Efficacy, Pharmacokinetics, Tolerability, Safety of SB012 Intrarectally Applied in Active Ulcerative Colitis Patients

Colitis, Ulcerative Clinical Trial

— SECURE  

Official title:

SB012 for Treatment of Active Ulcerative Colitis: Prospective Multi-centre Randomised Double-blind Placebo-controlled Phase IIa Clinical Trial to Evaluate Efficacy, Pharmacokinetics, Tolerability and Safety of SB012 Enema Administered OD

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02129439
• Other study ID #: SB012/01/2013
• Status: Completed
• Phase: Phase 1/Phase 2
• First received: April 30, 2014
• Last updated: March 8, 2018
• Start date: April 2014
• Est. completion date: June 22, 2017

Study information

• Verified date: July 2017
• Source: Sterna Biologicals GmbH & Co. KG
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Ulcerative colitis (UC) represents one of the major entities of idiopathic inflammatory bowel diseases which are defined as chronically relapsing inflammations of the gastrointestinal tract not due to specific pathogens. It is characterised by a superficial, continuous mucosal inflammation, which predominantly affects the large intestine. The clinical course is typically marked by periods of asymptomatic remission punctuated by unpredictable recurrent attacks. The symptoms of the patients are marked by persistent diarrhoea with severe faecal urgency and often incontinence, rectal bleeding, abdominal cramping and weight loss.

Uncontrolled activation of mucosal effector T cells has been identified as the main pathogenic mechanism involved in the initiation and perpetuation of intestinal inflammatory reactions.

Patients with moderate UC are initially treated with mesalazine, applied both orally and rectally. If symptoms do not improve, systemic corticosteroids are to be administered. Patients who do not respond to systemic corticosteroids may become eligible for treatment with a calcineurin inhibitor or an anti-tumor necrosis factor (TNF)α antibody. Alternatively, patients may have to undergo major colorectal surgery.

Patients who do not adequately respond to these treatment strategies exhibit serious drawbacks. Colorectal surgery may result in a severely compromised quality of life.

Therefore, patients with moderate or severe UC may significantly benefit from new therapeutic alternatives.

The transcription factor GATA-3 is an interesting target for a novel therapeutic strategy in UC.

GATA-3 is the key regulation factor of Th2-driven immune responses. It is indispensable for the differentiation and activation of Th2 cells, integrates Th2 signals, and induces Th2 cytokine expression. Results of a recent clinical trial in children showed that GATA-3 is involved in the pathogenesis of the acute phase of UC.

The investigational product SB012 contains the DNAzyme hgd40 that targets GATA-3. By cleaving GATA-3 mRNA hgd40 reduces specific cytokine production and thereby reduces key features of mucosal inflammation.

DNAzymes are completely generated by chemical synthesis, not by use of any living organism and are therefore not biological drugs.

This study will evaluate the efficacy, safety, tolerability and pharmacokinetics of the topical formulation SB012 available in a concentration of 7.5mg/ml hgd40 in 30ml PBS once daily as a ready-for-use enema in patients with active UC.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 20
• Est. completion date: June 22, 2017
• Est. primary completion date: June 22, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

The trial population consists of adult subjects of both sexes with active ulcerative colitis aged 18 to 75 years.

The main inclusion criteria comprise:

• Fully capable to give informed consent.

• Mentally able to understand the nature, significance, implications and risks of the clinical trial and to follow instructions of the trial staff.

• Written informed consent

• Clinical Mayo Score of =3

• Total Mayo Score of =6

• Endoscopic Mayo score =2 in the sigmoid

• Body mass index =18.0 to =29.0kg/m2 and body weight =50 to =100kg

• Negative urine pregnancy test (female subject only)

• Using two methods of contraception

Exclusion Criteria:

• Colectomy and presence of ileal pouch-anal anastomosis or ileorectal anastomosis

• Diagnosis of ulcerative proctitis, fulminant colitis, toxic megacolon, of colitis indeterminata or Crohn's disease

• Ileostoma

• Anti-TNFa treatment with adalimumab, certolizumab, etanercept, golimumab, or infliximab =4 weeks prior to screening visit.

• Change in systemic glucocorticoid treatment =1 weeks prior to screening visit

• Change in 5-Aminosalicylic Acid (ASA) therapy =1 week prior to screening visit

• Start of treatment with an immunosuppressive agent =3 months prior to screening visit

• Change in treatment with an immunosuppressive agent =4 weeks prior to baseline visit

• Planned concomitant therapeutic administration of suppositories or foams or enema other than the IMP.

• Impaired blood coagulation (Quick value <50% and/or partial thromboplastin time (PTT) >55sec and/or platelet count <50.000/µl.)

• Signs of renal insufficiency

• Signs of hepatic insufficiency.

• Current treatment with drugs of high hepatotoxic potential.

• Evidence of recent alcohol abuse.

• Acute or chronic heart failure with NYHA functional class III or IV.

• Known active tuberculosis.

• Known acute serious infections or sepsis.

• Known current malignant disease.

• Positive blood test against HBs antigen, anti-HBc antibodies, anti-HCV antibodies or anti-HIV-1/2 antibodies.

• Known opportunistic infections including invasive fungal infections.

• Known hypersensitivity to the IMP or any of their formulation ingredients.

• Any condition that is thought to reduce the compliance to cooperate with the trial procedures.

• Employee of the department of the investigator, of the Center for Clinical Studies (CCS) or of the sponsor.

• Prior participation in this clinical trial.

• Participation in an interventional clinical trial within the last three months (six months in case of a biological IMP) or be under the exclusion period from another clinical trial.

• Known or planned absence that may collide with the clinical trial visit schedule.

Related Conditions & MeSH terms

• Colitis
• Colitis, Ulcerative
• Ulcer

Intervention

Drug:
• SB012
The treatment phase lasts 28 consecutive days. The IMP will be administered for the first time at the study site in the morning on Day 1 (IMP administration training by study site staff). The final administration will be performed at the study site in the morning of Day 28. On all other treatment days (Day 2 to Day 27), the IMP will be self-administered by the subject at home. SB012 will be available in this clinical trial in a concentration of 7.5mg/ml hgd40 in 30ml PBS (Maximum daily dose: 225mg) The IMP is formulated as an enema and will be administered in this clinical trial by the rectal route. The enema is a ready-for-use preparation. No further preparation steps are required. No modifications are permitted to the dosing regimen except for premature study discontinuation.
• Placebo
Intervention of placebo-treated subjects does not vary to SB012-treated subjects. The treatment phase lasts 28 consecutive days. Placebo will be administered for the first time at the study site in the morning on Day 1 (Administration training by study site staff). The final administration will be performed at the study site in the morning of Day 28. On all other treatment days (Day 2 to Day 27), the IMP/Placebo will be self-administered by the subject at home. Placebo will be administered with a volume of 30ml. The IMP/Placebo is formulated as an enema (plastic rectal tube) and will be administered in this clinical trial by the rectal route. The enema is a ready-for-use preparation. No further preparation steps are required.

Locations

Country	Name	City	State
Germany	Braunschweig Municipal Hospital - Medical Clinic 1	Braunschweig
Germany	Department of Medicine 1 - Gastroenterology, Pneumology and Endocrinology, University Clinic Erlangen, Germany	Erlangen
Germany	Asklepios West Hospital Hamburg - Division Gastroenterology	Hamburg

Sponsors (1)

Lead Sponsor	Collaborator
Sterna Biologicals GmbH & Co. KG

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Pharmacokinetic (PK) analysis	In subjects with hgd40 plasma levels equal to or above "lower limit of quantification" (LLOQ): mean hgd40 plasma concentrations per time point.; Blood sampling for PK analysis prior to IMP administration and 1, 2, 4, 6 and 24 hours after IMP administration with a time window of ±2min for the 1 and 2 hour time point, of ±5min for the 4 and 6 hour time points and a time window of ±1 h for the 24 hour time point.	First treatment Day 1/day 2 (Visit 3/4) to Last treatment day 28/29 (Visit 7/8)
Other	Exploratory analysis: Systemic biomarker plasma levels	To evaluate the effects of SB012 enema on disease activity assessed by histology of, and biomarker expression in, biopsies from affected colonic tissue and on systemic biomarker expression in the blood.	Day 1 (Visit 3) to Day 28 or Day 56 (V7 or V10)
Other	Exploratory analysis: Systemic biomarker plasma levels	Change in GATA-3 mRNA expression 4 and 8 weeks after start of treatment compared to baseline value in the active treatment group (SB012) versus placebo.	Day 1 (Visit 3) to Day 28 or Day 56 (V7 or V10)
Other	Exploratory analysis: Riley Score	Change in Riley score 4 and 8 weeks after start of treatment compared to baseline value in the active treatment group (SB012) versus placebo.; The Riley score is a 19-point ordinal scale for the quantification of inflammatory activity in tissue affected by ulcerative colitis based on the following six histological criteria : Acute inflammatory cell infiltrates (polymorphonuclear).; Crypt abscesses.; Mucin depletion.; Surface epithelial integrity.; Chronic inflammatory cell infiltrate.; Crypt architectural irregularities.; Each criterion has a grade ranging from 0 to 3, with 18 representing the most severe state of inflammation: Score Inflammation; None 0; Mild 1; Moderate 2; Severe 3	Day 1 (Visit 3) to Day 28 or Day 56 (V7 or V10)
Primary	Efficacy: Total Mayo score (4 weeks comparison)	Change in Total Mayo score after 4 weeks of treatment compared to baseline value in the active treatment group (SB012) versus placebo.; The Total Mayo score is a 13-point ordinal scale for the assessment of concurrent severity of ulcerative colitis. It comprises four components: stool frequency, rectal bleeding, endoscopic findings and physician's global assessment of disease severity. Each component has four grades ranging from 0 to 3. The Total Mayo score ranges from 0 to 12, with 12 representing the most severe disease.	Baseline (Visit 2) to day 28 (Visit 7) (28 days)
Secondary	Efficacy: Total Mayo score (8 weeks comparison)	Change in Total Mayo score 8 weeks after start of treatment compared to baseline value in the active treatment group (SB012) versus placebo.	Baseline (Visit 2) to End-of-Study Visit10 (56 days)
Secondary	Efficacy: Endoscopic Mayo score (4 and 8 weeks comparison)	Change in Endoscopic Mayo score 4 and 8 weeks after start of treatment compared to baseline value in the active treatment group (SB012) versus placebo.; The Endoscopic Mayo score represents a subscore of the Total Mayo score and consists of the endoscopic findings. It ranges from 0 to 3.; Normal or inactive disease 0 Mild disease (erythema, decreased vascular pattern, mild friability) 1 Moderate disease (marked erythema, absent vascular pattern, friability, erosions) 2 Severe disease (spontaneous bleeding, ulceration) 3	Baseline (Visit 2) to Visit 7 and Visit 10 (28 and 56 days)
Secondary	Efficacy/Pharmacodynamics: Glucocorticoid consumption	Change in systemic glucocorticoid consumption (measured as Defined Daily Dose) 8 weeks after start of treatment compared to baseline value in the active treatment group (SB012) versus placebo.	Baseline (Visit 2) to day 56 End of Study Visit 10 (56 days)
Secondary	Safety: Treatment Emergent Adverse Events (AE) and Serious Adverse Events (SAE)	Number of treatment-emergent AEs and SAEs in the active treatment group (SB012) versus placebo in patient´s overall study period.	Visit 1 (Screening) to Visit 10 (End of Study - 56 days) or Visit X (Early Study Termination)