A Phase 2 interventional study of Hydrocortisone Modified Release Capsules in Endocrine Disease, Adrenal Insufficiency and Congenital Adrenal Hyperplasia, sponsored by Neurocrine UK Limited. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2017-05-17.
Sponsored by Neurocrine UK Limited · Phase 2, Interventional, and Treatment
The purpose of this study is to gather safety and effectiveness information about a new formulation of Hydrocortisone (Chronocort®) used to treat patients with a disease called congenital adrenal hyperplasia (CAH). Hydrocortisone is the man-made version of the hormone cortisol, which is released in the body following a regular daily pattern. The objective of the study is to measure the levels of hydrocortisone that are absorbed into the bloodstream once Chronocort® is taken and what affects it has on other hormones in the body. Since Chronocort® is anticipated to mimic the same release pattern of cortisol in the body, it is hoped that patients with CAH will be treated more effectively to manage their disease.
This study is a Phase 2 pilot study to characterize and examine the pharmacokinetics and efficacy profile of Chronocort® in adults with congenital adrenal hyperplasia (CAH). It is designed as a two-part, single cohort, open label, multiple dose Phase 2 pilot study to: (Part A) characterize and examine the pharmacokinetics (PK) and disease bio-marker behavior following short-term dosing with Chronocort®; and to (Part B) examine the disease control after six months dose titration with Chronocort® in adults with CAH.
Exclusion Criteria:
Chronocort Modified Release Capsules, 5mg, 10mg and 20mg Dosing frequency twice-daily (mane and nocte) Dose setting by titration to achieve optimal biochemical and therapeutic response
Drug: Hydrocortisone Modified Release Capsules
Patients with congenital adrenal hyperplasia standardised on conventional therapy is enrolled onto the study and treatment is switched to Chronocort, initially for pharmacokinetic assessment followed by longer-term biochemical and efficacy assessment
Also known as: Chronocort
Pharmacokinetic Profile (Cmax) Following Short-term Treatment With Chronocort® in Adult Patients With Congenital Adrenal Hyperplasia
The maximum plasma concentration (Cmax) of chronocort
Time frame: 24 hours
Pharmacokinetic Profile (AUC0-24) Following Short-term Treatment With Chronocort® in Adult Patients With Congenital Adrenal Hyperplasia
Area under the curve (AUC) from 0 to 24 hours (sampling occurs at the following timepoints: 2300, 0100, 0300, 0500, 0600, 0700, 0800, 0900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1900, 2100, 2300hrs)
Time frame: 24 hours (at 2300, 0100, 0300, 0500, 0600, 0700, 0800, 0900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1900, 2100, 2300hrs)
Pharmacokinetic Profile (Tmax) Following Short-term Treatment With Chronocort® in Adult Patients With Congenital Adrenal Hyperplasia
Time to maximum plasma concentration (tmax)
Time frame: 24 hours
The Percentage of Patients With 17-OHP and Androstenedione Levels at 0700h Within Proposed Optimal Ranges Whilst on Chronocort and Whilst on Standard Therapy (at Baseline)
Proposed optimal ranges of 17-OHP: 300-1200ng/dl Proposed optimal ranges of androstenedione: 40-150ng.dl for males and 30-200ng/dl for females
Time frame: Specific time point (0700hrs)
17-OHP Levels at 0700h, 1700h and 2300h
17-OHP levels at 0700h, 1700h and 2300h
Time frame: Specified time points (0700h, 1700h and 2300h)
Androstenedione Levels at 0700h, 1700h and 2300h
Androstenedione levels at 0700h, 1700h and 2300h
Time frame: Specified time points (0700h, 1700h and 2300h)
ACTH Levels at 0700h, 1700h and 2300h
ACTH levels at 0700h, 1700h and 2300h
Time frame: Specified time points (0700h, 1700h and 2300h)
AUC Values (Nmol*h/L) for Androstenedione
AUC values (nmol\*h/L) for Androstenedione for the following reporting periods: 24 hours (2300-2300h), 2300-0700h, 0700-1500h and 1500-2300h
Time frame: Specific time points (2300-2300h, 2300-0700h, 0700-1500h and 1500-2300h)
AUC Values (Nmol*h/L) for 17-OHP
AUC values (nmol\*h/L) for 17-OHP for the following reporting periods: 24 hours (2300-2300h), 2300-0700h, 0700-1500h and 1500-2300h
Time frame: Specific time points (2300-2300h, 2300-0700h, 0700-1500h and 1500-2300h)
AUC Values (Pmol*h/L) for ACTH
AUC values (pmol\*h/L) for ACTH for the following reporting periods: 24 hours (2300-2300h), 2300-0700h, 0700-1500h and 1500-2300h
Time frame: Specific time points (2300-2300h, 2300-0700h, 0700-1500h and 1500-2300h)
| Milestone | Hydrocortisone Modified Release Capsules |
|---|---|
| Started | 16 |
| Completed | 16 |
| Not completed | 0 |
The maximum plasma concentration (Cmax) of chronocort
| nmol/L | Chronocort |
|---|---|
| Pharmacokinetic Profile (Cmax) Following Short-term Treatment With Chronocort® in Adult Patients With Congenital Adrenal Hyperplasia | 601.213 ± 114.5987 |
Area under the curve (AUC) from 0 to 24 hours (sampling occurs at the following timepoints: 2300, 0100, 0300, 0500, 0600, 0700, 0800, 0900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1900, 2100, 2300hrs)
| h*nmol/L | Chroncort |
|---|---|
| Pharmacokinetic Profile (AUC0-24) Following Short-term Treatment With Chronocort® in Adult Patients With Congenital Adrenal Hyperplasia | 5027.641 ± 1247.8425 |
Time to maximum plasma concentration (tmax)
| Hours | Chronocort |
|---|---|
| Pharmacokinetic Profile (Tmax) Following Short-term Treatment With Chronocort® in Adult Patients With Congenital Adrenal Hyperplasia | 7.9 ± 2.9 |
Proposed optimal ranges of 17-OHP: 300-1200ng/dl Proposed optimal ranges of androstenedione: 40-150ng.dl for males and 30-200ng/dl for females
| percentage of participants | Hydrocortisone Modified Release Capsules |
|---|---|
| 17-OHP (baseline) | 0 |
| 17-OHP (final visit) | 12.5 |
| Androstenedione (baseline) | 56.3 |
| Androstenedione (final visit) | 81.3 |
17-OHP levels at 0700h, 1700h and 2300h
| nmol/L | Hydrocortisone Modified Release Capsules |
|---|---|
| 17-OHP: Part A, Days 1-2 (0700h) | 76.97 ± 91.986 |
| 17-OHP: Part A, Days 1-2 (1700h) | 70.99 ± 104.106 |
| 17-OHP: Part A, Days 1-2 (2300h) | 55.35 ± 93.632 |
| 17-OHP: Part A, Days 4-5 (0700h) | 7.72 ± 8.231 |
| 17-OHP: Part A, Days 4-5 (1700h) | 23.55 ± 66.046 |
| 17-OHP: Part A, Days 4-5 (2300h) | 27.27 ± 55.140 |
| 17-OHP: Part B, Visit 2 (0700h) | 24.86 ± 54.086 |
| 17-OHP: Part B, Visit 2 (1700h) | 15.17 ± 20.400 |
| 17-OHP: Part B, Visit 2 (2300h) | 26.65 ± 51.185 |
| 17-OHP: Part B, Visit 3 (0700h) | 34.87 ± 49.072 |
| 17-OHP: Part B, Visit 3 (1700h) | 13.81 ± 20.700 |
| 17-OHP: Part B, Visit 3 (2300h) | 18.95 ± 28.276 |
| 17-OHP: Part B, Visit 4 (0700h) | 13.67 ± 19.091 |
| 17-OHP: Part B, Visit 4 (1700h) | 34.70 ± 69.876 |
| 17-OHP: Part B, Visit 4 (2300h) | 22.19 ± 46.826 |
Androstenedione levels at 0700h, 1700h and 2300h
| nmol/L | Hydrocortisone Modified Release Capsules |
|---|---|
| Androstenedione: Part A, Days 1-2 (0700h) | 7.92 ± 8.474 |
| Androstenedione: Part A, Days 1-2 (1700h) | 7.54 ± 7.966 |
| Androstenedione: Part A, Days 1-2 (2300h) | 7.43 ± 9.388 |
| Androstenedione: Part A, Days 4-5 (0700h) | 3.11 ± 2.178 |
| Androstenedione: Part A, Days 4-5 (1700h) | 4.62 ± 8.005 |
| Androstenedione: Part A, Days 4-5 (2300h) | 5.37 ± 8.340 |
| Androstenedione: Part B, Visit 2 (0700h) | 4.96 ± 6.731 |
| Androstenedione: Part B, Visit 2 (1700h) | 3.47 ± 3.094 |
| Androstenedione: Part B, Visit 2 (2300h) | 3.79 ± 3.748 |
| Androstenedione: Part B, Visit 3 (0700h) | 4.57 ± 3.561 |
| Androstenedione: Part B, Visit 3 (1700h) | 3.61 ± 2.713 |
| Androstenedione: Part B, Visit 3 (2300h) | 3.91 ± 3.103 |
| Androstenedione: Part B, Visit 4 (0700h) | 3.40 ± 1.973 |
| Androstenedione: Part B, Visit 4 (1700h) | 4.19 ± 4.602 |
| Androstenedione: Part B, Visit 4 (2300h) | 3.37 ± 2.655 |
ACTH levels at 0700h, 1700h and 2300h
| pmol/L | Hydrocortisone Modified Release Capsules |
|---|---|
| ACTH: Part A, Days 1-2 (0700h) | 21.06 ± 29.767 |
| ACTH: Part A, Days 1-2 (1700h) | 20.93 ± 30.121 |
| ACTH: Part A, Days 1-2 (2300h) | 7.75 ± 9.873 |
| ACTH: Part A, Days 4-5 (0700h) | 4.16 ± 9.190 |
| ACTH: Part A, Days 4-5 (1700h) | 4.71 ± 7.382 |
| ACTH: Part A, Days 4-5 (2300h) | 7.37 ± 7.990 |
| ACTH: Part B, Visit 2 (0700h) | 7.02 ± 12.159 |
| ACTH: Part B, Visit 2 (1700h) | 5.57 ± 6.769 |
| ACTH: Part B, Visit 2 (2300h) | 8.66 ± 14.637 |
| ACTH: Part B, Visit 3 (0700h) | 9.66 ± 12.418 |
| ACTH: Part B, Visit 3 (1700h) | 4.71 ± 6.331 |
| ACTH: Part B, Visit 3 (2300h) | 6.04 ± 7.997 |
| ACTH: Part B, Visit 4 (0700h) | 12.18 ± 29.911 |
| ACTH: Part B, Visit 4 (1700h) | 13.66 ± 22.851 |
| ACTH: Part B, Visit 4 (2300h) | 9.44 ± 17.474 |
AUC values (nmol\*h/L) for Androstenedione for the following reporting periods: 24 hours (2300-2300h), 2300-0700h, 0700-1500h and 1500-2300h
| nmol*h/L | Hydrocortisone Modified Release Capsules |
|---|---|
| Androstenedione: Part A, Days 1-2 AUC (2300-2300h) | 166.19 ± 171.969 |
| Androstenedione: Part A, Days 1-2 AUC (2300-0700h) | 41.42 ± 34.133 |
| Androstenedione: Part A, Days 1-2 AUC (0700-1500h) | 65.33 ± 76.337 |
| Androstenedione: Part A, Days 1-2 AUC (1500-2300h) | 59.44 ± 65.995 |
| Androstenedione: Part A, Days 4-5 AUC (2300-2300h) | 104.37 ± 128.725 |
| Androstenedione: Part A, Days 4-5 AUC (2300-0700h) | 36.02 ± 40.225 |
| Androstenedione: Part A, Days 4-5 AUC (0700-1500h) | 32.01 ± 31.503 |
| Androstenedione: Part A, Days 4-5 AUC (1500-2300h) | 37.91 ± 58.394 |
| Androstenedione: Part B, Visit 2 AUC (2300-2300h) | 88.58 ± 86.364 |
| Androstenedione: Part B, Visit 2 AUC (2300-0700h) | 35.12 ± 43.580 |
| Androstenedione: Part B, Visit 2 AUC (0700-1500h) | 26.07 ± 22.298 |
| Androstenedione: Part B, Visit 2 AUC (1500-2300h) | 27.39 ± 23.989 |
| Androstenedione: Part B, Visit 3 AUC (2300-2300h) | 91.46 ± 65.295 |
| Androstenedione: Part B, Visit 3 AUC (2300-0700h) | 33.25 ± 26.255 |
| Androstenedione: Part B, Visit 3 AUC (0700-1500h) | 27.92 ± 16.297 |
| Androstenedione: Part B, Visit 3 AUC (1500-2300h) | 30.30 ± 26.188 |
| Androstenedione: Part B, Visit 4 AUC (2300-2300h) | 86.27 ± 70.892 |
| Androstenedione: Part B, Visit 4 AUC (2300-0700h) | 29.09 ± 23.314 |
| Androstenedione: Part B, Visit 4 AUC (0700-1500h) | 27.03 ± 20.009 |
| Androstenedione: Part B, Visit 4 AUC (1500-2300h) | 30.13 ± 28.797 |
AUC values (nmol\*h/L) for 17-OHP for the following reporting periods: 24 hours (2300-2300h), 2300-0700h, 0700-1500h and 1500-2300h
| nmol*h/L | Hydrocortisone Modified Release Capsules |
|---|---|
| 17-OHP: Part A, Days 1-2 AUC 2300-2300h | 1407.83 ± 1829.291 |
| 17-OHP: Part A, Days 1-2 AUC 2300-0700h | 243.99 ± 339.580 |
| 17-OHP: Part A, Days 1-2 AUC 0700-1500h | 607.74 ± 805.822 |
| 17-OHP: Part A, Days 1-2 AUC 1500-2300h | 556.11 ± 769.492 |
| 17-OHP: Part A, Days 4-5 AUC 2300-2300h | 446.90 ± 817.074 |
| 17-OHP: Part A, Days 4-5 AUC 2300-0700h | 169.83 ± 268.178 |
| 17-OHP: Part A, Days 4-5 AUC 0700-1500h | 91.53 ± 147.801 |
| 17-OHP: Part A, Days 4-5 AUC 1500-2300h | 190.73 ± 425.505 |
| 17-OHP: Part B, Visit 2 AUC 2300-2300h | 395.65 ± 587.533 |
| 17-OHP: Part B, Visit 2 AUC 2300-0700h | 168.01 ± 337.666 |
| 17-OHP: Part B, Visit 2 AUC 0700-1500h | 82.41 ± 91.708 |
| 17-OHP: Part B, Visit 2 AUC 1500-2300h | 145.24 ± 215.115 |
| 17-OHP: Part B, Visit 3 AUC 2300-2300h | 432.02 ± 393.897 |
| 17-OHP: Part B, Visit 3 AUC 2300-0700h | 152.63 ± 144.576 |
| 17-OHP: Part B, Visit 3 AUC 0700-1500h | 139.21 ± 147.353 |
| 17-OHP: Part B, Visit 3 AUC 1500-2300h | 140.18 ± 182.786 |
| 17-OHP: Part B, Visit 4 AUC 2300-2300h | 436.54 ± 678.052 |
| 17-OHP: Part B, Visit 4 AUC 2300-0700h | 101.33 ± 148.003 |
| 17-OHP: Part B, Visit 4 AUC 0700-1500h | 120.32 ± 172.134 |
| 17-OHP: Part B, Visit 4 AUC 1500-2300h | 214.89 ± 364.641 |
AUC values (pmol\*h/L) for ACTH for the following reporting periods: 24 hours (2300-2300h), 2300-0700h, 0700-1500h and 1500-2300h
| pmol*h/L | Hydrocortisone Modified Release Capsules |
|---|---|
| ACTH: Part A, Days 1-2 AUC (2300-2300h) | 356.25 ± 415.949 |
| ACTH: Part A, Days 1-2 AUC (2300-0700h) | 54.72 ± 70.267 |
| ACTH: Part A, Days 1-2 AUC (0700-1500h) | 166.18 ± 206.294 |
| ACTH: Part A, Days 1-2 AUC (1500-2300h) | 135.35 ± 169.002 |
| ACTH: Part A, Days 4-5 AUC (2300-2300h) | 120.00 ± 121.454 |
| ACTH: Part A, Days 4-5 AUC (2300-0700h) | 52.22 ± 62.067 |
| ACTH: Part A, Days 4-5 AUC (0700-1500h) | 21.29 ± 19.824 |
| ACTH: Part A, Days 4-5 AUC (1500-2300h) | 47.13 ± 57.145 |
| ACTH: Part B, Visit 2 AUC (2300-2300h) | 125.45 ± 118.081 |
| ACTH: Part B, Visit 2 AUC (2300-0700h) | 43.09 ± 46.711 |
| ACTH: Part B, Visit 2 AUC (0700-1500h) | 34.14 ± 48.423 |
| ACTH: Part B, Visit 2 AUC (1500-2300h) | 48.22 ± 49.078 |
| ACTH: Part B, Visit 3 AUC (2300-2300h) | 154.10 ± 172.474 |
| ACTH: Part B, Visit 3 AUC (2300-0700h) | 50.02 ± 57.268 |
| ACTH: Part B, Visit 3 AUC (0700-1500h) | 52.46 ± 64.571 |
| ACTH: Part B, Visit 3 AUC (1500-2300h) | 51.63 ± 70.735 |
| ACTH: Part B, Visit 4 AUC (2300-2300h) | 252.30 ± 420.220 |
| ACTH: Part B, Visit 4 AUC (2300-0700h) | 58.80 ± 107.955 |
| ACTH: Part B, Visit 4 AUC (0700-1500h) | 110.58 ± 329.386 |
| ACTH: Part B, Visit 4 AUC (1500-2300h) | 82.92 ± 120.287 |
Collected over Approximately 7 months. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Hydrocortisone Modified Release Capsules | — | 0/16 (0%) | 16/16 (100%) |
| Event | Hydrocortisone Modified Release Capsules |
|---|---|
| HeadacheNervous system disorders | 13/16 |
| FatigueGeneral disorders | 13/16 |
| DizzinessNervous system disorders | 8/16 |
| AnaemiaBlood and lymphatic system disorders | 7/16 |
| Weight increaseInvestigations | 7/16 |
| Appetite decreaseMetabolism and nutrition disorders | 7/16 |
| Appetite increaseMetabolism and nutrition disorders | 6/16 |
| ArthralgiaMusculoskeletal and connective tissue disorders | 5/16 |
| InsomniaPsychiatric disorders | 5/16 |
| AcneSkin and subcutaneous tissue disorders | 5/16 |
All treated subjects
| Age, Continuous(years) | Hydrocortisone Modified Release Capsules |
|---|---|
| Mean | 28.7 ± 12.97 |
| Sex: Female, Male(Participants) | Hydrocortisone Modified Release Capsules |
|---|---|
| Female | 8 |
| Male | 8 |
| Race (NIH/OMB)(Participants) | Hydrocortisone Modified Release Capsules |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 0 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 1 |
| White | 13 |
| More than one race | 1 |
| Unknown or Not Reported | 1 |
| Region of Enrollment(participants) | Hydrocortisone Modified Release Capsules |
|---|---|
| United States | 16 |
Plan to share: No
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Adrenal Hyperplasia, Congenital→
Neurocrine UK Limited