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Oral PTH(1-34) PK and PD Study in Patients With Hypoparathyroidism

Primary Purpose

Hypoparathyroidism

Status
Completed
Phase
Phase 2
Locations
Israel
Study Type
Interventional
Intervention
EB612 (EBP05)
NATPARA/NATPAR
Sponsored by
Entera Bio Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hypoparathyroidism focused on measuring Hypoparathyroidism, PTH(1-34), Parathyroid Hormone

Eligibility Criteria

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

-Criteria for Inclusion:

  1. Confirmed diagnosis of primary hypoparathyroidism, as defined by the European Society of Endocrinology as a patient with hypocalcemia and inappropriately low PTH levels. If the source of hypoparathyroidism is surgical or iatrogenic, diagnosis must be for more than 1 year. If the source of hypoparathyroidism is not surgical or iatrogenic, and confirmed by inappropriately low PTH levels and hypercalciuria, diagnosis does not have time limitations.
  2. 1, 25(OH)2D levels ≥20 ng/mL.
  3. Signed Informed Consent Form).
  4. Age 18 to 80 years with body mass index of 19 to 35 kg/m2.
  5. Patients able to adhere to the visit schedule and protocol requirements.

Criteria for Exclusion:

  1. Known history of hypoparathyroidism resulting from an activating mutation in the calcium sensing receptor gene or impaired responsiveness to PTH (pseudohypoparathyroidism).
  2. Hemoglobin <11.5 g/dL (females) / <12.5g/dL (males) [lower limit of reference range, 12 to 15 g/dL and 13 to 17 g/dL]
  3. Acute or chronic renal failure (estimated glomerular filtration rate <60 mL/min/1.73 m²).
  4. Significant liver function impairment (liver enzymes above ×2 the upper limit of normal range).
  5. Patients with hypomagnesemia should be excluded unless serum magnesium is corrected prior to study initiation.
  6. Active gastrointestinal inflammatory, gastrointestinal motility disorders, and chronic gastritis, such as ulcerative colitis, Crohn's disease, irritable bowel syndrome, short bowel syndrome, celiac disease, gastroparesis, etc.
  7. Active hepatitis or acquired immunodeficiency syndrome (AIDS)/AIDS-related syndrome
  8. Any conditions or factors that, in the judgment of the Investigator, somehow may impact gastrointestinal absorption.
  9. Concurrent therapy with the following medications: (1) 14 days: thiazide diuretics; loop diuretics (2) 30 days: lithium, systemic corticosteroid; (3) 1 month: calcitonin, cinacalcet hydrochloride, recombinant PTH(1-84) or N-terminal PTH or PTH-related peptide fragments or analogs; (4) females only; changes in hormone replacement therapy within 2 months; (5) 3 months: methotrexate, growth hormone, digoxin; raloxifene or similar selective estrogen receptor modulators; (7) chronic or concurrent use of gastrointestinal motility modulators (domperidone, loperamide, erythromycin metoclopramide etc.); and (8) other concurrent therapy that, in the Investigator's opinion, would interfere with the evaluation of the safety or efficacy of the study medication.
  10. Significant drug or alcohol abuse as assessed by the PI.
  11. Treatment with any investigational product within the last 30 days or 5 half-lives (if known) whichever is longer.
  12. Has participated as a patient in any investigational drug study within the last 30 days preceding the screening visit or plans to participate in another investigational drug study at any time during the study or within 30 days of his/her completion of this study.
  13. Presence of any other condition or circumstance that, in the judgment of the Investigator, might increase the risk to the patient or decrease the chance of obtaining satisfactory data to achieve the objectives of the study.
  14. Historical documented allergy to soy bean products or known hypersensitivity to the PTH (1-34).
  15. Patients at increased risk for osteosarcoma, such as those with Paget's disease of bone or unexplained elevations of alkaline phosphatase, hereditary disorders predisposing to osteosarcoma, or with a prior history of external beam or implant radiation involving the skeleton.
  16. Patients with skeletal malignancies or bone metastases.
  17. Pregnancy or suspected pregnancy or lactating. Female patients of childbearing potential must have a negative pregnancy test at screening and be willing and able to use two medically acceptable methods of birth control (reliable use of oral contraceptive with physical barrier, non-hormonal intrauterine device with condom, diaphragm with condom, or condom with spermicide) from the screening visit through 90 days from last dose or declare that they are abstaining from sexual intercourse from the screening visit through the study termination visit or are surgically sterile (have undergone bilateral tubal ligation, bilateral oophorectomy, or hysterectomy) or postmenopausal. True abstinence can only be in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, and postovulation methods), declaration of abstinence for the duration of a study, and withdrawal are not acceptable methods of contraception.

Childbearing potential is defined as those who are not surgically sterile (i.e., bilateral tubal ligation, bilateral oophorectomy, or complete hysterectomy) or postmenopausal. Women will be defined as postmenopausal if they have been amenorrheic for 12 months (prior to signature of Informed Consent Form) without an alternative medical cause.

Sites / Locations

  • Clinical Research Center Hadassah Ein Kerem Medical Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Active Comparator

Experimental

Experimental

Arm Label

Treatment A

Treatment B

Treatment C

Treatment D

Treatment E - EB612 (EBP05)

Arm Description

Intervention: EB612 (EBP05) 2.25 mg orally (PO) four times a day (QID) (approximately 5 hours apart) for 4 doses, for a total dose of 9 mg per day

Intervention: EB612 (EBP05) 2.25 mg PO twice a day (BID) (approximately 10 hours apart) for 2 doses, for a total dose of 4.5 mg per day

Intervention: NATPARA/NATPAR PTH(1-84) 100 μg subcutaneous injection once daily (single dose)

Intervention: EB612 (EBP05) 2.25 mg PO TID (dose 1 and dose 2 approximately 10 hours apart; dose 2 and dose 3 approximately 5 hours apart- TID schedule option 2), for a total dose of 6.75 mg per day

Intervention: EB612 (EBP05) 0.75 mg PO TID (dose 1 and dose 2 approximately 10 hours apart; dose 2 and dose 3 approximately 5 hours apart- TID schedule option 2), for a total dose of 2.25 mg per day

Outcomes

Primary Outcome Measures

Plasma PTH(1-34) levels
Pharmacokinetic Parameter
Serum albumin-adjusted total calcium levels
Pharmacodynamic Parameter
urinary calcium levels
Pharmacodynamic Parameter

Secondary Outcome Measures

Adverse Events
Safety Parameter
Rate of Adverse Events leading to discontinuation
Tolerability Parameter

Full Information

First Posted
April 23, 2018
Last Updated
March 22, 2019
Sponsor
Entera Bio Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT03516773
Brief Title
Oral PTH(1-34) PK and PD Study in Patients With Hypoparathyroidism
Official Title
An Evaluation of the Pharmacokinetics and Pharmacodynamics of Oral Parathyroid Hormone [PTH (1-34)] and NATPARA® in Patients With Hypoparathyroidism
Study Type
Interventional

2. Study Status

Record Verification Date
March 2019
Overall Recruitment Status
Completed
Study Start Date
June 17, 2018 (Actual)
Primary Completion Date
December 5, 2018 (Actual)
Study Completion Date
February 24, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Entera Bio Ltd.

4. Oversight

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

5. Study Description

Brief Summary
A Randomized, active comparator, two-part, partial crossover design. The study is designed to assess the pharmacokinetics and pharmacodynamics of EnteraBio's Oral PTH(1-34) [EB612 (EBP05)] in adult patients with hypoparathyroidism.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hypoparathyroidism
Keywords
Hypoparathyroidism, PTH(1-34), Parathyroid Hormone

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
Randomized, active comparator, two-part, within-part, partial crossover design.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment A
Arm Type
Experimental
Arm Description
Intervention: EB612 (EBP05) 2.25 mg orally (PO) four times a day (QID) (approximately 5 hours apart) for 4 doses, for a total dose of 9 mg per day
Arm Title
Treatment B
Arm Type
Experimental
Arm Description
Intervention: EB612 (EBP05) 2.25 mg PO twice a day (BID) (approximately 10 hours apart) for 2 doses, for a total dose of 4.5 mg per day
Arm Title
Treatment C
Arm Type
Active Comparator
Arm Description
Intervention: NATPARA/NATPAR PTH(1-84) 100 μg subcutaneous injection once daily (single dose)
Arm Title
Treatment D
Arm Type
Experimental
Arm Description
Intervention: EB612 (EBP05) 2.25 mg PO TID (dose 1 and dose 2 approximately 10 hours apart; dose 2 and dose 3 approximately 5 hours apart- TID schedule option 2), for a total dose of 6.75 mg per day
Arm Title
Treatment E - EB612 (EBP05)
Arm Type
Experimental
Arm Description
Intervention: EB612 (EBP05) 0.75 mg PO TID (dose 1 and dose 2 approximately 10 hours apart; dose 2 and dose 3 approximately 5 hours apart- TID schedule option 2), for a total dose of 2.25 mg per day
Intervention Type
Drug
Intervention Name(s)
EB612 (EBP05)
Other Intervention Name(s)
Oral PTH(1-34)
Intervention Description
Entera Bio's proprietary drug for the administration of PTH(1-34) orally
Intervention Type
Drug
Intervention Name(s)
NATPARA/NATPAR
Other Intervention Name(s)
PTH(1-84)
Intervention Description
A PTH replacement (PTH [1-84]; NATPARA (Shire-NPS Pharmaceuticals, Inc., Lexington, Massachusetts) was approved by the United States (US) Food and Drug Administration (FDA) in April 2015 / NATPAR (Shire Pharmaceuticals Ltd., Dublin, Ireland) was approved by the European Medicines Agency in April 2017 for use as an adjunct to calcium and vitamin D to control hypocalcemia in patients with hypoparathyroidism. Like many other hormonally active peptides, PTH (1 84); NATPARA is parenterally administered. In this protocol when a specific formulation is referenced (e.g. NATPARA) it may be read interchanged with the alternate formulation (e.g. NATPAR).
Primary Outcome Measure Information:
Title
Plasma PTH(1-34) levels
Description
Pharmacokinetic Parameter
Time Frame
18 weeks
Title
Serum albumin-adjusted total calcium levels
Description
Pharmacodynamic Parameter
Time Frame
18 weeks
Title
urinary calcium levels
Description
Pharmacodynamic Parameter
Time Frame
18 weeks
Secondary Outcome Measure Information:
Title
Adverse Events
Description
Safety Parameter
Time Frame
60 days
Title
Rate of Adverse Events leading to discontinuation
Description
Tolerability Parameter
Time Frame
60 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
-Criteria for Inclusion: Confirmed diagnosis of primary hypoparathyroidism, as defined by the European Society of Endocrinology as a patient with hypocalcemia and inappropriately low PTH levels. If the source of hypoparathyroidism is surgical or iatrogenic, diagnosis must be for more than 1 year. If the source of hypoparathyroidism is not surgical or iatrogenic, and confirmed by inappropriately low PTH levels and hypercalciuria, diagnosis does not have time limitations. 1, 25(OH)2D levels ≥20 ng/mL. Signed Informed Consent Form). Age 18 to 80 years with body mass index of 19 to 35 kg/m2. Patients able to adhere to the visit schedule and protocol requirements. Criteria for Exclusion: Known history of hypoparathyroidism resulting from an activating mutation in the calcium sensing receptor gene or impaired responsiveness to PTH (pseudohypoparathyroidism). Hemoglobin <11.5 g/dL (females) / <12.5g/dL (males) [lower limit of reference range, 12 to 15 g/dL and 13 to 17 g/dL] Acute or chronic renal failure (estimated glomerular filtration rate <60 mL/min/1.73 m²). Significant liver function impairment (liver enzymes above ×2 the upper limit of normal range). Patients with hypomagnesemia should be excluded unless serum magnesium is corrected prior to study initiation. Active gastrointestinal inflammatory, gastrointestinal motility disorders, and chronic gastritis, such as ulcerative colitis, Crohn's disease, irritable bowel syndrome, short bowel syndrome, celiac disease, gastroparesis, etc. Active hepatitis or acquired immunodeficiency syndrome (AIDS)/AIDS-related syndrome Any conditions or factors that, in the judgment of the Investigator, somehow may impact gastrointestinal absorption. Concurrent therapy with the following medications: (1) 14 days: thiazide diuretics; loop diuretics (2) 30 days: lithium, systemic corticosteroid; (3) 1 month: calcitonin, cinacalcet hydrochloride, recombinant PTH(1-84) or N-terminal PTH or PTH-related peptide fragments or analogs; (4) females only; changes in hormone replacement therapy within 2 months; (5) 3 months: methotrexate, growth hormone, digoxin; raloxifene or similar selective estrogen receptor modulators; (7) chronic or concurrent use of gastrointestinal motility modulators (domperidone, loperamide, erythromycin metoclopramide etc.); and (8) other concurrent therapy that, in the Investigator's opinion, would interfere with the evaluation of the safety or efficacy of the study medication. Significant drug or alcohol abuse as assessed by the PI. Treatment with any investigational product within the last 30 days or 5 half-lives (if known) whichever is longer. Has participated as a patient in any investigational drug study within the last 30 days preceding the screening visit or plans to participate in another investigational drug study at any time during the study or within 30 days of his/her completion of this study. Presence of any other condition or circumstance that, in the judgment of the Investigator, might increase the risk to the patient or decrease the chance of obtaining satisfactory data to achieve the objectives of the study. Historical documented allergy to soy bean products or known hypersensitivity to the PTH (1-34). Patients at increased risk for osteosarcoma, such as those with Paget's disease of bone or unexplained elevations of alkaline phosphatase, hereditary disorders predisposing to osteosarcoma, or with a prior history of external beam or implant radiation involving the skeleton. Patients with skeletal malignancies or bone metastases. Pregnancy or suspected pregnancy or lactating. Female patients of childbearing potential must have a negative pregnancy test at screening and be willing and able to use two medically acceptable methods of birth control (reliable use of oral contraceptive with physical barrier, non-hormonal intrauterine device with condom, diaphragm with condom, or condom with spermicide) from the screening visit through 90 days from last dose or declare that they are abstaining from sexual intercourse from the screening visit through the study termination visit or are surgically sterile (have undergone bilateral tubal ligation, bilateral oophorectomy, or hysterectomy) or postmenopausal. True abstinence can only be in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, and postovulation methods), declaration of abstinence for the duration of a study, and withdrawal are not acceptable methods of contraception. Childbearing potential is defined as those who are not surgically sterile (i.e., bilateral tubal ligation, bilateral oophorectomy, or complete hysterectomy) or postmenopausal. Women will be defined as postmenopausal if they have been amenorrheic for 12 months (prior to signature of Informed Consent Form) without an alternative medical cause.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Arthur Santora, MD
Organizational Affiliation
Entera Bio Ltd.
Official's Role
Study Chair
Facility Information:
Facility Name
Clinical Research Center Hadassah Ein Kerem Medical Center
City
Jerusalem
ZIP/Postal Code
91120,
Country
Israel

12. IPD Sharing Statement

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Oral PTH(1-34) PK and PD Study in Patients With Hypoparathyroidism

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