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A Study to Evaluate the Efficacy and Safety of Vonoprazan Compared to Placebo in Participants With Symptomatic Non-Erosive Gastroesophageal Reflux Disease

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ClinicalTrials.gov Identifier: NCT04799158
Recruitment Status : Recruiting
First Posted : March 16, 2021
Last Update Posted : June 11, 2021
Sponsor:
Information provided by (Responsible Party):
Phathom Pharmaceuticals, Inc.

Brief Summary:
The primary objectives of this study are to assess the efficacy of vonoprazan (10 mg, 20 mg, and 40 mg On-Demand) compared to placebo (On-Demand) in relief of episodic heartburn over 6 weeks in participants with symptomatic non-erosive gastroesophageal reflux disease (NERD), and to assess the safety of vonoprazan (10 mg, 20 mg, and 40 mg On-Demand) compared to placebo (On-Demand) in participants with symptomatic NERD.

Condition or disease Intervention/treatment Phase
Non-Erosive Gastro-Esophageal Reflux Disease Heartburn Drug: Vonoprazan Drug: Placebo Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 334 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Masking Description: During the Run-In Period, participants will receive open-label vonoprazan.
Primary Purpose: Treatment
Official Title: A Phase 2, Randomized, Double-Blind, Multicenter Study to Evaluate the Efficacy and Safety of Vonoprazan 10 mg, 20 mg, and 40 mg Compared to Placebo for Relief of Episodic Heartburn in Subjects With Symptomatic Non-Erosive Gastroesophageal Reflux Disease
Actual Study Start Date : March 25, 2021
Estimated Primary Completion Date : December 13, 2021
Estimated Study Completion Date : December 20, 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: GERD Heartburn

Arm Intervention/treatment
Experimental: Run-In Period
Participants will receive vonoprazan 20 mg once daily for up to 4 weeks.
Drug: Vonoprazan
Orally via capsules

Experimental: Vonoprazan 10 mg: On-Demand Treatment Period
Participants who have stable disease (no heartburn on the last 7 days of the Run-In Period) will take vonoprazan 10 mg when heartburn occurs during the 6 week On-Demand Treatment Period. Participants can take no more than one dose in a 24 hour period.
Drug: Vonoprazan
Orally via capsules

Experimental: Vonoprazan 20 mg: On-Demand Treatment Period
Participants who have stable disease (no heartburn on the last 7 days of the Run-In Period) will take vonoprazan 20 mg when heartburn occurs during the 6 week On-Demand Treatment Period. Participants can take no more than one dose in a 24 hour period.
Drug: Vonoprazan
Orally via capsules

Experimental: Vonoprazan 40 mg: On-Demand Treatment Period
Participants who have stable disease (no heartburn on the last 7 days of the Run-In Period) will take vonoprazan 40 mg when heartburn occurs during the 6 week On-Demand Treatment Period. Participants can take no more than one dose in a 24 hour period.
Drug: Vonoprazan
Orally via capsules

Placebo Comparator: Placebo: On-Demand Treatment Period
Participants who have stable disease (no heartburn on the last 7 days of the Run-In Period) will take a placebo when heartburn occurs during the 6 week On-Demand Treatment Period. Participants can take no more than one dose in a 24 hour period.
Drug: Placebo
Orally via capsules




Primary Outcome Measures :
  1. Percentage of Evaluable Heartburn Episodes Completely Relieved Within 3 Hours and With No Further Heartburn Reported for 24 Hours After Taking Study Drug [ Time Frame: On-Demand Treatment Period Day 1 to Day 42 ]

    An evaluable heartburn episode is an episode for which study drug is taken and for which the participant completes at least one entry in the heartburn episode diary.

    For a heartburn episode to be considered completely relieved, a participant must not take rescue antacid within 3 hours of taking study drug.



Secondary Outcome Measures :
  1. Percentage of Evaluable Heartburn Episodes Completely Relieved Within 3 Hours After Taking Study Drug [ Time Frame: On-Demand Treatment Period Day 1 to Day 42 ]

    An evaluable heartburn episode is an episode for which study drug is taken and for which the participant completes at least one entry in the heartburn episode diary.

    For a heartburn episode to be considered completely relieved, a participant must not take rescue antacid within 3 hours of taking study drug.


  2. Percentage of Evaluable Heartburn Episodes for Each Participant That are Completely Relieved Within 3 Hours and With No Further Heartburn Reported for 24 Hours After Taking Study Drug [ Time Frame: On-Demand Treatment Period Day 1 to Day 42 ]

    An evaluable heartburn episode is an episode for which study drug is taken and for which the participant completes at least one entry in the heartburn episode diary.

    For a heartburn episode to be considered completely relieved, a participant must not take rescue antacid within 3 hours of taking study drug.


  3. Mean Number of Tablets of Rescue Antacid Taken Per Day Over the On-Demand Treatment Period [ Time Frame: On-Demand Treatment Period Day 1 to Day 42 ]
  4. Percentage of Participants With Complete Relief of Heartburn Within 3 Hours After the First Episode and With No Further Heartburn Reported for 24 Hours After Taking Study Drug [ Time Frame: On-Demand Treatment Period Day 1 to Day 42 ]
  5. Percentage of Days Study Drug was Taken Over the On-Demand Treatment Period [ Time Frame: On-Demand Treatment Period Day 1 to Day 42 ]
  6. Percentage of 24-Hour Heartburn-Free Days Over the On-Demand Treatment Period [ Time Frame: On-Demand Treatment Period Day 1 to Day 42 ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria for Run-In Period

  1. The participant is ≥18 years of age at the time of informed consent signing.
  2. In the opinion of the investigator or subinvestigators, the participant is capable of understanding and complying with protocol requirements.
  3. The participant signs and dates a written informed consent form (ICF) and any required privacy authorization prior to the initiation of any study procedures. The participant is informed of the full nature and purpose of the study, including possible risks and side effects. The participant has the ability to cooperate with the investigator. Ample time and opportunity should be given to read and understand verbal and/or written instructions.
  4. The participant identified their main symptom as heartburn, a burning sensation in the retrosternal area (behind the breastbone).
  5. History of episodes of heartburn for 6 months or longer prior to screening.
  6. Heartburn reported on 4 or more days during any 7 consecutive days in the Screening Period as recorded in the electronic diary.
  7. A female participant of childbearing potential who is or may be sexually active with a nonsterilized male partner agrees to routinely use adequate contraception from the signing of informed consent until 4 weeks after the last dose of study drug.

Inclusion Criteria for On-Demand Treatment Period

  1. The participant completes the Run-In Period, during which the participant was at least 80% compliant with open-label study drug.
  2. The participant has no heartburn the last 7 days of the Run-In Period.
  3. The participant continues to meet the inclusion and exclusion criteria for the Run-In Period (except Inclusion Criteria 4).
  4. Participant completes at least 80% of diary entries during Run-In Period, including 80% of diary entries over the last 7 days.

Exclusion Criteria for Run-In Period

  1. Endoscopically confirmed erosive esophagitis (EE) during the Screening Period assessed by the investigator. Endoscopy should be performed after participants meet Inclusion Criteria 6. Any endoscopic confirmation performed in a routine clinical setting within 7 days before signing the informed consent is acceptable to use for the purpose of fulfilling the screening requirement.
  2. The participant has irritable bowel syndrome (IBS).
  3. The participant has a history of or is suspected of having functional heartburn diagnosed by the Rome IV criteria.
  4. The participant has a history of or is suspected of having functional dyspepsia diagnosed by the Rome IV criteria.
  5. The participant has endoscopic Barrett's esophagus (>1 cm of columnar-lined esophagus) and/or definite dysplastic changes in the esophagus.
  6. The participant has any other condition affecting the esophagus, including eosinophilic esophagitis; esophageal varices; viral or fungal infection; esophageal stricture; a history of radiation therapy, radiofrequency ablation, endoscopic mucosal resection, or cryotherapy to the esophagus; or any history of caustic or physiochemical trauma (including sclerotherapy or esophageal variceal band ligation). However, participants diagnosed with Schatzki's ring (mucosal tissue ring around lower esophageal sphincter) or hiatal hernia are eligible to participate.
  7. The participant has scleroderma (systemic sclerosis).
  8. The participant has a history of surgery or endoscopic treatment affecting gastroesophageal reflux, including fundoplication and dilation for esophageal stricture (except Schatzki's ring) or a history of gastric or duodenal surgery (except endoscopic removal of benign polyps).
  9. The participant has an active gastric or duodenal ulcer within 4 weeks before the first dose of study drug.
  10. Use of prescription or non-prescription proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) throughout the study.
  11. The participant has received any investigational compound (including those in post-marketing studies) within 30 days prior to the start of the Screening Period. A participant who has been screen failed from another clinical study and who has not been dosed may be considered for enrollment in this study.
  12. The participant is a study site employee, an immediate family member, or is in a dependent relationship with a study site employee who is involved in the conduct of this study (eg, spouse, parent, child, sibling) or who may have consented under duress.
  13. The participant has cutaneous lupus erythematosus or systemic lupus erythematosus.
  14. The participant has had clinically significant upper or lower gastrointestinal bleeding within 4 weeks prior to randomization.
  15. The participant has Zollinger-Ellison syndrome or other gastric acid hypersecretory conditions.
  16. The participant has a history of hypersensitivity or allergies to vonoprazan (including the formulation excipients: D-mannitol, microcrystalline cellulose, hydroxypropyl cellulose, fumaric acid, croscarmellose sodium, magnesium stearate, hypromellose, macrogol 8000, titanium oxide, or red or yellow ferric oxide). Skin testing may be performed according to local standard practice to confirm hypersensitivity.
  17. The participant has a history of alcohol abuse, illegal drug use, drug addiction, or regularly consumes >21 units of alcohol (1 unit = 12 oz/300 mL beer, 1.5 oz/25 mL hard liquor/spirits, or 5 oz/100 mL wine) per week based on self-report within the 12 months prior to screening. Participants must have a negative urine drug screen for cannabinoids/ tetrahydrocannabinol and nonprescribed medications at screening. Participants taking prescription drugs will be allowed.
  18. The participant is taking any excluded medications or treatments listed in the protocol.
  19. If female, the participant is pregnant, lactating, or intending to become pregnant before, during, or within 4 weeks after participating in this study, or intending to donate ova during such time period.
  20. The participant has a history or clinical manifestations of significant central nervous system, cardiovascular, pulmonary, hepatic, renal, metabolic, other gastrointestinal, urological, endocrine, or hematological disease that, in the opinion of the investigator, would confound the study results or compromise participant safety.
  21. The participant requires hospitalization or has surgery scheduled during the course of the study or has undergone major surgical procedures within 30 days prior to the Screening Visit.
  22. The participant has a history of malignancy or has been treated for malignancy within 5 years prior to the start of the Screening Period (Visit 1). (The participant may be included in the study if he/she has recovered from cutaneous basal cell carcinoma or cervical carcinoma in situ).
  23. The participant has acquired immune deficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection, or tests positive for the hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibody, or HCV ribonucleic acid (HCV-RNA). However, participants who test positive for HCV antibody but negative for HCV-RNA are permitted to participate.
  24. The participant has any of the following abnormal laboratory test values at the start of the Screening Period:

    1. Creatinine levels: >2 mg/dL (>177 μmol/L)
    2. Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >2 × the upper limit of normal (ULN) or total bilirubin >2 × ULN (except participants with Gilbert Syndrome)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04799158


Contacts
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Contact: Phathom Medical Information Phathom Pharmaceuticals, Inc. medicalinformation@phathompharma.com

Locations
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Sponsors and Collaborators
Phathom Pharmaceuticals, Inc.
Investigators
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Study Director: Medical Director Phathom Pharmaceuticals
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Responsible Party: Phathom Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier: NCT04799158    
Other Study ID Numbers: NERD-201
First Posted: March 16, 2021    Key Record Dates
Last Update Posted: June 11, 2021
Last Verified: June 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: Data from this study will be published; however, it is undecided if patient level data will be made available at this time.

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Phathom Pharmaceuticals, Inc.:
Symptomatic Non-Erosive Gastroesophageal Reflux Disease
NERD
Vonoprazan
Heartburn
Additional relevant MeSH terms:
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Gastroesophageal Reflux
Heartburn
Esophageal Motility Disorders
Deglutition Disorders
Esophageal Diseases
Gastrointestinal Diseases
Digestive System Diseases
Signs and Symptoms, Digestive