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Hatano T, Oyama G, Shimo Y, Ogaki K, Nishikawa N, Nakamura R, Tsunemi T, Ogawa T, Eguchi H, Daida K, Kurita N, Ueno SI, Fukae J, Sako W, Shiina K, Nakajima S, Oji Y, Wakamori R, Saiki S, Nishioka K, Okuzumi A, Taniguchi D, Takeshige-Amano H, Fuse A, Nakajima A, Kano M, Kamo H, Yamashita Y, Shindo A, Yanagisawa N, Hattori N. Efficacy and Safety of Elobixibat in Parkinson's Disease with Chronic Constipation: CONST-PD Study. Mov Disord Clin Pract 2024; 11:352-362. [PMID: 38264844 PMCID: PMC10982595 DOI: 10.1002/mdc3.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Chronic constipation is a common digestive complication of Parkinson's disease (PD). OBJECTIVES To verify the usefulness of elobixibat, an ileal bile acid transporter inhibitor, for chronic constipation in PD. METHODS This double-blind, placebo-controlled study consisted of a 2-week observation/washout period and a 4-week treatment period. All patients received a Bowel Movement Diary at Week -2 and were allocated to elobixibat (10 mg) or placebo at Week 0. Patients visited at Weeks 2 and 4 to report daily spontaneous bowel movements (SBM), stool form, drug use, quality of life (QOL), and safety. Changes in these parameters were assessed. RESULTS The study included 38 patients in the elobixibat group and 39 in the placebo group, and 37 each completed the study. SBM frequency/week (mean ± standard deviation) increased significantly from 4.2 ± 2.6 at baseline to 5.9 ± 3.2 at Week 4 in the elobixibat group (P = 0.0079), but not in the placebo group (4.5 ± 2.7 to 5.3 ± 3.5; P = 0.0889). On analysis of covariance, the between-group difference in frequency changes at Week 4 (primary endpoint) was not significant after adjustment by baseline and sex (point estimate = 0.8; 95% confidence interval = -0.57 to 2.09, P = 0.2601), although a significant difference (P = 0.0011) was evidenced at Week 1 by a similar analysis. Stool form and scores of satisfaction and stigma were improved by elobixibat. Adverse events were as previously reported. CONCLUSIONS Elobixibat improved the SBM frequency, though the defined primary endpoint was not evidenced. QOL parameters (stool consistency and treatment satisfaction) were also improved. Elobixibat may have therapeutic benefits in PD patients suffering from chronic constipation. TRIAL REGISTRATION INFORMATION Trial Registration Number: JPRN-jRCTs031200172 (submitted: October 26, 2020; first patient enrolment: December 23, 2020; https://jrct.niph.go.jp/en-latest-detail/jRCTs031200172).
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Affiliation(s)
- Taku Hatano
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Genko Oyama
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yasushi Shimo
- Department of Neurology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Kotaro Ogaki
- Department of Neurology, Juntendo Urayasu Hospital, Urayasu, Japan
| | - Noriko Nishikawa
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ryota Nakamura
- Department of Neurology, Juntendo Urayasu Hospital, Urayasu, Japan
| | - Taiji Tsunemi
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takashi Ogawa
- Department of Neurology, Juntendo Urayasu Hospital, Urayasu, Japan
| | - Hiroto Eguchi
- Department of Neurology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Kensuke Daida
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Naohide Kurita
- Department of Neurology, Juntendo Urayasu Hospital, Urayasu, Japan
| | - Shin-Ichi Ueno
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jiro Fukae
- Department of Neurology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Wataru Sako
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kenta Shiina
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Sho Nakajima
- Department of Neurology, Juntendo Urayasu Hospital, Urayasu, Japan
| | - Yutaka Oji
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ryo Wakamori
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shinji Saiki
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kenya Nishioka
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ayami Okuzumi
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Daisuke Taniguchi
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | - Atsuhito Fuse
- Department of Neurology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Asuka Nakajima
- Department of Neurology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Masayoshi Kano
- Department of Neurology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Hikaru Kamo
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuri Yamashita
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuhiko Shindo
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Naotake Yanagisawa
- Juntendo Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Hatano T, Oyama G, Shimo Y, Ogaki K, Nishikawa N, Fukae J, Nakamura R, Kurita N, Tsunemi T, Oji Y, Saiki S, Nishioka K, Takeshige-Amano H, Taniguchi D, Ogawa T, Kamo H, Eguchi H, Fuse A, Nakajima A, Kano M, Nakajima S, Yanagisawa N, Hattori N. Investigating the efficacy and safety of elobixibat, an ileal bile acid transporter inhibitor, in patients with Parkinson's disease with chronic constipation: a multicentre, placebo-controlled, randomised, double-blind, parallel-group stud (CONST-PD). BMJ Open 2022; 12:e054129. [PMID: 35149566 PMCID: PMC8845182 DOI: 10.1136/bmjopen-2021-054129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Chronic constipation worsens the quality of life (QOL) of patients with Parkinson's disease (PD). Elobixibat, an ileal bile acid transporter inhibitor, is a useful laxative, but its effect on chronic constipation in patients with PD remains unclear. Therefore, we designed a placebo-controlled, randomised, double-blind study to investigate the efficacy and safety of elobixibat in patients with PD with chronic constipation. METHODS AND ANALYSIS The study will consist of 2-week observation and 4-week treatment periods. Patients with clinically established PD will record the status of spontaneous bowel movements and use of rescue medications/concomitant medications in a Bowel Movement Diary from the start of the observation period at visit 1 (week -2). At visit 2 (week 0), patients will be assessed for final registration based on the diary records and physical examinations, and allocated to either the elobixibat or placebo group. Daily intake of the investigational drug will be recorded in the diary. Patients will undergo laboratory tests and answer constipation-related, PD-related and QOL-related questionnaires at visits 2 and 4 (week 4). Subjective symptoms and objective findings will be collected at visits 2, 3 (week 2) and 4. Since patients' motor function might be improved by treatment of constipation, the use of dopamine preparations will also be monitored. Bowel movement data and other parameters will be compared between groups.Safety information will be collected as adverse events, specifically focusing on those occurring in association with study conduct. ETHICS AND DISSEMINATION This study will be conducted in accordance with the Helsinki Declaration, the Clinical Trials Act of the Japan Ministry of Health, Labour and Welfare, and related laws and regulations. The study was approved by the Juntendo University Certified Review Board. The results will be disseminated through an online study registry (Japan Registry of Clinical Trials), presented at scientific conferences, and published in medical journals. TRIAL REGISTRATION NUMBER JPRN-jRCTs031200172; Pre-results.
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Affiliation(s)
- Taku Hatano
- Neurology, Juntendo Univerity Faculty of Medicine, Tokyo, Japan
| | - Genko Oyama
- Neurology, Juntendo Univerity Faculty of Medicine, Tokyo, Japan
| | | | - Kotaro Ogaki
- Neurology, Juntendo Urayasu Hospital, Urayasu, Japan
| | | | - Jiro Fukae
- Neurology, Juntendo Nerima Hospital, Tokyo, Japan
| | | | | | - Taiji Tsunemi
- Neurology, Juntendo Univerity Faculty of Medicine, Tokyo, Japan
| | - Yutaka Oji
- Neurology, Juntendo Univerity Faculty of Medicine, Tokyo, Japan
| | - Shinji Saiki
- Neurology, Juntendo Univerity Faculty of Medicine, Tokyo, Japan
| | - Kenya Nishioka
- Neurology, Juntendo Univerity Faculty of Medicine, Tokyo, Japan
| | | | | | - Takashi Ogawa
- Neurology, Juntendo Univerity Faculty of Medicine, Tokyo, Japan
| | - Hikaru Kamo
- Neurology, Juntendo Univerity Faculty of Medicine, Tokyo, Japan
| | | | | | | | | | - Sho Nakajima
- Neurology, Juntendo Urayasu Hospital, Urayasu, Japan
| | - Naotake Yanagisawa
- Juntendo Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
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Ura K, Yamada K, Tsujimoto T, Ukeba D, Iwasaki N, Sudo H. Ultra-purified alginate gel implantation decreases inflammatory cytokine levels, prevents intervertebral disc degeneration, and reduces acute pain after discectomy. Sci Rep 2021; 11:638. [PMID: 33436742 PMCID: PMC7804289 DOI: 10.1038/s41598-020-79958-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022] Open
Abstract
Lumbar intervertebral disc (IVD) herniation causes severe low back pain (LBP), which results in substantial financial and emotional strains. Despite the effectiveness of discectomy, there is no existing treatment for post-operative LBP induced by progressive IVD degeneration. Two key factors of LBP are intradiscal inflammation, indicated by tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6), and sensory nerve ingrowth into the inner layer of the annulus fibrosus, triggered by nerve growth factor/high-affinity tyrosine kinase A (TrkA) signalling. In an animal models of discectomy, the bioresorbable ultra-purified alginate (UPAL) gel with an extremely low-toxicity has been effective in acellular tissue repair. We aimed to investigate whether UPAL gel can alleviate LBP using a rat nucleus pulposus (NP) punch model and a rabbit NP aspirate model. In both models, we assessed TNF-α and IL-6 production and TrkA expression within the IVD by immunohistochemistry. Further, histological analysis and behavioural nociception assay were conducted in the rat model. UPAL gel implantation suppressed TNF-α and IL-6 production, downregulated TrkA expression, inhibited IVD degeneration, and reduced nociceptive behaviour. Our results suggest the potential of UPAL gel implantation as an innovative treatment for IVD herniation by reducing LBP and preventing IVD degeneration after discectomy.
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Affiliation(s)
- Katsuro Ura
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Katsuhisa Yamada
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan.
| | - Takeru Tsujimoto
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Daisuke Ukeba
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan.
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