Universität zu Köln

Kerem, Elton, Konstan, Michael W., De Boeck, Kris, Accurso, Frank J., Sermet-Gaudelus, Isabelle, Wilschanski, Michael, Elborn, J. Stuart, Melotti, Paola ORCID: 0000-0002-5276-1595, Bronsveld, Inez, Fajac, Isabelle ORCID: 0000-0002-1532-1486, Malfroot, Anne, Rosenbluth, Daniel B., Walker, Patricia A., McColley, Susanna A., Knoop, Christiane, Quattrucci, Serena, Rietschel, Ernst, Zeitlin, Pamela L., Barth, Jay, Elfring, Guy L., Welch, Ellen M., Branstrom, Arthur, Spiegel, Robert J., Peltz, Stuart W., Ajayi, Temitayo and Rowe, Steven M. (2014). Ataluren for the treatment of nonsense-mutation cystic fibrosis: a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Resp. Med., 2 (7). S. 539 - 548. OXFORD: ELSEVIER SCI LTD. ISSN 2213-2600

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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. Interpretation 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 taldng chronic inhaled tobramycin.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kerem, Elton UNSPECIFIED UNSPECIFIED UNSPECIFIED Konstan, Michael W. UNSPECIFIED UNSPECIFIED UNSPECIFIED De Boeck, Kris UNSPECIFIED UNSPECIFIED UNSPECIFIED Accurso, Frank J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sermet-Gaudelus, Isabelle UNSPECIFIED UNSPECIFIED UNSPECIFIED Wilschanski, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Elborn, J. Stuart UNSPECIFIED UNSPECIFIED UNSPECIFIED Melotti, Paola UNSPECIFIED orcid.org/0000-0002-5276-1595 UNSPECIFIED Bronsveld, Inez UNSPECIFIED UNSPECIFIED UNSPECIFIED Fajac, Isabelle UNSPECIFIED orcid.org/0000-0002-1532-1486 UNSPECIFIED Malfroot, Anne UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenbluth, Daniel B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Walker, Patricia A. UNSPECIFIED UNSPECIFIED UNSPECIFIED McColley, Susanna A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Knoop, Christiane UNSPECIFIED UNSPECIFIED UNSPECIFIED Quattrucci, Serena UNSPECIFIED UNSPECIFIED UNSPECIFIED Rietschel, Ernst UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeitlin, Pamela L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Barth, Jay UNSPECIFIED UNSPECIFIED UNSPECIFIED Elfring, Guy L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Welch, Ellen M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Branstrom, Arthur UNSPECIFIED UNSPECIFIED UNSPECIFIED Spiegel, Robert J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Peltz, Stuart W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ajayi, Temitayo UNSPECIFIED UNSPECIFIED UNSPECIFIED Rowe, Steven M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-435376
DOI:	10.1016/S2213-2600(14)70100-6
Journal or Publication Title:	Lancet Resp. Med.
Volume:	2
Number:	7
Page Range:	S. 539 - 548
Date:	2014
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	2213-2600
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PULMONARY-FUNCTION; PSEUDOMONAS-AERUGINOSA; PTC124 TREATMENT; COMPOUND; GENOTYPE Multiple languages Critical Care Medicine; Respiratory System Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/43537