The primary safety objectives were: * Part 1: To determine the safety and tolerability of single doses of ZP-059 in healthy subjects * Part 2: To determine the safety and tolerability of multiple doses of ZP-059 in subjects with mild stable asthma * Part 3: To determine the safety and tolerability of single doses of ZP-059 in subjects with mild to moderate stable asthma. The primary PK objectives were: * Part 1: To characterize systemic PK of voriconazole and N-oxide voriconazole after single doses of ZP-059 in healthy subjects * Part 2: To characterize systemic PK of voriconazole and N-oxide voriconazole after multiple doses of ZP-059 in subjects with mild stable asthma * Part 3: To characterize systemic PK of voriconazole and N-oxide voriconazole after single doses of ZP-059 and single doses of oral voriconazole in subjects with mild to moderate stable asthma.
This was an integrated Phase 1, single centre, multi-part, open-label study in both healthy subjects (Part 1), subjects with mild stable asthma (Part 2) and subjects with mild to moderate stable asthma (Part 3). In all three parts of the study every effort was made to include as close as possible an equal balance between male and female subjects. This study assessed safety, tolerability and PK of single and multiple ascending doses of ZP-059 capsules administered as dry powder for inhalation in Part 1 to healthy volunteers (single ascending dose; SAD) and in Part 2 to subjects with mild asthma (multiple ascending dose; MAD), respectively. In Part 3, the bioavailability of ZP-059 in subjects with mild to moderate stable asthma were compared to that of oral voriconazole. Part 3 started only after review of safety data from cohorts 1 to 4 of Part 1 (SAD) have been completed. Parts 2 and 3 of the study also explored voriconazole concentrations in induced sputum samples in asthmatic subjects. As part of the safety and tolerability assessment, this study investigated the effects of ZP-059 on airway function in both mild and mild to moderate stable asthma subjects.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
58
Part 1 (SAD): eligible subjects received a single ascending inhaled dose (5 mg, 10 mg, 20 mg, and 40 mg) of ZP-059 5mg capsules administered via dry powder inhaler (DPI) on the morning of Day 1. Part 2 (MAD): eligible subjects received 2 (10mg twice daily \[BID\]) or 4 \[20mg BID\]) inhaled doses of ZP-059 5mg capsules administered via DPI BID for 9 days and once in the morning of Day 10, or 8 inhaled doses of ZP-059 5 mg capsules (40mg once daily \[QD\]) for 10 days. For QD dosing, subjects received QD doses of ZP-059 (at hour 0) on Days 1 to 10. Part 3 (2-period crossover): eligible subjects received a 4 \[20mg BID\] inhaled doses of ZP-059 5mg capsules administered via DPI on the morning of Day 1 according to the crossover scheme of the study. ZP-059 (inhaled voriconazole) was provided in clear, colorless size 3 hydroxypropylmethylcellulose hard capsules, which were individually and manually triggered by a breath actuated inhalation device (RS01 monodose inhaler).
Part 3 (2-period crossover): eligible subjects received a single dose of oral voriconazole (200mg oral film-coated tablet, Vfend) on the morning of Day 1 according to the crossover scheme of the study.
Medicines Evaluation Unit Ltd. (MEU)
Manchester, United Kingdom
Number of Participants With Treatment-Emergent Adverse Events (TEAE)
An AE is any untoward medical occurrence in a patient or clinical study subject, temporally associated with the use of IMP, whether or not considered related to the study IMP.
Time frame: Part 1: screening (Day -28 to -1) to follow-up (8 to 12 days after last dose); part 2: screening (Day -28 to -1) to follow-up (11-17 days after last dose); Part 3: screening (Day -28 to -1) to follow-up (8-12 days after last dose of study drug).
AUC0-t, AUC0-inf for Voriconazole and N-oxide Voriconazole - Part 1
AUC0-t = Area under the serum concentration time curve from time 0 to time t (hours) (AUC0-t) (AUC0-12 for Part 1) AUC0-inf = Area under the serum concentration time curve from time 0 to infinity
Time frame: Part 1: at day 1 (pre-dose, at 1.5h-2h-3h-4h-12h post dose).
Cmax for Voriconazole and N-oxide Voriconazole - Part 1
Cmax is the highest concentration of a drug in the blood, cerebrospinal fluid, or target organ after a dose is given;
Time frame: Part 1: at day 1 (pre-dose, at 1.5h-2h-3h-4h-12h post dose).
Tmax and T1/2 for Voriconazole and N-oxide Voriconazole - Part 1
Tmax= Time to maximum concentration (Cmax). T 1/2 = Elimination half-life: the time taken for the plasma concentration to fall by half its original value.
Time frame: Part 1: at day 1 (pre-dose, at 1.5h-2h-3h-4h-12h post dose).
Kel for Voriconazole and N-oxide Voriconazole - Part 1
Kel (Elimination rate constant): is a value used to describe the rate at which a drug is removed from the human system. It is equivalent to the fraction of a substance that is removed per unit time measured at any particular instant and has units of 1/h.
Time frame: Part 1: at day 1 (pre-dose, at 1.5h-2h-3h-4h-12h post dose).
CL/F for Voriconazole - Part 1
Apparent clearance: Equal to the drug dose divided by the area-under-the-curve; is an important pharmacokinetic parameter and plays an important role in the selection of a safe and tolerable dose for first-in-human studies.
Time frame: Part 1: at day 1 (pre-dose, at 1.5h-2h-3h-4h-12h post dose).
Vz/F for Voriconazole - Part 1
Vz/F=Apparent volume of distribution during terminal phase.
Time frame: Part 1: at day 1 (pre-dose, at 1.5h-2h-3h-4h-12h post dose).
MR AUC0-t, MR AUC0-inf for N-oxide Voriconazole - Part 1
MR = metabolite ratio. Metabolite ratios (as appropriate) will be calculated for AUC and Cmax parameters. Area under the serum concentration time curve from time 0 to time t (hours) (AUC0-t)
Time frame: Part 1: at day 1 (pre-dose, at 1.5h-2h-3h-4h-12h post dose).
MR Cmax for N-oxide Voriconazole - Part 1
MR = metabolite ratio. Metabolite ratios (as appropriate) will be calculated for AUC and Cmax parameters. Cmax is the highest concentration of a drug in the blood, cerebrospinal fluid, or target organ after a dose is given.
Time frame: Part 1: at day 1 (pre-dose, at 1.5h-2h-3h-4h-12h post dose).
AUC0-t, AUC0-inf for Voriconazole and N-oxide Voriconazole - Part 2
AUC0-t = Area under the serum concentration time curve from time 0 to time t (hours) (AUC0-t) (AUC0-24 for Part 2) AUC0-inf = Area under the serum concentration time curve from time 0 to infinity
Time frame: Part 2: Day 1 (1.5, 2, 3, 4, and 12 hours post-0-hour dose) and Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
Cmax for Voriconazole and N-oxide Voriconazole - Part 2
Cmax is the highest concentration of a drug in the blood, cerebrospinal fluid, or target organ after a dose is given;
Time frame: Part 2: Day 1 (1.5, 2, 3, 4, and 12 hours post-0-hour dose) and Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
Tmax and T1/2 for Voriconazole and N-oxide Voriconazole - Part 2
Tmax= Time to maximum concentration (Cmax). T 1/2 = Elimination half-life: the time taken for the plasma concentration to fall by half its original value.
Time frame: Part 2: Day 1 (1.5, 2, 3, 4, and 12 hours post-0-hour dose) and Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
Kel for Voriconazole and N-oxide Voriconazole - Part 2
Kel (Elimination rate constant): is a value used to describe the rate at which a drug is removed from the human system. It is equivalent to the fraction of a substance that is removed per unit time measured at any particular instant and has units of 1/h.
Time frame: Part 2: Day 1 (1.5, 2, 3, 4, and 12 hours post-0-hour dose) and Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
CL/F for Voriconazole - Part 2
Apparent clearance: Equal to the drug dose divided by the area-under-the-curve; is an important pharmacokinetic parameter and plays an important role in the selection of a safe and tolerable dose for first-in-human studies.
Time frame: Part 2: Only at Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
Swing for Voriconazole and N-oxide Voriconazole - Part 2
Swing for voriconazole and N-oxide voriconazole = \[(Cmax - Cmin) / Cmin\]\*100%
Time frame: Part 2: Only at Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
AUCtau for Voriconazole and N-oxide Voriconazole - Part 2
Area under the serum concentration time curve for the dosing interval
Time frame: Part 2: Only at Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
Css,av for Voriconazole and N-oxide Voriconazole - Part 2
Css,av or Css(ave): Average drug concentration at steady state; Steady-state concentration (Css) occurs when the amount of a drug being absorbed is the same amount that's being cleared from the body when the drug is given continuously or repeatedly
Time frame: Part 2: Only at Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
Fluctuation for Voriconazole and N-oxide Voriconazole - Part 2
Peak trough fluctuation in serum concentrations within one dosing interval at steady state. Fluctuation - Over the Dosing Interval - is expressed as percentage concentration.
Time frame: Part 2: Only at Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
Rac for Voriconazole and N-oxide Voriconazole - Part 2
Accumulation ratio. The drug accumulation ratio (Rac) is the ratio of accumulation of a drug under steady state conditions as compared to a single dose. The higher the value, the more the drug accumulates in the body. An Rac of 1 means no accumulation.
Time frame: Part 2: Only at Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
Rlinear for Voriconazole and N-oxide Voriconazole - Part 2
Rlinear means linearity ratio for Area Under the Serum Concentration-Time Curve from time zero to infinity.
Time frame: Part 2: Only at Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
MR AUC0-t, MR AUC0-inf and MR AUCtau for N-oxide Voriconazole - Part 2
MR = metabolite ratio. Metabolite ratios (as appropriate) will be calculated for AUC and Cmax parameters. Area under the serum concentration time curve from time 0 to time t (hours) (AUC0-t)
Time frame: Part 2: Day 1 (1.5, 2, 3, 4, and 12 hours post-0-hour dose) and Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
MR Cmax N-oxide Voriconazole - Part 2
MR = metabolite ratio. Metabolite ratios (as appropriate) will be calculated for AUC and Cmax parameters. Cmax is the highest concentration of a drug in the blood, cerebrospinal fluid, or target organ after a dose is given.
Time frame: Part 2: Day 1 (1.5, 2, 3, 4, and 12 hours post-0-hour dose) and Day 10 (post-0-hour dose at 1.5, 2, 3, 4, and 12 hours)
Cmax for Voriconazole and N-oxide Voriconazole - Part 3
Cmax is the highest concentration of a drug in the blood, cerebrospinal fluid, or target organ after a dose is given;
Time frame: Day 1 of the respective treatment period 1 or 2
Vz/F for Voriconazole - Part 3
Vz/F=Apparent volume of distribution during terminal phase.
Time frame: Only at Day 10
AUC0-t, AUC0-inf for Voriconazole and N-oxide Voriconazole - Part 3
AUC0-t = Area under the serum concentration time curve from time 0 to time t (hours) (AUC0-t) (AUC0-96 for Part 3) AUC0-inf = Area under the serum concentration time curve from time 0 to infinity
Time frame: Day 1 of the respective treatment period 1 or 2
Tmax and T1/2 for Voriconazole and N-oxide Voriconazole - Part 3
Tmax= Time to maximum concentration (Cmax). T 1/2 = Elimination half-life: the time taken for the plasma concentration to fall by half its original value.
Time frame: Day 1 of the respective treatment period 1 or 2 (Pre-dose, 0.25h, 0.75h 1.5h, 2h ,3h ,4h ,6h ,8h ,12h ,16h , 24h ,48h after dosing)
CL/F for Voriconazole - Part 3
Apparent clearance: Equal to the drug dose divided by the area-under-the-curve; is an important pharmacokinetic parameter and plays an important role in the selection of a safe and tolerable dose for first-in-human studies.
Time frame: Day 1 of the respective treatment period 1 or 2
Kel for Voriconazole and N-oxide Voriconazole - Part 3
Kel (Elimination rate constant): is a value used to describe the rate at which a drug is removed from the human system. It is equivalent to the fraction of a substance that is removed per unit time measured at any particular instant and has units of 1/h.
Time frame: Day 1 of the respective treatment period 1 or 2
Vz/F for Voriconazole - Part 3
Vz/F=Apparent volume of distribution during terminal phase.
Time frame: Day 1 of the respective treatment period 1 or 2
MR AUC0-t and MR AUC0-inf for N-oxide Voriconazole - Part 3
MR = metabolite ratio. Metabolite ratios (as appropriate) will be calculated for AUC and Cmax parameters. Area under the serum concentration time curve from time 0 to time t (hours) (AUC0-t)
Time frame: Day 1 of the respective treatment period 1 or 2
MR Cmax for N-oxide Voriconazole - Part 3
MR = metabolite ratio. Metabolite ratios (as appropriate) will be calculated for AUC and Cmax parameters. Cmax is the highest concentration of a drug in the blood, cerebrospinal fluid, or target organ after a dose is given.
Time frame: Day 1 of the respective treatment period 1 or 2
Bioavailability of Voriconazole - Cmax
The Cmax estimated from Part 3 was analyzed to assess the relative bioavailability of inhaled ZP-059 to oral voriconazole. The Cmax was compared between asthma subjects in Part 3 and healthy subjects in Part 1 and separately with asthma subjects in Part 2 to assess the relative bioavailability of ZP-059 dose taken in Part 3 in these populations. In Part 1 and 3, Cmax was estimated only on Day1. In Part 2, Cmax was estimated on Day 10.
Time frame: On Day 1 in Parts 1-3 and on Day 10 in Part 2
Bioavailability of Voriconazole - AUC-inf
The AUC0-inf estimated from Part 3 was analyzed to assess the relative bioavailability of inhaled ZP-059 to oral voriconazole. The AUC0-inf was compared between asthma subjects in Part 3 and healthy subjects in Part 1 and separately with asthma subjects in Part 2 to assess the relative bioavailability of ZP-059 dose taken in Part 3 in these populations. In Part 1 and 3, AUC0-inf was estimated on Day 1. In part 2, AUC0-in f was estimated on Day 10.
Time frame: On Day 1 in Parts 1-3 and on Day 10 in Part 2
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