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    Clinical Trial Results:
    A Phase 2, Randomized, Double-Masked, Placebo-Controlled, Parallel-Group Study of the Safety and Efficacy of Daily CF101 Administered Orally in Subjects with Elevated Intraocular Pressure

    Summary
    EudraCT number
    2011-002777-27
    Trial protocol
    BG  
    Global end of trial date
    10 Feb 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    16 Feb 2020
    First version publication date
    16 Feb 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CF101-231GL
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Can Fite Biopharma Ltd
    Sponsor organisation address
    10 Bareket St., Tikva, Israel,
    Public contact
    Medical Director, Can-Fite BioPharma Ltd., +972 39241114, info@canfite.co.il
    Scientific contact
    Medical Director, Can-Fite BioPharma Ltd., +972 39241114, info@canfite.co.il
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    10 Feb 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    10 Feb 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    10 Feb 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Determine the effects of oral CF101 in lowering intraocular pressure (IOP) when administered twice daily for 16 weeks in subjects with elevated IOP; and Determine the safety of oral CF101 in this subject population
    Protection of trial subjects
    The study was conducted in compliance with applicable International Conference on Harmonisation (ICH) guidelines, the ICH E6 Good Clinical Practice (GCP) guideline, and regulations, guidelines, and applicable laws and regulations of the locale and country where the study was conducted. The study was conducted with the approval of a duly constituted institutional review board (IRB) or ethics committee (EC) in accordance with the requirement of United States regulation Title 21 Code of Federal Regulations (CFR) Part 56 - Institutional Review Boards. The nature and risks of the study were fully explained to each subject and written consent obtained in accordance with the requirements of 21 CFR 50 - Protection of Human Subjects. Subjects were informed of their rights, including the right to withdraw from the study at any time.
    Background therapy
    None
    Evidence for comparator
    Placebo as control
    Actual start date of recruitment
    27 Sep 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Romania: 55
    Country: Number of subjects enrolled
    Bulgaria: 32
    Country: Number of subjects enrolled
    Israel: 2
    Worldwide total number of subjects
    89
    EEA total number of subjects
    87
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    60
    From 65 to 84 years
    29
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    There were 89 subjects enrolled and randomised in 14 sites in 3 countries (Romania [7], Bulgaria [6], and Israel [1]) and included in the study between 02 Nov 2010 and 24 Sep 2015

    Pre-assignment
    Screening details
    At a Screening Visit subjects who provided written informed consent and fulfilled the inclusion criteria (notably: Ocular hypertension or open-angle glaucoma in at least 1 eye) underwent specified procedures.

    Period 1
    Period 1 title
    Baseline (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst
    Blinding implementation details
    Treatment was allocated in a double-blinded (double-masked) fashion. The Investigator was supplied with sealed envelopes, each one containing the treatment allocation for the treatment assignment (randomization) number that appeared on the outside of the envelope.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    CF101 1 mg
    Arm description
    Medication was taken orally BID for 16 weeks in a double-blinded fashion
    Arm type
    Active comparator

    Investigational medicinal product name
    Methyl 1-[N6-(3-iodobenzyl)-adenin-9-yl]-β-D-ribofuronamide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    1 mg tablet BID

    Arm title
    CF101 2 mg
    Arm description
    Medication was taken orally BID for 16 weeks in a double-blinded fashion
    Arm type
    Active comparator

    Investigational medicinal product name
    Methyl 1-[N6-(3-iodobenzyl)-adenin-9-yl]-β-D-ribofuronamide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    2 mg tablet BID

    Arm title
    Placebo
    Arm description
    Medication was taken orally BID for 16 weeks in a double-blinded fashion
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo, matching for methyl 1-[N6-(3-iodobenzyl)-adenin-9-yl]-β-D-ribofuronamide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Matching CF101 placebo tablet BID

    Number of subjects in period 1
    CF101 1 mg CF101 2 mg Placebo
    Started
    34
    32
    23
    Completed
    33
    28
    22
    Not completed
    1
    4
    1
         Consent withdrawn by subject
    1
    1
    -
         Other
    -
    2
    -
         An unacceptable rise in IOP occurred, requiring a
    -
    1
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    CF101 1 mg
    Reporting group description
    Medication was taken orally BID for 16 weeks in a double-blinded fashion

    Reporting group title
    CF101 2 mg
    Reporting group description
    Medication was taken orally BID for 16 weeks in a double-blinded fashion

    Reporting group title
    Placebo
    Reporting group description
    Medication was taken orally BID for 16 weeks in a double-blinded fashion

    Reporting group values
    CF101 1 mg CF101 2 mg Placebo Total
    Number of subjects
    34 32 23 89
    Age categorical
    Units: Subjects
        Adults 18 years and over
    34 32 23 89
    Gender categorical
    Units: Subjects
        Female
    25 28 20 73
        Male
    9 4 3 16
    Diagnosis
    Glaucoma or ocular hypertension
    Units: Subjects
        Untreated ocular hypertension without glaucomatous
    6 12 4 22
        Glaucoma diagnosed within the past 2 months but un
    7 7 4 18
        Previously treated glaucoma, provided that previou
    6 0 3 9
        Currently treated glaucoma with inadequate IOP con
    15 13 12 40
    Family History
    Units: Subjects
        Yes
    5 3 4 12
        No
    29 29 19 77
    Time since diagnosis (Years)
    Units: Years
        geometric mean (standard deviation)
    3.27 ± 4.831 1.69 ± 2.778 5.84 ± 9.441 -
    Subject analysis sets

    Subject analysis set title
    Safety Population
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The Safety Population consists of all subjects who received at least one dose of study medication and the opportunity for at least one safety assessment, ie, at least one post-Baseline visit. A listing of all subjects excluded from the Safety Population, including subjects who failed re-qualification at Baseline, will be provided.

    Subject analysis set title
    Intent-to-Treat
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The intent-to-treat (ITT) population consists of all randomized subjects who received at least one dose of study medication with assessments sufficient to determine IOP for at least one post-baseline visit. Determination of the ITT population will be based on observed data, without imputation of missing data.

    Subject analysis sets values
    Safety Population Intent-to-Treat
    Number of subjects
    89
    89
    Age categorical
    Units: Subjects
        Adults 18 years and over
    89
    89
    Age continuous
    Units:
        
    ±
    ±
    Gender categorical
    Units: Subjects
        Female
    73
    73
        Male
    16
    16
    Diagnosis
    Glaucoma or ocular hypertension
    Units: Subjects
        Untreated ocular hypertension without glaucomatous
    22
    22
        Glaucoma diagnosed within the past 2 months but un
    18
    18
        Previously treated glaucoma, provided that previou
    9
    9
        Currently treated glaucoma with inadequate IOP con
    40
    40
    Family History
    Units: Subjects
        Yes
    12
    12
        No
    77
    77
    Time since diagnosis (Years)
    Units: Years
        geometric mean (standard deviation)
    3.37 ± 6.057
    3.37 ± 6.057

    End points

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    End points reporting groups
    Reporting group title
    CF101 1 mg
    Reporting group description
    Medication was taken orally BID for 16 weeks in a double-blinded fashion

    Reporting group title
    CF101 2 mg
    Reporting group description
    Medication was taken orally BID for 16 weeks in a double-blinded fashion

    Reporting group title
    Placebo
    Reporting group description
    Medication was taken orally BID for 16 weeks in a double-blinded fashion

    Subject analysis set title
    Safety Population
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The Safety Population consists of all subjects who received at least one dose of study medication and the opportunity for at least one safety assessment, ie, at least one post-Baseline visit. A listing of all subjects excluded from the Safety Population, including subjects who failed re-qualification at Baseline, will be provided.

    Subject analysis set title
    Intent-to-Treat
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The intent-to-treat (ITT) population consists of all randomized subjects who received at least one dose of study medication with assessments sufficient to determine IOP for at least one post-baseline visit. Determination of the ITT population will be based on observed data, without imputation of missing data.

    Primary: Change from Baseline in IOP (Target Eye) at Week 16

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    End point title
    Change from Baseline in IOP (Target Eye) at Week 16 [1]
    End point description
    Change from Baseline in Intraocular Pressure (Target Eye) at Week 16
    End point type
    Primary
    End point timeframe
    Baseline to Week 16
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The primary analysis for this study was limited to change from baseline in each arm as the planned comparisons to placebo did not show any significant difference. The p values were as follows: 0.628 for 1 mg v placebo and 0.428 for 2 mg v placebo.
    End point values
    CF101 1 mg CF101 2 mg Placebo
    Number of subjects analysed
    34
    32
    23
    Units: mmHg
        median (full range (min-max))
    -3.67 (-10.5 to 2.5)
    -3.75 (-11.0 to 10.5)
    -5.00 (-10.5 to 7.5)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events that occurred during the study (Weeks 0 to 16).
    Adverse event reporting additional description
    AEs were coded using MedDRA. All TEAEs were summarized by treatment group. Counts and percent were presented by treatment group for each observed SOC and preferred term as defined in MedDRA.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    9.0
    Reporting groups
    Reporting group title
    CF101 2 mg
    Reporting group description
    Analysed as the Safety Population during the treatment period (Weeks 0 to 16).

    Reporting group title
    CF101 1 mg
    Reporting group description
    Analysed as the Safety Population during the treatment period (Weeks 0 to 16).

    Reporting group title
    Placebo
    Reporting group description
    Analysed as the Safety Population during the treatment period (Weeks 0 to 16).

    Serious adverse events
    CF101 2 mg CF101 1 mg Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 32 (3.13%)
    0 / 23 (0.00%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Cardiac disorders
    Arterial hypertension
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 32 (3.13%)
    0 / 23 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    CF101 2 mg CF101 1 mg Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    6 / 34 (17.65%)
    6 / 32 (18.75%)
    3 / 23 (13.04%)
    Investigations
    Blood pressure increased
         subjects affected / exposed
    0 / 34 (0.00%)
    0 / 32 (0.00%)
    1 / 23 (4.35%)
         occurrences all number
    0
    0
    1
    Vascular disorders
    Hypertension
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 32 (3.13%)
    0 / 23 (0.00%)
         occurrences all number
    0
    1
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 32 (3.13%)
    1 / 23 (4.35%)
         occurrences all number
    0
    1
    2
    General disorders and administration site conditions
    Feeling cold
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Eye disorders
    Abnormal sensation in eye
         subjects affected / exposed
    0 / 34 (0.00%)
    0 / 32 (0.00%)
    1 / 23 (4.35%)
         occurrences all number
    0
    0
    2
    Ocular discomfort
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Gastrointestinal disorders
    Haemorrhoids
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Nausea
         subjects affected / exposed
    0 / 34 (0.00%)
    0 / 32 (0.00%)
    1 / 23 (4.35%)
         occurrences all number
    0
    0
    1
    Procedural nausea
         subjects affected / exposed
    0 / 34 (0.00%)
    0 / 32 (0.00%)
    1 / 23 (4.35%)
         occurrences all number
    0
    0
    1
    Skin and subcutaneous tissue disorders
    Rash erythematous
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 32 (3.13%)
    0 / 23 (0.00%)
         occurrences all number
    0
    1
    0
    Skin disorder
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Psychiatric disorders
    Anger
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Insomnia
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Renal and urinary disorders
    Glycosuria
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    0 / 34 (0.00%)
    0 / 32 (0.00%)
    1 / 23 (4.35%)
         occurrences all number
    0
    0
    2
    Spinal pain
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Infections and infestations
    Conjunctivitis bilateral
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Influenza
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Nasopharyngitis
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 32 (3.13%)
    0 / 23 (0.00%)
         occurrences all number
    0
    1
    0
    Oral herpes
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Rhinitis
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0
    Upper aerodigestive tract infection
         subjects affected / exposed
    0 / 34 (0.00%)
    0 / 32 (0.00%)
    1 / 23 (4.35%)
         occurrences all number
    0
    0
    1
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 34 (0.00%)
    1 / 32 (3.13%)
    0 / 23 (0.00%)
         occurrences all number
    0
    1
    0
    Vulvovaginal candidiasis
         subjects affected / exposed
    1 / 34 (2.94%)
    0 / 32 (0.00%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    21 Apr 2010
    • Amendment #1, Version 2.0, dated 21 April 2010: This amendment made 2 minor modifications in clinical procedures that enhanced feasibility and subject safety without affecting the efficacy objectives of the trial: o First, the type of tonometer was no longer limited to a single instrument, so that the protocol was more readily implemented at multiple sites. Since each subject served as his/her own control for tonometry measurements over the course of the trial, and since the same tonometer was always to be used within any given study site, intra-ocular pressure data analyses would not be affected. o Second, for purposes of safety monitoring, visual field (VF) testing was added at Week 8, and corneal pachymetry was added at Weeks 8 and 16. o This amendment also modified the inclusion criteria to further enhance subject safety by eliminating from consideration potential enrollees who would have had to discontinue previously efficacious ocular anti-hypertensive medication to qualify for the trial.
    24 May 2010
    • Amendment #2, Version 3.0, dated 24 May 2010: This amendment clarified the Exclusion Criteria by removing redundancy and introducing more precision about which patient population certain criteria applied to. o The Exclusion Criterion reading “Mean VF pattern standard deviation (PSD), on reliable testing, of ≥2.0 dB in either eye” was removed because it was applicable only to patients with ocular hypertension, who were already well defined in Inclusion Criterion #1.a and Exclusion Criterion #5 (in this amendment); and contradicted Inclusion Criterion #1.b, because most glaucoma patients have a mean VF PSD of >2.0 dB. It was therefore removed because it was redundant and potentially confusing. o The Exclusion Criterion relating to “advanced VF defect in either eye” (Exclusion Criterion #4 in this amendment) was modified to refer specifically to patients with glaucoma, because it was not relevant to patients with ocular hypertension. Likewise, the Exclusion Criterion relating to the “Ocular Hypertension Treatment Study Group and European Glaucoma Prevention Study Group Primary Open-Angle Glaucoma Risk Table” (Exclusion Criterion #5 in this amendment) was modified to refer specifically to patients with ocular hypertension, because it is used only in this population to stratify risk. o In sum, these changes were made to ensure consistency of patient population definitions and application of the entry criteria, and did not impact upon patient safety. o Additional editorial changes were made to clarify screening and inclusion procedures and details of selected ophthalmologic examinations. None altered the nature or the conduct of the protocol.
    15 Feb 2011
    • Amendment #3, Version 4.0, dated 15 February 2011 (Israel only): The purpose of this amendment was to specify the expected enrollment in the 2 countries involved in this trial for informational and regulatory purposes. There were no changes to any protocol procedures, and patient safety was not affected.
    03 Jul 2012
    • Amendment #4, Version 5.0, dated 03 July 2012: The purpose of this amendment was to specify the 3 countries involved in this trial for informational and regulatory purposes and allow the enrollment of a more representative patient population without compromising the trial’s safety or efficacy objectives.
    03 Jan 2013
    • Amendment #5, Version 6.0, dated 03 January 2013: The purpose of this Amendment was to facilitate protocol enrollment and operations, without affecting subject risk. Since both ophthalmologists and patients were accustomed to treating elevated IOP and glaucoma with available therapies, it had been difficult to enroll untreated patients under the original protocol entry criteria, despite the rigorous safety incorporated into the trial. These original criteria excluded concomitant ocular hypotensive treatments, in an attempt to isolate the pharmacologic activity of CF101 monotherapy in this population. Amendment 5 allowed CF101 to be used in combination with standard topical regimens, and was therefore expected to facilitate enrollment without interfering with the efficacy objectives of the trial. In recognition of the fact that subjects would now enter the trial already receiving standard ocular hypotensive therapy, the minimum entry IOP was reduced from 24 to 22 mmHg. Since the sample size calculation was based not on absolute IOP values but on relative differences between active and placebo groups, no change in sample size was necessary. Amendment 5 also made several minor editorial and administrative modifications and clarifications, reconciled the use of “subject” and “patient”, and removed the names of participating countries to allow for flexibility.
    20 May 2013
    • Amendment #6, Version 7.0, dated 20 May 2013: At the request of study sites, the sponsor clarified the examination procedures.
    23 Jun 2014
    • Amendment #7, Version 8.0, dated 23 June 2014: The initial rationale for this clinical trial is described in protocol Section 6.6. Since the launch of CF101-231GL, the Sponsor completed enrollment in protocol CF101-301KCS, a Phase 3 trial in 237 subjects with keratoconjunctivitis sicca. Analysis of IOP data from that trial indicated that the 1 mg BID dose of CF101 was less effective in reducing IOP than initially found in protocol CF101-201KCS (see protocol Section 6.6). It should be noted that in that trial, all enrolled subjects were ocularly normotensive, and that IOP was measured as a safety, not an efficacy, assessment. Thus, even though Segment 1 of the current trial had not completed or been reviewed by the planned Data Review Committee, there were data from an external source strongly suggesting that a higher dose range of CF101 needed to be explored in subjects with elevated IOP. Therefore, this Amendment did the following: o Eliminated the possibility of a CF101 0.1 mg dose group, based on data suggesting this dose will be too low to be effective; o Formalized the CF101 2.0 mg dose group, to explore a higher and perhaps more efficacious dose level and to better define the dose-range of CF101 in this patient population; and o Eliminated the requirement for the Data Review Committee, as no new dosing decisions would have to be made based on current knowledge. o Given existing and accumulating data from Phase 2 trials in other indications (see current Clinical Investigator Brochure), no new risks to subjects are anticipated from the dosing changes proposed in this Amendment.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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