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    Summary
    EudraCT Number:2013-000081-11
    Sponsor's Protocol Code Number:BFS-AS-306
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2013-04-30
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2013-000081-11
    A.3Full title of the trial
    A 12-Week Efficacy and Safety Evaluation of Budesonide/Formoterol SPIROMAX® 160/4.5 mcg Inhalation Powder Versus SYMBICORT® TURBOHALER® 200/6 mcg in Adult and Adolescent Patients with Persistent Asthma.
    12 settimane di valutazione dell’efficacia e della sicurezza di Budesonide/Formoterolo
    SPIROMAX® 160/4,5 mcg polvere per inalazione verso SYMBICORT® TURBOHALER® 200/6 mcg in
    pazienti adulti e adolescenti con asma persistente.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A 12-Week study to find out if the effect of Budesonide/Formoterol SPIROMAX® is at least the same as of SYMBICORT TURBOHALER® and is safe and effective to treat children, teenagers, and adults with asthma.
    12 settimane di studio per scoprire se l'effetto di Budesonide/Formoterolo SPIROMAX® è almeno lo stesso di SYMBICORT TURBOHALER® ed è sicuro ed efficace per il trattamento dell'asma nei bambini, adolescenti e adulti.
    A.4.1Sponsor's protocol code numberBFS-AS-306
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorTeva Branded Pharmaceutical Products R&D, Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportTeva Branded Pharmaceutical Products R&D, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationTeva Pharma GmbH
    B.5.2Functional name of contact pointClinical Trial Information Desk
    B.5.3 Address:
    B.5.3.1Street AddressWaldeckerstrasse 7
    B.5.3.2Town/ cityMöerfelden-Walldorf
    B.5.3.3Post code64546
    B.5.3.4CountryGermany
    B.5.4Telephone number000000000 000
    B.5.5Fax number000000000 000
    B.5.6E-mailInfo-era-clinical@teva.de
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameBudesonide/Formoterol (BF) SPIROMAX (budesonide/formoterol fumarate dihydrate 160/4.5 mcg)
    D.3.2Product code BF Spiromax
    D.3.4Pharmaceutical form Inhalation powder
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPInhalation use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNBUDESONIDE
    D.3.9.1CAS number 51333-22-3
    D.3.9.3Other descriptive name16α,17-[(1RS)-butylidenebis(oxy)]-11β,21-dihydroxypregna-1,4-diene-3,20-dione
    D.3.9.4EV Substance CodeSUB05955MIG
    D.3.10 Strength
    D.3.10.1Concentration unit µg microgram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number160
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNFormoterol fumarate dihydrate
    D.3.9.1CAS number 183814-30-4
    D.3.9.3Other descriptive nameN-[2-Hydroxy-5-[(1RS)-1-hydroxy-2-[[(1RS)-2-(4-methoxyphenyl)-1-methylethyl]amino]ethyl]phenyl] formamide(E)-butenedioate dihydrate
    D.3.9.4EV Substance CodeSUB25660
    D.3.10 Strength
    D.3.10.1Concentration unit µg microgram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number4.5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Symbicort® Turbohaler® 200 /6 inhalation powder
    D.2.1.1.2Name of the Marketing Authorisation holderAstrazeneca UK Ltd
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameSymbicort® Turbohaler® 200 /6 inhalation powder
    D.3.4Pharmaceutical form Inhalation powder
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPInhalation use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNBUDESONIDE
    D.3.9.1CAS number 51333-22-3
    D.3.9.3Other descriptive name16α,17-[(1RS)-butylidenebis(oxy)]-11β,21-dihydroxypregna-1,4-diene-3,20-dione
    D.3.9.4EV Substance CodeSUB05955MIG
    D.3.10 Strength
    D.3.10.1Concentration unit µg microgram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNFormoterol fumarate dihydrate
    D.3.9.1CAS number 183814-30-4
    D.3.9.3Other descriptive nameN-[2-Hydroxy-5-[(1RS)-1-hydroxy-2-[[(1RS)-2-(4-methoxyphenyl)-1-methylethyl]amino]ethyl]phenyl] formamide(E)-butenedioate dihydrate
    D.3.9.4EV Substance CodeSUB25660
    D.3.10 Strength
    D.3.10.1Concentration unit µg microgram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboInhalation powder
    D.8.4Route of administration of the placeboInhalation use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboInhalation powder
    D.8.4Route of administration of the placeboInhalation use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Persistent Asthma
    Asma Persistente
    E.1.1.1Medical condition in easily understood language
    Asthma
    Asma
    E.1.1.2Therapeutic area Diseases [C] - Respiratory Tract Diseases [C08]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.1
    E.1.2Level PT
    E.1.2Classification code 10003553
    E.1.2Term Asthma
    E.1.2System Organ Class 10038738 - Respiratory, thoracic and mediastinal disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of the study is to establish the noninferiority of budesonide/formoterol fumarate dihydrate (BF) SPIROMAX 160/4.5 mcg with that of SYMBICORT TURBOHALER 200/6 mcg administered twice daily in patients 12 years of age and older with persistent asthma as assessed by the change from baseline in average of daily trough (predose and pre-rescue bronchodilator) morning (AM) peak expiratory flow rate (PEF) over a 12-week treatment period.
    L’obiettivo primario dello studio è quello di stabilire la non inferiorità di budesonide/formoterolo fumarato diidrato (BF) SPIROMAX 160/4,5 mcg rispetto a SYMBICORT TURBOHALER 200/6 mcg somministrati due volte al giorno a pazienti di almeno 12 anni di età con asma persistente, secondo la valutazione della variazione dal basale della media del valore minimo giornaliero (pre-dose e prima del broncodilatatore di salvataggio) del PEF AM in un periodo di trattamento di 12 settimane.
    E.2.2Secondary objectives of the trial
    The secondary objectives of the study are to evaluate patient preference and ease of use of the budesonide/formoterol fumarate dihydrate (BF) SPIROMAX device compared to SYMICORT TURBOHALER.
    Safety and tolerability of budesonide/formoterol fumarate dihydrate (BF) SPIROMAX 160/4.5 mcg will also be evaluated by the following:
    • incidence of adverse events throughout the 12-week treatment period
    • oropharynx examination findings at the screening visit (visit 1) and at the end of the double-blind treatment period (visit 5)
    • physical examination findings at the screening visit and the at the end of the double-blind treatment period (visit 5)
    • vital sign measurements (including blood pressure (BP), pulse rate, respiratory rate, and temperature) at the screening visit and throughout the study
    Gli obiettivi secondari dello studio sono la valutazione della preferenza del paziente e della facilità d'uso del dispositivo budesonide/formoterolo fumarato diidrato (BF) SPIROMAX rispetto a SYMBICORT TURBOHALER.
    Sicurezza e tollerabilità di budesonide/formoterolo fumarato diidrato (BF) SPIROMAX 160/4.5 mcg saranno anche valutate dal seguente:
    • incidenza di eventi avversi nel corso delle 12 settimane di trattamento
    • risultati degli esami orofaringei alla visita di screening (visita 1) e alla fine del periodo di trattamento in doppio cieco (visita 5)
    • risultati dell'esame fisico alla visita di screening e alla fine del periodo di trattamento in doppio cieco (visita 5)
    • Le misurazioni dei segni vitali (tra cui pressione arteriosa (BP), la frequenza cardiaca, la frequenza respiratoria e la temperatura) alla visita di screening e per tutto lo studio
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Serial spirometry:
    - Information regarding the substudy is located in the main protocol for this study, dated 10 December 2012.
    - Serial spirometry is planned to be performed for a subset of patients (approximately 30 patients from 3-4 sites) at the baseline visit (visit 2) only.
    Spirometria seriale:
    - Le informazioni riguardo il sotto-studio sono presenti nel protocollo principale di studio, datato 10 Dicembre 2012.
    - La spirometria seriale è prevista per un sottogruppo di 30 pazienti (approssimativamente 30 pazienti in 3-4 centri) solo alla visita di baseline (visita 2).
    E.3Principal inclusion criteria
    a. Informed consent/assent: For adult patients, written informed consent signed and dated by the patient before conducting any study related procedures; for minor patients, written informed consent signed and dated by the parent/legal guardian and written assent signed and dated by the patient before conducting any study related procedure.
    b. Male or female patients 12 years and older as of the screening visit. Male or female patients 18 years and older, as of the screening visit, in countries where local regulations or the regulatory status of study medication permit enrollment of adult patients only.
    c. General good health, and free of any concomitant conditions or treatment that could interfere with study conduct, influence the interpretation of study observations/results, or put the patient at increased risk during the study.
    d. Asthma Diagnosis: The asthma diagnosis must be in accordance with the Global Initiative for Asthma (GINA).
    e. Patient has an ACQ score of ≥1.0 at the screening visit.
    f. Severity of Disease: Persistent asthma, with an FEV1 40-85% predicted for age, height, gender and race, as per the third National Health and Nutrition Examination Survey (NHANES III) reference values, with adjustments to predicted values for African American patients, for a minimum of 3 months duration, and that has been stable for at least 30 days before the screening visit, as defined by clinical history.
    g. Reversibility of Disease: Demonstrated a ≥12% reversibility of FEV1 within 30 minutes after 2-4 inhalations of albuterol/salbutamol (if required, spacers are permitted for reversibility testing) at the screening visit. Documented historical reversibility of ≥12% to a beta-agonist in the 12 months before the screening visit is also acceptable.
    h. Current Asthma Therapy: Patients will be required to be on a short-acting β2 agonist (SABA) and inhaled corticosteroid (ICS) for a minimum of 8 weeks before the screening visit and have been maintained on a stable dose of inhaled corticosteroids for 4 weeks before the screening visit at on of the doses specified in the protocol.
    i. Short-Acting β2-Agonists: All patients must be able to replace their current SABA with albuterol/salbutamol at the screening visit for use as needed for the duration of the study. Nebulized albuterol/salbutamol will not be allowed at any time during the study. Patients must be able to withhold all inhaled short-acting β2-sympathomimetic bronchodilators for at least 6 hours before all study visits.
    j. If female, is currently not pregnant, breast feeding, or attempting to become pregnant, and is of Nonchildbearing potential, defined as:
    − Pre-menarche
    − ≥1 year post-menopausal
    − Surgically sterile (tubal ligation, bilateral oophorectomy, or hysterectomy)
    − Congenital sterility
    − Diagnosed as infertile and not undergoing treatment to reverse infertility or is of:
    Childbearing potential, must have a negative serum pregnancy test and be willing to commit to using a consistent and acceptable method of birth control as defined below for the duration of the study:
    − Systemic contraception used for ≥1 month prior to screening, including birth control pills, transdermal patch, vaginal ring, levonorgesterel, or injectable progesterone
    − Double barrier methods (condoms, cervical cap, diaphragm, and vaginal contraceptive film with spermicide)
    − Intrauterine device (IUD)
    Childbearing potential and not sexually active, willing to commit to using a consistent and acceptable method of birth control, as defined above, for the duration of the study, in the event the patient becomes sexually active.
    If male, is willing to commit to using 2 consistent and acceptable methods of birth control for the duration of the study, and for a period of 3 months after dosing
    k. Capable of understanding the requirements, risks, and benefits of study participation, and, as judged by the investigator, capable of giving informed consent/assent and being compliant with all study requirements (visits, record-keeping, etc.).
    a. Consenso informato/assenso: per i pazienti adulti, consenso informato scritto firmato e datato dal paziente prima di condurre qualsiasi procedura correlata allo studio; per i pazienti minorenni, consenso informato scritto firmato e datato dal genitore/tutore legale e assenso scritto firmato e datato dal paziente prima di condurre qualsiasi procedura correlata allo studio.
    b. Pazienti maschi o femmine di almeno 12 anni di età alla visita di screening. Pazienti maschi o femmine di almeno 18 anni di età, alla visita di screening, nei paesi in cui le norme locali o lo, status regolatorio del farmaco dello studio consentano solo l’arruolamento di pazienti adulti.
    c. Buona salute generale e assenza di patologie o trattamenti concomitanti che potrebbero interferire con la conduzione dello studio, influenzare l’interpretazione delle osservazioni o dei risultati dello studio o aumentare i rischi per il paziente durante lo studio.
    d. Diagnosi di asma: la diagnosi di asma deve corrispondere ai requisiti di Global Initiative for Asthma (GINA).
    e. Il paziente deve avere un punteggio ACQ ≥ 1.0 alla visita di screening.
    f. Gravità della malattia: asma persistente, con FEV1 pari al 40-85% del valore previsto per età, altezza, sesso e razza, secondo i valori di riferimento del National Health and Nutrition Examination Survey (NHANES III), con le modifiche ai valori previsti per i pazienti afroamericani, della durata di almeno 3 mesi e stabile da almeno 30 giorni prima della visita di screening secondo l’anamnesi clinica.
    g. Reversibilità della malattia: reversibilità dimostrata ≥ 12% di FEV1 entro 30 minuti dopo 2-4 inalazioni di albuterolo/salbutamolo (se necessari, per i test di reversibilità sono ammessi gli
    spaziatori) alla visita di screening. E’ inoltre accettabile una reversibilità storica documentata ≥ 12% con un beta-agonista nei 12 mesi precedenti la visita di screening.
    h. Terapia per l’asma in atto: i pazienti dovranno essere sotto trattamento con un β2-agonista a breve durata d’azione (SABA) e corticosteroidi inalatori (ICS) da almeno 8 settimane prima della visita di screening e dovranno aver mantenuto una dose stabile di corticosteroidi inalatori per 4 settimane prima della visita di screening a una delle dosi specificate nel protocollo.
    i. β2-agonisti a breve durata d’azione: tutti i pazienti devono avere la possibilità di sostituire il SABA in uso con albuterolo/salbutamolo alla visita di screening per l’uso al bisogno durante l’intero studio. L’uso di albuterolo/salbutamolo nebulizzato non sarà ammesso in alcun
    momento durante lo studio. I pazienti devono essere in grado di sospendere l’uso di tutti i broncodilatatori β2-simpatomimetici a breve durata d’azione per almeno 6 ore prima di tutte le visite dello studio.
    j. Se di sesso femminile, la paziente non deve essere in gravidanza o allattamento o alla ricerca di una gravidanza, e deve essere non potenzialmente fertile, ovvero:
    - in pre-menarca
    - in post-menopausa da ≥1 anno
    - chirurgicamente sterile (legatura tubarica, ovariectomia bilaterale o isterectomia)
    - congenitamente sterile
    - con diagnosi di infertilità e non sottoposta a un trattamento contro l’infertilità oppure:
    - potenzialmente fertile, nel qual caso deve avere un risultato negativo al test di gravidanza sul siero e accettare di utilizzare con costanza per l’intero studio un metodo contraccettivo accettabile secondo la definizione seguente:
    - contraccezione sistemica usata da ≥1 mese prima dello screening, come pillola contraccettiva, cerotto transdermico, anello vaginale, levonorgesterel o progesterone iniettabile
    - metodi a doppia barriera (preservativo, cappuccio cervicale, diaframma e pellicola contraccettiva vaginale con spermicida)
    - dispositivo intrauterino (IUD)
    Potenzialmente fertile e non sessualmente attiva, nel qual caso deve accettare di utilizzare con costanza per l’intero studio un metodo contraccettivo accettabile secondo la definizione precedente se dovesse diventare sessualmente attiva.
    Se di sesso maschile, il paziente deve accettare di utilizzare con costanza 2 metodi contraccettivi accettabili per l’intero studio e per
    3 mesi dopo il trattamento
    k. Essere in grado di comprendere i requisiti, i rischi e i benefici della partecipazione allo studio e, secondo il giudizio dello sperimentatore, essere in grado di dare il consenso informato/l’assenso e di osservare tutti i requisiti dello studio (visite, registrazione dati, ecc.).
    E.4Principal exclusion criteria
    a. History of life-threatening asthma, defined for this protocol as an asthma episode that required intubation and/or was associated with hypercapnea, respiratory arrest or hypoxic seizures.
    b. Culture-documented or suspected bacterial or viral infection of the upper or lower respiratory tract, sinus, or middle ear that is not resolved within 2 weeks before the screening visit. In addition, the patient must be excluded if such infection occurs between the screening visit and the baseline visit.
    c. Any asthma exacerbation requiring oral corticosteroids within one month of the screening visit. A patient must not have been hospitalized for asthma within 6 months before the screening visit.
    d. Presence of glaucoma, cataracts, ocular herpes simplex, or malignancy other than basal cell carcinoma.
    e. Historical or current evidence of a clinically significant disease including, but not limited to: cardiovascular conditions (eg, congestive heart failure, known aortic aneurysm, clinically significant cardiac arrhythmia or coronary heart disease), hepatic, renal, hematological, neuropsychological, endocrine conditions (eg, uncontrolled diabetes mellitus, uncontrolled thyroid disorder, Addison’s disease, Cushing’s syndrome), gastrointestinal conditions (eg, poorly-controlled peptic ulcer, gastroesophageal reflux disease [GERD]), or pulmonary conditions (eg, chronic bronchitis, emphysema, bronchiectasis with the need for treatment, cystic fibrosis, bronchopulmonary dysplasia, chronic obstructive pulmonary disease). Significant is defined as any disease that, in the opinion of the investigator, would put the safety of the patient at risk through participation, or which could affect the efficacy or safety analysis if the disease/condition became exacerbated during the study.
    f. Have any of the following conditions that, in the judgment of the investigator, might cause participation in this study to be detrimental to the patient, including, but not limited to:
    - Current malignancy, excluding basal cell carcinoma. History of malignancy is acceptable only if the patient has been in remission for one year prior to the screening visit. (Remission is defined as no current evidence of malignancy and no treatment for the malignancy in the 12 months before the screening visit)
    - Current or untreated tuberculosis. History of tuberculosis is acceptable only if a patient has received an approved prophylactic treatment regimen or an approved active treatment regimen and has had no evidence of active disease for a minimum of 2 years
    - Uncontrolled hypertension (systolic blood pressure (BP) ≥160 or diastolic BP >100)
    - Stroke within 3 months before the screening visit
    - Immunologic compromise
    g. History of a positive test for human immunodeficiency virus (HIV), hepatitis B or hepatitis C infection.
    h. Clinical visual evidence of oral candidiasis at the screening visit.
    i. History of any adverse reaction, including immediate or delayed hypersensitivity to any β2-agonist, sympathomimetic drug, or any intranasal, inhaled, or systemic corticosteroid therapy.
    j. Known or suspected sensitivity to the constituents of the DPIs (SPIROMAX or TURBOHALER) used in the study (eg, lactose).
    k. History of severe allergy to milk protein.
    l. Use of systemic, oral or depot corticosteroids within 4 weeks before the screening visit
    - Use of topical corticosteroids (≤1% hydrocortisone cream) for dermatological disease is permitted
    - Use of intranasal corticosteroids at a stable dose or as needed may be used during the study for treatment of allergic rhinitis.
    m. Use of immunosuppressive medications within 12 weeks before the screening visit and during the study.
    n. Immunotherapy at a stable dose for at least 90 days before the screening visit and throughout the study for the treatment of allergies is permitted.
    o. Use of potent Cytochrome P450 3A4 (CYP3A4) inhibitors (eg, ritonavir, ketoconazole, intraconzole) within 4 weeks before the screening visit.
    p. Use of any prohibited concomitant non-asthma medications, such as treatment with β2-adrenergic receptor antagonists and non-selective β-receptor blocking agents, such as β-blocking anti-hypertensive products (administered by any route), monoamine oxidase (MAO) inhibitors, and tricyclic antidepressants within 1 week before the screening visit.
    q. History of alcohol or drug abuse within 2 years preceding the screening visit.
    r. Current smoker or a smoking history of 10 pack years or more (a pack year is defined as smoking 1 pack of cigarettes/day for 1 year). A patient may not have used tobacco products within the past 1 year (eg, cigarettes, cigars, chewing tobacco, or pipe tobacco).
    s. Patient is a clinical investigator site employee or their immediate relatives.
    For exclusion criteria (t) to (v), please refer to the current protocol
    a. Storia di asma potenzialmente fatale, definito in questo protocollo come un episodio di asma che ha richiesto l’intubazione e/o è stato associato a ipercapnia, arresto respiratorio o convulsioni ipossiche.
    b. Infezione batterica o virale documentata da coltura o presunta delle vie respiratorie superiori o inferiori, dei seni nasali o dell’orecchio medio, non risolta entro 2 settimane prima della visita di screening. Il paziente deve inoltre essere escluso se tale infezione si verifica tra la
    visita di screening e la visita basale.
    c. Qualsiasi esacerbazione dell’asma tale da richiedere corticosteroidi nel mese precedente la visita di screening. Il paziente non deve essere stato ricoverato in ospedale nei 6 mesi precedenti la visita di screening.
    d. Presenza di glaucoma, cataratta, herpes simplex oculare o malignità diversa dal carcinoma a cellule basali.
    e. Storia o evidenze correnti di una malattia clinicamente significativa come, ad esempio: patologie cardiovascolari (es. insufficienza cardiaca congestizia, aneurisma aortico noto, aritmia cardiaca clinicamente significativa o cardiopatia coronarica), patologie epatiche,
    renali, ematologiche, neuropsicologiche, endocrine (es. diabete mellito incontrollato, disturbo tiroideo incontrollato, malattia di Addison, sindrome di Cushing), patologie gastrointestinali (es. ulcera peptica mal controllata, malattia da reflusso gastroesofageo [GERD]) o patologie polmonari (es. bronchite cronica, enfisema, bronchiectasia che richiede trattamento, fibrosi cistica, displasia broncopolmonare, broncopneumopatia cronica ostruttiva). Una malattia significativa è qualsiasi disturbo che, a giudizio dello sperimentatore, metterebbe a rischio la sicurezza del paziente durante la partecipazione allo studio o che potrebbe influire sull'analisi dell'efficacia o della sicurezza in caso di esacerbazione di tale malattia/condizione durante lo studio.
    f. Il paziente ha una delle seguenti patologie che, a giudizio dello sperimentatore, potrebbero rendere deleteria la sua partecipazione a questo studio, comprese, ad esempio:
    - Malignità in atto, escluso il carcinoma a cellule basali. La malignità pregressa è accettabile solo se il paziente è in remissione da un anno prima della visita di screening (la remissione è definita come l’assenza di evidenze correnti di malignità e di trattamenti per la malignità nei 12 mesi precedenti la visita di screening)
    - Tubercolosi in atto o non trattata. La tubercolosi pregressa è accettabile solo se il paziente ha ricevuto un regime di trattamento profilattico approvato o un regime di trattamento attivo approvato e non presenta evidenze di malattia attiva da almeno 2 anni
    - Ipertensione incontrollata (pressione arteriosa (BP) sistolica ≥ 160 o BP diastolica > 100)
    - Ictus nei 3 mesi precedenti la visita di screening
    - Compromissione immunologica
    g. Paziente con test positivo al virus dell’immunodeficienza umana (HIV), con infezione da epatite B o epatite C.
    h. Evidenze cliniche visive di candidosi orale alla visita di screening.
    i. Storia di reazione avversa, compresa l’ipersensibilità immediata o ritardata a qualsiasi β2-agonista, agente simpatomimetico o terapia con corticosteroidi intranasali, inalatori o sistemici.
    j. Sensibilità nota o presunta ai componenti dei DPI (SPIROMAX o TURBOHALER) usati nello studio (es. lattosio).
    k. Storia di allergia grave alle proteine del latte.
    l. Uso di corticosteroidi sistemici, orali o a deposito nelle 4 settimane precedenti la visita di screening
    - L’uso di corticosteroidi topici (crema con idrocortisone ≤ 1%) per le malattie dermatologiche è ammesso
    - L’uso di corticosteroidi intranasali a una dose stabile o al bisogno può essere ammesso durante lo studio per il trattamento della rinite allergica.
    m. Uso di farmaci immunosoppressivi nelle 12 settimane precedenti la visita di screening e durante lo studio.
    n. L’immunoterapia a una dose stabile per almeno 90 giorni prima della visita di screening e per l’intera durata dello studio per il trattamento di allergie è ammessa.
    o. Uso di inibitori potenti del citocromo P450 3A4 (CYP3A4) (es. ritonavir, ketoconazolo, itraconazolo) nelle 4 settimane precedenti la visita di screening.
    p. Uso di farmaci concomitanti proibiti per indicazioni diverse dall’asma, come il trattamento con antagonisti del recettore β2-adrenergico e agenti bloccanti non selettivi del β-recettore, come prodotti antipertensivi β-bloccanti (qualsiasi via di somministrazione), inibitori della monoamino-ossidasi (MAO) e antidepressivi triciclici, entro 1 settimana prima della visita di screening.
    q. Storia di abuso di alcool o droghe nei 2 anni precedenti la visita di screening.
    Per i criteri di esclusione dalla (r) alla (v), si prega di fare riferimento al protocollo.
    E.5 End points
    E.5.1Primary end point(s)
    The primary efficacy measure and endpoint for this study is the change from baseline in weekly average of daily trough (predose and pre-rescue bronchodilator) AM PEF over the 12-week treatment period.
    L’endpoint primario di efficacia di questo studio è la variazione dal basale della media settimanale del valore minimo giornaliero (pre-dose e prima del broncodilatatore di salvataggio) del PEF AM nel periodo di trattamento di 12 settimane.
    E.5.1.1Timepoint(s) of evaluation of this end point
    PEF will be determined twice daily (AM and PM)
    PEF sarà determinato due volte al giorno (AM e PM)
    E.5.2Secondary end point(s)
    Secondary Efficacy Measures and Endpoints:
    1) change from baseline in weekly average of daily PM PEF over the 12-week treatment period
    2) change from baseline in the percentage of symptom-free 24-hour periods during the 12-week treatment period
    3) change from baseline in the percentage of rescue-free 24-hour periods during the 12-week treatment period
    4) change from baseline in trough (AM predose and pre-rescue bronchodilator) FEV1 over the 12-week treatment period
    5) change from baseline in Patient Satisfaction and Preference Questionnaire for Inhalation Devices (PASAPQ) total satisfaction score (Part I), performance and convenience domain scores (Part I), device preference category (Part II), and willingness to continue using the device score (Part II) at week 12
    6) change from baseline in overall inhaler quickness satisfaction score at week 12

    For all other Efficacy Measures and Endpoints, please refer to the protocol.

    Safety Measures and Endpoints
    • The safety of BF SPIROMAX will be assessed throughout the study by evaluating adverse events, oropharynx examination results, physical examination results, and vital signs measurements.

    For a subset of approximately 30 patients from 3-4 sites the following endpoints will be analyzed:
    1) the onset time when patients experience an increase of at least 12% above baseline FEV1 up to 6 hours
    2) duration of effect when patients experience an increase of at least 12% above baseline FEV1
    3) number of patients who experience at least 12% increase in FEV1 during 6 hours from baseline
    Gli endpoint secondari di efficacia sono i seguenti:
    1) variazione dal basale della media settimanale del PEF PM giornaliero nel periodo di trattamento di 12 settimane
    2) variazione dal basale della percentuale di periodi di 24 ore liberi da sintomi nel periodo di
    trattamento di 12 settimane
    3) variazione dal basale della percentuale di periodi di 24 ore senza farmaco di salvataggio nel
    periodo di trattamento di 12 settimane
    4) variazione dal basale del valore minimo di FEV1 (AM pre-dose e prima del broncodilatatore
    di salvataggio) nel periodo di trattamento di 12 settimane
    5) variazione dal basale del punteggio totale di soddisfazione PASAPQ (Parte I), dei punteggi
    delle prestazioni e della praticita (Parte I), categoria di preferenza del dispositivo (Parte II) e
    punteggio dell'intenzione di continuare a usare il dispositivo (Parte II) alla settimana 12
    6) variazione dal basale del punteggio complessivo di soddisfazione per la rapidità dell'inalatore
    alla settimana 12

    Per tutte le altre misure di efficacia ed endpoints, si prega di fare riferimento al protocollo.

    Misure di sicurezza ed endpoints
    La sicurezza di BF SPIROMAX sarà valutata nel corso dello studio attraverso la valutazione degli eventi avversi, risultati dell'esame orofaringeo, risultati dell'esame fisico e misurazioni dei segni vitali.

    Per un sottogruppo di circa 30 pazienti di 3-4 centri saranno analizzati i seguenti endpoint:
    1) il tempo di insorgenza in cui i pazienti manifestano un incremento almeno del 12% rispetto a FEV1 basale fino a 6 ore
    2) la durata dell’effetto per cui i pazienti manifestano un incremento almeno del 12% rispetto a
    FEV1 basale
    3) il numero di pazienti che manifestano un incremento almeno del 12% di FEV1 nelle 6 ore
    successive al basale
    E.5.2.1Timepoint(s) of evaluation of this end point
    Secondary Efficacy Measures and Endpoints:
    1,2,3) Recorded in patient diary daily throughout 12 week study treatment period
    4 and 5) Visit 2 (Day 1) and Visit 5 (Day 84)

    Safety Measures and Endpoints
    This will be monitored throughout the 12 week treatment period through the patient diary and at all visits (visits 2 to visit 5)

    Subset Endpoints
    1,2,3) Visit 2 (Day1- baseline), Visit 3, (Day 28) Visit 4 (Day 56), Visit 5 (Day 84) - please refer to protocol Study Procedures and Assessments for more information on timings of spirometry at each visit.
    Misure di efficacia ed endpoints secondari:
    1,2,3) Registrato nel diario del paziente tutti i giorni per tutta studio di 12 settimane
    periodo di trattamento 4 e 5) Visita 2 (giorno 1) e visita 5 (Giorno 84)

    Misure di sicurezza ed endpoints
    Questo sarà monitorato durante il periodo di 12 settimane di trattamento attraverso
    il diario del paziente e in tutte le visite (dalla visita 2 alla visita 5)

    Subset endpoints
    1,2,3) Visita 2 (Day1- basale), Visita 3 (Giorno 28) Visita 4 (giorno 56), Visita 5
    (Giorno 84) - si prega di far riferimento alle Procedure e Valutazioni del protocollo di studio per ulteriori informazioni sugli orari della spirometria ad ogni visita.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Non-inferiority
    Non-inferiorità
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    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.8.4.1Number of sites anticipated in Member State concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA114
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Austria
    Belgium
    Czech Republic
    Denmark
    Finland
    France
    Germany
    Hungary
    Israel
    Italy
    Netherlands
    Poland
    Russian Federation
    Spain
    Sweden
    Turkey
    United Kingdom
    E.8.7Trial 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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1Number of subjects for this age range: 90
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 90
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 595
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 15
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state15
    F.4.2 For a multinational trial
    F.4.2.2In the whole clinical trial 600
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Nessuno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2013-06-06
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2013-05-09
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2014-03-20
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