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A Phase Ia/Ib, SAD and MAD Study of of KL1333 in Healthy Subjects and Patients With Primary Mitochondrial Disease

Primary Purpose

Mitochondrial Diseases, Mitochondrial Respiratory Chain Deficiencies, MELAS Syndrome

Status
Completed
Phase
Phase 1
Locations
United Kingdom
Study Type
Interventional
Intervention
KL1333
Placebo Oral Tablet
Sponsored by
Abliva AB
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mitochondrial Diseases focused on measuring Mitochondrial Diseases, Mitochondrial Respiratory Chain Deficiencies, MELAS Syndrome, Mitochondrial Myopathies, Kearns-Sayre Syndrome, Ophthalmoplegia, Chronic Progressive External

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria (selected):

Healthy subjects and patients with mitochondrial disease must satisfy all of the following criteria at the Screening visit unless otherwise stated:

  1. Females will not be pregnant or lactating, and females of childbearing potential and males will agree to use contraception.
  2. Able to comprehend and willing to sign an ICF and to abide by the study restrictions.
  3. Able to perform all protocol-specified assessments and comply with the study visit schedule.

    Additional inclusion criteria for healthy subjects:

  4. Males or females, of any race, between 18 and 65 years of age, inclusive.
  5. Weight ≥50 kg and body mass index between 18.0 and 32.0 kg/m2, inclusive.
  6. In good health, determined by no clinically significant findings from medical history, physical examination, 12 lead ECG, vital signs measurements, and clinical laboratory evaluations (congenital nonhaemolytic hyperbilirubinemia [eg, Gilbert's syndrome] is not acceptable) at Screening and Check in as assessed by the Investigator.

    Additional inclusion criteria for patients with mitochondrial disease:

  7. Males or females, of any race, between 18 and 75 years of age, inclusive.
  8. Body mass index between 15.0 and 32.0 kg/m2, inclusive.
  9. Any mitochondrial disease that has been genetically confirmed.
  10. Clinically stable, apart from symptoms associated with the diagnosis of mitochondrial disease, as determined by medical history, physical examination, 12 lead ECG, vital signs measurements, and clinical laboratory evaluations at Screening and Check-in as assessed by the Investigator.

Exclusion Criteria (selected):

Healthy subjects and patients with mitochondrial disease will be excluded from the study if they satisfy any of the following criteria at the Screening visit unless otherwise stated:

  1. History of significant hypersensitivity, intolerance, or allergy to any drug compound, food, or other substance, including KL1333 or its excipients, unless approved by the Investigator.
  2. History of gastroesophageal reflux disease, gastric erosions, peptic ulcer disease, or gastrointestinal bleeding episodes.
  3. History of stomach or intestinal surgery or resection that would potentially alter absorption and/or excretion of orally administered drugs including cholecystectomy (uncomplicated appendectomy and hernia repair will be allowed).
  4. History of malignancy of any organ system other than localised basal cell carcinoma of the skin, treated or untreated, within 5 years prior to Screening, regardless of whether there is evidence of local recurrence or metastases.
  5. History of clinically significant illness (except for mitochondrial disease in the patients in Part C) or surgery within 4 weeks prior to Screening, as determined by the Investigator.
  6. History of alcoholism or drug/chemical abuse within 2 years prior to Screening.
  7. Alcohol consumption of >28 units per week for males and >21 units per week for females. One unit of alcohol equals ½ pint (285 mL) of beer or lager, 1 glass (125 mL) of wine, or 1/6 gill (25 mL) of spirits.
  8. Positive alcohol breath test result or positive urine drug screen (confirmed by repeat) at Screening or Check in.
  9. Positive hepatitis panel and/or positive human immunodeficiency virus test

Additional exclusion criteria for patients with mitochondrial disease:

  1. Use of idebenone or medications (prescription or nonprescription) that have effects on metabolism or unknown binding sites (eg, vitamin E, co-enzyme 10, arginine) within 35 days or 5 half-lives, whichever is longer, prior to the first dose.
  2. Use of prescription drugs within 14 days prior to dosing, with the exception of established therapy for mitochondrial disease and the treatment of associated disorders that has been stable for at least 7 days prior to the first dose, as approved by the Medical Monitor and Investigator, in consultation with the Sponsor.
  3. Uncontrolled diabetes mellitus, as determined by the Investigator. Creatinine clearance <45 mL/min as calculated by the Cockcroft-Gault equation

Sites / Locations

  • Covance Leeds
  • UCL

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

KL1333

Matching placebo

Arm Description

25 and 100 mg KL1333 encapsulated tablets for daily oral dosing

25 and 100 mg KL placebo encapsulated tablets for daily oral dosing

Outcomes

Primary Outcome Measures

Safety: incidence and severity of AEs
Safety: incidence of laboratory abnormalities, based on haematology, clinical chemistry, and urinalysis test results
Safety: 12 lead ECG parameters
Safety: Number of participants with clinically significant abnormal vital signs measurements
Safety: Number of participants with clinically significant abnormal physical examinations

Secondary Outcome Measures

PK: area under the curve, AUC0 ∞
PK: AUC over a dosing interval (AUC0 τ)
PK: temporal change parameter (TCP; AUC0 τ/AUC0-∞)
PK: Cmax
PK: time of the Cmax (Tmax)
PK: minimum observed plasma concentration (Cmin)
PK: apparent plasma terminal elimination half life (t1/2)
PK: mean residence time (MRT)
PK: apparent total plasma clearance (CL/F)
PK: apparent volume of distribution during the terminal phase (Vz/F)

Full Information

First Posted
March 19, 2019
Last Updated
October 19, 2021
Sponsor
Abliva AB
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1. Study Identification

Unique Protocol Identification Number
NCT03888716
Brief Title
A Phase Ia/Ib, SAD and MAD Study of of KL1333 in Healthy Subjects and Patients With Primary Mitochondrial Disease
Official Title
A Phase Ia/Ib, Multiple-site Study to Assess the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of KL1333 After a Single and Multiple Ascending Oral Doses in Healthy Subjects and Patients With Primary Mitochondrial Disease
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Completed
Study Start Date
March 18, 2019 (Actual)
Primary Completion Date
March 16, 2021 (Actual)
Study Completion Date
March 16, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Abliva AB

4. Oversight

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

5. Study Description

Brief Summary
This will be a double blind, randomised, placebo controlled, single and multiple oral dose study conducted in 3 parts: Part A, Part B and Part C. Part A and Part B include healthy volunteers only and will be completed before Part C including patients with primary mitochondrial disease will be initiated. The starting dose in the first cohort of Part A will be 25 mg. The dose level in the additional cohorts will be decided following review of data of the previous cohorts.
Detailed Description
Part A: Eight healthy subjects will be studied in a single cohort (Group A1). Potential subjects will be screened to assess their eligibility to enter the study within 28 days prior to the first dose administration. Subjects will participate in 2 treatment periods, fasting or after consuming a standard high-fat breakfast. For each treatment period, subjects will reside at the Phase I clinical site from Days 1 to 3 (48 hours postdose). Subjects will return to the clinical site for outpatient visits on Days 4 and 5. There will be at least a 10 day washout between doses Additional single-dose cohorts may be enrolled based on data obtained from either Parts A or B. Part B: Sixteen healthy subjects will be studied in 2 cohorts (Groups B1 and B2), with each cohort consisting of 8 subjects. Following review of safety, tolerability, and PK data, up to 3 additional dose cohorts of healthy subjects may be added to further explore the PK, safety, and tolerability of KL1333. Potential subjects will be screened to assess their eligibility to enter the study within 28 days prior to the first dose administration. All subjects will participate in 1 treatment period and will reside at the Phase I clinical site from Days -1 to 12 (48 hours post final dose). Subjects will return to the clinical site for outpatient visits on Days 13 and 14. On Day 1, 6 subjects will be randomised to receive KL1333 and 2 subjects will be randomised to receive placebo. Subjects will return for a Follow-up visit on Day 15, 5 days after their final dose. Part C: A total of 8 patients diagnosed with any mitochondrial disease will be enrolled in this part of the study. Part C may start after the dose selection conference has been completed for the final cohort of Part B, at a daily dose no higher than the highest well-tolerated dose in Part B. Potential study patients will be screened to assess their eligibility to enter the study within 35 days prior to the first dose administration. Patients will reside at the clinical site from Days -1 to 2 and Days 10 to 11 and return to the clinical site for outpatient visits on Days 4 and 8. It is planned for patients to receive study drug once daily on Days 1 to 10. Patients will return for a Follow-up visit on Day 15, 5 days after their final dose.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mitochondrial Diseases, Mitochondrial Respiratory Chain Deficiencies, MELAS Syndrome, Mitochondrial Myopathies
Keywords
Mitochondrial Diseases, Mitochondrial Respiratory Chain Deficiencies, MELAS Syndrome, Mitochondrial Myopathies, Kearns-Sayre Syndrome, Ophthalmoplegia, Chronic Progressive External

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
72 (Actual)

8. Arms, Groups, and Interventions

Arm Title
KL1333
Arm Type
Experimental
Arm Description
25 and 100 mg KL1333 encapsulated tablets for daily oral dosing
Arm Title
Matching placebo
Arm Type
Placebo Comparator
Arm Description
25 and 100 mg KL placebo encapsulated tablets for daily oral dosing
Intervention Type
Drug
Intervention Name(s)
KL1333
Intervention Description
25 and 100 mg KL1333 encapsulated tablets
Intervention Type
Drug
Intervention Name(s)
Placebo Oral Tablet
Intervention Description
25 and 100 mg placebo encapsulated tablets
Primary Outcome Measure Information:
Title
Safety: incidence and severity of AEs
Time Frame
Day 15
Title
Safety: incidence of laboratory abnormalities, based on haematology, clinical chemistry, and urinalysis test results
Time Frame
Day 15
Title
Safety: 12 lead ECG parameters
Time Frame
Day 15
Title
Safety: Number of participants with clinically significant abnormal vital signs measurements
Time Frame
Day 15
Title
Safety: Number of participants with clinically significant abnormal physical examinations
Time Frame
Day 15
Secondary Outcome Measure Information:
Title
PK: area under the curve, AUC0 ∞
Time Frame
Day 1
Title
PK: AUC over a dosing interval (AUC0 τ)
Time Frame
Days 1 and 10
Title
PK: temporal change parameter (TCP; AUC0 τ/AUC0-∞)
Time Frame
Days 1 and 10
Title
PK: Cmax
Time Frame
Day 1
Title
PK: time of the Cmax (Tmax)
Time Frame
Day 1
Title
PK: minimum observed plasma concentration (Cmin)
Time Frame
Days 1 and 10
Title
PK: apparent plasma terminal elimination half life (t1/2)
Time Frame
Days 1 and 10
Title
PK: mean residence time (MRT)
Time Frame
Days 1 and 10
Title
PK: apparent total plasma clearance (CL/F)
Time Frame
Days 1 and 10
Title
PK: apparent volume of distribution during the terminal phase (Vz/F)
Time Frame
Days 1 and 10
Other Pre-specified Outcome Measures:
Title
NAD+/NADH concentrations and ratio (part B and C)
Description
Biomarker
Time Frame
Days 10 and 15
Title
FGF21 and GDF15 concentrations (part B and C)
Description
Biomarker
Time Frame
Days 10 and 15
Title
Lactate/pyruvate concentrations and ratio (part B and C)
Description
Biomarker
Time Frame
Days 10 and 15
Title
Newcastle Mitochondrial Disease Adult Scale (NMDAS) (part C)
Description
Assessment of mitochondrial disease. The NMDAS is a validated clinical rating scale designed to capture the natural history of mitochondrial disease. The NMDAS includes 3 domains: current function, system specific involvement, and current clinical, assessed on 6-point Likert-type scale from 0 to 5, as well as a fourth section including a score for the 12-Item Short Form Survey-Version 2.
Time Frame
Day 10
Title
Clinician Global Impression (CGI) (part C)
Description
Assessment of illness severity, global improvement or change, and therapeutic response.The CGI is a 3-item observer-rated scale that measures illness severity, global improvement or change, and therapeutic response. The CGI is rated on a 7-point Likert-type scale, with the severity of illness scale using a range of responses from 1 (normal) to 7 (amongst the most severely ill patients).
Time Frame
Day 10
Title
Patient Global Impression-Improvement (PGI-I) (part C)
Description
Patient reported assessment of severity of illness. The PGI-I is a patient-rated scale using a 7-point Likert-type scale, with the severity of illness scale using a range of responses from 1 (normal) to 7 (amongst the most severely ill patients). An item about the patient's worst symptom will be included in the assessment for this study.
Time Frame
Day 10
Title
Daily Fatigue Impact Severity (D-FIS) (part C)
Description
Assessment of fatigue. The D-FIS is a patient-rated scale developed to assess the symptom of fatigue as part of an underlying chronic disease or condition. The D-FIS includes 8 items assessed on 5-point Likert-type scale from 0 (no problem) to 4 (extreme problem).
Time Frame
Day 10
Title
Quality of Life in Neurological Disorders Fatigue Scale (Neuro-QoL Fatigue) (part C)
Description
Assessment of fatigue. The Neuro-QoL Fatigue is one of several scales that make up the Quality of Life in Neurological Disorders measurement system. It is a reliable and validated brief 19-item survey of fatigue, completed by the subject, with a recall period of the past 7 days. The 19 items are scored from 1 (never) to 5 (always) and consequently, Neuro-QoL Fatigue total scores range from 19 to 95, with higher scores indicating greater fatigue and greater impact of mitochondrial disease on activities.
Time Frame
Day 10
Title
30 Second Sit-to-Stand Test (part C)
Description
Test
Time Frame
Day 10

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria (selected): Healthy subjects and patients with mitochondrial disease must satisfy all of the following criteria at the Screening visit unless otherwise stated: Females will not be pregnant or lactating, and females of childbearing potential and males will agree to use contraception. Able to comprehend and willing to sign an ICF and to abide by the study restrictions. Able to perform all protocol-specified assessments and comply with the study visit schedule. Additional inclusion criteria for healthy subjects: Males or females, of any race, between 18 and 65 years of age, inclusive. Weight ≥50 kg and body mass index between 18.0 and 32.0 kg/m2, inclusive. In good health, determined by no clinically significant findings from medical history, physical examination, 12 lead ECG, vital signs measurements, and clinical laboratory evaluations (congenital nonhaemolytic hyperbilirubinemia [eg, Gilbert's syndrome] is not acceptable) at Screening and Check in as assessed by the Investigator. Additional inclusion criteria for patients with mitochondrial disease: Males or females, of any race, between 18 and 75 years of age, inclusive. Body mass index between 15.0 and 32.0 kg/m2, inclusive. Any mitochondrial disease that has been genetically confirmed. Clinically stable, apart from symptoms associated with the diagnosis of mitochondrial disease, as determined by medical history, physical examination, 12 lead ECG, vital signs measurements, and clinical laboratory evaluations at Screening and Check-in as assessed by the Investigator. Exclusion Criteria (selected): Healthy subjects and patients with mitochondrial disease will be excluded from the study if they satisfy any of the following criteria at the Screening visit unless otherwise stated: History of significant hypersensitivity, intolerance, or allergy to any drug compound, food, or other substance, including KL1333 or its excipients, unless approved by the Investigator. History of gastroesophageal reflux disease, gastric erosions, peptic ulcer disease, or gastrointestinal bleeding episodes. History of stomach or intestinal surgery or resection that would potentially alter absorption and/or excretion of orally administered drugs including cholecystectomy (uncomplicated appendectomy and hernia repair will be allowed). History of malignancy of any organ system other than localised basal cell carcinoma of the skin, treated or untreated, within 5 years prior to Screening, regardless of whether there is evidence of local recurrence or metastases. History of clinically significant illness (except for mitochondrial disease in the patients in Part C) or surgery within 4 weeks prior to Screening, as determined by the Investigator. History of alcoholism or drug/chemical abuse within 2 years prior to Screening. Alcohol consumption of >28 units per week for males and >21 units per week for females. One unit of alcohol equals ½ pint (285 mL) of beer or lager, 1 glass (125 mL) of wine, or 1/6 gill (25 mL) of spirits. Positive alcohol breath test result or positive urine drug screen (confirmed by repeat) at Screening or Check in. Positive hepatitis panel and/or positive human immunodeficiency virus test Additional exclusion criteria for patients with mitochondrial disease: Use of idebenone or medications (prescription or nonprescription) that have effects on metabolism or unknown binding sites (eg, vitamin E, co-enzyme 10, arginine) within 35 days or 5 half-lives, whichever is longer, prior to the first dose. Use of prescription drugs within 14 days prior to dosing, with the exception of established therapy for mitochondrial disease and the treatment of associated disorders that has been stable for at least 7 days prior to the first dose, as approved by the Medical Monitor and Investigator, in consultation with the Sponsor. Uncontrolled diabetes mellitus, as determined by the Investigator. Creatinine clearance <45 mL/min as calculated by the Cockcroft-Gault equation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Matilda Hugerth, MSc
Organizational Affiliation
Abliva AB
Official's Role
Study Director
Facility Information:
Facility Name
Covance Leeds
City
Leeds
State/Province
West Yorkshire
ZIP/Postal Code
LS2 9LH
Country
United Kingdom
Facility Name
UCL
City
London
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
According to EMA rules.

Learn more about this trial

A Phase Ia/Ib, SAD and MAD Study of of KL1333 in Healthy Subjects and Patients With Primary Mitochondrial Disease

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