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Cantillon M, Hennessy T, Amon B, Dragoni F, O'Brien D. Mitigation of gaseous emissions from dairy livestock: A farm-level method to examine the financial implications. J Environ Manage 2024; 352:119904. [PMID: 38194877 DOI: 10.1016/j.jenvman.2023.119904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
Feeding the world's population while minimising the contribution of agriculture to climate change is one of the greatest challenges facing modern society. This challenge is particularly pronounced for dairy production where the carbon footprint of products and the mitigation costs are high, relative to other food stuffs. This paper reviews a number of mitigation measures that may be adopted by dairy farmers to reduce greenhouse gas emissions from their farms. A simulation model is developed to assess the cost-benefit of a range of mitigation measures. The model is applied to data from Ireland, a country with a large export-oriented dairy industry, for a range of farms including top, middle and bottom performing farms from a profitability perspective. The mitigation measures modelled included animal productivity, grass production and utilisation, better reproductive performance, early compact calving, reduced crude protein, decreased fertiliser N, protected urea, white clover, slurry tank cover and low emission slurry spreading (LESS). The results show that over half of the greenhouse gas abatement potential and most of the ammonia abatement potential were realised with cost-beneficial measures. Animal and feed-related measures that increased efficiency drove the abatement of GHG emissions. Low-emission slurry spreading was beneficial for the bottom and middle one-third of farms, while protected urea and reducing nitrogen use accounted for most of the ammonia abatement potential for the most profitable farms. Results showed that combining mitigation measures resulted in a decrease of 23%, 19%, and 12% in GHG emissions below 2020 levels for the bottom, middle, and top performing dairy farms, respectively. The findings imply that top dairy farms, that are already managed efficiently and optimally, may struggle to achieve the national and international GHG reduction targets with existing technologies and practices.
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Affiliation(s)
- M Cantillon
- Teagasc, Crops, Environment and Land Use Research Centre, Johnstown Castle, Co. Wexford, Ireland; Cork University Business School, University College Cork, College Road, Ireland.
| | - T Hennessy
- Cork University Business School, University College Cork, College Road, Ireland
| | - B Amon
- Leibniz Institute for Agricultural Engineering and Bioeconomy (ATB), Max-Eyth-Allee 100, 14469 Potsdam, Germany; University of Zielona Gora, Faculty of Civil Engineering, Architecture and Environmental Engineering, Poland
| | - F Dragoni
- Leibniz Institute for Agricultural Engineering and Bioeconomy (ATB), Max-Eyth-Allee 100, 14469 Potsdam, Germany
| | - D O'Brien
- Teagasc, Crops, Environment and Land Use Research Centre, Johnstown Castle, Co. Wexford, Ireland
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Cantillon M, Andreasen N, Prins N. Phase 1/2a Intravenous and Subcutaneous Oligomer-Specific Antibody KHK6640 in Mild to Moderate Alzheimer's Disease. J Prev Alzheimers Dis 2024; 11:65-70. [PMID: 38230718 DOI: 10.14283/jpad.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND KHK6640 is a novel humanized anti-amyloid beta oligomer-specific antibody. Both KHK6640 and the mouse parent antibody E64 have demonstrated high potency and efficacy for cognitive improvement in several rodent Alzheimer's disease models, including an anti-amyloid beta injection mouse model and in age-matched double transgenic littermates. The favorable safety and pharmacokinetic profiles of KHK6640 reported in preclinical studies warrant clinical trials in Alzheimer's disease patients. OBJECTIVES We evaluated the safety, pharmacokinetics, and efficacy of intravenous and subcutaneous oligomer-specific antibody KHK6640 in treating patients with prodromal Alzheimer's disease or mild to moderate Alzheimer's disease. DESIGN Phase I/2a, multicenter, randomized, double-blind, placebo-controlled trial. SETTING Nine sites in Europe participated in this clinical trial. PARTICIPANTS 97 patients with prodromal Alzheimer's disease or mild to moderate Alzheimer's disease. INTERVENTION Single and multiple ascending intravenous and subcutaneous doses of KHK6640 in doses ranging from 0.1 mg/kg to 20 mg/kg or placebo was administered to patients monthly for six months. MEASUREMENTS Primary outcomes were safety including amyloid-related imaging abnormalities for edema and hemorrhage, assessed with magnetic resonance imaging. Plasma and cerebrospinal fluid samples were analyzed to investigate pharmacokinetics and KHK6640 effects on biomarkers. Cognition, brain glucose metabolism and amyloid load were exploratory outcomes. RESULTS No amyloid-related imaging abnormalities for edema were observed. Amyloid-related imaging abnormalities for hemorrhage were comparable to that of placebo and population background. KHK6640 exposure was approximately dose-equivalent, with a serum terminal elimination half-life of approximately 19 days. KHK6640 pharmacokinetics in serum and cerebrospinal fluid, including cerebrospinal fluid oligomers trapped by the antibody were dose related. Positive trends seen in the positron emission tomography brain glucose metabolism and amyloid load, cerebrospinal tau but cognition assessments were inconclusive, due to low numbers. CONCLUSIONS KHK6640 was well-tolerated across all doses, without any amyloid-related imaging abnormalities for edema, and amyloid-related imaging abnormalities for hemorrhage was as population background. The demonstrated dose-response of specific target biomarkers provides dosing guidance on dose and administration method selection for further clinical development.
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Affiliation(s)
- M Cantillon
- Marc Cantillon, 125 Paterson St, New Brunswick, New Jersey, United States 08901, Phone: 973 4620496, Fax: 973 5358646,
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Mortby ME, Adler L, Agüera‐Ortiz L, Bateman DR, Brodaty H, Cantillon M, Geda YE, Ismail Z, Lanctôt KL, Marshall GA, Padala PR, Politis A, Rosenberg PB, Siarkos K, Sultzer DL, Theleritis C. Apathy as a treatment target in neurocognitive disorders: Clinical trial implications. Alzheimers Dement 2021. [DOI: 10.1002/alz.055082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Dan R Bateman
- Regenstrief Institute, Inc Indianapolis IN USA
- Indiana University Indianapolis IN USA
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Sydney NSW Australia
| | | | | | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary Calgary AB Canada
| | | | | | - Prasad R Padala
- Central Arkansas Veterans Healthcare System North Little Rock AR USA
| | - Antonis Politis
- 1st Department of Psychiatry, School of Medicine, National and Kapodestrian University of Athens Athens Greece
| | | | - Kostas Siarkos
- National and Kapodistrian University of Athens Athens Greece
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Xiao S, Chan P, Wang T, Hong Z, Wang S, Kuang W, He J, Pan X, Zhou Y, Ji Y, Wang L, Cheng Y, Peng Y, Ye Q, Wang X, Wu Y, Qu Q, Chen S, Li S, Chen W, Xu J, Peng D, Zhao Z, Li Y, Zhang J, Du Y, Chen W, Fan D, Yan Y, Liu X, Zhang W, Luo B, Wu W, Shen L, Liu C, Mao P, Wang Q, Zhao Q, Guo Q, Zhou Y, Li Y, Jiang L, Ren W, Ouyang Y, Wang Y, Liu S, Jia J, Zhang N, Liu Z, He R, Feng T, Lu W, Tang H, Gao P, Zhang Y, Chen L, Wang L, Yin Y, Xu Q, Xiao J, Cong L, Cheng X, Zhang H, Gao D, Xia M, Lian T, Peng G, Zhang X, Jiao B, Hu H, Chen X, Guan Y, Cui R, Huang Q, Xin X, Chen H, Ding Y, Zhang J, Feng T, Cantillon M, Chen K, Cummings JL, Ding J, Geng M, Zhang Z. A 36-week multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 3 clinical trial of sodium oligomannate for mild-to-moderate Alzheimer's dementia. Alzheimers Res Ther 2021; 13:62. [PMID: 33731209 PMCID: PMC7967962 DOI: 10.1186/s13195-021-00795-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND New therapies are urgently needed for Alzheimer's disease (AD). Sodium oligomannate (GV-971) is a marine-derived oligosaccharide with a novel proposed mechanism of action. The first phase 3 clinical trial of GV-971 has been completed in China. METHODS We conducted a phase 3, double-blind, placebo-controlled trial in participants with mild-to-moderate AD to assess GV-971 efficacy and safety. Participants were randomized to placebo or GV-971 (900 mg) for 36 weeks. The primary outcome was the drug-placebo difference in change from baseline on the 12-item cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog12). Secondary endpoints were drug-placebo differences on the Clinician's Interview-Based Impression of Change with caregiver input (CIBIC+), Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale, and Neuropsychiatric Inventory (NPI). Safety and tolerability were monitored. RESULTS A total of 818 participants were randomized: 408 to GV-971 and 410 to placebo. A significant drug-placebo difference on the ADAS-Cog12 favoring GV-971 was present at each measurement time point, measurable at the week 4 visit and continuing throughout the trial. The difference between the groups in change from baseline was - 2.15 points (95% confidence interval, - 3.07 to - 1.23; p < 0.0001; effect size 0.531) after 36 weeks of treatment. Treatment-emergent adverse event incidence was comparable between active treatment and placebo (73.9%, 75.4%). Two deaths determined to be unrelated to drug effects occurred in the GV-971 group. CONCLUSIONS GV-971 demonstrated significant efficacy in improving cognition with sustained improvement across all observation periods of a 36-week trial. GV-971 was safe and well-tolerated. TRIAL REGISTRATION ClinicalTrials.gov, NCT0229391 5. Registered on November 19, 2014.
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Affiliation(s)
- Shifu Xiao
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China. .,Alzheimer's Disease and Related Disorders Center, Shanghai Jiaotong University, 600 South Wan Ping Road, Shanghai, 200030, China.
| | - Piu Chan
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tao Wang
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Alzheimer's Disease and Related Disorders Center, Shanghai Jiaotong University, 600 South Wan Ping Road, Shanghai, 200030, China
| | - Zhen Hong
- Huashan Hospital, Fudan University, Shanghai, China
| | - Shuzhen Wang
- Qilu Hospital of Shandong University, Ji'nan, China
| | - Weihong Kuang
- West China Hospital of Sichuan University, Chengdu, China
| | - Jincai He
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoping Pan
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yuying Zhou
- Tianjin Huanhu Hospital, Huanhu Hospital Affiliated to Nankai University, Tianjin, China
| | - Yong Ji
- Tianjin Huanhu Hospital, Huanhu Hospital Affiliated to Nankai University, Tianjin, China
| | - Luning Wang
- Department of Geriatric Neurology of PLA General Hospital, Beijing, China
| | - Yan Cheng
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Peng
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qinyong Ye
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoping Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuncheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiumin Qu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Medical Neurobiology of Zhejiang Province, Hangzhou, China
| | - Jun Xu
- Northern Jiangsu People's Hospital, Yangzhou, China
| | - Dantao Peng
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | | | - Yansheng Li
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yifeng Du
- Shandong Provinical Hospital affiliated to Shandong University, Ji'nan, China
| | - Weixian Chen
- Jiangsu Province People's Hospital, Nanjing, China
| | | | - Yong Yan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaowei Liu
- Department of Geriatric psychiatry, Wuxi Mental Health Center, Wuxi, China
| | - Wei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Benyan Luo
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenyuan Wu
- Tongji Hospital of Tongji University, Shanghai, China
| | - Lu Shen
- Xiangya Hospital Central South University, Changsha, China
| | - Chunfeng Liu
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Peixian Mao
- Beijing An Ding Hospital, Capital Medical University, Beijing, China
| | - Qiumei Wang
- Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Qianhua Zhao
- Huashan Hospital, Fudan University, Shanghai, China
| | - Qihao Guo
- Huashan Hospital, Fudan University, Shanghai, China
| | - Yongtao Zhou
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yi Li
- Qilu Hospital of Shandong University, Ji'nan, China
| | - Lijun Jiang
- West China Hospital of Sichuan University, Chengdu, China
| | - Wenwei Ren
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingjun Ouyang
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yan Wang
- Tianjin Huanhu Hospital, Huanhu Hospital Affiliated to Nankai University, Tianjin, China
| | - Shuai Liu
- Tianjin Huanhu Hospital, Huanhu Hospital Affiliated to Nankai University, Tianjin, China
| | - Jianjun Jia
- Department of Geriatric Neurology of PLA General Hospital, Beijing, China
| | - Nan Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhonglin Liu
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Raoli He
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Tingyi Feng
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhui Lu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huidong Tang
- Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ping Gao
- Beijing Hospital, Beijing, China
| | - Yingchun Zhang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Medical Neurobiology of Zhejiang Province, Hangzhou, China
| | - Lanlan Chen
- Northern Jiangsu People's Hospital, Yangzhou, China
| | - Lei Wang
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - You Yin
- Shanghai Changzheng Hospital, Shanghai, China
| | - Qun Xu
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jinsong Xiao
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lin Cong
- Shandong Provinical Hospital affiliated to Shandong University, Ji'nan, China
| | - Xi Cheng
- Jiangsu Province People's Hospital, Nanjing, China
| | - Hui Zhang
- Peking University Third Hospital, Beijing, China
| | - Dan Gao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Minghua Xia
- Department of Geriatric psychiatry, Wuxi Mental Health Center, Wuxi, China
| | - Tenghong Lian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guoping Peng
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xu Zhang
- Tongji Hospital of Tongji University, Shanghai, China
| | - Bin Jiao
- Xiangya Hospital Central South University, Changsha, China
| | - Hua Hu
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xueyan Chen
- Beijing An Ding Hospital, Capital Medical University, Beijing, China
| | - Yihui Guan
- Huashan Hospital, Fudan University, Shanghai, China
| | - Ruixue Cui
- Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Qiu Huang
- Med-X Research Institution, Shanghai Jiao Tong University, Shanghai, China
| | - Xianliang Xin
- Shanghai Green Valley Pharmaceutical Co. Ltd., No. 421, Niudun Road, Shanghai, China
| | - Hongjian Chen
- Shanghai Green Valley Pharmaceutical Co. Ltd., No. 421, Niudun Road, Shanghai, China
| | - Yu Ding
- Shanghai Green Valley Pharmaceutical Co. Ltd., No. 421, Niudun Road, Shanghai, China
| | - Jing Zhang
- Shanghai Green Valley Pharmaceutical Co. Ltd., No. 421, Niudun Road, Shanghai, China
| | - Teng Feng
- Shanghai Green Valley Pharmaceutical Co. Ltd., No. 421, Niudun Road, Shanghai, China
| | - Marc Cantillon
- Shanghai Green Valley Pharmaceutical Co. Ltd., No. 421, Niudun Road, Shanghai, China
| | - Kewei Chen
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Jeffrey L Cummings
- Chamberrs-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, USA
| | - Jian Ding
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu chong zhi Road, Nevada, China
| | - Meiyu Geng
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu chong zhi Road, Nevada, China.
| | - Zhenxin Zhang
- Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Beijing, 100730, China.
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DeKarske D, Alva G, Aldred JL, Coate B, Cantillon M, Jacobi L, Nunez R, Norton JC, Abler V. An Open-Label, 8-Week Study of Safety and Efficacy of Pimavanserin Treatment in Adults with Parkinson's Disease and Depression. J Parkinsons Dis 2020; 10:1751-1761. [PMID: 32804101 PMCID: PMC7683094 DOI: 10.3233/jpd-202058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Many patients with Parkinson's disease (PD) experience depression. OBJECTIVE Evaluate pimavanserin treatment for depression in patients with PD. METHODS Pimavanserin was administered as monotherapy or adjunctive therapy to a selective serotonin reuptake inhibitor or serotonin/noradrenaline reuptake inhibitor in this 8-week, single-arm, open-label phase 2 study (NCT03482882). The primary endpoint was change from baseline to week 8 in Hamilton Depression Scale-17-item version (HAMD-17) score. Safety, including collection of adverse events and the Mini-Mental State Examination (MMSE) and Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III) scores, was assessed in patients who received ≥1 pimavanserin dose. RESULTS Efficacy was evaluated in 45 patients (21 monotherapy, 24 adjunctive therapy). Mean (SE) baseline HAMD-17 was 19.2 (3.1). Change from baseline to week 8 (least squares [LS] mean [SE]) in the HAMD-17 was -10.8 (0.63) (95% CI, -12.0 to -9.5; p < 0.0001) with significant improvement seen at week 2 (p < 0.0001) and for both monotherapy (week 8, -11.2 [0.99]) and adjunctive therapy (week 8,-10.2 [0.78]). Most patients (60.0%) had ≥50% improvement at week 8, and 44.4% of patients reached remission (HAMD-17 score ≤7). Twenty-one of 47 patients experienced 42 treatment-emergent adverse events; the most common by system organ class were gastrointestinal (n = 7; 14.9%) and psychiatric (n = 7; 14.9%). No negative effects were observed on MMSE or MDS-UPDRS Part III. CONCLUSION In this 8-week, single-arm, open-label study, pimavanserin as monotherapy or adjunctive therapy was well tolerated and associated with early and sustained improvement of depressive symptoms in patients with PD.
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Affiliation(s)
| | - Gustavo Alva
- Department of Neuroscience, University of California, Riverside, Riverside, CA, USA
| | | | - Bruce Coate
- ACADIA Pharmaceuticals Inc., San Diego, CA, USA
| | - Marc Cantillon
- Department of Neurology and Psychiatry, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Lori Jacobi
- ACADIA Pharmaceuticals Inc., San Diego, CA, USA
| | - Rene Nunez
- ACADIA Pharmaceuticals Inc., San Diego, CA, USA
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Stern Y, Chételat G, Habeck C, Arenaza-Urquijo EM, Vemuri P, Estanga A, Bartrés-Faz D, Cantillon M, Clouston SAP, Elman JA, Gold BT, Jones R, Kempermann G, Lim YY, van Loenhoud A, Martínez-Lage P, Morbelli S, Okonkwo O, Ossenkoppele R, Pettigrew C, Rosen AC, Scarmeas N, Soldan A, Udeh-Momoh C, Valenzuela M, Vuoksimaa E. Mechanisms underlying resilience in ageing. Nat Rev Neurosci 2019; 20:246. [PMID: 30814677 DOI: 10.1038/s41583-019-0138-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Richard Jones
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Gerd Kempermann
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Yen Ying Lim
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | | | - Pablo Martínez-Lage
- Center for Research and Advanced Therapies, CITA-Alzheimer Foundation, San Sebastian, Spain
| | | | | | | | | | - Allyson C Rosen
- National and Kapodistrian University of Athens, Athens, Greece
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Bhat L, Cantillon M, Ings R. Brilaroxazine (RP5063) Clinical Experience in Schizophrenia: "A New Option to Address Unmet Needs". ACTA ACUST UNITED AC 2018. [DOI: 10.29245/2572.942x/2018/5.1225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cantillon M, Bhat L. Response to concerns over Cantillon et al. dopamine serotonin stabilizer RP5063 clinical trial's design, analyses and findings (SCHRES-D-17-00455) by Ahmed S Aboraya, MD, DrPh. Schizophr Res 2018; 195:581-582. [PMID: 29395606 DOI: 10.1016/j.schres.2017.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 10/18/2022]
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Cantillon M, Ings R, Bhat L. Initial Clinical Experience of RP5063 Following Single Doses in Normal Healthy Volunteers and Multiple Doses in Patients with Stable Schizophrenia. Clin Transl Sci 2018; 11:387-396. [PMID: 29637739 PMCID: PMC6039200 DOI: 10.1111/cts.12545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/29/2018] [Indexed: 02/06/2023] Open
Abstract
RP5063 is a multimodal dopamine (D)‐serotonin (5‐HT) stabilizer with a high affinity for D2/3/4 and 5‐HT1A/2A/2B/7 receptors and moderate affinity for the serotonin transporter. Single‐dose (10 and 15 mg fasting, 15 mg fed) safety in healthy volunteers and multiple‐dose (10, 20, 50, and 100 mg fed, 10 days) safety and pharmacodynamics in patients with stable schizophrenia were defined in two phase I studies. In the single‐dose study, 32 treatment‐emergent adverse events (TEAEs) were observed. Orthostatic hypotension (n = 6), nausea (n = 5), and dizziness (n = 4) were the most common. One serious adverse event (SAE), seen in a patient who should not have been in the study due to a history of seizures, involved brief seizure‐like symptoms. In the multiple‐dose study, 75 TEAEs were reported. Akathisia (n = 20) and somnolence (n = 14) were the most frequent. No clinically significant changes were seen in glucose or prolactin levels, lipid profiles, weight, or electrocardiographic recordings. In both studies, all TEAEs resolved and none led to withdrawal from the study or death. A pharmacodynamic evaluation reflected significant improvements with RP5063 (P < 0.05) over placebo in an analysis of patients with a baseline Positive and Negative Syndrome Scale (PANSS) score ≥50 for positive subscale scores. Improvements of the Trail Making A and Trail Making B test results were observed for patients treated in the 50 mg dose group for days 5, 10, and 16. These findings indicate that RP5063 is well‐tolerated up to 100 mg and displays promising preliminary clinical behavioral and cognition activity signals in patients with stable disease over a 10‐day period.
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Affiliation(s)
- Marc Cantillon
- Reviva Pharmaceuticals, Inc., Sunnyvale, California, USA
| | - Robert Ings
- Reviva Pharmaceuticals, Inc., Sunnyvale, California, USA
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Bhat L, Hawkinson J, Cantillon M, Reddy DG, Bhat SR, Laurent CE, Bouchard A, Biernat M, Salvail D. Evaluation of the effects of RP5063, a novel, multimodal, serotonin receptor modulator, as single-agent therapy and co-administrated with sildenafil, bosentan, and treprostinil in a monocrotaline-induced pulmonary arterial hypertension rat model. Eur J Pharmacol 2018; 827:159-166. [PMID: 29453947 DOI: 10.1016/j.ejphar.2018.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/18/2022]
Abstract
Pulmonary arterial hypertension (PAH), a condition that is defined by pulmonary vasculature constriction and remodeling, involves dysfunctional signaling of the serotonin (5-HT) receptors, 5-HT2A/2B/7. In a rat model of monocrotaline (MCT)-induced PAH, the effectiveness of RP5063 (RP), a dopamine and 5-HT receptor modulator, was evaluated as monotherapy and as an adjunct to standard PAH treatments. After a single 60 mg/kg dose of MCT, rats received vehicle (MCT+Veh; gavage twice-daily [b.i.d.]), RP (10 mg/kg; gavage b.i.d.), bosentan (B; 100 mg/kg; gavage BID), sildenafil (S; 50 mg/kg; gavage, BID), treprostinil (T; 100 ng/kg/min over 24 h intravenous), RP+B, RP+S, and RP+T for 28 days. Single-agent RP limited the functional and structural effects of PAH seen in the MCT+Veh group, with significant improvements in pulmonary hemodynamics, right ventricular (RV) hypertrophy, SO2, and pulmonary blood vessel structural changes. These effects appeared comparable with those associated with B, S, and T. Adjunctive RP treatment resulted in significantly lower mean pulmonary arterial pressures, RV systolic pressure. It also improved SO2 measurements, as compared with MCT+Veh (P < 0.05), and diastolic pulmonary artery pressure (P < 0.05), as compared with single-agent B and S therapy (Bonferroni method adjusting for multiplicity). RP+S appeared to show the most consistent and extensive effects on pulmonary hemodynamics, respiratory parameters, and histopathologic changes. These results corroborate earlier preclinical findings supporting the efficacy of single-agent RP in PAH. RP, as mono and adjunctive therapy compared with induced-control, mitigated the functional and structural effects of MCT-induced PAH.
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Affiliation(s)
| | - Jon Hawkinson
- Institute for Therapeutics Discovery & Development and Department of Medicinal Chemistry, University of Minnesota, Minnesota, MN, USA
| | | | | | - Seema R Bhat
- Reviva Pharmaceuticals, Inc., Sunnyvale, CA, USA
| | | | | | | | - Dany Salvail
- IPS Therapeutique Inc., Sherbrooke, Quebec, Canada
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11
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Cantillon M, Ings R, Bhat L. Pharmacokinetics of RP5063 Following Single Doses to Normal Healthy Volunteers and Multiple Doses Over 10 Days to Stable Schizophrenic Patients. Clin Transl Sci 2017; 11:378-386. [PMID: 29119704 PMCID: PMC6039205 DOI: 10.1111/cts.12518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/06/2017] [Indexed: 11/28/2022] Open
Abstract
RP5063, a multimodal dopamine (D)-serotonin (5-HT) stabilizer, possesses high affinity for D2/3/4 and 5-HT1A/2A/2B/2C/6/7 receptors and moderate affinity for the serotonin transporter. Two phase I studies characterized the pharmacokinetics of a single dose (10 and 15 mg fasting, 15 mg fed/fasting) in healthy volunteers and multiple doses (10, 20, 50, and 100 mg fed) over 10 days in patients with stable schizophrenia. RP5063 displayed a dose-dependent Cmax at 4 to 6 h, linear dose proportionality for both Cmax and AUC, and a half-life between 40 and 71 h. In the single-dose study, food slightly increased the extent of drug absorption. In the multiple-dose study, steady-state was approached after 120 h of daily dosing. Pooled data in the single-dose study indicate that the pharmacokinetic profile appears to be comparable between Japanese and Caucasians. RP5063 appears to have a straightforward pharmacokinetic profile that supports for phase II and III evaluation as a once-daily oral administered agent.
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Affiliation(s)
- Marc Cantillon
- Reviva Pharmaceuticals, Inc., Santa Clara, California, USA
| | - Robert Ings
- Reviva Pharmaceuticals, Inc., Santa Clara, California, USA
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12
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Cantillon M, Prakash A, Alexander A, Ings R, Sweitzer D, Bhat L. Dopamine serotonin stabilizer RP5063: A randomized, double-blind, placebo-controlled multicenter trial of safety and efficacy in exacerbation of schizophrenia or schizoaffective disorder. Schizophr Res 2017; 189:126-133. [PMID: 28215471 DOI: 10.1016/j.schres.2017.01.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 01/21/2017] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
Abstract
The study objectives were to evaluate the efficacy, safety, tolerability, and pharmacokinetics of RP5063 versus placebo. The study was conducted in adults with acute exacerbation of schizophrenia or schizoaffective disorder. This 28-day, multicenter, placebo-controlled, double-blind study randomized 234 subjects to RP5063 15, 30, or 50mg; aripiprazole; or placebo (3:3:3:1:2) once daily. The aripiprazole arm was included solely to show assay sensitivity and was not powered to show efficacy. The primary endpoint was change from baseline to Day 28/EOT (End-of-Treatment) in Positive and Negative Syndrome Scale (PANSS) total score; secondary endpoints included PANSS subscales, improvement ≥1 point on the Clinical Global Impressions-Severity (CGI-S), depression and cognition scales. The primary analysis of PANSS Total showed improvement by a mean (SE) of -20.23 (2.65), -15.42 (2.04), and -19.21 (2.39) in the RP5063 15, 30, and 50mg arms, versus -11.41 (3.45) in the placebo arm. The difference between treatment and placebo reached statistical significance for the 15mg (p=0.021) and 50mg (p=0.016) arms. Improvement with RP5063 was also seen for multiple secondary efficacy outcomes. Discontinuation for any reason was much lower for RP5063 (14%, 25%, 12%) versus placebo (26%) and aripiprazole (35%). The most common treatment-emergent adverse events (TEAE) in the RP5063 groups were insomnia and agitation. There were no significant changes in body weight, electrocardiogram, or incidence of orthostatic hypotension; there was a decrease in blood glucose, lipid profiles, and prolactin levels. In conclusion, the novel dopamine serotonin stabilizer, RP5063 is an efficacious and well-tolerated treatment for acute exacerbation of schizophrenia or schizoaffective disorder.
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Affiliation(s)
- Marc Cantillon
- Reviva Pharmaceuticals Inc., 3900 Freedom Circle, Suite 101, Santa Clara, CA 95054, USA.
| | - Arul Prakash
- Reviva Pharmaceuticals Inc., 3900 Freedom Circle, Suite 101, Santa Clara, CA 95054, USA
| | - Ajay Alexander
- Reviva Pharmaceuticals Inc., 3900 Freedom Circle, Suite 101, Santa Clara, CA 95054, USA
| | - Robert Ings
- Reviva Pharmaceuticals Inc., 3900 Freedom Circle, Suite 101, Santa Clara, CA 95054, USA
| | - Dennis Sweitzer
- Reviva Pharmaceuticals Inc., 3900 Freedom Circle, Suite 101, Santa Clara, CA 95054, USA
| | - Laxminarayan Bhat
- Reviva Pharmaceuticals Inc., 3900 Freedom Circle, Suite 101, Santa Clara, CA 95054, USA
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13
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Isaacson S, Eggert K, Kumar R, Stocchi F, Mori A, Ohta E, Toyama K, Spence G, Clark G, Cantillon M. Efficacy and safety of istradefylline in moderate to severe Parkinson’s disease: A phase 3, multinational, randomized, double-blind, placebo-controlled trial (i-step study). J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Mukai M, Uchimura T, Zhang X, Greene D, Vergeire M, Cantillon M. Effects of Rifampin on the Pharmacokinetics of a Single Dose of Istradefylline in Healthy Subjects. J Clin Pharmacol 2017; 58:193-201. [PMID: 28881378 PMCID: PMC5811788 DOI: 10.1002/jcph.1003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/25/2017] [Indexed: 11/22/2022]
Abstract
Istradefylline, a selective adenosine A2A inhibitor, is under development for the treatment of Parkinson's disease. The effect of oral steady‐state rifampin 600 mg/day, a potent cytochrome P450 (CYP) 3A4 inducer, on the disposition of a single oral dose of istradefylline 40 mg was determined in a crossover study in 20 healthy subjects by measuring plasma concentrations of istradefylline and its M1 and M8 metabolites and their derived pharmacokinetic parameters. Based on the geometric mean ratio of log‐transformed data, rifampin reduced istradefylline exposure: Cmax, 0.55 (90%CI, 0.49–0.62); AUClast, 0.21 (90%CI, 0.19–0.22); and AUCinf, 0.19 (90%CI, 0.18–0.20), indicating nonequivalence. These changes were primarily because of the effect of rifampin on the elimination parameters of istradefylline; mean CL/F was increased from 4.0 to 20.6 L/h, and mean t1/2 was reduced from 94.8 to 31.5 hours. The effect of rifampin coadministration on the disposition of the istradefylline M1 and M8 metabolites was inconsistent and variable. Furthermore, as exposure of the istradefylline M1 and M8 metabolites in plasma was generally <9% of total drug exposure, it would be expected to have a negligible impact on the pharmacodynamic effect of istradefylline. Caution should be exercised when istradefylline is administered concurrently with strong CYP3A4 inducers and dose adjustment considered.
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Affiliation(s)
- Mayumi Mukai
- Kyowa Kirin Pharmaceutical Development, Inc., Princeton, NJ, USA
| | | | - Xiaoping Zhang
- Kyowa Kirin Pharmaceutical Development, Inc., Princeton, NJ, USA
| | - Douglas Greene
- Kyowa Kirin Pharmaceutical Development, Inc., Princeton, NJ, USA
| | | | - Marc Cantillon
- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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15
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Bhat L, Hawkinson J, Cantillon M, Reddy DG, Bhat SR, Laurent CE, Bouchard A, Biernat M, Salvail D. RP5063, a novel, multimodal, serotonin receptor modulator, prevents monocrotaline-induced pulmonary arterial hypertension in rats. Eur J Pharmacol 2017; 810:92-99. [PMID: 28577964 DOI: 10.1016/j.ejphar.2017.05.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
Pulmonary arterial hypertension (PAH), a condition characterized by pulmonary vasculature constriction and remodeling, involves dysregulation of the serotonin (5-HT) receptors 5-HT2A and 5-HT2B. A rat model of monocrotaline (MCT)-induced PAH was used to examine the potential beneficial effects of RP5063, a 5-HT receptor modulator. After a single 60mg/kg dose of MCT, rats were gavaged twice-daily (b.i.d.) with vehicle, RP5063 (1, 3, or 10mg/kg), or sildenafil (50mg/kg) for 28 days. RP5063 at a dose as low as 1mg/kg, b.i.d. reduced pulmonary resistance and increased systemic blood oxygen saturation. The highest dose of RP5063 (10mg/kg, b.i.d.) reduced diastolic, systolic, and mean pulmonary pressure, right systolic ventricular pressure, ventilatory pressure, and Fulton's index (ratio of right to left ventricular weight). Doses as low as 3mg/kg RP5063, b.i.d. also increased weight gain and body temperature, suggesting an improvement in overall health of MCT-treated animals. Similar reductions in pulmonary, right ventricular, and ventilatory pressure, pulmonary resistance, and Fulton's index as well as increased systemic blood oxygen saturation were observed in animals treated with the reference agent sildenafil at a higher dose (50mg/kg, b.i.d.). Histological examination revealed that RP5063 produced dose-dependent reductions in pulmonary blood vessel wall thickness and proportion of muscular vessels, similar to sildenafil. RP5063 completely blocked MCT-induced increases in the plasma cytokines TNFα, IL-1β, and IL-6 at all doses. In summary, RP5063 improved pulmonary vascular pathology and hemodynamics, right ventricular pressure and hypertrophy, systemic oxygen saturation, and overall health of rats treated with MCT.
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Affiliation(s)
| | - Jon Hawkinson
- Institute for Therapeutics Discovery & Development and Department of Medicinal Chemistry, University of Minnesota, USA
| | | | | | - Seema R Bhat
- Reviva Pharmaceuticals, Inc., Santa Clara, CA, USA
| | | | | | | | - Dany Salvail
- IPS Therapeutique Inc., Sherbrooke, Quebec, Canada
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16
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Cantillon M, Wilson G, Montero J, Novak B, Smith R. Istradefylline Parkinson's disease trial: Methodology of data quality. Parkinsonism Relat Disord 2016. [DOI: 10.1016/j.parkreldis.2015.10.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Cantillon M, Wilson G, Montero J, Novak B, Smith R. Istradefylline Parkinson's disease trial: Methodology of data quality. Parkinsonism Relat Disord 2016. [DOI: 10.1016/j.parkreldis.2015.10.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Cantillon M, Hendrix S, Ellison N, Liu L. P3‐307: Empirical assessment of cognitive decline: A comparison of domains and neuropsychological tests over time based on multiple studies. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | - Li Liu
- Kyowa Kirin Pharma, Inc.PrincetonNJUSA
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19
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Hill DLG, Schwarz AJ, Isaac M, Pani L, Vamvakas S, Hemmings R, Carrillo MC, Yu P, Sun J, Beckett L, Boccardi M, Brewer J, Brumfield M, Cantillon M, Cole PE, Fox N, Frisoni GB, Jack C, Kelleher T, Luo F, Novak G, Maguire P, Meibach R, Patterson P, Bain L, Sampaio C, Raunig D, Soares H, Suhy J, Wang H, Wolz R, Stephenson D. Coalition Against Major Diseases/European Medicines Agency biomarker qualification of hippocampal volume for enrichment of clinical trials in predementia stages of Alzheimer's disease. Alzheimers Dement 2015; 10:421-429.e3. [PMID: 24985687 DOI: 10.1016/j.jalz.2013.07.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/26/2013] [Accepted: 07/23/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Regulatory qualification of a biomarker for a defined context of use provides scientifically robust assurances to sponsors and regulators that accelerate appropriate adoption of biomarkers into drug development. METHODS The Coalition Against Major Diseases submitted a dossier to the Scientific Advice Working Party of the European Medicines Agency requesting a qualification opinion on the use of hippocampal volume as a biomarker for enriching clinical trials in subjects with mild cognitive impairment, incorporating a scientific rationale, a literature review and a de novo analysis of Alzheimer's Disease Neuroimaging Initiative data. RESULTS The literature review and de novo analysis were consistent with the proposed context of use, and the Committee for Medicinal Products for Human Use released an opinion in November 2011. CONCLUSIONS We summarize the scientific rationale and the data that supported the first qualification of an imaging biomarker by the European Medicines Agency.
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Affiliation(s)
| | | | | | - Luca Pani
- European Medicines Agency, London, UK
| | | | | | | | - Peng Yu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Jia Sun
- Eli Lilly and Company, Indianapolis, IN, USA; The University of Texas School of Public Health, Houston, TX, USA
| | | | | | | | - Martha Brumfield
- Coalition Against Major Diseases, Critical Path Institute, Tucson, AZ, USA
| | | | | | - Nick Fox
- UCL Institute of Neurology, London, UK
| | | | | | | | - Feng Luo
- Bristol Myers Squibb, Wallingford, CT, USA
| | - Gerald Novak
- Janssen Pharmaceutical Research and Development, Titusville, NJ, USA
| | | | | | | | - Lisa Bain
- Independent science writer, Elverson, PA, USA
| | | | | | | | | | | | - Robin Wolz
- IXICO Ltd., London, UK; Department of Computing, Imperial College London, London, UK
| | - Diane Stephenson
- Coalition Against Major Diseases, Critical Path Institute, Tucson, AZ, USA.
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20
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Factor SA, Wolski K, Togasaki DM, Huyck S, Cantillon M, Ho TW, Hauser RA, Pourcher E. Long-term safety and efficacy of preladenant in subjects with fluctuating Parkinson's disease. Mov Disord 2013; 28:817-20. [PMID: 23589371 DOI: 10.1002/mds.25395] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 01/10/2013] [Accepted: 01/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preladenant is a selective adenosine A₂A receptor antagonist under investigation for Parkinson's disease treatment. METHODS A phase 2 36-week open-label follow-up of a double-blind study using preladenant 5 mg twice a day as a levodopa adjunct in 140 subjects with fluctuating Parkinson's disease was conducted. The primary end point was adverse event (AE) assessment. Secondary (efficacy) analyses included hours/day spent in OFF and ON states and dyskinesia prevalence/severity. RESULTS The 36-week open-label phase was completed by 106 of 140 subjects (76%). AE-related treatment discontinuations occurred in 19 subjects (14%). Treatment-emergent AEs, reported by ≥15% of subjects, were dyskinesia (33%) and constipation (19%). Preladenant 5 mg twice a day provided OFF time reductions (1.4-1.9 hours/day) and ON time increases (1.2-1.5 hours/day) throughout the 36-week treatment relative to the baseline of the double-blind study. CONCLUSIONS Long-term preladenant treatment (5 mg twice a day) was generally well tolerated and provided sustained OFF time reductions and ON time increases.
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Affiliation(s)
- Stewart A Factor
- Emory University School of Medicine, Department of Neurology, Atlanta, Georgia 30329, USA.
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21
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Boxer AL, Gold M, Huey E, Gao FB, Burton EA, Chow T, Kao A, Leavitt BR, Lamb B, Grether M, Knopman D, Cairns NJ, Mackenzie IR, Mitic L, Roberson ED, Van Kammen D, Cantillon M, Zahs K, Salloway S, Morris J, Tong G, Feldman H, Fillit H, Dickinson S, Khachaturian Z, Sutherland M, Farese R, Miller BL, Cummings J. Frontotemporal degeneration, the next therapeutic frontier: molecules and animal models for frontotemporal degeneration drug development. Alzheimers Dement 2012; 9:176-88. [PMID: 23043900 DOI: 10.1016/j.jalz.2012.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 03/07/2012] [Indexed: 02/04/2023]
Abstract
Frontotemporal degeneration (FTD) is a common cause of dementia for which there are currently no approved therapies. Over the past decade, there has been an explosion of knowledge about the biology and clinical features of FTD that has identified a number of promising therapeutic targets as well as animal models in which to develop drugs. The close association of some forms of FTD with neuropathological accumulation of tau protein or increased neuroinflammation due to progranulin protein deficiency suggests that a drug's success in treating FTD may predict efficacy in more common diseases such as Alzheimer's disease. A variety of regulatory incentives, clinical features of FTD such as rapid disease progression, and relatively pure molecular pathology suggest that there are advantages to developing drugs for FTD as compared with other more common neurodegenerative diseases such as Alzheimer's disease. In March 2011, the Frontotemporal Degeneration Treatment Study Group sponsored a conference entitled "FTD, the Next Therapeutic Frontier," which focused on preclinical aspects of FTD drug development. The goal of the meeting was to promote collaborations between academic researchers and biotechnology and pharmaceutical researchers to accelerate the development of new treatments for FTD. Here we report the key findings from the conference, including the rationale for FTD drug development; epidemiological, genetic, and neuropathological features of FTD; FTD animal models and how best to use them; and examples of successful drug development collaborations in other neurodegenerative diseases.
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Affiliation(s)
- Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
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22
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Romero K, Corrigan B, Neville J, Kopko S, Cantillon M. Striving for an integrated drug-development process for neurodegeneration: the coalition against major diseases. Neurodegener Dis Manag 2011. [DOI: 10.2217/nmt.11.51] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Alzheimer’s and Parkinson’s diseases are the two main neurodegenerative disorders and despite the public health need, drug development for these conditions has been plagued by a high attrition rate in the late phases of evaluation. In order to improve the efficiency of the drug development process for these conditions, the Coalition Against Major Diseases was formed by the Critical Path Institute in September 2008, in collaboration with the Engelberg Center for Health Care Reform at the Brookings Institution (Washington, DC, USA), with the aim of sharing precompetitive patient level data from legacy clinical trials, and transforming those data into generalizable and shareable knowledge in the form of drug development tools for Alzheimer’s and Parkinson’s diseases. As of May 2011, Coalition Against Major Diseases has 21 members (14 pharmaceutical companies and seven patient groups), joined by the US FDA, the European Medicines Agency, the National Institute of Aging and the National Institute of Neurological Disorders and Stroke. The drug development tools in development will take the form of biomarkers and modeling and simulation frameworks, and will be submitted for regulatory evaluation and qualification as ‘fit for purpose’ in the specific context of the drug development process for these diseases. This article constitutes a report of the progress of the work of the coalition in data standards, disease models and biomarkers.
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Affiliation(s)
| | - Brian Corrigan
- Pfizer Global Research & Development, 50 Pequot Avenue, New London, CT 06320, USA
| | - Jon Neville
- Critical Path Institute, 1730 East River Road, Tucson, AZ 85718, USA
| | - Steve Kopko
- CDISC, PO Box 2068, Round Rock, TX 78680, USA
| | - Marc Cantillon
- Critical Path Institute, 1730 East River Road, Tucson, AZ 85718, USA
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23
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Cantillon M. F5‐03‐01: Alzheimer's‐specific data standards. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.2337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Soares H, Frank D, Kirby L, Dean R, Berman R, Risinger R, Kelleher T, Gans‐Brangs K, Cantillon M. P2‐071: Biomarker Qualification in Alzheimer's Disease. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Holly Soares
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
| | - Denise Frank
- Critical Path InstituteTucsonArizonaUnited States
| | - Louis Kirby
- Critical Path InstituteTucsonArizonaUnited States
| | | | - Robert Berman
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
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25
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Jack CR, Barkhof F, Bernstein MA, Cantillon M, Cole PE, Decarli C, Dubois B, Duchesne S, Fox NC, Frisoni GB, Hampel H, Hill DLG, Johnson K, Mangin JF, Scheltens P, Schwarz AJ, Sperling R, Suhy J, Thompson PM, Weiner M, Foster NL. Steps to standardization and validation of hippocampal volumetry as a biomarker in clinical trials and diagnostic criterion for Alzheimer's disease. Alzheimers Dement 2011; 7:474-485.e4. [PMID: 21784356 PMCID: PMC3396131 DOI: 10.1016/j.jalz.2011.04.007] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 04/26/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND The promise of Alzheimer's disease biomarkers has led to their incorporation in new diagnostic criteria and in therapeutic trials; however, significant barriers exist to widespread use. Chief among these is the lack of internationally accepted standards for quantitative metrics. Hippocampal volumetry is the most widely studied quantitative magnetic resonance imaging measure in Alzheimer's disease and thus represents the most rational target for an initial effort at standardization. METHODS AND RESULTS The authors of this position paper propose a path toward this goal. The steps include the following: (1) Establish and empower an oversight board to manage and assess the effort, (2) adopt the standardized definition of anatomic hippocampal boundaries on magnetic resonance imaging arising from the European Alzheimer's Disease Centers-Alzheimer's Disease Neuroimaging Initiative hippocampal harmonization effort as a reference standard, (3) establish a scientifically appropriate, publicly available reference standard data set based on manual delineation of the hippocampus in an appropriate sample of subjects (Alzheimer's Disease Neuroimaging Initiative), and (4) define minimum technical and prognostic performance metrics for validation of new measurement techniques using the reference standard data set as a benchmark. CONCLUSIONS Although manual delineation of the hippocampus is the best available reference standard, practical application of hippocampal volumetry will require automated methods. Our intent was to establish a mechanism for credentialing automated software applications to achieve internationally recognized accuracy and prognostic performance standards that lead to the systematic evaluation and then widespread acceptance and use of hippocampal volumetry. The standardization and assay validation process outlined for hippocampal volumetry was envisioned as a template that could be applied to other imaging biomarkers.
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26
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Hauser RA, Cantillon M, Pourcher E, Micheli F, Mok V, Onofrj M, Huyck S, Wolski K. Preladenant in patients with Parkinson's disease and motor fluctuations: a phase 2, double-blind, randomised trial. Lancet Neurol 2011; 10:221-9. [PMID: 21315654 DOI: 10.1016/s1474-4422(11)70012-6] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Preladenant is an adenosine 2A (A₂(A)) receptor antagonist. In animal models of Parkinson's disease, preladenant monotherapy improves motor function without causing dyskinesia and, as an adjunct to levodopa, it improves motor function without worsening dyskinesia. We aimed to assess the efficacy and safety of preladenant in patients with Parkinson's disease and motor fluctuations who were receiving levodopa and other antiparkinsonian drugs. METHODS In this phase 2, dose-finding trial, patients with Parkinson's disease who were receiving levodopa were enrolled and treated at 44 sites in 15 countries between December, 2006, and November, 2008. Assignment to treatment was done centrally with an interactive voice response system, according to a block randomisation schedule that was computer generated by the sponsor. Patients were assigned to receive 1, 2, 5, or 10 mg oral preladenant twice daily, or matching placebo for 12 weeks. Patients, study staff, investigators, and all sponsor personnel were masked to treatment assignment. The primary outcome was change in mean daily off time from baseline to week 12, as assessed by home diaries. Efficacy analysis included all patients who received at least one dose of study drug and had data for assessments after baseline. This trial is registered with ClinicalTrials.gov, number NCT00406029. FINDINGS 253 patients were randomised to receive preladenant (1 mg [n=49], 2 mg [n=49], 5 mg [n=49], 10 mg [n=57]) or placebo (n=49), of whom 234 on preladenant (1 mg [n=47], 2 mg [n=48], 5 mg [n=45], 10 mg [n=49]) and placebo (n=45) were eligible for the efficacy analysis. Mean daily off time from baseline to week 12 was reduced versus placebo in patients on 5 mg preladenant (difference -1·0 h, 95% CI -2·1 to 0·0; p=0·0486) and 10 mg preladenant (-1·2 h, -2·2 to -0·2; p=0·019). Changes in mean daily off time versus placebo were not significant for 1 mg preladenant (0·2 h, -0·9 to 1·2; p=0·753) or 2 mg preladenant (-0·7 h, -1·7 to 0·3; p=0·162). The most common adverse events in the combined preladenant group versus placebo were worsening of Parkinson's disease (22 [11%] vs 4 [9%]), somnolence (20 [10%] vs 3 [6%]), dyskinesia (18 [9%] vs 6 [13%]), nausea (17 [9%] vs 5 [11%]), constipation (15 [8%] vs 1 [2%]), and insomnia (15 [8%] vs 4 [9%]). INTERPRETATION 5 and 10 mg preladenant twice daily might be clinically useful to reduce off time in patients with Parkinson's disease and motor fluctuations. FUNDING Schering-Plough, a subsidiary of Merck.
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Gan TJ, Gu J, Singla N, Chung F, Pearman MH, Bergese SD, Habib AS, Candiotti KA, Mo Y, Huyck S, Creed MR, Cantillon M. Rolapitant for the Prevention of Postoperative Nausea and Vomiting. Anesth Analg 2011; 112:804-12. [DOI: 10.1213/ane.0b013e31820886c3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hauser R, Pourcher E, Micheli F, Mok V, Onofrj M, Huyck S, Wolski K, Cantillon M. P2.101 Efflcacy and safety of preladenant, a novel A2A receptor antagonist, as a levodopa adjunct in patients with moderate-to-severe Parkinson's disease. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Diez BD, Statkevich P, Zhu Y, Abutarif MA, Xuan F, Kantesaria B, Cutler D, Cantillon M, Schwarz M, Pallotta MG, Ottaviano FH. Evaluation of the exposure equivalence of oral versus intravenous temozolomide. Cancer Chemother Pharmacol 2009; 65:727-34. [PMID: 19641919 PMCID: PMC2808524 DOI: 10.1007/s00280-009-1078-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 07/08/2009] [Indexed: 01/05/2023]
Abstract
Purpose Oral temozolomide is approved in many countries for malignant glioma and for melanoma in some countries outside the USA. This study evaluated the exposure equivalence and safety of temozolomide by intravenous infusion and oral administration. Methods Subjects with primary central nervous system malignancies (excluding central nervous system lymphoma) received 200 mg/m2 of oral temozolomide on days 1, 2 and 5. On days 3 and 4, subjects received 150 mg/m2 temozolomide either as a 90-min intravenous infusion on one day or by oral administration on an alternate day. Results Ratio of log-transformed means (intravenous:oral) of area under the concentration–time curve and maximum concentration of drug after dosing for temozolomide and 5-(3-methyltriazen-1-yl)imidazole-4-carboxamide (MTIC) met exposure equivalence criteria (90% confidence interval = 0.8–1.25). Treatment-emergent adverse events were consistent with those reported previously in subjects with recurrent glioma treated with oral temozolomide, except for mostly mild and transient injection site reactions with intravenous administration. Conclusions This study demonstrated an exposure equivalence of a 90-min intravenous infusion of temozolomide and an equivalent oral dose.
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Affiliation(s)
- Blanca D Diez
- Department of Neuro-Oncology, Institute of Neurological Research Dr Raul Carrea (FLENI), Montañeses 2325, Buenos Aires 1428, Argentina.
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Files JG, Hargrove D, Delute L, Cantillon M. Measured Neutralizing Titers of IFN-β Neutralizing Antibodies (NAbs) Can Depend on the Preparations of IFN-β Used in the Assay. J Interferon Cytokine Res 2007; 27:637-42. [PMID: 17784815 DOI: 10.1089/jir.2006.0131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An immune response to recombinant human protein therapeutics, including type I interferons (IFNs), has the potential to have a serious negative impact on safety and efficacy. Monitoring of patients for neutralizing antibodies (NAbs) often is advisable. In the case of IFN-beta therapy for multiple sclerosis (MS), we obtained reproducible quantitative titers of NAbs using an improved and well-characterized assay based on a 10-fold reduction of a challenge dose of IFN-beta. However, the observed titer was significantly affected by the preparation of IFN-beta used as the assay challenge. NAb titers obtained using IFN-beta1b averaged 3-5-fold lower than titers of the same sample assayed using either IFN-beta1a or human fibroblast-derived IFN-beta. This was the case whether neutralizing serum was obtained from patients on therapy with IFN-beta1a or IFN-beta1b. The reason for this apparent titer difference is not fully understood but appears to be related to protein folding or other structural properties that differentiate the IFN-beta1b both from commercial IFN-beta1a preparations and from human fibroblast-derived IFN-beta.
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Affiliation(s)
- James G Files
- J. Files Consulting, 120 C Street, San Rafael, CA 94901, USA.
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Cantillon M, Antonijevic I. Clinical relevance of anti-drug antibodies with interferon beta-1b therapy in multiple sclerosis. Mult Scler 2007. [DOI: 10.1177/1352458507076986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Interferon beta-1b (IFNβ-1b; Betaferon®/Betaseron®) is an effective treatment for relapsing forms of multiple sclerosis (MS). It was the first immunomodulatory therapy to receive approval for this indication in 1993 in the USA and in 1995 in Europe. It remains the only high-dose, high-frequency treatment with proven efficacy in patients with a clinical demyelinating event, RRMS and SPMS. Several large controlled studies have been performed, including 16 years follow-up of patients, providing a unique data set to evaluate long-term safety and efficacy. Results obtained from several studies have shown an inconsistent impact of neutralizing antibodies (NAb) to IFNβ-1b, unlike NAb to other IFNβ therapies. Although patient heterogeneity and the use of different NAb assays are involved, this reflects intrinsic differences between the respective IFNβ-1b versus IFNβ-1a molecules as well as their sensitivity to NAb effects. When evaluating the occurrence and the impact of NAb during different IFNβ therapies, standardization is a necessity. Three phase III trials of IFNβ-1b, in which the same assay methodology was applied, suggest that NAb to IFNβ-1b are transient, mostly of low to moderate titre and have no effect on disability progression with only limited effect on relapse rate. Two controlled studies showed better efficacy of high dose, high frequency beta-interferon treatment even in NAb-positive patients over low dose, low frequency beta-interferon treatment in NAb-negative individuals. Given the overall clinical efficacy of IFNβ-1b, the inconsistent data regarding the effect of NAb to IFNβ-1b on treatment outcome, and the unpredictable course of disease in a given patient, treatment decisions should be based on patient response to therapy, not on NAb status. This position is endorsed by current regulatory and neurology association guidelines and is reflected in the package insert information. Multiple Sclerosis 2007; 13: S21—S27 http://msj.sagepub.com
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Abstract
OBJECTIVE To investigate whether differences in antidepressant efficacy are moderated by an interaction of age and gender. METHODS A pooled dataset from eight randomized, controlled trials of patients with major depressive disorder (MDD) was reanalyzed to compare remission rates following therapy with venlafaxine (n = 851), one of several selective serotonin reuptake inhibitors (SSRIs) (n = 748), or placebo (n = 446). Remission was defined as a final Hamilton Rating Scale for Depression (HAM-D) score < or =7. Pairwise comparisons were conducted using stepwise multiple logistic regression models with main effect and interaction terms for treatment, sex, and age (younger: <50; older: > or =50). Among older women, the impact of hormone replacement therapy (HRT) on remission rates also was examined. RESULTS Remission rates on venlafaxine therapy were not affected by age, sex, or HRT use. Among women, but not men, there was a significant interaction reflecting poorer SSRI response in the older age group (Wald chi-square = 4.21, df = 1, p = 0.04); HRT appeared to eliminate this difference. Whereas the advantage in remission rates favoring venlafaxine was modest for men and younger women (6%-9%), the difference among older women not taking HRT was 23%. CONCLUSIONS These findings provide further evidence that age, gender, and HRT moderate response to antidepressant medications.
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Affiliation(s)
- Michael E Thase
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213-2593, USA.
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Cantillon M, Vause E, Sykes D, Tagoe M. Safety, tolerability and efficacy of intraoperative ALGRX 4975 in a randomized, double-blind, placebo-controlled study of subjects undergoing bunionectomy. The Journal of Pain 2005. [DOI: 10.1016/j.jpain.2005.01.190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Davidson JRT, Meoni P, Haudiquet V, Cantillon M, Hackett D. Achieving remission with venlafaxine and fluoxetine in major depression: its relationship to anxiety symptoms. Depress Anxiety 2002; 16:4-13. [PMID: 12203668 DOI: 10.1002/da.10045] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Venlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), produces significantly higher remission rates in depressed patients than do the selective serotonin reuptake inhibitors (SSRIs). In this analysis of pooled data, we explored the relationship between differences in treatment efficacy, early improvement of symptoms, and severity of baseline anxiety in depressed patients treated with either venlafaxine or fluoxetine. A pooled analysis was performed on data from 1,454 outpatients with major depression from five double-blind, randomized studies comparing the 6-week efficacy of venlafaxine (542 patients) with fluoxetine (555 patients). The Hamilton rating scale for depression (HAM-D) total and item scores were analyzed at different treatment times up to 6 weeks. Venlafaxine and fluoxetine both produced statistically significant higher response and remission rates compared with placebo starting from week 2 for response and weeks 3 to 4 for remission. Venlafaxine was statistically significantly superior to fluoxetine from week 3 until week 6 in respect of response rate, and from week 2 until week 6 for remission rate. After 1 week of treatment, greater improvement in individual symptoms was observed in the depressed mood, suicide, and psychic anxiety items of the HAM-D scale for both venlafaxine- and fluoxetine-treated patients compared with placebo. Improvement in psychic anxiety was statistically significantly greater with venlafaxine than with fluoxetine. The presence of baseline psychic anxiety correlated significantly to treatment outcome when analyzing the remission rates. In depressed patients with moderate anxiety (HAM-D psychic anxiety score < or = 2), venlafaxine statistically significantly increased remission rates compared with placebo from week 4 until week 6, while a significant effect of fluoxetine on remission rates was observed starting at week 6. Remission rates in the severely anxious depressed patients (score > 2) were statistically significantly higher with venlafaxine than placebo starting from week 3 until the end of the study period, but no difference could be observed between fluoxetine and placebo. Baseline severity of psychic anxiety had a significant impact on remission rates after treatment of patients diagnosed with depression. Venlafaxine's superior remission rates in the more severely anxious patients and its ability to improve psychic anxiety as early as week 1 compared with fluoxetine suggest that venlafaxine's early efficacy on anxiety symptoms may be the basis for its superior efficacy in depression.
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Affiliation(s)
- Jonathan R T Davidson
- Department of Psychology Behavioral Sciences, Anxiety and Traumatic Stress Program, Duke University Medicine Center, Durham, North Carolina 27710, USA.
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Kalin N, Nemeroff C, Wan G, Panish J, Cantillon M. Improvement in general life functioning with venlafaxine versus fluoxetine in outpatients with major depression. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80829-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Evans D, Nemeroff C, Thase M, Wan G, Panish J, Cantillon M. Improvement in social activity level, general life and cognitive functioning with venlafaxine versus fluoxetine in inpatients with melancholic depression. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80830-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Harwood DG, Barker WW, Cantillon M, Loewenstein DA, Ownby R, Duara R. Depressive symptomatology in first-degree family caregivers of Alzheimer disease patients: a cross-ethnic comparison. Alzheimer Dis Assoc Disord 1998; 12:340-6. [PMID: 9876963 DOI: 10.1097/00002093-199812000-00015] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study investigated the prevalence of depressive symptoms among White Hispanic (WH) and White non-Hispanic (WNH) first-degree family caregivers. We screened 653 primary caregivers of family members with possible or probable Alzheimer disease who presented at our outpatient memory disorders clinic. Caregiver depression was assessed utilizing the Center for Epidemiologic Studies-Depression (CES-D) Scale. Overall, depression (CES-D scores > or = 16) was more common among WH (45%) than among WNH (36%) caregivers (p < 0.05). Elevated CES-D scores among the entire caregiving sample were also linked with being a female spouse (p=0.002), increased level of patient cognitive impairment (p=0.002), and patient psychosis (p=0.002). Risk factors for caregiver depression were identified and compared when the sample was stratified by ethnicity (WH and WNH) and generation (spouses and children). Patient cognitive impairment was a predictor of caregiver depression only among WH spouses and children, whereas patient psychosis was a predictor only among WNH spouses. Female caregiver gender was the most robust risk factor for caregiver depression, being a predictor in all groups except WH children. Implications of this study include the need for increased clinical sensitivity to depression in ethnic minority caregivers, treatment of psychiatric morbidity in dementia caregivers, and respite care for caregivers with high risk for depression.
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Affiliation(s)
- D G Harwood
- Mount Sinai Medical Center and the University of Miami School of Medicine, Miami Beach, Florida 33140, USA
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Reichman WE, Coyne AC, Borson S, Negrón AE, Rovner BW, Pelchat RJ, Sakauye KM, Katz P, Cantillon M, Hamer RM. Psychiatric consultation in the nursing home. A survey of six states. Am J Geriatr Psychiatry 1998; 6:320-7. [PMID: 9793580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The authors examined availability, characteristics, and perceived adequacy of psychiatric consultation in nursing homes, as reported by directors of nursing, who returned 899 questionnaires. Thirty-eight percent of nursing home residents were judged to need a psychiatric evaluation; current frequency of consultation was rated as adequate by half of nursing directors. Nearly two-thirds reported that psychiatrists adequately provided diagnostic and medication recommendations; however, advice on nonpharmacologic management techniques, staff support, and dealing with staff stress and family conflicts was largely viewed as inadequate. Findings suggest that perceived need for psychiatric services is far greater than the level actually provided. Overall, more attention must be directed to identifying incentives for psychiatrists to practice in nursing homes, determining clinical effectiveness of mental health services, and examining effects of alternative payment mechanisms on level of care.
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Affiliation(s)
- W E Reichman
- Division of Geriatric Psychiatry, University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School (RWJMS), Piscataway 08855-1392, USA.
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Cantillon M, Harwood D, Barker W, St George-Hyslop P, Tsuda T, Ekatarina R, Duara R. No association between apolipoprotein E genotype and late-onset depression in Alzheimer's disease. Biol Psychiatry 1997; 41:246-8. [PMID: 9018400 DOI: 10.1016/s0006-3223(96)00422-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Cantillon
- Wien Center, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
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Hellerstein DJ, Samstag LW, Cantillon M, Maurer M, Rosenthal J, Yanowitch P, Winston A. Follow-up assessment of medication-treated dysthymia. Prog Neuropsychopharmacol Biol Psychiatry 1996; 20:427-42. [PMID: 8771599 DOI: 10.1016/0278-5846(96)00007-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
1. The objective was to assess long-term efficacy of antidepressant medications in dysthymia. 2. In a naturalistic study, patients with DSMIII-R dysthymia who had participated in previous antidepressant trials with fluoxetine and trazodone were evaluated at a mean of 40.0 weeks of follow-up to assess whether medication response persisted over time. A multivariate analysis was performed for patients on vs. off medication. Relapse rates (with relapse defined as HDRS score > 13) were also compared for these two groups. 3. Of 40 patients, the 24 still on medication showed significantly lower scores on most rating scales (HDRS, Cornell Dysthymia Rating Scale, and CGI, but not on the SCL-58) than the heterogeneous group of 16 patients not taking medication. Relapse was low (17.4%) among patients remaining on medication. 4. These preliminary findings suggest that dysthymia patients who remain on medication maintain improvement over time.
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Affiliation(s)
- D J Hellerstein
- Psychiatric Outpatient Services, Beth Israel Medical Center, New York, N.Y., USA
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Little JT, Broocks A, Martin A, Hill JL, Tune LE, Mack C, Cantillon M, Molchan S, Murphy DL, Sunderland T. Serotonergic modulation of anticholinergic effects on cognition and behavior in elderly humans. Psychopharmacology (Berl) 1995; 120:280-8. [PMID: 8524975 DOI: 10.1007/bf02311175] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cholinergic neurotransmission is thought to be modulated by serotonin as documented in animal and human studies. We examined the effects of the muscarinic antagonist scopolamine (0.4 mg IV) given alone or together with the serotonin mixed agonist/antagonist m-chlorophenylpiperazine (m-CPP, 0.08 mg/kg IV), and the selective 5-HT3 receptor antagonist ondansetron (0.15 mg/kg IV). Ten normal elderly volunteers each received five separate pharmacologic challenges (placebo, ondansetron, scopolamine, scopolamine+ondansetron, and scopolamine+m-CPP). Cognitive, behavioral, and physiologic variables were analyzed using repeated measures analysis of variance. The acute effects of scopolamine in certain cognitive, behavioral, and physiological measures were significantly exaggerated by the addition of m-CPP. Scopolamine's cognitive effects were unaffected by ondansetron at the dose tested, nor did ondansetron given alone affect basal cognitive performance. This pilot study suggests that the serotonin mixed agonist/antagonist m-CPP may influence cholinergic neurotransmission. The changes associated with the combination of scopolamine and m-CPP do not appear to be secondary to simple pharmacokinetic alterations and suggest a complex interaction between the cholinergic and serotonergic systems centrally.
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Affiliation(s)
- J T Little
- Section on Psychobiology, Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 208-992, USA
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Feinberg TE, Roane DM, Miner CR, Kaufman H, Cantillon M. Neuropsychiatric evaluation in an outpatient setting. J Neuropsychiatry Clin Neurosci 1995; 7:145-54. [PMID: 7626957 DOI: 10.1176/jnp.7.2.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In a retrospective case review of 336 outpatients who underwent neuropsychiatric evaluations, patients were sorted into five groups: 1) atypical psychiatric; 2) atypical neurological; 3) prior psychiatric/new-onset neurological; 4) prior neurological/new-onset psychiatric; 5) dementia versus pseudodementia. Cluster analysis of 19 presenting complaints differentiated among groups. Post-consultation changes in preconsultation diagnosis occurred frequently overall, with more new case finding for psychiatric than for neurological disorders. For example, mood disorder diagnoses increased from 7.7% to 16.1%. Overall, dementia was the most common postconsultation diagnosis (32.8%). The authors conclude that suspicion for dementia should be high in neuropsychiatric referrals and that mood disorders may be especially common in neuropsychiatric patients.
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Affiliation(s)
- T E Feinberg
- Neurobehavior and Alzheimer's Disease Center, Beth Israel Medical Center, New York, NY 10003, USA
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Molchan SE, Matochik JA, Zametkin AJ, Szymanski HV, Cantillon M, Cohen RM, Sunderland T. A double FDG/PET study of the effects of scopolamine in older adults. Neuropsychopharmacology 1994; 10:191-8. [PMID: 7916916 DOI: 10.1038/npp.1994.21] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Two consecutive positron emission scans were done in one session using a double injection method of [18F]2-fluoro-2-deoxyglucose administration to examine the effects of the antimuscarinic drug scopolamine on cerebral glucose metabolism in ten older adults. Scopolamine causes temporary memory impairment, and its effects have been used to model aspects of the cognitive impairment that occur in Alzheimer's disease (AD). Cortical metabolic rates of patients with AD have been reported to be depressed, especially in parietal, temporal, and frontal association areas. After scopolamine administration to the elderly volunteers, absolute and normalized glucose metabolic rates were depressed in prefrontal and occipital regions and increased in parietal-occipital cortical regions and a left middle temporal region. These changes in the older volunteers are generally not consistent with changes seen in AD. We conclude that deficits in muscarinic system function may contribute to some but not all of the hypometabolic changes seen in AD patients.
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Affiliation(s)
- S E Molchan
- Section on Geriatric Psychiatry, National Institute of Mental Health, Bethesda, Maryland
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Hellerstein DJ, Yanowitch P, Rosenthal J, Samstag LW, Maurer M, Kasch K, Burrows L, Poster M, Cantillon M, Winston A. A randomized double-blind study of fluoxetine versus placebo in the treatment of dysthymia. Am J Psychiatry 1993; 150:1169-75. [PMID: 8328559 DOI: 10.1176/ajp.150.8.1169] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the efficacy of fluoxetine, a selective serotonergic antidepressant, in the treatment of dysthymia. METHOD Thirty-five patients who met criteria for dysthymia, but not major depression, began randomized, double-blind 8-week trials of fluoxetine or placebo. RESULTS Of 32 patients who completed the study, 10 (62.5%) of the 16 patients given fluoxetine and three (18.8%) of the 16 given placebo responded to treatment. Response was defined as 1) 50% or greater decrease in Hamilton Rating Scale for Depression score and 2) a score of 1 or 2 on the Clinical Global Impression (CGI) improvement subscale. Fluoxetine subjects showed significantly greater improvement at week 8 than placebo subjects on the Hamilton depression and CGI scales, but not on the Hopkins Symptom Check-list (58-item) or the Cornell Dysthymia Rating Scale. CONCLUSIONS When compared to placebo, fluoxetine showed short-term effectiveness in treating dysthymic symptoms.
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Affiliation(s)
- D J Hellerstein
- Psychiatric Outpatient Service, Beth Israel Medical Center, New York, NY 10003
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