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NCT02927457

Safety, Tolerability, Pharmacokinetics, Pharmacodynamics and Clinical Effect of GSK2646264 in Cutaneous Lupus Erythematosus Subjects

Completed Phase 1 Results posted Last updated 8 April 2021
What this trial tests

Phase 1 trial testing GSK2646264 1% in Lupus Erythematosus, Cutaneous in 11 participants. Completed in 12 June 2018.

Timeline
13 January 2017
Primary endpoint
12 June 2018
12 June 2018

Quick facts

Lead sponsorGlaxoSmithKline
PhasePhase 1
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingdouble
Primary purposetreatment
Enrollment11
Start date13 January 2017
Primary completion12 June 2018
Estimated completion12 June 2018
Sites5 locations across Germany

Drugs / interventions tested

Conditions studied

Sponsor

GlaxoSmithKline — full company profile →

Who can join

Adults 18 to 70, any sex, with Lupus Erythematosus, Cutaneous. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Number of Participants With Emergent Chemistry Results by Potential Clinical Importance (PCI) Criteria Primary · Day 14, Day 28 and follow-up (up to Day 56)

Blood samples were collected to analyze the clinical chemistry parameters; albumin, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), calcium, glucose, potassium (Pot) and sodium. PCI ranges were albumin (low: \<30 grams per liter), calcium (low: \<2 millimoles per liter \[mmol/L\] and high: \>2.75 mmol/L), glucose (low: \<3 mmol/L and high: \>9 mmol/L), Pot (low: \<3 mmol/L and high: \>5.5 mmol/L), sodium (low: \<130 mmol/L and high: \>150 mmol/L), ALT (high: \>=2 times upper limit of normal \[ULN\] units per liter {U/L}), AST

Albumin, Day 14, To low, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions0
Albumin, Day 14, To normal or no change, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions11
Albumin, Day 28, To low, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions0
Albumin, Day 28, To normal or no change, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions10
Albumin, Follow-up, To low, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions0
Albumin, Follow-up, To normal or no change, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions11
ALP, Day 14, To normal or no change, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions11
ALP, Day 14, To high, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions0
Number of Participants With Emergent Hematology Results by PCI Criteria Primary · Day 14, Day 28 and follow-up (up to Day 56)

PCI ranges were hematocrit \[Hct\] (high: \>0.54 proportion of red blood cell \[RBC\] in blood), hemoglobin \[Hb\] (high: \>180 grams per liter), RBC (low: \<4.2x10\^12 cells per liter and high: \>5.9x10\^12 cells per liter), lymphocytes \[Lympho\] (low: \<0.8x10\^9 cells per liter), monocytes \[Mono\] (low: \<0.14x10\^9 cells per liter and high: \>1.3x10\^9 cells per liter), neutrophils \[Neutro\] (low: \<1.5x10\^9 cells per liter), platelet count \[PC\] (low: \<100x10\^9 cells per liter and high: \>550x10\^9 cells per liter), eosinophils \[Eos\] (high: \>0.55x10\^9 cells per liter), basophil

Baso, Day 14, To normal or no change, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions10
Baso, Day 14, To high, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions0
Baso, Day 28, To normal or no change, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions10
Baso, Day 28, To high, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions0
Baso, Follow-up, To normal or no change, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions11
Baso, Follow-up, To high, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions0
Eos, Day 14, To normal or no change, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions10
Eos, Day 14, To high, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions0
Change From Baseline in Urine Potential of Hydrogen (pH) Primary · Baseline (Day 1), Day 14, Day 28 and follow-up (up to Day 56)

Urine samples were collected to monitor the pH. pH is a measure of hydrogen ion concentration and is used to determine the acidity or alkalinity of urine. pH scale ranges from 0 to 14. A neutral pH is 7.0. The higher number indicates the more basic (alkaline) nature of urine and lower number indicates the more acidic urine. Day 1 was considered as Baseline. Change from Baseline was calculated by subtracting Baseline value from the post-dose visit value. All participants received both treatment interventions at the same time (on different skin sites), hence data for these participants were comb

Day 14, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions-0.10± 0.843
Day 28, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions-0.35± 0.669
Follow-up, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions-0.32± 0.783
Change From Baseline in Urine Specific Gravity Primary · Baseline (Day 1), Day 14, Day 28 and follow-up (up to Day 56)

Urine samples were collected to monitor the specific gravity. Specific gravity is a measure of urine concentration and is measured using a chemical test. Specific gravity measurements provide a comparison of the amount of substances dissolved in urine as compared to pure water. If there were no solutes present, the specific gravity of urine would be 1.000 the same as pure water. Specific gravity between 1.002 and 1.035 could be considered as normal. Day 1 was considered as Baseline. Change from Baseline was calculated by subtracting Baseline value from the post-dose visit value. All participan

Day 14, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions0.0007± 0.00629
Day 28, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions-0.0001± 0.00626
Follow-up, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions0.0003± 0.00746
Number of Participants With Emergent Vital Sign Results by PCI Criteria Primary · Day 14 and Day 28

Vital signs such as diastolic blood pressure (DBP), heart rate (HR) and systolic blood pressure (SBP) were measured in semi-supine position after 5 minutes rest for the participants. PCI ranges were SBP (lower: \<85 millimeters of mercury \[mmHg\] and upper: \>160 mmHg), DBP: (lower: \<45 mmHg and upper: \>100 mmHg) and HR (lower: \<40 beats per minute \[bpm\] and upper: \>110 bpm). All participants received both treatment interventions at the same time (on different skin sites), hence data for these participants were combined.

DBP, Day 14, To low, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions0
DBP, Day 14, To normal or no change, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions10
DBP, Day 14, To high, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions0
DBP, Day 28, To low, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions0
DBP, Day 28, To normal or no change, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions11
DBP, Day 28, To high, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions0
HR, Day 14, To low, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions0
HR, Day 14, To normal or no change, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions10
Change From Baseline in Electrocardiogram (ECG); HR Primary · Baseline (Day 1), Day 14 and follow-up (up to Day 56)

Triplicate 12-lead ECGs were obtained using an ECG machine that automatically calculated the heart rate. Day 1 was considered as Baseline. Change from Baseline was calculated by subtracting Baseline value from the post-dose visit value. All participants received both treatment interventions at the same time (on different skin sites), hence data for these participants were combined.

HR, Day 14, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions1.633± 8.3702
HR, Follow-up, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions-0.606± 4.1280
Change From Baseline in ECG; PR Interval, QRS Duration, QT Interval and QTcF Primary · Baseline (Day 1), Day 14 and follow-up (up to Day 56)

Triplicate 12-lead ECGs were obtained using an ECG machine that automatically measured PR, QRS, QT, and QT interval corrected using Fridericia's formula (QTcF) intervals. Day 1 was considered as Baseline. Change from Baseline was calculated by subtracting Baseline value from the post-dose visit value. All participants received both treatment interventions at the same time (on different skin sites), hence data for these participants were combined.

PR interval, Day 14, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions-0.900± 5.2306
PR interval, Follow-up, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions3.424± 11.4174
QRS duration, Day 14, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions-0.967± 3.4728
QRS duration, Follow-up, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions1.061± 3.5113
QT interval, Day 14, n=0,10
GroupValue95% CI
Group B-Participants With Natural Lesions-4.467± 21.8955
QT interval, Follow-up, n=0,11
GroupValue95% CI
Group B-Participants With Natural Lesions4.455± 17.5463
QTcF interval, Day 14, n=0,3
GroupValue95% CI
Group B-Participants With Natural Lesions-2.739± 7.4559
QTcF interval, Follow-up, n=0,4
GroupValue95% CI
Group B-Participants With Natural Lesions4.532± 10.0979
Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs) Primary · Up to Day 56

An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. SAE is defined as any untoward medical occurrence that, at any dose, results in death, is life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent disability/incapacity, is a congenital anomaly/birth defect and other situations according to medical or scientific judgement or events associated with liver injury and impaired liver function.

Any AEs
GroupValue95% CI
Group B-Participants With Natural Lesions8
Any SAEs
GroupValue95% CI
Group B-Participants With Natural Lesions1
Change From Baseline in Erythema, Scaling Hyperkeratosis, Edema/Infiltration, Dyspigmentation, Modified Revised Cutaneous Lupus Erythematosus Disease Area and Severity Index (RCLASI) Activity Score and Overall RCLASI Modified Score. Secondary · Baseline (Day 1), Day 14 and Day 28

The score ranges for different components were; erythema \[0 (absent) to 3 (dark red, purple/violaceous/crusted/hemorrhagic)\], scaling/hyperkeratosis \[0 (absent) to 2 (verrucous hyperkeratosis)\], edema/infiltration \[0 (absent) to 2 (palpable and visible)\] and dyspigmentation \[0 (absent) to 2 (hypo and hyper pigmentation)\]. For all components, 0 (better) and 3 (worse). Modified RCLASI activity score was derived by adding score for erythema, scaling hyperkeratosis and edema/infiltration. Modified change from Baseline ranged from -7 to 7, 0 (no change), minus (better) and positive (worse).

Erythema, Day 14, n=0,0,9,9
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo-0.8± 0.83
Group B-Participants With Natural Lesions; GSK2646264-0.8± 0.83
Erythema, Day 28, n=0,0,10,10
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo-0.5± 0.71
Group B-Participants With Natural Lesions; GSK2646264-0.5± 0.71
Scaling/Hyperkeratosis, Day 14, n=0,0,9,9
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo0.0± 0.00
Group B-Participants With Natural Lesions; GSK26462640.0± 0.00
Scaling/Hyperkeratosis, Day 28, n=0,0,10,10
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo0.0± 0.00
Group B-Participants With Natural Lesions; GSK26462640.0± 0.00
Edema/infiltration, Day 14, n=0,0,9,9
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo-0.2± 0.44
Group B-Participants With Natural Lesions; GSK2646264-0.2± 0.44
Edema/infiltration, Day 28, n=0,0,10,10
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo-0.4± 0.52
Group B-Participants With Natural Lesions; GSK2646264-0.3± 0.48
Dyspigmentation, Day 14, n=0,0,9,9
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo-0.1± 0.33
Group B-Participants With Natural Lesions; GSK2646264-0.1± 0.33
Dyspigmentation, Day 28, n=0,0,10,10
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo-0.1± 0.32
Group B-Participants With Natural Lesions; GSK2646264-0.1± 0.32
Maximum Observed Concentration (Cmax) of GSK2646264 in Participants With Cutaneous Lupus Erythematosus (CLE) Secondary · Day 1 (pre-dose and 5 hours post-dose), Day 2 to Day 13, Day 14 (pre-dose), Day 21 to Day 27, Day 28 (post-dose), Day 29 to Day 42 and Follow-up (up to Day 56)

Blood samples were collected at designated timepoints and pharmacokinetic (PK) analysis was performed. Cmax was calculated by non-compartmental analysis using WinNonlin. PK Population comprised of all participants in the safety population for whom a PK sample was obtained and analyzed.

GroupValue95% CI
Group B-Participants With Natural Lesions0.8324± 109.3
Time to Reach Maximum Observed Concentration (Tmax) of GSK2646264 in Participants With CLE Secondary · Day 1 (pre-dose and 5 hours post-dose), Day 2 to Day 13, Day 14 (pre-dose), Day 21 to Day 27, Day 28 (post-dose), Day 29 to Day 42 and Follow-up (up to Day 56)

Blood samples were collected at designated timepoints and PK analysis was performed. Tmax was calculated by non-compartmental analysis using WinNonlin.

GroupValue95% CI
Group B-Participants With Natural Lesions311.4674.68 – 651.92
Mean Fold Change in Messenger Ribonucleic Acid (mRNA) Expression of Interferon (IFN) Signatures in Skin Biopsies Secondary · Baseline (Day -5 to -3) and Day 28

Microarray mRNA data was collected from the skin biopsy in both GSK2646264 and placebo treated lesions on Day -5 to -3 visit (Baseline) and Day 28. Fold change represents the change at Day 28 relative to Baseline for each treatment group. Analysis was conducted using mixed model with participant as a random effect and treatment as a fixed effect where treatment is set to "not applicable" at Baseline. Mean fold change and 95% confidence interval is presented for different genes and probesets. IFI16 indicated interferon, gamma-inducible protein 16, IFI44 indicated interferon-induced protein 44,

Chemokine (C-X-C motif)Ligand10, 204533_at, Day 28
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo1.173-1.899 – 2.610
Group B-Participants With Natural Lesions; GSK2646264-1.464-3.259 – 1.521
IFI16, 206332_s_at, Day 28
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo-1.001-1.286 – 1.283
Group B-Participants With Natural Lesions; GSK2646264-1.064-1.367 – 1.207
IFI16, 208965_s_at, Day 28
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo1.055-1.219 – 1.356
Group B-Participants With Natural Lesions; GSK2646264-1.164-1.496 – 1.105
IFI16, 208966_x_at, Day 28
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo-1.044-1.328 – 1.219
Group B-Participants With Natural Lesions; GSK2646264-1.096-1.394 – 1.161
IFI44, 214059_at, Day 28
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo1.018-1.429 – 1.481
Group B-Participants With Natural Lesions; GSK2646264-1.029-1.497 – 1.413
IFI44, 214453_s_at, Day 28
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo1.021-1.541 – 1.606
Group B-Participants With Natural Lesions; GSK2646264-1.270-1.998 – 1.239
IFI44-like, 204439_at, Day 28
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo1.043-1.602 – 1.744
Group B-Participants With Natural Lesions; GSK2646264-1.122-1.875 – 1.491
IFIH1, 1555464_at, Day 28
GroupValue95% CI
Group B-Participants With Natural Lesions; Placebo1.037-1.081 – 1.162
Group B-Participants With Natural Lesions; GSK2646264-1.074-1.204 – 1.043

Adverse events — posted to ClinicalTrials.gov

Time frame: Serious adverse events (SAEs) and non-serious AEs were collected from the start of study treatment up to Day 56. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Group A-Participants With Photoprovocation Lesions
Serious: 0
Deaths: 0
Group B-Participants With Natural Lesions
Serious: 1/11 (9%)
Deaths: 0/11

Serious adverse events (1 terms)

ReactionSystemGroup A-Participants With …Group B-Participants With …
Ankle fractureInjury, poisoning and procedural complications
Other adverse events (13 terms — click to expand)

ReactionSystemGroup A-Participants With …Group B-Participants With …
NasopharyngitisInfections and infestations
Tinea pedisInfections and infestations
Post procedural haemorrhageInjury, poisoning and procedural complications
Postoperative wound complicationInjury, poisoning and procedural complications
HeadacheNervous system disorders
MigraineNervous system disorders
Dermatitis contactSkin and subcutaneous tissue disorders
PanniculitisSkin and subcutaneous tissue disorders
PruritusSkin and subcutaneous tissue disorders
ConstipationGastrointestinal disorders
DiarrhoeaGastrointestinal disorders
Back painMusculoskeletal and connective tissue disorders
Hot flushVascular disorders

Most-reported serious reactions: Ankle fracture.

Data from ClinicalTrials.gov NCT02927457 adverse events section.

Sponsor's own description

This study is designed to examine safety, tolerability, pharmacokinetics, pharmacodynamics and clinical effect of repeat dosing of GSK2646264 in patients with subacute and chronic cutaneous lupus erythematosus (CLE) lesions and in acute CLE like lesions induced by photoprovocation (PV). Current study is two group study. In Group A, Patients with fewer than two active lesions will be enrolled and exposed to photoprovocation (PV) for 3 consecutive days. Patients that develop PV lesions at any time during this period, as determined by the local investigative team, will receive 1% strength GSK2646264 on 1 lesion and placebo on 1 lesion daily and either 1% strength GSK2646264 or placebo on an area of uninvolved skin, for skin pharmacokinetic (PK) of study drug, for 28 days. In Group B, Patients that have a minimum of 2 active existing CLE lesions as determined by the investigators will be enrolled into group B and have one lesion treated with 1% GSK2646264 and 1 lesion with placebo. A completed patient will be defined as a subject who receives at least 25 days of study drug and completes the end of treatment biopsy (at day 28) and assessment. Thereafter patients will be followed for 28 days in Group A only or until complete resolution of induced PV lesions, as determined by the investigator.

Publications & conference data

7 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Protein kinases: drug targets for immunological disorders.
    Castelo-Soccio L, Kim H, Gadina M, Schwartzberg PL, et al · · 2023 · cited 67× · PMID 37188939 · DOI 10.1038/s41577-023-00877-7
  2. Cutaneous Lupus Erythematosus: An Update on Pathogenesis and Future Therapeutic Directions.
    Niebel D, de Vos L, Fetter T, Brägelmann C, et al · · 2023 · cited 47× · PMID 37140884 · DOI 10.1007/s40257-023-00774-8
  3. GSK2646264, a spleen tyrosine kinase inhibitor, attenuates the release of histamine in ex vivo human skin.
    Ramirez Molina C, Falkencrone S, Skov PS, Hooper-Greenhill E, et al · · 2019 · cited 22× · PMID 30735243 · DOI 10.1111/bph.14610
  4. Drugs for discoid lupus erythematosus.
    Jessop S, Whitelaw DA, Grainge MJ, Jayasekera P. · · 2017 · cited 17× · PMID 28476075 · DOI 10.1002/14651858.cd002954.pub3
  5. Safety, pharmacokinetics and pharmacodynamics of a topical SYK inhibitor in cutaneous lupus erythematosus: A double-blind Phase Ib study.
    Walker A, Erwig L, Foster K, Nevin K, et al · · 2021 · cited 14× · PMID 33336508 · DOI 10.1111/exd.14253
  6. Characterization of the mechanism of action of lanraplenib, a novel spleen tyrosine kinase inhibitor, in models of lupus nephritis.
    Pohlmeyer CW, Shang C, Han P, Cui ZH, et al · · 2021 · cited 10× · PMID 33781343 · DOI 10.1186/s41927-021-00178-3
  7. Interferon Inhibition in SLE: From Bench to Bedside.
    Deligeorgakis D, Skouvaklidou E, Adamichou C. · · 2024 · cited 3× · PMID 39193183 · DOI 10.31138/mjr.010324.iis

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