A Phase 1 QT Study in Healthy Male Subjects (QT/QTc)

A Phase 1, Double-blind, Four Period Crossover Study to Investigate the Effects of Pomalidomide (CC 4047) on the QT Interval in Healthy Male Subjects

This is a single-center, randomized, double-blind crossover study with four treatments, four periods and four sequences to investigate the effects of orally administered pomalidomide on QT interval. The study will be conducted in healthy male subjects. Pomalidomide (clinically indicated dose for multiple myeloma [MM] as per the United States Package Insert [USPI] of 4 mg and supratherapeutic dose of 20 mg) and placebo treatments will be double-blinded. Moxifloxacin (positive control) will be administered in an open-label fashion to determine the sensitivity of the assay. The core electrocardiogram (ECG) laboratory and ECG readers will be blinded to all study treatments and sequences.

Study Overview

• Status: Completed
• Conditions: Clinical Pharmacology, Healthy Volunteer Study
• Intervention / Treatment: Drug: Placebo; Drug: Pomalidomide; Drug: Pomalidomide; Drug: Moxifloxacin

Detailed Description

A total of 72 male subjects will be randomized and enrolled, with 18 subjects assigned to each treatment sequence. For each treatment sequence, each subject will participate in a screening phase, four baseline phases, four treatment periods and a follow up visit. Within 28 days prior to Period 1 dosing, subjects will sign an informed consent document (ICD) and undergo screening procedures to confirm eligibility. Qualifying subjects will return to the clinical site on Day -2 of Period 1 to begin baseline assessments, and will be domiciled at the clinical site from Day -2 to Day 2 of Period 1. For all remaining study periods, subjects will return to the clinical site on Day -1 to begin baseline assessments, and will be domiciled at the clinical site from Day -1 to Day 2. Subjects will be assigned randomly to one of four treatment sequences and will receive a single dose of the assigned treatment on Day 1 of each study period. There will be a minimum of 7 days and no more than 14 days between each dose.

Subjects will begin an overnight fast of at least 8 hours prior to the start of continuous Holter monitoring on Day 1 (and Day 1 in Period 1). On the morning of Day 1 (and Day -1 in Period 1), continuous Holter monitoring for approximately 24 hours will be performed. Triplicate ECGs will be extracted for analysis at specific predose and postdose timepoints (or equivalent times on Day -1 of Period 1). Blood samples will be collected at pre specified timepoints for pharmacokinetic (PK) and clinical laboratory assessments. Safety will be monitored throughout the study.

During each study period, subjects will be discharged from the clinical site on Day 2 upon satisfactory safety review and completion of the required study procedures. A safety follow up will be conducted by telephone 5 to 7 days following discharge in Period 4. In the event that a subject discontinues from the study, an early termination visit will be performed.

• Study Type: Interventional
• Enrollment (Actual): 72
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Texas
    • Austin, Texas, United States, 78744
      • PPD Phase I Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 50 years (ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• 1. Must understand and voluntarily sign a written informed consent (ICD) prior to any study related procedures being performed.

  2. Must be able to communicate with the Investigator, understand and comply with the requirements of the study, and agree to adhere to restrictions and examination schedules 3. Healthy male of any race between 18 to 50 years of age (inclusive) at the time of signing the ICD, and in good health as determined by a physical exam (P)E.

  4. Must practice true abstinence* or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential (FCBP) while participating in the study, during dose interruptions and for at least 28 days following study drug discontinuation, even if he has undergone a successful vasectomy.

• True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the subject. Period abstinence (e.g., calendar, ovulation, symptothermal, post ovulation methods) and withdrawal are not acceptable methods of contraception.

  5. Must have a body-mass index (BMI) between 18 and 30 kg/m2 (inclusive). 6. Clinical laboratory tests must be within normal limits or acceptable to the Investigator.

  7. Subject must be afebrile, with supine systolic blood pressure (BP): 90 to 140 mmHg, supine diastolic BP: 60 to 90 mmHg, and pulse rate (PR): 40 to 110 bpm.

At screening: After the supine measurements, when BP and pulse rate are measured again after 5 minutes of standing, there shall be no more than a 20 mmHg drop in systolic BP or no more than a 10 mmHg drop in diastolic BP and/or no more than a 20 bpm increase in pulse rate associated with clinical manifestation of postural hypotension.

8. Must have a normal or clinically acceptable 12-lead electrocardiogram (ECG) at screening; must have a QTcF value ≤ 430 msec.

9. Must agree to refrain from donating sperm or semen while participating in this study and for at least 28 days following the last dose of study drug.

10. Must agree to refrain from donating blood or plasma (other than for this study) while participating in this study and for at least 28 days following the last dose of study drug.

Exclusion Criteria:

• 1. History of any clinically significant and relevant neurological, gastrointestinal, renal, hepatic, cardiovascular (including hypertension, atherosclerosis, heart failure, supraventricular or ventricular arrhythmias and stroke [Cerebral Vascular Accident (CVA)] or transient ischemic attack [TIA]), psychological, pulmonary (including asthma and chronic obstructive pulmonary disease [COPD], treated or not treated), metabolic, endocrine, hematological, allergic disease, drug allergies, known hypersensitivity to a member of the class of IMiDs®, known hypersensitivity to moxifloxacin or other major disorders.

  2. Any condition which places the subject at unacceptable risk if he was to participate in the study, or confounds the ability to interpret data from the study.

  3. Have a first degree relative (parent, sibling, child) with Long QT Syndrome. 4. A hemoglobin level of less than 12.0 g/dL. 5. Abnormal Electrocardiogram (ECG) findings as follows:

  • Heart rate < 40 or > 110 bpm, after resting in the supine position for 5 minutes;
  • Pulse rate (PR) interval > 220 msec;
  • QRS interval > 120 including any degree of bundle branch block;
  • QTcF < 300 or > 430 msec;
  • Evidence of pre-excitation (e.g., Wolfe-Parkinson-White syndrome);
  • Cardiac pacemaker;

  • Atrial fibrillation / flutter. 6. QRS and/or T wave that the Investigator judges to be unfavorable for consistently accurate QT measurements (e.g., indistinct QRS onset, low amplitude T wave, inverted or terminally inverted T wave, merged T/U waves, indistinct T wave offset, or prominent U wave that affects QT measurement).

    7. Neuromuscular artifact that cannot readily be eliminated. 8. Subjects with hypokalemia and/or hypomagnesemia condition. 9. Used any prescribed systemic or topical medication (including but not limited to analgesics, anesthetics, etc) within 30 days of the first dose administration, unless sponsor agreement is obtained.

    10. Used any non-prescribed systemic or topical medication (including vitamin/mineral supplements, and herbal medicines) within 14 days of the first dose administration, unless sponsor agreement is obtained.

    11. Has any surgical or medical conditions possibly affecting drug absorption, distribution, metabolism and excretion (ADME), e.g., bariatric procedure. Appendectomy and cholecystectomy are acceptable.

    12. Donated blood or plasma within 8 weeks before the first dose administration to a blood bank or blood donation center.

    13. History of drug abuse (as defined by the current version of the Diagnostic and Statistical Manual [DSM]) within 2 years before dosing, or positive drug test reflecting consumption of illicit drugs.

    14. History of alcohol abuse (as defined by the current version of the DSM) within 2 years before dosing, or positive alcohol screen.

    15. Known to have serum hepatitis or known to be a carrier of hepatitis B surface antigen (HbsAg) or hepatitis C virus antibody (HCV Ab), or have a positive result to the test for human immunodeficiency virus (HIV) antibodies at screening.

    16. Exposed to an investigational drug (new chemical entity) within 30 days preceding the first dose administration, or 5 half-lives of that investigational drug, if known (whichever is longer).

    17. Cotinine level at screening or on Day 2 of Period 1 indicates subject is a moderate or heavy smoker.

    18. History of autonomic dysfunction (e.g., history of fainting or orthostatic hypotension).

    19. Subjects who are part of the clinical staff personnel or family members of the clinical site staff.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: RANDOMIZED
• Interventional Model: CROSSOVER
• Masking: QUADRUPLE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
PLACEBO_COMPARATOR: Treatment 1 (placebo); Five placebo capsules matching the appearance of the 4 mg pomalidomide capsule will be administered orally on the morning of Day 1	Drug: Placebo; Single oral dose of Placebo
EXPERIMENTAL: Treatment 2 (4 mg pomalidomide); Five capsules (one 4 mg pomalidomide capsule and four placebo capsules matching the appearance of the 4 mg pomalidomide capsule) will be administered orally on the morning of Day 1	Drug: Pomalidomide; Single oral dose of 4 mg pomalidomide; Other Names: POMALYST®; Drug: Pomalidomide; Single oral dose of 20 mg pomalidomide; Other Names: POMALYST®
EXPERIMENTAL: Treatment 3 (20 mg pomalidomide); Five 4 mg pomalidomide capsules will be administered orally on the morning of Day 1	Drug: Pomalidomide; Single oral dose of 4 mg pomalidomide; Other Names: POMALYST®; Drug: Pomalidomide; Single oral dose of 20 mg pomalidomide; Other Names: POMALYST®
ACTIVE_COMPARATOR: Treatment 4 (moxifloxacin); One 400 mg moxifloxacin tablet (AVELOX®, moxifloxacin hydrochloride, Bayer Pharmaceuticals Corporation) will be administered orally on the morning of Day 1	Drug: Moxifloxacin; Single oral dose of 400 mg moxifloxacin tablet; Other Names: AVELOX®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time matched, baseline corrected change from placebo of QTcF	To evaluate the effect of pomalidomide on the time matched changes from placebo in the baseline adjusted QT interval of the electrocardiogram (ECG) using the Fridericia correction method (QTcF)	From before dosing until 23 hours after dosing
Categorical analyses on ECG intervals and changes in ECG morphology		From before dosing until 23 hours after dosing

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time matched, baseline corrected changes from placebo of other ECG intervals (RR, PR, QRS) and categorical analyses on ECG intervals and changes in ECG morphology	To evaluate the change from placebo in selected ECG parameters (heart rate, PR interval, QRS interval, uncorrected QT interval and morphological patterns) following pomalidomide treatment	From before dosing until 23 hours after dosing
Safety	To assess the safety and tolerability of single oral doses of pomalidomide	2 months (from screening visit until end of study
Pharmacokinetics - Cmax	Maximum observed plasma concentration	From before dosing until 32 hours after dosing
Pharmacokinetics - Tmax	Time to Cmax	From before dosing until 32 hours after dosing
Pharmacokinetics - AUCinf	Area under the plasma concentration time curve from time zero extrapolated to infinity	From before dosing until 32 hours after dosing
Pharmacokinetics - AUCt	Area under the plasma concentration time curve from time zero to the last quantifiable concentration	From before dosing until 32 hours after dosing
Pharmacokinetics - t1/2	Terminal phase elimination half-life	From before dosing until 32 hours after dosing
Pharmacokinetics - CL/F	Apparent total plasma clearance when dosed orally	From before dosing until 32 hours after dosing
Pharmacokinetics - Vz/F	Apparent total volume of distribution when dosed orally, based on the terminal phase	From before dosing until 32 hours after dosing

Collaborators and Investigators

• Sponsor: Celgene

Study record dates

Study Major Dates

• Study Start (ACTUAL): October 18, 2013
• Primary Completion (ACTUAL): December 2, 2013
• Study Completion (ACTUAL): December 2, 2013

Study Registration Dates

• First Submitted: November 12, 2013
• First Submitted That Met QC Criteria: November 12, 2013
• First Posted (ESTIMATE): November 19, 2013

Study Record Updates

• Last Update Posted (ACTUAL): November 12, 2019
• Last Update Submitted That Met QC Criteria: November 7, 2019
• Last Verified: November 1, 2019

More Information

Terms related to this study

• Keywords: Healthy; Pharmacokinetic; TQT
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Enzyme Inhibitors; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Topoisomerase II Inhibitors; Topoisomerase Inhibitors; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Anti-Bacterial Agents; Leprostatic Agents; Thalidomide; Pomalidomide; Moxifloxacin
• Other Study ID Numbers: CC-4047-CP-010