Clinical trial NCT03177603: A Dose-escalation Study in Subjects With Pulmonary Arterial Hypertension (PAH)
Official title: An Open-label, Dose-escalation Study to Evaluate the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of Single Doses of GSK2586881 in Participants With Pulmonary Arterial Hypertension
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Hypertension, Pulmonary
Keywords: Pulmonary Arterial Hypertension
Dose-escalation
Safety
Tolerability
GSK2586881
Lead sponsor: GlaxoSmithKline
Sponsor class: INDUSTRY
First posted: 2017-06-06
Enrollment: 23
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: GSK2586881, a purified intravenous (IV) formulation of soluble recombinant human Angiotensin Converting Enzyme (rhACE2) is being investigated as a treatment for PAH. This GlaxoSmithKline (GSK) study will evaluate the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) of GSK2586881 in subjects with PAH. This open-label, dose-escalation study will comprise of 4 separate groups based on the planned dose range, and subjects in each group will be administered a single dose of GSK2586881 ranging between 0.1, 0.2, 0.4 and 0.8 milligram per kilogram (mg/kg) via IV route. Dose escalation will occur after 4 subjects have been dosed per cohort and review of safety, tolerability, PK and hemodynamic data up to 24 hours post dose has taken place. A maximum of 27 subjects will be included in the study and the total duration of the study will be up to a maximum of 59 days.


Eligibility criteria: Inclusion Criteria

* Subjects must be between 18-75 years of age (inclusive), at the time of signing the informed consent.
* Documented diagnosis of PAH, defined as mPAP \> 25 millimeter of mercury (mmHg) and pulmonary wedge pressure (PWP) \<= 15.
* Idiopathic PAH (IPAH), Hereditary PAH (HPAH), or PAH associated with collagen vascular disease, or appetite suppressant use.
* World Health Organization (WHO) functional class I, II, or III, stable for at least 8 weeks prior to enrollment.
* Hemodynamically stable on background therapy with no evidence of uncontrolled right heart failure (historic data), as determined by the investigator.
* Six minute walk (6MW) distance, as performed at screening or within 6 months prior to screening, of \>= 100 meters (m) and \<= 500 m.
* Mean BP of \>60 mmHg.
* Receiving stable doses of one or more medications that are approved for treatment of PAH, including endothelin receptor antagonists, phosphodiesterase 5 inhibitors, and/or prostanoids/prostacyclin receptor agonists, for a minimum of 12 consecutive weeks before enrollment.
* Diuretic dose stable for 8 weeks.
* Body weight \<= 100 kg and body mass index (BMI) within the range 18-35 kg per m square (kg/m\^2) (inclusive).
* Male and/or female (following confirmation of negative pregnancy test for Women of Childbearing Potential \[WOCBP\]). Women who are pregnant or breastfeeding are excluded.
* Capable of giving signed informed consent.

Exclusion Criteria

* History of systemic hypotension, defined as systolic BP \<90 mmHg and/or diastolic BP \<50 mmHg.
* Hospitalization for PAH associated deterioration in the previous 6 months.
* Any additional medical condition, serious intercurrent illness, or other extenuating circumstance that, in the opinion of the Investigator, may significantly interfere with study compliance, including all prescribed evaluations and follow-up activities. Concurrent disease or condition that may interfere with study participation or safety include bleeding disorders, arrhythmia, organ transplant, organ failure, current neoplasm, poorly controlled diabetes mellitus, and serious neurological disorders.
* Complex repaired and unrepaired congenital heart disease.
* Subjects with Eisenmenger physiology.
* Alanine transferase (ALT) \>2x upper limit of normal (ULN).
* Bilirubin \>1.5xULN (isolated bilirubin \>1.5xULN is acceptable if bilirubin is fractionated and direct bilirubin \<35 percent).
* Current or chronic history of liver disease, or known hepatic or biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones).
* Estimated glomerular-filtration-rate (eGFR) \<45 milliliter per minute per 1.73 meter square (mL/min/1.73m\^2).
* QTc \>480 millisecond (msec) or QTc \> 500 msec in subjects with bundle branch block.
* Any bleeding concerns as evidenced by International normalized ratio (INR) \>1.5 (in subjects not receiving anticoagulation therapy) or platelet count \<80,000.
* Hemoglobin (Hb) \<10 gram per deciliter (g/dL).
* Sensitivity to any of the study treatments, or components thereof, or drug or other allergy that, in the opinion of the investigator or Medical Monitor, contraindicates participation in the study.
* Any use of an Angiotensin-converting enzyme (ACE) inhibitor or Angiotensin receptor blocker or renin inhibitors within 14 days prior to dosing. Therapy can be stopped to enable inclusion if deemed safe by the subject's treating physician.
* Use of any investigational product (IP) or device within 30 days prior to dosing, or known requirement for any investigational agent prior to completion of all scheduled study assessments.
* Positive human immunodeficiency virus (HIV) antibody test.
* Presence of Hepatitis B surface antigen (HBsAg) at screening.
* Positive Hepatitis C antibody test result at screening or within 3 months prior to starting study treatment.
* Positive Hepatitis C ribonucleic acid (RNA) test result at screening or within 3 months prior to first dose of study treatment.
* Participation in the study would result in loss of blood or blood products in excess of 300mL within 65 days.
* Exposure to more than 4 new chemical entities within 12 months prior to the first dosing day.
* A known or suspected history of alcohol or drug abuse within the 2 years prior to screening.
* Unable to refrain from smoking during the in-house treatment period.

Primary outcomes:
measure: Change From Baseline in Pulmonary Vascular Resistance (PVR)
timeFrame: Baseline (Day 1, Pre-dose); 1 hour, 2 hours and 4 hours post-dose (Day 1)
measure: Change From Baseline in Cardiac Output (CO)
timeFrame: Baseline (Day 1, Pre-dose); 1 hour, 2 hours and 4 hours post-dose (Day 1)
measure: Change From Baseline in Mean Pulmonary Artery Pressure (mPAP)
timeFrame: Baseline (Day 1, Pre-dose); 1 hour, 2 hours and 4 hours post-dose (Day 1)
Secondary outcomes:
measure: Number of Participants With Non-serious Adverse Events (AEs)
timeFrame: Up to Day 28
measure: Number of Participants With Serious Adverse Events (SAEs)
timeFrame: Up to Day 28
measure: Change From Baseline in Clinical Chemistry Parameters: Alkaline Phosphatase, Alanine Amino Transferase and Aspartate Amino Transferase
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Clinical Chemistry Parameters: Direct Bilirubin, Total Bilirubin and Creatinine
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Clinical Chemistry Parameters: Calcium, Glucose, Potassium, Sodium and Blood Urea Nitrogen (BUN)
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Clinical Chemistry Parameter: Total Protein
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Hematology Parameters: Basophils, Eosinophils, Lymphocytes, Monocytes, Total Neutrophils, Platelet Count and White Blood Cell (WBC) Count
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Hematology Parameter: Hemoglobin
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Hematology Parameter: Hematocrit
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Hematology Parameter: Mean Corpuscle Hemoglobin
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Hematology Parameter: Mean Corpuscle Volume
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Hematology Parameter: Red Blood Cell (RBC) Count
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Hematology Parameter: Reticulocytes
timeFrame: Baseline (Day 1, Pre-dose), 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Number of Participants With Urinalysis Results by Dipstick Method
timeFrame: 24 hours post-dose (Day 1)
measure: Change From Baseline in Pulse Rate
timeFrame: Baseline (Day 1, Pre-dose); 0.5 hour, 1 hour, 2 hours, 4 hours, 8 hours, 24 hours post-dose (Day 1); and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Respiratory Rate
timeFrame: Baseline (Day 1, Pre-dose); 0.5 hour, 1 hour, 2 hours, 4 hours, 8 hours and 24 hours post-dose (Day 1); and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Diastolic Blood Pressure (DBP) and Systolic Blood Pressure (SBP)
timeFrame: Baseline (Day 1, Pre-dose); 0.5 hour, 1 hour, 2 hours, 4 hours, 8 hours and 24 hours post-dose (Day 1); and one sample between Day 7 to Day 14 (follow up visit)
measure: Number of Participants With Abnormal Electrocardiogram (ECG) Findings
timeFrame: 4 hours and 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Pulse Oximetry Parameter: Percent Oxygen in Blood
timeFrame: Baseline (Day 1, Pre-dose); 0.5 hour, 1 hour, 2 hours, 4 hours, 8 hours and 24 hours post-dose (Day 1); and one sample between Day 7 to Day 14 (follow up visit)
measure: Number of Participants With Positive Immunogenicity Results
timeFrame: Up to Day 28
measure: Change From Baseline in Systemic Renin-Angiotensin System (RAS) Peptides: Angiotensin II, Angiotensin (1-5) and Angiotensin (1-7)
timeFrame: Baseline (Day 1, Pre-dose); 0.08 hour, 0.5 hour, 1 hour, 2 hours, 4 hours, 8 hours and 24 hours post-dose (Day 1); and one sample between Day 7 to Day 14 (follow up visit)
measure: Change From Baseline in Pulmonary Wedge RAS Peptides: Angiotensin II, Angiotensin (1-5) and Angiotensin (1-7)
timeFrame: Baseline (Day 1, Pre-dose); 1 hour, 2 hours and 4 hours post-dose (Day 1)
measure: Systemic RAS Peptide: Angiotensin II/Angiotensin (1-7) Ratio at Indicated Time Points
timeFrame: 0.08 hour, 0.5 hour, 1 hour, 2 hours, 4 hours, 8 hours and 24 hours post-dose (Day 1) and one sample between Day 7 to Day 14 (follow up visit)
measure: Pulmonary Wedge RAS Peptide: Angiotensin II/Angiotensin (1-7) Ratio at Indicated Time Points
timeFrame: 1 hour, 2 hours and 4 hours post-dose (Day 1)
measure: Change From Baseline in Disease Biomarkers: N-terminal Pro B-type Natriuretic Peptide (NT Pro-BNP)
timeFrame: Baseline (Day 1, Pre-dose); 2 hours, 4 hours and 24 hours post-dose (Day 1)
measure: Change From Baseline in Nitrite, Nitrate and Endogenous Nitrite (Biomarkers of Nitric Oxide [NO])
timeFrame: Baseline (Day 1, Pre-dose); 2 hours, 4 hours and 24 hours post-dose (Day 1)
measure: Change From Baseline in Disease Biomarker: Cardiac Troponin-I
timeFrame: Baseline (Day 1, Pre-dose); 2 hours, 4 hours and 24 hours post-dose (Day 1)
measure: Maximum Observed Plasma Concentration (Cmax) of GSK2586881
timeFrame: Pre-dose (Day 1) and 0.08, 0.5, 1, 2, 4, 8 and 24 hours post-dose (Day 1)
measure: Time to Cmax (Tmax) of GSK2586881
timeFrame: Pre-dose (Day 1) and 0.08, 0.5, 1, 2, 4, 8 and 24 hours post-dose (Day 1)
measure: Area Under the Plasma Concentration-time Curve From Time Zero to the Time of the Last Quantifiable Concentration (AUC[0-t]) of GSK2586881
timeFrame: Pre-dose (Day 1) and 0.08, 0.5, 1, 2, 4, 8 and 24 hours post-dose (Day 1)
measure: Area Under the Concentration-time Curve From Time Zero (Pre-dose) Extrapolated to Infinite Time (AUC[0-inf]) of GSK2586881
timeFrame: Pre-dose (Day 1) and 0.08, 0.5, 1, 2, 4, 8 and 24 hours post-dose (Day 1)
measure: Last Observed Quantifiable Concentration (Ct) of GSK2586881
timeFrame: Pre-dose (Day 1) and 0.08, 0.5, 1, 2, 4, 8 and 24 hours post-dose (Day 1)
measure: Time of the Last Quantifiable Concentration (Tlast) of GSK2586881
timeFrame: Pre-dose (Day 1) and 0.08, 0.5, 1, 2, 4, 8 and 24 hours post-dose (Day 1)
measure: Plasma Clearance (CL) of GSK2586881
timeFrame: Pre-dose (Day 1) and 0.08, 0.5, 1, 2, 4, 8 and 24 hours post-dose (Day 1)
measure: Apparent Volume of Distribution of GSK2586881
timeFrame: Pre-dose (Day 1) and 0.08, 0.5, 1, 2, 4, 8 and 24 hours post-dose (Day 1)
measure: Apparent Terminal Phase Half-life (t1/2) of GSK2586881
timeFrame: Pre-dose (Day 1) and 0.08, 0.5, 1, 2, 4, 8 and 24 hours post-dose (Day 1)
Other outcomes:
measure: Change From Baseline in Cardiac Index (CI)
timeFrame: Baseline (Day 1, Pre-dose); 1 hour, 2 hours and 4 hours post-dose (Day 1)
Locations:
city: Pittsburgh
country: United States
facility: GSK Investigational Site
state: Pennsylvania
city: Dallas
country: United States
facility: GSK Investigational Site
state: Texas
city: Heidelberg
country: Germany
facility: GSK Investigational Site
state: Baden-Wuerttemberg
city: Koeln
country: Germany
facility: GSK Investigational Site
state: Nordrhein-Westfalen
city: Dresden
country: Germany
facility: GSK Investigational Site
state: Sachsen
city: Berlin
country: Germany
facility: GSK Investigational Site
city: Barcelona
country: Spain
facility: GSK Investigational Site
city: Madrid
country: Spain
facility: GSK Investigational Site
Study officials:
affiliation: GlaxoSmithKline
name: GSK Clinical Trials
role: STUDY_DIRECTOR
References: