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Pharmacokinetics, Tolerability and Safety of NEX-18a

Primary Purpose

Myelodysplastic Syndromes (MDS), Chronic Myelomonocytic Leukemia (CMML), Acute Myeloid Leukemia (AML)

Status
Completed
Phase
Phase 1
Locations
Sweden
Study Type
Interventional
Intervention
NEX-18a injection
Azacitidine Injection
Sponsored by
Nanexa AB
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myelodysplastic Syndromes (MDS)

Eligibility Criteria

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

Inclusion Criteria:

  1. Provision of written informed consent prior to any study specific procedures.
  2. Female and male patients ≥ 18 years of age.
  3. Body Mass Index (BMI) > 19 and < 30 kg/m2 BSA at screening.
  4. Treatment with azacitidine corresponding to 100 mg/m2 BSA x 5 per treatment cycle for at least six cycles for:

    1. intermediate-2 and high-risk myelodysplastic syndromes (MDS) according to the International Prognostic Scoring System (IPSS)
    2. chronic myelomonocytic leukemia (CMML) with 10-29 % marrow blasts
    3. acute myeloid leukemia (AML) according to World Health Organization (WHO) classification
  5. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.
  6. Recovery of Hematology and Clin. Chemistry assessment according to clinical praxis at the start of the last azacitidine treatment cycle before the screening visit.
  7. Female subject must be of non-childbearing potential (defined as pre-menopausal females with a documented tubal ligation or hysterectomy or bilateral oophorectomy; or as post-menopausal females defined as 12 months' amenorrhoea [in questionable cases a blood sample with simultaneous follicle stimulation hormone 25-140 IE/L and estradiol < 200 pmol/L is confirmatory])
  8. Male patients must agree to use an adequate method of contraception. Male patients who are sexually active must use, with their partner, a condom AND one of the following methods of highly effective contraception from the time of IMP administration until 90 days after the last dose of IMP.

    1. oral (except low-dose gestagen (lynestrenol and norestisteron)), injectable or implanted hormonal contraceptives
    2. intrauterine device
    3. intrauterine system (for example progestin-releasing coil)
    4. vasectomized male (with appropriate post vasectomy documentation of the absence of sperm in the ejaculate)
    5. bilateral tubal occlusion or hysterectomy
  9. Willingness and ability to comply with study procedures, visit schedules, study restrictions, and requirements.

Exclusion Criteria:

  1. The patient has participated in any other investigational/interventional trial including an investigational drug within 30 days (or five half-lives of the study drug prior to screening, whichever is longer) prior to screening.
  2. Diagnosis of malignant disease within the previous 5 years (excluding basal cell carcinoma of the skin without complications, "in-situ" carcinoma of the cervix or breast, or other local malignancy excised or irradiated with a high probability of cure).
  3. Any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the patient from participating in the study.
  4. The patient has a history of alcohol abuse or drug abuse within the past 12 months.
  5. Any condition including the presence of laboratory abnormalities, which places the patient at unacceptable risk if he/she were to participate in the study.
  6. Lack of suitability for participation in the study, for any reason, judged by the Investigator.

Sites / Locations

  • Karolinska University Hospital Huddinge
  • Kliniska Forsknings och Utvecklings Enheten KFUE

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Azacitidine

NEX-18a

Arm Description

Treatment phase 1: the patients will receive regular treatment with azacitidine for 4 days. Treatment phase 2: the patients will receive regular treatment with azacitidine for 3 days.

Treatment phase 1: the azacitidine dose for day 5 will be replaced by a single dose NEX-18a Treatment phase 2: the azacitidine dose for day 4 and 5 will be replaced by a single dose NEX-18a

Outcomes

Primary Outcome Measures

Hematology and Clinical Chemistry analyses
Change from baseline to 30 days follow-up. Descriptive individual data.
Adverse events
Change from baseline to 30 days follow-up. Descriptive individual data.
Vital signs
Change from baseline to 30 days follow-up. Descriptive individual data.
Physical examination
Change from baseline to 30 days follow-up. Descriptive individual data.
Local tolerance (injection site)
Change from baseline to 30 days follow-up. Descriptive individual data.
Concomitant medications/therapy
Change from baseline to 30 days follow-up. Descriptive individual data.

Secondary Outcome Measures

AUC-time curve
From time 0 to 24 hours
AUC from time 0-last
From time 0 to last
AUC from time 0 to infinity
From time 0 to infinity
Plasma Concentration
Maximum Plasma Concentration
Plasma Concentration over time
Plasma Concentration at 336h
Half-life measurement
Terminal elimination half-life
Measurement of distribution
Volume of distribution
Elimination
Clearance
Local tolerance of NEX-18a
Change from baseline to 30 days follow-up. Descriptive individual data. The local tolerance will be measured by inspection of injection sites. Pain, tenderness erythema/redness, and induration/swelling will be assessed by a four-grade scale where 1 is mild and 4 is potentially life threatening.

Full Information

First Posted
May 11, 2021
Last Updated
October 16, 2023
Sponsor
Nanexa AB
Collaborators
Uppsala University
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1. Study Identification

Unique Protocol Identification Number
NCT05048498
Brief Title
Pharmacokinetics, Tolerability and Safety of NEX-18a
Official Title
An Open Pilot Study to Assess the Pharmacokinetics, Tolerability, and Safety of NEX-18a Given as a Subcutaneous Injection for the Treatment of Intermediate 2 or Higher-risk MDS, CMML or AML
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Completed
Study Start Date
April 27, 2021 (Actual)
Primary Completion Date
February 10, 2022 (Actual)
Study Completion Date
February 10, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nanexa AB
Collaborators
Uppsala University

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
The study will evaluate the safety, tolerability and pharmacokinetics of NEX-18a, a long-acting injectable azacitidine, in patients diagnosed with intermediate 2 or higher-risk MDS, CMML, or AML and already on treatment with azacitidine.
Detailed Description
Since 2010, subcutaneous treatment with azacitidine has been the first-line treatment for patients with high-risk MDS. Azacitidine has been established as a standard of care and is described in the National Comprehensive Cancer Network (NCCN) guidelines as a core component of optimal treatment of MDS. However, mainly due to its short half-life (41 minutes) when administered subcutaneously azacitidine should, according to the approved label, be administered for seven consecutive days at a dose of 75 mg/m2 body surface area (BSA) each 28-day cycle. In the Nordic Guidelines, two alternative dosing schedules may also be considered: 100 mg/m2 BSA sc day 1-5 or 75 mg/m2 BSA sc day 1-5 + 8-9 (to avoid injection during weekends). Nanexa AB has developed NEX-18a, a subcutaneous injection of azacitidine with extended-release based on the drug delivery system, PharmaShell®. Drug particles are enclosed in a coating with controlled solubility, and as the coating dissolves over time the drug is released in a predefined manner. This technique provides a way to create drugs with a prolonged release for parenteral administration. The technology used by Nanexa to manufacture the coating is via Atomic Layer Deposition (ALD). In ALD, reactive gases are used which build up a surface coating with high precision, atomic layer by atomic layer. NEX-18a will offer a benefit to current azacitidine treatment with a reduction of subcutaneous administrations, decreased need for pre-medication, and will reduce the time each patient has to spend in the hospital in order to receive the treatment in each cycle. In addition, the patients will spend less time traveling to and from the hospital and from a health care perspective, one injection instead of seven per cycle will reduce the time and the resources the health care provider dedicates to treating the patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myelodysplastic Syndromes (MDS), Chronic Myelomonocytic Leukemia (CMML), Acute Myeloid Leukemia (AML)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Azacitidine
Arm Type
Active Comparator
Arm Description
Treatment phase 1: the patients will receive regular treatment with azacitidine for 4 days. Treatment phase 2: the patients will receive regular treatment with azacitidine for 3 days.
Arm Title
NEX-18a
Arm Type
Experimental
Arm Description
Treatment phase 1: the azacitidine dose for day 5 will be replaced by a single dose NEX-18a Treatment phase 2: the azacitidine dose for day 4 and 5 will be replaced by a single dose NEX-18a
Intervention Type
Drug
Intervention Name(s)
NEX-18a injection
Other Intervention Name(s)
PharmaShell, Azacitidine, 5-azacitidine
Intervention Description
In Treatment phase 1, NEX-18a will be given as a single subcutaneous injection. In Treatment phase 2, NEX-18a will be given as a single subcutaneous injection.
Intervention Type
Drug
Intervention Name(s)
Azacitidine Injection
Other Intervention Name(s)
Azacitidine, 5-azacitidine, Vidaza
Intervention Description
In Treatment phase 1, azacitidine will be administered once daily for four days. In Treatment phase 2, azacitidine will be administered once daily for three days.
Primary Outcome Measure Information:
Title
Hematology and Clinical Chemistry analyses
Description
Change from baseline to 30 days follow-up. Descriptive individual data.
Time Frame
0-30 days
Title
Adverse events
Description
Change from baseline to 30 days follow-up. Descriptive individual data.
Time Frame
0-30 days
Title
Vital signs
Description
Change from baseline to 30 days follow-up. Descriptive individual data.
Time Frame
0-30 days
Title
Physical examination
Description
Change from baseline to 30 days follow-up. Descriptive individual data.
Time Frame
0-30 days
Title
Local tolerance (injection site)
Description
Change from baseline to 30 days follow-up. Descriptive individual data.
Time Frame
0-30 days
Title
Concomitant medications/therapy
Description
Change from baseline to 30 days follow-up. Descriptive individual data.
Time Frame
0-30 days
Secondary Outcome Measure Information:
Title
AUC-time curve
Description
From time 0 to 24 hours
Time Frame
0-24 h
Title
AUC from time 0-last
Description
From time 0 to last
Time Frame
0-336 h
Title
AUC from time 0 to infinity
Description
From time 0 to infinity
Time Frame
0-336 h
Title
Plasma Concentration
Description
Maximum Plasma Concentration
Time Frame
0-336 h
Title
Plasma Concentration over time
Description
Plasma Concentration at 336h
Time Frame
0-336 h
Title
Half-life measurement
Description
Terminal elimination half-life
Time Frame
0-336 h
Title
Measurement of distribution
Description
Volume of distribution
Time Frame
0-336 h
Title
Elimination
Description
Clearance
Time Frame
0-336 h
Title
Local tolerance of NEX-18a
Description
Change from baseline to 30 days follow-up. Descriptive individual data. The local tolerance will be measured by inspection of injection sites. Pain, tenderness erythema/redness, and induration/swelling will be assessed by a four-grade scale where 1 is mild and 4 is potentially life threatening.
Time Frame
0-30 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Provision of written informed consent prior to any study specific procedures. Female and male patients ≥ 18 years of age. Body Mass Index (BMI) > 19 and < 30 kg/m2 BSA at screening. Treatment with azacitidine corresponding to 100 mg/m2 BSA x 5 per treatment cycle for at least six cycles for: intermediate-2 and high-risk myelodysplastic syndromes (MDS) according to the International Prognostic Scoring System (IPSS) chronic myelomonocytic leukemia (CMML) with 10-29 % marrow blasts acute myeloid leukemia (AML) according to World Health Organization (WHO) classification Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2. Recovery of Hematology and Clin. Chemistry assessment according to clinical praxis at the start of the last azacitidine treatment cycle before the screening visit. Female subject must be of non-childbearing potential (defined as pre-menopausal females with a documented tubal ligation or hysterectomy or bilateral oophorectomy; or as post-menopausal females defined as 12 months' amenorrhoea [in questionable cases a blood sample with simultaneous follicle stimulation hormone 25-140 IE/L and estradiol < 200 pmol/L is confirmatory]) Male patients must agree to use an adequate method of contraception. Male patients who are sexually active must use, with their partner, a condom AND one of the following methods of highly effective contraception from the time of IMP administration until 90 days after the last dose of IMP. oral (except low-dose gestagen (lynestrenol and norestisteron)), injectable or implanted hormonal contraceptives intrauterine device intrauterine system (for example progestin-releasing coil) vasectomized male (with appropriate post vasectomy documentation of the absence of sperm in the ejaculate) bilateral tubal occlusion or hysterectomy Willingness and ability to comply with study procedures, visit schedules, study restrictions, and requirements. Exclusion Criteria: The patient has participated in any other investigational/interventional trial including an investigational drug within 30 days (or five half-lives of the study drug prior to screening, whichever is longer) prior to screening. Diagnosis of malignant disease within the previous 5 years (excluding basal cell carcinoma of the skin without complications, "in-situ" carcinoma of the cervix or breast, or other local malignancy excised or irradiated with a high probability of cure). Any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the patient from participating in the study. The patient has a history of alcohol abuse or drug abuse within the past 12 months. Any condition including the presence of laboratory abnormalities, which places the patient at unacceptable risk if he/she were to participate in the study. Lack of suitability for participation in the study, for any reason, judged by the Investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ulla Olsson Strömberg, MD
Organizational Affiliation
Uppsala University, Uppsala, Sweden
Official's Role
Principal Investigator
Facility Information:
Facility Name
Karolinska University Hospital Huddinge
City
Huddinge
Country
Sweden
Facility Name
Kliniska Forsknings och Utvecklings Enheten KFUE
City
Uppsala
Country
Sweden

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Pharmacokinetics, Tolerability and Safety of NEX-18a

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