An Open Label Trial Evaluating Tacrolimus Inhalation Powder in Adult Lung Transplant Recipients

Lung Transplant Rejection Clinical Trial

Official title:

An Open Label Trial Evaluating the Safety and PK Profile of Tacrolimus Inhalation Powder in Adult Lung Transplant Recipients

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05501574
• Other study ID #: TFF-T2-001
• Status: Recruiting
• Phase: Phase 2
• Start date: April 18, 2023
• Est. completion date: January 31, 2025

Study information

• Verified date: April 2023
• Source: TFF Pharmaceuticals, Inc.
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is an open label, multicenter, safety and PK study comparing safety, efficacy, and pharmacokinetic (PK) levels of Tacrolimus Inhalation Powder in lung transplant patients that require reduced tacrolimus blood levels due to kidney toxicity.

Part A of the study will consist of a 12 week safety, efficacy, and PK study.

Part B of the study will be an optional safety extension following successful completion of the 12 week safety, efficacy, and PK study. Patients would have the option to continue Tacrolimus Inhalation Powder for up to 1 year, with a possibility to extend to 2 years depending on the results from Part A.

Description:

This is an open label, single-arm study that will evaluate the safety and PK of Tacrolimus Inhalation Powder in lung transplant patients who require reduced blood levels of tacrolimus due to kidney toxicity. Tacrolimus Inhalation Powder is being developed as an alternative to oral tacrolimus in adult lung transplant recipients. Patients enrolled in this study will have been receiving an oral dose of tacrolimus after a successful lung transplant that is resulting in kidney toxicity. During Part A, the patients will be transferred into the study with the anticipation of switching to inhaled tacrolimus with the goal of reducing blood levels to stabilize or minimize kidney toxicity while maintaining sufficiently high lung tacrolimus levels to prevent allograft rejection.

Once the study patients are enrolled, they will return to the clinic on a regular basis to allow for dose adjustment. Therapeutic tacrolimus drug concentrations will be measured at every clinic visit under trough conditions (i.e., pre-dose). Kidney function testing will also be monitored on a regular basis.

Part B of this study is an optional safety extension following successful completion of Part A. Patients would have the option to continue Tacrolimus Inhalation Powder for up to 1 year, with a possibility to extend to 2 years pending analysis of Part A data. Participants would return to clinic periodically for safety assessments, dose adjustments, and to receive more Tacrolimus Inhalation Powder. After 2 years, if the drug is still under development, the subject will be invited to continue receiving tacrolimus inhalation powder under a special access program.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 24
• Est. completion date: January 31, 2025
• Est. primary completion date: January 31, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Provide written informed consent to participate and is willing and able to participate in the study and abide by study restrictions in the judgement of the Investigator.

2. Males or females aged 18 or over, at time of screening.

3. Continuous non-smoker who has not used nicotine-containing products (including e-vaping) for at least 3 months prior to the first dosing and throughout the study, based on patient's self-reporting and urine cotinine levels at screening and Day 1.

4. Have undergone bilateral allograft lung transplantation prior to enrolment and meet all of the following':

1. Receiving oral immediate-release (not intravenous [IV], extended release or sublingual) tacrolimus immunosuppression at a stable dose for 3 weeks prior to first dosing according to institutional standards as part of an immunosuppressive regimen along with mycophenolate mofetil (MMF) or azathioprine and corticosteroids-

2. Demonstrating elevated markers of renal dysfunction: blood serum creatinine > 124 µmol/L (0.14 mg/dL) or estimated glomerular filtration rate (eGFR) < 45

3. Is able to undergo routine bronchoscopy with BAL and biopsy

4. Screening forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) values = 40% predicted (to assure viable graft)

5. Agree to use acceptable contraception or are not able to bear children.

6. Able to successfully perform spirometry, use the inhalation device, and comply with study restrictions and visit schedule.

7. Body mass index (BMI) = 34.0kg/m2 at screening, and a maximum weight of 120.0kg at screening

Exclusion Criteria:

1. Active antibody-mediated rejection (AMR) or any other evidence of acute rejection.

2. Active bacterial, viral or fungal infection not successfully resolved at least 4 weeks prior to study entry. Patients on prophylactic anti-fungal treatment may be enrolled.

3. Presence of uncontrolled gastro-esophageal reflux disease (GERD)

4. History or presence of hypersensitivity or idiosyncratic reaction to tacrolimus or any calcineurin inhibitor.

5. Received a treatment with other investigational drug within 5 times the elimination half-life, if known (e.g., a marketed product) or within 30 days (if the elimination half-life is unknown), whichever is longer, prior to Study Day 1 dosing.

6. Positive for hepatitis B surface antigen (HBsAg) PCR, hepatitis C PCR, and human immunodeficiency virus (HIV) I and II antibodies, tuberculosis (TB), or COVID-19 at Screening.

7. Patients who have taken any of the following prohibited medications within 30 days of the first dose or who are expected to require these medications during the study:

1. Cyclosporin

2. Any form of sirolimus or everolimus

8. Allergy or sensitivity to lactose or milk products

9. Clinically significant hepatic impairment defined as 2.5 times the upper limit of normal (ULN)

10. Active post-transplant lymphoproliferative disorder (PTLD) related to Epstein-Barr Virus (EBV) infection

11. Subjects with significant electrocardiogram (ECG) abnormalities at screening, including a QT interval corrected by the Fridericia correction formula that is = 440 msec in men and = 460 msec in women

12. Demonstrates an inability to operate the inhalation device after training

Related Conditions & MeSH terms

• Lung Transplant Rejection
• Respiratory Aspiration

Intervention

Drug:
• Tacrolimus Inhalation Powder
Tacrolimus powder for inhalation to prevent acute allograft rejection

Locations

Country	Name	City	State
Australia	Prince Charles Hospital	Brisbane	Queensland
Australia	St Vincent's Hospital	Darlinghurst	New South Wales
Australia	The Alfred Hospital	Melbourne	Victoria

Sponsors (1)

Lead Sponsor	Collaborator
TFF Pharmaceuticals, Inc.

Country where clinical trial is conducted

Australia, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of participants experiencing Adverse Events, Serious Adverse Events, and withdrawals due to Adverse Events	Number of AEs, SAEs, and discontinuation due to AEs	Baseline through end of study (up to 2 years)
Primary	Number of participants who experience laboratory test abnormalities	Number of participants with potentially clinically significant lab test values	Baseline through end of study (up to 2 years)
Primary	Number of participants who experience physical examination abnormalities	Number of participants with potentially clinically significant physical examination abnormalities	Baseline through end of study (up to 2 years)
Primary	Number of participants who experience pulse oximetry abnormalities	Number of participants with potentially clinically significant pulse oximetry values	Baseline through end of study (up to 2 years)
Primary	Number of participants who experience vital sign abnormalities	Number of participants with potentially clinically significant vital sign values	Baseline through end of study (up to 2 years)
Primary	Mean change from baseline in chest radiology	Number of participants with potentially clinically significant changes in chest radiology	Baseline through end of study (up to 2 years)
Primary	Mean change from baseline in blood serum creatinine	Number of participants with potentially clinically significant changes in blood serum creatinine	Baseline through end of study (up to 2 years)
Primary	Mean change from baseline in estimated glomerular flow rate (eGFR)	Number of participants with potentially clinically significant changes in eGFR	Baseline through end of study (up to 2 years)
Primary	Mean change from baseline in forced expiratory volume (FEV1)	Spirometry used to measure FEV1 lung function	Baseline through end of study (up to 2 years)
Primary	Mean change from baseline in forced vital capacity (FVC)	Spirometry used to measure FVC lung function	Baseline through end of study (up to 2 years)
Primary	Mean change from baseline in FEV1/FVC ratio	Spirometry used to measure FEV1 and FVC lung function	Baseline through end of study (up to 2 years)
Primary	Number of participants meeting treatment stopping rules of acute allograft rejection	Number of participants meeting treatment stopping rules of acute allograft rejection	Baseline through end of study (up to 2 years)
Secondary	Change from baseline in FEV1 percent predicted	Spirometry used to measure FEV1 lung function	Baseline through end of study (up to 2 years)
Secondary	PK of tacrolimus in whole blood AUC0-6	PK of tacrolimus in whole blood: Area under the plasma-concentration time curve (AUC0-6) from time 0 through 6 hours after dosing	Baseline through week 12
Secondary	PK of tacrolimus in whole blood AUClast	PK of tacrolimus in whole blood: Area under the plasma-concentration time curve (AUClast) from time of dosing to the last measurable concentration	Baseline through week 12
Secondary	PK of tacrolimus in whole blood Cmax	PK of tacrolimus in whole blood: Maximum observed concentration (Cmax)	Baseline through week 12
Secondary	PK of tacrolimus in whole blood Tmax	PK of tacrolimus in whole blood: Time to maximal observed concentration (Tmax)	Baseline through week 12
Secondary	Incidence of all-cause mortality	Incidence of all-cause mortality	Baseline through end of study (up to 2 years)
Secondary	Incidence of allograft-related mortality	Incidence of allograft-related mortality	Baseline through end of study (up to 2 years)
Secondary	Incidence of all-cause hospitalizations	Incidence of all-cause hospitalizations	Baseline through end of study (up to 2 years)
Secondary	Incidence of acute allograft-related hospitalizations	Incidence of acute allograft-related hospitalizations	Baseline through end of study (up to 2 years)