A study to examine health effect indicators when a smoker switches to using a tobacco heating product

ISRCTN ISRCTN81075760
DOI https://doi.org/10.1186/ISRCTN81075760
Secondary identifying numbers BAT3117011
Submission date
09/01/2018
Registration date
31/01/2018
Last edited
01/09/2022
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Other
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English Summary

Background and study aims
Cigarette smoking contributes to numerous illnesses including lung cancer, chronic obstructive lung disease and heart disease. The health risks of cigarette smoking are due to chemical toxicants in cigarette smoke which can lead to changes in the body, causing disease. Nicotine is mainly responsible for the addictive properties of cigarette smoking. The sponsor of this study is British American Tobacco (Investments) Limited, a manufacturer of tobacco products. The sponsor is developing an alternative approach to conventional (normal) cigarettes by developing new products which may reduce some of the risks of tobacco-related diseases. This study is designed for research purposes to collect data on a newly developed tobacco heating product (THP) in adult smokers. The main aim of this study is to find out whether the body is exposed to a lower amount of certain chemical toxicants from a THP as compared to smoke from regular cigarettes.

Who can participate?
Healthy volunteers aged 23 to 55, including regular smokers and people who have never smoked (smoked less than 100 cigarettes in their lifetime)

What does the study involve?
Regular smokers are randomly allocated to one of two groups (Arms A- & B) to either continue to smoke their own brand cigarettes, or to switch to smoking a THP 1.1 (RT), for 360 days. A further group (Arm D) is made up of participants who are regular smokers and who intend to quit. This group is provided with assisted smoking cessation (NRT/varenicline/counselling). The last group is made up of participants who have never smoked (Arm E). Levels of exposure to chemical toxicants are measured by testing blood and urine collected over a 24-hour period.

What are the possible benefits and risks of participating?
Participants should not expect to receive any health benefits from using the products in this study. Participants in the cessation group may expect the benefits associated with stopping smoking. The tests provided may help participants learn about their general health. They may also help participants discover an unknown medical condition. This study may help doctors, scientists or manufacturers learn things about tobacco and nicotine products that could help others to quit smoking. Nicotine and tobacco use can have side effects but as the participants are already using tobacco products the risks related to the side effects of nicotine are low. Participants are not likely to be exposed to nicotine levels higher than the ones they are usually exposed to when smoking. The following side effects have been reported for e-cigarettes and THPs, and participants are monitored for these: headache, dizziness, palpitations, mouth and throat irritation, skin irritation, and stomach disturbances. Inhalation of too much nicotine has been reported to lead to side effects such as feeling faint, nausea or headache. Common observed side effects also include cough, irritation of the mouth or throat, dizziness, nasal congestion, stomach discomfort, hiccups and sickness (vomiting).

Where is the study run from?
1. Covance Clinical Research Unit Ltd (UK)
2. SIMBEC Research Ltd (UK)
3. Celerion (GB) Ltd (UK)
4. Richmond Pharmacology Ltd (UK)

When is the study starting and how long is it expected to run for?
February 2018 to March 2020

Who is funding the study?
British American Tobacco (UK)

Who is the main contact?
Nathan Gale
nathan_gale@bat.com

Contact information

Mr Nathan Gale
Public

British American Tobacco (Investments) Ltd.
R&D Centre, Regents Park Road
Southampton
SO15 8TL
United Kingdom

Phone +44 (0)23 8058 8091
Email nathan_gale@bat.com

Study information

Study designMulti-centre randomised controlled interventional study
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Other
Study typeOther
Participant information sheet Not available in web format, please use the contact details to request a patient information sheet
Scientific titleA randomised, controlled study to evaluate the effects of switching from cigarette smoking to using a Tobacco Heating Product on health effect indicators in healthy subjects
Study hypothesisIt is hypothesised that there will be a reduction in exposure to toxicants which will cause changes in health effect indicators when smokers switch to using a tobacco heating product (THP) compared with smokers who continue to smoke, and that these changes will be directionally similar to changes seen in smokers who cease smoking (assisted with NRT) over a period of 12 months in an ambulatory setting. Furthermore, it is hypothesised that reductions in toxicant levels in THP emissions will translate to sustained reductions in human exposure to cigarette smoke toxicants, as assessed by measuring biomarkers of exposure (BoE) in an ambulatory setting.
Ethics approval(s)Wales Research Ethics Committee 2, 29/01/2018, REC ref: 17/WA/0212
Added 05/03/2019: Substantial Amendment approved on 01/02/2019, by same REC under same reference number.
ConditionCigarette smoking
InterventionCurrent interventions as of 05/03/2019:

Three separate populations:
1. Continue to smoke / THP population
Arm A – conventional cigarettes
Arm B – THP1.1(RT)

2. Intend-to-quit population
Arm D – assisted smoking cessation

3. Never-smoked population
Arm E – never-smoked

A total of up to 510 healthy male or female subjects aged 23-55 will be enrolled on the study across 4 study arms. Up to 280 subjects will be enrolled in to study arms A and B and randomised using blocks of computer generated random number sequences in PROC PLAN by SAS®. Up to 80 subjects will be randomised to study arm A, where subjects will continue to smoke their own brand cigarettes for the duration of the study. 200 subjects will be randomised to study arm B, and will switch on study day 1 from smoking conventional cigarettes to exclusive use of a test IP (THP 1.1(RT)) for 360 days. 50 subjects are required to complete the study to 360 days in both arms.

190 subjects who intend to quit tobacco and nicotine product use will be enrolled to the cessation arm (Arm D). Cessation may be assisted with the use of NRT/varenicline/counselling at the discretion of the PI. 50 subjects are required to complete the study to 360 days in this arm.

40 subjects who have smoked less than 100 cigarettes in their lifetime will be recruited to the never smoker arm (Arm E). 30 subjects are required to complete the study to 360 days in this arm.

Follow up for all study arms will be 28 days following discharge from the clinic.

Visit 1: 0 (baseline)
Visit 2: 30 days
Visit 3: 60 days
Visit 4: 90 days
Visit 7: 180 days
Visit 10: 270 days
Visit 13: 360 days

Previous interventions:

Three separate populations:
1. Continue to smoke / THP population
Arm A – conventional cigarettes
Arm B – THP1.1(RT)
Arm C – THD2.4T20

2. Intend-to-quit population
Arm D – assisted smoking cessation

3. Never-smoked population
Arm E – never-smoked

A total of 505 healthy male or female subjects aged 23-55 will be enrolled in the study across 5 study arms. 265 subjects will be enrolled in to study arms 1-3 and randomised using blocks of computer-generated random number sequences in PROC PLAN by SAS®. 65 subjects will be randomised to study arm 1, where subjects will continue to smoke their own brand cigarettes for the duration of the study. 100 subjects will be randomised to each study arm 2 and 3, and will switch on study day 1 from smoking conventional cigarettes to exclusive use of a test IP (THP 1 or 2) for 360 days. 50 subjects are required to complete the study to 360 days.

200 subjects who intend to quit tobacco and nicotine product use will be enrolled to the cessation arm. Cessation may be assisted with the use of NRT/varenicline/counselling at the discretion of the PI. 50 subjects are required to complete the study to 360 days.

40 subjects who have smoked less than 100 cigarettes in their lifetime will be recruited to the never smoker arm. 30 subjects are required to complete the study to 360 days.

Follow up for all study arms will be 28 days following discharge from the clinic.

Visit 1: 0 (baseline)
Visit 2: 30 days
Visit 3: 60 days
Visit 4: 90 days
Visit 7: 180 days
Visit 10: 270 days
Visit 13: 360 days
Intervention typeOther
Primary outcome measureMeasured using 24-hour urine ambulatory collection at visits 1, 2 ,3, 4, 7, 10, 13:
1. Total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (Total NNAL)
2. 8-epi-prostaglandin F2α Type III (8-Epi-PGF2α Type III)

Physiological measures, measured at visits 1, 2 ,3, 4, 7, 10, 13:
1. Augmentation Index (AIx)
Secondary outcome measuresCurrent secondary outcome measures as of 05/03/2019:

Measured from 24-hour urine ambulatory collection at visits 1, 2, 3, 4, 7, 10, 13:
1. Total nicotine equivalents (nicotine, cotinine, 3-hydroxycotinine and their glucuronide conjugates) (TNeq)
2. Total N-nitrosonornicotine (Total NNN)
3. 3-hydroxypropylmercapturic acid (3-HPMA)
4. 3-hydroxy-1-methylpropylmercapturic acid (HMPMA)
5. S-phenylmercapturic acid (S-PMA)
6. Monohydroxybutenyl-mercapturic acid (MHBMA)
7. 2-cyanoethylmercapturic acid (CEMA)
8. 1-hydroxypyrene (1-OHP)
9. 2-hydroxyethylmercapturic acid (HEMA)
10. 11-dehydrothromboxane B2 (11-dTX B2)
11. 4-hydroxy-nonenal + metabolites (4-HNE)
12. Creatinine
13. 4-aminobiphenyl (4-ABP)
14. 2-aminonaphthalene (2-AN)
15. ortho-toluidine (o-Tol)

Measured from blood samples:
1. N-(2-cyanoethyl)valine (HB [haemoglobin] adduct; CEVal) measured at visits 1, 2 ,3, 4, 7, 10, 13
2. White blood cell count (WBC count) measured at visits 1, 2 ,3, 4, 7, 10, 13
3. Monocyte chemotactic protein 1/C-C motif chemokine ligand 2 (MCP 1/CCL2) measured at visits 1, 4, 7, 10, 13
4. Soluble intercellular adhesion molecule-1 (s-ICAM1) measured at visits 1, 4, 7, 10, 13
5. Fibrinogen (Fib) measured at visits 1, 4, 7, 10, 13
6. High-sensitivity C-reactive protein (hsCRP) measured at visits 1, 4, 7, 10, 13
7. Homocysteine (HMCys) measured at visits 1, 4, 7, 10, 13
8. Glucose (Gluc) measured at visits 1, 4, 7, 10, 13
9. Plasminogen activator inhibitor-1 (PAI-1) measured at visits 1, 4, 7, 10, 13
10. Tissue plasminogen activator (tPA) measured at visits 1, 4, 7, 10, 13
11. E-Selectin (SELE) measured at visits 1, 4, 7, 10, 13
12. Endothelin-1 (ET-1) measured at visits 1, 4, 7, 10, 13
13. 3-nitrotyrosine (3-NTyr) measured at visits 1, 4, 7, 10, 13
14. Serum lipids (high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol [CholTotal], triglycerides [Trigly]) measured at visits 1, 2 ,3, 4, 7, 10, 13

Measured from exhaled breath:
1. Nitric oxide (NO) measured at visits 1, 2 ,3, 4, 7, 10, 13
2. Carbon monoxide (CO) measured at visits 1 to 13

Physiological measures:
1. Blood pressure at visits 1, 2 ,3, 4, 7, 10, 13
2. Spirometry at visits 1, 2 ,3, 4, 7, 10, 13:
2.1. Peak flow
2.2. Forced vital capacity (FVC)
2.3. Forced expiratory flow (FEF) 25-75%
2.4. Forced expiratory volume in 1 second (FEV1)
3. Body weight/waist circumference at visits 1, 4, 7, 10, 13
4. Carotid/femoral pulse wave velocity at visits 1, 2 ,3, 4, 7, 10, 13
5. 6-minute walking test at visits 1, , 4, 13
6. Finger plethysmography at visits 1, 4, 7, 10, 13

Questionnaires:
1. Fagerström Test for Cigarette Dependence (FTCD) at visit 1,
2. Product satisfaction at visits 4, 7, 10, 13
3. Smoking cessation quality of life at visits 1, 4, 7, 10, 13
4. Self-reported product usage (eDiary/paper diary) recorded throughout the study from visit 1 to 13
5. Cough and Shortness of Breath VAS at visits 1, 4, 7, 10, 13

Safety:
1. Physical examination at screening and symptom-driven at visits 1,2, 3, 4, 7, 10, 13 and follow-up
2. Vital signs at screening and at visits 1, 4, 7, 10, 13 and follow-up
3. Electrocardiogram (ECG) at screening and at visits 1, 4, 7, 10, 13 and follow-up
4. Clinical laboratory evaluations at screening and at visits 1, 4, 7, 10, 13 and follow-up
5. Lung function tests at screening, visits 1, 2 ,3, 4, 7, 10, 13
6. Adverse events (AE)/serious adverse events (SAE) recorded throughout the study

Previous secondary outcome measures:

Measured from 24-hour urine ambulatory collection:
1. Total nicotine equivalents (nicotine, cotinine, 3-hydroxycotinine and their glucuronide conjugates) (TNeq) measured at visits 1, 2 ,3, 4, 7, 10, 13
2. Total N-nitrosonornicotine (Total NNN) measured at visits 1, 2 ,3, 4
3. 3-hydroxypropylmercapturic acid (3-HPMA) measured at visits 1, 2 ,3, 4
4. 3-hydroxy-1-methylpropylmercapturic acid (HMPMA) measured at visits 1, 2 ,3, 4
5. S-phenylmercapturic acid (S-PMA) measured at visits 1, 2 ,3, 4
6. Monohydroxybutenyl-mercapturic acid (MHBMA) measured at visits 1, 2 ,3, 4, 7, 10, 13
7. 2-cyanoethylmercapturic acid (CEMA) measured at visits 1, 2 ,3, 4
8. 1-hydroxypyrene (1-OHP) measured at visits 1, 2 ,3, 4
9. 2-hydroxyethylmercapturic acid (HEMA) measured at visits 1, 2 ,3, 4
10. 11-dehydrothromboxane B2 (11-dTX B2) measured at visits 1, 2 ,3, 4, 7, 10, 13
11. 4-hydroxy-nonenal + metabolites (4-HNE) measured at visits 1, 2 ,3, 4, 7, 10, 13
12. Creatinine measured at visits 1, 2 ,3, 4, 7, 10, 13

Measured from blood samples:
1. N-(2-cyanoethyl)valine (HB [haemoglobin] adduct; CEVal) measured at visits 1, 2 ,3, 4, 7, 10, 13
2. White blood cell count (WBC count) measured at visits 1, 2 ,3, 4, 7, 10, 13
3. Monocyte chemotactic protein 1/C-C motif chemokine ligand 2 (MCP 1/CCL2) measured at visits 1, 4, 7, 10, 13
4. Soluble intercellular adhesion molecule-1 (s-ICAM1) measured at visits 1, 4, 7, 10, 13
5. Fibrinogen (Fib) measured at visits 1, 4, 7, 10, 13
6. High-sensitivity C-reactive protein (hsCRP) measured at visits 1, 4, 7, 10, 13
7. Homocysteine (HMCys) measured at visits 1, 4, 7, 10, 13
8. Glucose (Gluc) measured at visits 1, 4, 7, 10, 13
9. Plasminogen activator inhibitor-1 (PAI-1) measured at visits 1, 4, 7, 10, 13
10. Tissue plasminogen activator (tPA) measured at visits 1, 4, 7, 10, 13
11. E-Selectin (SELE) measured at visits 1, 4, 7, 10, 13
12. Endothelin-1 (ET-1) measured at visits 1, 4, 7, 10, 13
13. 3-nitrotyrosine (3-NTyr) measured at visits 1, 4, 7, 10, 13
14. Serum lipids (high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol [CholTotal], triglycerides [Trigly]) measured at visits 1, 2 ,3, 4, 7, 10, 13

Measured from exhaled breath:
1. Nitric oxide (NO) measured at visits 1, 2 ,3, 4, 7, 10, 13
2. Carbon monoxide (CO) measured at screening, visits 1, 2 ,3, 4, 7, 10, 13

Physiological measures:
1. Blood pressure at screening, visits 1, 2 ,3, 4, 7, 10, 13
2. Spirometry at screening, visits 1, 2 ,3, 4, 7, 10, 13:
2.1. Peak flow
2.2. Forced vital capacity (FVC)
2.3. Forced expiratory flow (FEF) 25-75%
2.4. Forced expiratory volume in 1 second (FEV1)
3. Body weight/waist circumference at visits 1, 4, 7, 10, 13
4. Carotid/femoral pulse wave velocity at visits 1, 2 ,3, 4, 7, 10, 13
5. 6-minute walking test at visits 1, 2 ,3, 4, 7, 10, 13
6. Finger plethysmography at visits 1, 4, 7, 10, 13

Questionnaires:
1. Fagerström Test for Cigarette Dependence (FTCD) at screening and at visits 1, 4, 7, 10, 13
2. Product satisfaction at visits 1, 4, 7, 10, 13
3. Smoking cessation quality of life at visits 1, 4, 7, 10, 13
4. Self-reported product usage (eDiary/SMS) recorded throughout the study
5. Cough and Shortness of Breath VAS at visits 1, 4, 7, 10, 13

Safety:
1. Physical examination at screening and at visits 1 to 13 and follow-up
2. Vital signs at screening and at visits 1, 4, 7, 10, 13 and follow-up
3. Electrocardiogram (ECG) at screening and at visits 1, 4, 7, 10, 13 and follow-up
4. Clinical laboratory evaluations at screening and at visits 1, 4, 7, 10, 13 and follow-up
5. Lung function tests at screening, visits 1, 2 ,3, 4, 7, 10, 13
6. Adverse events (AE)/serious adverse events (SAE) recorded throughout the study
Overall study start date15/02/2018
Overall study end date31/03/2020

Eligibility

Participant type(s)Healthy volunteer
Age groupAdult
SexBoth
Target number of participantsUp to 510
Total final enrolment506
Participant inclusion criteriaCurrent inclusion criteria as of 05/03/2019:
1. Males or non-pregnant, non-lactating females, between 23 and 55 years of age, inclusive. Age verification will be performed by checking government issued identification (e.g. passport or driving licence) during Screening
2. Body mass index (BMI) between 17.6 and 32.0 kg/m2, inclusive, body weight exceeding 50 kg (males) or 40 kg (females)
3. Subjects will be in good health, as judged by the Investigator or their appropriately qualified designee based on: medical history, physical examination, vital signs assessment (blood pressure <140 mmHg systolic),12-lead ECG, clinical laboratory evaluations, lung function tests (Gold stage 1 is acceptable; see exclusion criterion 16).
4. Subjects will have given their written informed consent to participate in the study and will have agreed to abide by the study restrictions
5. Subjects must demonstrate the ability to comprehend the Informed Consent Form (ICF), be able to communicate well with the Investigator or their appropriately qualified designee, understand and comply with the requirements of the study, and be judged suitable for the study in the opinion of the Investigator or their appropriately qualified designee
6. Subjects will be willing to refrain from consuming alcohol within 24 hours prior to Screening and Check-in at each study visit, with the exception of the Follow-up Visit
7. Subjects will be willing to refrain from consuming barbequed or chargrilled food, and avoid being in the presence of barbequed or chargrilled food for 48 hours prior to Check-in at each study visit. Subjects will also be willing to avoid food containing poppy seeds for 3 days before both Screening and Check-in at each study visit

Arms A, B and D:
8. Subjects will be regular smokers of commercially manufactured filter cigarettes and/or roll your own cigarettes.
9. Subjects will have smoked for at least five consecutive years prior to Screening
10. Subjects will typically smoke at least 10 and a maximum of 30 CPD and must have a urine cotinine level > 200 ng/mL and an exhaled breath CO level ≥ 7 ppm at Screening
11. Subjects in Arm A who continue to smoke will be willing to use factory-manufactured non-mentholated cigarettes and/or roll your own cigarettes.
12. Subjects in Arms B will be willing to use the study product (THP) provided to them during the study
13. Subjects in Arm D will be willing to abstain from smoking and using NGPs

Arm E:
14. Subjects will have never smoked (<100 cigarettes in their life and none within 30 days prior to Screening) and will continue to not smoke or use any form of tobacco or nicotine-containing product (including THPs) for the duration of the study.

Previous inclusion criteria:

1. Males or non-pregnant, non-lactating females, between 23 and 55 years of age, inclusive
2. Body mass index (BMI) between 17.6 and 32.0 kg/m2, inclusive, body weight exceeding 50 kg (males) or 40 kg (females)
3. Subjects will be in good health, as judged by the Investigator or their appropriately qualified designee based on: medical history, physical examination, vital signs assessment (blood pressure <140 mmHg systolic),12-lead ECG, clinical laboratory evaluations, lung function tests
4. Subjects will have given their written informed consent to participate in the study and will have agreed to abide by the study restrictions
5. Subjects must demonstrate the ability to comprehend the Informed Consent Form (ICF), be able to communicate well with the Investigator or their appropriately qualified designee, understand and comply with the requirements of the study, and be judged suitable for the study in the opinion of the Investigator or their appropriately qualified designee
6. Subjects will be willing to refrain from consuming alcohol within 72 hours prior to Screening and Check-in at each study visit, with the exception of the Follow-up Visit
7. Subjects will be willing to refrain from consuming cruciferous vegetables and grilled, smoked, fried or barbequed food, and avoid being in the presence of the cooking of cruciferous vegetables, and grilled, smoked, fried or barbequed food for 48 hours prior to Check-in at each study visit. Subjects will also be willing to avoid food containing poppy seeds for 3 days before both Screening and Check-in at each study visit

Arms A to D:
8. Subjects will be regular smokers of commercially manufactured filter cigarettes
9. Subjects will have smoked for at least five consecutive years prior to Screening
10. Subjects will typically smoke at least 10 and a maximum of 30 CPD and must have a urine cotinine level > 200 ng/mL and an exhaled breath CO level > 10 ppm at Screening
11. Subjects in Arm A who continue to smoke will be willing to use factory-manufactured non-mentholated cigarettes
12. Subjects in Arms B and C will be willing to use the study products (THP) provided to them during the study
13. Subjects in Arm D will be willing to abstain from smoking and using NGPs

Arm E:
14. Subjects will have never smoked (<100 cigarettes in their life and none within 30 days prior to Screening) and will continue to not smoke or use any form of tobacco or nicotine-containing product (including THPs) for the duration of the study
Participant exclusion criteriaCurrent exclusion criteria as of 05/03/2019:

1. Male subjects who do not agree, or whose partners of childbearing potential do not agree, to use a barrier method of contraception (i.e. a condom with spermicide) or to refrain from donating sperm from Visit 1 until the end of the Follow-up Visit
2. Female subjects of childbearing potential who do not agree to use a highly effective method of birth control in conjunction with male barrier method contraception (i.e. a condom with spermicide) from the time of signing the ICF until the end of the Follow-up Visit
3. Female subjects who are pregnant or breastfeeding. This will be confirmed at Screening and Visit 1. Any female subject who becomes pregnant during this study will be withdrawn
4. Subjects who have donated: ≥400 mL of blood within 12 weeks (male) or 16 weeks (female) prior to Visit 1, plasma in the 2 weeks prior to Visit 1, platelets in the 6 weeks prior to Visit 1
5. Subjects who have an acute illness (e.g. upper respiratory tract infection) requiring treatment within 4 weeks prior to Visit 1 (subjects who had viral infections that resolved ≥2 weeks prior to Visit 1 will be admissible to this study)
6. Subjects who have a significant history of alcoholism or drug/chemical abuse within 24 months prior to Screening, as determined by the Investigator
7. Subjects who have a positive urine drugs of abuse screen (confirmed by repeat) at Screening or Visit 1 or a positive alcohol breath test (confirmed by repeat) at Screening or Visit 1
8. Subjects who are carriers of the hepatitis B surface antigen (HBsAg), hepatitis C antibody or have a positive result for the test for human immunodeficiency virus (HIV) antibodies
9. Subjects who have used prescription or over-the-counter (OTC) bronchodilator medication (e.g. inhaled or oral β-adrenergic agonists) to treat a chronic condition within the 12 months prior to Visit 1
10. Subjects who have received any medications or substances (other than tobacco) which interfere with the cyclooxygenase pathway (e.g. anti-inflammatory drugs including aspirin and ibuprofen) within 14 days prior to Visit 1, are known to be strong inducers or inhibitors of cytochrome P450 (CYP) enzymes within 14 days or 5 half-lives of the drug (whichever is longer) prior to Visit 1
11. Subjects who perform strenuous physical activity (exceeding the subject’s normal activity levels) within 7 days prior to Screening or Visit 1
12. Subjects who are unable to communicate effectively with the Investigator/study staff (i.e. language problem, poor mental development, or impaired cerebral function)
13. Subjects who are unwilling or unable to comply with the study restrictions and requirements
14. Employees and immediate relatives of the tobacco industry and the clinical site
15. Subjects who are still participating in another clinical study (e.g. attending follow-up visits) or who have participated in a clinical study involving administration of an investigational drug (new chemical entity) in the past 3 months prior to first product use
16. Subjects who have any clinically relevant abnormal findings on the physical examination, medical history, ECG, lung function tests (post-bronchodilator FEV1/FVC < 0.7 and FEV1 < 80% predicted value at post-bronchodilator spirometry or have an asthma condition [post-bronchodilator FEV1/FVC < 0.75 and reversibility in FEV1R > 12% and > 200 mL from pre- to post-bronchodilator values at Screening]) or clinical laboratory panel, unless deemed not clinically significant by the Investigator or their appropriately qualified designee
17. Subjects who have, or who have a history of, any clinically significant neurological, gastrointestinal, renal, hepatic, cardiovascular, psychiatric, respiratory, metabolic, endocrine, haematological or other major disorder that, in the opinion of the Investigator or their appropriately qualified designee, would jeopardise the safety of the subject or impact on the validity of the study results
18. Subjects who have previously been diagnosed with any form of malignancy
19. Subjects who have any clinically significant abnormal laboratory safety findings at Screening, as determined by the Investigator or their appropriately qualified designee (1 repeat assessment is acceptable)
20. Subjects who have previously been enrolled in or withdrawn from this study
21. Subjects who, in the opinion of the Investigator, should not participate in this study

Arms A, B and D:
22. Subjects who regularly use any nicotine or tobacco product other than commercially manufactured filter cigarettes and/or roll your own cigarettes within 14 days of Screening

Arms A and B:
23. Subjects who are self-reported non-inhalers (smokers who draw smoke from the cigarette into the mouth and throat but who do not inhale)
24. Subjects who, prior to randomisation, are planning to quit smoking in the next 12 months. All subjects will be informed that they are free to quit smoking and withdraw from the study at any time. Any subject who decides to quit smoking will be directed to appropriate stop smoking services.

Previous exclusion criteria:

1. Male subjects who do not agree, or whose partners of childbearing potential do not agree, to use a barrier method of contraception (i.e. a condom with spermicide) in addition to a second highly effective method of contraception used by their female partners or to refrain from donating sperm from Visit 1 until the end of the Follow-up Visit
2. Female subjects of childbearing potential who do not agree to use a highly effective method of birth control in conjunction with male barrier method contraception (i.e. a condom with spermicide) from the time of signing the ICF until the end of the Follow-up Visit
3. Female subjects who are pregnant or breastfeeding. This will be confirmed at Screening and Visit 1. Any female subject who becomes pregnant during this study will be withdrawn
4. Subjects who have donated: ≥400 mL of blood within 12 weeks (male) or 16 weeks (female) prior to Visit 1, plasma in the 2 weeks prior to Visit 1, platelets in the 6 weeks prior to Visit 1
5. Subjects who have an acute illness (e.g. upper respiratory tract infection) requiring treatment within 4 weeks prior to Visit 1 (subjects who had viral infections that resolved ≥2 weeks prior to Visit 1 will be admissible to this study)
6. Subjects who have a significant history of alcoholism or drug/chemical abuse within 24 months prior to Screening, as determined by the Investigator
7. Subjects who have a positive urine drugs of abuse screen (confirmed by repeat) at Screening or Visit 1 and a positive alcohol breath test (confirmed by repeat) at Screening or Visit 1
8. Subjects who are carriers of the hepatitis B surface antigen (HBsAg), hepatitis C antibody and have a positive result for the test for human immunodeficiency virus (HIV) antibodies
9. Subjects who have used prescription or over-the-counter (OTC) bronchodilator medication (e.g. inhaled or oral β-adrenergic agonists) to treat a chronic condition within the 12 months prior to Visit 1
10. Subjects who have received any medications or substances (other than tobacco) which interfere with the cyclooxygenase pathway (e.g. anti-inflammatory drugs including aspirin and ibuprofen) within 14 days prior to Visit 1, are known to be strong inducers or inhibitors of cytochrome P450 (CYP) enzymes within 14 days or 5 half-lives of the drug (whichever is longer) prior to Visit 1
11. Subjects who perform strenuous physical activity (exceeding the subject’s normal activity levels) within 7 days prior to Screening or Visit 1
12. Subjects who are unable to communicate effectively with the Investigator/study staff (i.e. language problem, poor mental development, or impaired cerebral function)
13. Subjects who are unwilling or unable to comply with the study restrictions and requirements
14. Employees and immediate relatives of the tobacco industry and the clinical site
15. Subjects who are still participating in another clinical study (e.g. attending follow-up visits) or who have participated in a clinical study involving administration of an investigational drug (new chemical entity) in the past 3 months prior to first product use
16. Subjects who have any clinically relevant abnormal findings on the physical examination, medical history, ECG, lung function tests (post-bronchodilator FEV1/FVC < 0.7 and FEV1 < 80% predicted value at post-bronchodilator spirometry or have an asthma condition [post-bronchodilator FEV1/FVC < 0.75 and reversibility in FEV1R > 12% and > 200 mL from pre- to post-bronchodilator values at Screening]) or clinical laboratory panel, unless deemed not clinically significant by the Investigator or their appropriately qualified designee
17. Subjects who have, or who have a history of, any clinically significant neurological, gastrointestinal, renal, hepatic, cardiovascular, psychiatric, respiratory, metabolic, endocrine, haematological or other major disorder that, in the opinion of the Investigator or their appropriately qualified designee, would jeopardise the safety of the subject or impact on the validity of the study results
18. Subjects who have previously been diagnosed with any form of malignancy
19. Subjects who have any clinically significant abnormal laboratory safety findings at Screening, as determined by the Investigator or their appropriately qualified designee (1 repeat assessment is acceptable)
20. Subjects who have previously been enrolled in or withdrawn from this study
21. Subjects who, in the opinion of the Investigator, should not participate in this study

Arms A to D:
22. Subjects who regularly use any nicotine or tobacco product other than commercially manufactured filter cigarettes within 14 days of Screening

Arms A to C:
23. Subjects who are self-reported non-inhalers (smokers who draw smoke from the cigarette into the mouth and throat but who do not inhale)
24. Subjects who, prior to randomisation, are planning to quit smoking in the next 12 months. All subjects will be informed that they are free to quit smoking and withdraw from the study at any time. Any subject who decides to quit smoking will be directed to appropriate stop smoking services
Recruitment start date15/02/2018
Recruitment end date31/03/2019

Locations

Countries of recruitment

  • England
  • Northern Ireland
  • United Kingdom
  • Wales

Study participating centres

Covance Clinical Research Unit Ltd
Springfield House
Hyde Street
Leeds
LS2 9LH
United Kingdom
SIMBEC Research Ltd
Simbec House
Merthyr Tydfil Industrial Park
Pentrebach
Merthyr Tydfil
CF48 4DR
United Kingdom
Celerion (GB) Ltd
22-24 Lisburn Road
Belfast
BT9 6AD
United Kingdom
Richmond Pharmacology Ltd
1a Newcomen Street
London Bridge
London
SE1 1YR
United Kingdom

Sponsor information

British American Tobacco (Investments) Ltd
Industry

R&D Centre, Regents Park Road
Southampton
SO15 8TL
United Kingdom

Phone +44 (0)23 8058 8091
Email nathan_gale@bat.com
ROR logo "ROR" https://ror.org/01znsh139

Funders

Funder type

Industry

British American Tobacco
Private sector organisation / For-profit companies (industry)
Location
United Kingdom

Results and Publications

Intention to publish date01/06/2021
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planFull study protocol, statistical analysis plan, informed consent form, clinical study report will be available. Results from this study will be published in peer-reviewed scientific journals when the study has completed.
IPD sharing planParticipant level data will be available upon request. Deidentified study data including all data captured using the eCRF, subject diaries and full bioanalytical reports available in SDTM format. Data will be available immediately following publication. Data will be available to anyone who wishes access to the data and for any purpose. Requests for data should be made to clinical_info@bat.com. Data requestors will need to sign a data access agreement. Data will be available for at least 5 years following publication.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 01/09/2019 07/05/2019 Yes No
Statistical Analysis Plan statistical analysis plan 28/01/2020 19/05/2020 No No
Results article three-month results 16/02/2021 15/04/2021 Yes No
Results article six-month results 01/07/2021 15/07/2021 Yes No
Results article 28/08/2022 01/09/2022 Yes No
HRA research summary 28/06/2023 No No

Editorial Notes

01/09/2022: Publication reference added.
15/07/2021: Publication reference added.
15/04/2021: Publication reference added. The intention to publish date was changed from 02/12/2020 to 01/06/2021.
19/05/2020: Publication reference added.
07/05/2019: Publication reference added.
10/04/2019: The total final enrolment number was added.
05/03/2019: The following changes were made to the trial record:
1. Contact details, ethics approval, interventions, secondary outcome measures, and inclusion/exclusion criteria were updated.
2. The recruitment end date was changed from 02/07/2018 to 31/03/2019.
3. The overall trial end date was changed from 02/07/2019 to 31/03/2020.
4. The target number of participants was changed from 505 to Up to 510.
01/02/2018: Ethics approval details added.