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Bioavailability of DHE Administered by I123 POD Device, IV Injection, and Migranal Nasal Spray in Healthy Adults

Primary Purpose

Migraine Headache

Status
Completed
Phase
Phase 1
Locations
Australia
Study Type
Interventional
Intervention
INP104
Dihydroergotamine Mesylate (DHE)
Migranal Nasal Spray
Sponsored by
Impel Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Migraine Headache

Eligibility Criteria

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

Inclusion Criteria:

  • Adult male and females, 18 to 55 years of age (inclusive) at the time of screening.
  • Subjects must be in good general health, with no significant medical history (including migraine), have no clinically significant abnormalities on physical examination at screening, and/or before administration of the initial dose of investigational product.
  • Subjects must have a Body Mass Index (BMI) between 18 and 32 kg/m2, inclusive.
  • Subjects must have clinical laboratory values within normal range as specified by the testing laboratory, or assessed as not clinically significant by the Principal Investigator.
  • Negative urine drug screen/alcohol breath test at screening.
  • Subjects who are willing to refrain from smoking for the duration of the study.

Exclusion Criteria:

  • Subjects with a recent history of migraine and its variants including hemiplegic migraine and basilar migraine. A recent history of migraine is defined as (a) current or past history of migraine with at least 1 attack in last 6 months or (b) those receiving antimigraine prophylaxis.
  • Positive testing for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), or hepatitis C antibodies (HCV).
  • Subjects who have ingested caffeine within 48 hours before admission on Day -1. Subjects must also agree to refrain from consumption of caffeinated drinks for 48 hours before admission of Days 7 and 14 (i.e. prior to each subsequent dosing), and throughout confinement.
  • Subjects with ischemic heart disease or subjects who have clinical symptoms or findings consistent with coronary artery vasospasm including Prinzmetal's variant angina.
  • Subjects with hypertension, known peripheral arterial disease, Raynaud's phenomenon, sepsis, history of vascular surgery or severely impaired hepatic or renal function
  • Subjects who have previously shown hypersensitivity to ergot alkaloids or metoclopramide.
  • Use of any relevant prescription, over-the-counter medication (with the exception of oral contraceptives), foods (e.g. grapefruit juice) or supplements (including herbal) within 14 days of randomization [especially those affecting the Cytochrome P450 3A4 (CYP3A4) metabolic pathway].
  • History or presence of alcoholism or drug abuse within the 2 years prior to the first investigational product administration.
  • Surgery within the past three months prior to the first investigational product administration as determined by the PI to be clinically relevant.
  • Active infection and/or use of macrolide antibiotics within 14 days prior to enrollment.
  • History of recurrent infections.
  • Any nasal congestion or physical blockage in either nostril, or deviated nasal septum as determined by nasal examination.

Sites / Locations

  • Centre for Clinical Studies/Nucleus Network

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Active Comparator

Arm Label

INP104

D.H.E. 45 Injection (IV)

Migranal Nasal Spray

Arm Description

Single dose 1.45 mg Dihydroergotamine Mesylate (DHE), administered by I123 Precision Olfactory Delivery (POD) device nasal spray (INP104)

Single dose 1 mg Dihydroergotamine Mesylate (DHE) for intravenous injection

Single dose 2 mg Migranal Nasal Spray Dihydroergotamine Mesylate (DHE)

Outcomes

Primary Outcome Measures

DHE pharmacokinetics
Cmax
DHE pharmacokinetics
Tmax
DHE pharmacokinetics
AUC(0-t)
DHE pharmacokinetics
kel
DHE pharmacokinetics
T(1/2)
DHE pharmacokinetics
AUC(0-inf)
DHE pharmacokinetics
CL/F (CL for IV administration)

Secondary Outcome Measures

Incidence of treatment-emergent adverse events
Incidence of treatment-emergent adverse events after one dose of INP-104, Migranal Nasal Spray or DHE45 by IV injection
8'-OH-DHE pharmacokinetics
Cmax
8'-OH-DHE pharmacokinetics
Tmax
8'-OH-DHE pharmacokinetics
AUC(0-t)
8'-OH-DHE pharmacokinetics
kel
8'-OH-DHE pharmacokinetics
T(1/2)
8'-OH-DHE pharmacokinetics
AUC(0-inf)
8'-OH-DHE pharmacokinetics
CL/F (CL for IV administration)

Full Information

First Posted
December 17, 2017
Last Updated
March 13, 2019
Sponsor
Impel Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT03401346
Brief Title
Bioavailability of DHE Administered by I123 POD Device, IV Injection, and Migranal Nasal Spray in Healthy Adults
Official Title
A Phase I, Three-Period, Three-Way, Randomized, Open-Label, Single-Dose, Cross-Over, Comparative Bioavailability Study of Dihydroergotamine Mesylate (DHE) Administered by I123 Precision Olfactory Delivery (POD) Device Nasal Spray, DHE for Injection (Intravenous), and Migranal® Nasal Spray in Healthy Adult Subjects
Study Type
Interventional

2. Study Status

Record Verification Date
January 2018
Overall Recruitment Status
Completed
Study Start Date
October 19, 2017 (Actual)
Primary Completion Date
December 1, 2017 (Actual)
Study Completion Date
December 6, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Impel Pharmaceuticals

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Product Manufactured in and Exported from the U.S.
Yes

5. Study Description

Brief Summary
A Phase I clinical trial to compare the bioavailability of dihydroergotamine mesylate (DHE) following a single dose administration of INP104 (DHE administered by I123 Precision Olfactory Delivery (POD) Device Nasal Spray) to that of D.H.E. 45 for Injection (Intravenous) and Migranal Nasal Spray in healthy adult subjects. It is hypothesized that INP104 will address the current variability in nasal administration and give more reproducible dose delivery compared to Migranal nasal spray. Blood concentrations of all three investigational products will be compared for 48 hours following dosing. The safety and tolerability of INP104 will be monitored throughout the study. INP104 has been developed for the treatment of acute migraine headache. The device in which the drug will be delivered has been designed to deliver the medication to the upper nasal cavity with minimal variation in dose absorption, eg loss via dripping out of the nose or the dose being swallowed. Approximately 36 participants in general good health (equal ratio of males and females desired) will be enrolled and will be allocated to receive 3 treatments in a randomized sequence. They will receive a single dose of INP104, a single dose of DHE via intravenous injection, and a single dose of Migranal Nasal Spray. There will be a wash out period where no treatment will be administered for 7 days in between each treatment. Participants are required to attend 3 inpatient periods and 1 final outpatient visit. Each participant will be in the study for up to 43 days.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
36 (Actual)

8. Arms, Groups, and Interventions

Arm Title
INP104
Arm Type
Experimental
Arm Description
Single dose 1.45 mg Dihydroergotamine Mesylate (DHE), administered by I123 Precision Olfactory Delivery (POD) device nasal spray (INP104)
Arm Title
D.H.E. 45 Injection (IV)
Arm Type
Active Comparator
Arm Description
Single dose 1 mg Dihydroergotamine Mesylate (DHE) for intravenous injection
Arm Title
Migranal Nasal Spray
Arm Type
Active Comparator
Arm Description
Single dose 2 mg Migranal Nasal Spray Dihydroergotamine Mesylate (DHE)
Intervention Type
Combination Product
Intervention Name(s)
INP104
Intervention Description
Dihydroergotamine Mesylate (DHE) administered via I123 Precision Olfactory Delivery (POD) Device
Intervention Type
Drug
Intervention Name(s)
Dihydroergotamine Mesylate (DHE)
Intervention Description
Dihydroergotamine Mesylate (DHE) injection (intravenous)
Intervention Type
Combination Product
Intervention Name(s)
Migranal Nasal Spray
Intervention Description
Dihydroergotamine Mesylate (DHE) delivered via Migranal Nasal Spray pump
Primary Outcome Measure Information:
Title
DHE pharmacokinetics
Description
Cmax
Time Frame
48 hours
Title
DHE pharmacokinetics
Description
Tmax
Time Frame
48 hours
Title
DHE pharmacokinetics
Description
AUC(0-t)
Time Frame
48 hours
Title
DHE pharmacokinetics
Description
kel
Time Frame
48 hours
Title
DHE pharmacokinetics
Description
T(1/2)
Time Frame
48 hours
Title
DHE pharmacokinetics
Description
AUC(0-inf)
Time Frame
48 hours
Title
DHE pharmacokinetics
Description
CL/F (CL for IV administration)
Time Frame
48 hours
Secondary Outcome Measure Information:
Title
Incidence of treatment-emergent adverse events
Description
Incidence of treatment-emergent adverse events after one dose of INP-104, Migranal Nasal Spray or DHE45 by IV injection
Time Frame
Day 1 to day 22 post first dosing
Title
8'-OH-DHE pharmacokinetics
Description
Cmax
Time Frame
48 hours
Title
8'-OH-DHE pharmacokinetics
Description
Tmax
Time Frame
48 hours
Title
8'-OH-DHE pharmacokinetics
Description
AUC(0-t)
Time Frame
48 hours
Title
8'-OH-DHE pharmacokinetics
Description
kel
Time Frame
48 hours
Title
8'-OH-DHE pharmacokinetics
Description
T(1/2)
Time Frame
48 hours
Title
8'-OH-DHE pharmacokinetics
Description
AUC(0-inf)
Time Frame
48 hours
Title
8'-OH-DHE pharmacokinetics
Description
CL/F (CL for IV administration)
Time Frame
48 hours

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: Adult male and females, 18 to 55 years of age (inclusive) at the time of screening. Subjects must be in good general health, with no significant medical history (including migraine), have no clinically significant abnormalities on physical examination at screening, and/or before administration of the initial dose of investigational product. Subjects must have a Body Mass Index (BMI) between 18 and 32 kg/m2, inclusive. Subjects must have clinical laboratory values within normal range as specified by the testing laboratory, or assessed as not clinically significant by the Principal Investigator. Negative urine drug screen/alcohol breath test at screening. Subjects who are willing to refrain from smoking for the duration of the study. Exclusion Criteria: Subjects with a recent history of migraine and its variants including hemiplegic migraine and basilar migraine. A recent history of migraine is defined as (a) current or past history of migraine with at least 1 attack in last 6 months or (b) those receiving antimigraine prophylaxis. Positive testing for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), or hepatitis C antibodies (HCV). Subjects who have ingested caffeine within 48 hours before admission on Day -1. Subjects must also agree to refrain from consumption of caffeinated drinks for 48 hours before admission of Days 7 and 14 (i.e. prior to each subsequent dosing), and throughout confinement. Subjects with ischemic heart disease or subjects who have clinical symptoms or findings consistent with coronary artery vasospasm including Prinzmetal's variant angina. Subjects with hypertension, known peripheral arterial disease, Raynaud's phenomenon, sepsis, history of vascular surgery or severely impaired hepatic or renal function Subjects who have previously shown hypersensitivity to ergot alkaloids or metoclopramide. Use of any relevant prescription, over-the-counter medication (with the exception of oral contraceptives), foods (e.g. grapefruit juice) or supplements (including herbal) within 14 days of randomization [especially those affecting the Cytochrome P450 3A4 (CYP3A4) metabolic pathway]. History or presence of alcoholism or drug abuse within the 2 years prior to the first investigational product administration. Surgery within the past three months prior to the first investigational product administration as determined by the PI to be clinically relevant. Active infection and/or use of macrolide antibiotics within 14 days prior to enrollment. History of recurrent infections. Any nasal congestion or physical blockage in either nostril, or deviated nasal septum as determined by nasal examination.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jason Lickliter, MD
Organizational Affiliation
Centre for Clinical Studies/Nucleus Network
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centre for Clinical Studies/Nucleus Network
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
3004
Country
Australia

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
30659611
Citation
Shrewsbury SB, Jeleva M, Satterly KH, Lickliter J, Hoekman J. STOP 101: A Phase 1, Randomized, Open-Label, Comparative Bioavailability Study of INP104, Dihydroergotamine Mesylate (DHE) Administered Intranasally by a I123 Precision Olfactory Delivery (POD(R) ) Device, in Healthy Adult Subjects. Headache. 2019 Mar;59(3):394-409. doi: 10.1111/head.13476. Epub 2019 Jan 19.
Results Reference
derived

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Bioavailability of DHE Administered by I123 POD Device, IV Injection, and Migranal Nasal Spray in Healthy Adults

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