Heart Failure With Reduced Ejection Fraction
Conditions
Keywords
heart failure, HFrEF, neuregulin 1, NRG-1, heregulin, HER3, HER4, ErbB3, ErbB4, reduced ejection fraction
Brief summary
This is a Phase 1, randomized, double-blind, placebo-controlled, single-ascending dose study to assess the safety, tolerability, immunogenicity, PK, and exploratory efficacy of JK07 in subjects 18 to 80 years of age with HFrEF ≤40%. Initially 5 cohorts are planned with the option to expand the study to a total of 7 cohorts. The size of the cohorts will range from 5 to 9 subjects. Each cohort will include one single active unblinded sentinel subject receiving a single IV dose of JK07 prior to randomized single dose administration of JK07 or placebo \[3:1\] in the remainder of the cohort.
Detailed description
This is a Phase 1, randomized, double-blind, placebo-controlled, single-ascending dose study to assess the safety, tolerability, immunogenicity, PK, and exploratory efficacy of JK07 in HF subjects 18 to 80 years of age with LVEF ≤40%. Subjects must have been maintained on an optimal HF medical regimen for at least 2 months prior to enrollment and remain on the same treatment regimen throughout the course of the study, per the 2017 ACC/AHA/HFSA) treatment guidelines. At screening, eligible subjects will undergo a physical examination, 2-dimensional transthoracic echocardiography (2D-TTE), ECG assessment, blood sampling for laboratory parameters, and urine testing. Safety assessments at screening will include hematology, biochemistry, coagulation, liver, and thyroid function. Subjects will be observed in the hospital on continuous telemetry from the time of hospital admission until shortly before discharge approximately 48 hours later. During this time, they will additionally have safety labs, vital signs, PK and biomarker samples collected, and ECGs and 2D-TTEs performed. Only a single dose of the investigational product will be administered and only a single hospital admission is planned per subject during the study. Subjects will complete follow-up visits through 180 days after administration of the investigational product.
Interventions
DRUGJK07
Recombinant fusion protein consisting of a fully humanized immunoglobulin G1 monoclonal antibody and an active polypeptide fragment of the human growth factor NRG-1
DRUGMatching Placebo
Vehicle control
Sponsors
Salubris Biotherapeutics Inc
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Intervention model description
Double-blind, placebo-controlled, single-ascending dose with single active sentinel subject per cohort
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Adults 18 and 80 years with stable NYHA Class II or III HF diagnosis (ischemic or non-ischemic confirmed by medical history) at least 6 months prior to enrollment as confirmed by medical history. 2. Stable HF defined as no hospitalizations for cardiac-related issues within the previous 2 months prior to the screening visit or between screening and randomization, other than for routine percutaneous procedures such as device, battery, generator changes or pacemaker lead insertion/ replacement. 3. Subjects with clearly interpretable echocardiographic images and with a screening LVEF ≤ 40% in the absence of ≥ Grade 3 valvular disease on 2D-TTE. 4. Subjects must be taking clinician-directed appropriate pharmacological therapy for HF as per the 2017 ACC/AHA/HFSA treatment guidelines at stable doses and at investigator determined discretion (except for diuretics) for at least 2 months prior to informed consent. 5. Subjects with implantable cardioverter-defibrillators (ICDs) are allowed at the discretion of the investigator, but only if both the following criteria are met: (a) paced beats cannot exceed 15% of beats as quantified by screening e-Patch, and (b) if a non-paced baseline ECG can be obtained on day 1 prior to study drug administration. 5\. Body mass index ≥18 kg/m2 and ≤45 kg/m2. 6. Screening hemoglobin ≥9.0 g/dL, platelets ≥100 K/mL, ANC ≥1500/mL. 7. Able and willing to use adequate contraception until the end of the study. 8\. Capable of providing informed consent and to comply with the protocol.
Exclusion criteria
1. Participating in any other study, have received any other investigational drug within 30 days prior to screening or 5-half-lives or any other investigational implanted device within 30 days prior to screening, or are taking part in a nonmedication study which, in the opinion of the Investigator, would interfere with study compliance or outcome assessments. 2. Any past participation in a study that has investigated the NRG-1 pathway (e.g., Neucardin, Cimaglermin). 3. Heart failure due to hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricula dysplasia (ARVD), stress-induced (Takotsubo) cardiomyopathy, chemotherapy-induced cardiomyopathy, peripartum cardiomyopathy, infiltrative or inflammatory cardiomyopathies, and primary valvular disease. 4. Medically documented acute coronary syndrome within 3 months of screening or a medically documented acute MI within 6 months of screening. 5. Cardiac surgery, coronary artery revascularization, percutaneous coronary intervention, or valvuloplasty within 3 months prior to screening. 6. Any subject who has received an indication for coronary revascularization within 3 months prior to screening. 7. Any major surgical procedure within 1 month prior to screening or planned surgical procedure during the study period. 8. Sustained systolic blood pressure \<90 mm Hg and/or diastolic blood pressure \<50 mm Hg. 9. Sustained resting heart rate \>100 beats per minute sustained for \>15 minutes except in sustained atrial fibrillation when a heart rate of up to 110 beats per minute is acceptable. 10. Cerebrovascular accident or hospitalizations for CV (cardiovascular) causes other than routine percutaneous procedures such as device, battery, generator changes or pacemaker lead insertion/ replacement or device generator changes, including HF, chest pain, stroke, transient ischemic attack, or arrhythmias within 3 months prior to randomization. 11. At screening have an abnormal or clinically significant 12-lead ECG abnormality that, in the opinion of the Investigator, would affect efficacy or safety evaluation or place the subject at risk. 12. History or evidence of clinically significant arrhythmia uncontrolled by drug therapy or use of an implantable defibrillator, long QT syndrome, or evidence of QT prolongation with QTcF \>450 ms for males or QTcF \>470 ms for females prior to randomization. 13. Clinically significant renal dysfunction as measured by the estimated GFR \<45 mL/min/1.73m2 at screening, or a clinically significant change in renal function between screening and baseline. 14. Clinically significant liver dysfunction as measured by: ALT \>2.0 × ULN, alkaline phosphatase \> 2.0 × ULN, AST \>2.0 × the ULN, or GGT \>2.0 × the ULN or serum bilirubin ≥ 1.2 × the ULN at screening, or a clinically significant change in liver function between screening and baseline. 15. Subjects with alteration of the coagulation panel (INR) and/or PT ≥ 1.5 × the ULN; aPTT ≥ 1.5 × ULN, or serum albumin ≤ 3 gm/dL. For subjects on warfarin or other anticoagulants, an INR (or PT) considered by the Principal Investigator as therapeutically appropriate will be allowed. 16. Subjects with values of CPK and/or CK-MB \>2.5 times normal institutional limits at screening. 17. Any subject who by Investigator's judgement, has a significant hematuria or proteinuria at screening. 18. Concurrent treatment with Class Ia or III antiarrhythmic drugs (the medication must have been discontinued more than 2 months before informed consent). 19. Positive screening for HIV antibodies, hepatitis B surface antigen, or hepatitis C virus antibodies. 20. Known history of or active alcohol abuse (no more than 14 units/week for males or 7 units/week for females) or use of illicit drugs within 1 year prior to randomization (excluding recreational use of marijuana or cannabidiol \[CBD\]-based products. 21. Other medical or psychiatric condition that, in the opinion of the Investigator, would preclude obtaining voluntary consent/assent or would confound the secondary objectives of study. 22. A history of pathologically-confirmed malignancy of any type or any pathologically-confirmed pre-malignant condition (e.g. ductal carcinoma in situ, colonic polyp with premalignant diagnosis, or cervical atypia). 23. Pregnant or lactating female subjects at screening. 24. Subjects with clinically significant or poorly controlled disease including, but not limited to, endocrine (including diabetes and thyroid) disease, neurological or psychiatric (even mild), GI, hematological, urological, immunological, or ophthalmic diseases as determined by the Investigator. 25. Subjects who are not non-smokers or light smokers (no more than 5 cigarettes per day) and who cannot abstain from smoking from 2 weeks prior to the administration of IP through the end of the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability] | Screening to 30 days | All safety information is collected and evaluated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| AUC(0-last) of JK07 | Baseline to 60 days | Area under the concentration (time curve to the last quantifiable concentration) from blood samples taken on Days 1-4, and Days 7, 11, 15, 22, 30, and 60. |
| Cmax of JK07 | Baseline to 60 days | Maximum concentration from blood samples taken on Days 1-4, and Days 7, 11, 15, 22, 30, and 60. |
| t1/2 of JK07 | Baseline to 60 days | Half-life from blood samples taken on Days 1-4, and Days 7, 11, 15, 22, 30, and 60. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Left Ventricular Ejection Fraction (LVEF) | Screening to 180 days | 2D-transthoracic echocardiography-derived LVEF |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| JK07 - Cohort 1 Experimental: JK07 0.03 mg/kg
Cohort 1: Participants were administered 0.03 mg/kg of JK07 single dose by intravenous infusion over 60 minutes, with 180 days of follow-up. | 4 |
| JK07 - Cohort 2 Experimental: JK07 0.09 mg/kg
Cohort 2: Participants were administered 0.09 mg/kg of JK07 single dose by intravenous infusion over 60 minutes, with 180 days of follow-up. | 4 |
| JK07 - Cohort 3 Experimental: JK07 0.27 mg/kg
Cohort 3: Participants were administered 0.27 mg/kg of JK07 single dose by intravenous infusion over 60 minutes, with 180 days of follow-up. | 3 |
| Matching Placebo Matching Placebo: Vehicle control
Single dose of placebo administered by intravenous infusion over 60 minutes, with 180 days of follow-up. | 3 |
| Total | 14 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Death | 0 | 1 | 0 | 0 |
Baseline characteristics
| Characteristic | JK07 - Cohort 2 | JK07 - Cohort 3 | Matching Placebo | Total | JK07 - Cohort 1 |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 2 Participants | 2 Participants | 0 Participants | 4 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 2 Participants | 1 Participants | 3 Participants | 10 Participants | 4 Participants |
| Age, Continuous | 61.3 years STANDARD_DEVIATION 9.74 | 61.0 years STANDARD_DEVIATION 14.93 | 54.3 years STANDARD_DEVIATION 5.13 | 57.4 years STANDARD_DEVIATION 10.14 | 53.3 years STANDARD_DEVIATION 10.9 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 0 Participants | 1 Participants | 2 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 3 Participants | 3 Participants | 2 Participants | 12 Participants | 4 Participants |
| Region of Enrollment United States | 4 participants | 3 participants | 3 participants | 14 participants | 4 participants |
| Sex: Female, Male Female | 2 Participants | 1 Participants | 1 Participants | 4 Participants | 0 Participants |
| Sex: Female, Male Male | 2 Participants | 2 Participants | 2 Participants | 10 Participants | 4 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 / 4 | 1 / 4 | 0 / 3 | 0 / 3 |
| other Total, other adverse events | 1 / 4 | 3 / 4 | 3 / 3 | 1 / 3 |
| serious Total, serious adverse events | 0 / 4 | 0 / 4 | 1 / 3 | 0 / 3 |
Outcome results
Primary
Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability]
All safety information is collected and evaluated.
Time frame: Screening to 30 days
Population: All randomized participants
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| JK07 - Cohort 1 | Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability] | Treatment emergent AEs | 4 number of events |
| JK07 - Cohort 1 | Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability] | SAEs | 0 number of events |
| JK07 - Cohort 2 | Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability] | SAEs | 0 number of events |
| JK07 - Cohort 2 | Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability] | Treatment emergent AEs | 3 number of events |
| JK07 - Cohort 3 | Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability] | Treatment emergent AEs | 8 number of events |
| JK07 - Cohort 3 | Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability] | SAEs | 1 number of events |
| Matching Placebo | Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability] | Treatment emergent AEs | 2 number of events |
| Matching Placebo | Incidence and Severity of Treatment-emergent Adverse Events [Safety and Tolerability] | SAEs | 0 number of events |
Secondary
AUC(0-last) of JK07
Area under the concentration (time curve to the last quantifiable concentration) from blood samples taken on Days 1-4, and Days 7, 11, 15, 22, 30, and 60.
Time frame: Baseline to 60 days
Population: All randomized participants were included in the noncompartmental analysis of pharmacokinetic data.
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| JK07 - Cohort 1 | AUC(0-last) of JK07 | 5310 h*ng/mL | Geometric Coefficient of Variation 80.6 |
| JK07 - Cohort 2 | AUC(0-last) of JK07 | 34400 h*ng/mL | Geometric Coefficient of Variation 2.9 |
| JK07 - Cohort 3 | AUC(0-last) of JK07 | 139000 h*ng/mL | Geometric Coefficient of Variation 15.1 |
Secondary
Cmax of JK07
Maximum concentration from blood samples taken on Days 1-4, and Days 7, 11, 15, 22, 30, and 60.
Time frame: Baseline to 60 days
Population: All randomized participants were included in the noncompartmental analysis of pharmacokinetic data.
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| JK07 - Cohort 1 | Cmax of JK07 | 497 ng/mL | Geometric Coefficient of Variation 44.3 |
| JK07 - Cohort 2 | Cmax of JK07 | 1680 ng/mL | Geometric Coefficient of Variation 20.9 |
| JK07 - Cohort 3 | Cmax of JK07 | 5170 ng/mL | Geometric Coefficient of Variation 13.8 |
Secondary
t1/2 of JK07
Half-life from blood samples taken on Days 1-4, and Days 7, 11, 15, 22, 30, and 60.
Time frame: Baseline to 60 days
Population: All randomized participants were included in the noncompartmental analysis of pharmacokinetic data.
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| JK07 - Cohort 1 | t1/2 of JK07 | 8.11 h | Geometric Coefficient of Variation 42.7 |
| JK07 - Cohort 2 | t1/2 of JK07 | 10.95 h | Geometric Coefficient of Variation 10.8 |
| JK07 - Cohort 3 | t1/2 of JK07 | 18.32 h | Geometric Coefficient of Variation 8.2 |
Other Pre-specified
Left Ventricular Ejection Fraction (LVEF)
2D-transthoracic echocardiography-derived LVEF
Time frame: Screening to 180 days
Population: All randomized participants.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 1 - pre dose | 34 % of LVEF |
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 1 - 6 hrs post dose | 37 % of LVEF |
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 2 | 39.8 % of LVEF |
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 7 | 38.5 % of LVEF |
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 30 | 40.8 % of LVEF |
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 60 | 38.5 % of LVEF |
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 15 | 42.5 % of LVEF |
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 90 | 37 % of LVEF |
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 135 | 36 % of LVEF |
| JK07 - Cohort 1 | Left Ventricular Ejection Fraction (LVEF) | Day 180 | 36 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 90 | 36 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 60 | 35.3 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 2 | 28.8 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 7 | 33.5 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 1 - 6 hrs post dose | 30.5 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 180 | 38.7 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 135 | 31.7 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 30 | 33 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 15 | 34.5 % of LVEF |
| JK07 - Cohort 2 | Left Ventricular Ejection Fraction (LVEF) | Day 1 - pre dose | 28 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 2 | 30.7 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 15 | 28.3 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 135 | 32 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 30 | 28.7 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 60 | 30 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 7 | 28 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 90 | 27 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 1 - pre dose | 25 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 1 - 6 hrs post dose | 31 % of LVEF |
| JK07 - Cohort 3 | Left Ventricular Ejection Fraction (LVEF) | Day 180 | 32.3 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 2 | 32.3 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 30 | 32.7 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 1 - 6 hrs post dose | 33.7 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 1 - pre dose | 31 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 90 | 25 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 15 | 31 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 180 | 33.7 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 60 | 29.3 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 7 | 27.3 % of LVEF |
| Matching Placebo | Left Ventricular Ejection Fraction (LVEF) | Day 135 | 22 % of LVEF |