This is a 3-part Phase 1 dose-ranging study to evaluate the safety, tolerability, pharmacokinetics and pharmacodynamics of single (Part 1) and multiple (Part 2) ascending doses of BCX9930 in healthy subjects and in subjects with paroxysmal nocturnal hemoglobinuria (PNH; Part 3). Pharmacokinetics is an analysis of how the body handles the study drug BCX9930 and pharmacodynamics is an analysis of the activity that the study drug BCX9930 may have in the body.
Up to 6 sequential ascending dose cohorts are planned to be dosed in a sequential manner in Part 1 of the study. Eight subjects will be treated with a single dose of the study drug per dose cohort (6 subjects per cohort will receive BCX9930 and 2 subjects per cohort will receive matching placebo). Escalation to the next higher dose level will occur only after completion of a review of clinical safety and pharmacokinetics by the Sponsor and PI. Up to 7 ascending, multiple dose cohorts will be enrolled in a sequential manner in Part 2 of the study. In Cohorts 1 through 3, twelve subjects will be treated with either a 7-day or 14-day course of study drug (10 subjects per cohort will receive BCX9930 and 2 subjects per cohort will receive matching placebo) administered orally. In Cohorts 4 through 7, twelve subjects will be treated with a 3-day course of study drug (10 subjects per cohort will receive BCX9930 and 2 subjects per cohort will receive matching placebo) administered orally. The daily dose may be split into 2 times daily (BID) or 3 times daily (TID) dosing for the multiple ascending dose part as needed. Escalation to the next higher dose level in Part 2 will occur only after completion of a review of clinical safety and pharmacokinetics by the Sponsor and PI. Part 3 of the study consists of up to 2 sequential ascending multiple dose cohorts of up to 8 subjects; each cohort may enroll up to 4 subjects with PNH who are naïve to both eculizumab and ravulizumab and up to 4 subjects with PNH who are currently being treated with either eculizumab or ravulizumab. In each cohort, subjects will receive one daily dose of BCX9930 on Days 1 to 14 and a higher daily dose on Days 15 to 28. Cohort 2 will start after independent data monitoring committee (DMC) review of Cohort 1 data and communication of their evaluation to Part 3 investigators. In South Africa, subjects that have clinical benefit from BCX9930 will be allowed to continue dosing for up to 48 weeks.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
168
Study Site
Vienna, Austria
Study Site
Bloemfontein, South Africa
Study Site
Pretoria, South Africa
Study Site
London, United Kingdom
Incidence of graded treatment-emergent adverse events
Time frame: Part 1: Day 16
Incidence of graded treatment-emergent adverse events
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Incidence of graded treatment-emergent adverse events
Time frame: Part 3:Day 44 or Week 50 (South Africa only)
Incidence of graded laboratory chemistry abnormalities
Time frame: Part 1: Day 16
Incidence of graded laboratory chemistry abnormalities
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Incidence of graded laboratory chemistry abnormalities
Time frame: Part 3:Day 44 or Week 50 (South Africa only)
Incidence of graded urinalysis abnormalities
Time frame: Part 1: Day 16
Incidence of graded urinalysis abnormalities
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Incidence of graded urinalysis abnormalities
Time frame: Part 3: Day 44 or Week 50 (South Africa only)
Incidence of graded coagulation abnormalities
Time frame: Part 1: Day 16
Incidence of graded coagulation abnormalities
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Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Incidence of graded coagulation abnormalities
Time frame: Part 3: Day 44 or Week 50 (South Africa only)
Incidence of graded hematology abnormalities
Time frame: Part 1: Day 16
Incidence of graded hematology abnormalities
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Incidence of graded hematology abnormalities
Time frame: Part 3: Day 44 or Week 50 (South Africa only)
Change from baseline in blood pressure
Time frame: Part 1: Day 16
Change from baseline in blood pressure
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Change from baseline in blood pressure
Time frame: Part 3: Day 44 or Week 50 (South Africa only)
Change from baseline in temperature
Time frame: Part 1: Day 16
Change from baseline in temperature
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Change from baseline in temperature
Time frame: Part 3: Day 44 or Week 50 (South Africa only)
Change from baseline in heart rate
Time frame: Part 1: Day 16
Change from baseline in heart rate
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Change from baseline in heart rate
Time frame: Part 3: Day 44 or Week 50 (South Africa only)
Change from baseline in respiratory rate
Time frame: Part 3: Day 44 or Week 50 (South Africa only)
Change in Electrocardiogram (PR interval)
Time frame: Part 1: Day 16
Change in Electrocardiogram (PR interval)
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Change in Electrocardiogram (PR interval)
Time frame: Part 3: Day 44 or Week 50 (South Africa only)
Change in Electrocardiogram (QRS interval)
Time frame: Part 1: Day 16
Change in Electrocardiogram (QRS interval)
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Change in Electrocardiogram (QRS interval)
Time frame: Part 3: Day 44 or Week 50 (South Africa only)
Change in Electrocardiogram (RR interval)
Time frame: Part 1: Day 16
Change in Electrocardiogram (RR interval)
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Change in Electrocardiogram (RR interval)
Time frame: Part 3:Day 44 or Week 50 (South Africa only)
Change in Electrocardiogram (QT interval)
Time frame: Part 1: Day 16
Change in Electrocardiogram (QT interval)
Time frame: Part 2: Day 23 (cohorts with 3 and 7 day dosing duration) or Day 31 (cohorts with 14 day dosing duration)
Change in Electrocardiogram (QT interval)
Time frame: Part 3:Day 44 or Week 50 (South Africa only)
Plasma BCX9930 Cmax
Time frame: plasma PK parameters are based on blood sampling through Day 4 for Part 1; through Day 6, 14 or 18 for Part 2 (Day depends on dosing duration); and through Day 28 for Part 3
Plasma BCX9930 Tmax
Time frame: plasma PK parameters are based on blood sampling through Day 4 for Part 1; through Day 6, 14 or 18 for Part 2 (Day depends on dosing duration); and through Day 28 for Part 3
Plasma BCX9930 AUCinf
Time frame: plasma PK parameters are based on blood sampling through Day 4 for Part 1
Plasma BCX9930 t1/2
Time frame: plasma PK parameters are based on blood sampling through Day 4 for Part 1; through Day 6, 14 or 18 for Part 2 (Day depends on dosing duration); and through Day 28 for Part 3
Plasma BCX9930 AUCtau
Time frame: plasma PK parameters are based on blood sampling through Day 6, 14 or 18 for Part 2 (Day depends on dosing duration); and through Day 28 for Part 3
Serum AP complement activity
Time frame: Part 1:through Study Day 4; through Day 6, 14 or 18 for Part 2 (Day depends on dosing duration); and Part 3 through Day 28 or Week 48 (South Africa only)
Plasma Factor Bb
Time frame: Part 1:through Study Day 4; through Day 6, 14 or 18 for Part 2 (Day depends on dosing duration); and Part 3 through Day 28 or Week 48 (South Africa only)
Number of blood transfusions
Time frame: Part 3:baseline through Day 28 or Week 50 (South Africa only)
Lactate dehydrogenase
Time frame: Part 3: absolute and change from baseline through Day 28 or Week 50 (South Africa only)
Hemoglobin
Time frame: Part 3: absolute and change from baseline through Day 28 or Week 50 (South Africa only)
Absolute reticulocyte count
Time frame: Part 3: values and change from baseline through Day 28 or Week 50 (South Africa only)
Haptoglobin
Time frame: Part 3: absolute and change from baseline through Day 28 or Week 50 (South Africa only)