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First-in-Human Study of an Oral Plasmodium Falciparum Plasma Membrane Protein Inhibitor

Primary Purpose

Malaria

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
SJ733
Cobicistat
Sponsored by
St. Jude Children's Research Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Malaria focused on measuring Antimalarial, First-in-Human, Pharmacokinetic

Eligibility Criteria

18 Years - 55 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Healthy adult (as certified by comprehensive medical assessment including detailed history and complete physical examination), male or female, aged 18 to 55 years of age (inclusive) at screening
  • At least 50 kg in weight and body mass index (BMI) between 18 and 34 kg/m^2
  • Able and willing to provide informed consent and to be available for follow-up for the planned duration of the study
  • If female, then not of child bearing potential (i.e. permanently sterilized hysterectomy or bilateral oophorectomy at least 6 months before screening; proper documentation required] and/or post-menopausal defined as 12 months with no menses without an alternative cause and with an estradiol level of < 30 pg/mL and follicle-stimulating hormone level of > 40 IU/L at screening)
  • Sexually active males must agree to be abstinent or use condoms for the duration of the study.
  • Screening laboratories (hematology, chemistries, venous methemoglobin level specified in schedule of evaluations) within normal institutional range or if outside the range, not clinically significant in the opinion of the investigator.

Inclusion Criteria for Participants in Single-dose Cohort Only::

  • Agrees not to receive any vaccination within 7 days prior to Day 0 and through Day 7.
  • Agrees not to use nonprescription drugs, including vitamins, antacids, and herbal and dietary supplements within 7 days prior to Day 0 and through Day 7. Acetaminophen may be used at doses of ≤ 1 g/day, and ibuprofen may be used at doses of ≤ 1.2 g/day.
  • Agrees not to use nicotine containing products from screening through Day 7.
  • Agrees not to consume alcohol for the 24 hours prior to Day 0 and through Day 7.
  • Agrees not to eat pomegranate, grapefruit or other citrus fruits or drink their juices within 7 days prior to Day 0 and through Day 7.
  • Agrees to limit caffeine to no more than 200 mg on Day 0.
  • Agrees not to eat or drink (except water) for 10 hours before the Day 0 visit and have no water for the hour prior to dosing.

Exclusion Criteria:

  • Presence of a significant medical or psychiatric condition that in the opinion of the investigator precludes participation in the study.
  • Clinically significant abnormalities on physical examination that, in the opinion of the investigator, would preclude entry into the study.
  • History of having a significant illness within the 2 weeks prior to screening visit. Participants can screen after illness is resolved for two weeks.
  • History of clinically significant electrocardiogram abnormalities or clinically significant abnormalities from the screening electrocardiogram.
  • G6PD deficiency
  • History of hemolytic anemia or methemoglobinemia
  • History of severe drug hypersensitivity including a severe allergic reaction, anaphylaxis or convulsions following any medication, vaccination or infusion.
  • History of drug or alcohol abuse in the 12 months prior to screening or evidence at screening visit
  • Use of nicotine containing products within 30 days prior to screening
  • Positive blood test for HBsAg, HCV, or HIV-1
  • Participation in a clinical study of another investigational product within 30 days prior to study enrollment, or planning to begin such participation during the study.
  • Employment under the direct supervision of the investigators or study staff.
  • Receipt of any vaccination within 7 days of dosing.
  • Febrile illness within 48 hours of dosing
  • Use of any prescription medication within 14 days prior to study drug administration.
  • Use of nonprescription drugs, including vitamins, antacids, and herbal and dietary supplements within 7 days prior to study drug administration. Acetaminophen may be used at doses of ≤ 1 g/day, and ibuprofen may be used at doses of ≤ 1.2 g/day.
  • Consumption of pomegranate, grapefruit or other citrus fruits or their juices within 7 days prior to study drug administration.
  • Use of nicotine containing products from screening to study drug administration.
  • Consumption of alcohol within 24 hours prior to study drug administration.

Inclusion Criteria For participants in multi-dose cohort only:

  • Agrees not to receive any vaccination within 7 days prior to Day 1 and through Day 10.
  • Agrees not to use nonprescription drugs, including vitamins, antacids, and herbal and dietary supplements within 7 days prior to Day 1 and through Day 10. Acetaminophen may be used at doses of ≤ 1 g/day, and ibuprofen may be used at doses of ≤ 1.2 g/day.
  • Agrees not to use nicotine containing products from screening through Day 10.
  • Agrees not to consume alcohol for the 24 hours prior to Day 1 and through Day 10.
  • Agrees not to eat pomegranate, grapefruit or other citrus fruits or drink their juices within 7 days prior to Day 1 and through Day 10.
  • Agrees to limit caffeine to no more than 200 mg on Days 1, 2, and 3.
  • Agrees not to eat or drink (except water) for 10 hours before the Days 1, 2, and 3 visits and have no water for the hour prior to dosing on each of those days.

Note: As with the single dose study, sexually active must agree to be abstinent or use condoms for the duration of the study (through the Day 14 visit).

Sites / Locations

  • St. Jude Children's Research Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment Arm

Arm Description

Participants will receive SJ733, an investigational drug developed at St. Jude Children's Research Hospital, and cobicistat.

Outcomes

Primary Outcome Measures

Dose limiting toxicity (DLT)
Number of DLT events will be described at each study dose level. DLT is defined as possibly, probably, or definitely related Grade 4 event, possibly, probably or definitely related Grade 3 event, or possibly, probably, or definitely related Grade 2 methemoglobinemia or anemia (attributed to hemolysis) events.
Maximum tolerated dose (MTD)
MTD is defined as the dose level prior to the dose cohort that 2 or more Grade 2 methemoglobinemia or anemia (attributed to hemolysis) OR any related Grade 3 OR any Grade 4, study drug adverse event (AE) occurred in.
Drug absorption
Drug absorption of SJ733 and its metabolite will be reported.
Drug clearance
Drug clearance of SJ733 and its metabolite will be reported.
Drug volume of distribution
Drug volume of distribution of SJ733 and its metabolite will be reported.
Area under the curve (AUC)
AUC of SJ733 and its metabolite will be reported.
Time above threshold concentration
Time above threshold concentration of SJ733 and its metabolite will be reported.
Maximum drug concentration (Cmax)
Cmax of SJ733 and its metabolite will be reported.
Dose level of SJ733
The dose chosen for the phase 1b trial will be no greater than the MTD and provide an exposure (AUC and time above threshold concentration) that equates (using applicable scaling) with those that provided maximum parasitological effect in the gold standard rodent model.

Secondary Outcome Measures

Drug absorption in the fed cohort
Drug absorption of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Drug clearance in the fed cohort
Drug clearance of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Drug volume of distribution in the fed cohort
Drug volume of distribution of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Area under the curve (AUC) in the fed cohort
AUC of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Time above threshold concentration in the fed cohort
Time above threshold concentration SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Maximum drug concentration (Cmax) in the fed cohort
Drug absorption of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.

Full Information

First Posted
January 19, 2016
Last Updated
December 28, 2018
Sponsor
St. Jude Children's Research Hospital
Collaborators
Medicines for Malaria Venture, Eisai Inc., Global Health Innovative Technology Fund
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1. Study Identification

Unique Protocol Identification Number
NCT02661373
Brief Title
First-in-Human Study of an Oral Plasmodium Falciparum Plasma Membrane Protein Inhibitor
Official Title
Phase 1a, First-In-Human, Dose-Escalation Study of (+)-SJ000557733 (SJ733), an Oral, Novel Inhibitor of Plasmodium Falciparum Plasma Membrane Protein PfATP4
Study Type
Interventional

2. Study Status

Record Verification Date
December 2018
Overall Recruitment Status
Completed
Study Start Date
March 1, 2016 (Actual)
Primary Completion Date
March 9, 2018 (Actual)
Study Completion Date
March 9, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
St. Jude Children's Research Hospital
Collaborators
Medicines for Malaria Venture, Eisai Inc., Global Health Innovative Technology Fund

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Malaria is an infectious disease caused by a parasite that is passed to humans when an infected mosquito bites a person. About 3.4 billion people live in areas of the world where malaria is regularly found. In many countries, malaria is one of the leading causes of illness and death. Despite this, there are a limited number of drugs, called antimalarials, that can be used to treat malaria and increasing reports of resistance to existing antimalarials. The purpose of this research study is to test a new experimental antimalarial drug called SJ733 to first assess its safety, tolerability and blood levels in healthy adult volunteers. Single-dose, multi-dose and boosted-dose cohorts (both single and multi-dose) will be studied. The pharmacoenhancer (booster), cobicistat, will be given in combination with SJ733 in the boosted dose-cohorts. PRIMARY OBJECTIVES: To assess the preliminary safety and tolerability of escalating doses of antimalarial SJ733 in healthy human volunteers. To investigate the pharmacokinetic (PK) profile of escalating doses of antimalarial SJ733 and its metabolite in healthy human volunteers. To identify a dose of SJ733 that can be tested in a separate Phase 1b human malaria challenge study. To assess the preliminary safety and tolerability of SJ733 in healthy adult volunteers after multiple oral dosing. To assess the pharmacokinetics of SJ733 and its metabolite SJ506 after multiple dosing of SJ733 in healthy adult volunteers. To assess the preliminary safety and tolerability of escalating single oral doses of SJ733 in combination with cobicistat among healthy adult volunteers. To assess the pharmacokinetics of SJ733 and its metabolite SJ506 after single oral doses of SJ733 in combination with cobicistat among healthy adult volunteers. To assess the preliminary safety and tolerability of SJ733 in combination with cobicistat in healthy adult volunteers after multiple oral dosing. To assess the pharmacokinetics of SJ733 and its metabolite SJ506 after multiple dosing of SJ733 in combination with cobicistat among healthy volunteers. SECONDARY OBJECTIVE: To assess the impact of food intake on the pharmacokinetic profile of antimalarial SJ733.
Detailed Description
This is a single site, Phase 1a, first-in-human, oral, primarily single-dose, dose escalation study of (+)-SJ000557733 (SJ733) in healthy adult volunteers. SJ733, is an investigational oral anti-malarial agent is a novel inhibitor of Plasmodium falciparum plasma membrane protein (PfATP4). Subjects meeting eligibility criteria will be enrolled using a leap frog, fixed dose escalation design with an adaptive component where 6 subjects are enrolled per dose cohort. Following successful completion of the safety and pharmacokinetic (PK) assessment resulting from the single-dose escalation portion of the study, a three-dose cohort study will be undertaken. It includes once per day oral dosing for 3 consecutive days. Both single and multi-dose cohorts of SJ733 in combination with cobicistat (boosted cohorts) will also be completed. After the study results from the single-dose cohorts of SJ733 in combination with cobicistat (boosted cohorts) were reviewed, multi-dose cohorts of SJ733 in combination with cobicistat (boosted cohorts) were not conducted and Phase 2 study planning initiated.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malaria
Keywords
Antimalarial, First-in-Human, Pharmacokinetic

7. Study Design

Primary Purpose
Other
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
44 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment Arm
Arm Type
Experimental
Arm Description
Participants will receive SJ733, an investigational drug developed at St. Jude Children's Research Hospital, and cobicistat.
Intervention Type
Drug
Intervention Name(s)
SJ733
Other Intervention Name(s)
(+)-SJ000557733
Intervention Description
SJ733 is an oral, novel inhibitor of Plasmodium Falciparum plasma membrane protein PFATP4. It will be administered as a single, multi, or boosted oral dose.
Intervention Type
Drug
Intervention Name(s)
Cobicistat
Other Intervention Name(s)
Tybost®
Intervention Description
Commercially available cobicistat 150 mg tablets will be used. It will be administered as a single oral dose together with SJ733.
Primary Outcome Measure Information:
Title
Dose limiting toxicity (DLT)
Description
Number of DLT events will be described at each study dose level. DLT is defined as possibly, probably, or definitely related Grade 4 event, possibly, probably or definitely related Grade 3 event, or possibly, probably, or definitely related Grade 2 methemoglobinemia or anemia (attributed to hemolysis) events.
Time Frame
From baseline up to minimum of 7 days post-dose
Title
Maximum tolerated dose (MTD)
Description
MTD is defined as the dose level prior to the dose cohort that 2 or more Grade 2 methemoglobinemia or anemia (attributed to hemolysis) OR any related Grade 3 OR any Grade 4, study drug adverse event (AE) occurred in.
Time Frame
7 days after the last dose administration
Title
Drug absorption
Description
Drug absorption of SJ733 and its metabolite will be reported.
Time Frame
From baseline through 7 days post-dose
Title
Drug clearance
Description
Drug clearance of SJ733 and its metabolite will be reported.
Time Frame
From baseline through 7 days post-dose
Title
Drug volume of distribution
Description
Drug volume of distribution of SJ733 and its metabolite will be reported.
Time Frame
From baseline through 7 days post-dose
Title
Area under the curve (AUC)
Description
AUC of SJ733 and its metabolite will be reported.
Time Frame
From baseline through 7 days post-dose
Title
Time above threshold concentration
Description
Time above threshold concentration of SJ733 and its metabolite will be reported.
Time Frame
From baseline through 7 days post-dose
Title
Maximum drug concentration (Cmax)
Description
Cmax of SJ733 and its metabolite will be reported.
Time Frame
From baseline through 7 days post-dose
Title
Dose level of SJ733
Description
The dose chosen for the phase 1b trial will be no greater than the MTD and provide an exposure (AUC and time above threshold concentration) that equates (using applicable scaling) with those that provided maximum parasitological effect in the gold standard rodent model.
Time Frame
14 days after the last dose administration
Secondary Outcome Measure Information:
Title
Drug absorption in the fed cohort
Description
Drug absorption of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Time Frame
From baseline through 7 days post-dose
Title
Drug clearance in the fed cohort
Description
Drug clearance of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Time Frame
From baseline through 7 days post-dose
Title
Drug volume of distribution in the fed cohort
Description
Drug volume of distribution of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Time Frame
From baseline through 7 days post-dose
Title
Area under the curve (AUC) in the fed cohort
Description
AUC of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Time Frame
From baseline through 7 days post-dose
Title
Time above threshold concentration in the fed cohort
Description
Time above threshold concentration SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Time Frame
From baseline through 7 days post-dose
Title
Maximum drug concentration (Cmax) in the fed cohort
Description
Drug absorption of SJ733 and its metabolite in the fed cohort will be reported to assess the impact of food intake.
Time Frame
From baseline through 7 days post-dose

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Healthy adult (as certified by comprehensive medical assessment including detailed history and complete physical examination), male or female, aged 18 to 55 years of age (inclusive) at screening At least 50 kg in weight and body mass index (BMI) between 18 and 34 kg/m^2 Able and willing to provide informed consent and to be available for follow-up for the planned duration of the study If female, then not of child bearing potential (i.e. permanently sterilized hysterectomy or bilateral oophorectomy at least 6 months before screening; proper documentation required] and/or post-menopausal defined as 12 months with no menses without an alternative cause and with an estradiol level of < 30 pg/mL and follicle-stimulating hormone level of > 40 IU/L at screening) Sexually active males must agree to be abstinent or use condoms for the duration of the study. Screening laboratories (hematology, chemistries, venous methemoglobin level specified in schedule of evaluations) within normal institutional range or if outside the range, not clinically significant in the opinion of the investigator. Inclusion Criteria for Participants in Single-dose Cohort Only:: Agrees not to receive any vaccination within 7 days prior to Day 0 and through Day 7. Agrees not to use nonprescription drugs, including vitamins, antacids, and herbal and dietary supplements within 7 days prior to Day 0 and through Day 7. Acetaminophen may be used at doses of ≤ 1 g/day, and ibuprofen may be used at doses of ≤ 1.2 g/day. Agrees not to use nicotine containing products from screening through Day 7. Agrees not to consume alcohol for the 24 hours prior to Day 0 and through Day 7. Agrees not to eat pomegranate, grapefruit or other citrus fruits or drink their juices within 7 days prior to Day 0 and through Day 7. Agrees to limit caffeine to no more than 200 mg on Day 0. Agrees not to eat or drink (except water) for 10 hours before the Day 0 visit and have no water for the hour prior to dosing. Exclusion Criteria: Presence of a significant medical or psychiatric condition that in the opinion of the investigator precludes participation in the study. Clinically significant abnormalities on physical examination that, in the opinion of the investigator, would preclude entry into the study. History of having a significant illness within the 2 weeks prior to screening visit. Participants can screen after illness is resolved for two weeks. History of clinically significant electrocardiogram abnormalities or clinically significant abnormalities from the screening electrocardiogram. G6PD deficiency History of hemolytic anemia or methemoglobinemia History of severe drug hypersensitivity including a severe allergic reaction, anaphylaxis or convulsions following any medication, vaccination or infusion. History of drug or alcohol abuse in the 12 months prior to screening or evidence at screening visit Use of nicotine containing products within 30 days prior to screening Positive blood test for HBsAg, HCV, or HIV-1 Participation in a clinical study of another investigational product within 30 days prior to study enrollment, or planning to begin such participation during the study. Employment under the direct supervision of the investigators or study staff. Receipt of any vaccination within 7 days of dosing. Febrile illness within 48 hours of dosing Use of any prescription medication within 14 days prior to study drug administration. Use of nonprescription drugs, including vitamins, antacids, and herbal and dietary supplements within 7 days prior to study drug administration. Acetaminophen may be used at doses of ≤ 1 g/day, and ibuprofen may be used at doses of ≤ 1.2 g/day. Consumption of pomegranate, grapefruit or other citrus fruits or their juices within 7 days prior to study drug administration. Use of nicotine containing products from screening to study drug administration. Consumption of alcohol within 24 hours prior to study drug administration. Inclusion Criteria For participants in multi-dose cohort only: Agrees not to receive any vaccination within 7 days prior to Day 1 and through Day 10. Agrees not to use nonprescription drugs, including vitamins, antacids, and herbal and dietary supplements within 7 days prior to Day 1 and through Day 10. Acetaminophen may be used at doses of ≤ 1 g/day, and ibuprofen may be used at doses of ≤ 1.2 g/day. Agrees not to use nicotine containing products from screening through Day 10. Agrees not to consume alcohol for the 24 hours prior to Day 1 and through Day 10. Agrees not to eat pomegranate, grapefruit or other citrus fruits or drink their juices within 7 days prior to Day 1 and through Day 10. Agrees to limit caffeine to no more than 200 mg on Days 1, 2, and 3. Agrees not to eat or drink (except water) for 10 hours before the Days 1, 2, and 3 visits and have no water for the hour prior to dosing on each of those days. Note: As with the single dose study, sexually active must agree to be abstinent or use condoms for the duration of the study (through the Day 14 visit).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Aditya H. Gaur, MD
Organizational Affiliation
St. Jude Children's Research Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
St. Jude Children's Research Hospital
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38105
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
35598441
Citation
Gaur AH, Panetta JC, Smith AM, Dallas RH, Freeman BB 3rd, Stewart TB, Tang L, John E, Branum KC, Patel ND, Ost S, Heine RN, Richardson JL, Hammill JT, Bebrevska L, Gusovsky F, Maki N, Yanagi T, Flynn PM, McCarthy JS, Chalon S, Guy RK. Combining SJ733, an oral ATP4 inhibitor of Plasmodium falciparum, with the pharmacokinetic enhancer cobicistat: An innovative approach in antimalarial drug development. EBioMedicine. 2022 Jun;80:104065. doi: 10.1016/j.ebiom.2022.104065. Epub 2022 May 19.
Results Reference
derived
PubMed Identifier
32275867
Citation
Gaur AH, McCarthy JS, Panetta JC, Dallas RH, Woodford J, Tang L, Smith AM, Stewart TB, Branum KC, Freeman BB 3rd, Patel ND, John E, Chalon S, Ost S, Heine RN, Richardson JL, Christensen R, Flynn PM, Van Gessel Y, Mitasev B, Mohrle JJ, Gusovsky F, Bebrevska L, Guy RK. Safety, tolerability, pharmacokinetics, and antimalarial efficacy of a novel Plasmodium falciparum ATP4 inhibitor SJ733: a first-in-human and induced blood-stage malaria phase 1a/b trial. Lancet Infect Dis. 2020 Aug;20(8):964-975. doi: 10.1016/S1473-3099(19)30611-5. Epub 2020 Apr 8.
Results Reference
derived
Links:
URL
http://www.stjude.org
Description
St. Jude Children's Research Hospital
URL
http://www.stjude.org/protocols
Description
Clinical Trials Open at St. Jude

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First-in-Human Study of an Oral Plasmodium Falciparum Plasma Membrane Protein Inhibitor

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