The primary objective of the study is to determine the safety and tolerability of 4 week oral administration of EYP001a in subjects with Chronic Hepatitis B Virus Infection (CHBV) when given as monotherapy or in combination with Pegylated interferon…
ID
Source
Brief title
Condition
- Other condition
- Hepatic and hepatobiliary disorders
Synonym
Health condition
Hepatitis B
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Safety endpoint: evaluations will include the following:
* Incidence and severity of AEs;
* Vital signs parameters;
* Physical examination findings;
* ECG parameters;
* Clinical laboratory parameters (serum chemistry, hematology, coagulation,
urinalysis).
Pharmacokinetic endpoints:EYP001a PK parameters to be calculated include:
* Maximum concentration (Cmax);
* Time to maximum concentration (Tmax);
* Area under the concentration-time curve from time 0 to last measurable
concentration (AUC0-6h);
* Lag time (tlag);
* Average plasma drug concentration at steady state (Cavg,ss);
* Time to steady state (Tss).
Secondary outcome
PD markers:
The following markers will be measured:
-Bile acids: Bile acid precursor C4 (7*hydroxy-4-cholesten-3-one) and
fibroblast growth factor 19 (FGF19)
-Lipid metabolism: Total plasma cholesterol, triglycerides, high density
lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol,
apolipoprotein (Apo) A1 and ApoB.
-HBV virology: hepatitis B surface antigen (HBsAg), HBV core-related antigen
(HBcrAg), hepatitis B envelope antigen (HBeAg), HBV DNA (viral load) and HBV
pgRNA.
Background summary
Chronic hepatitis B (CHB) remains a public health problem despite the fact that
an efficient and safe vaccine exists. One third of the world*s population has
been infected by HBV and 240 million individuals are chronically infected with
the inherent risk of progression to cirrhosis and hepatocellular carcinoma.
Available treatments often fail to induce functional cure. Treatment with
multiple drugs having different mechanisms of action may be needed to improve
viral clearance. More effective and better tolerated therapies without the need
for lifelong medication should therefore be developed.
EYP001a is a novel synthetic agonist (stimulator) of the nuclear hepatocyte
farnesoid X receptor (FXR) which plays a pivotal role in regulating bile acids
(BA) biosynthesis. FXRs are expressed in high amounts in the liver, intestines
and kidney. One of the primary functions of FXR activation is the suppression
of cholesterol 7 alpha-hydroxylase (CYP7A1), the rate-limiting enzyme in bile
acid synthesis from cholesterol.
Hepatitis B virus and bile salt mechanism seem tightly interdependent. Given
the interdependence of HBV and FXR, and the fact that FXR agonist EYP001a
showed consistent anti-HBV in vitro activity, the compound was selected to be
developed as an oral HBV therapy aiming for a functional cure of chronic
infection.
EYP001a is not registered as a drug but has been administered to healthy male
subjects before in a clinical study. In addition a phase 1 clinical study has
been conducted in subjects with chronic HBV infection to determine the effect
of food on the PK. The overall clinical development goal is to achieve a safe
and tolerable dose or doses of EYP001a that would result in the same or greater
level of antiviral efficacy compared to the existing marketed drug for
hepatitis B.
Study objective
The primary objective of the study is to determine the safety and tolerability
of 4 week oral administration of EYP001a in subjects with Chronic Hepatitis B
Virus Infection (CHBV) when given as monotherapy or in combination with
Pegylated interferon alpha 2a (Peg-IFN*2a) (Part B only).
The secondary objectives of the study are to:
* Evaluate the pharmacodynamics (PD) of bile acid and lipid metabolism of
EYP001a in CHBV subjects;
* Evaluate the pharmacokinetics (PK) of EYP001a in CHBV subjects;
* Evaluate viral PD markers of EYP001 in CHBV against standard of care
entecavir (ETV);
* Evaluate viral PD markers of EYP001 in combination with standard of care
Peg-IFN*2a against EYP001a monotherapy.
Study design
This study is designed as a multicenter, randomized, double-blind,
placebo-controlled two-part trial. Part A and part B. The visits to the
hospital consist of outpatient visits.
The design incorporates 29 days monotherapy (6 parallel treatment arms in Part
A) and 29 days combination therapy (3 parallel treatment arms in Part B). Three
dose-levels and 2 dosing regimens of EYP001a will be explored.
The design also includes an open-label standard of care ETV monotherapy arm in
Part A and an open-label standard of care Peg-IFN*2a co-treatment arms in Part
B.
Each treatment group will consist of six subjects (n=6).
Intervention
The study will consist of Part A and Part B. Subjects who have completed Part A
and new CHBV subjects who meet study entry criteria are eligible for Part B.
Part A:
The subjects will be randomly assigned to receive 1 of the following 6
treatments for a period of 29 days:
* Treatment A: oral EYP001a (1x100 mg/day; n=6)
* Treatment B: oral EYP001a (1x200 mg/day; n=6)
* Treatment C: oral EYP001a (1x400 mg/day; n=6)
* Treatment D: oral EYP001a (2x200 mg/day; n=6)
* Treatment E: oral placebo (n=6) or
* Treatment F: oral ETV (open-label 0.5 mg/day) (n=6)
An external, independent Data Safety Monitoring Committee (DSMC) will review
all available unblinded preliminary safety, PK and PD results after 18 subjects
have completed study visit Day 15 across all treatment groups in Part A.
Following review of the available data the DSMC will advise any amendments
that are necessary for safety or methodological reasons or will recommend
continuation of the study according to this protocol. The DSMC may also
recommend accrual of up to 12 additional subjects to compensate for any
subjects dropping out of the study prior to completing 29 days of treatment.
Patient accrual will continue throughout the period of DSMC review.
Part B:
Following review of the available data from the first 18 subjects in Part A,
the DSMC will identify and recommend two dose levels of EYP001a to be evaluated
in Part B of this study. The a priori dose levels for Part B will be 300 mg/day
(morning dose only) and 150 mg 2x/day (morning and
evening doses). These dose levels can be modified by the DSMC. Alternative dose
levels selected by the DSMC will not be lower than a total dose of 100mg/day
and will not exceed a total dose of 500 mg/day.
In addition to selecting dose levels for Part B, the DSMC will also determine
whether dosing in Part B will be once a day or twice a day. This selection will
be based on safety, tolerability, PK and PD data obtained from the first 18
subjects who have been assessed at Day 15 study visit
across all treatment groups in Part A.
Adults with CHBV infection will be assigned randomly to receive 1 of the
following 3 treatment regimens:
* Treatment G: oral EYP001a (1x300 mg/day) plus open label Peg-INF*2a (n=6)
* Treatment H: oral EYP001a (2x150 mg/day plus open label Peg-INF*2a (n=6)
* Treatment I: oral placebo plus open label Peg-INF*2a (n=6)
EYP001a will be self-administered in the form of oral capsules from 50 mg or
100 mg capsule sizes. ETV will be self- administered in the form of film-coated
tablet and Peg-INF*2a will be administered subcutaneous.
The DSMC will review all available preliminary safety, PK and PD results after
9 subjects across the 3 treatment arms have completed study visit Day 15.
Following review of the available data, the DSMC will advise on any amendments
that are necessary for safety or methodological reasons or will recommend
continuation of the study according to this protocol.. The DSMC may also
recommend accrual of up to 6 additional subjects to compensate for any subjects
dropping out of the study prior to completing 29 days of treatment in Part B.
Patient accrual will continue throughout the period of DSMC review.
Study burden and risks
Preliminary experience from EYP001a in healthy subjects shows that single and
multiple oral doses are well tolerated. Short- lasting gastrointestinal events
(nausea, dyspepsia, loose stools and vomiting) of mild or moderate intensity
were seen mostly at the 500 mg (single and repeated) and 800 mg (single only)
dose levels.
Batiment Domilyon, Avenue Jean Jaures 321
Lyon 69007
FR
Batiment Domilyon, Avenue Jean Jaures 321
Lyon 69007
FR
Listed location countries
Age
Inclusion criteria
1. Have given voluntary written informed consent;
2. Have documented medical history of chronic HBV infection (defined as HBsAg
positivity lasting for at least 6 months at whatever point in time) and have recent,
documented, laboratory tests at the screening visit with the following results:
* Documented positive hepatitis B surface antigen (HBsAg) and
* Documented HBV DNA > 1000 IU/mL (HBV DNA load values of 750-1000 IU/mL may be allowed following consultation with the sponsor. Subjects with recent (within 12 months) documented HBV DNA >1000 IU/mL but with HBV DNA values below 750 at screening can be discussed with sponsor for inclusion);
Note: subject can be either hepatitis Be antigen (HBeAg) negative or positive, this test
result is not required for randomization and if not available can be established during
the Day 1 visit with baseline PD virology assessments.
3. Is anti-HBV treatment naive or treatment experienced (see also exclusion criterion #3).
4. Gender: male or female.
5. Age: 18 to 65 years inclusive.
6. Body mass index (BMI): 17.0-35.0 kg/m2 inclusive.
7. Has clinical chemistry, hematology, coagulation and urinalysis tests within normal,
allowable limits (with the exception of alanine aminotransferase [ALT]); see inclusion
criterion #10); if there is an out of range value, the result must be considered clinically
non-significant by the investigator in order to be eligible.
8. Vital signs after at least 5 minutes resting in supine position at screening within the
following ranges:
* systolic blood pressure: between 90 mm Hg and 145 mm Hg
* diastolic blood pressure: between 45 mm Hg and 90 mm Hg
* heart rate: between 40 bpm and 100 bpm
9. Have no clinically significant abnormal 12-lead automatic electrocardiogram (ECG)
(incomplete right bundle branch block can be accepted) at screening: PR interval * 210 ms, QRS-duration < 120 ms, QTc-interval (Fridericia*s) * 450 msec.
10. ALT at screening * 5 x upper limit of normal (ULN).
11. Agrees to abstain from all medication, including non-prescription and prescription
medication for 28 days prior to the Day 1 study visit, except for authorized medications
(such as hormonal contraceptives for females, vitamins prescribed per label dosages and
paracetamol). On a case-by-case basis, regular co-medication either as defined on the
medication exception list or as documented by written approval from the sponsor as
acceptable prior to randomization, will not be considered as a deviation from this criterion.
12. At screening, females must be non-pregnant and non-lactating, or of non-childbearing
potential (documented tubal ligation, bilateral oophorectomy or hysterectomy or physiologically incapable of becoming pregnant, or at least 1 year post-menopausal [amenorrhea duration of 12 consecutive months); non pregnancy will be confirmed for all females of child bearing potential by a pregnancy test conducted at screening, during the treatment period and at the EOS/ET visit.
13. Female subjects of child-bearing potential, with a fertile male sexual partner, should be
willing to use adequate contraception from screening until 90 days after the EOS/ET visit. Adequate contraception is defined as using hormonal contraceptives or an intrauterine device combined with at least 1 of the following forms of contraception: a diaphragm or cervical cap, or a condom. Also, total abstinence, in accordance with the lifestyle of the subject, is acceptable.
14. Male subjects, if not surgically sterilized, should be willing to use adequate contraception
and not donate sperm from the Day 1 visit to the clinical research centre until 90 days after
the EOS/ET visit. Adequate contraception for the male subject (and his female partner) is
defined as using hormonal contraceptives or an intrauterine device combined with at least
1 of the following forms of contraception: a diaphragm or cervical cap, or a condom. Also,
total abstinence, in accordance with the lifestyle of the subject is acceptable.
15. At screening, has no recent (<3 months) history of any clinically significant conditions,
which, in the opinion of the investigator, would jeopardize the safety of the subject or
impact the validity of the study results.
16. Willingness to abstain from alcohol from 24 hours prior to each study visit to the clinical
research centre.
Exclusion criteria
1. Employee of a CRO participating in this study or the sponsor.
2. Has certain or probable compensated liver cirrhosis documented by at least 2 of the
following:
a. Optional assessment: has documented liver histology Metavir score (F4), Ishak >5 or
Scheuer (F4)
b. Mandatory assessment: has presence or history of ascites, spontaneous bacterial
peritonitis, esophageal varices, hepatic encephalopathy
c. Mandatory assessment: platelet count below 90,000/uL within 12 months of
screening visit
d. Optional assessment: positive indirect blood test of APRI or FIB4 or positive direct
blood test Fibrosure, Fibrotest, or FibroSpect within 12 months of screening visit
e. Optional assessment: has positive elastography within 6 months of screening visit
(Fibroscan or Shearwave Aixplorer)
f. Optional assessment: has abnormal liver imaging (CT/US/MRI) consistent with a
lobular/nodular liver and cirrhosis or indirect signs of portal hypertension.
3. Subject is HBV treatment experienced AND currently on anti-HBV treatment during the 30 days (or 5 half-lives of the considered anti-HBV drug, whichever is longer) before the
first investigational product administration and until the last study visit.
4. Co-infection with active hepatitis C virus (HCV, except for patients with sustained viral
response SVR, who can be included).
5. Co-infection with human immunodeficiency virus (HIV). Note: hepatitis D virus (HDV) status is not required for randomization and if not available can be established during the Day 1 visit with baseline PD virology assessments.
6. Receives or plans to receive systemic immunosuppressive or immunomodulating
medications (e.g. IFN) during the study or * 4 months prior to the first investigational
product administration.
7. Has clinically relevant immunosuppression from, but not limited to immunodeficiency
conditions such as common variable hypogammaglobulinemia.
8. Clinical diagnosis of substance abuse during * 12 months prior to screening with narcotics
or cocaine or with alcohol (regular consumption > 21 units/week [men] and > 14
units/week [women]; 1 unit = 1*2 pint of beer, 25 mL shot of 40% spirit or a 125 mL glass
of wine. Expressed in g/day: > 30 g/day [men] and > 20 g/day [women]).
9. Has a positive drug urine screen (cocaine, phencyclidine, amphetamines (incl.
methamphetamines), opiates (incl. heroin, codeine and morphine), benzodiazepines,
barbiturates, methadone or alcohol screen. Subjects who
admit the occasional use of cannabis will not be excluded as long as they are able to
abstain from cannabis when they are assessed at study visits.
10. Has any known pre-existing medical or psychiatric condition that could interfere with the
subject*s ability to provide informed consent or participate in study conduct, or that may
confound study findings.
11. Has been diagnosed with hepatocellular carcinoma (HCC).
12. Has a history of long QT syndrome.
13. Has a history of clinically significant gastrointestinal disease, especially peptic ulcerations,
gastrointestinal bleeding, ulcerative colitis, Crohn*s disease or Inflammatory Bowel
Syndrome, renal, hepatic, neurologic, hematologic, endocrine, oncologic, pulmonary,
immunologic, or cardiovascular disease or any other condition which, in the opinion of the
investigator, would jeopardize the safety of the subject or impact the validity of the study
results.
14. Has participated in any drug study within 90 days prior to the first drug administration in
the current study. Note: Part A participation to this study is acceptable and not an
exclusion criteria when considering eligibility for Part B, under the condition that EOS
visit of Part A has been completed and no investigational product related SAEs have
occurred during Part A.
15. Has an uncontrolled ongoing illness at screening (e.g., active viral infection).
16. Has had major surgery within 30 days prior to the first drug administration, or within 6
months for gastrointestinal surgery prior to the first drug administration.
17. Has a history of relevant drug and/or food allergies.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2017-002211-33-NL |
ClinicalTrials.gov | NCT03272009 |
CCMO | NL62263.056.17 |