Pharmacokinetic, Safety and Tolerability Study of Altebrel in Healthy Male Subjects
Condition: Phase 1; Bioequivalence
Study type: Interventional
Phase: Phase 1

Summary: 
      This study aims to demonstrate pharmacokinetic (PK) similarity of biosimilar candidate
      Altebrel relative to etanercept reference product (Enbrel®) and evaluate safety and
      tolerability of Altebrel, in a crossover fashion in healthy male volunteers after
      administration of a single dose (25 mg) of etanercept.

      The primary objective of this study is to demonstrate that the PK of Altebrel is similar to
      its originator, Enbrel®, as assessed by the area under the serum concentration time curve
      (AUC) from time 0 extrapolated to infinity (AUCinf) and the Cmax.

      The secondary objectives of the study are:

      To further compare the PK of Altebrel and Enbrel®. To assess the safety of Altebrel.
    

Detailed description: 
      This is a single-dose trial with one administration of each product (Altebrel and Enbrel®).
      Each subject participates in two treatment period, and are randomised to receive Altebrel or
      Enbrel® in a crossover fashion. The subjects are closely monitored during the following 24
      hours (h), and are allowed to leave the site in the next morning post evaluation and blood
      samples are collected prior to and at the following time points after the dose: 6, 12 and 24
      hours post-dose (on day 2). The subjects are requested to visit the trial site 36, 48, 60,
      72, 96, 120, 144, 168, 216, 312 and 480 h after dose administration for blood sampling and
      evaluation of safety variable and tolerability.

      Before initiation, the trial is reviewed by food and drug administration of Iran. The
      protocol, electronic case report form (eCRF), information for subjects and informed consent
      form are submitted to the ethics committees responsible for review and approval purposes,
      according to national regulatory guidelines.

      In this study, no subject is recruited without an informed consent. All the informed consent
      forms which are signed by the subjects have two copies so that subjects could receive a copy
      of it.

      This is a crossover trial with a single dose of Altebrel and Enbrel®, separated by 28 days.
      34 (group A=17, group B=17) eligible subjects have been planned to enter to the study. All of
      whom are aged between 18 and 55 years. Subjects' randomization is done, using permuted block
      and subjects are assigned to treatment sequences AB or BA. Both groups receive 25 mg of
      either of the drugs as a single subcutaneous injection. The injection method and prefilled
      syringes are totally the same in both groups. The primary objective of this study is to
      demonstrate that the PK of Altebrel is similar to its originator, Enbrel®, as assessed by the
      area under the serum concentration time curve (AUC) from time 0 extrapolated to infinity
      (AUCinf) and the Cmax. Secondary objectives include assessment of the time to Cmax (tmax),
      AUC from time 0 to the last quantifiable concentration (AUClast) of Altebrel compared with
      Enbrel®, as well as evaluation of safety and tolerability. The safety endpoints of the trial
      are to evaluate the incidence of reported adverse effects, detecting changes in vital signs,
      clinical laboratory tests (hematologic, biochemistry, urine analysis and urine culture tests)
      and ECG.

      Determination of sample size:

      In an equivalence test of means using two one-sided tests on data from a two-period
      cross-over design, a total sample size of 34 achieves 81% power at a 10% significance level
      when the true ratio of the means is 1/0000, the coefficient of variation on the original,
      unlogged scale is 0/3600, and the equivalence limits of the mean ratio are 0/8000 and 1/2500.

      DATA QUALITY ASSURANCE:

      AryoGen pharmed Company conducts clinical trials according to procedures that incorporate the
      ethical principles of GCP. Accurate and reliable data collection was assured by verification
      and cross-check of the eCRFs against the subject's records by clinical monitors (source
      document verification was performed), and the maintenance of a drug-dispensing log by the
      center. A comprehensive validation check program was used to verify the data, and discrepancy
      reports were generated accordingly for resolution by the investigator.

      Blinding:

      This is a double-blind trial. During the clinical phase of the trial, neither the subjects
      nor the site personnel are aware of the identity (Altebrel and Enbrel®) of the treatments
      administered. However, there is an unblinded person who receives the randomisation list and
      dispenses the trial drugs according to the list. The unblinded person is not otherwise
      participate in the execution of the trial. The randomisation list determines the dispensing
      order of the trial products for each subject and only the randomisation number appear on the
      sample collection logs, as well as, on the sample aliquots delivered to the bioanalytical
      laboratory. Thus, the personnel responsible for analysing the PK samples are also be blinded.

      Randomisation envelopes are stored in the ISF, in a locked cabinet. In a case of emergency,
      the code of an individual subject may be opened and the reasons for opening will be
      documented and the subject will be discontinued from the trial
    

Intervention name(s): Etanercept
Intervention type(s): Drug
Intervention description(s): A single dose of etanercept (25mg/0.5ml prefilled syringe) was administered subcutaneously to healthy subjects.
Other intervention name(s): Altebrel; Enbrel
Intervention MeSH terms: Etanercept
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Basic Science
Keywords: healthy subjects; Pharmacokinetics; etanercept; single dose; Anti-Inflammatory Agents, Non-Steroidal