Vericiguat: a QTc interval study in patients with coronary artery disease

Background

Vericiguat is a soluble guanylate cyclase stimulator developed for the treatment of symptomatic chronic heart failure (HF) in adult patients with ejection fraction less than 45% who had a previous decompensation event. Guidelines on QT studies recommend evaluation of investigational drugs at supratherapeutic exposures in healthy volunteers. We anticipated that supratherapeutic doses of vericiguat would decrease blood pressure. We conducted an adjusted QT study using the therapeutic range of vericiguat in patients with coronary artery disease (CAD), who were expected to be more haemodynamically stable with fewer confounders (e.g., on the electrocardiogram) than a HF population.

Purpose

To assess the effect of vericiguat 10 mg once-daily on placebo-adjusted change from baseline of the Fridericia-corrected QT interval (QTcF) in patients with stable CAD.

Methods

This was a randomised, Phase Ib, placebo-controlled, double blind, double-dummy, multicentre study (NCT03504982). Test drug was vericiguat once-daily (up-titrated from 2.5 mg to 5 mg and then to 10 mg [treatments A, B, C] at 14-day intervals). The positive control was moxifloxacin 400 mg (single dose on Day 8 or Day 50 with placebo on other days [treatment D]; Figure). Patients were randomised to one of two sequences.

We evaluated QTcF interval prolongation potential of vericiguat at increasing doses up to 10 mg, steady state. We investigated the pharmacokinetics, safety and tolerability of vericiguat. A clinically meaningful effect was defined as a QTcF change from baseline >10 ms relative to placebo. Assay sensitivity for moxifloxacin was confirmed by the lower limit of the 90% confidence interval (CI) of the time-matched, baseline-adjusted mean difference to placebo exceeding 5 ms at >1 time point.

Results

A total of 74 patients (66 males and 8 females) with CAD, mean (standard deviation) age 63.4 (8.0) years, were included. Mean difference between vericiguat and placebo in QTcF change from baseline (≤7 h post-dose) was <6 ms; no upper limit of the 90% CIs crossed the threshold of 10 ms. Lower limits of the two-sided 90% CI of the differences between moxifloxacin and placebo in QTcF change from baseline were >5 ms at 3 of 4 time points (Table).

Peak plasma concentration (Cmax) of vericiguat following administration of vericiguat 10 mg was 322 μg/l and median time of maximum concentration (Tmax) was 4.5 h post-dose, in line with concentrations observed following administration of vericiguat 10 mg to patients with HF [1]. For moxifloxacin 400 mg, Cmax was 1960 μg/l and median Tmax was 3 h post-dose, in line with previously reported values [2]. Vericiguat up to 10 mg was generally safe and well tolerated.

Conclusion

This study supports the assessment that administration of vericiguat 10 mg is not associated with clinically meaningful QTc prolongation. These data contribute to the overall safety profile of vericiguat for the treatment of patients with HF.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Funding was provided by Bayer AG, Berlin, Germany, and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA QTc study design

Abediterol (LAS100977), a novel long-acting β2-agonist: efficacy, safety and tolerability in persistent asthma

BACKGROUND

Abediterol (LAS100977) is a novel, long-acting β2-agonist, in development for the once-daily treatment of asthma in combination with mometasone. Here we report the results of a Phase IIa trial of single doses of abediterol added to ongoing maintenance therapy (inhaled corticosteroids) in patients with persistent mild-to-moderate asthma.

METHODS

This was a randomised, double-blind, placebo- and active-comparator-controlled, five-way crossover study. Male patients (18-70 years) with a clinical diagnosis of persistent asthma received abediterol (5, 10 and 25 μg), salmeterol and placebo, on top of ongoing maintenance therapy. Lung function was determined using spirometry and whole body plethysmography. The primary efficacy endpoint was change from baseline in trough forced expiratory volume in 1 s (FEV1) after a single dose.

RESULTS

All three abediterol doses induced statistically significant increases in trough FEV1 vs placebo and salmeterol. Improvements in other lung function parameters were also statistically significantly greater with all abediterol doses vs both placebo (p < 0.0001) and salmeterol (p < 0.05) than the first assessment at 5 min post-dose. These improvements were sustained to 36 h post-dose. The profile of treatment-emergent adverse events judged as related to abediterol was consistent with that seen after adrenergic stimulation and occurred exclusively in patients who received abediterol 10 μg or 25 μg.

CONCLUSIONS

This first-in-patient study revealed the potent, rapid and long-acting bronchodilatory effect of abediterol in patients with persistent mild-to-moderate asthma together with an overall good safety and tolerability profile. Further studies are now underway to establish the optimal efficacy-safety-tolerability profile for this compound.

Effects of JNJ-40929837, a leukotriene A4 hydrolase inhibitor, in a bronchial allergen challenge model of asthma

Leukotriene B4 (LTB4) is a chemotactic mediator implicated in the pathogenesis of asthma. JNJ-40929837 is an oral inhibitor of LTA4 hydrolase, which catalyzes LTB4 production. We evaluated the effects of JNJ-40929837 in a human bronchial allergen challenge (BAC) model. In this double-blind, 3-period crossover study, 22 patients with mild, atopic asthma were randomized to one of three treatments per period: 100 mg/day JNJ-40929837 for 6 days followed by 50 mg/day on day 7; 10 mg/day montelukast for 6 days; and matched placebo. The BAC was performed on day 6 of each treatment period. Primary outcome was BAC-induced late asthmatic response (LAR) measured by maximal percent reduction in forced expiratory volume (FEV1) in one second. Secondary outcomes included early asthmatic response (EAR) by maximal percent reduction in FEV1, EAR and LAR evaluated by area under the FEV1/time curve (AUC0-2, AUC3-10, respectively), change in baseline FEV1 after 5-day treatment, safety, and correlation of JNJ-40929837 to the divalent cation ionophore A23187-stimulated whole blood LTB4 levels and sputum basal LTB4 levels. No significant differences were observed in the primary or secondary FEV1 endpoints with JNJ-40929837 versus placebo. Compared with placebo (n = 17, LS mean = 27.7), there was no significant attenuation of the maximal percent reduction in the LAR FEV1 with JNJ-40929837 (n = 16, LS mean = 28.6, P = 0.63) but montelukast (n = 17, LS mean = 22.6, P = 0.01) significantly attenuated the LAR. JNJ-40929837 substantially inhibited LTB4 production in whole blood, decreased sputum LTB4 levels and was well-tolerated. The number of adverse events leading to study withdrawal was the same in JNJ-40929837 and placebo groups. In conclusion, JNJ-40929837 demonstrated target engagement in blood and sputum. No significant impact in response to allergen inhalation was observed with JNJ-40929837 versus placebo.

REGISTRATION

This study is registered at ClinicalTrials.gov: NCT01241422.

[Results of autologous blood donation in orthopedic hip and knee joint replacement]

OBJECTIVE

This study was undertaken to investigate the efficiency of autologous blood donation (ABD) with regard to saving of homologous transfusion, to determine the reasons for exclusion from donations and the rate of incidents during the procedure, and to investigate the quality of autologous fresh frozen plasma (AFFP).

METHODS

During an observation period of 4.5 years, all patients scheduled for elective orthopaedic hip and knee replacement were included. A period of 4 years was evaluated retrospectively, and the last half year was evaluated prospectively.

RESULTS

Among a collective of 710 patients, 55 (8%) non-donors and 655 (92%) donors with a total number of 1592 ABD were found. Mean age of non-donors with hip surgery was significantly higher than that of donors (72 vs. 64 years), the same was observed in patients with knee surgery (71 vs. 68 years). In the hip surgery group, 11 of 338 patients were non-donors (3%), compared with 44 of 372 patients with knee surgery (12%). In the prospective part of the study, 7% of 121 patients were non-donors. Reasons for exclusion from donation were 5 times of medical and 4 times of organisational nature. In donors for hip surgery, a mean of 3.0 units was collected, compared with 1.9 units in donors for knee surgery. On the day before operation, mean haemoglobin concentrations were similar in donors and non-donors. During ABD, 11 incidents were observed, representing 0.69% of all ABD, 83.5% of 327 donors with hip surgery left the hospital without any transfusion of homologous blood, 16.5 of donors with hip surgery received one or more homologous transfusions, compared with 100% of non-donors (p < 0.001). In knee surgery, 93.3% of donors and 63.6% of non-donors required no homologous blood, whereas 6.7% of donors and 36.4% of non-donors received one or more homologous transfusions (p < 0.001). 529 of 2850 autologous blood units (19%) were not transfused, and 19 of these units were rejected due to technical or organisational problems. In 97 patients with 240 ABD and 240 AFFP, prothrombine time, fibrinogen concentration and AT III in defrosted AFFP exceeded 70% of the values determined before ABD.

CONCLUSION

ABD is a safe procedure in almost all, even elderly, patients scheduled for elective orthopaedic hip or knee replacement in both types of operations, ABD reduces the risk of homologous transfusion significantly. A number of 3-4 units is necessary for total hip replacement, whereas 2 units are sufficient for partial or total knee replacement. Haemostatic quality of AFFP meets the requirements of fresh frozen homologous plasma.

Systematic desensitization and relaxation as adjuncts in the treatment of anorexia nervosa: a preliminary study

This preliminary work assessed the effectiveness of systematic desensitization and relaxation training as adjuncts in the treatment of anorexia nervosa. All subjects (18 female anorexics) received behavioral contracting and supportive psychotherapy from the same psychiatrist. Seven were randomly assigned to receive either desensitization ( n = 4) or relaxation training ( n = 3) as an adjunctive treatment. Data on the 11 subjects without adjunctive treatment came from closed case files. Contrary to prediction, all significant differences in outcome favored use of relaxation. Relaxation was associated with higher self-esteem and less fear of fat than desensitization was at the 6-mo. follow-up and relaxation was associated with much better outcome at 18 mo. than were desensitization or no adjunctive treatment. Anorexia appears to differ from classical phobias in two ways, which may explain the unexpected effectiveness of relaxation training.

[Compatibility and efficacy of Meditonsin]

Heavy metals, including mercury, have recently been in discussion in connection with ecology and therapy. As Meditonsin represents a 0,004% solution of mercury cyanide the following were investigated: absorption, excretion, effect on the kidneys and the chemical behaviour of mercury cyanide and other mercury salts as well as the antimicrobial effectivity in in vitro tests. With the dose recommended for adults neither an increase of mercury ions nor an increased excretion of these could be detected in the blood or the urine respectively. Even in minimal inhibitory concentrations Meditonsin is characterised in the in vitro tests by an excellent antimicrobial effect.