Abstract
Bronchiectasis is characterised by uncontrolled neutrophil serine protease (NSP) activity. Cathepsin C (CatC; dipeptidyl peptidase 1) activates NSPs during neutrophil maturation. CatC inhibitors can potentially reduce neutrophil-mediated lung damage. This Phase II, randomised, double-blind, placebo-controlled trial (AIRLEAF®; NCT05238675) evaluated efficacy, safety and optimal dosing of BI 1291583, a novel, reversible CatC inhibitor, in adults with bronchiectasis.
In total, 322 participants were randomised (2:1:1:2) to receive one of three oral doses of BI 1291583 (1 mg/2.5 mg/5 mg) or placebo for 24 to 48 weeks. A multiple comparison procedure and modelling approach was used to demonstrate a non-flat dose–response curve based on the time to first pulmonary exacerbation up to Week 48. In addition, efficacy of individual BI 1291583 doses was evaluated based on the frequency of exacerbations, severe exacerbations (fatal or leading to hospitalisation and/or intravenous antibiotic administration), lung function and quality of life.
A significant dose-dependent benefit of BI 1291583 over placebo was established based on time to first exacerbation (shape: Emax; adjusted p-value: 0.0448). Treatment with BI 1291583 5 mg and 2.5 mg numerically reduced the risk of an exacerbation compared with placebo (hazard ratios: 0.71 and 0.66, 95% CIs 0.48–1.05 and 0.40–1.08; both p>0.05). BI 1291583 2.5 mg showed numerically better efficacy compared with 5 mg across several endpoints; 1 mg was similar to placebo. The safety profile of BI 1291583 was similar to placebo.
Treatment with BI 1291583 resulted in a reduction in the risk of experiencing an exacerbation in adults with bronchiectasis.
Footnotes
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Conflict of interest: EVA received support for this work from the Swedish Research Council, the Strategic Research Area in Epidemiology (SfoEpi) at Karolinska Institutet and the Sven and Ebba Hagberg Prize. EVA received an honorarium for grant review from the Milken Institute.
Conflict of interest: James D Chalmers reports grants or contracts from Astrazeneca, Genentech Gilead Sciences, Glaxosmithkline, Insmed, Grifols, Novartis, and Boehringer Ingelheim, outside the submitted work; consulting fees from Astrazeneca, Chiesi Glaxosmithkline, Insmed, Grifols, Novartis, Boehringer Ingelheim, Pfizer, Janssen, Antabio, Zambon, outside the submitted work; James D Chalmers is the current Chief Editor of the European Respiratory Journal.
Conflict of interest: Anastasia Eleftheraki has nothing to disclose.
Conflict of interest: Wiebke Sauter has nothing to disclose.
Conflict of interest: Peter Eickholz reports support for the present manuscript from Boehringer Ingelheim. Consulting fees received from Boehringer Ingelheim, outside the submitted work; Participation on a Data Safety Monitoring Board or Advisory Board for Boehringer Ingelheim, outside the submitted work.
Conflict of interest: Michal Shteinberg reports support for the present manuscript from Boehringer Ingelheim. Grants or contracts from GSK, Trudell medical international, Tel Aviv league for lung diseases, outside the submitted work; consulting fees from Astra Zeneca, Boehringer Ingelheim, Dexcel, Kamada, Synchrony medical, Trumed, Vertex, Zambon, outside the submitted work; Payment for lectures, presentations, speakers bureaus, manuscript writing or educational events from Astra Zeneca, Boehringer Ingelheim, GSK, Kamada, Sanofi, Insmed, outside the submitted work; Support for attending meetings and/or travel from Boehringer Ingelheim Israel, Astra Zeneca Israel, Kamada, Rafa, GSK Israel, outside the submitted work; Participation on a Data Safety Monitoring Board or Advisory Board or Bonus Biotherapeutics, Boehringer Ingelheim, Astra Zeneca, outside the submitted work; Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: AJRCCM Associate Editor Management board member: Israeli Pulmonology society, Israeli society for Tuberculosis and mycobacterial diseases Management board member: EMBARC Editorial board member: ERJ, Chest, ERJ taskforce member- bronchiectasis guidelines, outside the submitted work; Receipt of equipment, materials, drugs, medical writing, gifts or other services: Trudell medical international - Receipt of oPEP devices for clinical trial.
Conflict of interest: Johanna Rauch reports support for the present manuscript from Boehringer Ingelheim.
Conflict of interest: Abhya Gupta reports support for the present manuscript from Boehringer Ingelheim.
Conflict of interest: Edith Frahm reports support for the present manuscript from Boehringer Ingelheim.
Conflict of interest: Sanjay H Chotirmall reports support for the present manuscript from Singapore Ministry of Health's National Medical Research Council under its Clinician-Scientist Individual Research Grant (MOH-001356), Singapore Ministry of Health's National Medical Research Council under its Clinician Scientist Award (MOH-000710), Open Fund Individual Research Grant (MOH-000955), Singapore Ministry of Education under its AcRF Tier 1 Grant (RT1/22) (S.H.C). Consulting fees from CSL Behring, Boehringer Ingelheim, Pneumagen Ltd, outside the submitted work; Lecture fees from Astra-Zeneca, Chiesi Farmaceutici, outside the submitted work; Participation on a Data Safety Monitoring Board or Advisory Board for Inovio Pharmaceuticals Inc., Imam Abdulrahman Bin Faisal University, outside the submitted work.
Conflict of interest: Naoki Hasegawa reports support for the present manuscript from Boehringer Ingelheim. Royalties or licenses from Boehringer Ingelheim, outside the submitted work; Patents planned, issued or pending for Boehringer Ingelheim, outside the submitted work.
Conflict of interest: Pamela J McShane reports support for the present manuscript from Boehringer Ingelheim. Consulting fees from Boehringer Ingelheim, outside the submitted work; Speakers bureaus from Insmed, outside the submitted work.
Conflict of interest: Marcus A Mall reports support for the present manuscript from Boehringer Ingelheim. Grants or contracts from German Research Foundation (DFG), German Ministry for Education and Research (BMBF), Boehringer Ingelheim, outside the submitted work; Personal fees for consultancy received from Abbvie, Boehringer Ingelheim, Enterprise Therapeutics, Kither Biotec, Prieris, Recode, Splisense, Vertex Pharmaceuticals, outside the submitted work; Honoraria received for presentations and educational events from Vertex Pharmaceuticals, outside the submitted work; Travel reimbursement received for participation in advisory board meetings for Boehringer Ingelheim, Vertex Pharmaceuticals, outside the submitted work; Personal fees for participation in advisory board received from Abbvie, Boehringer Ingelheim, Enterprise Therapeutics, Kither Biotec, Pari, Vertex Pharmaceuticals, outside the submitted work.
Conflict of interest: Anne E O'Donnell reports support for the present manuscript from Boehringer Ingelheim. Grant or contracts from Insmed, Zambon, Paratek, Armata, Renovian, outside the submitted work; consulting fees from Boehringer Ingelheim, Insmed, outside the submitted work; Leadership or fiduciary role in other board, society, committee or advocacy group: US Bronchiectasis and NTM Research Registry -Steering committee, outside the submitted work.
Conflict of interest: April W Armstrong reports grants or contracts from Abbvie; ASLAN; BMS; Dermavant Sciences; Dermira; Eli Lilly; Galderma; Incyte; Janssen; Leo Pharma; Meiji Seika Pharma Co; Modernizing Medicine; Nimbus Therapeautics; Novartis; Ortho Dermatologics; Pfizer; Sanfoi Genzyme; UCB; Ventyx Biosciences, outside the submitted work; Consulting fees from Abbvie; ASLAN; Almirall; Amgen; Arcutis; Beiersdorf; BMS; Dermavant; EPI Health; Eli Lilly; Janssen; LEO Pharma; Mindera; Nimbus; Organon & Co; Sanofi; Sun Pharma; Takeda; Ventyx Biosciences, outside the submitted work; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events for Abbvie; Amgen; BMS; Galderma; Janssen; Mindera; Organon & Co; Sanofi; Takeda, outside the submitted work; Participation on a Data Safety Monitoring Board or Advisory Board for Incyte; Regeneron; UCB; Boehringer Ingelheim; Parexel, outside the submitted work; Leadership or fiduciary role in other board, society, committee or advocacy group: Board of Director Elect, American Academy of Dermatology, outside the submitted work.
Conflict of interest: Henrik Watz declares medical writing support for the present manuscript from Nucleus Global; and consulting fees, payment or honoraria, payment for expert testimony, support for attending meetings and participation on a Data Safety Monitoring Board or Advisory Board from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Sanofi.
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- Received August 5, 2024.
- Accepted August 29, 2024.
- Copyright ©The authors 2024. For reproduction rights and permissions contact permissions{at}ersnet.org