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    Clinical Trial Results:
    A randomized, multicenter, double-blind, placebo-controlled, parallel group study of the 12 month effect of treatment with once daily triamcinolone acetonide (NASACORT® AQ Nasal Spray 110 μg) on the growth velocity of children, 3 to 9 years of age, with perennial allergic rhinitis (PAR)

    Summary
    EudraCT number
    2014-004645-27
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    12 Oct 2011

    Results information
    Results version number
    v1(current)
    This version publication date
    01 Apr 2016
    First version publication date
    15 May 2015
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    XRG5029C_3503
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00449072
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Sanofi U.S Services Inc.
    Sponsor organisation address
    55 Corporate Drive Bridgewater, New Jersey, United States, NJ 08807
    Public contact
    Trial Transparency Team, Sanofi Aventis Recherche & Developpement, Contact-US@sanofi.com
    Scientific contact
    Trial Transparency Team, Sanofi Aventis Recherche & Developpement, Contact-US@sanofi.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    10 Nov 2011
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    12 Oct 2011
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of the study was to characterize the difference in prepubescent growth velocity in children 3 to 9 years of age with perennial allergic rhinitis (PAR) treated with triamcinolone acetonide (TAA) nasal spray (NASACORT® AQ 110 μg treatment group) or placebo (NASACORT® AQ placebo group) for 12-months.
    Protection of trial subjects
    The study was conducted by investigators experienced in the treatment of pediatric subjects. The parent(s) or guardian(s) as well as the children were fully informed of all pertinent aspects of the clinical trial as well as the possibility to discontinue at any time. In addition to the consent form for the parent(s)/guardian(s), an assent form in child-appropriate language was provided and explained to the child. Repeated invasive procedures were minimized. The number of blood samples as well as the amount of blood drawn were adjusted according to age and weight. A topical anesthesia may have been used to minimize distress and discomfort.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    14 Mar 2007
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 299
    Worldwide total number of subjects
    299
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    299
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted between 14 March 2007 (first subject enrolled) and 12 October 2011 (last subject last visit) at 69 active centers located in the US.

    Pre-assignment
    Screening details
    299 subjects were randomized, 298 were treated.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    3 to 9 year old subjects with PAR administered. - Placebo (once to demonstrate IP administration in the baseline/screening period). - Placebo in the double-blind treatment period. All subjects were provided Children's Claritin® Syrup as a rescue medication.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Nasal spray
    Routes of administration
    Nasal use
    Dosage and administration details
    Placebo to TAA-AQ was administered once at the study site in each nostril during the baseline/screening period to demonstrate intranasal IP administration. Placebo to TAA-AQ was administered intranasally once daily in each nostril during the double-blind period.

    Investigational medicinal product name
    Claritin® Syrup
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Syrup
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects were provided Children's Claritin® Syrup (5 mg of loratadine per 5 mL), as rescue medication for the relief of allergic rhinitis (AR) symptoms, and could be used throughout the study on an as needed basis according to the Food and Drug Administration-approved manufacturer's label.

    Arm title
    TAA-AQ
    Arm description
    3 to 9 year old subjects with Perennial Allergic Rhinitis (PAR) administered. - Placebo in the baseline/screening period to demonstrate administration of IP with the nasal spray bottle. - Triamcinolone acetonide (TAA-AQ) in the double-blind treatment period. All subjects were provided Children's Claritin® Syrup as a rescue medication.
    Arm type
    Experimental

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Nasal spray
    Routes of administration
    Nasal use
    Dosage and administration details
    Placebo to TAA-AQ was administered once at the study site in each nostril during the baseline/screening period to demonstrate intranasal IP administration.

    Investigational medicinal product name
    Triamcinolone acetonide aqueous (TAA-AQ) nasal spray (NASACORT AQ)
    Investigational medicinal product code
    XRG5029
    Other name
    Pharmaceutical forms
    Nasal spray
    Routes of administration
    Nasal use
    Dosage and administration details
    110 μg TAA-AQ was administered once daily intranasally (1 spray delivering 55 μg of TAA-AQ in each nostril) during the double-blind treatment period.

    Investigational medicinal product name
    Claritin® Syrup
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Syrup
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects were provided Children's Claritin® Syrup (5 mg of loratadine per 5 mL), as rescue medication for the relief of allergic rhinitis (AR) symptoms, and could be used throughout the study on an as needed basis according to the Food and Drug Administration-approved manufacturer's label.

    Number of subjects in period 1
    Placebo TAA-AQ
    Started
    148
    151
    Completed
    107
    109
    Not completed
    41
    42
         Relocation
    3
    2
         Physician decision
    1
    -
         Excluded medication
    -
    2
         Adverse event
    3
    1
         Non-compliance
    2
    5
         Protocol Violation
    14
    12
         'Withdrawal by subject '
    11
    8
         Sponsor decision
    1
    3
         Lost to follow-up
    5
    7
         Lack of efficacy
    1
    1
         Not treated
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    3 to 9 year old subjects with PAR administered. - Placebo (once to demonstrate IP administration in the baseline/screening period). - Placebo in the double-blind treatment period. All subjects were provided Children's Claritin® Syrup as a rescue medication.

    Reporting group title
    TAA-AQ
    Reporting group description
    3 to 9 year old subjects with Perennial Allergic Rhinitis (PAR) administered. - Placebo in the baseline/screening period to demonstrate administration of IP with the nasal spray bottle. - Triamcinolone acetonide (TAA-AQ) in the double-blind treatment period. All subjects were provided Children's Claritin® Syrup as a rescue medication.

    Reporting group values
    Placebo TAA-AQ Total
    Number of subjects
    148 151 299
    Age categorical
    Age group at screening
    Units: Subjects
        <=3 to <6 years
    64 65 129
        <=6 to <10 years
    84 86 170
    Age continuous
    Age at screening
    Units: years
        arithmetic mean (standard deviation)
    6.24 ± 1.55 6.12 ± 1.62 -
    Gender categorical
    Units: Subjects
        Female
    62 64 126
        Male
    86 87 173
    Race
    Units: Subjects
        Caucasian/White
    114 111 225
        Black
    22 28 50
        Asian/Oriental
    4 1 5
        American Indian or Alaska Native
    0 1 1
        Native Hawaiian or other Pacific Island
    0 0 0
        Other
    8 10 18
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    23 33 56
        Not Hispanic or Latino
    125 118 243
    Tanner classification at randomization
    Tanner classification distinguishes stages of puberty. Each stage differentiates the extent of breast, genitalia and pubic hair growth. Tanner Stage I represents the preadolescent stage where breast, genitalia and pubic hair growth are of the same size and shape as in early childhood; and in Tanner Stage 5 breasts and genitalia are of adult shape and size, and pubic hair is adult in quantity (mature stage). Stages 2, 3 and 4 are intermediate stages.
    Units: Subjects
        Stage 1
    148 151 299
        Stage 2
    0 0 0
        Stage 3
    0 0 0
        Stage 4
    0 0 0
        Stage 5
    0 0 0

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    3 to 9 year old subjects with PAR administered. - Placebo (once to demonstrate IP administration in the baseline/screening period). - Placebo in the double-blind treatment period. All subjects were provided Children's Claritin® Syrup as a rescue medication.

    Reporting group title
    TAA-AQ
    Reporting group description
    3 to 9 year old subjects with Perennial Allergic Rhinitis (PAR) administered. - Placebo in the baseline/screening period to demonstrate administration of IP with the nasal spray bottle. - Triamcinolone acetonide (TAA-AQ) in the double-blind treatment period. All subjects were provided Children's Claritin® Syrup as a rescue medication.

    Primary: Growth Velocity

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    End point title
    Growth Velocity
    End point description
    Individual subject's growth velocity over double-blind treatment period was calculated using a linear regression of height over time. Height was measured on the same wall-mounted Harpenden stadiometer with the subject barefoot and in light clothing. The modified intent-to-treat (mITT) population included all intent-to-treat subjects who had at least 3 postrandomization visits with recorded height measurements during the double-blind treatment period, excluding those from Good Clinical Practice (GCP) noncompliant sites.
    End point type
    Primary
    End point timeframe
    Day 1 to end of treatment (Day 360)
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    133
    134
    Units: centimeter/year
        least squares mean (standard error)
    6.09 ± 0.122
    5.65 ± 0.122
    Statistical analysis title
    TAA-AQ vs Placebo
    Statistical analysis description
    The treatment arm, age group (at Visit 1) and sex were fixed effects, and baseline growth velocity was a covariate in the ANCOVA model.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0096
    Method
    ANCOVA
    Parameter type
    Least squares mean difference
    Point estimate
    -0.45
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.78
         upper limit
    -0.11

    Secondary: Change From Baseline in Instantaneous Total Nasal Symptom Score (TNSS)

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    End point title
    Change From Baseline in Instantaneous Total Nasal Symptom Score (TNSS)
    End point description
    PAR symptoms nasal stuffiness, nasal discharge, sneezing, and nasal itching were scored upon arising in the morning according to the following 4point scale: 0 = symptom absent, 1 = mild (present but not annoying to self), 2 = moderate (annoying to self but not interfering with sleep or daily living), 3 = severe (interfered with daily living and/or sleep) TNSS was the sum of the individual symptom scores (ranging 0-3), and TNSS ranged from 0 (best outcome) to 12 (worst outcome). A negative value for change represents an improvement in symptoms. mITT population with scores available for TNSS: All randomized and treated subjects with at least 3 post-randomization height measurements during the double-blind treatment period with scores available for TNSS, excluding those from GCP noncompliant sites.
    End point type
    Secondary
    End point timeframe
    For 7 days prior to randomization (Baseline) and everyday for 7 days prior to Day 360 (end of treatment)
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    102
    104
    Units: score on a scale
        least squares mean (standard error)
    -2.68 ± 0.26
    -2.8 ± 0.25
    Statistical analysis title
    TAA-AQ vs Placebo
    Statistical analysis description
    The treatment arm, sex and age group were fixed effects, and baseline value was a covariate in the ANCOVA model.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    206
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7341
    Method
    ANCOVA
    Parameter type
    Least squares mean difference
    Point estimate
    -0.12
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.83
         upper limit
    0.58

    Secondary: Change From Baseline in Four Individual Nasal Symptom Scores at the End of Treatment

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    End point title
    Change From Baseline in Four Individual Nasal Symptom Scores at the End of Treatment
    End point description
    PAR symptoms - nasal stuffiness, nasal discharge, sneezing, and nasal itching were scored upon arising in the morning according to the following 4-point scale: 0 = symptom absent 1 = mild (present but not annoying to self) 2 = moderate (annoying to self but not interfering with sleep or daily living) 3 = severe (interfered with daily living and/or sleep) Individual symptom scores ranged from 0 (best outcome) to 3 (worst outcome). A negative value for change represents an improvement in symptoms. mITT population with available nasal symptom scores: All randomized and treated participants with at least 3 post-randomization height measurements during the double-blind treatment period with available nasal symptom scores, excluding those from GCP noncompliant sites.
    End point type
    Secondary
    End point timeframe
    For 7 days prior to randomization (Baseline) and everyday for 7 days prior to Day 360 (end of treatment)
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    133
    134
    Units: score on a scale
    least squares mean (standard error)
        Nasal stuffiness (N=101, N=104)
    -0.68 ± 0.08
    -0.83 ± 0.08
        Nasal discharge (N=102, N=103)
    -0.67 ± 0.07
    -0.71 ± 0.07
        Sneezing (N=102, N=103)
    -0.64 ± 0.07
    -0.55 ± 0.07
        Nasal itching (N=101, N=104)
    -0.69 ± 0.08
    -0.71 ± 0.08
    Statistical analysis title
    Change in nasal stuffiness
    Statistical analysis description
    The treatment arm, sex and age group were fixed effects, and baseline value was a covariate in the ANCOVA model.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.1963
    Method
    ANCOVA
    Parameter type
    Least squares mean difference
    Point estimate
    -0.15
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.37
         upper limit
    0.08
    Statistical analysis title
    Change in Nasal Discharge
    Statistical analysis description
    The treatment arm, sex and age group were fixed effects, and baseline value was a covariate in the ANCOVA model.
    Comparison groups
    TAA-AQ v Placebo
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7193
    Method
    ANCOVA
    Parameter type
    Least squares mean difference
    Point estimate
    -0.04
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.24
         upper limit
    0.17
    Statistical analysis title
    Change in Sneezing
    Statistical analysis description
    The treatment arm, sex and age group were fixed effects, and baseline value was a covariate in the ANCOVA model.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.402
    Method
    ANCOVA
    Parameter type
    Least squares mean difference
    Point estimate
    0.09
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.12
         upper limit
    0.29
    Statistical analysis title
    Change in Nasal Itching
    Statistical analysis description
    The treatment arm, sex and age group were fixed effects, and baseline value was a covariate in the ANCOVA model.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.8854
    Method
    ANCOVA
    Parameter type
    Least squares mean difference
    Point estimate
    -0.02
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.23
         upper limit
    0.2

    Secondary: Global Efficacy as Assessed by the Subject (With the Help of a Parent/Guardian/Caregiver) During and at the End of the Double-blind Treatment Period

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    End point title
    Global Efficacy as Assessed by the Subject (With the Help of a Parent/Guardian/Caregiver) During and at the End of the Double-blind Treatment Period
    End point description
    Global efficacy was assessed by the subject (with the help of a parent/guardian/caregiver) using the following scale: 0 = no relief (symptoms unchanged or worse than before), 1 = slight relief (symptoms were present and only minimally improved) 2 = moderate relief (symptoms were present and could have been troublesome but were noticeably improved) 3 = marked relief (symptoms were greatly improved and although present were scarcely troublesome) 4 = complete relief (virtually no symptom present). mITT population: All randomized and treated subjects with at least 3 post-randomization height measurements during the double-blind treatment period, excluding those from GCP noncompliant sites.
    End point type
    Secondary
    End point timeframe
    Day 120, Day 240 and Day 360
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    133
    134
    Units: score on a scale
    arithmetic mean (standard deviation)
        Day 120 (N=127, N=131)
    1.87 ± 1.1
    2.09 ± 1
        Day 240 (N=115, N=116)
    1.97 ± 1.04
    2.16 ± 1.03
        Day 360 (N=125, N=125)
    1.86 ± 1.08
    2.18 ± 1.19
    Statistical analysis title
    Statistical Analysis for Day 120
    Statistical analysis description
    The treatment arm, assessment visit, their interaction, sex and age group were fixed effects, and assessment visit was a repeated factor.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0951
    Method
    Mixed model for repeated measures
    Confidence interval
    Statistical analysis title
    Statistical analysis for Day 240
    Statistical analysis description
    The treatment arm, assessment visit, their interaction, sex and age group were fixed effects, and assessment visit was a repeated factor.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.1247
    Method
    Mixed model for repeated measures
    Confidence interval
    Statistical analysis title
    Statistical analysis for Day 360
    Statistical analysis description
    The treatment arm, assessment visit, their interaction, sex and age group were fixed effects, and assessment visit was a repeated factor.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0207
    Method
    Mixed model for repeated measures
    Confidence interval

    Secondary: Global Efficacy as Assessed by the Investigator During and at the End of the Double-blind Treatment Period

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    End point title
    Global Efficacy as Assessed by the Investigator During and at the End of the Double-blind Treatment Period
    End point description
    Global efficacy was assessed by the investigator using the following scale: 0 = no relief (symptoms unchanged or worse than before) 1 = slight relief (symptoms were present and only minimally improved) 2 = moderate relief (symptoms were present and could have been troublesome but were noticeably improved) 3 = marked relief (symptoms were greatly improved and although present were scarcely troublesome) 4 = complete relief (virtually no symptom present). mITT population: All randomized and treated subjects with at least 3 post-randomization height measurements during the double-blind treatment period, excluding those from GCP noncompliant sites.
    End point type
    Secondary
    End point timeframe
    Day 120, Day 240 and Day 360
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    133
    134
    Units: score on a scale
    arithmetic mean (standard deviation)
        Day 120 (N=128, N=130)
    1.89 ± 1.11
    2.04 ± 1.04
        Day 240 (N=115, N=136)
    2.11 ± 1.07
    2.21 ± 1.08
        Day 360 (N=125, N=125)
    1.8 ± 0.98
    2.14 ± 1.16
    Statistical analysis title
    Statistical Analysis for Day 120
    Statistical analysis description
    The treatment arm, assessment visit, their interaction, sex and age group were fixed effects, and assessment visit was a repeated factor.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.2445
    Method
    Mixed model for repeated measures
    Confidence interval
    Statistical analysis title
    Statistical Analysis for Day 240
    Statistical analysis description
    The treatment arm, assessment visit, their interaction, sex and age group were fixed effects, and assessment visit was a repeated factor.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.4488
    Method
    Mixed model for repeated measures
    Confidence interval
    Statistical analysis title
    Statistical Analysis for Day 360
    Statistical analysis description
    The treatment arm, assessment visit, their interaction, sex and age group were fixed effects, and assessment visit was a repeated factor.
    Comparison groups
    Placebo v TAA-AQ
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0142
    Method
    Mixed model for repeated measures
    Confidence interval

    Secondary: Percentage of Subjects Who Used the Rescue Medication During the Double-blind Phase of the Study

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    End point title
    Percentage of Subjects Who Used the Rescue Medication During the Double-blind Phase of the Study
    End point description
    Children's Claritin® syrup was provided as a rescue medication to control allergic rhinitis (AR) symptoms and could be used throughout the study on an as needed basis. Use of rescue medication was to be documented in the subject's diary. The percentage of subjects who used the rescue medication during each of the study periods is reported. mITT population: All randomized and treated subjects with at least 3 post-randomization height measurements during the double-blind treatment period, excluding those from GCP noncompliant sites.
    End point type
    Secondary
    End point timeframe
    Baseline (4-6 months before Day 1), double-blind treatment period (Day 1 to Day 360) and follow-up (Day 361 to Day 420)
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    133
    134
    Units: percentage of subjects
        number (not applicable)
    81.2
    90.3
    No statistical analyses for this end point

    Secondary: Percentage of Days Subjects Used the Rescue Medication During the Double-blind Treatment Phase of the Study

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    End point title
    Percentage of Days Subjects Used the Rescue Medication During the Double-blind Treatment Phase of the Study
    End point description
    Children's Claritin® syrup was provided as a rescue medication to control allergic rhinitis (AR) symptoms and could be used throughout the study on an as needed basis. Use of rescue medication was to be documented in the subject's diary. The percentage of days that subjects used the rescue medication during the double-blind treatment phase of the study. mITT population: All randomized and treated subjects with at least 3 post-randomization height measurements during the double-blind treatment period, excluding those from GCP noncompliant sites.
    End point type
    Secondary
    End point timeframe
    double-blind treatment period (Day 1 to Day 360)
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    133
    134
    Units: percentage of days
        arithmetic mean (standard deviation)
    20.39 ± 28.02
    15.69 ± 21.53
    No statistical analyses for this end point

    Secondary: 24 Hour Urinary Free Cortisol Levels

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    End point title
    24 Hour Urinary Free Cortisol Levels
    End point description
    Urine cortisol levels was determined at screening, at the end of treatment, and at follow-up visit using routine laboratory testing. The normal range for urinary free cortisol for 3- to 9-year-olds was considered to be [1.4 - 21 μg/24 hours]. All randomized and treated subjects, excluding those from GCP noncompliant sites.
    End point type
    Secondary
    End point timeframe
    Baseline (2 to 6 weeks before Day 1), end of treatment (Day 360), and at follow-up (Day 420)
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    147
    146
    Units: μg/24 hours
    arithmetic mean (standard deviation)
        at baseline (N=146, N=141)
    7.44 ± 4.23
    7.44 ± 4.04
        at end of treatment (EOT) (N=114, N=118)
    7.05 ± 5.33
    7.42 ± 5.93
        at follow-up (N=96, N=97)
    7.85 ± 5.65
    7 ± 5.28
    No statistical analyses for this end point

    Secondary: 24 Hour Cortisol/Creatinine Ratio

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    End point title
    24 Hour Cortisol/Creatinine Ratio
    End point description
    Urine cortisol and creatinine levels were determined at screening, at the end of treatment, and at follow-up visit using routine laboratory testing. The normal range for urinary free cortisol for 3- to 9-year-olds was considered to be [1.4 - 21 μg/24 hours]. No normal range is available for cortisol/creatinine ratio. All randomized and treated subjects, excluding those from GCP noncompliant sites.
    End point type
    Secondary
    End point timeframe
    Baseline (2 to 6 weeks before Day 1), end of treatment (Day 360), and at follow-up (Day 420)
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    147
    146
    Units: μg/g Creatinine
    arithmetic mean (standard deviation)
        at baseline (N=145, N=141)
    18.94 ± 9.64
    19.44 ± 10.62
        at end of treatment (N=114, N=118)
    15.47 ± 12.6
    15.86 ± 10.77
        at follow-up (N=96, N=97)
    17.01 ± 12.63
    15.1 ± 9.54
    No statistical analyses for this end point

    Secondary: Number of Subjects With Treatment-emergent Adverse Events (TEAE)

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    End point title
    Number of Subjects With Treatment-emergent Adverse Events (TEAE)
    End point description
    Adverse events that developed, worsened, or became serious during the double-blind treatment period or within 7 days after the last dose of double-blind investigational product (IP) are defined as TEAEs. A serious adverse event (SAE) was defined as any untoward medical occurrence that at any dose: •Resulted in death •Was life-threatening •Required inpatient hospitalization or prolongation of existing hospitalization •Resulted in persistent or significant disability/incapacity •Was a congenital anomaly/birth defect •Was a medically important event. All randomized and treated subjects, excluding those from GCP noncompliant sites.
    End point type
    Secondary
    End point timeframe
    From Day 1 to 7 days following end of treatment (Day 360)
    End point values
    Placebo TAA-AQ
    Number of subjects analysed
    147
    146
    Units: subjects
        with any TEAE
    113
    117
        with any treatment emergent SAE
    0
    2
        with any TEAE leading to permanent discontinuation
    3
    1
        with any TEAE leading to death
    0
    0
        with investigational product (IP) overdose TEAE
    0
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From treatment initiation to 7 days after the last dose of double-blind treatment (double blind treatment period)
    Adverse event reporting additional description
    Adverse events that developed, worsened, or became serious during the double-blind treatment period or within 7 days after the last dose of double-blind period, i.e. Treatment-emergent adverse events.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    14.1
    Reporting groups
    Reporting group title
    TAA-AQ
    Reporting group description
    Placebo at screening and Triamcinolone acetonide administered in the treatment period. All subjects were provided Children's Claritin® Syrup as a rescue medication.

    Reporting group title
    Placebo
    Reporting group description
    Placebo matched to triamcinolone acetonide at baseline and in the treatment period. All subjects were provided Children's Claritin® Syrup as a rescue medication.

    Serious adverse events
    TAA-AQ Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    2 / 146 (1.37%)
    0 / 147 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    Injury, poisoning and procedural complications
    Animal Bite
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 147 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Colitis Ulcerative
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 147 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    TAA-AQ Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    109 / 146 (74.66%)
    98 / 147 (66.67%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    34 / 146 (23.29%)
    31 / 147 (21.09%)
         occurrences all number
    98
    69
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    31 / 146 (21.23%)
    37 / 147 (25.17%)
         occurrences all number
    42
    62
    Ear and labyrinth disorders
    Ear Pain
         subjects affected / exposed
    7 / 146 (4.79%)
    14 / 147 (9.52%)
         occurrences all number
    7
    15
    Gastrointestinal disorders
    Vomiting
         subjects affected / exposed
    19 / 146 (13.01%)
    8 / 147 (5.44%)
         occurrences all number
    28
    10
    Abdominal Pain Upper
         subjects affected / exposed
    16 / 146 (10.96%)
    15 / 147 (10.20%)
         occurrences all number
    34
    21
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    10 / 146 (6.85%)
    10 / 147 (6.80%)
         occurrences all number
    15
    17
    Cough
         subjects affected / exposed
    29 / 146 (19.86%)
    30 / 147 (20.41%)
         occurrences all number
    45
    51
    Oropharyngeal Pain
         subjects affected / exposed
    17 / 146 (11.64%)
    18 / 147 (12.24%)
         occurrences all number
    32
    30
    Epistaxis
         subjects affected / exposed
    16 / 146 (10.96%)
    7 / 147 (4.76%)
         occurrences all number
    27
    23
    Nasal Congestion
         subjects affected / exposed
    6 / 146 (4.11%)
    11 / 147 (7.48%)
         occurrences all number
    9
    17
    Rhinorrhoea
         subjects affected / exposed
    8 / 146 (5.48%)
    9 / 147 (6.12%)
         occurrences all number
    17
    13
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    10 / 146 (6.85%)
    4 / 147 (2.72%)
         occurrences all number
    19
    5
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    28 / 146 (19.18%)
    18 / 147 (12.24%)
         occurrences all number
    46
    32
    Otitis Media
         subjects affected / exposed
    4 / 146 (2.74%)
    8 / 147 (5.44%)
         occurrences all number
    5
    8
    Pharyngitis Streptococcal
         subjects affected / exposed
    12 / 146 (8.22%)
    10 / 147 (6.80%)
         occurrences all number
    17
    14
    Sinusitis
         subjects affected / exposed
    12 / 146 (8.22%)
    11 / 147 (7.48%)
         occurrences all number
    14
    17
    Influenza
         subjects affected / exposed
    10 / 146 (6.85%)
    3 / 147 (2.04%)
         occurrences all number
    10
    3
    Gastroenteritis Viral
         subjects affected / exposed
    8 / 146 (5.48%)
    6 / 147 (4.08%)
         occurrences all number
    10
    7
    Upper Respiratory Tract Infection
         subjects affected / exposed
    25 / 146 (17.12%)
    19 / 147 (12.93%)
         occurrences all number
    34
    27
    Viral Infection
         subjects affected / exposed
    9 / 146 (6.16%)
    3 / 147 (2.04%)
         occurrences all number
    9
    4
    Viral Upper Respiratory Tract Infection
         subjects affected / exposed
    9 / 146 (6.16%)
    9 / 147 (6.12%)
         occurrences all number
    11
    14

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    05 Jul 2005
    - Removal of the nasal spray aerosol type only. - Removal Single-blind single-blind NASACORT AQ placebo, which was planned at baseline. - Removal of stratification by age grouping. - Removal of randomization procedure, including Interactive voice response system. - Removal of statistical methods, including subset analyses. - Removal of the NASACORT AQ HFA Nasal Aerosol reference materials.
    27 Sep 2005
    - Limiting the inclusion age to 3 years of age and older. - Clarifying why mild asthma is an inclusion criterion. - Excluding children with a bone age which is different from chronological age by more than 1 year. - Withholding intranasal corticosteroids and high potency topical corticosteroids for at least 6 weeks prior to baseline assessments. - Performing an additional physical examination and Tanner staging at the final follow-up visit (Visit 11). - Use of the 12-hour urinary free cortisol and not the urinary free cortisol corrected for creatinine to assess the effect of treatment on hypothalamic-pituitary-adrenal (HPA) axis. - Repeating the PAR symptoms assessment at the end of treatment, in addition to the proposed 14-day assessment prior to randomization. - Additional analyses to be included: A subset analysis excluding any subject who exhibits >Tanner Stage 2 characteristics at the end of treatment period; An analysis of the percent of children who are below a certain percentile of growth velocity (eg, 3 rd percentile) or percent of children whose percentile of height decreases during the treatment period; A subset analysis excluding children who receive systemic corticosteroids during the double-blind treatment period. - A statistical analysis adjusting for the age factor in order to prevent variation between strata that could contribute to variation in the treatment effect. - A linear regression model as it is a better method to estimate growth velocity since it takes into account all height measurements during the treatment period (vs change from baseline in height where it does not). - Removal CLARITIN Reditabs as a rescue medication option.
    09 Jan 2006
    Corrections in typographical errors and clarification of the timing of the dose.
    15 Sep 2006
    - An administrative change in responsible medical expert and sponsor signatory. - A change in the protocol title to extend the age range from 3-8 to 3-9 (9 year old males only). - A correction in the study duration and dates. - Re-wording of the Primary and Secondary Objectives; Inclusion and Exclusion Criteria; Concomitant Treatments section for greater clarity - A change in the Study Design to remove the Single-Blind Run-In period and insert the use of demo placebo prior to randomization at Visit 3 - A change in Urinary Cortisol from 12 hour to 24 hour along with insertion of cortisol/creatinine ratio assessment in addition to urinary free cortisol; and insertion of normal ranges. - A change in the Treatments section to add demo placebo and greater detail regarding the use of the rescue medication, Claritin Syrup. - A change in study schedule at Visit 2 from -2 wks to -3 weeks to allow 1 week in which to complete the 24 urine collection and to ensure results are available to site prior to Visit 3, Randomization; also inserted early term visit procedures. - The Period of Observation extended to the time the last 24 hour urine specimen is returned after the final visit (V11 or Early Term Visit). - Inclusion of the revised NASACORT AQ package insert. - Deletion of the Appendices for the US NCHS Growth charts for boys and girls-5th to 95th percentiles, as only the 3rd to 97th percentile growth charts were to be used.
    16 Jan 2007
    - Correction in staff location and nonfunctional hyperlinks. - Acceptance of an alternative bone image for bone assessment. - Modification of the inclusion criterion for rhinitis symptom score. - Demonstration of the placebo actuator earlier. - Adjustment of rescue medication use per manufacturer’s instructions. - Inclusion of a compliance measurement of partial dose administration. - Restriction of wearing shoes, socks, or head cover during height and weight measurements and allow a subject to wear light clothing or gown during height and weight measurements - Clarification that subject-reported daily diaries were to be dispensed at Visit 1 and collected, reviewed, and dispensed at Visits 2, 11, and early withdrawal Clarification of when subjects might prematurely be withdrawn - Administration of the first dose at the site - Clarification that subjects who become toilet trained after Visit 2 and did not complete the Visit 2 urine collection would not participate in the 24-hour urine collection procedure - Clarification that subjects who may have an abnormal cortisol at Visit 11 or an early withdrawal visit should either be continued for follow- up or referred to another physician – with documentation in the case report form - Permit the investigator or their designee to assess the validity of the 24-hour urine specimen - Define overdose by the sponsor - Permission of breaking of the blind by the investigator for expedited reporting or emergency medical treatment that would result in subject withdrawal.
    11 Sep 2008
    - Changed Visit 10 study day from 365 ± 5 to 360 ± 5 days after Visit 3. - Deletion of bone age Inclusion and Exclusion criteria at Visit 2. - Removal of bone age assessment from the protocol. - Addition of Inclusion criterion: subjects must be toilet-trained. - Addition of exclusion criterion: abnormal 24-hour urinary free cortisol level. - Clarification of Upper Respiratory Tract Infection, sinus infection, or nasal candidiasis. - Clarification of inclusion criterion to specify “legal guardian” and to require subjects 7 years of age and older to provide a signed assent form. - Changed the expected duration of the study from 44 months to 56 months, and the end of subject recruitment from 1st quarter 2009 to 1st quarter 2010. - Provided instructions regarding the labeling of each bottle of the investigational product and instructions to subjects and caregivers. - Provided compliance rate calculation and dosing adherence post-randomization. - Deletion of exclusion criterion regarding concomitant use of nasal or oral antihistamine or decongestant or oral leukotriene modifier prior to Visit 3. - Expanded visit window for screening (Visit 1) and baseline (Visit 2). - Added permission to allow non-randomized subject to be re-screened and re-entered into the study. - Clarification of sample size calculation. - Broadening the definition of ITT population to include all subjects who received at least 1 dose of investigational product, regardless of their randomization status. - Clarification of the End of Study follow-up period. - Changed “Early Withdrawal” to “Early Termination”. - Clarification that End of Study (Follow-up/post-treatment) Visit 11 procedures should be completed at 60 ± 5 days after Visit 10 or an Early Termination visit. - Changed the 6-month visit date from 182 ± 5 days to 180 days ± 5 days and 12-month visit date from 365 ± 5 days to 360 ± 5 days. - Changed language to clarify stratification by age and sex.
    01 Dec 2008
    - Expansion the number of clinical sites (from 60 to 100). - Clarification of systemic corticosteroid exclusion criterion: Treatment with systemic corticosteroids >2 courses received up to 1 year before Visit 1 was exclusionary. Up to 2 courses of systemic corticosteroids, each course not exceeding 14 days, up to 1 year before Visit 1 was allowed.
    23 Apr 2010
    - Conduct the primary analysis in the mITT population. - Conduct sensitivity analyses in the intent-to-treat (ITT) and per-protocol (PP) populations and other defined analysis sets. - Define an mITT and PP population(s). - Broaden the desired precision for growth velocity to a total width of 2*0.45 cm/year. - Recalculate the sample size based on the desired precision . - Identify unusual individual growth velocities and discuss their impact on the results of the overall analysis of growth velocity in the clinical study report. - Perform statistical analyses that exclude questionable height measurements and include the percent of subjects who are below certain percentiles of growth velocity. - Perform descriptive statistics (comparison) on the growth velocities by sex and ethnicity. - Summarize the number of subjects at each visit (from screening to follow-up) by investigational product treatment group. - Conduct sensitivity analysis using the random-effects model accounting for repeated height measurements within subjects and for the difference in variance of the estimated individual growth slopes when the number of height measurements per subject varies across subjects

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Two study sites with significant GCP noncompliance were reported to the U.S. Food and Drug Administration (FDA) by the Sponsor. A total of 5 treated participants (1 placebo and 4 TAA-AQ) from these 2 study sites were excluded from the analysis.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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