|E.1 Medical condition or disease under investigation
|Medical condition(s) being investigated
|Non-Cystic Fibrosis Bronchiectasis
|Medical condition in easily understood language
|Non-Cystic Fibrosis Bronchiectasis
|Diseases [C] - Respiratory Tract Diseases [C08]
|E.1.2 Medical condition or disease under investigation
|Non-cystic fibrosis bronchiectasis
|System Organ Class
|Condition being studied is a rare disease
|E.2 Objective of the trial
|Main objective of the trial
|To evaluate the effect of brensocatib at 10 mg and 25 mg compared with placebo on the rate of pulmonary exacerbations (PEs)
|Secondary objectives of the trial
|1. To evaluate the effect of brensocatib compared with placebo on the time to first PE
2. To evaluate effect of brensocatib compared with placebo on the responder status for exacerbation free
3. . To evaluate the effect of brensocatib compared with placebo on the change in postbronchodilator forced expiratory volume in 1 second (FEV1) at Week52
4. To evaluate the effect of brensocatib compared with placebo on the annualised rate of severe PEs
5. To evaluate the effect of brensocatib compared with placebo on the change in Quality of Life Questionnaire – Bronchiectasis (QOL-B) Respiratory Symptoms Domain Score at week 52 in adult subjects
6. To evaluate the effect of brensocatib compared with placebo on adverse events, clinical laboratory parameters, vital signs, and ECG.
7. To evaluate brensocatib exposure in adults and adolescents on Brensocatib plasma concentrations over time
|Trial contains a sub-study
|Full title, date and version of each sub-study and their related objectives
|This study will also comprise a pharmacokinetic/pharmacodynamic (PK/PD) sub-study and a computed tomography (CT) scan sub-study.
The PK/PD sub-study will be conducted in a select number of sites. Subjects who agree will undergo sparse PK and PD sampling. Approximately 300 adult subjects who are not receiving cyclic antibiotics at Baseline and all adolescent subjects who are not receiving cyclic antibiotics at Baseline will be included in the PK/PD sub-study (blood PD samples will not be collected from adolescent subjects).
A subgroup of subjects will be included in an evaluation of lung damage through CT scan at enrollment (Screening Visit) and End of Treatment (EOT-Week 52). Those subjects will have a guided inspiratory and expiratory CT scan done during the Screening Period and at the end of 12 months of treatment. Approximately 225 adult subjects (75 subjects per study arm) will be included in the CT Scan sub-study.
|Principal inclusion criteria
|1. Provide their signed study informed consent to participate.
a. Adolescent subjects must have signed study assent form (if required per local requirements) to participate, and the adolescent's parent or legal guardian must have provided signed informed consent for the adolescent to participate
2. Male or female ≥18 years and ≤85 years of age (inclusive) at screening.
a. Adolescent subjects – male or female ≥12 to <18 years of age at Screening in participating countries and sites where local regulations, countries, and/or
institutional policies allow for subjects <18 years of age to participate
3. Adult subjects must have a BMI ≥18.5 at screening.
a. Adolescent subjects must have a weight of ≥30 kg at Screening
4. Clinical history consistent with NCFBE (cough, chronic sputum production and/or recurrent respiratory infections) that is confirmed by chest CT demonstrating bronchiectasis affecting one or more lobes (confirmation may be based on prior chest CT).
a. For each subject, the most recent chest CT scan (but not older than 5 years before the Screening date) will be selected for transfer to the central reading facility for confirmation of the diagnosis of NCFBE.
b. If the CT scan cannot be read by the reviewers due to quality issues, a new high-resolution CT scan will be performed.
c. In case a chest CT Scan in the last 5 years is not available, a new high-resolution chest CT scan must be obtained for confirmation of the diagnosis of NCFBE by the central reading facility.
5. Postbronchodilator FEV1 at the Screening Visit ≥30% of predicted normal value, calculated using National Health and Nutrition Examination Survey reference equations and must have an absolute value ≥750 mL.
6. Adult Subjects: Current sputum producer with a history of chronic expectoration of at least 3 months in the past 12 months, and able to provide sputum sample during screening (Visit 1). If a subject is unable to produce sputum spontaneously during screening, the subject will be considered a screen failure. The subject should not undergo a sputum induction procedure during screening to meet inclusion criterion.
a. Adolescent subjects are exempt from the requirement to provide a sputum sample if they are unable to do so and should not undergo a sputum induction
procedure during Screening
7. Mucopurulent or purulent sputum color assessed at the Screening Visit by color chart developed by MP Murray.
8. At least 2 pulmonary exacerbations defined by need for antibiotic prescription by a physician for the signs and symptoms of respiratory infections in the past 12 months before the Screening Visit.
9. Women must be postmenopausal (defined as no menses for 12 months without an alternative medical cause), surgically sterile, or using highly
effective contraception (ie, methods that can achieve a failure rate <1% per year when used consistently and correctly) from Day 1 to at least 90 days after the last dose. Such methods include true abstinence (refraining from heterosexual intercourse during the study); combined (estrogen and progestogen containing) or progestogen-only hormonal contraception associated with inhibition of ovulation and supplemented with a double barrier (preferably male condom); intrauterine devices; intrauterine hormone-releasing systems; or vasectomized partner. The Investigator or designee should explain the acceptable methods of birth control to the subject, and instruct the subject to follow the direction. For WOCBP ≤45 years of age, testing of FSH level should be performed; a threshold of >40 mIU/mL should be performed to be considered infertile.
10. Male subjects with female partners of childbearing potential must be using effective contraception from Day 1 to at least 90 days after the last dose. Acceptable methods include true abstinence (refraining from intercourse during the study), combined (estrogen and progestogen-containing) or progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine devices, intrauterine hormone-releasing systems.
11. Male subjects with pregnant or non-pregnant WOCBP partners must use condoms to avoid potential exposure to the embryo/fetus.
|Principal exclusion criteria
|1. A primary diagnosis of COPD or asthma as judged by the Investigator. Patients with comorbid COPD and/or asthma can be enrolled if bronchiectasis is their primary diagnosis
2. Subjects receiving supplemental oxygen >12 hours per day.
3. Bronchiectasis due to cystic fibrosis.
4. Current smokers as defined per CDC; an adult who has smoked 100 cigarettes in his or her lifetime and who currently smokes cigarettes.
5. No evidence of bronchiectasis according to the BE-CT scoring system.
6. Known or suspected immunodeficiency disorder, including history of invasive opportunistic infections (eg, TB, histoplasmosis, listeriosis, coccidioidomycosis, pneumocystosis, aspergillosis) despite infection resolution, or otherwise recurrent infections of abnormal frequency, or prolonged infections suggesting an immunecompromised status, as judged by the Investigator.
7. Known history of HIV infection.
8. Established diagnosis of hepatitis B viral infection at the time of screening, or positive for HBsAg at the time of screening.
Subjects who have gained immunity for hepatitis B virus infection after vaccination (subjects who are HBsAg-negative, HBsAb-positive, and HBcAb-negative are eligible for the study).
Subjects with positive HBcAb are eligible for the study only if hepatitis B virus DNA level is undetectable.
9. Established diagnosis of HCV infection at the time of Screening. Subjects positive for hepatitis C antibody are eligible for the study only if HCV RNA is negative.
10. Currently being treated for NTM lung infection, allergic bronchopulmonary aspergillosis, or TB.
11. Active and current symptomatic infection by COVID-19.
12. Unable to perform technically acceptable spirometry that meet the ATS/ERS acceptability criteria with at least 3 acceptable flow-volume curves, at least 2 of which meet the ATS/ERS repeatability criteria for FEV1 during Screening.
13. Inability to follow the procedures of the study (eg, due to language problems or psychological disorders).
14. Receiving medications or therapy that are prohibited as concomitant medications
15. Started oral or inhaled antibiotics as chronic treatment for NCFBE for <3 months prior to the Screening Visit.
a. Subjects on antibiotics as chronic treatment should be on such treatment for at least 3 months prior to enrollment while meeting all other inclusion criteria and none of the exclusion criteria.
16. Chronic treatment with oral steroids (irrespective of the indication) is prohibited
17. Subjects who have adjustments to their baseline medications within 1 month before Screening; they can be rescreened a month after the new treatment has been initiated.
18. Abnormal renal function test result (estimated glomerular filtration rate <30 mL/min by Chronic Kidney Disease - Epidemiology Collaboration equation formula) at Screening.
19. Active liver disease or hepatic dysfunction manifested as follows:
a. ALT or AST >3 × ULN.
b. Total bilirubin >2 × ULN (isolated bilirubin >2 × ULN is acceptable if bilirubin is fractionated and direct bilirubin <35%).
c. Known hepatic or biliary abnormalities, not including Gilbert's syndrome or asymptomatic gallstones.
d. Child-Pugh class c
20. History of malignancy in the past 5 years, except completely treated in situ carcinoma of the cervix and completely treated non-metastatic squamous or basal cell carcinoma of the skin.
21. Previously participated in a clinical trial for brensocatib.
22. An absolute neutrophil count <1,000/mm3 at the Screening Visit.
23. Received any live attenuated vaccine within 4 weeks prior to Screening. If a live vaccine has been administered the subject should wait 4 weeks prior to Screening. During the study, subjects may not receive any live attenuated vaccine.
24. Significant hemoptysis (≥300 mL or requiring blood transfusion) within 6 weeks prior to the Screening Visit or during the Screening Period.
25. Have diagnosed periodontal disease and are either:
a. Currently treated by a dentist for this condition or
b. Are expected to have periodontal disease-related procedures within the study period.
26. Suffering an exacerbation 4 weeks before Screening or during the Screening Period. In this case, subjects will be considered a screen failure. Subjects are eligible for rescreen only after recovery and 4 weeks after last dose of antibiotic treatment
27. Adult subjects only: Have compliance issues with completion of electronic diary entries during the Screening Period AND in the opinion of the Investigator, compliance is unlikely to improve during the study.
28. Participated in any other interventional clinical studies within 3 months before Screening Visit.
29. Clinical diagnosis of Papillon-Lefèvre Syndrome.
Please refer to the protocol (Section 4.1.2) for full list of the exclusion criteria.
|E.5 End points
|Primary end point(s)
|Rate of adjudicated PEs over the 52-week treatment period.
|Timepoint(s) of evaluation of this end point
|Over the 52-week treatment period.
|Secondary end point(s)
|1. Time to first adjudicated PE over the 52-week treatment period
2. Proportion of subjects who are exacerbation free over the 52-week treatment period
3. Change from Baseline in postbronchodilator forced expiratory volume in 1 second (FEV1) at Week 52.
4. Rate of severe adjudicated PEs over the 52-week treatment period.
5. Change in QOL-B, Respiratory Symptoms Domain Score from Baseline to Week 52 in adult subjects.
6. Incidence and severity of treatment-emergent adverse events and other safety variables (eg, clinical laboratory test results, vital signs and ECG)
|Timepoint(s) of evaluation of this end point
|over the 52-week treatment period.
|E.6 and E.7 Scope of the trial
|Scope of the trial
|Other scope of the trial description
|Trial type and phase
|Human pharmacology (Phase I)
|First administration to humans
|Other trial type description
|Therapeutic exploratory (Phase II)
|Therapeutic confirmatory (Phase III)
|Therapeutic use (Phase IV)
|E.8 Design of the trial
| Comparator of controlled trial
|Other medicinal product(s)
|Number of treatment arms in the trial
The trial involves single site in the Member State concerned
| The trial involves multiple sites in the Member State concerned
|Number of sites anticipated in Member State concerned
|The trial involves multiple Member States
|Number of sites anticipated in the EEA
|E.8.6 Trial involving sites outside the EEA
|Trial being conducted both within and outside the EEA
|Trial being conducted completely outside of the EEA
|If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
|Trial has a data monitoring committee
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|E.8.9 Initial estimate of the duration of the trial
|In the Member State concerned years
|In the Member State concerned months
|In the Member State concerned days
|In all countries concerned by the trial years
|In all countries concerned by the trial months
|In all countries concerned by the trial days