Fluticasone and Salmeterol in Allergic Rhinitis
Information source: University of Dundee
ClinicalTrials.gov processed this data on August 23, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Allergic Rhinitis
Intervention: FLUTICASONE PROPRIONATE (Drug); Salmeterol (Drug); PLACEBO (Drug)
Phase: Phase 4
Status: Completed
Sponsored by: University of Dundee Official(s) and/or principal investigator(s): Brian J Lipworth, MD, Principal Investigator, Affiliation: University of Dundee, UK
Summary
Allergic rhinitis is an under diagnosed global health problem which affects up to 25% of the
population worldwide. It has been reported as being one of the 10 most common causes for
attendance to primary care clinics. It is clinically defined as a symptomatic disorder of
the nose induced by an IgE mediated inflammation following allergen exposure of the
membranes lining the nose and is characterized by varying combinations of nasal symptoms
including sneezing, nasal blockage, rhinorrhoea and itching. Intra nasal corticosteroids
form the cornerstone of anti-inflammatory therapy in allergic rhinitis and there is
increasing interest in the role of intranasal beta 2 agonists in the management of allergic
rhinitis. The question therefore arises as to whether salmeterol exhibits such synergistic
activity in the nose in terms of potentiating the steroid response of fluticasone.
Clinical Details
Official title: A Proof of Concept Study to Evaluate Effects of Intranasal Salmeterol and Fluticasone Given Alone and in Combination in Allergic Rhinitis
Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
Primary outcome: Change in Peak Nasal Inspiratory Flow (PNIF).
Secondary outcome: Nasal symptom scores.Nasal nitric oxide. Nasal impulse oscillometry. Eosinophil cationic protein (ECP) Overnight urinary cortisol/creatinine.
Detailed description:
In vitro and ex vitro data have suggested that salmeterol may exhibit ligand independent
activation of glucocorticoid receptors, which might result in potentiation of fluticasone by
salmeterol when given in combination.
Although no such evidence of synergy was reported with fluticasone salmeterol combination in
the nose with allergen challenge, no data are available on nasal AMP challenge in the nose.
This study compares the single and long term dosing effects of intranasal fluticasone alone,
salmeterol alone and fluticasone salmeterol combination on nasal AMP challenge in persistent
allergic rhinitis sufferers.
Nasal corticosteroid,leukotriene receptor antagonist and anti histamine stopped for one week
before the start of randomized treatment during the run in phase and wash out periods.
Intransal sodium cromoglycate spray provided for rescue use throughout the study but witheld
for at least twenty four hours before challenge.
Nasal AMP challenges performed at baseline, after run-in and each washout, and 12 hours
after the first and last evening dose of the study medication. A Zerostat Antistatic spacer
(Cipla, Mumbai, India) used to administer the randomized treatments, adapted with a nasal
olive for intranasal use instead of the conventional mouthpiece.
The randomized treatments given once daily at night time as follows: placebo
hydrofluoroalkane, 2 puffs (Cipla, Mumbai,India) salmeterol-hydrofluoroalkane, 2 puffs of 25
g (Serevent Evohaler Allen and Hanburys, Middlesex, United Kingdom) fluticasone- salmeterol
hydrofluoroalkane, 2 puffs of 250/25 g (Seretide Evohaler, Allen and Hanburys) and
fluticasone-hydrofluoroalkane,2 puffs of 250 g (Flixotide Evohaler, Allen and Hanburys).
The double-blind randomization process computer generated from www. randomization. com. Trial
drug randomization performed under the direct supervision of the clinical trial pharmacist
at Ninewells University Hospital.
Active fluticasone,salmeterol, and fluticasone-salmeterol combination procured from
GlaxoSmithKline (Allen and Hanburys) by the clinical trial pharmacy and matched placebo
provided by Cipla.
Following Informed Consent and screening visit, participants provided with randomized,
labeled treatment packs with a single inhaler, either active or placebo at each study
treatment visit.
Blinding of patients and investigators ensured by using identical colored actuators for each
treatment and labeling of active or placebo canisters with trial-specific labels.
Measurements made at 12 hours after the first and last dose of each randomized treatment.
At initial screening, nasal endoscopy performed to exclude significant nasal polyp disease
(greater than grade 1), concha bullosa, and septal deviation.
A Niox Flex nitric oxide analyzer (Aerocrine AB, Solna, Sweden) used to measure nasal nitric
oxide. The standard aspiration technique recommended by the American Thoracic
Society/European Respiratory Society guidelines used with a unilateral,nasal olive,
breath-holding, and velum closure.
For nasal AMP challenge, PNIF measured before and every 5 minutes for 60 minutes after 4
squirts of 0. 1 mL per actuation in each nostril of 400 mg/mL of AMP (ie, 320-mg total dose)
delivered to the nose. The maximum decrease in PNIF measured using an In-check Nasal
Inspiratory Flow Meter (Clement Clarke International Ltd, Harlow, United Kingdom).
It has been shown that measuring PNIF (PEAK NASAL INSPIRATORY FLOW) response is more
sensitive than measuring nasal airway resistance and is also more reproducible. PNIF
correlates well vs symptoms in response to treatment in allergic rhinitis patients and has
been shown to have a minimal clinically important difference of 5 L/min.
At screening, patients instructed in the correct technique with particular attention to
horizontal positioning of the meter, a closed mouth with maximal peak nasal inspiratory
effort, and an adequate mask seal around the mouth and nose.
Nasal impulse oscillometry measurements for nasal airway resistance at 5 Hz performed using
a Jaeger MasterScreen impulse oscillometry system (Erich Jaeger, Hoechberg, Germany).
The total nasal symptom 4 (TNS4) scores recorded at all visits, with a total score of 12 for
the sum of the 4 separate domains for nasal blockage, run, itch, and sneeze, each rated from
0 to 3.
The Juniper Mini Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) completed by
the participant immediately before and a week after each randomized treatment. The global
RQLQ is the mean of the 5 individual domains, with individual domains scored from 0 to 6.
Serum eosinophilic cationic protein measured using an enzyme-linked immunoassay technique
(UniCAP; Sweden Diagnostics UK Ltd, Milton Keyes, United Kingdom).
Eligibility
Minimum age: 18 Years.
Maximum age: 65 Years.
Gender(s): Both.
Criteria:
Inclusion Criteria:
1. Persistent allergic rhinitis without asthma.
2. Atopy to at least 1 allergen on SPT.
3. ≥ 20% drop in PNIF following nasal AMP challenge
4. Male to female aged 18-65
5. Informed Consent
6. Ability to comply with the protocol
Exclusion Criteria:
1. Severe allergic rhinitis as defined by those in whom there are symptoms which
significantly impair day to day activities on QOL questionnaire.
2. Nasal Polyposis grade 2/3, deviated nasal septum ≥ 50%
3. PNIF < 60 litres/min
4. The use of oral corticosteroids within the last 3 months.
5. Recent respiratory tract / sinus infection (2 months).
6. Significant concomitant respiratory disease such as COPD, CF, ABPA, bronchiectasis
and active pulmonary tuberculosis.
7. Any other clinically significant medical condition such as unstable angina, acute
myocardial infarction in the preceding 3 months, recent TIA/ CVA,that may endanger
the health or safety of the participant, or jeopardise the protocol.
8. Any significant abnormal laboratory result as deemed by the investigators
9. Pregnancy, planned pregnancy or lactation
10. Known or suspected contra-indication to any of the IMP's
11. Concomitant use of medicines (prescribed, over the counter or herbal) that may
interfere with the trial.
Locations and Contacts
Asthma and Allergy Research Group, University of Dundee, Dundee DD1 3AU, United Kingdom
Additional Information
Starting date: November 2006
Last updated: April 21, 2014
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