Study to Assess the Safety and PK of Oral and IV Xenleta in Adults With Cystic Fibrosis

A Phase 1, Open-Label, Randomized, Crossover Study to Assess the Safety and Pharmacokinetics Following Single Doses of Oral and Intravenous Xenleta (Lefamulin) in Adult Patients With Cystic Fibrosis

Status

Completed

Phases

Phase 1

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT05225805

Enrollment

Registered

2022-02-07

Start date

2022-03-01

Completion date

2023-01-13

Last updated

2024-06-17

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 study is intended to assess the pharmacokinetic (PK) and safety of a single dose of IV and oral formulations of lefamulin in adults with cystic fibrosis (CF).

Detailed description

Staphylococcus aureus is one of the most common causative pathogens associated with exacerbations of CF. Current treatment guidelines for the management of exacerbations of CF caused by S. aureus recommend the use of unapproved antibacterial agents. Further, many of the recommended treatments can only be administered via the IV route and/or have limitations due to safety and tolerability. Lefamulin is a novel, first-in-class, IV and oral pleuromutilin antimicrobial agent that has been demonstrated to be highly potent against S. aureus, including Methicillin-resistant Staphylococcus aureus (MRSA) and strains obtained from patients with CF. Cystic fibrosis patients have altered drug distribution and elimination kinetics for many antimicrobials relative to patients without CF. While the advent of Cystic fibrosis transmembrane conductance regulator (protein) (CFTR) modulators has resulted in improved lung function and had a positive impact on the quality of life of CF patients, limited data have been published describing the impact of the concomitant use of CFTR modulators and commonly used antibacterial agents.

Interventions

DRUGLefamulin

Antibiotic

Study design

Allocation

RANDOMIZED

Intervention model

CROSSOVER

Primary purpose

OTHER

Masking

NONE

Intervention model description

Open-label, Crossover Study

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

1. Signed informed consent. 2. Adult patients, ≥ 18 years of age. 3. Genetic confirmation of CF diagnosis by a report from a genetic test, such as F508 deletion detected. 4. Weight \> 40 kgs. 5. Forced expiration volume (FEV)1 \> 40% predicted, as measured during the most recent evaluation. 6. Mentally and physically able to participate in the study as determined by the Investigator, ie, clinically stable with no significant changes in health status within 28 days prior to, and including, Day 1. 7. Vital signs within the following ranges: 1. Tympanic temperature, \< 38°C 2. Systolic blood pressure, 90 to 160 mmHg 3. Diastolic blood pressure, 50 to 90 mmHg 4. Heart rate \< 100 beats per minute at rest 5. Respiration rate 12 to 20 breaths per minute 6. Oxygen saturation to be documented. No selection criteria; supplemental oxygen use is acceptable. 8. Negative beta-human chorionic gonadotropin (β-hCG) urine or serum pregnancy test for females of childbearing potential. 9. Willing to commit to acceptable methods of contraception as defined in the protocol.

Exclusion criteria

1. Known history of chronic liver or biliary disease, Gilbert's syndrome, or any of the following at Screening: aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \> 2 x upper limit of normal (ULN), total bilirubin \> 1.5 x ULN. 2. Prolonged baseline corrected QT interval corrected according to Fridericia (QTcF) defined as \> 440 ms (females) and \> 430 ms (males). 3. Family history or presence of prolonged QTc syndrome, Torsades de Pointes, or known conduction defects (eg, bundle branch block, atrioventricular block). 4. Use of Orkambi® (lumacaftor/ivacaftor) within 28 days prior to Day 1. 5. Use of cytochrome P450 (CYP)3A substrates that prolong the QT interval within 24 hours prior to Day 1. 6. Use of strong and moderate Cytochrome P450 (CYP3A) inducers or P-glycoprotein (P-gp) inducers within 28 days prior to Day 1. 7. Use of strong inhibitors of CYP3A4 within 24 hours prior to Day 1. 8. Serum potassium level below the normal reference range at Screening. 9. Known allergy to pleuromutilin class of antibiotic or any of the excipients of the lefamulin formulations. 10. Consumption of grapefruit, grapefruit juice, grapefruit products, pomelo, or Seville oranges within 24 hours before Day 1. 11. Use of vaporized nicotine or cannabidiol products, smoking (regularly or intermittently) more than 5 cigarettes (or equivalent) per day, or any use of tobacco other than in cigarettes or cigars within 28 days of Day 1. 12. Positive blood test for hepatitis C, human immunodeficiency virus (HIV), or hepatitis B antigen or core antibody (indicating active infection). 13. Positive test for drugs of abuse or alcohol at Screening or Day 1 that cannot be satisfactorily supported by medical history. 14. Use of an investigational product within the 30 days prior to Day 1 (3 months prior to Day 1 if the study drug was a new chemical entity). 15. Difficulty swallowing tablets. 16. Females who are pregnant or breastfeeding. 17. Does not have suitable venous access for multiple venipuncture or cannulation. 18. Any medical, psychological, cognitive, social, or legal conditions that, in the opinion of the Investigator, would interfere with the patient's ability to give an informed consent and/or participate fully in the study. 19. Any other reason, in the opinion of the Investigator, the patient is unsuitable to participate.

Design outcomes

Primary

Measure	Time frame	Description
The Key Geometric Mean for Lefamulin and Its Main Metabolite BC-8041 for PK Plasma Parameter t1/2 in CF Patients.	Pre-dose, 0.5 hr, 1 hr, 1.5 hrs, 2 hrs, 4 hrs, 8 hrs, 12 hrs & 24 hrs Post-dose	Appropriate non-compartmental techniques will be used to obtain estimates for thr PK parameter t1/2 in plasma for lefamulin and its metabolite BC-8041. Apparent elimination half-life calculated as ln(2)/ke (t½)
The Median for Lefamulin and Its Main Metabolite BC-8041 for PK Plasma Parameter Tmax in Cystic Fibrosis (CF) Patients.	Pre-dose, 0.5 hr, 1 hr, 1.5 hrs, 2 hrs, 4 hrs, 8 hrs, 12 hrs & 24 hrs Post-dose	Appropriate non-compartmental techniques were used to obtain estimates for the PK parameter Tmax in plasma for lefamulin and its metabolite BC-8041. Time to reach maximum plasma concentration of lefamulin following drug administration (Tmax) Tmax will be determined by direct inspection of the concentration versus time data by WinNonlin.
The Key Geometric Mean for Lefamulin and Its Main Metabolite BC-8041 for PK Plasma Parameter Cmax in CF Patients.	Pre-dose, 0.5 hr, 1 hr, 1.5 hrs, 2 hrs, 4 hrs, 8 hrs, 12 hrs & 24 hrs Post-dose	Appropriate non-compartmental techniques will be used to obtain estimates for the PK parameter Cmax in plasma for lefamulin and its metabolite BC-8041. Maximum observed plasma concentration (Cmax) Cmax was determined by direct inspection of the concentration versus time data by WinNonlin.
The Key Geometric Mean for Lefamulin and Its Main Metabolite BC-8041 for PK Plasma Parameter AUC(0-last) in CF Patients.	Pre-dose, 0.5 hr, 1 hr, 1.5 hrs, 2 hrs, 4 hrs, 8 hrs, 12 hrs & 24 hrs Post-dose	Appropriate non-compartmental techniques will be used to obtain estimates for the PK parameter (AUC0-last) in plasma for lefamulin and its metabolite BC-8041. AUC calculations will be performed using the linear/log trapezoidal rule. AUC0-last will be calculated between t0hr and the last measurable concentration. Area under the drug concentration curve from time zero (0 h) to 24 h (AUC0-last)
The Key Geometric Mean for Lefamulin and Its Main Metabolite BC-8041 for PK Plasma Parameter AUC(0-inf) in CF Patients.	Pre-dose, 0.5 hr, 1 hr, 1.5 hrs, 2 hrs, 4 hrs, 8 hrs, 12 hrs & 24 hrs Post-dose	Appropriate non-compartmental techniques will be used to obtain estimates for PK parameter AUC(0-inf) in plasma for lefamulin and its metabolite BC-8041. AUC calculations will be performed using the linear/log trapezoidal rule. AUC(0-inf) will be will be calculated between t0hr and infinity. Area under the drug concentration curve from time zero (0 h) to infinity (AUC(0-inf)

Countries

United States

Participant flow

Recruitment details

This study was conducted at multiple investigative sites in United States.

Pre-assignment details

A total of 13 subjects (4 females, 9 males) was enrolled in the study and treated in the study NAB-BC-3781-1014. One subject failed screening.

Participants by arm

Arm	Count
Group A (IV-Oral) Group A will receive single dose of lefamulin 150 mg IV infusion in 250 mL citrate buffered saline over 1 hour followed by lefamulin 600-mg immediate-release (IR) tablet orally in the fasted state. Lefamulin: Antibiotic	6
Group B (Oral-IV) Group B will receive single dose of lefamulin 600 mg immediate-release (IR) tablet orally in the fasted state followed by single dose of lefamulin 150 mg IV infusion in 250 mL citrate buffered saline over 1 hour. Lefamulin: Antibiotic	7
Total	13

Baseline characteristics

Characteristic	Group A (IV-Oral)	Total	Group B (Oral-IV)
Age, Continuous	27.0 Years STANDARD_DEVIATION 11.14	29.2 Years STANDARD_DEVIATION 9.84	31.1 Years STANDARD_DEVIATION 9.01
Ethnicity (NIH/OMB) Hispanic or Latino	0 Participants	0 Participants	0 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	6 Participants	13 Participants	7 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Asian	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Black or African American	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) More than one race	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) White	6 Participants	13 Participants	7 Participants
Sex: Female, Male Female	1 Participants	4 Participants	3 Participants
Sex: Female, Male Male	5 Participants	9 Participants	4 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk	EG002 affected / at risk
deaths Total, all-cause mortality	0 / 13	0 / 13	0 / 13
other Total, other adverse events	4 / 13	4 / 13	6 / 13
serious Total, serious adverse events	0 / 13	0 / 13	0 / 13

Outcome results

Primary

The Key Geometric Mean for Lefamulin and Its Main Metabolite BC-8041 for PK Plasma Parameter AUC(0-inf) in CF Patients.

Appropriate non-compartmental techniques will be used to obtain estimates for PK parameter AUC(0-inf) in plasma for lefamulin and its metabolite BC-8041. AUC calculations will be performed using the linear/log trapezoidal rule. AUC(0-inf) will be will be calculated between t0hr and infinity. Area under the drug concentration curve from time zero (0 h) to infinity (AUC(0-inf)

Time frame: Pre-dose, 0.5 hr, 1 hr, 1.5 hrs, 2 hrs, 4 hrs, 8 hrs, 12 hrs & 24 hrs Post-dose