Evaluation of levalbuterol metered dose inhaler in pediatric patients with asthma: a double-blind, randomized, placebo- and active-controlled trial

ABSTRACT Objective: To evaluate the efficacy and safety of levalbuterol metered dose inhaler (MDI) in children aged 4-11 years (n = 173). Research design and methods: Multicenter, randomized, double-blind 28‐day study of QID levalbuterol 90 µg, racemic albuterol 180 µg, and placebo (2:1:1 ratio). Serial spirometry was performed on Days 0, 14, and 28. The primary endpoint was the double-blind average peak percent (%) change in FEV1 from visit pre-dose; the primary comparison was with placebo. Secondary endpoints included the area under the FEV1 percent change from pre-dose curve and peak % predicted FEV1. Safety endpoints included adverse events, laboratory tests, rescue medication use, and electrocardiograms. Results: Levalbuterol significantly improved the least square mean peak percent change in FEV1 compared with placebo (levalbuterol 25.6% ± 1.3% [p < 0.001]; racemic albuterol 21.8% ± 1.8% [p = ns]; placebo 16.8% ± 1.9%). Results for levalbuterol were similar for the other spirometry endpoints ( p < 0.05 vs. placebo). No levalbuterol-treated patients had a peak percent change in FEV1 < 10% (compared with 15.8% of racemic albuterol-treated patients and 30.3% of placebo-treated patients). The incidence of adverse events was 43.4% for levalbuterol, 56.4% for racemic albuterol, and 51.4% for placebo. The rate of discontinuation was 1.3% for levalbuterol, 2.6% for racemic albuterol, and 8.6% for placebo. The rate of asthma attacks (10.5%, 12.8%, 14.3%, respectively) was similar among treatments. Levalbuterol and racemic albuterol both reduced rescue medication use ( p < 0.01 vs. placebo) and produced changes in ventricular heart rate and QTc‐F that were similar to placebo. Conclusions: In this study, levalbuterol administered via MDI significantly improved airway function in comparison with placebo in asthmatic children aged 4–11 years with a safety profile that was similar to placebo.