A Study to Evaluate Safety and Explore Efficacy of New Lipase NHS7108 in Adult Participants With Exocrine Pancreatic Insufficiency.
Condition(s) studied
Investigational drug(s) / intervention(s)
NHS7108: NHS7108 is the experimental drug. It is a recombinant, modified version of a triacylglycerol lipase enzyme derived from the bacteria Bacillus thermoamylovorans and produced by fermentation of recombinant Escherichia coli. Unit dose strength: 10 mg (approximately 25,000 LU) per capsule.
Zenpep®: Zenpep® is the active comparator. It is a combination of lipases, proteases, and amylases. Unit dose strength: 25,000 LU per capsule.
Study summary
The purpose of this study is to measure the safety and explore the efficacy of 4 different doses of the new lipase NHS7108 in participants with EPI. In this study, all participants will take NHS7108 daily for 14 days and a matching dose of standard-of-care, pancrelipase (Zenpep®) for 14 days according to Treatment Sequence assignment. Both NHS7108 and Zenpep® are oral capsules that will be taken with each of the daily 3 meals and 2 snacks. Participants will interrupt all of their usual pancrelipase/pancreatin treatment for up to 8 days during screening and for the entire 2 treatment periods, where participants will take either the new lipase NHS7108 or a matching dose of the standard-of-care pancrelipase (Zenpep®). Participants will be asked to stay in a setting that allows controlled diet and 72-hour stool collection for approximately 7 days during the screening period and again for approximately 7 days at the end of each treatment period. During these 3 supervised periods, participants will receive a standardized diet with a predefined amount of fat and protein, stools will be collected in special containers and during the last day of the treatment period, blood samples will be obtained to measure fat absorption. These are essential to ensure valid assessment of participants' fat and protein absorption. Outside the 3 supervised periods, participants will be provided with guidelines and recommendations to create their own home-controlled meals and snacks according to their preferences for the remainder of the study duration.
Number of Participants:
The aim is to have 56 participants completing the study. Assuming approximately 14% drop-out rate, approximately 66 participants will be randomized to study intervention.
Study Arms and Duration:
The total study duration for each participant will be about 100 days (approximately 14 weeks), including:
* A screening period of up to approximately 28 days (might be extended up to a total of 56 days) prior to the first dose administration.
* A crossover treatment period (2 treatment periods: approximately 14 days each, with no washout in between). For each treatment period, study intervention will be administered 5 times a day (with 3 main meals and 2 snacks). After completion of Treatment Period 1, the participant will receive and start the new treatment for Treatment Period 2.
* An end of treatment/early discontinuation visit within approximately 7 days of the last study intervention dose.
* An end-of-study safety follow-up visit at 14 (±2) days after the last dose administration.
Very low dose group: 10 mg NHS7108 (approximately 25,000 LU)/main meal and snack; 25,000 LU Zenpep/main meal and snack (50 mg NHS7108 \[approximately 125,000 LU\] per day; 125,000 LU Zenpep per day)
Low dose group: 20 mg NHS7108 (approximately 50,000 LU)/main meal and 10 mg NHS7108 (approximately 25,000 LU)/snack; 50,000 LU Zenpep/main meal and 25,000 LU Zenpep/snack (80 mg NHS7108 \[approximately 200,000 LU\] per day; 200,000 LU Zenpep per day)
Medium dose group: 40 mg NHS7108 (approximately 100,000 LU)/main meal and 20 mg (approximately 50,000 LU) NHS7108/snack; 100,000 LU Zenpep/main meal and 50,000 LU Zenpep/snack (160 mg \[approximately 400,000 LU\] NHS7108 per day; 400,000 LU Zenpep per day)
High dose group: 60 mg NHS7108 (approximately 150,000 LU)/main meal and 30 mg NHS7108 (approximately 75,000 LU)/snack; 150,000 LU Zenpep/main meal and 75,000 LU Zenpep/snack (240 mg NHS7108 \[approximately 600,000 LU\] per day; 600,000 LU Zenpep per day).
The dose for participants \< 60 kg who are assigned to the high dose group will need to be weight-adjusted to ensure that they receive no more than 10,000 LU/kg/day.
Eligibility
Primary outcome measure(s)
- Primary Objectives: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — 14 days after NHS7108 Treatment
Endpoint: Number of participants reporting 1 or more adverse events. Events Meeting the AE Definition: * Any abnormal laboratory test results or other safety assessments including those that worsen from baseline, considered clinically significant in the medical and scientific judgment of the Investigator. * Exacerbation of a chronic or in or intermittent pre-existing condition including either an increase in frequency and/or intensity of the condition. * New condition detected or diagnosed after study intervention administration even though it may have been present before the start of the study. * Signs, symptoms, or the clinical sequelae of a suspected intervention-intervention interaction. * Signs, symptoms, or the clinical sequelae of a suspected overdose of either study intervention or a concomitant medication. - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — At screening and end-of-study/safety follow-up visit. A brief symptom-directed physical examination may be performed at all other visits and at any time throughout the study, as clinically indicated.
A complete physical examination will be performed and include, at a minimum, assessments of general appearance, head, ears, eyes, nose, throat, neck (including thyroid), skin, cardiovascular system, respiratory system, GI system, musculoskeletal system, lymph nodes, and nervous system. - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include vital sign measurement, which will include Blood Pressure. Units of measurement for Blood Pressure: Millimeters of mercury (mm Hg) - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include vital sign measurement, which will include Heart Rate. Units of measurement for Heart Rate: Beats Per Minute (BPM) - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include vital sign measurement, which will include respiratory rate measurement. Units of measurement for respiratory rate measurement: breaths per minute (bpm). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment.
Endpoint: Changes from baseline in safety parameters include vital sign measurement, which will include body temperature. Units of measurement for body temperature: degrees Celsius (°C). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include 12-Lead electrocardiogram (ECG) recording. 12-lead ECG will be recorded as single bedside measurements using an ECG machine that automatically calculates the heart rate and measures: 1. PR interval (millisecond (ms)). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include 12-Lead electrocardiogram (ECG) recording. 12-lead ECG will be recorded as single bedside measurements using an ECG machine that automatically calculates the heart rate and measures: 2. QRS, and QT (QT interval corrected for heart rate using Fridericia's correction \[QTcF\]) intervals. - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — 14-day after NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Hematology tests: 1. Platelet count (x10E3/uL) 2. White Blood Cell count with differential (percent and absolute): Neutrophils (x10E3/uL) - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — 14-day after NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Hematology: 3\. RBC count (x10E6/uL) - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — 14-day after NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Hematology: 4\. Hemoglobin (g/dl) 5. Mean cell hemoglobin concentration (g/dl) - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — 14-day after NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Hematology: 6\. RBC indices: Mean Corpuscular Volume (femtoliters (fL)). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — 14-day after NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Hematology: 7\. Mean Corpuscular Hemoglobin (picograms (pg)). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — 14-day after NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Hematology: 8\. Hematocrit (%), 9. Reticulocytes (%), 10. WBC count with differential (percent and absolute): Lymphocytes (%), Monocytes (%), Eosinophils(%), Basophils (%). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — 14-day after NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Coagulation: 1. Fibrinogen (mg/dL), Prothrombin time (Sec) , Activated partial thromboplastin time (Sec). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — 14 -day after NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Coagulation: 2. Prothrombin time (Sec) , 3. Activated partial thromboplastin time (Sec). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Clinical Chemistry: 1. Bicarbonate (mmol/L), 2. Sodium(mmol/L), 3. Potassium (mmol/L), 4. Chloride (mmol/L). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Clinical Chemistry: 5. Albumin (g/dL), 6. Total protein (g/dL). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Clinical Chemistry: 7. Blood glucose (fasting at screening only) (mg/dL), 8. Phosphate (mg/dL), 9. Calcium (mg/dL), 10. Urea (mg/dL), 11. Creatinine (mg/dL), 12. Uric acid/urate (mg/dL), 13. Total and direct bilirubin (mg/dL), 14. Triglycerides (mg/dL), 15. Total Cholesterol (mg/dL). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Clinical Chemistry: 16. Creatine kinase (U/L), 17. AST/SGOT (U/L), 18. ALT/SGPT (U/L), 19. Alkaline phosphatase 2 (U/L), 20. GGT (U/L), 21. Lactate dehydrogenase (U/L). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — After 14 -day NHS7108 treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Routine Urinalysis: Leukocyte esterase, Protein, Urobilinogen, Ketones, Bilirubin, Microscopic examination (if blood, leukocytes, or protein is abnormal), Blood, pH, Nitrite, Specific gravity, Glucose. All the above urinalysis are reported in absolute units. They are semi-quantitative. Hence no units of measurement. - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — Serum Beta-HCG pregnancy test (mIU/mL) (at screening) and urine pregnancy tests (at all other timepoints) as needed for women of childbearing potential.
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Pregnancy Testing. Highly sensitive serum Beta-HCG pregnancy test (mIU/mL) and urine pregnancy tests (no units) - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety. — Will be performed at screening in women with unconfirmed reproductive potential status only (to confirm postmenopausal state).
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Other Screening Tests: 1. Follicle Stimulating Hormone- FSH (IU/L). - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety — 14 days after NHS7108 Treatment
Endpoint: Changes from baseline in safety parameters include clinical laboratory tests, which include- Other Screening Tests: 2. Serology: HIV antibody, hepatitis B surface antigen, and hepatitis C virus antibody, hepatitis B surface antibody and hepatitis B core antibody total. (No units) - Primary Objective: Safety of different doses of NHS7108 administered daily for 14 days in participants with exocrine pancreatic insufficiency (EPI). Coefficient of nitrogen absorption (CNA) will be measured as part of safety — After 14 days NHS7108 treatment
Endpoint: Change from baseline in the Coefficient of Nitrogen Absorption (CNA).CNA expresses the ratio between the amount of nitrogen absorbed and the amount of nitrogen provided with the diet. It will also be analyzed from the stool collection period. CNA is calculated as follows: nitrogen intake (g) - excreted nitrogen (g)/nitrogen intake (g), expressed as percentage (%).
Trial sites (39)
| Facility | City | Region | Status |
|---|---|---|---|
| HonorHealth Research Institute | Scottsdale | Arizona | Not Yet Recruiting |
| University of Arkansas for Medical Sciences Hospital - University | Little Rock | Arkansas | Not Yet Recruiting |
| Keck Hospital of USC | Los Angeles | California | Not Yet Recruiting |
| Cedars Sinai Medical Center - Inflammatory Bowel Disease Ctr | Los Angeles | California | Not Yet Recruiting |
| Omnicure Clinical Research | Doral | Florida | Not Yet Recruiting |
| Advent Health Medical Group | Orlando | Florida | Not Yet Recruiting |
| Johnson County Clin-Trials (JCCT) | Lenexa | Kansas | Recruiting |
| Johns Hopkins Medicine - Pulmonary and Critical Care | Baltimore | Maryland | Not Yet Recruiting |
| Billings Clinic Hospital - Public | Billings | Montana | Not Yet Recruiting |
| University Hospitals Cleveland Medical Center/Rainbow Babies & Children's Hospital | Cleveland | Ohio | Not Yet Recruiting |
| The Ohio State University College of Medicine (OSUCOM) | Columbus | Ohio | Not Yet Recruiting |
| University of Oklahoma Health Sciences Center - Pediatrics Hospital - University | Oklahoma City | Oklahoma | Not Yet Recruiting |
| Penn State Health | Hershey | Pennsylvania | Recruiting |
| Vanderbilt University Medical Center - Pulmonary Hospital - University | Nashville | Tennessee | Not Yet Recruiting |
| Medical Center Medconsult Pleven, Lovech branch | Lovech | Bulgaria | Not Yet Recruiting |
| Medical Center Medconsult Pleven | Pleven | Bulgaria | Not Yet Recruiting |
| MC Hipokrat-N - Gastroenterology | Plovdiv | Bulgaria | Not Yet Recruiting |
| Medical Center Excelsior base 3 | Sofia | Bulgaria | Not Yet Recruiting |
| MH Egészségügyi Központ - Gasztroenterológiai Osztály | Budapest | Hungary | Not Yet Recruiting |
| Semmelweis Egyetem. Sebeszeti, Transzplantacios es Gasztroenterologiai Klinika - Gasztroenterologiai Osztaly | Budapest | Hungary | Recruiting |
| Szegedi Tudomanyegyetem Altalanos Orvostudomanyi Kar I. sz. Belgyogyaszati Klinika | Csongrád | Hungary | Recruiting |
| AOU Policlinico G. Rodolico - Ospedale San Marco - Broncopneumologia Pediatrica e Fibrosi Cistica Hospital - Public | Catania | Catania | Not Yet Recruiting |
| Humanitas Research Hospital | Rozzano | Lombardy | Not Yet Recruiting |
| Azienda Ospedaliero Universitaria Policlinico Gaetano Martino - Gastroenterologia Pediatrica e Fibrosi Cistica Academic / University Clinic | Messina | Messina | Not Yet Recruiting |
| Azienda Ospedaliero Universitaria Careggi - Gastroenterologia | Florence | Italy | Not Yet Recruiting |
| IRCCS Ospedale San Raffaele - Endoscopia Biliopancreatica | Milan | Italy | Not Yet Recruiting |
| Azienda Ospedaliera Universitaria Sant'Andrea | Roma | Italy | Not Yet Recruiting |
| WIP Warsaw IBD Point Profesor Kierkus | Pomorskie | Warszawa | Not Yet Recruiting |
| Bonifraterskie Centrum Medyczne Sp. z o.o. Oddzial w Lodzi, Szpital Zakonu Bonifratrow Sw. Jana Bozego w Lodzi - Dzial Endoskopi | Lodz | Łódź Voivodeship | Not Yet Recruiting |
| Hospital Clinic De Barcelona - Cirug-ía General y Digestiva | Madrid | Barcelona | Not Yet Recruiting |
| Hospital Universitario La Paz Hospital - University | Madrid | Madrid | Not Yet Recruiting |
| Universidad de Murcia - Hospital Universitario Virgen de la Arrixaca (HUVA) | Murcia | Murcia | Not Yet Recruiting |
| Hospital Universitari Arnau de Vilanova de Lleida | Lleida | Spain | Recruiting |
| H. General de Málaga - Endocrinología | Málaga | Spain | Recruiting |
| Hospital Universitario y Politecnico La Fe - Neumología | Valencia | Spain | Recruiting |
| Liverpool University Hospitals NHS Foundation Trust - Royal Liverpool University Hospital | Liverpool | Merseyside | Not Yet Recruiting |
| Northern Ireland Clinical Research Facility (NICRF) Solo/Group Practice | Belfast | Northern Ireland | Not Yet Recruiting |
| Greater Glasgow and Clyde | Glasgow | United Kingdom | Not Yet Recruiting |
| The Newcastle Upon Tyne Hospitals NHS Foundation Trust - Royal Victoria Infirmary | Newcastle upon Tyne | United Kingdom | Not Yet Recruiting |
Other trials for the same condition
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
View NCT07559175 on ClinicalTrials.gov ↗ ← All trials in Spain