A Study to Evaluate the Safety, Tolerability, and Preliminary Efficacy of OsrhCT in Patients With Pleurisy

Primary Objectives:

To evaluate the safety and tolerability of single and multiple ascending doses of OsrhCT administered intrathoracically in patients with pleurisy, and to explore the DLT, MTD, and recommended effective dose of OsrhCT.

Secondary Objectives:

To evaluate the preliminary efficacy of single and multiple intrathoracic doses of OsrhCT.

Population:

Patients diagnosed with pleurisy requiring chest tube drainage.

Investigational Products:

Investigational Drug: Recombinant Human Chymotrypsin (OsrhCT), provided by Wuhan Healthgen Biotechnology Corporation, 4,000U/vial, freeze-dried powder, stored at 2-8°C.

Placebo:

Placebo for Recombinant Human Chymotrypsin (OsrhCT), provided by Wuhan Healthgen Biotechnology Corporation, freeze-dried powder, stored at 2-8°C.

Indication:

Pleurisy

Sample Size:

A total of 72 subjects (both male and female) are expected to be enrolled in this trial, including 48 subjects for single-dose administration and 24 subjects for multiple-dose administration.

Study Design:

The study comprises two parts: Single Ascending Dose (SAD) and Multiple Ascending Dose (MAD), both employing a multicenter, randomized, double-blind, and placebo-controlled design.

Single Ascending Dose (SAD) Study:

Eligible pleurisy patients will receive a single intrathoracic injection of different doses of OsrhCT to evaluate safety and tolerability. There are six dose groups (2000U, 4000U, 8000U, 12000U, 16000U, 20000U). If the previous dose group shows good tolerance and safety, the next dose group will be enrolled.

The plan is to enroll 48 subjects in this phase, with 8 subjects per dose group (6 receiving intrathoracic injection of OsrhCT and 2 receiving intrathoracic injection of placebo). Each subject can only receive administration in one dose group, and repeated administration is not allowed.

Each subject will be evaluated by the investigator based on their condition during the screening process to determine the necessity of chest tube drainage or confirm their current use of a chest tube drainage. Subsequently, the investigational drug will be administered into the pleural cavity following a baseline chest X-ray. After administration, the chest tube will be clamped for 6 hours. After 6 hours, the chest tube will be opened for drainage. Subjects are allowed to clamp the drainage tube for sleeping or going out for examination. The drainage of pleural effusion will be recorded in detail. Safety checks will be performed on Day 2, and a comprehensive safety check will be performed on Day 7. Subjects will be discharged from the study if the investigator evaluates that there are no drug-related safety issues. The administration of fibrinolytic agents into the pleural cavity is prohibited before Day 7.

Multiple Ascending Dose (MAD) Study:

Eligible pleurisy patients will receive multiple intrathoracic injections of different doses of OsrhCT to evaluate safety, tolerability, and preliminary efficacy. Based on the tolerability results from the SAD study, three dose groups (low, medium, and high) will be selected for multiple dosing. Each subject will receive only one dose group and no repeat dosing. If the previous dose group shows good tolerance and safety, the next dose group will be enrolled.

The plan is to enroll 24 subjects in this phase, with 6 subjects per dose group receiving OsrhCT and 2 subjects receiving placebo. Each subject will receive the drug once daily for three consecutive days.

Each subject will be evaluated by the investigator based on their condition during the screening process to determine the necessity of chest tube drainage or confirm their current use of a chest tube drainage. Subsequently, the investigational drug will be administered into the pleural cavity following a baseline chest X-ray. The drug is administered once a day for up to 3 days, and the interval between the two administrations is 24h±1h. If pleural effusion is completely resolved before the third dose, early termination of drug administration is allowed, and the subject can enter the follow-up period. After each administration, the chest tube will be clamped for 6 hours. After 6 hours, the chest tube will be opened for drainage. Subjects are allowed to clamp the drainage tube for sleeping or going out for examination. The drainage of pleural effusion will be recorded in detail. After the last dose, subjects will be observed in the hospital for at least 4 days. Comprehensive safety checks will be performed on Day 7 and Day 30. Subjects will be discharged from the study at Day 30 if there is no safety problem as evaluated by the investigator. The administration of fibrinolytic agents into the pleural cavity is prohibited before Day 7.

Dosing Plan:

Investigational drug preparation: Dissolve the corresponding dose of the investigational drug in 20ml of normal saline for later use.All subjects will undergo chest tube drainage before the investigational drug administration. For subjects who meet the enrollment conditions, 20ml of the prepared drug will be injected into the thoracic cavity through a chest tube. After the injection is completed, the tube will be flushed with 5ml of normal saline, and then the chest tube will be clamped. Subjects will be advised to change positions to ensure adequate drug contact with the pleura (position changes are not mandatory).

Outcome Measures:

Safety Outcome Measures:

AE and SAE; Physical examination; Vital signs; Laboratory tests (complete blood count, blood biochemistry, coagulation function, and urinalysis); 12-lead ECG.

Efficacy Outcome Measures:

Changes in pleural opacity area on chest X-ray (measured as the absolute change from baseline in the percentage of pleural opacity area in the ipsilateral half of the chest on chest X-ray from pre-administration to Day 7); Relative change in pleural opacity area on chest X-ray (measured as the percentage reduction of the baseline area from pre-administration to Day 7); Drainage of pleural effusion from the first administration to Day 7; Changes in inflammatory markers (white blood cell count and C-reactive protein) before and after treatment.