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Budesonide/Formoterol SPIROMAX

Phase 3

Asthma | Small molecule | Respiratory |Teva Pharmaceutical Industries Limited|Last Updated: Mar 25, 2025

Target and mechanism

Molecular targetNR3C1
Target classAgonist
ModalitySmall molecule

Also known as Budesonide and formoterol fumarate dehydrate (BF) SPIROMAX, Budesonide and formoterol dehydrate SPIROMAX

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindACTIVE_CONTROLLEDBiomarker
Total Trials3
Total Enrollment1,228

FDA Designations

No designations recorded

Clinical trial landscape

Budesonide/Formoterol SPIROMAX · 3 trials · 1 indication

Phase 3 3
NCT05831566Expertise Asthma COPD Program with Digital SupportAsthma
RECRUITING138 Analytics
NCT02062463Study to Evaluate the Mastery of Inhaler Technique for Budesonide Formoterol (BF) SPIROMAX® as Compared to SYMBICORT® TURBOHALER® as Treatment for Adult Participants With AsthmaAsthma
COMPLETED485 Analytics
NCT01803555Efficacy and Safety Evaluation of Budesonide/Formoterol SPIROMAX® Inhalation Powder Versus SYMBICORT® TURBOHALER®Asthma
COMPLETED605 Analytics
PHASE3RECRUITING
Expertise Asthma COPD Program with Digital Support
AsthmaUnlock trial analytics
PHASE3COMPLETED
Study to Evaluate the Mastery of Inhaler Technique for Budesonide Formoterol (BF) SPIROMAX® as Compared to SYMBICORT® TURBOHALER® as Treatment for Adult Participants With Asthma
AsthmaUnlock trial analytics
PHASE3COMPLETED
Efficacy and Safety Evaluation of Budesonide/Formoterol SPIROMAX® Inhalation Powder Versus SYMBICORT® TURBOHALER®
AsthmaUnlock trial analytics

Study Endpoints

Primary Endpoints

Difference in percentage of patients treated with biologicals after 6 months of follow up
6 months

Difference in number of patients who receive treatment with biologics in the intervention arm compared with the control arm

Stage 1: Percentage of Participants Achieving Device Mastery
Baseline (Day 1)

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).

Stage 2: Percentage of Participants Maintaining Device Mastery
Baseline up to Week 12

Maintenance of device mastery was defined as absence of HCP-observed errors after 12 weeks of device use.

Change From Baseline in Weekly Average of Daily Trough (Predose and Pre-rescue Bronchodilator) Morning (AM) Peak Expiratory Flow (PEF) Over the 12-Week Treatment Period
Baseline, Weeks 1 to 12 (averaged over 12 weeks)

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.

Secondary Endpoints

Difference in percentage of patients treated with biologicals after 12 months of follow up
12 months
Difference in change in asthma control over time between the intervention- and control group
6-12 months
Difference in change in quality of life over time between the intervention- and control group
6-12 months
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Study Design & Arms

AllocationRANDOMIZED
MaskingNONE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Intervention arm (EXACT@home)EXPERIMENTALThese 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_COMPARATORThese 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 TurbohalerNO_INTERVENTIONParticipants will be trained on the proper use of empty Spiromax followed by empty Turbohaler devices.
Stage 1: Empty Turbohaler Followed by Empty SpiromaxNO_INTERVENTIONParticipants will be trained on the proper use of empty Turbohaler followed by empty Spiromax devices.
Stage 2: BF SpiromaxEXPERIMENTALParticipants 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 TurbohalerACTIVE_COMPARATORParticipants 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 SpiromaxEXPERIMENTAL2 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 TurbohalerACTIVE_COMPARATOR2 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.

Interventions

NameTypeDescription
Budesonide/Formoterol fumarate dihydrateDRUGThe 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) SPIROMAXDRUGSPIROMAX (BF) Budesonide and formoterol fumarate dehydrate (160/4.5 and 320/9 μg)
SYMBICORT TURBOHALER budesonide and formoterol fumarateDRUGSYMBICORT® TURBOHALER® (200/6 and 400/12 μg)
Budesonide/Formoterol SPIROMAX®DRUGBF Spiromax will be administered per dose and schedule specified in the arm.
SYMBICORT® TURBOHALER®DRUGSymbicort Turbohaler will be administered per dose and schedule specified in the arm.
SYMBICORT placeboDRUGSYMBICORT 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 PlaceboDRUGSPIROMAX Placebo multi-dose dry powder inhaler (DPI) identical in appearance to BF SPIROMAX will be administered per dose and schedule specified in the arm.
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Eligibility Criteria

Age Range18 Years to N/A
SexALL
Healthy VolunteersNo
Study Sites1

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...

Countries:NetherlandsUnited KingdomAustriaBelgiumCzechiaDenmarkFinlandFranceGermanyHungaryIsraelItalyPolandRussiaSpainSweden
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