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Pilot Study Comparing Tiotropium (Spiriva) to Salmeterol (Serevent) Plus Fluticasone (Flixotide) in Chronic Obstructive Pulmonary Disease (COPD)

This study has been completed.
Information provided by:
Boehringer Ingelheim Identifier:
First received: October 14, 2005
Last updated: November 8, 2013
Last verified: November 2013

The primary objective of this study is to estimate the comparative bronchodilator effect size and variability for tiotropium (Spiriva, 18 µg q.d.) with the free combination of salmeterol (Serevent, 50 µg b.i.d.) and fluticasone (Flixotide, 250 µg b.i.d.) in COPD patients.

International COPD guidelines preserve milder stages of the disease (GOLD stage I and IIa) to bronchodilators and recommend the addition of inhaled corticosteroids only in those patients who have a documented spirometric response to inhaled corticosteroids and in patients with a post-bronchodilator FEV1 of less than 50% predicted, who suffer from frequent exacerbations requiring oral courses of corticosteroids.

Recently published reports indicate that additional bronchodilator efficacy may be achieved when a long-acting beta agonist is combined with an inhaled corticosteroid. Steady state bronchodilation was achieved within one week with the drug combination. However, results of these studies are not consistent, and since the inclusion criteria employed were different from those utilised in the previously conducted tiotropium studies, it is difficult to generalise the observed effects to the general COPD population.

In addition, no comparative data is available on the average response over the 12 daytime hours when COPD patients are active and in most need of bronchodilation. 12 hours corresponds to the dosing intervals for both salmeterol and fluticasone.

Condition Intervention Phase
Pulmonary Disease, Chronic Obstructive
Drug: Tiotropium
Drug: Salmeterol plus Fluticasone
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: A Six-Week, Randomised, Double-Blind, Triple-Dummy, Parallel Group, Multiple Dose, Pilot Study Comparing Tiotropium Inhalation Capsules to Salmeterol Inhalation Aerosol Combined With Fluticasone Inhalation Aerosol in Patients With Chronic Obstructive Pulmonary Disease (COPD).

Resource links provided by NLM:

Further study details as provided by Boehringer Ingelheim:

Primary Outcome Measures:
  • The primary efficacy endpoint will be FEV1 area under the curve for the time period 0 to 12 hours (FEV1 AUC0-12) measured after 6 weeks of treatment, at the final study visit (Visit 4).

Secondary Outcome Measures:
  • Trough and peak FEV1. Trough FVC at Visits 3 and 4 and peak FVC and FVC AUC0-12 at Visit 4. Individual FEV1 and FVC measurements at each time point. Weekly mean number of puffs of rescue therapy used per day and night.

Estimated Enrollment: 107
Study Start Date: September 2003
Estimated Study Completion Date: August 2004
Primary Completion Date: August 2004 (Final data collection date for primary outcome measure)
Detailed Description:

This is a six-week, multi-centre, randomised, double-blind, triple-dummy, parallel group pilot study to compare the bronchodilator efficacy and safety of the long-acting bronchodilator tiotropium (Spiriva, 18 µg q.d.) to the free combination of fluticasone (Flixotide, 250 µg b.i.d.) and salmeterol (Serevent, 50 µg b.i.d.) in patients with COPD.

Following an initial screening at Visit 1, subjects will enter a two-week run-in period during which they will record daily rescue salbutamol use in the Patient Daily Diary Card. At Visit 1, pre-dose and post-bronchodilator pulmonary function tests (PFT) will be measured. Four inhalations of ipratropium (20 µg per puff) and four inhalations of salbutamol (100 µg per puff) will be administered 60 minutes prior to obtaining post-bronchodilator PFT measurement.

At Visit 2, a pre-dose PFT will be performed prior to first administration of trial medication. Treatment with blinded study medication (tiotropium or fluticasone + salmeterol) will start in the morning of Visit 2 (Day 1). After three weeks of treatment, at Visit 3 (Day 22), pre-dose FEV1 and FVC will be measured, patient compliance checked and a re-supply of study medication dispensed. After six weeks of treatment, at Visit 4 (Day 43), a 12 hour profile of PFTs will be obtained.

Study Hypothesis:

As this is a pilot trial to investigate the efficacy and safety of tiotropium (18 µg q.d.) as compared to the free combination of fluticasone (250 µg b.i.d.) and salmeterol (50 µg b.i.d.), no formal hypothesis testing will be performed. However, the underlying hypothesis for this trial is that tiotropium is superior to the free combination with respect to the primary efficacy endpoint FEV1AUC0-12 (area under the curve for the time period 0 to 12 hours).


At least 100 male or female outpatients with clinical and spirometric evidence of chronic obstructive pulmonary disease (COPD) will be entered in this study. Patients will be randomly assigned to receive either tiotropium inhalation capsules 18 µg q.d., or salmeterol 50 µg oral inhalation b.i.d. in free combination with fluticasone 250 µg oral inhalation b.i.d. in a double-blind triple-dummy fashion.


Ages Eligible for Study:   40 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion criteria:

  • All patients must have a diagnosis of chronic obstructive pulmonary disease according to the GOLD criteria and must meet the following spirometric criteria:

    • Patients must have relatively stable airway obstruction with a post-bronchodilator FEV1 < 80% of predicted normal and FEV1/FVC < 70% at Visit 1, and a pre-dose FEV1 < 65% predicted at Visit 2.
  • Male or female patients 40 years of age or older. There is no upper age limit.
  • Patients must be current or ex-smokers with a smoking history of more than 10 pack-years.

Exclusion criteria:

  • Patients with significant diseases other than COPD.
  • Patients with a history of asthma, allergic rhinitis or atopy or who have a total blood eosinophil count more than or equal to 600/mm3.
  • Patients who have been treated with commercially available tiotropium (Spiriva®).
  Contacts and Locations
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Please refer to this study by its identifier: NCT00239499

South Africa
Tijger Trial Centre
Bellville, South Africa, 7530
Boehringer Ingelheim Investigational Site
Bloemfontein, South Africa, 9301
UCT Lung Institute
Cape Town, South Africa, 7700
Boehringer Ingelheim Investigational Site
Cape Town, South Africa, 8001
Durban Lung Centre
Durban, South Africa, 4001
St Augustine Hospital
Durban, South Africa, 4001
George, South Africa, 6529
Centre for Chest Diseases Research Unit
Johannesburg, South Africa, 2193
Boehringer Ingelheim Investigational Site
Paarl, South Africa, 7646
Boehringer Ingelheim Investigational Site
Pretoria, South Africa, 0001
Vergelegen Medi-Clinic
Somerset West, South Africa, 7130
Boehringer Ingelheim Investigational Site
Welkom, South Africa, 9460
Sponsors and Collaborators
Boehringer Ingelheim
Study Chair: Boehringer Ingelheim Study Coordinator B.I. South Africa (Pty.) Ltd.
  More Information Identifier: NCT00239499     History of Changes
Other Study ID Numbers: 205.273
Study First Received: October 14, 2005
Last Updated: November 8, 2013

Additional relevant MeSH terms:
Lung Diseases
Lung Diseases, Obstructive
Pulmonary Disease, Chronic Obstructive
Chronic Disease
Respiratory Tract Diseases
Disease Attributes
Pathologic Processes
Tiotropium Bromide
Salmeterol Xinafoate
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Asthmatic Agents
Respiratory System Agents
Cholinergic Antagonists
Cholinergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Adrenergic beta-2 Receptor Agonists
Adrenergic beta-Agonists
Adrenergic Agonists
Adrenergic Agents
Anti-Inflammatory Agents
Dermatologic Agents
Anti-Allergic Agents processed this record on March 30, 2017