The primary objective is to evaluate the safety of PEG-liposomal prednisolone sodium phosphate (Nanocort) The secondary objectives of this study are:To explore the efficacy of PEG-liposomal prednisolone sodium phosphate (Nanocort) To evaluate the…
ID
Source
Brief title
Condition
- Gastrointestinal inflammatory conditions
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
All (serious) adverse events will be classified according "MedDRA"
Primary Endpoints (safety):
Frequency of Serious adverse events in Nanocort versus placebo group
Frequency of Adverse events in Nanocort versus placebo group
Changes in clinical status, vital signs and laboratory parameters over the
duration of the study in Nanocort versus placebo group.
The number of adverse events, the number and percentage of subjects who
reported at least one adverse event will be provided by treatment group and by
system organ class and preferred term, the severity, causality of the event.
The number of adverse events, the number and percentage of subjects who
reported at least one serious adverse event (reported during all the study
period) will be provided by treatment group and by system organ class and
preferred term.
Descriptive statistics will be presented at relevant visits by treatment group
for physical examination and clinical status, vital signs and laboratory
assessments.
The number of subjects with laboratory parameter values out of the reference
ranges will be computed at each visit. Shift tables will count the number of
subjects with normal and abnormal values at the last visit of the treatment
phase with
The number of adverse events, the number and percentage of subjects who
reported at least one adverse event will be provided by treatment group and by
system organ class and preferred term, the severity, causality of the event.
Serious adverse events (reported during all the study period).
Secondary outcome
Secondary Endpoints (efficacy/PK):
Percentage of subjects achieving clinical remission at Day 29 as measured by
Mayo score in Nanocort versus placebo group.
Percentage of subjects achieving clinical remission at Day 15, 29, 57 and 85 as
measured by partial Mayo score in Nanocort versus placebo group. Percentage of
subjects achieving clinical response at Day 15, 29, 57 and 85 as measured by
partial Mayo score in Nanocort versus placebo group.
Percentage of subjects maintaining a clinical response in Nanocort versus
placebo group, in subjects having previously achieved a clinical response after
baseline evaluations.
Scoring the histopathological asessments on biopsies by microscopic evaluation
(acute inflammation score and grading scale of inflammation) in Nanocort versus
placebo group.
Free prednisolone and liposomal prednisolone phosphate levels in the plasma at
Day 1, 15, 29 and 57 in Nanocort versus placebo group.
Definitions:
Clinical remission is defined as a Mayo score <= 2 with no individual sub-score
exceeding 1 point and rectal bleeding score of 0.
Clinical response is defined as a reduction from base-line Mayo score of 30% or
>= 3 points, with an accompanying decrease in rectal bleeding sub-score of >= 1
point or absolute rectal bleeding score of <= 1 point.
Background summary
Nanocort is a novel pharmaceutical composed of prednisolone sodium phosphate
enclosed in carefully designed small lipid vesicles, which after IV infusion
selectively accumulate in inflamed tissues. The corticosteroid is largely
confined to the liposome in the blood stream after injection, and selectively
accumulates at sites of inflammation forming local depots. This effect is
possibly due to locally increased permeability of blood vessel walls at
inflamed sites. High local concentrations of corticosteroids may have a more
pronounced effect on the reduction of inflammatory cells and mediators. As a
result, Nanocort might be able to significantly reduce frequency of
administration and use of the steroid compared to the treatment with oral
steroids and so has a safety advantage.
Study objective
The primary objective is to evaluate the safety of PEG-liposomal prednisolone
sodium phosphate (Nanocort)
The secondary objectives of this study are:
To explore the efficacy of PEG-liposomal prednisolone sodium phosphate
(Nanocort)
To evaluate the pharmacokinetics of free prednisolone and prednisolone
phosphate in the plasma.
Study design
The study is an exploratory phase IIA, randomized, placebo-controlled
multicenter international study.
A total of 20 subjects with active UC will be randomized.
Intervention
The 20 randomized subjects with active UC will be distributed randomly into two
groups with a 3:1 ratio (15 subjects to receive Nanocort). In this study, each
group will receive two IV infusions either saline (placebo) or PEG-liposomal
prednisolone sodium phosphate (Nanocort) in saline.
Treatment consists in 2 IV infusions administered two weeks apart on day 1 and
on day 15.
Fifteen subjects will receive PEG-liposomal prednisolone sodium phosphate
(Nanocort) in saline at Day 1 and Day 15 as an IV infusion of 150 mg Nanocort
in 250 mL saline.
Five subjects will receive a 250 mL infusion with saline (placebo) on Day 1 and
Day 15.
Follow-up clinical visits will occur at Day 29, 57 and 85 after treatment was
initiated.
Study burden and risks
The total expected duration of subject participation will be approximately 14
weeks; 2 weeks of screening, 2 weeks of treatment visits, and post-treatment
follow-up visits 2, 6 and 10 weeks after the completion of study treatment (a
total of 6 visits).
During the visits, the investigator will perform, besides the normal clinical
procedures, an additional full physical examination.
Dring each visit urine and blood will be collected.
Sigmoidoscopy with imaging and collection of 2 to 4 biopsies will be performed
twice ( during screening visit and day 29)
At three time points a 24h urine collection will be requested to determine the
influence of Nanocort on the cortisol levels
On visit 1, serology for HIV, HBV and HCV will be checked.
On visits 2,3,4 and 5 additional blood will be taken to perform the
pharmacokinetics analysis. (PK)
Sint Annastraat 38A
Naarden 1411PH
NL
Sint Annastraat 38A
Naarden 1411PH
NL
Listed location countries
Age
Inclusion criteria
1.Male or non pregnant, non-lactating female >= 18 to 75 years of age.
2.Documented history of UC (at least 6 months) as assessed by endoscopy and confirmed by histological measurements with a minimal disease extent of 15 cm from the anal verge and a minimal period of moderately active disease of 14 days.
3.Negative stool culture for enteric pathogens, including Clostridium difficile, ova and parasites.
4.Mayo score >= 5 with endoscopic sub-score of >= 2 and rectal bleeding sub-score >=1.
5.Medication: 6-MP/azathioprine, MTX receiving for at least 12 weeks and stable dose for > 4 weeks or discontinued for > 4 weeks; rectal medications stopped for > 4 weeks, 5-ASA stable or stopped for > 2 weeks. If receiving cyclosporine or biologicals (e.g. TNFα blocker), these medications should be continued at the same dose for at least two cycles after Day 1. A cycle commonly takes 8 weeks, but may be shorter in the individual subject, when loss of response has been encountered previously and the dosing interval has been adjusted.
6.In good physical and mental health (other than the disease under study) as determined by medical history and physical examination.
7.The results of the following laboratory tests performed at the local laboratory at screening must be as below:
a.Hemoglobin >= 8.5 g/dL (International System of Units [SI]: >= 85 g/L)
b.White blood cells (WBC) >= 3.0 x 10E3 cells/mm3 (SI: >= 3.0 x109 cells/L)
c.Neutrophils >= 1.5 x 10E3 cells/mm3 (SI: >= 1.5 x109 cells/L)
d.Platelets >= 100 x 10E3 cells/mm3 (SI: >= 100 x109 cells/L)
e.Serum ALT <= 1.5 x upper limit of normal (ULN)
f.Total bilirubin level >= 1.25 x ULN
g.Creatinine clearance >80 mL/min using the Cockcroft formula
8.Female subjects must have a negative blood pregnancy test, unless they are surgically sterile, had a hysterectomy or have been post-menopausal for at least 1 year (at least 12 consecutive months without menses).
9.Women of childbearing potential must use a medically acceptable means of birth control and agree to continue its use during the study and for at least 12 weeks after the last dose of study drug. Medically acceptable forms of birth control include oral contraceptives, injectable or implantable methods, intrauterine devices, tubal ligation (if performed more than 1 year before screening), or double-barrier contraception. Sexually active men must agree to use a medically acceptable form of contraception during the study and continue for at least 12 weeks after the last dose of study drug.
10.Able and willing to give voluntary written informed consent and agree to schedule of assessments.
Exclusion criteria
1.Treatment with local or oral corticosteroids within 4 weeks of screening or with intra articular or intramuscular corticosteroids within 8 weeks before screening. If non-systemic steroids are being used for other chronic inflammatory conditions, subjects may be included at the discretion of the investigator after discussion with the medical monitor.
2. Severe colitis, defined as a bloody stool frequency of more than six per day with any one of tachycardia (pulse > 90 beats/min), temperature (> 37.8 degrees C), anaemia (haemoglobin < 10.5 g/dL or 6,5 mmol/L) or raised erythrocyte sedimentation rate (> 30 mm/h),
3.Intolerance of or unresponsiveness to corticosteroids, especially a history of steroid psychosis.
4.A history of significant psychological, neurologic, renal, gastrointestinal (other than ulcerative colitis), or metabolic disease. (diabetes mellitus)
5.A history of clinically severe or unstable medical condition involving cardiac, pulmonary, liver or endocrine disorders.
6.Any concurrent illness, disability or clinical abnormality (including laboratory tests) that may affect the interpretation of clinical safety or efficacy data or prevent the subject from safely completing the assessments required by the protocol as determined by the investigator.
7.The subject has a Stoma, proctocolectomy or total colectomy or imminent need for surgery.
8.Concurrent bowel and/or intestine malignancy or a history of cancer (other than basal cell carcinoma or cervical carcinoma successfully treated more than 5 years prior to screening be allowed);
9.Subjects with other bleeding, infectious, ischemic, or immunological diseases with or without gastrointestinal involvement.
10.Be currently pregnant or breastfeeding or not willing to maintain birth control methods for at least 12 weeks after last study medication administration.
11.Medical, psychiatric, cognitive, or other conditions that, according to investigator*s medical judgment, compromise the patient's ability to understand the patient information, to give informed consent, to comply with requirements of the study the study protocol (that is likely to affect the patient*s return for visits on schedule), or ability to complete the study.
12.Participation in another experimental therapy study within 90 days prior to screening for this study or current enrollment in any other study with investigational drugs or device.
13.Positive serology for human immunodeficiency virus (HIV) 1 or 2 or hepatitis B or C, or any history of HIV or hepatitis from any cause with the exception of hepatitis A.
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 | EUCTR2010-020448-37-NL |
CCMO | NL33742.041.10 |