Official Title
A Randomized, Double-Blind, Placebo-Controlled, Multicenter, Prospective, Investigator-Initiated Trial to Assess the Efficacy, Safety, and Pharmacokinetics of Epetraborole in Patients With Mycobacterium Abscessus Lung Disease: REBOUND Study
Brief Summary

This double-blind, randomized, placebo-controlled, parallel-group, multicenter,prospective, investigator-initiated trial will evaluate epetraborole (EBO) monotherapy inthe treatment of adults with Mycobacterium abscessus complex (MABc) Lung Disease (LD) ofmild to moderate severity. For this study, two EBO oral dose regimens will be studied inpatients with MABc-LD, each compared to a placebo group (ie, 4 treatment groups): 500 mgdaily and 750 mg daily. Detailed inclusion and exclusion criteria attempt to identifyonly those patients who have acceptable risks based upon the EBO preclinical findings,phase 1, phase 2, and Phase 3 experience; standard-of-care procedures; and the specifiedprocedures of the study. Following receipt of informed consent, and a Screening period,eligible patients will be randomized to one of the 4 treatment groups to receive activeor matched placebo EBO tablets for 84 days. Patients will be assessed for clinical andmicrobiological evidence of efficacy. At selected investigative sites, patients willundergo sparse PK sampling. Safety and tolerability will be determined by standardclinical and laboratory assessment, with oversight by a qualified and appropriatelyconstituted Data Safety Monitoring Board (DSMB). Data collected during the study will beanalyzed per a comprehensive Statistical Analysis Plan (SAP). The study will beregistered on clinicaltrials.gov. The total duration of patient participation isapproximately 6 months.

Detailed Description

Non-tuberculous mycobacterial lung disease (NTM-LD) is a chronic, debilitating disease
that can cause significant morbidity and mortality, and reduces quality of life. The
primary intervention to treat NTM-LD is antibiotic treatment to eliminate the causative
pathogen and thereby prevent progression of NTM-associated lung destruction and
respiratory compromise. Among NTM organisms causing pulmonary infection, Mycobacterium
abscessus complex (MABc) LD requires particularly complicated, prolonged and onerous
intravenous treatment regimens that are burdensome to patients. New therapeutic options,
especially those that can be administered orally, represent a high unmet need.

Epetraborole (EBO), a boron-containing heterocycle also possessing amine and hydroxyl
functional groups, blocks bacterial protein synthesis by inhibiting bacterial LeuRS.
Epetraborole is active against Mycobacterium abscessus complex (MABc) organisms in vitro,
including against isolates resistant to drugs commonly used to treat MABc-Lung Disease
(LD) (e.g., clarithromycin and amikacin). To date, no clinical efficacy data are
available for use of EBO in humans with MABc-LD. However, available nonclinical and PK
data support the potential efficacy of EBO in MABc-LD. A Phase 1 human lung PK study in
healthy volunteers showed that the exposure of EBO in alveolar (lung) macrophages, lung
cells that are primarily infected with mycobacteria in NTM-LD, was approximately 5-fold
higher than in plasma. EBO exposure in pulmonary epithelial lining fluid (ELF) is
approximately 53% of that in plasma. Because NTM organisms may also be found in ELF,
adequate EBO concentrations in that space are potentially important to achieve
therapeutic success. Furthermore, PK/PD modeling data support the potential efficacy of
EBO for treatment of MABc-LD. Since the EBO MIC90 for MABc isolates is ~256-fold lower
than that observed for MAC isolates from the truncated EBO-301 Phase 2/3 study in
treatment-refractory Mycobacterium avium complex lung disease, treatment outcomes in
MABc-LD are expected to be favorable. The molecule therefore has the potential to address
the unmet need in MABc-LD patients with limited treatment options.

For this study, two oral EBO dose regimens will be studied in patients with MABc-LD
compared to placebo: 500 mg daily and 750 mg daily.

Not yet recruiting
Mycobacterium Abscessus Infection

Drug: Epetraborole

High-dose intervention (750mg daily)

Drug: Epetraborole

Low-dose intervention (500mg daily)

Drug: Placebo

Placebo intervention (matching the high-dose experimental intervention)

Drug: Placebo

Placebo intervention (matching the low-dose experimental intervention)

Eligibility Criteria

Inclusion Criteria:

1. Male or female patients who are 18 years of age or older.

2. Willing and able to provide written informed consent.

3. Patients with MABc lung disease, meeting the following (a) Microbiological, (b)
Clinical, (c) Radiographic

a. Microbiological criteria: i. Documentation of at least 1 Pre-Study MABc-positive
respiratory specimen (sputum or deep bronchial specimen) collected per standard of
care within 6 months prior to signing the consent form.

ii. At least 1 Screening MABc-positive expectorated or induced sputum sample. b.
Clinical criteria: At least 2 of the following patient-reported clinical symptoms:
i. Chest pain ii. Chronic cough iii. Coughing up blood iv. Fatigue v. Fever
(documented by thermometer) vi. Mucus (sputum) production vii. Night sweats
(drenching perspiration with no other obvious etiology, e.g. perimenopausal) viii.
Poor appetite ix. Shortness of breath x. Weight loss (unintentional, more than 5% of
usual weight in 6 to 12 months) c. Radiographic criteria: Non-contrast chest CT scan
within 4 months prior to signing the ICF (Pre-Study chest CT) or within the
Screening Period (Screening chest CT) with abnormalities consistent with MABc-LD
based on local interpretation (e.g. Investigator or local radiologist).

4. Patients who, in the opinion of the investigator, will not require initiation of
guideline-directed antibiotic therapy for treatment of MABc-LD within the next 6
months, and for whom a delay, in order for the subject to participate in a
placebo-controlled clinical trial, is considered both reasonable and clinically
acceptable.

5. Patients who are willing to comply with all the study activities and procedures
throughout the duration of the study.

1. Patients must agree to use an effective method of birth control, if applicable,
as follows: Females of childbearing potential (FOCPs; defined in Appendix 1,
Contraception Requirements) must commit to either sexual abstinence or use of
at least 2 medically accepted, effective methods of birth control (defined in
Contraception Requirements) from Screening through the EOS Visit

2. Males who are sexually active with a FOCP must agree to use an effective
barrier method of contraception (defined in Contraception Requirements) from
Screening through the EOS Visit

6. Patients expected to survive with continued antimycobacterial therapy and
appropriate supportive care from Screening through the LFU Visit, in the judgment of
the Investigator.

Exclusion Criteria:

1. Patients with a presence of any suspected or confirmed disease or condition at
Screening or the time of randomization that, in the opinion of the Investigator, may
confound the assessment of symptom-based clinical response, including, but not
limited to, the following:

- Radiographic presence of cavitary disease (defined as a patient with one or
more cavities >2 cm internal diameter)

- Cystic fibrosis or other inherited disorders of airway ciliary dysfunction
(e.g., primary ciliary dyskinesia)

- Active allergic bronchopulmonary mycosis

- Anticipated or planned lung surgery for treatment of MABc lung disease

- Disseminated MABc infection, or other known or suspected non-pulmonary source
of infection (e.g., infective endocarditis, osteomyelitis, meningitis, or
urinary tract infection) requiring non-study antimicrobial therapy

- Concomitant pulmonary infection requiring antimicrobial therapy, including
infection caused by fungi, viruses, non-MABc mycobacteria (e.g., Mycobacterium
tuberculosis, Mycobacterium avium intracellulare, Mycobacterium avium complex,
Mycobacterium kansasii), or other bacteria (e.g., Pseudomonas aeruginosa,
Staphylococcus aureus).

Note: Patients with MABc lung disease and concomitant non-MABc lung infection
requiring antimicrobial therapy must complete the antimicrobial treatment for the
non-MABc infection prior to randomization. Patients with respiratory specimen
cultures that contain growth of non-MABc organisms that are deemed by the
Investigator to be respiratory tract colonizers and who do not require or receive
specific antimicrobial therapy may remain eligible. The Investigator should discuss
such cases with the Study Investigator prior to randomization and provide rationale
for study eligibility in the source document.

2. Patients on brensocatib who have not been on a stable dose for at least 12 weeks.

3. Patients with active pulmonary malignancy (primary or metastatic) or any malignancy
that required or would require chemotherapy or radiation therapy within 1 year prior
to randomization through the LFU Visit.

4. Patients with creatinine clearance (CrCl) of <30 mL/min, as estimated by the
Cockcroft-Gault formula, at Screening: Estimated CrCl (mL/min) = (140 - Age [years])
× Actual Body Weight [kg] × [0.85 if Female]) / (72 × Serum Creatinine [mg/dL]).

5. Patients with any of the following hematological findings:

1. Hemoglobin <11.0 g/dL or <6.83 mmol/L.

2. Donation of blood or plasma within 28 days prior to randomization; or
symptomatic loss of blood or hemorrhage within 28 days prior to randomization.

3. Pre-existing (inborn or acquired) disorder of hematopoiesis that could
substantially worsen the effect of EBO on hemoglobin levels or potentially
prevent hemoglobin recovery post cessation of treatment, for example,
thalassemia, sickle cell disease, hemolytic anemia, Inherited bone marrow
failure syndromes, myelodysplastic or myeloproliferative disorders, bone marrow
transplantation

6. Patients with severe hemoptysis within 28 days prior to randomization, defined as
>100 mL (approximately >7 tbsp blood) over any 24-hour period.

7. Patients with severe hepatic impairment, as evidenced by alanine aminotransferase
(ALT) or aspartate aminotransferase (AST) >3 × upper limit of normal (ULN) or total
bilirubin >2 × ULN, or clinical signs of cirrhosis or end-stage hepatic disease
(e.g., ascites, hepatic encephalopathy).

8. Patients who are pregnant or breastfeeding.

9. Patients with a mean QT interval corrected using Fridericia's formula (QTcF) >500
msec based 12-lead ECG at Screening.

10. Patients with an immunodeficiency or an immunocompromised condition and risk for an
opportunistic pulmonary infection, including:

- History of lung transplantation

- Known history of human immunodeficiency virus (HIV) infection plus either an
active acquired immunodeficiency syndrome (AIDS)-defining illness in the past
12 months, or a known cluster of differentiation 4 (CD4) count <200/mm3 within
the past 12 months

- Neutropenia at Screening (absolute neutrophil count <1,000 neutrophils/mm3)

- Use of immunosuppressive therapy at Screening that in the opinion of the
Investigator may place the patient at risk for an opportunistic pulmonary
infection, including transplant rejection medication and chronic systemic
corticosteroids defined as ≥15 mg/day of prednisone or systemic equivalent for
>4 weeks.

11. Patients with an anticipated start of new non-study antimycobacterial therapy to be
administered at any time between Screening and EOT.

12. Patients who have participated in a clinical trial of an investigational agent
within 30 days (or 5 half-lives, whichever is longer) prior to Screening.

13. Patients with any prior exposure to epetraborole.

14. Patients with any condition that, in the opinion of the Investigator, interferes
with the ability to safely complete the study or adhere to study requirements,
including the patient's inability or unwillingness to comply with all study
assessments and visits.

15. Patients with hypersensitivity to any EBO excipient (e.g., microcrystalline
cellulose, colloidal silicon dioxide, croscarmellose sodium, magnesium stearate,
polyvinyl alcohol, titanium dioxide, polyethylene glycol, talc).

16. Patients with a history of eosinophilic interstitial pneumonitis

For eligibility purposes, vital signs, clinical laboratory tests, and ECGs may be
repeated once if an abnormal result is observed at the initial reading during Screening.

Eligibility Gender
All
Eligibility Age
Minimum: 18 Years ~ Maximum: N/A
Countries
United States
Locations

Oregon Health & Science University
Portland, Oregon, United States

Investigator: Alyssa Schroeder
Contact: 503-494-2136
schroeder@ohsu.edu

Investigator: Kevin L Winthrop, MD, MPH

Contacts

Felicity Coulter, PhD
503-494-2565
rebound@ohsu.edu

Brandy Peacock, DAOM, MAcOM
(503) 494-8022
coulterf@ohsu.edu

Kevin L Winthrop, MD, MPH, Principal Investigator
Oregon Health and Science University

AN2 Therapeutics, Inc
NCT Number
Keywords
NTM
nontuberculous mycobacteria
Mycobacterium abscessus
M. abscessus
abscessus
MeSH Terms
Mycobacterium Infections, Nontuberculous