Study Assessing the Interaction of Pantoprazole With Cladribine in Subjects With Multiple Sclerosis

Overview[ - collapse ][ - ]

Purpose The purpose of the study is to assess the influence of pantoprazole on the pharmacokinetic profile of cladribine, especially any influence on the extent of absorption of cladribine since any pH-modifying drug may potentially affect the stability of cladribine and thereby its bioavailability
ConditionMultiple Sclerosis
InterventionDrug: Cladribine
Drug: Cladribine and Pantoprazole
PhasePhase 1
SponsorMerck KGaA
Responsible PartyMerck KGaA
ClinicalTrials.gov IdentifierNCT00938366
First ReceivedJuly 9, 2009
Last UpdatedFebruary 17, 2014
Last verifiedJanuary 2012

Tracking Information[ + expand ][ + ]

First Received DateJuly 9, 2009
Last Updated DateFebruary 17, 2014
Start DateJanuary 2008
Estimated Primary Completion DateNot Provided
Current Primary Outcome Measures
  • Maximum Plasma Concentration (Cmax) [Time Frame: 24 hours] [Designated as safety issue: No]Blood samples for pharmacokinetic analysis of cladribine were collected at pre-dose (within 30 minutes prior to dosing) and at 30 minutes, 1h, 3h, 6h, 8h, 12h, 16h and 24h post-dose during the confinement period and at 36h and 48h post-dose during ambulatory visits
  • Area under the plasma concentration-time curve from time zero to the last sampling time at which the concentration is at or above the lower limit of quantification (AUC0-t) [Time Frame: 24 hours] [Designated as safety issue: No]Blood samples for pharmacokinetic analysis of cladribine were collected at pre-dose (within 30 minutes prior to dosing) and at 30 minutes, 1h, 3h, 6h, 8h, 12h, 16h and 24h post-dose during the confinement period and at 36h and 48h post-dose during ambulatory visits
  • Area under the plasma concentration-time curve from time zero to infinity (AUC0-∞) [Time Frame: 24 hours] [Designated as safety issue: No]Blood samples for pharmacokinetic analysis of cladribine were collected at pre-dose (within 30 minutes prior to dosing) and at 30 minutes, 1h, 3h, 6h, 8h, 12h, 16h and 24h post-dose during the confinement period and at 36h and 48h post-dose during ambulatory visits
  • Time to reach the maximum plasma concentration (tmax) [Time Frame: 24 hours] [Designated as safety issue: No]Blood samples for pharmacokinetic analysis of cladribine were collected at pre-dose (within 30 minutes prior to dosing) and at 30 minutes, 1h, 3h, 6h, 8h, 12h, 16h and 24h post-dose during the confinement period and at 36h and 48h post-dose during ambulatory visits
  • Apparent terminal half-life (t1/2) [Time Frame: 24 hours] [Designated as safety issue: No]Blood samples for pharmacokinetic analysis of cladribine were collected at pre-dose (within 30 minutes prior to dosing) and at 30 minutes, 1h, 3h, 6h, 8h, 12h, 16h and 24h post-dose during the confinement period and at 36h and 48h post-dose during ambulatory visits
  • Total body clearance from plasma following extravascular administration (CL/f) [Time Frame: 24 hours] [Designated as safety issue: No]Blood samples for pharmacokinetic analysis of cladribine were collected at pre-dose (within 30 minutes prior to dosing) and at 30 minutes, 1h, 3h, 6h, 8h, 12h, 16h and 24h post-dose during the confinement period and at 36h and 48h post-dose during ambulatory visits
  • Apparent volume of distribution during the terminal phase following extravascular administration (Vz/f) [Time Frame: 24 hours] [Designated as safety issue: No]Blood samples for pharmacokinetic analysis of cladribine were collected at pre-dose (within 30 minutes prior to dosing) and at 30 minutes, 1h, 3h, 6h, 8h, 12h, 16h and 24h post-dose during the confinement period and at 36h and 48h post-dose during ambulatory visits
Current Secondary Outcome MeasuresNot Provided

Descriptive Information[ + expand ][ + ]

Brief TitleStudy Assessing the Interaction of Pantoprazole With Cladribine in Subjects With Multiple Sclerosis
Official TitleAn Open-label, Cross Over Study, to Assess the Interactions of Pantoprazole (Proton Pump Inhibitor) With Oral Cladribine Administered in Subjects With Multiple Sclerosis.
Brief Summary
The purpose of the study is to assess the influence of pantoprazole on the pharmacokinetic
profile of cladribine, especially any influence on the extent of absorption of cladribine
since any pH-modifying drug may potentially affect the stability of cladribine and thereby
its bioavailability
Detailed DescriptionNot Provided
Study TypeInterventional
Study PhasePhase 1
Study DesignAllocation: Randomized, Endpoint Classification: Pharmacokinetics Study, Intervention Model: Crossover Assignment, Masking: Open Label, Primary Purpose: Basic Science
ConditionMultiple Sclerosis
InterventionDrug: Cladribine
Cladribine 10 mg orally
Drug: Cladribine and Pantoprazole
Pantoprazole 40 mg per day orally, for 2 days ; Cladribine 10mg orally, 3 hours after Pantoprazole on the second day.
Study Arm (s)
  • Experimental: Cladribine alone/Cladribine plus Pantoprazole
    Treatment sequence: Subjects received a single cladribine dose. After a wash out period of a minimum of 10 days and a maximum of 25 days, subjects received pantoprazole for 2 days. On day 2 of the pantoprazole administration, a single cladribine dose was administered 3 hours after the pantoprazole dose.
  • Experimental: Cladribine plus pantoprazole/Cladribine alone
    Treatment sequence: Subjects received oral pantoprazole for 2 days. On day 2 of the pantoprazole administration, a single cladribine dose was administered 3 hours after the pantoprazole dose. After a wash out period of a minimum of 10 days and a maximum of 25 days, subjects received a single cladribine dose.

Recruitment Information[ + expand ][ + ]

Recruitment StatusCompleted
Estimated Enrollment18
Estimated Completion DateNot Provided
Estimated Primary Completion DateJanuary 2009
Eligibility Criteria
Inclusion Criteria:

- Subjects with a Body Mass Index ≤ 28 and have a body weight > 60 kg and < 120 kg, at
screening.

- Able to understand informed consent and had given written, informed consent.

- Had a diagnosis of clinically stable and definite multiple sclerosis (MS) by either
McDonald or Poser criteria.

- Expanded disability status scale (EDSS) score not to exceed 5.0.

- Male or non-pregnant, non-breast feeding women aged 18 to 65 years, inclusive at the
time that informed consent was obtained.

- Female subjects had to lack childbearing potential defined as post menopausal for at
least two years, were surgically or medically sterile or were sexually inactive; or
they had to be willing to avoid pregnancy by using an adequate method of birth
control (two barrier methods, or one barrier method with spermicide, or intrauterine
device or use of the oral female contraceptive) for 28 days prior to, during and up
to 90 days after the last administration of trial medication.

Exclusion Criteria:

- Subjects presenting a severe or unstable disorder: poorly controlled diabetes or
arterial hypertension, severe cardiac insufficiency, unstable ischemic heart disease,
a significant pre-existing hematological disease, or any medical condition, which in
the opinion of the investigator, would constitute a risk or a contraindication for
the participation of the subject to the study or that could interfere with the study
objectives, conduct or evaluation.

- Subjects who were on MS treatment; and subjects who were on a non-stable symptomatic
MS treatment (stable dose was defined as 3 weeks or longer prior to first study
dose).

- Clinically significant abnormal laboratory test results or electrocardiogram findings
that in the opinion of the investigator could increase the safety risk to the
subject.

- Positive results from serology examination for Hepatitis B surface antigen (HbsAg)
not due to vaccination, hepatitis B core antibody (HbcAb), Hepatitis C virus antibody
(anti-HCV) or Human Immunodeficiency antibody (anti-HIV).

- Signs and symptoms of Transmissible Spongiform Encephalopathy at screening, or family
members who suffered from such.

- Presence of chronic or recurrent infection or any acute infection within the last 2
weeks before first dosing in each study period.

- Presence of gastrointestinal disease that, in the opinion of the investigator, could
affect the pharmacokinetic outcome of the study.

- Consumption of any concomitant medication that could directly influence gastric
acidity (e.g. use of antacids, histamine receptor (H2) antagonists or other proton
pump inhibitor) taken within 7 days of study day 1 and throughout the study period.

- Intake of alcoholic beverages, caffeine and caffeine containing beverages,
grapefruit, oranges, cranberries and juices of these three fruits or smoking in the
48 hours prior to first dose and 48 hours post dose (cladribine).

- Exposure to any investigational drug or the use of any investigational device in the
12 weeks prior to first dose.

- Intake of any medications that could directly influence gastrointestinal motility and
absorption of cladribine (e.g., use of H2-antagonists, proton pump inhibitors) 7 days
prior to cladribine administration.

- Any immunomodulatory therapy (including but not limited to glatiramer acetate,
interferons, or natalizumab) and treatment with oral or systemic corticosteroids or
adrenocorticotropic hormone within 28 days of first dosing.

- Any cytokine or anti-cytokine therapy, IV immunoglobulin administration or
plasmapheresis was prohibited in the 3 months prior to first dosing.

- Current history or presence of drug or alcohol abuse, confirmed by positive test
results for drugs of abuse and/or alcohol or had a history of drug or alcohol abuse.
Alcohol abuse was defined as: an average daily intake of more than 3 units or a
weekly intake of more than 21 for males and 14 units for females where 1 unit equals
8-10g alcohol (1 unit equals 340 mL of beer, 115 mL of wine or 43 mL of spirits).

- History or presence of hypertension or other significant cardiovascular abnormality,
history of heart or kidney disease.

- Current diagnosis or personal history of cancer.

- Smoke 10 cigarettes or more per day or equivalent.

- Loss or donation of more than 400 mL of blood in the 12 weeks prior to first dose.

- Definite or suspected personal history or family history of adverse drug reaction or
hypersensitivity to drugs with a similar chemical structure to cladribine or
pantoprazole or with known hypersensitivity to cladribine or pantoprazole excipients.

- Presence or history of any serious allergy (requiring hospitalization or prolonged
systemic treatment).

- Pregnant or nursing women. Treatment of pregnant and nursing women with cladribine in
this study was prohibited.

- Signs or symptoms of neurological disease other than MS that could explain the
symptoms of the subject.
GenderBoth
Ages18 Years
Accepts Healthy VolunteersNo
ContactsNot Provided
Location CountriesNot Provided

Administrative Information[ + expand ][ + ]

NCT Number NCT00938366
Other Study ID Numbers27967
Has Data Monitoring CommitteeNo
Information Provided ByMerck KGaA
Study SponsorMerck KGaA
CollaboratorsMerck Serono S.A., Geneva
Investigators Study Director: Marianne Ekblom, PhD Merck Serono S.A., Geneva
Verification DateJanuary 2012