The trial is an open-label, non-controlled, multicenter, pilot clinical trial of inhaled molgramostim (recombinant human granulocyte-macrophage colony stimulating factor; rhGM-CSF) in subjects with persistent pulmonary non-tuberculous mycobacterial (NTM) infection. Participants will be treated for 24-weeks with inhaled molgramostim and followed up for 12-weeks after end of treatment. The primary aim of the trial is to investigate the efficacy of inhaled molgramostim on NTM sputum culture conversion to negative.
The study will comprise a Screening Visit, a Baseline Visit, a 24-week treatment period and a 12-week follow-up period. 30 adult participants with a history of chronic NTM infection with at least 2 positive cultures in the prior 2 years, of which at least one is within the last 6 months prior to Screening, will be considered for enrollment. Participants should provide a positive NTM sputum culture at Screening to be eligible. Two subgroups of participants will be recruited: * Group 1: Participants who remain sputum culture positive while currently on a multidrug NTM guideline based antimycobacterial regimen, which has been ongoing for at least 6 months prior to the Baseline Visit. * Group 2: Participants who remain sputum culture positive but have either stopped a multidrug NTM guideline based antimycobacterial regimen at least 28 days prior to Screening due to lack of response or intolerance, or never started such treatment. The treatment period will consist of 14 trial visits (Screening \[within 10 weeks of Baseline\], Baseline, and every 4 weeks to Week 48 \[visits at Weeks 28, 36 and 44 included telephone contact, others included clinic visits\]) and a Follow-up visit 12 weeks after the end of treatment. At the Baseline visit, eligible participants will start treatment with molgramostim nebulizer solution, 300 μg, administered by inhalation using an eFlow Nebulizer System. At each visit, sputum samples will be collected for staining and microscopy, and microbiological culture. In addition, clinical assessments including body weight, patient reported outcomes, and diffusion capacity of the lung for carbon monoxide (DLCO) will be conducted at each clinic visit. Spirometry will be assessed at Baseline, and at Weeks 12, 24, 32, 40 and 48. A 6-minute walk test (6-MWT) will be conducted at Baseline, at Weeks 12, 24, 48 and at the 12-week Follow-up visit. Safety laboratory samples will be collected at Screening, Baseline and at Weeks 4, 12, 24, 32, 40, 48 and at the 12-week Follow-up visit. Anti-GM-CSF antibodies will be assessed at Baseline, at Week 4, 12, 24, 32, 48, and at the 12-week Follow-up visit.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
32
300 µg / dose molgramostim (recombinant human GM-CSF) for inhalation
Multidrug NTM guideline-based antimycobacterial regimen
Concord Repatriation General Hospital
Concord, New South Wales, Australia
The Prince Charles Hospital
Chermside West, Queensland, Australia
Greenslopes Private Hospital
Greenslopes, Queensland, Australia
Royal Perth Hospital
Perth, Western Australia, Australia
Number of Participants With Sputum Culture Conversion to Negative
Sputum culture conversion is defined as at least 3 consecutive sputum samples without growth of NTM during the treatment period.
Time frame: 48 weeks
Number of Participants With Sputum Smear Conversion to Negative
Sputum smear conversion is defined as at least three consecutive negative acid-fast bacilli (AFB) stained sputum smears on microscopy during the treatment period among participants who were smear positive at Baseline.
Time frame: 48 weeks
Number of Participants With Durable Sputum Culture Conversion
Durability is defined as sputum culture conversion at or before Week 24 and culture still negative for growth of NTM at 12-weeks follow-up.
Time frame: 60 weeks
Number of Participants With Durable Sputum Smear Conversion
Durability is defined as sputum smear conversion at or before Week 48 and AFB stained smear still negative for NTM at 12-weeks follow-up among participants who were smear positive at Baseline.
Time frame: 60 weeks
Change From Baseline in Symptom Scores (Assessed Using Lower Respiratory Tract Infections - Visual Analogue Scale)
For each of the clinical symptoms of Lower Respiratory Tract Infections (dyspnea, fatigue, cough, pain, and sputum), the participant assessed the severity using a 10 cm visual analogue scale (VAS) ranging from 0 = no symptoms to 10 = worst possible symptoms. A total LRTI score was calculated by summing up the score of each symptom (i.e., total LRTI score ranged from 0 to 50).
Time frame: Baseline to Week 48
Change From Baseline in Symptom Scores (Assessed Using Quality of Life Questionnaire - Bronchiectasis (QOL-B))
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Royal Brompton Hospital
London, United Kingdom
The QOL-B questionnaire including 37 items on 8 scales (emotional functioning, health perceptions, physical functioning, respiratory symptoms, role functioning, social functioning, treatment burden, vitality) was used to assess participant's quality of life (QoL). Each of the 37 items is scored from 1 to 4, and each of the 8 scale scores is standardised on a 0-100 point scale, with higher scores representing fewer symptoms or better functioning and QoL. Scales contain between 3 and 9 items, thus changing 1 answer category will correspond to a change of 11.1 to 3.7 points.
Time frame: Baseline to Week 48
Change From Baseline in Global Rating of Health (GRH)
GRH was assessed as an interviewer questionnaire, which assesses global health as "excellent, good, fair or poor". For analysis, these were scored as 1 (poor) to 4 (excellent).
Time frame: Baseline to Week 48
Change From Baseline in Body Weight
Time frame: Baseline to Week 48
Change From Baseline in 6-Minute Walking Distance (6MWD)
The 6-minute walk test (6MWT) was performed in accordance with the European Respiratory Society/American Thoracic Society (ERS/ATS) guideline by technicians with documented training and experience. The 6MWT was performed twice at each visit.
Time frame: Baseline to Week 48
Change From Baseline in Dyspnea Scores During a 6MWT
Time frame: Baseline to Week 48
Number of Adverse Events (AEs) During the Trial Period
All trial subjects were carefully monitored for the occurrence of AEs during the trial period from Baseline (Visit 2) to the 12-week Follow-up visit (Visit 15). AEs were collected by the investigator by a non-leading question and by reporting events directly observed or spontaneously volunteered by participants. Participants were also encouraged to contact the clinic in between visits if they experienced AEs or had any concerns.
Time frame: 60 weeks
Number of Serious AEs (SAEs) During the Trial Period
SAEs were defined as any untoward medicinal occurrence or effect that at any dose: * Results in death * Is life-threatening * Requires hospitalisation or prolongation of existing hospitalisation * Results in persistent or significant disability or incapacity * Is a congenital abnormality or birth defect * May jeopardise the participant or may require medical intervention to prevent one or more of the outcomes listed above (Important Medical Events).
Time frame: 60 weeks
Number of Adverse Drug Reactions (ADRs) During the Trial Period
All AEs were assessed by the investigator for causality (unlikely, possible, probable, not applicable) according to current regulatory standards. AEs which had a 'possible' or 'probable' causality were classified as ADRs.
Time frame: 60 weeks
Number of Severe AEs During the Trial Period
All AEs were assessed by the investigator for severity (mild, moderate, severe) according to current regulatory standards.
Time frame: 60 weeks
Number of Participants Withdrawn From Treatment Due to an AE During the Trial Period
Time frame: 60 weeks
Change From Baseline in Diffusing Capacity of the Lung for Carbon Monoxide (DLCO)
Time frame: Baseline to Week 48
Change From Baseline in Forced Expiratory Volume in 1 Second (FEV1) (% Predicted)
Time frame: Baseline to Week 48
Change From Baseline in Forced Vital Capacity (FVC) (% Predicted)
Time frame: Baseline to Week 48
Number of Subjects With Development of Anti-GM-CSF Antibodies in Serum
Analyses for anti-GM-CSF antibodies were performed at a central laboratory.
Time frame: 60 weeks