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A Two-Part Phase 2a Study of RVX000222 in Patients With End-Stage Renal Disease Treated With Hemodialysis

Primary Purpose

Kidney Failure, Chronic

Status
Unknown status
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
apabetalone
Placebos
Sponsored by
Resverlogix Corp
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Kidney Failure, Chronic focused on measuring Chronic Kidney Failure, ESRD, End-Stage Kidney Disease, End-Stage Renal Disease, Renal Disease, End-Stage, Renal Failure, Chronic, Renal Failure, End-Stage

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Men or women ≥18 and ≤80 years of age.
  2. Diagnosis of end-stage renal disease and receiving hemodialysis an average of three (3) times per week for at least ninety (90) days prior to Enrollment/Visit 2.
  3. Clinically stable, in the judgment of the investigator.
  4. Female subjects must meet one of the following:

    1. If of childbearing potential, must have a negative serum pregnancy test and be willing and able to use medically acceptable non-hormonal method of birth control (non-hormonal intrauterine device, condom, or diaphragm) or remain abstinent from Screen until Follow-up Visit, or
    2. Be of non-child-bearing potential: post-surgical sterilization (hysterectomy or a bilateral oophorectomy) or post-menopausal. Post-menopausal is defined as amenorrhea for ≥2 years at Screen/Visit 1.
  5. In the view of the investigator, during the course of the trial, subject is expected to:

    1. remain on unchanged standard of care medication from 4 weeks prior to Enrollment/Visit 2.
    2. not require hospitalization for any condition other than routine hemodialysis.
  6. Have given signed informed consent to participate in the study.

Exclusion Criteria:

  1. Planned major surgery in the next 4 months, including renal transplant, from Enrollment/Visit 2.
  2. Major surgery, in the judgement of the investigator, within 12 weeks before enrollment/Visit 2 (excluding vascular access surgery).
  3. Hospitalization for congestive heart failure, myocardial infarction, deep vein thrombosis, stroke or transient ischemic attack or peripheral arterial disease within 6 months before Enrollment/Visit 2.
  4. New York Heart Association (NYHA) Classification, Class III or IV Heart Failure at Screen/Visit 1.
  5. Diastolic blood pressure >110 mm Hg or systolic blood pressure >180 mm Hg during screen.
  6. Currently receiving antibiotic therapy for systemic infection.
  7. In the judgement of the Investigator, evidence of active hepatitis. Hepatitis serology testing will be performed at Screen/Visit 1.
  8. History of malignancy of any organ system, treated or untreated, within the past 2 years whether or not there is evidence of local recurrence or metastases, with the exception of localized basal cell carcinoma of the skin.
  9. Red blood cell (RBC) transfusions within 12 weeks before Enrollment/Visit 2.
  10. Current or recent (within 12 months prior to Visit 1) treatment with immunosuppressants (e.g., cyclosporine).
  11. Use of fibrates at any dose or niacin/nicotinic acid 250 mg or more within 30 days prior to Screen/Visit 1.
  12. Diagnosis of systemic hematologic disease (e.g., sickle cell anemia, myelodysplastic syndromes, hematologic malignancy, myeloma, hemolytic anemia).
  13. Hemoglobin <9.5 g/dL at Screen/Visit 1.
  14. Alanine aminotransferase (ALT) >1.5 x upper limit of normal (ULN) at Screen/Visit 1.
  15. Bilirubin >1.0 x ULN at Screen/Visit 1.
  16. Pregnant or breast-feeding women.
  17. Any condition which, in the opinion of the investigator, may place the subject at higher risk from his/her participation in the study, or is likely to prevent the subject from complying with the requirements of the study or completing the study.
  18. Treatment with an investigational agent or device within 30 days or 5 half-lives before Enrollment/Visit 2 or scheduled to receive an investigational agent other than those specified by this protocol during the course of this study.
  19. History of noncompliance with medical regimens or unwillingness to comply with the study protocol.
  20. In the judgement of the Investigator, any disorder that may impact the ability to give informed consent for participation in this study.
  21. Any condition that, in the opinion of the investigator, would confound the evaluation and interpretation of efficacy and/or safety data.
  22. Persons directly involved in the execution of this protocol.

    Exclusion Criteria, Part A Only:

  23. Are unwilling to abstain from alcoholic beverages, caffeine or xanthine-containing products (e.g., tea, coffee, chocolate, cola), and use of nicotine products from 24 hours prior to Clinical Research Unit (CRU) admission to 48 hours post RVX000222 dose administration.

Exclusion Criteria, Part B Only:

23. Parathyroid hormone, intact (PTH, intact) <150 pg/mL or >800 pg/mL at Screen/Visit 1.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Experimental

    Placebo Comparator

    Placebo Comparator

    Arm Label

    Part A PK Arm

    Part B Sequence A

    Part B Sequence B

    Arm Description

    a single 100 mg dose of RVX000222 (apabetalone) on the day of dialysis, followed by a one (1) week washout period, and a second dose of RVX000222 (apabetalone) administered on a non-dialysis day (total of two (2) 100 mg RVX000222 doses)

    RVX000222 (apabetalone) 100 mg b.i.d (total 200 mg/day) for 6 weeks; 4 Week Washout (No RVX000222/placebo administration); Placebo b.i.d for 6 weeks

    Placebo b.i.d for 6 weeks; 4 Week Washout (No RVX000222/placebo administration); RVX000222 (apabetalone) 100 mg b.i.d (total 200 mg/day) for 6 weeks

    Outcomes

    Primary Outcome Measures

    Percent change in alkaline phosphatase (ALP) concentration (Part B)
    The primary endpoint of the study is the comparison of the RVX000222 treatment period to the placebo period in the percent change in ALP concentration. Percent change is computed relative to the beginning of each period.
    Single Dose Cmax of RVX000222 (apabetalone) and the Metabolites RVX000288 and RVX000404
    Primary PK comparison between dialysis (test) and non-dialysis (reference) days for Cmax of RVX000222 and its two principal metabolites, RVX000288 and RVX000404
    Single Dose AUC of RVX000222 (apabetalone) and the Metabolites RVX000288 and RVX000404
    Primary PK comparison between dialysis (test) and non-dialysis (reference) days for AUC of RVX000222 and its two principal metabolites, RVX000288 and RVX000404

    Secondary Outcome Measures

    Changes in high-sensitivity C-Reactive Protein (hsCRP)
    Changes in hsCRP in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Changes in Interleukin-13 (IL-13)
    Changes in IL-13 in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Changes in Interleukin-6 (IL-6)
    Changes in IL-6 in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Changes in Interleukin-8 (IL-8)
    Changes in IL-8 in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Changes in Monocyte Chemoattractant Protein-1 (MCP-1)
    Changes in MCP-1 in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Change in key markers of vascular mineralization
    Change in key markers of vascular mineralization i.e. RANKL and osteoprotegerin at the end of the RVX000222 treatment period relative to the end of the placebo period
    Changes in ALP isoenzymes
    Changes in ALP isoenzymes at the end of the RVX000222 treatment period relative to the end of the placebo period
    Changes in Parathyroid hormone (PTH)
    Changes in parathyroid hormone at the end of the RVX000222 treatment period relative to the end of the placebo period
    Change in apolipoprotein A1 (apoA-I), HDL-C, LDL-C, apolipoprotein B (apoB), and triglycerides
    Change in apoA-I, HDL-C, LDL-C, apoB, and triglycerides at the end of the RVX000222 treatment period relative to the end of the placebo period
    Change in Analyzing Data, Recognizing Excellence and Optimizing Outcomes All-Cause Mortality Risk Score For Patients on Chronic Hemodialysis (ARO Score)
    Change in ARO Score at the end of the RVX000222 treatment period relative to the end of the placebo period

    Full Information

    First Posted
    May 16, 2017
    Last Updated
    July 11, 2019
    Sponsor
    Resverlogix Corp
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    1. Study Identification

    Unique Protocol Identification Number
    NCT03160430
    Brief Title
    A Two-Part Phase 2a Study of RVX000222 in Patients With End-Stage Renal Disease Treated With Hemodialysis
    Official Title
    A Two-Part Phase 2a Study in Patients With End-Stage Renal Disease Treated With Hemodialysis; Part A is an Open-Label Study Arm to Evaluate the Effect of Hemodialysis on the Pharmacokinetics of 100 mg RVX000222; and Part B is a Double-Blind, Randomized, Placebo-Controlled, Sequential Cross-Over Study Arm to Evaluate the Efficacy, Safety, and Pharmacokinetics of RVX000222
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    January 2019
    Overall Recruitment Status
    Unknown status
    Study Start Date
    March 1, 2020 (Anticipated)
    Primary Completion Date
    March 15, 2021 (Anticipated)
    Study Completion Date
    March 15, 2021 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Resverlogix Corp

    4. Oversight

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

    5. Study Description

    Brief Summary
    This is a multi-center, two-part study; Part A and Part B. Part A of the study is an open-label, single-dose pharmacokinetic (PK) evaluation of 100 mg RVX000222 on dialysis and non-dialysis days in eight (8) End Stage Renal Disease (ESRD) patients who receive hemodialysis as standard of care. Part B of the study is a double-blind, placebo-controlled study in up to thirty six (36) ESRD patients receiving hemodialysis using a sequential cross-over design with RVX000222 at a daily oral dose of 100 mg b.i.d. (200 mg per day) or matching placebo in combination with SoC. The primary objective of the study is to evaluate if treatment with RVX000222 in combination with standard of care (SoC) decreases plasma alkaline phosphatase in comparison to placebo and SoC.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Kidney Failure, Chronic
    Keywords
    Chronic Kidney Failure, ESRD, End-Stage Kidney Disease, End-Stage Renal Disease, Renal Disease, End-Stage, Renal Failure, Chronic, Renal Failure, End-Stage

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1, Phase 2
    Interventional Study Model
    Sequential Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    44 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Part A PK Arm
    Arm Type
    Experimental
    Arm Description
    a single 100 mg dose of RVX000222 (apabetalone) on the day of dialysis, followed by a one (1) week washout period, and a second dose of RVX000222 (apabetalone) administered on a non-dialysis day (total of two (2) 100 mg RVX000222 doses)
    Arm Title
    Part B Sequence A
    Arm Type
    Placebo Comparator
    Arm Description
    RVX000222 (apabetalone) 100 mg b.i.d (total 200 mg/day) for 6 weeks; 4 Week Washout (No RVX000222/placebo administration); Placebo b.i.d for 6 weeks
    Arm Title
    Part B Sequence B
    Arm Type
    Placebo Comparator
    Arm Description
    Placebo b.i.d for 6 weeks; 4 Week Washout (No RVX000222/placebo administration); RVX000222 (apabetalone) 100 mg b.i.d (total 200 mg/day) for 6 weeks
    Intervention Type
    Drug
    Intervention Name(s)
    apabetalone
    Other Intervention Name(s)
    RVX000222, RVX-208
    Intervention Description
    RVX000222 oral (apabetalone), 100 mg capsule
    Intervention Type
    Drug
    Intervention Name(s)
    Placebos
    Other Intervention Name(s)
    Matching placebo
    Intervention Description
    matching placebo capsule
    Primary Outcome Measure Information:
    Title
    Percent change in alkaline phosphatase (ALP) concentration (Part B)
    Description
    The primary endpoint of the study is the comparison of the RVX000222 treatment period to the placebo period in the percent change in ALP concentration. Percent change is computed relative to the beginning of each period.
    Time Frame
    Percent change is computed relative to the beginning of each period (6 weeks)
    Title
    Single Dose Cmax of RVX000222 (apabetalone) and the Metabolites RVX000288 and RVX000404
    Description
    Primary PK comparison between dialysis (test) and non-dialysis (reference) days for Cmax of RVX000222 and its two principal metabolites, RVX000288 and RVX000404
    Time Frame
    48 hours
    Title
    Single Dose AUC of RVX000222 (apabetalone) and the Metabolites RVX000288 and RVX000404
    Description
    Primary PK comparison between dialysis (test) and non-dialysis (reference) days for AUC of RVX000222 and its two principal metabolites, RVX000288 and RVX000404
    Time Frame
    48 hours
    Secondary Outcome Measure Information:
    Title
    Changes in high-sensitivity C-Reactive Protein (hsCRP)
    Description
    Changes in hsCRP in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks
    Title
    Changes in Interleukin-13 (IL-13)
    Description
    Changes in IL-13 in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks
    Title
    Changes in Interleukin-6 (IL-6)
    Description
    Changes in IL-6 in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks
    Title
    Changes in Interleukin-8 (IL-8)
    Description
    Changes in IL-8 in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks
    Title
    Changes in Monocyte Chemoattractant Protein-1 (MCP-1)
    Description
    Changes in MCP-1 in dialysis patients at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks
    Title
    Change in key markers of vascular mineralization
    Description
    Change in key markers of vascular mineralization i.e. RANKL and osteoprotegerin at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks
    Title
    Changes in ALP isoenzymes
    Description
    Changes in ALP isoenzymes at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks
    Title
    Changes in Parathyroid hormone (PTH)
    Description
    Changes in parathyroid hormone at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks
    Title
    Change in apolipoprotein A1 (apoA-I), HDL-C, LDL-C, apolipoprotein B (apoB), and triglycerides
    Description
    Change in apoA-I, HDL-C, LDL-C, apoB, and triglycerides at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks
    Title
    Change in Analyzing Data, Recognizing Excellence and Optimizing Outcomes All-Cause Mortality Risk Score For Patients on Chronic Hemodialysis (ARO Score)
    Description
    Change in ARO Score at the end of the RVX000222 treatment period relative to the end of the placebo period
    Time Frame
    6 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    80 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Men or women ≥18 and ≤80 years of age. Diagnosis of end-stage renal disease and receiving hemodialysis an average of three (3) times per week for at least ninety (90) days prior to Enrollment/Visit 2. Clinically stable, in the judgment of the investigator. Female subjects must meet one of the following: If of childbearing potential, must have a negative serum pregnancy test and be willing and able to use medically acceptable non-hormonal method of birth control (non-hormonal intrauterine device, condom, or diaphragm) or remain abstinent from Screen until Follow-up Visit, or Be of non-child-bearing potential: post-surgical sterilization (hysterectomy or a bilateral oophorectomy) or post-menopausal. Post-menopausal is defined as amenorrhea for ≥2 years at Screen/Visit 1. In the view of the investigator, during the course of the trial, subject is expected to: remain on unchanged standard of care medication from 4 weeks prior to Enrollment/Visit 2. not require hospitalization for any condition other than routine hemodialysis. Have given signed informed consent to participate in the study. Exclusion Criteria: Planned major surgery in the next 4 months, including renal transplant, from Enrollment/Visit 2. Major surgery, in the judgement of the investigator, within 12 weeks before enrollment/Visit 2 (excluding vascular access surgery). Hospitalization for congestive heart failure, myocardial infarction, deep vein thrombosis, stroke or transient ischemic attack or peripheral arterial disease within 6 months before Enrollment/Visit 2. New York Heart Association (NYHA) Classification, Class III or IV Heart Failure at Screen/Visit 1. Diastolic blood pressure >110 mm Hg or systolic blood pressure >180 mm Hg during screen. Currently receiving antibiotic therapy for systemic infection. In the judgement of the Investigator, evidence of active hepatitis. Hepatitis serology testing will be performed at Screen/Visit 1. History of malignancy of any organ system, treated or untreated, within the past 2 years whether or not there is evidence of local recurrence or metastases, with the exception of localized basal cell carcinoma of the skin. Red blood cell (RBC) transfusions within 12 weeks before Enrollment/Visit 2. Current or recent (within 12 months prior to Visit 1) treatment with immunosuppressants (e.g., cyclosporine). Use of fibrates at any dose or niacin/nicotinic acid 250 mg or more within 30 days prior to Screen/Visit 1. Diagnosis of systemic hematologic disease (e.g., sickle cell anemia, myelodysplastic syndromes, hematologic malignancy, myeloma, hemolytic anemia). Hemoglobin <9.5 g/dL at Screen/Visit 1. Alanine aminotransferase (ALT) >1.5 x upper limit of normal (ULN) at Screen/Visit 1. Bilirubin >1.0 x ULN at Screen/Visit 1. Pregnant or breast-feeding women. Any condition which, in the opinion of the investigator, may place the subject at higher risk from his/her participation in the study, or is likely to prevent the subject from complying with the requirements of the study or completing the study. Treatment with an investigational agent or device within 30 days or 5 half-lives before Enrollment/Visit 2 or scheduled to receive an investigational agent other than those specified by this protocol during the course of this study. History of noncompliance with medical regimens or unwillingness to comply with the study protocol. In the judgement of the Investigator, any disorder that may impact the ability to give informed consent for participation in this study. Any condition that, in the opinion of the investigator, would confound the evaluation and interpretation of efficacy and/or safety data. Persons directly involved in the execution of this protocol. Exclusion Criteria, Part A Only: Are unwilling to abstain from alcoholic beverages, caffeine or xanthine-containing products (e.g., tea, coffee, chocolate, cola), and use of nicotine products from 24 hours prior to Clinical Research Unit (CRU) admission to 48 hours post RVX000222 dose administration. Exclusion Criteria, Part B Only: 23. Parathyroid hormone, intact (PTH, intact) <150 pg/mL or >800 pg/mL at Screen/Visit 1.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Sr. Director of Clinical Operations
    Phone
    403-254-9252
    Email
    clinicaltrials@resverlogix.com

    12. IPD Sharing Statement

    Plan to Share IPD
    Undecided

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    A Two-Part Phase 2a Study of RVX000222 in Patients With End-Stage Renal Disease Treated With Hemodialysis

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