A Randomized, Double Blind, Placebo Controlled, Incomplete Block, Crossover, Dose Ranging Study to Evaluate the Dose Response of GSK573719 Administered Once or Twice Daily Over 7 Days in Patients With Chronic Obstructive Pulmonary Disease (COPD) (AC4115321)

• Weighted mean FEV1 over 0-24 hours after morning dosing [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
  Mean evaluation of FEV1 assessments obtained over the 24 hours post-dose
• Serial FEV1 at each timepoint over 24 hours after morning dosing [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
  FEV1 measures at multiple timepoints during the 24 hours after morning dosing

• Weighted mean FEV1 over 0-24 hours after morning dosing [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
  Mean evaluaton of FEV1 assessments obtained over the 24 hours post-dose
• Serial FEV1 at each timepoint over 24 hours after morning dosing [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
  FEV1 measures at multiple timepoints during the 24 hours after morning dosing

The purpose of this study is to further characterize the dose response of GSK573719 at doses of 15.6 micrograms (mcg) to 125 mcg once daily in patients with chronic obstructive pulmonary disease (COPD). Treatment with doses of GSK573719 dosed twice daily will also be included to further evaluate dosing frequency. Treatment with tiotropium (18 mcg) once daily via the Handihaler will be included as an active control. A placebo treatment will be included in order to evaluate absolute treatment effect of the different doses of GSK573719.

Inhaled bronchodilators, such as beta 2 agonists and anticholinergics, and inhaled corticosteroids are the mainstays of therapy in patients diagnosed with COPD. Anticholinergic bronchodilators or long acting muscarinic receptor antagonists function by blocking endogenous airway smooth muscle cholinergic tone. Treatment with anticholinergics has been shown to significantly improve forced expiratory volume in 1 second (FEV1), resting and dynamic lung hyperinflation, symptoms, and exercise capacity in patients with COPD. Currently tiotropium is the only approved long acting muscarinic antagonist available for treatment of COPD.

This is a multicenter, randomized, double-blind, placebo controlled, three way crossover, incomplete block study to evaluate 4 doses of GSK573719 inhaled once daily and 2 doses of GSK573719 inhaled twice daily over 7 days in patients with COPD. Tiotropium will be included as an open label active comparator. A placebo treatment will be included to evaluate treatment effect of each GSK573719 dose. Pharmacokinetic profiles of GSK573719 will also be determined. Each eligible subject will receive a sequence of 3 of 8 potential treatments for a total of 3 treatment periods per subject. There will be 7 clinic visits, during three of which 24 hour serial spirometry will be performed. The total duration of subject participation is approximately 9 weeks.

• Drug: GSK573719
  125 mcg once daily
• Drug: GSK573719
  62.5 mcg once daily
• Drug: GSK573719
  31.25 mcg once daily
• Drug: GSK573719
  15.6 mcg once daily
• Drug: GSK573719
  31.25 mcg twice daily
• Drug: GSK573719
  15.6 mcg twice daily
• Drug: Tiotropium
  18 mcg once daily
• Drug: Placebo
  once or twice daily

• Active Comparator: Tiotropium
  18 mcg, inhaled long acting muscarinic antagonist
  Intervention: Drug: Tiotropium
• Experimental: GSK573719
  inhaled medication
  Interventions:

  • Drug: GSK573719
  • Drug: GSK573719
  • Drug: GSK573719
  • Drug: GSK573719
  • Drug: GSK573719
  • Drug: GSK573719
• Placebo Comparator: Placebo
  inactive/excipients only
  Intervention: Drug: Placebo

Inclusion Criteria:

• Outpatient
• A signed and dated written informed consent prior to study participation.
• Male or female adults.
• 40 to 80 years of age at Visit 1
• Diagnosis of COPD
• Current or former cigarette smokers with a history of cigarette smoking of greater than or equal to 10 pack-years
• Post-albuterol forced expiratory volume in 1 second (FEV1)/ forced vital capacity (FVC)<0.70 and post albuterol FEV1 of greater than or equal to 35% and less than or equal to 70% of predicted normal values

Exclusion Criteria:

• Women who are pregnant or lactating or are planning on becoming pregnant during the study.
• A current diagnosis of asthma
• Known alpha-1 antitrypsin deficiency, active lung infections (such as tuberculosis), and lung cancer
• Other significant respiratory conditions in addition to COPD
• Other diseases that are uncontrolled including cancer in remission for less than 5 years
• Chest x-ray or CT scan with clinically significant abnormalities not believed to be due to the presence of COPD
• Hypersensitivity to any anticholinergic/muscarinic receptor antagonist, beta2-agonist, lactose/milk protein or magnesium stearate
• A medical condition that contraindicates study participation or use of an inhaled anticholinergic
• Hospitalization for COPD or pneumonia within 12 weeks of Visit 1
• Any previous lung resection surgery
• A body mass index (BMI) value of >35 kilogram (kg)/meter squared (m2)
• An abnormal and significant electrocardiogram finding at Visit 1
• Significantly abnormal finding from clinical chemistry or haematology tests at Visit 1.
• A positive Hepatitis B surface antigen or positive Hepatitis C antibody
• Medically unable to withhold albuterol (salbutamol) for the 6 hour period prior to study visits
• Use of depot corticosteroids within 12 weeks of Visit 1
• Use of oral or parenteral corticosteroids or antibiotics for lower respiratory tract infection within 6 weeks of Visit 1
• Use of long-acting beta-agonist (LABA)/inhaled corticosteroid (ICS) product if LABA/ICS therapy is discontinued within 30 days of Visit 1
• Use of ICS at a dose of >1000mcg/day of fluticasone propionate or equivalent within 30 days of Visit 1
• Initiation or discontinuation of ICS within 30 days of Visit 1
• Use of tiotropium or phosphodiesterase 4 inhibitors within 14 days of Visit 1
• Use of theophyllines, oral leukotriene inhibitors, long-acting oral beta-agonists, or inhaled long-acting beta-agonists within 48 hours of Visit 1
• Short-acting oral beta-agonists within 12 hours of Visit 1
• Use of LABA/ICS combination products only if discontinuing LABA therapy and switching to ICS monotherapy within 48 hours of Visit 1 for the LABA component
• Use of sodium cromoglycate or nedocromil sodium within 24 hours of Visit 1
• Use of inhaled short-acting beta-agonists, inhaled short-acting anticholinergics, or inhaled short-acting anticholinergic/short-acting beta-agonist combination products within 6 hours of Visit 1
• Use of any other investigational medication within 30 days or 5 drug half-lives (whichever is longer)
• Oxygen therapy prescribed for greater than 12 hours a day
• Regular use (prescribed for use every day, not for as-needed use) of short-acting bronchodilators
• Use of continuous positive airway pressure (CPAP), nocturnal positive pressure or non-invasive positive pressure ventilation (NIPPV), including use for sleep apnea.
• Acute phase of a pulmonary rehabilitation program within 4 weeks prior to Visit 1
• A known or suspected history of alcohol or drug abuse within 2 years prior to Visit 1
• Anyone affiliated with investigator site
• Previous use of GSK573719 or GSK53719/GW642444