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Langford R, Pogatzki-Zahn EM, Morte A, Sust M, Cebrecos J, Vaqué A, Ortiz E, Fettiplace J, Adeyemi S, López-Cedrún JL, Bescós S, Gascón N, Plata-Salamán C. Co-crystal of Tramadol-Celecoxib Versus Tramadol or Placebo for Acute Moderate-to-Severe Pain After Oral Surgery: Randomized, Double-Blind, Phase 3 Trial (STARDOM1). Adv Ther 2024; 41:1025-1045. [PMID: 38183526 PMCID: PMC10879371 DOI: 10.1007/s12325-023-02744-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/16/2023] [Accepted: 11/16/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Co-crystal of tramadol-celecoxib (CTC) is the first analgesic co-crystal for acute pain. This completed phase 3 multicenter, double-blind trial assessed the efficacy and safety/tolerability of CTC in comparison with that of tramadol in the setting of moderate-to-severe pain up to 72 h after elective third molar extraction requiring bone removal. METHODS Adults (n = 726) were assigned randomly to five groups (2:2:2:2:1): orally administered twice-daily CTC 100 mg (44 mg rac-tramadol hydrochloride/56 mg celecoxib; n = 164), 150 mg (66/84 mg; n = 160) or 200 mg (88/112 mg; n = 160); tramadol 100 mg four times daily (n = 159); or placebo four times daily (n = 83). Participants in CTC groups also received twice-daily placebo. The full analysis set included all participants who underwent randomization. The primary endpoint was the sum of pain intensity differences over 0 to 4 h (SPID0-4; visual analog scale). Key secondary endpoints included 4-h 50% responder and rescue medication use rates. Safety endpoints included adverse events (AEs), laboratory measures, and Opioid-Related Symptom Distress Scale (OR-SDS) score. RESULTS All CTC doses were superior to placebo (P < 0.001) for primary and key secondary endpoints. All were superior to tramadol for SPID0-4 (analysis of covariance least squares mean differences [95% confidence interval]: - 37.1 [- 56.5, - 17.6], - 40.2 [- 59.7, - 20.6], and - 41.7 [- 61.2, - 22.2] for 100, 150, and 200 mg CTC, respectively; P < 0.001) and 4-h 50% responder rate. Four-hour 50% responder rates were 32.9% (CTC 100 mg), 33.8% (CTC 150 mg), 40.6% (CTC 200 mg), 20.1% (tramadol), and 7.2% (placebo). Rescue medication use was lower in the 100-mg (P = 0.013) and 200-mg (P = 0.003) CTC groups versus tramadol group. AE incidence and OR-SDS scores were highest for tramadol alone. CONCLUSIONS CTC demonstrated superior pain relief compared with tramadol or placebo, as well as an improved benefit/risk profile versus tramadol. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02982161; EudraCT number, 2016-000592-24.
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Affiliation(s)
| | | | | | | | | | - Anna Vaqué
- ESTEVE Pharmaceuticals, Barcelona, Spain
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Langford R, Margarit C, Morte A, Cebrecos J, Sust M, Ortiz E, Giménez-Arnau JM, de Leon-Casasola O. Co-crystal of tramadol-celecoxib (CTC) for acute moderate-to-severe pain. Curr Med Res Opin 2024; 40:455-468. [PMID: 38205948 DOI: 10.1080/03007995.2023.2276118] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/24/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE This narrative review aims to provide a clinical perspective on the potential role of co-crystal of tramadol-celecoxib (CTC) in the management of acute moderate-to-severe pain by synthesizing the available preclinical and clinical data, with emphasis on phase 3 trials. METHODS A non-systematic literature review was performed using a targeted PubMed search for articles published between January 1, 2000, and May 2, 2023; all publication types were permitted, and selected articles were limited to those published in English. Search results were manually reviewed to identify references based on their preclinical and clinical relevance to CTC and management of acute moderate-to-severe pain. RESULTS The crystalline structure of CTC alters the physicochemical properties of tramadol and celecoxib, modifying their pharmacokinetics. If taken in a free combination, tramadol reduces absorption of celecoxib. Conversely, administration of CTC slows tramadol absorption and lowers its maximum plasma concentration, while increasing celecoxib plasma concentration through its enhanced release. In clinical studies across models of acute moderate-to-severe pain, CTC demonstrated an early onset of analgesia, with improved efficacy and lower rescue medication use, compared with either agent alone. CTC's safety profile was in line with that expected for the individual components; no additive effects were observed. CTC exhibited tramadol-sparing effects, with efficacy seen at lower daily/cumulative opioid doses vs. tramadol alone. CONCLUSIONS Results from phase 3 trials suggest that the modified physicochemical properties of tramadol and celecoxib in CTC translate into an improved clinical benefit-risk profile, including fewer opioid-related adverse effects due to lower overall opioid dosing.
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Affiliation(s)
| | - Cesar Margarit
- Hospital General Universitario de Alicante, Alicante, Spain
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3
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Viscusi ER, de Leon‐Casasola O, Cebrecos J, Jacobs A, Morte A, Ortiz E, Sust M, Vaqué A, Gottlieb I, Daniels S, Gimbel JS, Muse D, Winkle P, Kuss M, Videla S, Gascón N, Plata‐Salamán C. Celecoxib-tramadol co-crystal in patients with moderate-to-severe pain following bunionectomy with osteotomy: A phase 3, randomized, double-blind, factorial, active- and placebo-controlled trial. Pain Pract 2023; 23:8-22. [PMID: 35686380 PMCID: PMC10084286 DOI: 10.1111/papr.13136] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/11/2023]
Abstract
BACKGROUND Celecoxib-tramadol co-crystal (CTC) is a first-in-class analgesic co-crystal of celecoxib and racemic tramadol with an improved pharmacologic profile, conferred by the co-crystal structure, compared with its active constituents administered alone/concomitantly. AIM We evaluated CTC in moderate-to-severe acute postoperative pain. MATERIALS AND METHODS This randomized, double-blind, factorial, active- and placebo-controlled phase 3 trial (NCT03108482) was conducted at 6 US clinical research centers. Adults with moderate-to-severe acute pain following bunionectomy with osteotomy were randomized to oral CTC (200 mg [112 mg celecoxib/88 mg rac-tramadol hydrochloride] every 12 h), tramadol (50 mg every 6 h), celecoxib (100 mg every 12 h), or placebo for 48 h. Patients, investigators, and personnel were blinded to assignment. The primary endpoint was the 0-48 h sum of pain intensity differences (SPID0-48) in all randomized patients. Pain intensity was assessed on a 0-10 numerical rating scale (NRS). Safety was analyzed in patients who received study medication. Funded by ESTEVE Pharmaceuticals. RESULTS In 2017 (March to November), 1323 patients were screened and 637 randomized to CTC (n = 184), tramadol (n = 183), celecoxib (n = 181), or placebo (n = 89). Mean baseline NRS was 6.7 in all active groups. CTC had a significantly greater effect on SPID0-48 (least-squares mean: -139.1 [95% confidence interval: -151.8, -126.5]) than tramadol (-109.1 [-121.7, -96.4]; p < 0.001), celecoxib (-103.7 [-116.4, -91.0]; p < 0.001), or placebo (-74.6 [-92.5, -56.6]; p < 0.001). Total treatment-emergent adverse events (TEAEs) were 358 for CTC and 394 for tramadol. Drug-related TEAEs occurred in 37.7% patients in the CTC group, compared with 48.6% in the tramadol group. There were no serious TEAEs/deaths. CONCLUSION CTC provided greater analgesia than comparable daily doses of tramadol and celecoxib, with similar tolerability to tramadol. CTC is approved in the United States.
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Affiliation(s)
- Eugene R. Viscusi
- Department of AnesthesiologySidney Kimmel Medical College, Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Oscar de Leon‐Casasola
- Department of AnesthesiologyUniversity of Buffalo/Roswell Park Cancer InstituteBuffaloNew YorkUSA
| | | | | | | | | | | | - Anna Vaqué
- ESTEVE Pharmaceuticals S.ABarcelonaSpain
| | - Ira Gottlieb
- Chesapeake Research Group LLCPasadenaMarylandUSA
| | | | | | - Derek Muse
- JBR Clinical ResearchSalt Lake CityUtahUSA
| | | | - Michael E. Kuss
- Premier ResearchDurhamNorth CarolinaUSA
- Present address:
Michael Kuss ConsultingAustinTexasUSA
| | - Sebastián Videla
- ESTEVE Pharmaceuticals S.ABarcelonaSpain
- Present address:
Clinical Research Support UnitClinical Pharmacology DepartmentBellvitge University HospitalL’Hospitalet deLlobregat and Pharmacology UnitDepartment of Pathology and Experimental TherapeuticsFaculty of Medicine and Health SciencesIDIBELL, University of Barcelona, L’Hospitalet de LlobregatBarcelonaSpain
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Langford R, Morte A, Sust M, Cebrecos J, Vaqué A, Ortiz E, Fettiplace J, Adeyemi S, Raba G, But‐Husaim L, Gascón N, Plata‐Salamán C. Efficacy and safety of co-crystal of tramadol-celecoxib (CTC) in acute moderate-to-severe pain after abdominal hysterectomy: A randomized, double-blind, phase 3 trial (STARDOM2). Eur J Pain 2022; 26:2083-2096. [PMID: 35974668 PMCID: PMC9826359 DOI: 10.1002/ejp.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/13/2022] [Accepted: 08/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND STARDOM2 is a randomized, double-blind, phase 3 trial evaluating the efficacy and safety of co-crystal of tramadol-celecoxib (CTC)-a first-in-class analgesic co-crystal comprising racemic tramadol hydrochloride and celecoxib in a supramolecular network that modifies their pharmacokinetic properties-for the management of acute postoperative pain (NCT03062644; EudraCT:2016-000593-38). METHODS Patients with moderate-to-severe pain following abdominal hysterectomy were randomized 2:2:2:2:2:1 to oral CTC 100 mg (rac-tramadol hydrochloride 44 mg/celecoxib 56 mg) twice daily (BID); CTC 150 mg (66/84 mg) BID; CTC 200 mg (88/112 mg) BID; immediate-release tramadol 100 mg four times daily (QID); celecoxib 100 mg BID; or placebo, for 5 days. The primary endpoint was the sum of pain intensity differences over 0-4 h (SPID0-4 ). Key secondary endpoints were rescue medication use within 4 h, 50% response rate at 4 h, and safety/tolerability. RESULTS Of 1355 patients enrolled, 1138 were randomized (full analysis set) and 1136 treated (safety analysis set). In the prespecified gatekeeping analysis of SPID0-4 , CTC 200 mg was not superior to tramadol but showed non-inferior efficacy (p < 0.001) that was sustained throughout the 120-h period, despite a 5-day cumulative tramadol administration of 880 mg with CTC 200 mg BID versus 2000 mg with tramadol 100 mg QID. Treatment-emergent adverse events (TEAEs) and severe TEAEs were less common with CTC 200 mg versus tramadol. Treatment-related TEAEs were 14.4% with CTC 200 mg and 23.6% with tramadol. CONCLUSIONS Although the study did not meet its primary endpoint, CTC 200 mg showed a clinically relevant improvement in overall benefit/risk profile versus tramadol alone, with considerably lower cumulative opioid exposure. SIGNIFICANCE In the randomized, double-blind, phase 3 STARDOM2 trial-in acute moderate-to-severe pain after abdominal hysterectomy-the novel co-crystal of tramadol-celecoxib (CTC) 200 mg BID was superior to placebo and non-inferior to tramadol 100 mg QID. Although superiority to tramadol was not reached, CTC 200 mg BID exposed patients to lower cumulative opioid (tramadol) doses than tramadol (100 mg QID) alone, with fewer treatment-emergent adverse events. CTC 200 mg thus has a clinically relevant improved benefit/risk profile compared with tramadol alone.
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Affiliation(s)
| | | | | | | | - Anna Vaqué
- ESTEVE Pharmaceuticals S.A.BarcelonaSpain
| | | | - James Fettiplace
- Mundipharma Research LimitedCambridgeUK,GlaxoSmithKlineStevenageUK
| | - Shola Adeyemi
- Mundipharma Research LimitedCambridgeUK,STATSXPERTS Consulting LimitedHaverhillUK
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López-Cedrún J, Videla S, Burgueño M, Juárez I, Aboul-Hosn S, Martín-Granizo R, Grau J, Puche M, Gil-Diez JL, Hueto JA, Vaqué A, Sust M, Plata-Salamán C, Monner A. Co-crystal of Tramadol-Celecoxib in Patients with Moderate to Severe Acute Post-surgical Oral Pain: A Dose-Finding, Randomised, Double-Blind, Placebo- and Active-Controlled, Multicentre, Phase II Trial. Drugs R D 2018; 18:137-148. [PMID: 29799099 PMCID: PMC5995791 DOI: 10.1007/s40268-018-0235-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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] [Indexed: 12/17/2022] Open
Abstract
Background Co-crystal of tramadol–celecoxib (CTC), containing equimolar quantities of the active pharmaceutical ingredients (APIs) tramadol and celecoxib (100 mg CTC = 44 mg rac–tramadol hydrochloride and 56 mg celecoxib), is a novel API-API co-crystal for the treatment of pain. We aimed to establish the effective dose of CTC for treating acute pain following oral surgery. Methods A dose-finding, double-blind, randomised, placebo- and active-controlled, multicentre (nine Spanish hospitals), phase II study (EudraCT number: 2011-002778-21) was performed in male and female patients aged ≥ 18 years experiencing moderate to severe pain following extraction of two or more impacted third molars requiring bone removal. Eligible patients were randomised via a computer-generated list to receive one of six single-dose treatments (CTC 50, 100, 150, 200 mg; tramadol 100 mg; and placebo). The primary efficacy endpoint was the sum of pain intensity difference (SPID) over 8 h assessed in the per-protocol population. Results Between 10 February 2012 and 13 February 2013, 334 patients were randomised and received study treatment: 50 mg (n = 55), 100 mg (n = 53), 150 mg (n = 57), or 200 mg (n = 57) of CTC, 100 mg tramadol (n = 58), or placebo (n = 54). CTC 100, 150, and 200 mg showed significantly higher efficacy compared with placebo and/or tramadol in all measures: SPID (0–8 h) (mean [standard deviation]): − 90 (234), − 139 (227), − 173 (224), 71 (213), and 22 (228), respectively. The proportion of patients experiencing treatment-emergent adverse events was lower in the 50 (12.7% [n = 7]), 100 (11.3% [n = 6]), and 150 (15.8% [n = 9]) mg CTC groups, and similar in the 200 mg (29.8% [n = 17]) CTC group, compared with the tramadol group (29.3% [n = 17]), with nausea, dizziness, and vomiting the most frequent events. Conclusion Significant improvement in the benefit–risk ratio was observed for CTC (doses ≥ 100 mg) over tramadol and placebo in the treatment of acute pain following oral surgery. Funding Laboratorios del Dr. Esteve, S.A.U.
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Affiliation(s)
- José López-Cedrún
- Department of Maxillofacial Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Sebastián Videla
- Clinical Investigation Department, Laboratorios del Dr. Esteve, S.A.U., Av Mare de Déu de Montserrat 221, 08041, Barcelona, Spain. .,Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/IDIBELL, Barcelona, Spain.
| | - Miguel Burgueño
- Maxillofacial Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Inma Juárez
- Department of Oral and Maxillofacial Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Samir Aboul-Hosn
- Department of Maxillofacial Surgery, Hospital Plató, Barcelona, Spain
| | | | - Joan Grau
- Department of Maxillofacial Surgery, Hospital General de Granollers, Granollers, Spain
| | - Miguel Puche
- Department of Maxillofacial Surgery, Hospital Clínico de Valencia, Valencia, Spain
| | - José-Luis Gil-Diez
- Department of Maxillofacial Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - José-Antonio Hueto
- Maxillofacial Surgery Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Anna Vaqué
- Clinical Investigation Department, Laboratorios del Dr. Esteve, S.A.U., Av Mare de Déu de Montserrat 221, 08041, Barcelona, Spain
| | - Mariano Sust
- Clinical Investigation Department, Laboratorios del Dr. Esteve, S.A.U., Av Mare de Déu de Montserrat 221, 08041, Barcelona, Spain
| | - Carlos Plata-Salamán
- Clinical Investigation Department, Laboratorios del Dr. Esteve, S.A.U., Av Mare de Déu de Montserrat 221, 08041, Barcelona, Spain
| | - Antoni Monner
- Department of Oral and Maxillofacial Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
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Bruna J, Videla S, Argyriou AA, Velasco R, Villoria J, Santos C, Nadal C, Cavaletti G, Alberti P, Briani C, Kalofonos HP, Cortinovis D, Sust M, Vaqué A, Klein T, Plata-Salamán C. Efficacy of a Novel Sigma-1 Receptor Antagonist for Oxaliplatin-Induced Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Phase IIa Clinical Trial. Neurotherapeutics 2018; 15:178-189. [PMID: 28924870 PMCID: PMC5794691 DOI: 10.1007/s13311-017-0572-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
This trial assessed the efficacy of MR309 (a novel selective sigma-1 receptor ligand previously developed as E-52862) in ameliorating oxaliplatin-induced peripheral neuropathy (oxaipn). A discontinuous regimen of MR309 (400 mg/day, 5 days per cycle) was tested in patients with colorectal cancer receiving FOLFOX in a phase II, randomized, double-blind, placebo-controlled, multicenter clinical trial. Outcome measures included changes in 24-week quantitative measures of thermal sensitivity and total neuropathy score. In total, 124 patients were randomized (1:1) to MR309 or placebo. Sixty-three (50.8%) patients withdrew prematurely before completing 12 planned oxaliplatin cycles. Premature withdrawal because of cancer progression was less frequent in the MR309 group (7.4% vs 25.0% with placebo; p = 0.054). MR309 significantly reduced cold pain threshold temperature [mean treatment effect difference (SE) vs placebo: 5.29 (1.60)°C; p = 0.001] and suprathreshold cold stimulus-evoked pain intensity [mean treatment effect difference: 1.24 (0.57) points; p = 0.032]. Total neuropathy score, health-related quality-of-life measures, and nerve-conduction parameters changed similarly in both arms, whereas the proportion of patients with severe chronic neuropathy (National Cancer Institute Common Terminology Criteria for Adverse Events ≥ 3) was significantly lower in the MR309 group (3.0% vs 18.2% with placebo; p = 0.046). The total amount of oxaliplatin delivered was greater in the active arm (1618.9 mg vs 1453.8 mg with placebo; p = 0.049). Overall, 19.0% of patients experienced at least 1 treatment-related adverse event (25.8% and 11.9% with MR309 and placebo, respectively). Intermittent treatment with MR309 was associated with reduced acute oxaipn and higher oxaliplatin exposure, and showed a potential neuroprotective role for chronic cumulative oxaipn. Furthermore, MR309 showed an acceptable safety profile.
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Affiliation(s)
- Jordi Bruna
- Hospital Universitari de Bellvitge-ICO L'Hospitalet, Barcelona, Spain.
| | - Sebastián Videla
- Clinical Investigation, Laboratorios del Dr. Esteve, Barcelona, Spain
| | | | - Roser Velasco
- Hospital Universitari de Bellvitge-ICO L'Hospitalet, Barcelona, Spain
| | | | - Cristina Santos
- Hospital Universitari de Bellvitge-ICO L'Hospitalet, Barcelona, Spain
| | | | | | | | | | | | | | - Mariano Sust
- Clinical Investigation, Laboratorios del Dr. Esteve, Barcelona, Spain
| | - Anna Vaqué
- Clinical Investigation, Laboratorios del Dr. Esteve, Barcelona, Spain
| | - Thomas Klein
- Mundipharma Research GmbH & Co. KG, Limburg (Lahn), Germany
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Videla S, Lahjou M, Vaqué A, Sust M, Escriche M, Soler L, Sans A, Sicard E, Gascón N, Encina G, Plata-Salamán C. Pharmacokinetics of multiple doses of co-crystal of tramadol-celecoxib: findings from a four-way randomized open-label phase I clinical trial. Br J Clin Pharmacol 2017; 84:64-78. [PMID: 28888220 PMCID: PMC5736845 DOI: 10.1111/bcp.13428] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 04/25/2017] [Revised: 08/19/2017] [Accepted: 09/03/2017] [Indexed: 01/01/2023] Open
Abstract
Aim We compared the pharmacokinetic (PK) profiles of co‐crystal of tramadol–celecoxib (CTC) vs. each reference product (alone and in open combination) after single (first dose) and multiple dosing. Methods Healthy adults aged 18–50 years received, under fasted conditions, 15 twice‐daily doses of the following treatments (separated by ≥14‐day washout): 200 mg immediate‐release (IR) CTC (equivalent to 88 mg tramadol and 112 mg celecoxib; treatment 1); 100 mg IR tramadol (treatment 2), 100 mg celecoxib (treatment 3); and 100 mg IR tramadol and 100 mg celecoxib (treatment 4). The treatment sequence was assigned by computer‐generated randomization. PK parameters were calculated using non‐compartmental analysis. Parameters for CTC were adjusted according to reference product dose. Results A total of 30 subjects (20 males, mean age 35 years) were included. Multiple‐dose tramadol PK parameters for treatments 1, 2 and 4, respectively, were 551, 632 and 661 ng ml−1 [mean maximum plasma concentration (Cmax)]; 4796, 4990 and 5284 ng h ml−1 (area under the plasma concentration–time curve over the dosing interval at steady state); and 3.0, 2.0 and 2.0 h (median time to Cmax at steady state). For treatments 1, 3 and 4, multiple‐dose celecoxib PK parameters were 445, 536 and 396 ng ml−1; 2803, 3366 and 2897 ng h ml−1; and 2.0, 2.0 and 3.0 h. Single‐dose findings were consistent with multiple‐dose data. Types of adverse events were consistent with known reference product safety profiles. Conclusion After single (first dose) and multiple dosing, PK parameters for each active pharmaceutical ingredient in CTC were modified by co‐crystallization compared with reference products alone or in open combination.
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Affiliation(s)
| | | | - Anna Vaqué
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
| | - Mariano Sust
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
| | | | - Lluis Soler
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
| | - Artur Sans
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
| | | | - Neus Gascón
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
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Videla S, Lahjou M, Vaqué A, Sust M, Encabo M, Soler L, Sans A, Sicard E, Gascón N, Encina G, Plata-Salamán C. Single-dose pharmacokinetics of co-crystal of tramadol-celecoxib: Results of a four-way randomized open-label phase I clinical trial in healthy subjects. Br J Clin Pharmacol 2017; 83:2718-2728. [PMID: 28810061 PMCID: PMC5698592 DOI: 10.1111/bcp.13395] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 04/25/2017] [Revised: 06/22/2017] [Accepted: 07/30/2017] [Indexed: 12/30/2022] Open
Abstract
Aims Co‐crystal of tramadol–celecoxib (CTC) is a novel co‐crystal molecule containing two active pharmaceutical ingredients under development by Esteve (E‐58425) and Mundipharma Research (MR308). This Phase I study compared single‐dose pharmacokinetics (PK) of CTC with those of the individual reference products [immediate‐release (IR) tramadol and celecoxib] alone and in open combination. Methods Healthy adults aged 18–55 years were orally administered four treatments under fasted conditions (separated by 7‐day wash‐out period): 200 mg IR CTC (equivalent to 88 mg tramadol and 112 mg celecoxib; Treatment 1); 100 mg IR tramadol (Treatment 2); 100 mg celecoxib (Treatment 3); and 100 mg IR tramadol and 100 mg celecoxib (Treatment 4). Treatment sequence was assigned using computer‐generated randomization. PK parameters were calculated using noncompartmental analysis with parameters for CTC adjusted according to reference product dose (100 mg). Results Thirty‐six subjects (28 male, mean age 36 years) participated. Tramadol PK parameters for Treatments‐1, –2 and –4, respectively, were 263, 346 and 349 ng ml–1 (mean maximum plasma concentration); 3039, 2979 and 3119 ng h ml–1 (mean cumulative area under the plasma concentration–time curve); and 2.7, 1.8 and 1.8 h (median time to maximum plasma concentration). For Treatments 1, 3 and 4, the respective celecoxib PK parameters were 313, 449 and 284 ng ml–1; 2183, 3093 and 2856 ng h ml–1; and 1.5, 2.3 and 3.0 h. No unexpected adverse events were reported. Conclusion PK parameters of each API in CTC were modified by co‐crystallization compared with marketed formulations of tramadol, celecoxib, and their open combination.
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Affiliation(s)
| | | | - Anna Vaqué
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
| | - Mariano Sust
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
| | | | - Lluis Soler
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
| | - Artur Sans
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
| | | | - Neus Gascón
- Laboratorios del Dr. Esteve, S.A.U., Barcelona, Spain
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Täubel J, Ferber G, Lorch U, Wang D, Sust M, Camm AJ. Single Doses up to 800 mg of E-52862 Do Not Prolong the QTc Interval--A Retrospective Validation by Pharmacokinetic-Pharmacodynamic Modelling of Electrocardiography Data Utilising the Effects of a Meal on QTc to Demonstrate ECG Assay Sensitivity. PLoS One 2015; 10:e0136369. [PMID: 26291080 PMCID: PMC4546378 DOI: 10.1371/journal.pone.0136369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/30/2015] [Indexed: 12/29/2022] Open
Abstract
Background E-52862 is a Sigma-1 receptor antagonist (S1RA) currently under investigation as a potential analgesic medicine. We successfully applied a concentration-effect model retrospectively to a four-way crossover Phase I single ascending dose study and utilized the QTc shortening effects of a meal to demonstrate assay sensitivity by establishing the time course effects from baseline in all four periods, independently from any potential drug effects. Methods Thirty two healthy male and female subjects were included in four treatment periods to receive single ascending doses of 500 mg, 600 mg or 800 mg of E-52862 or placebo. PK was linear over the dose range investigated and doses up to 600 mg were well tolerated. The baseline electrocardiography (ECG) measurements on Day-1 were time-matched with ECG and pharmacokinetic (PK) samples on Day 1 (dosing day). Results In this conventional mean change to time-matched placebo analysis, the largest time-matched difference to placebo QTcI was 1.44 ms (90% CI: -4.04, 6.93 ms) for 500 mg; -0.39 ms (90% CI: -3.91, 3.13 ms) for 600 mg and 1.32 ms (90% CI: -1.89, 4.53 ms) for 800 mg of E-52862, thereby showing the absence of any QTc prolonging effect at the doses tested. In addition concentration-effect models, one based on the placebo corrected change from baseline and one for the change of QTcI from average baseline with time as fixed effect were fitted to the data confirming the results of the time course analysis. Conclusion The sensitivity of this study to detect small changes in the QTc interval was confirmed by demonstrating a shortening of QTcF of -8.1 (90% CI: -10.4, -5.9) one hour and -7.2 (90% CI: -9.4, -5.0) three hours after a standardised meal. Trial Registration EU Clinical Trials Register EudraCT 2010 020343 13
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Affiliation(s)
- Jörg Täubel
- Richmond Pharmacology Ltd., St George's University of London, Cranmer Terrace, London, United Kingdom
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, Cranmer Terrace, London, United Kingdom
- * E-mail:
| | - Georg Ferber
- Statistik Georg Ferber GmbH, Cagliostrostrasse, Riehen, Switzerland
| | - Ulrike Lorch
- Richmond Pharmacology Ltd., St George's University of London, Cranmer Terrace, London, United Kingdom
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mariano Sust
- Department of Clinical Investigation, ESTEVE Research & Development, Av. Mare de Déu de Montserrat, Barcelona, Spain
| | - A. John Camm
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, Cranmer Terrace, London, United Kingdom
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10
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Homedes J, Salichs M, Sabaté D, Sust M, Fabre R. Effect of ketoprofen on pre-weaning piglet mortality on commercial farms. Vet J 2014; 201:435-7. [PMID: 25011706 DOI: 10.1016/j.tvjl.2014.05.038] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/29/2022]
Abstract
The effect of ketoprofen on pre-weaning piglet mortality was evaluated in a large-scale study on commercial farms. Sows (n= 1486) from 15 farms were included. Half of the sows received 3 mg/kg ketoprofen in a single intramuscular administration within 12 h after farrowing. The other half remained untreated. Pre-weaning mortality was lower in the ketoprofen-treated group than in the control group (8.43% vs. 10.24%, respectively; P= 0.010). The major impact of ketoprofen on mortality was seen between days 2 and 7 postpartum (mortality rates of 2.75% vs. 4.02% for treated and control groups, respectively; P= 0.001). In addition, ketoprofen treatment was associated with a higher number of piglets weaned per litter than when no treatment was given (10.0 vs. 9.84, respectively; P= 0.012).
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Affiliation(s)
- Josep Homedes
- Department of Research and Development, ESTEVE Veterinaria, Laboratorios Dr. ESTEVE S.A., Barcelona, Spain.
| | - Marta Salichs
- Department of Research and Development, ESTEVE Veterinaria, Laboratorios Dr. ESTEVE S.A., Barcelona, Spain
| | - David Sabaté
- Department of Research and Development, ESTEVE Veterinaria, Laboratorios Dr. ESTEVE S.A., Barcelona, Spain
| | - Mariano Sust
- Department of Research and Development, ESTEVE Veterinaria, Laboratorios Dr. ESTEVE S.A., Barcelona, Spain
| | - Ramon Fabre
- Department of Research and Development, ESTEVE Veterinaria, Laboratorios Dr. ESTEVE S.A., Barcelona, Spain
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11
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Abadias M, Escriche M, Vaqué A, Sust M, Encina G. Safety, tolerability and pharmacokinetics of single and multiple doses of a novel sigma-1 receptor antagonist in three randomized phase I studies. Br J Clin Pharmacol 2013; 75:103-17. [PMID: 22607269 PMCID: PMC3555050 DOI: 10.1111/j.1365-2125.2012.04333.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [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] [Received: 02/14/2012] [Accepted: 05/13/2012] [Indexed: 11/30/2022] Open
Abstract
AIM To assess the safety, tolerability, pharmacodynamics and pharmacokinetics in healthy subjects of a novel, highly selective, sigma-1 receptor antagonist (S1RA). METHODS Three randomized, double-blind, placebo-controlled trials evaluated single oral doses (5-500 mg, study 101; 500-800 mg, study 106) and multiple doses (50-400 mg once daily for 8 days, study 102) of S1RA. Safety and tolerability were assessed by adverse event reporting, clinical laboratory, physical examinations, vital signs and electrocardiography, including Holter monitoring. Pharmacodynamic assessments included computerized cognitive testing. Plasma samples were analyzed using validated HPLC-MS/MS methods. RESULTS One hundred and seventy-five subjects were enrolled. Single and multiple doses were safe and well tolerated, with no serious adverse events. The most common side effects were headache and dizziness. The highest single doses were associated with some mild to moderate transient CNS effects. The maximum tolerated dose was not reached. There were no clinically significant changes in the electrocardiogram (ECG), 24 h Holter monitoring, or in vital signs and laboratory assessments. Subjective CNS pharmacodynamics evaluations showed no relevant differences vs. placebo. Cognitive testing showed no effects on visual memory, executive function, attention or somnolence, while revealing some transient slowing of response for simple reaction time and choice reaction time at 2 h following the administration of higher doses. A fast absorption, rapid distribution and slow elimination were observed (t(max) 0.75-2.0 h, t(1/2) compatible with once a day administration) and steady-state was reached. No gender differences were observed. CONCLUSIONS S1RA exhibited an acceptable safety, tolerability, pharmacodynamic and pharmacokinetic profile in healthy subjects over the dose range studied.
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Affiliation(s)
| | | | - Anna Vaqué
- Drug Safety and Pharmacovigilance, ESTEVE Research & DevelopmentBarcelona, Spain
| | - Mariano Sust
- Department of Clinical InvestigationBarcelona, Spain
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12
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Escriche M, Sust M, Xu Z, Encabo M, Farrán R, Gomez A, Puig S, Martínez-Cabot A, Encina G, Ortiz E, Casals S, Gich I, Barbanoj MJ, Abadías M. 446 PHARMACOKINETIC PROFILE OF A SELECTIVE SIGMA-1 RECEPTOR ANTAGONIST (S1RA) IN HUMAN. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1754-3207(10)70451-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Sabaté D, Homedes J, Salichs M, Sust M, Monreal L. Multicentre, controlled, randomised and blinded field study comparing efficacy of suxibuzone and phenylbutazone in lame horses. Equine Vet J 2010; 41:700-5. [PMID: 19927590 DOI: 10.2746/042516409x464807] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY In horses, it has been demonstrated that suxibuzone (SBZ) has a lower gastric ulcerogenic effect than phenylbutazone (PBZ). However, no field trials have been reported comparing the efficacy of the drugs in alleviating lameness. OBJECTIVES To compare the therapeutic effect of SBZ to that of PBZ when administered orally in lame horses. Acceptability of both products was also compared. METHODS Lame horses (n = 155) were used in a multicentre, controlled, randomised and double-blinded clinical trial. Horses were treated orally with either SBZ or PBZ at equivalent therapeutic dosages. PBZ was given to 79 horses at a dose of 4.4 mg/kg bwt/12 h for 2 days, followed by 2.2 mg/kg bwt/12 h for 6 days. SBZ was given to 76 horses at 6.6 mg/kg bwt/12 h for 2 days, followed by 3.3 mg/kg bwt/ 12 h for 6 days. Efficacy of treatments was evaluated by clinicians in equine practices according to lameness progression throughout the study. Product ingestion was checked daily to evaluate product acceptability. RESULTS Although SBZ showed a statistically significant tendency to have a better efficacy than PBZ (Odds ratio = 2.7; P = 0.016), significance dissipated once the analysis was adjusted for some imbalanced baseline covariates, confirming that they were actually related to the apparent advantage of SBZ over PBZ. Product acceptability was significantly higher in the SBZ group than in the PBZ group (96.1% vs. 77.2%; P = 0.001). CONCLUSIONS SBZ and PBZ did not show significant differences in alleviating lameness in horses. However, SBZ had better product acceptability when administered orally with some food. POTENTIAL RELEVANCE SBZ is a good therapeutic alternative to PBZ in horses since there is no significant difference in alleviating lameness between the 2 therapies.
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Affiliation(s)
- D Sabaté
- Department of Research and Development, ESTEVE veterinaria, Laboratorios ESTEVE, Barcelona, Spain
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14
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Abadias M, Escriche M, Ortiz E, Casals S, Xu Z, Gómez A, Encina G, Sust M, González A, Antonijoan RM, Puntes M, Barbanoj M. 700 FIRST‐IN‐HUMAN (FIH) STUDY IN HEALTHY MALE VOLUNTEERS OF A NEW SELECTIVE SIGMA‐1 RECEPTOR ANTAGONIST (S1RA). Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60703-5] [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: 11/30/2022]
Affiliation(s)
- M. Abadias
- Research and Development. Lab. Dr. Esteve, Barcelona, Spain
| | - M. Escriche
- Research and Development. Lab. Dr. Esteve, Barcelona, Spain
| | - E. Ortiz
- Research and Development. Lab. Dr. Esteve, Barcelona, Spain
| | - S. Casals
- Research and Development. Lab. Dr. Esteve, Barcelona, Spain
| | - Z. Xu
- Research and Development. Lab. Dr. Esteve, Barcelona, Spain
| | - A. Gómez
- Research and Development. Lab. Dr. Esteve, Barcelona, Spain
| | - G. Encina
- Research and Development. Lab. Dr. Esteve, Barcelona, Spain
| | - M. Sust
- Research and Development. Lab. Dr. Esteve, Barcelona, Spain
| | - A. González
- Research and Development. Lab. Dr. Esteve, Barcelona, Spain
| | - RMí. Antonijoan
- Centre d'Investigació de Medicaments. H. de la Sta. Creu i Sant Pau, Barcelona, Spain
| | - M. Puntes
- Centre d'Investigació de Medicaments. H. de la Sta. Creu i Sant Pau, Barcelona, Spain
| | - M.J. Barbanoj
- Centre d'Investigació de Medicaments. H. de la Sta. Creu i Sant Pau, Barcelona, Spain
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15
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Martínez-García R, Abadías M, Arañó P, Perales L, Ruíz JL, Sust M, Conejero J. Cizolirtine Citrate, an Effective Treatment for Symptomatic Patients with Urinary Incontinence Secondary to Overactive Bladder: A Pilot Dose-Finding Study. Eur Urol 2009; 56:184-90. [DOI: 10.1016/j.eururo.2008.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 04/10/2008] [Indexed: 11/24/2022]
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16
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Videla S, Villoria J, Sust M, Drábek F, Všetička J, Pavlik I, Kawaciuk I, Louda M, García C, Angulo J, Sáenz de Tejada Í. Calcium Dobesilate for the Treatment of Erectile Dysfunction in Men with Diabetes Mellitus. Basic Clin Pharmacol Toxicol 2008; 103:360-6. [DOI: 10.1111/j.1742-7843.2008.00305.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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Siebert T, Sust M, Thaller S, Tilp M, Wagner H. An improved method to determine neuromuscular properties using force laws - From single muscle to applications in human movements. Hum Mov Sci 2007; 26:320-41. [PMID: 17343950 DOI: 10.1016/j.humov.2007.01.006] [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: 10/23/2022]
Abstract
We evaluate an improved method for individually determining neuromuscular properties in vivo. The method is based on Hill's equation used as a force law combined with Newton's equation of motion. To ensure the range of validity of Hill's equation, we first perform detailed investigations on in vitro single muscles. The force-velocity relation determined with the model coincides well with results obtained by standard methods (r=.99) above 20% of the isometric force. In addition, the model-predicted force curves during work loop contractions very well agree with measurements (mean difference: 2-3%). Subsequently, we deduce theoretically under which conditions it is possible to combine several muscles of the human body to model muscles. This leads to a model equation for human leg extension movements containing parameters for the muscle properties and for the activation. To numerically determine these invariant neuromuscular properties we devise an experimental method based on concentric and isometric leg extensions. With this method we determine individual muscle parameters from experiments such that the simulated curves agree well with experiments (r=.99). A reliability test with 12 participants revealed correlations r=.72-.91 for the neuromuscular parameters (p<.01). Predictions of similar movements under different conditions show mean errors of about 5%. In addition, we present applications in sports practise and theory.
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Affiliation(s)
- T Siebert
- Institute of Sport Science, Friedrich-Schiller-University Jena, Germany
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18
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19
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Videla S, Sust M, Fresquet A, Villoria J. How to ensure clinical trial sensitivity in psychotropic drug development: A case study. Clin Ther 2005; 27:252-4. [PMID: 15811489 DOI: 10.1016/j.clinthera.2005.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2004] [Indexed: 10/25/2022]
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20
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Pavlik I, Suchy J, Pacík D, Bokr R, Sust M, Villoria J, Abadías M. Comparison of cizolirtine citrate and metamizol sodium in the treatment of adult acute renal colic: a randomized, double-blind, clinical pilot study. Clin Ther 2004; 26:1061-72. [PMID: 15336471 DOI: 10.1016/s0149-2918(04)90178-6] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Accepted: 04/29/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Renal colic causes excruciating pain that provides a good clinical model of acute pain for the development of new analgesics. OBJECTIVE The purpose of the study was to compare the analgesic efficacy and tolerability of cizolirtine citrate and metamizol sodium in adult acute renal colic. METHODS This Phase II, randomized, double-blind, clinical pilot study was conducted in the emergency departments of 6 general hospitals in the Czech Republic between October 2000 and February 2001. Male and female patients aged 18 to 65 years and presenting with hematuria and moderate to severe pain due to suspected renal colic starting within the 24 hours before presentation were eligible. Patients were randomized to receive a single IV dose of cizolirtine 350 mg or metamizol 2,500 mg, administered by slow infusion over 15 minutes. Both doses were maximal for the respective drugs to attain adequate analgesia. Use of rescue medication with butorphanol was allowed 30 minutes after study drug administration. Pain intensity was assessed at various time points during the following 360 minutes using a 100-mm visual analog scale (VAS) and a verbal categoric scale. In addition, a specific verbal categoric scale was used to rank pain relief. Physical examinations, laboratory tests, and questioning for adverse events addressed drug tolerability. RESULTS Sixty-four patients (50 men, 14 women; mean [SD] age, 44.21 [12.29] years; mean [SD] body mass index, 25.97 [3.38] kg/m(2)) were enrolled. Physical examination findings and mean VAS pain intensity scores at baseline (mean [SD], 79.42 [7.89] mm and 82.59 [10.50] mm in the cizolirtine and metamizol groups, respectively) were similar in both groups. After 30 minutes, the mean (SD) scores were 33.84 (25.15) mm and 25.41 (24.51) mm, respectively. This difference was not statistically significant, and the noninferiority of cizolirtine with respect to the comparator could not be established. However, the proportion of patients that showed satisfactory pain relief (ie, decrease of > or = 50% in VAS pain intensity score compared with baseline) at 30 minutes in the cizolirtine group was fairly high (64.5%), which means relevant analgesic activity. Both treatments were well tolerated; 6 adverse events were reported in 5 patients (7.8%), and all were considered as not treatment related. CONCLUSIONS Although this limited pilot study did not include an internal measure of sensitivity, relevant pain reduction was shown in the population of patients with suspected renal colic undergoing treatment with cizolirtine, suggesting the presence of analgesic activity. However, the efficacy of cizolirtine was found to be similar to that of metamizol. Treatments were well tolerated.
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Affiliation(s)
- Ivan Pavlik
- Department of Urology, University Hospital, Prague, Czechoslovakia
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21
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Masana L, Villoria J, Sust M, Ros E, Plana N, Pérez-Jiménez F, Franco M, Oliván JJ, Pintó X, Videla S. Treatment of type IIb familial combined hyperlipidemia with the combination pravastatin-piperazine sultosilate. Eur J Pharmacol 2004; 496:205-12. [PMID: 15288592 DOI: 10.1016/j.ejphar.2004.05.041] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 10/09/2003] [Revised: 05/17/2004] [Accepted: 05/25/2004] [Indexed: 11/26/2022]
Abstract
The risk of coronary heart disease is increased for any given low-density lipoprotein (LDL) cholesterol level in patients with high levels of triglycerides because some triglyceride-rich lipoproteins are atherogenic. This paper reports the results of a pilot clinical trial aimed to evaluate a novel triglyceride-lowering drug in combination with pravastatin to treat combined hyperlipidemia. Twenty-six patients with type 2b hyperlipoproteinemia were randomized to receive pravastatin 40 mg/day or pravastatin 40 mg/day plus piperazine-sultosilate 1000 mg/day for 12 weeks if their cholesterol levels, but not triglyceride levels, had responded to therapeutic lifestyle changes and treatment with 40 mg/day of pravastatin. Concentrations of triglycerides, cholesterol and apolipoproteins A and B were measured in duplicate before and after the intervention. There were no significant differences between groups in the change from baseline in the concentration of serum triglycerides. Conversely, significant differences were found for LDL cholesterol, which increased slightly with pravastatin alone but decreased with the combination (12.605+/-22.777% vs. -6.396+/-13.157%, respectively; p=0.022). Apolipoprotein-B levels increased with pravastatin alone but remained stable with the combined treatment (10.464+/-8.446% vs. 0.767+/-12.335%; P=0.028). The increase in the pravastatin group was significant. Although sultosilate was not efficacious in reducing triglycerides, it helped to decrease the concentration of small, dense, atherogenic LDL particles that are less receptor-sensitive and which could accumulate during long-term statin therapy in patients with high levels of triglycerides.
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Affiliation(s)
- Lluís Masana
- School of Medicine, Rovira i Virgili University, Reus, Spain
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22
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López-Vélez R, Videla S, Márquez M, Boix V, Jiménez-Mejías ME, Górgolas M, Arribas JR, Salas A, Laguna F, Sust M, Cañavate C, Alvar J. Amphotericin B lipid complex versus no treatment in the secondary prophylaxis of visceral leishmaniasis in HIV-infected patients. J Antimicrob Chemother 2004; 53:540-3. [PMID: 14739148 DOI: 10.1093/jac/dkh084] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [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: 11/14/2022] Open
Abstract
OBJECTIVES Visceral leishmaniasis (VL) in HIV-positive patients is characterized by a chronic course with frequent relapse. The aim of this study was to evaluate the efficacy and safety of amphotericin B lipid complex (ABLC) in preventing VL relapses in HIV-infected patients. METHODS This was a multicentre, open-label (with blinded centralized randomization), parallel, no-treatment, controlled clinical trial. HIV-infected patients, with at least one previous treated episode of VL and with negative bone marrow aspirate for Leishmania parasites prior to the study, were randomized to receive either ABLC 3 mg/kg/day every 21 days (ABLC) or no treatment (NT). Patients were followed-up every 9 weeks for up to 12 months, and the efficacy was measured as the proportion of patients remaining free (non-relapse) of VL at 1 year of follow-up. The primary analysis was performed on an intention-to-treat basis. RESULTS One hundred and fifteen patients were screened, but only 17 were randomized: eight in the ABLC group and nine in the NT group. The intention-to-treat analysis of data showed 50% of patients remaining free of VL at 12 months of follow-up (95% CI = 15.7%, 84.3%) in the ABLC group, and 22.2% (95% CI = 2.8%, 60.0%) in the NT group. The non-relapse odds ratio was 3.5 (95% CI = 0.30%, 52.0%) favouring ABLC. ABLC was well tolerated: patients only presented infusion-related mild adverse events. No patients from either group discontinued treatment or died during follow-up. CONCLUSIONS ABLC, administered every 21 days for 12 months, is useful as secondary prophylaxis in preventing VL relapse in HIV-infected patients, and is well tolerated.
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Affiliation(s)
- Rogelio López-Vélez
- Enfermedades Infecciosas, Hospital Ramón y Cajal, Carretera de Colmenar, km 9.100, 28034-Madrid, Spain.
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Laguna F, Videla S, Jiménez-Mejías ME, Sirera G, Torre-Cisneros J, Ribera E, Prados D, Clotet B, Sust M, López-Vélez R, Alvar J. Amphotericin B lipid complex versus meglumine antimoniate in the treatment of visceral leishmaniasis in patients infected with HIV: a randomized pilot study. J Antimicrob Chemother 2003; 52:464-8. [PMID: 12888588 DOI: 10.1093/jac/dkg356] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [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: 11/13/2022] Open
Abstract
Optimal treatment for HIV-related visceral leishmaniasis (VL) has still to be established. A pilot clinical trial was carried out in 57 HIV-VL coinfected patients to compare the efficacy and safety of amphotericin B lipid complex (ABLC) versus meglumine antimoniate. The patients were randomized to receive either ABLC 3 mg/kg/day for 5 days (ABLC-5, 18 patients), ABLC 3 mg/kg/day for 10 days (ABLC-10, 20 patients) or meglumine antimoniate 20 mg Sbv /kg/day for 28 days (19 patients). Treatment was considered successful if parasites were not detected in a bone marrow aspirate after treatment. Parasitological cure was attained in 33% (95% CI: 13%-59%) of the ABLC-5 group, in 42% (95% CI: 16%-62%) of the ABLC-10 group and in 37% (95% CI: 16%-62%) of the meglumine antimoniate group (P = 0.94). Eight out of 19 patients administered antimoniate discontinued treatment prematurely following serious adverse events, compared with one in the ABLC groups (P = 0.0006). The efficacy of ABLC is similar to meglumine antimoniate, but the severity of toxicity in the treatment of HIV-VL is lower with ABLC.
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Affiliation(s)
- Fernando Laguna
- Servicio de Enfermedades Infecciosas, Hospital Carlos III, Instituto de Salud Carlos III, C/Sinesio Delgado 12, 28029-Madrid, Spain.
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24
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Fresquet A, Sust M, Lloret A, Murphy MF, Carter FJ, Campbell GM, Marion-Landais G. Efficacy and safety of lesopitron in outpatients with generalized anxiety disorder. Ann Pharmacother 2000; 34:147-53. [PMID: 10676820 DOI: 10.1345/aph.19041] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/27/2022] Open
Abstract
OBJECTIVE To compare the relative efficacy and safety of lesopitron 4-80 mg/d versus lorazepam 2-4 mg/d and placebo in a subgroup of patients with anxiety history taken from a larger study of patients with a primary diagnosis of generalized anxiety disorder (GAD). DESIGN Six-week, randomized, double-blind, parallel, placebo and lorazepam-controlled, Phase II, single-center, outpatient study. SETTING Outpatient clinic. PATIENTS One hundred sixty-one patients with GAD were randomized in the main study; 68 with a documented history of GAD or anxiety disorder not otherwise specified were included in the subgroup. METHODS After a one-week placebo lead-in, patients were randomized to receive placebo, lesopitron, or lorazepam twice daily for six weeks, followed by a one-week taper period. Efficacy was assessed using the Hamilton Rating Scale for Anxiety (HAM-A) and the Clinical Global Impressions scale. Safety was assessed through physical examinations, monitoring of vital signs, 12-lead electrocardiograms, laboratory analyses, and adverse event monitoring. RESULTS An overall mean improvement in the HAM-A total score between baseline and end point for all three treatment groups was seen, with mean changes of 3.4 (95% CI 2.0 to 4.8), 6.1 (95% CI 4.1 to 8.1), and 6.1 (95% CI 4.6 to 7.6) for the placebo, lesopitron, and lorazepam groups, respectively (omnibus p = 0.044, uncorrected). Positive treatment effects were also observed in the subgroup population on several other measures and suggest that additional therapeutic trials may be warranted. Future trials could be stratified on the basis of referral status (symptomatic volunteer vs. clinical patient with preexisting illness) or previous exposure to anxiolytics, and use a fixed-dose rather than flexible-fixed-dose design. CONCLUSIONS The subgroup analysis represents a comparison of treatment outcome in GAD patients presenting with a history of previous episodes of GAD or anxiety disorder not otherwise specified compared with those who were experiencing their first episode of GAD and reported no anxiety history. Although the overall study analysis was equivocal, for the approximately 40% of patients with recurrent anxiety disorder, beneficial effects for both lesopitron and lorazepam are suggested.
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Affiliation(s)
- A Fresquet
- Clinical Research, Laboratorios Dr. Esteve, S.A., Barcelona, Spain
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García-Guasch R, Llubià C, Preciado MJ, Costa A, Sust M, Vidal F. [Diltiazem compared with placebo in the prevention of myocardial ischemia during non-cardiac surgery]. Rev Esp Anestesiol Reanim 1998; 45:409-15. [PMID: 9927831] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy and safety of intravenous diltiazem to prevent myocardial ischemia during surgery on patients with ischemic heart disease undergoing non cardiac surgery under general anesthesia. PATIENTS AND METHOD Sixty patients scheduled for elective non cardiac surgery under general anesthesia were randomly assigned to two groups to receive diltiazem or placebo under double blind conditions. After an intravenous dose of 0.15 mg/kg of diltiazem or an equivalent amount of placebo, an infusion of 3 micrograms/kg/min of diltiazem or placebo was begun and continued until three hours after surgery. Thirty minutes after starting the infusion, anesthesia was induced by 0.1 mg/kg diazepam, 3 micrograms/kg of fentanyl and 0.3 mg/kg of etomidate. Intubation followed administration of 0.6 mg/kg of atracurium. Anesthesia was maintained with N2O/O2 and halothane and was the same for both groups. DII and V5 leads were monitored on a Cardiowiss CM-8 ECG machine that allowed us to set the alarm when ST segment variations reached 1 mm above or below baseline. We analyzed the number, intensity and duration of ischemic episodes recorded, as well as hemodynamic variables and side effects. RESULTS Data for 46 patients were valid. At least one ischemic episode was experienced by 15% of patients in the placebo group and 1 in the diltiazem group (p < 0.05). The episodes were related to increased systolic arterial pressure (p = 0.04). ST segment decreases were 1.1 to 3.6 mm (1.75 +/- 0.7) (mean +/- SD) and lasted between 1 and 45 minutes (11.62 +/- 13.26) (mean +/- SD). No significant side effects were observed. CONCLUSIONS Intravenous diltiazem administered to patients with ischemic heart disease under general anesthesia for non cardiac surgery was effective in our study for preventing intraoperative ischemic episodes.
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Affiliation(s)
- R García-Guasch
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Badalona Germans Trias i Pujol, Badalona, Barcelona
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Sust M, Schmalz T, Beyer L, Rost R, Hansen E, Weiss T. Assessment of isometric contractions performed with maximal subjective effort: corresponding results for EEG changes and force measurements. Int J Neurosci 1997; 92:103-18. [PMID: 9522260 DOI: 10.3109/00207459708986394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 02/06/2023]
Abstract
In order to find a parameter or parameters that can be attributed to movements performed with maximal subjective effort, EEG recordings and force measurements were taken in connection with isometric muscle contractions performed with 80% of the subjective maximal force (IMC80) or with maximal subjective effort (IMC100). Criteria based on EEG recordings and force measurements have been considered as indicators for maximal subjective effort in a given movement. The following criteria were selected: A. If the mean spectral theta amplitude across the parieto-occipital area decreases from IMC80 to IMC100 then the isometric contraction is taken to be performed with maximal effort; B. If the obtained force values can be fitted to a switch function and if the achieved forces are only a predetermined percentage lower than the maximal force value obtained over all trials then this isometric contraction is accepted to be performed with maximal effort. 18 out of 24 cases fulfill the EEG criterion whereas the criterion for force measurements is fulfilled in 16 out of 24 trials. The comparison between the results obtained by means of the EEG criterion and by means of criterion for force measurement shows that the results are in agreement in 22 out of 24 cases (p < .001). The high correspondence of the assessments allows us to suspect that both criteria specify the same phenomenon, namely the performance of a motor task with maximal subjective effort.
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Affiliation(s)
- M Sust
- Westfälische Wilhelms-Universität, Institute of Sport Sciences, Laboratory for Appied Biomechanics, Münster, F.R. Germany
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Weiss T, Sust M, Beyer L, Hansen E, Rost R, Schmalz T. Theta power decreases in preparation for voluntary isometric contractions performed with maximal subjective effort. Neurosci Lett 1995; 193:153-6. [PMID: 7478171 DOI: 10.1016/0304-3940(95)11688-s] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 01/25/2023]
Abstract
In order to find EEG parameters that can be attributed to movements performed with maximal subjective effort, EEG recordings and force measurements were realized in connection with isometric contractions (IMC). IMC were performed with submaximal and maximal subjective effort. Mean spectral power density within the theta band was found as an indicator for maximal subjective effort. The theta power across the parieto-occipital area decreases from rest through movements performed with submaximal force to movements performed with maximal effort. It is argued that this theta decrease possibly reflects a down-regulation of the posterior attention system in order to minimize the influences of external stimuli during the preparation for voluntary IMC performed with maximal subjective effort.
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Affiliation(s)
- T Weiss
- Friedrich Schiller University Jena, Institute of Physiology, Germany
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Abstract
Ethanol and anaesthetics increase glycogen levels in the brain. However, no data have been reported about the effect of ethanol on glycogen and glucose metabolism in specific brain regions. We have studied the concentrations of glycogen, glucose, glucose 6-P, glucose 1,6-P2 and fructose 2,6-P2 and the activities of glycogen synthase, glycogen phosphorylase and glycogen phosphorylase kinase in seven brain regions of starved rats following treatment with a single dose or several doses of ethanol. Our results show that: (1) the effect of ethanol on glucose metabolism depends on whether it is given in one single dose or in a series of doses; (2) glycogen concentration increases after a single dose of ethanol but not after long exposure; (3) glucose, glucose 6-P in some areas, and the bisphosphorylated sugar, fructose 2,6-P2 significantly increase after prolonged exposure to ethanol; and (4) the enzymatic activities of glycogen metabolism are not modified after a long exposure to ethanol. In summary, these data show that ethanol may modify the use of glycogen, glucose and derivatives in brain. Moreover, the changes produced depend on the pattern of ethanol intake and the brain area considered.
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Affiliation(s)
- J Garriga
- Unitat de Bioquímica, Facultat de Medicina, Universitat de Barcelona, Spain
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Leutert B, Beyer L, Weiβ T, Hansen E, Rost R, Sust M. Mapping of EEG activity during mental training of isometric leg contractions. Int J Psychophysiol 1993. [DOI: 10.1016/0167-8760(93)90199-y] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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García-Valdecasas JC, Almenara R, Cabrer C, de Lacy AM, Sust M, Taurá P, Fuster J, Grande L, Pera M, Sentis J. Subcostal incision versus midline laparotomy in gallstone surgery: a prospective and randomized trial. Br J Surg 1988; 75:473-5. [PMID: 3292005 DOI: 10.1002/bjs.1800750523] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [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: 01/05/2023]
Abstract
We report the results of a prospective and randomized trial designed to study the incidence of abdominal and pulmonary complications in gallstone surgery comparing subcostal (SI) with midline incision. The need for postoperative analgesia was lower in the SI group. There was no difference in the degree of hypoxaemia in the first two postoperative days, but there was less impairment of pulmonary function in terms of vital capacity and forced expiratory volume in 1 s (P less than 0.0001) in the SI group. SI patients also had a lower incidence of pulmonary or abdominal complications but the difference was not significant. Finally, we found a reduced hospital stay for the SI patients (P less than 0.01), probably related to a reduced postoperative analgesic requirement and an improved pulmonary function. We conclude that subcostal incision is a better approach for biliary tract surgery and should be used whenever possible.
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Affiliation(s)
- J C García-Valdecasas
- Department of Surgery, Medical School, Hospital Clinic, University of Barcelona, Spain
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