Clinical trial NCT00775138: Safety and Tolerability Study of 2 Dose Level of Arikayce™ in Patients With Bronchiectasis and Chronic Infection Due to Pseudomonas Aeruginosa.
Official title: A Placebo Controlled, Randomized, Parallel Cohort, Safety And Tolerability Study Of 2 Dose Levels Of Liposomal Amikacin For Inhalation (Arikayce™) In Patients With Bronchiectasis Complicated By Chronic Infection Due To Pseudomonas Aeruginosa.
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Bronchiectasis
Keywords: Bronchiectasis
Respiratory Infections
Amikacin
Respiratory Tract Diseases
Respiratory Tract Infections
Lung Diseases
Pseudomonas aeruginosa
Amikacin liposome inhalation suspension (ALIS)
Lead sponsor: Insmed Incorporated
Sponsor class: INDUSTRY
First posted: 2008-10-17
Enrollment: 64
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a study to determine the safety and tolerability of 28 days of daily dosing of two doses (280 mg and 560 mg) of Arikayce™ versus placebo in patients who have bronchiectasis and chronic infection due to Pseudomonas infection.

Detailed description: Bronchiectasis is a chronic disorder of the major bronchi and bronchioles characterized by permanent dilation, microbial infection, a persistent inflammatory response with the release of immune mediators and microbial toxins leading to destruction. The origin of bronchiectasis varies, but the presence of microbial infection and a persistent inflammatory response is typical of the disease. The chronic nature of the infection and the associated considerable morbidity provides the rationale for using aerosolized antibiotics for the treatment of bronchiectasis patients.

This is a multi-national Phase 2 study of safety and tolerability of 28 days of daily dosing with two dose levels (280 mg and 560 mg) of Arikayce™ versus placebo in subjects with bronchiectasis and chronic Pseudomonas infection. Study subjects will be randomized to receive either study drug or placebo by inhalation via a PARI eFlow® nebulizer. Each subject will complete 28 days of daily dosing. All study subjects will be followed for microbiologic activity for 14 days after completion of treatment and for safety for 28 days post completion of study treatment.

The total study duration will be 56 days, with the screening visit occurring within the preceding 14 days prior to study day 1. At Day 1 (baseline), subjects will be evaluated at pre-dose and during the first 4-5 hours post-dose. Subjects will return at Week 2 (day 14) after start of treatment and at the end of Week 4 (Day 28) treatment period to determine safety and efficacy of Arikayce™. Subjects will be followed up on study Days 42 and 56 (about 2 and 4 weeks after end of treatment) for safety determination. After completion of this study, subjects will be followed up for an additional 6 months via phone contacts and records review, if hospitalized or treated for pulmonary exacerbation (under the extension protocol).

Clinical laboratory parameters, audiology testing, clinical adverse events and pulmonary function will be evaluated for all study subjects in order to determine the qualitative and quantitative safety and tolerability of Arikayce™ compared to placebo. Serum, urine and sputum specimens will be collected at periodic intervals to assess pharmacokinetics (PK) in subjects who consent for the PK portion of the study. Additionally, sputum samples will be collected to determine changes in bacterial density. Total Pulmonary Symptom Severity Score (PSSS) will be assessed, and respiratory quality of life will be evaluated by using the St. George's Respiratory Questionnaire (SGRQ). Arikace™,Arikayce™, Liposomal Amikacin for Inhalation (LAI), and Amikacin Liposome Inhalation Suspension (ALIS) may be used interchangeably throughout this study and the other studies evaluating amikacin liposome inhalation suspension.

Eligibility criteria: Inclusion Criteria:

* Male or female study subjects≥ 18 years of age
* Confirmed diagnosis of multi-focal bronchiectasis in two or more lung segments by HRCT of the chest
* History of chronic infection with P. aeruginosa
* Confirmation of infection with P. aeruginosa at screening
* SaO2 ≥ 90% at Screening while breathing room air
* Ability to comply with study medication use, study visits, and study procedures as judged by the investigator
* Ability to produce at least 0.5 grams sputum or be willing to undergo an induction to produce sputum for clinical evaluation

Key Exclusion Criteria:

* Forced Expiratory Volume in 1 second (FEV1) \< 50% of predicted at Screening
* Patients with hemoptysis of ≥60 mL within 4 weeks prior to screening
* Bronchiectasis due to cystic fibrosis (CF), bronchopulmonary Aspergillus, aspiration of foreign body, or secondary to lung compression from tumors
* History of non-tuberculous mycobacterial and/or Aspergillus infection requiring treatment or treated within 2 years prior to screening
* Pulmonary tuberculosis requiring treatment or treated within two years prior to screening
* History of Lung transplantation
* Use of any inhalation or systemic antibiotics (IV antibiotics, or oral antibiotics) within 4 weeks prior to Study Day 1
* Evidence of biliary cirrhosis with portal hypertension
* Smoking tobacco or any substance within 6 months prior to screening, and throughout the study
* History of alcohol, medication, or illicit drug abuse within the 1 year prior to screening

Primary outcomes:
measure: Number of Participants Reporting Treatment-emergent AEs (TEAEs) up to End of Treatment
timeFrame: Day 1 through 56.
measure: Treatment-emergent Marked Laboratory Abnormalities up to 28 Days After Study Medication Discontinuation
timeFrame: Day 1 through 56.
measure: Treatment-emergent Pulmonary Function Test (PFT) for Acute Tolerability Assessment
timeFrame: Pre-dose, 0-1 hour post-dose and 2-4 hours post-dose on day 1, 0-1 hour post-dose and 2-4 hours post-dose on day 14, and 0-1 hour post-dose and 2-4 hours post-dose on day 28
measure: Treatment-emergent PFT Abnormalities up to the End of Study
timeFrame: Day 1, Day 14 and Day 28
measure: Number of Subjects With an Adverse Event Leading to Permanent Discontinuation of Study Medication
timeFrame: Screening to Day 56
measure: Serious Adverse Events up to 28 Days After Study Medication Discontinuation
timeFrame: Screening to Day 56
Secondary outcomes:
measure: Change From Baseline in Log10CFU Per Gram (Density) of Pseudomonas Aeruginosa in Sputum.
timeFrame: Baseline to Day 14, Day 28 and Day 42.
measure: Total Pulmonary Symptom Severity Score (PSSS)
timeFrame: Baseline to Day 14, Day 28, Day 42 and Day 56.
measure: To Evaluate Change in St. George's Respiratory Questionnaire Measurements
timeFrame: Day 1 to Day 14, Day 28, Day 42 and Day 56.
measure: To Evaluate the Use of Systemic Antipseudomonal Rescue Therapy
timeFrame: Screening to Day 56.
Other outcomes:
Locations:
city: Washington
country: United States
state: District of Columbia
city: Philadelphia
country: United States
state: Pennsylvania
city: Sofia
country: Bulgaria
city: Athens
country: Greece
city: Mosdos
country: Hungary
city: Bangalore
country: India
city: Hyderabad
country: India
city: Manipal
country: India
city: Mumbai
country: India
city: Nagpur
country: India
city: New Delhi
country: India
city: Rabka Zdrój
country: Poland
city: Belgrade
country: Serbia
city: Kragujevac
country: Serbia
city: Nis
country: Serbia
city: Kiev
country: Ukraine
city: Cambridge
country: United Kingdom
city: London
country: United Kingdom
Study officials:
affiliation: Insmed Incorporated
name: Gina Eagle, MD
role: STUDY_DIRECTOR
References: