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    Clinical Trial Results:
    A First-in-Human, Double-Blind, Randomised, Vehicle Controlled Phase I/II Proof of Concept Study to Investigate the Safety, Tolerability, Pharmacokinetics and Efficacy of BEN2293 in Patients with Mild to Moderate Atopic Dermatitis (AD).

    Summary
    EudraCT number
    2020-003143-28
    Trial protocol
    GB   PL   NL   HU  
    Global end of trial date
    26 Jan 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    01 Nov 2023
    First version publication date
    01 Nov 2023
    Other versions
    Summary report(s)
    synopsis-2020-003143-28

    Trial information

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    Trial identification
    Sponsor protocol code
    BB-2293-101b
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04737304
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    BenevolentAI Bio Limited
    Sponsor organisation address
    4-8 Maple Street, London, United Kingdom, W1T 5HD
    Public contact
    Chief Scientific Officer, BenevolentAI Bio Limited, anne.phelan@benevolent.ai
    Scientific contact
    Chief Scientific Officer, BenevolentAI Bio Limited, anne.phelan@benevolent.ai
    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
    17 Aug 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    26 Jan 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    26 Jan 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this study is to assess the safety and tolerability of BEN2293, administered as multiple topical doses to increasing body surface areas, in patients with mild to moderate AD.
    Protection of trial subjects
    In this study, safety will be monitored closely both by subjective reporting and by objective means i.e., serial assessments of vital signs, clinical laboratory evaluations data, physical examinations, local tolerability and 12-lead electrocardiogram (ECG). Part A of this study will be run in a Clinical Research Unit (CRU) with immediate access to hospital facilities for the treatment of medical emergencies. Sentinel dosing will be used for all cohorts in Part A of this study, and for the first two cohorts in Part A, sentinel patients will be given a choice as to whether they reside in the CRU for the full duration of Day -1 to Day 9, or reside from Day -1 to Day 3, as per the remainder of the cohort. Other participants in Part A will reside in the CRU for the first 2 days of dosing, will be closely monitored and will only be discharged from the CRU if the Investigator deems it safe to do so. Part B of this study will be run across multiple sites and safety will be monitored on visit days.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    14 Oct 2020
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Georgia: 8
    Country: Number of subjects enrolled
    Poland: 10
    Country: Number of subjects enrolled
    United Kingdom: 82
    Country: Number of subjects enrolled
    Hungary: 3
    Country: Number of subjects enrolled
    Netherlands: 20
    Worldwide total number of subjects
    123
    EEA total number of subjects
    33
    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)
    123
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Part A: Thirty-two patients were enrolled, randomised evenly across treatment groups and dosed during Part A of the study. Thirty-one patients completed Part A of the study; one patient withdrew consent. Part B: Ninety-one patients were enrolled during Part B of the study. Eighty patients completed Part B of the study and 11 patients discontinued.

    Pre-assignment
    Screening details
    All subjects satisfied the inclusion/exclusion criteria prior to entry in the study.

    Period 1
    Period 1 title
    Overall Trial (full study) (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator
    Blinding implementation details
    This study is a double-blinded (Investigator- and patient-blinded) during the double-blind treatment period. The study will be single-blind (patient-blinded) during the run-in phase (Part B only). In Part A, the randomisation list will be kept in a secure location until the end of the study. Only the Pharmacy staff involved in handling the study drug will have access to the randomisation list. In Part B, an externally provided IRT system will be used to randomly allocate patients to treatment.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Part A - Cohort 1
    Arm description
    0.25% BEN2293 ointment daily for 7 days on 10% of body surface area
    Arm type
    Experimental

    Investigational medicinal product name
    BEN2293 0.25% w/w
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Ointment
    Routes of administration
    Topical
    Dosage and administration details
    BEN2293 0.25% w/w ointment QD for 7 days to 10% BSA

    Arm title
    Part A - Cohort 2
    Arm description
    1.0% BEN2293 ointment daily for 7 days on 10% of body surface area
    Arm type
    Experimental

    Investigational medicinal product name
    BEN2293 1.0% w/w
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Ointment
    Routes of administration
    Topical
    Dosage and administration details
    BEN2293 1.0% w/w QD for 7 days to 10% BSA

    Arm title
    Part A - Cohort 3
    Arm description
    1.0% BEN2293 ointment daily for 14 days on up to 30% of body surface area
    Arm type
    Experimental

    Investigational medicinal product name
    BEN2293 1.0% w/w
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Ointment
    Routes of administration
    Topical
    Dosage and administration details
    BEN2293 1.0% w/w QD for 14 days to up to 30% BSA

    Arm title
    Part A - Cohort 4
    Arm description
    1.0% BEN2293 ointment twice-daily for 14 days on up to 30% of body surface
    Arm type
    Experimental

    Investigational medicinal product name
    BEN2293 1.0% w/w
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Ointment
    Routes of administration
    Topical
    Dosage and administration details
    BEN2293 1.0% w/w BID for 14 days to up to 30% BSA

    Arm title
    Part B - Active
    Arm description
    1.0% BEN2293 ointment twice-daily for 28 days on up to 33% of body surface area
    Arm type
    Experimental

    Investigational medicinal product name
    BEN2293 1.0% w/w
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Ointment
    Routes of administration
    Topical
    Dosage and administration details
    BEN2293 1.0% w/w BID for 28 days to a maximum of 33% BSA

    Arm title
    Part A - Placebo
    Arm description
    Placebo ointment on regimen matched to active cohort
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Ointment
    Routes of administration
    Topical
    Dosage and administration details
    Placebo ointment on regimen matched to active cohort

    Arm title
    Part B - Placebo
    Arm description
    Placebo ointment twice-daily for 28 days on up to 33% of body surface area
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Ointment
    Routes of administration
    Topical
    Dosage and administration details
    Placebo ointment twice-daily for 28 days on up to 33% of body surface area

    Number of subjects in period 1
    Part A - Cohort 1 Part A - Cohort 2 Part A - Cohort 3 Part A - Cohort 4 Part B - Active Part A - Placebo Part B - Placebo
    Started
    6
    6
    6
    6
    49
    8
    42
    Completed
    5
    6
    6
    6
    42
    8
    38
    Not completed
    1
    0
    0
    0
    7
    0
    4
         Consent withdrawn by subject
    1
    -
    -
    -
    3
    -
    3
         Physician decision
    -
    -
    -
    -
    1
    -
    1
         Adverse event, non-fatal
    -
    -
    -
    -
    2
    -
    -
         Circumstances of contraception changed
    -
    -
    -
    -
    1
    -
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Trial (full study)
    Reporting group description
    -

    Reporting group values
    Overall Trial (full study) Total
    Number of subjects
    123 123
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    123 123
        From 65-84 years
    0 0
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    66 66
        Male
    57 57
    Subject analysis sets

    Subject analysis set title
    Part A Cohort 1: 0.25% BEN2293 daily for 7 days on 10% of BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part A - Cohort 2 1.0% BEN2293 daily for 7 days on 10% of BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part A - Cohort 3 1.0% BEN2293 daily for 14 days up to 30% BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part A - Cohort 4 1.0% BEN2293 twice daily 14 days to 30% BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part A - Placebo
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part B Active: 1.0% BEN2293 twice daily for 28 days to 33% BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part B - Placebo
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis sets values
    Part A Cohort 1: 0.25% BEN2293 daily for 7 days on 10% of BSA Part A - Cohort 2 1.0% BEN2293 daily for 7 days on 10% of BSA Part A - Cohort 3 1.0% BEN2293 daily for 14 days up to 30% BSA Part A - Cohort 4 1.0% BEN2293 twice daily 14 days to 30% BSA Part A - Placebo Part B Active: 1.0% BEN2293 twice daily for 28 days to 33% BSA Part B - Placebo
    Number of subjects
    6
    6
    6
    6
    8
    49
    42
    Age categorical
    Units: Subjects
        In utero
    0
    0
    0
    0
    0
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
    0
    0
    0
    0
    0
        Newborns (0-27 days)
    0
    0
    0
    0
    0
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
    0
    0
    0
    0
    0
        Children (2-11 years)
    0
    0
    0
    0
    0
    0
    0
        Adolescents (12-17 years)
    0
    0
    0
    0
    0
    0
    0
        Adults (18-64 years)
    6
    6
    6
    6
    8
    49
    42
        From 65-84 years
    0
    0
    0
    0
    0
    0
    0
        85 years and over
    0
    0
    0
    0
    0
    0
    0
    Age continuous
    Units:
        
    27.5 ( 15.030 )
    23.33 ( 4.131 )
    28.5 ( 13.278 )
    28.83 ( 11.737 )
    25 ( 7.071 )
    29.9 ( 10.50 )
    33.6 ( 12.20 )
    Gender categorical
    Units: Subjects
        Female
    4
    1
    3
    5
    1
    28
    24
        Male
    2
    5
    3
    1
    7
    21
    18

    End points

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    End points reporting groups
    Reporting group title
    Part A - Cohort 1
    Reporting group description
    0.25% BEN2293 ointment daily for 7 days on 10% of body surface area

    Reporting group title
    Part A - Cohort 2
    Reporting group description
    1.0% BEN2293 ointment daily for 7 days on 10% of body surface area

    Reporting group title
    Part A - Cohort 3
    Reporting group description
    1.0% BEN2293 ointment daily for 14 days on up to 30% of body surface area

    Reporting group title
    Part A - Cohort 4
    Reporting group description
    1.0% BEN2293 ointment twice-daily for 14 days on up to 30% of body surface

    Reporting group title
    Part B - Active
    Reporting group description
    1.0% BEN2293 ointment twice-daily for 28 days on up to 33% of body surface area

    Reporting group title
    Part A - Placebo
    Reporting group description
    Placebo ointment on regimen matched to active cohort

    Reporting group title
    Part B - Placebo
    Reporting group description
    Placebo ointment twice-daily for 28 days on up to 33% of body surface area

    Subject analysis set title
    Part A Cohort 1: 0.25% BEN2293 daily for 7 days on 10% of BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part A - Cohort 2 1.0% BEN2293 daily for 7 days on 10% of BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part A - Cohort 3 1.0% BEN2293 daily for 14 days up to 30% BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part A - Cohort 4 1.0% BEN2293 twice daily 14 days to 30% BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part A - Placebo
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part B Active: 1.0% BEN2293 twice daily for 28 days to 33% BSA
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Subject analysis set title
    Part B - Placebo
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS will include all randomised patients who received at least one application of randomised therapy. Patients will be analysed according to their randomised treatment.

    Primary: Part A: Local tolerance

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    End point title
    Part A: Local tolerance [1]
    End point description
    Adverse events related to local tolerability
    End point type
    Primary
    End point timeframe
    Recorded from informed consent through 14 days after the last dose
    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: Safety parameters are listed and summarised using descriptive statistics.
    End point values
    Part A Cohort 1: 0.25% BEN2293 daily for 7 days on 10% of BSA Part A - Cohort 2 1.0% BEN2293 daily for 7 days on 10% of BSA Part A - Cohort 3 1.0% BEN2293 daily for 14 days up to 30% BSA Part A - Cohort 4 1.0% BEN2293 twice daily 14 days to 30% BSA Part A - Placebo
    Number of subjects analysed
    6
    6
    6
    6
    8
    Units: Participants
        Application site pain
    1
    0
    0
    0
    1
        Application site paraesthesia
    0
    0
    2
    0
    0
        Application site pruritus
    0
    0
    0
    0
    1
        Application site rash
    0
    0
    0
    0
    1
        COVID-19
    0
    0
    0
    1
    0
        Post-procedural infection
    0
    0
    0
    1
    0
        Paraesthesia
    0
    0
    1
    0
    0
        Dry skin
    0
    0
    0
    0
    1
        Eczema
    0
    1
    0
    1
    1
        Pruritus
    0
    0
    0
    0
    1
        Skin exfoliation
    0
    0
    1
    0
    0
    No statistical analyses for this end point

    Primary: Part B: Local tolerance

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    End point title
    Part B: Local tolerance [2]
    End point description
    Adverse events related to local tolerability
    End point type
    Primary
    End point timeframe
    Recorded from informed consent through 14 days after the last dose
    Notes
    [2] - 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: Safety parameters are listed and summarised using descriptive statistics.
    End point values
    Part B Active: 1.0% BEN2293 twice daily for 28 days to 33% BSA Part B - Placebo
    Number of subjects analysed
    49
    42
    Units: Participants
        Application site bruise
    1
    0
        Application site discomfort
    1
    0
        Application site pain
    1
    0
        Pain
    1
    0
        Arthropod bite
    0
    1
        Dizziness
    1
    0
        Insomnia
    1
    0
        Eczema
    2
    0
        Pain of skin
    0
    1
        Pruritus
    2
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events were recorded from screening through until follow up.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    Part A: Cohort 1: Treatment Emergent AE
    Reporting group description
    -

    Reporting group title
    Part A: Cohort 2: Treatment Emergent AE
    Reporting group description
    -

    Reporting group title
    Part A: Cohort 3: Treatment Emergent AE
    Reporting group description
    -

    Reporting group title
    Part A: Cohort 4: Treatment Emergent AE
    Reporting group description
    -

    Reporting group title
    Part A: Placebo: Treatment Emergent AE
    Reporting group description
    -

    Reporting group title
    Part B: Active: Treatment Emergent AE
    Reporting group description
    -

    Reporting group title
    Part B: Placebo: Treatment Emergent AE
    Reporting group description
    -

    Serious adverse events
    Part A: Cohort 1: Treatment Emergent AE Part A: Cohort 2: Treatment Emergent AE Part A: Cohort 3: Treatment Emergent AE Part A: Cohort 4: Treatment Emergent AE Part A: Placebo: Treatment Emergent AE Part B: Active: Treatment Emergent AE Part B: Placebo: Treatment Emergent AE
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         number of deaths (all causes)
    0
    0
    0
    0
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    0
    0
    0
    0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Part A: Cohort 1: Treatment Emergent AE Part A: Cohort 2: Treatment Emergent AE Part A: Cohort 3: Treatment Emergent AE Part A: Cohort 4: Treatment Emergent AE Part A: Placebo: Treatment Emergent AE Part B: Active: Treatment Emergent AE Part B: Placebo: Treatment Emergent AE
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    5 / 6 (83.33%)
    5 / 6 (83.33%)
    5 / 6 (83.33%)
    4 / 6 (66.67%)
    7 / 8 (87.50%)
    21 / 49 (42.86%)
    22 / 42 (52.38%)
    Vascular disorders
    Orthostatic hypotension
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    3 / 49 (6.12%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    4
    0
    General disorders and administration site conditions
    Application site pain
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 8 (12.50%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    1
    0
    0
    0
    1
    1
    0
    Application site paraesthesia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    2 / 6 (33.33%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    0
    0
    Application site pruritus
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 8 (12.50%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    2
    0
    0
    Application site rash
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 8 (12.50%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Medical device site rash
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    2 / 6 (33.33%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    0
    0
    Pain
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    2
    0
    Vaccination site pain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Vessel puncture site bruise
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Vessel puncture site phlebitis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Vessel puncture site reaction
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Application site bruise
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Application site discomfort
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Influenza like illness
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    1
    Pyrexia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Tenderness
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Immune system disorders
    Seasonal allergy
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    1 / 8 (12.50%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    1
    0
    2
    0
    1
    Reproductive system and breast disorders
    Dysmenorrhoea
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Oropharyngeal pain
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    2 / 42 (4.76%)
         occurrences all number
    1
    0
    0
    0
    0
    1
    2
    Epistaxis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Nasal congestion
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Respiratory symptom
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 8 (12.50%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    1
    0
    Insomnia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    1
    Investigations
    Blood pressure increased
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Haemoglobin decreased
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Transaminases increased
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    2 / 49 (4.08%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    3
    1
    Aspartate aminotransferase increased
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Blood bilirubin abnormal
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Red blood cell sedimentation rate increased
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Urine analysis abnormal
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Injury, poisoning and procedural complications
    Contusion
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    1
    0
    Post procedural pruritus
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 8 (12.50%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Scar
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Arthropod bite
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    1
    Procedural pain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    1 / 42 (2.38%)
         occurrences all number
    1
    0
    0
    0
    0
    1
    2
    Headache
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    2 / 8 (25.00%)
    2 / 49 (4.08%)
    5 / 42 (11.90%)
         occurrences all number
    1
    0
    1
    0
    4
    2
    5
    Paraesthesia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Presyncope
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Tension headache
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 8 (12.50%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Sciatica
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Syncope
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Ear and labyrinth disorders
    Ear pain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 8 (12.50%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Nausea
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    1
    0
    Oral pruritus
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Diarrhoea
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Skin and subcutaneous tissue disorders
    Dry skin
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    3 / 8 (37.50%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    1
    1
    0
    0
    4
    0
    0
    Eczema
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 6 (16.67%)
    2 / 6 (33.33%)
    2 / 6 (33.33%)
    2 / 8 (25.00%)
    2 / 49 (4.08%)
    0 / 42 (0.00%)
         occurrences all number
    1
    1
    3
    2
    2
    2
    0
    Pruritus
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    2 / 6 (33.33%)
    1 / 6 (16.67%)
    1 / 8 (12.50%)
    2 / 49 (4.08%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    3
    1
    1
    3
    0
    Skin exfoliation
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Dermatitis allergic
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Dermatitis atopic
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    2 / 49 (4.08%)
    2 / 42 (4.76%)
         occurrences all number
    0
    0
    0
    0
    0
    2
    2
    Hyperhidrosis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Miliaria
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Night sweats
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Pain of skin
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Back pain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    1
    Neck pain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Infections and infestations
    COVID-19
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    1 / 8 (12.50%)
    2 / 49 (4.08%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    1
    1
    2
    0
    Post procedural infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    2 / 6 (33.33%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    2
    0
    0
    0
    Gastroenteritis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Gastrointestinal infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Herpes zoster
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Nasopharyngitis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    3 / 49 (6.12%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    4
    1
    Onychomycosis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Rhinitis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    2 / 42 (4.76%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    2
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    2 / 42 (4.76%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    2
    Urinary tract infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    2 / 42 (4.76%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    2
    Viral infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    0 / 42 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Viral upper respiratory tract infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    1 / 49 (2.04%)
    2 / 42 (4.76%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    2
    Metabolism and nutrition disorders
    Hypercalcaemia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 8 (0.00%)
    0 / 49 (0.00%)
    1 / 42 (2.38%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    02 Dec 2020
    • Amend the Principal Investigator. • Inclusion /exclusion criteria amendments based on the Sponsor’s experience in Screening during the trial • Amend the requirement for sentinel patients in Cohorts 1 and 2 to reside in the CRU from Day -1 to Day 9. • Allow an alternative emollient and shower cream to be used for the washout period and throughout the study at the Investigator’s discretion. • Add a body weight measurement on Day 1 for all cohorts in Part A and Part B to allow individual calculation of dose. • Remove 12-lead electrocardiogram (ECG) and vital signs assessment at 24 hours postdose on Day 1, Day 2 (and Day 7 [Cohorts 1 and 2] or Day 14 [Cohorts 3 and 4] for 12-lead ECGs) for all cohorts in Part A, due to predose assessments being performed the following day at the same time. • Remove the 5% time window for all procedures performed at 1 and 2 hours postdose except pharmacokinetic sampling, and replace this with a ±10 minute window, for all cohorts in Part A and Part B for logistical reasons. It was also clarified that there will be no time window for predose assessments. • Clarify that four blood samples will be taken for pharmacogenomic analysis.
    12 Jan 2021
    Incorporate updates from Version 2.0 (dated 14 September 2020) to Version 3.0 (dated 02 December 2020) as part of the overall Protocol amendment. The rationale for this substantial amendment was to address the comments from the MHRA on Version 3.0 with respect to Exclusion Criteria #14 and #20. In addition to the amendments in V3.0, the following points were amended in V3.1 of the Protocol: • Clarify the eligibility criteria in exclusion criteria points (14) and (20) to allow the Investigator to determine patient eligibility without prior consultation with the Medical Monitor.
    17 Feb 2021
    The purpose of this substantial amendment was to amend the range of BSA of treatable skin (not including face, scalp, genital area, palms of hands or soles of feet) affected by mild to moderate AD from ≥5% to ≤15% to ≥5% to ≤30% for Cohorts 1 and 2 in Part A (inclusion criterion [9]). The rationale for this change was to ensure that the patients entering Cohorts 1 and 2 had the same severity and extent of AD as all other patients in the study. This homogeneity of the study populations was important because the primary objective of Part A of this study was to assess the safety and tolerability of increasing dose levels of BEN2293. Restricting the BSA in Cohorts 1 and 2 may therefore have led to the inclusion only of patients with more mild disease, with the potential to skew the emergent safety data from these initial cohorts. Previously, the rationale for limiting the BSA in Cohorts 1 and 2 was to facilitate the collection of efficacy data. However, the Sponsor concluded that collection of robust efficacy data from Cohorts 1 and 2 is unlikely due to the short duration of dosing (once daily for 7 days) and the limited BSA affected by AD that was to be dosed (5%). The IMP application in Cohorts 1 and 2 in Part A remained as 5% BSA healthy skin and 5% BSA AD skin. Study emollient continued to be applied to any untreated areas for the duration of the study. The Investigator maintained close monitoring of the patients for any exacerbations in their AD and managed these as described in the Protocol.
    21 Apr 2021
    The purpose of this substantial amendment was to amend the eligibility criteria to allow patients who received a COVID-19 or other routine vaccination within 28 days of Day 1, and throughout the study, to take part in the study (exclusion criterion point [20]). Additionally, requirements for study emollient use during the washout, treatment and Follow-up periods were clarified. A time window of 2 hours postdose (± 60 minutes) was also added for skin biopsies to be taken on the last day of dosing.
    18 Aug 2021
    The purpose of this substantial amendment was to amend the exclusion criteria, the criteria for stopping dose escalation, individual stopping criteria, baseline and on study clinical laboratory evaluations, and the sentinel observation period, in response to increased liver transaminases observed in one patient in Cohort 3. Overall, the following changes to the Protocol were made: • For Cohort 4, the sentinel patients were dosed for 14 days, and their safety data reviewed before the remainder of the cohort could be dosed. • An extra inpatient visit was added for Cohort 4 on Day 9 for additional safety assessments; this was previously just a telephone contact. • Dose escalation stopping criteria were updated to state that if one or more patients experienced an increase in ALT and/or AST to ≥2 x ULN (confirmed upon repeat) or ≥3 x ULN (no repeat required), then dosing of all enrolled patients would stop and no further patients would be enrolled. Dosing could then only recommence following approval of a substantial Protocol amendment. • The exclusion criteria were amended to exclude any patient who had AST, ALT, GGT or total bilirubin levels above the ULN at Screening or Day -1, with no repeat testing permitted. • Added additional clinical chemistry assessments for IgG and IgE at baseline for Cohort 4 onwards, and added an extra clinical laboratory evaluation sample on Day 9 for Cohort 4.
    21 Dec 2021
    The purpose of this amendment was to amend the inclusion criteria related to %BSA affected by AD, to amend the number of sites to be used in Part B and to amend or clarify skin, urine and plasma sampling in Part B. Overall, the following changes to the Protocol were made: • The exploratory objectives and endpoints were amended to include the evaluation of BEN2293 and metabolite BEN6403 in urine in Part A only, and the evaluation of biomarkers in skin biopsies in Part B only. • Part B would be conducted across multiple sites in the United Kingdom, Europe and Israel. • The inclusion criteria were amended to include patients with AD affecting between ≥1% to ≤30% BSA of treatable skin; this was previously ≥5% to ≤30% BSA of treatable skin. • Patients in Part B were to be supplied with a double ended medicine spoon (5 mL/2.5 mL) to remove their ointment from the jar prior to application. • An externally provided IRT system would be used to randomise patients in Part B. • Urine PK sampling was removed from the Part B Schedule of Assessments. • The skin biopsy to be conducted at the Follow-up visit was removed from the Part B Schedule of Assessments. • The Part B Sampling Summary was amended to include two additional blood samples (2 x 40 mL) for MetaHeps testing, to be conducted if the hepatic transaminase threshold criteria were reached, or if there were any liver enzyme changes or trends of concern.
    22 Mar 2022
    The purpose of this amendment was to amend the design of Part B following completion of Part A. The main changes are listed below: • The adaptive study design was updated to clarify that up to 90 patients would be enrolled to be treated in two treatment arms of approximately 45 patients each. Patients would be randomised to receive either BEN2293 ointment or matching placebo ointment with a 1:1 parallel design. This was decided based on updated sample size determination calculations following completion of Part A of the study. • A single-blind placebo run-in period was added in which patients applied placebo ointment twice daily from Day -3 to Day -1. • Patients showing an improvement of ≥3 points in mean pruritus NRS scores (worst itch over the last 24 hours) between the end of the washout phase (mean of scores on Day 5, Day -4 and Day -3 [predose]), and the run-in phase (mean of scores on Day -2, Day 1 and Day 1 [predose]) were to be excluded from starting the double blind treatment period on Day 1. • The inclusion criteria on BP was amended • Ointment would be applied to all treatable lesioned skin (up to a maximum of 30% BSA at Day 1). Study ointment would also be applied to new treatable AD lesions that arose during the study (up to a total maximum of 33% BSA), following discussion with, or assessment by, the Investigator. • The Day 35 Follow-up visit was removed as it was not required based on Part A exposure data. • There would be only one application of BEN2293 or placebo on the final day of dosing (Day 28). • Pruritus NRS (current itch) assessments were added at predose and at 2, 4 and 8 hours postdose on Day 28. • Any participant with an affected BSA requiring treatment above 33% BSA was added to the withdrawal criteria.
    16 Sep 2022
    The main changes to the protocol are listed below: • Include the option to extend the run-in phase in Part B of the study by a maximum of 1 day, at the Investigator’s discretion. Inclusion Criteria 10 and Exclusion Criteria 32 were updated to reflect this. • Clarify that it was imperative that patients should not use the placebo ointment administered during the run-in phase before attending the clinic on the morning of Day 1 for first dosing. • Clarify that in Part B, patients would be monitored for 30 minutes in the unit after their first doses in the run-in phase and on Day 1. • Update Exclusion Criteria 21 to allow patients to take paracetamol (intermittent use of less than or equal to 2 g/day) for up to 24 hours before dosing on Day 1 of the treatment period. • Remove grapefruit juice as a potent CYP3A4 inhibitor. However, a dietary restriction for grapefruit juice remained. • Amend the Protocol to state that in countries where there was no validated translated PROMIS scale available in the local language, the assessment would not be performed. • Clarify that after Day 1, the %BSA to be treated (sum of Day 1 %BSA treated and new AD lesions in treatable areas) should be any treated, new and resolved lesions which must not have exceeded 33% BSA after Day 1 postdose, and that this would be documented. • Clarify that patients in Part B must have refrained from consuming poppy seeds 48 hours prior to Screening and Day -3 to avoid a positive result on the drugs of abuse screen.

    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.
    The secondary endpoints were not reported however, the synopsis (which includes description of the study endpoints) has been included.
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