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GSK1278863

Phase 3

Anaemia | Small molecule | Hematology |GSK plc|Last Updated: Feb 25, 2020

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindCONTROLLEDDMCBiomarker
Total Trials12
Total Enrollment1,059
FDA Designations
No designations recorded
Clinical Trials (12)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT02829320Efficacy and Safety Study of GSK1278863 in Japanese Hemodialysis Subjects With Anemia Associated With Chronic Kidney Disease Who Are Not Taking Erythropoiesis Stimulating AgentsPHASE3 COMPLETED 28Aug 8, 2016Oct 17, 2017Dec 3, 201917 Japan
NCT02689206Study to Evaluate the Efficacy, Safety and Pharmacokinetics of Three-times Weekly Dosing of GSK1278863 in Hemodialysis-dependent Subjects With Anemia Associated With Chronic Kidney Disease Who Are Switched From a Stable Dose of an Erythropoiesis-stimulating AgentPHASE2 COMPLETED 103Feb 17, 2016Jan 25, 2017Feb 25, 202038 United States, Canada +3
NCT02019719Study to Evaluate the Safety, Efficacy and Pharmacokinetics of GSK1278863 in Japanese Hemodialysis-Dependent Subjects With Anemia Associated With Chronic Kidney DiseasePHASE2 COMPLETED 97Nov 5, 2013Aug 6, 2014Feb 12, 201821 Japan
NCT01977482Evaluation of Dose Response Relationship, Safety and Efficacy of GSK1278863 in Hemodialysis-dependent Subjects With Chronic Kidney Disease Associated AnemiaPHASE2 COMPLETED 216Nov 1, 2013Feb 6, 2015Jun 8, 2018107 United States, Australia +14
NCT01977573A Study to Evaluate Safety and Efficacy of GSK1278863 in Non-Dialysis Dependent (NDD) Subjects With Anemia Associated With Chronic Kidney Diseases (CKD)PHASE2 COMPLETED 252Oct 31, 2013Jun 15, 2015Oct 12, 2018123 United States, Australia +13
NCT015879244 Week Switch Study in Hemodialysis-dependent Subjects With Anemia Associated With Chronic Kidney DiseasePHASE2 COMPLETED 80May 23, 2012May 27, 2013Nov 14, 201762 United States, Canada +4
NCT015878984 Week Correction Study in Subjects With Anemia Associated With Chronic Kidney Disease Who Are Not Undergoing DialysisPHASE2 COMPLETED 72May 17, 2012May 7, 2013Nov 9, 201755 United States, Canada +1
NCT02371603Drug-drug Interaction Study of GSK1278863 With Pioglitazone, Rosuvastatin and Trimethoprim in Healthy Adult VolunteersPHASE1 COMPLETED 70Feb 11, 2015Aug 12, 2015Nov 17, 20171 United States
NCT02293148Single Dose, Pharmacokinetic, Safety, Tolerability and QTc Study of GSK1278863 in Healthy VolunteersPHASE1 COMPLETED 61Nov 17, 2014Mar 10, 2015Jul 24, 20181 United States
NCT02243306Study to Assess the Pharmacokinetics of GSK1278863 in Subjects With End Stage Renal Disease Undergoing Peritoneal DialysisPHASE1 COMPLETED 8Oct 24, 2014May 10, 2017Apr 9, 20192 United States
NCT01673555Effects of GSK1278863A on Pulmonary Artery Pressure in Healthy VolunteersPHASE1 COMPLETED 49May 15, 2012Nov 19, 2012Jun 9, 20171 United States
NCT01376232Study to Assess the Pharmacokinetics of GSK1278863A Coadministered With a High Fat Meal or an Inhibitor of CYP2C8 (Gemfibrozil)PHASE1 COMPLETED 23Nov 8, 2010Dec 20, 2010Jun 9, 20171 India
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Study Endpoints
Primary Endpoints
Change From Baseline in Hgb at Week 4
Baseline and Week 4

Blood samples were collected from participants for measurement of Hgb values. The Baseline value was the latest pre-dose assessment. Change from Baseline at Week 4 was calculated by subtracting Baseline value from the post-dose visit value. The analysis was performed on All Treated Subjects Population which comprised of all participants who received at least one dose of GSK1278863.

Number of Participants by Hgb Change From Baseline Category at Week 4
Baseline and Week 4

Blood samples were collected from participants for measurement of Hgb values. The Baseline value was the latest pre-dose assessment. Change from Baseline at Week 4 was calculated by subtracting Baseline value from the post-dose visit value. The change in Hgb at Week 4 was classified into different categories (i.e., \<=-2.0, \>-2.0 to -1.0, \>-1.0 to 0, \>0 to 1.0, \>1.0 to 2.0, and \>2 g/dL), and the number of participants in each category were summarized.

Change From Baseline in Hgb Levels at Day 29
Baseline and Day 29

Blood samples were collected from participants for measurement of Hgb values. Baseline is the average of Hgb measured at Week -2 and Day 1 visits. Change from Baseline at Day 29 was defined as post dose value at Day 29 minus Baseline value. The analysis was performed on intent-to-treat (ITT) Population which comprised of all randomized participants who received at least one dose of study treatment, had a Baseline and at least one corresponding on treatment assessment, including Hgb.

Change From Baseline (CFB) in Hemaglobin (Hgb) at Week 4
Baseline (Day 1) and Week 4

Baseline was defined as the value on Day 1. CFB was calculated by subtracting the baseline value from the post-dose value at Week 4. To model the dose-response relationship a four-parameter Emax model was used. E0 is the expected Hgb change from Baseline for a participant receiving placebo and experiencing the average Hgb Baseline observed in the study. Emax is the expected Hgb change from Baseline for a participant receiving the highest dose above which no further increase in response can be achieved. ED50 is the dose that attains the intermediate response. Gamma is the slope parameter. Minimal Effective Dose (MED) is defined as the smallest dose that achieves a placebo-corrected change of 0.5 g/dL over Week 4. Target dose (TD) is defined as the dose that achieves a placebo-corrected 1.0 g/dL change over Week 4. Maximum Acceptable Dose (MAD) is defined as the dose that achieves a placebo-corrected 2.0 g/dL change over Week 4.

Change From Baseline in Hemoglobin (Hgb) at Week 4
Baseline (Week -4, Week-2 and Day 1) and Week 4

Baseline Hgb value was the average of three Hgb values taken during screening period at Week (W) -4, W-2 and Day 1. Change from Baseline in Hgb was calculated as W4 value minus the Baseline value. To model the dose-response relationship a four-parameter Emax model was used. The dose response dataset was based on all non-missing data collected up to W4. Participants (par.) who had a Week 2 Hgb measurement, but a missing Week 4 Hgb measurement were included with a change from Baseline at Week 4 value imputed as twice the change from Baseline at Week 2. E0 is the expected Hgb change from Baseline for a par. receiving placebo and experiencing the average Hgb Baseline observed in the study. Emax is the expected Hgb change from Baseline for a par. receiving the highest dose above which no further increase in response can be achieved. ED50 is the dose that attains the intermediate response. Gamma is the slope parameter. Alpha is the coefficient of the model covariate for centred Baseline.

Summary of Hemoglobin (Hgb) Concentration at Week 24
Week 24

The original Hgb Criteria for Group 1- rhEPO naive participants with a stable baseline Hgb of 8.0-10.0 g/dL (8.0-10.0 g/dL USA site only) and for Group 2- rhEPO users with a stable baseline Hgb of 9.0-10.5 g/dL (9.0-10.5 g/dL USA site only); the Hgb target range was 9.0 to 10.5 g/dL (9.0-10.5 g/dL USA site only). The study amended Hgb Criteria for Group 1- rhEPO naive participants with a stable baseline Hgb of 8.0-11.0 g/dL and Group 2- rhEPO users with a stable baseline Hgb of 9.0-11.5 g/dL; Hgb target range - 10.0 to 11.5 g/dL. Data are presented for those participants following the original criteria ("Original") and those following the amended ("Amended") criteria. The primary objective was to characterize the ability of GSK1278863 to achieve mean Hgb response within the target range.

Modeled Hemoglobin (Hgb) Change From Baseline (Pre-dose on Day 1) at 4 Weeks of Treatment
Baseline (pre-dose on Day 1) and up to week 4

Modeled Hgb change from Baseline over 4 weeks of treatment. Change from Baseline is the actual value of Hgb at Week 4 minus the Baseline value. For modeled change at Week 4 participants required a Baseline and two or more non missing post-baseline values. Baseline is the average of Week -2, -1 and Day 1 values. The model included fixed effects for Baseline Hgb, treatment, and treatment by day interaction. Covariate analysis for modeled Hgb change was performed. Random effects were fitted in the intercept and the slope over time.

Modeled Hgb Change From Baseline Over 4 Weeks of Treatment
Baseline (average of Week -2, -1 and Day 1) and Week 4

Modeled Hgb change from baseline over 4 weeks was derived using a random coefficient mixed effects linear regression model. The model included fixed effects for baseline Hgb, treatment and a treatment by day interaction. Random effects was fitted in the intercept and the slope over time. All data up until investigational product discontinuation was included for Hgb efficacy evaluable participants; where efficacy evaluable was defined as having a baseline and at least 2 on-treatment Hgb assessments. Baseline was the average of Week -2 , Week -1 and Day 1 visits. The change from Baseline was calculated by subtracting the Baseline value from the individual post-dose visit values.

Composite of pharmacokinetic (PK) parameters for pioglitazone following oral administration of pioglitazone alone and in combination with GSK1278863, evaluated by measurement of plasma Cmax and AUC (0-infinity) for Part A
Pre-dose, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, and 24 hours (h) post-dose in each treatment period

The effect of an oral dose of GSK1278863 on the pharmacokinetics of pioglitazone will be assessed using the following PK parameters: maximum observed concentration (Cmax), area under the concentration-time curve from time zero (pre-dose) extrapolated to infinite time (AUC (0-infinity)

Composite of PK parameters for rosuvastatin following oral administration of rosuvastatin alone and in combination with GSK1278863 evaluated by measurement of plasma Cmax and AUC (0-infinity) for Part A
Pre-dose, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 24, 36, and 48 h post-dose in each treatment period

The effect of an oral dose of GSK1278863 on the pharmacokinetics of rosuvastatin will be assessed using the following PK parameters: Cmax and AUC (0-infinity)

Composite of PK parameters for GSK1278863 and its 6 predominant metabolites following oral administration of GSK1278863 alone and in combination with steady-state trimethoprim evaluated by measurement of plasma Cmax and AUC (0-infinity) for Part B
Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 5, 6, 8, 12, 18, 24, and 48 h post-dose of GSK1278863 on day 1 and day 6

The effect of trimethoprim on the pharmacokinetics of GSK1278863 and six predominant metabolites (GSK2391220 \[M2\], GSK2506104 \[M3\], GSK2487818 \[M4\], GSK2506102 \[M5\], GSK2531398 \[M6\], GSK2531401 \[M13\]) will be assessed using the following PK parameters: Cmax and AUC (0-infinity)

Composite of pharmacokinetic (PK) parameters for GSK1278863 and its metabolites for Part A
Pre Dose, 0.25hour (h), 0.5h, 1h, 2h, 3h, 4h, 5h, 6h, 8h, 12h, 18h, and 24h post dose in each treatment period

Plasma concentrations of GSK1278863 and its metabolites (GSK2391220 \[M2\], GSK2506104 \[M3\], GSK2487818 \[M4\], GSK2506102 \[M5\], GSK2531398 \[M6\], and GSK2531401 \[M13\]) and derived pharmacokinetic parameters including maximum observed concentration (Cmax), Time of occurrence of Cmax (tmax), Area under the concentration-time curve (AUC)

Change from baseline in QT duration corrected for heart rate by Fridericia's formula (QTcF) interval for Part B
At each treatment period (there are 4 periods) up to 24 hours

Change from baseline in QTcF interval at each time-point (average of at least three 12-lead Holter ECG replicates per time-point (Pre-dose, Day 1 \[0.25h, 0.5h, 1h, 2h, 3h, 4h, 5h, 6h, 8h, 12h, 18h\] and 24h) for 75 and 500 mg dose of GSK1278863 as compared with time-matched placebo

Assessment of 12-lead ECG for Part A
Up to Week 3

12-lead ECGs will be obtained at each time-point

Assessment of Vital Signs for Part A
Up to Week 3

Vital Signs includes. temperature, systolic and diastolic blood pressure (BP) and pulse

Number of participants with Adverse Events (AE) for Part A
Up to Week 3

An AE is any untoward medical occurrence in a patient or clinical investigation subject, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product

Assessment of Clinical Laboratory Tests for Part A
Up to Week 3

Clinical Laboratory Tests includes Hematology, Clinical Chemistry and Urinalysis

Area Under the Concentration-time Curve (AUC) Over the Dosing Interval (AUC[0-tau]) of GSK1278863 and Its Metabolites
Pre-dose and 0.5, 1, 2, 3, 4, 6, 8, 12, 16, 24 hours post-dose on Day 1; Pre-dose and 0.5, 1, 2, 3, 4, 6, 8, 12, 16, 24, 48, 72 hours post-dose on Day 14

Serial blood samples were collected from participants at indicated time points for Pharmacokinetic (PK) analysis of GSK1278863 and its metabolites (GSK2391220, GSK2487818, GSK2506102, GSK2531398, GSK2531403 and GSK2531401). Geometric mean and geometric coefficient of variation has been presented for all metabolites. NA indicates data is not available. Geometric coefficient of variation could not be calculated for CAPD cohort due to small number of participants. PK Population comprised of participants in the 'All Subjects' Population for whom a PK sample was obtained and analyzed.

AUC From Time Zero (Pre-dose) Extrapolated to Infinite Time (AUC [0-inf]) of GSK1278863 and Its Metabolites
Pre-dose and 0.5, 1, 2, 3, 4, 6, 8, 12, 16, 24 hours post-dose on Day 1

Serial blood samples were collected from participants at indicated time points for PK analysis of GSK1278863 and its metabolites (GSK2487818 and GSK2531398). Geometric mean and geometric coefficient of variation has been presented for all metabolites. NA indicates data is not available. Geometric coefficient of variation could not be calculated for CAPD cohort due to small number of participants.

Maximum Observed Concentration (Cmax) of GSK1278863 and Its Metabolites
Pre-dose and 0.5, 1, 2, 3, 4, 6, 8, 12, 16, 24 hours post-dose on Day 1; Pre-dose and 0.5, 1, 2, 3, 4, 6, 8, 12, 16, 24, 48, 72 hours post-dose on Day 14

Serial blood samples were collected from participants at indicated time points for PK analysis of GSK1278863 and its metabolites (GSK2391220, GSK2487818, GSK2506102, GSK2531398, GSK2531403 and GSK2531401). Geometric mean and geometric coefficient of variation has been presented for all metabolites. NA indicates data is not available. Geometric coefficient of variation could not be calculated for CAPD cohort due to small number of participants. Only those participants with data available at the specified data points were analyzed (represented by n= X in the category titles).

Placebo-adjusted change from baseline in PASP (estimated by transthoracic echocardiography) under normoxic conditions following 5 days of GSK1278863
Day 5
GSK1278863A (and metabolites, as appropriate) AUC(0-¥) and Cmax
48 hours

1\. To assess the relative bioavailability GSK1278863A following single-dose administration under fasting and fed (standard high fat/calorie meal) conditions

Secondary Endpoints
Hgb Values at the Indicated Time Points
Up to Week 24
Change From Baseline in Hgb at the Indicated Time Points
Baseline and up to Week 24
Number of Participants Who Had Hgb Level Within the Target Range (10.0-12.0 g/dL)
Up to Week 24
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Study Design & Arms
AllocationNA
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
GSK1278863EXPERIMENTALSubjects will receive GSK1278863 once daily orally at a starting dose of 4 milligrams (mg) on Day 1, and continued until the day of Week 4. From Weeks 4 to 24, interruption of treatment or dose adjustments will be made within the maintenance dose range of 1 mg to 24 mg according to the dose adjustment algorithm to achieve and/or maintain Hgb within the target range (10.0 to 12.0 g/dL) based on the Hgb value measured every 4 weeks. Dose changes will be made every 4 weeks. Iron replacement therapy will be given according to the standard starting criteria.
GSK1278863 10 mgEXPERIMENTALSubject will receive 10 mg of GSK1278863 three-times weekly for 4 weeks (up to 29 days).
GSK1278863 15 mgEXPERIMENTALSubject will receive 15 mg of GSK1278863 three-times weekly for 4 weeks (up to 29 days).
GSK1278863 25 mgEXPERIMENTALSubject will receive 25 mg of GSK1278863 three-times weekly for 4 weeks (up to 29 days).
GSK1278863 30 mgEXPERIMENTALSubject will receive 30 mg of GSK1278863 three-times weekly for 4 weeks (up to 29 days).
PlaceboPLACEBO_COMPARATORSubject will receive GSK1278863 matching placebo three-times weekly for 4 weeks (up to 29 days).
GSK1278863 4 milligrams (mg)EXPERIMENTALSubjects will receive GSK1278863 4 mg once daily for 4 weeks
GSK1278863 6 mgEXPERIMENTALSubjects will receive GSK1278863 6 mg once daily for 4 weeks
GSK1278863 8 mgEXPERIMENTALSubjects will receive GSK1278863 8 mg once daily for 4 weeks
GSK1278863 4 mgEXPERIMENTALSubjects will take GSK1278863 4 mg blinded once daily (OD) orally for 4 weeks with a glass of water. From Week 4, study medication will continue to be administered OD and the dose will be adjusted based on Hgb levels dose every 4 weeks till Week 24.
GSK1278863 12 mgEXPERIMENTALSubjects will take GSK1278863 12 mg blinded OD orally for 4 weeks with a glass of water. From Week 4, study medication will continue to be administered OD and the dose will be adjusted based on Hgb levels dose every 4 weeks till Week 24.
ControlACTIVE_COMPARATORSubjects will take GSK1278863 matching placebo blinded OD orally for 4 weeks with a glass of water. From Week 4, rhEPO will be administered and the dose will be adjusted based on Hgb levels dose every 4 weeks till Week 24.
0.5 mg GSK1278863EXPERIMENTALonce daily
2 mg GSK1278863EXPERIMENTALonce daily
5 mg GSK1278863EXPERIMENTALonce daily
rhEPOACTIVE_COMPARATORas required
0.5mg GSK1278863EXPERIMENTALOnce daily
2mg GSK1278863EXPERIMENTALOnce daily
5mg GSK1278863EXPERIMENTALOnce daily
Part A: GSK1278863, pioglitazone and rosuvastatinEXPERIMENTALSubjects will receive single, oral 15 milligram (mg) pioglitazone, 10 mg rosuvastatin and 25 mg dose of GSK1278863 (Treatment A) or 15 mg pioglitazone and 10 mg rosuvastatin (Treatment B) on Day 1 and a 25 mg dose of GSK1278863 alone on Day 2 in two treatment periods as per treatment sequence AB or BA. The 2 treatment periods will be separated by a wash out period of approximately 7 days
Part B: GSK1278863 and trimethoprimEXPERIMENTALSubjects will receive a single, oral 25 mg dose of GSK1278863 on Day 1 and Day 6 morning. The subjects will also receive 200 mg dose of trimethoprim twice daily from Day 3 to 6, with Day 6 dosing being concomitant with morning dosing of GSK1278863
GSK1278863 (Part A)EXPERIMENTALAll subjects will receive a single, oral 500 mg dose of GSK1278863 on Day 1 administered as 5 x 100 mg tablets of GSK1278863. Additional doses/cohorts may be added depending upon the emerging safety, tolerability, pharmacokinetic and/or pharmacodynamics findings at the 500 mg dose level in Part A
GSK1278863 (75 mg/500 mg)/Moxifloxacin 400 mg/Placebo (Part B)EXPERIMENTALSubjects will be assigned to one of four treatment sequences (A-1 x Moxifloxacin placebo tablet, 3 x 25 mg tablets of GSK1278863, 2 x GSK1278863 matched placebo; B-1 x Moxifloxacin placebo tablet, 5 x 100 mg tablets of GSK1278863; C-1 x Moxifloxacin placebo tablet, 5 x GSK1278863 matched placebo tablets; D-1 x 400 mg Moxifloxacin tablet, 5 x GSK1278863 matched placebo tablets) (ABDC, BCAD, CDBA, DACB) in accordance with the randomization schedule
Cohort 1EXPERIMENTALSubjects on continuous ambulatory peritoneal dialysis (CAPD) will receive 5 mg of GSK1278863 orally, once daily for 14 days.
Cohort 2EXPERIMENTALSubjects on automated peritoneal dialysis (APD) will receive 5 mg of GSK1278863 orally, once daily for 14 days
GSK1278863 5mgEXPERIMENTALGSK1278863 5mg
GSK1278863 100mgEXPERIMENTALGSK1278863 100mg
GSK1278863 + foodEXPERIMENTAL100 mg of GSK1278863 given with a high fat meal
GSK1278863 + GemfibrozilEXPERIMENTALGSK1278863A 100mg + Gemfibrozil 600mg steady state
Interventions
NameTypeDescription
GSK1278863DRUGGSK1278863 will be provided as round, standard biconvex, white film coated tablets containing 1 mg, 2 mg, 4 mg or 6 mg of GSK1278863 as active ingredient.
IronDRUGSubjects will receive supplemental iron therapy if ferritin is \<=100 ng/mL and TSAT is \<=20%. The investigator (or subinvestigator) will choose the route of administration and dose of prescription iron.
GSK1278863 matching PlaceboDRUGGSK1278863 matching placebo will be supplied as a round, biconvex, 10 mm white film coated tablet.
PlaceboDRUGFilm coated tablets of GSK1278863 matching placebo for oral administration.
rhEPODRUGrhEPO will be procured from local market
GSK1278863 25 mg TabletDRUGA round, biconvex, white film coated tablet to be taken orally in the fasted state in the morning
Pioglitazone 15 mg TabletDRUGWhite to off-white, round, convex, non scored tablet with "ACTOS" on one side, and "15" on the other, to be taken orally in the fasted state in the morning
Rosuvastatin 10 mg TabletDRUGPink, round, biconvex, coated tablets. Debossed "CRESTOR" and "10" on one side, to be taken orally in the fasted state in the morning
Trimethoprim 100 mg TabletDRUGWhite, round, scored, convex tablet, debossed "93" above the score and debossed "2159" below the score on one side and plain on the other, to be taken orally as two tablets once in the morning and once in the evening
GSK1278863 75 mgDRUGA round, biconvex, white film coated tablet available in two doses (25 and 100 mg)
GSK1278863 500 mgDRUGA round, biconvex, white film coated tablet available in two doses (25 and 100 mg)
Moxifloxacin 400 mgDRUGOblong, dull red, film-coated, convex tablets with M400 on one side
Placebo matching GSK1278863DRUGA round, biconvex, white film coated tablet as matching placebo for GSK1278863
Placebo matching MoxifloxacinDRUGCapsule shaped white film coated tablet as matching placebo for Moxifloxacin
GSK1278863 + foodDRUGHigh Fat meal + 100 mg GSK1278863
GemfibrozilDRUG600 mg Gemfibrozil
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Eligibility Criteria
Age Range20 Years — N/A
SexALL
Healthy VolunteersNo
Study Sites17

Inclusion Criteria: * Age (at the time of informed consent): \>=20 years * Dialysis: Patients on hemodialysis (HD) or hemodiafiltration (HDF) * Use of any erythropoiesis stimulating agent (ESA): Newly started dialysis (Dialysis newly started \<12 weeks before screening): Patients not using ESAs aft...

Countries:JapanUnited StatesCanadaGermanyRussiaSpainAustraliaCzechiaDenmarkFranceHungaryNorwayPolandSouth KoreaSwedenUnited KingdomIndia
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