Safety and Efficacy of Arformoterol Tartrate Inhalation Solution in Subjects With Chronic Obstructive Pulmonary Disease

Multicenter, Double-Blind, Double-Dummy, Randomized, Active-Controlled, Parallel Group Long-Term Safety Study of 15 μg and 25 μg Arformoterol Tartrate Inhalation Solution BID in Subjects With Chronic Obstructive Pulmonary Disease

To evaluate the long-term safety and monitor the long-term efficacy of arformoterol over a period of 6 months in subjects with chronic obstructive pulmonary disease (COPD).

Study Overview

• Status: Completed
• Conditions: Chronic Obstructive Pulmonary Disease; Emphysema; Bronchitis
• Intervention / Treatment: Drug: Formoterol 12 ųg BID; Drug: Placebo; Drug: Arformoterol tartrate inhalation solution; Drug: Arformoterol 25 ųg BID

Detailed Description

This is a double-blind, double-dummy, multicenter, randomized, active-controlled, parallel group, outpatient, safety study to evaluate the long term safety of arformoterol in the treatment of subjects with COPD. Study participation will be over approximately 6 months. This study was previously posted by Sepracor Inc. In October 2009, Sepracor Inc. was acquired by Dainippon Sumitomo Pharma., and in October 2010, Sepracor Inc's name was changed to Sunovion Pharmaceuticals Inc.

• Study Type: Interventional
• Enrollment (Actual): 443
• Phase: Phase 3

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States
    • Jasper, Alabama, United States
    • Mobile, Alabama, United States
  • Arkansas
    • Little Rock, Arkansas, United States
  • California
    • Carmichael, California, United States
    • Fullerton, California, United States
    • Long Beach, California, United States
    • Paramount, California, United States
    • Rancho Mirage, California, United States
    • San Diego, California, United States
    • Walnut Creek, California, United States
  • Colorado
    • Denver, Colorado, United States
  • Connecticut
    • Hartford, Connecticut, United States
  • Florida
    • Bay Pines, Florida, United States, 33744
    • Brandon, Florida, United States
    • Gainesville, Florida, United States, 32605
    • Panama City, Florida, United States
    • Tampa, Florida, United States
  • Georgia
    • Atlanta, Georgia, United States, 30309
    • Marietta, Georgia, United States
  • Illinois
    • Normal, Illinois, United States
  • Indiana
    • Evansville, Indiana, United States
  • Kansas
    • Topeka, Kansas, United States
  • Louisiana
    • East Slidell, Louisiana, United States
    • Lafayette, Louisiana, United States
    • Metairie, Louisiana, United States
    • Sunset, Louisiana, United States
  • Maryland
    • Baltimore, Maryland, United States
    • Chester, Maryland, United States
    • Wheaton, Maryland, United States
  • Michigan
    • Ann Arbor, Michigan, United States
  • Missouri
    • St. Charles, Missouri, United States
    • St. Louis, Missouri, United States
    • St. Louis, Missouri, United States, 63117
  • New Mexico
    • Albuquerque, New Mexico, United States
  • North Carolina
    • Chapel Hill, North Carolina, United States
    • Charlotte, North Carolina, United States
    • Statesville, North Carolina, United States, 28625
    • Wilmington, North Carolina, United States
    • Winston-Salem, North Carolina, United States
  • Ohio
    • Cincinnati, Ohio, United States
  • Oregon
    • Lake Oswego, Oregon, United States
    • Medford, Oregon, United States, 97504
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States
    • Swarthmore, Pennsylvania, United States
  • Rhode Island
    • East Providence, Rhode Island, United States
  • South Carolina
    • Charleston, South Carolina, United States
    • Columbia, South Carolina, United States
    • Simpsonville, South Carolina, United States
    • Spartanburg, South Carolina, United States
    • Union, South Carolina, United States, 29379
  • Tennessee
    • Knoxville, Tennessee, United States
  • Texas
    • Houston, Texas, United States
    • Katy, Texas, United States
    • San Antonio, Texas, United States
  • Virginia
    • Danville, Virginia, United States
    • Richmond, Virginia, United States
  • Washington
    • Spokane, Washington, United States
    • Tacoma, Washington, United States
  • West Virginia
    • Morgantown, West Virginia, United States

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 35 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Key Inclusion Criteria:

• Male and female subjects must be at least 35 years old at the time of consent
• Subjects must have a pre-established, documented primary clinical diagnosis of non-asthmatic COPD or are referred for diagnosis of non-asthmatic COPD
• Subjects must have a >=15 pack-year smoking history and a baseline breathlessness severity grade of >=2 (Modified Medical Research Council [MMRC] Dyspnea Scale Score) at Visits 1 and 2
• Female subjects <=65 years of age must have a negative serum pregnancy test, females of childbearing potential must be using an acceptable method of birth control
• Subjects must be in general good health.

Key Exclusion criteria:

• Subjects with a history of asthma, with the exception of asthma diagnosed in childhood
• Subjects with a blood eosinophil count >5% of total white blood cell count
• Subjects have had a febrile illness within 72 hours (3 days) before Screening Visit 1
• Subjects with a chest x-ray that suggests a diagnosis other than COPD (e.g., diagnostic of pneumonia, other infection, atelectasis, or pneumothorax or other active/ongoing pulmonary conditions)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Formoterol 12 ųg 2x/day	Drug: Formoterol 12 ųg BID; Formoterol fumarate 12 ųg BID via aerolizer/DPI; Other Names: Foradil; R,S-formoterol; Drug: Placebo; Placebo nebule or placebo aerolizer
Experimental: Arformoterol 15 ųg 2x/day	Drug: Placebo; Placebo nebule or placebo aerolizer; Drug: Arformoterol tartrate inhalation solution; Arformoterol 15 ųg BID by nebulization; Other Names: Brovana®
Experimental: Arformoterol 25 ųg 2x/day	Drug: Placebo; Placebo nebule or placebo aerolizer; Drug: Arformoterol 25 ųg BID; Arformoterol 25 ųg BID by nebulization; Other Names: Brovana; R,R formoterol

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent (%) of Participants With Adverse Events (AEs), in Particular COPD Exacerbations	Percent of participants with the adverse event specified. SOC = system organ class.	Six months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With New 24-Hour Holter Monitoring Alerts	New holter monitoring alerts are defined as those alerts that occurred post-randomization and were not present at baseline.	Visit 6 (week 27)
Number of Participants With Potentially Clinically Significant Glucose Evaluations	Patients with glucose values that met low (<=40 mg/dL) or high (>=175 mg/dL) criteria were considered potentially clinically significant.	visit 6 (week 27)
Number of Participants With Potentially Clinically Significant Potassium Evaluations	Patients with potassium values that met low (<=3 mEq/L) or high (>=6 mEq/L) criteria were considered potentially clinically significant.	visit 6 (week 27)
Number of Participants With New 12-Lead Electrocardiogram (ECG) Alerts	New Electrocardiogram (ECG) alerts are defined as those alerts that occurred post-treatment and were not present at baseline.	visit 6 (week 27)
Inspiratory Capacity Changes From Baseline	Mean Change in Inspiratory Capacity values from baseline (baseline assessment obtained at Visit 2, pre-dose). Spirometry measurements collected within 6 hours following in-clinic rescue/supplemental medications use were excluded from analysis.	weeks 0,3,13,26
6-Hour Peak Changes From Baseline in Forced Expiratory Volume (FEV1)	The 6 hour peak change from baseline is the maximum of the post-dose change values through 6 hours at each visit.	weeks 0,3,13,26
Number of Participants With Potentially Clinically Significant Heart Rate	Number of subjects with a heart rate that was lower/higher than a set limit and increased/decreased from set baseline limit in beats per minute (bpm)	visit 6 (week 27)
Ipratropium Bromide Metered Dose Inhaler (MDI) Usage: Days Used Per Week	Supplemental medication usage is recorded throughout the study. MDI stands for metered dose inhaler.	Screening (day-14 to 0) and Treatment (week 0 - 26)
Ipratropium Bromide Metered Dose Inhaler (MDI) Usage: Number of Actuations Per Day	Supplemental medication usage during the study. MDI stands for metered dose inhaler. An actuation is one depression of the device that releases medication.	Screening (day-14 to 0) and Treatment (week 0 - 26)
Racemic Albuterol or Levalbuterol Metered Dose Inhaler (MDI) Usage: Days Used Per Week	Rescue medication usage during the study. MDI stands for metered dose inhaler.	Screening (day-14 to 0) and Treatment (week 0 - 26)
Racemic Albuterol or Levalbuterol Metered Dose Inhaler (MDI) Usage: Number of Actuations Per Day	Rescue medication usage during the study. MDI stands for metered dose inhaler. An actuation is one depression of the device that releases medication.	Screening (day-14 to 0) and Treatment (week 0 - 26)
Time-Normalized Area Under the Curve (nAUC) From 0 to 6 Hrs for Forced Expiratory Volume in One Second (FEV1) Changes From Baseline	Area under the change from baseline curve from 0 to 6 hours. Time-normalized AUC (0-6 hrs) was derived using the linear trapezoidal method.	weeks 0,3,13,26
Transitional (Relative Change in) Dyspnea Index	The transitional focal score (-9 to 9) is the sum of relative change from baseline for the Functional Impairment, Magnitude of Task, and Magnitude of Effort scores (each -3 to 3 scale). A Transitional Dyspnea Index score of -9 represents a maximum degradation of all three tests; a score of 9 represents a maximum improvement of all three tests.	weeks 13, 26
Number of Participants With an Improved Transitional Dyspnea Index	The number of participants with a transitional focal score (range -9 to 9) of >=1 improvement. Transitional focal score compares current health against baseline for the Functional Impairment, Magnitude of Task, and Magnitude of Effort scores. A score of -9 is maximum worsening and 9 is maximum improvement.	weeks 13, 26
Forced Expiratory Volume in One Second (FEV1) Changes From Baseline for 24 Hour Post Dose Timepoint (Trough)	The 24 hour trough is the FEV1 value obtained 24 hours post first dose. This value is compared to the baseline FEV1 value.	weeks 0,3,13,26
Subject Global Evaluations Change From Baseline	The global evaluation is a COPD symptoms rating ranging from 1 to 7, with 1=much better and 7=much worse. Ratings were assessed relative to the subject's initial entry into the study.	weeks 13, 26
Investigator Global Evaluations Change From Baseline	The global evaluation is a COPD symptoms rating ranging from 1 to 7, with 1 = much better and 7 = much worse. Ratings were assessed relative to the subject's initial entry into the study.	weeks 13, 26
BODE Index	The BODE index (0=relative health and 10=severe chronic obstructive pulmonary disease) is a multi-dimension COPD grading system that incorporates body-mass index (B), degree of airflow obstruction (O), dyspnea (D), and exercise capacity (E) as measured by the 6-minute walk test. Scores were derived using pre-dose assessments from each visit.	Baseline (visit 2), weeks 13, 26
6-Minute Walk: Change From Baseline in the Distance Walked in 6 Minutes	Mean change from baseline in distance walked (meters)	Post-Dose weeks 0, 13, 26
Mean Change From Baseline in St. George's Respiratory Questionnaire	Scores are expressed as a mean change from baseline of overall impairment (total score). The questionnaire has a scale of 100 which represents worst possible health status to 0 which indicates best possible health status.	weeks 13, 26
Number of Participants With a >=4 Unit Improvement on the St. George's Respiratory Questionnaire	Scores are expressed as the number of participants with >= 4 unit improvement in overall impairment (total score), where 100 represents worst possible health status and 0 indicates best possible health status.	Visit 4 (week 13) , Visit 5 (week 26)
Modified Medical Research Council Dyspnea Questionaire	Scores range from 0 to 4, with a score of 4 indicating that a subject is too breathless to leave the house or becomes breathless when dressing or undressing. The highest numbered question to which the subject answered 'Yes' is the Dyspnea Scale Score.	Baseline (visit 2), weeks 13, 26
Percent (%) of Participants With an Improved Transitional Dyspnea Index	The percentage of participants with a transitional focal score (range -9 to 9) of >=1 improvement. Transitional focal score is the sum of the Functional Impairment, Magnitude of Task, and Magnitude of Effort scores. A score of -9 is maximum worsening and 9 is maximum improvement.	visits 4 (week 13), visit 5 (week 26)
Percent (%) of Participants With a >=4 Unit Improvement in the St. George's Respiratory Questionaire	Percent of participants with a >=4 unit improvement in the overall impairment (total score) of the St. George's Respiratory Questionaire. This questionaire uses a 100 - 0 scale, where 100 represents the worst possible health status and 0 indicates the best possible health status.	visit 4 (week 13), visit 5 (week 26)
Mean Values for the 6-Minute Walk Test: Distance Walked in Meters	This test measures the participants' level of fitness. It is a measure of the distance the participant can walk in 6 minutes.	Baseline (Visit 2), week 13, week 26
Mean Values for Investigator Global Evaluations	The investigator global evaluation is reported by the study investigator. It is a COPD symptoms rating ranging from 1 to 7, with 1 = much better and 7 = much worse.	Baseline (Visit 2), Weeks 13, 26
Mean Values for St. George's Respiratory Questionnaire	A questionnaire to assess respiratory health. Scores are expressed as a percentage of overall impairment (total score), where 100 represents the worst possible health status and 0 indicates best possible health status.	Baseline (Visit 2), weeks 13, 26
Mean Values for Subject Global Evaluations	The subject global evaluation is reported by study subjects/participants. It is a COPD symptoms rating ranging from 1 to 7, with 1 = much better and 7 = much worse.	Baseline (Visit 2), weeks 13, 26
Mean Values for Inspiratory Capacity	Inspiratory capacity is the maximum volume that can be inhaled.	Baseline (Visit 2), Weeks 3, 13, 26
Mean Values for Forced Expiratory Volume in One Second (FEV1)	Forced Expiratory Volume in one second	Baseline (Visit 2), weeks 3, 13, 26

Collaborators and Investigators

• Sponsor: Sunovion
• Investigators: Study Director: Sepracor Medical Director, Sunovion

Publications and helpful links

General Publications

• Hanania NA, Donohue JF, Nelson H, Sciarappa K, Goodwin E, Baumgartner RA, Hanrahan JP. The safety and efficacy of arformoterol and formoterol in COPD. COPD. 2010 Feb;7(1):17-31. doi: 10.3109/15412550903499498.

Helpful Links

• Patient Medication Guide

Study record dates

Study Major Dates

• Study Start: October 1, 2005
• Primary Completion (Actual): October 1, 2007
• Study Completion (Actual): October 1, 2007

Study Registration Dates

• First Submitted: November 4, 2005
• First Submitted That Met QC Criteria: November 4, 2005
• First Posted (Estimate): November 8, 2005

Study Record Updates

• Last Update Posted (Estimate): June 4, 2012
• Last Update Submitted That Met QC Criteria: May 29, 2012
• Last Verified: May 1, 2012

More Information

Terms related to this study

• Keywords: COPD; emphysema; chronic bronchitis
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Bronchial Diseases; Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Emphysema; Bronchitis; Physiological Effects of Drugs; Adrenergic Agents; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Autonomic Agents; Peripheral Nervous System Agents; Adrenergic Agonists; Bronchodilator Agents; Anti-Asthmatic Agents; Respiratory System Agents; Adrenergic beta-2 Receptor Agonists; Adrenergic beta-Agonists; Formoterol Fumarate
• Other Study ID Numbers: 091-061

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No