GlaxoSmithKline Plc (GSK) and Theravance, Inc. announced results from a phase II safety and efficacy study for developmental combination treatment Relovair in chronic obstructive pulmonary disorder (COPD). Relovair is an investigational drug which combines fluticasone furoate (FF; an inhaled corticosteroid or ICS) and vilanterol trifenatate (VI; a newly developed long-acting beta agonist or LABA) in a once-daily treatment for patients with COPD or asthma. The results were presented at the European Respiratory Society congress in Barcelona where GSK presented a total of 13 clinical and pre-clinical abstracts for Relovair and its individual components in COPD and asthma.

The Relovair (FFVI 400/25mcg) COPD phase II study showed that the effect of FF/VI on heart function and safety (as measured by weighted mean heart rate) was comparable to placebo (0.6bpm; 95 per cent confidence interval (CI): -3.9, 5.1; upper CI was below non-inferiority limit). The most common adverse events (FFVI; placebo) were nasopharyngitis (18%;15%), headache (15%; 5%), dizziness (5%; 5%) and candidiasis (8%;0%). In the FFVI group, 68% of the patients reported adverse events versus 50% in the placebo group.

There were no clinically relevant effects seen in laboratory measures, vital signs or additional heart assessments.

Patients treated with Relovair showed greater improvements in lung function from baseline compared with placebo (as measured by pre-dose FEV1, a standard measure of lung function) in the analysis of this secondary endpoint.Placebo-adjusted trough FEV1 for the Relovair patients on Day 29 was 183mL (95% confidence interval (CI): 87, 279mL) and the weighted mean FEV1 for the Relovair patients on Day 28 was 236mL (95% CI: 154, 319mL).

Darrell Baker, SVP GSK Respiratory Medicines Development Centre, commented, “These phase II data are encouraging and show potential for Relovair as the first once-a-day combination in COPD. The development programme for Relovair builds on GSK’s extensive respiratory heritage and confirms our continued commitment to bring new respiratory medicines to patients.”

“We are very pleased with the results of this phase 2 combination study. Our ongoing collaboration with GSK includes the phase III programmes in both COPD and asthma, which are already underway for Relovair and its components. The phase III studies are being conducted to help us confirm these early findings,” said Rick E Winningham, chief executive officer at Theravance.

The phase II study employed a multicentre, randomised, double-blind, parallel-group, placebo-controlled design to assess the safety and efficacy of Relovair (FF 400mcg combined with VI 25mcg) administered once daily in 60 patients with COPD (GOLD Stage II-III) for four weeks. The patients enrolled had a mean age of 64 years. The co-primary endpoints of the study were change from baseline in weighted mean heart rate 0-4 hours post-dose at the end of the 28day treatment period and incidence of adverse events. The secondary endpoints were change from baseline in trough FEV1 (23–24 hours post-dose) and weighted mean FEV1 (0–4 hours post-dose).

All patients in the study were dosed using a novel, single-step activation dry powder inhaler.

A phase 2b study evaluated the dose response, efficacy and safety of five doses of VI in COPD patients. The study showed improvements in lung function observed in all doses after 4 weeks, compared with placebo; p<0.001 (as measured by change in pre-dose FEV1)

Phase IIb data from the Relovair asthma programme, which evaluated the efficacy and safety of the VI and FF components of Relovair, were also presented at ERS. In three separate studies, significant improvements in lung function in patients who were not controlled by current standards of care including low or moderate dose ICS and non-steroidal therapy were found with FF (p<0.001, <0.001 and <0.05 respectively). A fourth study demonstrated that the efficacy of FF taken once-daily in the evening was comparable with half the dose taken twice daily. A low incidence of adverse events (nasopharyngitis, headache, and candidiasis) were reported across all four FF studies.

Another study evaluated the dose response, efficacy and safety of five doses of VI in asthma patients aged from 12 years.8 A significant relationship between the dose of VI and pre-dose FEV1 was observed, compared with placebo (p=0.003 including placebo, p=0.037 excluding placebo). The incidence of adverse events was low in all treatment groups (tremor 0-2%, palpitations 0-2%, glucose and potassium effects 0-1%).

The phase III programmes for Relovair in COPD and asthma commenced in October 2009 and March 2010 respectively. Both programmes are assessing the potential benefit of the combination FF/VI versus the component products and existing treatments for asthma and COPD in over 11,000 patients.

Relovair is a trademark of the GlaxoSmithKline group of companies. Mark is intended for US and subject to FDA approval.

GlaxoSmithKline – one of the world’s leading research-based pharmaceutical and healthcare companies – is committed to improving the quality of human life by enabling people to do more, feel better and live longer.

Theravance - is a biopharmaceutical company with a pipeline of internally discovered product candidates. Theravance is focused on the discovery, development and commercialization of small molecule medicines across a number of therapeutic areas including respiratory disease, bacterial infections and gastrointestinal motility dysfunction.