MannKind Corporation announced the discontinuation of its Phase 3 ICoN-1 clinical trial evaluating MNKD-101, a nebulized clofazimine inhalation suspension, for the treatment of refractory nontuberculous mycobacterial (NTM) lung disease following a futility determination based on interim efficacy data.
Trial Results and Decision
As part of routine study monitoring, an analysis was conducted on sputum culture conversion data from the first 46 participants who completed the double-blind treatment phase. No conversions were observed, raising concerns about the likelihood of achieving the study's primary endpoint. Following an ad hoc meeting on November 8, 2025, the independent Data Safety Monitoring Board (DSMB) reviewed the data and agreed with the decision to discontinue the trial due to futility.
Importantly, the DSMB did not identify any safety concerns at any point during the study, indicating that the discontinuation was solely based on lack of efficacy rather than safety issues.
"We are disappointed that the nebulized formulation did not demonstrate efficacy in this patient population," said Dr. Ajay Ahuja, Chief Medical Officer of MannKind Corporation. "However, we remain hopeful regarding the potential of MNKD-102, our dry powder inhalation (DPI) formulation of clofazimine, which has been progressing toward Phase 1 development."
Study Design and Endpoints
The ICoN-1 trial was designed as a multi-national, randomized, double-blind, placebo-controlled, Phase 3 registrational study to evaluate the efficacy and safety of clofazimine inhalation suspension when added to guideline-based therapy in adults with refractory NTM lung disease caused by mycobacterium avium complex (MAC). The study included an open-label extension phase.
The co-primary endpoints in the U.S. were sputum culture conversion (negative for NTM for 3 consecutive months) from baseline to end of Month 6 and change in quality of life during the same timeframe. Outside the U.S., the primary endpoint was sputum culture conversion.
Future Development Plans
The discontinuation of the nebulized formulation does not impact the development of MNKD-102, MannKind's dry powder inhalation formulation of clofazimine, which remains under consideration for future clinical advancement. The company is committed to understanding the factors that contributed to the failure of the nebulized formulation and applying those insights to guide future development efforts.
Disease Background and Unmet Need
Pulmonary NTM infection represents a significant global health concern due to its rising prevalence worldwide and association with shortened life span, high morbidity, and substantial impact on patients' quality of life. NTM is a group of bacteria naturally found in the environment, including water and soil, that can cause cough, fatigue, reduction in lung function, and poor quality of life.
Individuals with underlying conditions such as COPD, asthma, and bronchiectasis face increased risk of NTM establishing infection in the lungs, leading to progressive worsening of lung function. There are nearly 200 species of NTM, with MAC accounting for approximately 80% of all NTM lung disease cases in the United States.
The disease predominantly affects women over age 65. Current estimates indicate NTM disease prevalence exceeds 100,000 patients in the U.S. and over 150,000 in Japan as of 2022. Approximately 15-20% of NTM patients are refractory to existing treatments. The prevalence rate is increasing globally, with claims-based studies suggesting an annual rise of 7.5% within the U.S. alone.
