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Study to Evaluate Arikayce™ in CF Patients With Chronic Pseudomonas Aeruginosa Infections

Randomized, Open-Label, Active-Controlled, Multicenter Study to Assess the Efficacy, Safety and Tolerability of Arikayce™ in Cystic Fibrosis Patients With Chronic Infection Due to Pseudomonas Aeruginosa

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01315678
Enrollment
302
Registered
2011-03-15
Start date
2012-02-29
Completion date
2013-09-18
Last updated
2020-06-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Pseudomonas Aeruginosa Infection

Keywords

Cystic Fibrosis, Respiratory Infections, Pulmonary Cystic Fibrosis, CFTR, Amikacin, Anti-bacterial Agents, Amikacin liposome inhalation suspension (ALIS)

Brief summary

A major factor in the respiratory health of Cystic Fibrosis (CF) participants is the prevalence of chronic Pseudomonas aeruginosa (Pa) infections. The Pa infection rate in CF patients increases with age and by age 18 years approximately 85% of CF patients in the US are infected. Liposomal amikacin for inhalation (Arikayce™) was developed as a possible treatment for chronic infection due to Pa in CF patients. The purpose of this study is to determine whether Arikayce™ is effective in treating chronic lung infections caused by Pa in CF participants. The effectiveness, safety, and tolerability of Arikayce™ will be compared to Tobramycin TOBI®, an inhalation antibiotic already available for use.

Detailed description

CF is a genetic disease resulting from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Patients with CF manifest pathological changes in a variety of organs that express CFTR. The lungs are frequently affected often resulting in chronic infections by bacteria such as Pseudomonas aeruginosa and airway inflammation. Treatment of chronic lung infections is one of the principal goals of CF therapy. Arikayce™ LAI (liposomal amikacin for inhalation) is a sustained-release formulation of amikacin encapsulated inside nanoscale liposomal carriers designed for administration via inhalation. It is hypothesized that the sustained-release pulmonary targeting and biofilm penetration properties of this formulation will have several advantages over current therapies in treating CF patients with chronic lung infection caused by Pseudomonas aeruginosa. This Phase 3 study has been designed to evaluate the efficacy, safety and tolerability of Arikayce™ in treating CF patients with chronic bronchopulmonary infection compared to a currently available antibiotic, TOBI® Inhalation Solution. Eligible participants will be randomized 1:1 to receive 590 mg of Arikayce™ once daily via a PARI Investigational eFlow® Nebulizer or 300 mg TOBI® BID via a PARI LC® PLUS nebulizer. Participants will receive 3 cycles of treatment with each cycle being comprised of 28 days on treatment followed by 28 days off-treatment. Total study duration is up to 186 days (\ 6 months) including an up to 18 day Screening period. Participants will be evaluated for safety, tolerability and efficacy bi-weekly during the first 4 weeks of treatment, and thereafter every 4 weeks for the duration of the study. Pharmacokinetics (PK) of Arikayce™ in blood, sputum and 24-hour urine will be determined in a subgroup of study participants who consent to PK evaluation. At the completion of the TR02-108 protocol, participants who have consented and meet study safety criteria may enroll in the long-term, open-label, multi-cycle extension study of 590 mg of Arikayce™ (under a separate protocol TR02-110). Arikace™, Arikayce™, Liposomal Amikacin for Inhalation (LAI), and Amikacin Liposome Inhalation Suspension (ALIS) may be used interchangeably throughout this study and other studies evaluating amikacin liposome inhalation suspension.

Interventions

DRUGLiposomal amikacin for inhalation (Arikayce™) using the PARI Investigational eFlow® Nebulizer.

Liposomal amikacin for inhalation is provided as a sterile aqueous liposomal dispersion for inhalation via nebulization. * 590 mg of liposomal amikacin for inhalation is administered once daily using the PARI Investigational eFlow® Nebulizer. * Administration time is approximately 13 minutes. * liposomal amikacin for inhalation will be administered for 3 cycles where each cycle consists of 28 days on-treatment followed by 28 days off-treatment.

DRUGTobramycin inhalation solution using a PARI LC® Plus nebulizer.

300 mg tobramycin inhalation solution is administered twice a day using a PARI LC® Plus nebulizer. * Nebulization time is approximately 20 minutes for each administration. * Tobramycin inhalation solution will be administered for 3 cycles where each cycle consists of 28 days on-treatment followed by 28 days off-treatment

Sponsors

Insmed Incorporated
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
6 Years to No maximum
Healthy volunteers
No

Inclusion criteria

Key Inclusion Criteria: * Written informed consent or assent * Confirmed diagnosis of CF * History of chronic infection with Pseudomonas aeruginosa * Sputum culture positive for Pseudomonas aeruginosa at Screening * FEV1 ≥ 25% of predicted value at Screening Key

Exclusion criteria

* FEV1 \<25% of predicted at Screening * History of major complications of lung disease within 8 weeks prior to Screening * Hemoptysis of ≥60 mL in a 24-hour period within 4 weeks prior to Screening * History of positive culture for Burkholderia cepacia within 2 years prior to Screening * History of pulmonary tuberculosis or non-tuberculous mycobacterial lung disease treated within 2 years prior to Screening or requiring treatment at the time of screening * History of Allergic Broncho-Pulmonary Aspergillosis or any other condition requiring systemic steroids at a dose ≥ equivalent of 10 mg/day of prednisone within 3 months prior to Screening * Presence of any clinically significant cardiac disease * History of lung transplantation * Daily, continuous oxygen supplementation or nighttime supplemental oxygen requirement of greater than 2 L/min * Administration of any investigational products within 8 weeks prior to study Day 1 * Smoking tobacco or any substance within 6 months prior to screening or anticipated inability to refrain from smoking throughout the study

Design outcomes

Primary

MeasureTime frameDescription
Pulmonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Baseline to168 daysRelative Change (%) from baseline to end of study (Day 168) in FEV1 (1 second)

Secondary

MeasureTime frameDescription
Number of Participants Experiencing a Pulmonary Exacerbation168 daysNumber of participants experiencing a pulmonary exacerbation measured by number with event and number censored
Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary Exacerbation168 daysNumber of participants to first antipseudomonal antibiotic treatment for pulmonary exacerbation measured by number with event and number censored
Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Baseline, Day 14, Day 28, Day 57, Day 84, Day 113, Day 140 and Day 168.Relative changes (%) from baseline to Study Days 14, 28, 57, 84, 113, 140, 168 in FEV1
Change in Density (Log CFU) in Pseudomonas Aeruginosa in SputumBaseline, Day 14, Day 28, Day 57, Day 84, Day 113, Day 140 and Day 168Change in density (Log CFU) from baseline in Pseudomonas aeruginosa in sputum
Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 14, Day 28, Day 57, Day 84, Day 113, Day 140 and Day 168Quality of Life was measured by the absolute change from baseline in the Cystic Fibrosis Questionnaire-Revised (CFQ-R) respiratory scale. Disease specific instrument designed to measure impact on overall health, daily life, perceived well-being and symptoms in patients with a diagnosis of cystic fibrosis. Scores range from 0 to 100, with higher scores indicating better health. Scores for each Health Related Quality of Life (HRQoL) domain; after recoding, each item is summed to generate a domain score and standardized.
Number of Participants to First All Cause Hospitalization168 daysNumber of participants to first all cause hospitalization measured by number with event and number censored

Countries

Austria, Belgium, Bulgaria, Canada, Denmark, France, Germany, Greece, Hungary, Ireland, Italy, Netherlands, Poland, Serbia, Slovakia, Spain, Sweden, United Kingdom

Participant flow

Recruitment details

302 participants were randomized. 8 were not treated.

Participants by arm

ArmCount
Arikayce™
Arikayce™ is liposomal amikacin for inhalation Liposomal amikacin for inhalation (Arikayce™) using the PARI Investigational eFlow® Nebulizer: Liposomal amikacin for inhalation is provided as a sterile aqueous liposomal dispersion for inhalation via nebulization. * 590 mg of liposomal amikacin for inhalation is administered once daily using the PARI Investigational eFlow® Nebulizer. * Administration time is approximately 13 minutes. * Liposomal amikacin for inhalation will be administered for 3 cycles where each cycle consists of 28 days on-treatment followed by 28 days off-treatment.
148
TOBI®
TOBI® is tobramycin inhalation solution Tobramycin inhalation solution using a PARI LC® Plus nebulizer: 300 mg tobramycin inhalation solution is administered twice a day using a PARI LC® Plus nebulizer. * Nebulization time is approximately 20 minutes for each administration. * Tobramycin inhalation solution will be administered for 3 cycles where each cycle consists of 28 days on-treatment followed by 28 days off-treatment
146
Total294

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event31
Overall StudyLost to Follow-up10
Overall Studysimilar reason to those listed above32
Overall StudyWithdrawal by Subject73

Baseline characteristics

CharacteristicArikayce™TotalTOBI®
Age, Customized
Age
>12-18 years
34 Participants67 Participants33 Participants
Age, Customized
Age
>18 years
87 Participants174 Participants87 Participants
Age, Customized
Age
6-12 years
27 Participants53 Participants26 Participants
Race/Ethnicity, Customized
Ethnicity
African
1 Participants1 Participants0 Participants
Race/Ethnicity, Customized
Ethnicity
Caucasian
139 Participants280 Participants141 Participants
Race/Ethnicity, Customized
Ethnicity
Hispanic
5 Participants8 Participants3 Participants
Race/Ethnicity, Customized
Ethnicity
Other
3 Participants4 Participants1 Participants
Sex: Female, Male
Female
69 Participants139 Participants70 Participants
Sex: Female, Male
Male
79 Participants155 Participants76 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 1480 / 146
other
Total, other adverse events
114 / 14891 / 146
serious
Total, serious adverse events
26 / 14829 / 146

Outcome results

Primary

Pulmonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)

Relative Change (%) from baseline to end of study (Day 168) in FEV1 (1 second)

Time frame: Baseline to168 days

Population: The PP is the primary analysis population for the primary efficacy analysis

ArmMeasureValue (MEAN)Dispersion
Arikayce™Pulmonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)0.47 Percent (%) changeStandard Deviation 13.93
TOBI®Pulmonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)1.67 Percent (%) changeStandard Deviation 16.05
Secondary

Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum

Change in density (Log CFU) from baseline in Pseudomonas aeruginosa in sputum

Time frame: Baseline, Day 14, Day 28, Day 57, Day 84, Day 113, Day 140 and Day 168

Population: Modified intent-to-treat (mITT; received at least 1 dose of study drug)

ArmMeasureGroupValue (MEAN)Dispersion
Arikayce™Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum57 days-0.210 Log 10 CFUStandard Deviation 1.9874
Arikayce™Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum14 days-1.124 Log 10 CFUStandard Deviation 2.0542
Arikayce™Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum84 days-0.945 Log 10 CFUStandard Deviation 2.2223
Arikayce™Change in Density (Log CFU) in Pseudomonas Aeruginosa in SputumBaseline6.872 Log 10 CFUStandard Deviation 1.8806
Arikayce™Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum140 days-1.440 Log 10 CFUStandard Deviation 2.4357
Arikayce™Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum28 days-1.208 Log 10 CFUStandard Deviation 2.1594
Arikayce™Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum168 days-0.725 Log 10 CFUStandard Deviation 2.0073
Arikayce™Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum113 days-0.613 Log 10 CFUStandard Deviation 2.1928
TOBI®Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum168 days-0.136 Log 10 CFUStandard Deviation 2.175
TOBI®Change in Density (Log CFU) in Pseudomonas Aeruginosa in SputumBaseline6.510 Log 10 CFUStandard Deviation 2.3202
TOBI®Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum14 days-1.663 Log 10 CFUStandard Deviation 2.4017
TOBI®Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum28 days-1.453 Log 10 CFUStandard Deviation 2.444
TOBI®Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum57 days-0.098 Log 10 CFUStandard Deviation 1.7446
TOBI®Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum113 days-0.135 Log 10 CFUStandard Deviation 2.3461
TOBI®Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum140 days-1.315 Log 10 CFUStandard Deviation 2.23
TOBI®Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum84 days-1.182 Log 10 CFUStandard Deviation 2.6914
Secondary

Number of Participants Experiencing a Pulmonary Exacerbation

Number of participants experiencing a pulmonary exacerbation measured by number with event and number censored

Time frame: 168 days

Population: Modified intent-to-treat (mITT; received at least 1 dose of study drug)

ArmMeasureGroupValue (NUMBER)
Arikayce™Number of Participants Experiencing a Pulmonary ExacerbationNumber with Event73 participants
Arikayce™Number of Participants Experiencing a Pulmonary ExacerbationNumber Censored75 participants
TOBI®Number of Participants Experiencing a Pulmonary ExacerbationNumber with Event63 participants
TOBI®Number of Participants Experiencing a Pulmonary ExacerbationNumber Censored83 participants
Comparison: Stratified Cox proportional hazards modelp-value: 0.028695% CI: [1.07, 2.13]Regression, Cox
Secondary

Number of Participants to First All Cause Hospitalization

Number of participants to first all cause hospitalization measured by number with event and number censored

Time frame: 168 days

Population: Modified intent-to-treat (mITT; received at least 1 dose of study drug)

ArmMeasureGroupValue (NUMBER)
Arikayce™Number of Participants to First All Cause HospitalizationNumber Censored124 participants
Arikayce™Number of Participants to First All Cause HospitalizationNumber with Event24 participants
TOBI®Number of Participants to First All Cause HospitalizationNumber with Event29 participants
TOBI®Number of Participants to First All Cause HospitalizationNumber Censored117 participants
p-value: 0.486195% CI: [0.49, 1.44]Regression, Cox
Secondary

Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary Exacerbation

Number of participants to first antipseudomonal antibiotic treatment for pulmonary exacerbation measured by number with event and number censored

Time frame: 168 days

Population: Modified intent-to-treat (mITT; received at least 1 dose of study drug)

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Arikayce™Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary ExacerbationNumber with Event55 Participants
Arikayce™Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary ExacerbationNumber Censored93 Participants
TOBI®Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary ExacerbationNumber with Event48 Participants
TOBI®Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary ExacerbationNumber Censored98 Participants
p-value: 0.603195% CI: [0.76, 1.66]Regression, Cox
Secondary

Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)

Relative changes (%) from baseline to Study Days 14, 28, 57, 84, 113, 140, 168 in FEV1

Time frame: Baseline, Day 14, Day 28, Day 57, Day 84, Day 113, Day 140 and Day 168.

Population: Modified intent-to-treat (mITT; received at least 1 dose of study drug)

ArmMeasureGroupValue (MEAN)Dispersion
Arikayce™Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 57-3.49 percentage (%) changeStandard Deviation 12.319
Arikayce™Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 113-0.90 percentage (%) changeStandard Deviation 12.028
Arikayce™Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 280.79 percentage (%) changeStandard Deviation 14.745
Arikayce™Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 1400.43 percentage (%) changeStandard Deviation 15.299
Arikayce™Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 840.44 percentage (%) changeStandard Deviation 14.35
Arikayce™Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 168-0.12 percentage (%) changeStandard Deviation 14.326
Arikayce™Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 142.59 percentage (%) changeStandard Deviation 13.332
TOBI®Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 1681.58 percentage (%) changeStandard Deviation 15.97
TOBI®Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 146.64 percentage (%) changeStandard Deviation 15.669
TOBI®Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 283.32 percentage (%) changeStandard Deviation 14.715
TOBI®Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 570.70 percentage (%) changeStandard Deviation 14.51
TOBI®Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 843.59 percentage (%) changeStandard Deviation 14.642
TOBI®Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 1130.42 percentage (%) changeStandard Deviation 14.434
TOBI®Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1)Day 1401.37 percentage (%) changeStandard Deviation 16.563
Secondary

Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R

Quality of Life was measured by the absolute change from baseline in the Cystic Fibrosis Questionnaire-Revised (CFQ-R) respiratory scale. Disease specific instrument designed to measure impact on overall health, daily life, perceived well-being and symptoms in patients with a diagnosis of cystic fibrosis. Scores range from 0 to 100, with higher scores indicating better health. Scores for each Health Related Quality of Life (HRQoL) domain; after recoding, each item is summed to generate a domain score and standardized.

Time frame: Day 14, Day 28, Day 57, Day 84, Day 113, Day 140 and Day 168

Population: Modified intent-to-treat (mITT; received at least 1 dose of study drug)

ArmMeasureGroupValue (LEAST_SQUARES_MEAN)Dispersion
Arikayce™Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 578.00 Percent (%) changeStandard Error 3.12
Arikayce™Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 1133.58 Percent (%) changeStandard Error 3.323
Arikayce™Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 2815.54 Percent (%) changeStandard Error 3.363
Arikayce™Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 14013.84 Percent (%) changeStandard Error 3.06
Arikayce™Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 8413.20 Percent (%) changeStandard Error 3.079
Arikayce™Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 16812.06 Percent (%) changeStandard Error 3.784
Arikayce™Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 1413.65 Percent (%) changeStandard Error 2.995
TOBI®Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 1688.07 Percent (%) changeStandard Error 3.79
TOBI®Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 148.81 Percent (%) changeStandard Error 3.019
TOBI®Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 2811.03 Percent (%) changeStandard Error 3.419
TOBI®Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 577.97 Percent (%) changeStandard Error 3.146
TOBI®Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 848.55 Percent (%) changeStandard Error 3.111
TOBI®Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 1135.03 Percent (%) changeStandard Error 3.29
TOBI®Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-RDay 1406.10 Percent (%) changeStandard Error 3.079

Source: ClinicalTrials.gov · Data processed: Mar 2, 2026