Approval Probability
TA Base Rate
Adjusted LOA
ML Risk
Also known as Budesonide and formoterol fumarate dehydrate (BF) SPIROMAX, Budesonide and formoterol dehydrate SPIROMAX
Budesonide/Formoterol SPIROMAX · 3 trials · 1 indication
Difference in number of patients who receive treatment with biologics in the intervention arm compared with the control arm
Device mastery was defined as absence of healthcare professional (HCP)-observed errors by the end of Step 3 of a 6-step standardized device training protocol for empty Spiromax compared to empty Turbohaler. The 6 steps of device training protocol were: Step 1 - Intuitive use; Step 2 - Patient information leaflet; Step 3 - Instructional video; Step 4 - HCP tuition; Step 5 - HCP tuition (1st repeat); Step 6 - HCP tuition (2nd repeat).
Maintenance of device mastery was defined as absence of HCP-observed errors after 12 weeks of device use.
PEF is defined as the maximum airflow during a forced expiration beginning with the lungs fully inflated. Baseline trough morning PEF was defined as the average value of recorded (nonmissing) morning assessments 5 out of the last 7 days prior to randomization. The first day before randomization consisted of the electronic patient diary entry at home on the morning of the randomization visit (Baseline \[Day 1\]) and the first day postrandomization consisted of the electronic patient diary entry at home on the morning of the day after the randomization visit (Baseline \[Day 1\]). For postdose weekly average of trough morning PEF measurements, the values were the averages based on the available data for that week. The averages were calculated as the sum of morning PEF values divided by the number of nonmissing assessments. The final value for change from baseline was calculated as the average of the weekly change from baseline averaged over 12 weeks.
| Arm | Type | Description |
|---|---|---|
| Intervention arm (EXACT@home) | EXPERIMENTAL | These patients will first undergo the systematic assessment (=EXACT@home) of +/- 6 weeks including a systematic anamnesis, questionnaires and home monitoring with multiple digital devices (digital inhaler, activity tracker, hand-held spirometer and FeNO measuring device) and a Personal Digital Health Environment (PDHE). Based on this evaluation and the degree of asthma control a treatment will be chosen: optimization of treatable traits if present and/or biologics. The personal digital healthcare environment and digital inhaler will be used for 12 months and the activity tracker, hand-held spirometer and FeNO measuring device will be used for 12 weeks. |
| Control arm (biologics) | ACTIVE_COMPARATOR | These patients will immediately receive a biologic after the indication is determined at the regional asthma Multi-Disciplinary Team Meeting (MDTM). These patients also have access to the Personal Digital Health Environment (PDHE) and they will also use the digital inhaler but without being able to see their own results or receiving feedback/reminders (silent). The personal digital healthcare environment and digital inhaler will be used for 12 months. |
| Stage 1: Empty Spiromax Followed by Empty Turbohaler | NO_INTERVENTION | Participants will be trained on the proper use of empty Spiromax followed by empty Turbohaler devices. |
| Stage 1: Empty Turbohaler Followed by Empty Spiromax | NO_INTERVENTION | Participants will be trained on the proper use of empty Turbohaler followed by empty Spiromax devices. |
| Stage 2: BF Spiromax | EXPERIMENTAL | Participants who have currently received 800 to 1000 micrograms (μg) beclomethasone-equivalent inhaled corticosteroid (ICS) per day will receive budesonide/formoterol twice daily using the BF Spiromax 160/4.5 device. Therefore, the daily, ex-mouthpiece doses of budesonide and formoterol using BF Spiromax will be 640 μg and 18 μg, respectively. Participants who have currently received 1600 to 2000 μg beclomethasone-equivalent ICS per day will receive budesonide/formoterol twice daily using the BF Spiromax 320/9 μg device. Therefore, the daily, ex-mouthpiece doses of budesonide and formoterol using BF Spiromax will be 1280 μg and 36 μg, respectively. |
| Stage 2: Symbicort Turbohaler | ACTIVE_COMPARATOR | Participants who have currently received 800 to 1000 μg beclomethasone-equivalent ICS per day will receive budesonide/formoterol twice daily using the Symbicort Turbohaler 200/6 μg device. Therefore, the daily, ex-mouthpiece doses of budesonide and formoterol using Symbicort Turbohaler will be 800 μg and 24 μg respectively. Participants who have currently received 1600 to 2000 μg beclomethasone-equivalent ICS per day will receive budesonide/formoterol twice daily using the Symbicort Turbohaler 400/12 μg device. Therefore, the daily, ex-mouthpiece doses of budesonide and formoterol using Symbicort Turbohaler will be 1600 μg and 48 μg respectively. |
| BF Spiromax | EXPERIMENTAL | 2 inhalations of BF Spiromax at a dosage of 160/4.5 mcg and 2 inhalations of SYMBICORT placebo administered twice daily (AM and PM) during the 12-week treatment period. |
| Symbicort Turbohaler | ACTIVE_COMPARATOR | 2 inhalations of SYMBICORT TURBOHALER at a dosage of 200/6 mcg and 2 inhalations of placebo SPIROMAX administered twice daily (AM and PM) during the 12-week treatment period. |
| Name | Type | Description |
|---|---|---|
| Budesonide/Formoterol fumarate dihydrate | DRUG | The Digihaler will measure use of inhalation medication and inhaler technique and will give feedback and reminders. The aim is to improve adherence en inhaler technique. The device/medicinal product will be used for 12 months. It will be used in both groups, but patients in the intervention group are not able to see their own results and will not receive feedback/reminders. |
| Budesonide and formoterol fumarate dehydrate (BF) SPIROMAX | DRUG | SPIROMAX (BF) Budesonide and formoterol fumarate dehydrate (160/4.5 and 320/9 μg) |
| SYMBICORT TURBOHALER budesonide and formoterol fumarate | DRUG | SYMBICORT® TURBOHALER® (200/6 and 400/12 μg) |
| Budesonide/Formoterol SPIROMAX® | DRUG | BF Spiromax will be administered per dose and schedule specified in the arm. |
| SYMBICORT® TURBOHALER® | DRUG | Symbicort Turbohaler will be administered per dose and schedule specified in the arm. |
| SYMBICORT placebo | DRUG | SYMBICORT placebo multi-dose dry powder inhaler (DPI) identical in appearance to SYMBICORT TURBOHALER will be administered per dose and schedule specified in the arm. |
| SPIROMAX Placebo | DRUG | SPIROMAX Placebo multi-dose dry powder inhaler (DPI) identical in appearance to BF SPIROMAX will be administered per dose and schedule specified in the arm. |
Inclusion criteria: * Confirmed asthma diagnoses (≥12% and \>200 ml reversibility in FEV1 or positive histamine/methacholine provocation test or FeNO ≥50) according to the asthma guidelines * Diagnosed with severe, refractory asthma with eligibility for treatment with specific asthma biologics (oma...