Clinical Trial Results:
A multicentre, randomised, double-blind, double dummy, parallel group study to compare the salmeterol/fluticasone propionate combination (SERETIDE™) at a dose of 50/100mcg twice daily and fluticasone propionate (FLIXOTIDE™) at a dose of 200mcg twice daily, both delivered via a dry powder inhaler (DISKUS™) for 12 weeks in asthma in children aged 4-11 years not controlled by inhaled corticosteroids alone at medium dose
Summary
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EudraCT number |
2005-002949-40 |
Trial protocol |
LT NO ES SE LV BE IT DK |
Global end of trial date |
26 Oct 2006
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Results information
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Results version number |
v1(current) |
This version publication date |
27 Apr 2016
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First version publication date |
31 May 2015
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
SAM104926
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT00353873 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
GlaxoSmithKline
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Sponsor organisation address |
980 Great West Road, Brentford, Middlesex, United Kingdom,
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Public contact |
GSK Response Center, GlaxoSmithKline, 1 866-435-7343,
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Scientific contact |
GSK Response Center, GlaxoSmithKline, 1 866-435-7343,
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
08 Jan 2007
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
26 Oct 2006
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
The main objective of this study is to compare salmeterol/fluticasone propionate 50/100mcg bd with fluticasone propionate (FP) 200mcg bd on lung function in subjects that are not controlled when previously treated at medium daily doses of inhaled corticosteroids alone.
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Protection of trial subjects |
All subjects were randomized to active treatment. Oral corticosteroid use was permitted to treat asthma exacerbations should they have occurred during the study. The protocol advised that subjects should contact the investigator/primary physician should they experience worsening asthma during the study. No blood draws were required for this study.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
18 Nov 2005
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Sweden: 6
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Country: Number of subjects enrolled |
Belgium: 13
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Country: Number of subjects enrolled |
Denmark: 24
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Country: Number of subjects enrolled |
France: 189
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Country: Number of subjects enrolled |
Italy: 33
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Country: Number of subjects enrolled |
Latvia: 38
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Country: Number of subjects enrolled |
Norway: 6
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Country: Number of subjects enrolled |
Spain: 8
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Country: Number of subjects enrolled |
Lithuania: 46
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Country: Number of subjects enrolled |
Netherlands: 34
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Country: Number of subjects enrolled |
Poland: 66
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Country: Number of subjects enrolled |
Russian Federation: 121
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Worldwide total number of subjects |
584
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EEA total number of subjects |
463
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
584
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
0
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
- | |||||||||||||||||||||||||||
Pre-assignment
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Screening details |
A total of 584 participants were screened and entered into a 4-week run-in period receiving fluticasone propionate (FP) 100 microgram (µg) dry powder inhaler (DISKUS) twice daily (BD) and inhaled salbutamol (sal) as required. The number of participants randomized was 321, and 303 participants received investigational product post randomization. | |||||||||||||||||||||||||||
Period 1
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Period 1 title |
Overall Study (overall period)
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Is this the baseline period? |
Yes | |||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor, Data analyst, Carer, Assessor | |||||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Fluticasone Propionate 200 µg BD | |||||||||||||||||||||||||||
Arm description |
Participants received one inhalation from dry powder inhaler A (FP 100 µg) and dry powder inhaler B (FP 100 µg) twice-daily, in the morning and evening for 12 weeks. Participants were provided salbutamol 100 µg per actuation metered dose inhaler (MDI) to be used as needed throughout the study, for prevention of exercise induced asthma and symptomatic relief from asthma symptoms. | |||||||||||||||||||||||||||
Arm type |
Active comparator | |||||||||||||||||||||||||||
Investigational medicinal product name |
Fluticasone propionate
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Inhalation powder, pre-dispensed
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Routes of administration |
Inhalation use
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Dosage and administration details |
200 μg twice daily
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Arm title
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Salmeterol/Fluticasone Propionate 50/100 µg BD | |||||||||||||||||||||||||||
Arm description |
Participants received one inhalation from dry powder inhaler A (salmeterol/fluticasone propionate [SFC] 50/100 µg) and dry powder inhaler B (placebo for FP 100 µg) twice-daily, in the morning and evening for 12 weeks. Participants were provided salbutamol 100 µg per actuation MDI to be used as needed throughout the study, for prevention of exercise induced asthma and symptomatic relief from asthma symptoms. | |||||||||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||||||||
Investigational medicinal product name |
Salmeterol/fluticasone propionate combination
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Inhalation powder, pre-dispensed
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Routes of administration |
Inhalation use
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Dosage and administration details |
50/100 μg twice daily
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Notes [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same. Justification: A total of 584 participants were screened and entered into a 4-week run-in period receiving fluticasone propionate (FP) 100 microgram (µg) dry powder inhaler (DISKUS) twice daily (BD) and inhaled salbutamol as required. The number of participants randomized was 321, and 303 participants received investigational product post randomization. These 303 participants are reported to be in the baseline period. |
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Baseline characteristics reporting groups
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Reporting group title |
Fluticasone Propionate 200 µg BD
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Reporting group description |
Participants received one inhalation from dry powder inhaler A (FP 100 µg) and dry powder inhaler B (FP 100 µg) twice-daily, in the morning and evening for 12 weeks. Participants were provided salbutamol 100 µg per actuation metered dose inhaler (MDI) to be used as needed throughout the study, for prevention of exercise induced asthma and symptomatic relief from asthma symptoms. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Salmeterol/Fluticasone Propionate 50/100 µg BD
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Reporting group description |
Participants received one inhalation from dry powder inhaler A (salmeterol/fluticasone propionate [SFC] 50/100 µg) and dry powder inhaler B (placebo for FP 100 µg) twice-daily, in the morning and evening for 12 weeks. Participants were provided salbutamol 100 µg per actuation MDI to be used as needed throughout the study, for prevention of exercise induced asthma and symptomatic relief from asthma symptoms. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Fluticasone Propionate 200 µg BD
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Reporting group description |
Participants received one inhalation from dry powder inhaler A (FP 100 µg) and dry powder inhaler B (FP 100 µg) twice-daily, in the morning and evening for 12 weeks. Participants were provided salbutamol 100 µg per actuation metered dose inhaler (MDI) to be used as needed throughout the study, for prevention of exercise induced asthma and symptomatic relief from asthma symptoms. | ||
Reporting group title |
Salmeterol/Fluticasone Propionate 50/100 µg BD
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Reporting group description |
Participants received one inhalation from dry powder inhaler A (salmeterol/fluticasone propionate [SFC] 50/100 µg) and dry powder inhaler B (placebo for FP 100 µg) twice-daily, in the morning and evening for 12 weeks. Participants were provided salbutamol 100 µg per actuation MDI to be used as needed throughout the study, for prevention of exercise induced asthma and symptomatic relief from asthma symptoms. |
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End point title |
Mean Change from Baseline in Morning Peak Expiratory Flow (PEF) Over 12 weeks in Intent-to-treat (ITT) population | ||||||||||||
End point description |
PEF is the maximum flow generated during expiration, as measured with a peak flow meter and recorded in electronic diary record card (eDRC), performed with maximal force and started after a full inspiration. The mean morning PEF measurement was constructed by calculating a simple mean for each participant over the interval Weeks 1 to 12. All PEF measurements were converted to the Wright/McKerow peak flow meter scale for the purposes of analyses. The change from baseline is then calculated by subtracting the baseline PEF values from the individual on-treatment values. Baseline was calculated as the mean of the values recorded on the seven days preceding randomization. The analysis was done using analysis of covariance (ANCOVA) adjusted for baseline PEF, country amalgamation, age, sex and treatment. ITT Population: all participants randomized to treatment who received at least one dose of randomized study medication.
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End point type |
Primary
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End point timeframe |
Baseline; Week 1 up to Week 12
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Notes [1] - ITT Population. Only participants with analyzable data at the indicated time point were assessed. [2] - ITT Population. Only participants with analyzable data at the indicated time point were assessed. |
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Statistical analysis title |
Statistical Analysis 1 | ||||||||||||
Comparison groups |
Fluticasone Propionate 200 µg BD v Salmeterol/Fluticasone Propionate 50/100 µg BD
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Number of subjects included in analysis |
302
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Analysis specification |
Pre-specified
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Analysis type |
non-inferiority [3] | ||||||||||||
P-value |
= 0.012 | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
7.6
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Confidence interval |
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level |
95% | ||||||||||||
sides |
1-sided
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lower limit |
1.7 | ||||||||||||
upper limit |
- | ||||||||||||
Notes [3] - Non-inferiority was tested using a one-sided significance level of 2.5%. If the lower confidence interval for the difference SFC-FP falls above -12 L/min the once daily SFC treatment combination was deemed to be statistically non-inferior. In the event that the lower confidence limit (2.5% 1-sided significance) exceeded 0, and using a separate closed testing procedure, superiority could be established. |
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End point title |
Mean Change from Baseline in Morning PEF Over 12 weeks in Per Protocol (PP) population | ||||||||||||
End point description |
PEF is the maximum flow generated during expiration, as measured with a peak flow meter and recorded in eDRC, performed with maximal force and started after a full inspiration. The mean morning PEF measurement was constructed by calculating a simple mean for each participant over the interval Weeks 1 to 12. All PEF measurements were converted to the Wright/McKerow peak flow meter scale for the purposes of analyses. The change from baseline is then calculated by subtracting the baseline PEF values from the individual on-treatment values. Baseline was calculated as the mean of the values recorded on the seven days preceding randomization. The analysis was done using ANCOVA adjusted for baseline PEF, country amalgamation, age, sex and treatment. PP population: all participants in the ITT Population who did not have any protocol violations which could impact treatment effect.
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End point type |
Primary
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End point timeframe |
Baseline; Week 1 up to Week 12
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Notes [4] - PP Population. Only participants with analyzable data at the indicated time point were assessed. [5] - PP Population. Only participants with analyzable data at the indicated time point were assessed. |
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Statistical analysis title |
Statistical Analysis 1 | ||||||||||||
Comparison groups |
Fluticasone Propionate 200 µg BD v Salmeterol/Fluticasone Propionate 50/100 µg BD
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Number of subjects included in analysis |
262
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Analysis specification |
Pre-specified
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Analysis type |
non-inferiority [6] | ||||||||||||
P-value |
= 0.003 | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
9.3
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Confidence interval |
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level |
95% | ||||||||||||
sides |
1-sided
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lower limit |
3.2 | ||||||||||||
upper limit |
- | ||||||||||||
Notes [6] - Non-inferiority was tested using a one-sided significance level of 2.5%. If the lower confidence interval for the difference SFC-FP falls above -12 L/min the once daily SFC treatment combination was deemed to be statistically non-inferior. In the event that the lower confidence limit (2.5% 1-sided significance) exceeded 0, and using a separate closed testing procedure, superiority could be established. |
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End point title |
Number of Participants who Achieved 'Totally Controlled' Asthma | |||||||||
End point description |
Totally Controlled (TC) asthma is defined as no daily symptoms, no night-time wakening due to asthma, no exacerbations, no rescue sal/albuterol use, no emergency visits, >=80% predicted morning PEF, and no treatment related adverse events enforcing a change in asthma therapy over 7 consecutive days. Number of participants/group who achieved the status of at least TC during the last 8 weeks (wks) of treatment was analysed using logistic regression, including covariates for sex, age, treatment group, country amalgamation and baseline pre-bronchodilator forced expiratory volume in one second(FEV1). Asthma control was assessed each week for the last 8 wks of treatment period. Each week was classified as ‘Totally Controlled’, ‘Well Controlled’, ‘Not Controlled’ or ‘Unevaluable’. A subject was considered to have TC asthma if they achieved 4/4, 5/5, 6/6, 6/7, 7/8 or 8/8 wks that were TC. ‘Unevaluable’ classification included subjects with less than 4 wks of data during the assessment period.
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End point type |
Secondary
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End point timeframe |
Week 5 up to Week 12
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Notes [7] - ITT Population. Only participants with analyzable data at the indicated time point were assessed. [8] - ITT Population. Only participants with analyzable data at the indicated time point were assessed. |
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Statistical analysis title |
Statistical Analysis 1 | |||||||||
Comparison groups |
Fluticasone Propionate 200 µg BD v Salmeterol/Fluticasone Propionate 50/100 µg BD
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Number of subjects included in analysis |
302
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||
P-value |
= 0.389 | |||||||||
Method |
Regression, Logistic | |||||||||
Parameter type |
Odds ratio (OR) | |||||||||
Point estimate |
1.31
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Confidence interval |
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level |
95% | |||||||||
sides |
2-sided
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lower limit |
0.7 | |||||||||
upper limit |
2.4 |
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End point title |
Number of Participants who Achieved 'Well Controlled' Asthma | |||||||||
End point description |
Well Controlled (WC) asthma is defined as two or more of symptom score >1 only allowed on <=2 days/week, rescue salbutamol/albuterol use on <=2 days/week and up to a maximum of 4 times per week, >=80% predicted morning PEF daily assessed for 7 consecutive days and all the following criteria: no night-time awakening due to asthma, no exacerbations, no emergency visits, no treatment related adverse events enforcing a change in any asthma therapy. Number of participants/group who achieved the status of at least WC during the last 8 wks of treatment was analysed using logistic regression, including covariates for sex, age, treatment group, country amalgamation and baseline pre-bronchodilator FEV1. Each week was classified as ‘Well Controlled’, ‘Not Controlled’ or ‘Unevaluable’. A subject was considered to have WC asthma if they achieved 4/4, 5/5, 6/6, 6/7, 7/8 or 8/8 wks that were WC. ‘Unevaluable’ classification included subjects with less than 4 wks of data during the assessment period.
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End point type |
Secondary
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End point timeframe |
Week 5 up to Week 12
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Notes [9] - ITT Population. Only participants with analyzable data at the indicated time point were assessed. [10] - ITT Population. Only participants with analyzable data at the indicated time point were assessed. |
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Statistical analysis title |
Statistical Analysis 1 | |||||||||
Comparison groups |
Fluticasone Propionate 200 µg BD v Salmeterol/Fluticasone Propionate 50/100 µg BD
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Number of subjects included in analysis |
302
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||
P-value |
= 0.535 | |||||||||
Method |
Regression, Logistic | |||||||||
Parameter type |
Odds ratio (OR) | |||||||||
Point estimate |
1.16
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Confidence interval |
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level |
95% | |||||||||
sides |
2-sided
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lower limit |
0.7 | |||||||||
upper limit |
1.9 |
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Adverse events information
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Timeframe for reporting adverse events |
Serious adverse events (SAEs) and non-serious adverse events (AEs) were collected from the first day of treatment until the last day of treatment (up to 12 weeks).
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Adverse event reporting additional description |
On-treatment SAEs and non-serious adverse events were reported for ITT Population, composed of all participants randomized to treatment who received at least one dose of randomized study medication.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
9.1
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Reporting groups
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Reporting group title |
Fluticasone Propionate 200 µg BD
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Reporting group description |
Participants received one inhalation from dry powder inhaler A (FP 100 µg) and dry powder inhaler B (FP 100 µg) twice-daily, in the morning and evening for 12 weeks. Participants were provided salbutamol 100 µg per actuation metered dose inhaler (MDI) to be used as needed throughout the study, for prevention of exercise induced asthma and symptomatic relief from asthma symptoms. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Salmeterol/Fluticasone Propionate 50/100 µg BD
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Reporting group description |
Participants received one inhalation from dry powder inhaler A (salmeterol/fluticasone propionate [SFC] 50/100 µg) and dry powder inhaler B (placebo for FP 100 µg) twice-daily, in the morning and evening for 12 weeks. Participants were provided salbutamol 100 µg per actuation MDI to be used as needed throughout the study, for prevention of exercise induced asthma and symptomatic relief from asthma symptoms. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? No | |||
Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |