Title

Comparative, Pharmacokinetic and Pharmacodynamic Study of Subcutaneous Injections of INTP5 of Intas Pharmaceuticals Ltd., India Against Neulasta of Amgen Inc., USA in Healthy, Adult Human Subjects.
An Assessor-blind, Balanced, Randomized, Two-treatment, Two-period, Single-dose, Two-way, Crossover, Comparative, Pharmacokinetic and Pharmacodynamic Study of Subcutaneous Injections of INTP5 of Intas Pharmaceuticals Ltd., India Against Neulasta of Amgen Inc., USA in Healthy, Adult Human Subjects Under Fed Condition.
  • Phase

    Phase 1
  • Study Type

    Interventional
  • Study Participants

    144
The study was an assessor-blind, balanced, randomized, two-treatment, two-period, single-dose, two-way crossover, comparative, pharmacokinetic (PK) and pharmacodynamic (PD) study of subcutaneous (SC) Pegfilgrastim injection (6 mg/0.6 mL; INTP5 and US-Neulasta) in healthy, adult, human subjects under fed conditions.
Study Started
Feb 12
2018
Primary Completion
May 01
2018
Study Completion
May 01
2018
Results Posted
Oct 04
2019
Last Update
Oct 04
2019

Combination Product INTP5

INTP5: A proposed pegfilgrastim biosimilar to US Neulasta.

Combination Product US Neulasta

US Neulasta: FDA-approved pegfilgrastim innovator product.

INTP5 Period I Crossover Experimental

Period I: Subjects received a single dose of INTP5 subcutaneously at a dose of 6 mg/0.6 mL. Period II: After the first treatment cycle and a six week wash out period, patients received a single dose of US Neulasta.

US Neulasta Period I Crossover Active Comparator

Period I: Subjects received a single dose US Neulasta subcutaneously at a dose of 6 mg/0.6 mL. Period II: After the first treatment cycle and a six week wash out period, patients received a single dose of INTP5.

Criteria

Inclusion Criteria:

Normal, healthy adult human volunteers between 18 and 45 years of age (both inclusive) living in and around Ahmedabad city or western part of India.
Having body weight ≥50 kg and body mass index (BMI) between 18.5 and 29.9 (both inclusive), calculated as weight in kg/height in meter^2.
Not having any significant disease in medical history or clinically significant abnormal findings during screening, abdominal ultrasonography, medical history, clinical examination, laboratory evaluations, 12-lead ECG and chest X-ray (posterior-anterior view; within the last 6 months) recordings.
Volunteer who is a Non-smoker
Able to understand and comply with the study procedures, in the opinion of the investigator.
Able to give voluntary written informed consent for participation in the trial.

In case of female subjects:

Surgically sterilized at least 6 months prior to study participation;- Or - If a woman of childbearing potential is willing to use a suitable and effective double barrier contraceptive method or intra uterine device during the study.
Serum pregnancy test (for female subjects) must be negative.

Exclusion Criteria:

Known hypersensitivity to the study drug or its constituents and/or hypersensitivity to E. coli derived proteins, and/or previous exposure to the study drug.
History or presence of any disease or condition which might compromise the haemopoietic, renal, hepatic, endocrine, pulmonary, central nervous, cardiovascular, immunological, dermatological, gastrointestinal or any other body system.
Known case of hereditary fructose intolerance.
Subjects with latex allergies will be excluded as the needle cover on the single-use pre-filled syringe contains dry natural rubber (latex).
Any clinically significant laboratory finding including ANC, platelet, RBC count or hemoglobin level at the time of screening.
Prior exposure to any peptide colony stimulating or growth factor, including erythropoietin, filgrastim or Pegfilgrastim; Prior exposure to vaccines, immunoglobulin preparations, or immunomodulator's within the past 6 months prior to receiving the first dose; evidence of E. coli diarrhea or diseases within 3 months.
Any history or presence of asthma (including aspirin-induced asthma) or nasal polyp or NSAIDs induced urticaria.
Subjects with a history of pulmonary infiltrate or pneumonia in the last 6 months.
History of any hematologic disease including sickle cell disorders.
Smokers, or who have smoked within last six months prior to start of the study.
Ingestion or use of any prescribed medication at any time within 1 month prior to receiving first dose in Period-I.
Receipt of over-the-counter medicines which have not yet cleared from the body (5 half-lives must have passed for the medicine to be considered to have cleared from the body).
A recent history of harmful use of alcohol, i.e. alcohol consumption of more than 14 standard drinks per week for men and more than 7 standard drinks per week for women (A standard drink is defined as 360 mL of beer or 150 mL of wine or 45 mL of 40% distilled spirits, such as rum, whisky, brandy etc.) or consumption of alcohol or alcoholic products within 72 hours prior to receiving study medicine in Period-I.
Use of any recreational drugs or history of drug addiction or testing positive in pre-study drug scans.
Donation of blood (1 unit or 350 mL) or equivalent amount of blood substitute. Receipt of an investigational medicinal product or participation in a drug research study within a period of 180 days prior to the first dose of study medication. Elimination half-life of the study drug should be taken into consideration for inclusion of the subject in the study.
Positive result for human immunodeficiency virus (HIV I &/or II) and/or hepatitis B and C tests.
History or presence of cancer because of which anticipated life span is less than 5 years as per the investigator's assessment.
History or presence of psychiatric disorders.
Presence of tattoo or scars or any type of skin lesions due to infection, burning, wound or inflammation at the proposed site of injection.
An unusual diet, for whatever reason (e.g. low-sodium), for 4 weeks prior to receiving the study medicine in Period-I. In any such case, subject selection will be at the discretion of the Principal Investigator.
Consumption of grape fruit or grape fruit products within 72 hours prior to receiving study drug in Period-I.
A history of difficulty in donating blood.
Females, pregnant or lactating, or planning to become pregnant during the course of the study or found positive in pregnancy test at screening.
Any infections in the last 4 weeks before receiving study medication in Period-I.

Summary

INTP5 Treatment

US Neulasta Treatment

All Events

Event Type Organ System Event Term INTP5 Treatment US Neulasta Treatment

Pharmacokinetic (PK) Endpoints: Pegfilgrastim C[Max]

Maximum measured serum concentration, calculated from the serum concentration vs. time profile of the individual subjects.

INTP5 Treatment

474.269
ng/mL (Mean)
Standard Deviation: 240.2247

US Neulasta Treatment

425.578
ng/mL (Mean)
Standard Deviation: 219.8054

Pharmacokinetic (PK) Endpoints: Pegfilgrastim AUC[0-infinity]

Area under the serum concentration versus time curve from time zero to infinity. Where AUC[0-infinity]= AUC[0-t] + Ct/λz(lambda-z), Ct is the last measurable concentration and λz(lambda-z) is the terminal rate constant.

INTP5 Treatment

21015.8632
ng.h/mL (Mean)
Standard Deviation: 12985.3760

US Neulasta Treatment

18327.4192
ng.h/mL (Mean)
Standard Deviation: 11156.1580

Pharmacodynamic (PD) Endpoints: E[Max] for Baseline Non-adjusted ANC

Maximum measured absolute neutrophil count (ANC).

INTP5 Treatment

38.82
x10^3 cells/uL (Mean)
Standard Deviation: 9.009

US Neulasta Treatment

37.97
x10^3 cells/uL (Mean)
Standard Deviation: 9.258

Pharmacodynamic (PD) Endpoints: AUEC[0-t] for Baseline Non-adjusted ANC

Area under the absolute neutrophil count (ANC) versus time curve from time zero to the last measurable concentration as calculated by linear trapezoidal method.

INTP5 Treatment

6638.12
x10^3 cells*h/uL (Mean)
Standard Deviation: 1404.376

US Neulasta Treatment

6554.04
x10^3 cells*h/uL (Mean)
Standard Deviation: 1465.072

PK Endpoint: Pegfilgrastim AUC[0-t]

Area under the serum concentration vs. time curve, calculated by linear trapezoidal rule from measured data points from the time zero to the time of last quantified concentration.

INTP5 Treatment

21001.567
ng.h/mL (Mean)
Standard Deviation: 12983.9811

US Neulasta Treatment

18312.112
ng.h/mL (Mean)
Standard Deviation: 11156.5248

PK Endpoint: Pegfilgrastim T[Max]

The time of observing the peak concentration, calculated from the serum concentration vs. time profile of the individual subjects.

INTP5 Treatment

26.189
h (Mean)
Standard Deviation: 6.8110

US Neulasta Treatment

25.754
h (Mean)
Standard Deviation: 7.6188

PK Endpoint: Pegfilgrastim λz(Lambda-z)

Terminal rate constant: First order rate constant associated with the terminal (log-linear) portion of the curve. This was estimated via linear regression of time vs. log concentration. This parameter was calculated by linear least squares regression analysis using last three or more nonzero plasma concentration values.

INTP5 Treatment

0.021
1/h (Mean)
Standard Deviation: 0.0094

US Neulasta Treatment

0.019
1/h (Mean)
Standard Deviation: 0.0088

PK Endpoint: Pegfilgrastim R^2 Adjusted

Goodness of fit statistic for the terminal phase, adjusted for the number of points used in the estimation of λz. R^2 is the coefficient of Determination and can range from 0 to 1,; with higher values indicating greater predictability.

INTP5 Treatment

0.968
Coefficient of Determination (Mean)
Standard Deviation: 0.0543

US Neulasta Treatment

0.967
Coefficient of Determination (Mean)
Standard Deviation: 0.0344

PK Endpoint: Pegfilgrastim t[1/2]

The terminal half-life calculated using the formula 0.693/λz(lambda-z).

INTP5 Treatment

39.963
h (Mean)
Standard Deviation: 18.5548

US Neulasta Treatment

44.824
h (Mean)
Standard Deviation: 29.3461

PK Endpoint: Pegfilgrastim AUC[_Percent_Extrap_Obs]

The residual area in percentage determined by the formula, [(AUC[0-infinity]-AUC]0-t])/AUC0-infinity] x 100.

INTP5 Treatment

0.105
percent of AUC (Mean)
Standard Deviation: 0.117

US Neulasta Treatment

0.139
percent of AUC (Mean)
Standard Deviation: 0.1726

PD Endpoint: T[Max] for Baseline Non-adjusted ANC

Time to reach the maximum measured absolute neutrophil count (ANC)

INTP5 Treatment

67.231
h (Mean)
Standard Deviation: 16.0553

US Neulasta Treatment

63.734
h (Mean)
Standard Deviation: 13.1649

PD Endpoint: E[Max], Baseline-adjusted ANC

Maximum measured absolute neutrophil count (ANC)

INTP5 Treatment

34.66
x10^3 cells/uL (Mean)
Standard Deviation: 8.531

US Neulasta Treatment

33.84
x10^3 cells/uL (Mean)
Standard Deviation: 8.863

PD Endpoint: AUEC[0-t], Baseline-adjusted ANC

Area under the absolute neutrophil count (ANC) versus time curve from time zero to the last measurable concentration as calculated by linear trapezoidal method.

INTP5 Treatment

4626.4
x10^3cells*h/uL (Mean)
Standard Deviation: 1163.806

US Neulasta Treatment

4565.8
x10^3cells*h/uL (Mean)
Standard Deviation: 1278.987

PD Endpoint: T[Max], Baseline-adjusted ANC

Time to reach the maximum measured absolute neutrophil count (ANC)

INTP5 Treatment

67.231
h (Mean)
Standard Deviation: 16.0553

US Neulasta Treatment

63.734
h (Mean)
Standard Deviation: 20.7

PD Endpoint: λz(Lamda-z) and Baseline-adjusted ANC

First order rate constant associated with the terminal (log-linear) portion of the curve. This is estimated via linear regression of time vs. log concentration. This parameter will be calculated by linear least squares regression analysis using at least last three or more non-zero values.

INTP5 Treatment

0.02
1/h (Mean)
Standard Deviation: 0.011

US Neulasta Treatment

0.02
1/h (Mean)
Standard Deviation: 0.013

PD Endpoint: t[1/2] for Baseline-adjusted ANC

The terminal half-life will be calculated as 0.693/λz(lamda-z).

INTP5 Treatment

55.98
h (Mean)
Standard Deviation: 34.973

US Neulasta Treatment

56.27
h (Mean)
Standard Deviation: 31.671

Immunogenicity: Presence of Anti-drug Antibodies

Evaluation of immunogenicity is carried out in a tiered fashion: Screening assay to assess if samples were positive or negative for anti-PegG-CSF. Confirmatory assays for samples that were positive in the screening assay. The confirmatory assays assessed if antibodies were specific for INTP5, Neulasta, PEG and/or filgrastim. Titer assay was performed to determine titer of the anti-PEG-GCSF antibody samples. Neutralizing antibody (NAb) assay for those samples that were positive in the confirmatory assays to assess the neutralizing capability of the antibody to inhibit pegfilgrastim activity.

INTP5 Treatment

Period I

Period II

US Neulasta Treatment

Period I

Period II

Total

142
Participants

Age, Continuous

33.6
years (Mean)
Standard Deviation: 6.15

BMI

24.04
kg/m^2 (Mean)
Standard Deviation: 2.996

Height

159.2
cm (Mean)
Standard Deviation: 8.48

Weight

60.8
kg (Mean)
Standard Deviation: 7.98

Race (NIH/OMB)

Region of Enrollment

Sex: Female, Male

Period I: Dosing

INTP5 Period I, US Neulasta Period II Crossover

US Neulasta Period I, INTP5 Period II Crossover

Period II: Crossover Dosing

INTP5 Period I, US Neulasta Period II Crossover

US Neulasta Period I, INTP5 Period II Crossover

Drop/Withdrawal Reasons

INTP5 Period I, US Neulasta Period II Crossover

US Neulasta Period I, INTP5 Period II Crossover