Developing medications is a structured and regulated process. It usually begins with an idea that that a certain compound could benefit patients by improving their condition.

The compound is first tested in the laboratory – in cells or animals – to find out if it could be beneficial. Only then is the compound tested in humans, in a series of studies called “clinical trials”. If these prove safe and effective, the compound may then be licensed and marketed as a drug for treatment of the condition.

Clinical trials are usually conducted by drug companies, but in some cases by academic institutions.

Clinical trials are tightly regulated by laws, which were made to protect participants, while ensuring that the drug in development will not be released for use as a patient treatment until it is safe and effective.

These trials are advanced in steps, each of which has to be successful in order to move on to the next phase - see phases I to IV below:

• Phase I trials determine how safe a compound is in healthy volunteers (looking out for potential undesired side effects).
• Phase II trials determine safety and the optimal dose in patients (the amount of the compound and how often it should be taken).
• Phase III trials determine the compound’s effectiveness in patients.
• Phase IV trials may be performed after the drug is already licensed and usually look for the effect of the drug outside the limited specifications of earlier clinical phase trials.

Each phase trial must show that it was successful in order to move on to the next phase trial.

Due to the complexity of these processes, it typically takes years from early development to marketing of a drug. In this process, many compounds fail to demonstrate effectiveness or for other reasons their development may be stopped.

Conducted by aTyr Pharma, this is the only Phase 3 trial currently taking place for pulmonary sarcoidosis.

The investigational drug, efzofitimod, is from a new class of drugs that leverages our natural biology to resolve inflammation without immune suppression and potentially prevent the progression of fibrosis.

The company has performed a series of preclinical and clinical studies to suggest effectiveness in sarcoidosis. These include animal and cell culture models of sarcoidosis.

In addition, they have completed and published their Phase 1b/2a study in patients with pulmonary sarcoidosis, which found a positive response, including a dose response, in improving quality of life, lung function and tapering daily prednisone dose compared to placebo patients.

The study is currently enrolling patients in the U.S., Europe and Japan. The study will examine the impact of therapy on steroid tapering, quality of life, lung function, and safety of the drug.

Details regarding the ongoing study can be found at: www.efzofit.com and www.clinicaltrials.gov (NCT05415137).

This is a Phase 2 trial for pulmonary sarcoidosis.

The drug being studied is Namilumab, which binds to a protein called granulocyte-macrophage colony-stimulating factor (GM-CSF). It has been found that inflammatory cells in sarcoidosis patients have increased levels of GM-CSF. There are no sarcoidosis animal or cell culture model studies published yet.

Namilumab has been studied previously in patients with other inflammatory diseases, such as Rheumatoid Arthritis and Psoriasis.

As this study is a Phase 2 trial, there is no information about how patients will respond to therapy.

Details regarding the ongoing study can be found at: https://www.sarcoidosistrial.com/

This is a Phase 2 trial for pulmonary sarcoidosis.

The drug XTMAB-16 is a monoclonal antibody that aims to inhibit tumor necrosis factor (TNF).

Other anti-TNF antibodies such as infliximab and adalimumab have been used clinically in sarcoidosis. However, none have been approved by regulatory agencies for patients living with sarcoidosis.

There are cell culture model studies published demonstrating that XTMAB-16 suppresses formation of sarcoidosis granulomas.

The Phase 2 trial is examining different doses and frequencies of the IV administered study drug.

Details regarding the ongoing study can be found at: https://xentria.com/clinical/xtmab16-phase-2.