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NCT02554786

A Multicenter Randomized 52 Week Treatment Double-blind, Triple Dummy Parallel Group Study to Assess the Efficacy and Safety of QMF149 Compared to Mometasone Furoate in Participants With Asthma

Completed Phase 3 Results posted Last updated 5 March 2020
What this trial tests

Phase 3 trial testing Indacaterol acetate/Mometasone furoate in Asthma in 2,216 participants. Completed in 28 June 2019.

Timeline
29 December 2015
Primary endpoint
21 November 2018
28 June 2019

Quick facts

Lead sponsorNovartis Pharmaceuticals
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingdouble
Primary purposetreatment
Enrollment2,216
Start date29 December 2015
Primary completion21 November 2018
Estimated completion28 June 2019
Sites388 locations across Japan, Ireland, Poland, South Korea, Guatemala, Croatia, Russia, Estonia

Drugs / interventions tested

Conditions studied

Sponsor

Novartis Pharmaceuticals — full company profile →

Who can join

Adults 12 to 75, any sex, with Asthma. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Trough Forced Expiratory Volume in One Second (Trough FEV1) at Week 26 Primary · 26 weeks

Trough FEV1 was assessed by performing spirometric assessment. It is defined as average of the two FEV1 measurements taken 23 hr 15 min and 23 hr 45 min post-evening dose. FEV1 is the amount of air which can be forcibly exhaled from the lungs in the first second of a forced exhalation, measured through spirometry testing.

GroupValue95% CI
QMF149 150/320 μg2.383± 0.0159
QMF149 150/160 μg2.387± 0.0160
MF 800 μg2.250± 0.0162
MF 400 μg2.176± 0.0162
Salmeterol/Fluticasone 50/500 μg2.346± 0.0160
Asthma Control Questionnaire (ACQ-7) at Weeks 4, 12, 26 and 52 Secondary · Weeks 4, 12, 26 and 52

The ACQ-7 measured asthma symptom control and consists of 7 items: 5 on symptom assessment, 1 on rescue bronchodilator use and 1 on airway calibre (FEV1 % predicted). All 7 questions of the ACQ-7 were equally weighted. Items 1-5 were scored along a 7-point response scale, where 0 = totally controlled and 6 = severely uncontrolled. Item 6 is scored between 0 = no rescue medication and 6 = More than 16 puffs/inhalations most days. The 7th item was scored by the investigator based on the FEV1 % predicted from the masterscope at the site (i.e., Score = 0 means \> 95% of predicted FEV1, 1 = 90 - 95

Week 4
GroupValue95% CI
QMF149 150/320 μg1.486± 0.0337
QMF149 150/160 μg1.533± 0.0338
MF 800 μg1.659± 0.0338
MF 400 μg1.730± 0.0337
Salmeterol/Fluticasone 50/500 μg1.541± 0.0335
Week 12
GroupValue95% CI
QMF149 150/320 μg1.394± 0.0347
QMF149 150/160 μg1.377± 0.0348
MF 800 μg1.523± 0.0348
MF 400 μg1.625± 0.0350
Salmeterol/Fluticasone 50/500 μg1.445± 0.0345
Week 26
GroupValue95% CI
QMF149 150/320 μg1.267± 0.0350
QMF149 150/160 μg1.261± 0.0350
MF 800 μg1.439± 0.0352
MF 400 μg1.509± 0.0354
Salmeterol/Fluticasone 50/500 μg1.322± 0.0349
Week 52
GroupValue95% CI
QMF149 150/320 μg1.231± 0.0358
QMF149 150/160 μg1.183± 0.0356
MF 800 μg1.373± 0.0359
MF 400 μg1.449± 0.0361
Salmeterol/Fluticasone 50/500 μg1.221± 0.0354
Trough FEV1 at Week 52 Secondary · Week 52

Trough FEV1 was assessed by performing spirometric assessment. It is defined as average of the two FEV1 measurements taken 23 hr 15 min and 23 hr 45 min post-evening dose. FEV1 is the amount of air which can be forcibly exhaled from the lungs in the first second of a forced exhalation, measured through spirometry testing.

GroupValue95% CI
QMF149 150/320 μg2.386± 0.0168
QMF149 150/160 μg2.357± 0.0167
MF 800 μg2.249± 0.0170
MF 400 μg2.148± 0.0170
Salmeterol/Fluticasone 50/500 μg2.338± 0.0167
Pre-dose FEV1 at Weeks 4 and 12 Secondary · Weeks 4 (Day 30) and 12 (Day 86)

Pre-dose trough FEV1 is defined as average of the two FEV1 measurements taken 45 min and 15 min pre evening dose. It was assessed by performing spirometric assessment. FEV1 is the amount of air which can be forcibly exhaled from the lungs in the first second of a forced exhalation, measured through spirometry testing.

Day 30
GroupValue95% CI
QMF149 150/320 μg2.369± 0.0141
QMF149 150/160 μg2.367± 0.0142
MF 800 μg2.237± 0.0143
MF 400 μg2.171± 0.0143
Salmeterol /Fluticasone 50/500 μg0.2333± 0.0141
Day 86
GroupValue95% CI
QMF149 150/320 μg2.368± 0.0148
QMF149 150/160 μg2.361± 0.0148
MF 800 μg2.245± 0.0148
MF 400 μg2.177± 0.0149
Salmeterol /Fluticasone 50/500 μg2.330± 0.0146
Post Dose FEV1 (5 Minutes-1 Hour) Secondary · Up to Week 52 (Day 364)

Post-dose FEV1 measurements were analyzed at 5 minutes, 15 minutes, 30 minutes and 1 hour. FEV1 is the amount of air which can be forcibly exhaled from the lungs in the first second of a forced exhalation, measured through spirometry testing.

Day 1: 5 minutes
GroupValue95% CI
QMF149 150/320 μg2.279± 0.0084
QMF149 150/160 μg2.270± 0.0085
MF 800 μg2.138± 0.0085
MF 400 μg2.118± 0.0084
Salmeterol/Fluticasone 50/500 μg2.224± 0.0084
Day 1: 15 minutes
GroupValue95% CI
QMF149 150/320 μg2.321± 0.0088
QMF149 150/160 μg2.312± 0.0089
MF 800 μg2.159± 0.0089
MF 400 μg2.137± 0.0089
Salmeterol/Fluticasone 50/500 μg2.278± 0.0088
Day 1: 30 minutes
GroupValue95% CI
QMF149 150/320 μg2.338± 0.0095
QMF149 150/160 μg2.326± 0.0096
MF 800 μg2.162± 0.0096
MF 400 μg2.141± 0.0095
Salmeterol/Fluticasone 50/500 μg2.310± 0.0095
Day 1: 1 hour
GroupValue95% CI
QMF149 150/320 μg2.343± 0.0100
QMF149 150/160 μg2.347± 0.0101
MF 800 μg2.166± 0.0101
MF 400 μg2.142± 0.0100
Salmeterol/Fluticasone 50/500 μg2.337± 0.0100
Day 30: 5 minutes
GroupValue95% CI
QMF149 150/320 μg2.413± 0.0142
QMF149 150/160 μg2.406± 0.0144
MF 800 μg2.224± 0.0145
MF 400 μg2.174± 0.0145
Salmeterol/Fluticasone 50/500 μg2.360± 0.0142
Day 30: 30 minutes
GroupValue95% CI
QMF149 150/320 μg2.432± 0.0143
QMF149 150/160 μg2.426± 0.0145
MF 800 μg2.238± 0.0146
MF 400 μg2.174± 0.0146
Salmeterol/Fluticasone 50/500 μg2.389± 0.0143
Day 30: 1 hour
GroupValue95% CI
QMF149 150/320 μg2.448± 0.0145
QMF149 150/160 μg2.440± 0.0146
MF 800 μg2.257± 0.0147
MF 400 μg2.183± 0.0148
Salmeterol/Fluticasone 50/500 μg2.411± 0.0144
Day 86:5 minutes
GroupValue95% CI
QMF149 150/320 μg2.411± 0.0150
QMF149 150/160 μg2.409± 0.0150
MF 800 μg2.248± 0.0150
MF 400 μg2.178± 0.0153
Salmeterol/Fluticasone 50/500 μg2.356± 0.0148
Trough Forced Vital Capacity (FVC) Secondary · Up to Week 52 (Day 365)

FVC is the total amount of air exhaled during the FEV test. Trough FVC is defined as average of the two FVC measurements taken 23 hr 15 min and 23 hr 45 min post-evening dose. It was assessed by performing spirometric assessment.

Day 2
GroupValue95% CI
QMF149 150/320 μg3.342± 0.0173
QMF149 150/160 μg3.342± 0.0174
MF 800 μg3.256± 0.0177
MF 400 μg3.203± 0.0173
Salmeterol/Fluticasone 50/500 μg3.344± 0.0176
Day 184
GroupValue95% CI
QMF149 150/320 μg3.372± 0.0179
QMF149 150/160 μg3.387± 0.0180
MF 800 μg3.322± 0.0183
MF 400 μg3.246± 0.0182
Salmeterol/Fluticasone 50/500 μg3.355± 0.0180
Day 365
GroupValue95% CI
QMF149 150/320 μg3.394± 0.0182
QMF149 150/160 μg3.364± 0.0181
MF 800 μg3.319± 0.0184
MF 400 μg3.218± 0.0183
Salmeterol/Fluticasone 50/500 μg3.358± 0.0182
Trough Forced Expiratory Flow (FEF)Between 25% and 75% of FVC (FEF25-75) Secondary · Up to Week 52 (Day 365)

FEF is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration. Trough FEF25-75% is defined as average of the two FEF25-75% measurements taken 23 hr 15 min and 23 hr 45 min post-evening dose. It was assessed by performing spirometric assessment.

Day 2
GroupValue95% CI
QMF149 150/320 μg1.644± 0.0186
QMF149 150/160 μg1.617± 0.0187
MF 800 μg1.455± 0.0191
MF 400 μg1.406± 0.0186
Salmeterol/Fluticasone 50/500 μg1.662± 0.0189
Day 184
GroupValue95% CI
QMF149 150/320 μg1.775± 0.0249
QMF149 150/160 μg1.738± 0.0250
MF 800 μg1.546± 0.0253
MF 400 μg1.473± 0.0254
Salmeterol/Fluticasone 50/500 μg1.692± 0.0250
Day 365
GroupValue95% CI
QMF149 150/320 μg1.745± 0.0259
QMF149 150/160 μg1.686± 0.0257
MF 800 μg1.530± 0.0261
MF 400 μg1.440± 0.0261
Salmeterol/Fluticasone 50/500 μg1.692± 0.0258
Change From Baseline in Morning and Evening Peak Expiratory Flow Rate (PEF) Over 26 and 52 Weeks of Treatment Secondary · Up to Weeks 26 and 52

PEF is a person's maximum speed of expiration. All the participants were instructed to record PEF twice daily using a mini Peak Flow Meter device, once in the morning (before taking the morning dose) and once approximately 12 h later in the evening (before taking the evening dose). At each timepoint, the participant was instructed to perform 3 consecutive manoeuvres within 10 minutes. These PEF values were captured in the e-PEF/diary. The best of 3 values were used.

Week 26: Mean morning PEF
GroupValue95% CI
QMF149 150/320 μg42.4± 2.15
QMF149 150/160 μg38.1± 2.15
MF 800 μg12.8± 2.13
MF 400 μg5.9± 2.14
Salmeterol/Fluticasone 50/500 μg29.1± 2.14
Week 26:Mean evening PEF
GroupValue95% CI
QMF149 150/320 μg32.5± 2.05
QMF149 150/160 μg30.4± 2.04
MF 800 μg7.7± 2.04
MF 400 μg0.0± 2.05
Salmeterol/Fluticasone 50/500 μg23.9± 2.04
Week 52:Mean morning PEF
GroupValue95% CI
QMF149 150/320 μg42.1± 2.24
QMF149 150/160 μg36.9± 2.22
MF 800 μg13.4± 2.21
MF 400 μg6.7± 2.22
Salmeterol/Fluticasone 50/500 μg28.3± 2.22
Week 52:Mean evening PEF
GroupValue95% CI
QMF149 150/320 μg31.2± 2.14
QMF149 150/160 μg28.7± 2.13
MF 800 μg7.4± 2.13
MF 400 μg-0.3± 2.14
Salmeterol/Fluticasone 50/500 μg22.1± 2.13
Percentage of Participants Achieving the Minimal Important Difference (MID) ACQ ≥ 0.5 at Weeks 26 and 52 Secondary · Weeks 26 (Day 183) and 52 (Day 364)

Change from baseline in ACQ-7 scores of ≤ 0.5 was defined as minimal clinically important difference and were considered clinically meaningful. The ACQ-7 measured asthma symptom control and consists of 7 items: 5 on symptom assessment, 1 on rescue bronchodilator use and 1 on airway calibre (FEV1 % predicted). All 7 questions of the ACQ-7 were equally weighted. Items 1-5 were scored along a 7-point response scale, where 0 = totally controlled and 6 = severely uncontrolled. Item 6 is scored between 0 = no rescue medication and 6 = More than 16 puffs/inhalations most days. The 7th item was scored

Day 183
GroupValue95% CI
QMF149 150/320 μg76.4
QMF149 150/160 μg76.2
MF 800 μg72.3
MF 400 μg66.9
Salmeterol/Fluticasone 50/500 μg75.9
Day 364
GroupValue95% CI
QMF149 150/320 μg77.7
QMF149 150/160 μg82.1
MF 800 μg73.6
MF 400 μg69.2
Salmeterol/Fluticasone 50/500 μg77.3
Change From Baseline in Percentage of Asthma Symptoms Free Days Secondary · Up to Week 52

All participants were provided with an electronic diary (e-Diary) to record clinical symptoms. They were instructed to routinely complete the e-Diary twice daily at the same time each morning and again approximately 12 hours later in the evening. The e-Diary was reviewed at each visit until study completion. Asthma symptoms free days are days with no daytime symptoms, no night-time awakenings and no symptoms on awakening. The daytime asthma symptom score was based on the daily e-diary recordings by participants with respect to shortness of breath, wheeze, cough, chest tightness, and impact on

GroupValue95% CI
QMF149 150/320 μg28.3± 1.72
QMF149 150/160 μg28.4± 1.72
MF 800 μg22.5± 1.72
MF 400 μg19.3± 1.72
Salmeterol/Fluticasone 50/500 μg24.9± 1.72
Change Form Baseline in Percentage of Days With no Daytime Symptoms Secondary · Up to Week 52

All participants were provided with an electronic diary (e-Diary) to record clinical symptoms. They were instructed to routinely complete the e-Diary twice daily at the same time each morning and again approximately 12 hours later in the evening. The e-Diary was reviewed at each visit until study completion. For days with no daytime symptoms, all 5 evening questions must have a score = 0 with respect to shortness of breath, wheeze, cough, chest tightness and impact on usual daily activities due to symptoms, each with scores from 0 (no problems) to 4 (very severe problems).

GroupValue95% CI
QMF149 150/320 μg28.0± 1.69
QMF149 150/160 μg28.0± 1.69
MF 800 μg23.0± 1.68
MF 400 μg20.0± 1.69
Salmeterol/Fluticasone 50/500 μg24.8± 1.68
Change From Baseline in Percentage of Nights With no Night-time Awakenings Secondary · Up to Week 52

All participants were provided with an electronic diary (e-Diary) to record clinical symptoms. They were instructed to routinely complete the e-Diary twice daily at the same time each morning and again approximately 12 hours later in the evening. The e-Diary was reviewed at each visit until study completion. The question asked for nights with no night-time awakenings was "How did you sleep last night?" had to be answered with "I did not wake up because of any breathing problems" with scores from 0 (no problem)-4 (very severe problems).

GroupValue95% CI
QMF149 150/320 μg17.0± 1.28
QMF149 150/160 μg16.4± 1.27
MF 800 μg14.2± 1.27
MF 400 μg12.5± 1.27
Salmeterol/Fluticasone 50/500 μg16.1± 1.27

Adverse events — posted to ClinicalTrials.gov

Time frame: Serious adverse events: From first dose up to 30 days post last dose (approximately 56 weeks) Other adverse events: From first dose up to 7 days post last dose (approximately 53 weeks). Reporting threshold: 2%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

QMF 150/320
Serious: 21/443 (5%)
Deaths: 0/443
QMF 150/160
Serious: 20/437 (5%)
Deaths: 0/437
MF 800
Serious: 21/440 (5%)
Deaths: 0/440
MF 400
Serious: 31/443 (7%)
Deaths: 1/443
S/F 50/500
Serious: 21/444 (5%)
Deaths: 0/444

Serious adverse events (109 terms)

ReactionSystemQMF 150/320QMF 150/160MF 800MF 400S/F 50/500
AsthmaRespiratory, thoracic and mediastinal disorders
PneumoniaInfections and infestations
PeritonitisInfections and infestations
Acute myocardial infarctionCardiac disorders
Rib fractureInjury, poisoning and procedural complications
Atrial fibrillationCardiac disorders
Coronary artery diseaseCardiac disorders
VertigoEar and labyrinth disorders
GoitreEndocrine disorders
Corneal depositsEye disorders
Optic ischaemic neuropathyEye disorders
Retinal detachmentEye disorders
Abdominal herniaGastrointestinal disorders
Abdominal pain upperGastrointestinal disorders
Diverticulum intestinalGastrointestinal disorders
Diverticulum intestinal haemorrhagicGastrointestinal disorders
Gastric polypsGastrointestinal disorders
Gastric ulcer haemorrhageGastrointestinal disorders
GastritisGastrointestinal disorders
Inguinal herniaGastrointestinal disorders
Irritable bowel syndromeGastrointestinal disorders
Large intestine polypGastrointestinal disorders
Pancreatitis acuteGastrointestinal disorders
Peptic ulcerGastrointestinal disorders
Cholecystitis acuteHepatobiliary disorders
Other adverse events (19 terms — click to expand)

ReactionSystemQMF 150/320QMF 150/160MF 800MF 400S/F 50/500
AsthmaRespiratory, thoracic and mediastinal disorders
NasopharyngitisInfections and infestations
Upper respiratory tract infectionInfections and infestations
HeadacheNervous system disorders
BronchitisInfections and infestations
Viral upper respiratory tract infectionInfections and infestations
InfluenzaInfections and infestations
Back painMusculoskeletal and connective tissue disorders
Respiratory tract infection viralInfections and infestations
CoughRespiratory, thoracic and mediastinal disorders
PharyngitisInfections and infestations
Upper respiratory tract infection bacterialInfections and infestations
HypertensionVascular disorders
Viral infectionInfections and infestations
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
Rhinitis allergicRespiratory, thoracic and mediastinal disorders
RhinitisInfections and infestations
DiarrhoeaGastrointestinal disorders
GastroenteritisInfections and infestations

Most-reported serious reactions: Asthma, Pneumonia, Peritonitis, Acute myocardial infarction, Rib fracture, Atrial fibrillation, Coronary artery disease, Vertigo.

Data from ClinicalTrials.gov NCT02554786 adverse events section.

Sponsor's own description

The purpose of the trial is to evaluate the efficacy and safety of two different doses of QMF149 (QMF149 150/160 µg and QMF149 150/320 µg via Concept1) over two respective MF doses (MF 400 µg and MF 800 µg via Twisthaler® (total daily dose)) in poorly controlled asthmatic participants as determined by pulmonary function testing, and effects on asthma control

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Once-daily mometasone plus indacaterol versus mometasone or twice-daily fluticasone plus salmeterol in patients with inadequately controlled asthma (PALLADIUM): a randomised, double-blind, triple-dummy, controlled phase 3 study.
    van Zyl-Smit RN, Krüll M, Gessner C, Gon Y, et al · · 2020 · cited 35× · PMID 32653075 · DOI 10.1016/s2213-2600(20)30178-8
  2. Effectiveness and tolerability of dual and triple combination inhaler therapies compared with each other and varying doses of inhaled corticosteroids in adolescents and adults with asthma: a systematic review and network meta-analysis.
    Oba Y, Anwer S, Maduke T, Patel T, et al · · 2022 · cited 11× · PMID 36472162 · DOI 10.1002/14651858.cd013799.pub2
  3. A Review of the Unique Drug Development Strategy of Indacaterol Acetate/Glycopyrronium Bromide/Mometasone Furoate: A First-in-Class, Once-Daily, Single-Inhaler, Fixed-Dose Combination Treatment for Asthma.
    Brittain D, D'Andrea P, Gruen E, Hosoe M, et al · · 2022 · cited 7× · PMID 35072888 · DOI 10.1007/s12325-021-02025-w
  4. Inhaled steroids with and without regular formoterol for asthma: serious adverse events.
    Janjua S, Schmidt S, Ferrer M, Cates CJ. · · 2019 · cited 6× · PMID 31553802 · DOI 10.1002/14651858.cd006924.pub4
  5. Addition of long-acting beta2 agonists or long-acting muscarinic antagonists versus doubling the dose of inhaled corticosteroids (ICS) in adolescents and adults with uncontrolled asthma with medium dose ICS: a systematic review and network meta-analysis.
    Oba Y, Anwer S, Patel T, Maduke T, et al · · 2023 · cited 5× · PMID 37602534 · DOI 10.1002/14651858.cd013797.pub2
  6. One time a day mometasone/indacaterol fixed-dose combination versus two times a day fluticasone/salmeterol in patients with inadequately controlled asthma: pooled analysis from PALLADIUM and IRIDIUM studies.
    Chapman K, van Zyl-Smit R, Maspero J, Kerstjens HAM, et al · · 2021 · cited 4× · PMID 34452934 · DOI 10.1136/bmjresp-2020-000819
  7. Population Pharmacokinetic Analysis of Indacaterol/Glycopyrronium/Mometasone Furoate After Administration of Combination Therapies Using the Breezhaler<sup>®</sup> Device in Patients with Asthma.
    Bartels C, Jain M, Yu J, Tillmann HC, et al · · 2021 · cited 4× · PMID 34024035 · DOI 10.1007/s13318-021-00689-x
  8. Mometasone/Indacaterol/Glycopyrronium (MF/IND/GLY) and MF/IND at Different MF Strengths versus Fluticasone Propionate/Salmeterol Xinafoate (FLU/SAL) and FLU/SAL+ Tiotropium in Patients with Asthma.
    van Zyl-Smit RN, Chapman KR, Kerstjens HAM, Gessner C, et al · · 2023 · cited 2× · PMID 36714049 · DOI 10.2147/jaa.s392975

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