A Phase 2 Study of KZR-616 to Evaluate Safety and Efficacy in Patients With Active Polymyositis or Dermatomyositis (PRESIDIO)

A Phase 2 Randomized, Double-blind, Placebo-controlled, Crossover Multicenter Study to Evaluate the Safety and Efficacy of KZR-616 in the Treatment of Patients With Active Polymyositis or Dermatomyositis

This was a Phase 2 randomized, double-blind, placebo-controlled, crossover, multicenter study to evaluate the safety, tolerability, efficacy, pharmacokinetics (PK) and pharmacodynamics (PD) of treatment with KZR-616 in patients with active polymyositis (PM) or dermatomyositis (DM). Patients were evaluated for eligibility during the Screening Period. Eligible patients were stratified by diagnosis of DM or PM and randomized 1:1 to Arm A or Arm B of the study.

During the 32-week treatment period, patients received study drug subcutaneously (SC) once weekly with 2 treatment periods of 16 weeks each.

This study was conducted on an outpatient basis.

Study Overview

• Status: Completed
• Conditions: Dermatomyositis; Polymyositis
• Intervention / Treatment: Drug: KZR-616; Drug: Placebo

• Study Type: Interventional
• Enrollment (Actual): 25
• Phase: Phase 2

Contacts and Locations

Study Locations

• Czechia
  • Prague, Czechia
    • KZR Research Site
• Germany
  • Göttingen, Germany
    • KZR Research Site
• United States
  • California
    • Beverly Hills, California, United States, 90211
      • KZR Research Site
    • Orange, California, United States, 92868
      • KZR Research Site
  • Florida
    • Miami, Florida, United States, 33136
      • KZR Research Site
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • KZR Research Site
  • Kansas
    • Kansas City, Kansas, United States, 66160
      • KZR Research Site
  • Maryland
    • Baltimore, Maryland, United States, 21224
      • KZR Research Site
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • KZR Research Site
  • New York
    • Great Neck, New York, United States, 11021
      • KZR Research Site
  • Pennsylvania
    • Duncansville, Pennsylvania, United States, 16635
      • KZR Research Site
    • Pittsburgh, Pennsylvania, United States, 15213
      • KZR Research Site
  • Texas
    • Austin, Texas, United States, 78756
      • KZR Research Site
  • Virginia
    • Henrico, Virginia, United States, 23233
      • KZR Research Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Adult patients at least 18 years of age
2. Body Mass Index (BMI) of 18 to 40 kg/m^2
3. Diagnosis of probable or definite DM or PM by the 2017 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) Classification Criteria

4. Must have their data reviewed by an adjudication committee to confirm eligibility unless at least 1 of the following is present:

   1. Muscle biopsy with evidence of active myositis within the last 6 months prior to or at Screening
   2. Electromyography or magnetic resonance imaging with evidence of active myositis within the last 6 months prior to Screening
   3. A creatine kinase (CK) ≥4 × upper limit of normal (ULN).

5. Must have demonstrable muscle weakness as measured by the Manual Muscle Testing-8 muscle Groups (MMT-8) with a score ≥80/150 but ≤136/150 units and any 2 of the following:

   1. Physician Global Assessment (MDGA) visual analog scale (VAS) ≥2 cm
   2. Patient Global Assessment of Disease Activity (PtGADA) VAS ≥2 cm
   3. At least one muscle enzyme laboratory measurement ≥1.3 × ULN
   4. Myositis Disease Activity Assessment Tool (MDAAT) Extramuscular Global Activity VAS ≥1 cm.
6. Documented inadequate response OR have demonstrated documented toxicity or intolerance to prior standard of care therapies
7. Has had age-appropriate cancer screening that is up to date and negative for evidence of malignancy as per local standard of care

Exclusion Criteria:

1. Has significant muscle damage or has a muscle damage VAS score ≥5 cm on the MDI
2. Any other form of myositis or myopathy other than PM or DM
3. Any condition that precludes the ability to quantitate muscle strength
4. Has severe interstitial lung disease or has a pulmonary damage VAS score ≥5 cm on the Myositis Damage Index (MDI)
5. Presence of autoinflammatory disease
6. Use of nonpermitted medications or treatments within the specified washout periods prior to screening
7. Patient has had recent serious or ongoing infection, or risk for serious infection

8. Any of the following laboratory values at Screening:

   1. Estimated glomerular filtration rate <45 mL/min
   2. Hemoglobin <10 g/dL
   3. White blood cell (WBC) count <3.0 × 10^9/L
   4. Absolute neutrophil count (ANC) <1.5 × 10^9/L (1500/mm^3)
   5. Platelet count <100 × 10^9/L
   6. Serum AST or serum ALT >2.5 × ULN (unless considered consistent with muscle origin)
   7. Serum alkaline phosphatase >2.5 × ULN
   8. Total bilirubin >1.5 × ULN (3 × ULN for patients with documented Gilbert's syndrome)
   9. Thyroid stimulating hormone outside of the central laboratory normal range
   10. Immunoglobulin G (IgG) <500 mg/dL.
9. Presence of New York Heart Association Class III or IV heart failure, or uncontrolled blood pressure, or prolonged QT interval
10. Major surgery within 12 weeks before Screening or planned during the study period
11. Clinical evidence of significant unstable or uncontrolled diseases
12. Any active or suspected malignancy, including myeloproliferative or lymphoproliferative disorder, or history of documented malignancy within the last 5 years before Screening or within 3 years of diagnosis of myositis, except appropriately excised and cured cervical carcinoma in situ or basal or squamous cell carcinoma of the skin

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Arm A; Treatment Period 1: KZR-616 30 mg SC weekly for 2 weeks, then 45 mg SC weekly for 14 weeks; Treatment Period 2: Placebo SC weekly for 16 weeks	Drug: KZR-616; Subcutaneous 30 mg weekly for 2 weeks, then 45 mg weekly for 14 weeks; Other Names: zetomipzomib; Drug: Placebo; Subcutaneous injection for 16 weeks
Other: Arm B; Treatment Period 1: Placebo SC weekly for 16 weeks; Treatment Period 2: KZR-616 30 mg SC weekly for 2 weeks, then 45 mg SC weekly for 14 weeks	Drug: KZR-616; Subcutaneous 30 mg weekly for 2 weeks, then 45 mg weekly for 14 weeks; Other Names: zetomipzomib; Drug: Placebo; Subcutaneous injection for 16 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change in the Total Improvement Score (TIS) From Start to End of Zetomipzomib (KZR-616) Treatment Period	The primary efficacy endpoint was mean change from start to end of zetomipzomib (KZR-616) Treatment Periods in the Total Improvement Score (TIS), which ranges from 0 to 100 [low of 0 to high of 100, where higher scores are better]. Mean change in TIS was calculated by comparing the Baseline and post Baseline observations for patients in both KZR-616 treatment periods combined. Note: TIS scores for placebo treatment periods are presented in this outcome measure but were not included in the primary outcome measure analysis.	16 weeks in each Treatment Period (32 weeks total)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of patients with an increase ≥20 points on the TIS from start to end of KZR-616 treatment.		16 weeks
Proportion of patients from start to end of KZR-616 treatment meeting International Myositis Assessment and Clinical Studies Group (IMACS) Definition of Improvement (DOI).		16 weeks
Absolute change from start to end of KZR-616 treatment in the IMACS individual core set activity measures (CSAMs)		16 weeks
Percent change from start to end of KZR-616 treatment in the IMACS individual CSAMs		16 weeks
For patients with DM, the mean change from start to end of KZR-616 treatment in the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI)		16 weeks
For patients with DM, the mean change from start to end of KZR-616 treatment in the Peak Pruritus Numeric Rating Scale.	The Peak Pruritus Numeric Rating Scale ranges from a score of 0 to 10, with 0 representing no itch and 10 representing the worst itch imaginable during the worst moment within a 24-hour recall period.	16 weeks
Safety and tolerability of KZR-616 in patients with PM or DM as assessed by monitoring incidence and severity of adverse events (AEs)		40 weeks
Peak plasma concentration (Cmax) following KZR-616 injection		Day 1
Time to peak plasma concentration (Tmax) following KZR-616 injection		Day 1
Area under the plasma concentration versus time curve (AUC) following KZR-616 injection		Day 1
Half life (T1/2) following KZR-616 injection		Day 1

Collaborators and Investigators

• Sponsor: Kezar Life Sciences, Inc.
• Investigators: Study Director: Kezar, Kezar Life Sciences, Inc.

Study record dates

Study Major Dates

• Study Start (Actual): January 14, 2020
• Primary Completion (Actual): April 6, 2022
• Study Completion (Actual): April 6, 2022

Study Registration Dates

• First Submitted: July 23, 2019
• First Submitted That Met QC Criteria: July 24, 2019
• First Posted (Actual): July 26, 2019

Study Record Updates

• Last Update Posted (Estimated): January 3, 2024
• Last Update Submitted That Met QC Criteria: December 14, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: Myositis; Dermatomyositis; Musculoskeletal Diseases; Muscular Diseases; Polymyositis; Idiopathic inflammatory myopathies
• Additional Relevant MeSH Terms: Nervous System Diseases; Skin Diseases; Musculoskeletal Diseases; Connective Tissue Diseases; Muscular Diseases; Neuromuscular Diseases; Myositis; Dermatomyositis; Polymyositis
• Other Study ID Numbers: KZR-616-003

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No