<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02966652</url>
  </required_header>
  <id_info>
    <org_study_id>DITEST-001</org_study_id>
    <nct_id>NCT02966652</nct_id>
  </id_info>
  <brief_title>Study to Compare DITEST to Testosterone Undecanoate in Adult Men With Hypogonadism</brief_title>
  <official_title>A Phase 1, Randomised, Open-label, 2-cohort, Cross-over Study to Evaluate the Pharmacokinetics, Safety, and Tolerability of a Native Oral Testosterone Formulation (DITEST) in the Fed and Fasted State and Compared to Testosterone Undecanoate in Adult Men With Primary or Secondary Hypogonadism</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Diurnal Limited</agency>
      <agency_class>Industry</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Sheffield Teaching Hospitals NHS Foundation Trust</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Simbec Research</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
    <collaborator>
      <agency>Voet Consulting</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
    <collaborator>
      <agency>EMAS Pharma</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
    <collaborator>
      <agency>Medical Matters International Ltd</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
    <collaborator>
      <agency>Brush Clinical Research Ltd.</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
    <collaborator>
      <agency>Manchester University NHS Foundation Trust</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Covance</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
  </sponsors>
  <source>Diurnal Limited</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      DITEST is an oral formulation of native testosterone for the treatment of androgen deficiency&#xD;
      in men. The study was a Phase 1 clinical study in hypogonadal men, defined according to FDA&#xD;
      and Endocrine Society Guidelines, designed to evaluate the pharmacokinetic (PK)&#xD;
      characteristics of DITEST, and to assess the safety and tolerability of DITEST in the target&#xD;
      population.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      There is an unmet need for a native oral testosterone therapy for men with androgen&#xD;
      (testosterone) deficiency. Ideally such a treatment should have reproducible PK, does not&#xD;
      need to be taken with fatty meals, can be taken once or twice daily, and provides&#xD;
      physiological exposure to testosterone. This Phase 1, randomised, open-label, 2-cohort,&#xD;
      cross-over study was therefore designed to evaluate the PK characteristics of DITEST in both&#xD;
      the fed and fasted states according to FDA guidelines, and to assess the safety and&#xD;
      tolerability of DITEST in the target population.&#xD;
&#xD;
      The study was conducted in male subjects from 18 to 80 years of age requiring testosterone&#xD;
      replacement therapy for primary or secondary hypogonadism. The study was a randomised, active&#xD;
      control, single dose, 2-way cross-over study in 2 cohorts. In each cohort subjects who meet&#xD;
      the entry criteria at screening and baseline were randomised to one of 2 sequences:&#xD;
&#xD;
      Cohort 1: single dose of 120 mg (3 x 40 mg) DITEST followed by a single dose of 80 mg (2 x 40&#xD;
      mg) testosterone undecanoate (TU) or a single dose of 80 mg TU followed by single dose of 120&#xD;
      mg DITEST. The two treatments were separated by a minimum of a 7-day washout period, with&#xD;
      both treatments given in the fed state.&#xD;
&#xD;
      Cohort 2: single dose of 200 mg (5 x 40 mg) DITEST (fed) followed by a single dose of 200 mg&#xD;
      DITEST (fasted) or a single dose of 200 mg DITEST (fasted) followed by single dose of 200 mg&#xD;
      DITEST (fed). The two treatments were separated by a minimum of a 7-day washout period.&#xD;
&#xD;
      13 subjects were recruited into cohort 1 and 12 subjects were recruited into cohort 2,&#xD;
      resulting in a total of 25 subjects being administered study medication in this study.&#xD;
      Subjects were not recruited into Cohort 2 until the results of subjects treated in Cohort 1&#xD;
      had been evaluated (this review was to determine if the intended dose for Cohort 2 needed to&#xD;
      be adjusted). No other testosterone treatments were allowed for the duration of the study&#xD;
      (including the washout periods).&#xD;
&#xD;
      Each subject was required to attend the study centre for a minimum of either 4 or 5 visits: a&#xD;
      screening assessment, an evaluation of baseline testosterone levels after the washout period&#xD;
      from the subject's current medication (only for subjects currently on testosterone&#xD;
      replacement therapy), both dosing days, and a follow-up visit at the end of the study.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">November 3, 2016</start_date>
  <completion_date type="Actual">October 4, 2018</completion_date>
  <primary_completion_date type="Actual">October 4, 2018</primary_completion_date>
  <phase>Phase 1</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Crossover Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Testosterone serum concentrations - Peak Plasma Concentration (Cmax)</measure>
    <time_frame>Study day 0 to Study Day &gt;7 (sampling time points at -0.5, 0.25 [120mg and TU arms only], 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8 and 10 hours post-Investigational Medicinal Product (IMP) administration, on each visit date)</time_frame>
    <description>Testosterone serum concentrations after administration of a single dose of 120mg or 200mg DITEST and 80mg testosterone undecanoate in the fed state, as measured by the primary PK parameter of Cmax.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Testosterone serum concentrations - Area under the serum testosterone concentration-time curve from time 0-10 (AUC(0-10))</measure>
    <time_frame>Study day 0 to Study Day &gt;7 (sampling time points at -0.5, 0.25 [120mg and TU arms only], 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8 and 10 hours post-IMP administration, on each visit date)</time_frame>
    <description>Testosterone serum concentrations after administration of a single dose of 120mg or 200mg DITEST and 80mg testosterone undecanoate in the fed state, as measured by the primary PK parameter of AUC.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Testosterone serum concentrations - Peak serum testosterone Concentration (Cmax)</measure>
    <time_frame>Study day 0 to Study Day &gt;7 (sampling time points at -0.5, 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8 and 10 hours post-IMP administration, on each visit date)</time_frame>
    <description>Testosterone serum concentrations after 200mg dose of DITEST in the fed and fasted states, as measured by the primary PK parameter of Cmax.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Testosterone serum concentrations after 200mg dose - Area under the serum testosterone concentration-time curve (AUC 0-10)</measure>
    <time_frame>Study day 0 to Study Day &gt;7 (sampling time points at -0.5, 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8 and 10 hours post-IMP administration, on each visit date)</time_frame>
    <description>Testosterone serum concentrations after 200mg dose of DITEST in the fed and fasted states, as measured by the primary PK parameter of AUC (0-10)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Adverse events</measure>
    <time_frame>Through study completion - a maximum of 84 days.</time_frame>
    <description>Adverse events (AEs) observed throughout the study.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Vital signs</measure>
    <time_frame>Through study completion - a maximum of 84 days.</time_frame>
    <description>Observed changes in vital signs data during the course of the study.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Electrocardiogram (ECG)</measure>
    <time_frame>Through study completion - a maximum of 84 days.</time_frame>
    <description>Observed changes in ECG data during the course of the study.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Safety Laboratory Data</measure>
    <time_frame>Through study completion - a maximum of 84 days.</time_frame>
    <description>Observed changes in Safety Laboratory data during the course of the study.</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">25</enrollment>
  <condition>Male Hypogonadism</condition>
  <arm_group>
    <arm_group_label>Testosterone undecanoate</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>Cohort 1: single dose of 120 mg (3 x 40 mg) DITEST followed by a single dose of 80 mg (2 x 40 mg) testosterone undecanoate or a single dose of 80 mg (2 x 40 mg) testosterone undecanoate followed by single dose of 120 mg (3 x 40 mg) DITEST. The two treatments are separated by a minimum of a 7-day washout period, with both treatments given in the fed state.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>DITEST</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Cohort 2: single dose of 200 mg (5 x 40 mg) DITEST (fed) followed by a single dose of 200 mg DITEST (fasted) or a single dose of 200 mg DITEST (fasted) followed by single dose of 200 mg (5 x 40 mg) DITEST (fed). The two treatments are separated by a minimum of a 7-day washout period.</description>
  </arm_group>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>DITEST</intervention_name>
    <description>Lipid formulation of native oral testosterone.</description>
    <arm_group_label>DITEST</arm_group_label>
    <arm_group_label>Testosterone undecanoate</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Testosterone undecanoate</intervention_name>
    <description>Generic treatment for patients with primary or secondary male hypogonadism</description>
    <arm_group_label>Testosterone undecanoate</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Male subjects aged 18 to 80 years.&#xD;
&#xD;
          -  Diagnosis of primary testicular failure or secondary hypogonadism due to known&#xD;
             pituitary disease or congenital deficit.&#xD;
&#xD;
          -  Body mass index (BMI) &gt;18kg/m2 and &lt;35kg/m2&#xD;
&#xD;
          -  Testosterone level &lt;8nmol/L after washout of current testosterone treatment, if&#xD;
             applicable.&#xD;
&#xD;
          -  Normal prostate specific antigen (PSA) levels based on the age of the subject.&#xD;
&#xD;
          -  Provision of written informed consent and able to participate in the study and abide&#xD;
             by the study restrictions.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Subjects with a past history of, or current prostate cancer, male breast cancer or&#xD;
             hepatic neoplasm.&#xD;
&#xD;
          -  Subjects with a history of or current myocardial infarction (MI), unstable&#xD;
             cardiovascular disease, or clinically relevant findings on the screening&#xD;
             electrocardiogram (ECG) (as determined by the investigator)&#xD;
&#xD;
          -  Subjects with a history of or current alcohol abuse (consumption of more than 28 units&#xD;
             per weekweek: 1 unit equals 25mL single measure of whisky (ABV 40%), a third of a pint&#xD;
             of beer (ABV 5-6%) or half a standard (175 mL) glass of red wine (ABV 12%).&#xD;
&#xD;
          -  Subjects with other unstable or inadequately treated endocrine conditions.&#xD;
&#xD;
          -  Haematocrit levels &gt;0.5 at baseline&#xD;
&#xD;
          -  Subjects with poor dental hygiene that would interfere with the collection of saliva&#xD;
             samples or contaminate them with blood.&#xD;
&#xD;
          -  Subjects with any severe co-morbidity or with any significant medical or psychiatric&#xD;
             conditions that in the opinion of the investigator would preclude participation in the&#xD;
             trial.&#xD;
&#xD;
          -  Participation in another clinical trial or an investigation or licensed drug or device&#xD;
             within the 3 months prior to inclusion in this study.&#xD;
&#xD;
          -  Allergic to any of the ingredients in the DITEST capsule, particularly sesame oil, or&#xD;
             to any components of testosterone undecanoate capsules, particularly castor oil.&#xD;
&#xD;
          -  Subjects with a known intolerance to alcohol (e.g. flushing) or ethnic populations at&#xD;
             high risk of alcohol dehydrogenase (ADH) enzyme polymorphism with potential to impair&#xD;
             metabolism of benzyl alcohol and ethanol, both of which are contained in the DITEST&#xD;
             formulation.&#xD;
&#xD;
          -  Meeting any of the contraindications for testosterone undecanoate, as detailed in the&#xD;
             Summary of Product Characteristics (SmPC) of the comparator product.&#xD;
&#xD;
          -  Subjects who are unable to consume the standard high-fat breakfast.&#xD;
&#xD;
          -  Subjects who have donated blood or plasma in the previous 3 months prior to screening.&#xD;
&#xD;
          -  Any subjects taking a concomitant medication known to enhance or inhibit the action of&#xD;
             p450 CYP3A4 (rifampicin, barbiturates, carbamazepine, dichloralphenazone,&#xD;
             phenylbutazone, phenytoin or primidone).&#xD;
      </textblock>
    </criteria>
    <gender>Male</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>80 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>J Newell-Price, MA, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of Sheffield</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Sheffield Teaching Hospital - Royal Hallamshire Hospital</name>
      <address>
        <city>Sheffield</city>
        <state>England</state>
        <zip>S10 2JF</zip>
        <country>United Kingdom</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United Kingdom</country>
  </location_countries>
  <verification_date>October 2019</verification_date>
  <study_first_submitted>September 26, 2016</study_first_submitted>
  <study_first_submitted_qc>November 15, 2016</study_first_submitted_qc>
  <study_first_posted type="Estimate">November 17, 2016</study_first_posted>
  <last_update_submitted>November 25, 2019</last_update_submitted>
  <last_update_submitted_qc>November 25, 2019</last_update_submitted_qc>
  <last_update_posted type="Actual">November 26, 2019</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Male</keyword>
  <keyword>Hypogonadism</keyword>
  <keyword>Primary</keyword>
  <keyword>Secondary</keyword>
  <keyword>Androgen deficiency</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Hypogonadism</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Methyltestosterone</mesh_term>
    <mesh_term>Testosterone</mesh_term>
    <mesh_term>Testosterone undecanoate</mesh_term>
    <mesh_term>Testosterone enanthate</mesh_term>
    <mesh_term>Testosterone 17 beta-cypionate</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02966652
org study id: DITEST-001
nct id: NCT02966652
lead sponsor: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
has dmc: Yes
DITEST is an oral formulation of native testosterone for the treatment of androgen deficiency
      in men. The study was a Phase 1 clinical study in hypogonadal men, defined according to FDA
      and Endocrine Society Guidelines, designed to evaluate the pharmacokinetic (PK)
      characteristics of DITEST, and to assess the safety and tolerability of DITEST in the target
      population.
There is an unmet need for a native oral testosterone therapy for men with androgen
      (testosterone) deficiency. Ideally such a treatment should have reproducible PK, does not
      need to be taken with fatty meals, can be taken once or twice daily, and provides
      physiological exposure to testosterone. This Phase 1, randomised, open-label, 2-cohort,
      cross-over study was therefore designed to evaluate the PK characteristics of DITEST in both
      the fed and fasted states according to FDA guidelines, and to assess the safety and
      tolerability of DITEST in the target population.

      The study was conducted in male subjects from 18 to 80 years of age requiring testosterone
      replacement therapy for primary or secondary hypogonadism. The study was a randomised, active
      control, single dose, 2-way cross-over study in 2 cohorts. In each cohort subjects who meet
      the entry criteria at screening and baseline were randomised to one of 2 sequences:

      Cohort 1: single dose of 120 mg (3 x 40 mg) DITEST followed by a single dose of 80 mg (2 x 40
      mg) testosterone undecanoate (TU) or a single dose of 80 mg TU followed by single dose of 120
      mg DITEST. The two treatments were separated by a minimum of a 7-day washout period, with
      both treatments given in the fed state.

      Cohort 2: single dose of 200 mg (5 x 40 mg) DITEST (fed) followed by a single dose of 200 mg
      DITEST (fasted) or a single dose of 200 mg DITEST (fasted) followed by single dose of 200 mg
      DITEST (fed). The two treatments were separated by a minimum of a 7-day washout period.

      13 subjects were recruited into cohort 1 and 12 subjects were recruited into cohort 2,
      resulting in a total of 25 subjects being administered study medication in this study.
      Subjects were not recruited into Cohort 2 until the results of subjects treated in Cohort 1
      had been evaluated (this review was to determine if the intended dose for Cohort 2 needed to
      be adjusted). No other testosterone treatments were allowed for the duration of the study
      (including the washout periods).

      Each subject was required to attend the study centre for a minimum of either 4 or 5 visits: a
      screening assessment, an evaluation of baseline testosterone levels after the washout period
      from the subject's current medication (only for subjects currently on testosterone
      replacement therapy), both dosing days, and a follow-up visit at the end of the study.
allocation: Randomized
intervention model: Crossover Assignment
primary purpose: Treatment
masking: None (Open Label)
measure: Testosterone serum concentrations - Peak Plasma Concentration (Cmax)
time frame: Study day 0 to Study Day >7 (sampling time points at -0.5, 0.25 [120mg and TU arms only], 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8 and 10 hours post-Investigational Medicinal Product (IMP) administration, on each visit date)
description: Testosterone serum concentrations after administration of a single dose of 120mg or 200mg DITEST and 80mg testosterone undecanoate in the fed state, as measured by the primary PK parameter of Cmax.
measure: Testosterone serum concentrations - Area under the serum testosterone concentration-time curve from time 0-10 (AUC(0-10))
time frame: Study day 0 to Study Day >7 (sampling time points at -0.5, 0.25 [120mg and TU arms only], 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8 and 10 hours post-IMP administration, on each visit date)
description: Testosterone serum concentrations after administration of a single dose of 120mg or 200mg DITEST and 80mg testosterone undecanoate in the fed state, as measured by the primary PK parameter of AUC.
measure: Testosterone serum concentrations - Peak serum testosterone Concentration (Cmax)
time frame: Study day 0 to Study Day >7 (sampling time points at -0.5, 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8 and 10 hours post-IMP administration, on each visit date)
description: Testosterone serum concentrations after 200mg dose of DITEST in the fed and fasted states, as measured by the primary PK parameter of Cmax.
measure: Testosterone serum concentrations after 200mg dose - Area under the serum testosterone concentration-time curve (AUC 0-10)
time frame: Study day 0 to Study Day >7 (sampling time points at -0.5, 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8 and 10 hours post-IMP administration, on each visit date)
description: Testosterone serum concentrations after 200mg dose of DITEST in the fed and fasted states, as measured by the primary PK parameter of AUC (0-10)
measure: Adverse events
time frame: Through study completion - a maximum of 84 days.
description: Adverse events (AEs) observed throughout the study.
measure: Vital signs
time frame: Through study completion - a maximum of 84 days.
description: Observed changes in vital signs data during the course of the study.
measure: Electrocardiogram (ECG)
time frame: Through study completion - a maximum of 84 days.
description: Observed changes in ECG data during the course of the study.
measure: Safety Laboratory Data
time frame: Through study completion - a maximum of 84 days.
description: Observed changes in Safety Laboratory data during the course of the study.
arm group label: Testosterone undecanoate
arm group type: Active Comparator
description: Cohort 1: single dose of 120 mg (3 x 40 mg) DITEST followed by a single dose of 80 mg (2 x 40 mg) testosterone undecanoate or a single dose of 80 mg (2 x 40 mg) testosterone undecanoate followed by single dose of 120 mg (3 x 40 mg) DITEST. The two treatments are separated by a minimum of a 7-day washout period, with both treatments given in the fed state.
arm group label: DITEST
arm group type: Experimental
description: Cohort 2: single dose of 200 mg (5 x 40 mg) DITEST (fed) followed by a single dose of 200 mg DITEST (fasted) or a single dose of 200 mg DITEST (fasted) followed by single dose of 200 mg (5 x 40 mg) DITEST (fed). The two treatments are separated by a minimum of a 7-day washout period.
intervention type: Drug
intervention name: DITEST
description: Lipid formulation of native oral testosterone.
arm group label: DITEST
arm group label: Testosterone undecanoate
intervention type: Drug
intervention name: Testosterone undecanoate
description: Generic treatment for patients with primary or secondary male hypogonadism
arm group label: Testosterone undecanoate
criteria: 
gender: Male
minimum age: 18 Years
maximum age: 80 Years
healthy volunteers: No
last name: J Newell-Price, MA, PhD
role: Principal Investigator
affiliation: University of Sheffield
facility: 
country: United Kingdom
responsible party type: Sponsor
mesh term: Hypogonadism
mesh term: Methyltestosterone
mesh term: Testosterone
mesh term: Testosterone undecanoate
mesh term: Testosterone enanthate
mesh term: Testosterone 17 beta-cypionate
sharing ipd: No