A Phase 2, Multicenter Study of Nevanimibe for the Treatment of Congenital Adrenal Hyperplasia

Diala El-Maouche, Deborah P. Merke, Maria G. Vogiatzi, Alice Y. Chang, Adina F. Turcu, Elizabeth G. Joyal, Vivian H. Lin, Lauren Weintraub, Marianne R. Plaunt, Pharis Mohideen, Richard J. Auchus

Research output: Contribution to journalArticle

Abstract

CONTEXT: Patients with classic congenital adrenal hyperplasia (CAH) often require supraphysiologic glucocorticoid doses to suppress adrenocorticotropic hormone (ACTH) and control androgen excess. Nevanimibe hydrochloride (ATR-101), which selectively inhibits adrenal cortex function, might reduce androgen excess independent of ACTH and thus allow for lower glucocorticoid dosing in CAH. 17-hydroxyprogesterone (17-OHP) and androstenedione are CAH biomarkers used to monitor androgen excess. OBJECTIVE: Evaluate the efficacy and safety of nevanimibe in subjects with uncontrolled classic CAH. DESIGN: This was a multicenter, single-blind, dose-titration study. CAH subjects with baseline 17-OHP ≥4× the upper limit of normal (ULN) received the lowest dose of nevanimibe for 2 weeks followed by a single-blind 2-week placebo washout. Nevanimibe was gradually titrated up if the primary outcome measure (17-OHP ≤2× ULN) was not met. A total of 5 nevanimibe dose levels were possible (125, 250, 500, 750, 1000 mg twice daily). RESULTS: The study enrolled 10 adults: 9 completed the study, and 1 discontinued early due to a related serious adverse event. At baseline, the mean age was 30.3 ± 13.8 years, and the maintenance glucocorticoid dose, expressed as hydrocortisone equivalents, was 24.7 ± 10.4 mg/day. Two subjects met the primary endpoint, and 5 others experienced 17-OHP decreases ranging from 27% to 72% during nevanimibe treatment. The most common side effects were gastrointestinal (30%). There were no dose-related trends in adverse events. CONCLUSIONS: Nevanimibe decreased 17-OHP levels within 2 weeks of treatment. Larger studies of longer duration are needed to further evaluate its efficacy as add-on therapy for CAH.

Original languageEnglish (US)
JournalThe Journal of clinical endocrinology and metabolism
Volume105
Issue number8
DOIs
StatePublished - Aug 1 2020

Keywords

  • ATR-101
  • adrenal hypertrophy
  • clinical trial
  • congenital adrenal hyperplasia
  • nevanimibe

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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    El-Maouche, D., Merke, D. P., Vogiatzi, M. G., Chang, A. Y., Turcu, A. F., Joyal, E. G., Lin, V. H., Weintraub, L., Plaunt, M. R., Mohideen, P., & Auchus, R. J. (2020). A Phase 2, Multicenter Study of Nevanimibe for the Treatment of Congenital Adrenal Hyperplasia. The Journal of clinical endocrinology and metabolism, 105(8). https://doi.org/10.1210/clinem/dgaa381