The Safety, Tolerability, Pharmacokinetics and Clinical Efficacy of the NLRX1 agonist NX-13 in Active Ulcerative Colitis: Results of a Phase 1b Study

BACKGROUND AND AIMS

NX-13 activation of NLRX1 reduces intracellular reactive oxygen species and decreases inflammation in animal models of colitis. A phase 1a trial demonstrated a gut-selective pharmacokinetic (PK) profile with good tolerability. This phase Ib study aimed to evaluate the safety, tolerability, and PK of NX-13 in patients with active ulcerative colitis (UC).

METHODS

We conducted a multicenter, randomized, double-blinded, placebo-controlled trial of NX-13 in patients with active UC. Patients with a Mayo Clinic Score of 4-10 were randomly assigned (3:3:3:1 ratio) to three NX-13 oral dose groups (250mg Immediate Release (IR), 500mg IR, or 500mg Delayed Release (DR) or placebo) once daily for 4 weeks. Safety and PK were the primary and secondary objectives, respectively.

RESULTS

Thirty-eight patients (11 females) were recruited and randomized to placebo (5), NX-13 250mg IR (11), NX-13 500mg IR (11), or NX-13 500mg DR (11) and received at least one dose. There were no Serious Adverse Events (SAEs) or deaths during the trial. One patient (500mg DR, 1/11) withdrew for worsening of UC and a second (500mg IR, 1/11) on the last day of treatment after a panic attack associated with atrial fibrillation. In the efficacy population (36 patients), clinical improvement in rectal bleeding and stool frequency scores relative to placebo were seen as early as week 2 and endoscopic response was seen at week 4.

CONCLUSIONS

NX-13 was generally safe and well tolerated with early signs of rapid symptom and endoscopic improvement. This novel mechanism of action warrants further investigation. ClinicalTrials.gov: NCT04862741.

Randomized Controlled Clinical Trial of bivalent Oral Poliovirus Vaccine and Inactivated Poliovirus Vaccine in Nigerian Children

BACKGROUND

We conducted a trial in Nigeria to assess the immunogenicity of the new bOPV + IPV immunization schedule and gains in type 2 immunity with addition of second dose of IPV. The trial was conducted in August 2016-March 2017 period, well past the tOPV-bOPV switch in April 2016.

METHODS

This was an open-label, two-arm, non-inferiority, multi-center, randomized controlled trial. We enrolled 572 infants of age ≤14 days and randomized them into two arms. Arm A received bOPV at birth, 6 and 10 weeks, bOPV+IPV at week 14 and IPV at week 18. Arm B received IPV each at 6, 10, 14 weeks and bOPV at 18 weeks of age.

RESULTS

Seroconversion rates for poliovirus types 1 and 3, respectively, were 98.9% (95%CI:96.7-99.8) and 98.1% (95%CI:88.2-94.8) in Arm A, and 89.6% (95%CI:85.4-93.0) and 98.5% (95%CI:96.3-99.6) in Arm B. Type 2 seroconversion with one dose IPV in Arm A was 72.0% (95%CI:66.2-77.3), which increased significantly with addition of second dose to 95.9% (95%CI:92.8-97.9).

CONCLUSION

This first trial on the new EPI schedule in a sub-Saharan African country demonstrated excellent immunogenicity against poliovirus types 1 and 3, and substantial/enhanced immunogenicity against poliovirus type 2 after 1 to 2 doses of IPV respectively.

Corneal Collagen Cross-Linking in the Treatment of Progressive Keratoconus: A Randomized Controlled Contralateral Eye Study

BACKGROUND

To assess the short-term efficacy and safety of corneal collagen cross-linking (CXL) in preventing the progression of keratoconus (KCN).

MATERIALS AND METHODS

This randomized controlled clinical trial enrolled 26 patients diagnosed with bilateral progressive KCN and were eligible for CXL. In each patient, one eye was randomly selected for treatment, and the contralateral eye served as the control. The patients underwent CXL with riboflavin drops and ultraviolet radiation in the treated eye. One year follow-up data are presented. Postoperatively, patients were assessed for progression of KCN, visual changes, and other findings. The main outcome measures were maximum simulated keratometry (K-max), best spectacle-corrected visual acuity (BSCVA), and average simulated keratometry. P <0.05 was considered as statistically significant.

RESULTS

In the treated eyes, the mean K-max values decreased by 0.22 D at 1-year postoperatively and increased by 0.41 D in the control group. This difference was statistically significant (P < 0.001). BSCVA improved slightly (a decrease of 0.13 LogMAR) and decreased slightly in the control group (a 0.01 LogMAR increase). The difference between groups was statistically significant (P = 0.014). There was no decrease in visual acuity attributable to complications of CXL in the treated eyes. At 1-year, the keratometry in 3 (12%) treated eyes increased by more than 0.50 D and were considered cases of failed treatment.

CONCLUSION

Preliminary and 1-year results indicate CXL can halt the progression of KCN in most cases without causing serious complications.