Pharmacokinetics and Safety of TIN816 in Patients With Sepsis-associated Acute Kidney Injury

Study Overview
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Brief Summary
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The purpose of this study is to characterize the pharmacokinetic (PK) and pharmacodynamic (PD) profile and to evaluate the safety and tolerability of TIN816 in hospitalized adult participants in an intensive care setting with a diagnosis of sepsis-associated acute kidney injury (SA-AKI).

Detailed Description
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This is a multicenter, participant and investigator-blinded, randomized, placebo-controlled study to characterize PK/PD profile and to evaluate the safety and the tolerability of TIN816. The study will enroll hospitalized adult participants with a diagnosis of sepsis and acute kidney injury (AKI). Approximately 20 participants will be randomized in the study. The study consists of a screening period (24-48 hours), a treatment period (day 1), and post-treatment period (days 2 to 90). Screening will take place during hospitalization in a intensive care unit (ICU) (or intermediate/high dependency unit (HDU care) where potential participants will undergo screening to assess the presence of sepsis and AKI. Pre-identified participants will provide informed consent and undergo screening assessments to determine eligibility. Potential study candidates will be hospitalized patients with a diagnosis of sepsis based on Sepsis 3 criteria with suspected or confirmed infection and SOFA score ≥ 2 after excluding the renal component, and a diagnosis of AKI stage 1 or greater. At Treatment Day 1, participants who meet eligibility criteria at screening and baseline will be randomized in a 3:1 ratio to treatment with TIN816 or placebo by intravenous infusion in a participant and investigator-blinded fashion. Treatment day 1 is followed by a 90 day post-treatment period for pharmocokinetic, pharmacodynamic, safety and tolerability assessments.

Official Title
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A Participant and Investigator-blinded, Randomized, Placebo-controlled Phase 2a Study to Investigate the Pharmacokinetics, Pharmacodynamics, Safety and Tolerability of TIN816 in Patients With Sepsis-associated Acute Kidney Injury

Conditions
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Acute Kidney Injury Due to Sepsis

Intervention / Treatment
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* Biological: TIN816 70 mg lyophilisate powder
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed informed consent must be obtained prior to participation in the study. ≥ 18 and ≤ 85 years of age. Admitted to ICU or intermediate/HDU. Diagnosis of sepsis according to criteria defined by The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) based on: Suspected or confirmed infection SOFA score of 2 or more (excluding renal component) Diagnosis of AKI Stage 1 or greater per the following criterion at randomization : An absolute increase in serum or plasma creatinine (CR) by ≥0.3 mg/dL (≥26.5 µmol/L) within 48 hours or presumed to have occurred in the previous 48 hours as compared to the reference creatinine baseline. For hospital-acquired AKI, a stable serum creatinine obtained in the hospital prior to AKI should be used as reference baseline, otherwise, baseline serum creatinine in the following order of preference: Median value within 3 months of the hospital admission. If not available: Median value between 3 and 6 months prior to hospital admission. If not available: At hospital admission. Exclusion criteria Not expected to survive for 24 hours. Not expected to survive for 30 days due to medical conditions other than SA-AKI. History of CKD with a documented estimated GFR <45 ml/min prior to development of AKI. Receiving RRT or a decision has been made to initiate RRT within 24 hours of admission. Weight is less than 40 kg or more than 125 kg . Has life support limitations (eg, do not resuscitate, do not dialyze, do not intubate). AKI diagnosis according to the AKI inclusion criteria for a period longer than 48 hours prior to study drug administration. Presence of AKI for a period longer than 48 hours prior to study drug administration as suggested by clinical manifestations, e.g., prolonged oliguria or severe renal dysfunction (eg, serum creatinine > 4 mg/dL) on admission without a history of CKD. Evidence of recovery from AKI based on the investigator's clinical judgement prior to randomization. AKI is most likely attributable to causes other than sepsis such as nephrotoxic drugs (Non-steroidal anti-inflammatory drugs (NSAIDs), contrast, aminoglycosides), other medical conditions (e.g. heart failure, liver failure, acute abdominal aortic aneurysm, dissection, renal artery stenosis) or urinary obstruction. Documented (biopsy proven) or suspected history of acute or sub-acute kidney diseases such as rapidly progressive glomerular nephritis (RPGN) and acute interstitial nephritis (AIN). Patients who are post-nephrectomy. Patients who are on dual antiplatelet therapy. Patients who are thrombocytopenic at screening (Platelet count <100,000 microliter) or other high risk for bleeding in the opinion of the investigator. Immunosuppressed patients: History of immunodeficiency diseases or known HIV test positive. Is receiving immunosuppressant treatment or is on chronic high doses (high-dose therapy exceeding 2 weeks of treatment) of steroids equivalent to prednisone/prednisolone 0.5 mg/kg/day, including solid organ transplant patients. Patients with septic shock treated with hydrocortisone (e.g., 3 × 100 mg) can be included. Active hepatitis (defined as (a) abnormal liver enzymes (Alanine aminotransferase (ALT), Gamma-glutamyl transferase (GGT), ALP > 3x Upper Limit of Normal (ULN) or (b)) for active hepatitis B or C infection, a positive Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV) serology or patients with advanced chronic liver disease, confirmed by a Child-Pugh score of 10-15 (Class C). Acute pancreatitis with no established source of infection. Active hematological malignancy (previous hematological malignancies that are not actively treated are allowable). Burns requiring ICU treatment. Sepsis attributed to confirmed COVID-19. Use of other investigational drugs within 5 half-lives of enrollment within 30 days (e.g., small molecules) / or until the expected pharmacodynamic effect has returned to baseline (e.g., biologics), whichever is longer; or longer if required by local regulations. History of hypersensitivity to the study treatment or its excipients or to drugs of similar chemical classes. Any medical conditions that could significantly increase risk of participants' safety by participating in this study according to investigator's judgement. Women with a positive pregnancy test, pregnancy or breast feeding. Women of child-bearing potential

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: TIN816<br>Administered as an intravenous dose | Biological: TIN816 70 mg lyophilisate powder<br>* Recombinant human CD39 enzyme<br>|
| Placebo Comparator: Placebo<br>0.9% sterile sodium chloride solution administered as an intravenous dose | Other: Placebo<br>* 0.9% sterile sodium chloride solution<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CMax:The maximum (peak) observed serum drug concentration | To characterize the pharmacokinetic (PK) profile of TIN816 IV infusion | Baseline day 1, day 2, day 3, day 5, day 8, day 14, day 30, day 60 and day 90 | 
| AUClast:The AUC from time zero to the last measurable concentration sampling time (tlast) (mass × time × volume-1) | To characterize the pharmacokinetic (PK) profile of TIN816 IV infusion | Baseline day 1, day 2, day 3, day 5, day 8, day 14, day 30, day 60 and day 90 | 
| AUCinf: The AUC from time zero to infinity | To characterize the pharmacokinetic (PK) profile of TIN816 IV infusion | Baseline day 1, day 2, day 3, day 5, day 8, day 14, day 30, day 60 and day 90 | 
| Tmax: - Time to reach observed maximum drug concentration following TIN816 administration | To characterize the pharmacokinetic (PK) profile of TIN816 IV infusion | Baseline day 1, day 2, day 3, day 5, day 8, day 14, day 30, day 60 and day 90 | 
| T1/2: Terminal half-life | To characterize the pharmacokinetic (PK) profile of TIN816 IV infusion | Baseline day 1, day 2, day 3, day 5, day 8, day 14, day 30, day 60 and day 90 | 
| CL: - Total clearance of drug from serum after intravascular administration | To characterize the pharmacokinetic (PK) profile of TIN816 IV infusion | Baseline day 1, day 2, day 3, day 5, day 8, day 14, day 30, day 60 and day 90 | 
| Vz: Volume of distribution from a systemic dose | To characterize the pharmacokinetic (PK) profile of TIN816 IV infusion | Baseline day 1, day 2, day 3, day 5, day 8, day 14, day 30, day 60 and day 90 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with treatment emergent adverse events (AEs) and serious adverse events (SAEs) | Number of participants with AEs/SAEs as measures of safety and tolerability. | Baseline up to 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sepsis, acute kidney injury, intensive care, therapy