Study of Ataluren in Nonsense Mutation Cystic Fibrosis (ACT CF)

A Phase 3 Efficacy and Safety Study of Ataluren (PTC124®) in Patients With Nonsense Mutation Cystic Fibrosis

Status

Completed

Phases

Phase 3

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT02139306

Enrollment

279

Registered

2014-05-15

Start date

2014-08-31

Completion date

2016-11-30

Last updated

2020-05-14

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

Conditions

Cystic Fibrosis

Brief summary

This is a Phase 3, international, multicenter, randomized, double-blind, placebo-controlled, efficacy and safety study of ataluren in patients with nonsense mutation cystic fibrosis (nmCF) not receiving chronic inhaled aminoglycosides.

Detailed description

This study is to enroll 208 subjects (184 fully evaluable) with nonsense-mutation-mediated CF who are at least 6 years of age and have an forced expiratory volume in 1 second (FEV1) \>= 40% and \<= 90% of predicted. Subjects will be stratified based on age, inhaled antibiotic use, and baseline FEV1, and will be randomized in a 1:1 ratio to receive oral ataluren administered 3 times per day (TID) at respective morning, midday, and evening doses of 10-, 10-, and 20-mg/kg or placebo. Based on the results of a previously conducted study, patients treated with chronic inhaled aminoglycosides (including TOBI) will not be eligible for participation. Spirometry measurement at the screening visit will establish patient eligibility for inclusion based on lung function. FEV1 stability will be assessed during the approximately 4-week screening period, at the conclusion of which patients will be required to demonstrate a relative change in %-predicted FEV1 of less than 15% when compared to the screening value. Assessments will be performed every 8 weeks, depending upon the outcome measure.

Interventions

DRUGAtaluren (PTC124®)

Oral Ataluren TID

DRUGPlacebo

Oral Placebo TID

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

6 Years to No maximum

Healthy volunteers

Inclusion criteria

* Evidence of signed and dated informed consent/assent document(s) indicating that the subject (and/or his parent/legal guardian) has been informed of all pertinent aspects of the trial * Age \>=6 years. * Body weight \>=16 kg. * Sweat chloride \>60 milliequivalent per liter (mEq/L) * Documentation of the presence of a nonsense mutation in at least 1 allele of the cystic fibrosis transmembrane conductance regulator (CFTR) gene, as determined by genotyping performed at a laboratory certified by the College of American Pathologists (CAP), or under the Clinical Laboratory Improvement Act/Amendment (CLIA), or by an equivalent organization * Verification that a blood sample has been drawn for sequencing of the CFTR gene * Ability to perform a valid, reproducible spirometry test using the study-specific spirometer with demonstration of an FEV1 \>=40% and \<=90% of predicted * Demonstration at Visit 2 of a valid %-predicted FEV1 within 15% of the Screening % predicted FEV1 value * Resting oxygen saturation (as measured by pulse oximetry) \>=92% on room air. * Confirmed screening laboratory values within pre-specified ranges * In subjects who are sexually active, willingness to abstain from sexual intercourse or employ a barrier or medical method of contraception during the study drug administration and 60-day follow-up period * Willingness and ability to comply with all study procedures and assessments, including scheduled visits, drug administration plan, study procedures, laboratory tests, and study restrictions

Exclusion criteria

* Known hypersensitivity to any of the ingredients or excipients of the study drug * Previous participation in the Phase 3 trial of ataluren (PTC124-GD-009-CF). * Any change (initiation, change in type of drug, dose modification, schedule modification, interruption, discontinuation, or re-initiation) in a chronic treatment/prophylaxis regimen for Cystic Fibrosis (CF) or for CF-related conditions within 4 weeks prior to screening * Chronic use of inhaled aminoglycosides (eg, tobramycin) or use of inhaled aminoglycosides within 4 weeks prior to screening. * Exposure to another investigational drug within 4 weeks prior to screening * Ongoing participation in any other therapeutic clinical trial * Evidence of pulmonary exacerbation or acute upper or lower respiratory tract infection (including viral illnesses) within 3 weeks prior to screening * Treatment with intravenous antibiotics within 3 weeks prior to screening * Ongoing immunosuppressive therapy (other than corticosteroids) * Ongoing warfarin, phenytoin, or tolbutamide therapy * History of solid organ or hematological transplantation * Major complications of lung disease (including massive hemoptysis, pneumothorax, or pleural effusion) within 8 weeks prior to screening * Known portal hypertension * Positive hepatitis B surface antigen, hepatitis C antibody test, or human immunodeficiency virus (HIV) test * Pregnancy or breast-feeding * Current smoker or a smoking history of \>=10 pack-years (number of cigarette packs/day x number of years smoked). * Prior or ongoing medical condition (eg, concomitant illness, alcoholism, drug abuse, psychiatric condition), medical history, physical findings, electrocardiogram (ECG) findings, or laboratory abnormality that, in the investigator's opinion, could adversely affect the safety of the subject, makes it unlikely that the course of treatment or follow-up would be completed, or could impair the assessment of study results

Design outcomes

Primary

Measure	Time frame	Description
Absolute Change From Baseline in Percent-predicted Forced Expiratory Volume in One Second (ppFEV1) at Week 48	From Baseline to Week 48	The FEV1 is the volume of air forcibly exhaled in one second and is measured using forced expiratory air spirometry. Change in ppFEV1 at Week 48 was defined as the average between the change from baseline at Week 40 and that at Week 48. Baseline for ppFEV1 was defined as an average of ppFEV1 at Screening (Weeks -4 to -1) and Baseline (Day 1) visits.

Secondary

Measure	Time frame	Description
Change From Baseline in the Cystic Fibrosis Questionnaire - Revised (CFQ-R) Respiratory Domain at Week 48	Baseline (Day 1) and Week 48	The teen/adult CFQ-R was used for this study. It was developed specifically for participants with cystic fibrosis. It is a disease-specific instrument designed to measure impact on overall health, daily life, perceived well-being, and symptoms. The respiratory domain assessed respiratory symptoms like coughing, congestion, wheezing etc. Scaling of each item is done via 4-point Likert scales. Scores for each item are summed up to generate a domain score. Scores ranges from 0 to 100, with higher scores indicating better health and lower scores indicating worse health.
Change From Baseline in Body Mass Index (BMI) at Week 48	Baseline (Day 1) and Week 48	Malnutrition is common in participants with cystic fibrosis. The BMI is an important clinical measure of nutritional status.
Number of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (SAEs)	From study drug administration to 4-week post treatment follow-up visit (approximately 52 weeks)	An adverse event (AE) is any unfavourable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a study treatment, whether or not considered related to the study treatment. A TEAE is defined as an AE that occurs or worsens in the period extending from first dose of study drug to 4 weeks after last dose of study drug. An SAE is an untoward medical occurrence or effect associated with the use of a study drug at any dose, regardless of whether it is considered to be related to the study drug, which results in one of the following: death; inpatient hospitalization or prolongation of existing hospitalization; life threatening adverse event; persistent or significant disability or incapacity or substantial disruption of the ability to conduct normal life functions; any other medically important event; or a pregnancy resulting in spontaneous abortion, stillbirth, neonatal death, or congenital anomaly.
Number of Participants With TEAEs by Severity and Relationship to Study Drugs	From study drug administration to 4-week post treatment follow-up visit (approximately 52 weeks)	The relationship of TEAEs to the study drugs were assessed as: probable related, possibly related, unlikely related, and unrelated. The severity of TEAEs were graded using the Common Terminology Criteria for Adverse Events, Version 3.0 as: Grade 1 (mild), Grade 2 (moderate), Grade 3 (severe), Grade 4 (life threatening), or Grade 5 (fatal).
48-week Rate of Pulmonary Exacerbations	Week 48	Pulmonary exacerbations were assessed using expanded Fuchs criteria. The expanded Fuchs exacerbation is defined as the presence of at least 4 of 12 Fuchs' signs and symptoms requiring treatment with any form of antibiotic treatment (inhaled, oral, or intravenous). Fuchs' signs and symptoms included increased cough; change in sputum volume, color, or consistency; new or increased hemoptysis; increased dyspnea during moderate or mild exertion, or at rest; sinus pain or tenderness; change in sinus discharge; malaise, fatigue, or lethargy; anorexia or weight loss; temperature above 38 degrees Celsius; change in findings on chest examination; relative 10% decrease in ppFEV1, and chest radiography results consistent with pulmonary infection. The 48-week rate was calculated as: 48-week rate = total number of events /treatment duration by week\*48.
Number of Participants With Abnormal Vital Signs Reported as TEAEs	From study drug administration to 4-week post treatment follow-up visit (approximately 52 weeks)	Vital signs included systolic and diastolic blood pressure, pulse rate, pulse oximetry, and body temperature. Participants with abnormal vital signs who required clinical intervention or further investigation (beyond ordering a repeat \[confirmatory\] test) unless they are associated with an already reported clinical event are reported.
Number of Participants With Abnormal Clinical Laboratory Parameters Reported as TEAEs	From study drug administration to 4-week post treatment follow-up visit (approximately 52 weeks)	Clinical laboratory tests included haematology, biochemistry, and urinalysis. Participants with abnormal laboratory parameters who required clinical intervention or further investigation (beyond ordering a repeat \[confirmatory\] test) unless they are associated with an already reported clinical event are reported.
Number of Participants With Abnormal Electrocardiogram Reported as TEAEs	From study drug administration to 4-week post treatment follow-up visit (approximately 52 weeks)	Participants with abnormal electrocardiogram who required clinical intervention or further investigation (beyond ordering a repeat \[confirmatory\] test) unless they are associated with an already reported clinical event are reported.
Number of Participants With SAEs by Severity and Relationship to Study Drugs	From study drug administration to 4-week post treatment follow-up visit (approximately 52 weeks)	The relationship of SAEs to the study drugs were assessed as: probable related, possibly related, unlikely related, and unrelated. The severity of SAEs were graded using the Common Terminology Criteria for Adverse Events, Version 3.0 as: Grade 1 (mild), Grade 2 (moderate), Grade 3 (severe), Grade 4 (life threatening), or Grade 5 (fatal).

Countries

Argentina, Australia, Belgium, Brazil, Bulgaria, Canada, France, Germany, Greece, Israel, Italy, Netherlands, Poland, Spain, United Kingdom, United States

Participant flow

Recruitment details

This study was conducted from 15 August 2014 to 02 November 2016.

Participants by arm

Arm	Count
Ataluren Participants received ataluren as oral powder for suspension at the dosages of 10, 10, and 20-mg/kg at morning, midday and evening, respectively for 48 weeks of treatment duration or until treatment discontinuation	140
Placebo Participants received matching placebo orally at morning, midday and evening for 48 weeks of treatment duration or until treatment discontinuation.	139
Total	279

Withdrawals & dropouts

Period	Reason	FG000	FG001
Overall Study	Adverse Event	3	4
Overall Study	Other Unspecified	2	3
Overall Study	Physician Decision	0	1
Overall Study	Protocol Violation	4	0
Overall Study	Withdrawal by Subject	4	6

Baseline characteristics

Characteristic	Ataluren	Placebo	Total
Age, Continuous	22.0 years STANDARD_DEVIATION 11	22.0 years STANDARD_DEVIATION 10.44	22.0 years STANDARD_DEVIATION 10.7
Sex: Female, Male Female	59 Participants	74 Participants	133 Participants
Sex: Female, Male Male	81 Participants	65 Participants	146 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	0 / 140	0 / 139
other Total, other adverse events	123 / 140	120 / 139
serious Total, serious adverse events	40 / 140	46 / 139

Outcome results

Primary

Absolute Change From Baseline in Percent-predicted Forced Expiratory Volume in One Second (ppFEV1) at Week 48

The FEV1 is the volume of air forcibly exhaled in one second and is measured using forced expiratory air spirometry. Change in ppFEV1 at Week 48 was defined as the average between the change from baseline at Week 40 and that at Week 48. Baseline for ppFEV1 was defined as an average of ppFEV1 at Screening (Weeks -4 to -1) and Baseline (Day 1) visits.

Time frame: From Baseline to Week 48

Population: The intent-to-treat (ITT) population included all randomized participants who had FEV1 data available at Baseline and at least one post-baseline visit.

Arm	Measure	Value (LEAST_SQUARES_MEAN)
Ataluren	Absolute Change From Baseline in Percent-predicted Forced Expiratory Volume in One Second (ppFEV1) at Week 48	-1.396 Percentage of predicted FEV1
Placebo	Absolute Change From Baseline in Percent-predicted Forced Expiratory Volume in One Second (ppFEV1) at Week 48	-1.992 Percentage of predicted FEV1

p-value: 0.533695% CI: [-1.2881, 2.4813]Mixed-model, repeated-measures

Secondary

48-week Rate of Pulmonary Exacerbations

Pulmonary exacerbations were assessed using expanded Fuchs criteria. The expanded Fuchs exacerbation is defined as the presence of at least 4 of 12 Fuchs' signs and symptoms requiring treatment with any form of antibiotic treatment (inhaled, oral, or intravenous). Fuchs' signs and symptoms included increased cough; change in sputum volume, color, or consistency; new or increased hemoptysis; increased dyspnea during moderate or mild exertion, or at rest; sinus pain or tenderness; change in sinus discharge; malaise, fatigue, or lethargy; anorexia or weight loss; temperature above 38 degrees Celsius; change in findings on chest examination; relative 10% decrease in ppFEV1, and chest radiography results consistent with pulmonary infection. The 48-week rate was calculated as: 48-week rate = total number of events /treatment duration by week\*48.

Time frame: Week 48

Population: The ITT population included all randomized participants who had FEV1 data available at Baseline and at least one post-baseline visit.

Arm	Measure	Value (MEAN)	Dispersion
Ataluren	48-week Rate of Pulmonary Exacerbations	0.950 number of exacerbations per 48 weeks	Standard Deviation 1.4038
Placebo	48-week Rate of Pulmonary Exacerbations	1.127 number of exacerbations per 48 weeks	Standard Deviation 2.5241

p-value: 0.400895% CI: [0.5973, 1.2288]Negative binomial regression

Secondary

Change From Baseline in Body Mass Index (BMI) at Week 48

Malnutrition is common in participants with cystic fibrosis. The BMI is an important clinical measure of nutritional status.

Time frame: Baseline (Day 1) and Week 48

Population: The ITT population included all randomized participants who had FEV1 data available at Baseline and at least one post-baseline visit.

Arm	Measure	Value (LEAST_SQUARES_MEAN)
Ataluren	Change From Baseline in Body Mass Index (BMI) at Week 48	0.296 kilogram per meter square (kg/m^2)
Placebo	Change From Baseline in Body Mass Index (BMI) at Week 48	0.361 kilogram per meter square (kg/m^2)

p-value: 0.620895% CI: [-0.3233, 0.1934]Mixed-model, repeated measures

Secondary

Change From Baseline in the Cystic Fibrosis Questionnaire - Revised (CFQ-R) Respiratory Domain at Week 48

The teen/adult CFQ-R was used for this study. It was developed specifically for participants with cystic fibrosis. It is a disease-specific instrument designed to measure impact on overall health, daily life, perceived well-being, and symptoms. The respiratory domain assessed respiratory symptoms like coughing, congestion, wheezing etc. Scaling of each item is done via 4-point Likert scales. Scores for each item are summed up to generate a domain score. Scores ranges from 0 to 100, with higher scores indicating better health and lower scores indicating worse health.

Time frame: Baseline (Day 1) and Week 48

Population: The ITT population included all randomized participants who had FEV1 data available at Baseline and at least one post-baseline visit.

Arm	Measure	Value (LEAST_SQUARES_MEAN)
Ataluren	Change From Baseline in the Cystic Fibrosis Questionnaire - Revised (CFQ-R) Respiratory Domain at Week 48	-0.760 units on a scale
Placebo	Change From Baseline in the Cystic Fibrosis Questionnaire - Revised (CFQ-R) Respiratory Domain at Week 48	-1.032 units on a scale

p-value: 0.888195% CI: [-3.5292, 4.0731]Mixed-model, repeated measures

Secondary

Number of Participants With Abnormal Clinical Laboratory Parameters Reported as TEAEs

Clinical laboratory tests included haematology, biochemistry, and urinalysis. Participants with abnormal laboratory parameters who required clinical intervention or further investigation (beyond ordering a repeat \[confirmatory\] test) unless they are associated with an already reported clinical event are reported.