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Study to Evaluate Itraconazole Administered as Inhaled Dry Powder in Adults With Asthma and ABPA

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ClinicalTrials.gov Identifier: NCT05667662
Recruitment Status : Terminated (Low enrollment)
First Posted : December 28, 2022
Last Update Posted : April 2, 2024
Sponsor:
Information provided by (Responsible Party):
Pulmatrix Inc.

Brief Summary:

The goal of this clinical trial is to learn about PUR1900 as an inhaled, antifungal therapeutic for the treatment of allergic bronchopulmonary aspergillosis (ABPA) in patients with asthma. The main questions it aims to answer are:

  1. Is PUR1900 safe and well tolerated in adults with asthma and ABPA?
  2. Is there an effect of daily administration of PUR1900 on potential outcome measures in adults with asthma and ABPA?
  3. Is there fungal resistance to A. fumigatus?

This study includes a 28-day screening period, a 112-day (16-week) treatment period, and a 56-day (8 week) observation period.

Participants will take either 40mg of PUR1900, 20 mg of PUR1900 or Placebo for 112 days and complete an eDairy, answer questions about their asthma and complete peak respiratory flow measurements at home. They will come to the clinic approximate once a month during the treatment period and complete study assessments. At the end of the observation period participants will complete one more clinic visit. Participants who complete this study may be given the opportunity to continue on study drug in an open label extension study.


Condition or disease Intervention/treatment Phase
ABPA Drug: Itraconazole Powder Drug: Placebo Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 8 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Study to Evaluate the Effect of Dose and Duration of Treatment of Itraconazole Administered as a Dry Powder for Inhalation (PUR1900) on Safety, Tolerability, and Potential Outcomes in Adult Patients With ABPA
Actual Study Start Date : February 1, 2023
Actual Primary Completion Date : February 27, 2024
Actual Study Completion Date : February 27, 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Asthma

Arm Intervention/treatment
Experimental: PUR1900 40 mg
4 PUR1900 (10 mg itraconazole) Capsules with 20 mg total powder (10 mg itraconazole plus 10 mg excipients) administered via oral inhalation, using the RS01 Monodose inhaler once daily for 112 days at approximately the same time each day.
Drug: Itraconazole Powder
Capsules with 20 mg total powder (10 mg itraconazole plus 10 mg excipients)
Other Name: PUR1900

Experimental: PUR1900 20 mg
2 PUR1900 (10 mg itraconazole) Capsules with 20 mg total powder (10 mg itraconazole plus 10 mg excipients) and 2 Placebo Capsules with with 11.8 mg total powder (excipients only) administered via oral inhalation, using the RS01 Monodose inhaler once daily for 112 days at approximately the same time each day.
Drug: Itraconazole Powder
Capsules with 20 mg total powder (10 mg itraconazole plus 10 mg excipients)
Other Name: PUR1900

Placebo Comparator: Placebo
4 Placebo Capsules with with 11.8 mg total powder (excipients only) administered via oral inhalation, using the RS01 Monodose inhaler once daily for 112 days at approximately the same time each day.
Drug: Placebo
Capsules with 11.8 mg total powder (excipients only)




Primary Outcome Measures :
  1. Incidence of Treatment Emergent Adverse Events (TEAEs) [ Time Frame: 168 days ]
    Review of TEAEs from time of consent to study completion.

  2. Safety spirometry assessments [ Time Frame: 168 days ]
    FEV1 (the volume of air (in liters) exhaled in the first second during forced exhalation after maximal inspiration), FVC (liters), and PEFR (L/min) measurements compared to baseline.

  3. Vital sign measurements [ Time Frame: 168 days ]
    Vital signs measurements collected before exposure, during and after treatment and compared to baseline. Vital sign measurements will include respiratory rate (bpm), blood pressure (mmHg), heart rate (bpm), oxygen saturation (by pulse oximetry), and oral or tympanic temperature (°C).

  4. Physical examinations [ Time Frame: 168 Days ]
    At screening, a complete physical examination will be performed which includes measurement of height (cm), weight (kg) and evaluation of appearance; skin; head and neck; eyes, ears, nose, and throat; chest and lungs; heart; abdomen; neurological system; and extremities.

  5. Clinical safety laboratory test results [ Time Frame: 168 days ]
    Hematology, serum chemistry, or urinalysis test results (normal, abnormal, clinical significance) compared to baseline.

  6. Cardiac safety monitoring [ Time Frame: 168 days ]
    Electrocardiogram (ECG) recordings collected before exposure, during and after treatment. Electrocardiogram measurements will include heart rate and PR, RR, QRS, and QT intervals, as well as the QTcF and compared to baseline.


Secondary Outcome Measures :
  1. Magnitude of effect of daily administration of PUR1900 - Spirometry [ Time Frame: 168 days ]
    Changes in measured Forced Expiratory Volume (FEV1) over time compared to baseline

  2. Magnitude of effect of daily administration of PUR1900 - Patient Reported Outcomes (ACQ) [ Time Frame: 168 days ]
    Responses to the Asthma Control Questionnaire (ACQ) sored from 0-6 with 0 being totally controlled and 6 being extremely poorly controlled compared to baseline.

  3. Magnitude of effect of daily administration of PUR1900 - Patient Reported Outcomes (AQLQ(s) 12+) [ Time Frame: 168 days ]
    Responses to the Asthma Quality of Life Questionnaire with scores ranging 1-7 and higher scores indicating better quality of life compared to baseline.

  4. Frequency of asthma exacerbations versus baseline [ Time Frame: 168 days ]
    Occurrence of asthma exacerbations before, during, and after treatment with PUR1900


Other Outcome Measures:
  1. Fungal resistance to Aspergillus fumigatus [ Time Frame: 168 days ]
    Fungal susceptibility of sputum samples collected at the before and after anti-fungal treatment to determine resistance risks using the EUCAST microdilution method



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Is a male or female, ≥18 years old at the time of signing the informed consent.
  • BMI of ≥18.0 and <40.0 kg/m2 at screening.
  • Has a diagnosis of asthma, as per the Global Initiative for Asthma (GINA) 2018 update
  • Has a confirmed diagnosis of ABPA, based on the modified International Society for human and Animal Mycology (ISHAM) ABPA working group 2013 and 2021 criteria including a history of or documentation at screening of serum IgE ≥ 500 IU/mL and A. fumigatus-specific IgE>0.35KUA/L, or above normal IgE antibody to A. fumigatus, or a positive immediate skin test and at least 2 of the 3 following supportive criteria: eosinophil count >500 cells/µL; A. fumigatus-specific IgG >27 mgA/L or presence of precipitating (or above normal immunoglobulin G [IgG]) antibody to A. fumigatus; consistent radiographic opacities or bronchiectasis on chest CT.
  • Is currently considered to be in one of the following stages of ABPA: Stage 2 (Response), Stage 4 (Remission), Stage 5a (Treatment-dependent ABPA), or Stage 5b (Glucocorticoid-dependent asthma).
  • At least 1 exacerbation requiring a systemic glucocorticosteroid(s) in the 12 months prior to Screening. For patients on a biologic agent, at least one exacerbation requiring a systemic glucocorticosteroid(s) must have occurred at least 3 months after the initiation of the biologic agent.
  • Has a serum IgE ≥500 IU/mL at screening.
  • Has a documented stable asthma medication regimen during the 28 days prior to the first dose of study drug ; applicable asthma medications can include but are not limited to the following: inhaled short-acting beta agonist (SABA), inhaled long-acting beta agonist (LABA), and leukotriene receptor antagonist (LTRA) use and inhaled and/or oral glucocorticosteroids. SABA use during this period should be mostly within a stable range (e.g., 2 puffs 2 to 4 times a day) and should not exceed 8 puffs a day on 2 out of 3 consecutive days.
  • Can perform a valid, reproducible spirometry test with demonstration of a prebronchodilator FEV1 ≥50% of predicted normal for age, sex, race, and height at a screening visit.
  • Can demonstrate the correct inhalation technique and achieve a minimum inspiratory flow rate of 45 L/min for the use of the delivery device at screening and before dosing on Day 1.
  • Is willing and able to comply with all study procedures and assessments, including scheduled visits, drug dosing plan, study procedures, laboratory tests, and study restrictions.
  • Subjects who are sexually active, male subjects able to father a child, and female subjects of childbearing potential must agree to follow contraception requirements.

Exclusion Criteria:

  • Currently requiring medications that are sensitive substrates for CYP3A4-mediated metabolism or medications that are contraindicated with oral itraconazole.
  • Has evidence of ventricular dysfunction, such as congestive cardiac failure (New York Heart Association functional class III or IV), or a history of congestive cardiac failure. N-terminal pro B-type natriuretic peptide (NT pro BNP) will be checked at screening only. A subject with a confirmed value of >400 pg/mL will not be eligible to participate.
  • Has used any systemic azole antifungal agent in the 6 weeks before first dose of study drug.
  • Has discontinued previously administered biologic agent(s) in the 3 months prior to screening.
  • Has a history of life-threatening asthma within the last 24 months, defined as an asthma episode that required intubation and/or was associated with hypercapnia, respiratory arrest, and/or hypoxic seizures.
  • Has a current diagnosis of any chronic airway disease other than asthma, ABPA, or bronchiectasis believed to be related to ABPA, such as chronic obstructive pulmonary disease, pulmonary fibrosis, cystic fibrosis, or Churg-Strauss syndrome. A subject whose predominating clinical disease burden is related to bronchiectasis (e.g., a subject with 2 or more infective exacerbations of bronchiectasis in the past 12 months or a subject with chronic colonization with Pseudomonas aeruginosa) will be excluded. Refer to Appendix 4 for definition of bronchiectasis exacerbations.
  • Had an occurrence of clinically significant bacterial, viral, or fungal infection that required systemic (oral or intravenous) antibiotics, antivirals, or antifungals within the 28 days before screening. Topical treatments, other than antifungals, are allowed.
  • Had an occurrence of asthma or ABPA exacerbations within the 28 days before screening.
  • Has the presence of hoarseness or oropharyngeal candidiasis at screening.
  • Had a major trauma or surgery within the last 28-days before screening.
  • Has a history of any clinically significant cardiovascular, renal, hepatic, or gastrointestinal disease or neurological or psychiatric disorder endocrine, immunological, or autoimmune disease or other medical condition that would affect the subject's safety or confound the assessment of study endpoints as judged by the Investigator.
  • Has a history of any clinically significant drug or alcohol abuse in the past 6 months before screening, as judged by the Investigator.
  • Has current inhaled tobacco/nicotine or inhaled marijuana use or history of smoking or vaping including tobacco or marijuana within the last 6 months before screening.
  • Has a history of any clinically significant drug or alcohol abuse in the past 6 months before screening, as judged by the Investigator.
  • Has current tobacco or inhaled marijuana use or history of smoking or vaping including tobacco or marijuana within the last 6 months before screening.
  • Has a history of allergic or hypersensitivity reaction or serious adverse reaction after dosing of itraconazole or other antifungal azoles.
  • Has a history of serious adverse reaction or known serious hypersensitivity to any of the formulation excipients.
  • Has a positive urine test result for drugs of abuse or cotinine at screening (unless, in the opinion of the Investigator, this can be explained by the subject's current medications). Note that results that are positive for a drug of abuse or cotinine may be acceptable for drugs that have been obtained by legal means or non-inhaled tobacco/nicotine product use.
  • At screening, has alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >2x upper limit of normal (ULN), white blood cell (WBC) count > 20,000 X 109/L, absolute neutrophil count <1000 cells/L, platelet counts <100,000 to or >500,000 X 109/L, or hemoglobin <10 g/dL
  • Is a female of childbearing potential who is pregnant or lactating or who plans to become pregnant during the study. All female subjects must have a negative pregnancy test at screening and pre dose on Day 1. A woman is of childbearing potential unless she is either permanently sterile (hysterectomy, bilateral salpingectomy, or bilateral oophorectomy, bilateral tubal occlusion/ligation, endometrial ablation) or postmenopausal (had no menses for 12 months without an alternative medical cause).
  • Has a 12-lead ECG demonstrating a mean QT interval corrected by the Fridericia formula (QTcF) >450 msec for a male subject or >470 msec for a female subject at screening. A repeat triplicate ECG is allowed if a mean QTcF >450 msec for males and >470 msec for females is recorded at Visit 1.
  • Has a planned or elective surgery, hospitalizations, or participation in other interventional studies any time during the study that may interfere with study logistics or safety.
  • Has donated or had a loss of greater than 400 mL of blood within the 3 months before screening.
  • Has other social, psychiatric, surgical, or medical conditions or screening laboratory abnormalities that may increase the risk associated with study participation or may interfere with the interpretation of study results and, in the judgement of the Investigator, would make the subject inappropriate for entry into the study.
  • Received any investigational medical product in a clinical research study within the previous 3 months before first dose of study drug.
  • Is a study site employee, an immediate family member of a study site employee, or a Sponsor employee.
  • Has previously received PUR1900.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05667662


Locations
Show Show 18 study locations
Sponsors and Collaborators
Pulmatrix Inc.
Investigators
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Study Director: Chris Cabell, MD Pulmatrix Inc.
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Responsible Party: Pulmatrix Inc.
ClinicalTrials.gov Identifier: NCT05667662    
Other Study ID Numbers: 601-0018
First Posted: December 28, 2022    Key Record Dates
Last Update Posted: April 2, 2024
Last Verified: April 2024

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Pulmatrix Inc.:
Asthma
Allergic Bronchopulmonary Aspergillosis
Additional relevant MeSH terms:
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Itraconazole
Antifungal Agents
Anti-Infective Agents
14-alpha Demethylase Inhibitors
Cytochrome P-450 Enzyme Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Steroid Synthesis Inhibitors
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Cytochrome P-450 CYP3A Inhibitors