A Drug-Drug Interaction Study of CYP3A4 Inhibition and Pan-CYP Induction on APX001
Primary Purpose
Fungal Infection
Status
Completed
Phase
Phase 1
Locations
Netherlands
Study Type
Interventional
Intervention
APX001
Itraconazole
Rifampin
Sponsored by
About this trial
This is an interventional treatment trial for Fungal Infection
Eligibility Criteria
Inclusion Criteria:
- Women must be postmenopausal or surgically sterile, or
- Women of childbearing potential must agree to avoid pregnancy during the study and to use contraception, or abstinence, at least 2 weeks before the start of study drug administration until 3 months after the last dose of study drug.
- Male subjects must agree to use barrier contraception, or commit to abstinence, from first Admission to the clinic until 3 months after the last dose of study drug.
- Body mass index (BMI): 18.0 to 32.0 kg/m sq, inclusive
- Weight: >= 50 kg
- Screening hematology, clinical chemistry, coagulation, and urinalysis consistent with overall good health
- Able to understand and comply with the requirements of the study, willing to return for all clinic visits, including confinement periods, and complete all study-related procedures Willing and able to provide written informed consent.
Exclusion Criteria:
- Having any uncontrolled or active major systemic disease including, but not limited to: cardiovascular, pulmonary, ,gastrointestinal, metabolic, urogenital, neurological, immunological, psychiatric, or neoplastic disorder with metastatic potential.
- History or presence of malignancy within the past year. Subjects who have been successfully treated with no recurrence of basal cell carcinoma of the skin or carcinoma in-situ of the cervix may be enrolled.
- Active acute or chronic infection, including, but not limited to: upper airway infection, urinary tract infection, or skin infection within 30 days preceding entry into the study.
- Significant and/or acute illness within 5 days prior to the first study drug administration that may impact safety assessments, in the opinion of the Investigator.
- Participation in an investigational drug study within 60 days prior to the first study drug administration in the current study. Participation in more than 3 other drug studies in the 10 months prior to the first study drug administration in the current study.
- Use of any prescription medication within 14 days prior to the planned first study drug administration and throughout the study (excluding female contraception).
- Use of any non-prescription or over-the-counter medications within 7 days prior to the planned first study drug administration and throughout the study. This includes all vitamins, other herbal supplements, or remedies.
- Taking any drug or herbal CYP3A modulator (e.g. erythromycin; St. John's Wort) within 4 weeks (or 5 half-lives, whichever is longer) or any other nutrients known to modulate CYP3A activity (e.g. grapefruit juice; Seville orange) within 2 weeks prior to the first Admission.
- History of tobacco or any nicotine-containing product or device use within the past 3 months prior to the planned first study drug administration
- History of alcohol or substance abuse based on Investigator's judgment, within the past 12 months prior to the planned first study drug administration
- Concurrent social conditions (e.g. drugs-of-abuse, alcohol use of more than 24 units per week) that may potentially interfere with the subject's compliance with the protocol
- History of clinically significant allergic drug reactions
- Clinically significant physical examination, vital signs, laboratory safety test, or electrocardiogram (ECG) abnormalities
- Donation or loss of more than 100 mL of blood within 60 days prior to the first study drug administration. Donation or loss of more than 1.5 liters of blood (for male subjects) or more than 1.0 liter of blood (for female subjects) in the 10 months prior to the first study drug administration in the current study.
- Positive results on any of the following screening laboratory tests: serum pregnancy test, urine alcohol test, urine drugs-of-abuse (including cotinine), hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibody, and human immunodeficiency virus (HIV) antibody.
- Prior exposure to APX001
- Known allergy to corn or corn products or any inactive components of the study drug
- Known hypersensitivity to culprit drugs (itraconazole or rifampin).
Additional Exclusion Criteria for Cohort 2:
- Diagnosis or suspected of having porphyria or having first-degree relatives diagnosed or suspected of having porphyria.
- Unwilling not to use contact lenses for the duration of rifampin dosing (Day 15 to Day 33 for Cohort 2) until 7 days after the last dose of rifampin (subjects in Cohort 2 may resume wearing contact lenses on Day 40).
Sites / Locations
- PRA Health Sciences (PRA) - Early Development Services (EDS)
- PRA-EDS
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Experimental
Arm Label
Cohort 1
Cohort 2
Arm Description
Drugs: APX001, itraconazole
Drugs: APX001, rifampin
Outcomes
Primary Outcome Measures
Pharmacokinetics of APX001/APX001A as measured by area under the plasma concentration-time curve (AUC) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Pharmacokinetics of APX001/APX001A as measured by maximum observed plasma concentration (Cmax) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Pharmacokinetics of APX001/APX001A as measured by time to attain maximum observed plasma concentration (Tmax) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Pharmacokinetics of APX001/APX001A as measured by terminal elimination rate constant (λz) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Pharmacokinetics of APX001/APX001A as measured by terminal elimination half-life (t1/2) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Pharmacokinetics of APX001/APX001A as measured by total clearance (CL) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Pharmacokinetics of APX001/APX001A as measured by the volume of distribution during the terminal phase (Vz) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Secondary Outcome Measures
Number of subjects experiencing and frequency of occurrence of adverse events as rated by CTCAE v5.0 after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
Occurrence and magnitude of clinical lab test values outside the normal range, clinically significant, and differing from baseline results after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
The following parameters will be measured:
Clinical chemistry (serum quantitatively): total bilirubin, direct (conjugated) bilirubin, indirect (unconjugated) bilirubin (calculated), alkaline phosphatase, gamma-GT, ASAT, ALAT, LDH, p-amylase, lipase, CPK, creatinine, eGRF, urea, uric acid, cholesterol, triglycerides, total protein, albumin, globulin, glucose, inorganic phosphate, sodium, potassium, calcium, chloride, and bicarbonate.
Hematology (blood quantitatively): leukocytes, erythrocytes, hemoglobin, hematocrit, thrombocytes, partial automated absolute differentiation: lymphocytes, monocytes, eosinophils, basophils, neutrophils, MCV, MCH, and MCHC.
Coagulation (blood quantitatively): PT, aPTT, and fibrinogen.
Urinalysis (urine qualitatively): color, protein, glucose, bilirubin, urobilinogen, ketones, blood, pH, specific gravity, and leukocytes.
Occurrence of abnormal vital signs after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
Systolic and diastolic blood pressure and pulse will be recorded after the subject has been resting supine or semi-recumbent for at least 5 minutes. Body temperature and respiratory rate will be measured subsequently.
Occurrence of abnormal, clinically significant results from 12-lead ECGs after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
The following ECG parameters will be recorded: heart rate, PR interval, QRS duration, QT interval, and QTc interval (Fridericia's).
Occurrence of changes in physical examinations which differ from baseline after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
Physical examination will include: general appearance; skin/subcutaneous tissue; head; ears, nose, throat; neck and thyroid; thorax; lungs; cardiovascular; lymph nodes; abdomen; musculoskeletal; and neurological.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04166669
Brief Title
A Drug-Drug Interaction Study of CYP3A4 Inhibition and Pan-CYP Induction on APX001
Official Title
A Phase 1, Open-Label, Fixed-Sequence, Drug-Drug Interaction Study of APX001 to Evaluate the Effects of CYP3A4 Inhibition and Pan-CYP Induction in Two Parallel Groups of Healthy Male and Female Subjects
Study Type
Interventional
2. Study Status
Record Verification Date
September 2022
Overall Recruitment Status
Completed
Study Start Date
November 12, 2019 (Actual)
Primary Completion Date
March 3, 2020 (Actual)
Study Completion Date
March 3, 2020 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Pfizer
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
This is a Phase 1, open-label study to evaluate the drug-drug interaction potential of a strong CYP3A4 inhibitor (itraconazole) and a pan-CYP inducer (rifampin) on APX001 in two parallel groups of healthy subjects.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Fungal Infection
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
36 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Cohort 1
Arm Type
Experimental
Arm Description
Drugs: APX001, itraconazole
Arm Title
Cohort 2
Arm Type
Experimental
Arm Description
Drugs: APX001, rifampin
Intervention Type
Drug
Intervention Name(s)
APX001
Other Intervention Name(s)
Fosmanogepix
Intervention Description
Cohort 1 Day 1: APX001 500 mg IV BID over a 3-hour infusion; Day 18: APX001 500 mg IV BID over a 3-hour infusion. Cohort 2 Day 1: APX001 1000 mg IV BID over a 3-hour infusion; Day 24: APX001 1000 mg IV BID over a 3-hour infusion.
Intervention Type
Drug
Intervention Name(s)
Itraconazole
Other Intervention Name(s)
Sporanox
Intervention Description
Cohort 1 Days 15-30: itraconazole 200 mg oral solution QD.
Intervention Type
Drug
Intervention Name(s)
Rifampin
Other Intervention Name(s)
Rifampicin
Intervention Description
Cohort 2 Days 15-33: rifampin 600 mg oral QD.
Primary Outcome Measure Information:
Title
Pharmacokinetics of APX001/APX001A as measured by area under the plasma concentration-time curve (AUC) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Time Frame
6 weeks
Title
Pharmacokinetics of APX001/APX001A as measured by maximum observed plasma concentration (Cmax) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Time Frame
6 weeks
Title
Pharmacokinetics of APX001/APX001A as measured by time to attain maximum observed plasma concentration (Tmax) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Time Frame
6 weeks
Title
Pharmacokinetics of APX001/APX001A as measured by terminal elimination rate constant (λz) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Time Frame
6 weeks
Title
Pharmacokinetics of APX001/APX001A as measured by terminal elimination half-life (t1/2) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Time Frame
6 weeks
Title
Pharmacokinetics of APX001/APX001A as measured by total clearance (CL) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Time Frame
6 weeks
Title
Pharmacokinetics of APX001/APX001A as measured by the volume of distribution during the terminal phase (Vz) after multiple doses of a CYP3A4 inhibitor, itraconazole (oral solution) or multiple doses of a pan-CYP inducer, oral rifampin.
Time Frame
6 weeks
Secondary Outcome Measure Information:
Title
Number of subjects experiencing and frequency of occurrence of adverse events as rated by CTCAE v5.0 after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
Time Frame
6 weeks
Title
Occurrence and magnitude of clinical lab test values outside the normal range, clinically significant, and differing from baseline results after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
Description
The following parameters will be measured:
Clinical chemistry (serum quantitatively): total bilirubin, direct (conjugated) bilirubin, indirect (unconjugated) bilirubin (calculated), alkaline phosphatase, gamma-GT, ASAT, ALAT, LDH, p-amylase, lipase, CPK, creatinine, eGRF, urea, uric acid, cholesterol, triglycerides, total protein, albumin, globulin, glucose, inorganic phosphate, sodium, potassium, calcium, chloride, and bicarbonate.
Hematology (blood quantitatively): leukocytes, erythrocytes, hemoglobin, hematocrit, thrombocytes, partial automated absolute differentiation: lymphocytes, monocytes, eosinophils, basophils, neutrophils, MCV, MCH, and MCHC.
Coagulation (blood quantitatively): PT, aPTT, and fibrinogen.
Urinalysis (urine qualitatively): color, protein, glucose, bilirubin, urobilinogen, ketones, blood, pH, specific gravity, and leukocytes.
Time Frame
6 weeks
Title
Occurrence of abnormal vital signs after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
Description
Systolic and diastolic blood pressure and pulse will be recorded after the subject has been resting supine or semi-recumbent for at least 5 minutes. Body temperature and respiratory rate will be measured subsequently.
Time Frame
6 weeks
Title
Occurrence of abnormal, clinically significant results from 12-lead ECGs after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
Description
The following ECG parameters will be recorded: heart rate, PR interval, QRS duration, QT interval, and QTc interval (Fridericia's).
Time Frame
6 weeks
Title
Occurrence of changes in physical examinations which differ from baseline after dosing with APX001 IV alone and when co-administered with itraconazole (oral solution) or oral rifampin.
Description
Physical examination will include: general appearance; skin/subcutaneous tissue; head; ears, nose, throat; neck and thyroid; thorax; lungs; cardiovascular; lymph nodes; abdomen; musculoskeletal; and neurological.
Time Frame
6 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Women must be postmenopausal or surgically sterile, or
Women of childbearing potential must agree to avoid pregnancy during the study and to use contraception, or abstinence, at least 2 weeks before the start of study drug administration until 3 months after the last dose of study drug.
Male subjects must agree to use barrier contraception, or commit to abstinence, from first Admission to the clinic until 3 months after the last dose of study drug.
Body mass index (BMI): 18.0 to 32.0 kg/m sq, inclusive
Weight: >= 50 kg
Screening hematology, clinical chemistry, coagulation, and urinalysis consistent with overall good health
Able to understand and comply with the requirements of the study, willing to return for all clinic visits, including confinement periods, and complete all study-related procedures Willing and able to provide written informed consent.
Exclusion Criteria:
Having any uncontrolled or active major systemic disease including, but not limited to: cardiovascular, pulmonary, ,gastrointestinal, metabolic, urogenital, neurological, immunological, psychiatric, or neoplastic disorder with metastatic potential.
History or presence of malignancy within the past year. Subjects who have been successfully treated with no recurrence of basal cell carcinoma of the skin or carcinoma in-situ of the cervix may be enrolled.
Active acute or chronic infection, including, but not limited to: upper airway infection, urinary tract infection, or skin infection within 30 days preceding entry into the study.
Significant and/or acute illness within 5 days prior to the first study drug administration that may impact safety assessments, in the opinion of the Investigator.
Participation in an investigational drug study within 60 days prior to the first study drug administration in the current study. Participation in more than 3 other drug studies in the 10 months prior to the first study drug administration in the current study.
Use of any prescription medication within 14 days prior to the planned first study drug administration and throughout the study (excluding female contraception).
Use of any non-prescription or over-the-counter medications within 7 days prior to the planned first study drug administration and throughout the study. This includes all vitamins, other herbal supplements, or remedies.
Taking any drug or herbal CYP3A modulator (e.g. erythromycin; St. John's Wort) within 4 weeks (or 5 half-lives, whichever is longer) or any other nutrients known to modulate CYP3A activity (e.g. grapefruit juice; Seville orange) within 2 weeks prior to the first Admission.
History of tobacco or any nicotine-containing product or device use within the past 3 months prior to the planned first study drug administration
History of alcohol or substance abuse based on Investigator's judgment, within the past 12 months prior to the planned first study drug administration
Concurrent social conditions (e.g. drugs-of-abuse, alcohol use of more than 24 units per week) that may potentially interfere with the subject's compliance with the protocol
History of clinically significant allergic drug reactions
Clinically significant physical examination, vital signs, laboratory safety test, or electrocardiogram (ECG) abnormalities
Donation or loss of more than 100 mL of blood within 60 days prior to the first study drug administration. Donation or loss of more than 1.5 liters of blood (for male subjects) or more than 1.0 liter of blood (for female subjects) in the 10 months prior to the first study drug administration in the current study.
Positive results on any of the following screening laboratory tests: serum pregnancy test, urine alcohol test, urine drugs-of-abuse (including cotinine), hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibody, and human immunodeficiency virus (HIV) antibody.
Prior exposure to APX001
Known allergy to corn or corn products or any inactive components of the study drug
Known hypersensitivity to culprit drugs (itraconazole or rifampin).
Additional Exclusion Criteria for Cohort 2:
Diagnosis or suspected of having porphyria or having first-degree relatives diagnosed or suspected of having porphyria.
Unwilling not to use contact lenses for the duration of rifampin dosing (Day 15 to Day 33 for Cohort 2) until 7 days after the last dose of rifampin (subjects in Cohort 2 may resume wearing contact lenses on Day 40).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pfizer CT.gov Call Center
Organizational Affiliation
Pfizer
Official's Role
Study Director
Facility Information:
Facility Name
PRA Health Sciences (PRA) - Early Development Services (EDS)
City
Groningen
ZIP/Postal Code
9728 NZ
Country
Netherlands
Facility Name
PRA-EDS
City
Groningen
Country
Netherlands
12. IPD Sharing Statement
Links:
URL
https://pmiform.com/clinical-trial-info-request?StudyID=APX001-107
Description
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A Drug-Drug Interaction Study of CYP3A4 Inhibition and Pan-CYP Induction on APX001
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