1
|
Dioh W, Narkar V, Singh A, Malik F, Ferrucci L, Tourette C, Mariani J, van Maanen R, Fielding RA. Novel Potential Targets for Function-Promoting Therapies: Orphan Nuclear Receptors, Anti-inflammatory Drugs, Troponin Activators, Mas Receptor Agonists, and Urolithin A. J Gerontol A Biol Sci Med Sci 2023; 78:44-52. [PMID: 37325960 PMCID: PMC10272986 DOI: 10.1093/gerona/glad072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/16/2022] [Indexed: 06/17/2023] Open
Abstract
In recent years, several new classes of therapies have been investigated with their potential for restoring or improving physical functioning in older adults. These have included Mas receptor agonists, regulators of mitophagy, skeletal muscle troponin activators, anti-inflammatory compounds, and targets of orphan nuclear receptors. The present article summarizes recent developments of the function-promoting effects of these exciting new compounds and shares relevant preclinical and clinical data related to their safety and efficacy. The development of novel compounds in this area is expanding and likely will need the advent of a new treatment paradigm for age-associated mobility loss and disability.
Collapse
Affiliation(s)
| | - Vihang Narkar
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | | | - Fady Malik
- Cytokinetics, Inc., San Francisco, California, USA
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Baltimore, Maryland, USA
| | | | - Jean Mariani
- Biophytis, UMPC—BC9, Paris, France
- Sorbonne Université, CNRS—Institute de Biologie Paris Seine (UMR B2A), Paris, France
| | | | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Smeitink J, van Maanen R, de Boer L, Ruiterkamp G, Renkema H. A randomised placebo-controlled, double-blind phase II study to explore the safety, efficacy, and pharmacokinetics of sonlicromanol in children with genetically confirmed mitochondrial disease and motor symptoms ("KHENERGYC"). BMC Neurol 2022; 22:158. [PMID: 35477351 PMCID: PMC9044835 DOI: 10.1186/s12883-022-02685-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Methods The KHENERGYC trial will be a phase II, randomised, double-blinded, placebo-controlled (DBPC), parallel-group study in the paediatric population (birth up to and including 17 years). The study will be recruiting 24 patients suffering from motor symptoms due to genetically confirmed PMD. The trial will be divided into two phases. The first phase of the study will be an adaptive pharmacokinetic (PK) study with four days of treatment, while the second phase will include randomisation of the participants and evaluating the efficacy and safety of sonlicromanol over 6 months. Discussion Effective novel therapies for treating PMDs in children are an unmet need. This study will assess the pharmacokinetics, efficacy, and safety of sonlicromanol in children with genetically confirmed PMDs, suffering from motor symptoms. Trial registration clinicaltrials.gov: NCT04846036, registered April 15, 2021. European Union Clinical Trial Register (EUDRACT number: 2020–003124-16), registered October 20, 2020. CCMO registration: NL75221.091.20, registered on October 7, 2020.
Collapse
Affiliation(s)
- Jan Smeitink
- Khondrion BV, Transistorweg 5C, M Building, 6534, AT, Nijmegen, The Netherlands.
| | - Rob van Maanen
- Khondrion BV, Transistorweg 5C, M Building, 6534, AT, Nijmegen, The Netherlands
| | - Lonneke de Boer
- Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - Gerrit Ruiterkamp
- Khondrion BV, Transistorweg 5C, M Building, 6534, AT, Nijmegen, The Netherlands
| | - Herma Renkema
- Khondrion BV, Transistorweg 5C, M Building, 6534, AT, Nijmegen, The Netherlands
| |
Collapse
|
3
|
Karaa A, MacMullen LE, Campbell JC, Christodoulou J, Cohen BH, Klopstock T, Koga Y, Lamperti C, van Maanen R, McFarland R, Parikh S, Rahman S, Scaglia F, Sherman AV, Yeske P, Falk MJ. Community Consensus Guidelines to Support FAIR Data Standards in Clinical Research Studies in Primary Mitochondrial Disease. Adv Genet (Hoboken) 2021; 3:2100047. [PMID: 35317023 PMCID: PMC8936395 DOI: 10.1002/ggn2.202100047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Primary mitochondrial diseases (PMD) are genetic disorders with extensive clinical and molecular heterogeneity where therapeutic development efforts have faced multiple challenges. Clinical trial design, outcome measure selection, lack of reliable biomarkers, and deficiencies in long-term natural history data sets remain substantial challenges in the increasingly active PMD therapeutic development space. Developing "FAIR" (findable, accessible, interoperable, reusable) data standards to make data sharable and building a more transparent community data sharing paradigm to access clinical research metadata are the first steps to address these challenges. This collaborative community effort describes the current landscape of PMD clinical research data resources available for sharing, obstacles, and opportunities, including ways to incentivize and encourage data sharing among diverse stakeholders. This work highlights the importance of, and challenges to, developing a unified system that enables clinical research structured data sharing and supports harmonized data deposition standards across clinical consortia and research groups. The goal of these efforts is to improve the efficiency and effectiveness of drug development and improve understanding of the natural history of PMD. This initiative aims to maximize the benefit for PMD patients, research, industry, and other stakeholders while acknowledging challenges related to differing needs and international policies on data privacy, security, management, and oversight.
Collapse
Affiliation(s)
- Amel Karaa
- Department of Genetics, Massachusetts General HospitalHarvard Medical SchoolBostonMA02114USA
| | - Laura E. MacMullen
- Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPA19104USA
| | | | - John Christodoulou
- Murdoch Children's Research Institute and Department of PaediatricsUniversity of MelbourneMelbourneVictoria3052Australia
| | - Bruce H. Cohen
- Department of Pediatrics and the Rebecca D. Considine Research InstituteAkron Children's HospitalAkronOH44308USA
| | - Thomas Klopstock
- Friedrich‐Baur Institute, Department of NeurologyUniversity HospitalLMUMunich80336Germany
- German Center for Neurodegenerative Diseases (DZNE)Munich80336Germany
- Munich Cluster for Systems Neurology (SyNergy)Munich80336Germany
- German Network for Mitochondrial Disorders (mitoNET)Munich80336Germany
| | - Yasutoshi Koga
- Department of Pediatrics and Child HealthKurume University School of MedicineKurume830‐0011Japan
| | - Costanza Lamperti
- UO Genetics and NeurogeneticsFondazione IRCCS Instituto Neurologico C. BestaMilan20126Italy
| | | | | | | | - Shamima Rahman
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation TrustLondonWC1N 1EHUK
| | - Fernando Scaglia
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTX77030USA
- Texas Children's HospitalHoustonTX77030USA
- Joint BCM‐CUHK Center of Medical GeneticsPrince of Wales HospitalHong Kong SARNTChina
| | - Alexander V. Sherman
- Department of Neurology, Massachusetts General HospitalHarvard Medical SchoolBostonMA02114USA
| | - Philip Yeske
- United Mitochondrial Disease FoundationPittsburghPA15239USA
| | - Marni J. Falk
- Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPA19104USA
- Department of PediatricsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA19104USA
| |
Collapse
|
4
|
Ali M, Landeira M, Covernton PJO, Choudhury N, Jaggi A, Fatoye F, van Maanen R. The use of mono- and combination drug therapy in men and women with lower urinary tract symptoms (LUTS) in the UK: a retrospective observational study. BMC Urol 2021; 21:119. [PMID: 34474675 PMCID: PMC8414666 DOI: 10.1186/s12894-021-00881-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/19/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combination drug therapy for lower urinary tract symptoms (LUTS) is beneficial to selected patients and recommended by guidelines. Patterns of real-world LUTS drug use, especially combination drug therapy, have not been studied extensively. Moreover, further understanding of the recent landscape is required following the introduction of the beta-3-adrenoceptor agonist mirabegron in the UK in 2013 for overactive bladder (OAB). The objective was to describe mono- and combination drug therapy use for LUTS in patients in UK clinical practice. METHODS This was a retrospective, descriptive, observational database study using UK Clinical Practice Research Datalink GOLD and linked databases. Men and women ≥ 18 years with a first prescription for any LUTS drug from 2014 to 2016 with ≥ 12 months continuous enrollment pre- and post-index date were included. Primary endpoints were mono- or combination drug therapy use for LUTS in male and female cohorts. Secondary endpoints were description of treatment prescribed, treatment persistence and patient demographics. Data were analyzed descriptively. Sub-cohorts were defined by drugs prescribed at index date. RESULTS 79,472 patients (61.3% male) were included, based on index treatments. Of all men, 82.5% received any benign prostatic obstruction (BPO) drug, 25.4% any OAB drug, and 7.9% any BPO drug plus any OAB drug. As either mono- or combination drug therapy, 77.1% received an alpha-blocker, 18.9% a 5-alpha reductase inhibitor, 23.9% an antimuscarinic agent, and 2.1% mirabegron. Of all women, 94.5% received any OAB drug, 6.0% duloxetine, and 0.5% any OAB drug plus duloxetine. As either mono- or combination drug therapy, 87.7% received an antimuscarinic, and 9.7% mirabegron. In men or women receiving OAB treatment, approximately 2.5% received combination drug therapy with an antimuscarinic agent and mirabegron. For OAB drug monotherapies, mirabegron had the highest persistence in both male and female cohorts. CONCLUSIONS This study provides a better understanding of the recent landscape of LUTS drug use in UK clinical practice. It highlights potential undertreatment of storage symptoms in men with LUTS and the low use of combination OAB treatments.
Collapse
Affiliation(s)
- Mahmood Ali
- Manchester Metropolitan University, Manchester, UK. .,Astellas Pharma Europe Ltd, Addlestone, UK.
| | | | | | | | - Ashley Jaggi
- Manchester Metropolitan University, Manchester, UK.,Astellas Pharma Europe Ltd, Addlestone, UK
| | | | | |
Collapse
|
5
|
Wolf J, Kalocsai K, Fortuny C, Lazar S, Bosis S, Korczowski B, Petit A, Bradford D, Croos-Dabrera R, Incera E, Melis J, van Maanen R. Safety and Efficacy of Fidaxomicin and Vancomycin in Children and Adolescents with Clostridioides (Clostridium) difficile Infection: A Phase 3, Multicenter, Randomized, Single-blind Clinical Trial (SUNSHINE). Clin Infect Dis 2020; 71:2581-2588. [PMID: 31773143 PMCID: PMC7744996 DOI: 10.1093/cid/ciz1149] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fidaxomicin, a narrow-spectrum antibiotic approved for Clostridioides (Clostridium) difficile infection (CDI) in adults, is associated with lower rates of recurrence than vancomycin; however, pediatric data are limited. This multicenter, investigator-blind, phase 3, parallel-group trial assessed the safety and efficacy of fidaxomicin in children. METHODS Patients aged <18 years with confirmed CDI were randomized 2:1 to 10 days of treatment with fidaxomicin (suspension or tablets, twice daily) or vancomycin (suspension or tablets, 4 times daily). Safety assessments included treatment-emergent adverse events. The primary efficacy end point was confirmed clinical response (CCR), 2 days after the end of treatment (EOT). Secondary end points included global cure (GC; CCR without CDI recurrence) 30 days after EOT (end of study; EOS). Plasma and stool concentrations of fidaxomicin and its active metabolite OP-1118 were measured. RESULTS Of 148 patients randomized, 142 were treated (30 <2 years old). The proportion of participants with treatment-emergent adverse events was similar with fidaxomicin (73.5%) and vancomycin (75.0%). Of 3 deaths in the fidaxomicin arm during the study, none were CDI or treatment related. The rate of CCR at 2 days after EOT was 77.6% (76 of 98 patients) with fidaxomicin and 70.5% (31 of 44) with vancomycin, whereas the rate of GC at EOS was significantly higher in participants receiving fidaxomicin (68.4% vs 50.0%; adjusted treatment difference, 18.8%; 95% confidence interval, 1.5%-35.3%). Systemic absorption of fidaxomicin and OP-1118 was minimal, and stool concentrations were high. CONCLUSIONS Compared with vancomycin, fidaxomicin was well tolerated and demonstrated significantly higher rates of GC in children and adolescents with CDI. CLINICAL TRIALS REGISTRATION NCT02218372.
Collapse
Affiliation(s)
- Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Krisztina Kalocsai
- Gyermekinfektológia, Dél-pesti Centrumkórház Országos Haematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Claudia Fortuny
- Department of Paediatric Infectious Diseases, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Stefan Lazar
- Department of Pediatrics, Clinical Hospital for Infectious and Tropical Diseases “Dr. Victor Babeș,” Bucharest, Romania
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bartosz Korczowski
- Department of Pediatrics and Pediatric Gastroenterology, University of Rzeszów, Rzeszów, Poland
| | - Arnaud Petit
- Department of Pediatric Hematology and Oncology, Hôpital Trousseau, HUEP, APHP, Paris, France
- Faculty of Medicine, Sorbonne Université, UMRS 938, GRC MyPAC, Paris, France
| | | | | | | | - Joost Melis
- Astellas Pharma B.V., Leiden, the Netherlands
| | | |
Collapse
|
6
|
Mueller ER, van Maanen R, Chapple C, Abrams P, Herschorn S, Robinson D, Stoelzel M, Yoon SJ, Al-Shukri S, Rechberger T, Gratzke C. Long-term treatment of older patients with overactive bladder using a combination of mirabegron and solifenacin: a prespecified analysis from the randomized, phase III SYNERGY II study. Neurourol Urodyn 2019; 38:779-792. [PMID: 30644570 PMCID: PMC6850571 DOI: 10.1002/nau.23919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/30/2018] [Accepted: 12/11/2018] [Indexed: 12/25/2022]
Abstract
Aims SYNERGY II was a 12‐month phase III trial in patients with overactive bladder (OAB) symptoms that investigated the safety and efficacy of the combination of mirabegron and solifenacin in comparison with each monotherapy. This analysis evaluated the trial findings using four age subgroups (<65, ≥65, <75, and ≥75 years). Methods Eligible patients were ≥18 years with symptoms of “wet” OAB (urinary frequency and urgency with incontinence) for ≥3 months. Patients were randomized to receive once‐daily solifenacin succinate and mirabegron (5 mg/50 mg; combination), solifenacin succinate, or mirabegron (4:1:1). Safety evaluations: treatment‐emergent adverse events (TEAEs), vital signs, and electrocardiogram, post‐void residual volume, and laboratory assessments. Primary efficacy variables: change from baseline to end of treatment in number of incontinence episodes/24 h and micturitions/24 h. Results Of 1794 patients (full analysis set), 614 (34.2%) and 168 (9.4%) were ≥65 and ≥75 years old, respectively. Overall, 856 (47.2%) patients experienced ≥1 TEAE. Higher TEAE incidences were typically observed for the combination versus both monotherapies (eg, constipation) and in the older versus younger age groups (eg, urinary tract infection). Increases in mean pulse rate from baseline of >1 bpm were noted in the combination and mirabegron younger age groups only. No clinically significant findings were observed in the other safety parameters. The efficacy variables improved with all treatments and the greatest improvements were typically observed with combination therapy. Conclusions Mirabegron and solifenacin combination therapy was a well‐tolerated and effective treatment for patients with OAB symptoms irrespective of their age.
Collapse
Affiliation(s)
| | - Rob van Maanen
- Astellas Pharma Global Development, Leiden, The Netherlands
| | - Christopher Chapple
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Sender Herschorn
- University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | - Sang J Yoon
- Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, South Korea
| | - Salman Al-Shukri
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | | | | |
Collapse
|
7
|
Gratzke C, van Maanen R, Chapple C, Abrams P, Herschorn S, Robinson D, Ridder A, Stoelzel M, Paireddy A, Yoon SJ, Al-Shukri S, Rechberger T, Mueller ER. Long-term Safety and Efficacy of Mirabegron and Solifenacin in Combination Compared with Monotherapy in Patients with Overactive Bladder: A Randomised, Multicentre Phase 3 Study (SYNERGY II). Eur Urol 2018; 74:501-509. [PMID: 29866467 DOI: 10.1016/j.eururo.2018.05.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 01/17/2018] [Accepted: 05/03/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND The long-term potential of solifenacin and mirabegron combination treatment for patients with overactive bladder (OAB) has not been previously assessed. OBJECTIVES To evaluate the safety and efficacy of solifenacin succinate 5mg plus mirabegron 50mg tablets (combination treatment) versus solifenacin or mirabegron monotherapy in patients with OAB over 12 mo. DESIGN, SETTING, AND PARTICIPANTS Randomised, double-blind, multicentre, phase 3 trial (SYNERGY II) of patients with "wet" OAB symptoms (urinary frequency and urgency with incontinence) for ≥3 mo. The study was conducted from March 2014 to September 2016; with 1829 patients randomised. The full analysis set was comprised of 1794 patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary objective was safety, measured as treatment-emergent adverse events (TEAEs). Efficacy was measured as the change from baseline to the end of treatment in the mean number of incontinence episodes/24h and micturitions/24h. RESULTS AND LIMITATIONS The median age was 60 yr (range 19-86 yr) and 1434 patients (80%) were female. Overall, 856 patients (47%) experienced ≥1 TEAE. TEAE frequency was slightly higher in the combination group (596 patients, 49%; mirabegron 126 patients, 41%; solifenacin 134 patients, 44%). Serious TEAEs were reported by 67 patients (3.7%); one was considered possibly treatment-related (mirabegron group, atrial fibrillation). Dry mouth was the most common TEAE (combination 74 patients, 6.1%; solifenacin 18 patients, 5.9%; mirabegron 12 patients, 3.9%). Combination therapy was statistically superior to mirabegron and solifenacin for the number of incontinence episodes (vs mirabegron: adjusted mean difference [AMD] -0.5, 95% confidence interval [CI] -0.7 to -0.2, p<0.001; vs solifenacin: AMD -0.1, 95% CI -0.4 to 0.1, p=0.002) and micturitions (vs mirabegron: AMD -0.5, 95% CI -0.8 to -0.2, p<0.001; vs solifenacin: AMD -0.4, 95% CI -0.7 to -0.1, p=0.004). CONCLUSIONS Mirabegron and solifenacin combination treatment for OAB symptoms was well tolerated over 12 mo and led to efficacy improvements over each monotherapy. This innovative combination is a treatment option that could become widely used in the clinic. PATIENT SUMMARY This study looked at the safety and efficacy of a combination of solifenacin succinate 5mg plus mirabegron 50mg tablets over 12 mo in patients with the overactive bladder (OAB) symptoms of increased urination frequency, heightened urgency to urinate, and unintentional passing of urine. We compared this treatment with solifenacin succinate 5mg or mirabegron 50mg alone, and found that the combination treatment was well tolerated by patients and led to greater improvements in symptoms. This novel combination could be an improved treatment option in the clinical setting for patients with OAB. This study is registered at ClinicalTrials.gov as NCT02045862.
Collapse
Affiliation(s)
| | - Rob van Maanen
- Astellas Pharma Global Development, Leiden, The Netherlands
| | - Christopher Chapple
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Sender Herschorn
- University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Arwin Ridder
- Astellas Pharma Global Development, Leiden, The Netherlands
| | | | - Asha Paireddy
- Astellas Pharma Global Development, Leiden, The Netherlands
| | - Sang Jin Yoon
- Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, South Korea
| | - Salman Al-Shukri
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | | | | |
Collapse
|
8
|
Robinson D, Kelleher C, Staskin D, Mueller ER, Falconer C, Wang J, Ridder A, Stoelzel M, Paireddy A, van Maanen R, Hakimi Z, Herschorn S. Patient-reported outcomes from SYNERGY, a randomized, double-blind, multicenter study evaluating combinations of mirabegron and solifenacin compared with monotherapy and placebo in OAB patients. Neurourol Urodyn 2017; 37:394-406. [PMID: 28704584 DOI: 10.1002/nau.23315] [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] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/25/2017] [Indexed: 11/12/2022]
Abstract
AIMS To evaluate patient-reported outcomes (PROs) of combinations of solifenacin and mirabegron compared with solifenacin and mirabegron monotherapy and with placebo in patients with overactive bladder (OAB) from the SYNERGY trial. METHODS Following a 4-week placebo run-in, period patients (≥18 years) with OAB were randomized 2:2:1:1:1:1 to receive solifenacin 5 mg + mirabegron 25 mg (combination 5 + 25 mg), solifenacin 5 mg + mirabegron 50 mg, (combination 5 + 50 mg), solifenacin 5 mg, mirabegron 25 mg, mirabegron 50 mg or placebo for 12 weeks, followed by a 2-week washout period. At each visit, PROs related to quality of life, symptom bother, and treatment satisfaction were assessed, including OAB-q Symptom Bother score, health-related quality of life (HRQOL) Total score, treatment satisfaction-visual analogue scale (TS-VAS), and patient perception of bladder condition (PPBC) questionnaires. RESULTS Overall, 3527 patients were randomized into the study, with 3494 receiving double-blind treatment. At end of treatment (EoT), both combination groups showed greater improvements in OAB-q Symptom Bother score compared with the monotherapy groups (nominal P < 0.001). Statistically significant improvements in HRQOL Total scores were observed in the combination groups versus monotherapy groups (P ≤ 0.002). For both combination groups, the OAB-q Symptom Bother score responder rates at EoT were statistically significantly higher versus mirabegron monotherapy (P < 0.05). The mean adjusted changes from baseline to EoT for PPBC were greater in the combination groups compared with monotherapy groups. CONCLUSIONS PROs showed that combination therapy provided clear improvements and an additive effect for many HRQOL parameters, including OAB-q Symptom Bother score, HRQOL Total score, and PPBC.
Collapse
Affiliation(s)
| | | | - David Staskin
- Tufts University School of Medicine, Boston, Massachusetts
| | | | | | | | - Arwin Ridder
- Astellas Pharma Global Development, Leiden, Netherlands
| | | | - Asha Paireddy
- Astellas Pharma Global Development, Leiden, Netherlands
| | | | | | | |
Collapse
|
9
|
Herschorn S, Chapple CR, Abrams P, Arlandis S, Mitcheson D, Lee KS, Ridder A, Stoelzel M, Paireddy A, van Maanen R, Robinson D. Efficacy and safety of combinations of mirabegron and solifenacin compared with monotherapy and placebo in patients with overactive bladder (SYNERGY study). BJU Int 2017; 120:562-575. [DOI: 10.1111/bju.13882] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sender Herschorn
- Department of Surgery/Urology; University of Toronto; Sunnybrook Health Sciences Centre; Toronto ON Canada
| | | | - Paul Abrams
- Bristol Urological Institute; Southmead Hospital; Bristol UK
| | | | | | - Kyu-Sung Lee
- Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Arwin Ridder
- Astellas Pharma Global Development; Leiden The Netherlands
| | | | - Asha Paireddy
- Astellas Pharma Global Development; Leiden The Netherlands
| | - Rob van Maanen
- Astellas Pharma Global Development; Leiden The Netherlands
| | | |
Collapse
|
10
|
Abrams P, Paty J, Martina R, Newgreen DT, van Maanen R, Paireddy A, Kuipers-deGroot T, Ridder A. Electronic bladder diaries of differing duration versus a paper diary for data collection in overactive bladder. Neurourol Urodyn 2015; 35:743-9. [PMID: 26174907 DOI: 10.1002/nau.22800] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 01/12/2015] [Accepted: 04/24/2015] [Indexed: 11/06/2022]
Abstract
AIMS This observational study compared data values, reliability, consistency and compliance collected by electronic and paper diaries of differing durations. METHODS Subjects ≥18 years with overactive bladder (OAB) on stable antimuscarinic treatment for ≥12 weeks were assigned to one of five, 15-week diary schedules in this randomized, parallel-group observational study. Sample size was sufficient to assess reliability and consistency of diary data with adequate precision. Reliability was assessed via intraclass correlation coefficients, variability with ANCOVAs, and consistency using Cronbach's alpha. RESULTS Demographic characteristics of randomized subjects were representative of OAB trial populations. For mean volume voided, reliability was comparable across diary groups. For incontinence, reliability improved with increasing diary duration. For micturition frequency, electronic 7-day diary results had highest reliability and lowest variability. Lowest overall reliability was observed in the 3-day paper diary. Consistency was highest in the electronic continuous groups; Cont A (daily measurements throughout the study period [fully Continuous]) and Cont B (daily measurements for some but not all endpoints of interest [Partially Continuous]). Compliance was generally high; across groups ≥90% of diaries had at least one entry per day. There was no significant change in average micturition frequency with diary duration, suggesting no diary fatigue. One-third of subjects in the electronic Cont B group also reported micturitions as incontinence when they only needed to report incontinence; they also reported lowest satisfaction with the study. The electronic 7-day and electronic Cont A schedules (who reported incontinence and micturitions throughout the study) had lowest residual errors. CONCLUSIONS For future OAB trials, 7-day or continuous electronic diaries may improve accuracy and reliability of micturition and incontinence frequency data compared with shorter collection periods and paper diaries. Neurourol. Urodynam. 35:743-749, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Paul Abrams
- Southmead Hospital, Bristol Urological Institute, Southmead Road, Bristol, United Kingdom
| | - Jean Paty
- Quintiles, Skyline Drive, Hawthorne, New York
| | - Reynaldo Martina
- University of Leicester, University Road, Leicester, United Kingdom, (formerly of Astellas Pharma Europe BV, Netherlands)
| | | | | | | | | | | |
Collapse
|
11
|
Abrams P, Kelleher C, Staskin D, Kay R, Martina RV, Newgreen D, Paireddy A, van Maanen R, Ridder A. 1958 COMBINATION TREATMENT WITH MIRABEGRON AND SOLIFENACIN IN PATIENTS WITH OVERACTIVE BLADDER (OAB) - EFFICACY RESULTS FROM A PHASE 2 STUDY (SYMPHONY). J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
12
|
Maanen RV, Bentley D. Bioequivalence of zonisamide orally dispersible tablet and immediate-release capsule formulations: results from two open-label, randomized-sequence, single-dose, two-period, two-treatment crossover studies in healthy male volunteers. Clin Ther 2009; 31:1244-55. [PMID: 19695391 DOI: 10.1016/j.clinthera.2009.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND To make it easier for patients who are prescribed zonisamide to administer their medicine, a rapidly disintegrating oral tablet formulation has been developed. OBJECTIVE These 2 trials assessed the bioequiva-lence of a new orally dispersible tablet formulation of zonisamide (test) versus an immediate-release reference capsule. METHODS Study 1 assessed the bioequivalence of a 100-mg orally dispersible tablet versus a 100-mg reference capsule. Study 2 assessed the bioequivalence of a 300-mg test tablet versus three 100-mg reference capsules. Both trials were open-label, randomized-sequence, single-dose, 2-period, 2-treatment crossover studies in consenting healthy male volunteers aged 18 to 55 years. A 4-week washout separated treatment periods. The zonisamide test tablet was placed on the tongue and, after it had dispersed in saliva, swallowed without water. Zonisamide serum concentrations were analyzed using a validated high-performance liquid chromatography assay with tandem mass spectrome-try detection (lower limit of quantification, 10 ng/nL). Bioequivalence was concluded if the 90% CI of the ratio of AUC(0-72) and C(max) were within the regulatory criteria of 0.80 to 1.25. The safety profile was assessed through adverse events (AEs) and analysis of laboratory and echocardiogram parameters. RESULTS In study one, 36 male subjects were enrolled and randomized (mean [SD] age, 26.1 [6.9] years; weight, 77.6 [11.0] kg; race: white, 35 [97.2%], and Asian, 1 [2.8%]). Of those, 7 were withdrawn prior to completion (5 were lost to follow-up, 1 failed the drug screening, 1 withdrew due to AEs, and 1 was excluded due to undisclosed medical history). In study two, 40 male subjects were enrolled and randomized (mean [SD] age, 31.2 [10.3] years; weight, 76.1 [9.0] kg; race: white, 38 [95.0%], black, 1 [2.5%], and other, 1 [2.5%]). Of those, 2 were withdrawn prior to completion (1 failed the urine drug screening and 1 withdrew consent). The ratios (90% CIs) of AUC(0-72) for the 100-mg and 300-mg test formulations were 1.00 (0.98-1.02) and 1.00 (0.98-1.01), respectively. The ratios (90% CIs) of C(max) were 0.97 (0.94-1.00) and 0.98 (0.95-1.00). A total of 25 subjects experienced treatment-emergent AEs in study 1; of these, 8 events in 3 patients were considered to be possibly or probably related to study drug administration. A total of 21 subjects experienced treatment-emergent AEs in study 2; of these, 11 events in 6 subjects were considered to be possibly or probably related to study drug administration. All AEs and laboratory and ECG findings were similar between formulations. CONCLUSIONS The test formulation of zonisamide met regulatory criteria for bioequivalence to the reference formulation in these healthy male volunteers. Both formulations were generally well tolerated at both dose levels.
Collapse
Affiliation(s)
- Rob van Maanen
- Eisai Limited, Hatfield, United Kingdom. Rob_vanmaanenweisai.net
| | | |
Collapse
|