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Adaptive study design to assess effect of TRPV4 inhibition in patients with chronic cough

Valerie J. Ludbrook, Kate E. Hanrott, James L. Kreindler, Joanna E. Marks-Konczalik, Nick P. Bird, Debbie A. Hewens, Misba Beerahee, David J. Behm, Alyn Morice, Lorcan McGarvey, Sean M. Parker, Surinder S. Birring, Jaclyn Smith
ERJ Open Research 2021 7: 00269-2021; DOI: 10.1183/23120541.00269-2021
Valerie J. Ludbrook
1GlaxoSmithKline, Stevenage, UK
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  • For correspondence: Valerie.J.Ludbrook@GSK.com
Kate E. Hanrott
1GlaxoSmithKline, Stevenage, UK
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James L. Kreindler
2GlaxoSmithKline, Upper Providence, USA
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Joanna E. Marks-Konczalik
1GlaxoSmithKline, Stevenage, UK
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Nick P. Bird
1GlaxoSmithKline, Stevenage, UK
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Debbie A. Hewens
1GlaxoSmithKline, Stevenage, UK
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Misba Beerahee
1GlaxoSmithKline, Stevenage, UK
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David J. Behm
2GlaxoSmithKline, Upper Providence, USA
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Alyn Morice
3Hull York Medical School, Cottingham, UK
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  • ORCID record for Alyn Morice
Lorcan McGarvey
4Queens University, Belfast, UK
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Sean M. Parker
5North Tyneside General Hospital, North Shields, UK
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Surinder S. Birring
6Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Jaclyn Smith
7Division of Infection Immunity and Respiratory Medicine, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
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  • ORCID record for Jaclyn Smith
  • Article
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  • FIGURE 1
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    FIGURE 1

    Study design. Participants were randomised to receive either 4.8 mg GSK2798745 on Day 1, followed by 2.4 mg once daily for 6 days, or matching placebo once daily for 7 days in the first treatment period, followed by the alternative regimen in the second treatment period.

  • FIGURE 2
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    FIGURE 2

    Consolidated Standards of Reporting Trials participant disposition.

  • FIGURE 3
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    FIGURE 3

    Individual change from baseline cough counts over day-time and 24-h time periods. Individual patient data are plotted on each line.

  • FIGURE 4
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    FIGURE 4

    Patient reported outcome measure results for Severity of Cough visual analogue scale (VAS), Urge to Cough VAS and Leicester Cough Questionnaire (LCQ), presented as mean±95% CI.

Tables

  • Figures
  • TABLE 1

    Participant baseline demographics (n=17)

    DemographicsTotal
    Age years# (mean±sd)61.0±9.85
    Age range years#
     18–6410 (59)
     65–747 (41)
    Sex
     Female15 (88)
     Male2 (12)
    BMI kg·m−2 (mean±sd)27.61±4.96
    Height (cm) (mean±sd)162.9±6.58
    Weight (kg) (mean±sd)73.19±13.3
    Ethnicity
     Hispanic or Latino0
     Not Hispanic or Latino17 (100)
    Race
     Asian – South East Asian Heritage1 (6)
     White – White/Caucasian/European Heritage16 (94)
    GSK2798745Placebo
    Baseline day-time 10-h cough count (geometric mean (95% CI))205.2 (116.7–360.6)242.5 (144.7–406.4)
    Baseline Cough Severity VAS (mean±sd)53.9±18.557.2±23.35
    Baseline Urge to Cough VAS (mean±sd)58.6±18.456.2±26.81
    Baseline LCQ (mean±sd)12.07±3.611.62±3.49

    Data are presented as n (%) unless otherwise indicated. BMI: body mass index; VAS: visual analogue scale; LCQ: Leicester Cough Questionnaire. #: birth date was imputed as June 30 in the year of birth.

    • TABLE 2

      Statistical analysis model adjusted cough count estimates

      TreatmentNnPosterior median±sd95% credible interval
      Day-time 10-h total cough counts treatment estimates
      Placebo1717180.57±24.76(137.85–235.45)
      GSK27987451615241.11±35.41(181.38–320.60)
      24-h total cough counts treatment estimates
      Placebo1717413.44±43.56(336.35–508.34)
      GSK27987451615450.68±50.8(361.50–561.70)

      Total cough counts were log-transformed prior to analysis. N=number of participants in analysis population; n=number of participants providing data.

      • TABLE 3

        Statistical analysis treatment comparisons

        Treatment comparisonPosterior median ratio±sd90% credible intervalPosterior prob. of true Diff
        <1.0<0.7<0.5
        Day-time 10-h total cough counts treatment comparison
        GSK2798745/Placebo1.34±0.27(0.97–1.85)0.07000.001<0.0001
        24-h total cough counts treatment comparison
        GSK2798745/Placebo1.09±0.17(0.85–1.40)0.2840.003<0.0001

        Note a sensitivity analysis using non-imputed data: 1.31 (0.95–1.80 90% credible interval) for 10 h and 1.09 (0.85–1.40) for 24 h.

        • TABLE 4

          Most frequent adverse events observed in the study

          PlaceboGSK2798745Total
          Subjects n171617
          Number of participants with any event9 (53)11 (69)13 (76)
          Number of participants with a drug-related event2 (12)2 (13)4 (24)
          Most common adverse events: (adverse events occurring in ≥2 participants in any treatment group)
           Headache3 (18)7 (44)8 (47)
           Diarrhoea2 (12)1 (6)3 (18)
           Fatigue1 (6)2 (13)3 (18)
           Oropharyngeal pain2 (12)02 (12)

          Data expressed as n (%) unless otherwise noted. Note: Adverse events were assigned to a treatment group based on the start date of the adverse events in relation to the study treatment period. Adverse events that started during the washout period were assigned to the Period 1 treatment group.

          • TABLE 5

            Summary of GSK2798745 pharmacokinetic parameters

            ParameterVisit#NnGeometric mean95% CI (lower, upper)%CVb¶
            Cmax ng·mL−1Day 1161617.862(14.468–22.052)41.1
            Day 71510.959(9.425–12.741)27.7
            AUC(0–3.5) h·ng·mL−1Day 1161636.156(28.328–46.148)48.3
            Day 71526.151(22.479–30.424)27.8
            C24 ng·mL−1Day 716152.4179(1.7295–3.3803)66.5
            Tmax h+Day 116162.500(1.00–3.50)NA
            Day 7152.500(1.00–3.50)NA

            AUC: area under the curve. #: day 1 dose 4.8 mg; Days 2–7 dose 2.4 mg. ¶: coefficient of variability between participants. +: Tmax expressed as median and range.

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            Adaptive study design to assess effect of TRPV4 inhibition in patients with chronic cough
            Valerie J. Ludbrook, Kate E. Hanrott, James L. Kreindler, Joanna E. Marks-Konczalik, Nick P. Bird, Debbie A. Hewens, Misba Beerahee, David J. Behm, Alyn Morice, Lorcan McGarvey, Sean M. Parker, Surinder S. Birring, Jaclyn Smith
            ERJ Open Research Jul 2021, 7 (3) 00269-2021; DOI: 10.1183/23120541.00269-2021

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            Adaptive study design to assess effect of TRPV4 inhibition in patients with chronic cough
            Valerie J. Ludbrook, Kate E. Hanrott, James L. Kreindler, Joanna E. Marks-Konczalik, Nick P. Bird, Debbie A. Hewens, Misba Beerahee, David J. Behm, Alyn Morice, Lorcan McGarvey, Sean M. Parker, Surinder S. Birring, Jaclyn Smith
            ERJ Open Research Jul 2021, 7 (3) 00269-2021; DOI: 10.1183/23120541.00269-2021
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