Single-centre, randomized, double-blind, two-period, two-sequence, cross-over 7-day study. This study is the first safety/tolerability evaluation of a product -suppository formulation containing 6 mg BDP (once daily dosing), a second-generation oral or rectal corticosteroids with high topical anti-inflammatory efficacy in the gut and minimal systemic bioavailability (BA). BDP is marketed in different pharmaceutical formulations, including 3 mg suppositories, and approved for ulcerative proctosigmoiditis in the first attack or exacerbation phase at the dosage of 3 mg twice a day. For these reasons, a 6 mg suppository (Test - "T" product) is a scale-up of the 3 mg formulation (Reference - "R" product). For locally-applied-locally acting drug products that result in quantifiable systemic availability due to absorption from the administration site, relative systemic BA is informative for safety, but also with respect to efficacy. Therefore, safety/tolerability of T is evaluated through a comparison to R.
Primary objective is the evaluation of systemic safety of T, based on valid surrogate outcomes - systemic BA (relative BA) at the start of treatment (first 24 hours) and after 7 days of continuous treatment; effects on the hypothalamo-pituitary-adrenal axis (HPA) assessed based on 24-hour cortisol profile after 7 days of continuous treatment. This includes identification of subjects with cortisol levels \<10 μg/dL at the last sampling point in the 24-hour cortisol profile (08:00 a.m. on Day 8). In such cases, identified subjects will undergo ACTH stimulation test in the morning of Day 9. Secondary objective is the evaluation of safety/tolerability based on clinical and laboratory adverse events.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
DOUBLE
Enrollment
28
BDP 3 mg bid (R product) BDP 6 mg qd (T product)
Centro Ricerche Cliniche AOU Integrata di Verona - Policlinico Universitario G.B. Rossi
Verona, Italy
Pharmacokinetics - Cmax, morning;
Peak exposure after the morning dose (Cmax, morning)
Time frame: Day 1 and Day 7 of each Period
Pharmacokinetics - Cmax, evening;
Peak exposure after the evening dose (Cmax, evening)
Time frame: Day 1 and Day 7 of each Period
Pharmacokinetics - AUC0-24
• Total exposure over 24 hours (AUC0-24)
Time frame: Day 1 and Day 7 of each Period
Pharmacokinetics - AUC0-12
• Total exposure during dosing interval - morning (AUC0-12)
Time frame: Day 1 and Day 7 of each Period
Pharmacokinetics - AUC12-24
• Total exposure during dosing interval - evening (AUC12-24)
Time frame: Day 1 and Day 7 of each Period
HPA-axis: 24-hour plasma cortisol - AUC0-24, cortisol
Area under the cortisol level-time curve over 24 hours (AUC0-24, cortisol). AUC will be determined for each subject/treatment at baseline and at Day 7 by the linear trapezoidal rule and ln-transformed. Ln(AUCs) will be used to determine intra-subject difference Day 7 - baseline that will be subject to analysis.
Time frame: Baseline and Day 7 of each Period
HPA-axis: 24-hour plasma cortisol - AUC0-12, cortisol
Area under the cortisol level-time curve over 12 hours after the morning dose (AUC0-12, cortisol). As above.
Time frame: Baseline and Day 7 of each Period
HPA-axis: 24-hour plasma cortisol - AUC12-24, cortisol
Area under the cortisol level-time curve over 12 hours after the evening dose (AUC12-24, cortisol). As above.
Time frame: Baseline and Day 7 of each Period
HPA-axis: 24-hour plasma cortisol - pAUC2-8, cortisol
Partial area under the cortisol level-time curve "covering" 3rd, 4th, 5th, 6th, 7th and 8th hour post morning dose (i.e., between 10:00 and 16:00 hours, that is, between sampling times at 2 and 8 hours post-dose) - a time period during which normal cortisol levels are still relatively high and the strongest suppression after morning dose could be expected (pAUC2-8, cortisol). As above.
Time frame: Baseline and Day 7 of each Period
Pharmacokinetics - trough concentrations
Trough concentrations for R (C12) and T (C24) dosing on Day 1 and Day 7 as well as morning pre-dose (C0)
Time frame: Day 1 and Day 7 of each Period
Pharmacokinetics - Cmax morning/AUC0-12 ratio
Ratio of the peak exposure after the morning dose to exposure over the subsequent 12 hours (illustrates absorption rate) (Cmax,morning/AUC0-12)
Time frame: Day 1 and Day 7 of each Period
Pharmacokinetics - Tmax, morning
Time to peak exposure after the morning dose (Tmax,morning)
Time frame: Day 1 and Day 7 of each Period
Pharmacokinetics - Percent fluctuation (%PTF12)
Day 7 - percent fluctuation over 12 hours after morning dose (%PTF12)
Time frame: Day 7 of each Period
Pharmacokinetics - Percent fluctuation (%PTF24)
Day 7 - percent fluctuation over 24 hours (%PTF24)
Time frame: Day 7 of each Period
Pharmacokinetics - Accumulation ratio
Accumulation ratio (Cmax,morning Day 7/Day 1; AUC0-24 Day 7/Day 1). Accumulation ratio will be estimated based on two outcomes: peak exposure after the morning dose (Cmax, morning) and total exposure over 24 hours (AUC0-24).
Time frame: Day 1 and Day 7 of each Period
HPA axis - Number (proportion) of subjects with cortisol <10 μg/dL
ACTH stimulation test results on the morning of Day 9 (first post-dosing day) dichotomized as "normal" or "abnormal"
Time frame: Day 8 and 9 of each Period
HPA axis - Number/proportion of subjects with abnormal ACTH stimulation test.
Number (proportion) of subjects with cortisol levels \<10 μg/dL at 08:00 a.m. on Day 8 and number (proportion) of subjects with abnormal ACTH stimulation test results in the morning of Day 9 (should any subject be submitted).
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Time frame: Day 8 and 9 of each Period
HPA axis - 24-hour cortisol profile
24-hour cortisol profile: time-point-by-time-point differences Day 7 vs. baseline
Time frame: Baseline and Day 7 of each Period