A 52-week, double-blind, randomised, multi-centre, phase III, parallel-group study in patients 12 years and older with asthma, evaluating the efficacy and safety of Symbicort (budesonide/formoterol) Turbuhaler 160/4.5 µg ‘as needed’ compared with Pulmicort (budesonide) Turbuhaler 200 µg twice daily plus terbutaline Turbuhaler 0.4 mg ‘as needed’

• Register: EUCTR
• Last refreshed on: 2 October 2017
• Main ID: EUCTR2013-004473-28-CZ
• Date of registration: 31/07/2014
• Prospective Registration: Yes
• Primary sponsor: AstraZeneca AB
• Public title: A 52-week, double-blind, randomised, multi-centre, phase III, parallel-group study in patients 12 years and older with asthma, evaluating the efficacy and safety of Symbicort (budesonide/formoterol) Turbuhaler 160/4.5 µg ‘as needed’ compared with Pulmicort (budesonide) Turbuhaler 200 µg twice daily plus terbutaline Turbuhaler 0.4 mg ‘as needed’
• Scientific title: A 52-week, double-blind, randomised, multi-centre, phase III, parallel-group study in patients 12 years and older with asthma, evaluating the efficacy and safety of Symbicort (budesonide/formoterol) Turbuhaler 160/4.5 µg ‘as needed’ compared with Pulmicort (budesonide) Turbuhaler 200 µg twice daily plus terbutaline Turbuhaler 0.4 mg ‘as needed’ - SYGMA 2
• Date of first enrolment: 18/11/2014
• Target sample size: 4114
• Recruitment status: Not Recruiting
• URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:2013-004473-28
• Study type: Interventional clinical trial of medicinal product
• Study design: Controlled: yes Randomised: yes Open: no Single blind: no Double blind: yes Parallel group: yes Cross over: no Other: no If controlled, specify comparator, Other Medicinial Product: yes Placebo: no Other: no Number of treatment arms in the trial: 2
• Phase: Human pharmacology (Phase I): no Therapeutic exploratory (Phase II): no Therapeutic confirmatory - (Phase III): yes Therapeutic use (Phase IV): no

Countries of recruitment

Argentina, Australia, Brazil, Bulgaria, Chile, Colombia, Czech Republic, France, Germany, Hungary, Italy, Korea, Republic of, Mexico, New Zealand, Peru, Philippines, Poland, Romania, Russian Federation, Slovakia, South Africa, Spain, Sweden, Thailand, Ukraine, Vietnam

Contacts

• Name: Information Center
• Affiliation: AstraZeneca

• Name: Information Center
• Affiliation: AstraZeneca

Key inclusion & exclusion criteria

Inclusion criteria:
1. Provision of informed consent prior to any study specific procedures. For patients under-age, signed informed consent from both the patient and the patient’s parent/legal guardian is required
2. Outpatients of either gender aged =12 years at Visit 1
3. Diagnosis of asthma according to GINA criteria with a documented history of at least 6 months prior to Visit 1
4. Patients who are in need of GINA step 2 treatment:
- uncontrolled on an inhaled short acting bronchodilator(s) "as needed" (short acting beta2 agonist and/or short acting anticholinergic agent) as judged by the investigator for the last 30 days before Visit 2, or
- controlled on mono-maintenance therapy with low stable dose ICS (= 400 µg budesonide per day or corresponding dose of other ICS) (see Appendix E for conversion) or LTRA in addition to "as needed" use of inhaled short-acting bronchodilator (short acting beta2 agonist and/or short acting anticholinergic agent) as judged by the investigator for the last 30 days prior to Visit 2
5. Based on lung function tests (see Section 5.1.2) at Visit 2, patients pre-treated with
- a SABA only should have pre-bronchodilator FEV1 = 60 % of predicted normal (PN) and post- bronchodilator FEV1 = 80 % of PN according to the European Respiratory Society (ERS) guidelines (Quanjer at al 2012)
- low dose ICS or LTRA medication should have pre-bronchodilator FEV1 =80 % PN according to the ERS guidelines
6. Reversible airway obstruction according to a reversibility test (see Section 5.1.2.2) performed at Visit 2 defined as an increase in FEV1 =12% and =200 ml relative to baseline, after inhalation of 1 mg Bricanyl Turbuhaler. The test can be repeated at Visit 3 in case the patients fail at Visit 2. If patients fail at both occasions, they can still be included if they have a documented historical reversibility test within the last 12 months prior to Visit 3, with an increase in FEV1 =12% and =200 ml relative to baseline after administration of a rapid acting ß2-agonist.

For randomisation at Visit 3, patients should fulfil the following criteria:
7. Use of Bricanyl Turbuhaler ‘as needed’ due to asthma symptoms on at least 3 separate days during the last week of the run-in period
8. Ability to use Turbuhaler correctly.

Are the trial subjects under 18? yes
Number of subjects for this age range: 411
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 3292
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 411

Exclusion criteria:
1. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site)
2. Previous randomisation in the present study or in the study D589SC00001 (SYGMA 1)
3. Participation in another clinical study with a non-biologic investigational product or new formulation of a marketed non-biologic drug during the last 30 days prior to Visit 1
4. Participation in another clinical trial with any marketed or investigational biologic drug within 4 months or 5 half-lives whichever is longer, prior to Visit 1
5. Any asthma worsening requiring change in asthma treatment other than SABA within 30 days prior to Visit 1
6. Use of oral, rectal or parenteral GCS within 30 days and/or depot parenteral GCS within 12 weeks prior to Visit 1
7. Use of any ß-blocking agent including eye-drops
8. Known or suspected hypersensitivity to study drugs or excipient
9. Smoker (current or previous) with a smoking history of = 10 pack years
10. Medical history of life-threatening asthma including intubation and intensive care unit admission
11. Any significant disease or disorder (e.g., cardiovascular, pulmonary other than asthma, gastrointestinal, hepatic, renal, neurological, musculoskeletal, endocrine, metabolic, malignant, psychiatric, major physical impairment) which, in the opinion of the investigator, may either put the patient at risk because of participation in the study, or may influence the results of the study, or the patient’s ability to participate in the study
12. Any clinically relevant abnormal findings in physical examination and/or vital signs at Visit 2, which, in the opinion of the investigator, may put the patient at risk if participating in the study
13. Pregnancy, breast-feeding or planned pregnancy during the study. Fertile women not using acceptable contraceptive measures, as judged by the investigator
14. Planned hospitalisation during the study
15. Suspected poor capability, as judged by the investigator, of following instructions of the study

For randomisation at Visit 3, patients should not fulfil any of the following criteria:
16. Use of = 6 Bricanyl Turbuhaler ‘as needed’ inhalations per day, for a certain number of days depending on the actual length of run-in: for = 2 days out of 14 days; for = 3 days out of 15-21 days; for = 4 days out of 22 or more days of run-in
17. Any asthma worsening requiring change in treatment other than SABA from Visit 1 until randomisation.



Age minimum:
Age maximum:
Gender:
Female: yes
Male: yes

Health Condition(s) or Problem(s) studied

English Asthma

Therapeutic area: Diseases [C] - Respiratory Tract Diseases [C08]

Intervention(s)

Trade Name: Symbicort Turbuhaler, 160 micrograms/4.5 micrograms/inhalation,
inhalation powder
Pharmaceutical Form: Inhalation powder
INN or Proposed INN: Budesonide
CAS Number: 51333-22-3
Other descriptive name: BUDESONIDE
Concentration unit: µg microgram(s)
Concentration type: equal
Concentration number: 160-
INN or Proposed INN: Formoterol
CAS Number: 43229-80-7
Other descriptive name: FORMOTEROL FUMARATE
Concentration unit: µg microgram(s)
Concentration type: equal
Concentration number: 4.5-

Product Name: Terbutaline Turbuhaler 0.4 mg/dose
Pharmaceutical Form: Inhalation powder
INN or Proposed INN: Terbutaline sulfate
CAS Number: 23031-32-5
Other descriptive name: TERBUTALINE SULFATE
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 0.4-

Trade Name: Pulmicort Turbuhaler, 200 micrograms/dose, inhalation powder
Pharmaceutical Form: Inhalation powder
INN or Proposed INN: Budesonide
CAS Number: 51333-22-3
Other descriptive name: BUDESONIDE
Concentration unit: µg microgram(s)
Concentration type: equal
Concentration number: 200-
Pharmaceutical form of the placebo: Inhalation powder
Route of administration of the placebo: Inhalation use

Primary Outcome(s)

Primary end point(s): Annual severe asthma exacerbation rate

Secondary Objective: To estimate the difference in efficacy between Symbicort Turbuhaler 160/4.5 µg ‘as needed’ and Pulmicort Turbuhaler 200 µg twice daily plus terbutaline Turbuhaler 0.4 mg ‘as needed’

To compare the safety of Symbicort Turbuhaler 160/4.5 µg ‘as needed’ with that of Pulmicort Turbuhaler 200 µg twice daily plus terbutaline Turbuhaler 0.4 mg ‘as needed’

Timepoint(s) of evaluation of this end point: up to 52 weeks

Main Objective: To demonstrate that Symbicort Turbuhaler 160/4.5 µg ‘as needed’ is non-inferior to Pulmicort Turbuhaler 200 µg twice daily plus terbutaline Turbuhaler 0.4 mg ‘as needed’

Secondary Outcome(s)

Secondary end point(s): •Time to first severe asthma exacerbation
•Average change from baseline in pre-dose FEV1
•Time to study specific asthma related discontinuation
•Average change from baseline in ‘as needed’ use
•Change from baseline in percent of ‘as needed’ free days
•Percentage of controller use days
•Average change from baseline in Asthma Control Questionnaire (5-item version) - ACQ-5 score
•Average change from baseline in Asthma Quality of Life Questionnaire Standardised Version - AQLQ(S) score

Timepoint(s) of evaluation of this end point: Up to 52 weeks
Time to first severe asthma exacerbation
Time to study specific asthma related discontinuation
Average change from baseline in ‘as needed’ use
Change from baseline in percent of ‘as needed’ free days
Percentage of controller use days
Study weeks 0,17,34,52
Average change from baseline in pre-dose FEV1
Average change from baseline in Asthma Control Questionnaire (5-item version) - ACQ-5 score -
Average change from baseline in Asthma Quality of Life Questionnaire Standardised Version - AQLQ(S) score

Secondary ID(s)

2013-004473-28-SE

D589SC00003

Source(s) of Monetary Support

AstraZeneca AB