Chlofazamine Clinical Trial Experience and Watch & Wait

Posted by annagh @annagh, Jan 13 2:03pm

I was diagnosed with bronchiectasis in 2015 and MAC and H-infulenza in December 2023. Treatment for H-flu helped greatly with fatigue and lessened the severe cough. A CT scan in 2023 compared to the previous one in 2017 showed some progression of disease, but not that much for 5 or 6 years, especially since I did not start any airway clearance until late 2023. My pulmonologist wanted me to start the Big 3, but I opted instead to do a 6 month clinical trail with Kevin Winthrop, ID doctor as OHSU. It involved three trips to Portland, at beginning, mid-point, and end of trial for testing and reporting, taking either a placebo or Chlofazamine for 6 months, sending sputum samples every other week, and having an ECG once a month. I did not turn tan, as 75% of people do, and did not notice any other side effects, so assumed I was on placebo, but Dr. Winthrop said my ECGs showed a prolonged QT interval, which convinced him I was on the real drug. Since it's a double-blind study he is not told who gets drug or placebo. Nor does he see results of the sputum cultures.
I saw him last week for the end of study. I still have my cough, and it can fluctuate, but I'd say is a bit improved, and I still produce a good amount of sputum daily. With bronchiectasis I suspect that will always be true. My CT scan showed that some areas (tree in bud or mucus plugs) that were new in May '23 (as compared to October '23) are gone, but there are some new areas. Overall he said, more are gone than have shown up new. His conclusion is that the drug knocked the disease down a bit, but that MAC is hanging out in the area where I have the original bronchiectasis, and sending out "starters" which my immune system, nebulizing and Areobika use, are fighting off, possibly with the help of the Chlofazamine. We will not get results on my sputum sample for another eight weeks, and I have a follow up visit in May at which time we'll have another "what's next" discussion. Hopefully airway clearance (and walking 2 miles a day) will continue to keep me relatively stable.
I am glad I had the opportunity to participate in this trail, happy that my mild symptoms and slow progression allow me to do that, and so grateful to this group and NTM Info and Research for the support and shared information. This is where I learned about the Aerobika and all the nitty-gritty stuff about nebulizing and airway clearance.
Thanks and my best wishes for good health to all of us.

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

Can you post the link to the Clinical Trial, I would like to see what it is about. I am considering the MAC2vs3trial but was not aware of this trial.

REPLY

Clofazimine in the Treatment of Pulmonary Mycobacterium Avium Complex (MAC)
https://classic.clinicaltrials.gov/ct2/show/NCT02968212

REPLY

Gosh it sounds like you are doing well! Because I am asymptomatic and nothing had changed in my CT for a year, and because I have macular degeneration, getting injections every right weeks, plus several other health issues, I will continue to watch and wait. I'm happy for you that the regimen has worked for you.
I pray they will find a cure for this disease that will not be so debilitating.
Thank you for your information.

REPLY
@wabashacabin

Thank you. I want to do this trial but not sure I am brave enough to try. Any information you can offer would be great. Side effects, etc.
After reading all the information in the trial material it sounds so scary!!! Can't make a decision.

Jump to this post

I think I'd be more afraid not to do it. It has shown to be effective.

REPLY
@formergardener

The trial begins with 4 months of 200 mg a day for 4 months. Then it drops to 100 mg a day for 2 months.

My skin did darken, and it did become extremely dry. The nurse recommended Gold Bond cream. I never had nausea and always took the meds with the evening meal. I was told to take it with food, and I think that taking it with a full meal hindered some absorption. I think the small amount of fat is a better idea.

I had some loose stools occasionally but no diarrhea. No pains or nausea. I felt well and found it easier to gain weight on the 200 mg. Clofazimine. A couple of weeks into the 100 mg, I began to feel tired. My doctor pulled me out of the trial after 6 months because my numbers started climbing.

It has a long half life. I started the Azithromycin and Ethambutol 3x weekly immediately after stopping Clofazimine, and I dropped to just a few colonies in a few weeks. My doctor had to wait until six months before adding the nebulized liposomal Arikayce. They will soon allow Arikayce to be started right away with the other drugs. Since the Arikayce is nebulized, and I only use it 3 times a week, I don’t have side effects that would occur with daily use of if it was in pill form and swallowed. I have been smear and culture negative for 3 months now.

I think the Rifampin is the nasty med that causes so many issues. Since they now have Arikayce, you can be treated without Rifampin. I always think about the people who stopped their meds because of Rifampin side effects

Clofazimine is probably better for people with mild disease. Probably more effective as a single drug for those people. It is the best when combined with 2 other drugs because it facilitates their entry into the cell wall. When I was first diagnosed, I had a +2 smear and a +3 culture and had symptoms. The Clofazimine alone will have better results if you are not yet symptomatic.

I think they are looking for a maintenance drug that is more tolerable, and Clofazimine is. It took about 5 -6 months for my skin discoloration to disappear. I would say that, for me, the extreme dryness was the only bothersome side effect. This is one of the more tolerable drugs.

I would not be afraid of the drugs they have now. This bug damages your lungs and worsens bronchiectasis, which then leads to more risk for bronchiectasis and greater likelihood of reinfection. By treating it early, you shorten time to culture conversion and lessen damage. That is just my opinion from what I have learned. If you have an excellent team that is closely monitoring you, they will know when it is time to start meds.

Jump to this post

Thank you for such a helpful description of these meds! I'm glad they were successful for you and hope you are feeling well and continue to do so.

REPLY

Following up on the Clofazamine trial which I participated in, my sputum culture results from the end of the 6 month trial period, just cam back negative. My next appointment with Dr. Winthrop is in early May, but his assistant says, though the results don't necessarily mean it's gone, it does indicate that the micobacterial infection is at least suppressed. I'm happy about the news and eager to discuss what the next steps will be. I'm expecting CT scan at 6 months, but wondering how often he'll want to do sputum cultures.
For those who are "holding your own" how often are cultures done?

REPLY
@annagh

Following up on the Clofazamine trial which I participated in, my sputum culture results from the end of the 6 month trial period, just cam back negative. My next appointment with Dr. Winthrop is in early May, but his assistant says, though the results don't necessarily mean it's gone, it does indicate that the micobacterial infection is at least suppressed. I'm happy about the news and eager to discuss what the next steps will be. I'm expecting CT scan at 6 months, but wondering how often he'll want to do sputum cultures.
For those who are "holding your own" how often are cultures done?

Jump to this post

I asked Dr. W's assistant about culture frequency and she said that for patients in treatment he usually does AFB testing every 3-4 months, and for patients not in treatment it's 6-12 months—oftener if something of concern comes up.
Good to know, and to have doctors I trust. I'm also feeling good about my pulmonologist who is closer to my home. He was following the recommended protocol in advising me to start the Big 3, but as he said last time I saw him, he likes bringing in Dr. Winthrop (ID doctor and researcher), because he has more options. For now it's nebulizing and walking for me!
Anna

REPLY

Just curious if you are walking outdoors year round and if you wear a mask all the time or especially when pollen is on the rise. Thank you

REPLY
@bbeers

Just curious if you are walking outdoors year round and if you wear a mask all the time or especially when pollen is on the rise. Thank you

Jump to this post

I walk outdoors year round and don't worry about pollen. I don't notice that it effects me. I do skip the walk when air quality from smoke is 90 or above and when weather is bad.

REPLY
Please sign in or register to post a reply.