Phase 1/2, open-label, dose-escalation, dose-expansion study of menin inhibitor DSP-5336 in adult patients with acute leukemia with and without mixed-lineage leukemia (MLL)-rearrangement (r) or nucleophosmin 1 (NPM1) mutation (m)

TPS7066

Background: DSP-5336, a menin MLL interaction inhibitor, elicited antitumor activity in MLL–r or NPM1m acute leukemia models in vitro and in vivo. An open-label, single-arm, phase 1/2 study (NCT04988555) will evaluate the safety and efficacy of DSP-5336 and determine the recommended phase 2 dose (RP2D) in patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) or acute lymphocytic leukemia (ALL). Methods: Patients aged ≥18 y with R/R AML, ALL, or acute leukemia of ambiguous lineage after ≥1 line of standard therapy, ECOG PS 0–2, and adequate organ function are eligible. Patients will receive DSP-5336 twice daily for 28 d/cycle. In phase 1, there will be two parallel escalation cohorts: patients who do not receive concomitant azole antifungal medication and patients who receive antifungal azoles (ie, posaconazole, voriconazole, or fluconazole); 21–30 patients will be enrolled during phase 1 into multiple ascending dose levels. Dose escalation will use a Bayesian logistic regression model. Phase 2 will enroll two arms: R/R AML with MLL –r and R/R AML with NPM1m (10 –20 patients/arm). Patients will be treated at the RP2D to evaluate clinical activity and safety. Clinical trial information: NCT04988555. [Table: see text]

Pharmacokinetics, pharmacodynamics and safety assessment of multiple doses of soticlestat in healthy volunteers

Aims

Soticlestat, a first‐in‐class inhibitor of cholesterol 24‐hydroxylase (also known as cytochrome P450 46A1), is currently in development for the treatment of developmental and epileptic encephalopathies. Here, we report safety, tolerability, pharmacokinetic and pharmacodynamic outcomes from a phase I, randomized, double‐blind, placebo‐controlled, multiple‐rising‐dose study of soticlestat in healthy adults.

Methods

Five cohorts of healthy subjects (n = 8 each, randomized 6:2 soticlestat:placebo) received oral soticlestat 100‐600 mg once daily (QD) or 300 mg twice daily (BID) for 10‐14 days. Serial blood and urine samples were obtained on days 1, 7 (blood only) and 14.

Results

Soticlestat in the dose range 100‐400 mg/day for up to 14 days was generally well tolerated. In total, 45 treatment‐emergent adverse events (TEAEs) were reported; most (91%) were transient and mild in intensity. Two subjects experienced TEAEs leading to discontinuation: one receiving soticlestat 600 mg QD reported a severe event of acute psychosis; another receiving 300 mg BID reported a mild event of confusional state. Steady‐state exposure to soticlestat increased in a slightly greater than dose‐proportional manner across the dose range 100‐400 mg QD. Peak plasma concentrations were reached within 0.33‐0.5 hour, and soticlestat elimination half‐life was approximately 4 hours. Renal excretion of soticlestat was negligible. Soticlestat 100‐400 mg QD reduced 24S‐hydroxycholesterol levels by 46.8 (coefficient of variation [CV%] −9.2) to −62.7% (CV% −7.3) at steady state; values of enzymatic inhibition were compatible with antiepileptic effects observed in preclinical models.

Conclusion

The pharmacokinetic and pharmacodynamic profiles of soticlestat characterized here provided a data‐driven rationale for clinical trial dose selection.

Safety, tolerability, pharmacokinetics, pharmacodynamics, bioavailability and food effect of single doses of soticlestat in healthy subjects

Aims

Soticlestat is a first‐in‐class selective inhibitor of cholesterol 24‐hydroxylase, the enzyme that converts brain cholesterol to 24S‐hydroxycholesterol (24HC), a positive allosteric modulator of N‐methyl‐D‐aspartate receptors. Soticlestat is under development as treatment for rare developmental and epileptic encephalopathies.

Methods

In this first‐in‐human study, 48 healthy men and women received single ascending doses of soticlestat oral solution or placebo. Subsequently, nine healthy subjects received soticlestat tablets under fed and fasting conditions to assess the relative oral bioavailability and effects of food. Serial blood and urine samples were collected for pharmacokinetic and pharmacodynamic assessments.

Results

Soticlestat appeared to be well tolerated up to a single dose of 1350 mg. Adverse events (AEs) were mild in intensity, and dose‐dependent increase in AE prevalence was not apparent. Soticlestat administered via oral solution was rapidly absorbed (median time to maximum plasma concentration [C_max] 0.250–0.520 h). Mean C_max and area under plasma concentration–time curve from zero to infinity increased by 183‐ and 581‐fold, respectively, over a 90‐fold dose increase. Mean terminal elimination half‐life was 0.820–7.16 hours across doses. Renal excretion was negligible. Administration of soticlestat tablets, and with food, lowered C_max but did not affect overall exposure. Plasma 24HC concentrations generally decreased with increasing dose.

Conclusions

Soticlestat appeared to be well tolerated after a single oral administration of up to 1350 mg and dose‐dependently reduced plasma 24HC concentrations. Systemic exposure increased in a greater than dose‐proportional manner over the dose range evaluated but was not affected by formulation or administration with food.

Lack of Effect of Vortioxetine on the Pharmacokinetics and Pharmacodynamics of Ethanol, Diazepam, and Lithium

INTRODUCTION

Because the multimodal antidepressant vortioxetine is likely to be coadministered with other central nervous system (CNS)-active drugs, potential drug-drug interactions warrant examination.

OBJECTIVE

These studies evaluated whether there are pharmacokinetic and/or pharmacodynamic interactions between vortioxetine and ethanol, diazepam, or lithium.

METHODS

This series of phase I studies included healthy men and women (only men in the lithium study) aged 18-45 years. The ethanol study was a randomized, double-blind, two-parallel group, four-period crossover study in which subjects received a single dose of vortioxetine (20 or 40 mg) or placebo with or without ethanol, and the diazepam study was a randomized, double-blind, placebo-controlled, two-sequence, two-period crossover study in which subjects received a single dose of diazepam following multiple doses of vortioxetine 10 mg/day or placebo. These two studies evaluated the effect of coadministration on standardized psychomotor parameters and on selected pharmacokinetic parameters of each drug. The lithium study was a single-blind, single-sequence study evaluating the effect of multiple doses of vortioxetine 10 mg/day on the steady-state pharmacokinetics of lithium.

RESULTS

Concomitant administration of vortioxetine and single doses of either ethanol or diazepam had no significant effect on the psychomotor performance of subjects compared with administration of ethanol or diazepam alone. Vortioxetine had no significant effect on the pharmacokinetics of ethanol, diazepam, or lithium, and ethanol had no significant effect on the pharmacokinetics of vortioxetine.

CONCLUSIONS

Concomitant administration of these agents with vortioxetine was generally well tolerated, with no clinically relevant drug-drug pharmacokinetic or pharmacodynamic interactions identified.