Obstructive Sleep Apnea (OSA)
Conditions
Brief summary
The purpose of this study is to assess the safety and tolerability of multiple dose administration of gefapixant (MK-7264) in participants with moderate to severe obstructive sleep apnea (OSA). The primary hypothesis is that multiple dose administration of gefapixant (MK-7264) in participants with moderate to severe OSA reduces the Apnea Hypopnea Index (AHI) relative to placebo.
Interventions
DRUGGefapixant
In Periods 1 and 2 (7 days each) participants receive 4 tablets (180 mg) of gefapixant (MK-7264) QHS.
DRUGPlacebo
In Periods 1 and 2 (7 days each) participants receive 4 tablets of placebo QHS.
Sponsors
Merck Sharp & Dohme LLC
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
* International Classification of Sleep Disorders (ICSD-3) diagnosis of OSA, based on investigator's assessment of the obstructive sleep apnea (OSA) history and diagnostic interview which must include: Documented sleep study in the past that confirmed the OSA diagnosis without significant prior medical intervention. * Apnea-Hypopnea Index (AHI) ≥ 20 events/hour at screening. * No use of a positive airway pressure (PAP) device within the preceding 1 month or a dental appliance within the preceding 7 days prior to screening and is not allowed to use PAP or a dental appliance throughout the study (including washout intervals between treatment periods) and until the post-study visit. * A baseline oxygen saturation via pulse oximetry (SpO2) ≥ 94% at screening to ensure that carotid body response to hyperoxia is not impaired. * A body mass index (BMI) ≤ 35 kg/m\^2 at the pre-study (Screening 1) visit. * Judged to be in good health based on medical history, physical examination, vital sign measurements, and laboratory safety tests. * No clinically significant abnormality on electrocardiogram (ECG) * Contraceptive use by men and women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. * A female participant is eligible to participate if she is not pregnant or breastfeeding, and is not a woman of childbearing potential (WOCBP) OR is a WOCBP and using an acceptable contraceptive method. * A WOCBP must have a negative highly sensitive pregnancy test (urine as required by local regulations) within 72 hours before the first dose of study intervention. * If a urine test cannot be confirmed as negative (e.g., an ambiguous result), a serum pregnancy test is required. * The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy. * A consistent sleep-wake schedule that is not subject to any other unusual changes in sleeping routine (i.e., bedtimes and wake times do not vary more than 1-2 hours except on rare occasions). * Able to maintain sleep for at least 4 consecutive hours based on self-report.
Exclusion criteria
* Other than OSA, has evidence of another clinically significant, active pulmonary disorder such as bronchiectasis, emphysema, or asthma documented by history, physical examination, or chest x-ray. * A history within the past 6 months prior to the pre-study visit or current evidence of an unstable or clinically significant cardiovascular disorder, including but not limited to: acute coronary syndrome, unstable angina, congestive heart failure, cardiogenic syncope, cardiomyopathy, any symptomatic arrhythmia, orthostatic hypotension, uncontrolled hypertension, chronic kidney disease, kidney transplant * Abnormal pre-randomization laboratory values for alanine transaminase \> 1.5 x the upper limit of normal (x ULN), aspartate transaminase \> 1.5 x ULN, direct bilirubin \> 1.5 x ULN, serum creatinine of \> 2 mg/dL * A history or diagnosis of any of the following conditions, in the opinion of the investigator: narcolepsy (with or without cataplexy) or Idiopathic hypersomnia, circadian rhythm sleep disorder, parasomnia including nightmare disorder, sleep terror disorder, sleepwalking disorder, and rapid eye movement (REM) behavior disorder, periodic limb movement (PLM) disorder, restless legs syndrome, chronic insomnia * A WOCBP who has a positive urine or serum pregnancy test within 24 hours before the baseline 1 of study intervention. * A history of clinically significant or poorly-controlled endocrine, gastrointestinal, cardiovascular, hematological, hepatic, immunological, renal, respiratory, genitourinary, or major neurological (including stroke and chronic seizures) abnormalities or diseases. * Mentally or legally incapacitated, or has significant emotional problems at the time of pre-study screening * A history or current evidence of any condition, therapy, lab or ECG abnormality or other circumstances that might confound the results of the study, or interfere with the participant's participation for the full duration of the study. * Any history of a neurological disorder, including but not limited to seizure disorder (other than single episodes of childhood febrile seizures), stroke, transient ischemic attack, multiple sclerosis, cognitive impairment, or significant head trauma with sustained loss of consciousness within the last 10 years. * A history of significant multiple and/or severe allergies (e.g., food, drug, latex allergy), or has had an anaphylactic reaction or significant intolerability (i.e., systemic allergic reaction) to prescription or non-prescription drugs or food. * A history of anaphylaxis or cutaneous adverse drug reaction (with or without systemic symptoms) to sulfonamide antibiotics or other sulfonamide-containing drugs. * Positive for hepatitis B surface antigen, hepatitis C antibodies or HIV. * A history of cancer (malignancy) with some exceptions including adequately treated non-melanomatous skin carcinoma or carcinoma in situ of the cervix or; and other malignancies that have been successfully treated with appropriate follow up and therefore unlikely to recur for the duration of the study, in the opinion of the investigator and with agreement of the Sponsor (e.g., malignancies that have been successfully treated ≥ 10 years prior to the pre-study \[screening\] visit). * An estimated glomerular filtration rate (eGFR) \< 60 mL/min/1.73 m\^2 based on the Cockcroft-Gault (CG) Equation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Apnea-Hypopnea Index (AHI) Change From Baseline as Calculated From Polysonagraphy (PSG) | Day-1 at Baseline and Day 7 of each treatment period | The apnea-hypopnea index (AHI) is the sum of the apnea and hypopnea indices for each participant. The apnea index for each participant is calculated as the number of apneas divided by the total sleep time. The hypopnea index for each participant is calculated as the number of hypopneas divided by the total sleep time. These measurements are collected from polysonagraphs (PSGs), which are diagnostic sleep studies that collect electroencephalogram (EEG), electrooculograph (EOG), electromyogram (EMG), electrocardiogram (ECG), airflow, respiratory effort, oximetry, and sleep position data. Baseline AHI measurements in each period are obtained on Day -1. Individual AHI fold-change from baseline in each treatment period are calculated as the ratio of on-treatment AHI to baseline AHI. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Experienced an Adverse Event (AE) During the Study | Up to 14 days after last dose of study drug (Up to 35 days) | An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the product, whether or not considered related to the use of the product. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with the use of the product, is also an AE. |
| Number of Participants Who Discontinued Study Drug Due to an AE | Up to 21 days | An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the product, whether or not considered related to the use of the product. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with the use of the product, is also an AE. |
Countries
Belgium, United States
Participant flow
Recruitment details
Participants were enrolled from 3 centers in a single country
Pre-assignment details
24 participants were randomized and enrolled, 23 were administered with at least one dose of study drug, 1 participant was never dosed.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Then Gefapixant 180 mg Placebo once daily at bedtime (QHS) oral for 7 days in Period 1 followed by a 7-day washout period and then Gefapixant, 180 mg, QHS, oral for 7 days in Period 2. | 12 |
| Gefapixant 180 mg Then Placebo Gefapixant, 180 mg, QHS, oral for 7 days in Period 1 followed by a 7-day washout period and then placebo, QHS, oral for 7 days in Period 2. | 12 |
| Total | 24 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Period 1 | Adverse Event | 0 | 1 |
| Period 1 | Never treated with study drug | 1 | 0 |
| Period 1 | Non-compliance with study drug | 1 | 1 |
| Period 2 | Non-compliance with study drug | 0 | 1 |
| Washout Period | Physician Decision | 0 | 1 |
Baseline characteristics
| Characteristic | Placebo Then Gefapixant 180 mg | Total | Gefapixant 180 mg Then Placebo |
|---|---|---|---|
| Age, Continuous | 53.7 Years STANDARD_DEVIATION 7 | 55.0 Years STANDARD_DEVIATION 7.5 | 56.4 Years STANDARD_DEVIATION 7.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 8 Participants | 16 Participants | 8 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 4 Participants | 8 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 6 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 9 Participants | 17 Participants | 8 Participants |
| Sex: Female, Male Female | 6 Participants | 10 Participants | 4 Participants |
| Sex: Female, Male Male | 6 Participants | 14 Participants | 8 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 24 | 0 / 22 | 0 / 20 | 0 / 24 |
| other Total, other adverse events | 2 / 24 | 13 / 22 | 2 / 20 | 1 / 24 |
| serious Total, serious adverse events | 0 / 24 | 0 / 22 | 0 / 20 | 0 / 24 |
Outcome results
Primary
Apnea-Hypopnea Index (AHI) Change From Baseline as Calculated From Polysonagraphy (PSG)
The apnea-hypopnea index (AHI) is the sum of the apnea and hypopnea indices for each participant. The apnea index for each participant is calculated as the number of apneas divided by the total sleep time. The hypopnea index for each participant is calculated as the number of hypopneas divided by the total sleep time. These measurements are collected from polysonagraphs (PSGs), which are diagnostic sleep studies that collect electroencephalogram (EEG), electrooculograph (EOG), electromyogram (EMG), electrocardiogram (ECG), airflow, respiratory effort, oximetry, and sleep position data. Baseline AHI measurements in each period are obtained on Day -1. Individual AHI fold-change from baseline in each treatment period are calculated as the ratio of on-treatment AHI to baseline AHI.
Time frame: Day-1 at Baseline and Day 7 of each treatment period
Population: Analysis population consisted of all randomized participants who received at least 1 dose of study drug, were compliant with the study procedure and had available data.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo | Apnea-Hypopnea Index (AHI) Change From Baseline as Calculated From Polysonagraphy (PSG) | 0.86 ratio |
| Gefapixant 180 mg | Apnea-Hypopnea Index (AHI) Change From Baseline as Calculated From Polysonagraphy (PSG) | 0.97 ratio |
90% CI: [0.73, 1.17]
Secondary
Number of Participants Who Discontinued Study Drug Due to an AE
An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the product, whether or not considered related to the use of the product. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with the use of the product, is also an AE.
Time frame: Up to 21 days
Population: Any participant who received at least 1 dose of study drug
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Placebo | Number of Participants Who Discontinued Study Drug Due to an AE | 0 Participants |
| Gefapixant 180 mg | Number of Participants Who Discontinued Study Drug Due to an AE | 1 Participants |
Secondary
Number of Participants Who Experienced an Adverse Event (AE) During the Study
An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the product, whether or not considered related to the use of the product. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with the use of the product, is also an AE.
Time frame: Up to 14 days after last dose of study drug (Up to 35 days)
Population: Any participant who received at least one dose of study drug.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Placebo | Number of Participants Who Experienced an Adverse Event (AE) During the Study | 2 Participants |
| Gefapixant 180 mg | Number of Participants Who Experienced an Adverse Event (AE) During the Study | 13 Participants |