Lung function, pharmacokinetics, and tolerability of inhaled indacaterol maleate and acetate in asthma patients

Abstract

Background Indacaterol maleate delivered with the Breezhaler® inhalation device is a long-acting β2-agonist approved for chronic obstructive pulmonary disease. In the development of a once daily, inhaled fixed dose combination (FDC) of indacaterol, glycopyrronium bromide (a long-acting muscarinic antagonist), and mometasone furoate (an inhaled corticosteroid [ICS]) for the treatment of patients with asthma, the acetate salt of indacaterol is used instead of the maleate salt. Here, we investigated the lung function, pharmacokinetics (PK) and safety of indacaterol maleate 150 μg once daily (o.d.) and indacaterol acetate 150 μg o.d. in comparison with placebo. Methods This was a randomised, double-blind, three-period crossover study (ClinicalTrials.gov identifier, NCT03257995) in patients with asthma on background ICS therapy. Patients with percent predicted pre-bronchodilator forced expiratory volume per second (FEV1) ≥50% and ≤ 90% were included in the study. Patients received indacaterol maleate 150 μg o.d., indacaterol acetate 150 μg o.d., or placebo on top of stable background ICS in randomised sequence. Trough FEV1 was assessed after 14 days of treatment. PK of indacaterol salts were assessed at steady state after 14 days of treatment; peak expiratory flow (PEF) rate and rescue medication use were collected with a combined PEF-meter/electronic diary throughout the study. Results Of the 54 adult patients (median age of 48 years), 51 patients completed the study. Both indacaterol salts demonstrated statistically significant improvements in trough FEV1 of 186 mL (maleate) and 146 mL (acetate) compared with placebo (both P < 0.001). FEV1 AUC0-4h improved by 248 mL (maleate) and 245 mL (acetate), and PEF by 33 L/min (maleate) and 30.8 L/min (acetate) versus placebo. Systemic exposure of indacaterol (AUC0-24h,ss and Cmax,ss on Day 14) was comparable after administration of both salt forms. Both salt forms demonstrated a good safety profile and were well tolerated, with a difference in the reporting frequency of AEs of coughing (maleate, 23.5%; acetate, 0%). Conclusions In patients with asthma, indacaterol maleate and acetate elicited comparable and significant improvements in lung function compared with placebo and achieved comparable systemic exposure. Both indacaterol salts were safe and well tolerated. Trial registration ClinicalTrials.gov NCT03257995 June 06, 2017

Investigational Treatments in Phase I and II Clinical Trials: A Systematic Review in Asthma

“…Study results for seven RCTs [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] were retrieved from ClinicalTrials.gov, results for five RCTs [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ] were published in full text articles, and data for two RCTs [ 40 , 41 , 42 , 43 ] were obtained through the European Union (EU) Clinical Trial Register. Results for two RCTs [ 44 , 45 , 46 , 47 ] were available only from conference abstracts or posters, data for one RCT [ 48 , 49 , 50 ] were retrieved from both the EU Clinical Trial Register and abstract, and for another RCT, they were retrieved from both ClinicalTrials.gov and the abstract [ 51 , 52 ].…”

“…A Phase I RCT [ 34 , 35 ] compared the efficacy of the maleate salt with the acetate salt of indacaterol 150 μg vs. PCB in patients with asthma. Indacaterol maleate significantly ( p < 0.001) improved trough FEV 1 of 186.0 mL (95%CI 129.0–243.0), FEV 1 AUC0-4h by 248.0 mL (95%CI 186.0–310.0), and PEF of 33.0 L/min (95%CI 25.6–40.3) vs. PCB, and it was as effective as indacaterol acetate.…”

“…No data are available for symptoms control. Rescue medication use was significantly ( p < 0.01) reduced with both indacaterol salts of 0.42 puffs/day vs. PCB [ 34 , 35 ].…”

A Review of the Unique Drug Development Strategy of Indacaterol Acetate/Glycopyrronium Bromide/Mometasone Furoate: A First-in-Class, Once-Daily, Single-Inhaler, Fixed-Dose Combination Treatment for Asthma

“…was considered an optimal dose to advance to phase III studies for IND/GLY/MF and IND/MF [ 24 ]. No alterations in fine particle mass of IND in either of the combinations meant that no dose adjustments were necessary [ 25 ]. The dose of GLY selected for IND/GLY/MF is the approved dose for COPD—50 μg o.d.…”