General Information

Arcapta contains the active ingredient indacaterol, a long-acting beta2-adrenergic agonist. When inhaled, indacaterol acts locally in the lung as a bronchodilator.

Arcapta is specifically approved for the treatment of airflow obstruction in patients with chronic obstructive pulmonary disease, including chronic bronchitis and/or emphysema.

Arcapta is supplied with inhalation powder capsules and an inhaler. The recommended dose is the once-daily inhalation of the contents of one 75 mcg Arcapta capsule using the Neohaler inhaler. Arcapta should be administered once daily every day at the same time of the day by the orally inhaled route only.

Clinical Results

FDA Approval
The FDA approval of Arcpata was based on three dose-ranging trials and six confirmatory trials.

Dose-ranging trials:
Dose selection for Arcapta for COPD was based on three dose-ranging trials: Trial 1, a two-week dose-ranging trial in an asthma population; Trial 2, a two-week dose-ranging trial in a COPD population; and Trial 3, a 26-week adaptive seamless design trial that included an initial two-week dose ranging phase. Although Arcapta is not indicated for asthma, dose selection was primarily based upon the results from the dose-ranging trial in asthma patients (Trial 1) as an asthma population is the most responsive to beta-agonist bronchodilation and is most likely to demonstrate a dose response. Trial 2 and 3 evaluated dose-ranging in COPD patients and provided supportive information.
Dose-Ranging in Asthma
Trial 1 was a two-week, randomized, double-blinded, placebo-controlled design that enrolled 511 adults with persistent asthma. Trial 1 included Arcapta doses of 18.75, 37.5, 75, and 150 mcg once daily, a salmeterol active control group, and placebo. The trial showed that the effect on FEV1 in subjects treated with Arcapta 18.75 and 37.5 mcg doses was lower compared to subjects treated with other Arcapta doses, particularly after the first dose. The effect did not clearly differ between the 75 and 150 mcg doses.
Dose-ranging in COPD
Trial 2 was a two-week, randomized, double-blinded, placebo-controlled design that enrolled 552 subjects with a clinical diagnosis of COPD, who were 40 years or older, had a smoking history of at least 10 pack years. The subjects received Arcapta doses of 18.75, 37.5, 75 and 150 mcg once daily, a salmeterol active control group, and placebo. The effect on FEV1 in subjects treated with Arcapta 18.75 mcg dose was lower compared to subjects treated with other Arcapta doses. Although a dose-response relationship was observed at Day 1, the effect did not clearly differ among the 37.5, 75 and 150 mcg doses by Day 15. Trial 3 evaluated doses of 75, 150, 300, and 600 mcg once daily, placebo, and two active comparators. Although a dose-response relationship was observed at week 2, the effect did not clearly differ among the Arcapta doses.

Confirmatory Trials:
Six confirmatory randomized, double-blinded placebo and active-controlled trials were conducted:
Trial 3 was a 26-week seamless adaptive design trial that included an initial two week dose-ranging phase. The trial evaluated Arcapta doses of 150 mcg and 300 mcg once daily, placebo, and an active comparator;
Trials 4 and 5 were 12-week trials and evaluated Arcapta 75 mcg once daily, and placebo;
Trial 6 was a 12-week trial that evaluated Arcapta 150 mcg once daily and placebo;
Trial 7 was a 26-week trial that evaluated Arcapta 150 mcg once daily, an active comparator, and placebo, and
Trial 8 was a 52 week trial that evaluated Arcapta 300 mcg and 600 mcg once daily, an active comparator, and placebo.
A total of 5,474 subjects were enrolled. All subjects had a clinical diagnosis of COPD, were 40 years or older, had a smoking history of at least 10 pack years, had a post-bronchodilator FEV1 less than 80% and at least 30% of the predicted normal value and a post-bronchodilator ratio of FEV1 over FVC of less than 70%. The primary efficacy endpoint was 24-hour post-dose trough FEV1 after 12 weeks of treatment. In all six confirmatory COPD trials, all doses of Arcapta tested (75 mcg, 150 mcg, 300 mcg, and 600 mcg) showed significantly greater 24-hour post-dose trough FEV1 compared to placebo at 12 weeks. In addition, serial FEV1 measurements in patients treated with Arcapta demonstrated a bronchodilatory treatment effect after the first dose compared to placebo at 5 minutes post dose of 0.09 L (Trial 4) and 0.10 L (Trial 5). The mean peak improvement relative to baseline within the first 4 hours after the first dose (Day 1) was 0.19 L (Trial 4) and 0.22 L (Trial 5) and was 0.24 L (Trial 4) and 0.27 L (Trial 5) after 12 weeks. Improvement in lung function observed at week 4 was consistently maintained over the 12-week treatment period in both trials.

Literature References

Tashkin DP, Fabbri LM Long-acting beta-agonists in the management of chronic obstructive pulmonary disease: current and future agents. Respiratory Research 2010 Oct 29;11:149

Vogelmeier C, Ramos-Barbon D, Jack D, Piggott S, Owen R, Higgins M, Kramer B; INTIME study investigators (INdacaterol & TIotropium: Measuring Efficacy) Indacaterol provides 24-hour bronchodilation in COPD: a placebo-controlled blinded comparison with tiotropium. Respiratory Research 2010 Oct 5;11:135

Baur F, Beattie D, Beer D, Bentley D, Bradley M, Bruce I, Charlton SJ, Cuenoud B, Ernst R, Fairhurst RA, Faller B, Farr D, Keller T, Fozard JR, Fullerton J, Garman S, Hatto J, Hayden C, He H, Howes C, Janus D, Jiang Z, Lewis C, Loeuillet-Ritzler F, Moser H, Reilly J, Steward A, Sykes D, Tedaldi L, Trifilieff A, Tweed M, Watson S, Wissler E, Wyss D The identification of indacaterol as an ultralong-acting inhaled beta2-adrenoceptor agonist. The Journal of Medicinal Chemistry 2010 May 13;53(9):3675-84