Study to Assess the Safety, Tolerability, and Preliminary Efficacy of ST266 in Infants With Necrotizing Enterocolitis (NEC)

Official title

Randomized, Controlled, Phase 1-2 Open Label Study of ST266 IV Administration to Assess the Safety, Tolerability, and Preliminary Efficacy of ST266 in Infants With Necrotizing Enterocolitis (NEC)

Overview

The primary objective of this study is to determine the safety and tolerability of two dose levels (0.5 mL/kg and 1.0 mL/kg) of once daily (QD) via IV route of administration of ST266 in treating patients with Bell's stage IIA or higher medical NEC by incidence of treatment emergent adverse events (TEAEs) and SAEs, with a secondary objective to assess preliminary efficacy of the same two dose levels (0.5 mL/kg and 1.0 mL/kg) of QD via IV route of administration of ST266 in treating patients with Bell's stage IIA or higher medical NEC.

Detailed description

This Phase 1-2 clinical trial is a randomized, controlled, open-label study using a modified sequential cohort design. Assignment to cohorts will be based on the following dosages and weight ranges: 0.5 mL/kg and 1.0 mL/kg; weight ≥1000 g and ≤3000 g, and weight ≥500 g and ≤999 g.

In each cohort, patients will be randomized to either ST266 + SOC or SOC alone. In the first cohort, the first three patients randomized to ST266 were staggered, where each patient completed their 10-day treatment period containing 10 treatment cycles and Day 28/1 Month follow-up visit and were evaluated by the Data Safety Monitoring Board (DSMB), before dosing of the next patient occurred. Patients randomized to SOC alone followed the treatment plan as dictated by the Investigator site SOC procedures and were evaluated for the same inclusion/exclusion criteria and selected endpoints for analysis. If for any reason a patient was withdrawn, the decision for replacement was determined by the DSMB.

Dosing for the next cohort will occur after review of safety data up to and including Day 28/1 Month post-treatment follow-up visit from all patients in Cohort 1. DSMB reviews will include comprehensive safety data analysis of data available at that time. In Cohorts 2, 3, and 4, only a single sentinel ST266-treated patient will be required to complete their 10-day treatment period containing 10 treatment cycles and Day 28/1 Month follow-up visit and be evaluated by the Data Safety Monitoring Board (DSMB), before dosing of the next patient occurs. Given that Cohort 2 shares the same weight range and Cohort 3 the same dose as Cohort 1, Cohorts 2 and 3 may be opened for enrollment in parallel. If any safety event occurs in either Cohort 2 or 3, the DSMB will promptly evaluate and determine whether to continue the study and/or reinstate patient staggering.

Interventions

• Biological ST266
  Patients randomized to investigative drug product (ST266) will receive either 0.5 mL/kg or 1.0 mL/kg of ST266 QD in addition to Standard of Care treatment; Patients randomized to SOC will receive standard of care treatment only.

Primary outcome measures

• Safety and Tolerability endpoint: incidence of adverse events [Time frame: From date of randomization through 24 months of age]
• Safety and Tolerability endpoint: incidence of serious adverse events [Time frame: From date of randomization through 24 months of age]
• Safety and Tolerability endpoint: Changes in labs and vitals relative to disease progression [Time frame: From date of randomization through 24 months of age]

Secondary outcome measures (4)

• Efficacy endpoint: Time to pneumatosis resolution [Time frame: From date of NEC diagnosis until resolved, up to 10 days]
• Efficacy endpoint: Time to full enteral nutrition assessment [Time frame: From date of completion of antibiotics and/or IP treatment until full feeding tolerance reached, 3-5 days]
• Efficacy endpoint: Incidence of abdominal surgical intervention [Time frame: Assessed from Day 1/Baseline visit through 24 months of age]
• Efficacy endpoint: Change in Neonatal Sequential Organ Failure Assessment (nSOFA) score [Time frame: From Randomization/Day 1 through Day 10 of treatment period (10 days).]

Eligibility criteria

Inclusion criteria

• Infants born from ≥22 weeks gestational age up to and including 40 weeks gestational age; up to 40 weeks postmenstrual age (gestational age plus chronological age in terms of weeks) with current weight at diagnosis of NEC between ≥500g and ≤3000g, as a result of prematurity and/or IUGR. Parent(s)/legal medical representative(s) voluntarily provides written consent prior to study enrollment.
• Bell's Stage IIA or higher medical NEC (Stages IIA - IIIA only) diagnosis by radiologic confirmed pneumatosis intestinalis and may include intestinal dilation and ileus. The clinician confirms NEC diagnosis by evaluation of the radiologic imaging for confirmed pneumatosis intestinalis. If X-ray is used and is equivocal, an ultrasound (US) may be used, if available, to confirm pneumatosis. If the clinician (Neonatologist and/or Pediatric Surgeon) has differing interpretation from that of the Radiologist, that should be documented in both the medical and research records for accuracy of NEC diagnosis.

Exclusion criteria

• Infants with abdominal perforation.
• Not expected to survive ≥2 weeks or born with a lethal condition requiring hospice or palliative care (e.g., disease has progressed to NEC totalis, or patient has multi-organ system failure).
• Born with major congenital anomalies such as cardiac defects (e.g., Tetralogy of Fallot) or chromosomal disorders/anomalies (e.g., neural tube defect).
• Mother's receipt of any investigational product during pregnancy.
• Infants with malignancies (e.g., neoplastic cell growth as a solid tumor or a blood neoplasm, such as congenital leukemia).
• Infants with hypercoagulability disorders (any active thrombosis, diagnosis of disseminated intravascular coagulation or other acquired/inherited disorders (i.e., hemophilia) of coagulation.
• Infants with a known immunodeficiency (such as galactosemia or agranulocytosis).
• Infants with anatomic defects that require surgical intervention.
• Infants with persistent pulmonary hypertension of newborn.
• Infants with any congenital or acquired gastrointestinal pathology that preclude feeds within 7 days after birth (e.g., duodenal atresia).
• Infants who have hypoxic ischemic injury (perinatal asphyxia).
• Infants with polycythemia (at time of treatment) (>22 g/dL).
• Positive maternal human immunodeficiency virus status.
• History of maternal drug abuse (such as amphetamines, opiates, cocaine). This does not include marijuana, or prescription medications for treatment of drug abuse.
• Considered by the Investigator, for any reason, to be an unsuitable candidate for the study.
• Infants diagnosed with NEC who will require immediate surgical intervention.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Sequential

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 8 centers

• Arkansas Children's Hospital — Little Rock
• University of Arkansas for Medical Sciences — Little Rock
• Yale-New Haven Hospital — New Haven
• BayCare Health System-St. Joseph's Women's Hospital — Tampa
• NorthShore University-Evanston Hospital — Evanston
• Oklahoma Children's Hospital — Oklahoma City
• Penn State Health Milton S Hershey Medical Center/Penn State University College of Medicin — Hershey
• University of Pittsburgh Medical Center Magee Womens Hospital — Pittsburgh

Identifiers

NCT: NCT06315738 · ST266-NEC-201

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗