PT027 shows positive results in MANDALA and DENALI phase III trials

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Positive high-level results from the MANDALA and DENALI Phase III trials of PT027 (albuterol/budesonide), at both 180/160mcg and 180/80mcg doses, met all primary endpoints demonstrating statistically significant benefits in patients with asthma versus individual components albuterol, also known as salbutamol (180mcg) and budesonide (160mcg).

PT027 is a potential first-in-class inhaled, fixed-dose combination of albuterol, a short-acting beta2-agonist (SABA), and budesonide, an inhaled corticosteroid (ICS), being developed by AstraZeneca and Avillion.

The MANDALA trial met the primary endpoint, with PT027 demonstrating statistically significant and clinically meaningful reductions in the risk of severe exacerbations compared to albuterol, when used as a rescue medicine in response to symptoms. The trial included 3,132 patients with moderate to severe asthma taking maintenance ICS with or without additional controller medicines.

The DENALI trial met the dual primary endpoints, with PT027 showing a statistically significant improvement in lung function measured by forced expiratory volume in one second (FEV1), compared to the individual components albuterol and budesonide, and compared to placebo. The trial included 1,001 patients with mild to moderate asthma previously treated either with a SABA as needed alone or in addition to low-dose maintenance ICS therapy.

Asthma is a chronic, inflammatory, fluctuating respiratory disease that affects as many as 339 million adults and children worldwide, including over 25 million in the US. Inflammation is a distinctive feature of asthma and plays a key role in asthma symptoms, exacerbations and deaths.

Bradley E. Chipps, past president of the American College of Allergy, Asthma & Immunology and Medical Director of Capital Allergy & Respiratory Disease Center, said: “Severe asthma exacerbations are a significant burden for many asthma patients of all ages resulting in impaired quality of life, hospitalization, treatment with systemic corticosteroids, which can lead to serious side effects, and the possibility of premature death. Many millions of patients globally rely on their rescue inhaler to alleviate acute symptoms, but this does not treat the underlying inflammation in asthma. The MANDALA and DENALI trials demonstrate an albuterol/budesonide rescue inhaler can address inflammation and prevent exacerbations, making PT027 an important potential new treatment option for patients.”

“All patients with asthma are at risk of severe exacerbations, regardless of their disease severity, and many are known to overuse short-acting bronchodilators. These exciting results with PT027 bring us one step closer to providing an innovative and superior treatment approach for asthma by preventing exacerbations,” said Mene Pangalos, executive vice president of BioPharmaceuticals R&D.

The safety and tolerability of PT027 in both trials were consistent with the known profiles of the components. 

Asthma

Inflammation is central to both asthma symptoms and exacerbations. Many patients experiencing asthma symptoms use a SABA as a rescue medicine, however, taking a SABA alone does not address inflammation, leaving patients at risk of severe exacerbations, which can result in impaired quality of life, hospitalization and frequent oral corticosteroid (OCS) use. Repeated courses of OCS therapy are associated with an increased risk of systemic side effects including pneumonia, osteoporosis and type 2 diabetes. International recommendations from the Global Initiative for Asthma no longer recommend SABA as the preferred rescue therapy.

MANDALA

MANDALA is a Phase III, randomized, double-blind, multicenter, parallel-group, event-driven trial evaluating the efficacy and safety of PT027 compared to albuterol on the time to first severe asthma exacerbation in 3,132 adults and children aged four years and older with moderate to severe asthma taking ICS alone or in combination with a range of asthma maintenance therapies, including long-acting beta2-agonists (LABA), leukotriene receptor antagonists (LTRA), long-acting muscarinic antagonists (LAMA) or theophylline. The trial comprised a two- to four-week screening period, at least a 24-week treatment period and a two-week post-treatment follow-up period.

Patients were randomly assigned to one of the following three treatment groups in a 1:1:1 ratio: PT027 180/160mcg (excluding patients aged 11 years or younger), PT027 180/80mcg or albuterol 180mcg, taken as a rescue medicine in response to symptoms. PT027 and the albuterol comparator were delivered in a pressurized metered-dose inhaler (pMDI) using AstraZeneca’s Aerosphere delivery technology. The primary efficacy endpoint was the time to first severe asthma exacerbation during the treatment period. Secondary endpoints included severe exacerbation rate (annualized), total systemic corticosteroid exposure over the treatment period, asthma control and health-related quality of life.

DENALI

DENALI is a Phase III, randomized, double-blind, placebo-controlled, multicenter, parallel-group trial evaluating the efficacy and safety of PT027 compared to its components albuterol and budesonide on improvement in lung function in 1,001 adults and children aged four years and older with mild to moderate asthma previously treated either with SABA as needed alone or in addition to regular low-dose ICS maintenance therapy. The trial comprised a two-to-four-week screening period, a 12-week treatment period and a two-week post-treatment follow-up period.

Patients were randomly assigned to one of the following five treatment groups in a 1:1:1:1:1 ratio: PT027 180/160mcg four times daily (excluding patients aged 11 years or younger), PT027 180/80mcg four times daily, albuterol 180mcg four times daily, budesonide 160mcg four times daily and placebo four times daily (excluding patients aged 11 years or younger). PT027 and the albuterol and budesonide comparators were delivered in a pMDI using AstraZeneca’s Aerosphere delivery technology. The dual primary efficacy endpoints were a change from baseline in FEV1 area under the curve 0-6 hours over 12 weeks of PT027 compared to budesonide to assess the effect of albuterol and a change from baseline in trough FEV1 at week 12 of PT027 compared to albuterol to assess the effect of budesonide. Secondary endpoints included the time to onset and duration of response on day one, number of patients who achieved a clinically meaningful improvement in asthma control from baseline at week 12 and trough FEV1 at week one.

PT027

PT027 is a potential first-in-class SABA/ICS rescue treatment for asthma in the U.S., to be taken as needed in response to symptoms. It is an inhaled, fixed-dose combination of albuterol (also known as salbutamol), a SABA, and budesonide, a corticosteroid, and is being developed in a pMDI using AstraZeneca’s Aerosphere delivery technology. 

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