NOX-100 for Preventing Hypotension During Hemodialysis

• Number of hypotension episode requiring intervention [ Time Frame: 10 weeks ] [ Designated as safety issue: No ]
  Number reduction of symptomatic hypotension requiring intervention during HD with NOX-100 treatment.
  
  

• systolic blood pressure (SBP) [ Time Frame: 10 weeks ] [ Designated as safety issue: No ]
  Change in systolic blood pressure
  
  
• Onset of symptoms of hypotension during HD [ Time Frame: 10 weeks ] [ Designated as safety issue: No ]
  Time to onset of symptoms of hypotension during HD
  
  
• The need for treatment intervention to raise BP. [ Time Frame: 10 weeks ] [ Designated as safety issue: No ]
  Time to conduct a treatment intervention to raise BP
  
  

This is a 2-stage, prospective, randomized, double-blind, multi-dose, placebo-controlled, cross-over, phase IIa study to evaluate the safety, tolerability and efficacy profiles of NOX-100 to reduce the number of intradialytic hypotension episodes. At single-blind stage I, the eligible subject will receive a 1-week run-in period followed by a 1-week NOX-100 treatment in a dose of 0.4mg/kg/hr. To evaluate the clearance of NOX-100, plasma levels of NOX-100 at the end of the 1st dialysis and prior to the 2nd dialysis will be measured. An interim analysis will be undertaken after the completion of first stage. The following process should be conducted only if the plasma level of NOX-100 decreases by 90% or more in these patients and all safety data have been reviewed by the medical monitor.

At double blind stage II, patients will be randomized to one of the following treatment sequences in a 1:1 ratio.

• Sequence A: NOX-100 treatment phase followed by Placebo treatment phase
• Sequence B: Placebo treatment phase followed by NOX-100 treatment phase

After a 1-week placebo, the subjects will receive the two 4-week treatment (sequence A or sequence B)which are separated by 1-week wash-out. In the NOX-100 treatment phase, subjects will subsequently receive NOX-100 in doses of 1.2, 2.5, 5, and 10 mg/kg/hr at the first three dialysis sessions over each week. In the placebo treatment phase, subjects will receive comparative placebo for four weeks. For the first 20 subjects, the treatment dose could be escalated only after the individual safety data have been reviewed by an unblinded medical monitor.

To confirm if there is hepatic metabolism of NOX-100 between dialysis sessions, a pre-dialysis plasma level will be tested at the 2nd dialysis of Week 2, 5, 7 and 10 in the second stage.

In both stages, the blood pressure will be measured pre-HD, every 30 minutes during HD and post-HD for monitoring the hypotension episode. For safety assessment, all AE(s), SAE(s) and any signs/symptoms during HD will be recorded. The safety of study drug will be followed until 4 weeks after last treatment.

A Data and Safety Monitoring Board (DSMB) will be established prior to start of the trial and the DSMB meeting will be hold every 6~12 months during study period. Both medical monitor and DSMB will be responsible for safeguarding the interests of trial participants.