E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Chronic Obstructive Pulmonary Disease (COPD) |
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E.1.1.1 | Medical condition in easily understood language |
Chronic Obstructive Pulmonary Disease (COPD) |
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E.1.1.2 | Therapeutic area | Diseases [C] - Respiratory Tract Diseases [C08] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10010952 |
E.1.2 | Term | COPD |
E.1.2 | System Organ Class | 100000004855 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10010953 |
E.1.2 | Term | COPD exacerbation |
E.1.2 | System Organ Class | 100000004855 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective is to determine whether adding bisoprolol (maximum dose 5mg a day) to existing COPD treatment in patients who have chronic obstructive pulmonary disease will reduce the number of exacerbations (or flare ups) of the condition. If the treatment is effective, we will also assess whether it is cost effective |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives are to compare the following outcomes between participants treated with bisoprolol, and those treated with placebo: -Hospital admissions with a primary diagnosis of COPD exacerbation. -Total number of emergency hospital admissions. -Total number of major adverse cardiovascular events (MACE). -Lung function. -Changes in breathlessness during treatment. -All-cause, respiratory and cardiac mortality. -Drug reactions and serious adverse events. -Health related quality of life. -Disease specific health status. -Health care utilisation. -Incremental cost-per-exacerbation avoided. -Costs to the NHS and patients and lifetime cost-effectiveness based on extrapolation modelling. -Modelled lifetime incremental cost per Quality Adjusted Life Year. -Treatment effects in participants with and without clinically diagnosed heart disease.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
-Aged ≥ 40 years. -A smoking history of at least 10 pack years. -An established predominant diagnosis of COPD (NICE Guideline definition: post bronchodilator FEV1<80% predicted, FEV1/FVC<0.7) receiving treatment as per local guidelines’. -A history of at least two exacerbations requiring treatment with antibiotics and/or oral corticosteroid use in the previous year, based on patient report. -Clinically stable with no COPD exacerbation for at least 4 weeks. -Able to swallow study medication. -Able and willing to give informed consent to participate. -Able and willing to participate in the study procedures, complete study questionnaire. -Able and willing to undergo spirometric assessment, able to perform an FEV1 manoeuvre as a minimum.
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E.4 | Principal exclusion criteria |
-A current sole respiratory diagnosis of asthma. -Any diagnosis of asthma before the age of 40 years. -A predominant respiratory disease other than COPD. -Any significant disease/disorder which, in the investigator’s opinion, either puts the patient at risk because of study participation or may influence the results of the study or the patient's ability to participate in the study. -Previous allocation of a randomisation code in the study or current participation in another interventional study (CTIMP or non-CTIMP). -Already taking beta-blocker. -Known or suspected hypersensitivity to beta-blocker. -For women, current pregnancy or breast-feeding, or planned pregnancy during the study. -Unable to perform spirometry (FEV1 manoeuvre). -Current resting (5 minutes sitting) heart rate <60 bpm. -Current resting (5 minutes sitting) systolic blood pressure <100mmHg. -2nd, 3rd degree heart block on ECG (unless pacemaker in situ). -Conditions for which beta-blocker use is a guideline recommendation, i.e. heart failure, or within the last year: myocardial infarction, acute coronary syndrome. -Current tachyarrythmia or bradyarrhythmia (including sick sinus syndrome, sinoatrial block) requiring treatment. -Current treatment with interacting drugs: o heart rate limiting drug such as calcium channel blockers (diltiazem, verapamil), ivabradine, o class-I antiarrhythmic drugs (e.g. quinidine, disopyramide; lidocaine, phenytoin; flecainide, propafenone), o centrally-acting antihypertensive drugs (e.g. clonidine methyldopa, moxonidine, rilmenidine). -Severe peripheral arterial occlusive disease, severe forms of Raynauds syndrome. -Conditions that are known to be triggered by beta-blockers or beta-blocker withdrawal including myasthenia gravis, periodic hypokalaemic paralysis, pheochromocytoma, thyrotoxicosis and psoriasis/history of psoriasis.
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary clinical outcome measure will be the total number of exacerbations of COPD necessitating changes in management (minimum management change use of oral corticosteroids and/or antibiotics) during the one year treatment period, as reported by the participant.
The primary economic outcome measure will be cost per QALY gained during the one year treatment period. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The number of participant reported exacerbations of COPD requiring treatment with antibiotics and/or oral corticosteroids will be ascertained at the 26 and 52 week assessment visits. |
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E.5.2 | Secondary end point(s) |
-Total number of COPD exacerbations requiring hospital admission*. -Time to first exacerbation of COPD. -Total number of emergency hospital admissions (all causes)*. -Total number of major adverse cardiovascular events (MACE) (defined by cardiovascular death, hospitalisation for myocardial infarction, heart failure, or stroke), percutaneous coronary intervention or coronary artery bypass grafting. -Lung function (FEV1, FVC) post bronchodilator using spirometry performed to ATS/ERS standards. -Breathlessness using Baseline and Transition Dyspnoea Indices (BDI & TDI). -All-cause, respiratory and cardiac mortality. -Serious adverse events, adverse reactions. -Health related quality of life using EuroQoL 5D (EQ-5D-5L) Index. -Disease specific health status using the COPD Assessment Test (CAT). -Utilisation of primary or secondary health care for respiratory events. -Change in disease associated symptoms using the Hull Airways Reflux Questionnaire (HARQ) [this will only be done at some recruitment sites]. -Modelled lifetime incremental cost per Quality Adjusted Life Year.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
These will be assessed at the 26 and 52 week assessment visits. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | No |
E.6.5 | Efficacy | No |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 160 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The end of clinical follow up for each participant is defined as completion of the weaning off the study medication 3 weeks after follow up visit at 12 months. The end of clinical follow up is when the last participant weans off study medication 3 weeks after the follow up visit at 12 months.
The end of the trial is defined as the end of funding. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 11 |
E.8.9.1 | In the Member State concerned days | 31 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 11 |
E.8.9.2 | In all countries concerned by the trial days | 31 |