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    Clinical Trial Results:
    A Phase 1, Randomized, Parallel-group, Open-label, Multicenter Study to Evaluate the Pharmacokinetics, Pharmacodynamics and Safety of Vonoprazan (10 or 20 mg Once Daily) in Children Aged ≥ 6 to < 12 Years Who Have Symptomatic Gastroesophageal Reflux Disease

    Summary
    EudraCT number
    2022-003228-42
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    29 Apr 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    06 Nov 2024
    First version publication date
    06 Nov 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    VPED-103
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT06106022
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Phathom Pharmaceuticals, Inc.
    Sponsor organisation address
    2150 East Lake Cook Road, Suite 800, Buffalo Grove, IL, United States, 60089
    Public contact
    Phathom Medical Information, Phathom Pharmaceuticals, Inc., 1 888-775-7428, medicalinformation@phathompharma.com
    Scientific contact
    Phathom Medical Information, Phathom Pharmaceuticals, Inc., 1 888-775-7428, medicalinformation@phathompharma.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-002703-PIP01-19
    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?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    29 Apr 2024
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    29 Apr 2024
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objective of the trial was to evaluate the pharmacokinetic profile of vonoprazan (10 or 20 mg once daily [QD]) in children ≥ 6 to < 12 years of age who have symptomatic gastroesophageal reflux disease (GERD).
    Protection of trial subjects
    This study was performed according to the International Council for Harmonisation harmonized tripartite guideline E6(R2): Good Clinical Practice.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Nov 2023
    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
    United States: 22
    Worldwide total number of subjects
    22
    EEA total number of subjects
    0
    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)
    22
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 22 participants were enrolled at 6 study sites in the United States between November 2023 and April 2024.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Vonoprazan 10 mg
    Arm description
    Participants received vonoprazan 10 mg QD for 14 days.
    Arm type
    Experimental

    Investigational medicinal product name
    Vonoprazan
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Administered orally.

    Arm title
    Vonoprazan 20 mg
    Arm description
    Participants received vonoprazan 20 mg QD for 14 days.
    Arm type
    Experimental

    Investigational medicinal product name
    Vonoprazan
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Administered orally.

    Number of subjects in period 1
    Vonoprazan 10 mg Vonoprazan 20 mg
    Started
    11
    11
    Completed
    10
    9
    Not completed
    1
    2
         Voluntary Withdrawal
    -
    2
         Lost to follow-up
    1
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Vonoprazan 10 mg
    Reporting group description
    Participants received vonoprazan 10 mg QD for 14 days.

    Reporting group title
    Vonoprazan 20 mg
    Reporting group description
    Participants received vonoprazan 20 mg QD for 14 days.

    Reporting group values
    Vonoprazan 10 mg Vonoprazan 20 mg Total
    Number of subjects
    11 11 22
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    9.1 ( 1.92 ) 8.6 ( 1.69 ) -
    Gender categorical
    Units: Subjects
        Female
    7 5 12
        Male
    4 6 10
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    6 9 15
        Not Hispanic or Latino
    5 2 7
        Unknown or Not Reported
    0 0 0
    Race
    Units: Subjects
        White
    10 10 20
        Black or African American
    1 1 2

    End points

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    End points reporting groups
    Reporting group title
    Vonoprazan 10 mg
    Reporting group description
    Participants received vonoprazan 10 mg QD for 14 days.

    Reporting group title
    Vonoprazan 20 mg
    Reporting group description
    Participants received vonoprazan 20 mg QD for 14 days.

    Primary: Maximum Drug Concentration at Steady-state (Cmax,ss) of Vonoprazan

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    End point title
    Maximum Drug Concentration at Steady-state (Cmax,ss) of Vonoprazan [1]
    End point description
    Plasma pharmacokinetic (PK) parameters were estimated using a non-linear mixed effects model and were determined from the concentration-time data for all evaluable participants. Actual sampling times, rather than scheduled or nominal sampling times, were used in all computations using sampling time. Data presented based on collections on both Day 7 and Day 14. PK Set: includes all participants who received at least 1 dose of study drug and had sufficient concentration data to support accurate estimation of at least 1 PK parameter.
    End point type
    Primary
    End point timeframe
    Day 7: pre-dose, 0.5 to 1.5 hour and 2.5 to 3.5 hours post dose; Day 14: pre-dose, 1 to 2 hours and 3 to 4 hours post 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: No statistical analyses were pre-specified for this endpoint.
    End point values
    Vonoprazan 10 mg Vonoprazan 20 mg
    Number of subjects analysed
    10
    11
    Units: ng/mL
        arithmetic mean (full range (min-max))
    16.2 (9.31 to 27.1)
    42.1 (10.1 to 72.7)
    No statistical analyses for this end point

    Primary: Area Under the Plasma Concentration-time Curve During the Dosing Interval τ at Steady State (AUCτ,ss) of Vonoprazan

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    End point title
    Area Under the Plasma Concentration-time Curve During the Dosing Interval τ at Steady State (AUCτ,ss) of Vonoprazan [2]
    End point description
    Plasma PK parameters were estimated using a non-linear mixed effects model and were determined from the concentration-time data for all evaluable participants. Actual sampling times, rather than scheduled or nominal sampling times, were used in all computations using sampling time. PK Set: includes all participants who received at least 1 dose of study drug and had sufficient concentration data to support accurate estimation of at least 1 PK parameter.
    End point type
    Primary
    End point timeframe
    Day 7: pre-dose, 0.5 to 1.5 hour and 2.5 to 3.5 hours post dose; Day 14: pre-dose, 1 to 2 hours and 3 to 4 hours post 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: No statistical analyses were pre-specified for this endpoint.
    End point values
    Vonoprazan 10 mg Vonoprazan 20 mg
    Number of subjects analysed
    10
    11
    Units: h*ng/mL
        arithmetic mean (full range (min-max))
    88.3 (51.7 to 121)
    251 (72.1 to 549)
    No statistical analyses for this end point

    Primary: Apparent Oral Clearance (CL/F) at Steady State of Vonoprazan

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    End point title
    Apparent Oral Clearance (CL/F) at Steady State of Vonoprazan [3]
    End point description
    Oral PK parameters were estimated using a non-linear mixed effects model and were determined from the concentration-time data for all evaluable participants. Actual sampling times, rather than scheduled or nominal sampling times, were used in all computations using sampling time. PK Set: includes all participants who received at least 1 dose of study drug and had sufficient concentration data to support accurate estimation of at least 1 PK parameter.
    End point type
    Primary
    End point timeframe
    Day 7: pre-dose, 0.5 to 1.5 hour and 2.5 to 3.5 hours post dose; Day 14: pre-dose, 1 to 2 hours and 3 to 4 hours post dose
    Notes
    [3] - 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: No statistical analyses were pre-specified for this endpoint.
    End point values
    Vonoprazan 10 mg Vonoprazan 20 mg
    Number of subjects analysed
    10
    11
    Units: L/h
        arithmetic mean (full range (min-max))
    125 (82.9 to 193)
    118 (36.4 to 278)
    No statistical analyses for this end point

    Primary: Apparent Central Volume of Distribution (Vz/F) at Steady State of Vonoprazan

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    End point title
    Apparent Central Volume of Distribution (Vz/F) at Steady State of Vonoprazan [4]
    End point description
    Plasma PK parameters were estimated using a non-linear mixed effects model and were determined from the concentration-time data for all evaluable participants. Actual sampling times, rather than scheduled or nominal sampling times, were used in all computations using sampling time. PK Set: includes all participants who received at least 1 dose of study drug and had sufficient concentration data to support accurate estimation of at least 1 PK parameter.
    End point type
    Primary
    End point timeframe
    Day 7: pre-dose, 0.5 to 1.5 hour and 2.5 to 3.5 hours post dose; Day 14: pre-dose, 1 to 2 hours and 3 to 4 hours post dose
    Notes
    [4] - 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: No statistical analyses were pre-specified for this endpoint.
    End point values
    Vonoprazan 10 mg Vonoprazan 20 mg
    Number of subjects analysed
    10
    11
    Units: liters
        arithmetic mean (full range (min-max))
    491 (227 to 828)
    444 (164 to 1310)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Up to Day 28
    Adverse event reporting additional description
    Safety Set: includes all participants who received at least 1 dose of study drug.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    24.0
    Reporting groups
    Reporting group title
    Vonoprazan 10 mg
    Reporting group description
    Participants received vonoprazan 10 mg QD for 14 days.

    Reporting group title
    Vonoprazan 20 mg
    Reporting group description
    Participants received vonoprazan 20 mg QD for 14 days.

    Serious adverse events
    Vonoprazan 10 mg Vonoprazan 20 mg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 11 (0.00%)
    0 / 11 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Vonoprazan 10 mg Vonoprazan 20 mg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    1 / 11 (9.09%)
    0 / 11 (0.00%)
    Investigations
    Electrocardiogram QT prolonged
         subjects affected / exposed
    1 / 11 (9.09%)
    0 / 11 (0.00%)
         occurrences all number
    1
    0
    Ear and labyrinth disorders
    Tympanic membrane perforation
         subjects affected / exposed
    1 / 11 (9.09%)
    0 / 11 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Vomiting
         subjects affected / exposed
    1 / 11 (9.09%)
    0 / 11 (0.00%)
         occurrences all number
    1
    0
    Infections and infestations
    Otitis media
         subjects affected / exposed
    1 / 11 (9.09%)
    0 / 11 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    23 Jun 2023
    The purposes of the amendment were to: • Remove requirement that body weight be ≥30 kg. • Clarify that the primary endpoints comprise PK assessments from data collected on Day 7 and Day 14. • Revise justification for dose selection using an updated popPK model. • Add electrocardiograms to safety endpoints. • Add the following: Following completion of study drug dosing on Day 14 or early discontinuation, the subject will be transitioned to local standard of care for 14 days during the Follow-up Period. • Addition of inclusion and exclusion criteria. • Clarify instructions for administration of study drug by specifying when study drug will be taken. • Provide additional instructions for recording date/time of each dose and actions required for missed study drug doses and missed visits/poor compliance. • Differentiate timing of PK blood samples between Days 7 and 14. Sodium heparin vacutainer collection tubes were specified. • Add bone fracture and hematologic abnormalities as adverse event of special interest. • Add urine pregnancy tests for female participants who had experienced menarche to protocol-required safety laboratory assessments. • Add Tanner staging to the physical examination. • Remove the measurement of electrocardiogram intervals, and specify that electrocardiograms were to be read and interpreted centrally by a pediatric cardiologist. • Define the pharmacodynamic population to include participants who received at least 1 dose of study drug and had sufficient pH data to support calculation of pharmacodynamic parameters. • Include a potential popPK analysis of interim data from a subset of participants prior to completion of enrollment to assess whether plasma exposure in pediatric participants aged ≥6 to <12 years was within the range observed in adults receiving the same dose. • Add appendices for contraceptive guidance, Tanner Staging criteria and growth charts.
    30 Aug 2023
    The purposes of the amendment were to: • Change exclusion criterion for creatinine from >2 mg/dL (>177 µmol/L) to >0.8 mg/dL (>70 µmol/L). • Change the reporting period for pregnancy during administration of active study drug from ‘after Visit 2 or within 4 weeks of the last dose of active study drug’ to ‘after Visit 2 or within 2 weeks of the last dose of active study drug’. • Remove the requirement for an 8-hour fast before obtaining a glucose measurement. • Require participants to be dressed in light clothing and without shoes when body weight was measured. • Remove the telephone call at the Day 14 in-clinic visit from the schedule of assessments.

    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 reported
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