Best African American Response to Asthma Drugs

NCT ID: NCT01967173

Last Updated: 2018-11-15

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

574 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-02-28

Study Completion Date

2017-07-01

Brief Summary

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The purpose of this study is to find the best asthma treatment to add for Blacks who have asthma that is not well controlled on a low dose of inhaled steroid. This study will also try to find out if Black adults and children differ in how they respond to the medications used in this study.

Detailed Description

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BARD is a 66 week prospective, randomized, double-blind, crossover trial in Blacks (individuals who self-report Black ancestry) who have inadequately controlled asthma while taking low-dose inhaled corticosteroids (ICS). BARD will examine the efficacy of increasing the dose of ICS with or without the addition of a long-acting beta agonist (LABA) to determine whether individual patients respond better to one treatment than another and, if so, whether the responses are different for children and adults or if they are related to genetic ancestry.

Conditions

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Asthma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Crossover sequence 1

Flovent Diskus® 250 mcg,followed by Advair Diskus® 250/50 mcg, followed by Flovent Diskus® 100 mcg, followed by Advair Diskus® 100/50 mcg

Group Type EXPERIMENTAL

Flovent Diskus® 100 mcg

Intervention Type DRUG

Flovent is an ICS

Flovent Diskus® 250 mcg

Intervention Type DRUG

Flovent is an ICS

Advair Diskus® 100/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Advair Diskus® 250/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Crossover sequence 2

Advair Diskus® 250/50 mcg, followed by Advair Diskus® 100/50 mcg, followed by Flovent Diskus® 250 mcg, followed by Flovent Diskus® 100 mcg

Group Type EXPERIMENTAL

Flovent Diskus® 100 mcg

Intervention Type DRUG

Flovent is an ICS

Flovent Diskus® 250 mcg

Intervention Type DRUG

Flovent is an ICS

Advair Diskus® 100/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Advair Diskus® 250/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Crossover sequence 3

Flovent Diskus® 100 mcg, followed by Flovent Diskus® 250 mcg, followed by Advair Diskus® 100/50 mcg, followed by Advair Diskus® 250/50 mcg

Group Type EXPERIMENTAL

Flovent Diskus® 100 mcg

Intervention Type DRUG

Flovent is an ICS

Flovent Diskus® 250 mcg

Intervention Type DRUG

Flovent is an ICS

Advair Diskus® 100/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Advair Diskus® 250/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Crossover sequence 4

Advair Diskus® 100/50 mcg, followed by Flovent Diskus® 100 mcg, followed by Advair Diskus® 250/50 mcg, followed by Flovent Diskus® 250 mcg

Group Type EXPERIMENTAL

Flovent Diskus® 100 mcg

Intervention Type DRUG

Flovent is an ICS

Flovent Diskus® 250 mcg

Intervention Type DRUG

Flovent is an ICS

Advair Diskus® 100/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Advair Diskus® 250/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Crossover sequence 5

Flovent Diskus® 500 mcg, followed by Advair Diskus® 250/50 mcg, followed by Flovent Diskus® 250 mcg, followed by Advair Diskus® 100/50 mcg

Group Type EXPERIMENTAL

Flovent Diskus® 250 mcg

Intervention Type DRUG

Flovent is an ICS

Flovent Diskus® 500 mcg

Intervention Type DRUG

Flovent is an ICS

Advair Diskus® 100/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Advair Diskus® 250/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Crossover sequence 6

Advair Diskus® 250/50 mcg, followed by Advair Diskus® 100/50 mcg, followed by Flovent Diskus® 500 mcg, followed by Flovent Diskus® 250 mcg

Group Type EXPERIMENTAL

Flovent Diskus® 250 mcg

Intervention Type DRUG

Flovent is an ICS

Flovent Diskus® 500 mcg

Intervention Type DRUG

Flovent is an ICS

Advair Diskus® 100/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Advair Diskus® 250/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Crossover sequence 7

Flovent Diskus® 250 mcg, followed by Flovent Diskus® 500 mcg, followed by Advair Diskus® 100/50 mcg, followed by Advair Diskus® 250/50 mcg

Group Type EXPERIMENTAL

Flovent Diskus® 250 mcg

Intervention Type DRUG

Flovent is an ICS

Flovent Diskus® 500 mcg

Intervention Type DRUG

Flovent is an ICS

Advair Diskus® 100/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Advair Diskus® 250/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Crossover sequence 8

Advair Diskus® 100/50 mcg, followed by Flovent Diskus® 250 mcg, followed by Advair Diskus® 250/50 mcg, followed by Flovent Diskus® 500 mcg

Group Type EXPERIMENTAL

Flovent Diskus® 250 mcg

Intervention Type DRUG

Flovent is an ICS

Flovent Diskus® 500 mcg

Intervention Type DRUG

Flovent is an ICS

Advair Diskus® 100/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Advair Diskus® 250/50 mcg

Intervention Type DRUG

Advair is an ICS/LABA combination

Interventions

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Flovent Diskus® 100 mcg

Flovent is an ICS

Intervention Type DRUG

Flovent Diskus® 250 mcg

Flovent is an ICS

Intervention Type DRUG

Flovent Diskus® 500 mcg

Flovent is an ICS

Intervention Type DRUG

Advair Diskus® 100/50 mcg

Advair is an ICS/LABA combination

Intervention Type DRUG

Advair Diskus® 250/50 mcg

Advair is an ICS/LABA combination

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Individuals who self-report Black ancestry (with at least 1 Black grandparent).
2. Able to perform reproducible spirometry according to ATS criteria.
3. Clinical history consistent with asthma.
4. Baseline FEV1≥40% of predicted and/or post-bronchodilator FEV1≥40% of predicted.
5. Asthma confirmed either by: (1) Beta-agonist reversibility to 4 puffs albuterol ≥ 12% OR (2) PC20FEV1 ≤ 16 mg/ml OR (3) an absolute relative change in %predicted FEV1 of ≥ 12% over two measurements documented by repeat spirogram over the previous year
6. Either: A) inadequately controlled on low-, medium- or high-dose ICS monotherapy, or low- or medium-dose ICS/LABA, or B) well-controlled on medium- or high-dose ICS monotherapy, or low-, medium- or high-dose ICS/LABA. Inadequate asthma control will be defined as an ACT/c-ACT score \<20; well-controlled asthma will be defined as an ACT/c-ACT score ≥20.
7. Stable asthma controller therapy dose (ICS or ICS/LABA) for the 2 weeks prior to enrollment.
8. Non-smoker (total lifetime smoking history \< 5 pack-years if \<18, or \<10 pack-years if ≥18 years of age; no smoking for at least 1 year).
9. For participants ≥18 years of age: Ability to provide informed consent. For participants under 18 years of age: Ability to provide verbal or written assent and ability of parent to provide informed consent.

Exclusion Criteria

1. Medical contraindication to LABA or history of adverse reactions to ICS or LABA preparations or any of their ingredients.
2. Current or prior use of medications known to significantly interact with corticosteroid disposition within the two-week period preceding enrollment.
3. Unwilling to provide a blood sample for DNA extraction and genetic analysis.
4. Major medical problems prohibiting study participation, i.e. presence of chronic or active lung disease other than asthma or history of unstable significant medical illness other than asthma, including thyroid disease, diabetes mellitus, Cushing's disease, Addison's disease, hepatic disease, or concurrent medical problems that could require oral corticosteroids during the study or that would place the participant at increased risk.
5. Systemic corticosteroid treatment for any condition within 4 weeks of enrollment or more than five courses of systemic corticosteroids in the past year.
6. History of a life-threatening asthma exacerbation requiring intubation, mechanical ventilation, or resulting in a hypoxic seizure within the last 2 years.
7. History of a respiratory tract infection within 4 weeks of enrollment.
8. If a female of child-bearing potential, failure to practice abstinence or use an acceptable birth control method.
9. Pregnancy or lactation or planning to get pregnant during the course of the trial.
10. Receiving hyposensitization therapy other than an established maintenance regimen defined as a continuous regimen for ≥ 3 months prior to enrollment.
11. Participation in an intervention trial or use of investigative drugs in the past 30 days or plans to enroll in such a trial during the study.
Minimum Eligible Age

5 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Milton S. Hershey Medical Center

OTHER

Sponsor Role lead

Responsible Party

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dave mauger

Principal Investigator, AsthmaNet Data Coordinating Center

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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William Busse, MD

Role: STUDY_CHAIR

University of Wisconsin, Madison

Locations

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University of Arizona College of Medicine

Tucson, Arizona, United States

Site Status

Children's Hospital & Research Center Oakland

Oakland, California, United States

Site Status

UCSF Benioff Children's Hospital

San Francisco, California, United States

Site Status

University of California - San Francisco

San Francisco, California, United States

Site Status

National Jewish Health

Denver, Colorado, United States

Site Status

Nemours Children's Clinic

Jacksonville, Florida, United States

Site Status

Nemours Children's Clinic

Orlando, Florida, United States

Site Status

Emory University

Atlanta, Georgia, United States

Site Status

Northwestern Memorial Hospital

Chicago, Illinois, United States

Site Status

Rush University Medical Center

Chicago, Illinois, United States

Site Status

University of Illinois at Chicago

Chicago, Illinois, United States

Site Status

Ann and Robert H. Lurie Children's Hospital

Chicago, Illinois, United States

Site Status

University of Chicago

Chicago, Illinois, United States

Site Status

Brigham & Women's Hospital

Boston, Massachusetts, United States

Site Status

Children's Hospital Boston

Boston, Massachusetts, United States

Site Status

St. Louis Children's Hospital

St Louis, Missouri, United States

Site Status

Washington University

St Louis, Missouri, United States

Site Status

University of New Mexico

Albuquerque, New Mexico, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

Duke University School of Medicine

Durham, North Carolina, United States

Site Status

North Carolina Clinical Research

Raleigh, North Carolina, United States

Site Status

Wake Forest University Health Sciences

Winston-Salem, North Carolina, United States

Site Status

Rainbow Babies and Children's Hospital, Case Western Reserve University

Cleveland, Ohio, United States

Site Status

Allegheny General Hospital

Pittsburgh, Pennsylvania, United States

Site Status

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status

Children's Hospital of Pittsburgh of UPMC

Pittsburgh, Pennsylvania, United States

Site Status

University of Wisconsin-Madison

Madison, Wisconsin, United States

Site Status

Center for Urban Population Health

Milwaukee, Wisconsin, United States

Site Status

Countries

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United States

References

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Wechsler ME, Szefler SJ, Ortega VE, Pongracic JA, Chinchilli V, Lima JJ, Krishnan JA, Kunselman SJ, Mauger D, Bleecker ER, Bacharier LB, Beigelman A, Benson M, Blake KV, Cabana MD, Cardet JC, Castro M, Chmiel JF, Covar R, Denlinger L, DiMango E, Fitzpatrick AM, Gentile D, Grossman N, Holguin F, Jackson DJ, Kumar H, Kraft M, LaForce CF, Lang J, Lazarus SC, Lemanske RF Jr, Long D, Lugogo N, Martinez F, Meyers DA, Moore WC, Moy J, Naureckas E, Olin JT, Peters SP, Phipatanakul W, Que L, Raissy H, Robison RG, Ross K, Sheehan W, Smith LJ, Solway J, Sorkness CA, Sullivan-Vedder L, Wenzel S, White S, Israel E; NHLBI AsthmaNet. Step-Up Therapy in Black Children and Adults with Poorly Controlled Asthma. N Engl J Med. 2019 Sep 26;381(13):1227-1239. doi: 10.1056/NEJMoa1905560.

Reference Type DERIVED
PMID: 31553835 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

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Other Identifiers

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1U10HL098115

Identifier Type: NIH

Identifier Source: secondary_id

View Link

AsthmaNet 006

Identifier Type: -

Identifier Source: org_study_id

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