Phase 1 Evaluation of (2R,6R)-Hydroxynorketamine

A 6-cohort single ascending dose (SAD) study will be conducted in healthy volunteers utilizing a slow-infusion intravenous (IV) route of administration. Standard safety, pharmacokinetics (PK) and qEEG monitoring will be evaluated at all dose levels. Subsequently, a 3-cohort multiple ascending dose (MAD) study will be conducted. Doses will be administered on days 1, 4, 7, and 10. Standard safety parameters will be monitored, and PK will be evaluated at all dose levels.

Status Completed
Results Published Yes
Start date 11 January 2021
End date 01 April 2023
Chance of happening 100%
Phase Phase I
Design Blinded
Type Interventional
Generation Second
Participants 48
Sex All
Age 18- 65
Therapy No

Trial Details

A total of 48 Subjects are planned to be enrolled in a 6-cohort SAD study (36 in the treatment groups and 12 in the control groups). All SAD cohorts will have 6 Subjects in the treatment group and 2 Subjects in placebo group. All cohorts in the SAD study will incorporate sentinel dosing which will include 1 active and 1 placebo Subject. All remaining Subjects will be dosed at least 24 hours after the sentinel cohort participants. A total of 24 Subjects are planned to be enrolled in a 3 cohort MAD study (18 in the treatment groups and 6 in the control groups). All MAD cohorts will have 6 Subjects in the treatment group and 2 Subjects in placebo group. (2R,6R)-Hydroxynorketamine hydrochloride will be administered intravenously over a 40-minute period as a solution in a 25 mM sodium phosphate 0.9% w/v saline solution. The SAD doses will range from 0.1 mg/kg to 4.0 mg/kg and the investigational drug product will be diluted into a 53 mL total volume of formulant. Placebo will be made up of a 0.9% w/v saline solution (53 mL total volume) also administered via slow IV infusion over a 40-minute period. Serial PK blood samples will be collected during the SAD portion for each Subject receiving drug and placebo at 9 timepoints (preinfusion, end-of-infusion [approximately 40 minutes], 1, 2, 4, 8, 12, 24, and approximately 48 hr after the start of the infusion). Pharmacokinetic urine samples will be collected during the SAD study for each Subject receiving drug and placebo at set intervals following the initiation-of-infusion (0-4, >4-8, >8-12, >12-24 hr). Serial PK blood and urine samples will be collected for the first and fourth (last) dosing in the MAD study for each Subject receiving drug and placebo. Blood PK samples will be obtained at 9 timepoints (preinfusion, end-of-infusion [approximately 40 minutes], 1, 2, 4, 8, 12, 24, and approximately 48 hr after the start of the infusion). A single PK blood sample will be collected for the second and third dosing in the MAD study for each Subject receiving drug and placebo at approximately 10 minutes predose. Pharmacokinetic urine samples will be collected during the MAD study for each Subject receiving drug and placebo at set intervals following the initiation-of-infusion (0-4, >4-8, >8-12, >12-24 hr) after the first and last dose. Safety will be assessed throughout the study. Baseline and follow-up safety assessments will include height, body mass index (BMI), weight, temperature, medical, visual and ocular history, physical examinations, ocular examinations, visual acuity, color vision tests, electrocardiograms (ECGs), vital signs (VS), clinical laboratory tests (hematology, serum chemistry, and urinalysis), the Profile of Mood States (POMS), the Columbia-Suicide Severity Rating Scale (C-SSRS), the Clinician Administered Dissociative States Scale (CADSS), and adverse events (AEs). Safety assessments will include AEs, ECGs, VS, clinical laboratory results, and physical observations. Assessment of each Subject's level of alertness/sedation will be accomplished using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S). Evaluation of safety in the MAD study will utilize the same safety assessments used in the SAD study. Monitoring of AEs will be governed by change from baselines established during prescreening and Day -1 examinations and clinical laboratory tests. Dose escalation in the SAD study or continued dosing in the MAD study may be stopped according to the predefined halting rules or if a Subject's scores demonstrate acute suicidality on the C-SSRS assessment or at the discretion of the study Principal Investigator and/or sponsor. Determination of whether to escalate to the next dose level in the SAD study or continue dosing in the MAD will be made by the Principal Investigator in consultation with the Medical Monitor and Study Sponsor.

NCT Number NCT04711005

Sponsors & Collaborators

National Institute of Mental Health
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Papers

A Phase 1 Assessment of the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of (2R,6R)-Hydroxynorketamine in Healthy Volunteers
This Phase I study evaluates the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of (2R,6R)-Hydroxynorketamine (RR-HNK) in healthy volunteers. It finds that RR-HNK has a minimal adverse event profile, no serious adverse events, and no anaesthetic or dissociative effects at all doses. The study also reports dose-proportional increases in PK parameters and promising PD outcomes, including gamma power increases in some participants and CNS exposure, supporting progression to Phase II.

Data attribution

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