FDA Briefing Document Tafenoquine Tablet, 100 Mg Meeting of The
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FDA Briefing Document Tafenoquine Tablet, 100 mg Meeting of the Antimicrobial Drugs Advisory Committee (AMDAC) July 26, 2018 The committee will discuss new drug application (NDA) 210607 for tafenoquine tablet, 100 mg, sponsored by 60 Degrees Pharmaceuticals, for the proposed indication of prevention of malaria in adults for up to 6 months of continuous dosing. The attached package contains background information prepared by the Food and Drug Administration (FDA) for the panel members of the advisory committee. The FDA background package often contains assessments and/or conclusions and recommendations written by individual FDA reviewers. Such conclusions and recommendations do not necessarily represent the final position of the individual reviewers, nor do they necessarily represent the final position of the Review Division or Office. The FDA have brought tafenoquine tablets to this Advisory Committee to gain the Committee’s insights and opinions, and the background package may not include all issues relevant to the final regulatory recommendation and instead is intended to focus on issues identified by the Agency for discussion by the Advisory Committee. The FDA will not issue a final determination on the issues at hand until input from the advisory committee process has been considered and all reviews have been finalized. The final determination may be affected by issues not discussed at the advisory committee meeting. 1 Table of Contents 1 Introduction ........................................................................................................................................... 4 2 Background ............................................................................................................................................ 4 3 Product Information ............................................................................................................................... 4 4 Regulatory History ................................................................................................................................. 4 5 Clinical Pharmacology ........................................................................................................................... 4 6 Microbiology ......................................................................................................................................... 6 7 Pharmacology/Toxicology (Nonclinical Neurobehavioral Assessment) ............................................... 7 8 Overview of Clinical Development Program for the Prevention of Malaria ......................................... 8 8.1 Study 033 ...................................................................................................................................... 9 8.1.1 Study Design............................................................................................................................. 9 8.1.2 Statistical Methodologies.........................................................................................................10 8.1.3 Patient Disposition ...................................................................................................................11 8.1.4 Efficacy Results .......................................................................................................................12 8.2 Study 043 .....................................................................................................................................15 8.2.1 Study Design............................................................................................................................15 8.2.2 Statistical Methodologies.........................................................................................................16 8.2.3 Patient Disposition ...................................................................................................................17 8.2.4 Efficacy Results .......................................................................................................................18 8.3 Study 045 .....................................................................................................................................19 8.3.1 Study Design............................................................................................................................19 8.3.2 Statistical Methodologies.........................................................................................................20 8.3.3 Patient Disposition ...................................................................................................................21 8.3.4 Efficacy Results .......................................................................................................................22 8.4 Study 030 .....................................................................................................................................25 8.4.1 Study Design............................................................................................................................25 8.4.2 Statistical Methodologies.........................................................................................................26 8.4.3 Patient Disposition ...................................................................................................................26 8.4.4 Efficacy Results .......................................................................................................................27 8.5 Study TQ-2016-02 .......................................................................................................................28 8.5.1 Study Design............................................................................................................................28 8.5.2 Statistical Methodologies.........................................................................................................29 8.5.3 Patient Disposition ...................................................................................................................30 9 Overall Efficacy Summary ...................................................................................................................32 9.1 Assessment of Efficacy Across Trials ..........................................................................................32 2 9.2 Summary and Conclusions of Efficacy ........................................................................................33 10 Evaluation of Safety .............................................................................................................................34 10.1 Safety Summary ...........................................................................................................................34 10.2 Methods .......................................................................................................................................35 10.3 Adverse Event Analysis ...............................................................................................................36 10.4 Adverse Reactions of Special Interest and Submission Specific Safety Issues ............................38 10.4.1 Ophthalmic ..........................................................................................................................38 10.4.2 Cardiac ................................................................................................................................39 10.4.3 Hematologic ........................................................................................................................40 10.4.4 Renal ...................................................................................................................................41 10.4.5 Neurologic ...........................................................................................................................42 10.4.6 Psychiatric ...........................................................................................................................44 10.4.7 Hepatobiliary .......................................................................................................................46 10.4.8 Gastrointestinal ...................................................................................................................46 11 Draft Points for Advisory Committee Discussion ................................................................................46 3 1 Introduction This briefing document describing the safety and efficacy data for tafenoquine (TQ) was prepared by the FDA for panel members of the Antimicrobial Drugs Advisory Committee. The FDA would like the committee to discuss whether the data are adequate to support the safety and efficacy of TQ for the prevention of malaria in adults for up to 6 months of continuous dosing. 2 Background TQ is an 8-aminoquinoline antimalarial. TQ possesses activity against all pre- erythrocytic and erythrocytic stages of the Plasmodium species, including P. falciparum and P. vivax. The proposed indication is the prevention of malaria in adults for up to 6 months of continuous dosing. The indication encompasses all species of Plasmodia and includes prophylaxis while in the endemic region and post-exposure. The proposed regimen for TQ includes a loading dose of 200 mg (two 100 mg tablets) once daily for 3 days before travel to a malarious area, followed by 200 mg maintenance weekly dose while in the malarious area, followed by a single 200 mg dose in the week following exit from the malarious area. 3 Product