Pharmacokinetics, Safety and Efficacy of BIA 5-1058 in PAH (Zamicastat)

An Open-label, Multicentre Study to Evaluate Pharmacokinetics, Safety and Efficacy of Zamicastat as Adjunctive Therapy in Pulmonary Arterial Hypertension (PAH)

This Study evaluates the pharmacokinetic (PK) profile of different zamicastat doses in Pulmonary arterial hypertension (PAH) patients to find the most promising therapeutic dosage range for the treatment of PAH disease

Study Overview

• Status: Completed
• Conditions: Pulmonary Arterial Hypertension
• Intervention / Treatment: Drug: Oral zamicastat

Detailed Description

This is an open-label, multi-centre study in patients with PAH who are currently on stable treatment with at least one PAH medication. It is planned to evaluate the PK profile (24 hour profile and trough levels) and the safety, tolerability and efficacy of four different zamicastat doses. Each patient will start treatment with the lowest dose (50 mg zamicastat once daily) and the dose will be up-titrated to the individual highest tolerated dose (HTD) i.e. up to 200 mg zamicastat once daily.

A data safety monitoring board (DSMB) will periodically review the safety data and will issue a recommendation if the doses can be used as planned.

This study will consist of:

• A screening period, 5 to 12 days: visit V1

• Up to four dose finding periods, 14 days each:

  • Dose A (50 mg zamicastat once daily): visits A1, A2 and A3
  • Dose B (100 mg zamicastat once daily): visits B2 and B3
  • Dose C (150 mg zamicastat once daily): visits C2 and C3
  • Dose D (200 mg zamicastat once daily): visits D2 and D3
• Maintenance period, 42 days: maintenance period visit (MPV)1, MPV2 and MPV3
• Follow-up (FU) period, 14 to 28 days: visits FU (down-titration) and FU

• Study Type: Interventional
• Enrollment (Actual): 33
• Phase: Phase 2

Contacts and Locations

Study Locations

• Austria
  • Linz, Austria, 4020
    • Ordensklinikum Linz Elisabethinen, Interne 2 - Kardiologie, Angiologie & Interne Intensivmedizin Fadingerstraße 1
• Germany
  • Dresden, Germany, 01307
    • Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, Pneumologie Fetscherstraße 74
• Italy
  • Acquaviva delle Fonti, Italy, 70021
    • Ospedale Generale Regionale Miulli-Cardiologia e UTIC Strada Prov. 127 Acquaviva - Santeramo Km. 4,100
  • Monza, Italy, 20900
    • ASST di Monza-Ospedale San Gerardo -Dipartimento di Pneumologia via Pergolesi 33
  • Roma, Italy, 00161
    • AOU di Roma-Policlinico Umberto I-Unità Dipartimentale Malattie del Circolo Polmonare Viale del Policlinico 155
• Portugal
  • Lisboa, Portugal, 1769-001
    • Centro Hospitalar Lisboa Norte, E.P.E. - Hospital Pulido Valente Consulta Externa de Hipertensão Pulmonar Alameda das Linhas de Torres, 117
• Spain
  • Barcelona, Spain, 08036
    • Hospital Clinic de Barcelona Calle Villarroel, 170
  • Madrid, Spain, 28041
    • Hospital Universitario "12 de Octubre" Avda. de Córdoba, s/n
  • Salamanca, Spain, 37007
    • Complejo Asistencial Universitario de Salamanca Pº. San Vicente, 58
  • Santander, Spain, 39008
    • Hospital Universitario Marques de Valdecilla Avenida Valdecilla, 25
• Ukraine
  • Kyiv, Ukraine, 03151
    • State Institution ""National Scientific Centre "M.D. Strazhesko Institute of Cardiology" of NAMS of Ukraine", Department of symptomatic arterial hypertensions Narodnogo opolcheniya 5
• United Kingdom
  • Clydebank, United Kingdom, G81 4DY
    • Golden Jubilee National Hospital Golden Jubilee National Hospital Agamemnon St, Scottish Pulmonary Vascular Unit Golden Jubilee National Hospital
  • London, United Kingdom, NW3 2QG
    • Royal Free Hospital Pond Street

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 61 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Male or female patients aged 18 to 70 years.
2. Able to comprehend and willing to sign an informed consent form.

3. Diagnosis of PAH (pulmonary arterial hypertension WHO Group 1), documented by right heart catheterisation with a mean pulmonary artery pressure (mPAP) ≥ 25 mmHg, a pulmonary artery wedge pressure (PAWP) ≤ 15 mmHg and a pulmonary vascular resistance (PVR) > 3 wood unit (WU):

   1. Idiopathic, in non-vasoreactive patients
   2. Heritable: Bone morphogenetic protein receptor type II (BMPR2) mutation and other mutations, in non-vasoreactive patients
   3. Drugs and toxin induced, in non-vasoreactive patients
   4. Associated with connective tissue disease
   5. Associated with simple congenital defects (atrial septal defect and/or ventricular septal defect) if closed > 12 months before inclusion.
4. World Health Organization (WHO) functional class II or III as judged by the investigator.
5. Stable treatment with at least one of the following approved PAH therapies for at least 90 days prior to V1: Ambrisentan, Bosentan, Macitentan, Riociguat, Selexipag, Sildenafil, Tadalafil, Epoprostenol intravenous, Iloprost inhaled or Treprostinil intravenous or subcutaneous.

Exclusion Criteria:

1. Contraindication to zamicastat, i.e. known hypersensitivity to ingredients of zamicastat formulation.
2. Two or more consecutive measurements of systolic blood pressure (SBP) < 95 mmHg or diastolic blood pressure (DBP) < 50 mmHg.
3. Uncontrolled diabetes mellitus with HbA1c ≥ 8.5% within the last three months or at screening.
4. PAH WHO Group 1 due to portal hypertension, human immunodeficiency virus (HIV) infection and schistosomiasis.
5. Any disease known to cause pulmonary hypertension other than PAH WHO Group 1.
6. Obstructive lung disease: Forced Expiratory Volume in 1 second/Forced Vital Capacity (FEV1/FVC) < 60% and FEV1 < 60% of predicted value after bronchodilator administration.
7. Restrictive lung disease: Total Lung Capacity (TLC) < 70% of predicted value.
8. History of moderate to severe hepatic impairment (Child-Pugh B and C).
9. Estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 (measured at V1).
10. Use of the following prohibited medication or treatments during study participation: calcium channel blockers (CCBs) if used for the treatment of PAH in vasoreactive patients; drugs containing a catechol group that is metabolised by dopamine ß-hydroxylase (DβH) e.g. rimiterole, isoprenaline, dopamine, dopexamine or dobutamide or α- and/or β-blockers.
11. Current or previous (within the past year) alcohol or substance abuse excluding caffeine or nicotine.
12. Presence of any other significant or progressive/unstable medical condition that, in the opinion of the investigator, would compromise evaluation of the study treatment or may jeopardise the patient's safety, compliance or adherence to protocol requirements.

13. For women: Pregnancy or breast-feeding. Women of childbearing potential unable or unwilling to undergo pregnancy tests and practice acceptable contraceptive measures from the time of informed consent until 30 days after last investigational medicinal product (IMP) intake. Acceptable methods for women are surgical intervention (e.g. bilateral tubal occlusion), non-hormonal implantable intrauterine device, double-barrier methods, true sexual abstinence (i.e. when this is in line with the preferred and usual lifestyle of the patient) and vasectomised partner (provided that the partner is the sole sexual partner of the patient and the partner has received medical assessment of the surgical success). Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods), hormonal contraceptives and withdrawal are not acceptable methods of contraception.

    For men: Male patients who are sexually active with a partner of childbearing potential must use, with their partner, a condom plus an approved acceptable contraceptive measure from the time of informed consent until 90 days after the last IMP intake. The following methods are acceptable methods of contraception: partner's use of combined (oestrogen and progestogen-containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal); partner's use of progestogen-only hormonal contraception (oral, injectable/implantable, intrauterine hormone-releasing system); partner's use of implantable intrauterine device; surgical sterilisation (for example, vasectomy or bilateral tubal occlusion).

14. Previous participation in any other drug investigational study within the past 30 days (or five half-lives of IMP whichever is longer) prior to V1.
15. Vulnerable patients according to Section 1.61 of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guideline for Good Clinical Practice E6.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 50 mg zamicastat; 50 mg zamicastat once daily	Drug: Oral zamicastat; Tablets for oral administration under fed conditions containing 100 mg of zamicastat; Other Names: BIA 5-1058
Experimental: 100 mg zamicastat once daily	Drug: Oral zamicastat; Tablets for oral administration under fed conditions containing 100 mg of zamicastat; Other Names: BIA 5-1058
Experimental: 150 mg zamicastat once daily	Drug: Oral zamicastat; Tablets for oral administration under fed conditions containing 100 mg of zamicastat; Other Names: BIA 5-1058
Experimental: 200 mg zamicastat once daily	Drug: Oral zamicastat; Tablets for oral administration under fed conditions containing 100 mg of zamicastat; Other Names: BIA 5-1058

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Area Under the Curve 0-24h (AUC0-24h) (ng.h/mL) - 50 mg	This PK parameters (24-hour profile) for zamicastat and its metabolites will be derived after a single dose of 50 mg zamicastat	Day 1 (0 hours and then 1, 2, 4, 8, 16 and 24 hours after investigational medicinal product (IMP) intake)
Area Under the Curve 0-24h (AUC0-24h) (ng.h/mL/mg) - HTD	This PK parameter (24-hour profile) for zamicastat and its metabolites will be derived at steady-state at the individual highest tolerated dose (HTD)	1, 2, 4, 8, 16 and 24 hours after IMP intake
Maximum Plasma Concentration (Cmax) (ng/mL) - 50 mg	This PK parameters (24-hour profile) for zamicastat and its metabolites will be derived after a single dose of 50 mg zamicastat	Day 1 (0 hours and then 1, 2, 4, 8, 16 and 24 hours after IMP intake)
Maximum Plasma Concentration (Cmax) (ng/mL/mg) - HTD	This PK parameter (24-hour profile) for zamicastat and its metabolites will be derived at steady-state at the individual highest tolerated dose (HTD)	1, 2, 4, 8, 16 and 24 hours after IMP intake
Time Until Cmax (Tmax) (h) - 50 mg	This PK parameters (24-hour profile) for zamicastat and its metabolites will be derived after a single dose of 50 mg zamicastat	Day 1 (0 hours and then 1, 2, 4, 8, 16 and 24 hours after IMP intake)
Time Until Cmax (Tmax) (h) - HTD	This PK parameter (24-hour profile) for zamicastat and its metabolites will be derived at steady-state at the individual highest tolerated dose (HTD)	1, 2, 4, 8, 16 and 24 hours after IMP intake
Minimum Plasma Concentration at the End of the Dosing Interval (Cmin,SS) (ng/mL/mg) - HTD	This PK parameter (24-hour profile) for zamicastat and its metabolites will be derived at steady-state at the individual highest tolerated dose (HTD). Following multiple administrations of the HTD of zamicastat to PAH patients at MPV3, PK concentrations and parameter summaries for only the 50 mg, 100 mg and 200 mg dose levels are presented and discussed, as the only subject receiving the 150 mg HTD level had a major protocol deviation documented, impacting the reliability of their PK data.	1, 2, 4, 8, 16 and 24 hours after IMP intake

Collaborators and Investigators

• Sponsor: Bial - Portela C S.A.

Study record dates

Study Major Dates

• Study Start (Actual): June 3, 2019
• Primary Completion (Actual): October 20, 2021
• Study Completion (Actual): October 20, 2021

Study Registration Dates

• First Submitted: March 18, 2020
• First Submitted That Met QC Criteria: March 18, 2020
• First Posted (Actual): March 20, 2020

Study Record Updates

• Last Update Posted (Actual): October 15, 2024
• Last Update Submitted That Met QC Criteria: September 30, 2024
• Last Verified: September 1, 2024

More Information

Terms related to this study

• Keywords: PAH; idiopathic; BIA 5-1058; Zamicastat; Bial; Bial - Portela & Ca, S.A.; dopamine ß-hydroxylase (DßH) inhibitor; vascular obstruction; pulmonary arteries; right-heart catheterisation (RHC); rare lung disease
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Respiratory Tract Diseases; Lung Diseases; Hypertension, Pulmonary; Hypertension; Pulmonary Arterial Hypertension; Familial Primary Pulmonary Hypertension; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Zamicastat
• Other Study ID Numbers: BIA-51058-201; 2018-002448-10 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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