Positive Results from Phase 2 WILLOW Study of Brensocatib in Patients with Non-Cystic Fibrosis Bronchiectasis Presented at ATS Virtual Clinical Trials Session

Rhea-AI Summary

Insmed announced final results from the Phase 2 WILLOW study of brensocatib in patients with non-cystic fibrosis bronchiectasis (NCFBE). The study met its primary endpoint, showing significant prolongation of time to first pulmonary exacerbation versus placebo (p=0.027 for 10 mg; p=0.044 for 25 mg). Notably, the 10 mg group had a 42% reduction in exacerbation risk. The treatment was well-tolerated, with the most common adverse events being cough and headache. Following these results, Insmed plans to initiate a Phase 3 program for brensocatib in bronchiectasis in the second half of 2020.

Positive

• Phase 2 WILLOW study met primary endpoint with significant results.
• 42% reduction in exacerbation risk for the 10 mg group.
• Brensocatib well-tolerated in patients; most common AEs were mild.

Negative

• Limited effect on secondary endpoints; no approved therapies for NCFBE in the U.S.
• Adverse event rates for brensocatib were slightly higher than placebo in some categories.

BRIDGEWATER, N.J., June 24, 2020 /PRNewswire/ -- Insmed Incorporated (Nasdaq:INSM), a global biopharmaceutical company on a mission to transform the lives of patients with serious and rare diseases, today announced that final results from the Phase 2 WILLOW study of brensocatib (formerly INS1007) in patients with non-cystic fibrosis bronchiectasis (NCFBE) were presented during a virtual American Thoracic Society (ATS) session titled Breaking News: Clinical Trial Results in Pulmonary Medicine. Brensocatib is a novel, oral, reversible inhibitor of dipeptidyl peptidase 1 (DPP1) being developed by Insmed for the treatment of bronchiectasis and other inflammatory diseases.

The WILLOW study met its primary endpoint, with brensocatib significantly prolonging time to first pulmonary exacerbation over the 24-week treatment period versus placebo (p=0.027 for the 10 mg group; p=0.044 for the 25 mg group). The risk of exacerbation at any time during the trial was reduced by 42% for the 10 mg group versus placebo (HR 0.58, p=0.029) and by 38% for the 25 mg group versus placebo (HR 0.62, p=0.046).

Treatment with brensocatib 10 mg also resulted in a significant reduction in the rate of pulmonary exacerbations, a key secondary endpoint, versus placebo. Patients treated with brensocatib experienced a 36% reduction in the 10 mg arm (p=0.041) and a 25% reduction in the 25 mg arm (p=0.167) versus placebo. Change from baseline to the end of the treatment period in concentration of active neutrophil elastase (NE) in sputum demonstrated a significantly larger reduction with both brensocatib doses versus placebo (p=0.034 for 10 mg, p=0.021 for 25 mg).

"I am very encouraged by the results from the Phase 2 WILLOW study, which underscore the potential for brensocatib to reduce the risk of pulmonary exacerbation in patients with NCFBE," said presenter and lead study investigator James Chalmers, MBChB, Ph.D., Professor and Consultant Respiratory Physician at the School of Medicine, University of Dundee, UK. "These findings are critically important given the vicious cycle of inflammation, lung damage, and infection that patients with NCFBE face and the current lack of approved pharmaceutical therapies."

In addition to the previously reported primary and secondary endpoint data, Professor Chalmers presented new data today from a pooled analysis of patients treated with either dosage of brensocatib in the WILLOW study. This analysis showed that patients treated with brensocatib who achieved sputum NE below the limit of quantification post-baseline had a lower incidence of pulmonary exacerbations compared to patients who had a quantifiable level of sputum NE post-baseline. Importantly, the risk of having an exacerbation was 72% lower in these patients.

"We are thrilled to share positive final results from the Phase 2 WILLOW study today, confirming the top-line results presented earlier this year. These findings are very meaningful for patients with NCFBE, who currently suffer from severe outcomes in the absence of an approved therapy," said Martina Flammer, M.D., MBA, Chief Medical Officer of Insmed. "Importantly, the new data presented today demonstrate the relationship between NE reduction and risk of exacerbation and serve as further proof of concept of the potential of brensocatib and its unique mechanism of action. We look forward to initiating our Phase 3 program in bronchiectasis while also exploring the potential of brensocatib in other neutrophil-driven inflammatory conditions."

Brensocatib was generally well-tolerated in the study. Rates of adverse events (AEs) leading to discontinuation in patients treated with placebo, brensocatib 10 mg, and brensocatib 25 mg were 10.6%, 7.4%, and 6.7%, respectively. The most common AEs in patients treated with brensocatib were cough, headache, sputum increase, dyspnea, infective exacerbation of bronchiectasis, diarrhea, fatigue, and upper respiratory tract infection.

Rates of adverse events of special interest (AESIs) in patients treated with placebo, brensocatib 10 mg, and brensocatib 25 mg, respectively, were as follows: rates of skin events (including hyperkeratosis) were 11.8%, 14.8%, and 23.6%; rates of dental events were 3.5%, 16.0%, and 10.1%; and rates of infections considered AESIs were 17.6%, 13.6%, and 16.9%. Hyperkeratosis was reported in 1/85, 3/81, and 1/89 patients treated with placebo, brensocatib 10 mg, and brensocatib 25 mg, respectively. The study included extensive dental evaluations to closely monitor progression of periodontal disease. The results did not raise a signal about dental safety. The percentage of patients with change in periodontal pocket depth ≥2 mm and absolute value of ≥5 mm (the threshold of concern for periodontal disease) were 11.6%, 11.3%, and 12.3% for placebo, brensocatib 10 mg, and brensocatib 25 mg, respectively.

Brensocatib received breakthrough therapy designation from the U.S. Food and Drug Administration in June 2020 for the treatment of adult patients with NCFBE for reducing exacerbations. Insmed plans to initiate a Phase 3 program for brensocatib in bronchiectasis in the second half of 2020.

About WILLOW

WILLOW was a randomized, double-blind, placebo-controlled, parallel-group, multi-center, multi-national, Phase 2 study to assess the efficacy, safety and tolerability, and pharmacokinetics of brensocatib administered once daily for 24 weeks in patients with non-cystic fibrosis bronchiectasis (NCFBE). WILLOW was conducted at 116 sites and enrolled 256 adult patients diagnosed with NCFBE who had at least two documented pulmonary exacerbations in the 12 months prior to screening. Patients were randomized 1:1:1 to receive either 10 mg or 25 mg of brensocatib or matching placebo. The primary efficacy endpoint was the time to first pulmonary exacerbation over the 24-week treatment period in the brensocatib arms compared to the placebo arm.

About Brensocatib (Formerly INS1007)

Brensocatib is a small molecule, oral, reversible inhibitor of dipeptidyl peptidase I (DPP1) being developed by Insmed for the treatment of patients with bronchiectasis. DPP1 is an enzyme responsible for activating neutrophil serine proteases (NSPs), such as neutrophil elastase, in neutrophils when they are formed in the bone marrow. Neutrophils are the most common type of white blood cell and play an essential role in pathogen destruction and inflammatory mediation. In chronic inflammatory lung diseases, neutrophils accumulate in the airways and result in excessive active NSPs that cause lung destruction and inflammation. Brensocatib may decrease the damaging effects of inflammatory diseases such as bronchiectasis by inhibiting DPP1 and its activation of NSPs.

About Non-Cystic Fibrosis Bronchiectasis

Non-cystic fibrosis bronchiectasis (NCFBE) is a severe, chronic pulmonary disorder in which the bronchi become permanently dilated due to a cycle of infection, inflammation, and lung tissue damage. The condition is marked by frequent pulmonary exacerbations requiring antibiotic therapy and/or hospitalizations. Symptoms include chronic cough, excessive sputum production, shortness of breath, and repeated respiratory infections, which can worsen the underlying condition. NCFBE affects approximately 340,000 to 520,000 patients in the U.S. Today, there are no approved therapies specifically targeting NCFBE in the U.S., Europe, or Japan.

About Insmed

Insmed Incorporated is a global biopharmaceutical company on a mission to transform the lives of patients with serious and rare diseases. Insmed's first commercial product, ARIKAYCE^® (amikacin liposome inhalation suspension), is the first and only therapy approved in the United States for the treatment of refractory Mycobacterium avium complex (MAC) lung disease as part of a combination antibacterial drug regimen for adult patients with limited or no alternative treatment options. MAC lung disease is a chronic, debilitating condition that can cause severe and permanent lung damage. Insmed's earlier-stage clinical pipeline includes brensocatib, a novel oral reversible inhibitor of dipeptidyl peptidase 1 with therapeutic potential in non-cystic fibrosis bronchiectasis and other inflammatory diseases, and treprostinil palmitil, an inhaled formulation of a treprostinil prodrug that may offer a differentiated product profile for rare pulmonary disorders, including pulmonary arterial hypertension. For more information, visit www.insmed.com.

Forward-looking Statements

This press release contains forward-looking statements that involve substantial risks and uncertainties. "Forward-looking statements," as that term is defined in the Private Securities Litigation Reform Act of 1995, are statements that are not historical facts and involve a number of risks and uncertainties. Words herein such as "may," "will," "should," "could," "would," "expects," "plans," "anticipates," "believes," "estimates," "projects," "predicts," "intends," "potential," "continues," and similar expressions (as well as other words or expressions referencing future events, conditions or circumstances) may identify forward-looking statements.

The forward-looking statements in this press release are based upon the Company's current expectations and beliefs, and involve known and unknown risks, uncertainties and other factors, which may cause the Company's actual results, performance and achievements and the timing of certain events to differ materially from the results, performance, achievements or timing discussed, projected, anticipated or indicated in any forward-looking statements. Such risks, uncertainties and other factors include, among others, the following: the risk that brensocatib does not prove effective or safe for patients in the STOP-COVID19 study; business or economic disruptions due to catastrophes or other events, including natural disasters or public health crises; impact of the novel coronavirus (COVID-19) pandemic and efforts to reduce its spread on our business, employees, including key personnel, patients, partners and suppliers; failure to successfully commercialize or maintain U.S. approval for ARIKAYCE, the Company's only approved product; uncertainties in the degree of market acceptance of ARIKAYCE by physicians, patients, third-party payors and others in the healthcare community; the Company's inability to obtain full approval of ARIKAYCE from the FDA, including the risk that the Company will not timely and successfully complete the study to validate a PRO tool and complete the confirmatory post-marketing study required for full approval of ARIKAYCE; inability of the Company, PARI or the Company's other third party manufacturers to comply with regulatory requirements related to ARIKAYCE or the Lamira^® Nebulizer System; the Company's inability to obtain adequate reimbursement from government or third-party payors for ARIKAYCE or acceptable prices for ARIKAYCE; development of unexpected safety or efficacy concerns related to ARIKAYCE or brensocatib; inaccuracies in the Company's estimates of the size of the potential markets for ARIKAYCE or brensocatib or in data the Company has used to identify physicians; expected rates of patient uptake, duration of expected treatment, or expected patient adherence or discontinuation rates; the Company's inability to create an effective direct sales and marketing infrastructure or to partner with third parties that offer such an infrastructure for distribution of ARIKAYCE; failure to obtain regulatory approval to expand ARIKAYCE's indication to a broader patient population; failure to successfully conduct future clinical trials for ARIKAYCE, brensocatib and the Company's other product candidates, including due to the Company's limited experience in conducting preclinical development activities and clinical trials necessary for regulatory approval and the Company's inability to enroll or retain sufficient patients to conduct and complete the trials or generate data necessary for regulatory approval; risks that the Company's clinical studies will be delayed or that serious side effects will be identified during drug development; failure to obtain, or delays in obtaining, regulatory approvals for ARIKAYCE outside the U.S. or for the Company's product candidates in the U.S., Europe, Japan or other markets, including the United Kingdom as a result of its recent exit from the European Union; failure of third parties on which the Company is dependent to manufacture sufficient quantities of ARIKAYCE or the Company's product candidates for commercial or clinical needs, to conduct the Company's clinical trials, or to comply with laws and regulations that impact the Company's business or agreements with the Company; the Company's inability to attract and retain key personnel or to effectively manage the Company's growth; the Company's inability to adapt to its highly competitive and changing environment; the Company's inability to adequately protect its intellectual property rights or prevent disclosure of its trade secrets and other proprietary information and costs associated with litigation or other proceedings related to such matters; restrictions or other obligations imposed on the Company by its agreements related to ARIKAYCE or the Company's product candidates, including its license agreements with PARI and AstraZeneca AB, and failure of the Company to comply with its obligations under such agreements; the cost and potential reputational damage resulting from litigation to which the Company is or may become a party, including product liability claims; the Company's limited experience operating internationally; changes in laws and regulations applicable to the Company's business, including any pricing reform, and failure to comply with such laws and regulations; inability to repay the Company's existing indebtedness and uncertainties with respect to the Company's ability to access future capital; and delays in the execution of plans to build out an additional FDA-approved third-party manufacturing facility and unexpected expenses associated with those plans.

The Company may not actually achieve the results, plans, intentions or expectations indicated by the Company's forward-looking statements because, by their nature, forward-looking statements involve risks and uncertainties because they relate to events and depend on circumstances that may or may not occur in the future. For additional information about the risks and uncertainties that may affect the Company's business, please see the factors discussed in Item 1A, "Risk Factors," in the Company's Annual Report on Form 10-K for the year ended December 31, 2019, our Quarterly Report on Form 10-Q for the quarter ended March 31, 2020 and any subsequent Company filings with the SEC.

The Company cautions readers not to place undue reliance on any such forward-looking statements, which speak only as of the date of this press release. The Company disclaims any obligation, except as specifically required by law and the rules of the SEC, to publicly update or revise any such statements to reflect any change in expectations or in events, conditions or circumstances on which any such statements may be based, or that may affect the likelihood that actual results will differ from those set forth in the forward-looking statements.

Contact:

Investors:

Argot Partners
Laura Perry or Heather Savelle
(212) 600-1902 
Insmed@argotpartners.com 

Media:

Mandy Fahey 
Senior Director, Corporate Communications 
Insmed 
(732) 718-3621 
amanda.fahey@insmed.com

 

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SOURCE Insmed Incorporated

FAQ

What are the results of the Phase 2 WILLOW study for brensocatib (INSM)?

The Phase 2 WILLOW study showed that brensocatib significantly prolonged time to first pulmonary exacerbation in patients with NCFBE.

What is the next step for Insmed following the WILLOW study results?

Insmed plans to initiate a Phase 3 study for brensocatib in bronchiectasis in the second half of 2020.

How does brensocatib (INSM) impact pulmonary exacerbations?

Brensocatib demonstrated a 42% reduction in the risk of exacerbations in the 10 mg group during the trial.

What adverse events were reported in the WILLOW study for brensocatib?

Common adverse events included cough, headache, and dyspnea, with overall tolerability being good.

Is there an approved treatment for non-cystic fibrosis bronchiectasis (NCFBE)?

Currently, there are no approved therapies specifically targeting NCFBE in the U.S.