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Machida K, Kawayama T, Kinoshita M, Ichinose M, Tsuda T, Takata S, Koto H, Yoshida M, Ashihara Y, Kawashima M, Suna H, Inoue H. Imidafenacin, An Orally Active Muscarinic Receptor Antagonist, Improves Pulmonary Function In Patients With Chronic Obstructive Pulmonary Disease: A Multicenter, Randomized, Double-Blind, Placebo-Controlled 3×3 Crossover Phase II Trial. Int J Chron Obstruct Pulmon Dis 2019; 14:2175-2184. [PMID: 31571853 PMCID: PMC6757323 DOI: 10.2147/copd.s223002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/12/2019] [Accepted: 09/05/2019] [Indexed: 02/01/2023] Open
Abstract
Background Although long-acting muscarinic receptor antagonists are central to the management of chronic obstructive pulmonary disease (COPD), inhaled medicines may have technical difficulty in some patients and adherence barriers. Methods A multicenter, randomized, double-blind, placebo-controlled 3×3 crossover Phase II trial was performed to evaluate the efficacy and safety of oral administration of the antimuscarinic agent imidafenacin in patients with COPD. Twenty-seven male COPD patients with % forced expiratory volume in 1 s (FEV1) ≥30% and <80% predicted were randomized to single oral dose of imidafenacin 0.1 mg, imidafenacin 0.2 mg, or placebo. Results Maximum change in FEV1 with both doses of imidafenacin significantly improved from baseline to 24 hrs after administration when compared with a placebo. Area under the curve in FEV1 during 24 hrs after administration with 0.2 mg, but not 0.1 mg dose, was significantly improved when compared with a placebo, and the improvement was significantly based on dose-dependent manners. Plasma imidafenacin level was positively correlated with change in FEV1. All subjects with both doses of imidafenacin completed without moderate nor severe adverse events. Conclusion A single oral dose of imidafenacin 0.1 mg or imidafenacin 0.2 mg may contribute to the improvement of pulmonary function with excellent safety and tolerability in patients with COPD. Trial registration JapicCTI-121760 (Japan Pharmaceutical Information Center – Clinical Trials Information [JapicCTI]; http://www.clinicaltrials.jp/user/cteSearch_e.jsp).
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Affiliation(s)
- Kentaro Machida
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | | | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University, Graduate School of Medicine, Sendai 980-8574, Japan
| | - Tohru Tsuda
- Kirigaoka Tsuda Hospital, Kitakyushu 802-0052 Japan
| | - Shohei Takata
- Division of Respiratory Medicine, National Hospital Organization Fukuoka-Higashi Medical Center, Koga 811-3195, Japan
| | - Hiroshi Koto
- Division of Respiratory Medicine, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka 815-8588, Japan
| | - Makoto Yoshida
- Division of Respiratory Medicine, National Hospital Organization Fukuoka Hospital, Fukuoka 811-1394, Japan
| | - Yoshinori Ashihara
- Division of Respiratory Medicine, Oita Nakamura Hospital, Oita 870-0022, Japan
| | | | - Hideaki Suna
- ONO Pharmaceutical Co. Ltd., Osaka 541-8564, Japan
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
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Pushkar DY, Kasyan GR, Kolontarev KB, Sharvadze GG, Mukhametshina EI. Randomized, open-label, tolterodine-controlled, comparative study of the novel antimuscarinic agent imidafenacin in patients with overactive bladder. Neurourol Urodyn 2019; 38:1313-1321. [PMID: 30888691 DOI: 10.1002/nau.23980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/19/2019] [Accepted: 03/04/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND The role of the selective antimuscarinic imidafenacin in Caucasian patients with overactive bladder (OAB) has not been previously assessed. OBJECTIVE To evaluate the safety and efficacy of imidafenacin 0.2 mg vs tolterodine 4 mg per day in patients with OAB. DESIGN SETTING AND PARTICIPANTS This study was a randomized, open-label, tolterodine-controlled, comparative multicenter trial of 300 randomized patients with OAB symptoms for 12 weeks with full analysis of 289 patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Based on 5-day bladder diaries, the primary efficacy endpoint was the change in the mean number of micturitions per day. The secondary endpoints were the change in the mean incontinence episodes, voiding frequency, the OAB Awareness Tool score, and the European Quality of Life Questionnaire (EQ-5D) score. The superiority of tolterodine over imidafenacin in the mean number of micturitions/24 hours was the null hypothesis. RESULTS AND LIMITATION The median age was 46.6 years, and 82% of patients were female. After treatment, the change in the mean number of incontinence episodes was -2.1 ± 2.2 in the imidafenacin group and -1.9 ± 1.8 in the tolterodine group (P = .001). The change in the mean number of daytime incontinence episodes was -1.7 ± 1.7 and -1.5 ± 1.4 ( P = .01). The OAB Awareness Tool score decreased by 14.2 ± 8.5 and 14.5 ± 8.0, respectively ( P = 0.5). Most adverse events were mild and resolved without treatment. CONCLUSIONS The clinical efficacy and safety of imidafenacin are not inferior to those of tolterodine for the treatment of Caucasian patients with OAB. PATIENT SUMMARY Imidafenacin is as effective as tolterodine for the treatment of OAB.
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Affiliation(s)
- Dmitry Y Pushkar
- Department of Urology, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - George R Kasyan
- Department of Urology, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Georgy G Sharvadze
- Department of Urology, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Elvira I Mukhametshina
- Department of Urology, Moscow State University of Medicine and Dentistry, Moscow, Russia
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Al-Shukri SH, Pushkar DY, Apolikhin OI, Evdokimov MS, Kogan MI, Krivoborodov GG, Kagan OF, Petrov SB, Poltoratskyi AN, Kuzmin IV, Sharvadze GG. [ Imidafenacin for treatment of overactive bladder and urgent urinary incontinence: the results of open-label multicenter randomized controlled clinical trial]. Urologiia 2018:20-25. [PMID: 30742373] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The analysis of the results of a multicenter, open, randomized comparative phase III clinical trial on the use of imidafenacin for treating patients with OAB was carried out. A clinical study was conducted according to GCP standards in 12 urological centers of the Russian Federation with the support of company AO "R-Pharm". MATERIALS AND METHODS A total of 296 patients (men and women) aged from 18 to 65 years with OAB and urgent urinary incontinence were included in the study. All patients were randomized into two groups. In Group 1 (n=148) patients received -cholinoblocker imidafenacin 1 tablet (0,1 mg) twice a day. Group 2 patients (n=148) were prescribed a comparison drug tolterodine 1 tablet (2 mg) twice a day, as well. The duration of treatment was 12 weeks. RESULTS The analysis of results showed a significant decrease in the OAB symptoms in both groups. In Group 1 a decrease of episodes of urge urinary incontinence was more pronounce compared to Group 2, as well as amount of day-time and night-time of episodes of urge urinary incontinence by the 2nd, 4th, 8th and 12th weeks of treatment in comparison with baseline scores. There were no differences between two groups in the severity of reducing average urinary frequency per day. Reducing the severity of urinary disturbances in patients of both groups was accompanied by an improvement in the quality of life. There was a significant and similar decrease in the average total score of both OAB Awareness Tool and EQ-5D questionnaires. Tolerability of treatment was satisfactory in both groups and there were no differences in the adverse events in Group 1 and 2. CONCLUSION Imidafenacin showed high clinical efficacy for treating patients with OAB, which is not inferior, and in some values, is superior in comparison to tolterodine. Both drugs had a similar safety and tolerability profile.
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Affiliation(s)
- S H Al-Shukri
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - D Yu Pushkar
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - O I Apolikhin
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - M S Evdokimov
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - M I Kogan
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - G G Krivoborodov
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - O F Kagan
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - S B Petrov
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - A N Poltoratskyi
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - I V Kuzmin
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
| | - G G Sharvadze
- FGBOU VO Pavlov First Saint Petersburg State Medical University of Minzdrav of Russia, Saint Petersburg, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- FGBU The National Medical Research Radiologic Center of Minzdrav of Russia, Moscow, Russia
- Family Policlinic 4 LLC, Moscow, Russia
- FGBOU VO Rostov State Medical University of Minzdrav of Russia, Rostov-on-Don, Russia
- N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- Hospital Orkli LTD, Saint Petersburg, Russia
- FGBU All-Russian Centre of Emergency and Radiation Medicine named after A.M. Nikiforov of the Emergency of Russia
- Baltic Medicine LTD , Saint Petersburg, Russia
- AO R-Farm, Moscow, Russia
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Abstract
Imidafenacin is an antimuscarinic agent with high affinity for the M(3) and M(1) muscarinic receptor subtypes and low affinity for the M(2) subtype, and is used to treat overactive bladder. Several animal studies have demonstrated that imidafenacin has organ selectivity for the bladder over the salivary glands, colon, heart, and brain. In Phase I studies in humans, the approximately 2.9-hour elimination half-life of imidafenacin was shorter than that of other antimuscarinics such as tolterodine and solifenacin. Imidafenacin was approved for clinical use in overactive bladder in Japan in 2007 after a randomized, double-blind, placebo-controlled Phase II study and a propiverine-controlled Phase III study conducted in Japanese patients demonstrated that imidafenacin 0.1 mg twice daily was clinically effective for treating overactive bladder and was not inferior to propiverine for reduction of episodes of incontinence, with a better safety profile than propiverine. Several short-term clinical studies have demonstrated that imidafenacin also improves sleep disorders, nocturia, and nocturia-related quality of life. In addition, it is speculated that addon therapy with imidafenacin is beneficial for men with benign prostatic hyperplasia whose overactive bladder symptoms are not controlled by alpha-1 adrenoceptor antagonists. No cognitive impairment or influence of imidafenacin on the QTc interval has been observed. Although there have been very few relevant long-term clinical studies, the available information suggests the long-term efficacy, safety, and tolerability of imidafenacin, with less frequent severe adverse events, such as dry mouth and constipation. In addition, imidafenacin can be used safely for a long time even for cognitively vulnerable elderly patients with symptoms of overactive bladder. Thus, it is highly likely that imidafenacin is safe, efficacious, and tolerable to control symptoms of overactive bladder even over the long term. However, it remains unknown if the practical effectiveness of imidafenacin is applicable to ethnic groups other than Japanese.
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Affiliation(s)
- Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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