ICoN-1 Phase 3 Study of the Efficacy and Safety of Treatment With MNKD-101, Clofazimine Inhalation Suspension
Purpose
This clinical trial is designed to compare the efficacy and safety of Clofazimine Inhalation Suspension versus placebo when added to guideline-based therapy (GBT)
Conditions
- MAC Lung Disease
- Treatment Refractory MAC Lung Disease
- Mycobacterium Infections, Nontuberculous
Eligibility
- Eligible Ages
- Between 18 Years and 85 Years
- Eligible Genders
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- Evidence of signed and dated informed consent document(s) indicating the participant has been informed of all pertinent aspects of the trial. 2. Age ≥18 years or legal age for the participating country (e.g., the legal age in South Korea is 19 years) and ≤85 years. 3. Evidence of underlying nodular bronchiectasis and/or fibrocavitary disease on a chest radiograph or chest computed tomography, as determined by the investigator, within the last 12 months. 4. MAC-positive culture results from at least two separates (at least 1 week apart) expectorated sputum samples, one taken within 12 months, and another taken within 3 months prior to the date of informed consent. Note: A sputum culture will be obtained at baseline, but the participant may be randomized prior to availability of the results. 5. Be able to produce at least 3 mL of sputum or be willing to undergo an induction that produces at least 3 mL of sputum for mycobacteriology. 6. FEV1 ≥40% of predicted during screening, as calculated by the local spirometry laboratory standards. 7. Currently receiving a multi-drug regimen of GBT for pulmonary NTM infection in line with the 2020 ATS/ERS/ESCMID/IDSA guideline for the treatment of NTM pulmonary disease for at least 6 months prior to consenting in this study, with no changes in this regimen within 2 months of screening. 8. For female participants of childbearing potential, a negative serum pregnancy test and agreement to use a protocol-recommended method of contraception during heterosexual intercourse from the start of the screening period until ≥12 months after the final dose of study therapy. Note: A female participant is considered to be of childbearing potential, i.e., fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilization methods include hysterectomy, bilateral salpingectomy, and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle-stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However, in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient. 9. For male participants who can father a child and are having intercourse with females of childbearing potential, agreement to use a protocol-recommended method of contraception from the start of the study therapy until ≥12 months after the final dose of study therapy and to refrain from sperm donation from the start of study therapy until ≥12 months after administration of the final dose of study therapy. Note: A male participant is considered fertile after puberty unless permanently sterile by bilateral orchidectomy. 10. Willingness and ability to comply with scheduled visits, drug inhalation plan, study procedures, laboratory tests, and study restrictions.
Exclusion Criteria
- Cystic fibrosis. 2. Active tuberculosis. Note: Participants with a history of treated latent or active tuberculosis may be eligible as long as their sputum cultures in the last year are negative for tuberculosis and they are deemed by the investigator as not having current active tuberculosis. 3. Disseminated MAC or MABSC infection or participants with isolated MABSC infection. 4. Recent (i.e., within the last 3 months from date of screening) ICU admission with or without mechanical ventilation. 5. Inability to inhale with a nebulizer, in the opinion of the investigator. 6. Participants with known hypersensitivity to any of the ingredients or excipients of clofazimine. 7. Prior therapy with clofazimine in the previous 4 months from date of screening. 8. Participants with known resistance to clofazimine as treatment for MAC (i.e., MIC >8 ug/mL for MAC). 9. Prior therapy with amikacin by any route of administration (e.g., inhaled or IV) in the previous 2 months from date of screening. 10. Ongoing participation in any other interventional drug or device clinical trial, or exposure to another investigational drug within 28 days prior to start of study treatment. Note: For investigational therapies that have a prolonged half-life, a case-by-case assessment will be made regarding the required washout period prior to being eligible for this study. 11. Current (or planned during the study) pregnancy or breastfeeding. 12. QT prolongation during screening (450 ms or longer), and/or uncontrolled sinus rhythm (>110/minute). 13. Increased risk of proarrhythmia (e.g., recent [within 6 months] myocardial infarction, stroke, heart failure decompensation or left ventricular ejection of <45%, ventricular arrhythmias, torsade de pointes, unstable angina, or high-degree atrioventricular block). 14. A family history of sudden cardiac death, unexplained death, long-QT syndrome, or death from a primary dysrhythmia potentially associated with QT prolongation. 15. Recent (within 6 months) initiation of or change in the dosing regimen of any concomitant medication that is known to prolong the QT interval. Note: Participants who are on a stable regimen, in the opinion of the investigator, of the concomitant medication during screening are eligible. 16. Chronic and clinically meaningful, in the opinion of the investigator, abnormalities in potassium, magnesium, or calcium levels. 17. Active pulmonary malignancy (primary or metastatic) or any malignancy requiring chemotherapy or radiation therapy within 3 years before screening or anticipated during the study period. 18. Current alcohol, medication, or illicit drug abuse. 19. Prior or ongoing social or medical condition (e.g., concomitant illness, psychiatric condition, behavioral disorder), medical history, physical findings, ECG findings or laboratory abnormality that, in the opinion of the investigator, could adversely affect the safety of the participant, makes it unlikely that the course treatment or follow-up would be completed, or could impair the assessment of study results. 20. Any prior use of bedaquiline within 1 year of screening. 21. Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >1.5 times upper limit of normal (ULN) or total bilirubin >1.5 times ULN during screening. 22. Absolute neutrophil count <500/µL during screening. 23. Use of prednisone ≥10mg/day within 3 months prior to screening, or other significant immunosuppression as deemed by the investigator. 24. Estimated glomerular filtration rate <30mL/minute/1.73 m2 (according to the CKD-EPI 2021 creatine equation) during screening. 25. Advanced liver disease (Child-Pugh Class A, B, or C).
Study Design
- Phase
- Phase 3
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Intervention Model Description
- At least 234 eligible participants will be randomized in a 2:1 ratio of 1 of 2 possible treatment assignments in order to ensure that a minimum of 180 participants are evaluable for efficacy: Clofazimine Inhalation Suspension (N=120) and placebo (n=60). Randomization will be stratified by type of nontuberculous mycobacteria (NTM) infection (Mycobacterium avium complex [MAC] infection only vs MAC co-infection with Mycobacterium abscessus complex [MABSC] or other NTM species) based on historical samples used to establish eligibility during screening. Enrollment of participants with MAC coinfection with MABSC or other NTM species will be capped at 20% of all participants to limit heterogeneity in the participant population.
- Primary Purpose
- Treatment
- Masking
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
- Masking Description
- During Part A of the study, the identity of the treatments will be concealed by the use of a placebo, and treatment unblinding will only occur in the case of participant emergencies or if requested by the Data and Safety Monitoring Board (DSMB). Sputum Test Results: Results of post-baseline testing for the presence of NTM in sputum will remain concealed until the participant has completed Part A of the study and the participant's result for the sample taken at the end of Month 6 becomes available.
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Experimental Clofazimine Inhalation Suspension |
MNKD-101 (Clofazimine Inhalation Suspension) is a micronized suspension with a concentration of 20 mg/mL. Study drug will be inhaled using the PARI breath-enhanced jet nebulizer system daily for 28 days in Cycle 1. Cycle 2 will commence after 56 days off treatment and resume daily for 28 days. Dose: 80 mg |
|
|
Placebo Comparator Placebo |
The placebo is comprised of isotonic saline (0.9% weight/volume sodium chloride). Study drug will be inhaled using the PARI breath-enhanced jet nebulizer system daily for 28 days in Cycle 1. Cycle 2 will commence after 56 days off treatment and resume daily for 28 days. |
|
Recruiting Locations
University of Alabama at Birmingham School of Medicine
Birmingham, Alabama 35294
Birmingham, Alabama 35294
University of California San Francisco Fresno
Fresno, California 93701
Fresno, California 93701
Cedars-Sinai Medical Center
Los Angeles, California 90048
Los Angeles, California 90048
Hoag Hospital
Newport Beach, California 92663
Newport Beach, California 92663
Contact:
949-764-8220
949-764-8220
University of California Davis Medical Center
Sacramento, California 95817
Sacramento, California 95817
Santa Barbara Cottage Hospital
Santa Barbara, California 93105
Santa Barbara, California 93105
Stanford University
Stanford, California 94305
Stanford, California 94305
Yale University
New Haven, Connecticut 06520-8057
New Haven, Connecticut 06520-8057
Contact:
877-978-8343
877-978-8343
Georgetown University Hospital
Washington, District of Columbia 20007
Washington, District of Columbia 20007
The George Washington University Medical Faculty Associates
Washington, District of Columbia 20037
Washington, District of Columbia 20037
St. Francis Sleep, Allergy & Lung Institute
Clearwater, Florida 33765
Clearwater, Florida 33765
Malcolm Randall Veterans Affairs Medical Center
Gainesville, Florida 32608
Gainesville, Florida 32608
University of Florida College of Medicine
Jacksonville, Florida 32209
Jacksonville, Florida 32209
Theia Clinical Research
Saint Petersburg, Florida 33707
Saint Petersburg, Florida 33707
Infectious Diseases Consultants of the Treasure Coast
Sebastian, Florida 32958
Sebastian, Florida 32958
University of South Florida
Tampa, Florida 33620
Tampa, Florida 33620
Midway Specialty Care Center
West Palm Beach, Florida 33401
West Palm Beach, Florida 33401
Flourish Research
Winter Park, Florida 32789
Winter Park, Florida 32789
Emory University School Of Medicine
Atlanta, Georgia 30342
Atlanta, Georgia 30342
Medster Research
Valdosta, Georgia 31605
Valdosta, Georgia 31605
University of Iowa Hospital and Clinics
Iowa City, Iowa 52242
Iowa City, Iowa 52242
University of Kansas Medical Center
Kansas City, Kansas 66160
Kansas City, Kansas 66160
Infectious Disease Consultants Clinical Research
Wichita, Kansas 67211
Wichita, Kansas 67211
Ochsner Clinic Foundation
New Orleans, Louisiana 70115
New Orleans, Louisiana 70115
Massachusetts General Hospital
Boston, Massachusetts 02114
Boston, Massachusetts 02114
Henry Ford Hospital
Detroit, Michigan 48202
Detroit, Michigan 48202
University of Missouri
Columbia, Missouri 65201
Columbia, Missouri 65201
Washington University School of Medicine
Saint Louis, Missouri 63110
Saint Louis, Missouri 63110
University of Nebraska Medical Center
Omaha, Nebraska 68198
Omaha, Nebraska 68198
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire 03756
Lebanon, New Hampshire 03756
Rutgers New Jersey Medical School
Newark, New Jersey 07103
Newark, New Jersey 07103
Montefiore Medical Center
Bronx, New York 10467
Bronx, New York 10467
Northwell Health
New Hyde Park, New York 11042
New Hyde Park, New York 11042
NYU Langone Health
New York, New York 10016
New York, New York 10016
Mount Sinai-National Jewish Respiratory Institute
New York, New York 10029
New York, New York 10029
Columbia University
New York, New York 10032
New York, New York 10032
NYC Health and Hospitals-Elmhurst
Queens, New York 11373
Queens, New York 11373
Oregon Health & Science University
Portland, Oregon 97239
Portland, Oregon 97239
Temple Lung Center
Philadelphia, Pennsylvania 19140
Philadelphia, Pennsylvania 19140
Reading Hospital
West Reading, Pennsylvania 19611
West Reading, Pennsylvania 19611
AnMed Health
Anderson, South Carolina 29621
Anderson, South Carolina 29621
Low Country Infectious Diseases
Charleston, South Carolina 29414
Charleston, South Carolina 29414
Medical University of South Carolina
Charleston, South Carolina 29425
Charleston, South Carolina 29425
North Texas Infectious Diseases Consultants
Dallas, Texas 75246
Dallas, Texas 75246
The University of Texas Health Science Center
Tyler, Texas 75708
Tyler, Texas 75708
UVA Health Infectious Diseases Clinic
Charlottesville, Virginia 22903
Charlottesville, Virginia 22903
More Details
- NCT ID
- NCT06418711
- Status
- Recruiting
- Sponsor
- Mannkind Corporation
Detailed Description
Randomized, double-blind, placebo-controlled study (Part A) designed to compare the efficacy and safety of Clofazimine Inhalation Suspension versus placebo when added to guideline-based therapy (GBT). The primary objective of this study will be to compare the efficacy of Clofazimine Inhalation Suspension versus placebo as assessed by the co-primary endpoints, sputum culture conversion and change in Quality of Life-Bronchiectasis Respiratory Symptoms Score (QoL-B RSS). An open label extension study (Part B) will be offered to qualified participants for treatment with Clofazimine Inhalation Suspension.