Evaluation of ATx201 as a Topical Antibiotic Agent

Treatment of skin infections, including infected atopic dermatitis, is plagued by inactivity of or resistance towards the main topical antibiotics. Accordingly, the infections are either not effectively treated or harsher systemic antibiotics with side effects are needed.

Infections in atopic dermatitis are predominantly caused by Staphylococcus aureus and various species of Streptococcus. ATx201 is a potent antibiotic against these and other organisms. ATx201 overcomes current resistance problems such as methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE) as well as resistance towards all topical antibiotics. ATx201 also exhibits an extraordinarily strong ability to delay the onset of de novo resistance compared to currently marketed antibiotics.

The study is a combined Phase I/II study with 36 healthy volunteers and 40 patients.

The primary objective is to demonstrate the safety and tolerability of new topical formulations of ATx201 in healthy volunteers, and in a population of patients with infected atopic dermatitis. Efficacy of ATx201 in eradicating S. aureus compared to vehicle after 4 and 7 days of treatment will be evaluated. In Phase I of the study, three formulations of ATx201 including the respective Placebos will be applied to healthy volunteers. One formulation will advance into Phase II, where patients will be treated with the respective formulation or Placebo.

Inclusion criteria

General inclusion criteria:

• Signed and dated informed consent has been obtained
• Age 18 - 70 years
• Male or female
• Female subjects of childbearing potential must be confirmed not pregnant by a negative urine pregnancy test prior trial treatment
• Female subjects of childbearing potential must be willing to use effective contraceptive at trial entry until completion
• Male subjects must agree to use adequate contraception for the duration of the trial

Additional inclusion criteria for Phase II of the study:

• Localized disease (e.g. flexural eczema in a more or less symmetrical distribution on arms) where two individual lesions each covering an area between 10-200 cm2 and where each individual lesion has an investigators global assessment score between 1-3.
• Additional localized lesion of area between 10-200 cm2 and where the individual lesion has an investigators global assessment score between 1-3.
• Total localized disease not exceeding 20 % body surface area
• Colonization of lesions with S.aureus as determined by cultivation

General exclusion criteria

• Clinically relevant abnormalities in the laboratory testing, vital signs, ECG ( Phase I only) or physical examination
• Presence of any skin condition (scars, tattoos,…) that would interfere with the placement of study medication
• History of irritation to topical products
• Current acute or chronic disease unless considered clinically irrelevant by the Investigator
• Relevant history of malignancy, of renal, hepatic, cardiovascular, respiratory, gastrointestinal, musculoskeletal, skin (particularly at the site of drug application), haematological, endocrine or neurological diseases that may interfere with the aim of the study
• Positive HIV serology or evidence of active hepatitis
• Ascertained or presumptive hypersensitivity to the active principle and/or formulations ingredients of the study drugs (test, reference)
• History of drug or alcohol abuse (>2 drinks/day, defined according to USDA Dietary Guidelines 2005)
• caffeine (>5 cups coffee/tea/day) or tobacco abuse (consumption of 5 or more cigarettes/week)
• abnormal or special diet (e.g. vegetarian diet)
• Blood donations during 6 weeks prior to this study or planned within 6 weeks after the last blood withdrawal
• Subject considered unable or unlikely (per Investigator judgment) to comply with safety and PK profiling requirements (follow-up visits)
• Subjects who are pregnant (as determined by a positive pregnancy test at the screening visit) or lactating
• Participation in another clinical trial with an investigational day within 4 weeks before screening

Additional exclusion criteria for Phase I of the study:

• Regular use of medications
• Use of any dermatological drug therapy on the arms within 14 days before day 1 of this study

Additional exclusion criteria for Phase II of the study:

• Treatment with antibiotics (systemic or topical) within the past 3 months and during the study
• Treatment with drugs that affect the immune system within the past 3 months and during the study
• Treatment with topical steroids and calcineurin inhibitors 1 week before and during the study treatment period
• Treatment with systemic steroids within the past month and during the study
• Use of disinfectant soaps within 1 week before screening and during the study treatment period