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Safety, Tolerability and Pharmacokinetics of Tiotropium in Cystic Fibrosis Patients

Primary Purpose

Cystic Fibrosis

Status
Completed
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Tiotropium bromide low
Tiotropium bromide medium
Tiotropium bromide high
Placebo
Sponsored by
Boehringer Ingelheim
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cystic Fibrosis

Eligibility Criteria

undefined - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female patients (pediatric ≤11 years; adolescent / adult ≥12 years)
  • Documented diagnosis of CF (positive sweat chloride ≥60 mEq/liter, by pilocarpine iontophoresis) and/or a genotype with two identifiable mutations consistent with CF accompanied by one or more clinical features with the CF phenotype
  • Able to perform acceptable spirometric maneuvers, according to ATS (American Thoracic Society) standards
  • FEV1 >25% of predicted values
  • Patients must be able to inhale medication in a reproducible manner from the Respimat® inhaler and from a metered dose inhaler (MDI)
  • Clinical stability:

    • no evidence of acute upper or lower respiratory tract infection within 4 weeks of screening
    • no pulmonary exacerbation requiring use of i.v./oral/inhaled antibiotics, or oral corticosteroids within 4 weeks of screening
    • FEV1 at Visit 2 must be within 10% of FEV1 at Visit 1. If FEV1 at Visit 2 is not within 10% of FEV1 at Visit 1, Visit 2 may be re-scheduled once within 7 days
  • The patient or the patient's legally acceptable representative must be able to give informed consent in accordance with International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines and local regulation
  • Patients taking a chronic medication must be willing to continue this therapy for the entire duration of the study

Exclusion Criteria:

  • Patients with a significant history of allergy / hypersensitivity (including medication allergy) which is deemed relevant to the trial as judged by the Investigator. "Relevance" in this context refers to any increased risk of hypersensitivity reaction to trial medication
  • Patients with a known hypersensitivity to study drug or its components
  • Patients who have participated in another study with an Investigational drug within one month or six half-lives (whichever is greater) preceding the screening visit
  • Patients who are currently participating in another trial. Observational studies are allowed. Permission should be obtained from the sponsor of the study
  • Patients with known relevant substance abuse, including alcohol or drug abuse. The intention of this criterion was to exclude patients who are considered to be at risk of not complying with or abusing the trial medication administration directives.
  • Female patients who are pregnant or lactating, including females who have a positive urine pregnancy test at screening (pregnancy tests were performed for all females of child bearing potential)
  • Female patients of child bearing potential who are not using a medically approved form of contraception.
  • Patients with documented persistent colonization with B. cepacia (defined as more than one positive culture within the past year). The intention of this exclusion criterion is to be consistent with the current policy within the CF community for reducing the risk of B. cepacia cross infection.
  • Patients who have started a new chronic medication for CF within four (4) weeks of screening. Patients who are on a cycling TOBI® (Tobramycin treatment) regimen must have completed at least three (3) cycles of every other month TOBI® administration prior to the screening visit. As there are other cycles used with TOBI®, the clinical monitor should be consulted before the patient was enrolled.
  • Clinically significant disease or medical condition other than CF or CF-related conditions that, in the opinion of the Investigator, would compromise the safety of the patient or the quality of the data. This included significant hematological, hepatic, renal, cardiovascular, and neurologic disease. Patients with diabetes could participate if their disease is under good control prior to screening. This criterion provides an opportunity for the investigator to exclude patients based on clinical judgment, even if other eligibility criteria are satisfied.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm 5

    Arm 6

    Arm Type

    Experimental

    Experimental

    Experimental

    Experimental

    Experimental

    Placebo Comparator

    Arm Label

    Tiotropium bromide low

    Tiotropium bromide medium

    Tiotropium bromide high

    Tiotropium bromide low (28 days)

    Tiotropium bromide medium (28 days)

    Placebo

    Arm Description

    Single dose: 2.5 µg Tiotropium

    Single dose: 5 µg Tiotropium

    Single dose: 10 µg Tiotropium

    multiple dose: 2.5 µg Tiotropium

    Multiple dose: 5 µg Tiotropium

    single or multiple dose of Placebo

    Outcomes

    Primary Outcome Measures

    Changes from baseline in physical examination
    Changes from baseline in blood pressure
    Changes from baseline in pulse rate
    Changes from baseline in laboratory evaluation
    Occurrence of Adverse Events
    Change in FEV1 (Forced expiratory volume in one second)
    Change in FVC (Forced vital capacity)
    Change in FEF25-75% (Forced Expiratory Flow)

    Secondary Outcome Measures

    Cmax (maximum concentration of the analyte in plasma) after the first dose of 2.5 μg tiotropium bromide
    tmax (time from dosing to maximum concentration) after the first dose of 2.5 μg tiotropium bromide
    AUC0-tz (area under the concentration-time curve of the analyte in plasma over the time interval from 0 to the last quantifiable data point within the first dosing of 2.5 μg tiotropium bromide interval)
    Aet1-t2 (amount of analyte that is eliminated in urine from the time point t1 to time point t2) after the first dose of 2.5 μg tiotropium bromide
    fet1-t2 (fraction of analyte excreted in urine from time point t1 to t2) after the first dose of 2.5 μg tiotropium bromide
    AUCt1-t2 (area under the concentration-time curve of the analyte in plasma over the time interval t1 to t2) after the first dose of 5 μg and 10 μg tiotropium bromide
    AUC0-∞ (area under the concentration-time curve of the analyte in plasma over the time interval from 0 extrapolated to infinity) after the first dose of 5 μg and 10 μg tiotropium bromide
    %AUCtz-∞ (the percentage of the AUC 0-∞ that is obtained by extrapolation) after the first dose of 5 μg and 10 μg tiotropium bromide
    λz (terminal rate constant of the analyte in plasma) after the first dose of 5 μg and 10 μg tiotropium bromide
    t½ (terminal half-life of the analyte in plasma) after the first dose of 5 μg and 10 μg tiotropium bromide
    MRTih (mean residence time of the analyte in the body after inhalation) after the first dose of 5 μg and 10 μg tiotropium bromide
    CL/F (apparent clearance of the analyte in the plasma after extravascular administration) after the first dose of 5 μg and 10 μg tiotropium bromide
    Vz/F (apparent volume of distribution of the analyte during the terminal phase λz following an extravascular dose) after the first dose of 5 μg and 10 μg tiotropium bromide
    CLR,t1- t2 (renal clearance of the analyte in plasma from the time point t1 to time point t2) after the first dose of 5 μg and 10 μg tiotropium bromide
    Cmax,ss (maximum measured concentration of the analyte in plasma at steady state over a uniform dosing interval τ)
    tmax,ss (time from last dosing to maximum concentration of the analyte in plasma at steady state)
    Cmin,ss (minimum measured concentration of the analyte in plasma at steady state over a uniform dosing interval τ)
    Cpre,ss(predose concentration of the analyte in plasma at steady state immediately before administration of the next dose)
    AUCτ,ss (area under the concentration-time curve of the analyte in plasma at steady state over a uniform dosing interval τ)
    λz,ss (terminal rate constant in plasma at steady state)
    t1/2,ss (terminal half-life of the analyte in plasma at steady state)
    MRTih,ss (mean residence time of the analyte in the body after 14 administrations at steady state)
    CL/F,ss (apparent clearance of the analyte in the plasma at steady state following extravascular multiple dose administration)
    Vz/F,ss (apparent volume of distribution during the terminal phase λz at steady state following extravascular administration)
    Aet1-t2,ss (amount of analyte that is eliminated in urine at steady state from the time point t1 to time point t2)
    fet1-t2,ss (fraction of analyte eliminated in urine at steady state from time point t1 to time point t2)
    CLR,t1-t2,ss (renal clearance of the analyte in plasma from the time point t1 until the time point t2 at steady state)
    Accumulation Ratio (R)A,Cmax,28 based on Cmax
    Accumulation Ratio (R)A,AUC,28 based on AUC0-τ
    Linearity index (LI)

    Full Information

    First Posted
    June 20, 2014
    Last Updated
    June 20, 2014
    Sponsor
    Boehringer Ingelheim
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02172534
    Brief Title
    Safety, Tolerability and Pharmacokinetics of Tiotropium in Cystic Fibrosis Patients
    Official Title
    A Randomized, Double-blind Within Dose, Placebo-controlled Study to Investigate the Safety, Tolerability and Pharmacokinetics of Increasing Single and Multiple Doses (28-day Dosing) of Tiotropium Bromide Administered Once Daily Via the Respimat® Device in Cystic Fibrosis Patients
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    June 2014
    Overall Recruitment Status
    Completed
    Study Start Date
    September 2006 (undefined)
    Primary Completion Date
    September 2008 (Actual)
    Study Completion Date
    undefined (undefined)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Boehringer Ingelheim

    4. Oversight

    5. Study Description

    Brief Summary
    Study to obtain information about the safety and tolerability of tiotropium bromide administered via the Respimat® inhalation device in pediatric (≤11 y.o.) and adolescent/adult (≥12 y.o.) cystic fibrosis (CF) patients after single and multiple doses as well as to obtain pharmacokinetic data for tiotropium in CF patients after single and multiple doses

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Cystic Fibrosis

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1
    Interventional Study Model
    Parallel Assignment
    Masking
    Double
    Allocation
    Randomized
    Enrollment
    113 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Tiotropium bromide low
    Arm Type
    Experimental
    Arm Description
    Single dose: 2.5 µg Tiotropium
    Arm Title
    Tiotropium bromide medium
    Arm Type
    Experimental
    Arm Description
    Single dose: 5 µg Tiotropium
    Arm Title
    Tiotropium bromide high
    Arm Type
    Experimental
    Arm Description
    Single dose: 10 µg Tiotropium
    Arm Title
    Tiotropium bromide low (28 days)
    Arm Type
    Experimental
    Arm Description
    multiple dose: 2.5 µg Tiotropium
    Arm Title
    Tiotropium bromide medium (28 days)
    Arm Type
    Experimental
    Arm Description
    Multiple dose: 5 µg Tiotropium
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    single or multiple dose of Placebo
    Intervention Type
    Drug
    Intervention Name(s)
    Tiotropium bromide low
    Intervention Type
    Drug
    Intervention Name(s)
    Tiotropium bromide medium
    Intervention Type
    Drug
    Intervention Name(s)
    Tiotropium bromide high
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo
    Primary Outcome Measure Information:
    Title
    Changes from baseline in physical examination
    Time Frame
    Baseline, Day 1 and 28
    Title
    Changes from baseline in blood pressure
    Time Frame
    Baseline, Day 1 and 28
    Title
    Changes from baseline in pulse rate
    Time Frame
    Baseline, Day 1 and 28
    Title
    Changes from baseline in laboratory evaluation
    Time Frame
    Baseline, Day 28
    Title
    Occurrence of Adverse Events
    Time Frame
    up to 59 days
    Title
    Change in FEV1 (Forced expiratory volume in one second)
    Time Frame
    Pre-dose and 0.5, 1 and 2 hours after treatment on Day1 and 28
    Title
    Change in FVC (Forced vital capacity)
    Time Frame
    Pre-dose and 0.5, 1 and 2 hours after treatment on Day1 and 28
    Title
    Change in FEF25-75% (Forced Expiratory Flow)
    Time Frame
    Pre-dose and 0.5, 1 and 2 hours after treatment on Day1 and 28
    Secondary Outcome Measure Information:
    Title
    Cmax (maximum concentration of the analyte in plasma) after the first dose of 2.5 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    tmax (time from dosing to maximum concentration) after the first dose of 2.5 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    AUC0-tz (area under the concentration-time curve of the analyte in plasma over the time interval from 0 to the last quantifiable data point within the first dosing of 2.5 μg tiotropium bromide interval)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    Aet1-t2 (amount of analyte that is eliminated in urine from the time point t1 to time point t2) after the first dose of 2.5 μg tiotropium bromide
    Time Frame
    Pre-dose and 0-2, 2-4 and 4-8 hours after treatment on Day1
    Title
    fet1-t2 (fraction of analyte excreted in urine from time point t1 to t2) after the first dose of 2.5 μg tiotropium bromide
    Time Frame
    Pre-dose and 0-2, 2-4 and 4-8 hours after treatment on Day1
    Title
    AUCt1-t2 (area under the concentration-time curve of the analyte in plasma over the time interval t1 to t2) after the first dose of 5 μg and 10 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    AUC0-∞ (area under the concentration-time curve of the analyte in plasma over the time interval from 0 extrapolated to infinity) after the first dose of 5 μg and 10 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    %AUCtz-∞ (the percentage of the AUC 0-∞ that is obtained by extrapolation) after the first dose of 5 μg and 10 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    λz (terminal rate constant of the analyte in plasma) after the first dose of 5 μg and 10 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    t½ (terminal half-life of the analyte in plasma) after the first dose of 5 μg and 10 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    MRTih (mean residence time of the analyte in the body after inhalation) after the first dose of 5 μg and 10 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    CL/F (apparent clearance of the analyte in the plasma after extravascular administration) after the first dose of 5 μg and 10 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    Vz/F (apparent volume of distribution of the analyte during the terminal phase λz following an extravascular dose) after the first dose of 5 μg and 10 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    CLR,t1- t2 (renal clearance of the analyte in plasma from the time point t1 to time point t2) after the first dose of 5 μg and 10 μg tiotropium bromide
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day1
    Title
    Cmax,ss (maximum measured concentration of the analyte in plasma at steady state over a uniform dosing interval τ)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    tmax,ss (time from last dosing to maximum concentration of the analyte in plasma at steady state)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    Cmin,ss (minimum measured concentration of the analyte in plasma at steady state over a uniform dosing interval τ)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    Cpre,ss(predose concentration of the analyte in plasma at steady state immediately before administration of the next dose)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    AUCτ,ss (area under the concentration-time curve of the analyte in plasma at steady state over a uniform dosing interval τ)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    λz,ss (terminal rate constant in plasma at steady state)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    t1/2,ss (terminal half-life of the analyte in plasma at steady state)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    MRTih,ss (mean residence time of the analyte in the body after 14 administrations at steady state)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    CL/F,ss (apparent clearance of the analyte in the plasma at steady state following extravascular multiple dose administration)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    Vz/F,ss (apparent volume of distribution during the terminal phase λz at steady state following extravascular administration)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    Aet1-t2,ss (amount of analyte that is eliminated in urine at steady state from the time point t1 to time point t2)
    Time Frame
    Pre-dose and 0-2, 2-4 and 4-8 hours after treatment on Day 28
    Title
    fet1-t2,ss (fraction of analyte eliminated in urine at steady state from time point t1 to time point t2)
    Time Frame
    Pre-dose and 0-2, 2-4 and 4-8 hours after treatment on Day 28
    Title
    CLR,t1-t2,ss (renal clearance of the analyte in plasma from the time point t1 until the time point t2 at steady state)
    Time Frame
    Pre-dose and 5, 15, 30 min and 1, 2, 4, 6 hours after treatment on Day 28
    Title
    Accumulation Ratio (R)A,Cmax,28 based on Cmax
    Time Frame
    28 days
    Title
    Accumulation Ratio (R)A,AUC,28 based on AUC0-τ
    Time Frame
    28 days
    Title
    Linearity index (LI)
    Time Frame
    28 days

    10. Eligibility

    Sex
    All
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Male or female patients (pediatric ≤11 years; adolescent / adult ≥12 years) Documented diagnosis of CF (positive sweat chloride ≥60 mEq/liter, by pilocarpine iontophoresis) and/or a genotype with two identifiable mutations consistent with CF accompanied by one or more clinical features with the CF phenotype Able to perform acceptable spirometric maneuvers, according to ATS (American Thoracic Society) standards FEV1 >25% of predicted values Patients must be able to inhale medication in a reproducible manner from the Respimat® inhaler and from a metered dose inhaler (MDI) Clinical stability: no evidence of acute upper or lower respiratory tract infection within 4 weeks of screening no pulmonary exacerbation requiring use of i.v./oral/inhaled antibiotics, or oral corticosteroids within 4 weeks of screening FEV1 at Visit 2 must be within 10% of FEV1 at Visit 1. If FEV1 at Visit 2 is not within 10% of FEV1 at Visit 1, Visit 2 may be re-scheduled once within 7 days The patient or the patient's legally acceptable representative must be able to give informed consent in accordance with International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines and local regulation Patients taking a chronic medication must be willing to continue this therapy for the entire duration of the study Exclusion Criteria: Patients with a significant history of allergy / hypersensitivity (including medication allergy) which is deemed relevant to the trial as judged by the Investigator. "Relevance" in this context refers to any increased risk of hypersensitivity reaction to trial medication Patients with a known hypersensitivity to study drug or its components Patients who have participated in another study with an Investigational drug within one month or six half-lives (whichever is greater) preceding the screening visit Patients who are currently participating in another trial. Observational studies are allowed. Permission should be obtained from the sponsor of the study Patients with known relevant substance abuse, including alcohol or drug abuse. The intention of this criterion was to exclude patients who are considered to be at risk of not complying with or abusing the trial medication administration directives. Female patients who are pregnant or lactating, including females who have a positive urine pregnancy test at screening (pregnancy tests were performed for all females of child bearing potential) Female patients of child bearing potential who are not using a medically approved form of contraception. Patients with documented persistent colonization with B. cepacia (defined as more than one positive culture within the past year). The intention of this exclusion criterion is to be consistent with the current policy within the CF community for reducing the risk of B. cepacia cross infection. Patients who have started a new chronic medication for CF within four (4) weeks of screening. Patients who are on a cycling TOBI® (Tobramycin treatment) regimen must have completed at least three (3) cycles of every other month TOBI® administration prior to the screening visit. As there are other cycles used with TOBI®, the clinical monitor should be consulted before the patient was enrolled. Clinically significant disease or medical condition other than CF or CF-related conditions that, in the opinion of the Investigator, would compromise the safety of the patient or the quality of the data. This included significant hematological, hepatic, renal, cardiovascular, and neurologic disease. Patients with diabetes could participate if their disease is under good control prior to screening. This criterion provides an opportunity for the investigator to exclude patients based on clinical judgment, even if other eligibility criteria are satisfied.

    12. IPD Sharing Statement

    Links:
    URL
    http://trials.boehringer-ingelheim.com/content/dam/internet/opu/clinicaltrial/com_EN/results/205/205.338_U09-3457.pdf
    Description
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    Safety, Tolerability and Pharmacokinetics of Tiotropium in Cystic Fibrosis Patients

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