A Safety Study of AZD4041 in Healthy Participants

Opioid Use Disorder (OUD) Clinical Trial

Official title:

A Randomized, Double-Blind, Placebo-Controlled Study to Assess the Safety, Tolerability, and Pharmacokinetics of Multiple Ascending Doses of AZD4041 in Healthy Adult Subjects

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05233085
• Other study ID #: D7460C00002
• Secondary ID: UG3DA054825
• Status: Completed
• Phase: Phase 1
• Start date: December 17, 2021
• Est. completion date: June 7, 2022

Study information

• Verified date: November 2023
• Source: AstraZeneca
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a Phase 1, single-centre, randomized, double-blind, placebo-controlled, multiple ascending doses (MAD) study in healthy male and female adult participants.

The study will include up to 48 participants (12 participants per cohort) who will be randomized 9:3 to active drug or placebo. Each cohort will receive AZD4041 or placebo in a MAD study.

A sequential cohort MAD design will be employed to assure that higher doses are administered to healthy participants only after lower doses have demonstrated an acceptable safety profile.

The total study duration will be up to 59 days (including Screening) per participant.

Other known NCT identifiers

• NCT05209334

Recruitment information / eligibility

• Status: Completed
• Enrollment: 36
• Est. completion date: June 7, 2022
• Est. primary completion date: June 7, 2022
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 55 Years

Eligibility

Inclusion Criteria

• Provision of signed and dated written informed consent form prior to any study specific procedures

• Stated willingness to comply with all study procedures and availability for the duration of the study

• Healthy adult male or female participants. Female participants must be of non-childbearing potential (postmenopausal and/or surgically sterile)

• If female, meets one of the following criteria:

1. Physiological postmenopausal status, defined as the following:

1. absence of menses for at least 12 months following cessation of all exogenous hormonal treatments (without an alternative medical condition) at Screening and prior to the first study drug administration; and

2. follicle stimulating hormone (FSH) levels = 40 mIU/mL at Screening; and

3. must have a negative pregnancy test result at screening and check-in. and/or

2. Surgical sterile, defined as those who have had:

hysterectomy, bilateral oophorectomy and/or bilateral salpingectomy, or bilateral tubal ligation. Women who are surgically sterile must provide documentation of the procedure by an operative report, ultrasound, or other verifiable documentation; and must have a negative pregnancy test result at screening and check-in.

If postmenopausal and has an FSH of < 40 mIU/mL, but meets all other criteria in (1) or (2) above as well as all the other inclusion criteria, screening oestradiol serum level must be equal to or below 150 pmol/L.

• Men who are biologically capable of fathering children must agree and commit to use an adequate form of contraception for the duration of the treatment period and for no less than 120 days (4 months) after the last administration of study intervention. A male participant is considered capable of fathering children even if his sexual partner is sterile or using contraceptives.

• Men who are biologically capable of fathering children must also agree to refrain from sperm donation for the duration of the treatment period and for at least 90 days after the last administration of study intervention.

• Aged at least 18 years but not older than 55 years on the day of randomization

• Body mass index (BMI) within 18.0 kg/m^2 to 30.0 kg/m^2, inclusive

• Body weight of within 50 kg to 100 kg, inclusive

• Non- or ex-smoker (An ex-smoker is defined as someone who completely stopped using nicotine products for at least 180 days prior to the first study drug administration)

• Have no clinically significant diseases captured in the medical history or evidence of clinically significant findings on the physical or neurological examination (including vital signs) and/or ECG and/or safety laboratory tests, as determined by an Investigator

• Suitable veins for cannulation or repeated venepuncture

Exclusion Criteria

• Female who is lactating

• Female who is pregnant according to the pregnancy test at Screening or prior to the first study drug administration

• Male participants with a history of oligospermia or azoospermia or any other disorder of the reproductive system

• Male participants who are undergoing treatment or evaluation for infertility.

• History of significant allergy/ hypersensitivity to AZD4041 or products related to AZD4041 as well as severe allergy/hypersensitivity reactions (like angioedema) to any drugs

• Presence or history of significant gastrointestinal, liver or kidney disease, or any other condition that is known to interfere with drug absorption, distribution, metabolism, or excretion, or known to potentiate or predispose to undesired effects

• History of any significant disease, including [but not necessarily limited to] significant cardiovascular, pulmonary, hematologic, neurological, psychiatric, endocrine, immunologic, or dermatologic disease

• Maintenance therapy with any drug or significant history of drug dependency or alcohol abuse (> 21 units/week or > 3 units/day for men; > 14 units/week or > 2 units/day for women; intake of excessive alcohol, acute or chronic)

• History of any significant psychiatric disorder according to the criteria of the Diagnostic and Statistical manual of Mental Disorders, 5th Edition (DSM-5, American Psychiatric Association 2013) which, in the opinion of the Investigator, could be detrimental to participant safety or could compromise study data interpretation.

• History of substance use disorder, other than nicotine or caffeine (as per DSM-5 criteria)

• Use of any prescription drugs, including hormone replacement therapy in the 28 days prior to the first study drug administration, that in the opinion of an Investigator would put into question the status of the participant as healthy

• Use of St. John's wort in the 28 days prior to the first study drug administration

• Positive test result for alcohol and/or drugs of abuse at Screening or prior to the first study drug administration

• Any clinically significant illness, medical/surgical procedure or trauma within the 28 days prior to the first study drug administration

• Any abnormal or clinically significant findings in laboratory test results at Screening that would, in the opinion of an Investigator, increase the participant's risk of participation, jeopardize complete participation in the study, or compromise interpretation of study data

• Positive screening results to human immunodeficiency virus (HIV) antigen/antibody (Ag/Ab) combo, hepatitis B surface antigen, or hepatitis C virus tests

• Showing suicidal tendency as per the C-SSRS questionnaire administered at Screening

• Any abnormal vital signs, after 10 minutes supine rest, as defined in the list below, at the Screening Visit/or Day -2 Out of range tests may be repeated once for each visit at the discretion of an Investigator.

1. Systolic blood pressure (BP) < 90 mmHg or >140 mmHg

2. Diastolic BP < 50 mmHg or > 90 mmHg

3. Heart Rate < 45 or > 85 beats per minute (bpm)

• Any clinically important abnormalities in rhythm, conduction, or morphology of the resting ECG and any clinically important abnormalities in the 12-lead ECG which, in an Investigator's opinion, may interfere with the interpretation of QTc interval changes, including abnormal ST-T-wave morphology, particularly in the protocol-defined primary lead or left ventricular hypertrophy at Screening or prior to the first study drug administration

• Prolonged QT interval corrected for HR using Fridericia's formula (QTcF) > 440 ms at Screening or prior to the first study drug administration

• Shortened QTcF < 340 ms at Screening or prior to first study drug administration

• Known family history of long QT syndrome

• ECG interval measured from the onset of the P wave to the onset of the complex between Q and S waves (QRS complex) (PR [PQ]) interval shortening < 120 ms (PR > 110 ms but < 120 ms is acceptable if there is no evidence of ventricular preexcitation) at Screening or prior to the first study drug administration

• PR (PQ) interval prolongation (> 220 ms), persistent or intermittent second (Wenckebach block while asleep is not exclusive), or third degree atrioventricular (AV) block, or AV dissociation at Screening or prior to the first study drug administration

• Persistent or intermittent complete bundle branch block, incomplete bundle branch block, or intraventricular conduction delay (IVCD) with ECG interval measured from the onset of the QRS complex to the J point (QRS) > 110 ms. Participants with QRS > 110 ms but < 115 ms are acceptable if there is no evidence of ventricular hypertrophy or preexcitation at Screening or prior to the first study drug administration

• In the pre-dose 24 hour telemetry, presence of = 10 ventricular premature contractions (VPCs) during 1 hour, or = 100 VPCs during 24-hours of telemetry, or any occurrence of paired VPC (ventricular couplets) or other repetitive ventricular rhythms, including non-sustained or sustained (> 30 second duration), slow (< 100 bpm), or fast (= 100 bpm) ventricular tachycardias.

• Vaccination with the Coronavirus disease 2019 (COVID-19) vaccine less than 14 days prior to first study dose administration

• Scheduled immunization with a COVID-19 vaccine (first or second dose) during the study that, in the opinion of an Investigator, could potentially interfere with participant participation, participant safety, study results, or any other reason

• Use of any prescribed or nonprescribed oral and topical inhibitors/inducers of CYP3A4 (including shampoo).

• Excessive intake of caffeine-containing drinks or food (eg, coffee, tea, chocolate) as judged by an Investigator

• Participants who have previously received AZD4041

• Any history of tuberculosis

• Involvement of any AstraZeneca or study site employee or their close relatives

• Judgment by an Investigator that the participant should not participate in the study if they have any ongoing or recent (ie, during the Screening period) minor medical complaints that may interfere with the interpretation of study data or are considered unlikely to comply with study procedures, restrictions, and requirements

• Presence of any tongue piercings or history of any tongue piercings in the last 90 days prior to the first study drug administration

• Participants who have medical dietary restrictions

• Participants who cannot communicate reliably with the Investigator

• Inclusion in a previous group for this clinical study

• Intake of an investigational product (IP) within at least 28 days or 5 half-lives; whichever is longer, prior to the first study drug administration

• Donation of 50 mL or more of blood in the 28 days prior to the first study drug administration

• Donation of 500 mL or more of blood in the 56 days prior to the first study drug administration

Related Conditions & MeSH terms

• Opioid Use Disorder (OUD)
• Opioid-Related Disorders

Intervention

Drug:
• AZD4041
Participants will receive oral solution of AZD4041 as stated in arm description.

Other:
• Placebo
Participants will receive oral solution of placebo as stated in arm description.

Locations

Country	Name	City	State
Canada	Research Site	Laval	Quebec

Sponsors (2)

Lead Sponsor	Collaborator
AstraZeneca	Altasciences Company Inc.

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs)	An adverse event (AE) is any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. A serious adverse event (SAE) is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. The TEAEs are defined as events present at baseline that worsened in intensity after administration of study drug or events absent at baseline that emerged after administration of study drug.	From Day 1 to Day 31
Primary	Number of Participants With Abnormal Vital Signs Reported as TEAEs	Number of participants with abnormal vital signs reported as TEAEs are reported. Abnormal vital signs are defined as any abnormal finding in the vital sign parameters (blood pressure, pulse rate, and body temperature).	From Day 1 to Day 31
Primary	Number of Participants With Abnormal Clinical Laboratory Parameters Reported as TEAEs	Number of participants with abnormal clinical laboratory parameters reported as TEAEs are reported. Abnormal clinical laboratory parameters defined as any abnormal finding during analysis of general biochemistry, hematology, and urinalysis.	From Day 1 to Day 31
Primary	Number of Participants With Abnormal Electrocardiograms (ECGs) Reported as TEAEs	Number of participants with abnormal ECGs reported as TEAEs are reported.	From Day 1 to Day 31
Primary	Number of Participants With Suicidal Ideation or Behavior Assessed Using Columbia Suicide Severity Rating Scale (C-SSRS)	The C-SSRS is described as a scale developed at Columbia University that has 2-6 questions each in categories of Suicidal Ideation, Intensity of Ideation, Suicidal Behavior, and Actual Attempts. Four constructs were measured. Severity of Suicidal ideation is rated on a 5-point ordinal scale. Intensity of ideation is comprised of 5 items (frequency, duration, controllability, deterrents, and reason for ideation), each rated on a 5-point ordinal scale. Suicidal behavior is rated on a nominal scale that includes actual, aborted, and interrupted attempts; preparatory behavior; and non-suicidal self-injurious behavior. Lethality, assesses actual attempts; actual lethality is rated on a 6-point ordinal scale, and if actual lethality is 0, potential lethality of attempts is rated on a 3-point ordinal scale.The higher the C-SSRS score, the higher the suicide risk (ie. worse outcome).	Baseline (Days -28 to -1) through Day 17
Primary	Number of Participants With Clinically Significant Findings in Physical and Neurological Examinations	Number of participants with clinically significant findings in physical and neurological examinations are reported.	Baseline (Days -28 to -1) through Day 31
Primary	Number of Participants With Abnormal Male Hormone Levels as Assessed by the Investigator	Male hormone levels investigated included testosterone, luteinizing hormone, follicle stimulating hormone, and inhibin B. Number of Participants with abnormal male hormone levels as assessed by the investigator are reported.	Day -1, pre-dose and 1.5 hours post-dose on Days 1 and 14
Secondary	Maximum Observed Plasma Concentration (Cmax) of AZD4041 After Day 1 Dose	The Cmax of AZD4041 after Day 1 dose is reported.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose
Secondary	Maximum Observed Plasma Concentration (Cmax) of AZD4041 After Day 14 Dose	The Cmax of AZD4041 after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Time to Reach Maximum Observed Plasma Concentration (Tmax) of AZD4041 After Day 1 Dose	The Tmax of AZD4041 after Day 1 dose is reported.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose
Secondary	Time to Reach Maximum Observed Plasma Concentration (Tmax) of AZD4041 After Day 14 Dose	The Tmax of AZD4041 after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Area Under the Concentration-time Curve From Time Zero to 24 Hours (AUC0-24) of AZD4041 After Day 1 Dose	The AUC0-24 of AZD4041 after Day 1 dose is reported.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose
Secondary	Area Under the Concentration-time Curve From Time 0 (Dose Administration) to the Time of Last Quantifiable Concentration (AUC0-t) of AZD4041 After Day 1 Dose	The AUC0-t of AZD4041 after Day 1 dose is reported.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose
Secondary	Area Under the Concentration-time Curve From Time 0 (Dose Administration) to the Time of Last Quantifiable Concentration (AUC0-t) of AZD4041 After Day 14 Dose	The AUC0-t of AZD4041 after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Area Under the Concentration-time Curve Extrapolated to Infinity (AUC0-inf) of AZD4041 After Day 1 Dose	The AUC0-inf of AZD4041 after Day 1 dose is reported. This PK parameter (AUC0-inf) requiring apparent elimination rate constant (?z) estimation was not evaluable for Cohorts 1 and 3 due to meeting either the exclusion criteria R^2 < 0.8 or the extrapolated area > 20%.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose
Secondary	Area Under the Concentration-time Curve Over the Dosing Interval at Steady State (AUCt) of AZD4041 After Day 14 Dose	The AUCt of AZD4041 calculated after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Observed Concentration at the End of the Dosing Interval (Ctrough) of AZD4041	The Ctrough of AZD4041 is reported.	Predose on Days 2 (Day 1, 24-hours), 3, 4, 5, 6, 7, 8, 9, 10, 14
Secondary	Concentration at the End of the Dosing Interval (Ct) of AZD4041 After Day 14 Dose	The Ct of AZD4041 after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Terminal Elimination Half-life (t1/2,z) of AZD4041 After Day 1 Dose	The t1/2,z of AZD4041 after Day 1 dose is reported. This PK parameter (t1/2,z) requiring ?z estimation was not evaluable for Cohorts 1 and 3 due to meeting either the exclusion criteria R^2 < 0.8 or the extrapolated area > 20%.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose
Secondary	Terminal Elimination Half-life (t1/2,z) of AZD4041 After Day 14 Dose	The t1/2,z of AZD4041 after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Effective Half-life (t1/2Eff) of AZD4041 After Day 14 Dose	The t1/2Eff of AZD4041 after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Accumulation Ratio Evaluated by Comparing Day 14 Cmax to Day 1 Cmax (RAC[Cmax]) of AZD4041	The RAC(Cmax) of AZD4041 is reported.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose; Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Accumulation Ratio Evaluated by Comparing Day 14 AUCt to Day 1 AUC0-24 (RAC[AUC]) of AZD4041	The RAC(AUC) of AZD4041 is reported.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose; Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Apparent Total Clearance (CL/F) of AZD4041 After Day 1 Dose	The CL/F of AZD4041 after Day 1 dose is reported. This PK parameter (CL/F) requiring ?z estimation was not evaluable for Cohorts 1 and 3 due to meeting either the exclusion criteria R^2 < 0.8 or the extrapolated area > 20%.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose
Secondary	Apparent Total Clearance at Steady State (CL/Fss) of AZD4041 After Day 14 Dose	The CL/Fss of AZD4041 after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Apparent Volume of Distribution (Vz/F) of AZD4041 After Day 1 Dose	The Vz/F of AZD4041 after Day 1 dose is reported. This PK parameter (Vz/F) requiring ?z estimation was not evaluable for Cohorts 1 and 3 due to meeting either the exclusion criteria R^2 < 0.8 or the extrapolated area > 20%.	Day 1: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours postdose
Secondary	Apparent Volume of Distribution at Steady State (Vz/Fss) of AZD4041 After Day 14 Dose	The Vz/Fss of AZD4041 after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Apparent Elimination Rate Constant (?Z) of AZD4041 After Day 14 Dose	The ?Z of AZD4041 after Day 14 dose is reported.	Day 14: Predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, and 72 hours postdose
Secondary	Amount of AZD4041 Excreted Unchanged in Urine Over the 24-hour Dosing Interval (Ae0-24) After Day 1 Dose	The Ae0-24 of AZD4041 after Day 1 dose is reported.	Day 1: Predose spot collection, and 0 to 6 hours, 6 to 12 hours, and 12 to 24 hours postdose
Secondary	Amount of AZD4041 Excreted Unchanged in Urine Over the 24-hour Dosing Interval (Ae0-24) After Day 14 Dose	The Ae0-24 of AZD4041 after Day 14 dose is reported.	Day 14: Predose spot collection, and 0 to 6 hours, 6 to 12 hours, and 12 to 24 hours postdose
Secondary	Apparent Fraction of AZD4041 Excreted Unchanged in Urine Over the 24-hours Dosing Interval (fe/F0-24) After Day 1 Dose	The fe/F0-24 of AZD4041 after Day 1 dose is reported.	Day 1: Predose spot collection, and 0 to 6 hours, 6 to 12 hours, and 12 to 24 hours postdose
Secondary	Apparent Fraction of AZD4041 Excreted Unchanged in Urine Over the 24-hours Dosing Interval (fe/F0-24) After Day 14 Dose	The fe/F0-24 of AZD4041 after Day 14 dose is reported.	Day 14: Predose spot collection, and 0 to 6 hours, 6 to 12 hours, and 12 to 24 hours postdose
Secondary	Apparent Renal Clearance Over the 24-hours Dosing Interval (CLR 0-24) of AZD4041 After Day 1 Dose	The CLR 0-24 of AZD4041 after Day 1 dose is reported. Apparent renal clearance was calculated as: Ae (0-24) / AUC0-24 on Day 1.	Day 1: Predose spot collection, and 0 to 6 hours, 6 to 12 hours, and 12 to 24 hours postdose
Secondary	Apparent Renal Clearance Over the 24-hours Dosing Interval (CLR 0-24) of AZD4041 After Day 14 Dose	The CLR 0-24 of AZD4041 after Day 14 dose is reported. Apparent renal clearance was calculated as: Ae (0-24) / AUCt on Day 14.	Day 14: Predose spot collection, and 0 to 6 hours, 6 to 12 hours, and 12 to 24 hours postdose
Secondary	Cerebrospinal Fluid (CSF) Concentration as a Percentage of Total Plasma Concentration of AZD4041 in Cohorts 2 and 3	The CSF concentration as a percentage of total plasma concentration of AZD4041 in cohorts 2 and 3 is reported.	Day 14 post dose (approximately 3 hours ± 1 hour)
Secondary	CSF Concentration as a Percentage of Free Plasma Concentration of AZD4041 in Cohorts 2 and 3	The CSF concentration as a percentage of free plasma concentration of AZD4041 in cohorts 2 and 3 is reported.	Day 14 post dose (approximately 3 hours ± 1 hour)
Secondary	Day 14 / Day 1 Ratio of 4-ß-hydroxy-cholesterol Concentrations	Day 14 / Day 1 ratio of 4-ß-hydroxy-cholesterol concentrations is reported.	Pre-dose Day 1 and 24 hours post Day 14 dose

External Links

•   CSR Synopsis
•   Protocol
•   Statistical Analysis Plan (SAP)