BAREMSIS Now Shown to Treat PONV, as Well as Prevent it
CAMBRIDGE, UK I August 12, 2016 I Acacia Pharma Group plc (“Acacia Pharma”), the supportive care company developing products for US and international markets, announces positive results from a pivotal Phase 3 study investigating BAREMSIS™ (amisulpride injection, formerly APD421) for the treatment of established post-operative nausea & vomiting (“PONV”). These data further support the efficacy of BAREMSIS which has previously been shown to prevent PONV alone, and in combination with standard anti-emetics in pivotal Phase 3 prophylaxis studies.
Dr Julian Gilbert, Acacia Pharma’s CEO commented: “We are delighted with these data demonstrating that BAREMSIS is safe and effective at treating patients suffering PONV after surgery. It confirms our confidence in the dopamine antiemetic mechanism of action, and that BAREMSIS is effective at treating, as well as preventing, PONV. Our objective is to seek approval for BAREMSIS for the treatment and prophylaxis of PONV alone and in combination, which will provide us with a broad and unique label once approved. No other antiemetic has a PONV treatment claim following failed prophylaxis with standard antiemetics and no other antiemetic has a combination use claim in PONV prophylaxis.”
This Phase 3 treatment trial compared two doses of BAREMSIS, a novel dopamine D2/D3 antagonist antiemetic, against placebo in patients with established nausea and/or vomiting after surgery, who had not previously received any prophylactic antiemetics. The study took place in leading institutions in the USA, Canada, France and Germany and recruited 568 patients. The primary endpoint was the successful resolution of the episode of PONV (no recurrence of vomiting or requirement for further antiemetic rescue) in the 24-hour period after treatment, termed a complete response. Both doses of BAREMSIS significantly improved the complete response rate when compared to placebo (p<0.025), the magnitude of effect was consistent with previous trial results. Detailed data will be presented in due course at relevant scientific meetings and submitted for publication in a peer-reviewed journal.
A second pivotal Phase 3 treatment study of BAREMSIS in surgical patients who develop PONV despite receiving prior prophylaxis is ongoing. Acacia Pharma has already shown BAREMSIS prevents PONV in pivotal Phase 3 prophylaxis studies, alone and in combination with other antiemetics. The results from these studies, along with the results announced today, will complete the efficacy package Acacia Pharma aims to submit to the US FDA as part of its New Drug Application (NDA), looking to gain approval for BAREMSIS for the treatment and prophylaxis of PONV alone and in combination.
NOTES TO EDITORS
About Acacia Pharma
Acacia Pharma is developing supportive care product opportunities for post-surgical and cancer patients. Patients and healthcare professionals urgently need new and improved interventions in these rapidly expanding, yet poorly served, areas of supportive care, to improve treatment outcomes and patients’ quality of life.
Acacia Pharma has generated its pipeline of product opportunities using a commercially driven approach to product discovery, identifying completely new uses for marketed drugs, a process termed repurposing. This strategy leads to opportunities with a higher probability of success and enables more rapid development. All of Acacia Pharma’s repurposed programmes are optimised for their new use, by using a new route of delivery and dose that are appropriate for the new indication identified, thereby differentiating them from the original marketed product.
The lead project, BAREMSIS for post-operative nausea & vomiting (PONV), has generated positive results in Phase 3 clinical studies. Its sister project, APD403 for chemotherapy induced nausea & vomiting (CINV) has successfully completed one Phase 2 dose-ranging study in patients receiving highly emetogenic chemotherapy. In addition, the company has completed a Phase 2 study with APD515 for xerostomia (dry mouth) in advanced cancer patients and a Phase 2a study with APD209 for cancer cachexia (muscle wasting).
Acacia Pharma, is led by an experienced management team. Management, Gilde Healthcare, Lundbeckfonden Ventures, Novo A/S and F-Prime Capital are the Company’s key shareholders. Acacia Pharma is based in Cambridge, UK and has US operations in Indianapolis, IN. http://www.acaciapharma.com
About BAREMSIS
BAREMSIS (formerly APD421) comprises a low dose intravenous formulation of the marketed dopamine antagonist amisulpride, which Acacia Pharma has repurposed for the completely new, patent-protected use of management of PONV. Amisulpride is currently indicated for the management of psychoses, and is given at high doses in oral form. Amisulpride is not available for any use in the US.
Data generated by Acacia Pharma indicate that BAREMSIS is an effective, safe, dopamine antagonist. The company believes that a drug with these characteristics can be used prophylactically in combination with 5HT3 antagonists and/or corticosteroids in the highest risk patients and to rescue patients that have not responded to PONV prophylaxis with a 5HT3 antagonist alone or in combination.
Acacia Pharma is also developing APD403, with the same active ingredient, amisulpride, as in BAREMSIS, for the prevention of chemotherapy-induced nausea & vomiting (“CINV”).
About PONV
PONV
Post-operative nausea & vomiting (PONV) is a common complication of surgery which is distressing to patients and increases healthcare costs. In untreated patients, the incidence of vomiting is ~30%, the incidence of nausea is ~50% and the PONV rate in high-risk surgical patients is up to 80%[1]. PONV is reported by patients as one of the most troublesome of all post-operative complications[2].
PONV can lead to prolonged discharge times and unanticipated hospital admissions (increasing healthcare costs)[1] and to the possibility of reduced healthcare provider income as a consequence of Medicare’s Hospital Readmissions Reduction Program and the pay-for- performance payment system in the Hospital Value-Based Purchasing (VBP) Program, in the US[3]. The objective of PONV management, therefore, is to decrease the incidence of PONV, reducing patients’ length of stay in the hospital, particularly the post-anaesthesia care unit (PACU), and avoiding hospital readmission, thereby reducing healthcare costs; and reducing patient distress, improving overall satisfaction, thereby optimising provider income through improved patient outcomes.
PONV risk factors
A simplified risk scoring system has been developed by Apfel et al to assess the risk of PONV in surgical patients[4]. The four “Apfel risk factors” are:
- Being female
- Being a non-smoker
- Having a prior history of PONV or motion sickness
- An expected use of post-operative opioid analgesia.
Each of these four risk factors independently contributes around 20% risk of PONV. Patients with two “Apfel risk factors” are considered at moderate risk of PONV, while those with three or four are considered at high risk. A patient with all four risk factors has up to an 80% chance of PONV in the absence of effective prophylaxis.
Guidelines for the management of PONV
Prophylaxis
It is recommended that surgical patients are prescribed prophylactic antiemetics alone or in combination, according to their risk of PONV. Those considered at moderate risk of PONV should be given at least one prophylactic antiemetic and those at high risk of PONV, should be given multiple antiemetics of different mechanisms of action to optimise efficacy[1].
Rescue
It is recommended that when a patient who has received antiemetic prophylaxis suffers PONV, an antiemetic from a different mechanism of action to that given prophylactically, is used to provide rescue treatment[1]. Repeating the mechanism given prophylactically confers no additional benefit[5].
Current management of PONV
Two classes of drugs are predominantly used for the management of PONV: 5HT3 antagonists (eg ondansetron); and corticosteroids (eg dexamethasone). Ondansetron and dexamethasone have been investigated in many clinical studies and generally deliver a relative risk reduction (RRR) in the incidence of PONV of 15-30%[2],[ 6],[ 7].
Prophylaxis
The majority of surgical patients receiving prophylaxis are given a 5HT3 antagonist alone or in combination with a corticosteroid[8]. However, Acacia Pharma believes that drug choices are limited in the highest risk patients where a third antiemetic of a different mechanism is required.
Rescue
Up to 40% of patients experience PONV, requiring rescue medication, despite the routine use of prophylactic antiemetics[2]. The majority of surgical patients have been given a prophylactic 5HT3 antagonist[8] therefore precluding their use for rescue[1]. Dexamethasone (a corticosteroid) has a slow onset of action and is not recommended for rescue[1]. Therefore Acacia Pharma believes antiemetic choices for rescue are extremely limited.
Unmet need for a dopamine antagonist for PONV
Droperidol (a dopamine antagonist) was previously considered the drug of choice for PONV management until it received a boxed warning for QT-interval prolongation[9]. A boxed warning is the most serious form of warning issued by the U.S. Food and Drug Administration for prescription drug products. The boxed warning and concerns about its side effect profile have severely limited the use of droperidol as an antiemetic[8].
Therefore there is currently no safe, effective, dopamine antagonist antiemetic available for anaesthetists to:
- Add to the most prevalent prophylactic regimen of a 5HT3 antagonist plus a corticosteroid, in the highest risk patients.
- Rescue patients having previously been given prophylaxis with a 5HT3 antagonist (alone or in combination).
[1]Gan et al, Anesthesia & Analgesia (2014) 118 1 85-113
[2]Apfel et al, N Engl J Med (2004) 350 2441-51
[3]http://www.medicare.gov/hospitalcompare/linking-quality-to-payment.html
[4]Apfel et al, Anesthesiology (1999) 91 109-118
[5]Kovac et al, J Clin Anesth (1999) 11 453-459
[6]Fortney et al, Anesthesia & Analgesia (1998) 86 731-738
[7]Gan et al. Anesthesia & Analgesia (2011) 112 4 804-812
[8]Habib & Gan, J Clin Anesth (2008) 20 35-39
[9]Gan et al, Anesthesia & Analgesia (2007) 105 6 1615-1628
SOURCE: Acacia Pharma
Post Views: 97
BAREMSIS Now Shown to Treat PONV, as Well as Prevent it
CAMBRIDGE, UK I August 12, 2016 I Acacia Pharma Group plc (“Acacia Pharma”), the supportive care company developing products for US and international markets, announces positive results from a pivotal Phase 3 study investigating BAREMSIS™ (amisulpride injection, formerly APD421) for the treatment of established post-operative nausea & vomiting (“PONV”). These data further support the efficacy of BAREMSIS which has previously been shown to prevent PONV alone, and in combination with standard anti-emetics in pivotal Phase 3 prophylaxis studies.
Dr Julian Gilbert, Acacia Pharma’s CEO commented: “We are delighted with these data demonstrating that BAREMSIS is safe and effective at treating patients suffering PONV after surgery. It confirms our confidence in the dopamine antiemetic mechanism of action, and that BAREMSIS is effective at treating, as well as preventing, PONV. Our objective is to seek approval for BAREMSIS for the treatment and prophylaxis of PONV alone and in combination, which will provide us with a broad and unique label once approved. No other antiemetic has a PONV treatment claim following failed prophylaxis with standard antiemetics and no other antiemetic has a combination use claim in PONV prophylaxis.”
This Phase 3 treatment trial compared two doses of BAREMSIS, a novel dopamine D2/D3 antagonist antiemetic, against placebo in patients with established nausea and/or vomiting after surgery, who had not previously received any prophylactic antiemetics. The study took place in leading institutions in the USA, Canada, France and Germany and recruited 568 patients. The primary endpoint was the successful resolution of the episode of PONV (no recurrence of vomiting or requirement for further antiemetic rescue) in the 24-hour period after treatment, termed a complete response. Both doses of BAREMSIS significantly improved the complete response rate when compared to placebo (p<0.025), the magnitude of effect was consistent with previous trial results. Detailed data will be presented in due course at relevant scientific meetings and submitted for publication in a peer-reviewed journal.
A second pivotal Phase 3 treatment study of BAREMSIS in surgical patients who develop PONV despite receiving prior prophylaxis is ongoing. Acacia Pharma has already shown BAREMSIS prevents PONV in pivotal Phase 3 prophylaxis studies, alone and in combination with other antiemetics. The results from these studies, along with the results announced today, will complete the efficacy package Acacia Pharma aims to submit to the US FDA as part of its New Drug Application (NDA), looking to gain approval for BAREMSIS for the treatment and prophylaxis of PONV alone and in combination.
NOTES TO EDITORS
About Acacia Pharma
Acacia Pharma is developing supportive care product opportunities for post-surgical and cancer patients. Patients and healthcare professionals urgently need new and improved interventions in these rapidly expanding, yet poorly served, areas of supportive care, to improve treatment outcomes and patients’ quality of life.
Acacia Pharma has generated its pipeline of product opportunities using a commercially driven approach to product discovery, identifying completely new uses for marketed drugs, a process termed repurposing. This strategy leads to opportunities with a higher probability of success and enables more rapid development. All of Acacia Pharma’s repurposed programmes are optimised for their new use, by using a new route of delivery and dose that are appropriate for the new indication identified, thereby differentiating them from the original marketed product.
The lead project, BAREMSIS for post-operative nausea & vomiting (PONV), has generated positive results in Phase 3 clinical studies. Its sister project, APD403 for chemotherapy induced nausea & vomiting (CINV) has successfully completed one Phase 2 dose-ranging study in patients receiving highly emetogenic chemotherapy. In addition, the company has completed a Phase 2 study with APD515 for xerostomia (dry mouth) in advanced cancer patients and a Phase 2a study with APD209 for cancer cachexia (muscle wasting).
Acacia Pharma, is led by an experienced management team. Management, Gilde Healthcare, Lundbeckfonden Ventures, Novo A/S and F-Prime Capital are the Company’s key shareholders. Acacia Pharma is based in Cambridge, UK and has US operations in Indianapolis, IN. http://www.acaciapharma.com
About BAREMSIS
BAREMSIS (formerly APD421) comprises a low dose intravenous formulation of the marketed dopamine antagonist amisulpride, which Acacia Pharma has repurposed for the completely new, patent-protected use of management of PONV. Amisulpride is currently indicated for the management of psychoses, and is given at high doses in oral form. Amisulpride is not available for any use in the US.
Data generated by Acacia Pharma indicate that BAREMSIS is an effective, safe, dopamine antagonist. The company believes that a drug with these characteristics can be used prophylactically in combination with 5HT3 antagonists and/or corticosteroids in the highest risk patients and to rescue patients that have not responded to PONV prophylaxis with a 5HT3 antagonist alone or in combination.
Acacia Pharma is also developing APD403, with the same active ingredient, amisulpride, as in BAREMSIS, for the prevention of chemotherapy-induced nausea & vomiting (“CINV”).
About PONV
PONV
Post-operative nausea & vomiting (PONV) is a common complication of surgery which is distressing to patients and increases healthcare costs. In untreated patients, the incidence of vomiting is ~30%, the incidence of nausea is ~50% and the PONV rate in high-risk surgical patients is up to 80%[1]. PONV is reported by patients as one of the most troublesome of all post-operative complications[2].
PONV can lead to prolonged discharge times and unanticipated hospital admissions (increasing healthcare costs)[1] and to the possibility of reduced healthcare provider income as a consequence of Medicare’s Hospital Readmissions Reduction Program and the pay-for- performance payment system in the Hospital Value-Based Purchasing (VBP) Program, in the US[3]. The objective of PONV management, therefore, is to decrease the incidence of PONV, reducing patients’ length of stay in the hospital, particularly the post-anaesthesia care unit (PACU), and avoiding hospital readmission, thereby reducing healthcare costs; and reducing patient distress, improving overall satisfaction, thereby optimising provider income through improved patient outcomes.
PONV risk factors
A simplified risk scoring system has been developed by Apfel et al to assess the risk of PONV in surgical patients[4]. The four “Apfel risk factors” are:
- Being female
- Being a non-smoker
- Having a prior history of PONV or motion sickness
- An expected use of post-operative opioid analgesia.
Each of these four risk factors independently contributes around 20% risk of PONV. Patients with two “Apfel risk factors” are considered at moderate risk of PONV, while those with three or four are considered at high risk. A patient with all four risk factors has up to an 80% chance of PONV in the absence of effective prophylaxis.
Guidelines for the management of PONV
Prophylaxis
It is recommended that surgical patients are prescribed prophylactic antiemetics alone or in combination, according to their risk of PONV. Those considered at moderate risk of PONV should be given at least one prophylactic antiemetic and those at high risk of PONV, should be given multiple antiemetics of different mechanisms of action to optimise efficacy[1].
Rescue
It is recommended that when a patient who has received antiemetic prophylaxis suffers PONV, an antiemetic from a different mechanism of action to that given prophylactically, is used to provide rescue treatment[1]. Repeating the mechanism given prophylactically confers no additional benefit[5].
Current management of PONV
Two classes of drugs are predominantly used for the management of PONV: 5HT3 antagonists (eg ondansetron); and corticosteroids (eg dexamethasone). Ondansetron and dexamethasone have been investigated in many clinical studies and generally deliver a relative risk reduction (RRR) in the incidence of PONV of 15-30%[2],[ 6],[ 7].
Prophylaxis
The majority of surgical patients receiving prophylaxis are given a 5HT3 antagonist alone or in combination with a corticosteroid[8]. However, Acacia Pharma believes that drug choices are limited in the highest risk patients where a third antiemetic of a different mechanism is required.
Rescue
Up to 40% of patients experience PONV, requiring rescue medication, despite the routine use of prophylactic antiemetics[2]. The majority of surgical patients have been given a prophylactic 5HT3 antagonist[8] therefore precluding their use for rescue[1]. Dexamethasone (a corticosteroid) has a slow onset of action and is not recommended for rescue[1]. Therefore Acacia Pharma believes antiemetic choices for rescue are extremely limited.
Unmet need for a dopamine antagonist for PONV
Droperidol (a dopamine antagonist) was previously considered the drug of choice for PONV management until it received a boxed warning for QT-interval prolongation[9]. A boxed warning is the most serious form of warning issued by the U.S. Food and Drug Administration for prescription drug products. The boxed warning and concerns about its side effect profile have severely limited the use of droperidol as an antiemetic[8].
Therefore there is currently no safe, effective, dopamine antagonist antiemetic available for anaesthetists to:
- Add to the most prevalent prophylactic regimen of a 5HT3 antagonist plus a corticosteroid, in the highest risk patients.
- Rescue patients having previously been given prophylaxis with a 5HT3 antagonist (alone or in combination).
[1]Gan et al, Anesthesia & Analgesia (2014) 118 1 85-113
[2]Apfel et al, N Engl J Med (2004) 350 2441-51
[3]http://www.medicare.gov/hospitalcompare/linking-quality-to-payment.html
[4]Apfel et al, Anesthesiology (1999) 91 109-118
[5]Kovac et al, J Clin Anesth (1999) 11 453-459
[6]Fortney et al, Anesthesia & Analgesia (1998) 86 731-738
[7]Gan et al. Anesthesia & Analgesia (2011) 112 4 804-812
[8]Habib & Gan, J Clin Anesth (2008) 20 35-39
[9]Gan et al, Anesthesia & Analgesia (2007) 105 6 1615-1628
SOURCE: Acacia Pharma
Post Views: 97
