Pseudomonas Aeruginosa Infection
Conditions
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
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.
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
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Pulmonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Baseline to168 days | Relative Change (%) from baseline to end of study (Day 168) in FEV1 (1 second) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Experiencing a Pulmonary Exacerbation | 168 days | Number of participants experiencing a pulmonary exacerbation measured by number with event and number censored |
| Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary Exacerbation | 168 days | Number 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 Sputum | Baseline, Day 14, Day 28, Day 57, Day 84, Day 113, Day 140 and Day 168 | Change in density (Log CFU) from baseline in Pseudomonas aeruginosa in sputum |
| Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 14, Day 28, Day 57, Day 84, Day 113, Day 140 and Day 168 | 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. |
| Number of Participants to First All Cause Hospitalization | 168 days | Number 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
| Arm | Count |
|---|---|
| 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 |
| Total | 294 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 3 | 1 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | similar reason to those listed above | 3 | 2 |
| Overall Study | Withdrawal by Subject | 7 | 3 |
Baseline characteristics
| Characteristic | Arikayce™ | Total | TOBI® |
|---|---|---|---|
| Age, Customized Age >12-18 years | 34 Participants | 67 Participants | 33 Participants |
| Age, Customized Age >18 years | 87 Participants | 174 Participants | 87 Participants |
| Age, Customized Age 6-12 years | 27 Participants | 53 Participants | 26 Participants |
| Race/Ethnicity, Customized Ethnicity African | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Ethnicity Caucasian | 139 Participants | 280 Participants | 141 Participants |
| Race/Ethnicity, Customized Ethnicity Hispanic | 5 Participants | 8 Participants | 3 Participants |
| Race/Ethnicity, Customized Ethnicity Other | 3 Participants | 4 Participants | 1 Participants |
| Sex: Female, Male Female | 69 Participants | 139 Participants | 70 Participants |
| Sex: Female, Male Male | 79 Participants | 155 Participants | 76 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 148 | 0 / 146 |
| other Total, other adverse events | 114 / 148 | 91 / 146 |
| serious Total, serious adverse events | 26 / 148 | 29 / 146 |
Outcome results
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
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arikayce™ | Pulmonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | 0.47 Percent (%) change | Standard Deviation 13.93 |
| TOBI® | Pulmonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | 1.67 Percent (%) change | Standard Deviation 16.05 |
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)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Arikayce™ | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 57 days | -0.210 Log 10 CFU | Standard Deviation 1.9874 |
| Arikayce™ | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 14 days | -1.124 Log 10 CFU | Standard Deviation 2.0542 |
| Arikayce™ | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 84 days | -0.945 Log 10 CFU | Standard Deviation 2.2223 |
| Arikayce™ | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | Baseline | 6.872 Log 10 CFU | Standard Deviation 1.8806 |
| Arikayce™ | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 140 days | -1.440 Log 10 CFU | Standard Deviation 2.4357 |
| Arikayce™ | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 28 days | -1.208 Log 10 CFU | Standard Deviation 2.1594 |
| Arikayce™ | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 168 days | -0.725 Log 10 CFU | Standard Deviation 2.0073 |
| Arikayce™ | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 113 days | -0.613 Log 10 CFU | Standard Deviation 2.1928 |
| TOBI® | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 168 days | -0.136 Log 10 CFU | Standard Deviation 2.175 |
| TOBI® | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | Baseline | 6.510 Log 10 CFU | Standard Deviation 2.3202 |
| TOBI® | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 14 days | -1.663 Log 10 CFU | Standard Deviation 2.4017 |
| TOBI® | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 28 days | -1.453 Log 10 CFU | Standard Deviation 2.444 |
| TOBI® | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 57 days | -0.098 Log 10 CFU | Standard Deviation 1.7446 |
| TOBI® | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 113 days | -0.135 Log 10 CFU | Standard Deviation 2.3461 |
| TOBI® | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 140 days | -1.315 Log 10 CFU | Standard Deviation 2.23 |
| TOBI® | Change in Density (Log CFU) in Pseudomonas Aeruginosa in Sputum | 84 days | -1.182 Log 10 CFU | Standard Deviation 2.6914 |
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)
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arikayce™ | Number of Participants Experiencing a Pulmonary Exacerbation | Number with Event | 73 participants |
| Arikayce™ | Number of Participants Experiencing a Pulmonary Exacerbation | Number Censored | 75 participants |
| TOBI® | Number of Participants Experiencing a Pulmonary Exacerbation | Number with Event | 63 participants |
| TOBI® | Number of Participants Experiencing a Pulmonary Exacerbation | Number Censored | 83 participants |
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)
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arikayce™ | Number of Participants to First All Cause Hospitalization | Number Censored | 124 participants |
| Arikayce™ | Number of Participants to First All Cause Hospitalization | Number with Event | 24 participants |
| TOBI® | Number of Participants to First All Cause Hospitalization | Number with Event | 29 participants |
| TOBI® | Number of Participants to First All Cause Hospitalization | Number Censored | 117 participants |
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)
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Arikayce™ | Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary Exacerbation | Number with Event | 55 Participants |
| Arikayce™ | Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary Exacerbation | Number Censored | 93 Participants |
| TOBI® | Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary Exacerbation | Number with Event | 48 Participants |
| TOBI® | Number of Participants to First Antipseudomonal Antibiotic Treatment for Pulmonary Exacerbation | Number Censored | 98 Participants |
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)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Arikayce™ | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 57 | -3.49 percentage (%) change | Standard Deviation 12.319 |
| Arikayce™ | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 113 | -0.90 percentage (%) change | Standard Deviation 12.028 |
| Arikayce™ | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 28 | 0.79 percentage (%) change | Standard Deviation 14.745 |
| Arikayce™ | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 140 | 0.43 percentage (%) change | Standard Deviation 15.299 |
| Arikayce™ | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 84 | 0.44 percentage (%) change | Standard Deviation 14.35 |
| Arikayce™ | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 168 | -0.12 percentage (%) change | Standard Deviation 14.326 |
| Arikayce™ | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 14 | 2.59 percentage (%) change | Standard Deviation 13.332 |
| TOBI® | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 168 | 1.58 percentage (%) change | Standard Deviation 15.97 |
| TOBI® | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 14 | 6.64 percentage (%) change | Standard Deviation 15.669 |
| TOBI® | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 28 | 3.32 percentage (%) change | Standard Deviation 14.715 |
| TOBI® | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 57 | 0.70 percentage (%) change | Standard Deviation 14.51 |
| TOBI® | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 84 | 3.59 percentage (%) change | Standard Deviation 14.642 |
| TOBI® | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 113 | 0.42 percentage (%) change | Standard Deviation 14.434 |
| TOBI® | Pumonary Function Test: Forced Expiratory Volume in 1 Second (FEV1) | Day 140 | 1.37 percentage (%) change | Standard Deviation 16.563 |
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)
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Arikayce™ | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 57 | 8.00 Percent (%) change | Standard Error 3.12 |
| Arikayce™ | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 113 | 3.58 Percent (%) change | Standard Error 3.323 |
| Arikayce™ | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 28 | 15.54 Percent (%) change | Standard Error 3.363 |
| Arikayce™ | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 140 | 13.84 Percent (%) change | Standard Error 3.06 |
| Arikayce™ | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 84 | 13.20 Percent (%) change | Standard Error 3.079 |
| Arikayce™ | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 168 | 12.06 Percent (%) change | Standard Error 3.784 |
| Arikayce™ | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 14 | 13.65 Percent (%) change | Standard Error 2.995 |
| TOBI® | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 168 | 8.07 Percent (%) change | Standard Error 3.79 |
| TOBI® | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 14 | 8.81 Percent (%) change | Standard Error 3.019 |
| TOBI® | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 28 | 11.03 Percent (%) change | Standard Error 3.419 |
| TOBI® | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 57 | 7.97 Percent (%) change | Standard Error 3.146 |
| TOBI® | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 84 | 8.55 Percent (%) change | Standard Error 3.111 |
| TOBI® | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 113 | 5.03 Percent (%) change | Standard Error 3.29 |
| TOBI® | Relative Percent (%) Change in Respiratory Symptoms as Measured by the CFQ-R | Day 140 | 6.10 Percent (%) change | Standard Error 3.079 |