The primary objective of the study is to evaluate the effect of tiotropium + olodaterol FDCcompared to tiotropium monotherapy on the intensity of breathlessness during the 3min CSST.A secondary objective is to explore the relationship between…
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Source
Brief title
Condition
- Respiratory disorders NEC
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The primary objective of the study is to evaluate the effect of tiotropium +
olodaterol FDC
compared to tiotropium monotherapy on the intensity of breathlessness during
the 3min CSST.
Secondary outcome
A secondary objective is to explore the relationship between reductions in
breathlessness during
the 3min CSST and reductions in breathlessness during activities of everyday
living as measured
by the dyspnea domain of the Chronic Respiratory Questionnaire (CRQ) following
bronchodilator therapy
Secondary Endpoints include:
Change from baseline in Inspiratory Capacity (IC) measured prior to
exercise, after 6 weeks of treatment.
Change from baseline in IC measured at the end of exercise, after 6
weeks of treatment
Change from baseline in 1 hour post-dose FEV1, after 6 weeks of
treatment.
Change from baseline in 1 hour post-dose FVC, after 6 weeks of
treatment.
Change from baseline in intensity of Breathlessness (MBS-S) at 1, 2
and 2.5 min during the 3min CSST after 6 weeks of treatment.
Change in CRQ-SAI dyspnea subscale score after 6 weeks of treatment.
Change in CRQ-SAS dyspnea subscale score after 6 weeks of
treatment.
None of the primary or secondary endpoints are safety issues.
Background summary
European Respiratory Society (ERS), American Thoracic Society (ATS) and Global
Initiative for
Chronic Obstructive Lung Disease (GOLD) treatment guidelines all place
bronchodilators as the
foundation of pharmacologic management of COPD. In patients with moderate to
very severe
pulmonary impairment (i.e., GOLD Stage 2 to 4) whose symptoms are not
adequately controlled
with as-needed short-acting bronchodilators, adding regular treatment with one
or more longacting
inhaled bronchodilators is recommended (long acting *2-agonists, LABAs; long
acting
muscarinic antagonists, LAMAs).
The rationale for combining bronchodilators with different mechanisms is based
on the notion of
additive relaxation of airway smooth muscle by direct inhibition of cholinergic
activity and
functional antagonism of bronchoconstriction through *2-adrenergic pathways,
with the
expectation of an increase in the degree of bronchodilation for equivalent or
lesser side effects.
When beta-agonists and muscarinic antagonists with similar or equivalent
posologies are
combined, the opportunity exists for offering a simpler and more convenient
administration
regimen with the development of fixed combinations within the same inhaler
device. The
recently completed clinical development program for tiotropium + olodaterol
fixed dose
combination (FDC) was based on the hypothesis that the combination of the LAMA,
tiotropium,
and the LABA, olodaterol, inhaled once daily, is superior in improving airflow
over 24 hours
compared with tiotropium monotherapy once daily and olodaterol monotherapy once
daily.
(see protocol section 1.1)
Study objective
The primary objective of the study is to evaluate the effect of tiotropium +
olodaterol FDC
compared to tiotropium monotherapy on the intensity of breathlessness during
the 3min CSST.
A secondary objective is to explore the relationship between reductions in
breathlessness during
the 3min CSST and reductions in breathlessness during activities of everyday
living as measured
by the dyspnea domain of the Chronic Respiratory Questionnaire (CRQ) following
bronchodilator therapy.
(see protocol section 2.2)
Study design
This is a multi-centre, multi-national, randomised, double-blind,
active-controlled, two-period
cross-over, Phase IV study to evaluate the effects of once daily administration
of orally inhaled
tiotropium + olodaterol FDC (5 / 5 *g) (delivered by the Respimat® Inhaler)
compared with
tiotropium (5 *g) (delivered by the Respimat® Inhaler) on the intensity of
breathlessness in
patients with Chronic Obstructive Pulmonary Disease (COPD).
The trial consists of a run-in period, two 6-week treatment periods, each
separated by a 3-week
wash-out period and a follow-up period.
(see protocol section 3.1)
Intervention
Patients will recieve twice:
_ Bronchodilator therapy; during 6 weeks a once daily inhalation of
studymedication with the Respimat® Inhaler with one
of the following treatments:
1. tiotropium + olodaterol (5 ~g/5 ~g) fixed dose combination inhalation
solution
2. tiotropium (5 ~g) inhalation solution
Patients will also undergo/ need to:
- Shuttle walk test (while wearing a mobile pulmonary equipment)
- Laboratory tests
- Completing several different patient questionnaires during study visits
- Spirometry and Body Plethysmography
-ECG
Study burden and risks
The trial medication has been registrated and has a good safety profile.
Shuttle tests (excerise test) will be performed in all patients of this trial
Exercising could provoke symptoms like sudden chest pain, sudden changes in
blood pressure, loss of coordination, mental confusion or extreme shortness of
breath.
Potential risks associated with exercise testing will be avoided by
implementing standard
monitoring procedures under appropriate supervision
The supervising physician must be readily available to respond as needed.
The patient will recieve a compensation of 50 euro for each test
comeniusstraat 6
Alkmaar 1817 MS
NL
comeniusstraat 6
Alkmaar 1817 MS
NL
Listed location countries
Age
Inclusion criteria
- All patients must sign an informed consent consistent with International Conference on Harmonization - Good Clinical Practice (ICH-GCP) guidelines prior to participation in the trial, which includes medication washout and restrictions.;- All patients must have a diagnosis of chronic obstructive pulmonary disease and must meet the following spirometric criteria:;Patients must have relatively stable airway obstruction with a post-bronchodilator 30% <<= FEV1 <80% of predicted normal (ECSC); GOLD 2 - 3, and a postbronchodilator FEV1/FVC <0.70 at visit 1.;- Male or female patients, between 40 and 75 years of age (inclusive) on day of signing informed consent.;- Patients must be current or ex-smokers with a smoking history of more than 10 pack-years. Patients who have never smoked cigarettes must be excluded.;- Patients with a score on the Baseline Dyspnea Index (BDI) < 8 at visit 0.;- Patients with hyperinflation at rest, defined as FRC > 120% predicted at visit 1.;- BORG dyspnea score ><=4 at the end of 3min CSST at visit 2;- Patients must be able to perform technically acceptable pulmonary function tests (spirometry and body plethysmography), must be able to complete multiple shuttle walk tests during the study period as required in the protocol.;- Patients must be able to inhale medication in a competent manner from the Respimat® inhaler and from a metered dose inhaler (MDI).
Exclusion criteria
- Patients with a significant disease other than COPD; a significant disease is defined as a disease which, in the opinion of the investigator, may (i) put the patient at risk because of participation in the study, (ii) influence the results of the study, or (iii) cause concern regarding the patient's ability to participate in the study;- Patients with a, in the opinion of the investigator, clinically relevant abnormal baseline haematology, blood chemistry, or creatinine >x2 ULN will be excluded regardless of clinical condition.;- Patients with a current documented diagnosis of asthma. For patients with allergic rhinitis or atopy, source documentation is required to verify that the patient does not have asthma.;- Patients with a COPD exacerbation in the 6 weeks prior to screening (visit 1).;- A diagnosis of thyrotoxicosis (due to the known class side effect profile of B2-agonists);- A history of myocardial infarction within 6 months of screening visit (visit 1);- Life-threatening cardiac arrhythmia as judged by the Investigator.;- Known active tuberculosis;- Any malignancy unless free of disease for at least 5 years (patients with treated basal cell carcinoma or squamous cell skin cancers are allowed);- A history of cystic fibrosis;- Clinically relevant bronchiectasis, as judged by the Investigator.;- Patients with severe emphysema requiring endobronchial interventions within 6 months prior to screening.;- A history of significant alcohol or drug abuse, as judged by the investigator.;- Any contraindications for exercise testing as outlined below.;- Patients who have undergone thoracotomy with pulmonary resection (patients with a history of thoracotomy for other reasons should be evaluated as per exclusion criterion No. 1).;- Patients being treated with any oral or patch ß-adrenergics;- Patients being treated with oral corticosteroid medication at unstable doses (i.e., less than four weeks on a stable dose) or at doses in excess of the equivalent of 10 mg of prednisone per day or 20 mg every other day;- Patients being treated with antibiotics for any reason (not limited to exacerbation infection) within 4 weeks of screening visit.;- Patients being treated with PDE4 inhibitors within 3 months of screening visit (e.g.roflumilast) should not be enrolled and PDE4 inhibitors should not be withdrawn for the purpose of enrolling in this study.;- Patients who regularly use daytime oxygen therapy for more than one hour per day and in the investigator's opinion will be unable to abstain from the use of oxygen therapy during clinic visits;- Patients who have completed a pulmonary rehabilitation program in the six weeks prior to the screening visit (visit 1) or patients who are currently in a pulmonary rehabilitation program.;- Patients who have a limitation of exercise performance as a result of factors other than fatigue or exertional dyspnea, such as arthritis in the leg, angina pectoris or claudication or morbid obesity.;- Patients with an endurance time >=12 minutes during the incremental shuttle walk test (visit1).;- Patients with oxygen saturation < 85% (on room air) at rest or during exercise.;- Patients who have taken an investigational drug within one month or six half-lives (whichever is greater) or in case the investigational drug (sub) class is listed within the washout period specified prior to screening visit (visit 1);- Patients with known hypersensitivity to ß-adrenergics and/or anticholinergic drugs, BAC, EDTA or any other component of the Respimat® inhalation solution;- Women who are pregnant, nursing, or who plan to become pregnant while in the trial;- Women of childbearing potential not using a highly effective method of birth control.;- Patients who have previously been randomized in this study or are currently participating in another study;- Patients who are unable to comply with pulmonary medication restrictions prior to randomization (see protocol section 3.3.3.)
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2015-002974-20-NL |
CCMO | NL58016.096.16 |
Other | nog onbekend |