Therapy Areas: Diabetes
Aerpio Pharmaceuticals Shows Disappointing Results From TIME-2b Study of AKB-9778 in Diabetic Retinopathy
19 March 2019 - - US-based biopharmaceutical company Aerpio Pharmaceuticals, Inc. (NASDAQ: ARPO) has received top-line results from the company's TIME-2b study, a Phase 2b clinical trial designed to assess the efficacy and safety of Aerpio's lead candidate, AKB-9778, for patients with moderate to severe non-proliferative diabetic retinopathy, the company said.

Administration of AKB-9778 twice daily did not meet the study's primary endpoint of the percentage of patients with an improvement of two or more steps in the study eye diabetic retinopathy severity score compared to placebo.

The percentage of patients achieving this endpoint for AKB-9779 twice daily and placebo were 9.6% and 3.8%, respectively (p=0.270).

In all qualified eyes (i.e., study eyes and fellow eyes that met the inclusion/exclusion criteria), the percentage of eyes achieving this endpoint was 8.6% and 2.7%, for AKB-9778 BID and placebo, respectively (p=0.158).

The rates of progression to sight-threatening complications, including diabetic macular edema and/or proliferative diabetic retinopathy, during the 48-week treatment period were similar between treatment groups.

AKB-9778 did show encouraging data in a number of prespecified, key secondary endpoints, consistent with the observations in the prior Phase 2a (TIME-2) trial, including changes in Urine Albumin-Creatinine Ratio, a measure of kidney function, and in intraocular pressure.

The company plans to advance a topical drop formulation of AKB-9778 into clinical development and expects to initiate a Phase 1b study in 2Q19 with results anticipated by the end of 2019.

AKB-9778 was found to be safe and well-tolerated in this patient population through 48 weeks of twice-daily dosing.

The most common adverse events with higher incidence in the AKB-9778 BID group were dizziness of 10.9% versus 7.0% in the placebo arm, and headache of 10.9% compared to placebo of 3.5%. There was one death in the study, and it was in the placebo group.

The TIME-2b study was a double-masked, placebo-controlled, multi-center trial designed to evaluate the effect of AKB-9778 in patients with moderate-to-severe NPDR.

167 patients were randomised to receive 48 weeks of treatment with either AKB-9778 15 mg subcutaneously once daily (and placebo subcutaneously once daily), AKB-9778 15 mg subcutaneously twice daily, or placebo subcutaneously twice daily.

The primary endpoint of the TIME-2b study was the percentage of patients who improved by two or more steps in DRSS in the study eye. One of the study's secondary objectives, the urine albumin to creatinine ratio or UACR, was prospectively included based on a post-hoc analysis of this biomarker in the TIME-2 Phase 2a clinical trial of AKB-9778 in diabetic macular edema.

AKB-9778 is being developed as a subcutaneous injection for the treatment of non-proliferative diabetic retinopathy and as an eyedrop formulation for the treatment of glaucoma. AKB-9778 binds to and inhibits vascular endothelial protein tyrosine phosphatase (VE-PTP), an important negative regulator of Tie2.

Decreased Tie2 activity contributes to vascular instability in many diseases including diabetes. AKB-9778 activates the Tie2 receptor irrespective of extracellular levels of its binding ligands, angiopoietin-1 (agonist) or angiopoietin-2 (antagonist) and may be the most efficient pharmacologic approach to maintain normal Tie2 activation.

Aerpio Pharmaceuticals is a biopharmaceutical company focused on advancing first-in-class compounds that activate Tie2 to treat ocular diseases and complications of diabetes. Tie2 is an important regulator of vascular stability and its down-regulation is found in patients with diabetes.

Down-regulation is caused by activation of two inhibitors of Tie2, VE-PTP and Ang-2 due to hypoxia or tissue ischemia.

The company's lead compound, AKB-9778, is a systemically-administered small molecule activator of the Tie2 pathway (via highly selective and potent deactivation of VE-PTP) and is in clinical development for the treatment of non-proliferative diabetic retinopathy.

AKB-9778 is also being investigated for its potential utility in treating diabetic nephropathy and an eyedrop formulation is in development as a potential treatment for open-angle glaucoma.
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