Efficacy and Safety Study of Oral Eligen® B12 in Subjects With Low Serum Cobalamin

Study Overview
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Brief Summary
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The purpose of this study is to compare the efficacy and safety profile of a new oral vitamin B12 formulation (Eligen® B12) with intramuscular B12 in restoring normal B12 (cobalamin) concentrations in subjects with low cobalamin levels (<350 pg/mL).

Official Title
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A 60-DAY, Open-label, Randomized Study to Evaluate the Efficacy and Safety of Eligen® B12 OR Intramuscularly Administered B12 in Subjects With Low Serum Cobalamin With a 30 Day Extension to 90 Days of Dosing

Conditions
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Vitamin B 12 Deficiency

Intervention / Treatment
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* Other: Vitamin B12 (cyanocobalamin)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Vitamin B12 deficiency defined as serum cobalamin below 350 pg/mL Age 60 or older; or age 18 or older with gastrointestinal abnormalities including but not limited to gastrointestinal surgery (e.g. gastrectomy, gastric bypass), ileal resection, gastric atrophy, Celiac disease, Crohn's disease, or prolonged use (>3 months) of proton pump inhibitor drugs, or on a restricted diet (such as vegetarian or vegan). General good health, as indicated by lack of significant findings in medical history, physical examination, clinical laboratory tests (chemistry, hematology and urinalysis), vital signs, ECG and normal kidney function as determined by estimated creatinine clearance computed with the Cockcroft and Gault formula Exclusion Criteria: Current treatment from a health care provider to treat vitamin B12 deficiency and/or symptoms; Daily use of neutralizing antacids (e.g. Maalox®) Inability to ingest oral medication Clinically significant laboratory value at screening Hypersensitivity or allergic reaction to vitamin B12 Participation in a clinical research study involving a new chemical entity within 30 days of the first study dose Folate levels below the reference range provided by the clinical laboratory. Renal insufficiency Vitamin B6 deficiency

Ages Eligible for Study
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Minimum Age: 18 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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Oral Eligen® B12<br>Eligen® B12 1000 μg oral tablet taken in the fasted state as a single tablet with 50 mL water. Each dose self-administered daily, for 90 days, after an overnight fast and 1 hour before the morning meal. | Other: Vitamin B12 (cyanocobalamin)<br> <br> |
| Active Comparator: IM B12<br>Commercially available 1000 μg cyanocobalamin administered IM as 1 mL from a vial containing 1000 μg/mL drug administered by study personnel, in the research clinic, in the morning, in the fasted state and at least 1 hour prior to the morning meal on study Days 1, 3, 7, 10, 14, 21, 30, 60 and 90. | Other: Vitamin B12 (cyanocobalamin)<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Serum Cobalamin Normalization | The primary efficacy outcome compares the proportion of subjects in each treatment arm in whom cobalamin levels are normalized (i.e., cobalamin ≥ 350 ng/mL) following 60 days of treatment | 61 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maintenance of B12 Normalization | Maintenance of cobalamin normalization after 90 days of treatment | 91 days | 
| Time to Normalization | Time to normalization of cobalamin levels | 90 days | 
| Percent Change from Baseline in Cobalamin Levels After 60 and 90 days of Treatment | Change from baseline is defined as (X-B) where B is the baseline (pre-dose Day 1) measurement of cobalamin (pg/mL) and X is the measurement of cobalamin(pg/mL) at Day 61 or Day 91, as required. Percent change from baseline is defined as 100(X-B)/B. | 91 days | 
| Percent Change from Baseline in Methylmalonic Acid (MMA) Levels After 60 and 90 Days of Treatment | Change from baseline is defined as (X-B) where B is the baseline (pre-dose Day 1) measurement of MMA (ng/mL) and X is the measurement of MMA (ng/mL) at Day 61 or Day 91, as required. Percent change from baseline is defined as 100(X-B)/B | 91 days | 
| Percent Change from Baseline in Homocysteine Levels After 60 and 90 Days of Treatment | Change from baseline is defined as (X-B) where B is the baseline (pre-dose Day 1) measurement of homocysteine (umol/L) and X is the measurement of homocysteine (umol/L) at Day 61 or Day 91, as required. Percent change from baseline is defined as 100(X-B)/B | 91 days | 
| Number of Subjects with Adverse Events as a Measure of Safety and Tolerability | The safety and tolerability of Eligen® B12 and intramuscular B12 assessed by physical examination findings, clinical laboratory test results, vital signs, 12-lead ECG results and adverse event reporting. | 91 days | 
| Holo-trancobalamin (holo-TC) Normalization | The proportion of subjects who achieve normalization of holo-TC levels (≥ 40 pmol/L) on Days 61 and 91 as an exploratory endpoint | 91 days | 
| Holo-TC and Cobalamin Correlation | Holo-TC levels in relation to cobalamin levels on Days 61 and 91 as an exploratory endpoint | 91 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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B12, MMA, cobalamin, homocysteine, holotranscobalamin, Eligen