Single-Dose Study to Evaluate the PKs of Pretomanid in Subjects With Renal Impairment Compared to Subjects With Normal Renal Function
Renal Impairment, Tuberculosis
About this trial
This is an interventional treatment trial for Renal Impairment focused on measuring Open-Label, Pretomanid, Renal Pharmacokinetic, Safety, Single-Dose
Eligibility Criteria
Inclusion Criteria:
Subject Inclusion Criteria for Patients with Renal Impairment (Groups 2-4)
Have the ability to understand the requirements of the study and have provided written informed consent* before any study related procedure is performed.
*As evidence by signature on an informed consent document approved by the IRB
- Agree to abide by the study restrictions.
- Are between the ages of 18 and 70, inclusive, at the time of enrollment.
- Must have mild, moderate, severe or end stage renal disease but are not on dialysis.
- Are free from tobacco/nicotine usage (30-day minimum from screening visit).
- Have QTc interval on electrocardiogram (ECG) < 500 msec.
- Have a body mass index of 18 to 35 kg/m^2.
Women of childbearing potential** must use an acceptable contraception method*** for the duration of the study.
Not sterilized via tubal ligation, bilateral oophorectomy, salpingectomy, hysterectomy, implanted contraceptive device placement (permanent, non-surgical, non-hormonal sterilization) with documented radiological confirmation test at least 90 days after the procedure, and still menstruating or < 1 year has passed since the last menses if menopausal.
- Includes, non-male sexual relationships, abstinence from sexual intercourse with a male partner, monogamous relationship with vasectomized partner who has been vasectomized for 180 days or more prior to the subject receiving study product, barrier methods such as condoms or diaphragms/cervical caps with spermicide, effective intrauterine devices, NuvaRing(R), and licensed hormonal methods such as implants, injectables or oral contraceptives ("the pill").
If subject is male and capable of reproduction, agrees to avoid fathering a child for the duration of the study by using an acceptable method of birth control****.
****In addition to the use of a barrier method (condom) unless vasectomized, acceptable methods of birth control are restricted to a monogamous relationship with a woman who agrees to use acceptable contraception as outlined in inclusion criterion #8, and/or abstinence from sexual intercourse with women.
- Women of childbearing potential must have a negative urine pregnancy test within 24 hours prior to receipt of study product
Subject Inclusion Criteria for Healthy Subjects (Groups 1A-1C)
Have the ability to understand the requirements of the study and have provided written informed consent* before any study related procedure is performed.
*As evidence by signature on an informed consent document approved by the IRB.
- Agree to abide by the study restrictions.
- Are healthy male or non-pregnant female, between the ages of 18 and 70, inclusive, with normal GFR > / = 90 at screening.
- Are free from tobacco/nicotine usage (30-day minimum from screening visit).
- Have a normal QTc interval < 500 msecs on electrocardiogram (ECG).
- Have a body mass index of 18 to 35 kg/m^2.
Women of childbearing potential** must use an acceptable contraception method*** for the duration of the study.
**Not sterilized via tubal ligation, bilateral oophorectomy, salpingectomy, hysterectomy, implanted contraceptive device placement (permanent, non-surgical, non-hormonal sterilization) with documented radiological confirmation test at least 90 days after the procedure, and still menstruating or <1 year has passed since the last menses if menopausal.
***Includes, non-male sexual relationships, abstinence from sexual intercourse with a male partner, monogamous relationship with vasectomized partner who has been vasectomized for 180 days or more prior to the subject receiving study product, barrier methods such as condoms or diaphragms/cervical caps with spermicide, effective intrauterine devices, NuvaRing(R), and licensed hormonal methods such as implants, injectables or oral contraceptives ("the pill").
If subject is male and capable of reproduction, agrees to avoid fathering a child for the duration of the study by using an acceptable method of birth control****.
****In addition to the use of a barrier method (condom) unless vasectomized, acceptable methods of birth control are restricted to a monogamous relationship with a woman who agrees to use acceptable contraception as outlined in inclusion criterion #7, and/or abstinence from sexual intercourse with women.
- Women of childbearing potential must have a negative urine pregnancy test within 24 hours prior to receipt of study product
Exclusion Criteria:
Subject Exclusion Criteria for Patients with Renal Impairment (Groups 2-4)
- History of known active TB.
- History of peptic ulcer disease
- Have known hypersensitivity to pretomanid or any of the excipients
- History of any clinically significant uncontrolled cardiac abnormality (as deemed by the Principal Investigator (PI)).
Any clinically significant ECG abnormality at screening*
*Note: the following can be considered not clinically significant:
- Heart rate < / = 50 beats per minute (bpm) (sinus bradycardia with heart rate between 45 and 49, inclusive, is acceptable only in younger athletic subjects)
- Mild first degree A-V block (P-R interval > 0.23 seconds)
- Right or left axis deviation
- Incomplete right bundle branch block
- Isolated left anterior fascicular block (left anterior hemiblock) in younger athletic subjects
- History of or screening results show a QTc interval > / = 500 msecs.
Family history of Long-QT Syndrome or sudden death without a preceding diagnosis of a condition*** that could be causative of sudden death
***such as known coronary artery disease or congestive heart failure (CHF) or terminal cancer.
- Inability to swallow tablets.
- History of fever or documented fever (oral temperature > 100.4 degrees Fahrenheit) in the 48 hours prior to admission to the hospital.
- Resting pulse rate <50 or > 100 bpm at Screening.
At Screening blood pressure > / = 20 mm Hg systolic or 10 mm Hg diastolic above baseline**** (sitting).
****Baseline is most recent blood pressure in the last 3 months if not similar to control group.
- Current hypokalemia or hypomagnesemia.
- Positive result of urine drug screen or blood alcohol screen prior to hospital admission.
- Significant history of drug and/or food allergies (as deemed by the PI).
- For women, subject is pregnant (positive test for urine HCG at Screening or Check-in), breastfeeding or planning to conceive for the duration of the study.
- Women who are breastfeeding or lactating.
- Any contraindication to the use of nitromidazoles, or prior treatment with pretomanid or delamanid.
Treatment with strong CYP450 enzyme inducers or inhibitors***** within 7 days prior to admission or during the study, unless****** the substance would not likely impact the validity of the study results.
*****except hormonal contraceptives
******in the opinion of the site investigator
- Use of St. John's Wort within 7 days prior to admission and during the entire study.
- Consumption of products containing grapefruit within 5 days prior to dosing until discharged from the hospital.
- Donation of whole blood or blood products > 500 mL within 30 days and plans to donate during the study or up to 14 days after dosing.
- Participation in another interventional clinical trial within 30 days prior to dosing until after the last study visit.
- Hemoglobin < 9.0 g/dL in both men and women at the screening visit.
- Positive Screening test for HCV, HBV, or HIV.
- Renal transplant.
- Scheduled for hemodialysis or peritoneal dialysis
Presence of any condition or finding******* which would jeopardize subject safety, impact study result validity, or diminish the subject's ability to undergo all study procedures and assessments.
*******In the opinion of the investigator
- Semen donation for the duration of the study.
- AST and ALT > 2.0 x ULN.
- Hyperbilirubinemia > 1.5 x ULN.
Subject Exclusion Criteria for Healthy Subjects (Groups 1A-1C)
- History of known active TB.
- History of peptic ulcer disease
- Have known hypersensitivity to pretomanid or any of the excipients
- History of any clinically significant uncontrolled cardiac abnormality (as deemed by the Principal Investigator (PI).
Any clinically significant ECG abnormality at screening*.
*Note: the following can be considered not clinically significant:
- Heart rate < / = 50 beats per minute (bpm) (sinus bradycardia with heart rate between 45 and 49, inclusive, is acceptable only in younger athletic subjects)
- Mild first degree A-V block (P-R interval > 0.23 seconds)
- Right or left axis deviation
- Incomplete right bundle branch block
- Isolated left anterior fascicular block (left anterior hemiblock) in younger athletic subjects
Family history of Long-QT Syndrome or sudden death without a preceding diagnosis of a condition** that could be causative of sudden death
**such as known coronary artery disease or congestive heart failure (CHF) or terminal cancer.
- Inability to swallow tablets.
- History of fever or documented fever (oral temperature > / = 100.4 degrees Fahrenheit) in the 48 hours prior to admission to the hospital.
- Resting pulse rate < 50 or > 100 bpm at Screening.
- At Screening blood pressure > 140/90 mm Hg or < 90/65 mm Hg (sitting).
- History of or screening results show a QTc interval > / = 500 msecs.
- History of hypokalemia or hypomagnesemia.
- Positive result of urine drug screen or blood alcohol screen prior to hospital admission.
- Significant history of drug and/or food allergies (as deemed by the PI).
- For women, subject is pregnant (positive test for urine HCG at Screening or hospital admission), breastfeeding or planning to conceive for the duration of the study.
- Women who are breastfeeding or lactating.
- Any contraindication to the use of nitromidazoles, or prior treatment with pretomanid or delamanid.
Treatment with strong CYP450 enzyme inducers or inhibitors*** within 7 days prior to admission or during the study, unless**** the substance would not likely impact the validity of the study results.
***except hormonal contraceptives
****in the opinion of the site investigator
- Use of St. John's Wort within 7 days prior to admission and during the entire study.
- Consumption of products containing grapefruit within 5 days prior to dosing until discharged from the hospital.
- Donation of whole blood or blood products > 500 mL within 30 days and/or plans to donate during the study or up to 14 days after dosing.
- Participation in another interventional clinical trial within 30 days prior to dosing until after the last study visit.
- Hemoglobin < 10.0 g/dL in both men and women at the screening visit.
- Positive Screening test for HCV, HBV, or HIV.
- Renal transplant.
Presence of any condition or finding***** which would jeopardize subject safety, impact study result validity, or diminish the subject's ability to undergo all study procedures and assessments.
*****In the opinion of the investigator
- Semen donation for the duration of the study.
- AST and ALT > 2.0 x ULN.
- Hyperbilirubinemia > 1.5 x ULN.
Sites / Locations
- Saint Louis University Center for Vaccine Development
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm 6
Active Comparator
Experimental
Active Comparator
Active Comparator
Experimental
Experimental
Part A Group 1A
Part A Group 2
Part B Group 1B
Part B Group 1C
Part B Group 3
Part B Group 4
6 healthy participants with normal estimated Glomerular Filtration Rate (eGFR > / = 90 mL/min) matched to Group 2 by race, gender, age (+/- 10 years, but between 18 to 70 years of age) and weight at dosing (+/- 20% of weight) will receive a single oral dose of 200 mg pretomanid
6 participants with Severe renal impairment; Stage 4, Modification of Diet in Renal Disease (MDRD) (eGFR 15-29 mL/min) and End Stage Renal Disease (ESRD) not on dialysis: Stage 5, Modification of Diet in Renal Disease (MDRD) with estimated Glomerular Filtration Rate (eGFR < 15 mL/min) matched to Group 1A will receive a single oral dose of 200 mg pretomanid
6 healthy participants with normal eGFR of > / = 90 mL/min matched to Group 3 by race, gender, age (+/- 10 years, but between 18 to 70 years of age) and weight at dosing (+/- 20% of weight ) will receive a single oral dose of 200 mg pretomanid after the PK and safety of subjects enrolled in Part A have been reviewed
6 healthy participants with normal eGFR > / = 90 mL/min matched to Group 4 by race, gender, age (+/- 10 years, but between 18 to 70 years of age) and weight at dosing (+/- 20% of weight) will receive a single oral dose of 200 mg pretomanid after the PK and safety of subjects enrolled in Part A have been reviewed
6 participants with mild renal impairment: Stage 2, MDRD (eGFR 60-89 mL/min) matched to Group 1B will receive a single oral dose of 200 mg pretomanid after the PK and safety of subjects enrolled in Part A have been reviewed
6 participants with moderate renal impairment: Stage 3, MDRD (eGFR = 30-59 mL/min) matched to Group 1C will receive a single oral dose of 200 mg pretomanid after the PK and safety of subjects enrolled in Part A have been reviewed