Clinical trial NCT03937479: Study Investigating the Effect of 4 Doses of RPL554 Given in Addition to Tiotropium to Patients With COPD
Official title: A Phase II, Randomized, Double-Blind, Placebo Controlled Dose Ranging Study to Assess the Effect of RPL554 Added on to Tiotropium in Patients With Chronic Obstructive Pulmonary Disease
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: COPD
Lead sponsor: Verona Pharma plc
Sponsor class: INDUSTRY
Collaborators: name: Iqvia Pty Ltd
name: LGC Limited
First posted: 2019-05-03
Enrollment: 416
Sex: ALL
Minimum age (years): 40
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to investigate the dose response of RPL554 in patients with moderate to severe CHRONIC OBSTRUCTIVE PULMONARY DISEASE that are still symptomatic despite treatment with a stable background of tiotropium over 4 weeks of treatment. This study is intended to support optimal dose selection for a Phase III program evaluating RPL554 as an add-on treatment to standard of care therapy.

Detailed description: This is a Phase IIb, randomized, double-blind, placebo controlled, multiple dose, parallel group study to investigate the effects of 4 weeks of treatment with nebulized RPL554 (at different dose levels) compared to placebo in patients with moderate to severe CHRONIC OBSTRUCTIVE PULMONARY DISEASE on a stable background therapy of open-label tiotropium. The study comprises seven visits: Pre-screening (Visit 0), Screening (Visit 1) and then a Treatment Period consisting of Randomization (Visit 2), and weekly visits for 4 weeks (Visit 3 to Visit 6).

Eligibility criteria: Inclusion Criteria:

* Sign an informed consent document indicating they understand the purpose of and procedures required for the study and are willing to participate in the study.
* Male or female aged between 40 and 80 years inclusive, at the time of informed consent.
* Must agree to meet the following from the first dose up to 1 month after the last dose of study medication:

  * If male:

    * Not donate sperm
    * Either: be sexually abstinent in accordance with a patient's usual and preferred lifestyle (but agree to abide by the contraception requirements below should their circumstances change)
    * Or: use a condom with all sexual partners. If the partner is of childbearing potential the condom must be used with spermicide and a second reliable form of contraception must also be used (e.g., diaphragm/cap with spermicide, established hormonal contraception, intra-uterine device)
  * If female:

    * be of non-childbearing potential or use a highly effective form of contraception
* Have a 12-lead ECG recording at Screening showing the following (and no changes in the pre-dose value at the first treatment deemed clinically significant by the Investigator):

  * Heart rate between 45 and 90 beats per minute
  * QT interval corrected for heart rate using Fridericia's formula (QTcF) ≤450 msec for males, and ≤ 470 msec for females
  * QRS interval ≤ 120 msec
  * No clinically significant abnormality including morphology (e.g., left bundle branch block, atrio-ventricular nodal dysfunction, ST segment abnormalities consistent with ischemia)
* Capable of complying with study restrictions and procedures, including ability to use the nebulizer correctly.
* Body mass index (BMI) between 18 and 35 kg/m2 (inclusive) with a minimum weight of 45 kg.
* COPD diagnosis: Patients with a diagnosis of COPD as defined by the American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines (Celli and MacNee, 2004) with symptoms compatible with COPD for at least 1 year prior to Screening.
* Ability to perform acceptable and reproducible spirometry.
* Post-bronchodilator (four puffs of albuterol) spirometry at Screening demonstrating the following:

  * FEV1/ FVC ratio of ≤0.70
  * FEV1 ≥30% and ≤70% of predicted normal\* \*National Health and Nutrition Examination Survey (NHANES) III (Hankinson et al, 1999) will be used as the reference for normal predicted values.
* Clinically stable COPD in the 4 weeks prior to Screening (Visit 1) and during the period between Visits 1 and 2.
* A score of ≥2 on the modified Medical Research Council (mMRC) dyspnea scale at Screening.
* A chest X-ray (posterior-anterior) at Screening, or in the 12 months prior to Screening showing no clinically significant abnormalities unrelated to COPD.
* Meet the concomitant medication restrictions and be expected to do so for the rest of the study.
* Current and former smokers with smoking history of ≥10 pack years.
* Capable of withdrawing from long acting bronchodilators (other than tiotropium) for the duration of the study, and short acting bronchodilators for 6 hours prior to dosing.

Exclusion Criteria:

* A history of life-threatening COPD including Intensive Care Unit admission and/or requiring intubation.
* COPD exacerbation requiring oral or parenteral steroids, or lower respiratory tract infection requiring antibiotics, within 3 months of Screening or prior to the first treatment.
* A history of one or more hospitalizations for COPD or pneumonia within 6 months of Screening or prior to the first treatment.
* Intolerance or hypersensitivity to albuterol, tiotropium or other muscarinic receptor antagonists.
* Other respiratory disorders: Patients with a current diagnosis of asthma, active tuberculosis, lung cancer, bronchiectasis, sarcoidosis, lung fibrosis, interstitial lung diseases, uncontrolled or unstable sleep apnea, known alpha-1 antitrypsin deficiency, core pulmonale, clinically significant pulmonary hypertension or other active pulmonary diseases.
* Previous lung resection or lung reduction surgery.
* Pulmonary rehabilitation, unless such treatment has been stable from 4 weeks prior to Screening and remains stable during the study.
* Oral therapies for COPD (e.g. oral steroids, theophylline, and roflumilast) or antibiotics within 3 months prior to Screening, or ICS therapy within 4 weeks prior to Screening
* Prior exposure to RPL554.
* History of, or reason to believe a patient has, drug or alcohol abuse within the past 5 years.
* Received an experimental drug within 30 days or five half-lives, whichever is longer.
* Women who are pregnant or breast-feeding.
* Patients with uncontrolled disease including, but not limited to, endocrine, active hyperthyroidism, neurological, hepatic, gastrointestinal, renal, hematological, urological, immunological, psychiatric, or ophthalmic diseases that the Investigator believes are clinically significant. This includes any hepatic disease or moderate to severe renal impairment.
* Documented clinically significant cardiovascular disease such as: any history of arrhythmias, angina, recent (\<1 year) or suspected myocardial infarction, congestive heart failure, unstable or uncontrolled hypertension, or diagnosis of hypertension within 3 months prior to Screening.
* Use of non-selective oral β-blockers.
* Major surgery (requiring general anesthesia) within 6 weeks prior to Screening, lack of full recovery from surgery at Screening, or planned surgery through the end of the study.
* Required use of oxygen therapy, even on an occasional basis.
* History of malignancy of any organ system within 5 years, with the exception of localized skin cancers (basal or squamous cell).
* Clinically significant abnormal values for laboratory safety tests (hematology, blood chemistry, viral serology or urinalysis) at Screening, as determined by the Investigator. In particular, alanine aminotransferase or aspartate aminotransferase cannot be more than twice the upper limit of normal.
* Patients with conditions which are sensitive to antimuscarinic effects such as narrow angle glaucoma, urinary retention, prostatic hypertrophy, or bladder neck obstruction.
* Current marijuana use (all forms).
* A disclosed history or one known to the Investigator, of significant non-compliance in previous investigational studies or with prescribed medications.
* Any other reason that the Investigator considers makes the patient unsuitable to participate.

Primary outcomes:
measure: Least Square (LS) Mean Change From Baseline Forced Expiratory Volume in 1 Second (FEV1) to Peak FEV1 at Week 4
timeFrame: Baseline and Week 4
Secondary outcomes:
measure: LS Mean Change From Baseline FEV1 to Average Area Under the Curve Over 3 Hours (AUC0-3h) FEV1 on Day 1 and at Weeks 1 to 4
timeFrame: Baseline (30 minutes before first administration on Day 1); 30 minutes and 1, 2, and 3 hours post-dose on Day 1 and Weeks 1, 2, 3 and 4
measure: LS Mean Change From Baseline FEV1 to Average Area Under the Curve Over 12 Hours (AUC0-12h) FEV1 on Day 1 and at Week 4
timeFrame: Baseline (30 minutes before first administration on Day 1); 30 minutes and 1, 2, 3, 4, 6, 8 and 12 hours post-dose on Day 1 and at Week 4
measure: LS Mean Change From Baseline FEV1 to Peak FEV1 on Day 1 and at Weeks 1 to 3
timeFrame: Baseline (30 minutes before first administration on Day 1); 30 minutes post-dose on Day 1 and Weeks 1, 2 and 3
measure: LS Mean Change From Baseline FEV1 to Morning Trough FEV1 at Weeks 1 to 4
timeFrame: Baseline (30 minutes before first administration on Day 1) and morning pre-dose on Weeks 1, 2, 3 and 4
measure: LS Mean Change From Baseline to the Mean Weekly Evaluating Respiratory Symptoms of COPD (E-RS:COPD) Total Score at Weeks 1 to 4
timeFrame: Baseline and Weeks 1, 2, 3 and 4
measure: LS Mean Change From Baseline in the St George's Respiratory Questionnaire - COPD Specific (SGRQ-C) Total Score at Weeks 2 and 4
timeFrame: Baseline, Weeks 2 and 4
measure: LS Mean Transition Dyspnea Index (TDI) Questionnaire Total Score at Weeks 2 and 4
timeFrame: Weeks 2 and 4
measure: LS Mean Patient Global Assessment of Change (PGAC) Questionnaire Total Score at Weeks 2 and 4
timeFrame: Weeks 2 and 4
measure: LS Mean Change From Baseline to the Mean Weekly Values Over Weeks 1 to 4 in Number of Puffs of Rescue Medication
timeFrame: Baseline and Weeks 1, 2, 3 and 4
measure: LS Mean Change From Baseline Forced Vital Capacity (FVC) to Peak FVC on Day 1 and at Weeks 1 to 4
timeFrame: Baseline (30 minutes before first administration on Day 1); 30 minutes post-dose on Day 1 and Weeks 1, 2, 3 and 4
measure: LS Mean Change From Baseline FVC to Average AUC0-3h FVC on Day 1 and at Weeks 1 to 4
timeFrame: Baseline (30 minutes before first administration on Day 1); 30 minutes and 1, 2, and 3 hours post-dose on Day 1 and Weeks 1, 2, 3 and 4
measure: LS Mean Change From Baseline FVC to Average AUC0-12h FVC on Day 1 and at Week 4
timeFrame: Baseline (30 minutes before first administration on Day 1); 30 minutes and 1, 2, 3, 4, 6, 8 and 12 hours post-dose on Day 1 and at Week 4
measure: LS Mean Change From Baseline FVC to Morning Trough FVC at Weeks 1 to 4
timeFrame: Baseline (30 minutes before first administration on Day 1) and morning pre-dose on Weeks 1, 2, 3 and 4
measure: Steady-State Plasma Concentrations of Tiotropium on Day 1 and at Week 2
timeFrame: Pre-dose on Day 1 and Week 2
measure: Steady-State Plasma Concentrations of RPL554 at Week 2
timeFrame: Pre-dose at Week 2
measure: Number of Patients With Treatment Emergent Adverse Events (TEAEs)
timeFrame: TEAEs were collected from the first dose of study treatment up to 1 week after the final study visit at Week 4, approximately 5 weeks.
Other outcomes:
Locations:
city: Anniston
country: United States
facility: Pinnacle Research Group, LLC
state: Alabama
city: Fullerton
country: United States
facility: California Research Medical Group, Inc
state: California
city: Los Angeles
country: United States
facility: Southern California Institute For Respiratory Diseases, Inc.
state: California
city: Lafayette
country: United States
facility: Innovative Clinical Research
state: Colorado
city: Brandon
country: United States
facility: Meris Clinical Research
state: Florida
city: Clearwater
country: United States
facility: Clinical Research of West Florida
state: Florida
city: Kissimmee
country: United States
facility: Pulmonary Disease Specialists, PA d/b/a PDS Research
state: Florida
city: Leesburg
country: United States
facility: Medical Research of Central Florida, LLC
state: Florida
city: Miami
country: United States
facility: Clinical Trials of Florida, LLC
state: Florida
city: Ormond Beach
country: United States
facility: Peninsula Research, Ormond Beach, LLC
state: Florida
city: Port Charlotte
country: United States
facility: Medsol Clinical Research Center, Inc
state: Florida
city: Port Orange
country: United States
facility: Progressive Medical Research
state: Florida
city: Saint Petersburg
country: United States
facility: Pasadena Center for Medical Research, LLC
state: Florida
city: Winter Park
country: United States
facility: Florida Pulmonary Research Institute, LLC
state: Florida
city: Columbus
country: United States
facility: Columbus Regional Research Institute
state: Georgia
city: Dacula
country: United States
facility: VitaLink Research - Hamilton Mill
state: Georgia
city: Duluth
country: United States
facility: VitaLink Research - Duluth
state: Georgia
city: Lawrenceville
country: United States
facility: Gwinnett Biomedical Research
state: Georgia
city: Rincon
country: United States
facility: IACT Health
state: Georgia
city: Winder
country: United States
facility: Vitalink
state: Georgia
city: Fall River
country: United States
facility: Genesis Clinical Research and Consulting, LLC
state: Massachusetts
city: Farmington Hills
country: United States
facility: Pulmonary Research Institute of Southeast Michigan
state: Michigan
city: Fridley
country: United States
facility: Cities Research Center
state: Minnesota
city: Charlotte
country: United States
facility: American Health Research
state: North Carolina
city: Gastonia
country: United States
facility: Clinical Research of Gastonia
state: North Carolina
city: Huntersville
country: United States
facility: Research Carolina of Huntersville
state: North Carolina
city: Mooresville
country: United States
facility: Clinical Research of Lake Norman
state: North Carolina
city: Cincinnati
country: United States
facility: New Horizons Clinical Research
state: Ohio
city: Columbus
country: United States
facility: Aventiv Research, Inc
state: Ohio
city: Dublin
country: United States
facility: Aventiv Research, Inc
state: Ohio
city: Medford
country: United States
facility: Crisor, LLC
state: Oregon
city: Anderson
country: United States
facility: Vitalink Research - Anderson
state: South Carolina
city: Charleston
country: United States
facility: Lowcountry Lung and Critical Care, PA
state: South Carolina
city: Columbia
country: United States
facility: VitaLink-Columbia
state: South Carolina
city: Easley
country: United States
facility: VitaLink Research - Easley
state: South Carolina
city: Fort Mill
country: United States
facility: Piedmont Research Partners, LLC
state: South Carolina
city: Gaffney
country: United States
facility: VitaLink Research-Gaffney
state: South Carolina
city: Greenville
country: United States
facility: VitaLink Research-Greenville
state: South Carolina
city: Greenville
country: United States
facility: VitaLink Research-UPSTATE
state: South Carolina
city: Mount Pleasant
country: United States
facility: Clinical Research of Charleston
state: South Carolina
city: Rock Hill
country: United States
facility: Clinical Research of Rock Hill
state: South Carolina
city: Seneca
country: United States
facility: Vitalink Research-Seneca
state: South Carolina
city: Spartanburg
country: United States
facility: Fusion Clinical Research of Spartanburg, LLC
state: South Carolina
city: Spartanburg
country: United States
facility: Spartanburg Medical Research
state: South Carolina
city: Spartanburg
country: United States
facility: Vitalink Research-Spartanburg
state: South Carolina
city: Union
country: United States
facility: VitaLink Research - Union
state: South Carolina
city: Knoxville
country: United States
facility: New Phase Research & Development
state: Tennessee
city: Lampasas
country: United States
facility: FMC Science, LLC
state: Texas
city: Longview
country: United States
facility: DCOL Center for Clinical Research
state: Texas
city: McKinney
country: United States
facility: Metroplex Pulmonary and Sleep Center
state: Texas
Study officials:
affiliation: Pulmonary Research Institute of Southeast Michigan
name: Gary Ferguson
role: PRINCIPAL_INVESTIGATOR
References: