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Ability of Late Sodium or Calcium Current Block to Balance the ECG Effects of Potassium Current Block

Primary Purpose

Drug-induced QT Prolongation, Pharmacokinetics, Pharmacodynamics

Status
Completed
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Dofetilide
Mexiletine
Lidocaine
Moxifloxacin
Diltiazem
Placebo
Sponsored by
Food and Drug Administration (FDA)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Drug-induced QT Prolongation

Eligibility Criteria

18 Years - 35 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Subject is a healthy man or woman, 18 to 35 years of age, inclusive, who weighs at least 50 kg (110 pounds), no more than 85 kg (197 pounds) and has a body mass index of 18 to 27 kg/m2, inclusive, at Screening.
  2. Subject has normal medical history findings, clinical laboratory results, vital sign measurements, 12 lead ECG results, and physical examination findings at Screening or, if abnormal, the abnormality is not considered clinically significant (as determined and documented by the investigator or designee).
  3. Male or female subjects must agree to practice 2 highly effective methods of birth control (as determined by the investigator or designee; one of the methods must be a barrier technique) from Screening until 30 days after the last dose of study drug.

Exclusion Criteria:

  • 1. Subject has a 12 lead safety ECG result at Screening or Check in of Period 1 with evidence of any of the following abnormalities:

    • QT corrected interval (QTc) using Fridericia correction (QTcF) >430 milliseconds (ms)
    • PR interval >220 ms or <120 ms
    • QRS duration >110 ms
    • Second- or third-degree atrioventricular block
    • Complete left or right bundle branch block or incomplete right bundle branch block
    • Heart rate <50 or >90 beats per minute
    • Pathological Q-waves (defined as Q wave >40 ms)
    • Ventricular pre-excitation

      2. Subject has more than 12 ectopic beats during the 3 hour Holter ECG at Screening.

      3. Subject has a history of unexplained syncope, structural heart disease, long QT syndrome, heart failure, myocardial infarction, angina, unexplained cardiac arrhythmia, torsades de pointes, ventricular tachycardia, or placement of a pacemaker or implantable defibrillator. Subjects will also be excluded if there is a family history of long QT syndrome (genetically proven or suggested by sudden death of a close relative due to cardiac causes at a young age) or Brugada syndrome.

      4. Subject has a history or current evidence of any clinically significant (as determined by the investigator) cardiovascular, dermatologic, endocrine, gastrointestinal, hematologic, hepatic, immunologic, metabolic, neurologic, psychiatric, pulmonary, renal, urologic, and/or other major disease or malignancy (excluding nonmelanoma skin cancer). The investigator may allow exceptions to these criteria (e.g., stable mild joint disease [that will not interfere with or influence the activities required by the protocol, in the opinion of the investigator], cholecystectomy, childhood asthma) following discussion with the medical monitor.

      5. Subject has a history of thoracic surgery.

      6. Subject has any condition possibly affecting study drug absorption (e.g., gastrectomy, Crohn's disease, irritable bowel syndrome).

      7. Subject has a skin condition likely to compromise ECG electrode placement.

      8. Subject is a female with breast implants.

      9. Subject's laboratory test results at Screening or Check in of Period 1 are outside the reference ranges provided by the clinical laboratory and considered clinically significant (as determined and documented by the investigator or designee).

      10. Subject's laboratory test results at Screening or Check in of Period 1 indicate hypokalemia, hypocalcemia, or hypomagnesemia according to lower limits of the reference ranges provided by the clinical laboratory.

      11. Subject's laboratory test results at Screening or Check in of Period 1 are >2 × the upper limit of normal (ULN) for alanine aminotransferase or aspartate aminotransferase, >1.5 × ULN for bilirubin, or >1.5 × ULN for creatinine.

      12. Subject has a positive test result at Screening for human immunodeficiency virus, hepatitis C antibodies, or hepatitis B surface antigen.

      13. Subject has a mean systolic blood pressure <90 or >140 mmHg or a mean diastolic blood pressure <50 or >90 mmHg at either Screening or Check in of Period 1.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm 5

    Arm Type

    Active Comparator

    Active Comparator

    Active Comparator

    Active Comparator

    Placebo Comparator

    Arm Label

    Dofetilide

    Dofetilide + Mexiletine

    Dofetilide + Lidocaine

    Moxifloxacin + Diltiazem

    Placebo

    Arm Description

    Dofetilide alone arm

    Dofetilide combined with mexiletine

    Dofetilide combined with lidocaine

    Moxifloxacin with and without diltiazem.

    Placebo (#2 gelcap and intravenous saline)

    Outcomes

    Primary Outcome Measures

    Change in Placebo Corrected Change From Baseline QTc and J-Tpeakc Intervals on the ECG Measured in Milliseconds When Dofetilide is Administered With Mexiletine or Lidocaine Compared to When Dofetilide is Administered Alone at Evening Dose on Treatment Day
    After 3rd dose of mexiletine or lidocaine (evening dose) on treatment day when combined with dofetilide to evening dose on dofetilide alone day.

    Secondary Outcome Measures

    Change in Placebo Corrected Change From Baseline QTc Interval on the ECG Measured in Milliseconds When Moxifloxacin is Administered With Diltiazem at the Evening Dose Compared to When Moxifloxacin is Administered Alone at Afternoon Dose on Treatment Day.
    Evening dose (moxifloxacin+diltiazem) versus afternoon dose (diltiazem alone).

    Full Information

    First Posted
    November 6, 2014
    Last Updated
    June 6, 2016
    Sponsor
    Food and Drug Administration (FDA)
    Collaborators
    Spaulding Clinical Research LLC
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02308748
    Brief Title
    Ability of Late Sodium or Calcium Current Block to Balance the ECG Effects of Potassium Current Block
    Official Title
    Five Period Crossover Study of the Ability of Late Sodium or Calcium Current Block (Mexiletine, Lidocaine, or Diltiazem) to Balance the Electrocardiographic Effects of hERG Potassium Current Block (Dofetilide or Moxifloxacin)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    June 2016
    Overall Recruitment Status
    Completed
    Study Start Date
    May 2014 (undefined)
    Primary Completion Date
    June 2014 (Actual)
    Study Completion Date
    June 2014 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Food and Drug Administration (FDA)
    Collaborators
    Spaulding Clinical Research LLC

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The primary objective of this research study is to test the hypothesis that late sodium current blocking drugs (mexiletine or lidocaine) can attenuate the effect of hERG potassium channel blocking drugs (dofetilide) on ventricular repolarization (QTc) by shortening early repolarization (J-Tpeakc). The secondary object is to assess the ability of calcium channel block (diltiazem) to reduce the QTc prolongation associated with hERG block (moxifloxacin).
    Detailed Description
    This is a randomized, double-blind, 5-period crossover study in healthy male and female subjects, 18 to 35 years of age, to compare the electrophysiological response of hERG potassium channel blocking drugs with and without the addition of late sodium or calcium channel blocking drugs. The 5 treatment periods are 1) dofetilide alone, 2) mexiletine with and without dofetilide, 3) lidocaine with and without dofetilide, 4) moxifloxacin with and without diltiazem and 5) placebo. During each treatment period, 12 blood samples for pharmacokinetic measurements are obtained with matched 12-lead ECG recordings.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Drug-induced QT Prolongation, Pharmacokinetics, Pharmacodynamics

    7. Study Design

    Primary Purpose
    Basic Science
    Study Phase
    Phase 1
    Interventional Study Model
    Crossover Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    22 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Dofetilide
    Arm Type
    Active Comparator
    Arm Description
    Dofetilide alone arm
    Arm Title
    Dofetilide + Mexiletine
    Arm Type
    Active Comparator
    Arm Description
    Dofetilide combined with mexiletine
    Arm Title
    Dofetilide + Lidocaine
    Arm Type
    Active Comparator
    Arm Description
    Dofetilide combined with lidocaine
    Arm Title
    Moxifloxacin + Diltiazem
    Arm Type
    Active Comparator
    Arm Description
    Moxifloxacin with and without diltiazem.
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Placebo (#2 gelcap and intravenous saline)
    Intervention Type
    Drug
    Intervention Name(s)
    Dofetilide
    Other Intervention Name(s)
    Tikosyn
    Intervention Description
    8 am: Placebo 12 pm (noon): 250 µg 5:30 pm: 250 µg
    Intervention Type
    Drug
    Intervention Name(s)
    Mexiletine
    Other Intervention Name(s)
    Mexitil
    Intervention Description
    8 am: weight x 4 mg/kg 12 pm (noon): Same as at 8 am 5:30 pm: Same as at 8 am
    Intervention Type
    Drug
    Intervention Name(s)
    Lidocaine
    Other Intervention Name(s)
    Lidocaine hydrochloride
    Intervention Description
    9 am : 30 µg/min per kg (loading) for 60 minutes and 10 µg/min per kg (maintenance) for 30 minutes 2 pm: 55 µg/min per kg (loading) for 60 minutes and 20 µg/min per kg (maintenance) for 30 minutes 7:30 pm: 52 µg/min per kg (loading) for 60 minutes and 20 µg/min per kg (maintenance) for 30 minutes
    Intervention Type
    Drug
    Intervention Name(s)
    Moxifloxacin
    Other Intervention Name(s)
    Avelox
    Intervention Description
    9 am: 5.63 mg/h per kg (loading) for 1 hour and 0.26 mg/h per kg (maintenance for 30 minutes) 2 pm: 6.14 mg/h per kg (loading) for 1 hour and 0.49 mg/h per kg (maintenance for 30 minutes) 7:30 pm: 2.23 mg/h per kg (loading) for 1 hour and 0.49 mg/h per kg (maintenance for 30 minutes)
    Intervention Type
    Drug
    Intervention Name(s)
    Diltiazem
    Other Intervention Name(s)
    Diltiazem hydrochloride
    Intervention Description
    • 7:30 pm: 330 µg/h per kg (loading) for 60 minutes and 61 µg/h per kg (maintenance) for 30 minutes
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo
    Other Intervention Name(s)
    #2 Gelcaps or IV saline
    Intervention Description
    Placebo (#2 Gelcap or IV saline)
    Primary Outcome Measure Information:
    Title
    Change in Placebo Corrected Change From Baseline QTc and J-Tpeakc Intervals on the ECG Measured in Milliseconds When Dofetilide is Administered With Mexiletine or Lidocaine Compared to When Dofetilide is Administered Alone at Evening Dose on Treatment Day
    Description
    After 3rd dose of mexiletine or lidocaine (evening dose) on treatment day when combined with dofetilide to evening dose on dofetilide alone day.
    Time Frame
    5 weeks
    Secondary Outcome Measure Information:
    Title
    Change in Placebo Corrected Change From Baseline QTc Interval on the ECG Measured in Milliseconds When Moxifloxacin is Administered With Diltiazem at the Evening Dose Compared to When Moxifloxacin is Administered Alone at Afternoon Dose on Treatment Day.
    Description
    Evening dose (moxifloxacin+diltiazem) versus afternoon dose (diltiazem alone).
    Time Frame
    5 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    35 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Subject is a healthy man or woman, 18 to 35 years of age, inclusive, who weighs at least 50 kg (110 pounds), no more than 85 kg (197 pounds) and has a body mass index of 18 to 27 kg/m2, inclusive, at Screening. Subject has normal medical history findings, clinical laboratory results, vital sign measurements, 12 lead ECG results, and physical examination findings at Screening or, if abnormal, the abnormality is not considered clinically significant (as determined and documented by the investigator or designee). Male or female subjects must agree to practice 2 highly effective methods of birth control (as determined by the investigator or designee; one of the methods must be a barrier technique) from Screening until 30 days after the last dose of study drug. Exclusion Criteria: 1. Subject has a 12 lead safety ECG result at Screening or Check in of Period 1 with evidence of any of the following abnormalities: QT corrected interval (QTc) using Fridericia correction (QTcF) >430 milliseconds (ms) PR interval >220 ms or <120 ms QRS duration >110 ms Second- or third-degree atrioventricular block Complete left or right bundle branch block or incomplete right bundle branch block Heart rate <50 or >90 beats per minute Pathological Q-waves (defined as Q wave >40 ms) Ventricular pre-excitation 2. Subject has more than 12 ectopic beats during the 3 hour Holter ECG at Screening. 3. Subject has a history of unexplained syncope, structural heart disease, long QT syndrome, heart failure, myocardial infarction, angina, unexplained cardiac arrhythmia, torsades de pointes, ventricular tachycardia, or placement of a pacemaker or implantable defibrillator. Subjects will also be excluded if there is a family history of long QT syndrome (genetically proven or suggested by sudden death of a close relative due to cardiac causes at a young age) or Brugada syndrome. 4. Subject has a history or current evidence of any clinically significant (as determined by the investigator) cardiovascular, dermatologic, endocrine, gastrointestinal, hematologic, hepatic, immunologic, metabolic, neurologic, psychiatric, pulmonary, renal, urologic, and/or other major disease or malignancy (excluding nonmelanoma skin cancer). The investigator may allow exceptions to these criteria (e.g., stable mild joint disease [that will not interfere with or influence the activities required by the protocol, in the opinion of the investigator], cholecystectomy, childhood asthma) following discussion with the medical monitor. 5. Subject has a history of thoracic surgery. 6. Subject has any condition possibly affecting study drug absorption (e.g., gastrectomy, Crohn's disease, irritable bowel syndrome). 7. Subject has a skin condition likely to compromise ECG electrode placement. 8. Subject is a female with breast implants. 9. Subject's laboratory test results at Screening or Check in of Period 1 are outside the reference ranges provided by the clinical laboratory and considered clinically significant (as determined and documented by the investigator or designee). 10. Subject's laboratory test results at Screening or Check in of Period 1 indicate hypokalemia, hypocalcemia, or hypomagnesemia according to lower limits of the reference ranges provided by the clinical laboratory. 11. Subject's laboratory test results at Screening or Check in of Period 1 are >2 × the upper limit of normal (ULN) for alanine aminotransferase or aspartate aminotransferase, >1.5 × ULN for bilirubin, or >1.5 × ULN for creatinine. 12. Subject has a positive test result at Screening for human immunodeficiency virus, hepatitis C antibodies, or hepatitis B surface antigen. 13. Subject has a mean systolic blood pressure <90 or >140 mmHg or a mean diastolic blood pressure <50 or >90 mmHg at either Screening or Check in of Period 1.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Carlos Sanabria, MD
    Organizational Affiliation
    Spaulding Clinical
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    26259627
    Citation
    Johannesen L, Vicente J, Mason JW, Erato C, Sanabria C, Waite-Labott K, Hong M, Lin J, Guo P, Mutlib A, Wang J, Crumb WJ, Blinova K, Chan D, Stohlman J, Florian J, Ugander M, Stockbridge N, Strauss DG. Late sodium current block for drug-induced long QT syndrome: Results from a prospective clinical trial. Clin Pharmacol Ther. 2016 Feb;99(2):214-23. doi: 10.1002/cpt.205. Epub 2015 Nov 28.
    Results Reference
    result
    PubMed Identifier
    28036334
    Citation
    Vicente J, Johannesen L, Hosseini M, Mason JW, Sager PT, Pueyo E, Strauss DG. Electrocardiographic Biomarkers for Detection of Drug-Induced Late Sodium Current Block. PLoS One. 2016 Dec 30;11(12):e0163619. doi: 10.1371/journal.pone.0163619. eCollection 2016. Erratum In: PLoS One. 2018 May 21;13(5):e0197952.
    Results Reference
    derived
    PubMed Identifier
    28036330
    Citation
    Johannesen L, Vicente J, Hosseini M, Strauss DG. Automated Algorithm for J-Tpeak and Tpeak-Tend Assessment of Drug-Induced Proarrhythmia Risk. PLoS One. 2016 Dec 30;11(12):e0166925. doi: 10.1371/journal.pone.0166925. eCollection 2016.
    Results Reference
    derived

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    Ability of Late Sodium or Calcium Current Block to Balance the ECG Effects of Potassium Current Block

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