Novartis phase IIIb ARGON study meets primary endpoint in a comparison of Enerzair Breezhaler vs free combo of two existing inhaled treatments in uncontrolled asthma

Novartis announced that full results from the phase IIIb ARGON study were published online in Respiratory Medicine. These results show that once-daily treatment with single inhaler, high- and medium-dose Enerzair Breezhaler (QVM149; indacaterol acetate, glycopyrronium bromide and mometasone furoate [IND/GLY/MF]) demonstrated non-inferiority to a free combination of twice-daily, high-dose salmeterol xinafoate/fluticasone propionate (Sal/Flu) plus once-daily tiotropium (Tio), delivered in two different devices, in improving quality of life in people with uncontrolled asthma.

Among secondary analyses, improvements in lung function, asthma control, health status, and reductions in moderate exacerbations were observed with high-dose once-daily IND/GLY/MF compared to high-dose Sal/Flu plus Tio.

“Today, over 45% of patients at GINA Steps 4 and 5 remain uncontrolled, despite current therapy, demonstrating the need for additional treatment options in this patient population,” said Assistant Professor Christian Gessner, Head of POIS Leipzig Study Centre and Guest Doctor at Universität Leipzig. “The ARGON study shows that once-daily IND/GLY/MF improves quality of life and, if approved, could provide an effective and convenient treatment for patients whose asthma is uncontrolled with LABA/ICS treatment.”

The primary endpoint of the study was met, with both high- and medium- doses of IND/GLY/MF demonstrating non-inferiority in change from baseline in Asthma Quality of Life Questionnaire (AQLQ) score (high: 0.073; medium: -0.038; both p<0.001)1.

“Novartis is reimagining respiratory medicine by developing innovative, patient-focused medicines such as IND/GLY/MF that address areas of significant unmet clinical need and improve symptom control and quality of life for people with asthma,” said Dominic Brittain, Respiratory Global Program head, Novartis Pharmaceuticals. “The ARGON study results show the potential benefits of this once-daily, single inhaler, LABA/LAMA/ICS treatment option in patients with uncontrolled asthma. These data build on the clinically meaningful improvements in lung function and reduction of exacerbations observed for high-dose IND/GLY/MF in the IRIDIUM study.”

In secondary analyses, improvements in asthma control (as measured by Asthma Control Questionnaire; ACQ-7 score [-0.124; p=0.004]) and lung function (as measured by trough FEV1 [96 mL; p<0.001]) were seen with high-dose IND/GLY/MF compared with high-dose Sal/Flu plus Tio. In additional exploratory analyses, improvements in health status (as measured by St. George’s Respiratory Questionnaire; SGRQ [-2.00; p=0.04]), and peak expiratory flow (morning [9.56 L/min; p=0.005], evening [9.15 L/min; p=0.006]) were seen with high-dose IND/GLY/MF compared with high-dose Sal/Flu plus Tio.

A greater reduction in the rate of moderate exacerbations (43%; p=0.04) was seen with high-dose IND/GLY/MF versus high-dose Sal/Flu plus Tio; the rate of exacerbations across all severities was comparable between the two treatment groups. Comparable efficacy in these endpoints was seen with medium-dose IND/GLY/MF versus high-dose Sal/Flu plus Tio, but at a corresponding lower steroid dose. Adverse events were generally comparable across treatments.

The ARGON study assessed IND/GLY/MF, a once-daily, fixed-dose combination of a long-acting beta2-agonist (LABA), a long-acting muscarinic antagonist (LAMA) and an inhaled corticosteroid (ICS) in high- (150/50/160 µg) and medium- (150/50/80 µg) doses, delivered via the Breezhaler, compared with a free combination of twice-daily high-dose Sal/Flu (50/500µg) plus once-daily Tio (5 µg) in patients with asthma not adequately controlled on current inhaled therapies, over 24 weeks of active treatment.

To date, high-dose IND/GLY/MF has received a positive opinion from the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP); this submission was supported by the IRIDIUM study. The positive opinion for Enerzair Breezhaler also covered a digital companion with app and sensor that provide inhalation confirmation, medication reminders and access to objective data to better support therapeutic decisions. Further regulatory reviews are currently underway in multiple countries, including Switzerland and Japan.

In keeping with the Novartis commitment to reduce the environmental impact of our asthma combinations, IND/GLY/MF will be available in the Breezhaler device which is hydrofluoroalkane/chlorofluorocarbon (HFA/CFC)-free.

Asthma affects an estimated 358 million people worldwide and can cause a significant personal, health and financial burden when not adequately controlled. Despite current therapy, over 40% of patients with asthma at Global Initiative for Asthma (GINA) Step 3, and over 45% at GINA Steps 4 and 5 remain uncontrolled. Patients with uncontrolled asthma may downplay or underestimate the severity of their disease and are at a higher risk of exacerbation, hospitalization or death. Barriers, such as treatment mismatch, safety issues with an oral corticosteroid and ineligibility for biologics, have created an unmet medical need in asthma.

The CHMP adopted a positive opinion recommending the approval of high-dose Enerzair Breezhaler (QVM149; IND/GLY/MF) 150/50/160 µg once-daily as a maintenance treatment of asthma in adult patients not adequately controlled with a maintenance combination of a long-acting beta2-agonist (LABA) and a high dose of an inhaled corticosteroid (ICS) who experienced one or more asthma exacerbations in the previous year.

This formulation combines the bronchodilation of indacaterol acetate (a LABA) and the antimuscarinic effects of glycopyrronium bromide (a LAMA) with mometasone furoate (ICS) in a precise once-daily formulation, delivered via the dose-confirming Breezhaler device. Glycopyrronium bromide certain use and formulation intellectual property were exclusively licensed to Novartis in April 2005 by Sosei Heptares and Vectura. Mometasone furoate is exclusively licensed to Novartis from a subsidiary of Merck & Co., Inc, Kenilworth, NJ, USA, for use in IND/GLY/MF (worldwide excluding the US).

IND/GLY/MF will be administered via the dose-confirming Breezhaler device, which enables once-daily inhalation using a single inhaler. If approved, IND/GLY/MF will be the first asthma treatment in the EU that can be prescribed together with a digital companion; the Propeller Health app and a sensor custom-built for the Breezhaler device. The digital companion will provide patients with inhalation confirmation, medication reminders and access to objective data that can be shared with their physician in order to help them make better therapeutic decisions.

The sensor for the Breezhaler device was developed by Propeller Health and is a CE marked Medical Device, designed and licensed to Novartis exclusively for use with the Breezhaler inhaler worldwide. The sensor includes a microchip, a microphone, Bluetooth capabilities, an antenna and a battery. The sensor does not alter the drug delivery characteristics of the Breezhaler inhaler itself but produces a recording of each administered dose. Based on the patient’s recorded medication usage, personalized content is presented within the app to help the patient better self-manage their asthma.