E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Stable moderate to severe Chronic Obstructive Pulmonary Disease (COPD) |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10009033 |
E.1.2 | Term | Chronic obstructive pulmonary disease |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess whether the time of dosing (a.m. or p.m.) at steady state influences the bronchodilator response of aclidinium bromide compared to placebo in patients with moderate to severe COPD. |
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E.2.2 | Secondary objectives of the trial |
To further evaluate the safety and tolerability of multiple doses of aclidinium bromide in moderate to severe COPD patients. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
For inclusion and randomisation in the trial, patients must meet each of the following criteria:
1. Males and non-pregnant, non-lactating females aged ≥ 40. Women of childbearing potential are allowed to enter the trial ONLY if they use one medically approved (i.e., mechanical or pharmacological) contraceptive measure. A female is considered to be of childbearing potential unless she has had a hysterectomy, is at least one year post-menopausal or has undergone tubal ligation. All women of childbearing potential must have a negative pregnancy test at the screening visit.
2. Patients with a clinical diagnosis of COPD, according to the GOLD guidelines: (http://www.goldcopd.com) and stable airway obstruction.
3. Patients with a post salbutamol FEV1 equal to or greater than 30% of the predicted value and less than 80% of the predicted value (i.e., 30% ≤ 100xobserved post-salbutamol FEV1/ predicted FEV1 <80%)
4. Post-salbutamol FEV1/FVC < 70% at screening visit (i.e,. 100xpost-salbutamol FEV1/FVC < 70%).
5. Current, or ex-cigarette smokers with a smoking history of at least 10 pack-years. Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 (the number of cigarettes in a pack) and multiplying this figure by the number of years a person has smoked. For example, a person who smokes 40 cigarettes a day and has smoked for 10 years would have a 20 pack-year smoking history (40 cigarettes per day ¸ 20 cigarettes per pack = 2; 2 x 10 years of smoking = 20 pack-years history). Patients smoking other tobacco types will not be allowed, unless they meet the cigarette criterion as well.
6. Patients who are eligible and able to participate in the trial and who consent to do so in writing after the purpose and nature of the investigation have been explained to them.
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E.4 | Principal exclusion criteria |
Patients randomised into the trial must not present any of the following conditions:
1. History or current diagnosis of asthma, allergic rhinitis or atopy.
2. Eosinophil count ≥ 600 cells/mm3.
3. A respiratory tract infection (including the upper respiratory tract) or COPD exacerbation in the six weeks prior to the screening visit. Patients who develop a respiratory tract infection or exacerbation during the screening period will be discontinued from the trial prior to randomisation.
4. Patients who have been hospitalised for an acute COPD exacerbation in the 3 months prior to screening visit.
5. Use of long-term oxygen therapy (≥ 15 hours/day).
6. Clinically significant respiratory conditions defined as: · Known active tuberculosis. · History of interstitial lung or pulmonary thromboembolic disease. · Pulmonary resection during the past 12 months. · History of life-threatening COPD. · History of any bronchiectasis secondary to respiratory diseases others than COPD (e.g., cystic fibrosis, Kartagener’s syndrome, etc). · Patients who in the investigator’s opinion may need pulmonary rehabilitation or a thoracotomy during the trial. Patients on a stable pulmonary rehabilitation program prior to entry and anticipated to be stable throughout the study can be enrolled. · Lung cancer
7. Clinically significant cardiovascular conditions defined as: ·Myocardial infarction during the last 6 months. ·Unstable arrhythmia which has required changes in the pharmacological therapy or other intervention during the last 12 months, or newly diagnosed arrhythmia within the previous 3 months. · Hospitalisation within the previous 12 months for heart failure functional classes III (marked limitation of activity and only comfortable at rest) and IV (need of complete rest, confinement to bed or chair, discomfort at any physical activity and presence of symptoms at rest) as per the New York Heart Association.
8. Patients for whom the use of anticholinergic drugs is contraindicated: those with a known symptomatic prostatic hypertrophy, bladder neck obstruction or narrow-angle glaucoma.
9. Patients with any other serious or uncontrolled physical or mental dysfunction which at the discretion of the investigator could place the patient at higher risk derived from his/her participation in the study, could confound the results of the trial, or is likely to prevent the patient from complying with the requirements of the trial or completing the trial period.
10. QTc [calculated according to Bazett’s formula (QTc=QT/RR1/2) above 470 milliseconds in any of the ECGs performed at screening visit or at visit 1 (Day -1).
11. Patients who can not perform repeatable spirometry attempts at the screening visit.
12. History of untoward reactions to inhaled anticholinergics, sympathomimetic amines or inhaled medication or any component thereof (including report of paradoxical bronchospasm).
13. Patients unable to properly use a dry powder or pMDI inhaler device or unable to perform acceptable spirometry.
14. Clinically relevant abnormalities laboratory, ECG parameters (other than QTc), or physical examination results at the screening evaluation that in the investigator’s opinion, preclude study participation.
15. Patients who intend to use any concomitant medication not permitted by this protocol or who have not undergone the required washout period for a particular prohibited medication (see section 10.3.2).
16. Patients with a history of drug and/or alcohol abuse that may prevent compliance with trial activities.
17. Treatment with any Investigational Medicinal Product (IMP) within 1 month prior to the screening visit or the equivalent time of 6 half-lives of the IMP, whichever is longer.
18. Patients who do not maintain regular day/night, waking/sleeping cycles (e.g., history of sleep apnoea syndrome, any disease related with sleep disturbances such as restless-legs syndrome or somnambulism…). Moreover, night shift workers will be excluded.
19. Patients who are unlikely to be co-operative, take their medication, complete their patient diary or attend the clinic at the required times.
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E.5 End points |
E.5.1 | Primary end point(s) |
Efficacy variables:
Primary efficacy variable: • Change from baseline in the trough FEV1 after 6 days of treatment.
Secondary efficacy variables: • Change from baseline in the trough FVC after 6 days of treatment. • Change from baseline in the trough IC after 6 days of treatment. • Change from baseline in the FEV1 and FVC at all time-points after 7 days of treatment in the a.m. regimen and after 6-7 days of treatment in the p.m. regimen. • Change from baseline in the IC at all time-points after 7 days of treatment in the a.m. regimen and after 6-7 days of treatment in the p.m. regimen. • Change from baseline in the peak FEV1 and FVC after 7 days of treatment. • Change from baseline in normalised FEV1 and FVC AUC0-24 after 7 days of treatment in the a.m. regimen and after 6-7 days of treatment in the p.m. regimen. • Change from baseline in normalised FEV1 and FVC AUC0-12 after 7 days of treatment. • Change from baseline in normalised FEV1 and FVC AUC12-24 after 7 days of treatment in the a.m. regimen and after 6 days of treatment in the p.m. regimen. • Use of “as needed” daily rescue medication (number of salbutamol puffs, as recorded by the patient during the treatment period).
Safety variables: • Adverse Events (AEs). • Serious Adverse Events (SAEs). • 12-lead ECG parameters. • Blood pressure parameters. • Laboratory parameters (standard haematology, biochemistry and urinalysis). • Physical examination.
Other variables: • Use of concomitant medication. • Number (%) of withdrawals and reasons for withdrawal. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | Information not present in EudraCT |
E.7.1.2 | Bioequivalence study | Information not present in EudraCT |
E.7.1.3 | Other | Information not present in EudraCT |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | Yes |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 11 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 0 |
E.8.9.1 | In the Member State concerned months | 4 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 9 |
E.8.9.2 | In all countries concerned by the trial days | 0 |