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Phase 3 Safety and Efficacy Study of CTAP101 Extended-release Capsules in Children With Secondary Hyperparathyroidism

Primary Purpose

Chronic Kidney Disease stage3, Chronic Kidney Disease stage4, Vitamin d Deficiency

Status
Recruiting
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
CTAP101
Placebo
Sponsored by
OPKO Health, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Kidney Disease stage3

Eligibility Criteria

8 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Cohort 1: Be 12 to <18 years of age and have a body weight of ≥40 kg; Cohort 2: be 8 to <12 years of age and have a body weight of ≥20 kg.
  2. Be diagnosed with stage 3 to 4 CKD at least six months prior to the screening visit, and have an eGFR of ≥15 to <60 mL/min/1.73m2 at screening.
  3. Be without any disease state or physical condition that might impair evaluation of safety or which, in the investigator's opinion, would interfere with study participation, including:

    1. Serum albumin ≤ 3.0 g/dL;
    2. Serum transaminase (ALT or SGPT, AST or SGOT) > 2.5 times the upper limit of normal at screening; and,
    3. Urinary albumin excretion of >3000 mcg/mg creatinine.
  4. Exhibit during the initial or, if necessary, a screening visit after washout:

    1. Plasma iPTH >100 pg/mL (stage 3 CKD) or >160 pg/mL (stage 4 CKD)
    2. Serum calcium <9.8 mg/dL (corrected for albumin);
    3. Serum total 25-hydroxyvitamin D <30 ng/mL; and,
    4. Serum phosphorus >2.5 to ≤5.5 mg/dL (12 to <18 years) or ≤6.0 mg/dL (ages 8 to <12 years).
  5. If taking calcitriol or other 1α-hydroxylated vitamin D analogs, or cinacalcet, be willing to forgo treatment with these agents for the duration of the study and complete an 8-week washout period prior to commencing treatment in the study.
  6. If taking >1,000 mg/day of elemental calcium, discontinue or reduce calcium use and/or use non-calcium based therapies for the duration of the study.
  7. If receiving ≤1,700 IU/day nutritional vitamin D (ergocalciferol or cholecalciferol) therapy, must agree to remain on a stable dose during the study.
  8. If taking >1,700 IU/day of nutritional vitamin D, must discontinue or decrease the dose to ≤1,700 IU/day, maintain that dose for the duration of the study, and complete an 8-week washout period prior to commencing treatment in the study provided that serum total 25-hydroxyvitamin D is ≥30 ng/mL. The washout period is not necessary if serum total 25-hydroxyvitami D is <30 ng/mL.
  9. If taking any bone modifying treatment that could interfere with study endpoints, must discontinue use of such agent(s) for the duration of the study.
  10. Willing and able to comply with study instructions and commit to all clinic visits for the duration of the study.
  11. Female subjects of childbearing potential must be neither pregnant nor lactating and must have a negative urine pregnancy test at the first screening visit.
  12. All female subjects of childbearing potential and male subjects with female partners of childbearing potential must agree to use effective contraception (eg, implants, injectables, combined oral contraceptives, intrauterine device, sexual abstinence, vasectomy or vasectomized partner) for the duration of the study.
  13. Each subject or their legal representative must be able to read, understand and sign the informed consent form (ICF).

Exclusion Criteria:

  1. History of or planned kidney transplant or parathyroidectomy.
  2. History (prior three months) of serum calcium ≥9.8 mg/dL.
  3. Use of bisphosphonate therapy (denosumab) within six months prior to enrollment.
  4. Known previous or concomitant serious illness or medical condition, such as malignancy, human immunodeficiency virus, significant gastrointestinal or hepatic disease or cardiovascular event or hepatitis, or physical condition that in the opinion of the investigator may worsen and/or interfere with participation in the study.
  5. History of neurological/psychiatric disorder, including psychotic disorder, or any reason which, in the opinion of the investigator makes adherence to a treatment or follow up schedule unlikely.
  6. Known or suspected hypersensitivity to any of the constituents of either investigational product.
  7. Currently participating in, or has participated in, an interventional/investigational study within 30 days prior to study screening.

Sites / Locations

  • Nationwide Childrens HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

Cohort 1 and Cohort 2 Placebo

Cohort 1 and Cohort 2 CTAP101 Capsule

Arm Description

Outcomes

Primary Outcome Measures

Numbers of subjects who attained mean decrease in plasma iPTH of 30% from baseline
The primary efficacy endpoint is the proportion of subjects in the intent-to- treat (ITT) population (age 8 to <18 years) attaining a mean decrease in plasma iPTH of at least 30% from pre-treatment baseline compared to placebo during the EAP.
Safety and tolerability
Safety and tolerability will be evaluated in the safety population by AEs, PEs, VS, hematology and laboratory evaluations, and ECGs.
Pharmacokinetic
To assess the pharmacokinetic (PK) profile of 25-hydroxyvitamin D3 after repeated doses of CTAP101 Capsules in pediatric subjects

Secondary Outcome Measures

Level of serum total 25-hydroxyvitamin D at ≥30 ng/mL compared to placebo
To evaluate the efficacy of repeated dosing with CTAP101 Capsules versus placebo in raising serum total 25-hydroxyvitamin D to ≥30 ng/mL
Plasma iPTH mean absolute changes and serum total 25-hydroxyvitamin D
To determine the time courses of mean absolute changes from pre-treatment baseline in serum total 25-hydroxyvitamin D and plasma iPTH during administration of repeated doses of CTAP101 Capsules
Pharmacodynamic effects of repeated doses of CTAP101 Capsules
To assess the PD effects of repeated doses of CTAP101 Capsules versus placebo on mean serum calcium (corrected for albumin), serum phosphorus and serum calcium-timesphosphorus (CaxP) product, and the change in mean urine calcium:creatinine ratio
Incidence of hypercalcemia and hyperphosphatemia
To evaluate the safety of CTAP101 Capsules versus placebo with regard to the incidence of hypercalcemia and hyperphosphatemia

Full Information

First Posted
September 13, 2022
Last Updated
February 22, 2023
Sponsor
OPKO Health, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05543928
Brief Title
Phase 3 Safety and Efficacy Study of CTAP101 Extended-release Capsules in Children With Secondary Hyperparathyroidism
Official Title
A Multi-Center Study to Evaluate the Efficacy, Safety and Pharmacokinetics of CTAP101 Extended-release Capsules to Treat Secondary Hyperparathyroidism in Pediatric Subjects of Ages 8 to <18 Years With Stage 3 or 4 Chronic Kidney Disease and Vitamin D Insufficiency
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 31, 2023 (Actual)
Primary Completion Date
July 2025 (Anticipated)
Study Completion Date
July 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
OPKO Health, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a phase 3, multi-center, randomized, double-blind, placebo-controlled study in children with stage 3-4 chronic kidney disease (CKD), secondary hyperparathyroidism (SHPT) and vitamin D insufficiency.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Kidney Disease stage3, Chronic Kidney Disease stage4, Vitamin d Deficiency, Secondary Hyperparathyroidism

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Sequential Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
108 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1 and Cohort 2 Placebo
Arm Type
Placebo Comparator
Arm Title
Cohort 1 and Cohort 2 CTAP101 Capsule
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
CTAP101
Intervention Description
CTAP101 Capsules is an extended-release (ER) oral formulation of calcifediol which was approved as Rayaldee® ER Capsules in June 2016 by the United States (US) Food and Drug Administration (FDA) for the treatment of secondary hyperparathyroidism (SHPT) in adult patients with stage 3 or 4 chronic kidney disease (CKD) and vitamin D insufficiency (VDI), defined as serum total 25-hydroxyvitamin D levels less than 30 ng/mL.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo
Primary Outcome Measure Information:
Title
Numbers of subjects who attained mean decrease in plasma iPTH of 30% from baseline
Description
The primary efficacy endpoint is the proportion of subjects in the intent-to- treat (ITT) population (age 8 to <18 years) attaining a mean decrease in plasma iPTH of at least 30% from pre-treatment baseline compared to placebo during the EAP.
Time Frame
26 weeks
Title
Safety and tolerability
Description
Safety and tolerability will be evaluated in the safety population by AEs, PEs, VS, hematology and laboratory evaluations, and ECGs.
Time Frame
26 weeks
Title
Pharmacokinetic
Description
To assess the pharmacokinetic (PK) profile of 25-hydroxyvitamin D3 after repeated doses of CTAP101 Capsules in pediatric subjects
Time Frame
26 weeks
Secondary Outcome Measure Information:
Title
Level of serum total 25-hydroxyvitamin D at ≥30 ng/mL compared to placebo
Description
To evaluate the efficacy of repeated dosing with CTAP101 Capsules versus placebo in raising serum total 25-hydroxyvitamin D to ≥30 ng/mL
Time Frame
26 weeks
Title
Plasma iPTH mean absolute changes and serum total 25-hydroxyvitamin D
Description
To determine the time courses of mean absolute changes from pre-treatment baseline in serum total 25-hydroxyvitamin D and plasma iPTH during administration of repeated doses of CTAP101 Capsules
Time Frame
26 weeks
Title
Pharmacodynamic effects of repeated doses of CTAP101 Capsules
Description
To assess the PD effects of repeated doses of CTAP101 Capsules versus placebo on mean serum calcium (corrected for albumin), serum phosphorus and serum calcium-timesphosphorus (CaxP) product, and the change in mean urine calcium:creatinine ratio
Time Frame
26 weeks
Title
Incidence of hypercalcemia and hyperphosphatemia
Description
To evaluate the safety of CTAP101 Capsules versus placebo with regard to the incidence of hypercalcemia and hyperphosphatemia
Time Frame
26 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
8 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Cohort 1: Be 12 to <18 years of age and have a body weight of ≥40 kg; Cohort 2: be 8 to <12 years of age and have a body weight of ≥20 kg. Be diagnosed with stage 3 to 4 CKD at least six months prior to the screening visit, and have an eGFR of ≥15 to <60 mL/min/1.73m2 at screening. Be without any disease state or physical condition that might impair evaluation of safety or which, in the investigator's opinion, would interfere with study participation, including: Serum albumin ≤ 3.0 g/dL; Serum transaminase (ALT or SGPT, AST or SGOT) > 2.5 times the upper limit of normal at screening; and, Urinary albumin excretion of >3000 mcg/mg creatinine. Exhibit during the initial or, if necessary, a screening visit after washout: Plasma iPTH >100 pg/mL (stage 3 CKD) or >160 pg/mL (stage 4 CKD) Serum calcium <9.8 mg/dL (corrected for albumin); Serum total 25-hydroxyvitamin D <30 ng/mL; and, Serum phosphorus >2.5 to ≤5.5 mg/dL (12 to <18 years) or ≤6.0 mg/dL (ages 8 to <12 years). If taking calcitriol or other 1α-hydroxylated vitamin D analogs, or cinacalcet, be willing to forgo treatment with these agents for the duration of the study and complete an 8-week washout period prior to commencing treatment in the study. If taking >1,000 mg/day of elemental calcium, discontinue or reduce calcium use and/or use non-calcium based therapies for the duration of the study. If receiving ≤1,700 IU/day nutritional vitamin D (ergocalciferol or cholecalciferol) therapy, must agree to remain on a stable dose during the study. If taking >1,700 IU/day of nutritional vitamin D, must discontinue or decrease the dose to ≤1,700 IU/day, maintain that dose for the duration of the study, and complete an 8-week washout period prior to commencing treatment in the study provided that serum total 25-hydroxyvitamin D is ≥30 ng/mL. The washout period is not necessary if serum total 25-hydroxyvitami D is <30 ng/mL. If taking any bone modifying treatment that could interfere with study endpoints, must discontinue use of such agent(s) for the duration of the study. Willing and able to comply with study instructions and commit to all clinic visits for the duration of the study. Female subjects of childbearing potential must be neither pregnant nor lactating and must have a negative urine pregnancy test at the first screening visit. All female subjects of childbearing potential and male subjects with female partners of childbearing potential must agree to use effective contraception (eg, implants, injectables, combined oral contraceptives, intrauterine device, sexual abstinence, vasectomy or vasectomized partner) for the duration of the study. Each subject or their legal representative must be able to read, understand and sign the informed consent form (ICF). Exclusion Criteria: History of or planned kidney transplant or parathyroidectomy. History (prior three months) of serum calcium ≥9.8 mg/dL. Use of bisphosphonate therapy (denosumab) within six months prior to enrollment. Known previous or concomitant serious illness or medical condition, such as malignancy, human immunodeficiency virus, significant gastrointestinal or hepatic disease or cardiovascular event or hepatitis, or physical condition that in the opinion of the investigator may worsen and/or interfere with participation in the study. History of neurological/psychiatric disorder, including psychotic disorder, or any reason which, in the opinion of the investigator makes adherence to a treatment or follow up schedule unlikely. Known or suspected hypersensitivity to any of the constituents of either investigational product. Currently participating in, or has participated in, an interventional/investigational study within 30 days prior to study screening.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Christina Gomes
Phone
747-888-3011
Email
cgomes@opko.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Akhtar Ashfaq, MD
Organizational Affiliation
OPKO Health
Official's Role
Study Director
Facility Information:
Facility Name
Nationwide Childrens Hospital
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43205
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
John Mahan, MD
Phone
614-722-8535
Email
john.mahan@nationwidechildrens.org
First Name & Middle Initial & Last Name & Degree
John Mahan, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Phase 3 Safety and Efficacy Study of CTAP101 Extended-release Capsules in Children With Secondary Hyperparathyroidism

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