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Bucillamine Phase 2 Trial in Patients With Cystinuria

Primary Purpose

Cystinuria

Status
Unknown status
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Bucillamine
Sponsored by
Revive Therapeutics, Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cystinuria

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subjects of any gender and of any race ≥18 and ≤80 years of age
  2. Subjects with proven cystinuria who are failing their standard drug therapy of tiopronin plus first-line therapy (hydration, alkali and diet restriction) and who meet the following criteria.

    • formed new stones while taking a thiol.
    • had increase in stone size of pre-existing stones while taking a thiol.
    • had a urologic intervention for stones while taking a thiol
  3. Subjects must be able to reliably urinate in a collection vessel and measure urine volume
  4. Subjects must have documentation of a stable complete blood count (CBC) and urinalysis (UA) in the 6 months prior to date of enrollment
  5. Subjects may have a history of but not currently active CNS disorders or symptoms/effects (e.g., headache)
  6. Subjects must have adequate organ function, evidenced by the following laboratory results within 30 days prior to enrollment:

    • Absolute neutrophil count >2000 cells/mm
    • Platelet count >140,000 cells/mm3
    • Hemoglobin >11.0 g/dl
    • Albumin ≥2.5 g/dl
    • Total bilirubin ≤1.5 upper limit of normal (ULN)
    • SGOT (aspartate aminotransferase [AST]), SGPT (alanine aminotransferase [ALT]), and alkaline phosphatase (ALP)

      ≤ 2.5 x ULN

    • eGFR >60 ml/min/173m 2 based on Modification of Diet and Renal Disease (MDRD) Study equation which includes the variables of creatinine, age, sex and race
  7. Female subject who has been post-menopausal for at least 24 consecutive months, or women who have undergone surgical sterilization, (e.g. hysterectomy, bilateral oophorectomy, tubal ligation or salpingectomy) is eligible without requiring the use of a contraceptive methods described in Inclusion #8
  8. For women of childbearing potential and men with partners of childbearing potential, agreement to use a highly effective, non-hormonal form of contraception:

    • Acceptable forms of should include two of the following:

      • Placement of intrauterine device (IUD) or intrauterine system (IUS)
      • Condom with spermicidal foam/gel/film/cream/suppository
      • Diaphragm or cervical/vault caps with spermicidal foam/gel/film/cream/suppository
    • The above contraception is not a requirement in the case of any of the following:

      • Subject is surgically sterilized
      • Subject has had no menstrual period for 12 consecutive months
    • Contraception use should continue for the duration of the study treatment and for at least 3 months after the last dose of study treatment Periodic abstinence (e.g., calendar ovulation, symptom-thermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception
  9. Subjects must be willing and able to give written informed consent

Exclusion Criteria:

  1. Subjects with renal colic
  2. Subjects who are scheduled to undergo a surgical procedure
  3. Subjects on D-penicillamine (see page 35 for explanation)
  4. Subjects with cancer
  5. Subjects with acute or chronic infections including HIV, tuberculosis, hepatitis B or hepatitis C
  6. Patients with proteinuria ≥30 mg that is confirmed on repeat laboratory assessment within 24 hours
  7. Subjects with QTc interval >450 ms
  8. A history of, hypokalemia and family history of Long QT syndrome
  9. Use of concomitant medications that may prolong QT/QTc interval
  10. Patients with significant heart failure and activity impairment (Class III-IV of the New York Heart Association (NYHA)
  11. Subjects with serious hepatic disorder (Child-Pugh scores B or C)
  12. Subjects with a history of alcohol or substance abuse within the 12 months prior to enrollment
  13. Subjects with history of or active blood dyscrasia such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia, and aplastic anemia.
  14. Subjects with Coagulopathy (regardless if controlled by pharmacotherapy or not)
  15. Subjects who have any concomitant illness (including active significant infection) or other finding that, in the opinion of the Investigator, would confound the study data or place the subject at unacceptable risk if the subject were to participate in the study, or that would require frequent adjustments in concomitant medications during the course of the study
  16. Use of any investigational drug within 30 days prior to enrollment
  17. Subjects currently participating in another research study or anticipated to enroll in such during participation in this study
  18. Subjects for whom informed consent cannot be obtained

Sites / Locations

  • University of Alabama - Department of UrologyRecruiting
  • Massachusette General HospitalRecruiting
  • New York University School of MedicineRecruiting
  • Omega Medical ResearchRecruiting
  • University of Wisconsin School of Medicane and Public HealthRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Dose Group A

Dose Group B

Arm Description

Bucillamine 300 mg/day

Bucillamine 600 mg/day

Outcomes

Primary Outcome Measures

Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]
Number, type, and severity of AEs observed by the staff during visits on Days 0 (dosing), 3, 8 and +1 week post-study or volunteered by the subject during telephone follow-up on Days 2 and 7.

Secondary Outcome Measures

Cystine Excretion
Measurement of 24-hr urine cystine excretion.
Cystine Capacity
Measurement of 24-hr urine cystine capacity, i.e., the capacity of a patient's urine to solubilize or precipitate.

Full Information

First Posted
October 19, 2016
Last Updated
May 16, 2017
Sponsor
Revive Therapeutics, Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT02942420
Brief Title
Bucillamine Phase 2 Trial in Patients With Cystinuria
Official Title
Phase 2 Multi-Center, Dose Escalation Trial To Assess The Safety And Effectiveness Of Bucillamine On Urinary Cystine Excretion And Cystine Capacity In Patients With Cystinuria
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Unknown status
Study Start Date
May 1, 2017 (Actual)
Primary Completion Date
March 2018 (Anticipated)
Study Completion Date
March 2018 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Revive Therapeutics, Ltd.

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
Subjects on a standard regimen of tiopronin (cystine binding thiol drug; CBTD) plus prescribed first-line therapy (i.e. on a hydration, alkali therapy and dietary restriction) who are failing therapy will be selected for this trial. After completing informed consent, the subject will have Screening consisting of medication history and physical examination with vital signs. Samples of blood and urine will be taken for clinical laboratory and urinalysis. Patients will undergo a 12-lead ECG test. A history of side effects with current CBTD as well as laboratory recordings of abnormalities attributable to treatment will also be recorded. Subjects will be dosed in a sequential manner, starting with the low dose group (300 mg/day), then proceeding to the 600 mg.day dose group.. Safety and tolerability will be monitored closely by an Independent Medical Monitor (IMM) and based on the IMM's assessment that it is safe to proceed to the higher dose (600 mg/day), subsequent subjects will be enrolled into that group. Up to 15 subjects each will be enrolled into either Group A or Group B. After 7 days on the assigned bucillamine dose, a 24-hour urine sample will be taken and after completing the Day 8 safety visit, subjects will undergo a 7 day washout where no CBTDs will be taken. Thereafter, subjects will be allowed to resume their originally prescribed CBTDs under Investigator's supervision. One week following study drug discontinuation, subjects will return to the clinic for follow-up safety assessments.
Detailed Description
Subjects on a standard regimen of tiopronin (cystine binding thiol drug; CBTD) plus prescribed first-line therapy (i.e. on a hydration, alkali therapy and dietary restriction) who are failing therapy will be selected for this trial. Subjects will be encouraged to continue their usual self-selected ad-lib diets, fluid and alkali regimen and keep this regimen consistent throughout the duration of the study. Study diaries will be kept to assess consistency and drug compliance. After completing informed consent, the enrolled subject will have an initial Screening interview. During the interview the patient will be assessed for symptoms of renal colic as well as asked about any scheduled urological procedures (a positive indication is an exclusionary criteria). At the Screening visit, a medication history will be taken and a complete physical examination, including vital signs will be done. Samples of blood and urine will be taken for clinical laboratory and urinalysis. Patients will then undergo a 12-lead ECG test. A history of side effects with current CBTD as well as laboratory recordings of abnormalities attributable to treatment will also be recorded. Enrolled subjects will be dosed in a sequential manner, starting with the low dose group (300 mg/day). Safety and tolerability will be monitored closely by an Independent Medical Monitor (IMM) and based on the IMM's assessment that it is safe to proceed to the higher dose (600 mg/day), subsequent subjects will be enrolled into that group. Up to 15 subjects each will be enrolled into either Group A or Group B. Subjects will stop taking their current CBTDs for 7 days and perform a 24-hour urine collection on Day-7 and report for Day 1 Visit . Subjects enrolled into Group A will start taking bucillamine tablets orally, three times a day preferably 1hr before or 2hrs after meals in the following sequence; 100 mg (1 tab) in the morning; 100 mg (1 tab) at noon and 100 mg (1 tab) at night. This drug regimen will continue for 7 days. Safety Visits are scheduled on Day 3 and Day 8 (End of Study Visit). Furthermore, on Day 7 a 24-hour urine collection will be performed. Instructions for handling this sample will be provided in a separate manual. Subjects enrolled into Group B, will start taking bucillamine tablets orally, three times a day preferably 1hr before or 2hrs after meals in the following sequence; 200 mg (2 tabs) in the morning; 200 mg (2 tabs) at noon and 200 mg (2 tabs) at night. This drug regimen will continue for 7 days. Safety Visits are scheduled on Day 3 and Day 8 (End of Study Visit). Furthermore, on Day 7 a 24-hour urine collection will be performed. Instructions for handling this sample will be provided in a separate manual. After 7 days on the assigned bucillamine dose and after providing the 24-hour urine sample, and after completing the Day 8 safety visit, subjects will undergo a 7 day washout where no CBTDs will be taken. Thereafter, subjects will be allowed to resume their originally prescribed CBTDs under Investigator's supervision. One week following study drug discontinuation, subjects will return to the clinic for follow-up safety assessments.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cystinuria

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Dosing will occur sequentially from low to high dose: The 600 mg bucillamine dose group (Arm A) will enroll first, then after safety is assured, the 900 mg bucillamine dose group will enroll.
Masking
None (Open Label)
Masking Description
The study is unmasked, i.e., is open label.
Allocation
Non-Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dose Group A
Arm Type
Experimental
Arm Description
Bucillamine 300 mg/day
Arm Title
Dose Group B
Arm Type
Experimental
Arm Description
Bucillamine 600 mg/day
Intervention Type
Drug
Intervention Name(s)
Bucillamine
Intervention Description
Thiol donor which results in a cysteine-bucillamine complex for removing excess cysteine from the urine
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]
Description
Number, type, and severity of AEs observed by the staff during visits on Days 0 (dosing), 3, 8 and +1 week post-study or volunteered by the subject during telephone follow-up on Days 2 and 7.
Time Frame
Days 0, 2, 3, 7, 8 and + 1 wk post study
Secondary Outcome Measure Information:
Title
Cystine Excretion
Description
Measurement of 24-hr urine cystine excretion.
Time Frame
Day 0 and Day 8
Title
Cystine Capacity
Description
Measurement of 24-hr urine cystine capacity, i.e., the capacity of a patient's urine to solubilize or precipitate.
Time Frame
Day 0 and Day 8

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects of any gender and of any race ≥18 and ≤80 years of age Subjects with proven cystinuria who are failing their standard drug therapy of tiopronin plus first-line therapy (hydration, alkali and diet restriction) and who meet the following criteria. formed new stones while taking a thiol. had increase in stone size of pre-existing stones while taking a thiol. had a urologic intervention for stones while taking a thiol Subjects must be able to reliably urinate in a collection vessel and measure urine volume Subjects must have documentation of a stable complete blood count (CBC) and urinalysis (UA) in the 6 months prior to date of enrollment Subjects may have a history of but not currently active CNS disorders or symptoms/effects (e.g., headache) Subjects must have adequate organ function, evidenced by the following laboratory results within 30 days prior to enrollment: Absolute neutrophil count >2000 cells/mm Platelet count >140,000 cells/mm3 Hemoglobin >11.0 g/dl Albumin ≥2.5 g/dl Total bilirubin ≤1.5 upper limit of normal (ULN) SGOT (aspartate aminotransferase [AST]), SGPT (alanine aminotransferase [ALT]), and alkaline phosphatase (ALP) ≤ 2.5 x ULN eGFR >60 ml/min/173m 2 based on Modification of Diet and Renal Disease (MDRD) Study equation which includes the variables of creatinine, age, sex and race Female subject who has been post-menopausal for at least 24 consecutive months, or women who have undergone surgical sterilization, (e.g. hysterectomy, bilateral oophorectomy, tubal ligation or salpingectomy) is eligible without requiring the use of a contraceptive methods described in Inclusion #8 For women of childbearing potential and men with partners of childbearing potential, agreement to use a highly effective, non-hormonal form of contraception: Acceptable forms of should include two of the following: Placement of intrauterine device (IUD) or intrauterine system (IUS) Condom with spermicidal foam/gel/film/cream/suppository Diaphragm or cervical/vault caps with spermicidal foam/gel/film/cream/suppository The above contraception is not a requirement in the case of any of the following: Subject is surgically sterilized Subject has had no menstrual period for 12 consecutive months Contraception use should continue for the duration of the study treatment and for at least 3 months after the last dose of study treatment Periodic abstinence (e.g., calendar ovulation, symptom-thermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception Subjects must be willing and able to give written informed consent Exclusion Criteria: Subjects with renal colic Subjects who are scheduled to undergo a surgical procedure Subjects on D-penicillamine (see page 35 for explanation) Subjects with cancer Subjects with acute or chronic infections including HIV, tuberculosis, hepatitis B or hepatitis C Patients with proteinuria ≥30 mg that is confirmed on repeat laboratory assessment within 24 hours Subjects with QTc interval >450 ms A history of, hypokalemia and family history of Long QT syndrome Use of concomitant medications that may prolong QT/QTc interval Patients with significant heart failure and activity impairment (Class III-IV of the New York Heart Association (NYHA) Subjects with serious hepatic disorder (Child-Pugh scores B or C) Subjects with a history of alcohol or substance abuse within the 12 months prior to enrollment Subjects with history of or active blood dyscrasia such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia, and aplastic anemia. Subjects with Coagulopathy (regardless if controlled by pharmacotherapy or not) Subjects who have any concomitant illness (including active significant infection) or other finding that, in the opinion of the Investigator, would confound the study data or place the subject at unacceptable risk if the subject were to participate in the study, or that would require frequent adjustments in concomitant medications during the course of the study Use of any investigational drug within 30 days prior to enrollment Subjects currently participating in another research study or anticipated to enroll in such during participation in this study Subjects for whom informed consent cannot be obtained
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Fabio Chianelli
Phone
905-605-5535
Ext
10
Email
fabio@revivethera.com
First Name & Middle Initial & Last Name or Official Title & Degree
Angela Fuda
Phone
905-605-5535
Email
angela@revivethera.com
Facility Information:
Facility Name
University of Alabama - Department of Urology
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35294
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lisa Harvey
Phone
205-996-2613
Email
lharvey@uabmc.edu
First Name & Middle Initial & Last Name & Degree
Dean Assimos, MD
Facility Name
Massachusette General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sagar Uday Nigwekar, MD
Phone
617-726-7872
Email
snigwekar@mgh.harvard.edu
Facility Name
New York University School of Medicine
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Frank Moderstizki
Phone
212-686-7500
Ext
6379
Email
Frank.Moderstizki@nyumc.org
First Name & Middle Initial & Last Name & Degree
Lama Nazzal, MD
Facility Name
Omega Medical Research
City
Warwick
State/Province
Rhode Island
ZIP/Postal Code
02886
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Johnna Pezzullo
Phone
401-739-9350
Email
Johnna@omegamedicalresearch.com
First Name & Middle Initial & Last Name & Degree
Gyan Pareek, MD
Facility Name
University of Wisconsin School of Medicane and Public Health
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53705,
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Stephen Nakada, MD
Phone
360-252-2500
Email
nakada@urology.wisc.edu

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Bucillamine Phase 2 Trial in Patients With Cystinuria

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