Breath Therapeutics announced the initiation of the Phase 3 BOSTON clinical studies of L‑CsA‑i for the treatment of Bronchiolitis Obliterans Syndrome (BOS). Breath Therapeutics' lead drug candidate, L‑CsA‑i, is a proprietary liposomal formulation of cyclosporine A for inhalation administered via a drug-specific investigational eFlow® nebulizer (PARI Pharma). L‑CsA‑i has received orphan drug designation for the treatment of BOS from the Food and Drug Administration and European Medicines Agency.
The harmonized global randomized, controlled studies will evaluate the efficacy and safety of L‑CsA‑i in individuals with BOS following a single lung (BOSTON-1) or double lung (BOSTON-2) transplantation. The primary endpoint is mean change in FEV1 (mL) from baseline to week 48 and the key secondary endpoints are mean change in FEV1/FVC and time to progression of BOS. Each study will enroll 110 participants at leading lung transplant specialty centers in eight countries. Upon completion of the 48-week studies, all participants will be eligible to continue in the planned BOSTON-3, an open-label extension trial. Additional information is available at ClinicalTrials.gov. (BOSTON-1 NCT03657342) (BOSTON-2 NCT03656926). To view experts discuss their clinical experience with BOS and the BOSTON-1 and BOSTON-2 studies, please visit here.
"The initiation of the BOSTON pivotal trials represents a major milestone for Breath Therapeutics and is indicative of the outstanding progress we have achieved in the past 24 months. We have accomplished full commercial scale production capability of both the drug and the drug-specific inhalation device, and have also assembled an exceptional leadership team to execute on our clinical development programs and global commercialization strategy,” Jens Stegemann, Chief Executive Officer of Breath Therapeutics, said. “Together with the enthusiasm and commitment of our renowned investigators and their teams from more than 35 of the leading lung transplant centers world-wide, we are well positioned to succeed in our goal of bringing an effective and safe treatment to people with BOS."
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"Although lung transplant survival has improved with the advancement of surgical techniques and perioperative management, and more individuals are undergoing lung transplantation, survival has not improved to reach the rate of other organ transplantations,” Joseph M. Pilewski, MD, Associate Chief for Clinical Affairs and lung transplant physician in the Division of Pulmonary, Allergy & Critical Care Medicine at the University of Pittsburgh Medical Center, said. “One key factor impacting survival in lung recipients is rejection, particularly bronchiolitis obliterans syndrome (BOS), the most common form of chronic lung allograft dysfunction. The BOSTON trials are timely and important to lung recipients and the broader lung transplant community because inhaled cyclosporine may provide the first safe and effective treatment for BOS."
"We are pleased the BOSTON trials have started and are appreciative for the opportunity to contribute to this important global program. Bronchiolitis obliterans syndrome is a devastating disease for patients and their loved ones and there is an urgent need for a suitable therapy for this underserved community," Antonio Román, MD, Medical Coordinator of the Lung Transplantation and Director of PAH Unit at Hospital Vall d´Hebrón, Barcelona, said.
Bronchiolitis Obliterans Syndrome (BOS), also known as obliterative bronchiolitis (OB) or chronic lung allograft rejection, is caused by T-cell mediated inflammation that leads to blockage of bronchioles, the small and medium airways in the lungs, resulting in respiratory failure and death. BOS most commonly affects people who have received lung or stem cell transplantation, although it is also associated with autoimmune disease and exposure to environmental contaminants. Over 30,000 lung transplantation and allogeneic hematopoietic stem cell transplantation recipients worldwide are currently affected by BOS. Based on company research, lung and allogeneic stem cell transplantations increased between 3% to 5% in recent years, depending on the geographical region, translating to a similar growth in BOS cases.
Breath Therapeutics' lead candidate, L‑CsA‑i, is a novel liposomal formulation of cyclosporine A designed for inhaled delivery to the lungs. Calcineurin inhibitors (CNIs), like cyclosporine A, are highly potent immunosuppressive drugs and a cornerstone of lung transplant medicine. Due to a narrow therapeutic window, mainly caused by nephrotoxicity, the systemic administration of CNIs cannot achieve sufficient drug levels in the bronchiolar tissue needed to treat BOS. L‑CsA‑i is administered via a customized drug-specific investigational eFlow® nebulizer. The drug-device combination is designed to deliver L-CsA-i to the site of disease in the lung while minimizing systemic exposure.