Ataluren for the treatment of nonsense-mutation cystic fibrosis: a randomised, double-blind, placebo-controlled phase 3 trial

Eitan Kerem, Michael W. Konstan*, Kris De Boeck, Frank J. Accurso, Isabelle Sermet-Gaudelus, Michael Wilschanski, J. Stuart Elborn, Paola Melotti, Inez Bronsveld, Isabelle Fajac, Anne Malfroot, Daniel B. Rosenbluth, Patricia A. Walker, Susanna A. McColley, Christiane Knoop, Serena Quattrucci, Ernst Rietschel, Pamela L. Zeitlin, Jay Barth, Gary L. ElfringEllen M. Welch, Arthur Branstrom, Robert J. Spiegel, Stuart W. Peltz, Temitayo Ajayi, Steven M. Rowe

*Corresponding author for this work

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Abstract

Background: Ataluren was developed to restore functional protein production in genetic disorders caused by nonsense mutations, which are the cause of cystic fibrosis in 10% of patients. This trial was designed to assess the efficacy and safety of ataluren in patients with nonsense-mutation cystic fibrosis. 

Methods: This randomised, double-blind, placebo-controlled, phase 3 study enrolled patients from 36 sites in 11 countries in North America and Europe. Eligible patients with nonsense-mutation cystic fibrosis (aged ≥6 years; abnormal nasal potential difference; sweat chloride >40 mmol/L; forced expiratory volume in 1 s [FEV1] ≥40% and ≤90%) were randomly assigned by interactive response technology to receive oral ataluren (10 mg/kg in morning, 10 mg/kg midday, and 20 mg/kg in evening) or matching placebo for 48 weeks. Randomisation used a block size of four, stratified by age, chronic inhaled antibiotic use, and percent-predicted FEV1. The primary endpoint was relative change in percent-predicted FEV1 from baseline to week 48, analysed in all patients with a post-baseline spirometry measurement. This study is registered with ClinicalTrials.gov, number NCT00803205. 

Findings: Between Sept 8, 2009, and Nov 30, 2010, 238 patients were randomly assigned, of whom 116 in each treatment group had a valid post-baseline spirometry measurement. Relative change from baseline in percent-predicted FEV1 did not differ significantly between ataluren and placebo at week 48 (-2·5% vs -5·5%; difference 3·0% [95% CI -0·8 to 6·3]; p=0·12). The number of pulmonary exacerbations did not differ significantly between treatment groups (rate ratio 0·77 [95% CI 0·57-1·05]; p=0·0992). However, post-hoc analysis of the subgroup of patients not using chronic inhaled tobramycin showed a 5·7% difference (95% CI 1·5-10·1) in relative change from baseline in percent-predicted FEV1 between the ataluren and placebo groups at week 48 (-0·7% [-4·0 to 2·1] vs -6·4% [-9·8 to -3·7]; nominal p=0·0082), and fewer pulmonary exacerbations in the ataluern group (1·42 events [0·9-1·9] vs 2·18 events [1·6-2·7]; rate ratio 0·60 [0·42-0·86]; nominal p=0·0061). Safety profiles were generally similar for ataluren and placebo, except for the occurrence of increased creatinine concentrations (ie, acute kidney injury), which occurred in 18 (15%) of 118 patients in the ataluren group compared with one (<1%) of 120 patients in the placebo group. No life-threatening adverse events or deaths were reported in either group. I

nterpretation: Although ataluren did not improve lung function in the overall population of nonsense-mutation cystic fibrosis patients who received this treatment, it might be beneficial for patients not taking chronic inhaled tobramycin. 

Funding: PTC Therapeutics, Cystic Fibrosis Foundation, US Food and Drug Administration's Office of Orphan Products Development, and the National Institutes of Health. 

Original languageEnglish
Pages (from-to)539-547
Number of pages9
JournalThe Lancet Respiratory Medicine
Volume2
Issue number7
Early online date15 May 2014
DOIs
Publication statusPublished - Jul 2014

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Kerem, E., Konstan, M. W., De Boeck, K., Accurso, F. J., Sermet-Gaudelus, I., Wilschanski, M., Elborn, J. S., Melotti, P., Bronsveld, I., Fajac, I., Malfroot, A., Rosenbluth, D. B., Walker, P. A., McColley, S. A., Knoop, C., Quattrucci, S., Rietschel, E., Zeitlin, P. L., Barth, J., ... Rowe, S. M. (2014). Ataluren for the treatment of nonsense-mutation cystic fibrosis: a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet Respiratory Medicine, 2(7), 539-547. https://doi.org/10.1016/S2213-2600(14)70100-6