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Biglan K, Munsie L, Svensson KA, Ardayfio P, Pugh M, Sims J, Brys M. Safety and Efficacy of Mevidalen in Lewy Body Dementia: A Phase 2, Randomized, Placebo-Controlled Trial. Mov Disord 2021; 37:513-524. [PMID: 34859493 PMCID: PMC9300146 DOI: 10.1002/mds.28879] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/07/2021] [Accepted: 11/04/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Mevidalen is a selective positive allosteric modulator (PAM) of the dopamine D1 receptor subtype. OBJECTIVE To assess the safety and efficacy of mevidalen for treatment of cognition in patients with Lewy body dementia (LBD). METHODS PRESENCE was a phase 2, 12-week study in participants with LBD (N = 344) randomly assigned (1:1:1:1) to daily doses of mevidalen (10, 30, or 75 mg) or placebo. The primary outcome measure was change from baseline on Cognitive Drug Research Continuity of Attention (CoA) composite score. Secondary outcomes included Alzheimer's Disease Assessment Scale-Cognitive Subscale 13 (ADAS-cog13 ), Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC). Numerous safety measures were collected. RESULTS Mevidalen failed to meet primary or secondary cognition endpoints. Mevidalen resulted in significant, dose-dependent improvements of MDS-UPDRS total score (sum of Parts I-III, 10 mg P < 0.05, 30 mg P < 0.05, 75 mg P < 0.01, compared to placebo). The 30 mg and 75 mg mevidalen doses significantly improved ADCS-CGIC scores compared to placebo (minimal or better improvement: 30 mg P < 0.01, 75 mg P < 0.01; moderate or better improvement: 30 mg P < 0.05, 75 mg P < 0.001). Increases in blood pressure, adverse events, and cardiovascular serious adverse events were most pronounced at the 75 mg dose. CONCLUSIONS Mevidalen harnesses a novel mechanism of action that improves motor symptoms associated with LBD on top of standard of care while improving or not worsening non-motor symptoms associated with traditional dopaminergic therapy. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kevin Biglan
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | - Melissa Pugh
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - John Sims
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Garnett C, Johannesen L, McDowell T. Redefining Blood Pressure Assessment — The Role of the Ambulatory Blood Pressure Monitoring Study for Drug Safety. Clin Pharmacol Ther 2019; 107:147-153. [DOI: 10.1002/cpt.1690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Christine Garnett
- Division of Cardiovascular and Renal Products Center for Drug Evaluation and Research, Food and Drug Administration Silver Spring Maryland USA
| | - Lars Johannesen
- Division of Cardiovascular and Renal Products Center for Drug Evaluation and Research, Food and Drug Administration Silver Spring Maryland USA
| | - Tzu‐Yun McDowell
- Division of Cardiovascular and Renal Products Center for Drug Evaluation and Research, Food and Drug Administration Silver Spring Maryland USA
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Bhatt S, Northcott C, Wisialowski T, Li D, Steidl-Nichols J. Preclinical to Clinical Translation of Hemodynamic Effects in Cardiovascular Safety Pharmacology Studies. Toxicol Sci 2019; 169:272-279. [DOI: 10.1093/toxsci/kfz035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Siddhartha Bhatt
- Global Safety Pharmacology, Pfizer Worldwide Research and Development, Groton, Connecticut
| | - Carrie Northcott
- Global Safety Pharmacology, Pfizer Worldwide Research and Development, Groton, Connecticut
| | - Todd Wisialowski
- Global Safety Pharmacology, Pfizer Worldwide Research and Development, Groton, Connecticut
| | - Dingzhou Li
- Regulatory Strategy and Compliance, Pfizer Worldwide Research and Development, Groton, Connecticut
| | - Jill Steidl-Nichols
- Global Safety Pharmacology, Pfizer Worldwide Research and Development, Groton, Connecticut
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Turner JR. "Assessment of Pressor Effects of Drugs"-A New US FDA Draft Guidance for Industry. Ther Innov Regul Sci 2018; 52:397-399. [PMID: 29996733 DOI: 10.1177/2168479018786478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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A strategy utilizing ambulatory monitoring and home and clinic blood pressure measurements to optimize the safety evaluation of noncardiovascular drugs with potential for hemodynamic effects: a report from the SYNERGY trial. Blood Press Monit 2018; 23:153-163. [PMID: 29578880 PMCID: PMC5959217 DOI: 10.1097/mbp.0000000000000320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Objective The aim of this study was to perform a blood pressure (BP) safety evaluation in patients with an overactive bladder receiving solifenacin (an antimuscarinic agent), mirabegron (a β3-adrenoceptor agonist), or both compared with placebo in the SYNERGY trial. Patients and methods Patients were randomized to receive solifenacin 5 mg+mirabegron 50 mg (combination 5+50 mg); solifenacin 5 mg+mirabegron 25 mg (combination 5+25 mg); solifenacin 5 mg; mirabegron 50 mg; mirabegron 25 mg; or placebo for a double-blind 12-week treatment period. Systolic BP, diastolic BP, and heart rate were measured by ambulatory BP monitoring, and in the clinic or home. Results A total of 715 patients were analyzed in an ambulatory BP monitoring substudy. At the end of treatment, ambulatory BP monitoring measurements showed no consistent increases from baseline in the mean 24-h systolic BP or diastolic BP for combination versus monotherapy groups or for monotherapy groups versus placebo. Analysis of 1-h BP averages during the 6 h range that included the Tmax values of both study drugs showed no significant BP effects. Shift analysis (switch between different normotension/hypertension stages) did not show differences among the active and placebo groups, nor did outlier analysis of major BP changes differ between placebo and active treatment. Similarly, there were no significant signals in the 24-h heart rate. Office and home measurements were consistent with ambulatory BP monitoring findings. Conclusions A paradigm of ambulatory BP monitoring analysis designed to test BP safety of noncardiovascular drugs showed that solifenacin plus mirabegron combination therapy during 12 weeks produced no meaningful changes in BP or heart rate.
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Usefulness of ambulatory blood pressure monitoring to assess the melanocortin receptor agonist bremelanotide. J Hypertens 2017; 35:761-768. [PMID: 27977473 PMCID: PMC5338879 DOI: 10.1097/hjh.0000000000001221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text Background: Melanocortin receptor agonists that bind to the melanocortin receptor 4 may cause increases in blood pressure (BP). Bremelanotide is an on-demand, subcutaneous melanocortin-receptor agonist that binds to the melanocortin receptor 4 and is being developed for the treatment of female sexual dysfunction. Methods: We studied the effects of bremelanotide administration on ambulatory BP and heart rate (HR), in a randomized, double-blind, placebo-controlled, and parallel-arm trial of three doses of bremelanotide (0.75, 1.25, and 1.75 mg) in 397 premenopausal women with female sexual dysfunction with normotension or controlled hypertension. Pharmacokinetic exposure was assessed in conjunction with ambulatory BP measurements. Results: Increases in ambulatory SBP relative to placebo of 2.4 and 3.0 mmHg (1.25 mg; P values: 0.029 and 0.076) and 3.1 and 3.2 mmHg (1.75 mg; P values: 0.006 and 0.027), respectively, occurred following two doses, separated by 24 h at the 0 to 4-h postdose interval; peak increases typically lasted less than 15 min. Similar increases in the DBP were observed. Increases in BP were accompanied by reductions in HR during the 0–4-h interval for the 1.75-mg dose (−4.6 to −4.7 bpm; P < 0.001). Twenty-six participants discontinued after randomization due to prespecified increases in BP but the proportions were similar among the four treatment groups. Conclusion: These data show that ambulatory monitoring was a useful methodology to detect small, transient increases in ambulatory BP accompanied by reductions in HR following bremelanotide. Results of this trial led to appropriate in-clinic BP monitoring during the larger clinical development trials of this agent for female sexual dysfunction.
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Kazda CM, Frias J, Foga I, Cui X, Guzman CB, Garhyan P, Heilmann C, Yang JA, Hardy TA. Treatment with the glucagon receptor antagonist LY2409021 increases ambulatory blood pressure in patients with type 2 diabetes. Diabetes Obes Metab 2017; 19:1071-1077. [PMID: 28191913 DOI: 10.1111/dom.12904] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 11/27/2022]
Abstract
AIMS To assess the effect of LY2409021 on systolic blood pressure (SBP) in patients with type 2 diabetes. MATERIALS AND METHODS This 6-week, randomized, crossover study evaluated the effects of once-daily administration of LY2409021 20 mg vs those of placebo on SBP, diastolic BP (DBP), and mean arterial pressure (MAP) using 24-hour ambulatory BP monitoring (ABPM) in 270 subjects treated with diet/exercise ± metformin. Other measures included changes in glycemic control, serum lipids, and hepatic safety markers. RESULTS At 6 weeks of LY2409021 treatment, 24-hour mean SBP was increased, with a least squares mean (LSM) difference of 2.26 mm Hg vs placebo (95% CI: 1.11, 3.40; P < .001). The 24-hour mean DBP and MAP also increased, with LSM differences of 1.37 mm Hg (95% CI: 0.66, 2.08; P < .001) and 1.67 mm Hg (95% CI: 0.86, 2.47; P < .001) vs placebo, respectively. At week 6, LY2409021 treatment reduced glycated hemoglobin (HbA1c) levels, with an LSM difference of -0.49% (-5.4 mmol/mol) (95% CI: -0.56%, -0.42% [-6.1, -4.6 mmol/mol]; P < .001) vs placebo. Mean HbA1c at baseline was 7.3% (56 mmol/mol). Small but significant changes in serum lipid and aminotransferase levels were observed with LY2409021 treatment (all P < .05 vs placebo). CONCLUSIONS Statistically significant increases in BP, MAP and serum lipid levels were observed with LY2409021 treatment at a dose that lowered HbA1c and glucose levels. These effects may limit the clinical utility of LY2409021 as a chronic treatment for type 2 diabetes.
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Affiliation(s)
| | - Juan Frias
- National Research Institute, Los Angeles, California
| | | | - Xuewei Cui
- Eli Lilly and Company, Indianapolis, Indiana
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Turner JR. Integrated cardiovascular safety: multifaceted considerations in drug development and therapeutic use. Expert Opin Drug Saf 2017; 16:481-492. [DOI: 10.1080/14740338.2017.1300252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- J. Rick Turner
- Cardiac Safety Services, QuintilesIMS, Durham, NC, USA
- Department of Pharmacy Practice, Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
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Gottfridsson C, Panfilov S, Ebrahimi A, Gigger E, Pollard C, Henderson S, Ambery P, Raichlen JS. Drug-induced blood pressure increase - recommendations for assessment in clinical and non-clinical studies. Expert Opin Drug Saf 2016; 16:215-225. [PMID: 27830951 DOI: 10.1080/14740338.2017.1259615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Changes in blood pressure (BP) are now proactively examined throughout the drug development process as an integral aspect of safety monitoring. This is because hypertension is a very strong risk factor for cardiovascular events and drug-induced increases in BP have attracted increased regulatory attention. However, there is currently no guidance from regulatory agencies on the minimum BP data required for submissions, and there are no specific criteria for what constitutes a safety signal for increased BP in non clinical studies. Areas covered: Evaluation of BP increases through the drug discovery and development process. Expert opinion: Research into the effects of drugs should begin before clinical development is initiated and continue throughout the clinical trial program. Non clinical studies should inform a benefit-risk analysis that will aid decision-making of whether to enter the drug into Phase I development. The degree of acceptable risk will vary according to the therapy area, treatment indication and intended population for the new drug, and the approach to BP assessment and risk mitigation should be tailored accordingly. However, BP monitoring should always be included in clinical trials, and data collected from multiple studies, to convincingly prove or refute a suspicion of BP effects.
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Affiliation(s)
- Christer Gottfridsson
- a Patient Safety , Global Medicines Development, AstraZeneca R&D , Gothenburg , Sweden
| | - Seva Panfilov
- b CVMD Global Medicines Development , AstraZeneca R&D , Gothenburg , Sweden
| | - Ahmad Ebrahimi
- c ECG Centre, Global Medicines Development , AstraZeneca R&D , Gothenburg , Sweden
| | - Emery Gigger
- d Regulatory Policy, Global Medicines Development , AstraZeneca R&D , Gaithersburg , MD , USA
| | - Chris Pollard
- e Drug Safety & Metabolism , AstraZeneca R&D , Cambridge , UK
| | | | - Philip Ambery
- g Clinical CVMD, Biologics, MedImmune , Cambridge , UK
| | - Joel S Raichlen
- h CVMD Global Medicines Development , AstraZeneca R&D , Gaithersburg , MD , USA
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Lester RM, Olbertz J. Early drug development: assessment of proarrhythmic risk and cardiovascular safety. Expert Rev Clin Pharmacol 2016; 9:1611-1618. [PMID: 27718759 DOI: 10.1080/17512433.2016.1245142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION hERG assays and thorough ECG trials have been mandated since 2005 to evaluate the QT interval and potential proarrhythmic risk of new chemical entities. The high cost of these studies and the shortcomings inherent in these binary and limited approaches to drug evaluation have prompted regulators to search for more cost effective and mechanistic paradigms to assess drug liability as exemplified by the CiPA initiative and the exposure response ICH E14(R3) guidance document. Areas covered: This review profiles the changing regulatory landscape as it pertains to early drug development and outlines the analyses that can be performed to characterize preclinical and early clinical cardiovascular risk. Expert commentary: It is further acknowledged that the narrow focus on the QT interval needs to be expanded to include a more comprehensive evaluation of cardiovascular risk since unanticipated off target effects have led to the withdrawal of multiple drugs after they had been approved and marketed.
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Affiliation(s)
- Robert M Lester
- a Cardiovascular Safety Services , Celerion Inc. , Tempe , AZ , USA
| | - Joy Olbertz
- a Cardiovascular Safety Services , Celerion Inc. , Tempe , AZ , USA
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Turner JR, Kowey PR, Rodriguez I, Cabell CH, Gintant G, Green CL, Kunz BL, Mortara J, Sager PT, Stockbridge N, Wright TJ, Finkle J, Krucoff MW. The Cardiac Safety Research Consortium enters its second decade: An invitation to participate. Am Heart J 2016; 177:96-101. [PMID: 27297854 DOI: 10.1016/j.ahj.2016.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 01/06/2023]
Abstract
The Cardiac Safety Research Consortium (CSRC), a transparent, public-private partnership established in 2005 as a Critical Path Program and formalized in 2006 under a Memorandum of Understanding between the United States Food and Drug Administration and Duke University, is entering its second decade. Our continuing goal is to advance paradigms for more efficient regulatory science related to the cardiovascular safety of new therapeutics, both in the United States and globally, particularly where such safety questions add burden to innovative research and development. Operationally, CSRC brings together a broad base of stakeholders from academia, industry, and government agencies in a collaborative forum focused on identifying barriers and then creating novel solutions through shared data, expertise, and collaborative research. This white paper provides a brief overview of the Consortium's activities in its first decade and a context for some of our current activities and future directions. The growth and success of the CSRC have been primarily driven by members' active participation and the development of goodwill and trust throughout our membership, which have facilitated novel collaborations across traditionally competitive or contentious stakeholder boundaries. The continued expansion of our base of participating academicians, industry experts, and regulators will define the Consortium's success in our second decade. It is our hope that sharing our endeavors to date will stimulate additional participation in the CSRC and also provide a model for other groups starting to develop similar collaborative forums.
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Affiliation(s)
| | - Peter R Kowey
- Lankenau Institute for Medical Research & Thomas Jefferson University, PA
| | | | | | | | - Cynthia L Green
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC
| | | | | | | | | | | | | | - Mitchell W Krucoff
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC
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Conrado DJ, Chen D, Denney WS. Cardiovascular Safety Assessment in Early-Phase Clinical Studies: A Meta-Analytical Comparison of Exposure-Response Models. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2016; 5:324-35. [PMID: 27318037 PMCID: PMC5131889 DOI: 10.1002/psp4.12086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/28/2016] [Accepted: 04/27/2016] [Indexed: 01/08/2023]
Abstract
Exposure‐response analysis of QT interval in clinical studies has been proposed as a thorough QT study alternative. Many exposure‐response model structures have been proposed for cardiovascular (CV) safety markers, but few studies have compared models across multiple drugs. To recommend preferred drug‐effect exposure‐response models on vital signs and electrocardiogram (ECG) intervals, an individual‐level model‐based meta‐analysis (39 studies and 1,291 subjects) compared 90 model structures. Models were selected to describe the data and cross‐validate studies on the same drug. The most commonly selected baseline model was an unstructured model (estimation of a value at each study nominal time) for all measures but blood pressure. The unstructured model estimated a better cross‐validated drug‐effect when considering all markers. A linear model was the most commonly selected to characterize drug‐effect on all markers. We propose these models as a starting point assisting with CV safety exposure‐response assessment in nondedicated small studies with healthy subjects.
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Affiliation(s)
- D J Conrado
- Biotherapeutics Clinical Pharmacology, Pfizer Global Research and Development, Cambridge, Massachusetts, USA
| | - D Chen
- Biotherapeutics Clinical Pharmacology, Pfizer Global Research and Development, Cambridge, Massachusetts, USA
| | - W S Denney
- Biotherapeutics Clinical Pharmacology, Pfizer Global Research and Development, Cambridge, Massachusetts, USA
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Statistical power analysis of cardiovascular safety pharmacology studies in conscious rats. J Pharmacol Toxicol Methods 2016; 81:128-35. [PMID: 27071954 DOI: 10.1016/j.vascn.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/25/2016] [Accepted: 04/04/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED Cardiovascular (CV) toxicity and related attrition are a major challenge for novel therapeutic entities and identifying CV liability early is critical for effective derisking. CV safety pharmacology studies in rats are a valuable tool for early investigation of CV risk. Thorough understanding of data analysis techniques and statistical power of these studies is currently lacking and is imperative for enabling sound decision-making. METHODS Data from 24 crossover and 12 parallel design CV telemetry rat studies were used for statistical power calculations. Average values of telemetry parameters (heart rate, blood pressure, body temperature, and activity) were logged every 60s (from 1h predose to 24h post-dose) and reduced to 15min mean values. These data were subsequently binned into super intervals for statistical analysis. A repeated measure analysis of variance was used for statistical analysis of crossover studies and a repeated measure analysis of covariance was used for parallel studies. Statistical power analysis was performed to generate power curves and establish relationships between detectable CV (blood pressure and heart rate) changes and statistical power. Additionally, data from a crossover CV study with phentolamine at 4, 20 and 100mg/kg are reported as a representative example of data analysis methods. RESULTS Phentolamine produced a CV profile characteristic of alpha adrenergic receptor antagonism, evidenced by a dose-dependent decrease in blood pressure and reflex tachycardia. Detectable blood pressure changes at 80% statistical power for crossover studies (n=8) were 4-5mmHg. For parallel studies (n=8), detectable changes at 80% power were 6-7mmHg. Detectable heart rate changes for both study designs were 20-22bpm. DISCUSSION Based on our results, the conscious rat CV model is a sensitive tool to detect and mitigate CV risk in early safety studies. Furthermore, these results will enable informed selection of appropriate models and study design for early stage CV studies.
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Weber MA, Turner JR. Ambulatory Blood Pressure Monitoring: New Directions and Uncertainties Arise From the U.S. Preventive Services Task Force Recommendation on the Diagnosis of Hypertension. J Clin Hypertens (Greenwich) 2016; 18:172-4. [PMID: 26899617 DOI: 10.1111/jch.12798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
| | - J Rick Turner
- Cardiovascular Center of Excellence, Durham, NC, USA
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Nagayama T, Nishida M, Hizue M, Ogino Y, Fujiyoshi M. Adverse Drug Reactions for Medicines Newly Approved in Japan from 1999 to 2013: Hypertension and Hypotension. Basic Clin Pharmacol Toxicol 2015; 118:306-12. [PMID: 26407539 DOI: 10.1111/bcpt.12494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/15/2015] [Indexed: 12/14/2022]
Abstract
In this survey, the correlation between adverse drug reactions (ADRs) in human and animal toxicities was investigated for 393 medicines which were approved in Japan from September 1999 to March 2013. ADRs were collected from each Japanese package insert. Comparable animal toxicities with ADRs were collected by thorough investigation of common technical documents. The results of this survey show that hypertension and/or hypotension were mainly observed in medicines affecting the central nervous system. Hypertension was also observed in antipyretics, analgesics, anti-inflammatory agents, vasoconstrictors and agents using antibody. Concordance between human ADRs and animal toxicities was analysed. True-positive rate for hypertension and hypotension is 0.29 and 0.52, respectively. Positive likelihood ratio and inverse negative likelihood ratio are 1.98 and 1.21, respectively, in hypertension and 1.67 and 1.44, respectively, in hypotension. Concordance between human ADRs and animal toxicities is not so high in hypertension and hypotension. Identified mechanisms as on-target for hypertension and hypotension are 29.8% and 30.5%, respectively. More than half of the causative factors of hypertension and hypotension were unable to be elucidated. Our results show that the intake of medicines is often linked to blood pressure variations that are not predicted in animal toxicity studies. Improvement of drug development processes may be necessary to provide safer medicines because current animal toxicity studies are insufficient to predict all ADRs in human beings.
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Affiliation(s)
- Takashi Nagayama
- Non-Clinical Evaluation Expert Committee, Drug Evaluation Committee, Japan Pharmaceutical Manufacturers Association, Tokyo, Japan
| | - Minoru Nishida
- Non-Clinical Evaluation Expert Committee, Drug Evaluation Committee, Japan Pharmaceutical Manufacturers Association, Tokyo, Japan
| | - Masanori Hizue
- Non-Clinical Evaluation Expert Committee, Drug Evaluation Committee, Japan Pharmaceutical Manufacturers Association, Tokyo, Japan
| | - Yamato Ogino
- Non-Clinical Evaluation Expert Committee, Drug Evaluation Committee, Japan Pharmaceutical Manufacturers Association, Tokyo, Japan
| | - Masato Fujiyoshi
- Non-Clinical Evaluation Expert Committee, Drug Evaluation Committee, Japan Pharmaceutical Manufacturers Association, Tokyo, Japan
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Kassel LE, Odum LE. Our own worst enemy: pharmacologic mechanisms of hypertension. Adv Chronic Kidney Dis 2015; 22:245-52. [PMID: 25908474 DOI: 10.1053/j.ackd.2014.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/02/2014] [Accepted: 10/08/2014] [Indexed: 12/16/2022]
Abstract
Drug-induced hypertension is often an unrecognized cause of resistant or secondary hypertension. It is defined as hypertension resulting from the unintended effect of a drug or from a drug's antagonistic effect on antihypertensive medications. The main mechanisms of drug-induced hypertension, when categorized broadly, include volume retention and sympathomimetic effects. These mechanisms along with management strategies will be further discussed in this article.
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Sager PT, Seltzer J, Turner JR, Anderson JL, Hiatt WR, Kowey P, Prochaska JJ, Stockbridge N, White WB. Cardiovascular Safety Outcome Trials: A meeting report from the Cardiac Safety Research Consortium. Am Heart J 2015; 169:486-95. [PMID: 25819855 DOI: 10.1016/j.ahj.2015.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 01/21/2023]
Abstract
This White Paper provides a summary of presentations and discussions at a Cardiovascular Safety Outcome Trials Think Tank cosponsored by the Cardiac Safety Research Consortium, the US Food and Drug Administration, and the American College of Cardiology, held at American College of Cardiology's Heart House, Washington, DC, on February 19, 2014. Studies to assess cardiovascular (CV) risk of a new drug are sometimes requested by regulators to resolve ambiguous safety signals seen during its development or among other members of its class. Think Tank participants thought that important considerations in undertaking such studies were as follows: (1) plausibility-how likely it is that a possible signal indicating risk is real, based on strength of evidence, and/or whether a plausible mechanism of action for potential CV harm has been identified; (2) relevance-what relative and absolute CV risk would need to be excluded to determine that the drug had an acceptable benefit-to-risk balance for its use in the intended patient population; and (3) how plausibility and relevance influence the timing and approach to further safety assessment.
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Affiliation(s)
| | | | | | | | - William R Hiatt
- Division of Cardiology/CPC Clinical Research, University of Colorado School of Medicine, Aurora, CO
| | | | | | | | - William B White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, CT.
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Son M, Kim Y, Chae DW, Park K. A quantitative approach for cardiovascular safety evaluation of a generic drug. Transl Clin Pharmacol 2015. [DOI: 10.12793/tcp.2015.23.2.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mijeong Son
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Yukyung Kim
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Dong Woo Chae
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Kyungsoo Park
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Ewart L, Aylott M, Deurinck M, Engwall M, Gallacher DJ, Geys H, Jarvis P, Ju H, Leishman D, Leong L, McMahon N, Mead A, Milliken P, Suter W, Teisman A, Van Ammel K, Vargas HM, Wallis R, Valentin JP. The Concordance between Nonclinical and Phase I Clinical Cardiovascular Assessment from a Cross-Company Data Sharing Initiative. Toxicol Sci 2014; 142:427-35. [DOI: 10.1093/toxsci/kfu198] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens 2014; 31:1731-68. [PMID: 24029863 DOI: 10.1097/hjh.0b013e328363e964] [Citation(s) in RCA: 977] [Impact Index Per Article: 97.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a consensus meeting on ABPM in Milan in 2011 that the 34 attendees should prepare a comprehensive position paper on the scientific evidence for ABPM.This position paper considers the historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique. It examines the need for selecting an appropriate device, the accuracy of devices, the additional information and indices that ABPM devices may provide, and the software requirements.At a practical level, the paper details the requirements for using ABPM in clinical practice, editing considerations, the number of measurements required, and the circumstances, such as obesity and arrhythmias, when particular care needs to be taken when using ABPM.The clinical indications for ABPM, among which white-coat phenomena, masked hypertension, and nocturnal hypertension appear to be prominent, are outlined in detail along with special considerations that apply in certain clinical circumstances, such as childhood, the elderly and pregnancy, and in cardiovascular illness, examples being stroke and chronic renal disease, and the place of home measurement of blood pressure in relation to ABPM is appraised.The role of ABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined and finally the implementation of ABPM in practice is considered in relation to the issue of reimbursement in different countries, the provision of the technique by primary care practices, hospital clinics and pharmacies, and the growing role of registries of ABPM in many countries.
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Blankfield RP, Iftikhar IH. Food and Drug Administration Regulation of Drugs That Raise Blood Pressure. J Cardiovasc Pharmacol Ther 2014; 20:5-8. [DOI: 10.1177/1074248414531852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although it is recognized that a systolic blood pressure (SBP) increase ≥2 mm Hg or a diastolic blood pressure (DBP) increase ≥1 mm Hg increases the risk of heart attacks and strokes in middle-aged adults, the Food and Drug Administration (FDA) lacks an adequate policy for regulating medications that increase blood pressure (BP). Some FDA reviewers consider a clinically significant increase in BP to occur only if a drug raises SBP ≥20 mm Hg or if a drug raises DBP ≥10 to 15 mm Hg. In recent years, numerous drugs have been regulated or taken off the market due to cardiovascular safety concerns. The list includes rofecoxib (Vioxx), valdecoxib (Bextra), nonselective nonsteroidal anti-inflammatory drugs, sibutramine (Meridia), and phenylpropanolamine. It is probable that the hypertensive effect of these drugs explains why they increase the risk of adverse cardiovascular events. Other drugs, notably serotonin–norepinephrine reuptake inhibitors and drugs used to treat attention deficit hyperactivity disorder, were approved without cardiovascular safety data despite the fact that they raise BP comparable to valdecoxib and sibutramine. It is the responsibility of the FDA to ensure that drugs are properly labeled regarding risk. Even if a drug raises BP only modestly, FDA guidelines for new drug approvals should include a requirement for cardiovascular safety data. However, such guidelines will not address the problem of how to obtain cardiovascular safety data for the many already approved drugs that increase BP. The FDA should play a role in obtaining cardiovascular safety data for such drugs.
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Affiliation(s)
- Robert P. Blankfield
- Department of Family Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Imran H. Iftikhar
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
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Maison-Blanche P, Dakhil S, Baron A, Rottey S, Millard F, Daugaard G, Machiels JP, Conkright W, Sharma S, Soetekouw PMMB, Yachnin J, Sengeløv L, Van Veldhuizen P, Agarwala SS, Sémiond D, Chadjaa M, Shen L, Wade JL. An open-label study to investigate the cardiac safety profile of cabazitaxel in patients with advanced solid tumors. Cancer Chemother Pharmacol 2014; 73:1241-52. [PMID: 24718982 DOI: 10.1007/s00280-014-2460-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/21/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE This study assessed the cardiovascular safety of cabazitaxel, based on thorough evaluation of QT and non-QT variables, and the relationship between pharmacokinetic and pharmacodynamic electrocardiographic (ECG) profiles and the occurrence of Grade ≥3 cardiovascular adverse events. METHODS Patients with advanced solid tumors were treated with cabazitaxel 25 mg/m(2) every 3 weeks. Digital ECG recordings were obtained during Cycle 1 over 24 h after dosing. The primary end point was effect of cabazitaxel on QT interval corrected by the Fridericia formula (QTcF). Secondary end points were additional ECG parameters (QT, PR and QRS intervals, and heart rate), plasma pharmacokinetics of cabazitaxel and overall clinical safety. RESULTS The pharmacodynamic (ECG) population included 94 patients. In 63 patients with a full 24-h ECG evaluation, the maximum upper bound of 90 % confidence interval (CI) for mean QTcF change from baseline was 7.46 ms (mean 4.8 ms), occurring at 1 h 30 min post-infusion. The slope of QTcF change from baseline versus cabazitaxel concentration was slightly negative (-0.012 [95 % CI -0.017; -0.008], equivalent to a 1.2 ms decrease per 100 ng/mL increase in cabazitaxel concentration). For non-QT variables, no effect was noted. No Grade ≥3 cardiac adverse events were observed; Grade ≥3 hypotension and lymphocele occurred in two patients and one patient, respectively. CONCLUSION These results suggest that cabazitaxel has no clinically significant cardiovascular adverse effects in patients with advanced solid tumors.
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Affiliation(s)
- Pierre Maison-Blanche
- Cardiology Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Bichat, Paris, France,
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Blankfield RP. Letter to the Editor regarding "Assessment of drug-induced increases in blood pressure during drug development: report from the Cardiac Safety Research Consortium". Am Heart J 2013; 166:e9. [PMID: 24016520 DOI: 10.1016/j.ahj.2013.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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White WB, Sager PT. Response to Letter to the Editor by Blankfield regarding "Assessment of drug-induced increases in blood pressure during drug development: report from the Cardiac Safety Research Consortium.". Am Heart J 2013; 166:e11. [PMID: 24016513 DOI: 10.1016/j.ahj.2013.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT.
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