Almirall, SA and Forest Laboratories, Inc. have reported positive topline results from AUGMENT/COPD, the second six-month pivotal phase III clinical trial evaluating the efficacy and safety of investigational fixed dose combinations of aclidinium bromide (LAMA) and formoterol fumarate (LABA) for the treatment of Chronic Obstructive Pulmonary Disease (COPD), delivered in the Pressair inhaler (Genuair outside the USA).

The 400/12mcg combination of aclidinium/formoterol given twice daily demonstrated statistically significant improvements in change from baseline for the co-primary endpoints of Forced Expiratory Volume (FEV1) at 1 hour post-dose versus aclidinium 400mcg (p<0.0001), and morning predose trough FEV1 versus formoterol 12mcg at week 24 (p<0.05). The 400/6mcg combination demonstrated statistically significant improvements in (FEV1) at one hour post-dose versus aclidinium 400mcg (p<0.0001). For the change from baseline in morning pre-dose trough FEV1, the 400/6mcg combination did not reach significance versus formoterol 12mcg at week 24 (p>0.05).

Both combinations of aclidinium/ formoterol (400/12mcg and 400/6mcg) provided statistically significant improvements versus placebo in the above two comparisons (both p<0.0001).

The positive results of the aclidinium/ formoterol 400/12mcg combination in this study are consistent with the statistically significant improvement in lung function demonstrated by aclidinium/formoterol 400/12mcg in the previously completed ACLIFORM/COPD phase III study. In both studies, the 400/12mcg dose successfully met the required regulatory “Combination Rule” for testing two or more drugs combined in a single dosage form.

Both studies included secondary endpoints. The endpoints analyzed to date werechange from baseline vs placebo at 24 weeks in TDI (Transitional Dyspnea Index, which measures breathlessness) and in SGRQ (St. George’s Respiratory Questionnaire, a respiratory-specific disease-related quality of life assessment). Positive outcomes were seen with the two combinations achieving the MCID (Meaningful Clinical Important Difference) of a one point change (p<0.0001) in TDI in both studies, and a four point change (p<0.0001) in SGRQ in the AUGMENT/COPD study. Additional analyses, including those on pooled data, will be presented at future scientific meetings.

Additionally, both aclidinium/ formoterol treatment arms were well-tolerated in this study. The most common adverse events (greater than or equal to 3% and reported more frequently with either aclidinium/formoterol 400/12mcg or aclidinium/formoterol 400/6mcg than placebo respectively) were: cough (5.1%, 3.9% and 3.6%); nasopharyngitis (4.8%, 5.1% and 3.6%); headache (4.8%, 4.2% and 3.3%); urinary tract infection (4.5%, 2.1% and 3.0%); upper respiratory tract infection (3.0%, 3.9% and 1.5%); back pain (3.0%, 1.5% and 2.7%); diarrhea (2.7% 3.0% and 2.4%); nausea (1.5%, 4.5% and 1.2%); and dyspnea (1.5%, 3.3% and 1.8%).

“We are very pleased with these results which confirm the efficacy and safety profile of the novel combination of aclidinium/formoterol,” commented Dr Bertil Lindmark, chief scientific officer at Almirall.“The positive results in breathlessness and quality of life measures combined with the patient preferred Pressair/Genuair multidose device could place this new combination as a treatment option for patients suffering from COPD. The successful completion of both pivotal studies marks an important milestone towards achieving an innovative global respiratory franchise around aclidinium and the Almirall’s Genuair inhaler.”

“By successfully achieving the primary endpoints in these two pivotal trials, we have demonstrated that aclidinium/formoterol, 400/12mcg, delivers statistically significant improvement in lung function,” said Dr Marco Taglietti, president of Forest Research Institute. “The success of this phase III programme supports the potential of aclidinium/formoterol as a new treatment option for COPD patients who could benefit from the enhanced bronchodilation of two complementary, proven therapies.”

Regulatory filings in the USA (FDA) and Europe (EMA) are planned in Q4 2013.

AUGMENT (Aclidinium/formoterol FUmurate Combination for InvestiGative use in the TreatMENT of Moderate to Severe COPD) was a 24-week randomized double-blind trial evaluating the 400/12mcgand 400/6mcgfixed dose combinations of aclidinium bromide/formoterol fumarate compared with aclidinium bromide 400mcg, formoterol fumarate 12mcg and placebo administered BID through the Pressair inhaler (Genuair outside the USA) in 1,692patients with moderate to severe COPD in the USA, Australia and New Zealand.

In this AUGMENT/COPD study, the aclidinium/formoterol 400/12mcg and 400/6mcg also demonstrated superior efficacy in the secondary efficacy comparison for each co-primary parameter as compared to placebo, achieving statistically significant benefits 1-hour post-dose FEV1 (284mL and 263mL, respectively) and in trough FEV1 (130mL and 111mL, respectively).

The positive results of the aclidinium/formoterol 400/12mcg combination in this study are consistent with the statistically significant improvement in lung function demonstrated by aclidinium/formoterol 400/12mcg in the previously completed ACLIFORM/COPD phase III study.

ACLIFORM/COPD (ACLIdinium/FORMoterol fumarate combination for Investigative use in the treatmentof moderate to severe COPD) was a 24-week randomized double-blind trial evaluating the 400/6mcg and 400/12mcg fixed dose combinations of aclidinium bromide/formoterol fumarate compared with aclidinium bromide 400mcg, formoterol fumarate 12mcg and placebo administered BID through the Genuair/ Pressair inhalers in 1,729patients with moderate to severe COPD, in 22 countries including Europe, Korea and South Africa.

The full results of both studies will be presented at future scientific meetings.

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