A 6 Month Safety Study Of Ciclesonide Nasal Aerosol (Zetonna™) And Ciclesonide Nasal Spray (Omnaris®) In Subjects 12 Years And Older With Perennial Allergic Rhinitis (PAR)

• The number and percentage of subjects experiencing treatment emergent nasal AEs. [ Time Frame: 0-6 months ] [ Designated as safety issue: Yes ]
• The number and percentage of subjects experiencing treatment emergent AEs. [ Time Frame: 0-6 months ] [ Designated as safety issue: Yes ]
• The number and percentage of subjects experiencing treatment emergent serious adverse events (SAEs). [ Time Frame: 0-6 months ] [ Designated as safety issue: Yes ]
• The number and percentage of subjects experiencing treatment emergent AEs causing study medication discontinuation. [ Time Frame: 0-6 months ] [ Designated as safety issue: Yes ]
• Number and percentage of subjects with development of or worsening in lens opacities. [ Time Frame: 0-6 months ] [ Designated as safety issue: Yes ]
• Number and percentage of subjects with increase of 5 mm Hg from baseline in intraocular pressure. [ Time Frame: 0-6 months ] [ Designated as safety issue: Yes ]
• Number and percentage of subjects with change from baseline in best corrected visual acuity. [ Time Frame: 0-6 months ] [ Designated as safety issue: Yes ]

This is a 6 month, multicenter, randomized, open label, parallel group, study to evaluate the nasal safety of ciclesonide nasal aerosol and ciclesonide aqueous nasal spray administered once daily to male and female subjects 12 years and older diagnosed with PAR.

This is a 6 month, multicenter, randomized, open label, parallel group, safety study of ciclesonide nasal aerosol and ciclesonide aqueous nasal spray administered once daily to male and female subjects 12 years and older diagnosed with PAR. The objectives of this study are to evaluate the nasal and ocular safety of once daily dosing with ciclesonide nasal aerosol (Zetonna) 74 mcg and ciclesonide aqueous nasal spray (Omnaris) 200 mcg in subjects 12 years and older with PAR.

• Drug: ciclesonide nasal aerosol
  ciclesonide nasal aerosol 74 mcg (given as 1 actuation per nostril of 37 mcg ciclesonide nasal aerosol)
  Other Name: Zetonna
• Drug: ciclesonide nasal spray
  ciclesonide nasal spray 200 mcg (given as 2 actuations per nostril of 50 mcg ciclesonide nasal spray)
  Other Name: Omnaris

• Experimental: ciclesonide nasal aerosol
  ciclesonide nasal aerosol 74 mcg
  Intervention: Drug: ciclesonide nasal aerosol
• Active Comparator: ciclesonide nasal spray
  ciclesonide nasal spray 200 mcg
  Intervention: Drug: ciclesonide nasal spray

Inclusion Criteria:

• Subject or Subject's parent/guardian gives written informed consent and assent, including privacy authorization as well as adherence to concomitant medication withholding periods, prior to participation.
• Male or female 12 years and older, as of the Screening visit.
• Subject must be in general good health (defined as the absence of any clinically relevant abnormalities as determined by the Investigator) based on screening physical examination, medical history.
• A history of PAR to a relevant perennial allergen (eg, house dust mites, cockroach, molds, animal dander) for a minimum of one year immediately preceding the study Screening visit. The PAR must have been of sufficient severity to have required treatment (either continuous or intermittent) in the past 12 months, and require treatment throughout the entire study period.

• Subject, if female ≤ 65 years of age, must have a negative serum pregnancy test at screening. Females of childbearing potential must be instructed to and agree to avoid pregnancy during the study and must use an acceptable method of birth control:

  • An oral contraceptive, an intrauterine device (IUD), implantable contraceptive, transdermal or injectable contraceptive for at least 1 month prior to entering the study with continued use throughout the study and for thirty days following study participation.
  • Barrier method of contraception, eg, condom and/or diaphragm with spermicide while participating in the study.
  • Abstinence.
• Subject must possess an educational level and degree of understanding of English that enables them to communicate suitably with the PI and study coordinator.

Exclusion Criteria:

• Female subject who is pregnant or lactating.
• Current physical findings of nasal polyps, septal perforation, or nasal ulceration. (Subjects showing significant progression of nasal pathology between screening and randomization would be excluded at the discretion of the investigator.]
• Planned insertion of nasal septal jewelry during the study period.
• Surgery (including biopsy) and atrophic rhinitis or rhinitis medicamentosa are not permitted within the last 30 days prior to the Screening visit.
• Participation in any investigational drug trial within the 30 days preceding the Screening visit or planned participation in another investigational drug trial at any time during this trial.
• A known hypersensitivity to any corticosteroid or any of the excipients in the formulation of ciclesonide.
• History of a respiratory infection or disorder [including, but not limited to bronchitis, pneumonia, influenza, severe acute respiratory syndrome (SARS)] within the 14 days preceding the Screening visit.
• History of alcohol or drug abuse within 2 years preceding the Screening visit.
• History of a positive test for HIV, hepatitis B or hepatitis C.
• Active asthma requiring treatment with inhaled or systemic corticosteroids.
• Use of chronic treatment with agents known to promote the development of cataracts (potassium-sparing diuretics and allopurinol).
• Non vaccinated exposure to or active infection with, chickenpox or measles within the 21 days preceding the Screening Visit.
• Initiation of pimecrolimus cream 1% or greater or tacrolimus ointment 0.03% or greater during the study period or planned dose escalation during the study period. However, initiation of these creams/ointments 30 days or more prior to screening and use of a stable (maintenance) dose during the study period may be considered for inclusion.
• Use of corticosteroids within 14 days prior to screening.

• Have any of the following conditions that are judged by the investigator to be clinically significant and/or affect the subject's ability to participate in the clinical trial:

  • impaired hepatic function including alcohol related liver disease or cirrhosis
  • diabetes mellitus
  • malignancy (excluding basal cell carcinoma)
• Any condition that, in the judgment of the investigator, would preclude the subject from completing the protocol with capture of the assessments as written
• History of bacterial or viral infection of the upper respiratory tract within 14 days of the Screening visit or current or history of ocular herpes simplex.
• Any use of intraocular injection of a corticosteroid, or any use of ocular corticosteroids or periocular injection within 6 months prior to screening.
• Progressive retinal (including, but not limited to acute macular degeneration or unstable diabetic retinopathy) or optic nerve disease in either eye.
• Ocular injury/surgery in the last 6 months (including LASIK eye surgery, as well as any glaucoma intraocular surgery, including laser trabeculoplasty [ALT or SLT]).
• Any evidence of glaucomatous optic disc changes or a cup:disc ratio > 0.8.
• History of bacterial or viral infection of the eyes within 14 days of the Screening visit.
• Current or history of any glaucoma diagnosis, including open-angle or closed-angle, as well as secondary or congenital glaucoma.
• Occludable angles by gonioscopy (by the investigator's judgment (Shaffer grade 3 or grade 4 acceptable [wide or moderately open]) and/or with evidence of peripheral anterior synechiae ≥ 180 degrees by gonioscopy within the last 6 months in either eye.
• Current PSC cataract or previous history of cataract surgery.
• Current or history of congenital cataract or active or prior uveitis.
• Intraocular pressure of 22 mm Hg or higher in either eye.

• Inability to complete ocular examination, including:

  • Inability to measure intraocular pressure
  • Pupillary diameter < 3 mm upon dilation
  • Significant media opacity in either eye that would exclude adequate posterior segment examination
  • Clinically significant corneal dystrophy, epithelial, or endothelial disease that would preclude visualization or intraocular pressure measurement
  • Corneal irregularities or scarring that in the investigator's judgment would impeded an accurate measurement of intraocular pressure or visualization of intraocular anatomy
  • Unwillingness to remove contact lenses for ocular examination
  • Inability to grade nuclear, cortical or subcapsular changes in the lens LOCS III grade ≥ 4 in either eye at the screening (Visit 1) slit lamp examination. Subjects with LOCS III grade NO > 4.0, NC > 4.0 and C > 4.0 in either eye
• Best-corrected visual acuity in either eye of 20/200 or worse at the screening ocular examination.
• No planned or anticipated ocular surgery during the next 6 months.
• Any condition that, in the judgment of the ophthalmologist, would preclude the subject from completing the protocol with capture of the assessments as written.