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    Summary
    EudraCT Number:2018-001309-95
    Sponsor's Protocol Code Number:MPH966-2-01
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2018-10-09
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2018-001309-95
    A.3Full title of the trial
    A Phase 2, proof-of-concept, multicentre, double-blind, randomised, dose-ascending, sequential group, placebo-controlled study to evaluate the mechanistic effect, safety, and tolerability of 12 weeks twice daily oral administration of alvelestat (MPH966) in participants with alpha-1 (PiZZ or null genotype/phenotype) antitrypsin deficiency.
    Estudio de fase II preliminar, multicéntrico, con doble enmascaramiento, aleatorizado, con dosis ascendentes, grupos secuenciales y comparado con placebo para evaluar el mecanismo de acción, la seguridad y la tolerabilidad de 12 semanas de administración oral de alvelestat (MPH966) dos veces al día en participantes con déficit de a-1-antitripsina (genotipo/fenotipo PiZZ o nulo).
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2 placebo-controlled study to evaluate the mechanistic effect, safety, and tolerability of alvelestat (MPH966) in participants with alpha-1 (PiZZ or null genotype/phenotype) antitrypsin deficiency
    Estudio de fase II comparado con placebo para evaluar el mecanismo de acción, la seguridad y la tolerabilidad de alvelestat (MPH966) en participantes con déficit de a-1-antitripsina (genotipo/fenotipo PiZZ o nulo).
    A.4.1Sponsor's protocol code numberMPH966-2-01
    A.5.4Other Identifiers
    Name:INDNumber:101534
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorMereo BioPharma 4 Ltd
    B.1.3.4CountryUnited Kingdom
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMereo BioPharma Group Limited
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMereo BioPharma 4 Ltd
    B.5.2Functional name of contact pointClinical Operations Department
    B.5.3 Address:
    B.5.3.1Street Address1 Cavendish Place
    B.5.3.2Town/ cityLondon
    B.5.3.3Post codeW1G 0QF
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number4403330237300
    B.5.5Fax number4403330237301
    B.5.6E-mailenquiries@mereobiopharma.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAlvelestat
    D.3.2Product code MPH966
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAlvelestat tosylate
    D.3.9.1CAS number 1240425-05-1
    D.3.9.2Current sponsor codeMPH966
    D.3.9.3Other descriptive nameALVELESTAT
    D.3.9.4EV Substance CodeSUB130609
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Alpha-1 (PiZZ or null genotype/phenotype) antitrypsin deficiency
    déficit de α-1-antitripsina (genotipo/fenotipo PiZZ o nulo).
    E.1.1.1Medical condition in easily understood language
    Alpha-1 antitrypsin deficiency is a genetic disorder that may result in lung disease or liver disease.
    Déficit de α-1-antitripsina es un desorden genético que puede desencadenar en enfermedad pulmonar o hepática.
    E.1.1.2Therapeutic area Diseases [C] - Respiratory Tract Diseases [C08]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level PT
    E.1.2Classification code 10001806
    E.1.2Term Alpha-1 anti-trypsin deficiency
    E.1.2System Organ Class 10010331 - Congenital, familial and genetic disorders
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the mechanistic effect of alvelestat (MPH966) administered bid for 12 weeks on blood markers of neutrophil elastase activity
    - Evaluar el mecanismo de acción de alvelestat (MPH966) administrado dos veces al día (2 v/d) durante 12 semanas en los marcadores sanguíneos de la actividad de la elastasa neutrófila
    E.2.2Secondary objectives of the trial
    Secondary objectives:
    • To evaluate the effect of alvelestat (MPH966) on other blood PD markers of neutrophil activation and elastase activity
    • To evaluate the effect of alvelestat (MPH966) on blood biomarkers of lung tissue degradation
    • To evaluate the effect of alvelestat (MPH966) on biomarkers of inflammation in blood
    • To evaluate the effect of alvelestat (MPH966) on neutrophil activation, elastase, and inflammatory activity in lung
    • To evaluate the safety and tolerability of alvelestat (MPH966) administered bid for 12 weeks
    Exploratory objectives:
    • To evaluate the effect of alvelestat (MPH966) on pulmonary function
    • To evaluate the effect of alvelestat (MPH966) on respiratory symptoms
    • To evaluate PK efficacy relationships in AATD
    Objetivos secundarios:
    - Evaluar el efecto de alvelestat (MPH966) en otros marcadores sanguíneos farmacodinámicos de activación de neutrófilos y actividad de la elastasa
    - Evaluar el efecto de alvelestat (MPH966) en los biomarcadores sanguíneos de degradación del tejido pulmonary
    - Evaluar el efecto de alvelestat (MPH966) en los biomarcadores de inflamación en sangre
    - Evaluar el efecto de alvelestat (MPH966) en la activación de neutrófilos, elastasa, y actividad inflamatoria en el pulmón
    - Evaluar la seguridad y tolerabilidad de alvelestat (MPH966) administrado 2 v/d durante 12 semanas

    Objetivos exploratorios:
    - Evaluar el efecto de alvelestat (MPH966) en la función pulmonary
    - Evaluar el efecto de alvelestat (MPH966) en los síntomas respiratorios
    - Evaluar las relaciones de eficacia FC en el DAAT
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Sputum will either be induced or spontaneously produced by participants.
    • Sputum will be collected from all participants that spontaneously produce sputum according to the MPH966-2-01 Study Procedures Manual.
    • Participants who do not spontaneously produce sputum will be invited to participate in the induced sputum subset study. The aim to meet the study objectives is to include approximately 30% to 50% of non-sputum producers in the subset study. Sputum induction will not be undertaken if the baseline FEV1 for the procedure is less than 1 L. Further details of sputum induction will be included in the MPH966-2-01 Study Procedures Manual.
    Estudios de subgrupos
    A)Productores de esputo espontáneo
    B)Esputo inducido (se intentará inducir a aproximadamente el 50 % de aquellos que no producen esputo espontáneo)
    E.3Principal inclusion criteria
    1. Age 18 to 75 years
    2. Patients with a diagnosis or confirmation of AATD (PiZZ or null phenotype/genotype) with serum AAT levels <11 µM or <57.2 mg/dL
    3. FEV1 ≥25% predicted
    4. Computerised tomography (CT) scan evidence of emphysema
    5. Non-smokers (for at least 12 months prior to study entry)
    6. Absence of moderate/severe liver fibrosis or cirrhosis:
    a. Fibrosis-4 (FIB-4) score <1.45 or
    b. FIB-4 score >1.45 and ≤3.25 with transient elastography measurement <12.5 kPa within 3 months of randomisation
    c. Stable liver transaminases (ALT/AST) and Total bilirubin (TB) as determined by comparison of two separate assessments obtained at least 4 weeks apart
    7. Male or female
    Male participants: A male participant must agree to use a highly effective contraception as detailed in Appendix 5 during the treatment period and for at least 4 days after the last dose of study treatment and refrain from donating sperm during this period
    Female participants: A female participant is eligible to participate if she is not pregnant (see Appendix 5), not breastfeeding, and at least 1 of the following conditions applies:
    a. Not a woman of childbearing potential as defined in Appendix 5
    OR
    b. A woman of childbearing potential who agrees to follow the contraceptive guidance in Appendix 5 during the treatment period and for at least 4 days after the last dose of study treatment
    8. Capable of giving signed informed consent as described in Appendix 3, which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol
    1.Edad de 18 a 75 años.
    2.Pacientes con diagnóstico confirmado de DAAT (genotipo/fenotipo PiZZ o nulo) con niveles séricos de AAT <11 µM o <57,2 mg/dl
    3.VEF1 ≥25 % previsto
    4.Enfisema demostrado mediante tomografía computarizada (TAC)
    5.No fumadores (durante al menos 12 meses antes de la inclusión en el estudio)
    6.Ausencia de fibrosis hepática moderada/grave o cirrosis:
    a.Puntuación de fibrosis-4 (FIB-4) <1,45 o
    b.Puntuación FIB-4 ≥1,45 y ≤3,25 con medición de elastografía transitoria <12,5 kPa en los 3 meses tras la aleatorización
    c.Transaminasas hepáticas estables (ALAT/ASAT) y bilirrubina total (BT) según determinación por comparación de dos evaluaciones independientes realizadas al menos con 4 semanas de diferencia
    Sexo
    7.Hombres o mujeres
    Hombres participantes:
    -Los hombres participantes deben comprometerse a usar un método anticonceptivo altamente eficaz, como se detalla en el Anexo 5 durante el período de tratamiento y durante al menos 4 días después de la última dosis del tratamiento del estudio, y no deben donar esperma durante este período
    Mujeres participantes:
    -Las mujeres podrán participar en el estudio si no están embarazadas (véase el Anexo 5), no están dando el pecho, y cumplen al menos una de las condiciones siguientes:
    a.No son mujeres fértiles según la definición del Anexo 5
    O
    b.Son mujeres fértiles que se comprometen a seguir las directrices sobre anticonceptivos del Anexo 5 durante el período de tratamiento y durante al menos 4 días después de la última dosis del tratamiento del estudio.
    Consentimiento informado
    8.Pueden proporcionar un consentimiento informado firmado como se describe en el Anexo 3, que incluye el cumplimiento de los requisitos y restricciones enumerados en el formulario de consentimiento informado y en este protocolo.
    E.4Principal exclusion criteria
    1. Participants with other AATD phenotypes/genotypes
    2. Primary clinical diagnosis of bronchiectasis or evidence of significant bronchiectasis on CT scan (per Investigator judgement and with CT scan taken in the last 3 years)
    3. Acute exacerbation of underlying lung disease requiring oral steroids, antibiotics, and/or change in regular treatments within 4 weeks of baseline
    4. Acute or chronic hepatitis, including hepatitis B, hepatitis C (positive serologies, including hepatitis B antigen and also hepatitis B and C antibody) at screening
    5. History or current diagnosis of cirrhosis (on imaging or biopsy), oesophageal varices, ascites or hepatic encephalopathy
    6. History of other chronic liver diseases such as autoimmune liver disease, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson’s disease, Haemochromatosis or iron overload
    7. History of non-alcoholic fatty liver disease (NAFLD) or use of drugs associated with NAFLD for more than 2 weeks in the year prior to screening [drugs include amiodarone, methotrexate, systemic glucocorticoids (should not exceed >5mgs prednisolone or equivalent daily dose), tetracyclines, tamoxifen, oestrogens at doses greater than those used for hormone replacement, anabolic steroids, valproic acid, and other known hepatotoxins (including but not restricted to statins, anti-epileptics, antibiotics such as amoxicillin, amoxicillin/clavulanate, and NSAIDs)]
    8. History of significant alcohol consumption for a period of more than 3 consecutive months within 1 year prior to screening, defined as an average of >2.5units/day in female subjects and >3.75units/day in male subjects
    9. History of alcohol and/or drug abuse within the last 15 years
    10. HIV infection or other immunodeficiency or with an absolute neutrophil count ≤1.0 × 109/L at screening
    11. Abnormal liver-related biochemistry (ALT, AST, gamma-glutamyl transferase) >1.5 × ULN or total bilirubin > ULN (unless Gilbert’s disease with normal conjugated bilirubin), platelet count <150 x 109/L, serum albumin ≤ 3.5 g/dL, INR ≥1.2 or CPK ≥ ULN
    12. FIB-4 score >3.25
    13. Hyperlipidaemia requiring statins, where treatment would be initiated during the study treatment period (participants on established treatment >28 days will not be excluded)
    14. Any of the following cardiovascular conditions within 6 months prior to the screening visits:
    14.1. Myocardial infarction or unstable angina
    14.2. Coronary artery bypass surgery, balloon angioplasty, percutaneous coronary intervention, or carotid revascularisation procedure
    14.3. Uncontrolled hypertension within the 3 months of screening
    14.4. Congestive heart failure (New York Heart Association III/IV)
    14.5. Stroke or transient ischaemic attack
    15. Any clinically significant 12-lead ECG abnormalities at screening or baseline, including corrected QT interval by Fridericia’s correction method (QTcF) >450 ms or history of significant cardia dysrhythmia, including long QT syndrome
    16. Significant renal disease or infection (as determined by the Investigator) including stage 4 chronic kidney disease or estimated glomerular filtration rate <60 mL/min
    17. History of cancer within the last 5 years, except for well-treated basal cell carcinoma and squamous cell carcinoma
    18. Other clinically relevant haematology parameters that could impact the safety of the participant in the Investigator’s judgement
    19. Other documented comorbidities that, in the opinion of the Investigator, could affect the outcome of the study assessments or ability of the participant to comply with the requirements of the protocol
    20. Immunosuppressive therapies, including regular systemic corticosteroids
    21. Immunomodulating monoclonal antibodies within 6 months prior to screening
    22. Previous AAT augmentation therapy within the last 6 months
    23. Requirement for NSAIDs (paracetamol [acetaminophen] is allowed)
    24. Initiation of treatment with drugs known for hepatotoxic potential (including but not restricted to statins, anti-epileptics, antibiotics such as amoxicillin, amoxicillin/clavulanate, and NSAIDs) within 1 month of screening
    25. Requirement for medications mainly metabolised by CYP2C9 and with narrow therapeutic index (eg, warfarin)
    26. Participation in any clinical investigation using non-biologic treatments or medical devices within 4 weeks or 5 half-lives of the drug (whichever is longer) prior to the initial dosing (or longer if required by local regulations)
    27. Participation in any clinical investigation using biologic treatment within 6 months of screening
    28. Previous participation in a gene therapy study for AATD at any time
    29. History of hypersensitivity to alvelestat (MPH966) or any of its excipients or the class of neutrophil elastase inhibitors
    1.Personas con otros fenotipos/genotipos de DAAT
    2.Diagnóstico clínico primario de bronquiectasia o bronquiectasia significativa demostrada mediante TAC (según el criterio del investigador con un TAC realizado en los últimos 3 años)
    3.Exacerbación aguda o neumopatía subyacente que requiera esteroides orales, antibióticos, o un cambio en el tratamiento habitual en las 4 semanas siguientes al momento basal
    4.Hepatitis aguda o crónica, incluida la hepatitis B, hepatitis C (pruebas séricas positivas, incluido el antígeno de la hepatitis B y anticuerpos de la hepatitis B y de la hepatitis C) en la selección
    5.Antecedentes o diagnóstico actual de cirrosis (en imagen o biopsia), varices esofágicas, ascitis o encefalopatía hepática
    6.Antecedentes de enfermedades hepáticas crónicas, como enfermedad hepática autoinmune, cirrosis biliar primaria, colangitis esclerosante primaria, enfermedad de Wilson, hemocromatosis o sobrecarga de hierro
    7.Antecedentes de enfermedad de hígado graso no alcohólico (EHGNA) o administración de fármacos asociados con la EHGNA durante más de 2 semanas en el año anterior a la selección (tales fármacos incluyen amiodarona, metotrexato, glucocorticoides sistémicos [no debería ser >5 mg de prednisolona o una dosis diaria equivalente], tetraciclinas, tamoxifeno, estrógenos a dosis superiores a las usadas en terapias de sustitución hormonal, esteroides anabólicos, ácido valproico y otras hepatotoxinas conocidas [lo que incluye, entre otras cosas, estatinas, antiepilépticos, antibióticos como la amoxicilina, amoxicilina/clavulanato, y antiinflamatorios no esteroideos])
    8.Antecedentes de consumo significativo de alcohol durante un periodo superior a 3 meses consecutivos en el plazo de 1 año anterior a la selección, definido como un promedio >2,5 unidades/día en sujetos mujeres y >3,75 unidades/día en sujetos varones
    (Como referencia, contienen 14 g de alcohol los siguientes formatos: 355 ml de cerveza normal con un contenido de ~5 % de alcohol; 237-266 ml de licor de malta con un contenido de ~7 % de alcohol; 148 ml de vino de mesa con un contenido de ~12 % de alcohol o 44 ml de licores destilados (por ejemplo, ginebra, ron, vodka, whisky) con un contenido de ~40 % de alcohol)
    9.Antecedentes de alcoholismo o drogadicción en los últimos 15 años
    10.Infección por el VIH u otra inmunodeficiencia o una cifra absoluta de neutrófilos ≤1,0 × 109/l en la selección
    11.Bioquímica anómala relacionada con el hígado (alanina aminotransferasa, aspartato-aminotransferasa, gamma-glutamiltransferasa) >1,5 veces el límite superior de la normalidad o bilirrubina total por encima del límite superior de la normalidad (a menos que exista síndrome de Gilbert con bilirrubina conjugada normal), recuento plaquetario <150 x 109/l, albúmina sérica ≤3,5g/dl, IIN ≥1,2 o CPK ≥LSN
    12.Puntuación FIB-4 >3,25
    13.Hiperlipidemia que requiera estatinas, cuando el tratamiento se haya iniciado durante el período de tratamiento del estudio (no se excluirá a los participantes con un tratamiento establecido >28 días)
    14.Cualquiera de las siguientes afecciones cardiovasculares en los 6 meses antes de la visita de selección:
    a.Infarto de miocardio o angina inestable
    b.Cirugía de revascularización coronaria, angioplastia con globo, intervención coronaria percutánea, o revascularización carotídea
    c.Hipertensión no controlada en los 3 meses anteriores a la selección
    d.Insuficiencia cardíaca congestiva (clase III/IV de la New York Heart Association)
    e.Accidente cerebrovascular o accidente isquémico transitorio
    15.Cualquier anomalía clínicamente significativa en el electrocardiograma de 12 derivaciones en la selección o momento basal, incluido un intervalo QT corregido con el método de corrección de Fridericia >450 ms o antecedentes de arritmia cardíaca significativa, incluido el síndrome QT largo
    16.Enfermedad o infección renal significativa (según el criterio del investigador), incluida enfermedad renal crónica en estadio 4 o tasa de filtración glomerular estimada <60 ml/min
    17.Antecedentes de cáncer en los últimos 5 años, excepto carcinoma basocelular y carcinoma epidermoide tratados satisfactoriamente
    18.Otros parámetros hematológicos clínicamente relevantes que podrían tener un efecto en la seguridad del participante según el criterio del investigador
    19.Otras comorbilidades documentadas que, según la opinión del investigador, podrían afectar a los resultados de las evaluaciones del estudio o habilidad del participante para cumplir los requisitos del protocolo
    Tratamiento anterior/concomitante
    20.Tratamientos inmunosupresores, incluidos corticoesteroides sistémicos regulares
    21.Anticuerpos monoclonales inmunomoduladores en los 6 meses anteriores a la selección
    22.Tratamiento de refuerzo anterior para AAT en los 6 últimos meses
    23.Necesidad de antiinflamatorios no esteroideos (AINE; se permite el uso de paracetamol [acetaminofeno])
    Otros criterios de exclusión: refiérase al protocolo
    E.5 End points
    E.5.1Primary end point(s)
    Within-individual % change from baseline in plasma desmosine/isodesmosine at end of treatment compared to placebo
    Cambio en el porcentaje de desmosina/isodesmosina plasmática en cada participante individual desde el momento basal hasta el final del tratamiento en comparación con el placebo
    E.5.1.1Timepoint(s) of evaluation of this end point
    Blood sample for desmosine/isodesmosine: Base, W4, W8, W12 (EOT) and W16 (Safety FU visit)
    Muestra de sangre para desmosina/isodesmosina:basal, W4, W8, W12 (EOT) y W16 (Safety FU visit)
    E.5.2Secondary end point(s)
    • Change from baseline in plasma desmosine/isodesmosine at end of treatment compared to placebo
    • Change from baseline in blood Aα-Val360, neutrophil elastase, EL-NE, EL-CG, and EP-3 at end of treatment compared to placebo
    • Change from baseline in blood MMP: C6M, Pro-C6, C1M, and PGP at end of treatment compared to placebo
    • Change from baseline in blood inflammatory biomarkers (interleukin [IL]-6, IL-8, IL-1β, RANTES, high-sensitivity C-reactive protein, fibrinogen) at end of treatment compared to placebo
    • Change from baseline in markers of neutrophil elastase activity, desmosine, and inflammatory biomarkers (IL-6, IL-8, IL-1β, LTB4, RANTES, PGP) at end of treatment in induced sputum compared to placebo
    • Change from baseline in markers of neutrophil elastase activity, desmosine, and inflammatory biomarkers (IL-6, IL-8, IL-1β, LTB4, RANTES, PGP) at end of treatment in spontaneous sputum compared to placebo
    • Numbers and % of participants who experience at least 1 treatment-emergent adverse event
    • Adverse events of special interest (liver function abnormalities, corrected QT interval/cardiac, infections, and neutropenia)
    • Relationship of pharmacokinetics (PK) and safety
    Exploratory
    • Change from baseline in forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC (total and percent predicted), and maximal mid-expiratory flow at end of treatment
    • Change from baseline in St. George’s Respiratory Questionnaire (SGRQ-C) at end of treatment
    • PK/pharmacodynamic (PD) relationship with efficacy biomarkers in blood and sputum
    • Cambio en desmosina/isodesmosina plasmática desde el momento basal hasta el final del tratamiento en comparación con el placebo
    • Cambio en Aα-Val360 sanguíneo, elastasa neutrófila, EL-NE, EL-CG, y EP-3 desde el momento basal hasta el final del tratamiento en comparación con el placebo
    • El cambio respecto del valor basal en las MMP sanguíneas: C6M, Pro-C6, C1M, y PGP al final del tratamiento en comparación con el placebo
    • Cambio en los marcadores inflamatorios en sangre (interleucina [IL]-6, IL-8, IL-1β, RANTES, proteína C reactiva de alta sensibilidad, fibrinógeno) desde el momento basal hasta el final del tratamiento en comparación con el placebo
    • Cambio en los marcadores de la actividad de elastasa neutrófila, desmosina, y biomarcadores inflamatorios (IL-6, IL-8, IL-1β, LTB4, RANTES, PGP) entre el momento basal y el final del tratamiento en esputo inducido en comparación con el placebo
    • Cambio en los marcadores de la actividad de elastasa neutrófila, desmosina, y biomarcadores inflamatorios (IL-6, IL-8, IL-1β, LTB4, RANTES, PGP) entre el momento basal y el final del tratamiento en esputo espontáneo en comparación con el placebo
    • Número y porcentaje de participantes que sufren al menos un acontecimiento adverso surgido durante el tratamiento
    • Acontecimientos adversos de interés especial (anomalías en la función hepática, intervalo QT corregido/cardíaco, infecciones y neutropenia)
    • Relación entre la farmacocinética (FC) y la seguridad
    E.5.2.1Timepoint(s) of evaluation of this end point
    Blood sample for PD BK and PK: Alvelestat PK; IL-6, IL-8, IL-1β, RANTES, hsCRP, fibrinogen; desmosine/isodesmosine, neutrophil elastase; Aα-Val360; PGP; neutrophil elastase, EL-NE, EL-CG, EP-3, C6M, C1M, PRO-C6: Base, W4, W8, W12 (EOT) + W16 (Safety FU visit) for desmosine/isodesmosine, neutrophil elastase and Aα-Val360

    Sputum collection for biomarkers of desmosine, neutrophil elastase and inflammation RANTES, IL-1β, IL-6, IL-8, LTB4, PGP: Base, W4, W8, W12 (EOT). For induced sputum collection: Screening, baseline, W8, W12 (EOT)

    Lung function tests (FEV1, FVC, FEV1/FVC, maximal mid-expiratory flow): Base, W4, W8, W12 (EOT)
    12-Lead ECG: Baseline, W4, W8, W12 (EOT)

    Clinical laboratory tests: Scr, Base, W-1, W2, W4, W8, W12, Safety FU visit

    SGRQ-C: Base, W4, W8, W12 (EOT)
    • Cambio en el volumen espiratorio forzado en el primer segundo (VEF1), capacidad vital forzada (CVF), VEF1/CVF (total y porcentaje previsto), y flujo máximo espiratorio mesoespiratorio entre el momento basal y el final del tratamiento
    • Cambios en el Cuestionario Respiratorio St. George (SGRQ-C) entre el momento basal y el final del tratamiento
    • Relación FC/mecanismo de acción (FD) con biomarcadores de la eficacia en sangre y esputo
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy No
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Mechanistic effect
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA15
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Canada
    Denmark
    Poland
    Spain
    Sweden
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The end of the study is defined as the date of all data being entered into the study database and the database being locked and ready for analysis.

    Mereo BioPharma 4 Ltd (sponsor) considers that the trial is ended when the clinical database is locked and all data is ready for analysis, which should occur within 1 month after the last patient last visit.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years
    E.8.9.1In the Member State concerned months14
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial months14
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 127
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 55
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state24
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 117
    F.4.2.2In the whole clinical trial 182
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Ninguno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2018-11-08
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-11-06
    P. End of Trial
    P.End of Trial StatusOngoing
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