4 Week 2 Way Crossover Double Blind Treatment Phase With Combivent CFC Versus Albuterol Followed by a 4 Week Open Label Combivent Respimat When All Drugs Are Used for Symptom Relief as Needed in Pts With Moderate to Severe Asthma

A Multicenter Randomized Study Starting With a 4 Week 2 Way Crossover Double Blind Treatment Phase Comparing the Efficacy and Safety of Combivent CFC MDI to Albuterol HFA MDI Followed by a 4 Week Open Label Combivent Respimat Treatment Phase When All Study Drugs Are Used for Symptom Relief as Needed in Pts With Moderate to Severe Asthma (GINA 2007 Treatment Steps 3-5)

The primary goal of this trial is to compare the efficacy and safety of COMBIVENT CFC MDI with albuterol HFA MDI, the current standard reliever medication in asthma. In the first cross-over part of the study (Treatment Phases 1 and 2) the marketed product, COMBIVENT CFC MDI will be used. In the second, parallel group part of the trial (Treatment Phase 3) COMBIVENT RESPIMAT will be tested for acute bronchodilator efficacy in a blinded manner at the clinic visits. During the third 4-week treatment phase open label COMBIVENT RESPIMAT will be used for symptom relief as needed.

Study Overview

• Status: Completed
• Conditions: Asthma
• Intervention / Treatment: Drug: Albuterol HFA MDI; Drug: Combivent CFC MDI; Drug: Respimat Combivent

• Study Type: Interventional
• Enrollment (Actual): 226
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States
      • 1012.57.121 Boehringer Ingelheim Investigational Site
  • California
    • Los Angeles, California, United States
      • 1012.57.144 Boehringer Ingelheim Investigational Site
    • Los Angeles, California, United States
      • 1012.57.145 Boehringer Ingelheim Investigational Site
    • Palmdale, California, United States
      • 1012.57.124 Boehringer Ingelheim Investigational Site
    • San Diego, California, United States
      • 1012.57.137 Boehringer Ingelheim Investigational Site
    • Stockton, California, United States
      • 1012.57.130 Boehringer Ingelheim Investigational Site
  • Colorado
    • Centennial, Colorado, United States
      • 1012.57.134 Boehringer Ingelheim Investigational Site
    • Wheat Ridge, Colorado, United States
      • 1012.57.151 Boehringer Ingelheim Investigational Site
  • Florida
    • Panama City, Florida, United States
      • 1012.57.119 Boehringer Ingelheim Investigational Site
    • Winter Park, Florida, United States
      • 1012.57.149 Boehringer Ingelheim Investigational Site
  • Georgia
    • Augusta, Georgia, United States
      • 1012.57.104 Boehringer Ingelheim Investigational Site
  • Idaho
    • Coeur d'Alene, Idaho, United States
      • 1012.57.107 Boehringer Ingelheim Investigational Site
  • Illinois
    • Normal, Illinois, United States
      • 1012.57.127 Boehringer Ingelheim Investigational Site
  • Kentucky
    • Louisville, Kentucky, United States
      • 1012.57.140 Boehringer Ingelheim Investigational Site
  • Maryland
    • Baltimore, Maryland, United States
      • 1012.57.143 Boehringer Ingelheim Investigational Site
  • Massachusetts
    • North Dartmouth, Massachusetts, United States
      • 1012.57.126 Boehringer Ingelheim Investigational Site
    • North Dartmouth, Massachusetts, United States
      • 1012.57.147 Boehringer Ingelheim Investigational Site
  • Minnesota
    • Minneapolis, Minnesota, United States
      • 1012.57.113 Boehringer Ingelheim Investigational Site
    • Plymouth, Minnesota, United States
      • 1012.57.131 Boehringer Ingelheim Investigational Site
  • Missouri
    • St. Louis, Missouri, United States
      • 1012.57.116 Boehringer Ingelheim Investigational Site
  • Montana
    • Bozeman, Montana, United States
      • 1012.57.146 Boehringer Ingelheim Investigational Site
  • Nebraska
    • Omaha, Nebraska, United States
      • 1012.57.132 Boehringer Ingelheim Investigational Site
  • New Jersey
    • Skillman, New Jersey, United States
      • 1012.57.139 Boehringer Ingelheim Investigational Site
  • North Carolina
    • Chapel Hill, North Carolina, United States
      • 1012.57.109 Boehringer Ingelheim Investigational Site
    • Raleigh, North Carolina, United States
      • 1012.57.118 Boehringer Ingelheim Investigational Site
    • Winston-Salem, North Carolina, United States
      • 1012.57.128 Boehringer Ingelheim Investigational Site
  • Ohio
    • Cincinnati, Ohio, United States
      • 1012.57.102 Boehringer Ingelheim Investigational Site
  • Oregon
    • Lake Oswego, Oregon, United States
      • 1012.57.129 Boehringer Ingelheim Investigational Site
    • Portland, Oregon, United States
      • 1012.57.138 Boehringer Ingelheim Investigational Site
  • Pennsylvania
    • Hershey, Pennsylvania, United States
      • 1012.57.108 Boehringer Ingelheim Investigational Site
    • Philadelphia, Pennsylvania, United States
      • 1012.57.114 Boehringer Ingelheim Investigational Site
    • Upland, Pennsylvania, United States
      • 1012.57.111 Boehringer Ingelheim Investigational Site
  • South Carolina
    • Easley, South Carolina, United States
      • 1012.57.142 Boehringer Ingelheim Investigational Site
    • Greenville, South Carolina, United States
      • 1012.57.117 Boehringer Ingelheim Investigational Site
    • Union, South Carolina, United States
      • 1012.57.103 Boehringer Ingelheim Investigational Site
  • Texas
    • El Paso, Texas, United States
      • 1012.57.136 Boehringer Ingelheim Investigational Site
    • Killeen, Texas, United States
      • 1012.57.148 Boehringer Ingelheim Investigational Site
    • San Antonio, Texas, United States
      • 1012.57.101 Boehringer Ingelheim Investigational Site
  • Washington
    • Seattle, Washington, United States
      • 1012.57.141 Boehringer Ingelheim Investigational Site
    • Tacoma, Washington, United States
      • 1012.57.150 Boehringer Ingelheim Investigational Site
  • Wisconsin
    • Madison, Wisconsin, United States
      • 1012.57.105 Boehringer Ingelheim Investigational Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. All patients must sign and date an Informed Consent consistent with International Conference on Harmonization Good Clinical Practices (ICH GCP) guidelines and local regulations prior to participation in the trial (i.e., prior to any study procedures, including washout of any medication) at Visit 1.
2. Male or female patients greater to or equal to 18 years of age.
3. Physician diagnosis of moderate-to-severe asthma (GINA Guidelines) existing for >1 year.
4. Reversible airway obstruction (more than or equal to 12 % or at least 200 mL improvement in FEV1 post bronchodilator after 4 puffs of albuterol HFA MDI).
5. Pre-bronchodilator clinic measured FEV1 ≤80% of predicted normal value (measured greater to or equal to 6 hours of the last use of short acting bronchodilator and greater to or equal to 12 hours after the last use of LABA if applicable).
6. Continuous treatment with inhaled corticosteroids (ICS) with or without long-acting beta agonists (LABA) and other controller medication(s) for at least 6 weeks prior to screening (GINA 2007 Treatment Steps 3 to 5).
7. No change in dos or regimen of ICS and LABA or other controller medications (including oral corticosteroids [OCS] if applicable), for at least 2 weeks prior to Visit 2.
8. Use of short acting bronchodilator at least three times a week for symptom relief in the 2 weeks prior to Visit 1.
9. Score of ≥1.5 points on the Asthma Control Questionnaire (ACQ) (see Appendix 10.6).
10. Able to perform technically acceptable pulmonary function tests at the clinic and peak flow measurements with the eDiary/Peak Expiratory Flow Meter.
11. Able to perform all necessary recordings (symptoms and as needed medication use) in the electronic diary, which is a part of the eDiary/Peak Expiratory Flow Meter.
12. Investigator assessment of patients ability to inhale medication from a metered dose inhaler and RESPIMAT inhaler.

Exclusion Criteria:

1. Significant disease other than asthma not limited to diagnosis of COPD, such as, active tuberculosis, cystic fibrosis, alpha 1 antitrypsin deficiency, clinically significant bronchiectasis, interstitial lung disease, allergic bronchopulmonary aspergillosis, or constrictive bronchiolitis. 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, or (ii) influence the results of the study, or (iii) cause concern regarding the patient ability to participate in the study.
2. History of thoracotomy with pulmonary resection. Patients with a history of thoracotomy for other reasons should be evaluated as per exclusion criterion 1.
3. History of life-threatening asthma attack.
4. Worsening of asthma that required treatment with an addition or increase in OCS dose (steroid burst) in the 4- week period prior to Visit 2.

5. Current or ex-smokers who quit <1 year before enrollment. Ex-smokers who quit less than 1 year from enrollment must have a cigarette smoking history of less than 10 pack years.

   Pack years = Number of cigarettes/day x years of smoking 20

6. Use of oral beta-adrenergic agents within 4 weeks prior to screening.
7. Treatment with inhaled ipratropium, ipratropium/albuterol combination, or nasal ipratropium within 1week of Visit 2.
8. Treatment with inhaled tiotropium within 4 weeks of Visit 2.
9. Known hypersensitivity to anticholinergic drugs, benzalkonium chloride (BAC), ethylenediaminetetracetic acid (EDTA) or any other components of the tiotropium inhalation solution or MDI.
10. Known narrow-angle glaucoma.
11. Clinically relevant abnormal hematology or blood chemistry at screening if the abnormality defines a significant disease as defined in exclusion criterion 1.
12. Recent history (i.e., one year less) of myocardial infarction. Cardiac arrhythmias, newly diagnosed arrhythmias and/or any arrhythmia requiring an intervention (i.e., hospitalization, cardio version, pacemaker placement, and automatic implantable cardiac defibrillator placement) or a change in drug therapy during the last year.
13. Hospitalization for cardiac failure during the past year.
14. Malignancy for which the patient has undergone resection, radiation therapy or chemotherapy within the last five years, with the exception of treated basal cell carcinoma.
15. Unwillingness or inability to use a highly effective method of birth control by women of childbearing potential. Highly effective methods of birth control are defined as those which result in a low failure rate (i.e., less than 1% per year) when used consistently and correctly such as implants, injectables, combined oral contraceptives, some intrauterine devices (IUDs), sexual abstinence or vasectomised partner. Barrier methods of contraception are accepted if condom or occlusive cap is used together with spermicides (e.g., foam or gel). Female patients will be considered to be of childbearing potential unless surgically sterilized by hysterectomy or bilateral tubal ligation/salpingectomy, or post-menopausal for at least two years.
16. Pregnancy or nursing.
17. Any investigational drug taken within 30 days or six half-lives (whichever is greater) prior to Visit 2.
18. Previous randomization in this study or current participation in another study.
19. Symptomatic prostate hypertrophy or bladder neck obstruction. Patients with symptomatically controlled prostate hypertrophy on medications may be included and should continue their medications.
20. Use of monoamine oxidase inhibitors or tricyclic antidepressants. Examples include but are not limited to the following for monoamine oxidase inhibitors nardil, parnate, marplan and for tricyclic antidepressants: amitriptyline, norpramine, and pamelor.
21. History of and/or active alcohol or drug abuse.
22. Patient who have been treated with beta-blocker medication during the screening of the study. Topical cardio-selective beta-blocker eye medications for treatment of acute angle glaucoma are allowed.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Interventional Model: Crossover Assignment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
FEV1 AUC0-6 Response (Crossover Part of the Study)	Change from baseline after 4 weeks in Forced Expiratory Volume Area Under (FEV1 AUC) the Curve from 0 to 6 hours.	Test day baseline and test day FEV1 AUC 0-6, after 4 weeks
Peak FEV1 Response (Crossover Part of the Study)	Change from baseline after 4 weeks in peak Forced Expiratory Volume response	Test day baseline and test day peak FEV1, after 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mini Asthma Quality of Life Questionnaire (Crossover Part of the Study)	Change from baseline after 4 weeks in Mini-AQLQ score. Worst score - 1 (most severe), best score - 7 (less severe)	Baseline, 4 weeks
Asthma Control Questionnaire (Crossover Part of the Study)	Change from baseline after 4 weeks in ACQ score. Worst score - 6(most severe), best score - 0 (no symptoms)	Baseline, 4 weeks
Puffs Study Medication Used During Day (Crossover Part of the Study)	Change from baseline in weekly mean of puffs of blinded study medication (albuterol HFA or combivent CFC) used during day	Baseline, 4 weeks
Puffs Study Medication Used During Night (Crossover Part of the Study)	Change from baseline in weekly mean of puffs of blinded study medication (albuterol HFA or combivent CFC) used during night	Baseline, 4 weeks
Puffs Open-label Albuterol Used During Day (Crossover Part of the Study)	Change from baseline in weekly mean of puffs of open-label albuterol used during day	Baseline, 4 weeks
Puffs Open-label Albuterol Used During Night (Crossover Part of the Study)	Change from baseline in weekly mean of puffs of open-label albuterol used during night	Baseline, 4 weeks
FEV1 AUC0-6 Response (Parallel Part of the Study)	Change from baseline after 4 weeks in Forced Expiratory Volume Area Under the Curve from 0 to 6 hours	Test day baseline and test day FEV1 AUC 0-6, after 4 weeks
Peak FEV1 Response	Change from baseline after 4 weeks in peak Forced Expiratory Volume response	Test day baseline and test day peak FEV1, after 4 weeks

Collaborators and Investigators

• Sponsor: Boehringer Ingelheim

Publications and helpful links

General Publications

• Donohue JF, Wise R, Busse WW, Garfinkel S, Zubek VB, Ghafouri M, Manuel RC, Schlenker-Herceg R, Bleecker ER. Efficacy and safety of ipratropium bromide/albuterol compared with albuterol in patients with moderate-to-severe asthma: a randomized controlled trial. BMC Pulm Med. 2016 Apr 30;16(1):65. doi: 10.1186/s12890-016-0223-3.

Helpful Links

• Related Info

Study record dates

Study Major Dates

• Study Start: December 1, 2008
• Primary Completion (Actual): September 1, 2009

Study Registration Dates

• First Submitted: January 6, 2009
• First Submitted That Met QC Criteria: January 6, 2009
• First Posted (Estimate): January 7, 2009

Study Record Updates

• Last Update Posted (Estimate): February 14, 2014
• Last Update Submitted That Met QC Criteria: January 21, 2014
• Last Verified: January 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Immune System Diseases; Lung Diseases; Hypersensitivity, Immediate; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity; Asthma; 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; Reproductive Control Agents; Adrenergic beta-2 Receptor Agonists; Adrenergic beta-Agonists; Tocolytic Agents; Albuterol
• Other Study ID Numbers: 1012.57; 57948