A Ph2b to Evaluate Clinical Efficacy and Safety of Tildacerfont in Adult CAH

NCT ID: NCT04457336

Last Updated: 2025-07-08

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2

Total Enrollment

96 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-26

Study Completion Date

2024-05-23

Brief Summary

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An investigation of the efficacy and safety of up to 70 weeks of treatment with Tildacerfont in subjects with classic CAH who have elevated biomarkers at baseline on their current GC regimen. Optional open label treatment extension period up to 240 weeks with 200mg Tildacerfont QD.

Detailed Description

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This is a study that will test the efficacy and safety of Tildacerfont. The first 12-weeks will be a double-blind, placebo controlled, dose ranging study. The following 58-weeks will assess the long term safety of Tildacerfont. Optional open label treatment extension period up to 240 weeks with 200mg Tildacerfont QD.

Conditions

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Congenital Adrenal Hyperplasia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Subjects will be randomized in a 1:1:1:1 manner to one of three doses of Tildacerfont or Placebo.
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators
Double-Blind

Study Groups

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Tildacerfont Group 1

Tildacerfont administered daily via oral tablet for 12 weeks at dose level 1

Group Type EXPERIMENTAL

Tildacerfont/Placebo

Intervention Type DRUG

Tablet, administered daily

Tildacerfont Group 2

Tildacerfont administered daily via oral tablet for 12 weeks at dose level 2

Group Type EXPERIMENTAL

Tildacerfont/Placebo

Intervention Type DRUG

Tablet, administered daily

Tildacerfont Group 3

Tildacerfont administered daily via oral tablet for 70 weeks at dose level 3

Group Type EXPERIMENTAL

Tildacerfont/Placebo

Intervention Type DRUG

Tablet, administered daily

Placebo

Placebo administered daily via oral tablet for 12 weeks.

Group Type PLACEBO_COMPARATOR

Tildacerfont/Placebo

Intervention Type DRUG

Tablet, administered daily

Interventions

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Tildacerfont/Placebo

Tablet, administered daily

Intervention Type DRUG

Other Intervention Names

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SPR001

Eligibility Criteria

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Inclusion Criteria

1. Male and female subjects ≥18 years old at screening
2. Has a known childhood diagnosis of classic CAH due to 21-hydroxylase deficiency based on genetic mutation in CYP21A2 and/or documented (at any time) elevated 17-OHP and currently treated with HC, HC acetate, prednisone, prednisolone, methylprednisolone (or a combination of the aforementioned GCs)
3. Has been on a stable, supraphysiologic dose of GC replacement (defined as ≥15 mg/day and ≤60 mg/day in HCe) for ≥1 month before screening
4. Has A4 \>ULN at both screening and Week 4 (measured before any AM GC dose) if daily GC dose \<30 mg OR has A4 \>2.5x ULN at both screening and Week 4 (measured before any AM GC dose)
5. For subjects with the salt-wasting form of CAH, subject has been on a stable dose of mineralocorticoid replacement for ≥1 month before screening
6. Agrees to follow contraception guidelines. Male subjects must also agree to refrain from donating sperm throughout the treatment period and for 90 days after the last dose of study drug.
7. Is able to understand all study procedures and risks involved and provides written informed consent indicating willingness to comply with all aspects of the protocol.

Exclusion Criteria

1. Has a known or suspected diagnosis of any other known form of classic CAH (not due to 21 hydroxylase deficiency)
2. Has a history that includes bilateral adrenalectomy or hypopituitarism
3. Has a history of allergy or hypersensitivity to tildacerfont, any of its excipients, or any other CRF1 receptor antagonist
4. Current treatment with dexamethasone as GC therapy for CAH

a. Prior treatment with dexamethasone is allowed as long as the transition to an alternative GC regimen (eg, HC, prednisone, or prednisolone) has resulted in a stable dose of GC replacement for ≥1 month before screening.
5. Is not adherent to GC or study drug dosing regimen during the Run-in Period (defined as taking \<80% of expected doses based on drug accountability)
6. Shows clinical signs or symptoms of adrenal insufficiency
7. Has had a clinically significant unstable medical condition, medically significant illness, or chronic disease occurring within 30 days of screening, including but not limited to:

1. An ongoing malignancy or \<3 years of remission history from any malignancy, other than successfully treated localized skin cancer
2. eGFR of \<45 mL/min/1.73 m2
3. Current or history of liver disease (with the exception of Gilbert's syndrome).
4. History of alcohol or substance abuse within the last year, or any significant history of alcohol or substance abuse that would likely prevent the subject from reliably participating in the study, based on the opinion of the Investigator
5. Active hepatitis B, hepatitis C, or HIV at screening
6. Subjects who plan to undergo bariatric surgery during the study are excluded.
7. Any other condition that would impact subject safety or confound interpretation of study results
8. Psychiatric conditions, including but not limited to bipolar disorder, schizophrenia, or schizoaffective disorders that are not effectively controlled on medication and may have an adverse impact on study compliance. Symptoms including hallucinations, delusions, and psychosis are exclusionary. Additionally:

1. Increased risk of suicide based on the Investigator's judgment or the results of the C-SSRS conducted at screening and Week 6 (eg, C-SSRS Type 3, 4, or 5 ideation within the past 6 months or any suicidal behavior within the past 12 months)
2. HADS score \>12 for either depression or anxiety at screening or Week 6
9. Has clinically significant abnormal ECG or clinical laboratory results. Abnormal results that must be reviewed and discussed with the Medical Monitor to determine eligibility for this study include but are not limited to:

1. Any clinically meaningful abnormal ECG results, including QTcF \>450 ms for male participants or \>470 ms for female participants
2. ALT \>2x ULN
3. Total bilirubin \>1.5x ULN
4. Total bile acids \>5x ULN
10. Routinely works overnight shifts
11. Subjects with travel plans/work schedules that result in significant and frequent changes in time zones (\>2 hours) will require Medical Monitor approval for enrollment.
12. Females who are pregnant or nursing
13. Use of any other investigational drug from 30 days or 5 half-lives (whichever is longer) before screening to the end of the study
14. Use of the following drugs from 30 days or 5 half-lives (whichever is longer) before Day 1 to the end of the study:

1. Rosiglitazone, aromatase inhibitors, testosterone, growth hormones, or any other medication or supplement that could impact subject safety or confound interpretation of study results
2. The following drugs:

i. Moderate to strong inhibitors and/or inducers of CYP3A4 ii. Sensitive substrates or narrow-therapeutic-range substrates of CYP3A4 (except hormonal contraception containing ≤35 μg ethinyl estradiol) iii. Sensitive substrates or narrow-therapeutic-range substrates of BCRP (except those that can be administered QD in the morning, separated by approximately 10 hours from evening administration of study drug)
15. Donation or receipt of blood from 90 days before Screening to the end of the study; donation or receipt of platelets, white blood cells, or plasma from 30 days before Screening to the end of the study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Spruce Biosciences

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kyriakie Sarafoglou, M.D

Role: PRINCIPAL_INVESTIGATOR

Dept. of Pediatrics, Divisions of Endocrinology and Genetics & Metabolism, Univ. of Minnesota

Locations

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Spruce Study Site

Birmingham, Alabama, United States

Site Status

Spruce Study Site

Los Angeles, California, United States

Site Status

Spruce Clinical Site

Orange, California, United States

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Spruce Study Site

Sacramento, California, United States

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Spruce Study Site

Englewood, Colorado, United States

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Spruce Clinical Site

Tampa, Florida, United States

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Spruce Study Site

West Palm Beach, Florida, United States

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Spruce Study Site

Chicago, Illinois, United States

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Spruce Clinical Site

Indianapolis, Indiana, United States

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Spruce Study Site

Baltimore, Maryland, United States

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Spruce Clinical Site

Minneapolis, Minnesota, United States

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Spruce Study Site

Rochester, Minnesota, United States

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Spruce Clinical Site

Las Vegas, Nevada, United States

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Spruce Study Site

Hickory, North Carolina, United States

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Spruce Study Site

Canton, Ohio, United States

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Spruce Study Site

Cincinnati, Ohio, United States

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Spruce Study Site

Cleveland, Ohio, United States

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Spruce Study Site

Columbus, Ohio, United States

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Spruce Clinical Site

Bend, Oregon, United States

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Spruce Study Site

Philadelphia, Pennsylvania, United States

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Spruce Study Site

Philadelphia, Pennsylvania, United States

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Spruce Study Site

Providence, Rhode Island, United States

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Columbia, South Carolina, United States

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Spruce Clinical Site

Memphis, Tennessee, United States

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Austin, Texas, United States

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Dallas, Texas, United States

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Edinburg, Texas, United States

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Spruce Clinical Site

Fort Worth, Texas, United States

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Spruce Study Site

Nedlands, Western Australia, Australia

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Spruce study site

Brisbane, , Australia

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Spruce Study Site

Elizabeth Vale, , Australia

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Melbourne, , Australia

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Spruce Study Site

Brasília, , Brazil

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Spruce Study Site

São Paulo, , Brazil

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St. John's, Newfoundland and Labrador, Canada

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London, Ontario, Canada

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Ottawa, , Canada

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Sherbrooke, , Canada

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Spruce Study Site

Aarhus, , Denmark

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Spruce Study Site

Copenhagen, , Denmark

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Spruce Study Site

Tallinn, , Estonia

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Tartu, , Estonia

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Spruce Study Site

Munich, , Germany

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Dublin, , Ireland

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Milan, , Italy

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Napoli, , Italy

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Rome, , Italy

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Torino, , Italy

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Riga, , Latvia

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Kaunas, , Lithuania

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Nijmegen, , Netherlands

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Krakow, , Poland

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Warsaw, , Poland

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Spruce Study Site

Bucharest, , Romania

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Spruce Study Site

Seoul, , South Korea

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Spruce Study Site

Barcelona, , Spain

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Spruce Study Site

Madrid, , Spain

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Spruce Study Site

Seville, , Spain

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Spruce Study Site

Tarragona, , Spain

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Spruce Study Site

Falun, , Sweden

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Spruce Study Site

Stockholm, , Sweden

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Spruce Study Site

Sankt Gallen, , Switzerland

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Spruce Study Site

Zurich, , Switzerland

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Spruce Study Site

Istanbul, , Turkey (Türkiye)

Site Status

Spruce Study Site

Birmingham, , United Kingdom

Site Status

Countries

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United States Australia Brazil Canada Denmark Estonia Germany Ireland Italy Latvia Lithuania Netherlands Poland Romania South Korea Spain Sweden Switzerland Turkey (Türkiye) United Kingdom

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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CAHmelia 203

Identifier Type: OTHER

Identifier Source: secondary_id

SPR001-203

Identifier Type: -

Identifier Source: org_study_id

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