Abstract

PurposeInhaled drug delivery is an attractive route by which to deliver drugs to lungs of patients with idiopathic pulmonary fibrosis (IPF). GSK3008348 is a potent and selective small molecule being developed as the first inhaled inhibitor of the αvβ6 integrin for the treatment of IPF. The phase 1 first-time-in-human clinical trial (NCT02612051) presented here was designed to investigate the safety, tolerability and pharmacokinetic (PK) profile of single doses of GSK3008348 in healthy participants.MethodsSingle ascending doses of GSK3008348 were administered to three cohorts of eight healthy participants in a randomised, double-blind, placebo-controlled, 4-period crossover design. Safety, tolerability and PK were assessed after single doses of 1–3000 mcg given by nebulisation.ResultsA total of 29 participants were enrolled and received at least one dose of study treatment. There were no serious adverse events (AE) reported in any participant. No trends or clinically important differences were noted in the incidence or intensity of AEs or other safety assessments. Maximum plasma concentrations of GSK3008348 were generally attained within approximately 30 min after start of nebulisation, with geometric mean terminal elimination half-lives ranging from 7.95 to 10.2 h. Exposures, as measured by area under the plasma concentration-time curve (AUC), were dose proportional across all doses where estimates were possible (100–3000 mcg). Dose normalised geometric mean Cmax increased with dose up to 3000 mcg. This supra proportionality was relatively modest, with a less than 3-fold increase over the range from 30 to 3000 mcg. The reason(s) for this observation are currently not known but may be due to slower absorption at the lowest doses. All exposures were within the exposure margins set by the non-clinical toxicity studies and so this is not expected to have any impact on safety.ConclusionsIn summary, GSK3008348 was well tolerated at single doses up to 3000 mcg in healthy participants, and its PK profile was dose proportional at potentially clinically relevant doses (300–3000 mcg). These findings support further development of GSK3008348 as a novel inhaled treatment option for IPF.

Highlights

  • MethodsIdiopathic pulmonary fibrosis (IPF) is a form of chronic, progressive fibrosing interstitial pneumonia with unknown aetiology, associated with a histological appearance of usual interstitial pneumonia

  • Pirfenidone is associated with phototoxicity, and both pirfenidone and nintedanib cause significant gastrointestinal effects, resulting in discontinuation due to adverse events (AEs) in approximately 30% of patients treated with pirfenidone and 20% of patients treated with nintedanib [5]

  • The αvβ6 integrin plays a key role in the activation of transforming growth factor-β (TGFβ) [6] that is hypothesised to be central in the development of idiopathic pulmonary fibrosis (IPF) [7, 8]

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Summary

Introduction

MethodsIdiopathic pulmonary fibrosis (IPF) is a form of chronic, progressive fibrosing interstitial pneumonia with unknown aetiology, associated with a histological appearance of usual interstitial pneumonia. There are two disease-modifying treatments currently available to patients: pirfenidone and nintedanib. Both are oral anti-fibrotic therapies that demonstrate a reduction in the rate of decline in lung function (forced vital capacity, FVC) over 1 year [3, 4]. The αvβ integrin plays a key role in the activation of transforming growth factor-β (TGFβ) [6] that is hypothesised to be central in the development of IPF [7, 8]. The αvβ integrin is an attractive therapeutic target for IPF with the advantage of inhibiting disease-specific activation of TGFβ via αvβ, while limiting the potential for toxicological effects that may be associated with direct inhibition of TGFβ, that includes heart valve lesions and physeal dysplasia [12]

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