Asthma is a common, chronic respiratory disease affecting 1-18 percent of the population. It is accepted that much of the uncontrolled asthma is due to poor adherence and asthma outcomes in such cases may improve simply by increasing adherence to available treatments. GlaxoSmithKline (GSK) has developed a sensor, which clips on to the ELLIPTA® dry powder inhaler (DPI). This will inform subjects if/when they have taken their medication that is in the ELLIPTA inhaler, as well as other information, including: asthma management strategies, tracking of symptoms, asthma triggers, medication reminders and daily asthma forecasts. The sensors, application (app), and provider portal that provide data are subsequently described as the CIS. The combination of once-daily FF/UMEC/VI with the CIS will improve the disease management and adherence. Thus, this study is designed to study the effectiveness and adherence of single inhaler triple therapy (SITT) of FF/UMEC/VI with the CIS as compared to multiple inhaler triple therapy (MITT) of the combination of FP/SAL plus TIO without CIS in subjects with inadequately controlled asthma. The study randomization will be stratified by pre-study inhaled corticosteroids (ICS) dosage strength (mid- or high-dose). Subjects will be randomized in a 1:1 ratio to receive either FF/UMEC/VI delivered via the ELLIPTA DPI with the CIS or FP/SAL delivered via the DISKUS® DPI (with sensor only) plus TIO delivered via the RESPIMAT inhaler (without sensor). The maximum study duration will be approximately 29 weeks, which comprised of prescreen/ screening/ randomization period of up to 4 weeks, 24-week treatment period and a 1-week follow-up period. Approximately 1006 subjects will be randomized in the study. ELLIPTA and DISKUS are registered trademarks of GlaxoSmithKline (GSK) group of companies.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
FF/UMEC/VI will be given as dry white powder delivered via the ELLIPTA DPI once daily in the morning or evening. The ELLIPTA DPI holds 2 individual blister strips with 30 blisters on each strip: the first strip contains FF 100 mcg or 200 mcg in each blister and the second strip contains UMEC 62.5 mcg and VI 25 mcg in each blister.
FP/SAL will be given as dry white powder delivered via the DISKUS DPI twice daily in the morning or evening. The DISKUS DPI holds a single blister strip with 60 blisters, which contains FP 250 mcg or 500 mcg and SAL 50 mcg per blister.
TIO will be given as clear, colorless, inhalation solution delivered via RESPIMAT inhaler once daily in the morning or evening. The RESPIMAT inhaler will contain 60 puffs with 2.5 mcg TIO per puff.
Albuterol/salbutamol will be delivered as a rescue medication via MDI.
The ELLIPTA device will be used to administer FF/UMEC/VI once daily. The ELLIPTA DPI is a molded plastic two-sided inhaler that can hold two individual blister strips, which contain powder formulation for oral inhalation.
The DISKUS device will be used to administer FP/SAL twice daily. The DISKUS DPI is a plastic inhalation delivery system containing a single-foil blister strip of a powder formulation of FP/SAL for oral inhalation.
The RESPIMAT inhaler will be used to administer TIO once daily. The RESPIMAT inhaler has a solution filled into a polyethylene/polypropylene cartridge with a polypropylene cap with integrated silicone sealing ring. The cartridge is enclosed within an aluminum cylinder.
Albuterol/salbutamol will be delivered as a rescue medication via MDI.
The CIS will consist of a sensor, which clips on to the ELLIPTA DPI. This will inform subject's if/when they have taken their medication that is in the ELLIPTA inhaler. The sensor will measure when the ELLIPTA inhaler mouth piece cover is fully opened and closed and this data can be fed back, via the app on a mobile device to the subject. The sensors, app, and provider portal that provide data are subsequently described as the CIS.
Percentage of subjects who have an asthma control test (ACT) total score of >=20
The ACT is a self-administered tool to identify subjects with poorly controlled asthma. It is a 5-item questionnaire measuring the frequency of shortness of breath, general asthma symptoms, use of rescue medications, the effect of asthma on daily functioning, and overall assessment of asthma control. The response options for all these questions consist of a 5-point scale, ranging from 1 (all the time or not controlled at all for symptoms/activities) to 5 (not at all or completely controlled).
Time frame: Up to 24 weeks
Percentage of subjects with an increase from Baseline of >=3 in ACT total score
The ACT is a self-administered tool to identify subjects with poorly controlled asthma. It is a 5-item questionnaire measuring the frequency of shortness of breath, general asthma symptoms, use of rescue medications, the effect of asthma on daily functioning, and overall assessment of asthma control. The response options for all these questions consist of a 5-point scale, ranging from 1 (all the time or not controlled at all for symptoms/activities) to 5 (not at all or completely controlled).
Time frame: Baseline and up to 24 weeks
Annualized rate of moderate and/or severe asthma exacerbations
Annualized rate of moderate/severe asthma exacerbations will be compared to evaluate the effectiveness of FF/UMEC/VI with CIS on improving asthma control compared with FP/SAL+TIO after 24 weeks of treatment. Moderate asthma exacerbation is defined as deterioration in asthma symptoms, deterioration in lung function, or increased rescue bronchodilator use lasting for at least 2 days or more. Severe asthma exacerbation is defined as the deterioration of asthma requiring the use of systemic corticosteroids, or an increase from a stable maintenance dose, for at least 3 days or an inpatient hospitalization or emergency department visit due to asthma that required systemic corticosteroids.
Time frame: Up to 24 weeks
Percentage of subjects who have a decrease from Baseline of >=4 in St George's Respiratory Questionnaire (SGRQ) total score
The SGRQ is designed to measure quality of life in subjects with diseases of airway obstruction, measuring symptoms, impact, and activity. It is a well-established instrument, comprising 50 questions to be self-completed by the subject. Higher scores indicate worse health status, and a change of 4 points is considered a clinically relevant change.
Time frame: Baseline and up to 24 weeks
Percentage of ELLIPTA versus DISKUS doses taken as prescribed over the 24-week treatment period
The number of ELLIPTA and DISKUS doses taken will be collected using clip on sensors attached to the inhalers. The sensors will record the precise time and date when the mouthpiece cover of the inhalers has been opened and closed. Adherence is defined as the percentage of ELLIPTA and DISKUS doses taken as prescribed over the study treatment period as determined by the maintenance sensor records of date and time (within a 24-hour time period/window).
Time frame: Up to 24 weeks
Change from Baseline in trough forced expiratory volume in 1 second (FEV1)
FEV1 is a measure of lung function and is defined as the maximal amount of air that can be forcefully exhaled in one second. Trough FEV1 on treatment is defined as the mean FEV1 value obtained prior to the last dose of investigational product.
Time frame: Baseline and up to 24 weeks
Number of subjects with serious adverse events (SAEs) including hospitalizations for asthma
Any untoward event resulting in death, life threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent disability/incapacity, congenital anomaly/birth defect or any other situation according to medical or scientific judgment will be categorized as an SAE. Number of subjects with incidences and type of SAEs including hospitalizations for asthma will be evaluated.
Time frame: Up to 29 weeks from screening
Number of subjects with AEs leading to withdrawal or discontinuation of treatment
An AE is any untoward medical occurrence in a subject, temporally associated with the use of a study treatment, whether or not considered related to the study treatment. Number of subjects with AEs leading to withdrawal or discontinuation of treatment will be evaluated.
Time frame: Up to 25 weeks
Number of subjects with AEs leading to dose modification
An AE is any untoward medical occurrence in a subject, temporally associated with the use of a study treatment, whether or not considered related to the study treatment. Number of subjects with AEs leading to dose modification will be evaluated.
Time frame: Up to 25 weeks
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