The purpose of this study is to compare treatment with QVM149, an inhaler that contains three types of asthma medications compared to an inhaler that contains two types of asthma medications. Both inhalers contain an inhaled corticosteroid, which reduces inflammation in the lungs, and a medication that helps to open up the airways. The investigational inhaler, QVM149, contains a third medication that also works to open up the airways. The investigators will measure the difference in these two treatments with magnetic resonance imaging (MRI) using a special technique using xenon gas to show how gas spreads in the lungs. In healthy lungs, the gas fills the lungs evenly, but in unhealthy lungs, the gas may fill the lungs unevenly and they will appear patchy. The patchy areas are called ventilation defects. A CT of the chest will be done to assess the structure of the lungs. The investigators will also use lung function testing and questionnaires to evaluate the differences between these therapies.
A single site, two arm, randomized, open-label study in participants with asthma, who demonstrate visually obvious ventilation defects despite being on ICS/LABA was chosen to evaluate the capability of QVM149 150/50/160 μg once daily as compared to high dose dual therapy (ICS/LABA) to improve ventilation heterogeneity. According to the design of the study, hyperpolarized Xenon-129 (129Xe) will be used to measure ventilation defects in asthma participants as ventilation defect percent (VDP). A low-dose chest CT acquired within a few minutes of MRI will provide a way to measure both airway and parenchymal abnormalities. The selection of the QVM149 150/50/160 μg was made in order to keep the ICS dose equipotent to baseline therapy and to the active comparator arm and to directly compare the addition of a long-acting muscarinic antagonist (LAMA) versus continuing the therapy with high dose dual therapy (ICS/LABA). This study will be a single site, two arm, randomized, open-label study with the following treatment: * Treatment A: 2-week treatment with Indacaterol/Glycopyrronium/Mometasone 150/50/160 μg delivered as powder in hard capsules via Breezhaler, a breath-activated device which will deliver a specific dose of medication. * Treatment B: 2-week treatment with high dose dual therapy (ICS/LABA) in any approved drug formulation and delivery device. (Continue receiving high dose ICS/LABA therapy at the same dose and in the same formulation as at baseline). The study will consist of a screening/inclusion period of 1-5 days, followed by a treatment period of 14 days. The evaluation team including MRI observers will be blinded to treatment. At Visit 101, informed consent will be obtained before any study related assessments or procedures are performed. Asthma medications and eligibility criteria will be reviewed. Furthermore, at Visit 101, safety assessments including electrocardiography (ECG), hematology, blood chemistry, urinalysis, and spirometry to test reversibility will be performed. Once the above criteria are met, participants will move on to Visit 102. At Visit 102 all additional assessments, including MRI to detect visually obvious ventilation defects, low-dose chest CT, and Pulmonary Function Test assessments including spirometry, plethysmography, Lung Clearance Index (LCI) and Forced Oscillation Technique (FOT) will be conducted. Participants who qualify will then be randomized and entered into the 14 days treatment period and continue with the assessments according to study protocol. Participants will be supplied with open-label Indacaterol/Glycopyrronium/ Mometasone 150/50/160 μg o.d. delivered as powder in hard capsules via Breezhaler or continue with their previously prescribed high dose dual therapy (ICS/LABA) in any approved drug formulation and delivery device, which will be used during the study treatment period and stopped at Visit 201. Upon completion of the study treatment period at Visit 201, all participants will undergo post-treatment assessments, including MRI, pre- and post-salbutamol pulmonary function testing including spirometry, plethysmography, LCI, FOT, and asthma questionnaires. A final visit, Visit 301 will be scheduled for safety assessments. All participants will undergo vital signs, spirometry, ECG, bloodwork and urinalysis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
QVM149 is an investigational drug consisting of 150μg indacaterol acetate, 50μg glycopyrronium bromide and 160μg mometasone furoate. The drug is delivered as powder in hard capsules via Breezhaler, a breath-activated device which will deliver a specific dose of medication
High dose inhaled corticosteroid (ICS)/long-acting beta2-agonist (LABA) in any approved drug formulation and delivery device.
Robarts Research Insitute; The University of Western Ontario; London Health Sciences Centre
London, Ontario, Canada
Change from baseline airway function measured using 129-Xenon MRI ventilation defect percent at the end of 2 weeks of treatment with QVM149 150/50/160 μg once daily
Change in VDP
Time frame: Day 0 and 14
Difference in change from baseline airway function measured using 129-Xenon MRI ventilation defect percent after 2 weeks use of QVM149 150/50/160 μg once daily compared to high dose dual therapy (ICS/LABA)
Difference in change in VDP
Time frame: Day 0 and 14
Explore univariate correlation and linear regression of MRI ventilation defect percent and forced expiration volume in one second.
The relationship between ventilation defect percent and forced expiration volume in one second will be assessed using univariate correlation analysis and linear regression. This information gives insight into the relationship between pulmonary function and structure.
Time frame: Day 14
Explore univariate correlation and linear regression of MRI ventilation defect percent and forced vital capacity
The relationship between ventilation defect percent and forced vital capacity will be assessed using univariate correlation analysis and linear regression. This information gives insight into the relationship between pulmonary function and structure.
Time frame: Day 14
Explore univariate correlation and linear regression of MRI ventilation defect percent and lung volumes
The relationship between ventilation defect percent and lung volumes will be assessed using univariate correlation analysis and linear regression. This information gives insight into the relationship between pulmonary function and structure.
Time frame: Day 14
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Explore univariate correlation and linear regression of MRI ventilation defect percent and forced oscillation technique
The relationship between ventilation defect percent and forced oscillation technique will be assessed using univariate correlation analysis and linear regression. This information gives insight into the relationship between pulmonary function, structure and inflammation.
Time frame: Day 14
Explore univariate correlation and linear regression of MRI ventilation defect percent and lung clearance index
The relationship between ventilation defect percent and lung clearance index will be assessed using univariate correlation analysis and linear regression. This information gives insight into the relationship between pulmonary function and structure.
Time frame: Day 14
Explore univariate correlation and linear regression of MRI ventilation defect percent and asthma control as measured by the Asthma Control Questionnaire
The relationship between ventilation defect percent and asthma control, as measured by the Asthma Control Questionnaire (ACQ-6) will be assessed using a univariate correlation analysis and linear regression. The ACQ-6 is scored from 0 to 6, with higher scores indicating more uncontrolled asthma.
Time frame: Day 14
Explore univariate correlation and linear regression of MRI ventilation defect percent and asthma-related quality of life as measured by the Asthma Quality of Life Questionnaire
The relationship between ventilation defect percent and asthma-related quality of life as measured by the Asthma Quality of Life Questionnaire with Standardised Activities (AQLQ(S)) will be assessed using a univariate correlation analysis and linear regression. The AQLQ(S) is scored from 1-7, with lower scores indicating more severe impairment.
Time frame: Day 14
Explore univariate correlation and linear regression of MRI ventilation defect percent and daily life and perceived well-being as measured by the St. George's Respiratory Questionnaire
The relationship between ventilation defect percent and daily life and perceived well-being as measured by the St. George's Respiratory Questionnaire (SGRQ) will be assessed using univariate correlation analysis and linear regression. The SGRQ is scored from 0-100 with higher scores indicating more limitations.
Time frame: Day 14
Change from baseline forced expiration volume in one second
Indicator of pulmonary function
Time frame: Day 0 and 14
Difference in change from baseline forced expiration volume in one second after use of QVM149 compared to high dose dual therapy.
Indicator of pulmonary function
Time frame: Day 0 and 14
Change from baseline forced vital capacity
Indicator of pulmonary function
Time frame: Day 0 and 14
Difference in change from baseline forced vital capacity after use of QVM149 compared to high dose dual therapy.
Indicator of pulmonary function
Time frame: Day 0 and 14
Change from baseline residual volume.
Indicator of pulmonary function
Time frame: Day 0 and 14
Difference in change from baseline residual volume after use of QVM149 compared to high dose dual therapy.
Indicator of pulmonary function
Time frame: Day 0 and 14
Change from baseline total lung capacity.
Indicator of pulmonary function
Time frame: Day 0 and 14
Difference in change from baseline total lung capacity after use of QVM149 compared to high dose dual therapy.
Indicator of pulmonary function
Time frame: Day 0 and 14
Change from baseline forced oscillation technique
Indicator of pulmonary function and inflammation
Time frame: Day 0 and 14
Difference in change from baseline forced oscillation technique after use of QVM149 compared to high dose dual therapy.
Indicator of pulmonary function and inflammation
Time frame: Day 0 and 14
Change from baseline lung clearance index
Indicator of pulmonary function
Time frame: Day 0 and 14
Difference in change from baseline lung clearance index after use of QVM149 compared to high dose dual therapy.
Indicator of pulmonary function
Time frame: Day 0 and 14
Change from baseline in asthma control
Asthma Control Questionnaire (ACQ-6) is used to evaluate asthma control. The ACQ-6 is scored from 0 to 6, with higher scores indicating more severely uncontrolled asthma.
Time frame: Day 0 and 14
Difference in change from baseline in asthma control after use of QVM149 compared to high dose dual therapy.
Asthma Control Questionnaire (ACQ-6) is used to evaluate asthma control. The ACQ-6 is scored from 0 to 6, with higher scores indicating more severely uncontrolled asthma.
Time frame: Day 0 and 14
Change from baseline in asthma-related quality of life
Asthma Quality of Life Questionnaire with Standardised Activities (AQLQ(S)) evaluates asthma-related quality of life. The AQLQ(S) is scored from 1-7, with lower scores indicating more severe impairment.
Time frame: Day 0 and 14
Difference in change from baseline in asthma-related quality of life after use of QVM149 compared to high dose dual therapy.
Asthma Quality of Life Questionnaire with Standardised Activities (AQLQ(S)) evaluates asthma-related quality of life. The AQLQ(S) is scored from 1-7, with lower scores indicating more severe impairment.
Time frame: Day 0 and 14
Change from baseline in daily life and perceived well-being as measured by the St. George's Respiratory Questionnaire
Asthma Quality of Life Questionnaire with Standardised Activities (AQLQ(S)) evaluates asthma-related quality of life. The AQLQ(S) is scored from 1-7, with lower scores indicating more severe impairment.
Time frame: Day 0 and 14
Difference in change from baseline in daily life and perceived well-being as measured by the St. George's Respiratory Questionnaire after use of QVM149 compared to high dose dual therapy.
Asthma Quality of Life Questionnaire with Standardised Activities (AQLQ(S)) evaluates asthma-related quality of life. The AQLQ(S) is scored from 1-7, with lower scores indicating more severe impairment.
Time frame: Day 0 and 14