Bioequivalence evaluation of rilmenidine in healthy volunteers

The bioavailability of two rilmenidine tablet formulations was compared in healthy male (17) and female (8) subjects, aged 18 to 36 years, during a laboratory-blind, randomized, two-treatment, two-period, cross-over study under fasting conditions. In each treatment phase subjects received a single dose of 1.544 mg rilmenidine dihydrogen phosphate (CAS 85409-38-7), equivalent to 1 mg rilmenidine (CAS 54187-04-1). Consecutive dosing was separated by a drug-free wash-out period of 7 d. Following each dosing, serial venous blood samples were collected over a period of 48 h for the determination of plasma rilmenidine concentrations by means of a validated LCMS/MS method. The most frequently reported drug-related adverse events were dizziness and headache ranging from mild to moderate in intensity. The geometric mean C(max) of rilmenidine for the reference and test products was 3.73 and 3.97 ng/ml, respectively. The corresponding geometric mean AUC(0-infinity)) was 34.0 and 35.1 ng x h/ml. T(max) for both products under investigation appeared at 1.33 h. The test product was shown to be bioequivalent to the reference product with respect to all pharmacokinetic variables investigated.

Improvement of glycaemic and lipid profiles with muraglitazar plus metformin in patients with type 2 diabetes: an active-control trial with glimepiride

The efficacy and safety of muraglitazar versus glimepiride were evaluated in patients with type 2 diabetes. After open-label metformin monotherapy, 1,805 patients received randomised therapy with muraglitazar 2.5 mg or 5 mg or with glimepiride 1 mg in a double-blind 52-week study. The primary end point was change in glycosylated haemoglobin (HbA1C); secondary end points were changes in fasting lipid levels and glycaemic indices. At week 52, the reduction in HbA1C with muraglitazar 5 mg plus metformin was superior (p<0.0001) and with muraglitazar 2.5 mg it was non-inferior in comparison with glimepiride. At week 12, muraglitazar significantly decreased triglyceride levels (p<0.0001) and increased levels of high-density lipoprotein cholesterol (HDL-C) (p<0.0001). Oedema, weight gain and heart failure were more evident with muraglitazar. Muraglitazar 5 mg plus metformin significantly improved HbA1C, triglyceride and HDL-C levels in patients with type 2 diabetes. Cardiovascular events were similar among groups (~2%), but there was an imbalance of total mortality in favour of glimepiride.

Patch-Test Reactions to Formaldehydes, Bioban, and Other Formaldehyde Releasers

BACKGROUND

Contact allergy to formaldehyde, Bioban, and other formaldehyde releasers and cross-reactivity between them have been reported in the literature; however, not many studies have data on this cross-reactivity.

OBJECTIVE

To study (1) the rates of allergy to formaldehyde and to Bioban and other formaldehyde releasers and (2) the rates of cross-reactivity between them.

METHODS

We present a retrospective chart analysis of patch-test results for all patients referred for allergic contact dermatitis testing at the Milton S. Hershey Medical Center from June 2004 to September 2005. Anyone allergic to formaldehyde, Bioban, or other formaldehyde releasers was included. Cross-reactivity between the agents was then analyzed.

RESULTS

The charts of 210 patients were analyzed. Of these patients, 24 (11%) were allergic to formaldehyde, Bioban, or other formaldehyde-releasing agents. Seventeen (8.1%) of the patients were allergic to formaldehyde, 15 (7.1%) were allergic to Bioban, and 20 (9.5%) were allergic to other formaldehyde-releasing agents. Eleven (65%) of the 17 formaldehyde-allergic patients were also allergic to Bioban. Of the 20 patients allergic to formaldehyde-releasing agents, 14 (70%) were also allergic to one of the three Bioban products tested. Of the 15 patients allergic to Bioban, 11 (73%) were allergic to formaldehyde, 14 (93%) were allergic to formaldehyde-releasing agents, and 11 (73%) were allergic to both formaldehyde and formaldehyde-releasing agents.

CONCLUSION

A high cross-reactivity rate between formaldehyde, Bioban, and other formaldehyde-releasing agents was found.

Endocrine disruptor vinclozolin induced epigenetic transgenerational adult-onset disease

The fetal basis of adult disease is poorly understood on a molecular level and cannot be solely attributed to genetic mutations or a single etiology. Embryonic exposure to environmental compounds has been shown to promote various disease states or lesions in the first generation (F1). The current study used the endocrine disruptor vinclozolin (antiandrogenic compound) in a transient embryonic exposure at the time of gonadal sex determination in rats. Adult animals from the F1 generation and all subsequent generations examined (F1-F4) developed a number of disease states or tissue abnormalities including prostate disease, kidney disease, immune system abnormalities, testis abnormalities, and tumor development (e.g. breast). In addition, a number of blood abnormalities developed including hypercholesterolemia. The incidence or prevalence of these transgenerational disease states was high and consistent across all generations (F1-F4) and, based on data from a previous study, appears to be due in part to epigenetic alterations in the male germ line. The observations demonstrate that an environmental compound, endocrine disruptor, can induce transgenerational disease states or abnormalities, and this suggests a potential epigenetic etiology and molecular basis of adult onset disease.

Transgenerational epigenetic imprinting of the male germline by endocrine disruptor exposure during gonadal sex determination

Embryonic exposure to the endocrine disruptor vinclozolin at the time of gonadal sex determination was previously found to promote transgenerational disease states. The actions of vinclozolin appear to be due to epigenetic alterations in the male germline that are transmitted to subsequent generations. Analysis of the transgenerational epigenetic effects on the male germline (i.e. sperm) identified 25 candidate DNA sequences with altered methylation patterns in the vinclozolin generation sperm. These sequences were identified and mapped to specific genes and noncoding DNA regions. Bisulfite sequencing was used to confirm the altered methylation pattern of 15 of the candidate DNA sequences. Alterations in the epigenetic pattern (i.e. methylation) of these genes/DNA sequences were found in the F2 and F3 generation germline. Therefore, the reprogramming of the male germline involves the induction of new imprinted-like genes/DNA sequences that acquire an apparent permanent DNA methylation pattern that is passed at least through the paternal allele. The expression pattern of several of the genes during embryonic development were found to be altered in the vinclozolin F1 and F2 generation testis. A number of the imprinted-like genes/DNA sequences identified are associated with epigenetic linked diseases. In summary, an endocrine disruptor exposure during embryonic gonadal sex determination was found to promote an alteration in the epigenetic (i.e. induction of imprinted-like genes/DNA sequences) programming of the male germline, and this is associated with the development of transgenerational disease states.

Occupational allergic contact dermatitis from N,N-methylene-bis-5-methyl-oxazolidine in coolant oils

Contact with metal working fluids (MWF) is an important factor in the development of occupational hand dermatitis in patients working in the metal processing industry. Biocides are added to MWF as preservatives and are known sensitizers. We analysed 318 patch test reactions to N,N-methylene-bis-5-methyl-oxazolidine 1% in petrolatum (5-methyloxazolidine, Grotan OX, CAS no. 66204-44-2, a formaldehyde releasing biocide) present in coolant oils in patients exposed to MWF and with suspected occupational dermatitis (OD). Positive allergic reactions were noted in 15 (4.7%) cases. In 7 (47%) cases, we were able to confirm relevance by examining the material safety data sheets and these showed that N,N-methylene-bis-5-methyl-oxazolidine was present in the oils used by the patients. No certain relevance could be proved in 8 cases, but in these instances, further information on the biocides used in the oils could not be obtained. Positive reactions to formaldehyde were seen in 11 (73%) patients. Sensitization either to this biocide and/or formaldehyde allergy was considered to have been likely to have made a contribution to the workers' dermatitis.

Muraglitazar: beneficial or detrimental in the treatment of Type 2 diabetes?

Hyperglycaemia in Type 2 diabetes has a major role in the development of microvascular complications, whereas the dyslipidaemia is the major cause of macrovascular complications. In patients with Type 2 diabetes, activation of PPAR-alpha and PPAR-gamma with the fibrates and glitazones improves dyslipidaemia and increases insulin sensitivity, respectively. Muraglitazar is an agonist at both of these receptors and has been shown to increase high-density lipoprotein cholesterol, decrease triglycerides and improve insulin sensitivity. However, there is also some evidence that muraglitazar has detrimental effects on the cardiovascular system. Before muraglitazar is widely used in the treatment of Type 2 diabetes, more safety testing needs to be undertaken.

Improvement of glycemic control, triglycerides, and HDL cholesterol levels with muraglitazar, a dual (alpha/gamma) peroxisome proliferator-activated receptor activator, in patients with type 2 diabetes inadequately controlled with metformin monotherapy: A double-blind, randomized, pioglitazone-comparative study

OBJECTIVE

We sought to evaluate the effects of muraglitazar, a dual (alpha/gamma) peroxisome proliferator-activated receptor (PPAR) activator within the new glitazar class, on hyperglycemia and lipid abnormalities.

RESEARCH DESIGN AND METHODS

A double-blind, randomized, controlled trial was performed in 1,159 patients with type 2 diabetes inadequately controlled with metformin. Patients received once-daily doses of either 5 mg muraglitazar or 30 mg pioglitazone for a total of 24 weeks in addition to open-label metformin. Patients were continued in a double-blind fashion for an additional 26 weeks.

RESULTS

Analyses were conducted at week 24 for HbA1c (A1C) and at week 12 for lipid parameters. Mean A1C at baseline was 8.12 and 8.13% in muraglitazar and pioglitazone groups, respectively. At week 24, muraglitazar reduced mean A1C to 6.98% (-1.14% from baseline), and pioglitazone reduced mean A1C to 7.28% (-0.85% from baseline; P < 0.0001, muraglitazar vs. pioglitazone). At week 12, muraglitazar and pioglitazone reduced mean plasma triglyceride (-28 vs. -14%), apolipoprotein B (-12 vs. -6%), and non-HDL cholesterol (-6 vs. -1%) and increased HDL cholesterol (19 vs. 14%), respectively (P < 0.0001 vs. pioglitazone for all comparisons). At week 24, weight gain (1.4 and 0.6 kg, respectively) and edema (9.2 and 7.2%, respectively) were observed in the muraglitazar and pioglitazone groups; at week 50, weight gain and edema were 2.5 and 1.5 kg, respectively, and 11.8 and 8.9%, respectively. At week 50, heart failure was reported in seven patients (five with muraglitazar and two with pioglitazone), and seven deaths occurred: three from sudden death, two from cerebrovascular accident, and one from pancreatic cancer in the muraglitazar group and one from perforated duodenal ulcer in the pioglitazone group.

CONCLUSIONS

We found that 5 mg muraglitazar resulted in greater improvements in A1C and lipid parameters than a submaximal dose of 30 mg pioglitazone when added to metformin. Weight gain and edema were more common when muraglitazar was compared with a submaximal dose of pioglitazone.

Effect of muraglitazar on death and major adverse cardiovascular events in patients with type 2 diabetes mellitus

CONTEXT

Peroxisome proliferator-activated receptors (PPARs) are nuclear transcription factors that modulate gene expression. Therapeutic agents targeting 2 distinct families of PPARs (alpha and gamma) have been introduced in the United States. The first dual-PPAR agonist, muraglitazar, was reviewed by a US Food and Drug Administration (FDA) advisory committee on September 9, 2005, resulting in a vote of 8:1 recommending approval for its use in controlling blood glucose levels in patients with type 2 diabetes.

OBJECTIVE

To evaluate the incidence of death, myocardial infarction (MI), stroke, congestive heart failure (CHF), and transient ischemic attack (TIA) in diabetic patients treated with muraglitazar compared with controls.

DESIGN, SETTING, AND PARTICIPANTS

The source material for this analysis consisted of documents about phase 2 and 3 clinical trials released under public disclosure laws for the FDA advisory committee meeting. All reviewed trials were prospective, randomized, double-blind, multicenter studies enrolling patients with type 2 diabetes and hemoglobin A(1c) levels between 7% and 10%. Patients (N = 3725) were randomized to receive differing doses of muraglitazar, pioglitazone, or placebo as monotherapy or in combination with metformin or glyburide in trials ranging from 24 to 104 weeks.

MAIN OUTCOME MEASURES

The primary outcome was the incidence of death, nonfatal MI, or nonfatal stroke. A more comprehensive composite outcome included these events plus the incidence of CHF and TIA.

RESULTS

In the muraglitazar-treated patients, death, MI, or stroke occurred in 35 of 2374 (1.47%) patients compared with 9 of 1351 (0.67%) patients in the combined placebo and pioglitazone treatment groups (controls) (relative risk [RR], 2.23; 95% confidence interval [CI], 1.07-4.66; P = .03). For the more comprehensive outcome measure that included TIA and CHF, the incidence was 50 of 2374 (2.11%) for muraglitazar compared with 11 of 1351 (0.81%) for controls (RR, 2.62; 95% CI, 1.36-5.05; P = .004). Relative risks for each of the individual components of the composite end point exceeded 2.1 but were not statistically significant. Incidence of adjudicated CHF was 13 of 2374 (0.55%) muraglitazar-treated patients and 1 of 1351 controls (0.07%) (RR, 7.43; 95% CI, 0.97-56.8; P = .053).

CONCLUSIONS

Compared with placebo or pioglitazone, muraglitazar was associated with an excess incidence of the composite end point of death, major adverse cardiovascular events (MI, stroke, TIA), and CHF. This agent should not be approved to treat diabetes based on laboratory end points until safety is documented in a dedicated cardiovascular events trial.

Efficacy and tolerability of long-term rilmenidine treatment in hypertensive diabetic patients. A retrospective analysis of a general practice study

INTRODUCTION

Rilmenidine is a centrally acting antihypertensive which differs from the other representatives of this class by its very high specificity for the imidazoline I1 receptors and its good tolerability. Recent studies have shown rilmenidine improves glucose tolerance and reduces micro-albuminuria in patients with diabetes mellitus.

METHODOLOGY

The evidence of these potentially favorable characteristics encouraged a secondary retrospective analysis of a subgroup of 2738 diabetic patients included in a previous long-term open study of rilmenidine alone, or in combination with other classes of antihypertensives.

RESULTS

The antihypertensive efficacy of rilmenidine demonstrated previously in controlled studies was confirmed during the 12-month follow-up. In addition, favorable effects of drug treatment on fasting blood glucose and plasma triglyceride levels were consistent with an improvement in glucose and lipid metabolism during treatment. The profile of adverse events was similar to that observed in the nondiabetic population, the occurrence of postural hypotension being observed in <1% of patients and not necessitating any withdrawals from the study.

CONCLUSION

Diabetic hypertensive patients frequently require the use of multiple medications and consideration of the metabolic interactions between treatments. The results of this retrospective analysis support the use of rilmenidine in patients with hypertension and diabetes mellitus and should encourage the conduct of controlled trials of cardiovascular and renal protection and outcome with this compound.

[The effect of analysed hypotensive drugs on certain metabolic parameters]

The aim of this study was to assess the influence of 3 hypotensive drugs on the metabolic disorders: dyslipidemia, insulin resistance, hyperuricemia. There were 39 patients aged 20-55, with mild-to-moderate essential hypertension. The patients with other serious diseases or treated earlier with cholesterol or uric acid lowering drugs were excluded. Patients were divided into 3 groups, each was treated during 8 weeks with one drug: gr 1--trandolapril (T), gr 2--felodipine ER (F), gr 3--rilmenidine (R). Glucose and insulin in oral glucose tolerance test, I/G proportion, serum lipids and uric acid were tested before and after therapy. The therapy did not influence lipid parameters: LDL, HDL, triglyceride. In the T group there could be observed a significant reduction of total cholesterol value. Examined drugs did not induce changes in serum carbohydrate. The significant reduction of serum uric acid could be observed only after F therapy. Analysed drugs are very useful in therapy of hypertension with metabolic disorders.

[Efficacy and acceptability of rilmenidine in a population of 2 738 hypertensive diabetic patients]

CONTEXT

Despite the constant enrichment of the pharmacopoeia, the normalizing of blood pressure in hypertensive diabetic patients remains difficult.

OBJECTIVE

To assess the efficacy and acceptability of rilmenidine in first intention in hypertensive diabetics.

METHODS

In a population of 18 235 hypertensive patients, the sub-population of diabetic patients was followed-up in an open study over one year. These patients were initially treated with 1 mg/day of rilmenidine with the possibility of adapting the dose - increasing to 2 mg/d and association with a second or even third anti-hypertensor, left to the discretion of the physician - when the diastolic blood pressure remained strictly greater than 90 mmHg.

RESULTS

The complete blood pressure data over a period of 12 months were obtained in 2 311 patients out of 2 738 (84.4%). After 12 months' treatment, 75.9% of the 2 311 patients were normalized by the monotherapy with rilmenidine (diastolic blood pressure<90 mmHg according to the recommendations in force at the time of the study). The clinical acceptability was good and comparable to that obtained in the general population of 18 235 hypertensive patients. The biological parameters remained stable.

CONCLUSION

This pharmaco-epidemiological assessment demonstrates, in conditions of current practice, the anti-hypertensive efficacy and acceptability of rilmenidine in hypertensive diabetics, therefore confirming its place in the therapeutic arsenal of these patients.

Pharmacokinetics and safety of JTE-522, a novel selective cyclooxygenase-2 inhibitor, in healthy male volunteers

AIMS

The pharmacokinetics and safety profile of JTE-522, 4-(4-cyclohexyl-2 methyloxazol-5-yl)-2-fluorobenzensulphonamide, a novel selective cyclooxygenase-2 inhibitor were investigated in healthy male volunteers.

METHODS

Initially, as a pilot study, five groups of two subjects were given oral doses of 3-100 mg of JTE-522. After safety assessment, subjects were given 150 and 200 mg of JTE-522. The effect of food-intake on the pharmacokinetics of JTE-522 at a dose of 150 mg was examined. In the multiple-dose study, subjects were given 150 mg of JTE-522 once a day for 7 days. Concentrations of unchanged JTE-522 in plasma, blood and urine were determined by high performance liquid chromatography (h.p.l.c.). Concentrations of metabolites were estimated with h.p.l.c. chromatograms and calibration curves for quantification of unchanged JTE-522.

RESULTS

In the course of this study, no serious abnormality attributable to the test drug was observed, suggesting that JTE-522 was well tolerated in healthy subjects. In a single-dose study, the concentrations of JTE-522 in blood were much higher than the corresponding concentrations in plasma. JTE-522 was readily distributed to blood cells and percentage distribution into blood cells was more than 99.0%. However, the values of Cmax in blood at doses of 100, 150, 200 mg JTE-522 were 15241, 20445 +/- 3918 (16333-24556), 20965 +/- 3260 (17544-24386) ng ml-1, respectively. These findings suggest that JTE-522 has a high affinity for blood cells and the distribution into blood cells is limited at the higher doses of over 100 mg. In a multiple dose study, pharmacokinetic parameters including t1/2 and AUC after the fourth administration were comparable with that of the seventh administration. Thus, these findings suggest the absence of accumulation on the multiple-dosing of JTE-522.

CONCLUSIONS

These results indicate that JTE-522 has an acceptable pharmacokinetic profile for clinical use without any serious adverse events as we verified in healthy young male volunteers.

Concentration-effect relationships of two rilmenidine single-dose infusion rates in hypertensive patients

OBJECTIVES

This study was designed to assess the concentration-effect relationships for the antihypertensive effects of rilmenidine in patients to aid in the design of an optimized concentration profile of a sustained-release formulation.

METHODS

A placebo-controlled, randomized, double-blind, 2-way partial crossover study was performed in subjects with hypertension. Patients were randomized to receive 2 of 3 possible 12-hour infusion regimens, each consisting of a loading phase (2 hours) and a maintenance phase (10 hours): low-profile infusion (total dose of rilmenidine, 1.45 mg), high-profile infusion (total dose, 3.3 mg), or placebo. Drug plasma concentrations, adverse events, blood pressure, heart rate, and visual analog scales were measured frequently, up to 24 hours after dosing. Salivary flow was determined for up to 15 hours.

RESULTS

The high concentration profile was well tolerated and continued to produce a significant blood pressure reduction of 10.4 mm Hg (systolic)/5.8 mm Hg (diastolic) after 24 hours. The low concentration profile showed no significant effects on blood pressure compared with placebo after 24 hours. Decreases in salivary flow were -36% for the high-profile infusion and -20% for the low-profile infusion compared with placebo. Pharmacokinetic-pharmacodynamic analyses showed infusion rate-independent, linear concentration-dependent reductions in diastolic blood pressure and salivary flow up to the maximum observed rilmenidine concentration for both types of infusion.

CONCLUSIONS

The high concentration profile was well tolerated and still produced a significant blood pressure reduction after 24 hours. Pharmacokinetic-pharmacodynamic relationships were linear and unaffected by the rate of infusion. These results should aid in the design of an optimal slow-release profile.

[Efficacy and tolerance of rilmenidine in patients with mild to moderate hypertension. Results of a Czech and Slovak 6-month multicenter study]

AIM OF THE STUDY

To evaluate the efficacy and tolerability of rilmenidine (Tenaxum) in the dose of 1-2 mg in patients with mild to moderate hypertension.

GROUP OF PATIENTS AND METHODS

243 patients (53% men, 47% women, mean age 52 +/- 11 years with mild to moderate essential hypertension were included into the study. Several cardiovascular risk factors for CAD were reported in the investigated group of patients: dyslipidaemia in 54%, obesity in 29%, diabetes mellitus in 14% and smoking in 17% of subjects. 87% of patients were subjects with newly diagnosed untreated or shortly (< 3 months) treated hypertension. In remaining hypertensives the antihypertensive therapy was withdrawn two weeks before the beginning of rilmenidine treatment. The following parameters were studied: BMI, sitting and upright casual blood pressure, heart rate and basal laboratory tests. If necesary, additional therapy with indapamide or perindopril was allowed.

RESULTS

Rilmenidine treatment resulted in normalisation of blood pressure (BP) or significant (decrease of SBP/DBP = 20/10 mm Hg) blood pressure decrease in 69%, 22% of subjects, respectively. At the end of 6-month period significant BP decrease was noted: 134 +/- 6/83 +/- 5 mm Hg vs. 161 +/- 12/99 +/- 6 mm Hg (p < 0.001). Marked BP decrease was observed already during first visit after active treatment for 3 weeks. Six months of rilmenidine treatment led to significant heart rate decrease (71/min. +/- 8 vs. 74/min. +/- 9, p < 0.01). No significant laboratory (plasma Na, K, creatinine, urea, glycemia, triglycerides, haematocrit) changes were reported after rilmenidine treatment with the only exception of mild, but significant plasma cholesterol decrease. Rilmenidine had very good acceptability and mild side effects were noted in small percentage of patients.

CONCLUSION

Rilmenidine is a centraly acting drug of IInd generation (imidazoline I1 receptors agonist) with potent antihypertensive and mild negative chronotropic effect. Rilmenidine has very good clinical tolerability without negative influence on metabolic parameters.