Title

Cold Challenge With C21 in RP
A Phase 2, Single-center, Randomised, Double-blind, Placebo-controlled, Cross-over Cold Challenge Study Investigating the Effect of C21 on Cold-induced Vasoconstriction in Subjects With Raynaud's Phenomenon (RP) Secondary to Systemic Sclerosis (SSc)
  • Phase

    Phase 2
  • Study Type

    Interventional
  • Intervention/Treatment

    C21 C21 ...
  • Study Participants

    20
This is a randomised, double-blind, placebo-controlled, cross-over phase 2 trial investigating the effect of C21 on cold-induced vasoconstriction in subjects with Raynaud's phenomenon secondary to systemic sclerosis. The purpose of the trial is to achieve a vasodilatory effect in subjects with Raynaud's phenomenon by stimulation of the AT2R (angiotensin II type 2 receptor) with C21.
Study Started
Jan 03
2020
Primary Completion
Dec 14
2020
Study Completion
Dec 14
2020
Results Posted
May 18
2023
Last Update
May 18
2023

Drug C21

C21 as first treatment

Drug C21

C21 as second treatment

Drug Placebo

Placebo as second treatment

Drug Placebo

Placebo as first treatment

C21 followed by placebo Experimental

Placebo followed by C21 Experimental

Criteria

Inclusion Criteria:

Written informed consent must be obtained before any trial related procedures are performed.
Subjects diagnosed with SSc according to European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria
Age 19-75 years inclusive
RP secondary to SSc as determined by the investigator, and with a typical frequency of attacks during the winter months (November-March) of on average at least 5 per week.

Exclusion Criteria:

Smoking (including E-cigarettes) or use of nicotine replacement therapy for three months prior to Visit 1 and during the trial.
BMI >30
Mixed connective tissue disease or "overlap" (i.e. those who satisfy more than one set of ACR criteria for a rheumatic disease).
Concurrent serious medical condition with special attention to cardiac or ophthalmic conditions which in the opinion of the investigator makes the patient inappropriate for this study
Malignancy within the past 5 years with the exception of in situ removal of basal cell carcinoma and cervical intraepithelial neoplasia grade I
Planned major surgery within the duration of the study
Subjects who forsake any alcohol intake or have known uncontrolled allergic conditions or allergy/hypersensitivity to any components of the trial drug or placebo excipients (see Section 7.1)
Blood donation (or corresponding blood loss) within three months prior to Visit 1

Treatment with any of the medications listed below within 4 weeks prior to Visit 1:

Any dose-change or initiation of vasoactive substances

, and not able or willing to withhold these medications for 3 days preceding Visit 2 and Visit 3, respectively

Iloprost
Any treatment with CYP3A4 inducers (e.g. rifampicin, phenytoin, St John's Wort)
Any treatment with CYP3A4 inhibitors (e.g. clarithromycin, ketoconazole, nefazodone, itraconazole, ritonavir)
Any treatment with medicines that are substrates of CYP1A2, CYP3A4 or CYP2C9 with a narrow therapeutic range
Any experimental drug

Any systemic immunosuppressive therapy other than:

Inhaled corticosteroids which can be used throughout the trial period
The continuation of stable doses of <10 mg prednisolone
Mycophenolate mofetil (MMF) which must be withheld for 3 days preceding Visit 2 and Visit 3

Any of the following findings at the time of screening:

Finger temperature below 27°C after acclimatising at an ambient temperature of 23°C for a period of 20 minutes
Prolonged QTcF (>450 ms), cardiac arrhythmias or any clinically significant abnormalities in the resting ECG, as judged by the Investigator
Positive results for HBsAg, HCVAb or HIV 1+2 Ag/Ab
Positive serum pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG)
Clinically significant abnormal laboratory value at Visit 1 indicating a potential risk for the subject if enrolled in the trial as evaluated by the Investigator
Pregnant or breast-feeding female subjects.
Female subjects of childbearing potential not willing to use contraceptive methods described in Section 5.3.1.
Male subjects not willing to use contraceptive methods described in Section 5.3.1.
Participation in any other interventional trial during the trial period
Subjects known or suspected of not being able to comply with this trial protocol (e.g. due to alcoholism, drug dependency or psychological disorder)

Summary

Placebo

C21 200 mg

All Events

Event Type Organ System Event Term Placebo C21 200 mg

Area Under the Curve for Rewarming of Each Finger After Cold Challenge (AUC) as Measured by Thermography

Area under the curve for rewarming of each finger after cold challenge as measured by thermography for 15 min

Placebo

19558.43
C*sec (Geometric Mean)
Geometric Coefficient of Variation: 4.36

C21 200 mg

20045.96
C*sec (Geometric Mean)
Geometric Coefficient of Variation: 7.68

Maximum Skin Temperature After Rewarming (MAX)

Maximum skin temperature after rewarming within 15 min after cold challenge

C21 200 mg

23.5336
°C (Geometric Mean)
Geometric Coefficient of Variation: 8.49

Placebo

22.5043
°C (Geometric Mean)
Geometric Coefficient of Variation: 3.73

The Distal Dorsal Difference, Defined as the Difference in Temperature Between the Dorsum and the Finger (DDD)

The distal dorsal difference, defined as the difference in temperature between the dorsum and the finger (DDD), from administration of IMP until before cold challenge (0 to 40 min)

Placebo

10 min

-3.2378
°C (Mean)
Standard Error: 0.3045

20 min

-3.0596
°C (Mean)
Standard Error: 0.2323

30 min

-3.1005
°C (Mean)
Standard Error: 0.1903

40 min

-2.7921
°C (Mean)
Standard Error: 0.1918

Baseline

-2.81
°C (Mean)
Standard Error: 0.3375

C21 200 mg

10 min

-3.395
°C (Mean)
Standard Error: 0.4580

20 min

-3.1419
°C (Mean)
Standard Error: 0.4792

30 min

-3.0347
°C (Mean)
Standard Error: 0.4037

40 min

-2.9448
°C (Mean)
Standard Error: 0.333

Baseline

-2.4215
°C (Mean)
Standard Error: 0.4950

Gradient of Rewarming in the First 2 Minutes Post-cold Challenge (GRAD)

Placebo

0.5412
°C/min (Geometric Mean)
Geometric Coefficient of Variation: 42.26

C21 200 mg

0.4482
°C/min (Geometric Mean)
Geometric Coefficient of Variation: 39.35

Change in Finger Temperature From Intake of IMP to Start of Cold Challenge

Placebo

-0.697
°C (Mean)
Standard Error: 0.471

C21 200 mg

-1.347
°C (Mean)
Standard Error: 0.343

Nailfold Capillaroscopy (Including Red Blood Cell Velocity Measurements)

Nailfold capillaroscopy mean velocity was measured as red blood cell velocity before cold challenge and post recovery

Placebo

Baseline

0.122
mm/sec (Mean)
Standard Error: 0.042

Before cold

0.302
mm/sec (Mean)
Standard Error: 0.175

Post recovery

0.318
mm/sec (Mean)
Standard Error: 0.140

C21 200 mg

Baseline

0.369
mm/sec (Mean)
Standard Error: 0.193

Before cold

0.207
mm/sec (Mean)
Standard Error: 0.054

Post recovery

0.323
mm/sec (Mean)
Standard Error: 0.149

Total

12
Participants

Age, Continuous

55.5
years (Mean)
Full Range: 35.0 to 69.0

BMI

24.9
kg/m^2 (Mean)
Full Range: 19.2 to 29.3

Height

163.7
cm (Mean)
Full Range: 154.0 to 180.0

Weight

66.6
kg (Mean)
Full Range: 50.8 to 90.0

Age, Categorical

Ethnicity (NIH/OMB)

Race (NIH/OMB)

Region of Enrollment

Sex: Female, Male

Overall Study

C21 Followed by Placebo

Placebo Followed by C21