Third Harmonic Bio, Inc. announced its next-generation product candidate, THB335, a potent, highly selective oral small molecule KIT inhibitor with a meaningfully differentiated product profile as compared to the company?s first-generation product candidate THB001. Third Harmonic plans to file a U.S. IND and initiate clinical development of THB335 for the treatment of mast cell-mediated inflammatory diseases during the first half of 2024. The company also disclosed topline results of the Phase 1b clinical trial of THB001 for the treatment of chronic inducible urticaria, which was discontinued in December 2023 due to observed liver transaminitis in two of five patients enrolled.

The results demonstrated evidence of clinical benefit in four of the five patients, achieving partial or complete responses despite early termination of the trial. In addition, the company shared preliminary results from extensive studies of THB001 that were conducted to identify the mechanism for the observed liver toxicity, which was not predicted by nonclinical toxicology studies. These in-depth studies identified a metabolic pathway resulting in the formation of an intermediate reactive metabolite.

Reactive metabolite formation has been previously implicated as a mechanistic basis for drug-induced liver injury. Structural modifications introduced into THB335 are believed to address this risk and studies conducted to date support its differentiated metabolic profile. The Phase 1b clinical trial of THB001 in chronic inducible urticaria was designed to evaluate the preliminary safety and tolerability, efficacy and pharmacokinetics of three dose levels of THB001 over 12 weeks of treatment.

Five patients were enrolled in the lowest planned dose cohort of 200mg BID before study discontinuation. The first patient enrolled completed 12 weeks of treatment; the next two patients enrolled were discontinued from study drug at week eight due to observed liver transaminitis. The two remaining patients were discontinued from study drug at weeks three and four and followed for safety per the trial protocol.

The transaminitis adverse events (AEs) were reported as moderate and resolved at weeks 17 and 25. All other AEs were reported as mild and demonstrated to be reversible. The overall AE profile, including mild hematologic and hair color changes, was consistent with the known on-target effects of KIT inhibition.

Rapid and sustained reduction in serum tryptase, a serum biomarker associated with mast cell activation and correlated with clinical response in urticaria studies, was observed in the trial, with an 83.1% mean change from baseline by week one. Four out of the five patients treated in the study achieved partial (n=2) or complete (n=2) Critical Temperature Threshold responses despite early termination of dosing. The company plans to present the full results of the study at a scientific conference later this year.

THB335, the company?s next-generation oral small molecule wild-type KIT inhibitor product candidate, retains the potency and selectivity profile of THB001, with structural modifications which are expected to mitigate the hepatoxicity risk as well as provide a differentiated metabolic, distribution and physiochemical profile. Key attributes of THB335: Nanomolar potency against KIT High degree of selectivity against closest related kinases, including PDGRF and CSF1R, as measured by biochemical assays and confirmed in cell-line viability assays No evidence for reactive metabolite formation as observed with THB001 High oral bioavailability and metabolic stability Improved peripheral restriction compared to THB001 (decreased CNS penetrance) Improved solubility and lipophilicity compared to THB001 Favorable pharmacokinetic profile with long circulating half-life The company plans to file a U.S. IND and initiate clinical trials of THB335 in the first half of 2024. Phase 2 development is expected to initially focus on chronic spontaneous urticaria, with planned expansion into other mast-cell mediated inflammatory disorders.