDARD_DEVIATION 7.4 | 64.9 years STANDARD_DEVIATION 7.36 |
| Sex: Female, Male Female | 32 Participants | 44 Participants | 76 Participants |
| Sex: Female, Male Male | 58 Participants | 59 Participants | 117 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 20 / 90 | 12 / 103 |
| serious Total, serious adverse events | 4 / 90 | 6 / 103 |
Outcome results
Trough Forced Expiratory Volume in 1 Second (FEV1) After 28 Days of Blinded Treatment
Spirometry was conducted according to internationally accepted standards. Trough FEV1 is defined as the average of the 23 hour 15 minute and 23 hour 45 minute post-dose FEV1 readings measured at day 29, after 28 days of treatment. Mixed model: Trough FEV1 = treatment + baseline FEV1 + FEV1 reversibility components + baseline smoking status + baseline ICS use + country + center (country) + error. Center was included as a random effect nested within country.
Time frame: Day 29
Population: The Per Protocol Set includes the Full analysis Set patients with available data and without any major protocol deviations or criteria causing exclusion.~Patients were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| QVA149 | Trough Forced Expiratory Volume in 1 Second (FEV1) After 28 Days of Blinded Treatment | 1.459 Liters | Standard Error 0.0196 |
| QAB149 + NVA237 | Trough Forced Expiratory Volume in 1 Second (FEV1) After 28 Days of Blinded Treatment | 1.465 Liters | Standard Error 0.018 |
Change From Baseline in Percentage of Days With 'no Daytime Symptoms' Over 28 Days of Treatment
The mean total symptom scores and mean individual symptom scores for the patient were calculated for the whole study period. The mean change from baseline in the total scores and in the individual scores were summarized by treatment and were analyzed for the percentage of 'nights with no nighttime awakenings'. The symptom variables for the whole active treatment period was analyzed using the similar MIXED model as for the primary endpoint, with the baseline FEV1 term being replaced by the respective baseline symptom variables.
Time frame: 28 days
Population: The Modified per protocol set (PPS) was defined post-DBL and included all patients with available data and without any major protocol deviations or criteria or GCP finding causing exclusion. Patients were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| QVA149 | Change From Baseline in Percentage of Days With 'no Daytime Symptoms' Over 28 Days of Treatment | Baseline (day 1) | 6.2 percentage of days | Standard Deviation 16.54 |
| QVA149 | Change From Baseline in Percentage of Days With 'no Daytime Symptoms' Over 28 Days of Treatment | After 28 days of treatment | 9.3 percentage of days | Standard Deviation 23.69 |
| QAB149 + NVA237 | Change From Baseline in Percentage of Days With 'no Daytime Symptoms' Over 28 Days of Treatment | Baseline (day 1) | 3.9 percentage of days | Standard Deviation 10.44 |
| QAB149 + NVA237 | Change From Baseline in Percentage of Days With 'no Daytime Symptoms' Over 28 Days of Treatment | After 28 days of treatment | 6.0 percentage of days | Standard Deviation 15.85 |
Change From Baseline in the Mean Daily, (Daytime and Nighttime Combined) Number of Puffs of Rescue Medication Used Over 28 Days of Treatment
The number of puffs of rescue medication taken in the previous 12 hours was recorded in the Patient Diary in the morning and evening. The total number of puffs of rescue medication per day over the whole active treatment period was calculated and divided by the total number of days with non-missing rescue data to derive the mean daily number of puffs of rescue medication taken for the patient. If the number of puffs was missing for part of the day (either morning or evening) then a half day was used in the denominator.
Time frame: Baseline and 28 days
Population: The Per Protocol Set includes the Full analysis Set patients with available data and without any major protocol deviations or criteria causing exclusion.~Patients were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| QVA149 | Change From Baseline in the Mean Daily, (Daytime and Nighttime Combined) Number of Puffs of Rescue Medication Used Over 28 Days of Treatment | Baseline (day 1) | 2.24 puffs | Standard Deviation 2.437 |
| QVA149 | Change From Baseline in the Mean Daily, (Daytime and Nighttime Combined) Number of Puffs of Rescue Medication Used Over 28 Days of Treatment | 28 days after treatment | 1.85 puffs | Standard Deviation 2.283 |
| QAB149 + NVA237 | Change From Baseline in the Mean Daily, (Daytime and Nighttime Combined) Number of Puffs of Rescue Medication Used Over 28 Days of Treatment | Baseline (day 1) | 2.04 puffs | Standard Deviation 2.585 |
| QAB149 + NVA237 | Change From Baseline in the Mean Daily, (Daytime and Nighttime Combined) Number of Puffs of Rescue Medication Used Over 28 Days of Treatment | 28 days after treatment | 1.70 puffs | Standard Deviation 2.338 |
Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4 Hours at Day 1
Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4h at Day 1 was measured via spirometry conducted according to internationally accepted standards. Measurements were made at 0, 5, 15, and 30 minutes; and 1, 2, 3 and 4 hours post-dose. The standardized AUC FEV1 was calculated as the sum of trapezoids divided by the length of time. Mixed model used: AUC FEV1 = treatment + baseline FEV1 + FEV1 reversibility components + baseline smoking status + baseline ICS use + country + center (country) + error. Center was included as a random effect nested within country.
Time frame: 0, 5, 15, and 30 minutes; and 1, 2, 3 and 4 hours post-dose at Day 1
Population: The Per Protocol Set includes the Full analysis Set patients with available data and without any major protocol deviations or criteria causing exclusion.~Patients were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| QVA149 | Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4 Hours at Day 1 | 1.597 Liters | Standard Error 0.0125 |
| QAB149 + NVA237 | Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4 Hours at Day 1 | 1.573 Liters | Standard Error 0.0114 |
Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4 Hours at Day 28
Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4h at Day 28 was measured via spirometry conducted according to internationally accepted standards. Measurements were made at 0, 5, 15, and 30 minutes; and 1, 2, 3 and 4 hours post-dose. The standardized AUC FEV1 was calculated as the sum of trapezoids divided by the length of time. Mixed model used: AUC FEV1 = treatment + baseline FEV1 + FEV1 reversibility components + baseline smoking status + baseline ICS use + country + center (country) + error. Center was included as a random effect nested within country.
Time frame: 0, 5, 15, and 30 minutes; and 1, 2, 3 and 4 hours post-dose at Day 28
Population: The Per Protocol Set includes the Full analysis Set patients with available data and without any major protocol deviations or criteria causing exclusion.~Patients were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| QVA149 | Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4 Hours at Day 28 | 1.575 Liters | Standard Error 0.02 |
| QAB149 + NVA237 | Forced Expiratory Volume in 1 Second (FEV1) Area Under the Curve (AUC) 0-4 Hours at Day 28 | 1.587 Liters | Standard Error 0.0184 |
Peak Forced Expiratory Volume in 1 Second (FEV1) on Days 1 and 28 Post-dose
Spirometry was conducted according to internationally accepted standards. Peak FEV1 is the maximum FEV1 recorded in the period between 5 minutes and 4 hours post dose. Analysis of Covariance was carried out with a mixed model that used (period) baseline, defined as the value of FEV1 measured prior to the first study drug intake in the period, as a covariate.
Time frame: 5 min - 4 hr at Days 1 and 28
Population: The Per Protocol Set includes the Full analysis Set patients with available data and without any major protocol deviations or criteria causing exclusion.~Patients were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| QVA149 | Peak Forced Expiratory Volume in 1 Second (FEV1) on Days 1 and 28 Post-dose | Day 1 (n=83, 97) | 1.668 Liters | Standard Error 0.0132 |
| QVA149 | Peak Forced Expiratory Volume in 1 Second (FEV1) on Days 1 and 28 Post-dose | Day 28 (n= 80, 92) | 1.643 Liters | Standard Error 0.021 |
| QAB149 + NVA237 | Peak Forced Expiratory Volume in 1 Second (FEV1) on Days 1 and 28 Post-dose | Day 1 (n=83, 97) | 1.646 Liters | Standard Error 0.012 |
| QAB149 + NVA237 | Peak Forced Expiratory Volume in 1 Second (FEV1) on Days 1 and 28 Post-dose | Day 28 (n= 80, 92) | 1.654 Liters | Standard Error 0.0194 |
Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28
Time course of Forced Expiratory Volume in 1 second (FEV1) was measured at -45 min, -15 min predose, 5 min, 30 min, 1 hr, 2hr, 3hr and 4 hr post-dose on Day 28. FEV1 is the amount of air which can be forcibly exhaled from the lungs in the first second of a forced exhalation.
Time frame: -45 min, -15 min predose, 5 min, 30 min, 1 hr, 2hr, 3hr and 4 hr post-dose on Day 28
Population: The Per Protocol Set includes the Full analysis Set patients with available data and without any major protocol deviations or criteria causing exclusion. Patients were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| QVA149 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | -45 min predose (n=76,90) | 1.452 Liters | Standard Error 0.0197 |
| QVA149 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | -15 predose (n=72,87) | 1.449 Liters | Standard Error 0.0239 |
| QVA149 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 5 min postdose (n=76,89) | 1.491 Liters | Standard Error 0.0222 |
| QVA149 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 30 min postdose (n=76,88) | 1.529 Liters | Standard Error 0.0181 |
| QVA149 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 1 hour postdose (n=77,90) | 1.584 Liters | Standard Error 0.0204 |
| QVA149 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 2 hours postdose (n=77,90) | 1.601 Liters | Standard Error 0.0219 |
| QVA149 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 3 hours postdose (n=78,91) | 1.576 Liters | Standard Error 0.0211 |
| QVA149 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 4 hours postdose (n=77,84) | 1.554 Liters | Standard Error 0.0236 |
| QAB149 + NVA237 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 4 hours postdose (n=77,84) | 1.556 Liters | Standard Error 0.0228 |
| QAB149 + NVA237 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | -45 min predose (n=76,90) | 1.460 Liters | Standard Error 0.0184 |
| QAB149 + NVA237 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 1 hour postdose (n=77,90) | 1.604 Liters | Standard Error 0.0189 |
| QAB149 + NVA237 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | -15 predose (n=72,87) | 1.430 Liters | Standard Error 0.0227 |
| QAB149 + NVA237 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 3 hours postdose (n=78,91) | 1.587 Liters | Standard Error 0.0195 |
| QAB149 + NVA237 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 5 min postdose (n=76,89) | 1.514 Liters | Standard Error 0.0206 |
| QAB149 + NVA237 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 2 hours postdose (n=77,90) | 1.624 Liters | Standard Error 0.0203 |
| QAB149 + NVA237 | Time Course of Forced Expiratory Volume in One Second (FEV1) (Pre-dose to 4 Hours Post Dose) on Day 28 | 30 min postdose (n=76,88) | 1.544 Liters | Standard Error 0.0166 |