This study will evaluate the effects of nirogacestat 100 mg twice daily (BID) on the pharmacokinetics (PK) of a cytochrome P450 (CYP) cocktail.
This is a single-center, single-sequence crossover study to assess the potential induction effects of nirogacestat on the PK of probe substrates for CYPs (CYP2B6, CYP2C8, CYP2C9, CYP2C19, and CYP3A4) in healthy adult men. There will be a Screening Period of up to 33 days prior to Day -4. Eligible participants will be enrolled in the study and will complete a 3-day Lead-In Period, followed by an 18-day Treatment Period. A follow-up (FU) telephone call will be performed 26 to 28 days after the last dose of study treatment (Day 43 \[+2\]). During Screening, participants will sign the informed consent form prior to any study procedures being performed. Participants must satisfy all the inclusion and exclusion criteria to be eligible for study participation. Participants will be admitted to the clinical research unit (CRU) on Day -4 for check-in procedures and eligibility confirmation. Once eligibility is confirmed, participants will receive a CYP cocktail (CYP2B6 \[bupropion\], CYP2C8 \[repaglinide\], CYP2C9 \[flurbiprofen\], CYP2C19 \[omeprazole\], and CYP3A4 \[midazolam\]) on the morning of Day -3, following an overnight fast of at least 10 hours. The CYP cocktail will be administered orally. Beginning on Day 1 through Day 17, participants will be administered 100 mg nirogacestat orally BID. On Day 15, following an overnight fast of at least 10 hours, participants will also receive a single oral dose of the CYP cocktail in the morning immediately following the oral dose of nirogacestat. On all other days, nirogacestat can be administered with or without food. Study treatment will be administered orally. Assessments for safety along with serial samples of blood will be collected throughout the Lead-In and Treatment Period. Participants will remain domiciled at the CRU until all safety evaluations are completed on Day 18. Participants will complete a FU telephone visit on Day 43 (+2 days) for review of AEs/serious AEs and concomitant medications. Additional safety evaluations may be scheduled at the discretion of the investigator prior to the FU telephone visit.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
100 mg tablet Day 1 through Day 17
Drug: Nirogacestat 100 mg tablet Day 1 through Day 17 and Drug: Cocktail of CYP Specific Probe Substrates administered Day 15.
ICON Martini Groningen CRU
Groningen, Netherlands
Plasma area under the concentration-time curve from dosing extrapolated to infinity (AUCinf) and maximum observed plasma concentration (Cmax) for the CYP cocktail probes alone, and coadministered with nirogacestat.
Area under the concentration-time curve from dosing extrapolated to infinity. AUCinf = (AUClast + Clast/Kel) where Clast is the plasma concentration at the last quantifiable timepoint estimated from the log-linear regression analysis and Kel is the terminal elimination phase rate constant estimated by linear regression based on observations justified to describe the terminal phase on the log-linear concentration-time profile.
Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Maximum Observed Plasma Concentration (Cmax) of the CYP cocktail probes alone, and coadministered with nirogacestat.
Maximum observed plasma concentration. Observed directly from the data.
Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Plasma AUClast for the CYP cocktail probes alone and coadministered with nirogacestat.
Area under the concentration-time curve from dosing to time of the last quantifiable concentration. Linear-log trapezoidal method.
Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Plasma time of maximum observed concentration (Tmax) for the CYP cocktail probes alone and coadministered with nirogacestat.
Time of maximum observed concentration. Observed directly from the data as the time of first occurrence of Cmax
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Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Plasma apparent terminal elimination half-life (t1/2) for the CYP cocktail probes alone and coadministered with nirogacestat.
Apparent terminal elimination half-life calculated as ln(2)/Kel.
Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Plasma apparent oral clearance (CL/F) for the CYP cocktail probes alone and coadministered with nirogacestat.
Apparent oral clearance. Calculated as Dose/AUCinf
Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Plasma apparent oral volume of distribution (Vd/F) for the CYP cocktail probes alone and coadministered with nirogacestat.
Apparent oral volume of distribution. Calculated as Dose/(AUCinf × Kel).
Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Plasma AUClast of respective probe substrate metabolites alone and coadministered with nirogacestat and the metabolite(s) to parent molar ratio for AUClast (MRAUClast), AUCinf (MRAUCinf), and Cmax (MRCmax) (as data permit).
Area under the concentration-time curve from dosing to time of the last quantifiable concentration. Linear-log trapezoidal method.
Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Plasma Cmax of respective probe substrate metabolites alone and coadministered with nirogacestat and the metabolite(s) to parent molar ratio for AUClast (MRAUClast), AUCinf (MRAUCinf), and Cmax (MRCmax) (as data permit).
Maximum observed plasma concentration. Observed directly from the data.
Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Plasma Tmax of respective probe substrate metabolites alone and coadministered with nirogacestat and the metabolite(s) to parent molar ratio for AUClast (MRAUClast), AUCinf (MRAUCinf), and Cmax (MRCmax) (as data permit).
Time of maximum observed concentration. Observed directly from the data as the time of first occurrence of Cmax.
Time frame: CYP cocktail - Day -3 and Day 15 at predose (-60 minutes) and at 0.5, 1, 2, 3, 4, 6, 8, (10% nominal), 12, 24, 48, and 72 hours and nirogacestat Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Serum nirogacestat, trough concentration (Ctrough).
Pre-dose concentration. Observed directly from the data.
Time frame: Days 1 through 17 predose trough samples should be obtained within 1 hour of the nominal time from dosing.
Number of participants with Adverse Events
An adverse event (AE) was defined as any untoward medical occurrence in a participant. An AE was any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with use of a study intervention. A serious adverse event (SAE) was any untoward medical occurrence that resulted in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged inpatient hospitalization; congenital anomaly/birth defect or was otherwise considered medically important.
Time frame: Baseline (Day -4) through the Follow-up Phone Call (Day 43)
Number of Participants With Clinically Meaningful Change From Baseline in Laboratory Values
Number of participants with clinically significant change from baseline in laboratory parameters were reported. Clinical Significance was decided by the investigator. Laboratory investigation included hematology, biochemistry, urinalysis, and coagulation.
Time frame: Baseline (Day -4) through Day 18
Number of Participants With Clinically Meaningful Change From Baseline in Vital Signs
Number of participants with clinically significant change from baseline in vital signs. Clinical Significance was decided by the investigator. Vital signs included oral body temperature, systolic blood pressure, diastolic blood pressure, and pulse rate.
Time frame: Baseline (Day -4) through Day 18
Number of Participants With Clinically Meaningful Change From Baseline in Electrocardiogram (ECG)
Number of participants with clinically significant change from baseline in ECG parameters were reported. Clinical Significance was decided by the investigator. The 12-lead ECGs were recorded after the participants have rested for at least 5 minutes in supine position. The parameters included heart rate (HR), Respiratory Rate, Pulse Rate, QRS, QT, QTcB and QTcF
Time frame: Baseline (Day -4) through Day 18
Number of Participants With Clinically Meaningful Change From Baseline in Physical Exams
A comprehensive physical examination will include, at a minimum, assessments of the cardiovascular, respiratory, gastrointestinal, and neurologic systems. Height and weight will also be measured and recorded. A symptom-directed physical examination will include, at a minimum, assessments of the skin, lungs, cardiovascular system, and abdomen (liver and spleen).
Time frame: Baseline (Day -4) through Day 18