Veiligheid en werkzaamheid van PTH-IA
Een fase 1/2 open-label, eerste bij mensen, dose-escalerende veiligheids- en werkzaamheidsstudie naar subcutane toediening van PTH-IA bij volwassenen en kinderen met Jansen's metafysaire chondrodysplasie (JMC)
Jansen s Metaphyseal Chondrodysplasia (JMC) is a very rare disorder with only approximately 30 people known to have the disease worldwide. It is caused by parathyroid hormone 1 receptor (PTH1R) variants leading to constitutive activation of the receptor for parathyroid hormone (PTH) and parathyroid hormone-related peptide (PTHrP). PTH1R is predominantly expressed in the kidneys and bone and growth-plate chondrocytes. Individuals with JMC develop severe growth impairment resulting in significant short stature, scoliosis, frequent fractures, bone pain, mineral-ion abnormalities (typically hypercalcemia and hypercalciuria), hypertension, and chronic kidney disease due to nephrocalcinosis and nephrolithiasis. Children often undergo multiple surgeries for skeletal fractures and deformities; mobility is commonly impaired, usually requiring assistive devices for ambulation. Other complications may include premature closure of cranial sutures and cranial nerve compressions with the potential for vision and/or hearing loss [1-3]. Physical function impairment and the need for complication-related operations have profound deleterious effects on quality of life in individuals with JMC. There are currently no approved therapies for JMC, and novel therapies are critically needed to prevent irreversible disease complications and improve patient quality of life.
The inventors of the drug, parathyroid hormone inverse agonist (PTH-IA), have considerable expertise in both the basic and clinical aspects of PTH/PTHrP receptor molecular biology and pharmacology. They reported the first PTH1R JMC mutations (including the H223R mutation) over 20 years ago and identified certain PTH antagonist ligands that function as inverse agonists on the PTH1R JMC mutant receptors [2, 4]. These ligands suppress the mutant receptor s elevated basal rates of cAMP signalling, as assessed in cultured cells and animal models. In vivo studies confirm that inverse agonist ligands may be effective in treating JMC. This study involves the use of PTH-IA, a 30-amino acid PTH inverse agonist ligand with the amino acid sequence [Leu11,dTrp12,Trp23,Tyr36]-PTHrP(7-36)NH2. We hypothesize that PTH-IA will be a safe and effective treatment for individuals with JMC.
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Gedetailleerde beschrijving
Study Description:
This is a Phase 1/2 open-label, single-arm study to evaluate the safety of multiple ascending doses of PTH-IA administered subcutaneously twice a day in individuals with JMC conducted at the National Institutes of Health Clinical Center.
Objectives Primary Objectives
Period 1 - Adult
- Evaluate the safety and tolerability of PTH-IA in adults with JMC (>=18 years)
- Evaluate the pharmacokinetics (PK) of multiple ascending doses of PTH-IA in adults (>= 18 y/o) years old with JMC
Period 2 - Adult and Pediatrics
- Evaluate the safety and tolerability of PTH-IA in adults and children aged 3-17 years old with JMC
- Evaluate the pharmacokinetics (PK) of multiple ascending doses of PTH-IA in children aged 3-17 years old with JMC
- Evaluate the effect of PTH-IA on serum PTH levels on children and adults with JMC
Secondary Objectives
Periods 1 and 2
- Identify the optimal dose range of PTH-IA
- Evaluate potential measures of efficacy of PTH-IA in JMC
Exploratory Objectives
Periods 1 and 2
- Evaluate the effect of PTH-IA on physical function
- Evaluate the effect of PTH-IA on pain and health-related quality of life (QOL)
- Evaluate the immunogenicity of PTH-IA
- Describe the baseline and response to treatment histological characteristics of bone lesions in JMC
Endpoints Primary Endpoints
Period 1
- Dose limiting toxicities (DLTs) and incidence, severity, seriousness, and causality of all treatment-emergent adverse events (TEAEs)
- PK parameters after multiple ascending doses of PTH-IA
Period 2
- Dose limiting toxicities (DLTs) and incidence, severity, seriousness, and causality of all treatment-emergent adverse events (TEAEs)
- PK parameters after multiple ascending doses of PTH-IA
- Change in serum PTH from baseline to end of treatment
Secondary Endpoints
Periods 1 and 2
- Absolute levels and percentage change from baseline in serum corrected calcium pre- and post-intervention at end of treatment
- Absolute levels and change in ratio of serum corrected calcium to PTH ([mg/dl]/[pg/ml]) pre- and post-intervention at end of study
- Absolute levels and percentage change from baseline in fractional excretion of calcium at end of treatment
- Change in tubular reabsorption of phosphate and ratio of tubular maximum reabsorption of phosphate to GFR between pre- and post-intervention at end of treatment
- Absolute levels and percentage change from baseline in urine nephrogenous cAMP at end of treatment
- Absolute levels and percentage change from baseline in serum phosphate at end of treatment
- Change in bone turnover markers (P1NP, BSALP, CTX, osteocalcin) between pre- and post-intervention at end of treatment
- Absolute levels and percentage change from baseline in markers of mineral homeostasis: 1,25(OH)2 vitamin D and ratio of 1,25(OH)2 vitamin D to PTH at end of treatment
- Change in pre-defined sentinel skeletal lesion metabolic activity representing region of most intense pathology as measured by 18F- NaF PET/CT (<= 5 lesions) between pre- and post-intervention at end of treatment
- Change in pre-defined target skeletal lesion mineral density representing region of most intense pathology as measured by 18F- NaF PET/CT (<= 5 lesions) between pre- and postintervention at end of treatment
- Change in nephrocalcinosis scores on ultrasound from baseline to end of treatment (0-no nephrocalcinosis and 3- severe nephrocalcinosis)
- Change in HR-pQCT parameters of the radius and tibia: total BMD, cortical and trabecular BMD; cortical thickness, cortical porosity, BV/TV, trabecular number, thickness, and separation; stiffness and failure load of the peripheral skeleton
- Minimally effective dose defined by dose at which the mean of two highest PTH levels increases to 30-40 pg/mL (in individuals with baseline PTH <= 20 pg/mL) in the absence of DLTs. In individuals with baseline PTH >20 pg/mL, the optimal dose will be the dose at which the mean of two highest PTH obtained increases to 55-65 pg/mL in the absence ofDLTs.
Exploratory Endpoints
Periods 1 and 2
- Change from baseline in range of motion of upper and lower extremities
- Change from baseline in manual muscle strength testing of bilateral upper and lower extremities
- Change from baseline in gait assessment
- Change from baseline in assessment of skeletal bowing
- Change from baseline in walking speed
- Change from baseline in PROMIS pain intensity, pain interference, mobility, and fatigue scores
- Development and characterization of anti-drug antibodies (ADAs)
- JMC lesion histology as assessed by bone biopsies
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Fase
Fase
- Fase 2
- Fase 1
Contacten en locaties
Studiecontact
Studiecontact
- Naam: Alison M Boyce, M.D.
- Telefoonnummer: (301) 827-4802
- E-mail: alison.boyce@nih.gov
Studie Contact Back-up
- Naam: Olivia J de Jong, C.R.N.P.
- Telefoonnummer: (240) 595-2764
- E-mail: olivia.dejong@nih.gov
Studie Locaties
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Maryland
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Bethesda, Maryland, Verenigde Staten, 20892
- Werving
- National Institutes of Health Clinical Center
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Contact:
- NIH Clinical Center Office of Patient Recruitment (OPR)
- Telefoonnummer: TTY dial 711 800-411-1222
- E-mail: ccopr@nih.gov
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-
Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
- INCLUSION CRITERIA:
In order to be eligible to participate in this study, an individual must meet all of the following criteria:
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Willingness of participant and/or guardian to sign a written informed consent form, which must be obtained prior to initiation of study procedures.
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Period 1: Adults >=18 years of age
Period 2: Adults and children 3-17 years of age
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Minimum body weight of 35 kg for participation in Period 1 and 18 kg for participation in Period 2.
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Have an activating germline mutation of PTHIR (H223R, I458K, I458R, T410P, or T410R)
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Female participants of reproductive potential must agree to use one form of highly effective contraception. Highly effective contraception includes:
Total abstinence (when this is in line with the preferred and usual lifestyle of the participant). Periodic abstinence (e.g. calendar, ovulation, symptothermal, post- ovulation methods) and withdrawal are not acceptable methods of contraception.
Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy) or tubal ligation at least six weeks before taking study treatment.
Male sterilization (at least 6 months prior to screening). For female participants in the study, the vasectomized male partner should be the sole partner for that participant for the study duration.
Use of oral, injected, or implanted hormonal methods of contraception or other forms of hormonal contraception that have comparable efficacy (failure rate <1%), for example hormonal vaginal ring or transdermal hormone contraception
Placement of an intrauterine device (IUD) or intrauterine system (IUS)
Barrier methods of contraception used correctly by the male partner: condom or occlusive cap (diaphragm or cervical/ vault caps) with spermicidal foam/gel/film/cream/vaginal suppository.
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For males of reproductive potential: use of condoms or other methods described above to ensure effective contraception with partner.
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Stated willingness to comply with all study procedures and availability for the duration of the study, including the ability and willingness to travel to the NIH Clinical Center.
EXCLUSION CRITERIA:
An individual who meets any of the following criteria will be excluded from participation in this study:
- Pregnancy or lactation
- 25-hydroxyvitamin D <=20 ng/mL. Patients will be eligible for rescreening after a repletion period lasting up to 6 months.
- Clinically significant renal disease with estimated glomerular filtration rate (eGFR) <=45 mL/ min/1.73 m2.
- Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >2 times the upper limit of normal. If transaminitis is present, patients will be eligible for rescreening for a period of up to 6 months.
- Hgb <12 gm/dL for women and girls >=16 years, <=13 gm/dL for men and boys >=16 years, and <=11.5 gm/dL in children <=15 years. If reduced hemoglobin levels are related to iron, B12, or folate deficiency, patients will be eligible for rescreening after a repletion period lasting up to 6 months.
- Hypersensitivity or intolerance to any active substance or excipient of PTH-IA
- History of surgical removal of all parathyroid glands.
- Treatment with bisphosphonate use within 6 months of screening
- Treatment with denosumab within 3 months of screening
- Treatment with thiazides within 4 weeks of screening
- Any other significant medical conditions that, in the opinion of the study team, may present a concern for participant safety or difficulty with data interpretation.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: NVT
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Aantal wapens
Wapens en interventies
Deelnemersgroep / ArmDeelnemersgroep / Arm |
Interventie / BehandelingInterventie / Behandeling |
|---|---|
|
Experimenteel: Treatment with PTH-IA
All participants will receive PTH-IA for up to 90+/-7 days in Period 1, and 24 weeks +/- 7 days in Period 2. |
PTH-IA is a 30-amino acid peptide expected to act as an inverse agonist, decreasing the proportion of mutant PTH1R receptors in the active-state conformation and leading to a reduction in basal cAMP signaling. This hypothesis is based on results from PTH-IA treatment of cells and animal models expressing the different PTH1R mutations seen in JMC individuals. In-vitro studies of HEK293 cells stably transfected with a Glosensor cAMP reporter and plasmids expressing the different PTH1R constitutively active mutant JMC alleles (H223R, I458K, I458R, T410P, and T410R) showed that the cells displayed agonist-independent cAMP generation. Treatment of cells expressing the different PTH1R mutations with PTH-IA resulted in a rapid and persistent reduction in basal cAMP signaling, indicating that the peptide can act as an inverse agonist and thus decreases the proportion of mutant receptors in the active-state conformation. |
Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Period 1 - Adult: Evaluate the safety and tolerability of PTH-IA in adults with JMC (>= 18 years)
Tijdsspanne: 104 +/- 10 days
|
To assess dose-limiting toxicities (DLTs) and incidence, severity, seriousness, and causality of all treatment-emergent adverse events (TEAEs). |
104 +/- 10 days
|
|
Period 1 - Adult: Evaluate the pharmacokinetics (PK) of multiple ascending doses of PTH-IA in adults (>= 18 y/o) years old with JMC
Tijdsspanne: 104 +/- 10 days
|
To determine PK parameters after multiple ascending doses of PTH-IA. |
104 +/- 10 days
|
|
Period 2 - Adult and Pediatrics: Evaluate the safety and tolerability of PTH-IA in adults and children aged 3-17 years old with JMC.
Tijdsspanne: 28 weeks +/- 10 days
|
To assess dose-limiting toxicities (DLTs) and incidence, severity, seriousness, and causality of all treatment-emergent adverse events (TEAEs). |
28 weeks +/- 10 days
|
|
Period 2 - Adult and Pediatrics: Evaluate the pharmacokinetics (PK) of multiple ascending doses of PTH-IA in children aged 3-17 years old with JMC.
Tijdsspanne: 28 weeks +/- 10 days
|
To determine PK parameters after multiple ascending doses of PTH-IA. |
28 weeks +/- 10 days
|
|
Period 2 - Adult and Pediatrics: Evaluate the effect of PTH-IA on serum PTH levels in children and adults with JMC.
Tijdsspanne: 28 weeks +/- 10 days
|
To evaluate changes in serum PTH from baseline to the end of treatment. |
28 weeks +/- 10 days
|
Secundaire uitkomstmaten
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Periods 1 and 2 - Identify the optimal dose range of PTH-IA.
Tijdsspanne: Period 1: 104 +/- 10 days. Period 2: 28 weeks +/- 10 days.
|
To measure the absolute levels and percentage change: - From baseline in serum-corrected calcium pre- and post-intervention at the end of treatment.- In the ratio of serum-corrected calcium to PTH ([mg/dl]/[pg/ml]) pre- and post-intervention at the end of the study.- From baseline in fractional excretion of calcium at the end of treatment.- From baseline in urine nephrogenous cAMP at the end of treatment.- From baseline in serum phosphate at the end of treatment.- From baseline in markers of mineral homeostasis: 1,25(OH)2 vitamin D and ratio of 1,25(OH)2 vitamin D to PTH at the end of treatment.- To define the minimally effective dose defined by the dose at which the mean of the two highest PTH levels increases to 30-40 pg/mL (in individuals with baseline PTH <= 20 pg/mL) in the absence of DLTs. |
Period 1: 104 +/- 10 days. Period 2: 28 weeks +/- 10 days.
|
|
Periods 1 and 2 - Evaluate potential measures of efficacy of PTH-IA in JMC.
Tijdsspanne: Period 1: 104 +/- 10 days. Period 2: 28 weeks +/- 10 days.
|
To measure the change in: - Tubular reabsorption of phosphate and the ratio of tubular maximum reabsorption of phosphate to GFR between pre- & post-intervention at the end of treatment.- Bone turnover markers (P1NP, BSALP, CTX, osteocalcin) between pre- & post-intervention.- Pre-defined sentinel skeletal lesion metabolic activity representing region of most intense pathology as measured by 18F- NaF PET/CT (<= 5 lesions) between pre- & post-intervention.- Pre-defined target skeletal lesion mineral density representing region of most intense pathology as measured by 18F- NaF PET/CT (<= 5 lesions) between pre- & post-intervention. - Nephrocalcinosis scores on ultrasound from baseline to end of treatment (0-no nephrocalcinosis to 3-severe).- HR-pQCT parameters of the radius and tibia: total BMD, cortical and trabecular BMD; cortical thickness, cortical porosity, BV/TV, trabecular number, thickness, and separation; stiffness and failure load of the peripheral skeleton. |
Period 1: 104 +/- 10 days. Period 2: 28 weeks +/- 10 days.
|
Medewerkers en onderzoekers
Sponsor
Sponsor
Onderzoekers
Onderzoekers
- Hoofdonderzoeker: Alison M Boyce, M.D., National Institute of Dental and Craniofacial Research (NIDCR)
Publicaties en nuttige links
Nuttige links
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Studie start
Primaire voltooiing (Geschat)
Primaire voltooiing
Studie voltooiing (Geschat)
Studie voltooiing
Studieregistratiedata
Eerst ingediend
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Eerst geplaatst
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update geplaatst
Laatste update ingediend die voldeed aan QC-criteria
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
Andere studie-ID-nummers
- 10001653
- 001653-D
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Beschrijving IPD-plan
This study will comply with the NIH Data Sharing Policy and the Clinical Trials Registration and Results Information Submission rule.
IPD-tijdsbestek voor delen
Results from this trial will be made available 12 months after the primary study completion date.
IPD-toegangscriteria voor delen
PI will consider reasonable requests from qualified researchers for access to clinical data.
IPD delen Ondersteunend informatietype
- LEERPROTOCOOL
- SAP
- ICF
- MVO
Informatie over medicijnen en apparaten, studiedocumenten
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Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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