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Exhibit 99.2

 

POSTER NO. PS272

 

Ethnic sensitivity assessment of fluticasone furoate (FF)/vilanterol (VI) in asthma patients in Japan and Korea: a pre-specified subgroup analysis

 

Gross AS(1), Goldfrad C(2), Hozawa S(3), James M(4), Clifton CS(1), Sugiyama Y(5), Jacques L(6)

 


(1)Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline, Sydney, Australia; (2)Quantitative Sciences Division, GlaxoSmithKline, Uxbridge, UK; (3)Hiroshima Allergy and Respiratory Clinic, Hiroshima, Japan; (4)Medical Affairs, GlaxoSmithKline K.K., Tokyo, Japan; (5)Medicines Development Respiratory, GlaxoSmithKline K.K., Tokyo, Japan; (6)Respiratory Medicines Discovery and Development, GlaxoSmithKline, Uxbridge, UK

 

INTRODUCTION

 

·                  Inhaled corticosteroid (ICS)/long-acting beta2-agonist (LABA) combinations are recommended by Japanese(1) and global asthma guidelines(2) for asthma patients uncontrolled on ICS alone.

 

·                  FF/VI is a once-daily ICS/LABA combination therapy delivered via the ELLIPTATM dry powder inhaler, which is effective for 24h.

 

·                  Responses to pharmacotherapy can vary across ethnic groups(3),(4) including in Japanese patients.

 

OBJECTIVES

 

·                  To establish whether doses of FF/VI recommended from multinational studies are relevant to asthma patients in Japan.

 

·                    To compare the efficacy, safety, PK and PD data for FF/VI in patients from Japan and/or Korea with data from patients not from Japan or Korea

 

·                  Patients from Korea were included due to similarities in a range of intrinsic and extrinsic ethnic factors between the populations of Japan and Korea.(5)–(7)

 

METHODS

 

·                  A pre-specified subgroup analysis of multicentre, randomised, double-blind, parallel-group international studies that included asthma patients from Japan and/or Korea.

 

·                  Inclusion criteria: >12 years of age, pre-bronchodilator % predicted forced expiratory volume in one second (FEV1) of 40–90%, FEV1 reversibility of >12% and >200mL.

 

·           Efficacy results were pooled from three Phase III studies, ranging from 12 to 76 weeks duration, that included patients from Japan (GSK study numbers: HZA106827; HZA106829; HZA106837).

 

·           Change from baseline in trough FEV1 after 12 weeks with once-daily FF/VI 100/25mcg, once-daily FF 100mcg or placebo was analysed across two studies (HZA106827; HZA106837) and data for once-daily FF/VI 200/25mcg, once-daily FF 200mcg and twice-daily fluticasone propionate (FP) 500mcg were from one study (HZA106829).

 

·           Safety data were pooled from the three studies noted above and an additional three placebo-controlled Phase IIb studies, ranging from 28 days to 8 weeks duration, that included patients from Korea (B2C109575; FFA109685; FFA109687).

 

·           PK data were estimated based on a post-hoc analysis of population PK data for FF(8) and of study DB111207 data for VI(9); PD data, including 24h urinary cortisol excretion, were assessed.

 

RESULTS

 

Table 1. Demographic and baseline characteristics

 

Demographic and baseline characteristics (Efficacy population)

 

 

 

Japan

 

Not-Japan

 

Overall

 

 

 

N=148

 

N=3066

 

N=3214

 

Age(1) (years)

 

47.5 (14.66)

 

41.9 (16.63)

 

42.2 (16.59)

 

Male (%)

 

38

 

36

 

36

 

Weight(1) (kg)

 

62.5 (13.63)

 

76.2 (19.29)

 

75.5 (19.28)

 

Height(1) (cm)

 

160.7 (8.05)

 

165.7 (9.98)

 

165.5 (9.96)

 

FEV1(1) (L)

 

1.933(2) (0.5481)

 

2.231(3) (0.6469)

 

2.218(4) (0.6456)

 

% Predicted FEV1(1)

 

74.7(2) (11.13)

 

70.6(3) (11.18)

 

70.8(4) (11.21)

 

 

Demographic characteristics (Safety population)

 

 

 

 

 

Not-

 

 

 

 

 

Japan+Korea

 

Japan+Korea

 

Overall

 

 

 

N=194

 

N=4037

 

N=4231

 

Age(1) (years)

 

46.1 (15.00)

 

41.3 (16.47)

 

41.5 (16.44)

 

Male (%)

 

40

 

37

 

37

 

Weight(1) (kg)

 

63.5 (13.37)

 

76.1(5) (19.68)

 

75.5(6) (19.61)

 

Height(1) (cm)

 

161.6 (8.46)

 

165.7 (10.21)

 

165.5 (10.17)

 

 


(1)Mean (SD); (2)n=147; (3)n=3059; (4)n=3206; (5)n=4036; (6)n=4230

 

Efficacy

 

·                    Efficacy data were compared between patients (N=3214) from Japan and ‘Not-Japan’; 85% (N=2739) completed the studies.

 

·                    Improvements in trough FEV1 were reported in all populations for FF/VI 100/25mcg and FF 100mcg versus placebo and for FF/VI 100/25mcg versus FF 100mcg (Table 2)

 

·                  There was no evidence of a statistically significant difference in treatment effect between patients from Japan and Not-Japan (p=0.403).

 

·                    Changes from baseline in FEV1 were similar with FF/VI 200/25mcg and FF 200mcg in patients from Japan and the overall population (Figure 1)

 

·                  Improvements were greater than with twice-daily FP 500mcg.

 



 

Table 2. Comparison of change from baseline in trough FEV1 at Week 12 between treatment arms (Efficacy population)

 

 

 

 

 

FF/VI

 

FF

 

 

 

 

 

100/25mcg

 

100mcg

 

 

 

 

 

 

 

 

 

 

 

N

 

1201

 

1203

 

 

 

 

 

0.181

 

0.105

 

 

 

Difference vs. placebo(1)

 

(0.111, 0.252)

 

(0.034, 0.175)

 

 

 

 

 

p<0.001

 

p=0.003

 

Overall

 

 

 

 

 

 

 

 

 

 

 

0. 077

 

 

 

 

Difference vs. FF 100mcg

 

(0.045, 0.108)

 

 

 

 

 

 

p<0.001

 

 

 

 

 

 

 

 

 

 

 

 

n

 

46

 

46

 

 

 

 

 

0.323

 

0.216

 

Japan

 

Difference vs. placebo(2)

 

(0.104, 0.542)

 

(–0.003, 0.436)

 

 

 

 

 

 

 

 

 

 

 

Difference vs. FF 100mcg

 

0.107

 

 

 

 

 

 

(–0.056, 0.270)

 

 

 

 

 

 

 

 

 

 

 

 

n

 

1155

 

1157

 

Not-Japan

 

Difference vs. placebo(3)

 

0.168

 

0.093

 

 

 

 

 

(0.095, 0.241)

 

(0.020, 0.166)

 

 

 

 

 

 

 

 

 

 

 

Difference vs. FF 100mcg

 

0.075

 

 

 

 

 

 

(0.043, 0.108)

 

 

 

 

Least squares mean change (95% confidence interval). Studies included: HZA106827, HZA106837. Data were analysed using a Last Observation Carried Forward Analysis of Covariance model, with terms for baseline FEV1, region, gender, age, treatment group, study & region by treatment interaction. 1n=193; 2n=18, 3n=175

 

Figure 1. Box plot of change from baseline in trough FEV1 at Week 12 by geographic region (Efficacy population)

 

 

Safety

 

·                    Safety data were compared between patients (N=4231) from Japan/Korea and Not-Japan/Korea; N=3584 (85%) completed the studies.

 

·                    In all active treatment groups, a greater proportion of patients from Japan/Korea versus Not-Japan/Korea reported on-treatment adverse events; this trend was also observed in the placebo group, suggesting that this is not related to FF or VI (Table 3).

 

Table 3. Summary of on-treatment adverse events and serious adverse events (Safety population)

 

 

 

 

 

FF/VI

 

FF/VI

 

FF

 

FF

 

 

Placebo

 

100/25mcg

 

200/25 mcg

 

100mcg

 

200mcg

All on-treatment adverse events

 

 

 

 

 

 

 

 

 

 

Japan+Korea

 

12/29 (41)

 

37/47 (79)(1)

 

9/14 (64)(1)

 

38/55 (69)

 

16/22 (73)

Not-Japan/Korea

 

87/375 (23)

 

658/1163 (57)

 

83/183 (45)

 

744/1375 (54)

 

134/386 (36)

Overall

 

99/404 (25)

 

695/1210 (57)

 

92/197 (47)

 

782/1430 (55)

 

150/390 (38)

On-treatment non-fatal serious adverse events

 

 

 

 

 

 

 

 

 

 

Japan+Korea

 

0/29 (0)

 

1/47 (2)(1)

 

0/14 (0)(1)

 

1/55 (2)

 

0/22 (0)

Overall

 

0/404 (0)

 

40/1210 (3)

 

6/197 (3)

 

30/1430 (2)

 

1/390 (<1)

On-treatment fatal adverse events

 

 

 

 

 

 

 

 

 

 

Japan+Korea

 

0/29 (0)

 

0/47 (0)(1)

 

0/14 (0)(1)

 

0/55 (0)

 

0/22 (0)

Overall

 

0/404 (0)

 

1/1210(2) (<1)

 

0/197 (0)

 

1/1430 (<1)

 

0/390 (0)

 

Data presented as number of patients with an adverse event/number of patients in population group (%);

 


(1)Only subjects from Japan;

(2)One additional subject (South East Asian) died during follow-up

 

Safety (cont’d)

 

·                    Serious adverse events reported for patients from Japan+Korea (1 FF/VI 100/25mcg, 1 FF 100mcg: both subarachnoid haemorrhage) were not considered drug related.

 

PK/PD

 

·                    Estimated FF AUC(0-24) and VI Cmax were higher in Japanese versus White/Caucasian patients (Table 4).

 



 

PK/PD (cont’d)

 

·                    No clinically relevant effects on cortisol concentrations (Figure 2) or heart rate were observed.

 

·                    The PK profile of FF at clinical doses (<200mcg) did not differ when administered simultaneously with VI 25mcg compared with FF alone for either Japanese or White/Caucasian patients.

 

Table 4. Model predicted PK parameters

 

Race

 

Treatment

 

N

 

C max (pg/mL)

 

AUC (0-24) (pg.h/mL)

Model predicted FF PK parameters

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.0

 

348.6

 

 

FF/VI 100/25mcg

 

14

 

[11.8, 26.1]

 

[214.7, 510.8]

 

 

 

 

 

 

19.9

 

304.6

Japanese

 

FF 100mcg

 

15

 

[13.2, 27.8]

 

[240.4, 382.6]

 

 

 

 

 

 

42.4

 

605.1

 

 

FF/VI 200/25mcg

 

13

 

[28.2, 59.7]

 

[489.2, 871.8]

 

 

 

 

 

 

34.6

 

581.9

 

 

FF 200mcg

 

8

 

[24.2, 49.8]

 

[374.1, 855.1]

 

 

 

 

 

 

 

 

 

 

 

FF/VI 100/25mcg;

 

 

 

15.2

 

232.2

White /

 

FF 100mcg

 

492

 

[14.9, 15.6]

 

[226.0, 238.5]

Caucasian

 

FF/VI 200/25mcg;

 

 

 

30.0

 

471.6

 

 

FF 200mcg

 

471

 

[29.1, 30.8]

 

[459.0, 484.1]

 

 

 

 

 

 

 

 

 

Model predicted VI PK parameters

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

113.3

 

139.1

 

 

FF/VI 100/25mcg

 

14

 

[38.7, 243.7]

 

[117.2, 159.0]

Japanese

 

 

 

 

 

144.9

 

146.1

 

 

FF/VI 200/25mcg

 

13

 

[63.4, 236.1]

 

[119.4, 168.0]

 

 

 

 

 

 

 

 

 

White /

 

FF/VI 100/25mcg;

 

 

 

42.2

 

165.7

Caucasian

 

FF/VI 200/25mcg

 

660

 

[39.7, 44.9]

 

[160.2, 171.4]

 

Geometric mean (95% confidence interval); FF data from post-hoc analysis of population PK data(8); VI data from post-hoc analysis of study DB111207(9)

 

Figure 2. Ratio of 24h urinary cortisol excretion to baseline at the end of treatment  (Urinary cortisol population(1))

 

 


(1)Urinary cortisol population: subset of patients from Safety population, that were not considered to have confounding factors, and for whom urine samples were available;

(2)Only subjects from Japan

 

CONCLUSIONS

 

·                    The efficacy and safety profile of FF/VI is similar in asthma patients from Japan+Korea and Not-Japan+Korea.

 

·                    The FF/VI clinical doses recommended based on global studies are also suitable for asthma patients in Japan.

 


REFERENCES

 

(1)         Ohta K, et al. Allergol Int. 2011;60:115–45.

(2)         Global Initiative for Asthma. Global Burden of Asthma. Available at: http://www.ginasthma.org/ local/uploads/files/GINABurdenReport_1.pdf. Last accessed: 10 Sept 2013.

(3)         Bjornsson TD, et al. J Clin Pharmacol 2003;43:943–67.

(4)         Huang SM, et al. Clin Pharmacol Ther 2008;84:287–94.

(5)         Jin HJ, et al. PLoS ONE 2009;4:1–10.

(6)        HUGO Pan-Asian SNP Consortium, et al. Science 2009;326:1541–45.

(7)         Chowbay B, et al. Drug Metab Rev 2005;37:327–78.

(8)         GSK data on file.

(9)         Nakahara N, et al. Int J Clin Pharmacol Ther 2013;51:660–72

 

ACKNOWLEDEGMENTS

 

·                    The presenting author, Yutaro Sugiyama, is employed by GlaxoSmithKline.

 

·                    The authors acknowledge the contributions of the following employees of GlaxoSmithKline: Dr Romina Nand, Dr Carol Lee and Dr Ann Allen.

 

·                    These studies were funded by GlaxoSmithKline (GSK study codes HZA106827 (cllinicaltrial.gov registration number: NCT01165138); HZA106829 (NCT01134042); HZA106837 (NCT01086384); B2C109575 (NCT00600171); FFA109685 (NCT00603278); FFA109687 (NCT00603382); DB111207 (NCT00964249).

 

·                    Editorial support (in the form of writing assistance, assembling tables and figures, collating author comments, grammatical editing and referencing) was provided by Laura Maguire, MChem, at Gardiner-Caldwell Communications (Macclesfield, UK) and was funded by GlaxoSmithKline.

 

 

ELLIPTATM is a trade mark of the GlaxoSmithKline group of companies

 

Presented at the 18th Congress of the Asian Pacific Society of Respirology, Yokohama, Japan, 11–14 November 2013