Study of Ataluren (PTC124™) in Cystic Fibrosis

Cystic Fibrosis Clinical Trial

Official title:

A Phase 3 Efficacy and Safety Study of PTC124 as an Oral Treatment for Nonsense-Mutation-Mediated Cystic Fibrosis

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00803205
• Other study ID #: PTC124-GD-009-CF
• Secondary ID: Orphan Product G
• Status: Completed
• Phase: Phase 3
• Start date: September 8, 2009
• Est. completion date: November 12, 2011

Study information

• Verified date: May 2020
• Source: PTC Therapeutics
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Cystic fibrosis (CF) is a genetic disorder caused by a mutation in the gene that makes the cystic fibrosis transmembrane conductance regulator (CFTR) protein. A specific type of mutation called a nonsense (premature stop codon) mutation is the cause of CF in approximately 10% of patients with the disease. Ataluren is an orally delivered investigational drug that has the potential to overcome the effects of the nonsense mutation. This study is a Phase 3 trial that will evaluate the clinical benefit of ataluren in adult and pediatric participants with CF due to a nonsense mutation. The main goals of the study are to understand whether ataluren can improve pulmonary function and whether the drug can safely be given for a long period of time. The study will also assess the effects of ataluren on CF pulmonary exacerbation frequency, cough frequency, health-related quality of life, antibiotic use for CF-related infections, CF-related disruptions to daily living, body weight, and CF pathophysiology.

Description:

This study is a Phase 3, multicenter, randomized, double-blind, placebo-controlled, efficacy and safety study, designed to document the clinical benefit of ataluren when administered as therapy of participants with CF due to a nonsense mutation (premature stop codon) in the CFTR gene. It is planned that ~208 participants who are ≥6 years of age and have a forced expiratory volume in 1 second (FEV1) ≥40% and ≤90% of predicted will be enrolled. Study participants will be enrolled at sites in North America, Europe, and Israel. They will be randomized in a 1:1 ratio to either ataluren or placebo. Participants will receive study drug 3 times per day (at morning, midday, and evening) for 48 weeks. Participants will be evaluated at clinic visits every 8 weeks. Additional safety laboratory testing, which may be performed at the investigational site or at an accredited local laboratory or clinic, is required every 4 weeks for the first 6 months of study participation. At the completion of blinded treatment, all compliant participants will be eligible to receive open-label ataluren in a separate extension study.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 238
• Est. completion date: November 12, 2011
• Est. primary completion date: November 12, 2011
• Accepts healthy volunteers: No
• Gender: All
• Age group: 6 Years and older

Eligibility

Inclusion Criteria:

• Ability to provide written informed consent (parental/guardian consent and participant assent if <18 years of age)

• Age =6 years

• Body weight =16 kg

• Abnormal nasal transepithelial potential difference (TEPD) total chloride conductance (a less electrically negative value than -5 millivolts (mV) for total chloride conductance [?chloride-free+isoproterenol])

• Sweat chloride >40 milliequivalents/liter (mEq/L)

• Documentation of the simultaneous presence of a nonsense mutation in at least 1 allele of the CFTR gene and a CF-causing mutation in the other CFTR allele, as determined by gene sequencing from a laboratory certified by the College of American Pathologists (CAP), under the Clinical Laboratory Improvement Act/Amendment (CLIA), or by an equivalent organization

• Verification that a blood sample has been drawn for confirmation of the presence of a nonsense mutation in 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 for age, gender, and height

• Resting oxygen saturation (as measured by pulse oximetry) =92% on room air

• Documentation by VivoMetrics that the participant has satisfactorily completed a 24-hour LifeShirt® cough frequency assessment

• Confirmed screening laboratory values within the central laboratory ranges (hepatic, adrenal, renal, serum electrolytes, and reproduction [women only] parameters)

• In participants 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 4-week follow-up period

• Willingness and ability to comply with scheduled visits, drug administration plan, study restrictions, and study procedures

Exclusion Criteria:

• Known hypersensitivity to any of the ingredients or excipients of the study drug

• Any change (initiation, change in type of drug, dose modification, schedule modification, interruption, discontinuation, or reinitiation) in a chronic treatment/prophylaxis regimen for CF or for CF-related conditions within 4 weeks prior to start of study treatment

• Exposure to another investigational drug within 4 weeks prior to start of study treatment

• Treatment with systemic aminoglycoside antibiotics at the time of the Baseline TEPD assessment

• Treatment with intravenous antibiotics within 3 weeks prior to start of study treatment

• History of solid organ or hematological transplantation

• Ongoing immunosuppressive therapy (other than corticosteroids)

• Ongoing warfarin, phenytoin, or tolbutamide therapy

• Ongoing participation in any other therapeutic clinical trial

• Major complications of lung disease (including massive hemoptysis, pneumothorax, or pleural effusion) within 8 weeks prior to start of study treatment

• Evidence of pulmonary exacerbation or acute upper or lower respiratory tract infection (including viral illnesses) within 3 weeks prior to randomization

• 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 * number of years smoked)

• Prior or ongoing medical condition (for example, concomitant illness, alcoholism, drug abuse, psychiatric condition), medical history, physical findings, electrocardiography findings, or laboratory abnormality that, in the Investigator's opinion, could adversely affect the safety of the participant, makes it unlikely that the course of treatment or follow-up would be completed, or could impair the assessment of study results.

Related Conditions & MeSH terms

• Cystic Fibrosis
• Fibrosis

Intervention

Drug:
• Ataluren
Ataluren will be provided as a vanilla-flavored powder to be mixed with water.
• Placebo
Placebo matching to ataluren will be provided.

Locations

Country	Name	City	State
Belgium	Hôpital Erasme	Brussels
Belgium	Hôpital Universitaire des Enfants Reine Fabiola	Brussels
Belgium	University Hospital Brussels	Brussels
Belgium	University Hospital Leuven	Leuven
Canada	University of Toronto	Toronto
France	Hôpital Cochin	Paris
France	Hôpital Necker - Enfants Malades	Paris
France	Hôpital des Enfants	Toulouse
Germany	Klinikum der Universität Köln	Köln
Israel	Hadassah University Hospital - Mount Scopus	Jerusalem
Italy	Università La Sapienza	Rome
Italy	Azienda Ospedaliera di Verona	Verona
Netherlands	Universitair Medisch Centrum Utrecht	Utrecht
Spain	Hospital Universitario La Paz	Madrid
Sweden	Karolinska University Hospital, Huddinge	Stockholm
United Kingdom	Belfast City Hospital	Belfast
United Kingdom	Alder Hey Children's Hospital	Liverpool
United States	Emory University Cystic Fibrosis Center	Atlanta	Georgia
United States	The Children's Hospital	Aurora	Colorado
United States	Johns Hopkins Children's Center	Baltimore	Maryland
United States	University of Alabama-Birmingham	Birmingham	Alabama
United States	Children's Hospital Boston	Boston	Massachusetts
United States	University of North Carolina	Chapel Hill	North Carolina
United States	Children's Memorial Hospital	Chicago	Illinois
United States	Rainbow Babies & Children's Hospital	Cleveland	Ohio
United States	University of Iowa	Iowa City	Iowa
United States	Miller Children's Hospital Long Beach	Long Beach	California
United States	Miami Children's Hospital	Miami	Florida
United States	University of Miami	Miami	Florida
United States	Beth Israel Medical Center	New York	New York
United States	Lucile Packard Children's Hospital	Palo Alto	California
United States	Stanford	Palo Alto	California
United States	Childrens Hospital of Pittsburgh	Pittsburgh	Pennsylvania
United States	Washington University	Saint Louis	Missouri
United States	Rady Children's Hospital - San Diego	San Diego	California
United States	University of Washington	Seattle	Washington
United States	University of Texas	Tyler	Texas
United States	New York Medical College	Valhalla	New York

Sponsors (2)

Lead Sponsor	Collaborator
PTC Therapeutics	Cystic Fibrosis Foundation

Countries where clinical trial is conducted

United States,  Belgium,  Canada,  France,  Germany,  Israel,  Italy,  Netherlands,  Spain,  Sweden,  United Kingdom, 

References & Publications (1)

Kerem E, Konstan MW, De Boeck K, Accurso FJ, Sermet-Gaudelus I, Wilschanski M, Elborn JS, Melotti P, Bronsveld I, Fajac I, Malfroot A, Rosenbluth DB, Walker PA, McColley SA, Knoop C, Quattrucci S, Rietschel E, Zeitlin PL, Barth J, Elfring GL, Welch EM, Br — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Percentage of Participants With Treatment-Emergent Adverse Events (TEAE)	A TEAE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship that occurred or worsened in the period extending from first dose of study drug to 4 weeks after the last dose of study drug. A serious adverse event (SAE) was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. AEs included both SAEs and non-serious AEs. AE severity was graded as follows: Grade 1: mild; Grade 2: moderate; Grade 3: severe; Grade 4: life-threatening; Grade 5: fatal. A TEAE was considered related if in the opinion of the Investigator it was possibly or probably caused by the study drug. A summary of other non-serious AEs and all SAEs, regardless of causality is located in the Adverse Events module.	Baseline up to 4 Weeks Post-Treatment (Week 52) or Premature Discontinuation (PD)
Other	Rate of Study Drug Compliance by Drug Accountability	Study drug compliance was assessed by using a Pharmacy Subject Study Drug Accountability Log (completed by the investigational site personnel). The rate of compliance was defined as 100 * (number of sachets taken/number of planned sachets) during the study. All calculations were based on the records of the first dose date to the last dose date. To differentiate dose strengths while maintaining the blind, each kit had a unique kit number and had prominent lettering "A" and "B." Each kit contained 65 packets of 1 of the dose strengths (125, 250, or 1000 mg or matching placebo). Labeling for active drug and placebo was identical.	Baseline up to EOT (Week 48)
Other	Rate of Study Drug Compliance by Patient-Reported Data	Patient-reported data were obtained from the participant's electronic daily diary, which was completed by the participant or the caregiver. During study treatment, the electronic daily diary was to be completed by the participant or caregiver each day for each dose. For each participant, compliance is described in terms of the percentage of study drug actually taken. All calculations were based on the records of the first dose date to the last dose date. To differentiate dose strengths while maintaining the blind, each kit had a unique kit number and had prominent lettering "A" and "B." Each kit contained 65 packets of 1 of the dose strengths (125, 250, or 1000 mg or matching placebo). Labeling for active drug and placebo was identical.	Baseline up to EOT (Week 48)
Other	Concentration of Ataluren	Blood samples were drawn immediately before administration of the first daily dose (dose taken with breakfast) of study drug and 2 hours after the first daily dose. Whenever possible, the pre-dose sample was to be obtained within 15 minutes of drug administration. Participants in the Placebo arm did not receive Ataluren and are not included in this Outcome Measure.	Predose and 2 Hours Postdose at Week 1, Week 16, Week 32, EOT (Week 48)
Other	Rate of Interventions for Respiratory Symptoms	During treatment, any intervention including hospitalization or use of oral, inhaled, or intravenous antibiotics was documented if it was due to an exacerbation-like episode. Participants and caregivers recorded interventions in an electronic diary. The rate of interventions was defined as the total days with interventions divided by the total study duration.	Baseline up to EOT (Week 48)
Other	Rate of Disruptions in Activities of Daily Living Because of Pulmonary Symptoms	During treatment, any disruption in the activities of daily living, such as missed school or work, was documented if it was due to an exacerbation-like episode. Participants and caregivers recorded all disruptions in an electronic diary. The rate of disruptions was defined as the total days with disruptions to daily living divided by the total study duration.	Baseline up to EOT (Week 48)
Other	Change From Baseline in Body Weight at Week 48	Participants were weighed, and the weight was recorded at Baseline and then every 8 weeks during the treatment period. Baseline was the latest valid assessment prior to the treatment. A positive change from Baseline indicates that weight increased.	Baseline, EOT (Week 48)
Other	Change From Baseline in the Concentration of Interleukin-8 (IL-8) in Serum and Sputum at Week 48	Expression of IL-8 was measured in serum and in sputum. Sputum was spontaneously produced and tested by using standardized procedures developed by the Cystic Fibrosis Foundation Therapeutics, Inc. Therapeutics Development Network (CFFT-TDN). Baseline was the latest valid assessment prior to the treatment. A negative change from Baseline indicates that the concentration of IL-8 decreased.	Baseline, EOT (Week 48)
Other	Change From Baseline in the Concentration of Neutrophil Elastase in Sputum at Week 48	Expression of neutrophil elastase was measured in sputum. Sputum was spontaneously produced and tested by using standardized procedures developed by the CFFT-TDN. Baseline was the latest valid assessment prior to the treatment. A positive change from Baseline indicates that the concentration of neutrophil elastase increased.	Baseline, EOT (Week 48)
Other	Change From Baseline in the Concentration of C-Reactive Protein (CRP) in Serum at Week 48	Expression of CRP was measured in serum. Baseline was the latest valid assessment prior to the treatment. A positive change from Baseline indicates that CRP concentration increased.	Baseline, EOT (Week 48)
Other	Change From Baseline in the Total Lung Score as Assessed by Computed Tomography (CT) at Week 48	Lungs were imaged by using non-contrast, spiral CT. The total lung score for each CT scan was established by the sum of 5 characteristics from the Brody scoring system, with scores ranging from 0 to 40.5, with lower scores indicating better lung function. The characteristics scored were bronchiectasis (score range 0 - 12), mucus plugging (score range 0- 6), peribronchial thickening (score range 0 - 9), parenchyma (score range 0 - 9), and hyperinflation (score range 0 - 4.5). Baseline was the latest valid assessment prior to the treatment. A positive change from Baseline indicates that lung function worsened.	Baseline, EOT (Week 48)
Other	Change From Baseline in Total Nasal Chloride Transport as Assessed by Transepithelial Potential Difference (TEPD) at Week 48	TEPD was assessed in each nostril using standardized equipment, techniques, and solutions. Assessments were made on the nasal epithelium cells lining the inferior turbinate. Warmed solutions of Ringer's solution, amiloride, chloride-free gluconate, isoproterenol, and adenosine triphosphate (ATP) were perfused for =3-minute sequentially through a nasal catheter while a voltage tracing was recorded. Total chloride transport was computed for each nostril. The total chloride transport values were calculated by subtracting the voltages at the end of a perfusion from the voltage at the end of an earlier perfusion (isoproterenol - amiloride). The average of the values for each nostril was computed. If the assessment was available in only 1 nostril, this value was used as if it were the average of both nostrils. Baseline was the latest, valid assessment prior to the treatment. A positive change from Baseline indicates that nasal chloride transport increased.	Baseline, EOT (Week 48)
Other	Change From Baseline in Sweat Chloride Concentration at Week 48	Sweat was collected, from each arm, by using pilocarpine iontophoresis. The chloride concentration in the sweat was quantified for each arm by using standard laboratory methods. Tests were also considered valid if the sweat collection time was =35 minutes; tests with longer collection times were also considered valid if extra time was needed to obtain sufficient volume (=15uL) for analysis. For analysis purposes, the average of the values from each arm were computed. If the assessment was valid and/or available in only 1 arm, this value was used as if it were the average of both arms. The method used was consistent with the CFFT-TDN guidelines. Baseline was the latest, valid assessment prior to the treatment. A negative change from Baseline indicates that sweat chloride concentration decreased.	Baseline, EOT (Week 48)
Primary	Percentage of Predicted Function (Percent-Predicted) of Forced Expiratory Volume in One Second (FEV1) at Baseline	Spirometry was used to assess pulmonary function by measuring the percentage of predicted function, which was determined on the basis of the height value obtained at the same study visit, for FEV1 (the amount of air that can be exhaled in 1 second). Spirometry was assessed by using current guidelines of the American Thoracic Society (ATS) and European Respiratory Society (ERS). Baseline was the average of percent-predicted FEV1 at screening and randomization.	Baseline (Week 1)
Primary	Percentage Change From Baseline in Percent-Predicted of FEV1 at Week 48	Spirometry was used to assess pulmonary function by measuring the percentage of predicted function, which was determined on the basis of the height value obtained at the same study visit, for FEV1 (the amount of air that can be exhaled in 1 second). Spirometry was assessed by using current guidelines of the American Thoracic Society (ATS) and European Respiratory Society (ERS). The percentage of change in percent-predicted of FEV1 was calculated as follows: ([percent-predicted FEV1-Baseline percent-predicted FEV1]/Baseline percent-predicted FEV1)*100. Baseline was the average of percent-predicted FEV1 at screening and randomization. A negative change from Baseline indicates that percent-predicted of FEV1 decreased.	End of Treatment (EOT) (Week 48)
Secondary	Rate of Pulmonary Exacerbations as Defined by Modified Fuch's Criteria Over 48 Weeks	A Respiratory Event Form, which collected data on various signs, symptoms, and effects for each event, was completed by the Investigator when informed by the participant of a respiratory event. Pulmonary exacerbations were assessed by using the modified Fuchs' criteria, which defines an exacerbation as a respiratory event requiring treatment with parenteral antibiotics for any 4 of the following 12 symptoms, with or without intravenous antibiotics: change in sputum; new or increased hemoptysis; increased cough; increased dyspnea; fatigue; temperature >38°C; anorexia; sinus pain; change in sinus discharge; change in physical examination of the chest; decrease in pulmonary function by 10% or more from a previously recorded value; or radiographic changes indicative of pulmonary function. The 48-week exacerbation rate was determined by adding the weekly rates for each arm and dividing the sum by 48.	Baseline to EOT (Week 48)
Secondary	Change From Baseline in Awake Cough Hourly Rate at Week 48	The frequency of awake cough was measured using the LifeShirt, which incorporates motion-sensing transducers, electrodes, a microphone, and a 3-axis accelerometer into a lightweight vest. The rate was determined by dividing the total number of coughs by 24 (the number of hours of the observation period). Baseline was the latest, valid assessment prior to the treatment. A negative change from Baseline indicates that coughing decreased.	Baseline, EOT (Week 48)
Secondary	Change From Baseline in the Respiratory Domain Score of the Revised Cystic Fibrosis Questionnaire (CFQ-R) at Week 48	The CFQ-R consists of 44 items, including generic scales of physical functioning, role functioning, vitality, health perceptions, emotional functioning, and social functioning, and CF-specific scales of respiratory and digestive symptoms, body image, eating disturbances, and treatment burden. Each domain score ranges from 1 to 4. Scores were linearly transformed to a 0 to 100 scale, with higher scores indicating better health. Domain scores were calculated by using the following formula: 100 * (sum of responses - minimum possible sum)/ (maximum possible sum - minimum possible sum). The minimum possible sum = number of questions * 1; the maximum possible = the number of questions * 4. Baseline was the latest, valid assessment prior to the treatment. A negative change from Baseline indicates that health has worsened. Participants may have switched age groups during the study.	Baseline, EOT (Week 48)
Secondary	Percent-Predicted of Forced Vital Capacity (FVC) at Baseline	Spirometry was used to assess pulmonary function by measuring the percentage of predicted function, which was determined on the basis of the height value obtained at the same study visit, for FVC (the amount of air that can be exhaled after taking a deep breath). Spirometry was assessed by using current guidelines of the ATS and ERS. Baseline was the average of percent-predicted FVC at screening and randomization.	Baseline (Week 1)
Secondary	Percentage Change From Baseline in Percent-Predicted of FVC at Week 48	Spirometry was used to assess pulmonary function by measuring the percentage of predicted function, which was determined on the basis of the height value obtained at the same study visit, for FVC (the amount of air that can be exhaled after taking a deep breath). Spirometry was assessed by using current guidelines of the ATS and ERS. The percentage of change in percent-predicted of FVC was calculated as follows: ((percent-predicted FVC-Baseline percent-predicted FVC)/Baseline percent-predicted FVC)*100. Baseline was the average of percent-predicted FVC at screening and randomization. A negative change from Baseline indicates that percent-predicted of FVC decreased.	EOT (Week 48)