Study to Evaluate the Safety and Efficacy of 13 Weeks of the Selective Androgen Receptor Modulator (SARM) GSK2881078 in Chronic Obstructive Pulmonary Disease (COPD)
Condition: Cachexia
MeSH terms: Muscle Weakness; Cachexia
Intervention: GSK2881078; Matching Placebo
Intervention description: GSK2881078 will be available as capsules for oral administration. GSK2881078 will be administered once daily by the oral route at a dose of 1 mg and 2mg to post-menopausal female subjects and male subjects, respectively.; Subjects will be administered two capsules of GSK2881078 matching placebo once daily by the oral route.
Intervention MeSH terms: GSK2881078
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Study treatment will consist of two dosing cohorts: Cohort 1 will comprise of male subjects randomized to receive either placebo or 2 milligrams (mg) of GSK2881078 and Cohort 2 will comprise of post-menopausal female subjects randomized to receive either placebo or 1 mg of GSK2881078.
Masking: Double (Participant, Investigator)
Enrollment: 97.0
Sex: All
Minimum age: 50 Years
Maximum age: 75 Years
Healthy volunteers: No
Keywords: GSK2881078; COPD; muscle weakness; post-menopausal; selective androgen receptor modulator

Summary:

      Impaired physical function and muscle dysfunction are a major consequence of COPD, which may
      be associated with increased mortality, poor quality of life and increased health care use.
      This is a randomized, placebo-controlled, double-blind, parallel group study to evaluate the
      safety and tolerability of GSK2881078, an SARM over 13 weeks of dosing in older male subjects
      and post-menopausal female subjects with COPD and muscle weakness. This study will also
      assess the effect of GSK2881078 on physical strength and function after 13 weeks of
      treatment. Approximately 100 subjects with COPD and muscle weakness will be randomized into
      two cohorts of 50 male subjects and 50 female subjects. Within each cohort, subjects will be
      randomized to receive GSK2881078 or placebo in a ratio of 1:1. All subjects will participate
      in a standardized home exercise program, which will consist of daily walking, along with
      several resistance or weight-bearing exercises, such as bicep curls, upright rows, step ups
      and a sit-to-stand maneuver. The study will consist of a screening/Baseline period of up to
      30 days, a 13-week treatment period and a post-treatment follow-up period of 6 weeks.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Subject must be 50 to 75 years of age inclusive, at the time of signing the informed
             consent.

          -  Male and/or female subjects will be included. a) A male subject with a partner who is
             a woman of child bearing potential (WOCPB) must agree to use contraception during the
             treatment period and until at least 5 half-lives of study medication have passed after
             the last ingested dose [125 days, corresponding to time needed to eliminate study
             treatment for both genotoxic and teratogenic study treatments plus an additional 90
             days (a spermatogenesis cycle) for study treatments with genotoxic potential] after
             the last dose of study treatment and refrain from donating sperm during this period.
             b) A female subject is eligible to participate if she is post-menopausal and not a
             WOCBP.

          -  Confirmed diagnosis of COPD in accordance with the American Thoracic Society
             (ATS)/European Respiratory Society (ERS) criteria with a post-bronchodilator
             FEV1/forced vital capacity (FVC) <0.70 and 30% <= FEV1% predicted <=65% of predicted
             normal value calculated at Screen using the Quanjer reference equation.

          -  SPPB with ALL of the following: Timed chair stand score >=1 and <=3; No score of "0"
             on any component of the SPPB (that is, gait speed, balance, or timed chair stand).

          -  Body Mass Index (BMI) within the range 18-32 kilogram per meter square (kg/m^2)
             (inclusive), where BMI = (weight in kg)/(height in meters)^2

          -  Current smokers or former smokers with a cigarette smoking history of >=10 pack years
             (1 pack year =20 cigarettes smoked per day for 1 year or equivalent). Former smokers
             are defined as those who have stopped smoking for at least 6 months prior to Baseline.

          -  Subjects must be able to read and write in the language used for the provided
             electronic diary and be able to operate an electronic device to a level that allows
             them to complete an electronic diary on a daily basis.

          -  Subjects participating in a structured exercise program must be willing to convert
             their current exercise program to the home exercise program used in this study.

          -  Capable of giving signed informed consent which includes compliance with the
             requirements and restrictions listed in the informed consent form (ICF) and protocol.

        Exclusion Criteria:

          -  Subjects with a history of myocardial infarction, angina, congestive heart failure
             exacerbation, hospitalization for cardiac etiology, stroke or transient ischemic
             attack in the past 12 months.

          -  Neurologic, musculoskeletal, osteoarthritis, or any other condition that in the
             opinion of the investigator limits subject's ability to complete study physical
             assessments.

          -  Current or chronic history of liver disease, or known hepatic or biliary abnormalities
             (with the exception of Gilbert's syndrome or asymptomatic gallstones).

          -  Subjects with a history of cholecystectomy.

          -  Subjects with a history of malignancy that is not in complete remission for at least 2
             years or 1 year for non-melanoma skin carcinoma.

          -  Subjects with a family history of early onset prostate cancer or familial prostate
             cancer (multiple family members).

          -  Diseases known to cause malabsorption of protein or energy, such as inflammatory bowel
             disease, celiac disease, pancreatic insufficiency, etc.

          -  Current or planned administration of cholestyramine or strong oral or injectable
             cytochrome P-450 isoenzyme 3A4 (CYP3A4) inducers.

          -  Current or planned use of any prescription drugs known to affect muscle mass,
             including androgen supplements, anti-androgens (such as luteinizing hormone-releasing
             hormone [LHRH] agonists), anti-estrogens (tamoxifen, etc.), recombinant growth
             hormone, megesterol, etc.

          -  Use of oral steroids concurrently or within 4 weeks preceding the screening visit.

          -  The subject has participated in a clinical trial and has received an investigational
             product within the following time-period prior to randomization in the current study:
             30 days, 5 half-lives or twice the duration of the biological effect of the
             investigational product (whichever is longer).

          -  Subjects with values outside the specified ranges for the following Key Clinical
             Laboratory Tests must be excluded from the study: a) Renal function: Glomerular
             Filtration Rate (GFR) <30 milliliter per minute per 1.73 meter square (mL/min/1.73
             m^2). Subjects receiving dialysis are excluded from this study. b) Metabolic-glycated
             hemoglobin (HbA1c) >7.5%. c) ALT >2 times upper limit of normal (ULN) and bilirubin
             >1.5 times ULN (isolated bilirubin >1.5 times ULN is acceptable if bilirubin is
             fractionated and direct bilirubin <35%). d) Hematology - Hemoglobin <10.0 grams per
             deciliter (g/dL) at screening. e) Prostate Specific Antigen (PSA) >4.0 nanograms per
             milliliter (ng/mL).

          -  Presence of hepatitis B surface antigen (HBsAg), positive hepatitis C antibody test
             result at screening or within 3 months prior to first dose of study treatment.

          -  QT interval corrected for heart rate by Bazett's formula (QTcB) or QT interval
             corrected for heart rate by Fridericia's formula (QTcF) >450 milliseconds (msec) or QT
             interval corrected for heart rate (QTc) >480 msec in subjects with Bundle Branch Block
             based on a single ECG.

          -  A positive test for human immunodeficiency virus (HIV) antibody.

          -  More than two moderate/severe COPD exacerbations within the past year. Exacerbation is
             defined as worsening of two or more of the following major symptoms: dyspnea, sputum
             volume, sputum purulence OR worsening of any one major symptom together with at least
             one of the following additional symptoms: sore throat, colds (nasal discharge and/or
             nasal congestion), fever >37.5 degree Celsius without any explained cause, increased
             cough, increased wheeze. A moderate exacerbation is defined as an exacerbation that
             requires treatment with antibiotics and/or oral steroids. A severe exacerbation is
             defined as an event that is additionally associated with hospitalization or emergency
             room visit.

          -  Any moderate/severe COPD exacerbation in the 4 weeks preceding the screening visit.

          -  Subjects on long-term oxygen therapy (LTOT), defined as prescribed continuous oxygen
             use for >14 hours/day.

          -  Clinically diagnosed history of drug or alcohol abuse within 5 years prior to
             randomization.

          -  History of sensitivity to any of the study medications, or components thereof or a
             history of drug or other allergy that, in the opinion of the investigator or
             GlaxoSmithKline (GSK) Medical Monitor, contraindicates their participation.

          -  Participation in a formal pulmonary rehabilitation exercise program outside or inside
             the home, either currently or completed within the previous 6 months.

          -  For subjects who opt to have magnetic resonance imaging (MRI) at participating study
             sites, there must be no contraindications to MRI, for example known claustrophobia or
             a pacemaker. Specific MRI contraindications will be determined by the type of MRI
             scanner available at each site and study personnel should confirm local eligibility
             requirements.