Daprodustat Hepatic Impairment Study
Condition: Anaemia
MeSH terms: Liver Diseases
Intervention: Daprodustat (GSK1278863)
Intervention description: Daprodustat (GSK1278863) 6 mg tablet will be given to all subjects as a single dose via oral route. Daprodustat (GSK1278863) is a 9.0 millimeter (mm) round, compound radius, white film coated tablet.
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: All subjects will receive 6 mg of daprodustat as a single oral dose in parallel way throughout the study period.
Masking: None (Open Label)
Masking description: This will be an open-label study and no blinding will be performed.
Enrollment: 37.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: GSK1278863; Daprodustat; Healthy control; Single dose; Hepatic Impairment

Summary:

      Daprodustat (GSK1278863), is a small molecule currently in development for the treatment of
      anemia of chronic kidney disease (CKD). Results of the earlier studies shows that liver is
      involved in the clearance of Daprodustat and hence, hepatic impairment can affect Daprodustat
      levels in the body. This single dose study will assess the effect of liver impairment on the
      pharmacokinetics (PK) and pharmacodynamics (PD) of daprodustat. The study will be conducted
      in two parts, Part 1 will include subjects with moderate hepatic impairment and matched
      healthy control subjects whereas Part 2 will include subjects will either mild or severe
      hepatic impairment and matched healthy control subjects. Approximately 8 subjects will be
      included in each of the group and all subjects will receive 6 milligram (mg) of daprodustat
      as a single oral dose in the fasted state. Total duration of participation in the study for a
      subject will be up to 7 weeks.
    

Eligibility criteria:

        Inclusion Criteria:

        For all subjects:

          -  Subject must be at least 18 years of age inclusive, at the time of signing the
             informed consent.

          -  Hemoglobin values at screening <=16.0 gram per deciliter (g/dL) for males and <=14.0
             g/dL for females.

          -  Body weight >=45 kilograms (kg) and body mass index (BMI) within the range 18-40 kg
             per meter square (kg/m^2) (inclusive).

          -  Male or female subjects will be included. A female subject is eligible to participate
             if she is not breastfeeding, and at least one of the following applies: Not pregnant
             as confirmed by two pregnancy tests; Not a woman of childbearing potential (WOCBP);
             For WOCBP that are currently utilizing a highly-effective contraceptive method prior
             to enrolment, agrees to follow the contraceptive guidance during the treatment period
             to the follow-up visit.

          -  Capable of giving signed informed consent form.

        Additional inclusion criteria for Hepatically-Impaired subjects:

          -  Subjects in Part 1 with Moderate Hepatic Impairment Only (Cohort 1): Is considered to
             have moderate hepatic impairment (of any etiology) and has been clinically stable for
             at least 1 month prior to screening. To be classified as having moderate hepatic
             impairment, subjects must have a Child-Pugh (Class B) score of 7-9 AND previous
             confirmation of liver cirrhosis by liver biopsy or other medical imaging technique
             (including laparoscopy, computerized tomography (CT) scan, magnetic resonance imaging
             (MRI) or ultrasonography) associated with an unambiguous medical history (such as
             evidence of portal hypertension).

          -  Subjects in Part 2 with Mild OR Severe Hepatic Impairment Only (Cohort 3; if
             conducted): Is considered to have mild or severe hepatic impairment (of any etiology)
             and has been clinically stable for at least 1 month prior to screening. To be
             classified as having mild OR severe hepatic impairment, subjects must have: classified
             as having mild hepatic impairment, subjects must have a Child- Pugh (Class A) score of
             5-6 AND previous confirmation of chronic liver disease by liver biopsy or other
             medical imaging technique (including laparoscopy, CT scan, MRI or ultrasonography)
             associated with an unambiguous medical history (such as evidence of portal
             hypertension); classified as having severe hepatic impairment, subjects must have
             Child- Pugh (Class C) score of 10-13 AND previous confirmation of chronic liver
             disease by liver biopsy or other medical imaging technique (including laparoscopy, CT
             scan, MRI or ultrasonography) associated with an unambiguous medical history (such as
             evidence of portal hypertension).

          -  Supplemental inclusion criteria for ALL hepatically-impaired subjects: Chronic (>6
             months), stable (no acute episodes of illness due to deterioration in hepatic function
             within the previous 1 month prior to screening) hepatic impairment due to any
             etiology. Subjects must also remain stable throughout the Screening period. Assessment
             of the stability of the subjects hepatic function will be determined by the
             investigator.

        Additional inclusion criteria for healthy control subjects:

          -  Healthy control subjects will be matched for age +/-10 years to subjects in the
             respective hepatic impairment cohort but must also be at least 18 years of age
             inclusive, at the time of signing the informed consent.

          -  Healthy as determined by the investigator or medically qualified designee based on a
             medical evaluation including medical history, physical examination, laboratory tests
             and cardiac monitoring.

          -  A subject with a clinical abnormality or laboratory parameter(s) which is/are not
             specifically listed in the inclusion or exclusion criteria, outside the reference
             range for the population being studied may be included only if the investigator and/or
             the Medical Monitor agree and document that the finding is unlikely to introduce
             additional risk factors and will not interfere with the study procedures.

          -  Healthy control subjects will be matched for BMI +/-15% to subjects in the respective
             hepatic impairment cohort but must also remain in the range of body weight >=45 kg and
             BMI within the range 18-38 kg/m^2 (inclusive).

        Exclusion Criteria:

        For all subjects:

          -  QT interval corrected for heart rate according to Fridericia's formula (QTcF) >500
             milliseconds (msec).

          -  Recent history of deep vein thrombosis, pulmonary embolism or other thrombosis related
             condition. Any prior medical history in these areas will be reviewed and approved by
             the PI and the sponsor's Medical Monitor on a case by case basis as needed.

          -  Myocardial infarction or acute coronary syndrome, stroke or transient ischemic attack
             within the 12 weeks prior to enrollment.

          -  Subjects with a pre-existing condition (other than liver disease) interfering with
             normal gastrointestinal anatomy or motility that could interfere with the absorption,
             metabolism, and/or excretion of daprodustat.

          -  Subjects that have undergone cholecystectomy within the past 3 months.

          -  Subjects with chronic inflammatory joint disease (example, scleroderma, systemic lupus
             erythematosis, rheumatoid arthritis).

          -  History of malignancy within the prior 2 years or known kidney mass >3 centimeter (cm)
             (end stage renal disease subjects with impairment only) OR currently receiving
             treatment for cancer. ONLY exception is localized squamous cell or basal cell
             carcinoma of the skin definitively treated 12 weeks prior to enrollment.

          -  Class IV heart failure, as defined by the New York Heart Association (NYHA) functional
             classification system.

          -  Current enrolment or past participation (i.e., administration of last dose of
             investigational study treatment) within the last 30 days (or 5 half-lives, whichever
             is longer) before Day 1 in this or any other clinical study involving an
             investigational study treatment or any other type of medical research.

        Exclusion criteria for Hepatically-Impaired subjects:

          -  Present of 8 times Upper limit of normal (ULN) elevations in Aspartate
             aminotransferase (AST), Alanine aminotransferase (ALT), or bilirubin.

          -  Subjects with any other medical condition which, in the judgment of the investigator
             and Medical Monitor, could jeopardize the integrity of the data derived from that
             subject or the safety of the subject.

          -  Subjects with advanced ascites (Grade 3).

          -  Subjects with refractory encephalopathy as judged by the investigator or significant
             Central Nervous System (CNS) disease (example dementia, or seizures) which the
             investigator considers will interfere with the informed consent, conduct, completion,
             or results of this trial or constitutes an unacceptable risk to the subject.

          -  Subjects with functional Transjugular Intrahepatic Portosystemic Shunt (TIPS)
             placement.

          -  Presence of hepatopulmonary or hepatorenal syndrome.

          -  Presence of primarily cholestatic liver diseases.

          -  History of liver transplantation.

          -  Subjects with signs of active infection, including active spontaneous bacterial
             peritonitis.

          -  Subjects with unstable cardiac function or subjects with hypertension whose blood
             pressure is not controlled (based on the investigator's discretion).

          -  Diabetic subjects whose diabetes is not controlled (based on the investigator's
             discretion).

        Exclusion criteria for healthy control subjects:

          -  Exposure to more than 4 new chemical entities within 12 months prior to the first
             dosing day.

          -  Presence of Hepatitis B surface antigen (HBsAg) at screening or Positive Hepatitis C
             antibody test result at screening or within 3 months before the first dose of study
             treatment.

          -  Positive pre-study drug/alcohol screen.

          -  Positive human immunodeficiency virus (HIV) antibody test.

          -  Regular use of known drugs of abuse.

          -  Regular alcohol consumption within 6 months prior to the study defined as an average
             weekly intake of >14 drinks. One drink is equivalent to 12 g of alcohol: 12 ounces
             (360 mL) of beer, 5 ounces (150 mL) of wine or 1.5 ounces (45 mL) of 80 proof
             distilled spirits. One unit is equivalent to 8 g of alcohol: a half-pint
             (approximately 240 mL) of beer, 1 glass (125 mL) of wine or 1 (25 mL) measure of
             spirits.