Safety, Tolerability, PK and PD of ADX-038 in Healthy Participants and Paroxysmal Nocturnal Hemoglobinuria (PNH) Patients

NCT05876312 — Phase 1 / Phase 2, Recruiting, 50 participants, ADARx Pharmaceuticals, Inc.

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A Phase 1, Randomized, Double Blind, Placebo-Controlled, Single Ascending Dose Study in Healthy Participants Followed by a Phase 2a Open Label Study in Participants With PNH and Residual Anemia to Evaluate the Safety, Tolerability, PK and PD of ADX-038

RegistryNCT05876312, acronym PNH
StatusRecruiting
PhasePhase 1 / Phase 2
Study typeInterventional; randomized, parallel, masking: triple, treatment
Enrollment50 (Estimated)
SponsorADARx Pharmaceuticals, Inc. (Industry); collaborators: ADARx Australia Pty Ltd, Novotech (Australia) Pty Limited
ConditionsParoxysmal Nocturnal Hemoglobinuria (PNH)
InterventionsADX-038, Placebo (Drug)
Datesstart 2023-08-07, primary completion 2028-03-31 (estimated), completion 2028-07-31 (estimated), first posted 2023-05-25, last updated 2026-06-16
Locations4 sites in Australia, United Kingdom

Related Papers Related Patents Related Grants Related Experts
All trials for Paroxysmal Nocturnal Hemoglobinuria (PNH) All trials of ADX-038 All trials of Placebo

-Summary

The first-in-human Phase 1/Phase 2a study described herein will evaluate the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) of ADX-038 in both healthy participants (HP) and in patients with paroxysmal nocturnal hemoglobinuria (PNH).

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+Detailed description

The clinical study described in this protocol is a Phase 1/Phase 2a study evaluating safety, tolerability, PK, and PD of ADX-038.

The study consists of 2 parts:

1. Phase 1 - Randomized, double-blind, placebo-controlled, parallel group, single ascending dose (SAD) in HP with up to 5 dose cohorts.
2. Phase 2a - Open label, single-arm (ADX-038), 2 dose study in participants with paroxysmal nocturnal hemoglobinuria (PNH) and residual anemia on a standard-of-care (SOC) anti-C5 regimen of ravulizumab or eculizumab.

+Arms and interventions

ArmTypeInterventionsDescription
Phase 1 - Active ADX-038 administered to HPExperimentalDrug: ADX-038For each cohort in Phase 1 (SAD), 8 participants will be randomized in a 3:1 ratio; 6 participants to active (ADX-038): 2 participants to control (matched placebo). Randomization will be on Day 1. Initially, 2 sentinel participants (1 active and 1 placebo) will be randomized and dosed. The sentinel participants will be evaluated for safety. The investigator's assessment and the independent medical monitor will decide upon the randomization and dosing of the 6 remaining participants (5 active and 1 placebo) according to the randomization schedule.
Phase 1- Placebo administered to HPPlacebo comparatorDrug: PlaceboFor each cohort in Phase 1 (SAD), 8 participants will be randomized in a 3:1 ratio; 6 participants to active (ADX-038): 2 participants to control (matched placebo). Randomization will be on Day 1. Initially, 2 sentinel participants (1 active and 1 placebo) will be randomized and dosed. The sentinel participants will be evaluated for safety. The investigator's assessment and the independent medical monitor will decide upon the randomization and dosing of the 6 remaining participants (5 active and 1 placebo) according to the randomization schedule.
Phase 2a - ADX-038 administered to PNH participantsExperimentalDrug: ADX-038This will be initiated at the dose level determined by the Safety Review Committee from SAD in HPs. The treatment of PNH participants is an open-label study.
  • ADX-038 (Drug), also known as siRNA: siRNA duplex oligonucleotide
  • Placebo (Drug), also known as Saline: Saline

+Outcome measures

Primary outcomes

  • Safety in Healthy Volunteers [365 days]: To evaluate the safety and tolerability of ADX-038 in HVs by incidence, relationship, and severity of adverse events and serious adverse events
  • Safety in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Evaluate the safety and tolerability of ADX-038 by incidence, relationship, and treatment-emergent adverse events and serious adverse events.

Secondary outcomes

  • Pharmacokinetics in Healthy Participants [8 days]: To characterize the Pharmacokinetics of ADX-038 in HPs by measuring the Maximum observed plasma concentration (Cmax)
  • Pharmacodynamics in Healthy Participants [365 days]: Change from base in plasma concentrations over time in Complement factor B (CFB) protein via assay measurement
  • Pharmacodynamics in Paraxysmal Nocturnal Hemoglobinuria [365 days]: Evaluate the changes in hemoglobin concentrations
  • Pharmacodynamics in Paraxysmal Nocturnal Hemoglobinuria [365 days]: Characterize the changes in serum concentration of complement factor B (CFB) protein and complement alternative pathway activity level.
  • Pharmacodynamics in Healthy Participants [365 days]: Change in complement alternative pathway activity via assay measurement

Other outcomes

  • Immune Response in Healthy Participants [365 days]: Anti-polyethylene glycol (PEG) antibody titers and anti-drug antibody titers
  • Pharmacodynamics in Healthy Participants [365 days]: Change in complement classical pathway activity via assay measurement
  • Safety in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Evaluate the change from baseline in follow up visits for safety assesments
  • Clinical Effect in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Look at time (number of days) from dosing (Day 1) to diminished therapeutics effect (DTE)
  • Efficacy in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Evaluate changes in lactate dehydrogenase (LDH) (U/L)
  • Effects on Hemolysis in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Evaluate incidence of clinical breakthrough hemolysis, blood transfusions and Incidence of major adverse vascular events (MAVEs)
  • Pharmacokinetics in Paraxysmal Nocturnal Hemoglobinuria [8 days]: Characterize PK parameters of ADX-038 by plasma C(max)
  • Pharmacodynamics in Paraxysmal Nocturnal Hemoglobinuria [365 days]: Characterize changes in complement classical pathway activity level
  • Immune Response in Paraxysmal Nocturnal Hemoglobinuria [365 days]: Determine Anti-PEG and anti-drug antibody titers
  • Efficacy in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Evaluate changes in serum free hemoglobin
  • Efficacy in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Evaluate changes in Haptoglobin Concentrations
  • Efficacy in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Evaluate changes in Reticulocyte Counts (%)
  • Efficacy in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Evaluate changes in Bilirubin (umol/L)
  • Efficacy in Paroxysmal Nocturnal Hemoglobinuria Participants [365 days]: Evaluate changes in Aspartate aminotransferase (U/L)
  • Pharmacokinetics in Paraxysmal Nocturnal Hemoglobinuria [8 days]: Characterize PK parameters of ADX-038 by plasma AUC (0-infinity)
  • Pharmacokinetics in Paraxysmal Nocturnal Hemoglobinuria [8 days]: Characterize PK parameters of ADX-038 by plasma AUC(0-last)
  • Pharmacokinetics in Paraxysmal Nocturnal Hemoglobinuria [8 days]: Characterize PK parameters of ADX-038 by plasma T(max)

+Eligibility

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Phase 1 Key Inclusion Criteria

* 18 to 55 years of age
* Participants who are healthy as determined by medical evaluation
* History of recent meningococcal, pneumococcal and Haemophilus influenzae type B vaccinations or willing to be vaccinated
* Screening tests negative for illicit drug, nicotine, and alcohol use

Phase 1 Key Exclusion Criteria

* History of any significant medical conditions, except for completely excised non-melanoma skin cancer or low grade cervical intraepithelial neoplasia without evidence of recurrence within the prior 3 months
* Any viral, bacterial, parasitic, or fungal infection within the prior 30 days
* Frequent respiratory, nasopharyngeal or ear infections (more than 5 infections per year)
* History of environmental exposure or sick contact that increase the risk of meningococcal, pneumococcal and/or Haemophilus influenza type B infections
* Complement deficiency or immunodeficiency syndrome
* Major surgery or significant traumatic injury within the prior 3 months
* History of anaphylaxis or hypersensitivity reactions
* History of penicillin allergy
* History of splenectomy
* History of alcohol abuse or illicit drug use
* Donated plasma within the prior 7 days
* Donated blood or loss more than 400 milliliters of blood (excluding blood volume drawn at screening) within the prior 90 days
* Screening estimated creatinine clearance of less than 60 milliliters per minute
* Screening hematology, serum chemistry, or coagulation parameters that are outside the normal range
* Screening vital signs that are abnormal per protocol specification
* Screening electrocardiogram findings that are clinically significant
* Pregnant or lactating females
* Use of prescription (except for contraceptives and study-related prophylactic antibiotics) or over-the counter medications (except for paracetamol or ibuprofen) or vitamins/supplements within the prior 7 days
* Use of medications that may reduce the effectiveness of hormonal contraceptives within the prior 28 days
* Use of an investigational therapeutics within the prior 30 days or within the expected washout (at least 5 half-lives)
* Unwilling or unable to adhere to study-related prophylactic antibiotics requirements

Phase 2a Key Inclusion Criteria

* at least 18 years of age
* Diagnosis of paroxysmal nocturnal hemoglobinuria based on documented clone size
* Hemoglobin concentration of less than 12 gram per deciliter
* History of recent meningococcal, pneumococcal and Haemophilus influenzae type b vaccinations or willing to be vaccinated
* On a stable anti-C5 regimen for greater than or equal to 12 weeks prior to Day 1

Phase 2a Key Exclusion Criteria

* Any viral, bacterial, parasitic, or fungal infection within the prior 14 days
* HIV, active hepatitis C or hepatitis B infection
* History of meningococcal or tuberculosis infection
* History of malignancy in the past 5 years, except for completely excised non-melanoma skin cancer or low grade cervical intraepithelial neoplasia with no evidence of recurrence within the prior 3 months
* Complement deficiency syndrome
* History of hematopoietic stem cell transplantation
* History of splenectomy
* Inflammatory bowel disease, systemic lupus erythematosus, rheumatoid arthritis, or chronic liver disease
* Clinically significant and uncontrolled medical conditions including, but not limited to, thromboembolic disease, acute coronary syndrome, and diabetes
* Pregnant or lactating females
* Use of an investigational therapeutics within the prior 30 days or within the expected washout period (at lest 5 half-lives)
* Abstain from alcohol consumption for 48 hrs before day of dosing and restrict to no more than an average of 14 standard drinks per week

+Locations (4)

FacilityCityCountryStatus
Nucleus Network BrisbaneBrisbane, QueenslandAustraliaCompleted
Peter MacCallum Cancer CentreMelbourne, VictoriaAustraliaCompleted
Royal Melbourne HospitalParkville, VictoriaAustraliaRecruiting
Richmond Pharmacology LtdLondon, LondonUnited KingdomCompleted