Roflumilast Plus Montelukast in Adults With Severe Asthma

Overview[ - collapse ][ - ]

Purpose The purpose of this study is to evaluate the effect of roflumilast alone and in combination with montelukast on forced expiratory volume in 1 second (FEV1) in patients with inadequately controlled asthma.
ConditionAsthma
InterventionDrug: Roflumilast
Drug: Roflumilast Placebo
Drug: Montelukast
Drug: Roflumilast
Drug: Roflumilast Placebo
Drug: Montelukast
PhasePhase 2
SponsorTakeda
Responsible PartyTakeda
ClinicalTrials.gov IdentifierNCT01765192
First ReceivedJanuary 8, 2013
Last UpdatedFebruary 4, 2014
Last verifiedFebruary 2014

Tracking Information[ + expand ][ + ]

First Received DateJanuary 8, 2013
Last Updated DateFebruary 4, 2014
Start DateFebruary 2013
Estimated Primary Completion DateOctober 2013
Current Primary Outcome MeasuresChange from Baseline in pre-dose (trough) pre-bronchodilator forced expiratory volume in 1 second (FEV1) [Time Frame: Baseline (Days 1 and 56) and after 4 weeks of treatment (Days 28 and 84)] [Designated as safety issue: No]FEV1 is the amount of air which can be forcibly exhaled from the lungs in the first second of a forced exhalation. FEV1 will be measured using spirometry in accordance with the American Thoracic Society / European Respiratory Society (ATS/ERS) consensus guidelines.
Current Secondary Outcome Measures
  • Change from Baseline in pre-dose (trough) pre-bronchodilator forced vital capacity (FVC) [Time Frame: Baseline (Days 1 and 56) and after 4 weeks of treatment (Days 28 and 84)] [Designated as safety issue: No]FVC is the amount of air which can be forcibly exhaled from the lungs after taking the deepest breath possible. FVC will be measured using spirometry in accordance with ATS/ERS consensus guidelines.
  • Change from Baseline in pre-dose (trough) pre-bronchodilator forced expiratory flow (FEF) 25-75% [Time Frame: Baseline (Days 1 and 56) and after 4 weeks of treatment (Days 28 and 84)] [Designated as safety issue: No]FEF is a measure of how much air can be exhaled from the lungs. It is an indicator of obstruction of the smaller airways. FEF25-75% is the mid-flow rate or forced expiratory flow occurring in the middle 50% of the patient's exhaled volume, and will be measured using spirometry in accordance with ATS/ERS consensus guidelines.
  • Change from Baseline in pre-dose (trough) pre-bronchodilator peak expiratory flow (PEF) [Time Frame: Baseline (Days 1 and 56) and after 4 weeks of treatment (Days 28 and 84)] [Designated as safety issue: No]PEF is a person's maximum speed of expiration. It measures the airflow through the bronchi and thus the degree of obstruction in the airways. PEF will be measured using spirometry in accordance with ATS/ERS consensus guidelines.
  • Change from Baseline in morning peak expiratory flow (PEF) [Time Frame: Baseline (Days 1 and 56) and after 4 weeks of treatment (Days 28 and 84)] [Designated as safety issue: No]PEF will be measured at home using portable electronic peak flow meter. The participant will record PEF daily in the morning immediately after getting up.
  • Change from Baseline in daytime asthma symptoms [Time Frame: Baseline (Days 1 and 56) and after 4 weeks of treatment (Days 28 and 84)] [Designated as safety issue: No]Patients will assess their daily day-time asthma symptoms according to the following scale:
    0: Very well, no symptoms.
    One episode of wheezing, cough or breathlessness.
    More than one episode of wheezing, cough or breathlessness without interfering with normal activities.
    Wheezing, cough or short of breath most of the day which interfered to some extent with normal activities.
    Asthma very bad. Unable to carry out daily activities as usual.
  • Change from Baseline in nighttime asthma symptoms [Time Frame: Baseline (Days 1 and 56) and after 4 weeks of treatment (Days 28 and 84)] [Designated as safety issue: No]Patients will assess their daily night-time asthma symptoms according to the following scale:
    0: No symptoms, slept through the night.
    Slept well but some complaints in the morning.
    Woke up once because of asthma (inclusive early awakening).
    Woke up several times because of asthma (inclusive early awakening).
    Bad night, awake most of the night because of asthma.

Descriptive Information[ + expand ][ + ]

Brief TitleRoflumilast Plus Montelukast in Adults With Severe Asthma
Official TitleA Phase 2, Randomized, Double-blind, 4-week Cross-over Trial to Investigate The Effect of a Once-daily Combination of Roflumilast Plus Montelukast Versus Montelukast Alone on Pulmonary Function, Asthma Symptoms and Inflammatory Markers in Subjects With Severe Asthma Not Adequately Controlled With a Combination of at Least Medium Dose Inhaled Corticosteroids and Long-acting Beta Agonists Maintenance Therapy.
Brief Summary
The purpose of this study is to evaluate the effect of roflumilast alone and in combination
with montelukast on forced expiratory volume in 1 second (FEV1) in patients with
inadequately controlled asthma.
Detailed Description
The drug being tested in this study is called roflumilast. Roflumilast is being tested to
treat people who have asthma. This study will look at lung function and asthma symptoms of
people who take roflumilast in combination with montelukast.
Study TypeInterventional
Study PhasePhase 2
Study DesignAllocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
ConditionAsthma
InterventionDrug: Roflumilast
Roflumilast dose
Other Names:
DaxasDrug: Roflumilast Placebo
Roflumilast Placebo-matching dose
Other Names:
placeboDrug: Montelukast
Montelukast dose
Other Names:
SingulairDrug: Roflumilast
Roflumilast Dose
Other Names:
DaxasDrug: Roflumilast Placebo
Roflumilast placebo-matching dose
Other Names:
PlaceboDrug: Montelukast
Montelukast dose
Other Names:
Singulair
Study Arm (s)
  • Experimental: Roflumilast/Montelukast + Montelukast
    Roflumilast dose and montelukast dose, orally, then roflumilast placebo-matching dose and montelukast dose, orally.
  • Experimental: Montelukast + Roflumilast/Montelukast
    Roflumilast placebo-matching dose and montelukast dose, orally, then roflumilast dose and montelukast dose, orally.

Recruitment Information[ + expand ][ + ]

Recruitment StatusCompleted
Estimated Enrollment64
Estimated Completion DateOctober 2013
Estimated Primary Completion DateOctober 2013
Eligibility Criteria
Inclusion Criteria:

- 1. In the opinion of the investigator, the participant is capable of understanding
and complying with protocol requirements (ie, to follow clinical trial procedures and
Investigator instructions adequately).

2. The participantor, when applicable, the participant's legally acceptable
representative signs and dates a written, informed consent form and any required
privacy authorization prior to the initiation of any study procedures.

3. Has a documented physician diagnosis of severe asthma consistent with global
initiative for asthma (GINA) step 4 clinical features [Gina 2011] for at least 6
months.

4. Is male or female and aged 18 years or above. 5. Has been treated with a fixed or
free combination of at least medium-dose inhaled corticosteroid (ICS) (ie, ≥250 µg
fluticasone propionate daily or equivalent ICS) plus long-acting beta agonist (LABA)
for at least 3 months prior to Screening with stable ICS dose for at least 4 weeks
before Visit 2.

6. Shows GINA-defined uncontrolled asthma or an asthma control questionnaire (ACQ-7)
score ≥1.5 despite at least medium dose ICS/LABA therapy within 4 weeks prior to
Visit 1 (Screening).

7. Shows a pre-bronchodilator FEV1 of >55% and ≤85% of predicted at Visit 1
(Screening). For participants performing induced sputum FEV1 must be in addition > 1
liter.

8. Has airway obstruction proven to be reversible by an improvement of FEV1 of at
least 12% and 200 mL after inhalation of a short-acting bronchodilator. This can be
either documented in the medical history (with supporting spirometry recordings) in
the previous 12 months or demonstrated during screening at Visit 1 (Screening).

Exclusion Criteria:

- 1. Has received any investigational compound within 30 days prior to the start of the
clinical trial or has participated in the active treatment phase of another clinical
trial where a persisting pharmacodynamic effect of the trial treatment of that
clinical trial cannot be excluded (eg, participant is well into a treatment free
follow-up phase).

2. Participation in another clinical trial during the current trial. 3. Is an
immediate family member, study site employee, or is in a dependent relationship with
a study site employee who is involved in conduct of this study (eg, spouse, parent,
child, sibling) or may consent under duress.

4. Severe asthma exacerbation not resolved 4 weeks prior to Visit 1, (defined by the
need for oral or parenteral glucocorticosteroid intake for at least 3 days and/or
hospitalization or emergency room visit with the need for oral or parenteral
corticosteroid use).

5. Lower respiratory tract infection not resolved 4 weeks prior to Visit 1. 6. A
diagnosis of chronic obstructive pulmonary disease (COPD) (based on Global Initiative
for Chronic Obstructive Lung Disease [GOLD] criteria) and/or other relevant forms of
lung disease (eg, history of primary bronchiectasis, cystic fibrosis, idiopathic
(pan)bronchiolitis or bronchiolitis obliterans, bronchopulmonary allergic
aspergillosis, Churg-Strauss Syndrome, paradoxical vocal cord closure, lung
resection, lung cancer, interstitial lung disease [eg, fibrosis, silicosis,
sarcoidosis], or active tuberculosis) that may interfere with the evaluation of a
treatment response.

7. Current participation in a pulmonary rehabilitation program or completion of a
pulmonary rehabilitation program within 3 months preceding Visit 1.

8. Has, in the judgment of the investigator, clinically significant abnormal
laboratory values (hematology or biochemistry) at screening suggesting an undiagnosed
disease requiring further clinical evaluation.

9. Has severe neuropsychiatric or neurological disorders (eg, history of depression
associated with suicidal thinking, suicidal ideation or behavior).

10. Has congestive heart failure severity grade III or IV according to the New York
Heart Association.

11. Has symptomatic ischemic heart disease (angina pectoris). 12. Has hemodynamically
significant cardiac arrhythmias or heart valve deformations.

13. Has liver impairment, defined as Child-Pugh B/C and/or active viral hepatitis.

14. Has severe immunological diseases (eg, multiple sclerosis, systemic lupus
erythematosus, progressive multifocal leukoencephalopathy) or known infection with
human immunodeficiency virus (HIV).

15. Has severe acute infectious diseases (eg, tuberculosis, or acute hepatitis).

16. Has any diagnosis of a malignant disease (other than basal or squamous cell
carcinoma) within 5 years prior to Screening Visit 1.

17. Has a history of smoking within 1 year of Visit 1 and smoking history ≥10 pack
years.

18. Has a history of drug abuse (defined as illicit drug use) or a history of alcohol
abuse (defined as regular or daily consumption of more than 2 alcoholic drinks per
day) within the past 1 year prior to the Screening visit.

19. Has history of clinically significant allergies or idiosyncrasies to roflumilast,
montelukast or any inactive ingredient(s) of these products, eg, rare hereditary
problems of galactose intolerance, the Lapp lactase deficiency, glucose-galactose
malabsorption or phenylketonuria.

20. Has known highly unstable asthma defined by severe bronchoconstriction after
bronchoprovocation with isotonic saline.

21. Females of childbearing potential not willing to use acceptable contraceptive
methods such as hormonal contraceptives (oral, injection or implant) or intrauterine
contraceptive devices or who started such methods less than 2 months prior to
screening or who are not willing to use a double barrier method of contraception
(diaphragm plus condom).

22. If female, is pregnant or lactating or intending to become pregnant before,
during, or within 1 month after participating in this study; or intending to donate
ova during such time period.

23. Is required to take excluded medication
GenderBoth
Ages18 Years
Accepts Healthy VolunteersNo
ContactsNot Provided
Location CountriesGermany, Hungary, South Africa

Administrative Information[ + expand ][ + ]

NCT Number NCT01765192
Other Study ID NumbersROF-ASTHMA_202
Has Data Monitoring CommitteeNo
Information Provided ByTakeda
Study SponsorTakeda
CollaboratorsNot Provided
Investigators Study Director: Medical Director, MD Takeda
Verification DateFebruary 2014

Locations[ + expand ][ + ]

Germany
Berlin, Germany
Germany
Grosshansdorf, Germany
Germany
Hamburg, Germany
Germany
Hannover, Germany
Germany
Mainz, Germany
Germany
Schwerin, Germany
Hungary
Budapest, Hungary
Hungary
Nyiregyhaza, Hungary
Hungary
Szarvas, Hungary
Hungary
Torokbalint, Hungary
South Africa
Bloemfontein, South Africa
South Africa
Cape Town, South Africa
South Africa
Pretoria, South Africa