Arikace® for Nontuberculous Mycobacteria

This study is currently recruiting participants. (see Contacts and Locations)
Verified September 2013 by Insmed
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Insmed
ClinicalTrials.gov Identifier:
NCT01315236
First received: March 11, 2011
Last updated: September 3, 2013
Last verified: September 2013
  Purpose

Nontuberculous mycobacteria (NTM) are organisms common in the soil and in environmental and potable water, and have been associated with lung disease in select patient groups. Treatment requires lengthy multi-drug regimens that can be poorly tolerated and are often not very effective, especially in patients with severe disease or in those who have failed prior treatment attempts. There have been very few clinical trials to support current treatment recommendations and no new drugs have been assessed for this disease in many years.

Amikacin is an established antibiotic that is effective against a variety of NTM. However, intravenous amikacin treatment is limited by its systemic route of administration. Arikace®, liposomal amikacin for inhalation, is a sustained-release formulation of amikacin encapsulated inside very small liposomal carriers (fat particles) designed for administration via inhalation. This formulation allows for targeting the drug to the lungs and the site of disease. The purpose of this study is to determine whether Arikace® is effective in treating recalcitrant nontuberculous mycobacterial lung disease. The safety and tolerability of Arikace® in this patient population will also be assessed.


Condition Intervention Phase
Pulmonary Nontuberculous Mycobacterial Lung Disease
Drug: Liposomal amikacin for inhalation
Drug: placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized, Double-Blind, Placebo-Controlled Study of Liposomal Amikacin for Inhalation (Arikace®) in Patients With Recalcitrant Nontuberculous Mycobacterial Lung Disease

Resource links provided by NLM:


Further study details as provided by Insmed:

Primary Outcome Measures:
  • Change in semi-quantitative mycobacterial culture results from baseline to end of treatment [ Time Frame: 84 days ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Proportion of subjects with culture conversion to negative [ Time Frame: 84 days ] [ Designated as safety issue: Yes ]
  • Time to "rescue" anti-mycobacterial drugs [ Time Frame: 84 days ] [ Designated as safety issue: Yes ]
  • Change from baseline in 6-minute walk distance and oxygen saturation [ Time Frame: 84 days ] [ Designated as safety issue: Yes ]
  • Change from baseline in Patient Reported Outcomes [ Time Frame: 84 days ] [ Designated as safety issue: Yes ]
  • Evaluation of safety and tolerability [ Time Frame: For entire study duration ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 100
Study Start Date: May 2012
Estimated Study Completion Date: September 2013
Estimated Primary Completion Date: September 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arikace® Drug: Liposomal amikacin for inhalation
  • Liposomal amikacin for inhalation is provided as a sterile aqueous liposomal dispersion for inhalation via nebulization.
  • 560 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 84 days in the double-blind, randomized portion of the study.
  • Subjects can continue with 84 additional days of dosing in the open label extension.
Placebo Comparator: Placebo Drug: placebo
  • Placebo is provided as a sterile aqueous lipid dispersion for inhalation via nebulization.
  • Administration procedures, volume and administration time is the same as for Arikace™.
  • Placebo will be administered for 84 days only during the double-blind, randomized portion of the study.

Detailed Description:

This is a randomized, double-blind study evaluating the efficacy and safety of Arikace® administration compared to placebo for 84 days in subjects with recalcitrant non-tuberculous mycobacterial lung disease on a stable multi-drug regimen. Subjects will be randomized 1:1 to either 560 mg Arikace® or placebo administered once a day via a PARI Investigational eFlow® nebulizer. Subjects will visit the clinic about every 28 days for efficacy, safety and tolerability evaluations. At the conclusion of the double-blind portion of the study, subjects who have consented to additional treatment, will participate in an 84 day open label phase of once daily Arikace® treatment. A follow-up safety visit will occur 28 days after the conclusion of the open label treatment phase. Throughout the entire study, sputum, blood and urine specimens will be collected to assess drug concentrations in subjects who consent for Pharmacokinetic (PK) evaluation.

  Eligibility

Ages Eligible for Study:   18 Years to 85 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Key Inclusion Criteria:

  1. Diagnosis of pulmonary nontuberculous mycobacterial lung disease in accordance with the 2007 ATS/IDSA criteria with evidence of nodular bronchiectasis and/or cavitary disease by chest computed tomography (CT).
  2. History of chronic infection with either Mycobacterium avium complex or Mycobacterium abscessus or mixed infection with both species (defined as at least 2 documented positive cultures in the prior 2 years, of which at least one was obtained in the 6 months prior to screening).
  3. Positive sputum culture obtained at screening visit with either Mycobacterium avium complex or Mycobacterium abscessus or mixed infection with one dominant species.
  4. Receiving ATS/IDSA guidelines-based treatment regimen defined as: adherent to a multi-drug regimen for at least 6 months prior to screening with persistently positive mycobacterial cultures.
  5. Ability to produce at least 3 mL of sputum or be willing to undergo an induction that produces at least 3 mL of sputum for clinical evaluation.
  6. Female of childbearing potential agrees to practice an acceptable method of birth control (e.g., abstinence, hormonal or barrier methods, partner sterilization, or IUD).

Key Exclusion Criteria:

  1. Forced Expiratory Volume in 1 second (FEV1) <30% of predicted at Screening.
  2. Presence of any clinically significant cardiac disease as determined by Investigator. The QTc criteria for Exclusion is QTc> 450 msec for males or QTc> 470 msec for females.
  3. Subjects with hemoptysis of ≥60 mL in a 24 hour period within 4 weeks prior to screening.
  4. Active pulmonary malignancy (primary or metastatic) or any malignancy requiring chemotherapy or radiation therapy within one year prior to screening or anticipated during the study period.
  5. Active allergic bronchopulmonary mycosis or any other condition requiring systemic steroids at a dose ≥ equivalent of 10 mg/day of prednisone within 3 months prior to screening or anticipated during the study period.
  6. Pulmonary tuberculosis requiring treatment or treated within 2 years prior to screening.
  7. History of lung transplantation.
  8. Hypersensitivity to aminoglycosides.
  9. Any change in chronic NTM multi-drug regimen within 28 days prior to Study Day 1.
  10. Evidence of biliary cirrhosis with portal hypertension.
  11. History of daily, continuous oxygen supplementation.
  12. Smoking tobacco or any substance within 6 months prior to screening or anticipated inability to refrain from smoking throughout the study.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01315236

Contacts
Contact: Liza Micioni NTM@insmed.com

  Hide Study Locations
Locations
United States, Alabama
Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham Recruiting
Birmingham, Alabama, United States, 35233
Contact: Valerie Eubanks-Tam    205-558-2940    vetarn@peds.uab.edu   
Principal Investigator: Veena B Antony, M.D.         
United States, California
Stanford University Recruiting
Stanford, California, United States, 94305
Contact: Susan Jacobs    650-725-8082    ssjpulm@stanford.edu   
Principal Investigator: Stephen Ruoss, M.D.         
United States, Colorado
National Jewish Health Recruiting
Denver, Colorado, United States, 80206
Contact: Kim McPeak    303-398-1708    mcpeakk@NJHealth.org   
Principal Investigator: Charles Daley, MD         
United States, District of Columbia
Georgetown University Medical Center Recruiting
Washington, District of Columbia, United States, 20007
Contact: Michele Cooney    202-444-4982    cooneyd@georgetown.edu   
Principal Investigator: Anne E O'Donnell, M.D.         
United States, Florida
University of Florida Pulmonary Division Recruiting
Gainsville, Florida, United States, 32610
Contact: Christina Eagan    352-273-8990    Christina.Eagan@medicine.ufl.edu   
Principal Investigator: Kevin P Fennelly, MD, MPH         
University of Miami Miller School of Medicine Recruiting
Miami, Florida, United States, 33136
Contact: Fernando Cubillos    305-243-5545    fcubillos@med.miami.edu   
Principal Investigator: Matthias Salathe, M.D.         
Tampa General Hospital Recruiting
Tampa, Florida, United States, 33606
Contact: Suzanne Roberson    813-844-7179    sroberson@tgh.org   
Principal Investigator: Mark Rolfe, MD, FCCP         
United States, Kansas
University of Kansas Medical Center Recruiting
Kansas City, Kansas, United States, 66160
Contact: Adam Schooley    913-588-4022    aschooley@kumc.edu   
Principal Investigator: Joel Mermis, M.D.         
United States, Maryland
Nih/Niaid Recruiting
Bethesda, Maryland, United States, 20892
Contact: Charles Fiorentino    301-443-5447    fiorentinoc@niaid.nih.gov   
Contact: Andrea Henkel       andrea.henkel@niaid.nih.gov   
Principal Investigator: Kenneth Olivier, MD, MPH         
United States, Minnesota
Mayo Clinic College of Medicine, Division of Pulmonary and Critical Care Medicine Recruiting
Rochester, Minnesota, United States, 55905
Contact: Kathy Mieras    507-284-9187    mieras.kathleen@mayo.edu   
Principal Investigator: Timothy R Aksamit, M.D.         
United States, New York
NYU School of Medicine Recruiting
New York, New York, United States, 10016
Contact: Stephanie Lau    212-263-7951    stephanie.lau@nyumc.org   
Principal Investigator: Doreen J Addrizzo-Harris, M.D.         
United States, North Carolina
University of North Carolina School of Medicine Recruiting
Chapel Hill, North Carolina, United States, 27599
Contact: Sharikia Burt    919-966-2531    Sharikia_Burt@med.unc.edu   
Principal Investigator: Peader Noone, M.D.         
United States, Ohio
Rainbow Babies and Children's Hospital Recruiting
Cleveland, Ohio, United States, 44106
Contact: David Weaver    216-844-1841    david.weaver@uhhospitals.org   
Contact: Colette Bucur    216-844-1902    colette.bucur@uhhospitals.org   
Principal Investigator: James Chimel, M.D.         
United States, Oregon
Oregon Health and Science University Recruiting
Portland, Oregon, United States, 97239
Contact: Jennifer Ku    503-494-1384    kuj@ohsu.edu   
Principal Investigator: Kevin Winthrop, M.D.         
United States, Pennsylvania
University of Pennsylvania Medical Center Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Lisa Gardo    215-615-0276    Lisa.Gardo@uphs.upenn.edu   
Contact: Victoria Fleck    215-662-3115    fleckv@uphs.upenn.edu   
Principal Investigator: Daniel Dorgan, M.D.         
United States, South Carolina
Medical University of South Carolina Recruiting
Charleston, South Carolina, United States, 29425
Contact: Ashley Jones    843-792-4349    jonesash@musc.edu   
Principal Investigator: Patrick A Flume, MD, FCCP         
United States, Texas
The University of Texas Health Science Center at Tyler Recruiting
Tyler, Texas, United States, 75708
Contact: Jan Hoeft, RN    903-877-5518    Janice.hoeft@uthct.edu   
Contact: Mike Lay       Michael.lay@uthct.edu   
Principal Investigator: David Griffith, M.D.         
United States, Wisconsin
Medical College of Wisconsin and Froedtert Hospital Recruiting
Milwaukee, Wisconsin, United States, 53226
Contact: Rachel Harris    414-955-7030    racharris@mcw.edu   
Principal Investigator: Julie Biller, M.D.         
Canada, Ontario
Toronto Western Hospital Recruiting
Toronto, Ontario, Canada, M5T 2S8
Contact: Pearl Latty, BSc    416-603-5489    platty@uhnres.utoronto.ca   
Principal Investigator: Theodore Marras, M.D.         
Sponsors and Collaborators
Insmed
  More Information

No publications provided

Responsible Party: Insmed
ClinicalTrials.gov Identifier: NCT01315236     History of Changes
Other Study ID Numbers: TR02-112
Study First Received: March 11, 2011
Last Updated: September 3, 2013
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Lung Diseases
Respiratory Tract Diseases
Amikacin
Anti-Bacterial Agents
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions

ClinicalTrials.gov processed this record on August 18, 2014