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Pilot Study of Safety, Tolerability, Pharmacokinetics/Pharmacodynamics of RP103 Compared to Cystagon® in Patients With Cystinosis

Primary Purpose

Cystinosis

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Cystagon®
RP103
Sponsored by
Horizon Pharma USA, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cystinosis focused on measuring cystinosis, cysteamine, inheritable disease, orphan disease, CTNS protein, human, nephropathic cystinosis

Eligibility Criteria

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

Inclusion Criteria:

  • Male and female subjects must have nephropathic cystinosis.
  • Children less than 22.5 kg will only be included in the study if the investigator feels they can safely participate in the study including the required blood draw volume for the safety and PK/PD assessments.
  • Subjects must be on a stable dose of Cystagon® at least 21 days prior to Screening.
  • Subjects must be able to swallow a 150 mg Cystagon® capsule with the capsule intact.
  • Within the last 2 months, no clinically significant change in liver function [i.e., ALT, AST, alkaline phosphatase, bilirubin (total and direct)] and renal function [i.e., serum creatinine, albumin, total protein] at Screening as determined by the Investigator.
  • Sexually active female subjects of childbearing potential (i.e., not surgically sterile [tubal ligation, hysterectomy, or bilateral oophorectomy] or at least 2 years naturally postmenopausal) must agree to utilize the same acceptable form of contraception from screening through completion of the study.
  • Subjects or their authorized caregiver must provide written informed consent and assent (where applicable) prior to participation in the study.
  • If in the opinion of the investigator, patients can safely provide the study required blood draw volume.
  • Subjects must be willing and able to comply with the study restrictions and requirements.

Exclusion Criteria:

  • If, in the opinion of the investigator, the planned study dose would exceed the patient's tolerability of cysteamine based on their prior Cystagon® steady state drug requirements.
  • Evidence of or verbal attestation of Helicobacter pylori infection, presently, or within the last 90 days prior to Screening.
  • Subjects with a known history, currently or within the past 90 days prior to Screening, of the following conditions or other health issues that make it, in the opinion of the investigator, unsafe for them to participate, or whose concomitant medical problems preclude them from committing to the study schedule including the following: Crohn's disease, inflammatory bowel disease (if currently active) or have had prior resection of small intestine; • History of heart disease, e.g., myocardial infarction, heart failure, arrhythmias; Any bleeding disorder; Malignant disease; Severe liver disease as defined as ALT or AST > 2 times the upper limit of normal.
  • Subjects who have had a kidney transplant.
  • Subjects who are planning or are a registered candidate for a kidney transplant within 3 months of the Screening or have a serum creatinine > 2.4.
  • Subjects with known hypersensitivity to cysteamine.
  • If female (of child-bearing potential), are nursing, planning a pregnancy, known or suspected to be pregnant, or have a positive urine pregnancy screen.
  • Patients with a hemoglobin level < 10.5.
  • Subjects who have a made a blood donation within 60 days prior to study initiation.
  • Subjects who, in the opinion of the Investigator, are not able or willing to comply with the protocol.

Sites / Locations

  • University of California San Diego Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Cystagon®

RP103

Arm Description

Reference Product: Cystagon® (Cysteamine Bitartrate) Capsules, 150 mg/50 mg

Test Product: RP103 (Cysteamine Bitartrate) Delayed-release Capsules, 75 mg

Outcomes

Primary Outcome Measures

Plasma Pharmacokinetic Parameter: Cmax of Cysteamine
Plasma Pharmacokinetic Parameter: Tmax of Cysteamine
Plasma Pharmacokinetic Parameter: AUC(0-t) of Cysteamine
t = 6 for Cystagon and t = 12 for RP103. Cystagon is dosed every 6 hours and there is no measurement after 6 hours and up to 12 hours.
Pharmacodynamic Parameter: Changes of White Blood Cell (WBC) Cystine Level From Baseline
The pharmacodynamic (PD) parameter measures the changes of WBC cystine level from the baseline. Cystine is a disulfide amino acid formed through oxidation of two molecules of cysteine; hence, cystine's concentration is commonly given in half-cystine equivalents to avoid confusion. The level of cystine in WBC/leukocytes is expressed in units of nmol half-cystine/mg protein (nmol ½ cystine/mg protein). Half-cystine is quantified by a reduction of cystine followed by an assay for cysteine, which is then normalized by the total cellular protein content within the sample using methods of such as Lowry assay, bicinchoninic acid assay, or Bradford.

Secondary Outcome Measures

Full Information

First Posted
March 27, 2009
Last Updated
April 11, 2017
Sponsor
Horizon Pharma USA, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT00872729
Brief Title
Pilot Study of Safety, Tolerability, Pharmacokinetics/Pharmacodynamics of RP103 Compared to Cystagon® in Patients With Cystinosis
Official Title
A Pilot Study to Assess the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of Cysteamine Bitartrate Delayed-release Capsules (RP103), Compared to Cysteamine Bitartrate (Cystagon®) in Patients With Nephropathic Cystinosis
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
May 2009 (undefined)
Primary Completion Date
October 2009 (Actual)
Study Completion Date
October 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Horizon Pharma USA, Inc.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Cystinosis is an inheritable disease that if untreated, results in kidney failure as early as the first decade of life. The current marketed therapy is Cystagon® (cysteamine bitartrate) which must be taken every six hours for the rest of the patient's life to prevent complications of cystinosis. RP103 is a formulation of cysteamine bitartrate that is being studied to see if it may be able to be given less frequently, once every 12 hours, and have similar results.
Detailed Description
This is a single-dose, open-labeled, non-randomized, two-period study of Cysteamine Bitartrate Delayed-release Capsules (RP103) and Cystagon® in up to 10 patients (male or female) with nephropathic cystinosis under fasting conditions. It will involve a 4 night check-in to a clinical research center.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cystinosis
Keywords
cystinosis, cysteamine, inheritable disease, orphan disease, CTNS protein, human, nephropathic cystinosis

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Cystagon®
Arm Type
Active Comparator
Arm Description
Reference Product: Cystagon® (Cysteamine Bitartrate) Capsules, 150 mg/50 mg
Arm Title
RP103
Arm Type
Experimental
Arm Description
Test Product: RP103 (Cysteamine Bitartrate) Delayed-release Capsules, 75 mg
Intervention Type
Drug
Intervention Name(s)
Cystagon®
Intervention Description
Reference Product: Cystagon® (Cysteamine Bitartrate) Capsules, 150 mg/50 mg. Duration of Treatment and Dose: Reference Period up to four doses Q6H.
Intervention Type
Drug
Intervention Name(s)
RP103
Intervention Description
Test Product: RP103 (Cysteamine Bitartrate) Delayed-release Capsules, 75 mg. Duration of treatment and Dose: Single dose of Test Product at dose equivalent to Reference Product.
Primary Outcome Measure Information:
Title
Plasma Pharmacokinetic Parameter: Cmax of Cysteamine
Time Frame
12 hours post RP103 dosing and 7 hours post 1st Cystagon® dosing
Title
Plasma Pharmacokinetic Parameter: Tmax of Cysteamine
Time Frame
12 hours post RP103 dosing and 7 hours post 1st Cystagon® dosing
Title
Plasma Pharmacokinetic Parameter: AUC(0-t) of Cysteamine
Description
t = 6 for Cystagon and t = 12 for RP103. Cystagon is dosed every 6 hours and there is no measurement after 6 hours and up to 12 hours.
Time Frame
12 hours post RP103 dosing and 6 hours post 1st Cystagon® dosing
Title
Pharmacodynamic Parameter: Changes of White Blood Cell (WBC) Cystine Level From Baseline
Description
The pharmacodynamic (PD) parameter measures the changes of WBC cystine level from the baseline. Cystine is a disulfide amino acid formed through oxidation of two molecules of cysteine; hence, cystine's concentration is commonly given in half-cystine equivalents to avoid confusion. The level of cystine in WBC/leukocytes is expressed in units of nmol half-cystine/mg protein (nmol ½ cystine/mg protein). Half-cystine is quantified by a reduction of cystine followed by an assay for cysteine, which is then normalized by the total cellular protein content within the sample using methods of such as Lowry assay, bicinchoninic acid assay, or Bradford.
Time Frame
up to 12 hours post Cystagon® dosing and RP103 dosing

10. Eligibility

Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female subjects must have nephropathic cystinosis. Children less than 22.5 kg will only be included in the study if the investigator feels they can safely participate in the study including the required blood draw volume for the safety and PK/PD assessments. Subjects must be on a stable dose of Cystagon® at least 21 days prior to Screening. Subjects must be able to swallow a 150 mg Cystagon® capsule with the capsule intact. Within the last 2 months, no clinically significant change in liver function [i.e., ALT, AST, alkaline phosphatase, bilirubin (total and direct)] and renal function [i.e., serum creatinine, albumin, total protein] at Screening as determined by the Investigator. Sexually active female subjects of childbearing potential (i.e., not surgically sterile [tubal ligation, hysterectomy, or bilateral oophorectomy] or at least 2 years naturally postmenopausal) must agree to utilize the same acceptable form of contraception from screening through completion of the study. Subjects or their authorized caregiver must provide written informed consent and assent (where applicable) prior to participation in the study. If in the opinion of the investigator, patients can safely provide the study required blood draw volume. Subjects must be willing and able to comply with the study restrictions and requirements. Exclusion Criteria: If, in the opinion of the investigator, the planned study dose would exceed the patient's tolerability of cysteamine based on their prior Cystagon® steady state drug requirements. Evidence of or verbal attestation of Helicobacter pylori infection, presently, or within the last 90 days prior to Screening. Subjects with a known history, currently or within the past 90 days prior to Screening, of the following conditions or other health issues that make it, in the opinion of the investigator, unsafe for them to participate, or whose concomitant medical problems preclude them from committing to the study schedule including the following: Crohn's disease, inflammatory bowel disease (if currently active) or have had prior resection of small intestine; • History of heart disease, e.g., myocardial infarction, heart failure, arrhythmias; Any bleeding disorder; Malignant disease; Severe liver disease as defined as ALT or AST > 2 times the upper limit of normal. Subjects who have had a kidney transplant. Subjects who are planning or are a registered candidate for a kidney transplant within 3 months of the Screening or have a serum creatinine > 2.4. Subjects with known hypersensitivity to cysteamine. If female (of child-bearing potential), are nursing, planning a pregnancy, known or suspected to be pregnant, or have a positive urine pregnancy screen. Patients with a hemoglobin level < 10.5. Subjects who have a made a blood donation within 60 days prior to study initiation. Subjects who, in the opinion of the Investigator, are not able or willing to comply with the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Evelyn Olson, BS
Organizational Affiliation
Horizon Pharma USA, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
University of California San Diego Medical Center
City
San Diego
State/Province
California
ZIP/Postal Code
92103
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
16769383
Citation
Dohil R, Fidler M, Barshop BA, Gangoiti J, Deutsch R, Martin M, Schneider JA. Understanding intestinal cysteamine bitartrate absorption. J Pediatr. 2006 Jun;148(6):764-9. doi: 10.1016/j.jpeds.2006.01.050.
Results Reference
background
PubMed Identifier
17229040
Citation
Fidler MC, Barshop BA, Gangoiti JA, Deutsch R, Martin M, Schneider JA, Dohil R. Pharmacokinetics of cysteamine bitartrate following gastrointestinal infusion. Br J Clin Pharmacol. 2007 Jan;63(1):36-40. doi: 10.1111/j.1365-2125.2006.02734.x.
Results Reference
background
PubMed Identifier
16252107
Citation
Levtchenko EN, van Dael CM, de Graaf-Hess AC, Wilmer MJ, van den Heuvel LP, Monnens LA, Blom HJ. Strict cysteamine dose regimen is required to prevent nocturnal cystine accumulation in cystinosis. Pediatr Nephrol. 2006 Jan;21(1):110-3. doi: 10.1007/s00467-005-2052-0. Epub 2005 Oct 27.
Results Reference
background
Links:
URL
http://www.procysbi.com
Description
RP103 (marketed as PROCYSBI) is now approved by the US FDA for management of nephropathic cystinosis in patients 6 years and older

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Pilot Study of Safety, Tolerability, Pharmacokinetics/Pharmacodynamics of RP103 Compared to Cystagon® in Patients With Cystinosis

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