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Piacentino D, Ogirala A, Lew R, Loftus G, Worden M, Koblan KS, Hopkins SC. A Novel Method for Deriving Adverse Event Prevalence in Randomized Controlled Trials: Potential for Improved Understanding of Benefit-Risk Ratio and Application to Drug Labels. Adv Ther 2024; 41:152-169. [PMID: 37855974 PMCID: PMC10796692 DOI: 10.1007/s12325-023-02695-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Adverse event (AE) data in randomized controlled trials (RCTs) allow quantification of a drug's safety risk relative to placebo and comparison across medications. The standard US label for Food and Drug Administration-approved drugs typically lists AEs by MedDRA Preferred Term that occur at ≥ 2% in drug and with greater incidence than in placebo. We suggest that the drug label can be more informative for both patients and physicians if it includes, in addition to AE incidence (percent of subjects who reported the AE out of the total subjects in treatment), the absolute prevalence (percent of subject-days spent with an AE out of the total subject-days spent in treatment) and expected duration (days required for AE incidence to be reduced by half). We also propose a new method to analyze AEs in RCTs using drug-placebo difference in AE prevalence to improve safety signal detection. METHODS AE data from six RCTs in schizophrenia were analyzed (five RCTs of the dopamine D2 receptor-based antipsychotic lurasidone and one RCT of the novel trace amine-associated receptor 1 [TAAR1] agonist ulotaront). We determined incidence, absolute prevalence, and expected duration of AEs for lurasidone and ulotaront vs respective placebo. We also calculated areas under the curve of drug-placebo difference in AE prevalence and mean percent contribution of each AE to this difference. RESULTS A number of AEs with the same incidence had different absolute prevalence and expected duration. When accounting for these two parameters, AEs that did not appear in the 2% incidence tables of the drug label turned out to contribute substantially to drug tolerability. The percent contribution of a drug-related AE to the overall side effect burden increased the drug-placebo difference in AE prevalence, whereas the percent contribution of a placebo-related AE decreased such difference, revealing a continuum of risk between drug and placebo. AE prevalence curves for drug were generally greater than those for placebo. Ulotaront exhibited a small drug-placebo difference in AE prevalence curves due to a relatively low incidence and short duration of AEs in the ulotaront treatment arm as well as the emergence of disease-related AEs in the placebo arm. CONCLUSION Reporting AE absolute prevalence and expected duration for each RCT and incorporating them in the drug label is possible, is clinically relevant, and allows standardized comparison of medications. Our new metric, the drug-placebo difference in AE prevalence, facilitates signal detection in RCTs. We piloted this metric in RCTs of several neuropsychiatric indications and drugs, offering a new way to compare AE burden and tolerability among treatments using existing clinical trial information.
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Affiliation(s)
- Daria Piacentino
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Ajay Ogirala
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Robert Lew
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Gregory Loftus
- Sumitomo Pharma America, Inc. (Formerly Sumitovant Biopharma Inc.), Marlborough, MA, USA
| | - MaryAlice Worden
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Kenneth S Koblan
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Seth C Hopkins
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA.
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Tsukada H, Chen YL, Xiao G, Lennek L, Milanovic SM, Worden M, Polhamus DG, Chiu YY, Hopkins SC, Galluppi GR. A Phase I, Open-Label, Fixed Sequence Study to Investigate the Effect of Cytochrome P450 2D6 Inhibition on the Pharmacokinetics of Ulotaront in Healthy Subjects. Clin Pharmacokinet 2023; 62:1755-1763. [PMID: 37882999 PMCID: PMC10684410 DOI: 10.1007/s40262-023-01317-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Ulotaront is a novel psychotropic agent with agonist activity at trace amine-associated receptor 1 (TAAR1) and 5-hydroxytryptamine type 1A (5-HT1A) receptors in phase III clinical development for the treatment of schizophrenia. OBJECTIVE This study aimed to investigate the effect of paroxetine, a strong cytochrome P450 (CYP) 2D6 inhibitor, on ulotaront pharmacokinetics (PK) in healthy volunteers. METHODS Subjects received a single oral dose of 25 mg ulotaront on Day 1 and an oral dose of 20 mg paroxetine once daily from Days 5 to 10 to achieve steady-state plasma paroxetine levels. On Day 11, subjects received another single oral dose of 25 mg ulotaront, with continued daily oral dosing of 20 mg paroxetine from Days 11 to 14. All 24 subjects were CYP2D6 normal metabolizers. RESULTS Coadministration of paroxetine increased ulotaront maximum observed plasma concentration (Cmax) and area under the plasma concentration-time curve from time zero to infinity (AUC∞) by 31% and 72%, respectively, and decreased ulotaront apparent clearance (CL/F) by approximately 42%. While coadministration of paroxetine increased AUC∞ of active but minor metabolite SEP-363854 by 32%, it had no effect on SEP-363854 Cmax, or on SEP-363854 to the ulotaront AUC from time zero to the last quantifiable concentration (AUClast) ratio. Based on the acceptable adverse event profile of ulotaront across previous phase II studies, the increase in ulotaront exposure is unlikely to be clinically meaningful. CONCLUSIONS Weak drug-drug interactions were observed between ulotaront and the strong CYP2D6 inhibitor paroxetine; however, dose adjustment as a precondition when ulotaront is coadministered with strong CYP2D6 inhibitors or administered to CYP2D6 poor metabolizers should not be necessary.
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Affiliation(s)
- Hironobu Tsukada
- Sumitomo Pharma America, 84 Waterford Dr., Marlborough, MA, 01752, USA
- Sumitomo Pharma Co., Ltd, Tokyo, Japan
| | - Yu-Luan Chen
- Sumitomo Pharma America, 84 Waterford Dr., Marlborough, MA, 01752, USA
| | - Guangqing Xiao
- Sumitomo Pharma America, 84 Waterford Dr., Marlborough, MA, 01752, USA
| | - Lisa Lennek
- Sumitomo Pharma America, 84 Waterford Dr., Marlborough, MA, 01752, USA
| | | | - MaryAlice Worden
- Sumitomo Pharma America, 84 Waterford Dr., Marlborough, MA, 01752, USA
| | | | - Yu-Yuan Chiu
- Sumitomo Pharma America, 84 Waterford Dr., Marlborough, MA, 01752, USA
| | - Seth C Hopkins
- Sumitomo Pharma America, 84 Waterford Dr., Marlborough, MA, 01752, USA
| | - Gerald R Galluppi
- Sumitomo Pharma America, 84 Waterford Dr., Marlborough, MA, 01752, USA.
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Tsukada H, Milanovic SM, Darpo B, Xue H, Xiong K, Tripp E, Lennek L, Worden M, Hopkins SC, Galluppi GR. A randomized, single-dose, crossover study of the effects of ulotaront on electrocardiogram intervals in subjects with schizophrenia. Clin Transl Sci 2023. [PMID: 36949248 DOI: 10.1111/cts.13512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023] Open
Abstract
This study (NCT04369391) evaluated the effects of ulotaront (SEP-363856), a novel trace amine-associated receptor 1 (TAAR1) agonist in development for schizophrenia, on electrocardiogram parameters. Study design was a randomized, single-dose, 3-period crossover (ulotaront 150 mg, placebo, moxifloxacin 400 mg). Sixty subjects with schizophrenia completed all periods. Ulotaront had no clinically relevant effect on heart rate, PR interval, or QRS duration. In by-time-point analysis (secondary analysis), the upper bound of the 2-sided 90% CI for ΔΔQTcF was below 10 ms at all time points for ulotaront. In concentration-QTc analysis (primary analysis), a linear mixed-effects model with ulotaront and its major metabolite SEP-383103 was selected as the primary model based on prespecified criteria. Effect on ∆∆QTcF exceeding 10 ms can be excluded within observed ranges of ulotaront and SEP-383103 plasma concentrations up to ~574 and ~272 ng/mL, respectively. The upper bound of 90% CI for ΔΔQTcF can be predicted to be below 10 ms at the highest anticipated clinical exposure, currently defined as steady-state mean Cmax at ulotaront 100 mg/day in CYP2D6 poor metabolizers, ~416 and ~211 ng/mL for ulotaront and SEP-383103, respectively. Assay sensitivity was demonstrated by the QTc effect caused by moxifloxacin. In conclusion, ulotaront is unlikely to cause clinically relevant QTc prolongation in patients with schizophrenia at the anticipated maximum therapeutic dose.
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Affiliation(s)
- Hironobu Tsukada
- Sunovion Pharmaceuticals Inc, Marlborough, MA, USA
- Sumitomo Pharma Co., Ltd., Tokyo, Japan
| | | | | | | | | | - Emily Tripp
- Sunovion Pharmaceuticals Inc, Marlborough, MA, USA
| | - Lisa Lennek
- Sunovion Pharmaceuticals Inc, Marlborough, MA, USA
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Hopkins SC, Ogirala A, Zeni C, Worden M, Koblan KS. Depicting Risperidone Safety Profiles in Clinical Trials Across Different Diagnoses Using a Dopamine D2-Based Pharmacological Class Effect Query Defined by FAERS. Clin Drug Investig 2022; 42:1113-1121. [DOI: 10.1007/s40261-022-01218-7] [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] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
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Worden M, Bergquist L, Hegmann T. A quick and easy synthesis of fluorescent iron oxide nanoparticles featuring a luminescent carbonaceous coating via in situ pyrolysis of organosilane ligands. RSC Adv 2015. [DOI: 10.1039/c5ra18382k] [Citation(s) in RCA: 8] [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
We report a simple, two-step method for making magnetic, photoluminescent iron oxide (magnetite) core/carbonaceous shell nanoparticles emitting blue light.
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Affiliation(s)
- M. Worden
- Department of Chemistry and Biochemistry
- Kent State University
- Kent, 44240-0001 USA
| | - L. Bergquist
- Chemical Physics Interdisciplinary Program
- Liquid Crystal Institute
- Kent State University
- Kent, 44240-0001 USA
| | - T. Hegmann
- Department of Chemistry and Biochemistry
- Kent State University
- Kent, 44240-0001 USA
- Chemical Physics Interdisciplinary Program
- Liquid Crystal Institute
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Worden M. The current clinical revolution. Applications of gene therapy in treatment of disease. Physician Assist 1994; 18:83-8. [PMID: 10134065] [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: 02/11/2023]
Abstract
A major technological revolution is on the horizon that promises cures for inherited diseases such as cystic fibrosis, sickle cell anemia, muscular dystrophy, hemophilia, leukocyte-adhesion deficiency, and Gaucher's disease. This revolutionary technology also promises effective treatments for acquired diseases such as cancer and AIDS. The technique is gene therapy and it has already been used in humans. Some applications raise ethical considerations that not only affect the individual who is treated but have implications for future generations as well.
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Affiliation(s)
- M Worden
- Chiron Corporation, Emeryville, CA
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Abstract
Research in the field of attention and automaticity examines the nature of processing information with and without attention. Behavioral results show automatic processing is a continuous effect that is task specific and is affected by top-down influences. Neurobiological data show that differential attentional processing occurs in a distributed network, where initial performance is more strongly influenced by more anterior cortical structures. Recent models of attentional and autonomic processing directly incorporate physiological constraints and predict practice effects as a result of a variety of competing mechanisms.
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Abstract
A case is presented illustrating the diagnostic and therapeutic value of human figure drawings. The case study, an 11-year-old boy recovering from viral encephalitis, compares two projective techniques--the Draw-A-Person and the Kinetic Family Drawing. The tests were administered pre- and post-treatment. The relative merit of each technique within the therapeutic context is discussed.
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Worden M. The vagaries of program evaluation: A case study. J Psychedelic Drugs 1980; 12:157-64. [PMID: 7420431 DOI: 10.1080/02791072.1980.10471567] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Worden M. Proto-analysis of academic prevention. J Psychedelic Drugs 1980; 12:75-8. [PMID: 7392061 DOI: 10.1080/02791072.1980.10471556] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Worden M. Further perspectives on primary prevention. Am J Psychiatry 1979; 136:853-4. [PMID: 443480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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