Pharmacokinetics and Safety of PA-824 in Subjects With Mild, Moderate, and Severe Hepatic Impairment to Matched, Non-Hepatically Impaired Subjects

This is a Phase 1, single dose (200 mg), open-label, sequential group study comparing the
pharmacokinetics and safety of PA-824 in subjects with mild, moderate, and severe hepatic
impairment to matched, non-hepatically impaired subjects. This study will enroll
approximately 6 subjects with mild hepatic impairment (Child-Pugh A), approximately 6
subjects with moderate hepatic impairment (Child-Pugh B), approximately 6 subjects with
severe hepatic impairment (Child-Pugh C), and approximately 18 matched non-hepatically
impaired subjects. Non-hepatically impaired subjects in the control group will be matched to
subjects with hepatic impairment based on age (+/- 10 years) and body weight (+/- 20%) as
measured at screening (Visit 00A). There will be approximately 36 total subjects, adult males
and females, 18 to 70 years of age, inclusive. The study will be conducted at 1 VTEU site,
study duration is approximately 15 months, and subject participation duration is
approximately 5 weeks (including screening). Primary objective: To evaluate the
pharmacokinetics of a single oral dose of PA-824 in subjects with mild, moderate, and severe
hepatic impairment (as assessed by Child-Pugh score), relative to matched non-hepatically
impaired subjects. Secondary objective: To evaluate the safety of a single oral dose of
PA-824 in subjects with mild, moderate, and severe hepatic impairment (as assessed by
Child-Pugh score), relative to matched non-hepatically impaired subjects.

Inclusion Criteria:

Inclusion Criteria for Patients with Hepatic Impairment (Groups 1-3):

1. Subject is able to give voluntary written informed consent before any study related
procedure is performed.

2. 18-70 years of age, inclusive.

3. Acceptable laboratory values* obtained at screening (within 21 days prior to admission
to the DEPRU) and at admission to the DEPRU.

- Chemistry, complete blood count, AST, ALT, total bilirubin, alkaline phosphatase,
albumin, and urinalysis deemed not clinically significant by the investigator.

4. Hepatic impairment classified as Child-Pugh class A (mild), B (moderate), or C
(severe) criteria at screening for Groups 1, 2, or 3, respectively, and documented
evidence of hepatic cirrhosis*.

- by biopsy, nuclear scan, CT, MRI, ultrasound, or other clinically acceptable
methods

5. If female, not of childbearing potential* or agrees to avoid becoming pregnant by
using acceptable contraception** during the duration of the study.

*Non-childbearing potential is defined as being post-menopausal for at least 2 years,
status after bilateral oophorectomy or status after hysterectomy.

**Females of childbearing potential must agree to use two acceptable methods of
contraceptives: bilateral tubal ligation; barrier method (condom) by the male partner
(even if vasectomized); hormonal contraceptives; intrauterine contraceptive devices;
diaphragm in combination with contraceptive jelly, cream, foam, or spermicide; and
abstinence from sexual intercourse with men.

6. If subject is male and capable of reproduction, agrees to avoid fathering a child for
three months after dosing by using an acceptable method of birth control*.

- In addition to the use of a barrier method (condom) even if vasectomized,
acceptable methods of birth control are restricted to a monogamous relationship
with a woman who agrees to use acceptable contraception as outlined in inclusion
criterion #5, and abstinence from sexual intercourse with women.

7. If the subject is female, a negative serum pregnancy test at screening and a negative
urine pregnancy test at admission to DEPRU.

8. Willingness to comply with all protocol requirements.

Inclusion Criteria for Non-Hepatically Impaired Controls (Group 4):

1. Subject is able to give voluntary written informed consent before any study related
procedure is performed.

2. 18-70 years of age, inclusive.

3. Subject is a healthy volunteer as determined by no clinically significant findings
from medical history, physical examination, vital signs, and 12-lead ECG as determined
by the Site Investigator.

4. Acceptable laboratory values* obtained at screening (within 21 days prior to admission
to the DEPRU) and at admission to the DEPRU.

*Chemistry, complete blood count, AST, ALT, total bilirubin, alkaline phosphatase,
albumin, and urinalysis within the reference range for the test laboratory, unless
deemed not clinically significant by the investigator.

5. If female, not of childbearing potential* or agrees to avoid becoming pregnant by
using acceptable contraception** during the duration of the study.

*Non-childbearing potential is defined as being post-menopausal for at least 2 years,
status after bilateral oophorectomy or status after hysterectomy.

**Females of childbearing potential must agree to use two acceptable methods of
contraceptives: bilateral tubal ligation; barrier method (condom) by the male partner
(even if vasectomized); hormonal contraceptives; intrauterine contraceptive devices;
diaphragm in combination with contraceptive jelly, cream, foam, or spermicide; and
abstinence from sexual intercourse with men.

6. If subject is male and capable of reproduction, agrees to avoid fathering a child for
three months after dosing by using an acceptable method of birth control*.

*In addition to the use of a barrier method (condom) even if vasectomized, acceptable
methods of birth control are restricted to a monogamous relationship with a woman who
agrees to use acceptable contraception as outlined in inclusion criterion #5, and
abstinence from sexual intercourse with women.

7. If the subject is female, a negative serum pregnancy test at screening and a negative
urine pregnancy test at admission to DEPRU.

8. Willingness to comply with all protocol requirements.

Exclusion Criteria:

Exclusion Criteria for Patients with Hepatic Impairment (Groups 1-3):

1. Hypokalemia (< 3.5mEq/L), severe hypomagnesemia (< 1.1 mg/dL) or severe hypocalcemia
(< 7.5 mg/dL).

2. AST or ALT > 10 times the upper limit of normal.

3. Creatinine clearance < 60 ml/min.

4. Inability to swallow tablets.

5. Presence of any condition or finding* which would jeopardize subject safety, impact
study result validity, or diminish the subject's ability to undergo all study
procedures and assessments**.

*in the opinion of the site investigator

**e.g., inability to draw PK samples

6. History of fever or documented fever (oral temperature > / = 100.4 degrees F or > / =
38.0 degrees C) in the 48 hours prior to admission to the DEPRU.

7. Currently breastfeeding.

8. History of chronic tobacco/nicotine use (> 10 cigarettes per day for 3 months minimum
prior to DEPRU admission).

9. History of clinically significant allergy or severe side effects with nitroimidazoles
(e.g., Metronidazole and related substances and azole antifungals or aromatase
inhibitors).

10. Receipt of an investigational drug, vaccine or biologic in a clinical trial within 30
days prior to screening.

11. Use of any over the counter (OTC) medication* within 7 days prior to admission to the
DEPRU, unless** the substance would not likely impact the validity of the study
results.

*including vitamins and herbal supplements, cough and cold medications.

**in the opinion of the site investigator

12. Treatment with CYP450 enzyme altering drugs* within 7 days prior to admission to the
DEPRU, unless** the substance would not likely impact the validity of the study
results.

*except hormonal contraceptives

**in the opinion of the site investigator NOTE: See list of CYP450 enzyme altering
drugs under the concomitant medications section.

13. Treatment with any drugs* known to prolong the electrocardiographic QT interval within
15 days prior to admission to the DEPRU.

*Including excessive chronic caffeine (> six 8 oz cups of brewed coffee daily or > 3
energy drinks daily), theophylline (> 600 mg/day), or ephedrine (> 300 mg/day) use.

14. A positive blood screen for HIV.

15. A positive alcohol breath test or a urine screen test for drugs of abuse* at screening
and at admission to the DEPRU.

- Amphetamines, barbiturates, cocaine metabolites, marijuana, opiates,
phencyclidine (PCP).

NOTE: Results of the urine screen test can be ignored if in the opinion of the PI the
results can be explained by the concomitant medications history.

16. Unwillingness to abstain from engaging in strenuous physical activity (e.g. running,
bicycling, weight lifting, competitive sports) during the course of the study.

17. Consumption of grapefruit juice in the 48 hours before admission to the DEPRU, or the
inability to abstain from these until completion of Day 12.

18. A QTcF interval > 440 msec (males) or > 450 msec (females) at screening (Visit 00A) or
admission to the DEPRU (Visit 00B) or a history of prolonged QTc interval.

19. A family history* of Long QT Syndrome, premature cardiac death**, or sudden death
without a preceding diagnosis of a condition*** that could be causative of sudden
death.

- parents **due to ischemic heart disease or sudden cardiac death before 55 years
of age (men) or 65 years of age (women) ***such as known coronary artery disease,
congestive heart failure, or terminal cancer

20. Any clinically significant ECG abnormality, in the opinion of the site investigator,
at screening and at admission to the DEPRU.

21. Donation of > 500 mL blood within the 30 days prior to admission to the DEPRU.

22. Plans to donate blood during the study or up to 14 days after dosing.

Exclusion Criteria for Non-Hepatically Impaired Controls (Group 4):

1. Inability to swallow tablets.

2. Presence of any condition or finding* which would jeopardize subject safety, impact
study result validity, or diminish the subject's ability to undergo all study
procedures and assessments**.

*in the opinion of the site investigator

**e.g., inability to collect PK samples

3. History of fever or documented fever (oral temperature > / = 100.4 degrees F or > / =
38.0 degrees C) in the 48 hours prior to admission to the DEPRU.

4. Currently breastfeeding.

5. History of chronic tobacco/nicotine use (> 10 cigarettes per day for 3 months minimum
prior to DEPRU admission).

6. History of seizures (other than febrile seizures during childhood) or known or
suspected CNS disorders that may predispose to seizures.

7. History of clinically significant allergy or severe side effects with nitroimidazoles
(e.g., Metronidazole and related substances and azole antifungals or aromatase
inhibitors).

8. Receipt of an investigational drug, vaccine or biologic in a clinical trial within 30
days prior to screening.

9. Use of any over the counter (OTC) medication* within 7 days prior to admission to the
DEPRU, unless** the substance would not likely impact the validity of the study
results.

*including vitamins and herbal supplements, antacids, cough and cold medications.

- in the opinion of the site investigator

10. Use of prescription medication except hormonal contraceptives within 30 days prior to
admission to the DEPRU, unless* the substance would not likely impact study result
validity.

*in the opinion of the site investigator

11. Treatment with CYP450 enzyme altering drugs* within 7 days prior to admission to the
DEPRU, unless** the substance would not likely impact the validity of the study
results.

*except hormonal contraceptives

**in the opinion of the site investigator NOTE: See list of CYP450 enzyme altering
drugs under the concomitant medications section.

12. Treatment with any drugs* known to prolong the electrocardiographic QT interval within
15 days prior to admission to the DEPRU.

*Including excessive chronic caffeine (> six 8 oz cups of brewed coffee daily or > 3
energy drinks daily), theophylline (> 600 mg/day), or ephedrine (> 300 mg/day) use.

13. A positive blood screen for HIV.

14. A positive blood screen for hepatitis B surface antigen (HBsAg), or hepatitis C
antibody.

15. A positive alcohol breath test (or other suitable test for alcohol) or a urine screen
test for drugs of abuse* at screening and at admission to the DEPRU.

*Amphetamines, barbiturates, benzodiazepines, cocaine metabolites, marijuana, opiates,
phencyclidine (PCP).

16. A history of alcohol abuse or dependence within the past 1 month prior to admission to
the DEPRU.

17. Unwillingness to abstain from engaging in strenuous physical activity (e.g. running,
bicycling, weight lifting, competitive sports) during the course of the study.

18. Consumption of grapefruit juice in the 48 hours before admission to the DEPRU, or the
inability to abstain from these until completion of Day 12.

19. A QTcF interval > 440 msec (males) or > 450 msec (females) at screening (Visit 00A) or
admission to the DEPRU (Visit 00B) or a history of prolonged QTc interval.

20. A family history* of Long QT Syndrome, premature cardiac death**, or sudden death
without a preceding diagnosis of a condition*** that could be causative of sudden
death.

*parents

**due to ischemic heart disease or sudden cardiac death before 55 years of age (men)
or 65 years of age (women)

***such as known coronary artery disease, congestive heart failure, or terminal cancer

21. Any clinically significant ECG abnormality, in the opinion of the site investigator,
at screening and at admission to the DEPRU.

22. Donation of > 500 mL of blood within the 30 days prior to admission to the DEPRU.

23. Plans to donate blood during the study or up to 14 days after dosing.