First-Time-in-Human Study and Prediction of Early Bactericidal Activity for GSK3036656, a Potent Leucyl-tRNA Synthetase Inhibitor for Tuberculosis Treatment

David Tenero, Geo Derimanov, Alex Carlton, John Tonkyn, Matt Davies, Simon Cozens, Stephanie Gresham, Alison Gaudion, Adeep Puri, Morris Muliaditan, Joaquin Rullas-Trincado, Alfonso Mendoza-Losana, Andrew Skingsley, David Barros-Aguirre, David Tenero, Geo Derimanov, Alex Carlton, John Tonkyn, Matt Davies, Simon Cozens, Stephanie Gresham, Alison Gaudion, Adeep Puri, Morris Muliaditan, Joaquin Rullas-Trincado, Alfonso Mendoza-Losana, Andrew Skingsley, David Barros-Aguirre

Abstract

This first-time-in-human (FTIH) study evaluated the safety, tolerability, pharmacokinetics, and food effect of single and repeat oral doses of GSK3036656, a leucyl-tRNA synthetase inhibitor. In part A, GSK3036656 single doses of 5 mg (fed and fasted), 15 mg, and 25 mg and placebo were administered. In part B, repeat doses of 5 and 15 mg and placebo were administered for 14 days once daily. GSK3036656 showed dose-proportional increase following single-dose administration and after dosing for 14 days. The maximum concentration of drug in serum (Cmax) and area under the concentration-time curve from 0 h to the end of the dosing period (AUC0-τ) showed accumulation with repeated administration of approximately 2- to 3-fold. Pharmacokinetic parameters were not altered in the presence of food. Unchanged GSK3036656 was the only drug-related component detected in plasma and accounted for approximately 90% of drug-related material in urine. Based on total drug-related material detected in urine, the minimum absorbed doses after single (25 mg) and repeat (15 mg) dosing were 50 and 78%, respectively. Unchanged GSK3036656 represented at least 44% and 71% of the 25- and 15-mg doses, respectively. Clinical trial simulations were performed to guide dose escalation during the FTIH study and to predict the GSK3036656 dose range that produces the highest possible early bactericidal activity (EBA0-14) in the prospective phase II trial, with consideration of the predefined exposure limit. GSK3036656 was well tolerated after single and multiple doses, with no reports of serious adverse events. (This study has been registered at ClinicalTrials.gov under identifier NCT03075410.).

Keywords: EBA prediction; FTIH; GSK3036656; clinical trial simulations; dose escalation; dose rationale; food effect; pharmacokinetics; repeat dose; safety; single dose; tolerability; tuberculosis.

Copyright © 2019 Tenero et al.

Figures

FIG 1
FIG 1
Mean plasma GSK3036656 concentration-time plots (linear and semilog) for part A. Note that the lower limit of quantification (LLQ) is 10 ng/ml.
FIG 2
FIG 2
Mean plasma GSK3036656 concentration-time plots (linear and semilog) for part B (day 14). Note that the LLQ is 10 ng/ml.
FIG 3
FIG 3
Predicted early bactericidal activity of GSK3036656 in tuberculosis patients. Analysis predicted the early bactericidal activity (EBA0–14) following 14 days of treatment with 5 to 25 mg once daily, based on the estimated PK/PD relationship in mouse infection models. Box plots represent the 5th, 25th, 50th, 75th, and 95th percentiles of the simulated individual EBA0–14. Numbers in parentheses represent the reported average EBA0–14 of each reference drug at therapeutic doses. PMD, pretomanid; BDQ, bedaquiline; OPC, delamanid.

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