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AsthmaPhase 3SIENANCT02066298

Steroids In Eosinophil Negative Asthma

A Phase 3 study testing Mometasone 220mcg BID and Tiotropium Respimat 5mcg QD in people with Asthma, run by Milton S. Hershey Medical Center at 25 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Because approximately half of all mild-moderately-severe asthma is persistently non-eosinophilic, it is important to determine prospectively if patients who are persistently non-eosinophilic differ in their benefit from inhaled corticosteroid treatment compared to patients who are not persistently non-eosinophilic. Read more about this study

Who is it for?
Ages 12 years and older
Conditions the study is for
Asthma
What is being tested?
Mometasone 220mcg BID and Tiotropium Respimat 5mcg QD
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
295 participants
Where
25 sitesUnited States
Study dates
Jul 2014to May 2018
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 12 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Physician-diagnosed asthma for at least previous 12 months.
  • Able to perform reproducible spirometry.
  • Baseline FEV1≥70% of predicted.
  • Asthma confirmed either by:
  • Beta-agonist reversibility to 4 puffs albuterol ≥ 12% OR
  • Methacholine PC20 ≤ 16 mg/ml
Show all 12Show fewer
  • At least 1 of the following indications for chronic controller therapy:
  • Asthma Symptoms > 2 days/week OR
  • Nocturnal Asthma Symptoms > 2 nights/month OR
  • Short-acting beta-agonist use for symptom control > 2 days/week
  • 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.
  • Willingness, if female and able to conceive, to utilize one medically-acceptable form of contraception.

Who cannot join

  • Chronic inhaled or oral corticosteroid therapy.
  • Use of inhaled or oral corticosteroid therapy within 6 weeks.
  • New allergen immunotherapy within the past 3 months or anticipated changes to an ongoing immunotherapy regimen.
  • Use of omalizumab within 3 months.
  • History of:
  • bladder-neck obstruction, urinary retention or benign prostatic hyperplasia
Show all 12Show fewer
  • narrow angle glaucoma
  • significant cardiovascular disorders and arrhythmias
  • life-threatening asthma requiring treatment with intubation or mechanical ventilation within the past 5 years
  • Respiratory tract infection within past 6 weeks.
  • History of smoking within the past 1 year, or > 10 pack-years total if ≥ 18 years of age, or > 5 pack-years total if < 18 years of age.
  • Chronic diseases or medical conditions (other than asthma) that could put the participant at risk by participation, e.g. chronic diseases of the lung (other than asthma), heart, liver, kidney, endocrine or nervous system, or immunodeficiency.

Trial locations and contacts

25 sites in 1 country.

25 sites in 1 country

United States25 sites
  • Emory University

    Atlanta, Georgia, 30322

  • Brigham and Women's Hospital

    Boston, Massachusetts, 02115

  • Children's Hospital Boston

    Boston, Massachusetts, 02115

  • Northwestern Memorial Hospital

    Chicago, Illinois, 60611

  • Rush University Medical Center

    Chicago, Illinois, 60612

  • University of Illinois at Chicago

    Chicago, Illinois, 60612

  • Ann and Robert H. Lurie Children's Hospital

    Chicago, Illinois, 60614

  • University of Chicago

    Chicago, Illinois, 60637

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

    Cleveland, Ohio, 44106

  • National Jewish Health

    Denver, Colorado, 80206

  • Duke University School of Medicine

    Durham, North Carolina, 27110

  • Nemours Children's Clinic

    Jacksonville, Florida, 32207

  • University of Wisconsin-Madison

    Madison, Wisconsin, 53792

  • Columbia University Medical Center

    New York, New York, 10032

  • Nemours Children's Clinic

    Orlando, Florida, 32827

  • Allegheny General Hospital

    Pittsburgh, Pennsylvania, 15212

  • University of Pittsburgh

    Pittsburgh, Pennsylvania, 15213

  • Children's Hospital of Pittsburgh of UPMC

    Pittsburgh, Pennsylvania, 15224

  • North Carolina Clinical Research

    Raleigh, North Carolina, 27607

  • UCSF Benioff Children's Hospital

    San Francisco, California, 94143

  • University of California at San Francisco

    San Francisco, California, 94143

  • St. Louis Children's Hospital

    St Louis, Missouri, 63110

  • Washington University

    St Louis, Missouri, 63110

  • University of Arizona College of Medicine

    Tucson, Arizona, 85724

  • Wake Forest University Health Sciences

    Winston-Salem, North Carolina, 27157

Other trials in United States

About this study

Because approximately half of all mild-moderately-severe asthma is persistently non-eosinophilic, it is important to determine prospectively if patients who are persistently non-eosinophilic differ in their benefit from inhaled corticosteroid treatment compared to patients who are not persistently non-eosinophilic.

Read the detailed description

SIENA is a 42-week randomized, stratified, 3-period double-blind placebo-controlled crossover study of patients with symptomatic mild-to-moderate asthma, not already taking an inhaled corticosteroid, in whom the effect of "medium-dose" inhaled corticosteroid (ICS) will be compared with the effect of placebo and with a long-acting muscarinic antagonist (LMA).

Conditions
Asthma
Being tested
Mometasone 220mcg BID, Tiotropium Respimat 5mcg QD, Placebo
Keywords
Asthma, Mometasone, Tiotropium
Medical subject headings
Asthma

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Mometasone 220mcg BIDDrug

    Also called Asmanex

    Mometasone is an ICS

  • Tiotropium Respimat 5mcg QDDrug

    Tiotropium is a LMA

  • PlaceboDrug

Study groups in NCT02066298
Study groupRoleWhat they receive
Mometasone then Tiotropium then PlaceboExperimentalMometasone 220mcg BID, followed by Tiotropium Respimat 5mcg QD, followed by Placebo
Receives: Drug: Mometasone 220mcg BID; Drug: Tiotropium Respimat 5mcg QD; Drug: Placebo
Mometasone then Placebo then TiotropiumExperimentalMometasone 220mcg BID, followed by Placebo, followed by Tiotropium Respimat 5mcg QD
Receives: Drug: Mometasone 220mcg BID; Drug: Tiotropium Respimat 5mcg QD; Drug: Placebo
Placebo then Mometasone then TiotropiumExperimentalPlacebo, followed by Mometasone 220mcg BID, followed by Tiotropium Respimat 5mcg QD
Receives: Drug: Mometasone 220mcg BID; Drug: Tiotropium Respimat 5mcg QD; Drug: Placebo
Placebo then Tiotropium then MometasoneExperimentalPlacebo, followed by Tiotropium Respimat 5mcg QD, followed by Mometasone 220mcg BID
Receives: Drug: Mometasone 220mcg BID; Drug: Tiotropium Respimat 5mcg QD; Drug: Placebo
Tiotropium then Placebo then MometasoneExperimentalTiotropium Respimat 5mcg QD, followed by Placebo, followed by Mometasone 220mcg BID
Receives: Drug: Mometasone 220mcg BID; Drug: Tiotropium Respimat 5mcg QD; Drug: Placebo
Tiotropium then Mometasone then PlaceboExperimentalTiotropium Respimat 5mcg QD, followed by Mometasone 220mcg BID, followed by Placebo
Receives: Drug: Mometasone 220mcg BID; Drug: Tiotropium Respimat 5mcg QD; Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pairwise Comparison of Treatments Based on Composite Measure Using Treatment Failures, Asthma Control Days, and Percent Predicted FEV1.

    This composite outcome uses a hierarchical method to ascertain differences in asthma control. For each participant, treatments are first compared to see if they differ in terms of treatment failures. If one treatment results in no treatment failures and another treatment does, it is deemed the superior treatment and no further comparisons are made. If treatment superiority cannot be assigned by treatment failures, then they are compared by asthma control days (ACDs). If one treatment yields at least 31 annualized ACDs more than another, it is deemed the superior treatment. If treatment superiority still cannot be assigned by ACDs, then they are compared by percent predicted FEV1 at the end of a treatment period. If one treatment yields at least 5% greater FEV1 than another, it is deemed the superior treatment. If treatment superiority cannot be assigned by exacerbations, ACDs or FEV1, then that participant is classified as having no differential response.

    Measured: End of 12-week treatment period

Secondary outcomes (5)
  1. Treatment Failure

    Treatment Failure includes:

    • Awakening from asthma three or more times in a two-week period or on two consecutive nights, or
    • Using albuterol for relief of symptoms four or more times/day for two or more consecutive days, or
    • Albuterol has been relieving symptoms for less than four hours after each treatment over a 12-hour period, or
    • Using albuterol for relief of symptoms daily for seven days, and this use exceeds two times the weekly use of albuterol in the baseline period, or
    • exercise induces unusual breathlessness

    Measured: End of 12-week treatment period

  2. Annualized Asthma Control Days

    Asthma Control Days (ACD) are based on patient completed electronic daily diaries, and are defined as: A day with no rescue albuterol use (pre-exercise albuterol will not be counted), no non-study asthma medications, no daytime asthma symptoms (shortness of breath, wheezing, chest tightness, phlegm/mucus rated as mild, moderate or severe, or cough rated as moderate or severe), no nighttime asthma symptoms, no unscheduled healthcare visits for asthma, and no PEF < 80% of predetermined baseline. Annualized ACD are calculated as the proportion of ACD during the treatment period multiplied by 365.

    Measured: End of 12-week treatment period

  3. Forced Expiratory Volume at One Second (FEV1) Percent of Predicted

    FEV1, expressed as percent of predicted FEV1 based on age, sex, race, and height.

    Measured: End of 12-week treatment period

  4. Peak Expiratory Flow Rate

    Peak expiratory flow rate is a person's maximum speed of expiration. It measures the airflow through the bronchi and thus the degree of obstruction in the airways.

    Measured: End of 12-week treatment period

  5. Asthma Exacerbations

    Asthma exacerbations are more severe episodes of acute worsening, defined by meeting one or more of the following:

    • FEV1 <50% of baseline on 2 consecutive measurements
    • FEV1 <40% of predicted on 2 consecutive measurements
    • Use of ≥ 16 puffs of "as needed" β-agonist per 24 hours for a period of 48 hours
    • Use of oral/parenteral corticosteroid due to asthma

    Measured: End of 12-week treatment period

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Feb 2014 (estimated)
  2. Study startJul 2014
  3. Primary completionMay 2018
  4. Study completionMay 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
295 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02066298
Sponsor's protocol ID
AsthmaNet 007
Other IDs
1U10HL098115
Acronym
SIENA
Status last verified
May 2019
First submitted
10 Feb 2014
Last updated
29 May 2019
Data monitoring committee
Yes

Publications

  • Covar R, Lazarus SC, Krishnan JA, Blake KV, Sorkness CA, Dyer AM, Lang JE, Lugogo NL, Mauger DT, Wechsler ME, Wenzel SE, Cardet JC, Castro M, Israel E, Phipatanakul W, King TS; National Heart, Lung, and Blood Institute AsthmaNet. Association of Sputum Eosinophilia With Easily Measured Type-2 Inflammatory Biomarkers in Untreated Mild Persistent Asthma. J Allergy Clin Immunol Pract. 2024 Apr;12(4):960-969.e6. doi: 10.1016/j.jaip.2023.12.010. Epub 2023 Dec 12.

    PubMed 38097180
  • Lazarus SC, Krishnan JA, King TS, Lang JE, Blake KV, Covar R, Lugogo N, Wenzel S, Chinchilli VM, Mauger DT, Dyer AM, Boushey HA, Fahy JV, Woodruff PG, Bacharier LB, Cabana MD, Cardet JC, Castro M, Chmiel J, Denlinger L, DiMango E, Fitzpatrick AM, Gentile D, Hastie A, Holguin F, Israel E, Jackson D, Kraft M, LaForce C, Lemanske RF Jr, Martinez FD, Moore W, Morgan WJ, Moy JN, Myers R, Peters SP, Phipatanakul W, Pongracic JA, Que L, Ross K, Smith L, Szefler SJ, Wechsler ME, Sorkness CA; National Heart, Lung, and Blood Institute AsthmaNet. Mometasone or Tiotropium in Mild Asthma with a Low Sputum Eosinophil Level. N Engl J Med. 2019 May 23;380(21):2009-2019. doi: 10.1056/NEJMoa1814917. Epub 2019 May 19.

    PubMed 31112384
  • Sorkness CA, King TS, Dyer AM, Chinchilli VM, Mauger DT, Krishnan JA, Blake K, Castro M, Covar R, Israel E, Kraft M, Lang JE, Lugogo N, Peters SP, Wechsler ME, Wenzel SE, Lazarus SC; National Heart Lung and Blood Institute's "AsthmaNet". Adapting clinical trial design to maintain meaningful outcomes during a multicenter asthma trial in the precision medicine era. Contemp Clin Trials. 2019 Feb;77:98-103. doi: 10.1016/j.cct.2018.12.012. Epub 2018 Dec 27.

    PubMed 30593883

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Mometasone 220mcg BID and Tiotropium Respimat 5mcg QD in people with Asthma, run by Milton S. Hershey Medical Center at 25 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 12 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 May 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 25 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 18 Apr 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pairwise Comparison of Treatments Based on Composite Measure Using Treatment Failures, Asthma Control Days, and Percent Predicted FEV1. (time frame: End of 12-week treatment period). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02066298, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 May 2019.

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Steroids In Eosinophil Negative Asthma (NCT02066298) | AzTrials