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TerminatedNCT02931565Updated May 4, 2021Results posted

Study of IW-1701, A Stimulator of Soluble Guanylate Cyclase (sGC), in Patients With Type I or II Achalasia

A Phase 2 interventional study of Olinciguat and Matching Placebo in Achalasia, sponsored by Cyclerion Therapeutics. Terminated at 5 sites in United States. Open to participants aged 18 Years to 75 Years. Per ClinicalTrials.gov, last updated 2021-05-04.

Sponsored by Cyclerion Therapeutics · Phase 2, Interventional, and Treatment

Why this study was terminated
The study was prematurely terminated due to enrollment challenges.
Phase
Phase 2
Study type
Interventional
Enrollment
9
Allocation
Randomized
Ages
18 Years to 75 Years
Sex
All
01

Study summary

The objectives of this study are as follows:

In participants with primary Type I or II achalasia, following a single 5-mg dose of olinciguat (IW-1701),

  • To assess the safety and tolerability
  • To determine the effects on measures of esophageal function by high-resolution impedance manometry (HRIM)
  • To determine the pharmacokinetic (PK) parameters
02

Conditions studied

  • Achalasia

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03

Who can participate

Ages eligible
18 Years to 75 Years
Sexes eligible
All
Accepts healthy volunteers
No

Eligibility criteria

Key Inclusion Criteria:

  • Patient has a diagnosis of primary Type I or II achalasia.
  • Patient has no contraindications to the performance of the baseline and postdose HRIM procedures per Investigator discretion.

Key Exclusion Criteria:

  • Patient has had any prior esophageal, periesophageal, or gastric surgery, or treatment with sclerosing agent.
  • More than 1 pneumatic dilation procedure to a diameter of > 2 cm in their lifetime.
  • Pneumatic dilation procedure to a diameter of > 2 cm within 1 year prior to randomization. Prior bougie dilation(s) or pneumatic dilation(s) ≤ 2 cm are allowed.
  • Prior esophageal injection of botulinum toxin (Botox) within 6 months prior to randomization or more than 2 esophageal Botox injection procedures in their lifetime.
  • Patients with malignant or premalignant esophageal lesions.
  • Patient has taken any drug that can affect gastrointestinal (GI) motility in the 72 hours before check-in through discharge from the clinic.

Other inclusion and exclusion criteria specified in the protocol.

04

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
9 participants (actual)

Study arms

  • Experimental
    IW-1701

    Single 5-mg dose of IW-1701 administered orally

    Drug: Olinciguat

  • Placebo comparator
    Placebo

    Matching placebo administered orally

    Drug: Matching Placebo

Interventions

  • DrugOlinciguat

    oral tablet

    Also known as: IW-1701

  • DrugMatching Placebo

    oral tablet

05

What researchers measure

Primary outcomes

  1. Number of Participants With Treatment Emergent Adverse Events (TEAEs), Deaths, Serious Adverse Events (SAEs), and Adverse Events Resulting in Study Drug Discontinuation (ADOs)

    An adverse event (AE) is any untoward medical occurrence, which does not necessarily have to have a causal relationship with study treatment. An SAE is any AE occurring at any dose that results in any of the following outcomes: death; life-threatening: the patient was at immediate risk of death from the reaction as it occurred; hospitalization or prolongation of existing hospitalization; persistent or significant disability/incapacity; congenital anomaly/birth defect; important medical event. Deaths and SAEs include those that occurred on or after the participant signed the informed consent at the Screening Visit through the End-of-Trial Visit. TEAEs are defined as adverse events that occurred on/after administration of the double-blind study drug and within 72 hours after the double-blind study drug administration.

    Time frame: Deaths, SAEs, and AEs: from enrollment through end-of-trial visit Day 21 (±7 days). TEAEs: from first dose of study drug through 72 hours postdose.

  2. Change From Baseline in Supine Bolus Flow Time (BFT)

    Supine BFT defined as the median measurement from the 10 available swallows in supine position as measured by high resolution impedance manometry (HRIM), and determined by the central read (seconds; longer times=more severe achalasia). Change=(postdose supine BFT - predose supine BFT).

    Time frame: Day 1: predose (baseline) and 3 hours (+15 minutes) postdose

  3. Change From Baseline in Upright BFT

    Upright BFT defined as the median measurement from the 5 available swallows in the upright position as measured by HRIM, and determined by the central read (seconds; longer times=more severe achalasia). Change = (postdose upright BFT - predose upright BFT).

    Time frame: Day 1: predose (baseline) and 3 hours (+15 minutes) postdose

  4. Change From Baseline in Supine Integrated Relaxation Pressure (IRP)

    Supine IRP defined as the median measurement from the 10 available swallows in supine position as determined by the central read (mmHg; higher pressure=more severe achalasia), measured by HRIM. Change = (postdose supine IRP - predose supine IRP).

    Time frame: Day 1: predose (baseline) and 3 hours (+15 minutes) postdose

  5. Change From Baseline in Upright IRP

    Upright IRP is defined as the median measurement from the 5 available swallows in the supine position as determined by the central read (mmHg; higher pressure=more severe achalasia), measured by HRIM. Change = (postdose upright IRP - predose upright IRP).

    Time frame: Day 1: predose (baseline) and 3 hours (+15 minutes) postdose

  6. Change From Baseline in 1 Minute Impedance Bolus Height (IBH)

    1 minute IBH defined by the height in esophagus of 200 mL saline bolus 1 minute post-bolus as measured by HRIM and determined by the central read (cm; greater height=more severe achalasia). Change = (postdose height 1 min IBH - predose height 1 min IBH)

    Time frame: Day 1: predose (baseline) and 3 hours (+15 minutes) postdose

  7. Change From Baseline in 2 Minute IBH

    2 minute IBH defined by the height in esophagus of 200 mL saline bolus 2 minutes post-bolus as measured by HRIM and determined by the central read (cm; greater height=more severe achalasia). Change = (postdose height 2 min IBH - predose height 2 min IBH).

    Time frame: Day 1: predose (baseline) and 3 hours (+15 minutes) postdose

  8. Change From Baseline in 5 Minute IBH

    5 minute IBH defined by the height in esophagus of 200 mL saline bolus 5 minutes post-bolus as determined by the central read (cm; greater height=more severe achalasia). Change = (postdose height 5 min IBH - predose height 5 min IBH).

    Time frame: Day 1: predose (baseline) and 3 hours (+15 minutes) postdose

  9. Area Under the Plasma Concentration Time Curve From Time 0 to the Last Observation (AUClast)

    Time frame: Day 1 predose: 0 (≤15 minutes); Day 1 postdose: 0.5 hours (±2 minutes), 1, 2, 3, 4, 5, 6, 8 hours (±5 minutes), 12, 17 hours (±15 minutes). Day 2 postdose 24 hours (±30 minutes). End of Treatment Visit: Day 21 (±7 days).

  10. Maximum Observed Plasma Concentration (Cmax)

    Time frame: Day 1 predose: 0 (≤15 minutes); Day 1 postdose: 0.5 hours (±2 minutes), 1, 2, 3, 4, 5, 6, 8 hours (±5 minutes), 12, 17 hours (±15 minutes). Day 2 postdose 24 hours (±30 minutes). End of Treatment Visit: Day 21 (±7 days).

  11. Time of Maximum Observed Plasma Concentration (Tmax)

    Time frame: Day 1 predose: 0 (≤15 minutes); Day 1 postdose: 0.5 hours (±2 minutes), 1, 2, 3, 4, 5, 6, 8 hours (±5 minutes), 12, 17 hours (±15 minutes). Day 2 postdose 24 hours (±30 minutes). End of Treatment Visit: Day 21 (±7 days).

06

Results

Posted May 4, 2021
Limitations and caveats
The study was prematurely terminated due to enrollment challenges after 9 participants had completed the study. The small number of participants limits the interpretation of study results.

Participant flow

Participant flow — Overall Study
MilestonePlaceboOlinciguat
Started27
Completed27
Not completed00

Outcome measures

PrimaryNumber of Participants With Treatment Emergent Adverse Events (TEAEs), Deaths, Serious Adverse Events (SAEs), and Adverse Events Resulting in Study Drug Discontinuation (ADOs)

An adverse event (AE) is any untoward medical occurrence, which does not necessarily have to have a causal relationship with study treatment. An SAE is any AE occurring at any dose that results in any of the following outcomes: death; life-threatening: the patient was at immediate risk of death from the reaction as it occurred; hospitalization or prolongation of existing hospitalization; persistent or significant disability/incapacity; congenital anomaly/birth defect; important medical event. Deaths and SAEs include those that occurred on or after the participant signed the informed consent at the Screening Visit through the End-of-Trial Visit. TEAEs are defined as adverse events that occurred on/after administration of the double-blind study drug and within 72 hours after the double-blind study drug administration.

Time frame:
Deaths, SAEs, and AEs: from enrollment through end-of-trial visit Day 21 (±7 days). TEAEs: from first dose of study drug through 72 hours postdose.
Reported as:
Count of participants · Participants
Number of Participants With Treatment Emergent Adverse Events (TEAEs), Deaths, Serious Adverse Events (SAEs), and Adverse Events Resulting in Study Drug Discontinuation (ADOs)
ParticipantsPlaceboOlinciguat
>= 1 TEAE12
Deaths00
>= 1 SAE00
>= 1 ADO00
PrimaryChange From Baseline in Supine Bolus Flow Time (BFT)

Supine BFT defined as the median measurement from the 10 available swallows in supine position as measured by high resolution impedance manometry (HRIM), and determined by the central read (seconds; longer times=more severe achalasia). Change=(postdose supine BFT - predose supine BFT).

Time frame:
Day 1: predose (baseline) and 3 hours (+15 minutes) postdose
Reported as:
Mean · seconds
Change From Baseline in Supine Bolus Flow Time (BFT)
secondsPlaceboOlinciguat
Baseline1.240 ± NA0.297 ± 0.727
Change From Baseline-0.570 ± NA0.270 ± 0.657
PrimaryChange From Baseline in Upright BFT

Upright BFT defined as the median measurement from the 5 available swallows in the upright position as measured by HRIM, and determined by the central read (seconds; longer times=more severe achalasia). Change = (postdose upright BFT - predose upright BFT).

Time frame:
Day 1: predose (baseline) and 3 hours (+15 minutes) postdose
Reported as:
Mean · seconds
Change From Baseline in Upright BFT
secondsPlaceboOlinciguat
Baseline1.160 ± NA0.002 ± 0.004
Change From Baseline0.580 ± NA0.143 ± 0.356
PrimaryChange From Baseline in Supine Integrated Relaxation Pressure (IRP)

Supine IRP defined as the median measurement from the 10 available swallows in supine position as determined by the central read (mmHg; higher pressure=more severe achalasia), measured by HRIM. Change = (postdose supine IRP - predose supine IRP).

Time frame:
Day 1: predose (baseline) and 3 hours (+15 minutes) postdose
Reported as:
Mean · mm Hg
Change From Baseline in Supine Integrated Relaxation Pressure (IRP)
mm HgPlaceboOlinciguat
Baseline17.950 ± 9.26345.214 ± 15.730
Change From Baseline3.900 ± 8.556-7.471 ± 7.456
PrimaryChange From Baseline in Upright IRP

Upright IRP is defined as the median measurement from the 5 available swallows in the supine position as determined by the central read (mmHg; higher pressure=more severe achalasia), measured by HRIM. Change = (postdose upright IRP - predose upright IRP).

Time frame:
Day 1: predose (baseline) and 3 hours (+15 minutes) postdose
Reported as:
Mean · mm Hg
Change From Baseline in Upright IRP
mm HgPlaceboOlinciguat
Baseline17.650 ± 7.14245.757 ± 12.164
Change From Baseline3.850 ± 9.122-9.350 ± 5.613
PrimaryChange From Baseline in 1 Minute Impedance Bolus Height (IBH)

1 minute IBH defined by the height in esophagus of 200 mL saline bolus 1 minute post-bolus as measured by HRIM and determined by the central read (cm; greater height=more severe achalasia). Change = (postdose height 1 min IBH - predose height 1 min IBH)

Time frame:
Day 1: predose (baseline) and 3 hours (+15 minutes) postdose
Reported as:
Mean · cm
Change From Baseline in 1 Minute Impedance Bolus Height (IBH)
cmPlaceboOlinciguat
Baseline4.60 ± NA15.80 ± 3.81
Change From Baseline10.90 ± NA-2.76 ± 4.66
PrimaryChange From Baseline in 2 Minute IBH

2 minute IBH defined by the height in esophagus of 200 mL saline bolus 2 minutes post-bolus as measured by HRIM and determined by the central read (cm; greater height=more severe achalasia). Change = (postdose height 2 min IBH - predose height 2 min IBH).

Time frame:
Day 1: predose (baseline) and 3 hours (+15 minutes) postdose
Reported as:
Mean · cm
Change From Baseline in 2 Minute IBH
cmPlaceboOlinciguat
Baseline2.90 ± NA14.73 ± 4.32
Change From Baseline8.90 ± NA-2.37 ± 3.88
PrimaryChange From Baseline in 5 Minute IBH

5 minute IBH defined by the height in esophagus of 200 mL saline bolus 5 minutes post-bolus as determined by the central read (cm; greater height=more severe achalasia). Change = (postdose height 5 min IBH - predose height 5 min IBH).

Time frame:
Day 1: predose (baseline) and 3 hours (+15 minutes) postdose
Reported as:
Mean · cm
Change From Baseline in 5 Minute IBH
cmPlaceboOlinciguat
Baseline2.30 ± NA13.07 ± 3.62
Change from Baseline5.80 ± NA-1.52 ± 4.99
PrimaryArea Under the Plasma Concentration Time Curve From Time 0 to the Last Observation (AUClast)
Time frame:
Day 1 predose: 0 (≤15 minutes); Day 1 postdose: 0.5 hours (±2 minutes), 1, 2, 3, 4, 5, 6, 8 hours (±5 minutes), 12, 17 hours (±15 minutes). Day 2 postdose 24 hours (±30 minutes). End of Treatment Visit: Day 21 (±7 days).
Reported as:
Geometric mean · h*ng/mL
Area Under the Plasma Concentration Time Curve From Time 0 to the Last Observation (AUClast)
h*ng/mLOlinciguat
Area Under the Plasma Concentration Time Curve From Time 0 to the Last Observation (AUClast)700.8 ± 17.4
PrimaryMaximum Observed Plasma Concentration (Cmax)
Time frame:
Day 1 predose: 0 (≤15 minutes); Day 1 postdose: 0.5 hours (±2 minutes), 1, 2, 3, 4, 5, 6, 8 hours (±5 minutes), 12, 17 hours (±15 minutes). Day 2 postdose 24 hours (±30 minutes). End of Treatment Visit: Day 21 (±7 days).
Reported as:
Geometric mean · ng/mL
Maximum Observed Plasma Concentration (Cmax)
ng/mLOlinciguat
Maximum Observed Plasma Concentration (Cmax)43.4 ± 17.7
PrimaryTime of Maximum Observed Plasma Concentration (Tmax)
Time frame:
Day 1 predose: 0 (≤15 minutes); Day 1 postdose: 0.5 hours (±2 minutes), 1, 2, 3, 4, 5, 6, 8 hours (±5 minutes), 12, 17 hours (±15 minutes). Day 2 postdose 24 hours (±30 minutes). End of Treatment Visit: Day 21 (±7 days).
Reported as:
Median · hours
Time of Maximum Observed Plasma Concentration (Tmax)
hoursOlinciguat
Time of Maximum Observed Plasma Concentration (Tmax)5.0 (4 to 8)

Adverse events

Collected over Deaths and SAEs: from enrollment through end-of trial visit Day 21 (±7 days). AEs: from first dose of study drug through Day 2 (±72 hours).. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Placebo0/2 (0%)0/2 (0%)1/2 (50%)
Olinciguat0/7 (0%)0/7 (0%)2/7 (28.6%)
Most frequent other events
Most frequent other events
EventPlaceboOlinciguat
DizzinessNervous system disorders1/20/7
PresyncopeNervous system disorders0/21/7
Oropharyngeal painRespiratory, thoracic and mediastinal disorders0/21/7

Baseline characteristics

Due to privacy and reidentification concerns (rare disease, small population), the arms are combined for Baseline characteristics, and race and ethnicity data are not provided.

Age, Continuous
Age, Continuous(years)Placebo or Olinciguat
Mean46.6 ± 14.4
Sex: Female, Male
Sex: Female, Male(Participants)Placebo or Olinciguat
Female3
Male6
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Placebo or Olinciguat
Hispanic or LatinoNA
Not Hispanic or LatinoNA
Unknown or Not ReportedNA
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Placebo or Olinciguat
American Indian or Alaska NativeNA
AsianNA
Native Hawaiian or Other Pacific IslanderNA
Black or African AmericanNA
WhiteNA
More than one raceNA
Unknown or Not ReportedNA
07

Study locations

5 sites
  • Connecticut Clinical Research Foundation, Gastroenterology Institute
    Bristol, Connecticut 06010, United States
  • Mayo Clinic
    Rochester, Minnesota 55905, United States
  • Washington University in St. Louis - School of Medicine
    Saint Louis, Missouri 63110, United States
  • Vanderbilt University Medical Center
    Nashville, Tennessee 37232, United States
  • University of Utah School of Medicine, Division of Gastroenterology, Hepatology & Nutrition
    Salt Lake City, Utah 84132, United States
08

References and documents

Study documents

  • Study protocol · Oct 3, 2017
  • Statistical analysis plan · Jul 23, 2018

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Yes

09

Registry details

Key details

Study ID
NCT02931565
Lead sponsor
Cyclerion Therapeutics
Responsible party
Sponsor
First posted
Oct 13, 2016
Start date
Apr 6, 2017
Primary completion
May 1, 2018
Completion
May 1, 2018
Results posted
May 4, 2021
Last update
May 4, 2021

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
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