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A Study to Evaluate the Safety, Efficacy and Changes in Induced Sputum and Blood Biomarkers Following Daily Repeat Doses of Inhaled GSK2269557 in Chronic Obstructive Pulmonary Disease (COPD) Subjects With Acute Exacerbation

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ClinicalTrials.gov Identifier: NCT02522299
Recruitment Status : Active, not recruiting
First Posted : August 13, 2015
Last Update Posted : April 17, 2018
Sponsor:
Information provided by (Responsible Party):
GlaxoSmithKline

Brief Summary:
The purpose of this study is to evaluate specific alterations in immune cell mechanisms related to neutrophil function as detected by PI3Kdelta-dependent changes in messenger ribonucleic acid (mRNA) extracted from induced sputum in patients experiencing an exacerbation of COPD, with or without treatment with GSK2269557. The efficacy of treatment with GSK2269557 will also be measured using functional respiratory imaging (FRI) and spirometry. This is a randomised, double-blind, placebo-controlled, parallel-group study. The study consisted of Screening Phase (up to 3 days prior to Day 1), Treatment Phase (Days 1 to 84) and Follow phase (7 to 14 days after last dose). The total duration of the study is 13-14 weeks including the screening visit.

Condition or disease Intervention/treatment Phase
Pulmonary Disease, Chronic Obstructive Drug: GSK2269557 Drug: Placebo Device: DISKUS Phase 2

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 45 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: A Randomised, Double-blind, Placebo-controlled Study to Evaluate the Safety, Efficacy and Changes in Induced Sputum and Blood Biomarkers Following Daily Repeat Doses of Inhaled GSK2269557 for 12 Weeks in Adult Subjects Diagnosed With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Actual Study Start Date : November 4, 2015
Estimated Primary Completion Date : October 19, 2018
Estimated Study Completion Date : October 19, 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: COPD Lung Diseases

Arm Intervention/treatment
Experimental: GSK2269557 1000 microgram (mcg)
Each subject will receive 2 inhalations of GSK2269557 (30 seconds apart, 2 x 500 mcg, total dose of 1000 mcg) once daily for 84 consecutive days via DISKUS™ device. DISKUS is registered product of GSK groups of companies.
Drug: GSK2269557
GSK2269557 500 mcg blended with lactose per blister and will be administered using a DISKUS dry powder inhaler device

Device: DISKUS
It is multi-dose dry powder inhaler containing one foil strip of drug with 60 blisters

Placebo Comparator: Placebo
Each subject will receive 2 inhalations of placebo once daily for 84 days via DISKUS device
Drug: Placebo
Lactose will be administered using a DISKUS dry powder inhaler device

Device: DISKUS
It is multi-dose dry powder inhaler containing one foil strip of drug with 60 blisters




Primary Outcome Measures :
  1. Change in mRNA transcriptomics in induced sputum following treatment with GSK2269557 [ Time Frame: Screening, Days 12, 28 and 84 ]
    Sputum induction samples will be collected to determine the alterations in previously identified immune cell mechanisms specifically related to neutrophil function by identifying the changes in mRNA transcriptomics in induced sputum.


Secondary Outcome Measures :
  1. Change from baseline in specific imaging Airways Volume (siVaw) and imaging Airways Volume (iVaw) at Functional Residual Capacity (FRC) and Total Lung Capacity (TLC) after 12 and 28 days of treatment. [ Time Frame: Screening, Day 12 and Day 28 ]
    A Computed Tomography (CT) scan with a low radiation protocol at FRC and TLC will be conducted at Screening and at 12 and 28 days of treatment

  2. Change from baseline in imaging Airways resistance (iRaw) and specific airways resistance, (siRAW) at FRC and TLC after 12 and 28 days of treatment. [ Time Frame: Screening, Day 12 and Day 28 ]
    A CT scan with a low radiation protocol at FRC and TLC will be conducted at Screening and at 12 and 28 days of treatment

  3. Change from baseline in imaging Total lung capacity and Lung lobar volumes at FRC and TLC after 12 and 28 days of treatment. [ Time Frame: Screening, Day 12 and Day 28 ]
    A CT scan with a low radiation protocol at FRC and TLC will be conducted at Screening and at 12 and 28 days of treatment

  4. Change from baseline in imaging trachea length and diameter at FRC and TLC after 12 days and 28 days of treatment. [ Time Frame: Screening, Day 12 and Day 28 ]
    A CT scan with a low radiation protocol at FRC and TLC will be conducted at Screening and at 12 and 28 days of treatment

  5. Number of participants with adverse events (AE) /serious adverse event (SAE) as a measure of safety and tolerability [ Time Frame: From start of study treatment until follow-up contact (up to Week 14) ]
    AEs and SAEs will be collected from the start of study Treatment until the follow-up contact.

  6. Composite of clinical laboratory tests as a measure of safety and tolerability [ Time Frame: Up to Week 14 ]
    Clinical laboratory tests will include hematology, and clinical chemistry.

  7. Composite of vital signs as a measure of safety and tolerability [ Time Frame: Up to Week 14 ]
    Vital signs will include temperature, systolic and diastolic blood pressure, pulse rate and respiratory rate.

  8. Composite of 12-lead electrocardiogram (ECG) assessment as a safety measure [ Time Frame: Up to Week 14 ]
    ECG measurement include heart rate and measures PR, QRS, QT, and QT interval corrected using the Fridericia's formula (QTcF) intervals.

  9. Pharmacokinetic (PK) profile of GSK2269557 will be assessed by maximum concentration (Cmax) and trough [ Time Frame: Day 1 (5 min and 24 hours post-dose), Day 12, Day 28, Day 56 and Day 84 post dose. ]
    Blood sample for PK analysis of GSK2269557 will be collected at Days 1 for plasma Cmax and trough (24 hours) post dose for inpatients; and at Days 12, 28, 56 and 84 pre dose for trough concentration.

  10. Peak Expiratory Flow (PEF) [ Time Frame: From Day 1 to Day 84 ]
    PEF measurements will be taken (in triplicate) daily in the morning before dose administration.

  11. Usage of ventolin as a Reliever/rescue medication [ Time Frame: From Day 1 to Day 84 ]
    Reliever use medication will be collected from the subject diary card to assess the number of occasions taken in the last 24 hours while subject are on daily repeat inhaled doses of GSK2269557 compared to placebo

  12. Forced Expiratory Volume in One Second (FEV1) and forced vital capacity (FVC) at clinic visit prior to sputum induction [ Time Frame: From Day 1 to Day 84 ]
    A triplicate FEV1 and FVC measurement will be taken at the clinic visit before dosing using the site's spirometer.



Information from the National Library of Medicine

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Ages Eligible for Study:   40 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Between 40 and 80 years of age inclusive, at the time of signing the informed consent.
  • The subject has a confirmed and established diagnosis of COPD, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for at least 6 months prior to entry.
  • The subject is able to produce >100 milligram (mg) of sputum at screening for processing, (ie, total weight of sputum plugs).
  • The subject has a post-bronchodilator FEV1/FVC <0.7 and FEV1 <=80 % of predicted. Predictions should be according to the European Community of Coal and Steel (ECCS) equations OR the European Respiratory Society Global Lung Function Initiative reference equations and documented in the last 5 years.
  • Disease severity: Acute exacerbation of COPD requiring an escalation in therapy to include both corticosteroid and antibiotics. Acute exacerbation to be confirmed by an experienced physician and represent a recent change in at least two major and one minor symptoms, one major and two minor symptoms, or all 3 major symptoms. Major symptoms: Subjective increase in dyspnea; Increase in sputum volume; Change in sputum colour. Minor symptoms: Cough; Wheeze; Sore throat
  • The subject is a smoker or an ex-smoker with a smoking history of at least 10 pack years (pack years = [cigarettes per day smoked/20 x number of years smoked]).
  • Body weight >= 45 kilogram (kg) and body mass index (BMI) within the range 18 to32 kilogram per meter square (kg/m^2) (inclusive)
  • Male
  • Female subject: is eligible to participate if she is not pregnant (as confirmed by a negative urine human chorionic gonadotrophin [hCG] test), not lactating, and at least one of the following conditions applies: (1)Non-reproductive potential defined as: Pre-menopausal females with one of the following: Documented tubal ligation; Documented hysteroscopic tubal occlusion procedure with follow-up confirmation of bilateral tubal occlusion; Hysterectomy; Documented Bilateral Oophorectomy. Postmenopausal defined as 12 months of spontaneous amenorrhea. Females whose menopausal status is in doubt will be required to use, or have been using, one of the highly effective contraception methods as specified below from 30 days prior to the first dose of study medication and until completion of the follow-up visit. 2)Reproductive potential and agrees to follow one of the options listed below in the GlaxoSmithKline (GSK) Modified List of Highly Effective Methods for Avoiding Pregnancy in Females of Reproductive Potential (FRP) requirements from 30 days prior to the first dose of study medication and until completion of the follow-up visit. GSK Modified List of Highly Effective Methods for Avoiding Pregnancy in FRP. This list does not apply to FRP with same sex partners, when this is their preferred and usual lifestyle or for subjects who are and will continue to be abstinent from penile-vaginal intercourse on a long term and persistent basis. 1) Contraceptive subdermal implant that meets GSK standard criteria including a <1% rate of failure per year, as stated in the product label. 2) Intrauterine device or intrauterine system that meets GSK standard criteria including a <1% rate of failure per year, as stated in the product label. 3) Oral Contraceptive, either combined or progestogen alone. 4) Injectable progestogen. 5) Contraceptive vaginal ring. 6) Percutaneous contraceptive patches. 7) Male partner sterilization with documentation of azoospermia prior to the female subject's entry into the study, and this male is the sole partner for that subject. 8) Male condom combined with a vaginal spermicide (foam, gel, film, cream, or suppository). These allowed methods of contraception are only effective when used consistently, correctly and in accordance with the product label. The investigator is responsible for ensuring that subjects understand how to properly use these methods of contraception. Specific inclusion criteria for Male subjects with female partners of reproductive potential is outlined below: Male subjects with female partners of child bearing potential must comply with the following contraception requirements from the time of first dose of study medication until after the completion of the follow up visit. 1) Vasectomy with documentation of azoospermia. 2) Male condom plus partner use of one of the contraceptive options below: Contraceptive subdermal implant that meets GSK standard criteria including a <1% rate of failure per year, as stated in the product label. Intrauterine device or intrauterine system that meets GSK standard criteria including a <1% rate of failure per year, as stated in the product label. Oral Contraceptive, either combined or progestogen alone. Injectable progestogen. Contraceptive vaginal ring. Percutaneous contraceptive patches. These allowed methods of contraception are only effective when used consistently, correctly and in accordance with the product label. The investigator is responsible for ensuring that subjects understand how to properly use these methods of contraception.
  • Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the consent form and in this protocol.

Exclusion Criteria:

  • To avoid recruitment of subjects with a severe COPD exacerbation, the presence of any one of the following severity criteria will render the subject ineligible for inclusion in the study: Need for invasive mechanical ventilation (short term [<48 hour] Non-invasive ventilation [NIV] or continuous positive airway pressure [CPAP] is acceptable); Haemodynamic instability or clinically significant heart failure; Confusion; Clinically significant pneumonia, identified by chest X-ray at screening, and as judged by the Investigator.
  • Subjects who have current medical conditions or diseases that are not well controlled and, which as judged by the Investigator, may affect subject safety or influence the outcome of the study. (Note: Patients with adequately treated and well controlled concurrent medical conditions (e.g. hypertension or noninsulin-dependent diabetes mellitus [NIDDM]) are permitted to be entered into the study).
  • Subject has a diagnosis of active tuberculosis, lung cancer, clinically overt bronchiectasis, pulmonary fibrosis, asthma or any other respiratory condition that might, in the opinion of the investigator, compromise the safety of the subject or affect the interpretation of the results.
  • ALT >2xupper limit of normal (ULN) and bilirubin >1.5xULN (isolated bilirubin >1.5xULN is acceptable if bilirubin is fractionated and direct bilirubin <35%).
  • A subject with a clinical abnormality or laboratory parameter(s) which is/are not specifically listed in the exclusion criteria, outside of the reference range for the population being studied may be included if the Investigator [in consultation with the GSK Medical Monitor if required] documents that the finding is unlikely to introduce additional risk factors and will not interfere with the study procedures.
  • Current or chronic history of liver disease, or known hepatic or biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones)
  • ECG indicative of an acute cardiac event (e.g. Myocardial Infarction) or demonstrating a clinically significant arrhythmia requiring treatment.
  • QTcF > 450 msec or QTcF > 480 msec in subjects with Bundle Branch Block, based on single QTcF value.
  • Subjects who have undergone lung volume reduction surgery.
  • Subject is currently on chronic treatment with macrolides or long term antibiotics.
  • Subject is being treated with long term oxygen therapy (LTOT) (>15 hours/day).
  • The subject has been on chronic treatment with anti-Tumour Necrosis Factor (anti-TNF), or any other immunosuppressive therapy (except corticosteroid) within 60 days prior to dosing
  • History of regular alcohol consumption within 6 months of the study defined as an average weekly intake of >28 units for males or >21 units for females. One unit is equivalent to 8 gram (g) of alcohol: a half-pint (~240 milliliter [mL]) of beer, 1 glass (125 mL) of wine or 1 (25 mL) measure of spirits.
  • History of sensitivity to any of the study medications, or components thereof (such as lactose) or a history of drug or other allergy that, in the opinion of the investigator or Medical Monitor, contraindicates their participation.
  • A known (historical) positive test for human immunodeficiency virus (HIV) antibody.
  • Presence of hepatitis B surface antigen (HBsAg), positive hepatitis C antibody test result at screening or within 3 months prior to first dose of study treatment. NOTE: Because of the short window for screening, treatment with GSK2269557 may start before receiving the result of the hepatitis tests. If subsequently the test is found to be positive, the subject may be withdrawn, as judged by the Principal Investigator in consultation with the Medical Monitor.
  • Where participation in the study would result in donation of blood or blood products in excess of 500 mL within 56 days.
  • The subject has participated in a clinical trial and has received an investigational product within the following time period prior to the first dosing day in the current study: 30 days, 5 half-lives or twice the duration of the biological effect of the investigational product (whichever is longer).
  • Exposure to more than 4 investigational medicinal products within 12 months prior to the first dosing day.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02522299


Locations
Canada, British Columbia
GSK Investigational Site
Vancouver, British Columbia, Canada, V5Z 1M9
GSK Investigational Site
Vancouver, British Columbia, Canada, V6Z 1Y6
Canada, Ontario
GSK Investigational Site
Hamilton, Ontario, Canada, L8N 3Z5
GSK Investigational Site
Montreal, Ontario, Canada, H4A 3J1
Canada, Quebec
GSK Investigational Site
Montreal, Quebec, Canada, H2W1T8
Canada
GSK Investigational Site
Quebec, Canada, G1V 4G5
Denmark
GSK Investigational Site
Odense, Denmark, DK-5000
Sponsors and Collaborators
GlaxoSmithKline
Investigators
Study Director: GSK Clinical Trials GlaxoSmithKline

Responsible Party: GlaxoSmithKline
ClinicalTrials.gov Identifier: NCT02522299     History of Changes
Other Study ID Numbers: 201928
First Posted: August 13, 2015    Key Record Dates
Last Update Posted: April 17, 2018
Last Verified: April 2018

Keywords provided by GlaxoSmithKline:
double-blind
PI3Kdelta
GSK2269557
exacerbation
Chronic Obstructive Pulmonary Disease
randomised
placebo-controlled

Additional relevant MeSH terms:
Lung Diseases
Lung Diseases, Obstructive
Pulmonary Disease, Chronic Obstructive
Chronic Disease
Respiratory Tract Diseases
Disease Attributes
Pathologic Processes