A Four-way Crossover Study of 3 Formulations of M207 With Intranasal Zolmitriptan in Healthy Volunteers

Phase 1

Completed

Conditions: Migraine

Interventions: Drug: M207 3.8 mg "Sled" (two 1.9 mg patches made on a "Sled" coater, foil pouches)
Drug: M207 3.8 mg "MACAP" (two 1.9 mg patches made on a "MACAP" coater, foil cups)
Drug: M207 3.8 mg "MiniMac" (two 1.9 mg patches made on a "MiniMac" coater, foil cups
Drug: Zolmitriptan 2.5 mg/0.1 mL nasal spray [ZOMIG] single dose

Registration Number: NCT03978403

Lead Sponsor: Zosano Pharma Corporation

Brief Summary: This is a single-center, open-label, randomized, four-way crossover study. Subjects will receive the four study treatments once, followed by in-clinic monitoring and extensive pharmacokinetic analysis. Dosing occurs \~48 hours apart from patch application, in randomized order. Subjects will have final assessment and be dismissed from the study.

Detailed Description: This is a single-center, open-label, randomized, four-way crossover study. Each subject will receive each of the four study treatments once, followed by in-clinic monitoring and extensive blood sample collection for pharmacokinetic analysis.

Dosing will occur approximately 48 hours apart from the time of patch application, until completion of dosing in randomized order per the treatment sequence schedule. Plasma samples from the dosing days will be sent to the analytical laboratory for analysis and tolerability for each of the dose levels will be summarized.

After completion of the four dosing days, subjects will be assessed one final time and dismissed from the study.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 24

Inclusion Criteria

Women or men 18 to 50 years of age (inclusive)
Good general health with no clinically significant abnormalities as determined by medical history, physical examination, complete blood count, blood chemistry, urinalysis, and ECG.
Negative urine drug and alcohol screens and negative serum pregnancy tests (for female subjects) at screening and admission/baseline visit.
Consent of female subjects to use a medically effective method of contraception throughout the entire study period and for 30 days after the subject completes the study. Medically effective methods of contraception that may be used by the subject include abstinence, use of diaphragm and spermicide, intrauterine device (IUD), rings, condom and vaginal spermicide, hormonal contraceptives (subjects must be stable on hormonal contraceptives for at least 3 months prior to screening), surgical sterilization (hysterectomy, bilateral tubal ligation, hysteroscopic sterilization) and post-menopausal (≥ 2 years of amenorrhea).
Ability to read, understand, and provide written informed consent that they understand the purpose of the study and procedures required for the study before enrolling in the study, and willingness to comply with all study procedures and restrictions.

Exclusion Criteria

Evidence of significant history of hepatic, reproductive, gastrointestinal, renal, bleeding, or hematological disorders including coagulation, pulmonary, neurological, respiratory, endocrine, or cardiovascular system abnormalities (especially hypertension, peripheral vascular disease, coronary artery disease, transient ischemic attacks, or cardiac rhythm abnormalities), psychiatric disorders, acute infection, or other conditions that would interfere with study participation or with the absorption, distribution, metabolism, or excretion of drugs.
Presence of three or more of the following CAD risk factors for cardiovascular disease:

A. Current tobacco use (subjects who have smoked within 30 days of screening)

B. Hypertension (systolic BP > 140 or diastolic BP > 90) or receiving anti-hypertensive medication for treatment of hypertension

C. Hyperlipidemia - LDL > 159 mg/dL and/or HDL < 40 mg/dL (or on prescribed anti-cholesterol treatment)

D. Family history of premature coronary artery disease (CAD) (< 55 years of age in male first-degree relatives or < 65 years of age in female first degree relatives)

E. Diabetes mellitus
Any contraindication to zolmitriptan administration including:
- History of coronary artery disease or coronary vasospasm
- Symptomatic Wolf-Parkinson-White syndrome or other cardiac accessory conduction pathway disorders
- History of stroke, transient ischemic attack, or hemiplegic or basilar migraine
- Peripheral Vascular Disease
- Ischemic bowel disease
- Hypertension (greater than or equal to 140/90 mmHg at either the screening or admission/baseline visit
- Any history of hepatic impairment defined as alanine transaminase > 150 U/L, aspartate aminotransferase > 130 U/L or bilirubin > 2 times the upper limit of normal
History of contact dermatitis or known dermatological disorders that would interfere with the study procedures or assessments
Planned participation in activities which cause inflammation, irritation, sunburn, lesions, or tattoos at the intended application sites from 2 weeks prior to dosing through their last day of study participation
Use of any prescription anticoagulant within 1 month prior to the first dose
Use of prescription and over the counter medications within one week of dosing other than the following:
- Hormone Replacement Therapy (HRT)
- Birth control pills, patches, IUD, rings, injections, or implants (all hormonal contraceptives) are allowed provided the dose has been stable for at least three months prior to screening and may be continued throughout the study
- Proton Pump Inhibitors (PPIs)
- Antihistamines
- Intermittently used NSAIDS
- Acetaminophen if medically necessary (not more than 1000 mg/day)
- Exceptions may be allowed on a case by case basis
Subject has a known allergy or sensitivity to zolmitriptan or its derivatives or formulations
Subject has a known allergy or sensitivity to tapes or adhesives
Use of any other investigational compound within 30 days of planned study drug dosing
Current use or history of drug and/or alcohol abuse within 6 months of screening and deemed to be clinically significant by the investigator
History of nasal pathology (e.g., polyps) or abnormal nasal exam deemed to be clinically significant by the investigator
Body Mass Index (BMI) lower than 18 kg/m2 or greater than 35 kg/m2
If, in the opinion of the investigator, the subject is not suitable for the study
Any positive urine drug screen result or alcohol test
Subject currently smokes or is a nicotine a user

Study & Design

Study Type: INTERVENTIONAL

Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
BCAD	M207 3.8 mg "MACAP" (two 1.9 mg patches made on a "MACAP" coater, foil cups)	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
BCAD	M207 3.8 mg "MiniMac" (two 1.9 mg patches made on a "MiniMac" coater, foil cups	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
BCAD	Zolmitriptan 2.5 mg/0.1 mL nasal spray [ZOMIG] single dose	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
ABDC	M207 3.8 mg "Sled" (two 1.9 mg patches made on a "Sled" coater, foil pouches)	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
ABDC	M207 3.8 mg "MACAP" (two 1.9 mg patches made on a "MACAP" coater, foil cups)	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
ABDC	M207 3.8 mg "MiniMac" (two 1.9 mg patches made on a "MiniMac" coater, foil cups	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
ABDC	Zolmitriptan 2.5 mg/0.1 mL nasal spray [ZOMIG] single dose	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
BCAD	M207 3.8 mg "Sled" (two 1.9 mg patches made on a "Sled" coater, foil pouches)	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
CDBA	M207 3.8 mg "Sled" (two 1.9 mg patches made on a "Sled" coater, foil pouches)	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
CDBA	M207 3.8 mg "MACAP" (two 1.9 mg patches made on a "MACAP" coater, foil cups)	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
CDBA	M207 3.8 mg "MiniMac" (two 1.9 mg patches made on a "MiniMac" coater, foil cups	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
DACB	M207 3.8 mg "Sled" (two 1.9 mg patches made on a "Sled" coater, foil pouches)	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
DACB	M207 3.8 mg "MACAP" (two 1.9 mg patches made on a "MACAP" coater, foil cups)	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
DACB	M207 3.8 mg "MiniMac" (two 1.9 mg patches made on a "MiniMac" coater, foil cups	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
DACB	Zolmitriptan 2.5 mg/0.1 mL nasal spray [ZOMIG] single dose	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose
CDBA	Zolmitriptan 2.5 mg/0.1 mL nasal spray [ZOMIG] single dose	A: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "Sled" coater packaged in foil pouches; B: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "MACAP" coater packaged in foil cups; C: M207 3.8 mg administered as two 1.9 mg upper arm patches 30 min made on a "miniMac" coater packaged in foil cups; D: Zolmitriptan nasal 2.5 mg/0.1 mL single dose

Primary Outcome Measures

Name	Time	Method
Adverse Events	48 hours	Subjects with treatment emergent adverse events
Cmax	pre-dose, 2, 5, 10, 15, 20, 30, 45, 60, 90 minutes; 2, 4 , 8, 12, and 24 hours post-dose	maximum observed plasma concentration
Tmax	pre-dose, 2, 5, 10, 15, 20, 30, 45, 60, 90 minutes; 2, 4 , 8, 12, and 24 hours post-dose	Time to maximum concentration