Our drug candidate, TRC101 is a novel, non-absorbed polymer that is designed to treat metabolic acidosis by binding hydrochloric acid in the gastrointestinal tract and removing it from the body through excretion in the feces, thereby decreasing the total amount of acid in the body and increasing blood bicarbonate. TRC101 is administered orally as a suspension in water. It was specifically designed to combine high capacity and high selectivity for binding and removing hydrochloric acid. Importantly, TRC101 does not deliver sodium or other counterions, potentially allowing for chronic treatment of metabolic acidosis in chronic kidney disease (CKD) patients with common comorbidities such as hypertension, cardiovascular disease, heart failure or edema.
Tricida has successfully completed a pivotal Phase 3, double-blind, placebo-controlled, 12-week clinical trial of TRC101 in 217 CKD patients with metabolic acidosis (TRCA-301) and a blinded, placebo-controlled, 40-week extension trial (TRCA-301E) that enrolled 196 subjects who completed the 12-week treatment period in the TRCA-301 trial. The TRCA-301 trial evaluated the safety, tolerability and efficacy of TRC101. The primary and secondary efficacy endpoints of the TRCA-301 trial were based on the change in blood bicarbonate from baseline to the end of treatment (12 weeks) in TRC101-treated subjects compared to placebo. The trial met these endpoints with high statistical significance (p < 0.0001). The trial also showed significant improvement versus placebo (p = 0.0122) in patient reported physical functioning and a trend towards improvement on an objective measure of muscle function, which were pre-specified exploratory endpoints. TRC101 was well-tolerated in the TRCA-301 trial. Both the TRC101 and placebo groups had low discontinuation rates and low rates of treatment-related adverse events. Results from this trial were published in an article, titled “Veverimer versus Placebo in Patients with Metabolic Acidosis Associated with Chronic Kidney Disease: A Multicentre, Randomised, Double-blind, Controlled, Phase 3 Trial,” by Wesson et al.,” in The Lancet in March 2019.
Eligible subjects that completed the TRCA-301 trial were invited to participate in the TRCA-301E extension trial. One hundred ninety-six of the 208 subjects who completed the 12-week treatment period in our pivotal TRCA-301 trial agreed and were eligible to continue into our TRCA-301E extension trial. Based on the initial topline data analyses, the TRCA-301E extension trial met its primary and all secondary endpoints. We believe the trial provides evidence of long-term safety and tolerability of TRC101 and that the sustained increase in blood bicarbonate led to improvements in multiple clinical outcomes that matter to both patients and physicians.
The primary endpoint of the TRCA-301E trial was the assessment of the long-term safety profile of TRC101 versus placebo. The results demonstrated that fewer subjects on TRC101 than on placebo discontinued the 40-week treatment period prematurely (2.6% versus 9.8%, respectively). The incidence of serious adverse events was 1.8% for subjects in the TRC101 group and 4.9% for subjects in the placebo group, and none were assessed to be related to study drug by the trial investigator, Medical Monitor or Drug Safety and Pharmacovigilance Team. The only adverse event with a between-group frequency difference of >5% was headache, which was more common in the placebo group. Gastrointestinal adverse events occurred in 21.4% of subjects in the TRC101 group and in 25.9% of subjects in the placebo group.
The secondary endpoints of the TRCA-301E trial assessed the durability of effect of TRC101, both on blood bicarbonate levels and on measures of physical function, over the 52-week treatment period for those subjects who participated in the TRCA-301E trial. All were met with high statistical significance.
The durability of the effect of TRC101 was assessed based on differences in the treatment groups, in favor of TRC101, in the change in blood bicarbonate from baseline to Week 52 (p=0.0002) as well as in the proportion of subjects achieving a change from baseline to Week 52 in blood bicarbonate of at least 4 milliequivalents per liter (mEq/L) or a blood bicarbonate level in the normal range of 22 to 29 mEq/L (p=0.0015).
The effect of 1-year of treatment with TRC101 on physical function was also significantly greater than with placebo, both as measured using self-reported responses to the physical functioning subpart of the Kidney Disease and Quality of Life Short Form survey (p<0.0001) as well as by using a repeated chair stand test (p<0.0001). The placebo-adjusted improvements in favor of TRC101-treated subjects in the two measures of physical function at Week 52 approximately doubled compared to the results at Week 12 observed in the parent trial, TRCA-301. We believe the results from these two assessments provide consistent evidence of a clinically meaningful improvement in physical function and related aspects of quality of life for TRC101-treated subjects.
A prespecified analysis included the time to death (all-cause mortality), dialysis/kidney transplant (renal replacement therapy) or a ≥50% decline in estimated glomerular filtration rate (eGFR), taken together DD50. Over the combined (TRCA-301 and TRCA-301E trials) 52-week treatment period, the time to DD50 was prolonged in the TRC101 group compared to the placebo group, with an annualized DD50 incidence rate, calculated as 100 times the number of events divided by the total person-years, of 4.2% in the TRC101 group vs 12.0% in the placebo group (p = 0.0224). In aggregate, the 52-week treatment data with TRC101 provides evidence of clinical benefit beyond the increase in blood bicarbonate.
Previously, we completed a successful 135-subject, double-blind, randomized, placebo-controlled Phase 1/2 trial (TRCA-101), and the results from this trial were published in an article, titled “Randomized, Controlled Trial of TRC101 to Increase Serum Bicarbonate in Patients with CKD,” by Bushinsky et al., in the Clinical Journal of the American Society of Nephrology (CJASN).
We have successfully completed all of the clinical trials that we planned to complete prior to submission of a NDA to the FDA through the FDA’s Accelerated Approval Program. We plan to submit the NDA, in the second half of 2019. *
*Please review our Forward Looking Statements for information regarding the risks and uncertainties related to these statements.