Clinical trial NCT06310967: A Dose Escalation Study of IG3018 in Subjects With Hyperuricemia With or Without Chronic Kidney Disease
Official title: A Dose Escalation Study of IG3018 to Evaluate the Safety, Tolerability, Efficacy and Pharmacokinetics in Subjects With Hyperuricemia With or Without Chronic Kidney Disease
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE1
PHASE2
Conditions: Hyperuricemia
Hypouricemia, Renal
Keywords: Hyperuricemia, Renal
Hyperuricemia
Chronic Kidney Disease
CKD
Hyperuricemia, CKD
Lead sponsor: Intelligem Therapeutics Australia Pty Ltd.
Sponsor class: INDUSTRY
First posted: 2024-03-15
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: SEQUENTIAL
Intervention model description: Part 1 is a randomized, double-blind, placebo-controlled study where the doses of the study drug are escalated in a predesigned manner in 3 cohorts.

Initiation Dose shall be at 0.25 g tablets (Cohort A) and doses are escalated to 0.5 g (Cohort B) and then to 1.0 g (Cohort C) in a planned manner. Each cohort will have 10 eligible patients. Randomization will be performed in Part 1 and as per the randomization code, 8 subjects will receive the active study drug (IG3018) and 2 shall receive placebo in each dose cohort. A total of 30 subjects are planned to be enrolled.

Part 2 is an open-label PoC study involving hyperuricemia subjects with advanced predialysis CKD (Stage 3a, Stage 3b and Stage 4), and treated with two doses of IG3018 \[0.5 g BID (Cohort D) and 1.0 g BID (Cohort E)\]. 12 to 15 hyperuricemia subjects with advanced predialysis CKD (at least 6 Taiwanese subjects are required) will be enrolled in each dose and will receive the determined study dose of IG3018 BID for 4 weeks.
Primary purpose: TREATMENT

Brief summary: This is a phase I/II clinical study to evaluate the safety, tolerability, PK, and efficacy of IG3018 tablet in hyperuricemia (HUA) subjects with or without CKD.

Detailed description: The study has two parts:

Part 1 is a randomized, double-blind, placebo-controlled, dose escalation study in hyperuricemia subjects without CKD. Initiation Dose shall be at 0.25 g tablets (Cohort A) and doses are escalated to 0.5 g (Cohort B) and then to 1.0 g (Cohort C) in a planned manner.

Part 2 is an open-label, proof of concept study involving hyperuricemia subjects with advanced predialysis CKD (Stage 3a, Stage 3b and Stage 4), and treated with two doses \[0.5 g BID IG3018 (Cohort D) and 1.0 g BID IG3018 (Cohort E)\].

Eligibility criteria: Inclusion Criteria:

For Part 1 and Part 2:

Subjects must meet all the following criteria to be included in the study:

1. Male or female, aged 18 to 75 years (both inclusive).
2. According to the investigator's judgment, eGFR must be met as:

   Part 1 only: subjects without CKD and have eGFR ≥ 60 mL/minute/1.73 m2 at screening phase; Part 2 only: subjects with advanced predialysis CKD (Stage 3a, 3b and Stage 4) have eGFR≥15 and \<60 mL/minute/1.73 m2 at screening phase.
3. The serum uric acid level for subjects need to meet any of the following:

   For subjects already on ULT within 2 weeks prior to the screening visit, the serum uric acid would be measured during the screening visit/phase, and then at the end of the run-in phase, prior to confirming their eligibility. Subjects with ULT within 2 weeks before screening has fasting serum uric acid ≥ 0.48 mmol/L at the end of run-in phase.

   For subjects without ULT in 2 weeks prior to screening visit，the serum uric acid should be measured twice on 2 different days (at least 24 hours apart) prior to confirming their eligibility. Subjects without ULT within 2 weeks before screening has fasting serum uric acid ≥ 0.48 mmol/L at screening phase.
4. Body Mass Index (BMI) ≥ 18 and ≤ 35 kg/m2 (both inclusive) at screening.
5. Female subjects of child-bearing potential must agree to use highly effective contraceptive methods and must abstain from egg collection or donation from the screening phase to 90 days after the last dose of the IMP. And the male partner of a female subject also needs to agree to use highly effective method of birth control during this phase.
6. Male subjects considered fertile must agree to not donate sperm, and take effective contraceptive methods from the screening phase to 90 days after the last dose of the IMP. And the female partner of male subjects also needs to agree to use a highly effective method of female contraception during this phase.
7. Able to understand and give signed written informed consent form (ICF) and willing to comply with all study procedures.

   Only for Part 2
8. For subjects with anemia who require iron supplementation, steady iron or iron-containing drugs should be used for at least 3 months, and the original treatment regimen should be maintained during the study period.

Exclusion Criteria:

For Part 1 and Part 2:

Subjects who meet any of the following criteria will be excluded from the study:

1. Prior uricase/recombinant uricase (such as Rasburicase or Pegloticase) therapy within 2 weeks prior to screening or last dose of therapy\< 5 times the half-life (whichever is longer).
2. Subjects who have acute gout flares requiring treatment within 4 weeks prior to or during screening.
3. Major surgery within 3 months prior to the first administration.
4. History of malignant tumors within 6 months prior to screening.
5. Subjects within the last 3 months have: myocardial infarction, angina, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, or transient ischemia attack.
6. Subjects who are on other urate-lowering medication (allopurinol, febuxostat, probenecid and benzbromarone) and cannot stop during the study periods included in the run-in phase.
7. Subject with underlying medical conditions requiring changes or introduction of drugs that have the potential impact on the serum uric acid levels (e.g., salicylic acids, diuretics, angiotensin receptor blockers, etc.) within at least 1 month prior the screening phase.
8. History of gastrointestinal (GI) surgery, including gastric sleeve, colostomy/enterostomy, Roux-en-Y or gastric banding (unless gastric band removed for a minimum of 12 months prior to screening.
9. History of GI diseases, including gastrointestinal bleeding moderate to severe gastrointestinal dysfunction, moderate to severe chronic constipation for a minimum of 3 months prior to screening, or newly diagnosed peptic or duodenal ulcer diseases within 4 weeks prior to screening.
10. Chronic use of parenteral nutrition including manganese within 3 months prior to screening.
11. Subjects who have the history of manganese toxicity or excessive exposure to manganese (i.e., having worked in a mine, foundry, smelter, dry cell battery manufacturing facility) within 2 months prior to screening.
12. Inability to swallow oral medications.
13. Received treatment with or exposure to an investigational drug or device within 30 days of signing informed consent.
14. Subjects with one of positive results of HIV virus, or positive hepatitis B virus surface antigen (HBsAg) and the number of copies of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) ≥ 500 IU/mL (or 2500 copies, or the lower limit of the positive detection value of the study site) at screening, or HBsAg (-), hepatitis B core antibody (HBcAb) (+) and the number of copies of HBV DNA ≥ 500 IU/mL (or 2500 copies, or the lower limit of the positive detection value of the study site) after treatment of HBV infection, or positive hepatitis C antibody (HCV-Ab), and hepatitis C virus (HCV) ribonucleic acid (RNA) ≥upper limit of normal (ULN) of the study site during screening phase.
15. History of alcohol abuse, or subjects who consumed alcohol within 48 h before the first administration or did not agree to stop using alcohol products during the study.
16. Subjects who have previously been diagnosed with the following diseases and have not been able to control them after medication therapy or other treatment. Uncontrolled is defined as hypertension: msSBP ≥ 180 mmHg and/or msDBP ≥ 110 mmHg; or Diabetes mellitus: HbA1c ≥ 9% at screening.
17. Subjects with secondary hyperuricemia caused by tumor, hematological system diseases, drugs, etc. except for chronic kidney disease; or hereditary hyperuricemia at screening.
18. Subjects undergone kidney transplantation or planning to undergo kidney transplantation at screening.
19. Subjects with abnormal biliary function, biliary obstruction, or biliary gallstone at screening.
20. Prior or current cholestatic liver disease defined as a clinical condition associated with decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts.
21. History of serious hypersensitivity reaction to a known ingredient of IG3018 tablet judged by the investigator.
22. Subjects who are considered unsuitable for participating in the study in the opinion of the investigator judgment.

Primary outcomes:
measure: Safety Assessments (Part 1 and Part 2)
timeFrame: Baseline through study completion at up to 46 days
measure: The proportions of change from baseline in serum uric acid to normal level (≤ 0.36 mmol/L) (Part 1 and Part 2)
timeFrame: 4 weeks
Secondary outcomes:
measure: The proportions of change from baseline in serum uric acid to ≤ 0.30 mmol/L and ≤ 0.24 mmol/L respectively (Part 1 and Part 2)
timeFrame: 4 weeks
measure: The actual change of serum uric acid (Part 1 and Part 2)
timeFrame: 4 weeks
measure: The percentage change of serum uric acid (Part 1 and Part 2)
timeFrame: 4 weeks
measure: Gouty Attacks (Part 1 and Part 2)
timeFrame: Baseline through study completion at up to 46 days
measure: Urinary Albumin/Creatinine Ration (U-ACR) (Part 2 only)
timeFrame: Baseline through study completion at up to 43 days
measure: Ae of IG3018 (Part 1 only)
timeFrame: 32 days
measure: Cmax of IG3018 (Part 1 only)
timeFrame: 46 days
measure: Tmax of IG3018 (Part 1 only)
timeFrame: 46 days
measure: T1/2 of IG3018 (Part 1 only)
timeFrame: 46 days
measure: Estimated glomerular filtration rate (eGFR) (Part 2 only)
timeFrame: Baseline through study completion at up to 43 days
measure: Cmax of IG3018 (Part 2 Taiwanese subjects only)
timeFrame: 43 days
measure: Tmax of IG3018 (Part 2 Taiwanese subjects only)
timeFrame: 43 days
measure: T1/2 of IG3018 (Part 2 Taiwanese subjects only)
timeFrame: 43 days
Other outcomes:
Locations:
city: Botany
country: Australia
facility: Emeritus Research Pty Ltd -Sydney
state: New South Wales
city: Kotara
country: Australia
facility: Pendlebury Research Pty Ltd T/A Novatrials
state: New South Wales
city: Camberwell
country: Australia
facility: Emeritus Research Pty Ltd -Melbourne
state: Victoria
Study officials:
References: