The primary efficacy endpoint of the study was a semi-quantitative measurement of the change in mycobacterial density on a seven-point scale from baseline (day one) to the end of the randomized portion of the trial (day 84). ARIKAYCE did not meet the pre-specified level for statistical significance although there was a positive trend (p=0.148) in favor of ARIKAYCE. However, ARIKAYCE did achieve statistical significance with regard to the clinically relevant key secondary endpoint of culture conversion, with 11 out of 44 patients treated with ARIKAYCE (added to standard of care treatment) demonstrating negative cultures by day 84 of the study as compared to 3 out of 45 patients treated with placebo (added to standard of care treatment) (p=0.01).
Patients receiving ARIKAYCE experienced a greater number of adverse events than those receiving placebo. All adverse events experienced with ARIKAYCE were consistent with those seen in similar patient populations receiving inhaled antibiotics. The most common side effect was laryngeal irritation.
The Company plans to incorporate these results into discussions with the regulatory agencies in
"The results relating to the key secondary endpoint of culture conversion are encouraging, and I believe demonstrate that ARIKAYCE has the potential to be an option for treating even the most difficult treatment resistant patients with NTM lung infections," said
"We are encouraged by the achievement of culture conversion in this trial, which we believe is the ultimate goal in the treatment of mycobacterial infections," said Dr.
"While ARIKAYCE did not achieve statistical significance on the primary endpoint of bacterial density reduction, we are very pleased by the greater number of culture conversions among patients receiving ARIKAYCE," stated
"We extend our gratitude to the investigators and their patients who participated in this study," concluded
The objective of the primary endpoint was to show a reduction in the density of bacteria of at least one step along a seven point scale as a means of identifying whether a trend suggestive of ultimate culture conversion could be established. The number of patients showing at least a one-step reduction in the treatment arm versus those in the placebo arm was not statistically significant (p=0.148). The design of the study's primary endpoint was not culture conversion because it was assumed that culture conversion would not be achievable in 84 days treatment, particularly given the severe, treatment-resistant patient population that was the subject of this study.
ARIKAYCE achieved statistical significance with regard to the secondary outcome of culture conversion, with 11 out of 44 patients treated with ARIKAYCE demonstrating negative cultures by day 84 of the study as compared to 3 out of 45 patients treated with placebo arm (standard of care therapy only) (p=0.01). Data analyses for additional secondary, tertiary and exploratory endpoints are ongoing and will be discussed at a presentation at the
Patients receiving ARIKAYCE experienced adverse events consistent with those seen in similar patient populations receiving inhaled antibiotics. Overall, mild to moderate throat irritation was more common in the ARIKAYCE arm compared to the placebo arm. One Suspected Unexpected Serious Adverse Reaction (SUSAR) was observed in the ARIKAYCE arm, but there was no difference in severe serious adverse reactions or hemoptysis between the two arms. Instances of hearing loss or tinnitus, a side effect more commonly associated with intravenous dosing of amikacin, were evenly balanced between the ARIKAYCE and placebo arms. The study population was chronically ill with a mean age of 61.
Clinical Trial Design
Mycobacterial density is a measurement currently used in clinical practice to assess the progress or decline of those patients with recalcitrant NTM. Following the randomized portion of the study, all eligible patients had the option to receive ARIKAYCE once daily for an additional 84 days in an open-label design.
Patients in the trial were stratified for either Mycobacterium avium complex (MAC) infections or Mycobacterium abscessus infections. These pathogens collectively account for approximately 85% of all patients with NTM lung disease in the U.S. Stratification was also performed based on patients with cystic fibrosis versus those who do not have cystic fibrosis.
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About Nontuberculous Mycobacteria (NTM)
Nontuberculous mycobacteria (NTM) are organisms found in the soil and water that can cause serious lung disease in susceptible individuals, for which there are currently limited effective treatments and no approved therapies. The prevalence of NTM disease is reported to be increasing, and according to reports from the
NTM lung disease is often a chronic condition that can lead to progressive inflammation and lung damage, and is characterized by bronchiectasis and cavitary disease. NTM infections often require lengthy hospital stays for medical management. Treatment usually involves multi-drug regimens that can be poorly tolerated and have limited effectiveness, especially in patients with severe disease or in those who have failed prior treatment attempts. According to a company-sponsored patient chart study conducted by
ARIKAYCE is a form of the antibiotic amikacin, which is enclosed in nanocapsules of lipid called liposomes. This advanced pulmonary liposome technology prolongs the release of amikacin in the lungs while minimizing systemic exposure. The treatment uses biocompatible lipids endogenous to the lung that are formulated into small (0.3 micron), charge-neutral liposomes. ARIKAYCE is administered once-daily using an optimized, investigational eFlow® Nebulizer System manufactured by
This is the first controlled clinical trial of an antibiotic in patients suffering from NTM lung infections. There are no drugs approved by the
About eFlow® Technology and PARI Pharma
ARIKAYCE is delivered by an investigational eFlow® Nebulizer System developed by PARI Pharma and optimized specifically for ARIKAYCE. The optimized device uses eFlow Technology to enable highly efficient aerosolization of medication including liposomal formulations via a vibrating, perforated membrane that includes thousands of laser-drilled holes. Compared with other nebulization technologies, eFlow Technology produces aerosols with a very high density of active drug, a precisely defined droplet size and a high proportion of respirable droplets delivered in the shortest possible period of time. eFlow Technology is not an ultrasonic nebulizer technology and is not a general purpose electronic aerosol generator nebulizer technology. Combined with its quiet mode of operation, small size, light weight and battery use, eFlow Technology reduces the burden of taking daily, inhaled treatments.
This release contains forward-looking statements. Words, and variations of words, such as "intend," "expect," "will," "anticipate," "believe," "continue," "propose" and similar expressions are intended to identify forward-looking statements. Investors are cautioned that such statements in this release, including statements relating to the status, results and timing of clinical trials and clinical data, the anticipated benefits of Insmed's products, the anticipated timing of regulatory submissions, and the ability to obtain required regulatory approvals, the ability to obtain a Breakthrough Therapy Designation for ARIKAYCE in the U.S., bring products to market and successfully commercialize products constitute forward-looking statements that involve risks and uncertainties that could cause actual results to differ materially from those in the forward-looking statements. Such risks and uncertainties include, without limitation, failure or delay of European, Canadian,
Select ARIKAYCE™ Clinical Data
TARGET NTM (TR02-112 STUDY): Change from Baseline on the Full Semi Quantitative Scale for Mycobacterial Culture, mITT Population
|-6||1 (2.3)||0||1 (1.1)|
|-4||1 (2.3)||0||1 (1.1)|
|-3||3 (6.8)||1 (2.2)||4 (4.5)|
|-2||4 (9.1)||6 (13.3)||10 (11.2)|
|-1||9 (20.5)||6 (13.3)||15 (16.9)|
|0||20 (45.5)||20 (44.4)||40 (44.9)|
|+1||3 (6.8)||7 (15.6)||10 (11.2)|
|+2||0||3 (6.7)||3 (3.4)|
|+3||1 (2.3)||0||1 (1.1)|
|+4||1 (2.3)||2 (4.4)||3 (3.4)|
|+7 (Death)||1* (2.3)||0||1 (1.1)|
|* Death determined to be not related to study drug; data handling rules require any death to be scored as a +7|
TARGET NTM (TR02-112 STUDY): Summary of semi quantitative data for mITT population
|# of Patients||
|# of Patients||
Patients with decrease in bacterial
|Patients with no change on the scale||20||0||20||0|
Patients with increase in bacterial
|* Death determined to be not related to study drug, data handling rules require any death to be scored as a +7|
ARIKAYCE: TARGET NTM (TR02-112 STUDY): Overview of Adverse Events
|Number (%) of subjects with treatment-emergent adverse events||41 (93.2)||40 (88.9)||81 (91.0)|
|Number of treatment-emergent adverse events||240||140||380|
|Number (%) of subjects with treatment-emergent adverse events by maximum severity|
|Grade 1: Mild||12 (27.3)||25 (55.6)||37 (41.6)|
|Grade 2: Moderate||24 (54.5)||10 (22.2)||34 (38.2)|
|Grade 3: Severe||4 (9.1)||5 (11.1)||9 (10.1)|
|Grade 4: Life Threatening or Disabling||0||0||0|
|Grade 5: Death||1* (2.3)||0||1 (1.1)|
|Number (%) of subjects with treatment-emergent adverse events by seriousness|
|Serious||8 (18.2)||4 (8.9)||12 (13.5)|
|Not Serious||33 (75.0)||36 (80.0)||69 (77.5)|
|Number of treatment-emergent serious adverse events||12||5||17|
|Number (%) of subjects with treatment-emergent adverse events by strongest relationship to study drug |
|Related||32 (72.7)||17 (37.8)||49 (55.1)|
|Not Related||9 (20.5)||23 (51.1)||32 (36.0)|
|Number of subjects who discontinued||9||0||9|
|* Death determined to be not related to study drug|