1
|
Videnovic A, Amara AW, Comella C, Schweitzer PK, Emsellem H, Liu K, Sterkel AL, Gottwald MD, Steinerman JR, Jochelson P, Zomorodi K, Hauser RA. Solriamfetol for Excessive Daytime Sleepiness in Parkinson's Disease: Phase 2 Proof-of-Concept Trial. Mov Disord 2021; 36:2408-2412. [PMID: 34191352 PMCID: PMC8596433 DOI: 10.1002/mds.28702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Solriamfetol is approved (US and EU) for excessive daytime sleepiness (EDS) in narcolepsy and obstructive sleep apnea. Objectives Evaluate solriamfetol safety/efficacy for EDS in Parkinson's disease (PD). Methods Phase 2, double‐blind, 4‐week, crossover trial: adults with PD and EDS were randomized to sequence A (placebo, solriamfetol 75, 150, 300 mg/d), B (solriamfetol 75, 150, 300 mg/d, placebo), or C (placebo). Outcomes (safety/tolerability [primary]; Epworth Sleepiness Scale [ESS]; Maintenance of Wakefulness Test [MWT]) were assessed weekly. P values are nominal. Results Common adverse events (n = 66): nausea (10.7%), dizziness (7.1%), dry mouth (7.1%), headache (7.1%), anxiety (5.4%), constipation (5.4%), dyspepsia (5.4%). ESS decreased both placebo (−4.78) and solriamfetol (−4.82 to −5.72; P > 0.05). MWT improved dose‐dependently with solriamfetol, increasing by 5.05 minutes with 300 mg relative to placebo (P = 0.0098). Conclusions Safety/tolerability was consistent with solriamfetol's known profile. There were no significant improvements on ESS; MWT results suggest possible benefit with solriamfetol in PD. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
Collapse
Affiliation(s)
- Aleksandar Videnovic
- Movement Disorders Unit and Division of Sleep Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy W Amara
- Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cynthia Comella
- Parkinson's Disease and Movement Disorders Program, Rush University, Chicago, Illinois, USA
| | - Paula K Schweitzer
- Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, Missouri, USA
| | - Helene Emsellem
- The Center for Sleep & Wake Disorders, Chevy Chase, Maryland, USA
| | - Kris Liu
- Jazz Pharmaceuticals, Palo Alto, California, USA
| | | | | | | | | | | | - Robert A Hauser
- Parkinson's Disease and Movement Disorders Center, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
2
|
Schweitzer PK, Hauser RA, Amara AW, Videnovic A, Comella C, Liu K, Sterkel AL, Gottwald MD, Steinerman JR, Jochelson P, Emsellem H. 0617 Solriamfetol Treatment of Excessive Daytime Sleepiness in Parkinson’s Disease: Results from a Phase 2 Proof-of-Concept Trial. Sleep 2019. [DOI: 10.1093/sleep/zsz067.615] [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: 11/15/2022] Open
Affiliation(s)
- Paula K Schweitzer
- Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, MO, USA
| | - Robert A Hauser
- Parkinson's Disease and Movement Disorders Center, University of South Florida, Tampa, FL, USA
| | - Amy W Amara
- Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aleksandar Videnovic
- Movement Disorders Unit and Division of Sleep Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Cynthia Comella
- Parkinson's Disease and Movement Disorders Program, Rush University, Chicago, IL, USA
| | - Kris Liu
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | | | | | | | | | | |
Collapse
|
3
|
Pettus J, McNabb B, Eckel RH, Skyler JS, Dhalla A, Guan S, Jochelson P, Belardinelli L, Henry RH. Effect of ranolazine on glycaemic control in patients with type 2 diabetes treated with either glimepiride or metformin. Diabetes Obes Metab 2016; 18:463-74. [PMID: 26749407 DOI: 10.1111/dom.12629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/02/2015] [Revised: 12/27/2015] [Accepted: 12/29/2015] [Indexed: 12/19/2022]
Abstract
AIM To report the results of two phase III trials assessing the efficacy of ranolazine for glycaemic control in patients with type 2 diabetes on metformin or glimepiride background therapy. METHODS In two double-blind trials we randomized 431 and 442 patients with type 2 diabetes to ranolazine 1000 mg twice daily versus placebo added to either glimepiride (glimepiride add-on study) or metformin background therapy (metformin add-on study). Patients receiving ranolazine added to metformin had their metformin dose halved (with the addition of a metformin-matched placebo) relative to the placebo group to correct for a metformin-ranolazine pharmacokinetic interaction. The primary endpoint of the trials was the change from baseline in glycated haemoglobin (HbA1c) at week 24. RESULTS When added to glimepiride, ranolazine caused a 0.51% least squares mean [95% confidence interval (CI) 0.71, 0.32] decrease from baseline in HbA1c at 24 weeks relative to placebo and roughly doubled the proportion of patients achieving an HbA1c of <7% (27.1 vs 14.1%; p = 0.001). When added to metformin background therapy, there was no significant difference in the 24-week HbA1c change from baseline [placebo-corrected LS mean difference -0.11% (95% CI -0.31, 0.1)]. CONCLUSIONS Compared with placebo, addition of ranolazine in patients with type 2 diabetes treated with glimepiride, but not metformin, significantly reduced HbA1c over 24 weeks. The decreased dose of metformin used in the metformin add-on study complicates the interpretation of this trial. Whether an effective regimen of ranolazine added to metformin for glycaemic control can be identified remains unclear.
Collapse
Affiliation(s)
- J Pettus
- Department of Medicine, Division of Endocrinology, University of California San Diego, San Diego, CA, USA
| | - B McNabb
- Gilead Pharmaceuticals, Foster City, CA, USA
| | - R H Eckel
- Department of Medicine, Division of Endocrinology, University of California San Diego, San Diego, CA, USA
| | - J S Skyler
- Department of Medicine, Division of Endocrinology, University of California San Diego, San Diego, CA, USA
| | - A Dhalla
- Gilead Pharmaceuticals, Foster City, CA, USA
| | - S Guan
- Gilead Pharmaceuticals, Foster City, CA, USA
| | - P Jochelson
- Gilead Pharmaceuticals, Foster City, CA, USA
| | | | - R H Henry
- Department of Medicine, Division of Endocrinology, University of California San Diego, San Diego, CA, USA
| |
Collapse
|
4
|
Eckel RH, Henry RR, Yue P, Dhalla A, Wong P, Jochelson P, Belardinelli L, Skyler JS. Effect of Ranolazine Monotherapy on Glycemic Control in Subjects With Type 2 Diabetes. Diabetes Care 2015; 38:1189-96. [PMID: 26049552 PMCID: PMC4477340 DOI: 10.2337/dc14-2629] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/07/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Ranolazine is an antianginal drug that mediates its effects by inhibition of cardiac late sodium current. Although ranolazine is not approved for the treatment of type 2 diabetes, in post hoc analyses of pivotal angina trials, ranolazine was associated with reductions in percent glycosylated hemoglobin (HbA1c) in subjects with type 2 diabetes. The study prospectively assessed the safety and efficacy of ranolazine in subjects with type 2 diabetes with inadequate glycemic control managed by lifestyle alone. RESEARCH DESIGN AND METHODS The study was conducted worldwide in 465 subjects, with baseline HbA1c of 7-10% (53-86 mmol/mol) and fasting serum glucose of 130-240 mg/dL, randomized to placebo versus ranolazine. RESULTS Compared with placebo, there was a greater decline in HbA1c at week 24 from baseline (primary end point) in subjects taking ranolazine (mean difference -0.56% [-6.1 mmol/mol]; P < 0.0001). Moreover, the proportion of subjects achieving an HbA1c <7.0% was greater with ranolazine (25.6% vs. 41.2%; P = 0.0004). Ranolazine was associated with reductions in fasting (mean difference -8 mg/dL; P = 0.0266) and 2-h postprandial glucose (mean difference -19 mg/dL; P = 0.0008 vs. placebo). Subjects taking ranolazine trended toward a greater decrease from baseline in fasting insulin (P = 0.0507), a greater decrease in fasting glucagon (P = 0.0003), and a lower postprandial 3-h glucagon area under the curve (P = 0.0031 vs. placebo). Ranolazine was safe and well tolerated. CONCLUSIONS Compared with placebo, use of ranolazine monotherapy over 24 weeks, in subjects with type 2 diabetes and inadequate glycemic control on diet and exercise alone, significantly reduced HbA1c and other measures of glycemic control.
Collapse
Affiliation(s)
- Robert H Eckel
- Divisions of Endocrinology, Metabolism and Diabetes and Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Robert R Henry
- Center for Metabolic Research, VA San Diego Healthcare System, San Diego, CA Division of Endocrinology and Metabolism, University of California, San Diego, La Jolla, CA
| | - Patrick Yue
- Cardiovascular Clinical Research, Gilead Sciences, Foster City, CA
| | - Arvinder Dhalla
- Department of Biology, Cardiovascular Therapeutic Area, Gilead Sciences, Fremont, CA
| | - Pamela Wong
- Cardiovascular Therapeutic Area, Biostatistics, Gilead Sciences, Foster City, CA
| | - Philip Jochelson
- Cardiovascular Clinical Research, Gilead Sciences, Foster City, CA
| | - Luiz Belardinelli
- Cardiovascular Clinical Research, Gilead Sciences, Foster City, CA Department of Biology, Cardiovascular Therapeutic Area, Gilead Sciences, Fremont, CA
| | - Jay S Skyler
- Divisions of Endocrinology, Diabetes, and Metabolism, Pediatrics, and Psychology, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
5
|
Krystal AD, Lankford A, Durrence HH, Ludington E, Jochelson P, Rogowski R, Roth T. Efficacy and safety of doxepin 3 and 6 mg in a 35-day sleep laboratory trial in adults with chronic primary insomnia. Sleep 2011; 34:1433-42. [PMID: 21966075 PMCID: PMC3174845 DOI: 10.5665/sleep.1294] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [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: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the efficacy and safety of doxepin (DXP) 3 mg and 6 mg in adults diagnosed with primary insomnia. DESIGN AND METHODS The study was a randomized, double-blind, parallel-group, placebo-controlled trial. Patients meeting DSM-IV-TR criteria for primary insomnia were randomized to 35 days of nightly treatment with DXP 3 mg (n=75), DXP 6 mg (n=73), or placebo (PBO; n=73), followed by 2 nights of single-blind PBO to evaluate discontinuation (DC) effects. Efficacy was assessed using polysomnography (PSG) and patient reports. Efficacy data were examined for Night (N) 1, N15, and N29. Safety assessments were conducted throughout the study. RESULTS Compared with PBO, DXP 3 and 6 mg significantly improved wake time after sleep onset (WASO) on N1 (3 mg and 6 mg; P<0.0001), N15 (3 mg P=0.0025; 6 mg P=0.0009), and N29 (3 mg P=0.0248; 6 mg P=0.0009), latency to persistent sleep (LPS) on N1 (3 mg P=0.0047; 6 mg P=0.0007), and total sleep time (TST) on N1 (3 mg and 6 mg P<0.0001), N15 (6 mg P=0.0035), and N29 (3 mg P=0.0261; 6 mg P<0.0001). In terms of early morning awakenings, DXP 3 and 6 mg demonstrated significant improvements in SE in the final quarter of the night on N1, N15, and N29, with the exception of 3 mg on N29 (P=0.0691). Rates of discontinuation were low, and the safety profiles were comparable across the 3 treatment groups. There were no significant next-day residual effects, and there were no spontaneous reports of memory impairment, complex sleep behaviors, anticholinergic effects, weight gain, or increased appetite. Additionally, there was no evidence of rebound insomnia after DXP discontinuation. CONCLUSIONS Five weeks of nightly administration of DXP 3 mg and 6 mg to adults with chronic primary insomnia resulted in significant and sustained improvements in sleep maintenance and early morning awakenings (with the exception of SE in the final quarter of the night on N29 for 3 mg [P=0.0691]). These sleep improvements were not accompanied by next-day residual effects or followed by rebound insomnia or withdrawal effects upon discontinuation. These findings confirm the unique profile of sleep maintenance efficacy and safety of DXP observed in prior studies.
Collapse
|
6
|
Mansbach RS, Ludington E, Rogowski R, Kittrelle JP, Jochelson P. A Placebo- and Active-Controlled Assessment of 6- and 50-mg Oral Doxepin on Cardiac Repolarization in Healthy Volunteers: A Thorough QT Evaluation. Clin Ther 2011; 33:851-62. [DOI: 10.1016/j.clinthera.2011.05.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2011] [Indexed: 10/18/2022]
|
7
|
Krystal AD, Durrence HH, Scharf M, Jochelson P, Rogowski R, Ludington E, Roth T. Efficacy and Safety of Doxepin 1 mg and 3 mg in a 12-week Sleep Laboratory and Outpatient Trial of Elderly Subjects with Chronic Primary Insomnia. Sleep 2010; 33:1553-61. [PMID: 21102997 PMCID: PMC2954705 DOI: 10.1093/sleep/33.11.1553] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [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: 11/13/2022] Open
Abstract
STUDY OBJECTIVES to evaluate the efficacy and safety of doxepin 1 mg and 3 mg in elderly subjects with chronic primary insomnia. DESIGN AND METHODS the study was a randomized, double-blind, parallel-group, placebo-controlled trial. Subjects meeting DSM-IV-TR criteria for primary insomnia were randomized to 12 weeks of nightly treatment with doxepin (DXP) 1 mg (n = 77) or 3 mg (n = 82), or placebo (PBO; n = 81). Efficacy was assessed using polysomnography (PSG), patient reports, and clinician ratings. Objective efficacy data are reported for Nights (N) 1, 29, and 85; subjective efficacy data during Weeks 1, 4, and 12; and Clinical Global Impression (CGI) scale and Patient Global Impression (PGI) scale data after Weeks 2, 4, and 12 of treatment. Safety assessments were conducted throughout the study. RESULTS DXP 3 mg led to significant improvement versus PBO on N1 in wake time after sleep onset (WASO; P < 0.0001; primary endpoint), total sleep time (TST; P < 0.0001), overall sleep efficiency (SE; P < 0.0001), SE in the last quarter of the night (P < 0.0001), and SE in Hour 8 (P < 0.0001). These improvements were sustained at N85 for all variables, with significance maintained for WASO, TST, overall SE, and SE in the last quarter of the night. DXP 3 mg significantly improved patient-reported latency to sleep onset (Weeks 1, 4, and 12), subjective TST (Weeks 1, 4, and 12), and sleep quality (Weeks 1, 4, and 12). Several global outcome-related variables were significantly improved, including the severity and improvement items of the CGI (Weeks 2, 4, and 12), and all 5 items of the PGI (Week 12; 4 items after Weeks 2 and 4). Significant improvements were observed for DXP 1 mg for several measures including WASO, TST, overall SE, and SE in the last quarter of the night at several time points. Rates of discontinuation were low, and the safety profiles were comparable across the 3 treatment groups. There were no significant next-day residual effects; additionally, there were no reports of memory impairment, complex sleep behaviors, anticholinergic effects, weight gain, or increased appetite. CONCLUSIONS DXP 1 mg and 3 mg administered nightly to elderly chronic insomnia patients for 12 weeks resulted in significant and sustained improvements in most endpoints. These improvements were not accompanied by evidence of next-day residual sedation or other significant adverse effects. DXP also demonstrated improvements in both patient- and physician-based ratings of global insomnia outcome. The efficacy of DXP at the doses used in this study is noteworthy with respect to sleep maintenance and early morning awakenings given that these are the primary sleep complaints of the elderly. This study, the longest placebo-controlled, double-blind, polysomnographic trial of nightly pharmacotherapy for insomnia in the elderly, provides the best evidence to date of the sustained efficacy and safety of an insomnia medication in older adults.
Collapse
|
8
|
Roth T, Heith Durrence H, Jochelson P, Peterson G, Ludington E, Rogowski R, Scharf M, Lankford A. Efficacy and safety of doxepin 6 mg in a model of transient insomnia. Sleep Med 2010; 11:843-7. [DOI: 10.1016/j.sleep.2010.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 07/28/2010] [Accepted: 07/30/2010] [Indexed: 11/25/2022]
|
9
|
Keipert PE, Faithfull NS, Roth DJ, Bradley JD, Batra S, Jochelson P, Flaim KE. Supporting tissue oxygenation during acute surgical bleeding using a perfluorochemical-based oxygen carrier. Adv Exp Med Biol 1996; 388:603-9. [PMID: 8798865 DOI: 10.1007/978-1-4613-0333-6_77] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- P E Keipert
- Alliance Pharmaceutical Corporation, San Diego, CA 92121, USA
| | | | | | | | | | | | | |
Collapse
|