Asthma
Conditions
Keywords
asthma, breath-actuated inhaler, metered dose inhaler
Brief summary
This randomized, double-blind, double-dummy, placebo-controlled, parallel-group, 12-week study will evaluate the efficacy and safety of beclomethasone dipropionate (80 or 160 mcg/day) administered via breath-actuated inhaler (BAI) and metered-dose inhaler (MDI) in pediatric patients 4 through 11 years of age with persistent asthma, compared with placebo. Patients took 1 inhalation (with assistance from parents/guardians/caregivers, as needed) from each of 2 devices (BAI device followed by MDI device in that order) twice daily as per the double-dummy study design: 1 BAI treatment or placebo device and 1 MDI treatment or placebo device for a total of 2 inhalations each time.
Interventions
Beclomethasone dipropionate (BDP), was delivered by a single inhalation using a breath-actuated inhaler (BAI) at levels of 40 mcg or 80 mcg per inhalation, twice each day.
Placebo was delivered by a single inhalation using a breath-actuated inhaler (BAI) twice each day.
Rescue medication (albuterol/salbutamol hydrofluoroalkane (HFA) MDI \[90 mcg ex-actuator\] or equivalent) for use on an as-needed basis for the immediate relief of asthma symptoms throughout the treatment period.
Beclomethasone dipropionate (BDP), was delivered by a single inhalation using a metered-dose inhaler (MDI) at levels of 40 mcg or 80 mcg per inhalation, twice each day.
Placebo was delivered by a single inhalation using a metered-dose inhaler (MDI) twice each day.
Sponsors
Study design
Eligibility
Inclusion criteria
* Written informed consent * Asthma diagnosis: The patient has a diagnosis of asthma as defined by the National Institute 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 screening visit * Severity of disease: The patient has persistent asthma, with a forced expiratory volume in 1 second (FEV1) 40% to 90% of the value predicted for age, height, and sex at screening visit (SV) * Current asthma therapy: The patient is currently being treated with 1 of the following: 1) a stable daily dosage of an inhaled corticosteroid (ICS) in the range of 88-176 mcg/day of fluticasone propionate (or equivalent) for a minimum of 4 weeks (28 days) before screening visit 2) a stable daily dosage of non-corticosteroid therapy 3) a daily dose of ICS plus a long-acting beta2-agonist (LABA) (at a dose less than or equivalent to fluticasone propionate 100 mcg/salmeterol 50 mcg twice daily) * Reversibility of disease: The patient has demonstrated at least 12% reversibility of FEV1 within 30 minutes after 2-4 inhalations of albuterol/salbutamol hydrofluoroalkane (HFA) MDI (90 mcg ex-actuator) or equivalent at screening visit or on retesting. * Other criteria apply, please contact the investigator for more information
Exclusion criteria
* The patient has a 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. * The patient is pregnant or lactating, or plans to become pregnant during the study period or for 30 days after the patient's last study-related visit (for eligible patients only, if applicable). Any patient becoming pregnant during the study will be withdrawn from the study. * The patient has a known hypersensitivity to any corticosteroid or any of the excipients in the study drug or rescue medication formulation. * The patient has used tobacco products within the past year (eg, cigarettes, cigars, chewing tobacco, or pipe tobacco, as applicable). * The patient has had an asthma exacerbation requiring oral corticosteroids within 30 days before screening visit, or has had any hospitalization for asthma within 2 months before screening visit. * The patient has historical or current evidence of a clinically significant disease. Significant disease is defined as any disease 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 apply, please contact the investigator for more information
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Standardized Baseline-adjusted Trough Morning Percent Predicted Forced Expiratory Volume in 1 Second (FEV1) Area Under the Effect Curve From Time 0 to 12 Weeks (AUEC(0-12wk)) | Day 1 (baseline), Weeks 2, 4, 8, 12 | Trough morning FEV1 measurements were taken pre-dose and pre-rescue bronchodilator treatment for asthma. Baseline was defined as baseline trough morning percent predicted FEV1. Pulmonary function measurements (including FEV1) were obtained electronically by spirometry. All pulmonary function test data were submitted to a central reading center for evaluation. The highest ('best attempt') FEV1 value from 3 acceptable and 2 repeatable maneuvers (maximum of 8 attempts) was used. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Weekly Average of Daily Trough Morning Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | Day 1 (baseline), weeks 1-12 | The analysis of change from baseline in weekly average of daily trough morning (pre-dose and pre-rescue bronchodilator) PEF calculated across the 12-week treatment period was performed using a mixed model for repeated measures (MMRM) with effects due to baseline weekly average of daily trough morning PEF. |
| Change From Baseline in Weekly Average of Daily Evening Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | Day 1 (baseline), weeks 1-12 | The analysis of change from baseline in the weekly average of daily evening PEF across the 12-week treatment period was performed using a mixed model for repeated measures (MMRM) with effects due to baseline weekly average of daily evening PEF. |
| Change From Baseline in the Weekly Average of Total Daily (24-hour) Use of Albuterol/Salbutamol Inhalation Aerosol (Number of Inhalations) Over Weeks 1-12 | Day 1 (baseline), weeks 1-12 | The change from baseline in the weekly average of total daily (24-hour) use of albuterol/ salbutamol inhalation aerosol (number of inhalations) across the 12 weeks was analyzed using a mixed model for repeated measures (MMRM). |
| Change From Baseline in the Weekly Average of the Total Daily Asthma Symptom Score Over Weeks 1-12 | Day 1 (baseline), weeks 1-12 | The total daily asthma symptom score is the average of the daytime and nighttime scores analyzed using an mixed model for repeated measures (MMRM). Baseline was defined as the average of recorded morning and evening asthma symptom scores over the 7 days before randomization. Daytime Scores range from 0=No symptoms during the day to 5=Symptoms so severe that I could not go to work or perform normal daily activities; Nighttime Scores range from 0=No symptoms during the night to 4=Symptoms so severe that I did not sleep at all. The daily asthma symptom score was therefore 0 - 9 with 0=no symptoms during the day or night and 9=severe symptoms both day and night. |
| Kaplan-Meier Estimates For Time to Withdrawal Due to Meeting Stopping Criteria for Worsening Asthma During the 12-week Treatment Period | Day 1 to 12 weeks | Time to withdrawal due to meeting stopping criteria was defined as number of days elapsed from the date of first dose of double-blind study treatment to the date of withdrawal due to meeting stopping criteria. Kaplan-Meier estimates (median and 95% CI of the median) are not applicable if the proportion of participants withdrawn is less than 0.5. |
Countries
Croatia, Mexico, Poland, Ukraine, United States
Participant flow
Recruitment details
Patients were screened at 123 centers in Croatia, Mexico, Poland, Ukraine, and the United States. The intent-to-treat (ITT) population included all randomly assigned patients
Pre-assignment details
Patients were randomly assigned to treatment through a qualified randomization service provider. This system was used to ensure a balance across treatment groups, within each stratum
Participants by arm
| Arm | Count |
|---|---|
| Placebo BAI and MDI Placebo was administered via breath-actuated inhaler (BAI) twice daily. Additionally placebo was administered via metered-dose inhaler (MDI) twice daily.
Albuterol/salbutamol hydrofluoroalkane (HFA) metered-dose inhaler (MDI) at 90 mcg ex-actuator) or equivalent was used as rescue medication throughout the study. | 127 |
| BDP 80 mcg BAI Beclomethasone dipropionate (BDP) was administered via a breath-actuated inhaler (BAI) twice daily (40 mcg twice a day).
Placebo MDI twice daily for blinding.
Albuterol/salbutamol hydrofluoroalkane (HFA) metered-dose inhaler (MDI) at 90 mcg ex-actuator) or equivalent was used as rescue medication throughout the study. | 126 |
| BDP 160 mcg BAI Beclomethasone dipropionate (BDP) was administered via a breath-actuated inhaler (BAI) twice daily (80 mcg twice a day).
Placebo MDI twice daily for blinding.
Albuterol/salbutamol hydrofluoroalkane (HFA) metered-dose inhaler (MDI) at 90 mcg ex-actuator) or equivalent was used as rescue medication throughout the study. | 125 |
| BDP 80 mcg MDI Beclomethasone dipropionate (BDP) was administered via a metered-dose inhaler (MDI) twice daily (40 mcg twice a day).
Placebo BAI twice daily for blinding.
Albuterol/salbutamol hydrofluoroalkane (HFA) metered-dose inhaler (MDI) at 90 mcg ex-actuator) or equivalent was used as rescue medication throughout the study. | 125 |
| BDP 160 mcg MDI Beclomethasone dipropionate (BDP) was administered via a metered-dose inhaler (MDI) twice daily (80 mcg twice a day).
Placebo BAI twice daily for blinding.
Albuterol/salbutamol hydrofluoroalkane (HFA) metered-dose inhaler (MDI) at 90 mcg ex-actuator) or equivalent was used as rescue medication throughout the study. | 125 |
| Total | 628 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 |
|---|---|---|---|---|---|---|
| Overall Study | Adverse Event | 1 | 1 | 1 | 0 | 2 |
| Overall Study | Lack of Efficacy | 6 | 3 | 4 | 6 | 5 |
| Overall Study | Lost to Follow-up | 4 | 1 | 3 | 1 | 4 |
| Overall Study | Non-compliance | 0 | 1 | 0 | 0 | 0 |
| Overall Study | Not reported | 1 | 0 | 0 | 0 | 0 |
| Overall Study | Protocol Violation | 2 | 1 | 2 | 3 | 0 |
| Overall Study | Withdrawal by Subject | 4 | 3 | 2 | 3 | 2 |
Baseline characteristics
| Characteristic | Placebo BAI and MDI | Total | BDP 160 mcg MDI | BDP 80 mcg MDI | BDP 160 mcg BAI | BDP 80 mcg BAI |
|---|---|---|---|---|---|---|
| Age, Continuous | 8.2 years STANDARD_DEVIATION 2.06 | 8.3 years STANDARD_DEVIATION 1.93 | 8.4 years STANDARD_DEVIATION 1.86 | 8.2 years STANDARD_DEVIATION 1.78 | 8.4 years STANDARD_DEVIATION 1.24 | 8.5 years STANDARD_DEVIATION 2.1 |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants | 15 Participants | 1 Participants | 3 Participants | 4 Participants | 4 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 4 Participants | 0 Participants | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 42 Participants | 195 Participants | 49 Participants | 37 Participants | 33 Participants | 34 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 11 Participants | 66 Participants | 12 Participants | 9 Participants | 17 Participants | 17 Participants |
| Race (NIH/OMB) White | 71 Participants | 348 Participants | 63 Participants | 76 Participants | 69 Participants | 69 Participants |
| Sex: Female, Male Female | 41 Participants | 238 Participants | 50 Participants | 49 Participants | 46 Participants | 52 Participants |
| Sex: Female, Male Male | 86 Participants | 390 Participants | 75 Participants | 76 Participants | 79 Participants | 74 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 1 / 628 | 8 / 127 | 6 / 126 | 13 / 125 | 15 / 125 | 11 / 125 |
| serious Total, serious adverse events | 0 / 628 | 0 / 127 | 0 / 126 | 0 / 125 | 0 / 125 | 0 / 125 |
Outcome results
Standardized Baseline-adjusted Trough Morning Percent Predicted Forced Expiratory Volume in 1 Second (FEV1) Area Under the Effect Curve From Time 0 to 12 Weeks (AUEC(0-12wk))
Trough morning FEV1 measurements were taken pre-dose and pre-rescue bronchodilator treatment for asthma. Baseline was defined as baseline trough morning percent predicted FEV1. Pulmonary function measurements (including FEV1) were obtained electronically by spirometry. All pulmonary function test data were submitted to a central reading center for evaluation. The highest ('best attempt') FEV1 value from 3 acceptable and 2 repeatable maneuvers (maximum of 8 attempts) was used.
Time frame: Day 1 (baseline), Weeks 2, 4, 8, 12
Population: The full analysis set (FAS) included all patients in the ITT population who received at least 1 dose of study drug and had at least 1 post baseline trough morning (pre-dose and pre-rescue bronchodilator) assessment of percent predicted FEV1.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo BAI and MDI | Standardized Baseline-adjusted Trough Morning Percent Predicted Forced Expiratory Volume in 1 Second (FEV1) Area Under the Effect Curve From Time 0 to 12 Weeks (AUEC(0-12wk)) | 2.62 liters | Standard Error 0.744 |
| BDP 80 mcg BAI | Standardized Baseline-adjusted Trough Morning Percent Predicted Forced Expiratory Volume in 1 Second (FEV1) Area Under the Effect Curve From Time 0 to 12 Weeks (AUEC(0-12wk)) | 5.43 liters | Standard Error 0.742 |
| BDP 160 mcg BAI | Standardized Baseline-adjusted Trough Morning Percent Predicted Forced Expiratory Volume in 1 Second (FEV1) Area Under the Effect Curve From Time 0 to 12 Weeks (AUEC(0-12wk)) | 3.25 liters | Standard Error 0.732 |
| BDP 80 mcg MDI | Standardized Baseline-adjusted Trough Morning Percent Predicted Forced Expiratory Volume in 1 Second (FEV1) Area Under the Effect Curve From Time 0 to 12 Weeks (AUEC(0-12wk)) | 3.54 liters | Standard Error 0.734 |
| BDP 160 mcg MDI | Standardized Baseline-adjusted Trough Morning Percent Predicted Forced Expiratory Volume in 1 Second (FEV1) Area Under the Effect Curve From Time 0 to 12 Weeks (AUEC(0-12wk)) | 3.71 liters | Standard Error 0.734 |
Change From Baseline in the Weekly Average of the Total Daily Asthma Symptom Score Over Weeks 1-12
The total daily asthma symptom score is the average of the daytime and nighttime scores analyzed using an mixed model for repeated measures (MMRM). Baseline was defined as the average of recorded morning and evening asthma symptom scores over the 7 days before randomization. Daytime Scores range from 0=No symptoms during the day to 5=Symptoms so severe that I could not go to work or perform normal daily activities; Nighttime Scores range from 0=No symptoms during the night to 4=Symptoms so severe that I did not sleep at all. The daily asthma symptom score was therefore 0 - 9 with 0=no symptoms during the day or night and 9=severe symptoms both day and night.
Time frame: Day 1 (baseline), weeks 1-12
Population: Full analysis set
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo BAI and MDI | Change From Baseline in the Weekly Average of the Total Daily Asthma Symptom Score Over Weeks 1-12 | -0.27 units on a scale | Standard Error 0.036 |
| BDP 80 mcg BAI | Change From Baseline in the Weekly Average of the Total Daily Asthma Symptom Score Over Weeks 1-12 | -0.44 units on a scale | Standard Error 0.036 |
| BDP 160 mcg BAI | Change From Baseline in the Weekly Average of the Total Daily Asthma Symptom Score Over Weeks 1-12 | -0.36 units on a scale | Standard Error 0.036 |
| BDP 80 mcg MDI | Change From Baseline in the Weekly Average of the Total Daily Asthma Symptom Score Over Weeks 1-12 | -0.31 units on a scale | Standard Error 0.036 |
| BDP 160 mcg MDI | Change From Baseline in the Weekly Average of the Total Daily Asthma Symptom Score Over Weeks 1-12 | -0.36 units on a scale | Standard Error 0.036 |
Change From Baseline in the Weekly Average of Total Daily (24-hour) Use of Albuterol/Salbutamol Inhalation Aerosol (Number of Inhalations) Over Weeks 1-12
The change from baseline in the weekly average of total daily (24-hour) use of albuterol/ salbutamol inhalation aerosol (number of inhalations) across the 12 weeks was analyzed using a mixed model for repeated measures (MMRM).
Time frame: Day 1 (baseline), weeks 1-12
Population: Full analysis set
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo BAI and MDI | Change From Baseline in the Weekly Average of Total Daily (24-hour) Use of Albuterol/Salbutamol Inhalation Aerosol (Number of Inhalations) Over Weeks 1-12 | -0.36 Number of inhalations | Standard Error 0.069 |
| BDP 80 mcg BAI | Change From Baseline in the Weekly Average of Total Daily (24-hour) Use of Albuterol/Salbutamol Inhalation Aerosol (Number of Inhalations) Over Weeks 1-12 | -0.72 Number of inhalations | Standard Error 0.068 |
| BDP 160 mcg BAI | Change From Baseline in the Weekly Average of Total Daily (24-hour) Use of Albuterol/Salbutamol Inhalation Aerosol (Number of Inhalations) Over Weeks 1-12 | -0.50 Number of inhalations | Standard Error 0.069 |
| BDP 80 mcg MDI | Change From Baseline in the Weekly Average of Total Daily (24-hour) Use of Albuterol/Salbutamol Inhalation Aerosol (Number of Inhalations) Over Weeks 1-12 | -0.41 Number of inhalations | Standard Error 0.069 |
| BDP 160 mcg MDI | Change From Baseline in the Weekly Average of Total Daily (24-hour) Use of Albuterol/Salbutamol Inhalation Aerosol (Number of Inhalations) Over Weeks 1-12 | -0.54 Number of inhalations | Standard Error 0.069 |
Change From Baseline in Weekly Average of Daily Evening Peak Expiratory Flow (PEF) Over the 12-week Treatment Period
The analysis of change from baseline in the weekly average of daily evening PEF across the 12-week treatment period was performed using a mixed model for repeated measures (MMRM) with effects due to baseline weekly average of daily evening PEF.
Time frame: Day 1 (baseline), weeks 1-12
Population: Full analysis set
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo BAI and MDI | Change From Baseline in Weekly Average of Daily Evening Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 1.4 liters | Standard Error 2.11 |
| BDP 80 mcg BAI | Change From Baseline in Weekly Average of Daily Evening Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 13.1 liters | Standard Error 2.09 |
| BDP 160 mcg BAI | Change From Baseline in Weekly Average of Daily Evening Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 11.4 liters | Standard Error 2.12 |
| BDP 80 mcg MDI | Change From Baseline in Weekly Average of Daily Evening Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 11.3 liters | Standard Error 2.12 |
| BDP 160 mcg MDI | Change From Baseline in Weekly Average of Daily Evening Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 10.1 liters | Standard Error 2.12 |
Change From Baseline in Weekly Average of Daily Trough Morning Peak Expiratory Flow (PEF) Over the 12-week Treatment Period
The analysis of change from baseline in weekly average of daily trough morning (pre-dose and pre-rescue bronchodilator) PEF calculated across the 12-week treatment period was performed using a mixed model for repeated measures (MMRM) with effects due to baseline weekly average of daily trough morning PEF.
Time frame: Day 1 (baseline), weeks 1-12
Population: Full analysis set
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo BAI and MDI | Change From Baseline in Weekly Average of Daily Trough Morning Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 4.3 liters | Standard Error 2.11 |
| BDP 80 mcg BAI | Change From Baseline in Weekly Average of Daily Trough Morning Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 15.6 liters | Standard Error 2.08 |
| BDP 160 mcg BAI | Change From Baseline in Weekly Average of Daily Trough Morning Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 12.8 liters | Standard Error 2.12 |
| BDP 80 mcg MDI | Change From Baseline in Weekly Average of Daily Trough Morning Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 11.9 liters | Standard Error 2.11 |
| BDP 160 mcg MDI | Change From Baseline in Weekly Average of Daily Trough Morning Peak Expiratory Flow (PEF) Over the 12-week Treatment Period | 10.8 liters | Standard Error 2.11 |
Kaplan-Meier Estimates For Time to Withdrawal Due to Meeting Stopping Criteria for Worsening Asthma During the 12-week Treatment Period
Time to withdrawal due to meeting stopping criteria was defined as number of days elapsed from the date of first dose of double-blind study treatment to the date of withdrawal due to meeting stopping criteria. Kaplan-Meier estimates (median and 95% CI of the median) are not applicable if the proportion of participants withdrawn is less than 0.5.
Time frame: Day 1 to 12 weeks
Population: Full analysis set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo BAI and MDI | Kaplan-Meier Estimates For Time to Withdrawal Due to Meeting Stopping Criteria for Worsening Asthma During the 12-week Treatment Period | NA Days |
| BDP 80 mcg BAI | Kaplan-Meier Estimates For Time to Withdrawal Due to Meeting Stopping Criteria for Worsening Asthma During the 12-week Treatment Period | NA Days |
| BDP 160 mcg BAI | Kaplan-Meier Estimates For Time to Withdrawal Due to Meeting Stopping Criteria for Worsening Asthma During the 12-week Treatment Period | NA Days |
| BDP 80 mcg MDI | Kaplan-Meier Estimates For Time to Withdrawal Due to Meeting Stopping Criteria for Worsening Asthma During the 12-week Treatment Period | NA Days |
| BDP 160 mcg MDI | Kaplan-Meier Estimates For Time to Withdrawal Due to Meeting Stopping Criteria for Worsening Asthma During the 12-week Treatment Period | NA Days |