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    Clinical Trial Results:
    A 24-week treatment, multi-center, randomized, double-blind, double-dummy, parallel group study to compare Umeclidinium/Vilanterol, Umeclidinium, and Salmeterol in subjects with chronic obstructive pulmonary disease (COPD)

    Summary
    EudraCT number
    2016-002513-22
    Trial protocol
    SE   ES   DE   FR   NL   IT  
    Global end of trial date
    18 Jun 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    03 Jul 2019
    First version publication date
    03 Jul 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    201749
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    GlaxoSmithKline
    Sponsor organisation address
    980 Great West Road, Brentford, Middlesex, United Kingdom, TW8 9GS
    Public contact
    GSK Response Center, GlaxoSmithKline, 1 8664357343, GSKClinicalSupportHD@gsk.com
    Scientific contact
    GSK Response Center, GlaxoSmithKline, 1 8664357343, GSKClinicalSupportHD@gsk.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?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    15 Oct 2018
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    18 Jun 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To compare the effect of Umeclidinium/Vilanterol [(UMEC/VI) 62.5/25 mcg once daily] with Umeclidinium [UMEC (62.5 mcg once daily)] on lung function.
    Protection of trial subjects
    The protection of trial participants was enhanced by excluding participants with unstable liver and cardiac disease, pneumonia and/or moderate COPD exacerbation that had not resolved at least 14 days prior to screening, had >1 moderate exacerbation in the 12 months prior Screening, or 1 severe exacerbation requiring hospitalisation in the 12 months prior screening or other respiratory tract infections that had not resolved at least 7 days prior to screening. Female participants were only eligible to participate if they were not pregnant (as confirmed by a negative urine human chorionic gonadotrophin [hCG] test) and not lactating. Protocol-defined stopping criteria were put in place to safeguard participants and included: • Elevated liver chemistry • Positive urine pregnancy test. Unstable or life-threatening cardiac events (myocardial infarction, hospitalisation for unstable angina, stroke, and other CV events considered life- or intensively health-threatening by the study physician). • Participants with 2 moderate or 1 severe COPD exacerbation during the study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    16 Jun 2017
    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
    Argentina: 549
    Country: Number of subjects enrolled
    Australia: 35
    Country: Number of subjects enrolled
    Canada: 83
    Country: Number of subjects enrolled
    France: 36
    Country: Number of subjects enrolled
    Germany: 645
    Country: Number of subjects enrolled
    Italy: 77
    Country: Number of subjects enrolled
    Mexico: 35
    Country: Number of subjects enrolled
    Netherlands: 37
    Country: Number of subjects enrolled
    South Africa: 63
    Country: Number of subjects enrolled
    Spain: 78
    Country: Number of subjects enrolled
    Sweden: 109
    Country: Number of subjects enrolled
    United States: 678
    Worldwide total number of subjects
    2425
    EEA total number of subjects
    982
    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)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    1198
    From 65 to 84 years
    1208
    85 years and over
    19

    Subject disposition

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    Recruitment
    Recruitment details
    In this randomized, double-blind, double dummy, 3-arm parallel group study, eligible participants received Umeclidinium/Vilanterol (UMEC/VI) 62.5/25 microgram (mcg) once daily via the ELLIPTA dry powder inhaler (DPI), or UMEC 62.5 mcg once daily via ELLIPTA DPI, or Salmeterol (SAL) 50 mcg twice daily via the DISKUS DPI (1:1:1) for 24 weeks.

    Pre-assignment
    Screening details
    A total of 3591 participants who met the eligibility criteria were screened; 2431 participants were randomized and 2425 comprised the Intent to Treat (ITT) population (6 participants randomized in error and did not receive any treatment).The study consisted of a run-in period (4 weeks), treatment period (24 weeks) and follow up period (7+/-3 days).

    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
    UMEC/VI 62.5/25 mcg+ Placebo
    Arm description
    Participants with COPD received UMEC/VI 62.5/25 mcg once daily via the ELLIPTA DPI along with placebo twice daily via the DISKUS DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.
    Arm type
    Experimental

    Investigational medicinal product name
    UMEC/VI
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Participants received UMEC/VI, 62.5 mcg/25 mcg inhalation powder via ELLIPTA, once daily in the morning.

    Investigational medicinal product name
    Placebo via DISKUS
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Participants received placebo inhalation powder via DISKUS, one dose in the morning and one in the evening.

    Investigational medicinal product name
    Albuterol/salbutamol
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Participants received albuterol/salbutamol as a rescue medication via metered-dose inhaler (MDI) with a spacer which was used when needed during the study

    Arm title
    UMEC 62.5 mcg + Placebo
    Arm description
    Participants with COPD received UMEC 62.5mcg once daily via the ELLIPTA DPI along with placebo twice daily via DISKUS DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.
    Arm type
    Experimental

    Investigational medicinal product name
    UMEC
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Participants received UMEC 62.5 mcg inhalation powder via ELLIPTA, once daily in the morning.

    Investigational medicinal product name
    Placebo via DISKUS
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Participants received placebo inhalation powder via DISKUS, one dose in the morning and one in the evening.

    Investigational medicinal product name
    Albuterol/salbutamol
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Participants received albuterol/salbutamol as a rescue medication via metered-dose inhaler (MDI) with a spacer which was used when needed during the study

    Arm title
    Salmeterol 50 mcg+Placebo
    Arm description
    Participants with COPD received salmeterol 50 mcg twice daily via the DISKUS DPI along with placebo once daily via ELLIPTA DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.
    Arm type
    Experimental

    Investigational medicinal product name
    Salmeterol
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Participants received salmeterol 50 mcg administered one dose in the morning and one in the evening via DISKUS

    Investigational medicinal product name
    Placebo via ELLIPTA
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Participants received placebo inhalation powder via ELLIPTA, once daily in the morning.

    Investigational medicinal product name
    Albuterol/salbutamol
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Participants received albuterol/salbutamol as a rescue medication via metered-dose inhaler (MDI) with a spacer which was used when needed during the study

    Number of subjects in period 1
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Started
    812
    804
    809
    Completed
    717
    650
    683
    Not completed
    95
    154
    126
         Adverse event, serious fatal
    5
    2
    2
         Consent withdrawn by subject
    29
    46
    41
         Physician decision
    1
    5
    2
         Adverse event, non-fatal
    24
    30
    20
         Protocol Deviation
    2
    14
    7
         Protocol-defined withdrawal criteria met
    19
    26
    29
         Site closed
    2
    2
    4
         Lost to follow-up
    5
    13
    3
         Lack of efficacy
    8
    16
    18

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    UMEC/VI 62.5/25 mcg+ Placebo
    Reporting group description
    Participants with COPD received UMEC/VI 62.5/25 mcg once daily via the ELLIPTA DPI along with placebo twice daily via the DISKUS DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.

    Reporting group title
    UMEC 62.5 mcg + Placebo
    Reporting group description
    Participants with COPD received UMEC 62.5mcg once daily via the ELLIPTA DPI along with placebo twice daily via DISKUS DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.

    Reporting group title
    Salmeterol 50 mcg+Placebo
    Reporting group description
    Participants with COPD received salmeterol 50 mcg twice daily via the DISKUS DPI along with placebo once daily via ELLIPTA DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.

    Reporting group values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo Total
    Number of subjects
    812 804 809 2425
    Age categorical
    Units: Subjects
        In utero
    0 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0 0
        Newborns (0-27 days)
    0 0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0 0
        Children (2-11 years)
    0 0 0 0
        Adolescents (12-17 years)
    0 0 0 0
        Adults (18-64 years)
    400 398 400 1198
        From 65-84 years
    402 399 407 1208
        85 years and over
    10 7 2 19
    Age Continuous
    Units: Years
        arithmetic mean (standard deviation)
    64.6 ( 8.37 ) 64.9 ( 8.48 ) 64.4 ( 8.53 ) -
    Sex: Female, Male
    Units: Subjects
        Female
    319 327 342 988
        Male
    493 477 467 1437
    Race/Ethnicity, Customized
    Units: Subjects
        Black or African American
    24 23 25 72
        American Indian or Alaska Native
    13 12 12 37
        Asian - Central/South Asian Heritage
    5 0 0 5
        Asian - Japanese Heritage
    0 1 0 1
        Asian - East Asian Heritage
    0 0 1 1
        White – Arabic/North African Heritage
    3 1 1 5
        White – White/Caucasian/European Heritage
    764 763 765 2292
        American Indian or Alaska Native & White
    1 0 0 1
        Black or African American & White
    2 4 4 10
        Native Hawaiian or other Pacific Islander & White
    0 0 1 1

    End points

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    End points reporting groups
    Reporting group title
    UMEC/VI 62.5/25 mcg+ Placebo
    Reporting group description
    Participants with COPD received UMEC/VI 62.5/25 mcg once daily via the ELLIPTA DPI along with placebo twice daily via the DISKUS DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.

    Reporting group title
    UMEC 62.5 mcg + Placebo
    Reporting group description
    Participants with COPD received UMEC 62.5mcg once daily via the ELLIPTA DPI along with placebo twice daily via DISKUS DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.

    Reporting group title
    Salmeterol 50 mcg+Placebo
    Reporting group description
    Participants with COPD received salmeterol 50 mcg twice daily via the DISKUS DPI along with placebo once daily via ELLIPTA DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.

    Primary: Change from Baseline in trough Forced Expiratory Volume in One Second (FEV1) at Week 24

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    End point title
    Change from Baseline in trough Forced Expiratory Volume in One Second (FEV1) at Week 24
    End point description
    FEV1 is a measure of lung function and is defined as the maximal amount of air that can be forcefully exhaled in one second. Trough FEV1 at Week 24 is defined as the mean of the FEV1 values obtained 23 and 24 hours after dosing on the previous day. Baseline trough FEV1 is the mean of the values measured at 30 minutes and 5 minutes pre-dose on Day 1. Change from Baseline was calculated as the trough FEV1 value on Week 24 minus the Baseline value. Analysis was performed using a repeated measures model (MMRM) with covariates of Baseline FEV1, geographical region, stratum (number of bronchodilators per day during run-in), visit, treatment, visit by Baseline and visit by treatment interaction. ITT population comprised of all randomized participants (excluding those who were randomized in error) who received at least one dose of study medication.
    End point type
    Primary
    End point timeframe
    Baseline (Pre-dose on Day 1) and Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    691 [1]
    621 [2]
    654 [3]
    Units: Liters
        least squares mean (standard error)
    0.122 ( 0.0081 )
    0.056 ( 0.0085 )
    -0.019 ( 0.0083 )
    Notes
    [1] - ITT Population. Participants represents those with data available at the time point being presented
    [2] - ITT Population. Participants represents those with data available at the time point being presented
    [3] - ITT Population. Participants represents those with data available at the time point being presented
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus UMEC at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1312
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    < 0.001
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    0.066
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.043
         upper limit
    0.089
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.0118
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus salmeterol at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1345
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    0.141
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.118
         upper limit
    0.164
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.0117
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    LS Mean difference comparing UMEC versus salmeterol at Week 24.
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1275
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    0.075
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.051
         upper limit
    0.098
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.0119

    Secondary: Self administered computerized (SAC) transient dyspnea index (TDI) Focal score at Week 24

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    End point title
    Self administered computerized (SAC) transient dyspnea index (TDI) Focal score at Week 24
    End point description
    TDI focal score comprises of 3 individual scales (Functional Impairment, Magnitude of Task, Magnitude of Effort). Each of these scales had a possible score ranging from -6 to +6, lower scores indicates impairment. TDI focal score was calculated as the sum of 3 individual scores (range is -18 to +18). Lower score indicates deterioration of dyspnea. If a score is missing for any of the three scales, then the TDI focal score was set to missing. Analysis was performed using mixed model repeated measures (MMRM) with covariates of SAC BDI focal score, geographical region, stratum (no. of bronchodilators per day during run-in), visit, treatment, visit by SAC BDI and visit by treatment interactions.
    End point type
    Secondary
    End point timeframe
    Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    704 [4]
    636 [5]
    673 [6]
    Units: Scores on a scale
        least squares mean (standard error)
    1.68 ( 0.109 )
    1.30 ( 0.114 )
    1.22 ( 0.111 )
    Notes
    [4] - ITT Population. Participants represents those with data available at the time point being presented
    [5] - ITT Population. Participants represents those with data available at the time point being presented
    [6] - ITT Population. Participants represents those with data available at the time point being presented
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus UMEC at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1340
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.018
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    0.37
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.06
         upper limit
    0.68
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.157
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus salmeterol at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1377
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.004
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    0.45
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.15
         upper limit
    0.76
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.155
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    LS Mean difference comparing UMEC versus salmeterol at Week 24.
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1309
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.61
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    0.08
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.23
         upper limit
    0.39
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.159

    Secondary: Percentage of TDI responders according to SAC TDI Focal score

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    End point title
    Percentage of TDI responders according to SAC TDI Focal score
    End point description
    TDI focal score comprises of 3 individual scales (Functional Impairment, Magnitude of Task, Magnitude of Effort). Each of these scales had a possible score ranging from -6 to +6, lower scores indicates impairment. TDI focal score was calculated as the sum of 3 individual scores (range is -18 to +18). Lower score indicates deterioration of dyspnea. If a score is missing for any of the three scales, then TDI focal score was set to missing. A participant was considered as a responder if the on-treatment TDI focal score was at least 1 unit at that visit. Non-response was SAC TDI focal score of less than 1 unit or a missing SAC TDI focal score with no subsequent non-missing on-treatment scores. Analysis was performed using a generalized linear mixed model with treatment as an explanatory variable and visit, SAC BDI focal score, stratum (no. of bronchodilators per day during run-in), geographical region, visit by SAC BDI and visit by treatment interactions included as covariates.
    End point type
    Secondary
    End point timeframe
    Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    806 [7]
    799 [8]
    807 [9]
    Units: Percentage of responders
    50
    42
    41
    Notes
    [7] - ITT Population. Participants represents those with data available at the time point being presented
    [8] - ITT Population. Participants represents those with data available at the time point being presented
    [9] - ITT Population. Participants represents those with data available at the time point being presented
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC/VI versus UMEC at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1605
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.43
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.17
         upper limit
    1.75
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC/VI versus salmeterol at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1613
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.48
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.21
         upper limit
    1.81
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC versus salmeterol at Week 24.
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1606
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.755
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.03
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.84
         upper limit
    1.27

    Secondary: Mean change from Baseline in Evaluating Respiratory Symptoms (E-RS) total score

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    End point title
    Mean change from Baseline in Evaluating Respiratory Symptoms (E-RS) total score
    End point description
    The E-RS is intended to capture information related to respiratory symptoms. A daily symptom score for E-RS is derived by summing 11 item-scores. The domains include: respiratory symptoms (RS)-breathlessness (RS-BRL comprised of 5 items, score range [0-17]), RS-cough and sputum (RS-CSP comprised of 3 items, score range [0-11]), and RS-chest symptoms (RS-CSY comprised of 3 items, score range [0-12]). Total score ranged between 0-40 and higher values indicates severe respiratory symptoms. The instrument was completed each night prior to going to bed. Baseline E-RS score is the mean within-participant daily score over 7 days prior to randomization. Change from Baseline is the difference at Week 21-Week 24 value and Baseline value. Analysis was performed using MMRM with covariates of Baseline score, geographical region, stratum (no. of bronchodilators per day during run-in), 4-weekly period, treatment, 4-weekly period by Baseline and 4-weekly period by treatment interactions.
    End point type
    Secondary
    End point timeframe
    Baseline (Pre-dose on Day 1) and Week 21 to Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    677 [10]
    621 [11]
    653 [12]
    Units: Scores on a scale
        least squares mean (standard error)
    -1.52 ( 0.148 )
    -0.99 ( 0.152 )
    -0.69 ( 0.150 )
    Notes
    [10] - ITT Population. Participants represents those with data available at the time point being presented
    [11] - ITT Population. Participants represents those with data available at the time point being presented
    [12] - ITT Population. Participants represents those with data available at the time point being presented
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus UMEC at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1298
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.013
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.53
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.95
         upper limit
    -0.11
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.213
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1330
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.25
         upper limit
    -0.42
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.211
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    LS Mean difference comparing UMEC versus Salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1274
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.159
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.3
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.72
         upper limit
    0.12
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.214

    Secondary: Mean change from Baseline in E-RS Subscale Score

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    End point title
    Mean change from Baseline in E-RS Subscale Score
    End point description
    The E-RS is intended to capture information related to respiratory symptoms. A daily symptom score for E-RS is derived by summing 11 item-scores. The domains include: respiratory symptoms (RS)-breathlessness (RS-BRL comprised of 5 items, score range [0-17]), RS-cough and sputum (RS-CSP comprised of 3 items, score range [0-11]), and RS-chest symptoms (RS-CSY comprised of 3 items, score range [0-12]). Total score ranged between 0-40 and higher values indicates severe respiratory symptoms. The instrument was completed each night prior to going to bed. Baseline E-RS score is the mean within-participant daily score over 7 days prior to randomization. Change from Baseline is the difference at Week 21-Week 24 value and Baseline value. Analysis was performed using MMRM with covariates of Baseline score, geographical region, stratum (no. of bronchodilators per day during run-in), 4-weekly period, treatment, 4-weekly period by Baseline and 4-weekly period by treatment interactions.
    End point type
    Secondary
    End point timeframe
    Baseline (Pre-dose on Day 1) and Week 21 to Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    677 [13]
    621 [14]
    653 [15]
    Units: Scores on a scale
    least squares mean (standard error)
        RS-BRL
    -0.67 ( 0.080 )
    -0.40 ( 0.082 )
    -0.22 ( 0.081 )
        RS-CSP
    -0.45 ( 0.044 )
    -0.38 ( 0.045 )
    -0.32 ( 0.044 )
        RS-CSY
    -0.39 ( 0.049 )
    -0.22 ( 0.050 )
    -0.15 ( 0.049 )
    Notes
    [13] - ITT Population. Participants represents those with data available at the time point being presented
    [14] - ITT Population. Participants represents those with data available at the time point being presented
    [15] - ITT Population. Participants represents those with data available at the time point being presented
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus UMEC at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1298
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.016 [16]
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.27
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.5
         upper limit
    -0.05
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.114
    Notes
    [16] - E-RS Breathlessness Score
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1330
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001 [17]
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.46
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.68
         upper limit
    -0.23
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.113
    Notes
    [17] - E-RS Breathlessness Score
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    LS Mean difference comparing UMEC versus salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1274
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.115 [18]
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.18
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.41
         upper limit
    0.04
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.115
    Notes
    [18] - E-RS Breathlessness Score
    Statistical analysis title
    Statistical analysis 4
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus UMEC at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1298
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.247 [19]
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.07
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.2
         upper limit
    0.05
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.063
    Notes
    [19] - E-RS Cough and Sputum Score
    Statistical analysis title
    Statistical analysis 5
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1330
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.042 [20]
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.13
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.25
         upper limit
    0
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.063
    Notes
    [20] - E-RS Cough and Sputum Score
    Statistical analysis title
    Statistical analysis 6
    Statistical analysis description
    LS Mean difference comparing UMEC versus salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1274
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.391 [21]
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.05
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.18
         upper limit
    0.07
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.063
    Notes
    [21] - E-RS Cough and Sputum Score
    Statistical analysis title
    Statistical analysis 7
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus UMEC at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1298
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.014 [22]
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.17
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.31
         upper limit
    -0.04
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.07
    Notes
    [22] - E-RS Chest Symptoms Score
    Statistical analysis title
    Statistical analysis 8
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1330
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001 [23]
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.24
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.37
         upper limit
    -0.1
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.069
    Notes
    [23] - E-RS Chest Symptoms Score
    Statistical analysis title
    Statistical analysis 9
    Statistical analysis description
    LS Mean difference comparing UMEC versus salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1274
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.34 [24]
    Method
    Mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.07
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.2
         upper limit
    0.07
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.07
    Notes
    [24] - E-RS Chest Symptoms Score

    Secondary: Percentage of E-RS responders according to E-RS total score

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    End point title
    Percentage of E-RS responders according to E-RS total score
    End point description
    The E-RS is intended to capture information related to respiratory symptoms. A daily symptom score for E-RS is derived by summing 11 item-scores. The domains include: RS-BRL comprised of 5 items, score range (0-17); RS-CSP comprised of 3 items, score range (0-11); and RS-CSY comprised of 4 items, score range (0-12). Total score ranged between 0-40 and higher values indicates severe respiratory symptoms. The instrument was completed each night prior to going to bed. Response is defined as an E-RS total score of at least 2 or 3.35 below Baseline. Participants with a Baseline but all missing post-Baseline data are also considered a non-responder. Analysis was performed using a generalized linear mixed model with treatment as an explanatory variable and four-weekly period, Baseline score, stratum (no. of bronchodilators per day during run-in), geographical region, four-weekly period by baseline and four-weekly period by treatment interactions included as covariates.
    End point type
    Secondary
    End point timeframe
    Week 21 to Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    809 [25]
    800 [26]
    808 [27]
    Units: Percentage of responders
    36
    27
    27
    Notes
    [25] - ITT Population. Participants represents those with data available at the time point being presented
    [26] - ITT Population. Participants represents those with data available at the time point being presented
    [27] - ITT Population. Participants represents those with data available at the time point being presented
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC/VI vs UMEC at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1609
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.52
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.22
         upper limit
    1.89
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC/VI vs salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1617
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.53
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.23
         upper limit
    1.9
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC vs salmeterol at Week 21 to Week 24
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1608
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.969
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.8
         upper limit
    1.26

    Secondary: Change from Baseline in St George’s Respiratory Questionnaire (SGRQ) total score

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    End point title
    Change from Baseline in St George’s Respiratory Questionnaire (SGRQ) total score
    End point description
    SGRQ is a disease-specific questionnaire designed to measure impact of respiratory disease and its treatment on HRQoL of participants with COPD. It contains 14 questions with a total of 40 items grouped into domains (Symptoms, Activity and Impacts). SGRQ total score was calculated as 100 multiplied by summed weights from all positive items divided by sum of weights for all items in questionnaire. It ranges from 0 to 100, higher score indicates poor HRQoL. Baseline is last non-missing score recorded prior to dosing on Day 1. Change from Baseline was calculated by subtracting Baseline value from the value at Week 24. Analysis was performed using mixed model repeated measures (MMRM) with covariates of Baseline SGRQ total score, geographical region, stratum (no. of bronchodilators per day during run-in), visit, treatment, visit by Baseline and visit by treatment interactions.
    End point type
    Secondary
    End point timeframe
    Baseline (Pre-dose on Day 1) and Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    704 [28]
    636 [29]
    674 [30]
    Units: Scores on a scale
        least squares mean (standard error)
    -4.98 ( 0.465 )
    -5.23 ( 0.484 )
    -3.29 ( 0.475 )
    Notes
    [28] - ITT Population. Participants represents those with data available at the time point being presented
    [29] - ITT Population. Participants represents those with data available at the time point being presented
    [30] - ITT Population. Participants represents those with data available at the time point being presented
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus UMEC at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1340
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.709
    Method
    mixed model repeated measure
    Parameter type
    Mean difference (net)
    Point estimate
    0.25
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.07
         upper limit
    1.57
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.672
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus salmeterol at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1378
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.011
    Method
    mixed model repeated measure
    Parameter type
    Mean difference (net)
    Point estimate
    -1.69
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.99
         upper limit
    -0.39
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.665
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    LS Mean difference comparing UMEC versus salmeterol at Week 24.
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1310
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.004
    Method
    mixed model repeated measure
    Parameter type
    Mean difference (net)
    Point estimate
    -1.94
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -3.27
         upper limit
    -0.61
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.678

    Secondary: Change from Baseline in COPD assessment test (CAT)

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    End point title
    Change from Baseline in COPD assessment test (CAT)
    End point description
    The CAT is a participant-completed instrument designed to provide a simple and reliable measure of health status in COPD for the assessment and long-term follow-up of the individual participant. The CAT consists of eight items, each formatted on a differential scale. Participants rated their experience on a 6-point scale for each question, ranging from 0 (no impact) to 5 (high impact). A total CAT score was calculated by summing the non-missing scores on the eight items ranging from 0 to 40 with higher scores indicating greater disease impact. Baseline is defined as the last non-missing score recorded prior to dosing on Day 1. Change from Baseline was calculated by subtracting Baseline value from the value at Week 24. Analysis was performed using mixed model repeated measures (MMRM) with covariates of Baseline CAT score, geographical region, stratum (no. of bronchodilators per day during run-in), visit, treatment, visit by Baseline and visit by treatment interactions.
    End point type
    Secondary
    End point timeframe
    Baseline (Pre-dose on Day 1) and Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    703 [31]
    633 [32]
    669 [33]
    Units: Scores on a scale
        least squares mean (standard error)
    -3.5 ( 0.21 )
    -3.4 ( 0.22 )
    -2.9 ( 0.21 )
    Notes
    [31] - ITT Population. Participants represents those with data available at the time point being presented
    [32] - ITT Population. Participants represents those with data available at the time point being presented
    [33] - ITT Population. Participants represents those with data available at the time point being presented
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus UMEC at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1336
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.891
    Method
    mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    0
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.6
         upper limit
    0.6
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.3
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    LS Mean difference comparing UMEC/VI versus salmeterol at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1372
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.074
    Method
    mixed model repeated measures
    Parameter type
    Mean difference (net)
    Point estimate
    -0.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.1
         upper limit
    0.1
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.3
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    LS Mean difference comparing UMEC versus salmeterol at Week 24.
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1302
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.107
    Method
    mixed model repeated measures
    Parameter type
    Odds ratio (OR)
    Point estimate
    -0.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.1
         upper limit
    0.1
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.31

    Secondary: Percentage of responders according to CAT

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    End point title
    Percentage of responders according to CAT
    End point description
    The CAT is a participant-completed instrument designed to provide a simple and reliable measure of health status in COPD for the assessment and long-term follow-up of the individual participant. The CAT consists of eight items. Participants rated their experience on a 6-point scale for each question, ranging from 0 (no impact) to 5 (high impact). A total CAT score was calculated by summing the non-missing scores on the eight items ranging from 0 to 40 with higher scores indicating greater disease impact. Response was defined as an CAT score of >=2 below Baseline. Non response was defined as CAT score <2 units below Baseline or a missing CAT score with no subsequent on treatment scores. Analysis was performed using a generalized linear mixed model with treatment as an explanatory variable and visit, baseline CAT score, stratum (no. of bronchodilators per day during run-in), geographical region, visit by baseline and visit by treatment interactions included as covariates.
    End point type
    Secondary
    End point timeframe
    Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    812 [34]
    804 [35]
    809 [36]
    Units: Percentage of responders
    55
    48
    50
    Notes
    [34] - ITT Population.
    [35] - ITT Population.
    [36] - ITT Population.
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC/VI versus UMEC at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1616
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.003
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.35
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.11
         upper limit
    1.65
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC/VI versus salmeterol at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1621
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.037
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.23
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.01
         upper limit
    1.5
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC versus salmeterol at Week 24.
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1613
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.363
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.91
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.75
         upper limit
    1.11

    Secondary: Number of participants with on treatment adverse events (AE) and serious adverse events (SAE)

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    End point title
    Number of participants with on treatment adverse events (AE) and serious adverse events (SAE)
    End point description
    An AE is any untoward medical occurrence in a participant or clinical investigation participant , temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. Any untoward event resulting in death, life threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, congenital anomaly/birth defect, any other situation according to medical or scientific judgment or all events associated with liver injury and impaired liver function based on pre-defined criteria were categorized as SAE.
    End point type
    Secondary
    End point timeframe
    Up to Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    812 [37]
    804 [38]
    809 [39]
    Units: Participants
        Any AE
    315
    316
    314
        Any SAE
    49
    35
    38
    Notes
    [37] - ITT Population.
    [38] - ITT Population.
    [39] - ITT Population.
    No statistical analyses for this end point

    Secondary: Percentage of responders based on the Saint (St) George Respiratory Questionnaire COPD specific (SGRQ-C) Total Score

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    End point title
    Percentage of responders based on the Saint (St) George Respiratory Questionnaire COPD specific (SGRQ-C) Total Score
    End point description
    SGRQ-C is a disease-specific questionnaire designed to measure impact of respiratory disease and its treatment on HRQoL of participants with COPD. It contains 14 questions with a total of 40 items grouped into domains (Symptoms, Activity and Impacts). SGRQ-C total score was calculated as 100 multiplied by summed weights from all positive items divided by sum of weights for all items in questionnaire. It ranges from 0 to 100, higher score indicates poor HRQoL. SGRQ-C total score was converted to SGRQ total score by multiplying (SGRQ-Cx0.90) + 3.10 units. Analysis was performed using a generalized linear mixed model with treatment as an explanatory variable and visit, Baseline SGRQ score, stratum (no. of bronchodilators per day during run-in), geographical region, visit by Baseline and visit by treatment interactions included as covariates. Response was defined as an SGRQ total score of 4 or more units below Baseline.
    End point type
    Secondary
    End point timeframe
    Week 24
    End point values
    UMEC/VI 62.5/25 mcg+ Placebo UMEC 62.5 mcg + Placebo Salmeterol 50 mcg+Placebo
    Number of subjects analysed
    811 [40]
    802 [41]
    809 [42]
    Units: Percentage of responders
    45
    41
    36
    Notes
    [40] - ITT Population. Participants represents those with data available at the time point being presented
    [41] - ITT Population. Participants represents those with data available at the time point being presented
    [42] - ITT Population. Participants represents those with data available at the time point being presented
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC/VI versus UMEC at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v UMEC 62.5 mcg + Placebo
    Number of subjects included in analysis
    1613
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.063
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.21
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.99
         upper limit
    1.48
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC/VI versus salmeterol at Week 24.
    Comparison groups
    UMEC/VI 62.5/25 mcg+ Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1620
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    < 0.001
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.49
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.22
         upper limit
    1.83
    Statistical analysis title
    Statistical analysis 3
    Statistical analysis description
    Odds Ratio (responder vs. a non-responder) comparing UMEC versus salmeterol at Week 24.
    Comparison groups
    UMEC 62.5 mcg + Placebo v Salmeterol 50 mcg+Placebo
    Number of subjects included in analysis
    1611
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.045
    Method
    generalized linear mixed model
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.23
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1
         upper limit
    1.51

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    On-Treatment serious adverse events (SAEs) and non-serious AEs (nSAEs) were collected from start of study treatment until Week 24.
    Adverse event reporting additional description
    On-Treatment SAEs and nSAEs were reported for ITT Population.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    21.0
    Reporting groups
    Reporting group title
    UMEC/VI 62.5/25 mcg+ Placebo
    Reporting group description
    Participants with COPD received UMEC/VI 62.5/25 mcg once daily via the ELLIPTA DPI along with placebo BID via the DISKUS DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.

    Reporting group title
    Salmeterol 50 mcg+Placebo
    Reporting group description
    Participants with COPD received salmeterol 50 mcg twice daily via the DISKUS DPI along with placebo once daily via ELLIPTA DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.

    Reporting group title
    UMEC 62.5 mcg + Placebo
    Reporting group description
    Participants with COPD received UMEC 62.5mcg once daily via the ELLIPTA DPI along with placebo twice daily via DISKUS DPI for 24 weeks. In addition albuterol/salbutamol was provided to participants to use on an as-needed basis for relief of COPD symptoms throughout the study. Participants were followed up 7 days after the last dose of study medication.

    Serious adverse events
    UMEC/VI 62.5/25 mcg+ Placebo Salmeterol 50 mcg+Placebo UMEC 62.5 mcg + Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    49 / 812 (6.03%)
    38 / 809 (4.70%)
    35 / 804 (4.35%)
         number of deaths (all causes)
    4
    0
    4
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Bladder neoplasm
         subjects affected / exposed
    1 / 812 (0.12%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Small cell lung cancer
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Squamous cell carcinoma of lung
         subjects affected / exposed
    1 / 812 (0.12%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Adenocarcinoma of colon
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Adenosquamous cell lung cancer
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Benign lung neoplasm
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lung neoplasm malignant
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Malignant melanoma
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Meningioma
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Non-small cell lung cancer metastatic
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Papillary cystadenoma lymphomatosum
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Prostate cancer
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Peripheral arterial occlusive disease
         subjects affected / exposed
    1 / 812 (0.12%)
    1 / 809 (0.12%)
    2 / 804 (0.25%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haematoma
         subjects affected / exposed
    2 / 812 (0.25%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Aortic stenosis
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypertensive emergency
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypotension
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Subclavian artery stenosis
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Varicose vein
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Non-cardiac chest pain
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Asthenia
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Oedema peripheral
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    7 / 812 (0.86%)
    9 / 809 (1.11%)
    7 / 804 (0.87%)
         occurrences causally related to treatment / all
    0 / 7
    0 / 9
    0 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
    Pneumothorax
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Acute respiratory failure
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Hypoxia
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lung infiltration
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pulmonary oedema
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Psychiatric disorders
    Depression
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Rib fracture
         subjects affected / exposed
    1 / 812 (0.12%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Concussion
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Craniocerebral injury
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fibula fracture
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Humerus fracture
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Post-thoracotomy pain syndrome
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Spinal compression fracture
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tendon rupture
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular pseudoaneurysm
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    2 / 812 (0.25%)
    2 / 809 (0.25%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Coronary artery disease
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    2 / 804 (0.25%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Acute myocardial infarction
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    Cardio-respiratory arrest
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    Acute coronary syndrome
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Angina pectoris
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Angina unstable
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Atrioventricular block complete
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac arrest
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tachycardia
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ventricular fibrillation
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Transient ischaemic attack
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Basilar artery stenosis
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Brain stem stroke
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cerebellar infarction
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Encephalopathy
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Presyncope
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Status epilepticus
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tethered cord syndrome
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Microcytic anaemia
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Splenic infarction
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Small intestinal obstruction
         subjects affected / exposed
    2 / 812 (0.25%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Duodenal ulcer
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Enteritis
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Enterocolitis haemorrhagic
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Femoral hernia strangulated
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastric polyps
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastric ulcer
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastritis
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrooesophageal reflux disease
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Large intestine polyp
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal failure
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Rotator cuff syndrome
         subjects affected / exposed
    2 / 812 (0.25%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Spinal pain
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Synovial cyst
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    4 / 812 (0.49%)
    5 / 809 (0.62%)
    4 / 804 (0.50%)
         occurrences causally related to treatment / all
    0 / 4
    0 / 5
    0 / 4
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    2 / 812 (0.25%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Appendicitis perforated
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bacterial colitis
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Encephalitis
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infective exacerbation of chronic obstructive airways disease
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Muscle abscess
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyelonephritis acute
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Septic shock
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    0 / 812 (0.00%)
    0 / 809 (0.00%)
    1 / 804 (0.12%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    0 / 812 (0.00%)
    1 / 809 (0.12%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metabolic acidosis
         subjects affected / exposed
    1 / 812 (0.12%)
    0 / 809 (0.00%)
    0 / 804 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 3%
    Non-serious adverse events
    UMEC/VI 62.5/25 mcg+ Placebo Salmeterol 50 mcg+Placebo UMEC 62.5 mcg + Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    68 / 812 (8.37%)
    84 / 809 (10.38%)
    87 / 804 (10.82%)
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    68 / 812 (8.37%)
    84 / 809 (10.38%)
    87 / 804 (10.82%)
         occurrences all number
    81
    94
    103

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    07 Feb 2017
    Amendment 1:: Regulatory Agency Identifying Number(s): A typographical error in the EudraCT no. corrected. IND no. added. Section 4.1and Section 4.4: Typographical errors and inconsistencies corrected. Inconsistencies between Section 4.4, Section 7.3.1.5 and Section 7.1 revised. Section 7.1 Time and Events table: Un-intentional deletion of the (“x”) were added to confirm that concomitant medications should be reviewed at every clinic visit was corrected. Increased the visit window. Typographical error and inconsistencies corrected as described in Appendix 9, Section 12.9. Section 7.2.2 Critical procedures performed at Screening (Visit 1): To clarify that height and weight are collected at Visit 1 “Height and weight” added. Section 7.3.2 Spirometry: “At Screening, before the morning dose of usual COPD. medication(s)” added. Section 7.3.7: Physical activity monitor (study subset). Inconsistency between Section 1, Section 4.1 and Section 7.3.7 revised.
    21 Feb 2017
    Amendment 2 : This protocol amendment was created to comply with Health Canada guidelines. They require pharmaceutical manufacturers to expeditiously report domestic cases of unusual failure in efficacy (UFIE) for new drugs to the Marketed Health Products Directorate (MHPD) within 15 days of first notification. Changes were made to Section 7.4.1 and Appendix 4.
    18 Apr 2017
    Amendment 3: Clarifications concerning study design, stratification, permitted and prohibited COPD medications, stopping criteria, visit windows, chest x-rays performed in the context of the protocol and site professional expertise. Rate of COPD exacerbations from tertiary endpoints to exploratory endpoints. Addition of an inclusion criterion specific to France. Integration of Canadian Amendment 2, Correction of typographical errors and inconsistencies.

    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.
    None reported
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