RHB-204 for the Treatment of Pulmonary Mycobacterium Avium Complex Disease

Lung Diseases Clinical Trial

— CleaR-MAC  

Official title:

Study of RHB-204 for the Treatment of Pulmonary Mycobacterium Avium Complex (MAC) Disease in Adults With Nodular Bronchiectasis (CleaR-MAC Trial)

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04616924
• Other study ID #: RHB-204-01
• Status: Active, not recruiting
• Phase: Phase 3
• Start date: December 1, 2020
• Est. completion date: December 2024

Study information

• Verified date: June 2023
• Source: RedHill Biopharma Limited
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A 2-part multi-center, Phase 3, randomized, double-blind, placebo-controlled, parallel group study to evaluate the efficacy and safety of RHB-204 in adult subjects with underlying nodular bronchiectasis and documented MAC lung infection.

Description:

A 2-part multi-center, Phase 3, randomized, double-blind, placebo-controlled, parallel group study to evaluate the efficacy and safety of RHB-204 in adult subjects with underlying nodular bronchiectasis and documented MAC lung infection.

The co-primary efficacy endpoints at the end of Part 1 evaluate the proportion of patients with sputum culture conversion after 6 months of treatment defined as three consecutive monthly negative sputum cultures at Months 4, 5, and 6 for RHB-204 compared to placebo and the mean change in the Quality of Life Questionnaire - Bronchiectasis (QoL-B) Respiratory Symptoms domain score from baseline to Month 6 for RHB-204 compared to placebo.

At the Month 6 visit (end of Part 1), after all assessments including questionnaires and sputum samples have been collected, subjects will enter Part 2 of the study and receive open-label RHB-204.

In order to comply with current treatment duration guidelines (Nontuberculous Mycobacterial Pulmonary Disease Caused by Mycobacterium avium Complex: Developing Drugs for Treatment - FDA Draft Guidance September 2021) in this protocol subjects will receive active treatment for 12 months after sputum culture conversion. As such, each subject's first negative culture that defines conversion will determine the total duration of their active study drug treatment. The longest duration of active study drug treatment will be 16 months. At the end of study treatment, all subjects will enter a 3-month post-treatment follow-up period (see study design section below for additional details).

To maintain the blind and integrity of the data, an independent team (Sputum Culture Monitors) will inform sites on each subject's treatment duration based on sputum culture conversion. Sputum Culture Monitors will also have access to randomized treatment allocation. All other study related personnel will remain blinded to sputum culture results and treatment allocation (Sponsor, CRO, medical monitors, safety, ECG and sputum laboratories, site personnel as well as participating subjects).

During Part 1, subjects who have completed at least the first 3 months of treatment with study drug, and at the Investigator's discretion, require rescue therapy (alternative anti-NTM treatment) will discontinue study drug (performing an EOT visit) and remain in the study to complete all scheduled study visits and assessments/procedures to Month 6 (performing an EOS visit).

Subjects who complete treatment based on the timeline provided by the Sputum Culture Monitors (EOT visit) and have an ongoing negative sputum culture will be reconsented to enter a follow-up Extension Study, to evaluate sputum culture results at two (2) further time points: 6 months and 12 months following end of treatment (EOT) for each subject in protocol RHB-204-01.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 125
• Est. completion date: December 2024
• Est. primary completion date: December 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 85 Years

Eligibility

Key Inclusion Criteria

• Males and females aged =18 years to =85 years of age, inclusively

• Have a MAC lung infection documented by one MAC positive culture within 18 months prior to screening and a MAC positive culture at screening (cultures need to be at least 1 month apart). Prior sputum for culture may be obtained from sputum or bronchial washings however, sputum collected during screening must be either spontaneously expectorated by the patient or after sputum induction.

• Have MAC lung infection with evidence of underlying nodular infiltrates and/or bronchiectasis on a chest computed tomography (Chest CT) within 6 months of screening.

• Have symptoms of MAC lung infection that include one of the following: respiratory symptoms such as chronic cough, excessive mucous production, fatigue, dyspnea, hemoptysis or systemic symptoms such as fever, night sweats or loss of appetite.

• Be treatment naïve, or if previously treated for MAC, have not received treatment within the 6 months prior to screening

• Subject's weight is above 41 Kilograms or 90 pounds.

Key Exclusion Criteria

• Cavitary lung disease as observed on a chest CT scan (cavitary lesions exceeding 2 cm in diameter).

• Currently taking or treated in the 6 months prior to screening with any of the following: bedaquiline, clofazimine or any component of American Thoracic Society(ATS)/Infectious Diseases Society of America (IDSA) multi-drug recommended therapy (macrolides, ethambutol, rifabutins/rifampins) for MAC or other multi-drug regime for NTM lung disease

• Clarithromycin minimum inhibitory concentration (MIC) =32µg/mL on MAC isolates in screening sputum

• Known hypersensitivity or suspected history of hypersensitivity reactions to clarithromycin, rifabutin, or clofazimine or other drugs in each class

• Subjects requiring chronic supplemental oxygen use (including intermittent or continuous use)

• Planned lung resection surgery for MAC lung disease

• Subjects with Cystic Fibrosis, prior solid organ or hematologic transplant

• Current usage of inhaled products containing amikacin, tobramycin or gentamicin

• History of ventricular arrhythmias or family history of Long QT syndrome, including torsades de pointes

• Corrected QT (QTc) interval on electrocardiogram (ECG) >460 ms for females or >450 ms for males, calculated using Fridericia's formula (QTcF)

Related Conditions & MeSH terms

• Bronchiectasis
• Lung Diseases
• Mycobacterium avium-intracellulare Infection
• Mycobacterium Infections
• Pulmonary Mycobacterium Avium Complex Infection

Intervention

Drug:
• RHB-204
RHB-204
• Placebo
Matching placebo to RHB-204

Locations

Country	Name	City	State
United States	Medical Facility	Atlanta	Georgia
United States	Medical Facility	Boston	Massachusetts
United States	Medical Facility	Charleston	South Carolina
United States	Medical Facility	Clearwater	Florida
United States	Medical Facility	Farmington	Connecticut
United States	Medical Facility	Gainesville	Florida
United States	Medical Facility	Glendale	California
United States	Medical Facility	Kansas City	Kansas
United States	Medical Facility	Margate	Florida
United States	Medical Facility	New Orleans	Louisiana
United States	Medical Facility	New York	New York
United States	Medical Facility	Newark	New Jersey
United States	Medical Facility 1	Orlando	Florida
United States	Medical Facility 2	Orlando	Florida
United States	Medical Facility	Palm Springs	California
United States	Medical Facility	Portland	Oregon
United States	Medical Facility	Rochester	Minnesota
United States	Medical Facility	Saint Louis	Missouri
United States	Medical Facility	Sebring	Florida
United States	Medical Facility	Tyler	Texas
United States	Medical Facility	Valdosta	Georgia
United States	Medical Facility	Vero Beach	Florida
United States	Medical Facility	Washington	District of Columbia
United States	Medical Facility	Wauwatosa	Wisconsin
United States	Medical Facility	Winston-Salem	North Carolina

Sponsors (1)

Lead Sponsor	Collaborator
RedHill Biopharma Limited

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Quality of Life Questionnaire - Bronchiectasis (QoL B) Respiratory Symptoms domain score from baseline to Month 6 for RHB-204 compared to placebo	The mean change in the Quality of Life Questionnaire - Bronchiectasis (QoL B) Respiratory Symptoms domain score from baseline to Month 6 for RHB-204 compared to placebo	6 months
Primary	Sputum culture conversion (SCC)	The proportion of subjects who achieve SCC by Month 6, defined by 3 consecutive monthly negative sputum cultures, without reversion, at Months 4, 5 & 6 for THB-204 compared to placebo.	6 months
Secondary	Part 1 Secondary efficacy objective - Reduction of fatigue	The mean change in the PROMIS Fatigue SF 8a score from baseline to Month 6 for RHB-204 compared to placebo. The PROMIS Fatigue SF 8a score from baseline to Month 6 for RHB-204 compared to placebo.	6 months
Secondary	Part 1 Secondary efficacy objective - Time to culture conversion	The time to SCC (month of first negative sputum culture) for RHB-204 compared to placebo.	6 months
Secondary	Part 1 Secondary efficacy objective - Improvement in Physical Functioning	The mean change in the Short Form 36 Physical Functioning domain score from baseline to Month 6 for RHB-204 compared to placebo.	6 months
Secondary	Part 2 Secondary efficacy objective - Durable Sputum culture conversion at end of study	The proportion of subjects with SCC by Month 6 who sustain negative sputum cultures at Month 16 and negative sputum culture at Month 19 (3 months off treatment) for RHB-204 compared to placebo (durable responders).	19 months
Secondary	Part 2 Secondary efficacy objective - Durable Sputum culture conversion at end of treatment	Measure the proportion of subjects with SCC by Month 6 who sustain negative sputum cultures at Month 16 for RHB-204 compared to placebo.	16 months
Secondary	QoL B Respiratory Symptoms domain score mean change from baseline to Month 16	The mean change in Quality of Life Questionnaire - Bronchiectasis (QoL-B) Respiratory Symptoms domain scores from baseline to Month 16 for ex-RHB-204 compared to ex-placebo	16 months
Secondary	Part 2 Secondary efficacy objective - Improvement in Quality of Life - Fatigue 16 months	The mean change in the PROMIS Fatigue SF 8a score from baseline to Month 16 for ex-RHB-204 compared to ex-placebo	16 months
Secondary	Part 2 Secondary efficacy objective - Improvement in Quality of Life - Fatigue 19 Months	The mean change in the PROMIS Fatigue SF 8a score from baseline to Month 19 for ex-RHB-204 compared to ex-placebo	19 months
Secondary	Part 2 Secondary efficacy objective - Quality of Life Physical Functioning Symptoms 16 Months	The mean change in the Short Form 36 Physical Functioning domain score from baseline to Month 16 for ex-RHB-204 compared to ex-placebo	16 months
Secondary	Part 2 Secondary efficacy objective - Quality of Life Physical Functioning Symptoms 19 Months	The mean change in the Short Form 36 Physical Functioning domain score from baseline to Month 19 for ex-RHB-204 compared to ex-placebo	19 Months
Secondary	QoL-B Respiratory Symptoms domain scores at Month 19	The mean change in Quality of Life Questionnaire - Bronchiectasis (QoL-B) Respiratory Symptoms domain scores from baseline to Month 19 for ex-RHB-204 compared to ex-placebo	19 Months