Stuart Bloom, BA, MBBS, MRCP (UK), DM1, Tariq Iqbal, DM2, Chuka Nwokolo, MD3, Vipul Jairath, BSc, MBBCh, PhD, MRCP (UK)4, Jesse Hall, MD5, Bruce Dzyngel, BSc (Hons)5, Peter Gardzinski, MSc5
1University College London Hospitals, London, England, United Kingdom; 2Queen Elizabeth Hospital Birmingham, Birmingham, England, United Kingdom; 3University Hospital Coventry & Warwickshire, Coventry, England, United Kingdom; 4Robarts Clinical Trials, Western University, London, ON, Canada; 5Sublimity Therapeutics, Inc, Solana Beach, CA
Introduction: Patients (pts) with ulcerative colitis (UC) who have failed immunosuppressants (IM) and biologics have demonstrated poorer response to subsequent therapies.1 Cyclosporine (CsA) could be an alternative option since it has similar efficacy and safety to infliximab for severe UC,2 but its use is limited due to concerns regarding systemic toxicity. ST-0529 is a novel oral formulation of CsA that delivers the drug directly to the colon, allowing for precise targeting of the diseased tissue while potentially limiting the risk of systemic toxicity.
Methods: A phase IIa study was conducted in a total of 118 subjects with baseline Disease Activity Index (DAI) < 6 (mild UC) or ≥6 (moderate UC), randomized 1:1 to receive 75 mg ST-0529 once daily (n=53) or placebo (n=65) for 4 weeks. The primary endpoint was the induction of clinical remission (DAI score ≤2, with no individual score >1 and rectal bleeding subscore of 0 or 1). The secondary endpoints were safety and tolerability, mucosal healing, clinical response, and histological healing.3,4 Post-hoc subgroup analysis was conducted in 93 subjects with moderate UC, of whom 75 received at baseline 5-ASA alone or in combination (n=51, with/without steroids; n=24, with/without IM) to evaluate the impact of them on clinical improvement (DAI reduction ≥3) and composite subscores (rectal bleeding and stool frequency with or without mucosal appearance evaluation).
Results: Table 1 shows the influence of baseline medications on the improvement of DAI scores in subjects with moderate UC, and tables 2 and 3, the impact of IM on the analyzed parameters. Safety was balanced for the overall population.
Discussion: This analysis showed that clinical improvement and composite subscores were influenced by baseline medication in pts with moderate UC. The poorer response in the IM treated group was potentially a function of severity or refractory disease and/or concomitant use of UC medication (prednisone < 10mg/day, 5-ASAs or purine analogues) at baseline. Concomitant UC medications were not restricted at study entry as long as pts maintained stable dosing regimens throughout. These preliminary data support further investigation of ST-0529 usage as a twice daily treatment for the induction and maintenance of remission in UC pts with moderate disease, which will be the focus of the phase IIb trial.
1Reinglas J et al.WJG.2018;24:3567–82.
2Laharie D et al.Lancet.2012;380:1909–15.
3O´Donoghue D et al.Gut.2013;62(Suppl 2):A1.3-A2.
4Bloom S et al.JCC.2019;13(Suppl 1):S11.
Citation: Stuart Bloom, BA, MBBS, MRCP (UK), DM; Tariq Iqbal, DM; Chuka Nwokolo, MD; Vipul Jairath, BSc, MBBCh, PhD, MRCP (UK); Jesse Hall, MD; Bruce Dzyngel, BSc (Hons); Peter Gardzinski, MSc. P0521 - A RANDOMIZED, MULTICENTER, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY OF A TARGETED RELEASE ORAL CYCLOSPORINE FORMULATION IN THE TREATMENT OF MILD TO MODERATE ULCERATIVE COLITIS: INFLUENCE OF IMMUNOSUPPRESSANTS AT BASELINE. Program No. P0521. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.