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Study of Efficacy of ARA 290 on Corneal Nerve Fiber Density and Neuropathic Symptoms of Subjects With Sarcoidosis

Primary Purpose

Neuropathy of Sarcoidosis

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
ARA 290
Placebo
Sponsored by
Araim Pharmaceuticals, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Neuropathy of Sarcoidosis focused on measuring neuropathy, sarcoidosis

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

• Established diagnosis of sarcoidosis with both of the following two criteria:

  1. Score of 4 or greater on Brief Pain Inventory "pain now" or "average pain" questions (BPI; 0 (least discomfort)-10 (worst discomfort))
  2. Discomfort defined as distal pain/discomfort plus one of the following: 1) dysesthesia, 2) burning/painful feet worsening at night, or 3) intolerance of sheets or clothes touching the legs or feet

AND either of the following two criteria

  1. Corneal nerve fiber density reduced compared to normal (i.e., greater than 1 standard deviation less than the mean of a normative population)
  2. A previous skin biopsy (obtained within the prior 2 years) showing a reduced intraepidermal nerve fiber density ((i.e., greater than 1 standard deviation less than the mean of a normal age and gender relevant population)

In addition, subjects must:

  • Be able to read and understand the written consent form, complete study-related procedures, and communicate with the study staff
  • Be willing to comply with study restrictions
  • Be willing to check in with the study center via the telephone
  • Between 18 and 70 years of age (inclusive)
  • Body Mass Index (BMI) < 40 kg/m2 (inclusive)
  • If female of childbearing potential, a negative urine pregnancy test at screening and acceptable contraception will be maintained during the screening and dosing period and 1 month beyond. Acceptable contraception consists of hormonal methods such as oral, implantable, injectable, or transdermal contraceptives for a minimum of 1 full cycle (based on the subject's usual menstrual cycle period) before study entry, intrauterine device (IUD), or double barrier method (condoms, sponge, diaphragm, or vaginal ring with spermicidal jellies or cream).
  • Able to complete self-administered questionnaires (RAND-36, SFNSL, BPI, FAS, NPSI)
  • Refrigerator and freezer at home for storage of study medication.

Exclusion Criteria:

  • Clinically relevant abnormal history of physical and mental health other than conditions related to sarcoidosis, as determined by medical history taking (as judged by the investigator)
  • Clinically relevant abnormal laboratory results, vital signs, or physical findings other than conditions related to sarcoidosis or could interfere with conduct of 6-minute walk assessment (as judged by the investigator)
  • Other medical conditions known to be associated with small nerve fiber loss, except for diabetes in good control (as judged by the investigator)
  • Known clinically relevant abnormalities in ECG (as judged by the investigator)
  • Illicit drug abuse or excessive alcohol consumption (as judged by the investigator)
  • History of serious malignancy within the last 5 years other than a basal cell or squamous cell carcinoma of the skin that has been removed
  • History of severe allergies, or has had an anaphylactic reaction or significant intolerability to prescription or non-prescription drugs or food (as judged by the investigator)
  • Anti-TNF therapy, other biological anti-inflammatory agents, or immunoglobulins administered within the 3 months prior to screening.
  • Use of erythropoiesis stimulating agents within the two months prior to screening or during the trial
  • Participation in an investigational drug trial in the 3 months prior to administration of the initial dose of study drug or more than 4 times in the calendar year preceding study enrollment
  • Inadequate venous accessibility as judged by clinicians (physician or nurse)
  • Inability or unwillingness to self-administer ARA 290 via subcutaneous injections (or not have access to home health care for assistance in administration)
  • If female, pregnant or breast-feeding
  • Any other condition that in the opinion of the investigator would complicate or compromise the study, or the well-being of the subject

Sites / Locations

  • Cleveland Clinic
  • Leiden University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

1 mg per day ARA 290

4 mg per day ARA 290

8 mg per day ARA 290

placebo

Arm Description

1 mg ARA 290 administered subcutaneously for 28 consecutive days

4 mg ARA 290 administered subcutaneously for 28 consecutive days

8 mg ARA 290 administered subcutaneously for 28 consecutive days

1 mL placebo administered subcutaneously for 28 consecutive days

Outcomes

Primary Outcome Measures

Change in Corneal Nerve Fiber Area
Measurement of corneal nerve fiber area is a non-invasive procedure performed at baseline and at the end of dosing and at 12 weeks follow-up. The nerve fiber area in sarcoidosis patients is reduced compared to normal humans, a measurement of small fiber loss.

Secondary Outcome Measures

Change in the 6 Minute Walk Test
Measurement of the distance a patient can walk in 6 minutes
Change in Intra-epidermal Nerve Fiber Density (IENFD)
Measurement of small fiber density in skin biopsies. Density is reduced in sarcoidosis patients, an indication of neuropathy.
Change in the Scores of the SFNSL, BPI, NPSI, and FAS Questionnaires
Change in mean score from baseline to Day 28 is recorded for each outcome. Brief Pain Inventory (BPI), Pain Severity - scale of 0 (no pain) to 10 (worst pain imaginable) in 4 time frames, averaged. BPI, Pain Interference - scale of 0 (does not interfere) to 10 (completely interferes) how pain interferes with 7 lifestyle parameters, averaged. Small Fiber Neuropathy Screening List (SFNSL) - scale of 0 to 84 (higher score indicates greater neuropathy), sum of 21 questions. Neuropathic Pain Symptom Inventory (NPSI) - scale of 0 (least pain) to 10 (most pain) in 10 questions, summed. Total score range from 0 to 100. Fatigue Assessment Scale (FAS) - scale of 1 (never) to 5 (always) in 10 questions related to fatigue, summed. Total score range from 0 to 50, with 0 being the best possible score and 50 the worst..
Frequency of Adverse Events, Serious Adverse Events, and Laboratory Parameters
Patients reporting at least one treatment emergent adverse event (TEAE) or serious TEAE

Full Information

First Posted
January 16, 2014
Last Updated
March 7, 2017
Sponsor
Araim Pharmaceuticals, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02039687
Brief Title
Study of Efficacy of ARA 290 on Corneal Nerve Fiber Density and Neuropathic Symptoms of Subjects With Sarcoidosis
Official Title
A Double Blind, Placebo Controlled Phase 2 Dose Ranging Study of the Effects of ARA 290 on Corneal Nerve Fiber Density and Neuropathic Symptoms of Subjects With Sarcoidosis
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Completed
Study Start Date
January 2014 (undefined)
Primary Completion Date
January 2015 (Actual)
Study Completion Date
February 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Araim Pharmaceuticals, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine whether ARA 290, a new class of compound, is effective in the treatment of the neuropathic symptoms of sarcoidosis. Brief interaction of ARA 290 with the innate repair receptor results in anti-apoptotic and anti-inflammatory activities in myriad of cells, tissues and organs throughout the body to activate repair mechanisms and accelerate healing, including the nerve damage that can be associated with sarcoidosis. In this study, subjects with sarcoidosis and symptoms of small fiber neuropathy will administered ARA 290 or placebo by subcutaneous injection daily for 28 days. In addition to monitoring the safety of the treatment, the symptoms of the subjects will be assessed with several questionnaires, function tests, and measurement of nerve fibers in their cornea and skin (via a non-invasive test and a biopsy, respectively). The total participation time for each patient will be 16 weeks.
Detailed Description
This was a double-blind, randomized, placebo-controlled study to assess the effects of daily SC administration of ARA 290 at a dose of 1 mg, 4 mg, or 8 mg or placebo on corneal nerve fiber density of subjects with sarcoidosis and neuropathic symptoms consistent with small fiber neuropathy. The safety of these doses was also assessed. Up to 64 subjects with sarcoidosis and symptoms of small fiber neuropathy were planned to be enrolled in the study. Subjects determined to be eligible at the screening visit were asked to return to the study site for the start of the treatment period (Visit 1, study day 1) within 28 days of screening. Subjects who were not able to return for Visit 1 within 28 days of the screening visit could be rescreened. At Visit 1, the subjects were randomized to one of 4 treatment groups (approximately 16 subjects per group): 1 mg, 4 mg, or 8 mg of ARA 290 or placebo. The study drug (ARA 290 or placebo) was to be administered daily for 28 days via SC injection. The first injection of study drug was administered at the study site at Visit 1. After the first injection, the subjects were required to stay at the research site for 1 hour post dose for safety observation and recording of any adverse events (AEs). The subjects were trained for self-injection of the study drug and asked to self-administer the study medication daily at home before breakfast for the remaining treatment period using the supplied individual vials and disposable insulin needles and syringes. The subjects were asked to visit the study site after 14 ± 2 days of dosing (Visit 2) and at the end of the treatment period Day 28 ± 2 (Visit 3). Additionally, the study personnel contacted the subjects by telephone at study days 7 and 21. Following the treatment period the subjects were followed-up for a further 12 weeks (until study day 112). During this period the subjects visited the study site at Day 56 ± 2 days (Visit 4) and study personnel contacted the subjects by telephone at study days 35 and 42 and biweekly from study days 70 to 112. The duration of study participation for each subject was 16 weeks. Throughout the study the subjects were asked to complete several questionnaires regarding general health and well-being, pain, fatigue and neuropathic symptoms. Further assessments included the 6MWT, and determination of nerve fiber density. If feasible at the site, quantitative sensory and cardiac autonomic reflex testing were to be performed. The protocol was later amended to administer the Columbia-Suicide Severity Rating Scale (C-SSRS). Any positive results for active suicidal ideation and behavior, based on evaluation of the C-SSRS questionnaire, were reported as AEs. During the treatment period the subjects were also asked to complete a diary card to document compliance. Safety assessments included the documentation of AEs, vital signs and electrocardiogram (ECG), safety laboratory, physical examination and a test for ARA 290 antibodies.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neuropathy of Sarcoidosis
Keywords
neuropathy, sarcoidosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
64 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1 mg per day ARA 290
Arm Type
Experimental
Arm Description
1 mg ARA 290 administered subcutaneously for 28 consecutive days
Arm Title
4 mg per day ARA 290
Arm Type
Experimental
Arm Description
4 mg ARA 290 administered subcutaneously for 28 consecutive days
Arm Title
8 mg per day ARA 290
Arm Type
Experimental
Arm Description
8 mg ARA 290 administered subcutaneously for 28 consecutive days
Arm Title
placebo
Arm Type
Placebo Comparator
Arm Description
1 mL placebo administered subcutaneously for 28 consecutive days
Intervention Type
Drug
Intervention Name(s)
ARA 290
Other Intervention Name(s)
pHSBP, Cibinetide
Intervention Description
A small peptide that activates the innate repair receptor to induce anti-inflammatory and tissue repair mechanisms.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Formulation buffer
Primary Outcome Measure Information:
Title
Change in Corneal Nerve Fiber Area
Description
Measurement of corneal nerve fiber area is a non-invasive procedure performed at baseline and at the end of dosing and at 12 weeks follow-up. The nerve fiber area in sarcoidosis patients is reduced compared to normal humans, a measurement of small fiber loss.
Time Frame
Baseline and 28 days
Secondary Outcome Measure Information:
Title
Change in the 6 Minute Walk Test
Description
Measurement of the distance a patient can walk in 6 minutes
Time Frame
Baseline and 28 days
Title
Change in Intra-epidermal Nerve Fiber Density (IENFD)
Description
Measurement of small fiber density in skin biopsies. Density is reduced in sarcoidosis patients, an indication of neuropathy.
Time Frame
Baseline and 28 days
Title
Change in the Scores of the SFNSL, BPI, NPSI, and FAS Questionnaires
Description
Change in mean score from baseline to Day 28 is recorded for each outcome. Brief Pain Inventory (BPI), Pain Severity - scale of 0 (no pain) to 10 (worst pain imaginable) in 4 time frames, averaged. BPI, Pain Interference - scale of 0 (does not interfere) to 10 (completely interferes) how pain interferes with 7 lifestyle parameters, averaged. Small Fiber Neuropathy Screening List (SFNSL) - scale of 0 to 84 (higher score indicates greater neuropathy), sum of 21 questions. Neuropathic Pain Symptom Inventory (NPSI) - scale of 0 (least pain) to 10 (most pain) in 10 questions, summed. Total score range from 0 to 100. Fatigue Assessment Scale (FAS) - scale of 1 (never) to 5 (always) in 10 questions related to fatigue, summed. Total score range from 0 to 50, with 0 being the best possible score and 50 the worst..
Time Frame
Baseline to 28 days
Title
Frequency of Adverse Events, Serious Adverse Events, and Laboratory Parameters
Description
Patients reporting at least one treatment emergent adverse event (TEAE) or serious TEAE
Time Frame
Continuous reporting from baseline through 16 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: • Established diagnosis of sarcoidosis with both of the following two criteria: Score of 4 or greater on Brief Pain Inventory "pain now" or "average pain" questions (BPI; 0 (least discomfort)-10 (worst discomfort)) Discomfort defined as distal pain/discomfort plus one of the following: 1) dysesthesia, 2) burning/painful feet worsening at night, or 3) intolerance of sheets or clothes touching the legs or feet AND either of the following two criteria Corneal nerve fiber density reduced compared to normal (i.e., greater than 1 standard deviation less than the mean of a normative population) A previous skin biopsy (obtained within the prior 2 years) showing a reduced intraepidermal nerve fiber density ((i.e., greater than 1 standard deviation less than the mean of a normal age and gender relevant population) In addition, subjects must: Be able to read and understand the written consent form, complete study-related procedures, and communicate with the study staff Be willing to comply with study restrictions Be willing to check in with the study center via the telephone Between 18 and 70 years of age (inclusive) Body Mass Index (BMI) < 40 kg/m2 (inclusive) If female of childbearing potential, a negative urine pregnancy test at screening and acceptable contraception will be maintained during the screening and dosing period and 1 month beyond. Acceptable contraception consists of hormonal methods such as oral, implantable, injectable, or transdermal contraceptives for a minimum of 1 full cycle (based on the subject's usual menstrual cycle period) before study entry, intrauterine device (IUD), or double barrier method (condoms, sponge, diaphragm, or vaginal ring with spermicidal jellies or cream). Able to complete self-administered questionnaires (RAND-36, SFNSL, BPI, FAS, NPSI) Refrigerator and freezer at home for storage of study medication. Exclusion Criteria: Clinically relevant abnormal history of physical and mental health other than conditions related to sarcoidosis, as determined by medical history taking (as judged by the investigator) Clinically relevant abnormal laboratory results, vital signs, or physical findings other than conditions related to sarcoidosis or could interfere with conduct of 6-minute walk assessment (as judged by the investigator) Other medical conditions known to be associated with small nerve fiber loss, except for diabetes in good control (as judged by the investigator) Known clinically relevant abnormalities in ECG (as judged by the investigator) Illicit drug abuse or excessive alcohol consumption (as judged by the investigator) History of serious malignancy within the last 5 years other than a basal cell or squamous cell carcinoma of the skin that has been removed History of severe allergies, or has had an anaphylactic reaction or significant intolerability to prescription or non-prescription drugs or food (as judged by the investigator) Anti-TNF therapy, other biological anti-inflammatory agents, or immunoglobulins administered within the 3 months prior to screening. Use of erythropoiesis stimulating agents within the two months prior to screening or during the trial Participation in an investigational drug trial in the 3 months prior to administration of the initial dose of study drug or more than 4 times in the calendar year preceding study enrollment Inadequate venous accessibility as judged by clinicians (physician or nurse) Inability or unwillingness to self-administer ARA 290 via subcutaneous injections (or not have access to home health care for assistance in administration) If female, pregnant or breast-feeding Any other condition that in the opinion of the investigator would complicate or compromise the study, or the well-being of the subject
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Micheal Brines, MD, PhD
Organizational Affiliation
Araim Pharmaceuticals, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
Leiden University Medical Center
City
Leiden
Country
Netherlands

12. IPD Sharing Statement

Plan to Share IPD
No

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Study of Efficacy of ARA 290 on Corneal Nerve Fiber Density and Neuropathic Symptoms of Subjects With Sarcoidosis

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