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A Phase 1 (First in Human) Randomized, Double-blind, Placebo-controlled SAD, MAD Study With Oral REM0046127

Primary Purpose

Alzheimer Disease

Status
Completed
Phase
Phase 1
Locations
Austria
Study Type
Interventional
Intervention
REM0046127
Placebo
Sponsored by
reMYND
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer Disease

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. SAD/MAD: Young male subjects aged 18 to 45 years (limits included) willing and able to give their written consent to participate in the trial after having received information about the study design, the objectives of the project, the possible derivative risks, and their right to withdraw from the study at any time and for any reason
  2. Elderly Cohorts: Elderly male and female (not of childbearing potential) subjects aged 55 to 80 (limits included) willing and able to give their written consent to participate in the trial after having received information about the study design, the objectives of the project, the possible derivative risks, and their right to withdraw from the study at any time and for any reason.
  3. Women not of childbearing potential: Clinically significant abnormalities in screening laboratory tests, including:

    • Surgically sterile (bilateral tubal ligation, hysterectomy), or
    • Postmenopausal with last natural menses greater than 24 months
  4. Electrocardiogram without clinically significant pathologic abnormalities and with corrected QT interval (cQT) values lesser than 450 ms
  5. Normotensive as defined by Systolic Blood Pressure ≤ 150 mm Hg. Diastolic Blood Pressure ≤ 90 mm Hg without antihypertensive medication
  6. Body Mass Index (BMI) between 18 and 30 kg/m2.
  7. Body weight between 60 and 80 kg, inclusive

    Only for the elderly cohort of the MAD:

  8. Participants may be taking medication for non-serious chronic diseases, provided that the dose of these concomitant medications has been stable within the previous 2 months
  9. No suicidal ideation, as demonstrated by a score of "0" on the Columbia Suicide Severity Rating Scale (C-SSRS)

Exclusion Criteria:

  1. Women of childbearing potential (WOCBP)
  2. Failure to perform screening or baseline examinations
  3. Any chronic medical condition (such as type 1 diabetes) requiring chronic treatment that might increase the risk to the subject or confound the interpretation of safety observations according to the clinical assessment of the investigator (physician)
  4. Evidence of active infection requiring antibiotic therapy within 14 days prior to screening
  5. Medical history of vasculitis or any autoimmune disease excluding seasonal allergic rhinitis and childhood history of atopic dermatitis
  6. History of any treatment for cancer within the past 2 years, other than basal cell or squamous cell carcinoma of the skin
  7. Seropositive for human immunodeficiency virus (HIV)
  8. History of acute/chronic hepatitis B or C and/or carriers of hepatitis B (seropositive for Hepatitis B surface antigen [HbsAg] or anti-Hepatitis C [Hepatitis C Virus (HCV)] antibody)
  9. Clinically significant abnormalities in screening laboratory tests, including:

    • Absolute neutrophil count < 1.4 x109
    • Absolute lymphocyte count < 1.2 x 109
    • Alanine transaminase (ALT) or aspartate transaminase (AST) > 1.5 x the upper limit of normal (ULN)
    • Lactate Dehydrogenase (LDH) > 1.5 x ULN
    • Total bilirubin level: Out of normal range 0-1.5 mg/dL
    • Estimated glomerular filtration rate (eGFR) < 60 mL/min
    • Haemoglobin (Hgb): out of normal range (male: 13,5-18,0 g/dL).
    • Haemoglobin (Hgb): out of normal range (female: 12,0-16,0 g/dL)
  10. Use of an investigational drug within 2 months prior to dosing in this study
  11. Any disorder that could interfere with the absorption, distribution, metabolism or excretion of drugs (e.g. small bowel disease, Crohn's disease, celiac disease, or liver disease)
  12. Chronic kidney disease (defined as the presence of any degree of proteinuria on urine analysis and/or an eGFR of <60 ml/min using the (Modification of Diet in Renal Disease (MDRD) formula)
  13. Psychiatric history of current or past psychosis, bi-polar disorder, major depression, or anxiety disorder requiring chronic medication within the past 5 years
  14. History of substance abuse, including alcohol and nicotine or positive urine drug screen at screening visit
  15. Any reason or opinion of the investigator that would prevent the subject from participation in the study
  16. Inability to follow the instructions or an unwillingness to collaborate during the study
  17. Male subjects with female partner of child-bearing potential who are unwilling or unable to adhere to contraception requirements

    Only for the elderly cohort of the MAD:

  18. Chronic daily drug intake during the study period:

    • Benzodiazepines, neuroleptics or major sedatives
    • Antiepileptics
    • Centrally active anti-hypertensive drugs (clonidine, l-methyl-DOPA, guanidine, guanfacine, etc.)
    • Opioid containing analgesics
  19. History of cancer within the last 5 years, except basal cell carcinoma, non-squamous skin carcinoma, prostate cancer or carcinoma in situ with no significant progression over the past 2 years
  20. Clinically significant, advanced or unstable disease that may interfere with primary or secondary variable evaluations, and which may bias the assessment of the clinical or mental status of the volunteer or put the volunteer at special risk, such as:

    • Chronic liver disease, liver function test abnormalities or other signs of hepatic insufficiency (Alanine-Aminotransferase (ALT), Aspartate-Aminotransferase (AST), Gamma Glutamyl-Transferase (GT), alkaline phosphatase > 2.0 ULN)
    • Respiratory insufficiency
    • Heart disease (myocardial infarction, unstable angina, heart failure, cardiomyopathy within six months before screening)
    • Bradycardia (heartbeat <50/min) or tachycardia (heartbeat >95/min)
    • Hypertension (<180/95) or hypotension requiring treatment with more than 2 drugs
    • Atrioventricular (AV) block (type II / Mobitz II and type III), congenital long QT syndrome, sinus node dysfunction or prolonged QTcF-interval (males >450 and females >470 ms)
    • Uncontrolled diabetes defined by HbA1c >8.5
    • Renal insufficiency (serum creatinine > 2mg/dL) or creatinine clearance ≤ 30 mL/min according to Cockcroft-Gault formula).

Sites / Locations

  • Medical University Vienna, Department of Clinical Pharmacology

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Study Drug

Placebo

Arm Description

Each subject receives either a single dose (SAD) or a multiple dose (MAD) of REM0046127 as oral solution with a concentration of 100 mg/mL REM0046127. The starting dose for the first cohort in the SAD is 35mg up to a maximum of 2000mg at cohort 5. The starting dose for the MAD study is 0,75 of the Maximum Tolerated Dose (MTD) from the SAD.

Each subject receives either a single (SAD) or multiple (MAD) dose of REM0046127 as oral solution with a concentration of 0 mg/mL REM0046127. The dose for each cohort is corresponding the amount of solution needed in the verum group.

Outcomes

Primary Outcome Measures

Adverse Events
Number of Adverse Events either related or not related to treatment in the verum group in comparison to the placebo group
SAD: Plasma Concentration including Peak Plasma Concentration (Cmax)
The plasma concentration during 48 hours after the dosing.
SAD: Plasma Concentration including Half-Life(t1/2)
The plasma concentration during 48 hours after the dosing.
SAD: Area under the Curve (AUC)
The AUC between baseline and 48 hour safter dosing.
MAD: Half-Life(t1/2) between Baseline and 48 hours after the last dosing.
Half-Life(t1/2) between Baseline and 48 hours after the last dosing.
MAD: Plasma Concentration
Peak Plasma Concentration (Cmax) between Baseline and 48 hours after the last dosing.
MAD: Area under the Curve (AUC)
The AUC and steady-state volume of distribution(Vss) during the time interval from the first dose and 48 hour safterlast dose
Cerebrospinal Fluid (CSF) PK (MAD)
In CSF the unbound brain/plasma partition coefficient (Kp,u) will be determined.

Secondary Outcome Measures

Full Information

First Posted
November 12, 2020
Last Updated
May 18, 2022
Sponsor
reMYND
Collaborators
NeuroScios GmbH
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1. Study Identification

Unique Protocol Identification Number
NCT04672135
Brief Title
A Phase 1 (First in Human) Randomized, Double-blind, Placebo-controlled SAD, MAD Study With Oral REM0046127
Official Title
A Phase 1 (First in Human) Randomized, Double-blind, Placebo-controlled SAD, MAD Study With an Adaptive Dose Design to Evaluate the Safety, Tolerability, and Pharmacokinetics of REM0046127 in Healthy Subjects
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Completed
Study Start Date
November 9, 2020 (Actual)
Primary Completion Date
April 1, 2022 (Actual)
Study Completion Date
April 26, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
reMYND
Collaborators
NeuroScios GmbH

4. Oversight

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

5. Study Description

Brief Summary
This is a phase 1 randomized double blind, first in human (FIH) study with the novel oral Alzheimer drug candidate REM0046127, which consists of two main parts, a single ascending dose (SAD) study with 7 cohorts followed by a multiple ascending dose (MAD) study with 2 cohorts.
Detailed Description
SAD As a baseline, 5 cohorts of 8 young healthy males are foreseen, with a repeat to assess food impact and an additional elderly cohort. Depending on the early FIH findings, the number of cohorts could be more or less. FIH studies include initially only males due to the incomplete nature of preclinical reproductive toxicology studies Treatment duration: single day Each cohort: 2 volunteers on placebos, of which 1 sentinel 6 volunteers on study drug, of which 1 sentinel Timing for each cohort will be about 21 days Subjects will be screened for selection from day -21 to day -1 before starting the experimental phase of each cohort First the 2 sentinels will be dosed Following the review of sentinel safety and tolerability data through the Data Safety Monitoring Board (DSMB) after one day or 2 half-life times following the sentinel dosing, the remaining 1+5 subjects will be randomized and dosed approximately 7 days after the sentinels MAD First cohort of 10 healthy young male subjects. This cohort can be initiated after the food interaction has been assessed in the last safe SAD cohort, and does not need to wait for the elderly cohort. Second cohort of 12 healthy elderly subjects: The 1st cohort of healthy young male at about 75% of the Maximum Tolerated Dose (MTD) of the SAD The 2nd cohort of healthy older male and female (not of child-bearing potential) at about 50 or 100% of the highest tolerable dose of the SAD, depending on the observations in the 1st MAD cohort to assess potential impact of age on Pharmacokinetics (PK) Treatment duration: 7 days Timing for each cohort will be about 35 days Subjects will be screened for selection from day -21 to day -1 before starting the experimental phase each cohort First the sentinels will be dosed Following the review of sentinel safety and tolerability data through the DSMB, the remaining subjects will be randomized and dosed approximately 14 days later According to plan the sentinels of the 2nd cohort will be dosed about 35 days after the sentinels of the 1st cohort.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Model Description
A Single Ascending Dose study with 6 Cohorts with 8 young male subjects each and 1 cohort with 4 male and 4 female subjects A Multiple Ascending Dose MAD study with 2 Cohorts: (Cohort 1: 10 young male subjects, Cohort 2: 6 elderly male and 6 elderly female (not of CBP) subjects.
Masking
ParticipantInvestigator
Masking Description
An independent statistician will provide the randomization list to an unblinded person at the site. The unblinded person prepares the medication for the subjects. The ready medication is handed over to the blinded investigator and the investigator will dose the blinded subjects. Randomization numbers will be kept secret until data base lock. After data base lock the results will be unblinded for final analysis.
Allocation
Randomized
Enrollment
77 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Study Drug
Arm Type
Active Comparator
Arm Description
Each subject receives either a single dose (SAD) or a multiple dose (MAD) of REM0046127 as oral solution with a concentration of 100 mg/mL REM0046127. The starting dose for the first cohort in the SAD is 35mg up to a maximum of 2000mg at cohort 5. The starting dose for the MAD study is 0,75 of the Maximum Tolerated Dose (MTD) from the SAD.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Each subject receives either a single (SAD) or multiple (MAD) dose of REM0046127 as oral solution with a concentration of 0 mg/mL REM0046127. The dose for each cohort is corresponding the amount of solution needed in the verum group.
Intervention Type
Drug
Intervention Name(s)
REM0046127
Intervention Description
Oral solution: 100 mg/mL REM0046127
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Oral solution with 0 mg/mL REM0046127
Primary Outcome Measure Information:
Title
Adverse Events
Description
Number of Adverse Events either related or not related to treatment in the verum group in comparison to the placebo group
Time Frame
SAD: from dosing to 72 hours after dosing. MAD: from the first dosing until 48 hours after the last dosing on day 7.
Title
SAD: Plasma Concentration including Peak Plasma Concentration (Cmax)
Description
The plasma concentration during 48 hours after the dosing.
Time Frame
Plasma samples will be taken during SAD at baseline and 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 18, 24, 36 and 48 hours post-dose.
Title
SAD: Plasma Concentration including Half-Life(t1/2)
Description
The plasma concentration during 48 hours after the dosing.
Time Frame
Plasma samples will be taken during SAD at baseline and 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 18, 24, 36 and 48 hours post-dose.
Title
SAD: Area under the Curve (AUC)
Description
The AUC between baseline and 48 hour safter dosing.
Time Frame
Plasma samples will be taken during SAD at baseline and 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 18, 24, 36 and 48 hours post-dose.
Title
MAD: Half-Life(t1/2) between Baseline and 48 hours after the last dosing.
Description
Half-Life(t1/2) between Baseline and 48 hours after the last dosing.
Time Frame
Plasma samples will be taken pre-dose and 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 24 hours post-dose, pre-dose on Day 5 and on Day 7: 0, 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 24 hours (Day 8) and 48 hours (Day 9).
Title
MAD: Plasma Concentration
Description
Peak Plasma Concentration (Cmax) between Baseline and 48 hours after the last dosing.
Time Frame
Plasma samples will be taken pre-dose and 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 24 hours post-dose, pre-dose on Day 5 and on Day 7: 0, 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 24 hours (Day 8) and 48 hours (Day 9).
Title
MAD: Area under the Curve (AUC)
Description
The AUC and steady-state volume of distribution(Vss) during the time interval from the first dose and 48 hour safterlast dose
Time Frame
Plasma samples will be taken pre-dose and 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 24 hours post-dose, pre-dose on Day 5 and on Day 7: 0, 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 24 hours (Day 8) and 48 hours (Day 9).
Title
Cerebrospinal Fluid (CSF) PK (MAD)
Description
In CSF the unbound brain/plasma partition coefficient (Kp,u) will be determined.
Time Frame
CSF samples will be collected on the last day of dosing (Day 7) at approximately Tmax determined during SAD

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: SAD/MAD: Young male subjects aged 18 to 45 years (limits included) willing and able to give their written consent to participate in the trial after having received information about the study design, the objectives of the project, the possible derivative risks, and their right to withdraw from the study at any time and for any reason Elderly Cohorts: Elderly male and female (not of childbearing potential) subjects aged 55 to 80 (limits included) willing and able to give their written consent to participate in the trial after having received information about the study design, the objectives of the project, the possible derivative risks, and their right to withdraw from the study at any time and for any reason. Women not of childbearing potential: Clinically significant abnormalities in screening laboratory tests, including: Surgically sterile (bilateral tubal ligation, hysterectomy), or Postmenopausal with last natural menses greater than 24 months Electrocardiogram without clinically significant pathologic abnormalities and with corrected QT interval (cQT) values lesser than 450 ms Normotensive as defined by Systolic Blood Pressure ≤ 150 mm Hg. Diastolic Blood Pressure ≤ 90 mm Hg without antihypertensive medication Body Mass Index (BMI) between 18 and 30 kg/m2. Body weight between 60 and 80 kg, inclusive Only for the elderly cohort of the MAD: Participants may be taking medication for non-serious chronic diseases, provided that the dose of these concomitant medications has been stable within the previous 2 months No suicidal ideation, as demonstrated by a score of "0" on the Columbia Suicide Severity Rating Scale (C-SSRS) Exclusion Criteria: Women of childbearing potential (WOCBP) Failure to perform screening or baseline examinations Any chronic medical condition (such as type 1 diabetes) requiring chronic treatment that might increase the risk to the subject or confound the interpretation of safety observations according to the clinical assessment of the investigator (physician) Evidence of active infection requiring antibiotic therapy within 14 days prior to screening Medical history of vasculitis or any autoimmune disease excluding seasonal allergic rhinitis and childhood history of atopic dermatitis History of any treatment for cancer within the past 2 years, other than basal cell or squamous cell carcinoma of the skin Seropositive for human immunodeficiency virus (HIV) History of acute/chronic hepatitis B or C and/or carriers of hepatitis B (seropositive for Hepatitis B surface antigen [HbsAg] or anti-Hepatitis C [Hepatitis C Virus (HCV)] antibody) Clinically significant abnormalities in screening laboratory tests, including: Absolute neutrophil count < 1.4 x109 Absolute lymphocyte count < 1.2 x 109 Alanine transaminase (ALT) or aspartate transaminase (AST) > 1.5 x the upper limit of normal (ULN) Lactate Dehydrogenase (LDH) > 1.5 x ULN Total bilirubin level: Out of normal range 0-1.5 mg/dL Estimated glomerular filtration rate (eGFR) < 60 mL/min Haemoglobin (Hgb): out of normal range (male: 13,5-18,0 g/dL). Haemoglobin (Hgb): out of normal range (female: 12,0-16,0 g/dL) Use of an investigational drug within 2 months prior to dosing in this study Any disorder that could interfere with the absorption, distribution, metabolism or excretion of drugs (e.g. small bowel disease, Crohn's disease, celiac disease, or liver disease) Chronic kidney disease (defined as the presence of any degree of proteinuria on urine analysis and/or an eGFR of <60 ml/min using the (Modification of Diet in Renal Disease (MDRD) formula) Psychiatric history of current or past psychosis, bi-polar disorder, major depression, or anxiety disorder requiring chronic medication within the past 5 years History of substance abuse, including alcohol and nicotine or positive urine drug screen at screening visit Any reason or opinion of the investigator that would prevent the subject from participation in the study Inability to follow the instructions or an unwillingness to collaborate during the study Male subjects with female partner of child-bearing potential who are unwilling or unable to adhere to contraception requirements Only for the elderly cohort of the MAD: Chronic daily drug intake during the study period: Benzodiazepines, neuroleptics or major sedatives Antiepileptics Centrally active anti-hypertensive drugs (clonidine, l-methyl-DOPA, guanidine, guanfacine, etc.) Opioid containing analgesics History of cancer within the last 5 years, except basal cell carcinoma, non-squamous skin carcinoma, prostate cancer or carcinoma in situ with no significant progression over the past 2 years Clinically significant, advanced or unstable disease that may interfere with primary or secondary variable evaluations, and which may bias the assessment of the clinical or mental status of the volunteer or put the volunteer at special risk, such as: Chronic liver disease, liver function test abnormalities or other signs of hepatic insufficiency (Alanine-Aminotransferase (ALT), Aspartate-Aminotransferase (AST), Gamma Glutamyl-Transferase (GT), alkaline phosphatase > 2.0 ULN) Respiratory insufficiency Heart disease (myocardial infarction, unstable angina, heart failure, cardiomyopathy within six months before screening) Bradycardia (heartbeat <50/min) or tachycardia (heartbeat >95/min) Hypertension (<180/95) or hypotension requiring treatment with more than 2 drugs Atrioventricular (AV) block (type II / Mobitz II and type III), congenital long QT syndrome, sinus node dysfunction or prolonged QTcF-interval (males >450 and females >470 ms) Uncontrolled diabetes defined by HbA1c >8.5 Renal insufficiency (serum creatinine > 2mg/dL) or creatinine clearance ≤ 30 mL/min according to Cockcroft-Gault formula).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nikola Helmberg, PhD
Organizational Affiliation
NeuroScios GmbH
Official's Role
Study Director
Facility Information:
Facility Name
Medical University Vienna, Department of Clinical Pharmacology
City
Vienna
ZIP/Postal Code
1090
Country
Austria

12. IPD Sharing Statement

Plan to Share IPD
No

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A Phase 1 (First in Human) Randomized, Double-blind, Placebo-controlled SAD, MAD Study With Oral REM0046127

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