EAST-1 (ERAP-inhibition in Axial Spondyloarthritis Trial - 1)

Grey Wolf Therapeutics

Status and phase: Enrolling; Phase 2; Phase 1

Conditions: Axial Spondyloarthritis (AxSpA)

Treatments: Drug: Part D - Randomised, placebo-controlled, expansion cohort in participants with axSpA; Drug: Part C - Safety expansion cohort in participants with axSpA; Drug: Part A - Single Ascending Dose (SAD) in Healthy Human Volunteers; Drug: Part B - Multiple Ascending Dose (MAD) in participants with axSpA

Study type: Interventional

Funder types: Other

Identifiers

NCT07047703

GRWD0715-AS-01

Details and patient eligibility

About

GRWD0715 is an orally administered, selective inhibitor of the Endoplasmic Reticulum Aminopeptidase 1 [ERAP1] enzyme being explored as a potential new treatment for axial spondyloarthritis (axSpA), a long term condition caused by inflammation predominantly affecting the sacroiliac joints (SIJs) and spine.

Full description

GRWD0715 is an orally administered, selective inhibitor of the Endoplasmic Reticulum Aminopeptidase 1 [ERAP1] enzyme being explored as a potential new treatment for axial spondyloarthritis (axSpA), a long term condition caused by inflammation predominantly affecting the sacroiliac joints (SIJs) and spine.

ERAP1 is involved in trimming antigens from foreign bodies (e.g. bacteria, viruses) which are presented on the surface of a cell to trigger an immune response. In axSpA, it is thought an antigen from the person's own body, called a 'self-peptide' is presented by the ERAP1 processing pathway and incorrectly recognised by the immune system. The hypothesis is that stimulation of the immune system by the presentation of this self-peptide causes the inflammatory symptoms experienced by people living with axSpA.

As an inhibitor of ERAP1, GRWD0715 aims to prevent the generation of the antigenic self-peptide, and thus remove the stimulus of the immune system. If the immune system is not activated, the immune attack on the sacroiliac joint (SIJ) and spine would stop, halting the axSpA disease progress.

The study will consist of 4 parts: Part A conducted in healthy human volunteers, and Part B, Part C and/or D in participants with axSpA. The primary goal of Parts A, B and C is to assess whether GRWD0715 is safe and well tolerated in healthy human volunteers and participants with axSpA. The primary goal of Part D is to review whether GRWD0715 is efficacious when compared to placebo.

Enrollment: 141 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Healthy Volunteers

• Healthy male and female subjects aged 18-55 years inclusive, at the Screening visit
• Participant must provide written informed consent to participate in the study
• Participant must be able and willing to comply with the requirements of the protocol (including dietary restrictions and exclusion of grapefruit juice)
• Male participants (and their female partners) / female participants must be willing to adhere to contraception requirements as detailed in the protocol
• Non-smokers or ex-smokers who have not smoked within the previous 6 months, as determined at the Screening visit
• Participant with a Body Mass Index (BMI) of 19-30. Body Mass Index = Body weight (kg) / [Height (m)]2

AxSpA Participants

• Male or female, 18-65 years of age

• Participants diagnosed with Axial Spondyloarthritis, also fulfilling ASAS classification criteria including:

  1. HLA-B27 +ve (local testing)
  2. Objective evidence of inflammation at screening, specifically active sacroiliac joint inflammation on MRI fulfilling the ASAS MRI criteria (MRI+), assessed by the Principal Investigator or appropriately trained delegate, and/or elevated C-reactive protein (CRP+) ≥5.0mg/L.

• Symptom duration of ≥3 months

• Age at onset of active disease of <40 years

• A score of ≥ 2.1 on the Ankylosing Spondylitis Disease Activity Score (ASDAS) on current treatment.

• At least one of the following:

  1. Current treatment with a NSAID, at a sufficient dose and following an appropriate dosing duration per local clinical guidelines, with inadequate clinical response OR
  2. Intolerance to ≥1 NSAID or contraindication(s) to NSAIDs Participants may have received 1 prior b/ts DMARD and discontinued due to intolerance or inadequate efficacy.

• Participants who have received 1 prior treatment are required to undergo a washout at minimum:

  1. Biologic DMARDs 4 weeks or 5 half-lives prior to Day 1, whichever is longer.
  2. JAK inhibitor DMARDs 2 weeks prior to Day 1

Exclusion criteria

Healthy Volunteers

• History or presence of any clinically significant findings in medical history, physical examination, vital signs and/or laboratory tests that, in the opinion of the Investigator, would preclude inclusion in the study
• Participation in a New Chemical Entity clinical study within the previous 124 days or a marketed drug clinical study within the previous 93 days
• Known infection or lifestyle risk factors for human immunodeficiency virus (HIV) and/or hepatitis B or C infection, as determined at the Screening visit

AxSpA Participants

• Participants who have received >1 biologic or JAK inhibitor DMARD or are receiving any other disease-modifying antirheumatic drugs (other than those allowed), thalidomide (including previous use) and other prohibited concomitant medications.

• Inadequate Haematologic function, defined as:

  1. Haemoglobin <10 g/dL.
  2. Absolute white blood cell count <3.0 x 109 /L (<3000 mm3)
  3. Absolute neutrophil count <1.2 x 109 /L (<1200 mm3)
  4. Absolute lymphocyte count <1.0 x 109 /L (<1000 mm3)
  5. Platelet count <100 x 109 /L (<100.000 mm3)

• Inadequate liver function, defined as; total bilirubin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) more than 1.5 times the upper limit of normal at screening visit. For subjects with Gilberts syndrome, upper limit of normal for total bilirubin will be 2.9mg/dl

• History of any other autoimmune rheumatic disease (e.g., psoriatic arthropathy, systemic lupus erythematosus, mixed connective tissue disease, scleroderma, polymositis) or known diagnosis of fibromyalgia

• Participants with a previous history of or currently stable psoriasis are eligible

• Active or symptomatic inflammatory bowel disease (IBD). Participants with a history of IBD are allowed to participate

• Presence of active anterior uveitis

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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141 participants in 4 patient groups

Part A - Single Ascending Dose (SAD) in Healthy Human Volunteers

Experimental group

Treatment:

Drug: Part A - Single Ascending Dose (SAD) in Healthy Human Volunteers

Part B - Multiple Ascending Dose (MAD) in participants with axSpA

Experimental group

Treatment:

Drug: Part B - Multiple Ascending Dose (MAD) in participants with axSpA

Part C - Safety expansion cohort in participants with axSpA

Experimental group

Treatment:

Drug: Part C - Safety expansion cohort in participants with axSpA

Part D - Randomised, placebo-controlled, expansion cohort in participants with axSpA

Experimental group

Treatment:

Drug: Part D - Randomised, placebo-controlled, expansion cohort in participants with axSpA