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Kurumatani H, Okada K, Origasa H, Fujita T, Isono M, Nakamoto H. Prostacyclin analog beraprost sodium efficacy in primary glomerular disease or nephrosclerosis: Analysis of the Japanese subgroup in CASSIOPEIR study. Ther Apher Dial 2020; 25:551-564. [PMID: 33340238 PMCID: PMC8451904 DOI: 10.1111/1744-9987.13616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 01/13/2023]
Abstract
We conducted a multicenter, randomized, double‐blind, placebo‐controlled, phase IIb/III study (CASSIOPEIR) using a renal composite endpoint (i.e., doubling of SCr or end‐stage renal disease) in seven Asian countries/region. CASSIOPEIR compared TRK‐100STP (120 μg and 240 μg) with placebo in patients with non‐diabetic CKD patients with primary glomerular disease or nephrosclerosis (n = 892). However, the superiority of TRK‐100STP over placebo was not observed. A prior phase II study on which the Phase IIb/III study design was based included only Japanese patients. We therefore evaluated TRK‐100STP efficacy and safety in a subgroup of Japanese patients using the CASSIOPEIR dataset. As the timing of treatment initiation is important in CKD, we conducted additional subgroup analyses based on the baseline serum creatinine (SCr) and eGFR. ITT analysis was performed in a Japanese subgroup (n = 339) in which the primary endpoint was the first occurrence of renal composite endpoint. Significant differences were observed for TRK‐100STP 240 μg vs. placebo (P = 0.0493; HR 0.69 [95% CI: 0.47, 1.00]), but no significant difference was observed between TRK‐100 120 μg and placebo (P = 0.3523; HR 0.85). More prominent improvement was observed with TRK‐100STP 240 μg vs. placebo for baseline SCr < 3.0 mg/dL (P = 0.0031; HR 0.43); SCr < 3.5 mg/dL (P = 0.0237, HR 0.59); and eGFR ≥ 10 mL/min/1.73 m2 (P = 0.0339, HR0.67), respectively. No significant changes in urinary albumin/creatinine ratio and blood pressure were observed. TRK‐100STP was generally well tolerated and most adverse drug reactions were mild or moderate in severity. In conclusion, in the Japanese subgroup of CASSIOPEIR, TRK‐100STP 240 μg/day significantly improved the renal composite endpoint compared with placebo, with greater efficacy in subjects with SCr < 3.5 or eGFR ≥ 10 mL/min/1.73 m2.
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Koyama A, Fujita T, Gejyo F, Origasa H, Isono M, Kurumatani H, Okada K, Kanoh H, Kiriyama T, Yamada S. Orally active prostacyclin analogue beraprost sodium in patients with chronic kidney disease: a randomized, double-blind, placebo-controlled, phase II dose finding trial. BMC Nephrol 2015; 16:165. [PMID: 26475266 PMCID: PMC4608181 DOI: 10.1186/s12882-015-0130-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/28/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Evidence increasingly points to the importance of chronic hypoxia in the tubulointerstitium as a final common pathway to end-stage renal disease (ESRD). Beraprost sodium (BPS) is an orally active prostacyclin (PGI2) analogue demonstrating prevention of the progression of chronic kidney disease (CKD) in various animal models by maintaining renal blood flow and attenuating renal ischemic condition. METHODS This multicenter, randomized, double-blind, placebo-controlled, phase II trial was designed to determine the recommended dose of the sustained-release form of BPS (TRK-100STP 120 μg/day or 240 μg/day) in Japanese patients with CKD. TRK-100STP was administered to a total of 112 patients. The primary efficacy endpoint was the difference in the slope of the regression line of reciprocal of serum creatinine (1/SCr) over time, obtained by the least-squares method. RESULTS Regarding the primary endpoint, statistical superiority of TRK-100STP 240 μg over placebo was not confirmed and so a recommended dose was not determined. Compared to placebo, however, the slope of regression line of 1/SCr, elevation of SCr and serum cystatin C during the treatment period revealed greater improvement at 120 μg, at both doses, and at 240 μg, respectively. In terms of safety, both TRK-100STP treatment groups were well tolerated. CONCLUSIONS Although the study failed to meet the primary endpoint, results indicate that TRK-100STP may potentially prevent the decline in renal function of CKD patients independent of blood pressure or urinary protein levels. TRIAL REGISTRATION NCT02480751. June 21, 2015.
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Affiliation(s)
- Akio Koyama
- University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan.
| | - Toshiro Fujita
- Division of Clinical Epigenetics, Research Center for Advanced Science and Technology, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8904, Japan.
| | - Fumitake Gejyo
- Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, The University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan.
| | - Masanao Isono
- Toray Industries, Inc., 1-1, Nihonbashi-Muromachi 2-chome, Chuo-ku, Tokyo, 103-8666, Japan.
| | - Hajimu Kurumatani
- Toray Industries, Inc., 1-1, Nihonbashi-Muromachi 2-chome, Chuo-ku, Tokyo, 103-8666, Japan.
| | - Kiyonobu Okada
- Toray Industries, Inc., 1-1, Nihonbashi-Muromachi 2-chome, Chuo-ku, Tokyo, 103-8666, Japan.
| | - Hiroyuki Kanoh
- Astellas Pharma Inc., 2-5-1 Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Takashi Kiriyama
- Astellas Pharma Inc., 2-5-1 Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Shunsuke Yamada
- Astellas Pharma Inc., 2-5-1 Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8411, Japan.
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Nakamoto H, Fujita T, Origasa H, Isono M, Kurumatani H, Okada K, Kanoh H, Kiriyama T, Yamada S. A multinational phase IIb/III trial of beraprost sodium, an orally active prostacyclin analogue, in patients with primary glomerular disease or nephrosclerosis (CASSIOPEIR trial), rationale and study design. BMC Nephrol 2014; 15:153. [PMID: 25233856 PMCID: PMC4181382 DOI: 10.1186/1471-2369-15-153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/28/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is public health concern even in Asian countries. TRK-100STP, a sustained release tablet of an orally-active prostacyclin analogue, beraprost sodium, is suggested to suppress worsening of some parameters of renal filtration function, containing in slope of 1/serum creatinine (1/SCr) vs. time in a phase II clinical trial. METHODS/DESIGN We describe the design of the phase IIb/III trial of TRK-100STP, CASSIOPEIR (CRF Asian Study with Oral PGI2 derivative for Evaluating Improvement of Renal function) conducted in approximately 160 centers in China, Hong Kong, Japan, Malaysia, Republic of Korea, Taiwan, and Thailand. A total of 750 patients (n = 250 per group) with primary glomerular disease or nephrosclerosis were planned to be enrolled. Patients were randomized into one of three treatment groups in a double-bind, placebo-controlled manner: TRK-100STP 60 μg b.i.d.; TRK-100STP 120 μg b.i.d.; or placebo. The treatment period is planned to last 2 to 4 years. The primary efficacy endpoint is the renal composite endpoint including doubling of SCr and ESRD (dialysis induction, renal transplantation, or increase in SCr to ≥ 6.0 mg/dL). DISCUSSION This trial targeting CKD patients is designed to (a) demonstrate the superiority of TRK-100STP over placebo using renal composite endpoints, (b) determine the recommended clinical dose, and (c) assess the safety of TRK-100STP in this population and setting. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01090037.
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Affiliation(s)
- Hidetomo Nakamoto
- />Department of General Internal Medicine, Saitama Medical University, 38 Morohongo, Moroyamamachi, Iruma-gun, Saitama, 350-0495 Japan
| | - Toshiro Fujita
- />Division of Clinical Epigenetics, Research Center for Advanced Science and Technology, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8904 Japan
| | - Hideki Origasa
- />Division of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, The University of Toyama, 2630 Sugitani, Toyama city, 930-0194 Japan
| | - Masanao Isono
- />Toray Industries, Inc, Nihonbashi Mitsui Tower, 1-1, Nihonbashi-Muromachi 2-chome, Chuo-ku, Tokyo, 103-8666 Japan
| | - Hajimu Kurumatani
- />Toray Industries, Inc, Nihonbashi Mitsui Tower, 1-1, Nihonbashi-Muromachi 2-chome, Chuo-ku, Tokyo, 103-8666 Japan
| | - Kiyonobu Okada
- />Toray Industries, Inc, Nihonbashi Mitsui Tower, 1-1, Nihonbashi-Muromachi 2-chome, Chuo-ku, Tokyo, 103-8666 Japan
| | - Hiroyuki Kanoh
- />Astellas Pharma Inc, 2-5-1 Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8411 Japan
| | - Takashi Kiriyama
- />Astellas Pharma Inc, 2-5-1 Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8411 Japan
| | - Shunsuke Yamada
- />Astellas Pharma Inc, 2-5-1 Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8411 Japan
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Tanaka M, Hashimoto Y, Sekiya N, Honda N, Deacon S, Yamamoto M. Effects of novel cathepsin K inhibitor ONO-5334 on bone resorption markers: a study of four sustained release formulations with different pharmacokinetic patterns. J Bone Miner Metab 2014; 32:447-54. [PMID: 24114194 DOI: 10.1007/s00774-013-0517-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/11/2013] [Indexed: 12/26/2022]
Abstract
The purpose of the study was clarify the effect of the cathepsin K inhibitor ONO-5334 on bone resortion markers using sustained release (SR) formulations with different pharmacokinetic (PK) patterns, and identify the optimal SR formulation. The PK profiles and pharmacodynamic effect on bone resorption markers of 4 SR candidates formulations were evaluated in healthy postmenopausal women within a randomized, 2-part, open-label crossover study. In Part A, subject received a single dose of each formulation orally in the fed state. In Part B, two selected formulations were evaluated in the fasted state. From the results from Part A, C(max) was reduced and plasma concentrations of ONO-5334 were sustained with all SR formulations compared with an immediate release tablet. In pharmacodynamics, the level of C-terminal telopeptide of type I collagen (CTX) in serum and urine were inhibited with SR tablets rather than with granules. C max and area under the concentration-time curve from time 0 to the last measurable time point (AUC(0-t)) of SR tablets were higher than those of granules. From Part B, C max in the fasted condition was lower than that in the fed condition with two SR tablets. In contrast, C(24 h) in the fasted condition was slightly higher than that in the fed condition, but AUC(0-t) was similar. The inhibitory effect on CTX in serum and urine may depend on the PK pattern of ONO-5334. The SR tablets was well tolerated in postmenopausal women and has the optimal SR profiles on pharmacodynamics effect on bone resortion markers and PK profile. These results suggest that SR tablets of ONO-5334 are an excellent drug candidate for osteoporosis.
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Affiliation(s)
- Makoto Tanaka
- Research Promotion, Ono Pharmaceutical Co., Ltd., 3-1-1, Sakurai, Shimamoto, Osaka, 618-8585, Japan,
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