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AN2 Therapeutics Shifts Phase 3 MAC Lung Disease Trial to Quality of Life Endpoint

• AN2 Therapeutics has selected Quality of Life-Bronchiectasis (QOL-B) respiratory domain as the new primary efficacy endpoint for their Phase 3 EBO-301 trial in treatment-refractory MAC lung disease.

• The company plans to accelerate data unblinding in Q2 2025, following promising Phase 2 results where epetraborole showed statistical superiority versus placebo in QOL-B measurements.

• This strategic shift aligns with FDA's 2023 guidance emphasizing patient-reported outcomes as primary endpoints in NTM drug development trials.

AN2 Therapeutics has announced a strategic update to its Phase 3 EBO-301 trial for treatment-refractory MAC lung disease, submitting an amended statistical analysis plan to the FDA that establishes the Quality of Life – Bronchiectasis (QOL-B) respiratory domain as the primary efficacy endpoint.
The decision follows encouraging Phase 2 results where epetraborole demonstrated nominal statistical superiority compared to placebo. The QOL-B measurements showed a difference in least squares mean change from baseline of 6.90 (p=0.0365) at month 6, indicating meaningful clinical improvement in a highly refractory patient population.
"The FDA has made it clear that the primary bar for NTM drug approval is patient-reported improvement in NTM symptoms," stated Eric Easom, Co-Founder, President and CEO of AN2 Therapeutics. "Our recent statistical analysis plan submission provides the opportunity to seek FDA input on our selection of QOL-B as the new primary efficacy endpoint prior to unblinding the Phase 3 data."

Strategic Alignment with Regulatory Guidelines

The endpoint modification aligns with the FDA's 2023 Guidance for Industry on NTM drug development, which recommends patient-reported outcome (PRO) based clinical measures as primary endpoints in registrational trials. This approach mirrors the precedent set by Insmed's confirmatory study of Arikayce in treatment-naïve MAC patients.

Robust Evidence Supporting QOL-B Selection

Psychometric analyses from the Phase 2 study demonstrated strong evidence for:
  • Reliability and validity of the QOL-B respiratory domain score
  • Ability to detect change (responsiveness)
  • Clinically meaningful within-patient changes
A post-hoc analysis using the MACrO2 PRO showed comparable results, with epetraborole achieving a difference in least squares mean change from baseline of 5.81 (p=0.0433).

Path Forward

The company has completed treatment for 97 subjects in the Phase 3 portion of the trial, with data remaining blinded for analysis. AN2 Therapeutics plans to:
  • Release topline Phase 3 results in Q2 2025
  • Review both Phase 2 and Phase 3 results with the FDA
  • Discuss potential registrational pathways for this highly refractory population
The strategic pivot reflects AN2 Therapeutics' commitment to advancing treatment options for patients with limited alternatives while adhering to evolving regulatory standards in NTM drug development.
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