GS-441524 for COVID-19 SAD, FE, and MAD Study in Healthy Subjects

A Phase 1, Double-Blind, Placebo-Controlled, Randomized, Single Ascending Dose, Multiple Ascending Dose, and Food Effect Study to Assess the Safety, Tolerability, and Pharmacokinetics of GS-441524 in Healthy Subjects

The goal of this clinical trial is to evaluate the safety, tolerability, and pharmacokinetics of GS-441524 in healthy subjects. The main questions to answer are: 1) What dosage of GS-441524 is required for adequate therapeutic plasma levels? 2) Does fed or fasted state produce variability in plasma levels? 3) How is GS-441524 eliminated from the body.

Participants will receive varying levels of GS-441524 or placebo to evaluate AEs and plasma levels.

Study Overview

• Status: Withdrawn
• Conditions: COVID-19
• Intervention / Treatment: Drug: Placebo; Drug: GS-441524

Detailed Description

This study will consist of 3 parts: an a single ascending dose (SAD) part, an food effect (FE) part, and an multiple ascending dose (MAD) part.

- SAD Part This will be a randomized, double-blind, placebo-controlled single-dose study part of GS-441524 in healthy human subjects. The SAD part will consist of at least 4 cohorts and up to 5 cohorts. Subjects will be randomized into one dose cohort and receive either active drug or placebo. Within each cohort, 6 subjects will receive GS-441524 and 2 subjects will receive placebo. The proposed doses are: 100 mg, 300 mg, 600 mg, and 1000 mg.

A sentinel group of 2 subjects will be randomized to active drug or placebo (1 active; 1 placebo) and will be dosed ahead of the rest of each cohort. There will be a minimum of 48 hours between dosing of the 2 sentinel subjects and the remainder of the cohort. A review of sentinel group safety data after dosing will be completed before dose administration will continue in the remaining 6 subjects (5 active; 1 placebo) of each cohort. An optional fifth dose level may be added based on safety and PK data from the first 4 cohorts.

• FE Part This will be a randomized, balanced, single-dose, two-treatment (fed vs fasting), two-period, two sequence crossover study part in healthy human subjects using a clinically relevant dose of GS-441524 (a dose that may achieve an anticipated efficacious exposure of 2 µM3). The dose will be selected from the SAD part and will be given once under fasting conditions and once under fed conditions (after completion of a standard FDA defined high-fat breakfast) in 1 cohort of 6 subjects.
• MAD Part This will be a randomized, double-blind, placebo-controlled, repeat-dose study part of GS-441524 in healthy human subjects. There will be up to 3 dose cohorts. Subjects will be randomized into one dose cohort to receive either active drug or placebo. Within each cohort, 6 subjects will receive GS-441524 and 2 subjects will receive placebo. Subjects will be administered GS-441524 or placebo twice daily for 5 days (Days 1 to 5) and only a morning dose on Day 6.

• Study Type: Interventional
• Phase: Phase 1

Contacts and Locations

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Must be able to verbalize understanding of the consent form, able to provide written informed consent, and verbalize willingness to complete study procedures, be able to comply with protocol requirements, rules and regulations of study site, and be likely to complete all the study interventions.
• Must be considered a healthy male or healthy female of nonchildbearing potential.

• Women of nonchildbearing potential are considered women who:

  1. Do not have a uterus, or
  2. Are surgically sterile (for example: has undergone complete hysterectomy, bilateral oophorectomy, or tubal ligation; should be verified by medical documentation), or
  3. Have permanent cessation of ovarian function due to ovarian failure or surgical removal of the ovaries, or
  4. Are postmenopausal as defined by 12 months or more of spontaneous amenorrhea as confirmed by a follicle-stimulating hormone (FSH) level >30 mIU/mL.
• Between 18 and 55 years of age, inclusive.
• Body mass index (BMI) within 18.0 to 32.0 kg/m2, inclusive.
• Minimum weight of at least 50.0 kg at screening.

• Male subjects who are sexually active with female partners of childbearing potential must use, with their partner, a condom plus an approved method of effective contraception from the time of screening until 90 days after the last dose of investigational medicinal product (IMP). Additionally, male subjects must agree to not donate sperm during the study and for at least 90 days from the last dose of IMP. Effective methods of contraception are:

  1. Combined (estrogen- and progestogen-containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, or transdermal)
  2. Progestogen-only hormonal contraception (oral, injectable/implantable, or intrauterine hormone-releasing system)
  3. Implantable intrauterine device
  4. Surgical sterilization (for example, vasectomy or bilateral tubal ligation; should be verified by medical documentation)
  5. Male condom with spermicidal gel/foam or with female cap or diaphragm (double barrier)
• Must have normal renal function (estimated glomerular filtration rate [eGFR] >75 mL/min/1.73 m2, as calculated by the CKD-EPI 2021 creatinine formula).

Exclusion Criteria:

• Have a medical history of clinically significant neurological, cardiovascular, renal, hepatic, chronic respiratory or gastrointestinal disease, or psychiatric disorder as judged by an Investigator.
• Have clinically significant abnormal biochemistry, hematology, or urinalysis results as judged by an Investigator.
• Have disorders that may interfere with drug absorption, distribution, metabolism, and excretion processes.
• Positive test results for human immunodeficiency virus (HIV)-1/HIV-2 antibodies, hepatitis B surface antigen (HBsAg), or hepatitis C virus (HCV) antibody.

• Serious cardiac illness or other medical condition including, but not limited to:

  1. Uncontrolled arrhythmias
  2. History of congestive heart failure
  3. Corrected QT value with Fridericia's formula (QTcF) >450 msec for males and >470 msec for females or history of prolonged QT syndrome
  4. Have a blood pressure reading outside of the following range: systolic blood pressure <86 mmHg or >149 mmHg and diastolic blood pressure <50 mmHg or >94 mmHg
• History of pancreatitis and history of hepatic or biliary disease, including those with known history/diagnosis of Gilbert's syndrome. Subjects with gall bladder removal <90 days prior to screening.
• Regular alcohol consumption in males >21 units per week and females >14 units per week (1 unit=12 ounces of beer, 1.5 ounces of spirit, or 5 ounces of wine) within 12 months prior to screening.
• Positive test result for alcohol and/or drugs of abuse at screening or prior to the first IMP administration.
• Current smokers and those who have smoked within 90 days prior to the first IMP administration. Current users of e cigarettes and nicotine replacement products, and those who have used these products within 90 days prior to the first IMP administration.
• Concurrent treatment or treatment with an investigational drug within 30 days prior to the first dose of IMP.
• Blood donation of approximately 500 mL within 56 days or plasma donation within 7 days of screening.
• Subjects who are taking, or have taken, any prescribed or over-the-counter drugs (other than a maximum of 2 g per day of acetaminophen, hormone replacement therapy, hormonal contraception) or herbal remedies in the 14 days before randomization. Exceptions may apply on a case-by-case basis if considered not to interfere with the objectives of the study, as agreed by the Investigator and Sponsor's Medical Monitor.
• Known allergy or intolerance to remdesivir.
• Any condition that, in the opinion of an Investigator, would interfere with evaluation or interpretation of subject safety or study results.
• Affiliated with, or a family member of, site staff directly involved in the study, or anyone with a financial interest in the outcome of the study.
• Subjects who are unable, in the opinion of an Investigator, to comply fully with the study requirements.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

11

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: SAD Cohort 1; A single oral dose of 100 mg GS-441524 under fasted conditions	Drug: GS-441524; Oral GS-441524 capsules; Other Names: (2R,3R,4S,5R)-2-(4-aminopyrrolo[2,1-f][1,2,4]triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)tetrahydrofuran-2-carbonitrile
Placebo Comparator: SAD Placebo; Matching Placebo under fasted conditions	Drug: Placebo; Placebo capsules; Other Names: Pregelatinized starch, colloidal silicon dioxide, magnesium stearate
Experimental: SAD Cohort 2; A single oral dose of 300 mg GS-441524	Drug: GS-441524; Oral GS-441524 capsules; Other Names: (2R,3R,4S,5R)-2-(4-aminopyrrolo[2,1-f][1,2,4]triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)tetrahydrofuran-2-carbonitrile
Experimental: SAD Cohort 3; A single oral dose of 600 mg GS-441524	Drug: GS-441524; Oral GS-441524 capsules; Other Names: (2R,3R,4S,5R)-2-(4-aminopyrrolo[2,1-f][1,2,4]triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)tetrahydrofuran-2-carbonitrile
Experimental: SAD Cohort 4; A single oral dose of 1000 mg GS-441524	Drug: GS-441524; Oral GS-441524 capsules; Other Names: (2R,3R,4S,5R)-2-(4-aminopyrrolo[2,1-f][1,2,4]triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)tetrahydrofuran-2-carbonitrile
Experimental: SAD Cohort 5; Optional Cohort - dose TBD	Drug: GS-441524; Oral GS-441524 capsules; Other Names: (2R,3R,4S,5R)-2-(4-aminopyrrolo[2,1-f][1,2,4]triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)tetrahydrofuran-2-carbonitrile
Experimental: Food Effect; Randomized, balanced, single-dose, two-treatment (fed vs fasting), two-period, two sequence crossover study part in healthy human subjects Treatment A: a single oral dose of TBD mg GS-441524 under fasted conditions Treatment B: a single oral dose of TBD mg GS-441524 under fed conditions	Drug: GS-441524; Oral GS-441524 capsules; Other Names: (2R,3R,4S,5R)-2-(4-aminopyrrolo[2,1-f][1,2,4]triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)tetrahydrofuran-2-carbonitrile
Experimental: MAD Cohort 1; Multiple oral doses of TBD mg GS-441524under fasted or fed conditions twice daily for 5 days (Days 1 to 5) and only a morning dose on Day 6	Drug: GS-441524; Oral GS-441524 capsules; Other Names: (2R,3R,4S,5R)-2-(4-aminopyrrolo[2,1-f][1,2,4]triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)tetrahydrofuran-2-carbonitrile
Experimental: MAD Cohort 2; Multiple oral doses of TBD mg GS-441524under fasted or fed conditions twice daily for 5 days (Days 1 to 5) and only a morning dose on Day 6	Drug: GS-441524; Oral GS-441524 capsules; Other Names: (2R,3R,4S,5R)-2-(4-aminopyrrolo[2,1-f][1,2,4]triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)tetrahydrofuran-2-carbonitrile
Experimental: MAD Cohort 3; Multiple oral doses of TBD mg GS-441524under fasted or fed conditions twice daily for 5 days (Days 1 to 5) and only a morning dose on Day 6	Drug: GS-441524; Oral GS-441524 capsules; Other Names: (2R,3R,4S,5R)-2-(4-aminopyrrolo[2,1-f][1,2,4]triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)tetrahydrofuran-2-carbonitrile
Placebo Comparator: MAD Placebo; Matching Placebo under fasted or fed conditions	Drug: Placebo; Placebo capsules; Other Names: Pregelatinized starch, colloidal silicon dioxide, magnesium stearate

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment-emergent adverse events (TEAEs)	Number of incidences	10 days
Blood Pressure in mm/Hg	Changes from baseline	10 days
Pulse in beats/min	Changes from baseline	10 days
Respiratory Rate in breaths per minute	Changes from baseline	10 days
Body Temperature in degrees	Changes from baseline	10 days
Electrocardiogram (ECG) as measured by PR interval	Changes from baseline	10 days
Electrocardiogram (ECG) as measured by QT interval	Changes from baseline	10 days
Electrocardiogram (ECG) as measured by QT corrected (Fridericia's)	Changes from baseline	10 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Plasma PK Parameter C-Max	Maximum observed plasma concentration	10 days
Plasma PK Parameter t-max	Time to attain maximum observed plasma concentration	10 days
Plasma PK Parameter t-lag	Time before the first concentration above the lower limit of quantitation	10 days
Plasma PK Parameter AUC 0-last	Area under the plasma concentration time curve from time zero to the last quantifiable time point	6 days
Plasma PK Parameter AUC 0-inf	Area under the plasma concentration time curve from time 0 to infinity	6 days
Plasma PK Parameter t 1/2	Terminal elimination half-life	10 days
Plasma PK Parameter CL/F	Apparent oral clearance	10 days
Plasma PK Parameter Vz/F	Apparent volume of distribution	10 days
Urine PK Parameter Ae urine	Cumulative amount of study drug excreted in urine	10 days
Urine PK Parameter Fe urine	Fraction of the dose administered excreted (unchanged in urine)	10 days
Urine PK Parameter CL R	Renal clearance	10 days
Plasma PK Parameter C trough	Trough Plasma concentration	10 days
Plasma PK Parameter AUC 0-tau	Area under the plasma concentration time curve over a dosing interval tau	10 days
Plasma PK Parameter CL/F ss	Apparent oral clearance at steady state	10 days
Plasma PK Parameter Vz/F ss	Apparent volume of distribution at steady state	10 days
Plasma PK Parameter R ac	Accumulation ration, based on Auc 0-tau of day 6 versus day1	10 days

Collaborators and Investigators

• Sponsor: National Center for Advancing Translational Sciences (NCATS)
• Collaborators: Leidos Biomedical Research, Inc.; ICON Government and Public Health Solutions, Inc
• Investigators: Study Director: Philip E Sanderson, PhD, NCATS

Study record dates

Study Major Dates

• Study Start (Estimated): June 15, 2024
• Primary Completion (Estimated): December 1, 2024
• Study Completion (Estimated): December 1, 2024

Study Registration Dates

• First Submitted: February 8, 2024
• First Submitted That Met QC Criteria: February 21, 2024
• First Posted (Actual): February 23, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 12, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Respiratory Tract Infections; Infections; RNA Virus Infections; Virus Diseases; Respiratory Tract Diseases; Lung Diseases; Pneumonia, Viral; Pneumonia; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; COVID-19; Anti-Infective Agents; Physiological Effects of Drugs; Antiviral Agents; Trace Elements; Micronutrients; GS-441524; Silicon
• Other Study ID Numbers: 170327-0001; 6830/0003 (Other Identifier: ICON plc)

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