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Clinical Trial
. 2021 Feb;9(1):e00690.
doi: 10.1002/prp2.690.

Safety and nonclinical and clinical pharmacokinetics of PC945, a novel inhaled triazole antifungal agent

Affiliations
Clinical Trial

Safety and nonclinical and clinical pharmacokinetics of PC945, a novel inhaled triazole antifungal agent

Lindsey Cass et al. Pharmacol Res Perspect. 2021 Feb.

Abstract

PC945 is a novel antifungal triazole formulated for nebulized delivery to treat lung Aspergillus infections. Pharmacokinetic and safety profiles from nonclinical studies and clinical trials in healthy subjects, and subjects with mild asthma were characterized. Toxicokinetics were assessed following daily 2-hour inhalation for 14 days. Potential for drug-drug interactions was evaluated using pooled human liver microsomes. Clinical safety and pharmacokinetics were assessed following (a) single inhaled doses (0.5-10 mg), (b) 7-day repeat doses (5 mg daily) in healthy subjects; (c) a single dose (5 mg) in subjects with mild asthma. Cmax occurred 4 hours (rats) or immediately (dogs) after a single dose. PC945 lung concentrations were substantially higher (>2000-fold) than those in plasma. PC945 only inhibited CYP3A4/5 substrate metabolism (IC50 : 1.33 µM [testosterone] and 0.085 µM [midazolam]). Geometric mean Cmax was 322 pg/mL (healthy subjects) and 335 pg/mL (subjects with mild asthma) 4-5 hours (median tmax ) after a single inhalation (5 mg). Following repeat, once daily inhalation (5 mg), Day 7 Cmax was 951 pg/mL (0.0016 µM) 45 minutes after dosing. Increases in Cmax and AUC0-24h were approximately dose-proportional (0.5-10 mg). PC945 administration was well tolerated in both healthy subjects and subjects with mild asthma. Treatment-emergent adverse events were mild/moderate and resolved before the study ended. No clinically significant lung function changes were observed. PC945 pharmacokinetics translated from nonclinical species to humans showed slow absorption from lungs and low systemic exposure, thereby limiting the potential for adverse side effects and drug interactions commonly seen with systemically delivered azoles.

Keywords: PC945; antifungal; drug-drug interaction; first-in-human; inhaled administration; pharmacokinetics; safety.

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Conflict of interest statement

All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author). Pulmocide Ltd. provided funding for this clinical trial. LC, AM and AD are employees of Pulmocide Ltd and own stock options of Pulmocide Ltd. KI and PS are (co)founders and employees of Pulmocide Ltd, and own stock options of Pulmocide Ltd. JM and GR are (co)founders and consultants of Pulmocide Ltd. and own stocks of Pulmocide Ltd. KW, JA, JP, EF, PH, and CW are part‐time consultants to Pulmocide Ltd.

Figures

FIGURE 1
FIGURE 1
Subject disposition (CONSORT diagram)
FIGURE 2
FIGURE 2
Mean change from baseline in FEV1 for subjects with mild asthma (Cohort 3)
FIGURE 3
FIGURE 3
Mean plasma concentrations (linear [A] and log scales [B]) vs time profiles of PC945 after single dose administration in healthy subjects (Cohort 1 and Day 1 of Cohort 2)
FIGURE 4
FIGURE 4
Mean plasma concentrations (linear [A] and log scales [B]) vs time profiles of PC945 following a single inhalation of PC945 5 mg in healthy subjects (Cohort 1) and subjects with mild asthma (Cohort 3)
FIGURE 5
FIGURE 5
Mean plasma concentrations (linear [A] and log scales [B]) vs time profiles of PC945 following repeat daily administration of PC945 5 mg in healthy subjects (Cohort 2, Day 1 and Day 7)

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