This is a Phase 1, open-label, single-dose, sequential group study to compare the safety and pharmacokinetics (PK) of pretomanid in the following groups of participants: 1) participants with severe renal impairment including those with end stage renal disease (ESRD) not on dialysis, and participants with mild or moderate renal impairment, designated as Groups 2, 3, and 4, respectively; and 2) participants with normal renal function matched to the above renal impairment groups, designated as Groups 1A, 1B, and 1C, respectively. The study will be conducted following a reduced PK study design in Part A. Part A will enroll participants from Group 1A (i.e., 6 healthy matched controls) and Group 2 (i.e., 6 participants with severe renal impairment and ESRD, not on dialysis). A decision to proceed to Part B will be made after the PK of pretomanid, and safety in participants enrolled in Part A have been reviewed. If Part A demonstrates at least a 50% increase in pretomanid area under the plasma concentration-time curve (AUC) in Group 2 (severe renal impairments and ESRD, not on dialysis) relative to the exposures in Group 1A (matched participants with normal renal function), then the reduced PK study will extend to the full PK study to enroll participants into Part B (i.e., to investigate mild and moderate renal impairment). All Part B groups (1B, 1C, 3, and 4) will be enrolled concurrently. If the reduced PK study shows at least a 50% increase in AUC in patients with severe renal impairment and patients with ESRD not yet on dialysis relative to the matched healthy controls, a "full PK" renal impairment study in patients with all intermediate levels of renal function impairment should be conducted. Otherwise, no further study is recommended. The approximate patient involvement will be 3 months. The primary objective is to evaluate the PK profiles of pretomanid in plasma and urine after a single oral dose of 200 mg in participants with renal impairment compared to matched healthy controls.
This is a Phase 1, open-label, single-dose, sequential group study to compare the safety and pharmacokinetics (PK) of pretomanid in the following groups of participants: 1) participants with severe renal impairment including those with end stage renal disease (ESRD) not on dialysis, and participants with mild or moderate renal impairment, designated as Groups 2, 3, and 4, respectively; and 2) participants with normal renal function matched to the above renal impairment groups, designated as Groups 1A, 1B, and 1C, respectively. The study will be conducted following a reduced PK study design in Part A. Part A will enroll participants from Group 1A (i.e., 6 healthy matched controls) and Group 2 (i.e., 6 participants with severe renal impairment and ESRD, not on dialysis). A decision to proceed to Part B will be made after the PK of pretomanid, and safety in participants enrolled in Part A have been reviewed. If Part A demonstrates at least a 50% increase in pretomanid area under the plasma concentration-time curve (AUC) in Group 2 (severe renal impairments and ESRD, not on dialysis) relative to the exposures in Group 1A (matched participants with normal renal function), then the reduced PK study will extend to the full PK study to enroll participants into Part B (i.e., to investigate mild and moderate renal impairment). All Part B groups (1B, 1C, 3, and 4) will be enrolled concurrently. If the reduced PK study shows at least a 50% increase in AUC in patients with severe renal impairment and patients with ESRD not yet on dialysis relative to the matched healthy controls, a "full PK" renal impairment study in patients with all intermediate levels of renal function impairment should be conducted. Otherwise, no further study is recommended. The approximate patient involvement will be 3 months. The primary objective is to evaluate the PK profiles of pretomanid in plasma and urine after a single oral dose of 200 mg in participants with renal impairment compared to matched healthy controls. The secondary objectives are 1) to assess the safety profile of a single oral dose of 200 mg pretomanid in renally impaired participants to matched healthy controls; and 2) to evaluate the PK profiles or representative pretomanid metabolites (M19 and M50) in plasma and urine.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
12
PA-824, a nitroimidazooxazine, used in prior studies of pretomanid is a novel TB treatment that is being investigated for use with other TB drugs to shorten and/or simplify regimens to treat either drug susceptible or resistant disease. After fasting for a minimum of 8 hours, subjects will receive one dose of 200 mg of pretomanid orally under direct supervision with 240 mL of water and a mouth check will be done.
Advanced Pharma - Miami
Miami, Florida, United States
Saint Louis University Center for Vaccine Development
St Louis, Missouri, United States
Alliance for Multispecialty Research, LLC - Knoxville
Knoxville, Tennessee, United States
Fold Change in Pretomanid AUC(0-last) in Participants With Renal Impairment as Compared to Matched Healthy Controls
The mean fold change of AUC(0-last) Area under the concentration time-curve to the last concentration above the lower limit of quantitation at specified pre-dose and post-dose time points was calculated by noncompartmental analysis using the linear up log down method. The mean fold change of each enrolled renal impairment arm as compared to the Healthy Matched Control arm was calculated by a linear regression model controlling for site.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Fold Change in Pretomanid AUC(0-infinity) in Participants With Renal Impairment as Compared to Matched Healthy Controls
The mean fold change of AUC(0-infinity) was calculated by noncompartmental analysis using the linear up log down method with the area extrapolated to infinity as Clast/Lambda\_z where Clast was the last observed concentration and Lambda\_z is the elimination rate constant. The mean fold change of each enrolled renal impairment arm as compared to the Healthy Matched Control arm was calculated by a linear regression model controlling for site.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Area Under the M19 and M50 Concentration Time-curve Extrapolated to Infinity at Specified Pre-dose and Post-dose Time Points
AUC(0-infinity) was calculated by noncompartmental analysis using the linear up log down method with the area extrapolated to infinity as Clast/Lambda\_z where Clast was the last observed concentration and Lambda\_z is the elimination rate constant. M19 and M50 are the two primary representative metabolites of pretomanid.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Area Under the M19 and M50 Concentration Time-curve to the Last Concentration Above the Lower Limit of Quantitation at Specified Pre-dose and Post-dose Time Points
AUC(0-last) Area under the concentration time-curve to the last concentration above the lower limit of quantitation at specified pre-dose and post-dose time points was calculated by noncompartmental analysis using the linear up log down method. M19 and M50 are the two primary representative metabolites of pretomanid.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Maximum M19 and M50 Concentrations at Specified Pre-dose and Post-dose Time Points
Maximum M19 and M50 concentrations is the maximum observed drug concentration in blood plasma at specified pre-dose and post-dose timepoints. M19 and M50 are the two primary representative metabolites of pretomanid.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Apparent Terminal Elimination Half-life of M19 and M50 at Specified Pre-dose and Post-dose Time Points
Apparent terminal half-life of M19 and M50 at specified pre-dose and post-dose timepoints was estimated by ln(2)/Lambda\_z, where Lambda\_z is the elimination rate constant. M19 and M50 are the two primary representative metabolites of pretomanid.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Renal Clearance of M19 and M50 at Specified Pre-dose and Post-dose Time Points
Renal clearance (CLr) of M19 and M50 calculated as the amount excreted in urine to time t in urine divided by the plasma AUC from 0 to time t. M19 and M50 are the two primary representative metabolites of pretomanid.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Amount of M19 and M50 Excreted in Urine at Specified Pre-dose and Post-dose Time Points
Amount of M19 and M50 excreted in Urine \[Ae(0-t)\] is the sum of the amount of M19 and M50 recovered in urine during the collection window. M19 and M50 are the two primary representative metabolites of pretomanid.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Apparent Volume of Distribution of M19 and M50 at Specified Pre-dose and Post-dose Time Points
Apparent Volume of Distribution at specified pre-dose and post-dose timepoints is the volume that the total amount of administered drug would occupy to provide the same concentration as it currently is in blood plasma divided by the bioavailability. It is calculated by Dose/\[Lambda\_z x AUC(0-infinity)\]. M19 and M50 are the two primary representative metabolites of pretomanid.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Time of Maximum M19 and M50 Concentration at Specified Pre-dose and Post-dose Time Points
Time of maximum M19 and M50 concentration (Tmax) at specified pre-dose and post-dose timepoints. M19 and M50 are the two primary representative metabolites of pretomanid.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Apparent Oral Clearance of M19 and M50 From Dose/AUC(0-infinity) at Specified Pre-dose and Post-dose Time Points
Apparent oral clearance was calculated by noncompartmental analysis using the formula Dose/AUC(0-infinity). M19 and M50 are the two primary representative metabolites of pretomanid.
Time frame: Day 1 at 1, 2, 4, 5, 6, 8, 12, 16 hours post dose; Day 2 at 24 and 36 hours post dose; Day 3 at 48 hours post dose; Day 4 at 72 hours post dose; and Day 5 at 96 hours post dose.
Number of Participants With and Severity of Adverse Events
An Adverse Event (AE) was defined as any unfavorable or unintended medical occurrence temporally associated with the use of a study drug, device, other medical product, or procedure whether or not it is considered related to the product itself.
Time frame: Day 1 to Day 85
Mean Change From Baseline in Alanine Aminotransferase (ALT)
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5 and Day 12
Mean Change From Baseline in Aspartate Aminotransferase (AST)
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5 and Day 12
Mean Change From Baseline in Blood Urea Nitrogen (BUN)
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5 and Day 12
Mean Change From Baseline in Creatinine
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5 and Day 12
Mean Change From Baseline in Hemoglobin (Hgb)
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5 and Day 12
Mean Change From Baseline in Estimated Glomerular Filtration Rate (eGFR)
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5 and Day 12
Mean Change From Baseline in Magnesium
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5 and Day 12
Mean Change From Baseline in Serum Potassium
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5 and Day 12
Mean Change From Baseline in Total Bilirubin
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5 and Day 12
Mean Change in Oral Temperature From Baseline
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Days 1, 2, 3, 4, 5, and 12
Mean Change in Pulse From Baseline
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Days 1, 2, 3, 4, 5, and 12
Mean Change in Sitting Systolic Blood Pressure From Baseline
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Days 1, 2, 3, 4, 5, and 12
Mean Change in Sitting Diastolic Blood Pressure From Baseline
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Days 1, 2, 3, 4, 5, and 12
Mean Change in the Electrocardiogram (ECG) Corrected QT Interval by Fridericia (QTcF) Interval From Baseline
The mean change from baseline was calculated by taking the mean of each participant value at the specified day minus the value last recorded prior to drug administration.
Time frame: Day 5
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