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Additional Information about Linhaliq Phase 3 Trials and
Linhaliq, formerly known as Pulmaquin®, is composed of a mixture of liposome encapsulated and unencapsulated ciprofloxacin. Ciprofloxacin, available in oral and intravenous formulations, is a widely prescribed antibiotic. It is used often to treat acute lung infections because of its broad-spectrum antibacterial activity against various bacteria, such as P. aeruginosa. There are currently no treatments approved for NCFBE patients to prevent and reduce the number of pulmonary exacerbations (PEs).
Linhaliq was evaluated in two Phase 3 studies (ORBIT-3 and ORBIT-4) to determine its safety and effectiveness as a once-a-day inhaled formulation for the chronic treatment of patients with NCFBE who have chronic lung infections with P. aeruginosa.
The Phase 3 clinical program for Linhaliq in NCFBE consisted of two worldwide, double-blind, placebo-controlled pivotal trials (ORBIT-3 and ORBIT-4) that were identical in design except for a pharmacokinetics sub-study that was conducted in one of the trials. Each trial enrolled NCFBE patients (278 in ORBIT-3 and 304 in ORBIT-4) into a 48-week double-blind period consisting of 6 cycles of 28 days on treatment with Linhaliq or placebo plus 28 days off treatment, followed by a 28 day open label extension in which all participants received Linhaliq (total treatment duration, including the double-blind period, of approximately one year). The superiority of Linhaliq vs. placebo during the double-blind period was evaluated in terms of the primary endpoint - time to first PE, while key secondary endpoints included the reduction in the number of PEs and the number of severe PEs, and improvements in quality of life measures. Lung function was monitored as a safety indicator.
Top-line results for the two Phase 3 studies using the new stratification are described below:
In ORBIT-4 the median time to first PE was 230 days in the Linhaliq treatment group as compared to 158 days in the placebo group. This increase of 72 days in the median time to first PE was statistically significant (p=0.0323) using stratified unweighted log-rank analysis. For the first secondary efficacy endpoint, there was a 37% reduction in the frequency of PEs over the 48-week treatment period in the Linhaliq treatment group as compared to the placebo group. This result was statistically significant (p=0.0006). In the analysis of the second secondary endpoint, a statistically significant 60% reduction in the frequency of severe PEs in the Linhaliq group compared with placebo was found (p=0.0031).
In ORBIT-3 the median time to first PE was 214 days in the Linhaliq treatment group as compared to 136 days in the placebo group. This increase of 78 days in the median time to first PE was similar to ORBIT-4 but was not statistically significant (p=0.9743). For the first secondary efficacy endpoint, there was a 15% reduction in the frequency of PEs over the 48-week treatment period in the Linhaliq treatment group as compared to the placebo group but it was not statistically significant (p=0.2565). In the analysis of the second secondary endpoint, a statistically non-significant 20% reduction in the frequency of severe PEs in the Linhaliq group compared with placebo was found (p=0.4827).
In neither trial did Linhaliq compared to placebo demonstrate a statistically significant improvement in the third secondary endpoint of the quality of life using the difference in the Respiratory Domain score of the QoL-B questionnaire between baseline and Week 48.
Both studies demonstrated a statistically significant reduction in P. aeruginosa density at Day 28, the end of the first on-treatment period (ORBIT-3: p= < 0.0001; ORBIT-4: p= < 0.0001). For each study, the magnitude of this antibiotic effect remained persistent throughout all on-treatment periods. Similarly, the Phase 2b trial ORBIT-2 met its primary efficacy endpoint of reduction of P. aeruginosa density at Day 28 (p=0.002).
Linhaliq was generally safe and well tolerated in both Phase 3 studies. There were no significant differences in the changes of lung function (FEV1 % predicted and FVC % predicted) or symptoms of airway irritation between the Linhaliq and placebo groups in the two studies. Overall, the incidence of all treatment emergent adverse events ("TEAE") was similar between the Linhaliq and placebo groups in both ORBIT-3 (Linhaliq: 89.6%; placebo: 91.6%) and ORBIT-4 (Linhaliq: 86.9%; placebo: 96.9%). In ORBIT-3 the rates of serious TEAEs were 30.6% with Linhaliq and 25.3% with placebo while in ORBIT-4 the rates were 17.0% versus 28.6%.
For each Phase 3 study, the randomization rate of Linhaliq-treated subjects to placebo was 2 to 1. There were 8 deaths in ORBIT-3 (Linhaliq: 5 (2.7%); placebo: 3 (3.2%)) and 6 deaths in ORBIT-4 (Linhaliq: 2 (1.0%); placebo: 4 (4.1%)). None of the deaths was considered related to Linhaliq or placebo by the investigators. The most frequently observed treatment-related TEAEs were of respiratory/thoracic/mediastinal nature and were reported in ORBIT-3 by 25.7% of subjects with Linhaliq and in 21.1% of subjects with placebo, while the rates in ORBIT-4 were 16.5% with Linhaliq versus 20.4% with placebo. There were no deaths in ORBIT-2.
After the completion of the 48-week double-blind period of the Phase 3 studies, both Linhaliq and placebo treated patients were given the opportunity to receive Linhaliq in a 28-day open label extension period. Eighty-nine percent of the patients who completed ORBIT-3 and 91% percent of the patients who completed ORBIT-4 enrolled in the extension period.
Further information about the analyses of the Phase 3 results is presented at Aradigm's website www.aradigm.com.
About Non-Cystic Fibrosis Bronchiectasis
NCFBE is a severe, chronic and rare disease characterized by abnormal
dilatation of the bronchi and bronchioles, frequently associated with
chronic lung infections. It is often a consequence of a vicious cycle of
inflammation, recurrent lung infections, and bronchial wall damage.
NCFBE represents an unmet medical need with high morbidity and mortality
that affects more than 150,000 people in the
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