Study of Efficacy of ARA 290 on Corneal Nerve Fiber Density and Neuropathic Symptoms of Subjects With Sarcoidosis

Overview

The purpose of this study is to determine whether ARA 290, a new class of compound, is effective in the treatment of the neuropathic symptoms of sarcoidosis. Brief interaction of ARA 290 with the innate repair receptor results in anti-apoptotic and anti-inflammatory activities in myriad of cells, tissues and organs throughout the body to activate repair mechanisms and accelerate healing, including the nerve damage that can be associated with sarcoidosis. In this study, subjects with sarcoidosis and symptoms of small fiber neuropathy will administered ARA 290 or placebo by subcutaneous injection daily for 28 days. In addition to monitoring the safety of the treatment, the symptoms of the subjects will be assessed with several questionnaires, function tests, and measurement of nerve fibers in their cornea and skin (via a non-invasive test and a biopsy, respectively). The total participation time for each patient will be 16 weeks.

This was a double-blind, randomized, placebo-controlled study to assess the effects of daily SC administration of ARA 290 at a dose of 1 mg, 4 mg, or 8 mg or placebo on corneal nerve fiber density of subjects with sarcoidosis and neuropathic symptoms consistent with small fiber neuropathy. The safety of these doses was also assessed. Up to 64 subjects with sarcoidosis and symptoms of small fiber neuropathy were planned to be enrolled in the study. Subjects determined to be eligible at the screening visit were asked to return to the study site for the start of the treatment period (Visit 1, study day 1) within 28 days of screening. Subjects who were not able to return for Visit 1 within 28 days of the screening visit could be rescreened. At Visit 1, the subjects were randomized to one of 4 treatment groups (approximately 16 subjects per group): 1 mg, 4 mg, or 8 mg of ARA 290 or placebo. The study drug (ARA 290 or placebo) was to be administered daily for 28 days via SC injection. The first injection of study drug was administered at the study site at Visit 1. After the first injection, the subjects were required to stay at the research site for 1 hour post dose for safety observation and recording of any adverse events (AEs). The subjects were trained for self-injection of the study drug and asked to self-administer the study medication daily at home before breakfast for the remaining treatment period using the supplied individual vials and disposable insulin needles and syringes. The subjects were asked to visit the study site after 14 ± 2 days of dosing (Visit 2) and at the end of the treatment period Day 28 ± 2 (Visit 3). Additionally, the study personnel contacted the subjects by telephone at study days 7 and 21. Following the treatment period the subjects were followed-up for a further 12 weeks (until study day 112). During this period the subjects visited the study site at Day 56 ± 2 days (Visit 4) and study personnel contacted the subjects by telephone at study days 35 and 42 and biweekly from study days 70 to 112. The duration of study participation for each subject was 16 weeks. Throughout the study the subjects were asked to complete several questionnaires regarding general health and well-being, pain, fatigue and neuropathic symptoms. Further assessments included the 6MWT, and determination of nerve fiber density. If feasible at the site, quantitative sensory and cardiac autonomic reflex testing were to be performed. The protocol was later amended to administer the Columbia-Suicide Severity Rating Scale (C-SSRS). Any positive results for active suicidal ideation and behavior, based on evaluation of the C-SSRS questionnaire, were reported as AEs. During the treatment period the subjects were also asked to complete a diary card to document compliance. Safety assessments included the documentation of AEs, vital signs and electrocardiogram (ECG), safety laboratory, physical examination and a test for ARA 290 antibodies.