Fixed-Dose Combination of Albuterol and Budesonide (PT027) Demonstrated Significant Benefits for Asthma Patients in MANDALA and DENALI Phase III Trials
PT027 significantly reduced the risk of severe exacerbations compared to albuterol in patients with moderate to severe asthma in MANDALA trial when used as a rescue medicine in response to symptoms
PT027 significantly improved lung function compared to individual components in mild to moderate asthma in DENALI trial
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
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.
The safety and tolerability of PT027 in both trials were consistent with the known profiles of the components. Detailed data from MANDALA and DENALI will be presented at an upcoming medical meeting.
Patients with asthma experience recurrent breathlessness and wheezing, which varies over time, and in severity and frequency. These patients are at risk of severe exacerbations regardless of their disease severity, adherence to treatment or level of control.
There are an estimated 176 million asthma exacerbations globally per year, including more than 10 million in the US; these are physically threatening and emotionally significant for many patients and can be fatal.
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 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.
DENALIis 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 is a potential first-in-class SABA/ICS rescue treatment for asthma in the US, 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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