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Efficacy, Safety and Pharmacokinetics of Indacaterol Acetate in Patients With Persistent Asthma

15. januar 2015 opdateret af: Novartis Pharmaceuticals

A Multicenter, Randomized, Double-blind, Placebo-controlled, 12-week Treatment, Parallel-group Study to Assess the Efficacy, Safety and Pharmacokinetics of Indacaterol Acetate (75 and 150 µg o.d.) in Patients With Persistent Asthma

To provide the efficacy, safety and pharmacokinetics of indacaterol acetate in patients with persistent asthma to support dose selection of indacaterol in fixed dose combination QMF149.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

335

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Bulgarien
      • Lovech, Bulgarien, 5500
        • Novartis Investigative Site
      • Pleven, Bulgarien, 5800
        • Novartis Investigative Site
      • Plovdiv, Bulgarien, 4002
        • Novartis Investigative Site
      • Ruse, Bulgarien, 7002
        • Novartis Investigative Site
      • Sofia, Bulgarien, 1431
        • Novartis Investigative Site
      • Sofia, Bulgarien, 1233
        • Novartis Investigative Site
      • Sofia, Bulgarien, 1606
        • Novartis Investigative Site
      • Sofia, Bulgarien, 1612
        • Novartis Investigative Site
      • Sofia, Bulgarien, 1000
        • Novartis Investigative Site
      • Sofia, Bulgarien, 1234
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      • Sofia, Bulgarien, 1463
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      • Varna, Bulgarien, 9000
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      • Varna, Bulgarien, 9020
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      • Veliko Tarnovo, Bulgarien, 5000
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  • Canada
    • Ontario
      • Brampton, Ontario, Canada, L6T 0G1
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      • Downsview, Ontario, Canada, M3N 2Z9
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      • Etobicoke, Ontario, Canada, M9V 4B4
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      • Grimsby, Ontario, Canada, L3M 1P3
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      • Hamilton, Ontario, Canada, L8N 3Z5
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      • Newmarket, Ontario, Canada, L3Y 5G8
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      • Toronto, Ontario, Canada, M5T 3A9
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      • Woodstock, Ontario, Canada, N4S 5P5
        • Novartis Investigative Site
    • Quebec
      • Montreal, Quebec, Canada, H4J 1C5
        • Novartis Investigative Site
      • Pointe-Claire, Quebec, Canada, H9R 4S3
        • Novartis Investigative Site
      • St-Romuald, Quebec, Canada, G6W 5M6
        • Novartis Investigative Site
      • Ste-Foy, Quebec, Canada, G1W 4R4
        • Novartis Investigative Site
  • Holland
      • Rotterdam, Holland, 3045 PM
        • Novartis Investigative Site
      • Sittard-Geleen, Holland, 6162 BG
        • Novartis Investigative Site
  • Japan
      • Fukuoka, Japan, 811-1394
        • Novartis Investigative Site
      • Gifu, Japan, 502-8558
        • Novartis Investigative Site
    • Fukuoka
      • Yanagawa, Fukuoka, Japan, 832-0059
        • Novartis Investigative Site
    • Hokkaido
      • Obihiro, Hokkaido, Japan, 080-0805
        • Novartis Investigative Site
      • Sapporo-city, Hokkaido, Japan, 060-0061
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    • Hyogo
      • Himeji-city, Hyogo, Japan, 672-8064
        • Novartis Investigative Site
    • Hyogo-Ken
      • Ako-shi, Hyogo-Ken, Japan, 678-0241
        • Novartis Investigative Site
    • Ibaraki
      • Naka-gun, Ibaraki, Japan, 319-1113
        • Novartis Investigative Site
    • Kagawa
      • Sakaide, Kagawa, Japan, 762-0031
        • Novartis Investigative Site
    • Kyoto-Fu
      • Kyoto-shi, Kyoto-Fu, Japan, 615-8256
        • Novartis Investigative Site
    • Mie
      • Tsu, Mie, Japan, 514-1101
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    • Oita
      • Beppu, Oita, Japan, 874-0937
        • Novartis Investigative Site
    • Oita-Ken
      • Oita-shi, Oita-Ken, Japan, 870-0021
        • Novartis Investigative Site
    • Osaka
      • Kishiwada, Osaka, Japan, 596-8501
        • Novartis Investigative Site
    • Tokyo
      • Chuo-ku, Tokyo, Japan, 103-0027
        • Novartis Investigative Site
      • Cyuo-ku, Tokyo, Japan, 104-8560
        • Novartis Investigative Site
      • Itabashi-ku, Tokyo, Japan, 173-8610
        • Novartis Investigative Site
      • Kiyose-city, Tokyo, Japan, 204-8585
        • Novartis Investigative Site
      • Setagaya-ku, Tokyo, Japan, 158-0097
        • Novartis Investigative Site
    • Tokyo-To
      • Machida-shi, Tokyo-To, Japan, 194-0023
        • Novartis Investigative Site
      • Ota-ku, Tokyo-To, Japan, 144-0035
        • Novartis Investigative Site
    • Yamagata
      • Yonezawa, Yamagata, Japan, 992-0045
        • Novartis Investigative Site
  • Korea, Republikken
      • Seoul, Korea, Republikken, 120-752
        • Novartis Investigative Site
      • Seoul, Korea, Republikken, 158-710
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      • Seoul, Korea, Republikken, 152-703
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      • Seoul, Korea, Republikken, 100-032
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    • Chungbuk
      • Cheongju, Chungbuk, Korea, Republikken, 361 711
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    • Gangwon-Do
      • Wonju, Gangwon-Do, Korea, Republikken, 220-701
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    • Korea
      • Seoul, Korea, Korea, Republikken, 110 744
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  • Polen
      • Bialystok, Polen, 15-461
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      • Bienkowka, Polen, 34-212
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      • Bydgoszcz, Polen, 85-046
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      • Gdansk, Polen, 80-958
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      • Krakow, Polen, 31-023
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      • Lodz, Polen, 90-302
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      • Lodz, Polen, 90-242
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      • Lublin, Polen, 20-637
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      • Lublin, Polen, 20-044
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      • Torun, Polen, 87-100
        • Novartis Investigative Site
      • Wroclaw, Polen, 50-088
        • Novartis Investigative Site
      • Znin, Polen, 88-400
        • Novartis Investigative Site
  • Slovakiet
      • Dunajska Streda, Slovakiet, 929 01
        • Novartis Investigative Site
      • Komarno, Slovakiet, 945 01
        • Novartis Investigative Site
      • Kosice, Slovakiet, 040 01
        • Novartis Investigative Site
      • Liptovsky Hradok, Slovakiet, 033 01
        • Novartis Investigative Site
      • Liptovsky Mikulas, Slovakiet, 031 23
        • Novartis Investigative Site
      • Nove Zamky, Slovakiet, 940 01
        • Novartis Investigative Site
      • Rimavska Sobota, Slovakiet, 979 01
        • Novartis Investigative Site
      • Spisská Nová Ves, Slovakiet, 052 01
        • Novartis Investigative Site
      • Topolcany, Slovakiet, 955 01
        • Novartis Investigative Site
      • Vysne Hagy, Slovakiet, 5984
        • Novartis Investigative Site
      • Zvolen, Slovakiet, 960 01
        • Novartis Investigative Site
    • Slovak Republic
      • Banska Bystrica, Slovak Republic, Slovakiet, 975 17
        • Novartis Investigative Site
      • Bardejov, Slovak Republic, Slovakiet, 085 01
        • Novartis Investigative Site
    • Slovak republic
      • Levice, Slovak republic, Slovakiet, 934 01
        • Novartis Investigative Site
  • Tyskland
      • Bad Woerishofen, Tyskland, 86825
        • Novartis Investigative Site
      • Bonn, Tyskland, 53123
        • Novartis Investigative Site
      • Dortmund, Tyskland, 44263
        • Novartis Investigative Site
      • Dresden, Tyskland, 01307
        • Novartis Investigative Site
      • Frankfurt, Tyskland, 60596
        • Novartis Investigative Site
      • Lübeck, Tyskland, 23552
        • Novartis Investigative Site
      • Mainz, Tyskland, 55131
        • Novartis Investigative Site
      • Muenchen, Tyskland, 81677
        • Novartis Investigative Site
      • Wiesbaden, Tyskland, 65187
        • Novartis Investigative Site
      • Wiesloch, Tyskland, 69168
        • Novartis Investigative Site

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Patients with persistent asthma, diagnosed according to GINA 2010 guideline and who additionally meet the following criteria:
  • Patients who are receiving ICS treatment in a stable regimen for ≥ 4 weeks
  • Patients with a pre-bronchodilator FEV1 value of ≥ 40% and ≤ 80% of predicted normal value
  • Patients who demonstrate an increase of >= 12% and 200 mL in FEV1
  • ACQ-5 score ≥ 1.5

Exclusion Criteria:

  • Patients who are current smokers or have a smoking history of greater than 10 pack years (defined as the number of packs of 20 cigarettes smoked per day multiplied by number of years the patient smoked).
  • Patients with chronic lung disease, including COPD, pulmonary tuberculosis, bronchiectasis, sarcoidosis, interstitial lung disease and cystic fibrosis.
  • Patients with any chronic conditions affecting the respiratory tract (e.g., chronic sinusitis) which in the opinion of the investigator may interfere with the study evaluation or optimal participation in the study.

Other protocol-defined inclusion/exclusion criteria may apply

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: indacaterol acetate 75 µg

indacaterol acetate 75 µg od delivered via Concept 1 inhaler

Background therapy: mometasone furoate 200 mcg od
Medicin: indacaterol
indacaterol acetate 75 µg or indacaterol acetate 150 µg delivered via Concept 1 inhaler
Medicin: mometasone furoate
via Twisthaler inhaler
Eksperimentel: indacaterol acetate 150 µg

indacaterol acetate 150 µg od delivered via Concept 1 inhaler

Background therapy: mometasone furoate 200 mcg od
Medicin: indacaterol
indacaterol acetate 75 µg or indacaterol acetate 150 µg delivered via Concept 1 inhaler
Medicin: mometasone furoate
via Twisthaler inhaler
Placebo komparator: placebo

placebo delivered via Concept 1 inhaler

Background therapy: mometasone furoate 200 mcg od
Medicin: mometasone furoate
via Twisthaler inhaler
Medicin: placebo
placebo delivered via Concept 1 inhaler

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Trough Forced Expiratory Volume in One Second (FEV1) After 12 Weeks (Day 85)
Tidsramme: after 12 weeks (Day 85)
Forced Expiratory Volume in 1 second (FEV1) was measured via spirometry conducted according to internationally accepted standards. Trough FEV1 was defined as the average of measurements made 23 hours 10 minutes and 23 hours 45 minutes post-dose after 12 weeks (Day 85)
after 12 weeks (Day 85)

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Asthma Control Questionnaire 5 (ACQ-5) After 12 Weeks (Day 85)
Tidsramme: aftert 12 weeks (Day 85)
The Asthma Control Questionnaire (ACQ-5) is a validated questionnaire consisting of 5 items for the assessment of asthma symptom which are night symptom, morning symptom, limitation for the activities, shortness of breath, and wheeze. The ACQ-5 score is the mean of the 5 questions and therefore between 0 (totally controlled) and 6 (severely uncontrolled). A negative change in score indicates improvement in symptoms. MIXED model: Change from baseline in ACQ-5 = treatment + gender + baseline ACQ-5 score + age + level of asthma control + region + center (region) + error. Center is included as a random effect nested within region.
aftert 12 weeks (Day 85)
Trough Forced Expiratory Volume in One Second (FEV1) After 2 Weeks (Day 15), 4 Weeks (Day 29), and 8 Weeks (Day 57) of Treatment.
Tidsramme: Day 15, Day 29 and Day 57
Forced Expiratory Volume in 1 second (FEV1) was measured via spirometry conducted according to internationally accepted standards. Trough FEV1 was defined as the average of measurements made 23 hours 10 minutes and 23 hours 45 minutes post-dose after 2 weeks (Day 15), 4 weeks (Day 29), and 8 weeks (Day 57) of treatment.
Day 15, Day 29 and Day 57
Forced Vital Capacity (FVC) on Day 1, Day 2, Day 14, Day 15, Day 84, Day 85 at All Time Points
Tidsramme: Day 1, Day 2, Day 14, Day 15, Day 84, Day 85
Forced Vital Capacity (FVC) was measured via spirometry conducted according to internationally accepted standards. FVC is measured on Day 1, Day 2, Day 14, Day 15, Day 84, Day 85 at all time points
Day 1, Day 2, Day 14, Day 15, Day 84, Day 85
Forced Expiratory Volume in One Second (FEV1)/ Forced Vital Capacity (FVC) on Day 1, Day 2, Day 14, Day 15, Day 84, Day 85
Tidsramme: Day 1, Day 2, Day 14, Day 15, Day 84, Day 85
Forced Expiratory Volume in 1 second (FEV1)/Forced Vital Capacity (FVC) was measured via spirometry conducted according to internationally accepted standards.
Day 1, Day 2, Day 14, Day 15, Day 84, Day 85
Forced Expiratory Flow (FEF 25-75% )on Day 1, Day 2, Day 14, Day 15, Day 84, Day 85
Tidsramme: Day 1, Day 2, Day 14, Day 15, Day 84, Day 85
Forced Expiratory Flow (FEF 25-75%) was measured via spirometry conducted according to internationally accepted standards.
Day 1, Day 2, Day 14, Day 15, Day 84, Day 85
Standardized Forced Expiratory Volume in One Second (FEV1) Area Under the Curve (AUC) at (5 Min - 4 h), (5 Min - 1 h) (1 h - 4 h) Measured on Day 1, 2 Weeks (Day 14)&12 Weeks (Day 84)
Tidsramme: Day 1, 2 Weeks, 12 Weeks
Forced Expiratory Volume in 1 second (FEV1)/Area Under the Curve(AUC) was measured via spirometry conducted according to internationally accepted standards.FEV1 AUC(5 min - 4 h), (5 min - 1 h) and (1 h - 4 h) are measured at Day 1, 2 Weeks (Day 14) and 12 Weeks (Day84) and defined as average of FEV1 at specified timepoints above.
Day 1, 2 Weeks, 12 Weeks
Peak Forced Expiratory Volume in 1 Second (FEV1) at Day 1, 2 Weeks (Day 14), 12 Weeks (Day 84)
Tidsramme: Day 1, 2 weeks (Day 14), 12 weeks (Day 84)
Peak Forced Expiratory Volume in 1 second (FEV1) was measured via spirometry conducted according to internationally accepted standards. Peak FEV1 is defined as the maximum FEV1 during the first 4 h post morning dosing at Day 1, 2Weeks and 12 Weeks.
Day 1, 2 weeks (Day 14), 12 weeks (Day 84)
Asthma Control Questionnaire 5 (ACQ-5) After 4 Weeks (Day 29) and After 8 Weeks (Day 57) of Treatment
Tidsramme: after 4 weeks (Day 29) and after 8 weeks (Day 57)
The ACQ-5 is a validated questionnaire consisting of 5 items for the assessment of asthma symptom which are night symptom, morning symptom, limitation for the activities, shortness of breath, and wheeze. Each item is graded on a scale of 0-6 and the questions are equally weighted. The ACQ-5 score is the mean of the 5 questions and therefore between 0 (totally controlled) and 6 (severely uncontrolled).
after 4 weeks (Day 29) and after 8 weeks (Day 57)
Morning and Evening Peak Expiratory Flow Rate (PEFR) Over 12 Weeks of Treatment. This is LS Mean of the Treatment Period.
Tidsramme: baseline, 4weeks, 8 weeks and 12 weeks
PEFR is measured with portable spirometer by participants every morning and evening at home.
baseline, 4weeks, 8 weeks and 12 weeks
The Usage of Rescue Medication (Short Acting β2-agonist) Over 12 Weeks of Treatment
Tidsramme: 12 weeks
Participants record the number of puffs of rescue medication taken in the previous 12 hours in the morning and nighttime.
12 weeks
Asthma Quality of Life Questionnaire (AQLQ(S)) After 4 Weeks (Day 29) and 12 Weeks (Day 85) of Treatment
Tidsramme: 4 Weeks, 12 Weeks
The AQLQ is a 32-item disease specific questionnaire designed to measure functional impairments in asthma. Patients are asked to score each item on a 7-point scale based on the experience of last 2 weeks. The overall AQLQ score is the mean response to all 32 questions. Therefore, the possible highest score (better) would be 7 and the lowest (worse) would be 1. Changes in scores of 0.5 to 1.0 are considered clinically meaningful; 1.0 to 1.5 as moderate and > 1.5 as marked clinically important differences for any individual domain or for the overall summary score.
4 Weeks, 12 Weeks
Time to First Asthma Exacerbation (Mild, Moderate, Severe, Moderate or Severe and Any) Over the 12 Week Treatment Period
Tidsramme: 12 weeks
Duration of treatment until first asthma exacerbation by severity of exacerbation. A severe asthma exacerbation is systemic corticosteroids (SCS) use ≥3 days and hospitalization or emergency department visit (greater than 24 h) or death due to asthma. A moderate asthma exacerbation is SCS use ≥3 days either as an outpatient or in emergency department visits (less than or equal to 24 h). Worsening of asthma not requiring more than 3 days of SCS or hospitalization/emergency room will be considered mild asthma exacerbations.
12 weeks
The Annual Rate of Asthma Exacerbations (Mild, Moderate, Severe, Moderate or Severe and Any) Over the 12 Week Treatment Period
Tidsramme: 12 weeks
Annual incidence rate of asthma exacerbation by severity of exacerbation. The number of asthma exacerbation is used to calculate annual incidence rate. A severe asthma exacerbation is SCS use ≥3 days and hospitalization or emergency department visit (greater than 24 h) or death due to asthma. A moderate asthma exacerbation is SCS use ≥3 days either as an outpatient or in emergency department visits (less than or equal to 24 h). Worsening of asthma not requiring more than 3 days of SCS or hospitalization/emergency room will be considered mild asthma exacerbations. Number of the asthma exacerbation will be analyzed by the negative binomial regression including treatment, history of asthma exacerbation in the 12 months prior to screening and region as factors and FEV1 prior to inhalation and FEV1 30 min post inhalation of salbutamol/albuterol (components of SABA reversibility) as covariates. The estimates are obtained from the model and so we cannot specify a formula.
12 weeks
Duration of Asthma Exacerbations (Mild, Moderate, Severe, Moderate or Severe and Any) Over the 12 Week Treatment Period
Tidsramme: 12 weeks
Duration of asthma exacerbations by severity of exacerbation. A severe asthma exacerbation is SCS use ≥3 days and hospitalization or emergency department visit (greater than 24 h) or death due to asthma. A moderate asthma exacerbation is SCS use ≥3 days either as an outpatient or in emergency department visits (less than or equal to 24 h). Worsening of asthma not requiring more than 3 days of SCS or hospitalization/emergency room will be considered mild asthma exacerbations.
12 weeks
The Percentage of Patients With at Least One Asthma Exacerbation (Mild, Moderate, Severe, Moderate or Severe and Any) Over the 12 Week Treatment Period
Tidsramme: 12 weeks
The percentage of patients with at least one asthma exacerbation by severity of exacerbation. A severe asthma exacerbation is SCS use ≥3 days and hospitalization or emergency department visit (greater than 24 h) or death due to asthma. A moderate asthma exacerbation is SCS use ≥3 days either as an outpatient or in emergency department visits (less than or equal to 24 h). Worsening of asthma not requiring more than 3 days of SCS or hospitalization/emergency room will be considered mild asthma exacerbations.
12 weeks
Time to Permanent Study Discontinuation Due to Asthma Exacerbation Over the 12 Week Treatment Period
Tidsramme: 12 weeks
Time to permanent study discontinuation due to asthma exacerbation. A severe asthma exacerbation is SCS use ≥3 days and hospitalization or emergency department visit (greater than 24 h) or death due to asthma. A moderate asthma exacerbation is SCS use ≥3 days either as an outpatient or in emergency department visits (less than or equal to 24 h). Worsening of asthma not requiring more than 3 days of SCS or hospitalization/emergency room will be considered mild asthma exacerbations.
12 weeks
The Percentage of Patients Who Permanently Discontinued Study Due to Asthma Exacerbation Over the 12 Week Treatment Period
Tidsramme: 12 weeks
The percentage of patients who permanently discontinued study due to asthma exacerbation. A severe asthma exacerbation is SCS use ≥3 days and hospitalization or emergency department visit (greater than 24 h) or death due to asthma. A moderate asthma exacerbation is SCS use ≥3 days either as an outpatient or in emergency department visits (less than or equal to 24 h). Worsening of asthma not requiring more than 3 days of SCS or hospitalization/emergency room will be considered mild asthma exacerbations.
12 weeks
Total Amounts (in Doses) of Systemic Corticosteroids Used to Treat Asthma Exacerbations Over the 12 Week Treatment Period
Tidsramme: 12 weeks
Total amounts (in doses) of systemic corticosteroids (SCS) used to treat asthma exacerbations.SCS includes Intramuscular (IM), Intravenous (IV) and Oral. A severe asthma exacerbation is SCS use ≥3 days and hospitalization or emergency department visit (greater than 24 h) or death due to asthma. A moderate asthma exacerbation is SCS use ≥3 days either as an outpatient or in emergency department visits (less than or equal to 24 h). Worsening of asthma not requiring more than 3 days of SCS or hospitalization/emergency room will be considered mild asthma exacerbations.
12 weeks
Plasma Indacaterol Concentrations at Day 1 and Day 14
Tidsramme: Day 1 and Day 14
Maximum plasma concentration after drug administration (Cmax) was measured for indacaterol acetate 75 µg and indacaterol acetate 150 µg for Pharmacokinetic (PK) Subgroup
Day 1 and Day 14

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Novartis Pharmaceuticals

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. august 2012

Primær færdiggørelse (Faktiske)

1. juli 2013

Studieafslutning (Faktiske)

1. juli 2013

Datoer for studieregistrering

Først indsendt

23. april 2012

Først indsendt, der opfyldte QC-kriterier

29. maj 2012

Først opslået (Skøn)

1. juni 2012

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

27. januar 2015

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

15. januar 2015

Sidst verificeret

1. januar 2015

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • CQMF149E2203
  • 2012-000520-18 (EudraCT nummer)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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