Clinical Drug Experience Knowledgebase

Criteria

Inclusion Criteria:

Male or female ≥18 (and ≤99) at the time of Informed Consent.
Clinically and mycologically (KOH and culture positive for dermatophytes [microbial infection with fungus belonging to the genus Trichophyton, Microsporum, Epidermophyton]) confirmed diagnoses of DSO of the target toenail affecting ≥25% to ≤60% of the target toenail as determined through clinimetric measurement.
Signed written informed consent form (ICF) prior to any trial related activity (subjects must have the mental, literate, and legal ability to give a written informed consent, which must comply with the ICH GCP guidelines and local requirements).
Subjects must be willing and able to comply with trial requirements.

Females must be either postmenopausal for ≥1 year (ie 12 consecutive months of amenorrhea, for which there is no other obvious pathologic or physiologic cause), or surgically sterile (tubal ligation, hysterectomy, or bilateral oophorectomy) for at least 6 months or, if of childbearing potential must use either highly effective birth control methods such as:

Oral, intravaginal or transdermal oestrogen- and progestogen-containing hormonal contraception associated with inhibition of ovulation
Oral, injectable or implantable progestogen-only hormonal contraception associated with inhibition of ovulation
Intrauterine device or intrauterine hormone-releasing system
Bilateral tubal occlusion
Vasectomised partner provided that the partner is the sole sexual partner and that the vasectomised partner has received medical assessment of the surgical success Clinical Study Protocol
Sexual abstinence, ie, refraining from heterosexual intercourse during the entire period of risk associated with the trial treatments

OR

Acceptable birth control methods such as:

Progestogen-only oral hormonal contraception, where inhibition of ovulation is not the primary mode of action
Male or female condom with or without spermicide
Cap, diaphragm or sponge with spermicide
A combination of male condom with either cap, diaphragm or sponge with spermicide (double barrier methods) are also considered acceptable birth control methods

while using trial medication and 28 days after last dose of IMP.

Birth control methods which are considered unacceptable: Periodic abstinence (calendar, symptothermal, post-ovulation methods), withdrawal (coitus interruptus), spermicides only, and lactational amenorrhoea method. Female condom and male condom should not be used together.

Treatment with the IMP will be discontinued in case of pregnancy.

The criteria with respect to pregnancy and contraception are in line with the CTFG Recommendations, v1.1, Sept 2020.

Exclusion Criteria:

Any other form of OM except DSO.
Nails with clinical evidence of no or low distal growth.
DSO of the target toenail where involvement has extended into the proximal portion of the target nail (unaffected proximal nail is ≤3mm) or nail matrix. Any severe OM defined as 3 or more affected toes on one foot.
Estimated target toenail thickness >3mm.
Presence of dermatophytoma (defined as thick masses of fungal hyphae and necrotic keratin between the nail plate and nail bed) on the target nail.
History of dermatophyte infections unresponsive to systemic or topical anti-fungal drugs (other than OM).
Presence of toenail infection that does not involve a dermatophyte.
Presence of toenail infection that involves a non-dermatophyte fungus or yeast in combination with a dermatophyte, where the non-dermatophyte is, in the opinion of the Investigator, considered to be causative of OM based on clinical appearance, medical history or lifestyle risk.

Topical treatment with an antifungal medication within 12 weeks before Randomisation/Visit 2 (with the exception of up to 2 weeks' treatment during the screening period with a non-terbinafine topical antifungal to treat clinically active TP).

Other exclusion criteria

Systemic use of anti-fungal treatment within 12 months before Randomisation/Visit 2.
Past use within the last 6 months before Randomisation/Visit 2 or planned use of laser therapy, photodynamic therapy, chemical, surgical, relevant mechanical removal for OM or debridement.
Concomitant clinically suspected active TP at Randomisation/Visit 2.
Known allergy or known intolerabilities to any of the tested treatment products.
Subjects with diabetes, immune suppression, peripheral vascular disease, lymphatic insufficiency, recurrent cellulitis, or other compromised states of health whether due to underlying medical disorders or to long-term immunosuppressive treatments (including >4 weeks systemic corticoids or >4 weeks topical corticoids on the feet). Topical immunosuppressive treatment if not on the target nail is allowed.
Females of childbearing potential with a positive serum pregnancy test at Screening/Visit 1 and/or a positive urine pregnancy test at Randomisation/Visit 2 are excluded.
Women of childbearing potential who are pregnant or breast feeding or who plan to become pregnant after enrolment until 28 days after the last dose of IMP.
Subjects previously randomised in this trial or received BB2603 previously.
Use of any investigational agent during the study or within 28 days or 5 half-lives prior to Randomisation/Visit 2, whichever is longer.
Close affiliation with the Investigator (eg, a close relative) or persons working at a trial site, or subject who is an employee of the Sponsor's company.
Subjects who are institutionalised because of legal or regulatory order.
Hepatic impairment with AST or ALT >5 x Upper Limit of Normal.
Estimated creatinine clearance using Cockcroft-Gault formula and actual body weight <30 ml/min.
Presence of any other condition or infection of the foot or nail or other disease process that might affect the safety and well-being of the subject or confound the treatment evaluation (eg, psoriasis, lichen planus, or other medical conditions known to induce nail changes, trauma, previous toenail surgery with any residual disfigurement or any dermatological or nail condition that could mimic the signs and symptoms of OM, signs of severe peripheral circulatory insufficiency, use of chronic immunosuppressive medication or radiation therapy within 2 months prior to trial entry or planned during the trial period, immunocompromised).
Subjects deemed to be at risk of re-infection or recurrence of OM due to occupational, environmental or behavioural lifestyle in the opinion of the Investigator.
Any other significant disease or disorder which, in the opinion of the Investigator, may either put the subject at risk because of participation in this trial, or may influence the result of the trial, or the subject's availability to participate in the trial.
Any known or suspected hypersensitivity to, or known allergy to, or other intolerability to BB2603 or its active ingredient or excipients.