Clinical trial NCT04067492: Safety, Tolerability, Pharmacokinetics and Pharmacodynamics Evaluation of RPH-104 Administered at Different Doses to Patients With Acute Gout Attack
Official title: An Open-label, Single-dose, Active-controlled Randomized Phase IIa Clinical Study to Evaluate the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of RPH-104 (RPH-104/L04018) Administered at Different Doses to Patients With Acute Gout Attack
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE2
Conditions: Gout Attack
Keywords: hyperuricemia
acute arthritis
gouty arthritis
gout
Lead sponsor: R-Pharm
Sponsor class: INDUSTRY
Collaborators: name: Covance
name: Unimed Laboratories
name: Data Matrix Solutions
name: Center of Pharmaceutical Analytics LLC
name: OCT LLC
First posted: 2019-08-26
Enrollment: 47
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The primary goal of the study was to evaluate the parameters of efficacy, pharmacokinetics, pharmacodynamics, safety and tolerability of a single dose of RPH-104 in adult patients with acute gout attack.

Detailed description: The study consisted of two periods:

Period 1. In Study Period 1, eligible patients were enrolled in a group of 22 patients and randomized to receive either RPH-104 4 mg or Voltaren® (diclofenac) in the 15:7 ratio (15 RPH-104: 7 Voltaren® (diclofenac)). In order to prevent damage to the gastric and duodenal mucosa caused by Voltaren® (diclofenac), all patients receiving Voltaren® (diclofenac) had to simultaneously take Ortanol® (omeprazole) 20 mg, orally (1 capsule) daily before breakfast throughout the course of Voltaren® (diclofenac) treatment

Period 2. Upon completion of the enrollment of 22 patients, Study Period 2 started. In Period 2, newly enrolled patients were randomly assigned to one of 5 treatment groups: RPH-104 20 mg, 40 mg, 80 mg and 160 mg and active control (Voltaren® (diclofenac)). It was planned to include 14 patients in the RPH-104 groups in Period 2, and 7 patients in the Voltaren® (diclofenac) group.

The enrollment of patients in Period 1 and Period 2 was sequential. There was no pause between the enrollment of patients in Period 1 and Period 2. The study design included screening (24 hours), 11 visits to the study site, and a phone call at the end of the 60-day follow-up period.

Total number of patients which were planned to be enrolled for the study: 85 (15 patients in the group of treatment with RPH-104 4 mg and 14 patients in the each of the other treatment groups). Due to the low patient recruitment rate in the study and the negative impact of the COVID-19 pandemic on the recruitment, at the decision of the sponsor, an interim analysis of the data of 47 patients included in the study as of November 2020 was carried out in order to assess the feasibility of continuing recruitment and further conducting the study.

Patients who did not tolerate pain were allowed to receive a rescue medication, triamcinolone acetonide 40 mg intramuscularly, to intensify therapy 2 hours after the test product was administered. If the attack recurred after the use of the rescue medication, treatment was carried out in accordance with the standard practice of the hospital.

The primary efficacy endpoints were evaluated 72 hours after the end of administration of the test drug. The secondary efficacy endpoints were evaluated for 45 days of the treatment period and follow-up. The safety parameters were evaluated for 60 days of the treatment period and follow-up. Total duration of the study for a volunteer was not more than 70 days.

Eligibility criteria: Inclusion Criteria:

* 1. The subject has given his / her informed consent to participate in this study; the Informed Consent Form has been signed both by the patient and the Investigator;
* 2. Established diagnosis of gout according to Gout Classification Criteria established by the American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) in 2015;
* 3. Pain in at least one joint at the screening and immediately prior to initiation of therapy with the study drugs, with intensity 50 mm to 100 mm according to the Visual Analogue Scale (VAS);
* 4. Development of acute gout attack within 120 hours (5 days) prior to the randomization date;
* 5. History of 1 or more acute gout attacks prior to the Screening Visit;
* 6.The patients receiving uric acid-lowering drugs should continue receiving these drugs at a constant dose for at least 4 weeks prior to enrolment to the study and throughout the entire study period; the patients not receiving uric acid-lowering drugs may start receiving this treatment after the end of the study;
* 7. Body mass index ≤40 kg/m2;
* 8. QTcF interval ≤450 msec for male subjects and ≤470 msec for females on ECG at the screening;
* 9. For women of child-bearing potential: negative result of the serum pregnancy test performed at the screening;
* 10. The consent of a woman of child-bearing potential, as well as of a man who has female partners of child-bearing potential, to abstain from sexual intercourses or to use effective birth control methods throughout the entire study period and for 60 days after RPH-104 administration (if the patient received RPH-104);
* 11. The patient is able to fulfil the requirements of the Study Protocol as judged by the Investigator

Exclusion Criteria:

* 1. The patient received therapy with ibuprofen in a dose of up to 400 mg inclusive within 4 hours or \>400 mg within 8 hours prior to randomization.
* 2. The patient received therapy with diclofenac in a dose of up to 50 mg inclusive within 8 hours or \>50 mg within 24 hours prior to randomization.
* 3. The patient received any other non-steroidal anti-inflammatory drug (NSAID) within 24 hours prior to the randomization;
* 4.The patient received opioids within 48 hours prior to the randomization;
* 5. The patient received metamizole or metamizole-containing drugs within 12 hours prior to the randomization;
* 6. The patient received any drug with analgesic activity (including paracetamol) within 6 hours prior to the randomization;
* 7. The patient received a long-acting NSAID (half-life ≥24 hours) within 5 half-life periods or 1 month prior to the randomization whichever is longer;
* 8. The patient received extended-release naproxen, meloxicam, nabumetone, celecoxib, etoricoxib or indomethacin within 5 days prior to the randomization;
* 9 . The patient received corticosteroids (including their intra-articular administration and inhalations) within 4 weeks prior to the randomization;
* 10. The patient received colchicine within 7 days prior to the randomization;
* 11. Intolerance or contraindications for NSAID use;
* 12. Contraindications for the use of Ortanol® capsules 20 mg;
* 13. Chronic heart failure functional class II-IV (classification of NYHA);
* 14. A history of or current clinically significant ventricular arrhythmias or clinically significant atrial tachyarrhythmias;
* 15. Unstable angina or stable exercise-induced angina of functional class III or IV;
* 16. Secondary gout, chemotherapy-induced gout, lead- or transplantation-induced gout;
* 17. Rheumatoid arthritis, confirmed or suspected infectious septic arthritis or any other type of acute inflammatory arthritis;
* 18. Clinically significant renal impairment determined based on creatinine clearance (estimated using the Cockcroft-Gault equation) \<60 mL/min, or patients on hemodialysis;
* 19. Blood coagulation disorders; history of gastrointestinal bleedings or perforation;
* 20. Pregnant or breast-feeding women;
* 21. Elective surgery or major surgical intervention (minor surgical procedures, such as catheter placement or bone marrow biopsy, are not exclusion criteria) within 14 days before the first dose of the investigational medicinal product;
* 22. Current or suspected HIV-infection, HBsAg, Hepatitis C Virus antibodies (HCVAb), other acute or chronic bacterial, fungal or viral infections at the moment of subject's enrolment to the study;
* 23. Presence of any risk factors for tuberculosis based on the results of assessment using Tuberculosis Risk Assessment Questionnaire at the screening or confirmed tuberculosis or any other infectious disease of the lungs or bronchi based on findings of the chest X-ray exam in two views performed within 3 months prior to the screening visit, or the need for using therapy with tuberculosis medications, such as isoniazid in the course of the study;
* 24. Neutropenia, leukopenia, or thrombocytopenia determined based on the following laboratory parameters assessed during the screening:

  1. Absolute neutrophil count (ANC) \<1.5 x 10\^9/L;
  2. White blood cell count \<4.0 х 10\^9/L
  3. Platelet count \<150 х 10\^9/L;
* 25. Immunization with live vaccines within 3 months prior to the subject's enrolment to the study or planned vaccination within 60 days after the expected date of the first dose of the test drug;
* 26. History of allergic reactions to biologicals, Voltaren® (diclofenac) or Ortanol® (omeprazole);
* 27. Contraindications for subcutaneous, intramuscular, intravenous or intra-articular injections;
* 28. History of malignancy (except for patients with localized in situ basal cell carcinoma of the skin or in situ cervical cancer, who can be enrolled to the study immediately after the therapy for this disease), unless it is in remission for ≥5 years, as well as patients who are being examined for cancer or patients with suspected malignancy;
* 29. A condition or disease, which, in the Investigator's opinion, could put the patient's safety at risk or affect the test drug safety assessment;
* 30. Any other conditions and diseases, such as uncontrolled diabetes mellitus, uncontrolled hypertension, congestive heart failure, exacerbation of peptic ulcer disease, clinically significant liver diseases, kidney diseases, uncontrolled thyroid dysfunction, unhealed wounds, ulcers or bone fractures, psychiatric disorders, uncontrolled epilepsy, drug dependence, which could prevent the patient from complying with this Study Protocol.
* 31. The patient received biologicals or investigational medicinal products within 5 half-life periods of these drugs or 3 month prior to the randomization whichever is longer;
* 32. Blood donation or blood loss of ≥400 mL within 8 weeks prior to the randomization.
* 33. The patient was already randomized in this clinical study.

Primary outcomes:
measure: Change in Pain Intensity in the Assessed Joint 72 Hours After the Initiation of Treatment in Comparison to Baseline
timeFrame: Baseline and Day 4 (72 hours after the initiation of treatment with the test drug)
Secondary outcomes:
measure: Change in Pain Intensity in the Assessed Joint in 15, 30, 45 Minutes, 1, 1.5, 2, 4, 8, 24, 48, 72 Hours, on Days 5, 6, 10, 15, 18, 22, 29 and 45 Following the Initiation of Treatment and Compared to Baseline
timeFrame: Baseline and 15, 30, 45 minutes, 1, 1.5, 2, 4, 8, 24, 48, 72 hours, on Days 5, 6, 10, 15, 18, 22, 29 and 45 after the initiation of treatment
measure: Proportion of Patients Who Assessed the Response to Therapy With the Test Drug as "Excellent" or "Good"
timeFrame: 15, 30, 45 minutes, 1, 1.5, 2, 4, 8, 24, 48, 72 hours, on Days 5, 6, 10, 15, 18, 22, 29 and 45 after the initiation of treatment with the test drug
measure: Change in the Rate of Swelling of the Assessed Joint Evaluated After the Initiation of Treatment With the Test Drug
timeFrame: Baseline and 24, 48, 72 hours, on Days 5, 6, 10, 15, 18, 22, 29 and 45 following the initiation of treatment with the test drug
measure: Change in the Rate of Tenderness of the Assessed Joint Evaluated After the Initiation of Treatment With the Test Drug
timeFrame: Baseline and 24, 48, 72 hours, on Days 5, 6, 10, 15, 18, 22, 29 and 45 following the initiation of treatment with the test drug
measure: Change in the Rate of Erythema of the Assessed Joint Evaluated After the Initiation of Treatment With the Test Drug
timeFrame: Baseline and 24, 48, 72 hours, on Days 5, 6, 10, 15, 18, 22, 29 and 45 following the initiation of treatment with the test drug
measure: Change in the Rate of Movement Restrictions in the Specified Timeframes After Initiation of Treatment
timeFrame: Baseline and in 24, 48, 72 hours, on Days 5, 6, 10, 15, 18, 22, 29 and 45 following the initiation of treatment with the test drug
measure: Time to Achieve the 50% Decrease in Pain Intensity in the Assessed Joint Relative to the Baseline
timeFrame: Baseline and one of the pain intensity measurements in accordance with the schedule: 15, 30, 45 minutes, 1, 1.5, 2, 4, 8, 24, 48, 72 hours, on Days 5, 6, 10, 15, 18, 22, 29 and 45 after the initiation of treatment
measure: Time to Use of the Rescue Medication
timeFrame: from the date/time of IP administration (first dose) to the date/time of the first use of the rescue medication, up to day 60
measure: Proportion of Patients Who Received a Rescue Therapy Agent
timeFrame: 72 hours after the initiation of treatment with the test drug
measure: Proportion of Patients Who Received a Rescue Therapy Agent
timeFrame: up to day 60
measure: Changes in the Health Assessment Questionnaire (HAQ) Parameters: Disability Index
timeFrame: Baseline and 15, 29 and 45 days following the initiation of treatment with the test drug
measure: Changes in the Health Assessment Questionnaire (HAQ) Parameters: Arising
timeFrame: Baseline and 15, 29 and 45 days following the initiation of treatment with the test drug
measure: Changes in the Health Assessment Questionnaire (HAQ) Parameters: Eating
timeFrame: Baseline and 15, 29 and 45 days following the initiation of treatment with the test drug
measure: Changes in the Health Assessment Questionnaire (HAQ) Parameters: Walking
timeFrame: Baseline and 15, 29 and 45 days following the initiation of treatment with the test drug
measure: Changes in the Health Assessment Questionnaire (HAQ) Parameters: Hygiene
timeFrame: Baseline and 15, 29 and 45 days following the initiation of treatment with the test drug
measure: Changes in the Health Assessment Questionnaire (HAQ) Parameters: Grip
timeFrame: Baseline and 15, 29 and 45 days following the initiation of treatment with the test drug
Other outcomes:
measure: Pharmacokinetics (PK) - Area Under the Plasma concentration-of RPH-104 Under the Subcutaneous Administration
timeFrame: Baseline and in 2,8,24,48,72 hours,on Days 5,6,10,15,18,22,29,45 following the initiation of treatment with the test drug and on the follow-up visit (in case of premature withdrawal of patient)
measure: Pharmacokinetics (PK) - Area Under the Active Substance Concentration- of RPH-104 Under the Subcutaneous Administration
timeFrame: Baseline and in 2,8,24,48,72 hours,on Days 5,6,10,15,18,22,29,45 following the initiation of treatment with the test drug and on the follow-up visit (in case of premature withdrawal of patient)
measure: Pharmacokinetics (PK) - Maximum Concentration of the Active Substance -of RPH-104 Under the Subcutaneous Administration
timeFrame: Baseline and in 2,8,24,48,72 hours,on Days 5,6,10,15,18,22,29,45 following the initiation of treatment with the test drug and on the follow-up visit (in case of premature withdrawal of patient)
measure: Pharmacokinetics (PK) of RPH-104 Under the Subcutaneous Administration
timeFrame: Baseline and in 2,8,24,48,72 hours,on Days 5,6,10,15,18,22,29,45 following the initiation of treatment with the test drug and on the follow-up visit (in case of premature withdrawal of patient)
measure: Pharmacokinetics (PK) -Time to Reach Maximum Concentration of the Active Substance - of RPH-104 Under the Subcutaneous Administration
timeFrame: Baseline and in 2,8,24,48,72 hours,on Days 5,6,10,15,18,22,29,45 following the initiation of treatment with the test drug and on the follow-up visit (in case of premature withdrawal of patient)
measure: Pharmacokinetics (PK) - Terminal Half-life -of RPH-104 Under the Subcutaneous Administration
timeFrame: Baseline and in 2,8,24,48,72 hours,on Days 5,6,10,15,18,22,29,45 following the initiation of treatment with the test drug and on the follow-up visit (in case of premature withdrawal of patient)
measure: Change in the Serum Rate of High-sensitive CRP (Hs-CRP) in Specified Timeframes
timeFrame: Baseline and in 24, 72 hours, on Days 5, 6, 15, 29 and 45 after the initiation of treatment with the test drug
measure: Change in the Rate of Serum Amyloid Protein A in the Specified Timeframes
timeFrame: Baseline and in 24, 72 hours and on Day 5, 6, 15, 29 and 45 following the initiation of treatment with the test drug
measure: Change in the Serum Rates of Cytokines: IL-1α
timeFrame: Baseline and in 24, 72 hours and on Days 5, 6, 15, 29 and 45 following the initiation of treatment with the test drug
measure: Change in the Serum Rates of Cytokines: IL-1β
timeFrame: Baseline and in 24, 72 hours and on Days 5, 6, 15, 29 and 45 following the initiation of treatment with the test drug
measure: Change in the Serum Rates of Cytokines: Interleukin -1 Receptor Antagonist (IL-1RA)
timeFrame: Baseline and in 24, 72 hours and on Days 5, 6, 15, 29 and 45 following the initiation of treatment with the test drug
measure: Change in the Serum Rates of Cytokines: IL-6
timeFrame: Baseline and in 24, 72 hours and on Days 5, 6, 15, 29 and 45 following the initiation of treatment with the test drug
measure: Change in the Serum Rates of Cytokines: IL-8
timeFrame: Baseline and in 24, 72 hours and on Days 5, 6, 15, 29 and 45 following the initiation of treatment with the test drug
measure: Change in the Serum Rates of Cytokines: Tumor Necrosis Factor (TNF-α)
timeFrame: Baseline and in 24, 72 hours and on Days 5, 6, 15, 29 and 45 following the initiation of treatment with the test drug
Locations:
city: Moscow
country: Russian Federation
facility: Moscow City State Healthcare Institution "O.M. Filatov Municipal Clinical Hospital No. 15" of the Moscow Department of Healthcare
city: Moscow
country: Russian Federation
facility: State Budgetary Healthcare Institution of Moscow City "Municipal Clinical Hospital No.1 named after N.I. Pirogov" of Moscow Department of Healthcare
city: Moscow
country: Russian Federation
facility: Federal State Autonomous Educational Institution of Higher Education "I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
city: Moscow
country: Russian Federation
facility: State Budgetary Healthcare Institution of Moscow City "Municipal Clinical Hospital No.52" of Moscow Department of Healthcare
city: Nizhny Novgorod
country: Russian Federation
facility: State Budgetary Institution of Healthcare of Nizhny Novgorod region "City Clinical hospital #13 of Avozavodskiy district"
city: Orenburg
country: Russian Federation
facility: Federal State Budgetary Education Institution of Higher Education "Orenburg State Medical University" under Ministry of Healthcare of Russian Federation
city: Saint Petersburg
country: Russian Federation
facility: St. Petersburg State Budgetary Healthcare Institution "Clinical Rheumatological Hospital No.25"
city: Saint Petersburg
country: Russian Federation
facility: State Budget Institution "Saint Petersburg Research Insitute of emergency care named after I.I. Dzhanelidze
city: Saint Petersburg
country: Russian Federation
facility: Limited Liability company "Scientific Research Center Eco-safety"
city: Tula
country: Russian Federation
facility: State Insitution of healthcare "Tula regional clinical dermatovenerologic dispensary"
city: Yaroslavl
country: Russian Federation
facility: State Autonomous Healthcare Institution of the Yaroslavl Region "N.V. Solovyev Clinical Emergency Hospital"
Study officials:
affiliation: R-Pharm
name: Mikhail Samsonov
role: STUDY_DIRECTOR
References: