Study Designed to Assess the Safety, Tolerability and PK of PTI-808 in Healthy Volunteers and in Adults With Cystic Fibrosis

Study Overview
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Brief Summary
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Part 1 of this trial will enroll healthy volunteers into a single ascending dose (SAD), multiple ascending dose (MAD), and Food Effect (FE) treatment groups. The SAD treatment group is comprised of at least 3 ascending dose level cohorts where healthy adult subjects will be randomized to receive a single dose of either PTI-808 or placebo and will be followed for 7 days post dose. A safety review committee (SRC) will convene after the completion of each cohort to evaluate safety and pharmacokinetic (PK) data. Following the conclusion of the respective SAD level dose groups and after sufficient review of study data and approval by the SRC, a second set of healthy adult subjects will participate in an assigned MAD treatment group. The MAD treatment group is comprised of 3 ascending dose level cohorts where subjects will be randomized to receive either PTI-808 or placebo daily for 7 days and will be followed for 7 days after receiving the last dose. Also following the conclusion of the respective SAD level dose groups, healthy adult subjects will participate in the FE treatment group. Part 2 of this will enroll healthy volunteers to assess the safety, tolerability, and PK of PTI 808 co administered with PTI 801 and PTI 428 to HVs with daily dosing for 7 consecutive days. Part 3 will enroll adult subjects with cystic fibrosis (CF) into a MAD treatment group consisting of 2 cohorts. Subjects will receive PTI-808 co-administered with PTI-801 and PTI-428. PTI-808 will be administered daily for 7 consecutive days followed by PTI-808 + PTI-801 + PTI-428 administered daily for 14 consecutive days. Part 4 will enroll adult subjects with cystic fibrosis (CF) into 28-day cohorts. Subjects will receive PTI-808 co-administered with PTI-801 with or without PTI-428 versus matching placebo.

Detailed Description
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Part 1 of this trial will enroll healthy volunteers into a single ascending dose (SAD), multiple ascending dose (MAD), and Food Effect (FE) treatment groups. The SAD treatment group is comprised of at least 3 ascending dose level cohorts where healthy adult subjects will be randomized to receive a single dose of either PTI-808 or placebo and will be followed for 7 days post dose. The MAD treatment group is comprised of 3 ascending dose level cohorts where subjects will be randomized to receive either PTI-808 or placebo daily for 7 days and will be followed for 7 days after receiving the last dose. Following the conclusion of the respective SAD level dose groups the food effect portion of the study will be initiated and subjects will be randomized to receive an initial single dose of PTI-808 either after an overnight fast of at least 10 hours (fasted group) or after an overnight fast of at least 10 hours followed the consumption of a high fat high calorie meal (fed group). After a 10 day washout period, subjects will cross over to the opposite group and receive a second dose of PTI-808. Subjects will be followed for up to 7 days following dosing. Part 2 of this will enroll healthy volunteers to assess the safety, tolerability, and PK of PTI 808 co administered with PTI 801 and PTI 428 to HVs with daily dosing for 7 consecutive days. Part 3 - Part 3 will enroll adult subjects with CF to assess the safety, tolerability, and PK of multiple ascending doses of PTI-808 co-administered with PTI-801 and PTI-428. Subjects will receive 7 days of PTI-808 or placebo followed by 14 days of PTI-808 or placebo co-administered with PTI-801+PTI-428 or matching placebos. Part 4 - Part 4 will assess the safety, tolerability, PK, and the effects of PTI-808 co-administered with PTI-801 with or without PTI-428 over a 28-day treatment period in CF subjects who are either homozygous for the F508del CFTR genotype or are heterozygous for the F508del CFTR genotype. Subjects will be randomized to receive treatment with PTI-808 co-administered with PTI-801 with or without PTI-428 versus matching placebo.

Official Title
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A Phase 1/2 Study to Evaluate the Safety, Tolerability, and Pharmacokinetics of PTI-808 in Healthy Adult Subjects and in Adults With Cystic Fibrosis

Conditions
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Healthy Volunteer - Complete, Cystic Fibrosis - Complete

Intervention / Treatment
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* Drug: PTI-808
* Drug: Placebo
* Drug: PTI-428
* Drug: PTI-801


Participation Criteria
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Eligibility Criteria
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Part 1 and Part 2 Inclusion Criteria: Adults aged 18 to 55 years old, inclusive, at the time of informed consent Body mass index ≥18 and <30 kg/m2 Subject must be a non-smoker and non-tobacco user for a minimum of 30 days prior to screening and for the duration of the study. Subject understands the full nature and purpose of the study, including possible risks and side effects, and is willing and able to comply with all compulsory study procedures and provides informed consent/permission prior to any study procedures being performed. Females of childbearing potential and males capable of fathering a child must meet the contraception requirements Part 1 & Part 2 Exclusion Criteria: History or current evidence of any clinically significant cardiac, endocrinologic, hematologic, hepatobiliary, immunologic, metabolic, urologic, pulmonary, neurologic, dermatologic, psychiatric, renal, or other major disease, as determined by the investigator Prolonged QT interval with Fridericia's correction >450 msec at screening Abnormal liver function as defined by aspartate transaminase (AST), alanine transaminase (ALT), or bilirubin >1.5× the upper limit of the normal range Abnormal renal function at screening defined as creatinine clearance <90 mL/min using the Cockroft-Gault equation Clinically significant screening results that would exclude subject from the study (e.g., medical histories, PE, ECGs, vital signs, and laboratory profiles) as deemed by the investigator Participation in another clinical study or treatment with an investigational agent within 30 days or five half-lives, whichever is longer, prior to Study Day 1 History of cancer within the past 5 years (excluding non-melanoma skin cancer) History or current evidence of alcohol or drug abuse or dependence within 12 months of screening as determined by the investigator Positive urine screen for prohibited drugs (cocaine, cannabinoids, nicotine [urine cotinine is the detection mechanism for nicotine], opiates, barbiturates, amphetamines, and benzodiazepines) or positive alcohol test at screening Positive blood screen for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), or hepatitis C virus antibody (HCVAb) Clinically significant infection within 3 months of screening as determined by the investigator Known or suspected hypersensitivity or idiosyncratic reaction to study medication or any components thereof Has donated blood within 3 months of screening or plans to donate blood within 3 months of study completion Pregnant or nursing women Any conditions that, in the opinion of the investigator, would make the subject unsuitable for enrollment or could interfere with the subject's participation in or completion of the study Use of prohibited medications within 14 days prior to dosing of study drug Part 3 CF Inclusion Criteria: Confirmed diagnosis of CF with the F508del/F508del genotype Forced expiratory volume in 1 second (FEV1) 40-90% predicted, inclusive Non-smoker and non-tobacco user for a minimum of 30 days prior to screening Part 3 CF Exclusion Criteria: Participation in another clinical trial or treatment with an investigational agent within 28 days or 5 half-lives, whichever is longer, prior to Study Day 1 History of cancer within the past 5 years (excluding cervical cancer in situ with curative therapy for at least one year prior to screening and non-melanoma skin cancer) History of organ transplantation Hospitalization, sinopulmonary infection, CF exacerbation, or other clinically significant infection or illness (as determined by the investigator) requiring an increase or addition of medication, such as antibiotics or corticosteroids, within 14 days of Day 1 Initiation of any new chronic therapy (e.g., ibuprofen, hypertonic saline, azithromycin, Pulmozyme®, Cayston®, TOBI®)) or any change in chronic therapy (excluding pancreatic enzyme replacement therapy) within 28 days prior to Day 1 History or current evidence of alcohol or drug abuse or dependence within 12 months of screening as determined by the investigator Pregnant or nursing women Currently taking or has taken a CFTR modulator within 30 days prior to initial dose of study drugs Part 4 CF Inclusion Criteria: Confirmed diagnosis of CF with either the F508del CFTR homozygous genotype on record or for heterozygote subjects, only one copy of the F508del CFTR mutation on record Forced expiratory volume in 1 second (FEV1) 40-90% predicted, inclusive Non-smoker and non-tobacco user for a minimum of 30 days prior to screening Part 4 CF Exclusion Criteria: Participation in another clinical trial or treatment with an investigational agent within 28 days or 5 half-lives, whichever is longer, prior to Study Day 1 History of cancer within the past 5 years (excluding cervical cancer in situ with curative therapy for at least one year prior to screening and non-melanoma skin cancer) History of organ transplantation Hospitalization, sinopulmonary infection, CF exacerbation, or other clinically significant infection or illness (as determined by the investigator) requiring an increase or addition of medication, such as antibiotics or corticosteroids, within 28 days of Day 1 Initiation of any new chronic therapy (e.g., ibuprofen, hypertonic saline, azithromycin, Pulmozyme®, Cayston®, TOBI®)) or any change in chronic therapy (excluding pancreatic enzyme replacement therapy) within 28 days of Day 1 History or current evidence of alcohol or drug abuse or dependence within 12 months of screening as determined by the investigator Pregnant or nursing women Currently taking or has taken a CFTR modulator within 14 days prior to the screening visit

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: SAD PTI-808 Active<br>Three cohorts of SAD are planned for evaluation where subjects will be randomized to PTI-808 or placebo. | Drug: PTI-808<br>* Active<br>|
| Placebo Comparator: SAD PTI-808 Placebo<br>Three cohorts of SAD are planned for evaluation where subjects will be randomized to PTI-808 or placebo. | Drug: Placebo<br>* Placebo<br>|
| Active Comparator: MAD PTI-808 Active<br>Three cohorts of MAD are planned for evaluation where subjects will be randomized to PTI-808 or placebo. | Drug: PTI-808<br>* Active<br>|
| Placebo Comparator: MAD PTI-808 Placebo<br>Three cohorts of MAD are planned for evaluation where subjects will be randomized to PTI-808 or placebo. | Drug: Placebo<br>* Placebo<br>|
| Active Comparator: FE PTI-808 Active<br>Subjects will be randomized to Fed or Fasted on Days 1 and 12. Follow up visits will occur 7 days post Day 12 dose. | Drug: PTI-808<br>* Active<br>|
| Placebo Comparator: FE PTI-808 Placebo<br>Subjects will be randomized to Fed or Fasted on Days 1 and 12. Follow up visits will occur 7 days post Day 12 dose. | Drug: Placebo<br>* Placebo<br>|
| Experimental: Part 2 PTI-808 + PTI-801 + PTI-428 Active<br>One cohort is planned where subjects will be randomized to either the triple active arm (dosed with PTI 808+PTI 801+PTI 428) OR placebo arm. | Drug: PTI-808<br>* Active<br>Drug: PTI-428<br>* Active<br>Drug: PTI-801<br>* Active<br>|
| Placebo Comparator: Part 2 matching Placebos<br>In all three cohorts in part 2, subjects will be randomized to active drug or placebo. The placebo arm for all cohorts consists of placebo capsules matching PTI-808+PTI-801+PTI-428. | Drug: Placebo<br>* Placebo<br>|
| Experimental: Part 2 dual active arm PTI-801+PTI-428+ PTI-808 placebo<br>One cohort is planned where subjects are randomized to either 808 placebo + dual active arm (dosed with placebo matching PTI 808 plus PTI 801 + PTI 428) OR placebo arm. | Drug: Placebo<br>* Placebo<br>Drug: PTI-428<br>* Active<br>Drug: PTI-801<br>* Active<br>|
| Active Comparator: Part 2 dual active arm PTI-801+PTI-808+PTI-428 placebo<br>One cohort is planned where subjects are randomized to either 428 placebo + dual active arm (dosed with placebo matching PTI 428 plus PTI 808 and PTI 801) OR placebo arm. | Drug: PTI-808<br>* Active<br>Drug: Placebo<br>* Placebo<br>Drug: PTI-801<br>* Active<br>|
| Active Comparator: Part 3 CF MAD PTI-808 + PTI-801 + PTI-428<br>In all cohorts in Part 3, subjects will be will be randomized to receive 7 days of PTI-808 or placebo followed by 14 days of co-administration of PTI-808+PTI-801+PTI-428 or matching placebos. A follow-up will occur on Day 28. | Drug: PTI-808<br>* Active<br>Drug: PTI-428<br>* Active<br>Drug: PTI-801<br>* Active<br>|
| Placebo Comparator: Part 3 CF MAD PTI-808 placebo+PTI-801 placebo+PTI-428 placebo<br>In all cohorts in Part 3, subjects will be randomized to receive 7 days of PTI-808 or placebo followed by 14 days of co-administration of PTI-808+PTI-801+PTI-428 or matching placebos. A follow-up will occur on Day 28. | Drug: Placebo<br>* Placebo<br>|
| Active Comparator: Part 4 CF PTI-808 + PTI-801 + PTI-428<br>In cohorts 3 & 4 subjects will be randomized to receive PTI-808 + PTI-801 with or without PTI-428 or matching placebos. A follow-up will occur on Day 42. | Drug: PTI-808<br>* Active<br>Drug: PTI-428<br>* Active<br>Drug: PTI-801<br>* Active<br>|
| Active Comparator: Part 4 CF PTI-808 + PTI-801 + PTI-428 placebo<br>In cohorts 3 & 4, subjects will be randomized to receive PTI-808 + PTI-801 with or without PTI-428 or matching placebos. A follow-up will occur on Day 42. | Drug: PTI-808<br>* Active<br>Drug: PTI-801<br>* Active<br>|
| Placebo Comparator: Part 4 CF PTI-808 placebo + PTI-801 placebo + PTI-428 placebo<br>In cohorts 3 & 4, subjects will be randomized to receive PTI-808 + PTI-801 with or without PTI-428 or matching placebos. A follow-up will occur on Day 42. | Drug: Placebo<br>* Placebo<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Part 1 SAD and MAD: Adverse Events | Safety and tolerability measure by number of subjects who experience adverse events | Baseline to up to 14 days | 
| Part 1 SAD and MAD: Physical Exams | Safety and tolerability measure by number of subjects who experience potential clinically significant changes in physical examinations | Baseline to up to 14 days | 
| Part 1 SAD and MAD: The number of subjects who experience potential clinically significant changes in vital signs | Safety and tolerability measure by number of subjects who experience potential clinically significant changes in vital signs | Baseline to up to 14 days | 
| Part 1 SAD and MAD: ECGs | Safety and tolerability measure by number of subjects who experience potential clinically significant changes in ECGs | Baseline to up to 14 days | 
| Part 1 SAD and MAD: The number of subjects who experience potential clinically significant changes in safety labs | Safety and tolerability measure by number of subjects who experience potential clinically significant changes in safety labs | Baseline to up to 14 days | 
| Part 1 SAD and FE: terminal half life | Apparent terminal half-life (t1/2) of single oral dose | Through 72 hours post dose | 
| Part 1 SAD and FE : Tmax | Time to reach maximum plasma concentration (Tmax) of single oral dose | Through 72 hours post dose | 
| Part 1 SAD and FE: Cmax | Maximum plasma concentration (Cmax) of single oral dose | Through 72 hours post dose | 
| Part 1 SAD : AUC | Area under the concentration-time curve from time 0 to 24 hours post dose (AUC 0-24) of single oral dose | Through 24 hours post dose | 
| Part 1 SAD and FE: AUC0 | AUC from time 0 to time of last measurable concentration (AUC0-last) of single oral dose | Through 72 hours post dose | 
| Part 1 SAD and FE: AUC0-inf | AUC from time 0 to infinity (AUC0-inf) of single dose | Through 72 hours post dose | 
| Part 1 MAD: t1/2 | t1/2 of multiple oral dose | Through 72 hours post dose | 
| Part 1 MAD: Tmax | Tmax of multiple oral doses | Through 72 hours post dose | 
| Part 1 MAD: Cmax | Cmax of multiple oral doses | Through 72 hours post last dose | 
| Part 1 MAD: AUC0-24 | AUC0-24 of multiple oral dose | Through 24 hours post last dose | 
| Part 1 MAD: AUC0-last | AUC0-last of multiple oral doses | Through 72 hours post last dose | 
| Part 1 MAD: Urine | Cumulative amount of PTI-808 excreted unchanged in urine (Ae) as appropriate of multiple oral doses | Through 24 hours post last dose | 
| Part 1 MAD: CLR | Renal clearance (CLR) of multiple oral doses | Through 24 hours post dose | 
| Part 2: Physical Exams | Safety and tolerability measure by number of subjects who experience potential clinically significant changes in physical examinations | Baseline up to 14 days | 
| Part 2: ECGs | Safety and tolerability measure by number of subjects who experience potential clinically significant changes in ECGs | Baseline up to 14 days | 
| Part 2: Safety Labs | Safety and tolerability measure by number of subjects who experience potential clinically significant changes in safety labs | Baseline up to 14 days | 
| Part 2: Vitals Signs | Measure by number of subjects who experience potential clinically significant changes in vital signs | Baseline up to 14 days | 
| Part 3 CF: Physical Exams | Safety and tolerability measured by number of subjects who experience potential clinically significant changes in physical examinations | Baseline up to 28 days | 
| Part 3 CF: ECGs | Safety and tolerability measured by number of subjects who experience potential clinically significant changes in ECGs | Baseline up to 28 days | 
| Part 3 CF: Safety Labs | Safety and tolerability measured by number of subjects who experience potential clinically significant changes in safety labs | Baseline up to 28 days | 
| Part 3 CF: Vital Signs | Measured by number of subjects who experience potential clinically significant changes in vital signs | Baseline up to 28 days | 
| Part 4 CF: Physical Exams | Safety and tolerability measured by number of subjects who experience potential clinically significant changes in physical examinations | Baseline up to 42 days | 
| Part 4 CF: ECGs | Safety and tolerability measured by number of subjects who experience potential clinically significant changes in ECGs | Baseline up to 42 days | 
| Part 4 CF: Safety Labs | Safety and tolerability measured by number of subjects who experience potential clinically significant changes in safety labs | Baseline up to 42 days | 
| Part 4 CF: Vital Signs | Safety and tolerability measured by number of subjects who experience potential clinically significant changes in physical examinations | Baseline up to 42 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Part 2: Apparent terminal half life (t1/2) of multiple oral doses PTI 808 is co administered with PTI 801 and PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 is co administered with PTI 801 and PTI 428 in healthy adults | Day 1 through Day 10 | 
| Part 2: Maximum plasma concentration (Cmax) of multiple oral doses PTI 808 is co administered with PTI 801 and PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 is co administered with PTI 801 and PTI 428 in healthy adults | Day 1 through Day 10 | 
| Part 2: Time to reach maximum plasma concentration (Tmax) of multiple oral doses PTI 808 is co administered with PTI 801 and PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 is co administered with PTI 801 and PTI 428 in healthy adults | Day 1 through Day 10 | 
| Part 2: AUC0-last of multiple oral doses when PTI 808 is co administered with PTI 801 and PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 is co administered with PTI 801 and PTI 428 in healthy adults | Day 1 through Day 10 | 
| Part 2: AUC from time 0 to infinity (AUC0-inf) of multiple oral doses when PTI 808 is co administered with PTI 801 and PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 is co administered with PTI 801 and PTI 428 in healthy adults | Day 1 through Day 10 | 
| Part 3 CF: Time to reach maximum plasma concentration (Tmax) of multiple oral doses PTI 808 is co administered with PTI 801 and PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 is co administered with PTI 801 and PTI 428 in adults with CF | Day 1 through Day 22 | 
| Part 3 CF: Maximum plasma concentration (Cmax) of multiple oral doses PTI 808 is co administered with PTI 801 and PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 is co administered with PTI 801 and PTI 428 in adults with CF | Day 1 through Day 22 | 
| Part 3 CF: AUC0-last of multiple oral doses when PTI 808 is co administered with PTI 801 and PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 is co administered with PTI 801 and PTI 428 in adults with CF | Day 1 through Day 22 | 
| Part 3 CF: FEV1 | Change in forced expiratory volume in one second (FEV1) over time | Baseline through Day 28 | 
| Part 4 CF: Time to reach maximum plasma concentration (Tmax) of multiple oral doses of PTI 808 + PTI 801 co-administered with or without PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 + PTI 801 is co administered with or with out PTI 428 in adults with CF | Day 1 through Day 28 | 
| Part 4 CF: Maximum plasma concentration (Cmax) of multiple oral doses of PTI 808 + PTI 801 co-administered with or without PTI 428 | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 + PTI 801 is co administered with or with out PTI 428 in adults with CF | Day 1 through 28 | 
| Part 4 CF: AUC0-last of multiple oral doses when PTI 808 + PTI 801 is coadministered with or without PTI 428 in adults with CF | Evaluate the PK profile of PTI 808, PTI 801, and PTI 428 when PTI 808 + PTI 801 is co administered with or without PTI 428 in adults with CF | Day 1 through 28 | 
| Part 4 CF: FEV1 | Change in forced expiratory volume in one second (FEV1) over time | Baseline through Day 42 | 
| Part 4 CF Sweat Chloride | Change in sweat chloride concentrations over time | Baseline through Day 42 |