Qvar Versus Clenil, a General Practice Research Database Study

NCT ID: NCT01400217

Last Updated: 2012-10-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

56985 participants

Study Classification

OBSERVATIONAL

Study Start Date

1991-01-31

Study Completion Date

2010-10-31

Brief Summary

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This study will compare the absolute and relative effectiveness of asthma management in patients on inhaled corticosteroid (ICS) maintenance therapy as either extra-fine-particle or larger-particle formulation beclomethasone dipropionate (BDP) via metered-dose inhalers (MDIs) using the propellant hydrofluoroalkane propellant (HFA-BDP), namely Qvar® MDI compared with Clenil® MDI.

Detailed Description

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Current asthma guidelines in the UK are underpinned by evidence derived from randomised controlled trials (RCTs). Although RCT data are considered the gold standard, patients recruited to asthma RCTs are estimated to represent less than 10% of the UK's asthma population. The poor representation of the asthma population is due to a number of factors, such as tightly-controlled inclusion criteria for RCTs. There is, therefore, a need for more representative RCTs and real-life observational studies to inform existing guidelines and help optimise asthma outcomes.

In response to the Montreal Protocol's ruling to phase out ozone-depleting chlorofluorocarbon (CFC) propellants in asthma inhalers, several hydrofluoroalkane-134a-propellant (HFA-) formulations of BDP have been developed. Two branded generic formulations currently available in the UK are Qvar® (Teva Pharmaceutical Industries Ltd) - an extra-fine-particle (\~1.1 microns) HFA-BDP (solution) formulation and Clenil® (Chiesi Limited) - a larger particle (\~2.9 microns) HFA-BDP (suspension) formulation.

The extra-fine particle formulation HFA-BDP formulation (Qvar®) has been shown to improve total and small airway deposition relative to CFC-BDP. As a result of the more even distribution through both the large and small airways of the lungs and data from short-term randomised clinical trials (RCTs), Qvar® dosing is recommended at approximately one half the dose of traditional CFC-BDP (average particle size \~3.5 microns). However, the larger-particle Clenil® is recommended for prescribing at the same dose as traditional CFC-BDP.

Further studies are required to understand whether the differences in particle size and airway distribution have an impact on asthma outcomes over the long-term.

This observational study will investigate the real-world effectiveness of extra-fine HFA-BDP (Qvar®) as compared with larger-particle HFA-BDP (Clenil®) in patients with asthma who: were new to ICS therapy; received an increase in their ICS dose, or switched / changed baseline ICS therapy to HFA-BDP with no change in BDP-equivalent ICS dose. We hypothesise that differences in effectiveness might become apparent over the longer term through a retrospective database analysis of one-year outcomes for the diverse patient population seen in primary care.

Conditions

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Asthma

Keywords

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Primary Care Particle size beclomethasone dipropionate Asthma Management Maintenance Therapy Metered-Dose Inhaler

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

RETROSPECTIVE

Study Groups

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IPDI EF HFA-BDP

Patients initiating inhaled corticosteroid therapy as extra-fine HFA-BDP MDI at the index date

extra fine particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler

Intervention Type DRUG

IPDI cohort intervention = initiation of intervention drug; IPDS cohort intervention = switching from baseline inhaled corticosteroid therapy to intervention drug without a change in baseline inhaled corticosteroid dose; IPDA cohort intervention = increase in baseline inhaled corticosteroid drug as intervention drug

IPDI SP HFA-BDP

Patients initiating inhaled corticosteroid therapy as standard particle HFA-BDP MDI at the index date

standard particle particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler

Intervention Type DRUG

IPDI cohort intervention = initiation of intervention drug; IPDS cohort intervention = switching from baseline inhaled corticosteroid therapy to intervention drug without a change in baseline inhaled corticosteroid dose; IPDA cohort intervention = increase in baseline inhaled corticosteroid drug as intervention drug

IPDA SP HFA-BDP

Patients increased inhaled corticosteroid therapy as standard particle HFA-BDP MDI at the index date

standard particle particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler

Intervention Type DRUG

IPDI cohort intervention = initiation of intervention drug; IPDS cohort intervention = switching from baseline inhaled corticosteroid therapy to intervention drug without a change in baseline inhaled corticosteroid dose; IPDA cohort intervention = increase in baseline inhaled corticosteroid drug as intervention drug

IPDA EF HFA-BDP

Patients increased inhaled corticosteroid therapy as extra fine particle HFA-BDP MDI at the index date

extra fine particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler

Intervention Type DRUG

IPDI cohort intervention = initiation of intervention drug; IPDS cohort intervention = switching from baseline inhaled corticosteroid therapy to intervention drug without a change in baseline inhaled corticosteroid dose; IPDA cohort intervention = increase in baseline inhaled corticosteroid drug as intervention drug

IPDS SP HFA-BDP

Patients increased inhaled corticosteroid therapy as standard particle HFA-BDP MDI at the index date

standard particle particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler

Intervention Type DRUG

IPDI cohort intervention = initiation of intervention drug; IPDS cohort intervention = switching from baseline inhaled corticosteroid therapy to intervention drug without a change in baseline inhaled corticosteroid dose; IPDA cohort intervention = increase in baseline inhaled corticosteroid drug as intervention drug

IPDS EF HFA-BDP

Patients increased inhaled corticosteroid therapy as extrafine particle HFA-BDP MDI at the index date

extra fine particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler

Intervention Type DRUG

IPDI cohort intervention = initiation of intervention drug; IPDS cohort intervention = switching from baseline inhaled corticosteroid therapy to intervention drug without a change in baseline inhaled corticosteroid dose; IPDA cohort intervention = increase in baseline inhaled corticosteroid drug as intervention drug

Interventions

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extra fine particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler

IPDI cohort intervention = initiation of intervention drug; IPDS cohort intervention = switching from baseline inhaled corticosteroid therapy to intervention drug without a change in baseline inhaled corticosteroid dose; IPDA cohort intervention = increase in baseline inhaled corticosteroid drug as intervention drug

Intervention Type DRUG

standard particle particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler

IPDI cohort intervention = initiation of intervention drug; IPDS cohort intervention = switching from baseline inhaled corticosteroid therapy to intervention drug without a change in baseline inhaled corticosteroid dose; IPDA cohort intervention = increase in baseline inhaled corticosteroid drug as intervention drug

Intervention Type DRUG

Other Intervention Names

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Qvar Fostair

Eligibility Criteria

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Inclusion Criteria

* Aged: 4-80 years
* Paediatric cohort (aged 4-11 years), and
* Adult cohort (aged 12-80 years )
* Evidence of asthma and current asthma therapy:
* All cohorts (IPDI, IPDS, IPDA):

* a diagnostic code for asthma, and / or \*≥2 prescriptions for asthma at different points in time during the prior year and/or IPDI only: ≥2 prescriptions for asthma therapies during the outcome year, including ≥1 ICS prescription in addition to that received at IPD

IPDA and IPDS only:

* 1 ICS prescription in the baseline year, and
* 1 other asthma prescription during the baseline year.

\*Evidence of "current therapy":
* 2 prescription for ICS during the outcome year (i.e. ≥1 prescription in addition to the prescription at index date

* Have at least one year of up-to-standard (UTS) baseline data (prior to the IPD) and at least one year of UTS outcome data (following the IPD).

Exclusion Criteria

* Had a COPD read code at any time; and/or
* Had any chronic respiratory disease, except asthma, at any time; and/or
* Patients on maintenance oral steroids during baseline year
* Received a combination inhaler in addition to a separate ICS inhaler in the baseline year; and/or
* Received ICS therapy during baseline year via DPI (IPDA and IPDS cohorts only).
* If they received multiple ICS prescriptions on the same day at IPD or immediately before
Minimum Eligible Age

4 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Teva Branded Pharmaceutical Products R&D, Inc.

INDUSTRY

Sponsor Role collaborator

Research in Real-Life Ltd

NETWORK

Sponsor Role lead

Responsible Party

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David Price

Professor David Price

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David Price, MD

Role: PRINCIPAL_INVESTIGATOR

Company Director

Locations

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Research in Real Life Ltd

Cawston, Norfolk, United Kingdom

Site Status

Countries

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United Kingdom

References

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Herland K, Akselsen JP, Skjonsberg OH, Bjermer L. How representative are clinical study patients with asthma or COPD for a larger "real life" population of patients with obstructive lung disease? Respir Med. 2005 Jan;99(1):11-9. doi: 10.1016/j.rmed.2004.03.026.

Reference Type BACKGROUND
PMID: 15672843 (View on PubMed)

Travers J, Marsh S, Caldwell B, Williams M, Aldington S, Weatherall M, Shirtcliffe P, Beasley R. External validity of randomized controlled trials in COPD. Respir Med. 2007 Jun;101(6):1313-20. doi: 10.1016/j.rmed.2006.10.011. Epub 2006 Nov 17.

Reference Type BACKGROUND
PMID: 17113277 (View on PubMed)

Appleton SL, Adams RJ, Wilson DH, Taylor AW, Ruffin RE; North West Adelaide Cohort Health Study Team. Spirometric criteria for asthma: adding further evidence to the debate. J Allergy Clin Immunol. 2005 Nov;116(5):976-82. doi: 10.1016/j.jaci.2005.08.034.

Reference Type BACKGROUND
PMID: 16275363 (View on PubMed)

Vanden Burgt JA, Busse WW, Martin RJ, Szefler SJ, Donnell D. Efficacy and safety overview of a new inhaled corticosteroid, QVAR (hydrofluoroalkane-beclomethasone extrafine inhalation aerosol), in asthma. J Allergy Clin Immunol. 2000 Dec;106(6):1209-26. doi: 10.1067/mai.2000.111582.

Reference Type BACKGROUND
PMID: 11112914 (View on PubMed)

Leach CL, Davidson PJ, Hasselquist BE, Boudreau RJ. Influence of particle size and patient dosing technique on lung deposition of HFA-beclomethasone from a metered dose inhaler. J Aerosol Med. 2005 Winter;18(4):379-85. doi: 10.1089/jam.2005.18.379.

Reference Type BACKGROUND
PMID: 16379614 (View on PubMed)

Leach CL, Davidson PJ, Boudreau RJ. Improved airway targeting with the CFC-free HFA-beclomethasone metered-dose inhaler compared with CFC-beclomethasone. Eur Respir J. 1998 Dec;12(6):1346-53. doi: 10.1183/09031936.98.12061346.

Reference Type BACKGROUND
PMID: 9877489 (View on PubMed)

Busse WW, Brazinsky S, Jacobson K, Stricker W, Schmitt K, Vanden Burgt J, Donnell D, Hannon S, Colice GL. Efficacy response of inhaled beclomethasone dipropionate in asthma is proportional to dose and is improved by formulation with a new propellant. J Allergy Clin Immunol. 1999 Dec;104(6):1215-22. doi: 10.1016/s0091-6749(99)70016-3.

Reference Type BACKGROUND
PMID: 10589004 (View on PubMed)

Davies RJ, Stampone P, O'Connor BJ. Hydrofluoroalkane-134a beclomethasone dipropionate extrafine aerosol provides equivalent asthma control to chlorofluorocarbon beclomethasone dipropionate at approximately half the total daily dose. Respir Med. 1998 Jun;92 Suppl A:23-31. doi: 10.1016/s0954-6111(98)90214-1.

Reference Type BACKGROUND
PMID: 9850360 (View on PubMed)

Gross G, Thompson PJ, Chervinsky P, Vanden Burgt J. Hydrofluoroalkane-134a beclomethasone dipropionate, 400 microg, is as effective as chlorofluorocarbon beclomethasone dipropionate, 800 microg, for the treatment of moderate asthma. Chest. 1999 Feb;115(2):343-51. doi: 10.1378/chest.115.2.343.

Reference Type BACKGROUND
PMID: 10027430 (View on PubMed)

IBM SPSS Statistics. 2010. Statistics family. Available online at: www.spss.com/uk/software/statistics/

Reference Type BACKGROUND

AS Institute Inc. 2010. Statistical Analysis with SAS/STAT Software. Available online at: www.SAS.com/offices/europe/uk/technologies/analytics/statistics/stat/ondex.html

Reference Type BACKGROUND

Price D, Thomas M, Haughney J, Lewis RA, Burden A, von Ziegenweidt J, Chisholm A, Hillyer EV, Corrigan CJ. Real-life comparison of beclometasone dipropionate as an extrafine- or larger-particle formulation for asthma. Respir Med. 2013 Jul;107(7):987-1000. doi: 10.1016/j.rmed.2013.03.009. Epub 2013 May 3.

Reference Type DERIVED
PMID: 23643486 (View on PubMed)

Other Identifiers

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007/11

Identifier Type: -

Identifier Source: org_study_id