Pasireotide can induce sustained decreases in urinary cortisol and provide clinical benefit in patients with Cushing’s disease: results from an open-ended, open-label extension trial

International audiencePurpose Report the efficacy and safety of pasireotide sc in patients with Cushing's disease during an open-ended, open-label extension to a randomized, double-blind, 12-month, Phase III study. Methods 162 patients entered the core study. 58 patients who had mean UFC B ULN at month 12 or were bene-fiting clinically from pasireotide entered the extension. Patients received the same dose of pasireotide as at the end of the core study (300–1,200 lg bid). Dose titration was permitted according to efficacy or drug-related adverse events. Results 40 patients completed 24 months' treatment. Of the patients who entered the extension, 50.0 % (29/58) and 34.5 % (20/58) had controlled UFC (UFC B ULN) at months 12 and 24, respectively. The mean percentage decrease in UFC was 57.3 % (95 % CI 40.7–73.9; n = 52) and 62.1 % (50.8–73.5; n = 33) after 12 and 24 months' treatment, respectively. Improvements in clinical signs of Cushing's disease were sustained up to month 24. The most frequent drug-related adverse events in patients who received C1 dose of pasireotide (n = 162) from core baseline until the 24-month cut-off were diarrhea (55.6 %), nausea (48.1 %), hyperglycemia (38.9 %), and cholelithi-asis (31.5 %). No new safety issues were identified during the extension. Conclusions Reductions in mean UFC and improvements in clinical signs of Cushing's disease were maintained over 24 months of pasireotide treatment. The safety profile of pasireotide is typical for a somatostatin analogue, except for the frequency and degree of hyperglycemia; patients should be monitored for changes in glucose homeostasis. Pasireotide represents the first approved pituitary-targeted treatment for patients with Cushing's disease.-1) contains supplementary material, which is available to authorized users

Efficacy and safety of omalizumab in nasal polyposis : 2 randomized phase 3 trials

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by IgE hyperproduction and eosinophilic inflammation. The anti-IgE antibody, omalizumab, has demonstrated efficacy in patients with CRSwNP and comorbid asthma previously. Objective: Our aim was to determine omalizumab safety and efficacy in CRSwNP in phase 3 trials (POLYP 1 and POLYP 2). Methods: Adults with CRSwNP with inadequate response to intranasal corticosteroids were randomized (1:1) to omalizumab or placebo and intranasal mometasone for 24 weeks. Coprimary end points included change from baseline to week 24 in Nasal Polyp Score (NPS) and Nasal Congestion Score. Secondary end points included change from baseline to week 24 in Sino-Nasal Outcome Test-22 (SNOT-22) score, University of Pennsylvania Smell Identification Test, sense of smell, postnasal drip, runny nose, and adverse events. Results: Patients in POLYP 1 (n = 138) and POLYP 2 (n = 127) exhibited severe CRSwNP and substantial quality of life impairment evidenced by a mean NPS higher than 6 and SNOT-22 score of approximately 60. Both studies met both the coprimary end points. SNOT-22 score, University of Pennsylvania Smell Identification Test score, sense of smell, postnasal drip, and runny nose were also significantly improved for omalizumab versus placebo. In POLYP 1 and POLYP 2, the mean changes from baseline at week 24 for omalizumab versus placebo were as follows: NPS, -1.08 versus 0.06 (P < .0001) and - 0.90 versus -0.31 (P = .0140); Nasal Congestion Score, -0.89 versus -0.35 (P = .0004) and -0.70 versus -0.20 (P = .0017); and SNOT-22 score, -24.7 versus -8.6 (P < .0001) and -21.6 versus - 6.6 (P < .0001). Adverse events were similar between groups. Conclusion: Omalizumab significantly improved endoscopic, clinical, and patient-reported outcomes in severe CRSwNP with inadequate response to intranasal corticosteroids, and it was well tolerated

ASSESSMENT OF ETHNIC DIFFERENCES IN THE PHARMACOKINETICS OF VALSARTAN

In this study, the potential for ethnic differences in the pharmacokinetics and pharmacodynamics of valsartan between Japanese and Caucasian subjects was assessed. This was an open-label, parallel design study conducted in age and body weight matched healthy male Japanese (n=15) and Caucasian (n=15) subjects. All subjects received a single oral dose of 160 mg valsartan capsule, and the plasma levels of valsartan, aldosterone, and angiotensin II along with plasma renin activity (PRA) were determined at pre-determined time intervals post-dosing. The time to reach peak plasma concentrations of valsartan (Tmax) was in the range of 1–6 h in both groups. The mean Cmax of valsartan was 3.3 and 3.5 µg/mL in Japanese and Caucasian subjects, respectively, and the corresponding mean plasma exposure (AUC0-∞) values were 23.0 and 23.8 µg.h/mL. The mean elimination half-life (t1/2) of valsartan was 7.7 and 9.6 h in Japanese and Caucasian subjects, respectively. No significant difference (p>0.1) was found between two ethnic groups for PRA, angiotensin II and aldosterone at 2, 4 and 8 h post dose. In conclusion, pharmacokinetics and pharmacodynamics of valsartan were not found to be ethnic sensitive between healthy male Caucasian and Japanese subjects following single oral dose administration of valsartan

Effect of food on the pharmacokinetics of a vildagliptin/metformin (50/1000 mg) fixed-dose combination tablet in healthy volunteers.

OBJECTIVE: Vildagliptin is an orally active, potent and selective DPP-4 inhibitor that improves glycemic control in patients with type 2 diabetes by increasing alpha- and beta-cell responsiveness to glucose. RESEARCH DESIGN AND METHODS: This open-label, single-center, randomized, two-period crossover study in healthy subjects (n=23) ages 18-45 years investigated the effect of food on the pharmacokinetics of vildagliptin and metformin following administration of a vildagliptin/metformin (50/1000 mg) fixed-dose combination tablet. RESULTS: Administration of the fixed-dose combination tablet following a high-fat meal had no effect on vildagliptin AUC(0-infinity) (ratio of geometric mean for fed:fasted state, 1.10 [90% CI 1.03, 1.18]), C(max) (ratio of means 0.98 [90% CI 0.85, 1.13]) or median t(max) (2.5 h in fed and fasted states). The rate of absorption of metformin was decreased when given with food, as reflected by the prolonged t(max) (2-4 h) and reduction in C(max) (by 26%), but the extent of absorption was not changed. The food effect on the metformin component of the fixed-dose combination tablets was consistent with, but of a lesser magnitude compared with data stated. CONCLUSIONS: The vildagliptin/metformin (50/1000 mg) fixed-dose combination tablet can be administered in the same manner as metformin, and can be recommended to be taken with meals to reduce the gastrointestinal symptoms associated with metformin

Effect of food on the oral bioavailability of amlodipine/valsartan and amlodipine/valsartan/hydrochlorothiazide fixed dose combination tablets in healthy subjects

Amlodipine (calcium channel blocker), valsartan (angiotensin receptor blocker) and hydrochlorothiazide (HCTZ, a diuretic) are antihypertensive drugs available as monotherapies. A double fixed dose combination of amlodipine/valsartan and triple fixed dose combination of amlodipine/valsartan/HCTZ tablets have been developed to treat patients with moderate to severe hypertension. In this paper, the effect of food on the oral bioavailability of these two fixed dose combination tablets is presented. Two separate clinical studies were conducted in healthy subjects with each fixed dose combination product using a randomized, open-label, two-period crossover study design with a washout period of at least 14 days. In the study with amlodipine/valsartan combination tablet, a total of 37 healthy male and female subjects received a single 10/160 mg oral dose under fasted or fed conditions. In the study of amlodipine/valsartan/HCTZ tablet, a total of 35 subjects received a single 10/320/25 mg oral dose under fasted or fed conditions. Blood samples were collected at pre-determined time points (predose and up to 168 hours post-dose) in both studies to determine amlodipine, valsartan and/or HCTZ concentrations in plasma simultaneously by a validated LC/MS/MS methods. The PK parameters tmax, Cmax, AUC0-t and AUC0-∞ of these analytes were estimated by non-compartmental analysis. The study results were interpreted based on geometric mean ratios (90% CI) between fed and fasted conditions. Following single dose oral administration of 10/160 mg amlodipine/valsartan fixed combination tablet, amlodipine and valsartan AUCs were comparable between the fed and fasting conditions while the valsartan Cmax was decreased slightly by 14% under fed conditions. The bioavailability of amlodipine, valsartan and HCTZ was similar under fed and fasting conditions following a single dose oral administration of 10/320/25 mg amlodipine/valsartan/HCTZ fixed combination tablet. In conclusion, both fixed dose combination tablets can be administered without regards to meals. Key Words: Amlodipine, valsartan and hydrochlorothiazide (HCTZ), fixed dose combination, food effec