The FDA Gastrointestinal Drugs Advisory Committee voted unanimously (10 to 0) that the risk-benefit profile of Shire’s prucalopride supports the approval of this New Drug Application (NDA). The FDA will take the advisory committee’s recommendation into consideration when the agency makes a final determination. The Prescription Drug User Fee Act (PDUFA) action date for prucalopride is December 21, 2018.
The advisory committee also voted unanimously (10 to 0) that the potential risk of cardiovascular adverse events with the use of prucalopride in adults with CIC has been adequately addressed by Shire. Prucalopride, a serotonin type 4 (5-HT4) receptor agonist, is a gastrointestinal prokinetic agent that stimulates colonic peristalsis, increasing bowel motility.2,3,4,5Drugs similar to prucalopride have been associated with adverse cardiovascular (CV) events in the past.
“We are pleased with the advisory committee’s vote today supporting prucalopride for the treatment of adults with chronic idiopathic constipation in the U.S., and will continue working with the FDA during the final stages of its review,” said Andreas Busch, Ph.D., head of research and development at Shire. “This investigational compound reinforces Shire’s long-standing heritage in gastrointestinal conditions and deep in-house capabilities in the category.”
Prucalopride has been studied in more than 90 clinical trials worldwide over the last 20 years, including six key studies by which the advisory committee made its recommendation today. The advisory committee reviewed data included in the prucalopride NDA, specifically five main Phase 3 and one Phase 4 double-blind, placebo-controlled clinical trials. An integrated analysis of these six main randomized, controlled clinical trials evaluated the global efficacy and safety of prucalopride 2 mg daily in men and women with chronic constipation; study designs across the trials were similar.
Overall, there were 2,484 adult patients included in the integrated efficacy analysis and 2,552 adult patients included in the integrated safety analysis; all patients included received prucalopride less than or equal to 2 mg daily or placebo.6
The committee also reviewed results from an observational, pharmacoepidemiology safety study that Shire sponsored to estimate the risk, as measured by the pooled adjusted incidence rate ratio (IRR), of major adverse CV events (MACE) in adult new users of prucalopride compared to adult new users of polyethylene glycol (PEG). MACE included hospitalization for acute myocardial infarction or stroke and in-hospital CV death. Study data was from real-world settings in the United Kingdom and Sweden. This pooled analysis included over 35,000 patients with chronic constipation treated with prucalopride or PEG in a 1- to- 5 ratio.7
For the observational, pharmacoepidemiology safety study, the pooled adjusted IRR for MACE was 0.64 (95 percent CI, 0.36, 1.14)8 in this mostly female (>90%) patient population where many were aged 55 years or younger, which excluded a threefold increase risk of MACE in patients using prucalopride compared with PEG. The average total duration of use was over 170 days for prucalopride and over 80 days for PEG.7
There are an estimated 35 million adults in the U.S. with chronic idiopathic constipation.9,10* The condition is characterized by difficult, infrequent, or incomplete passage of stools over a prolonged period and a range of symptoms, which may include abdominal pain and/or bloating.11 There are many causes, and one of the possible underlying problems is an impairment or dysfunction of the gut’s ability to move, by contracting and releasing, naturally.12
References
1 Briejer MR et al. Eur J Pharmacol 2001;423:71–83.
2 Camilleri, M, et al. 2008 A Placebo-Controlled Trial of Prucalopride for Severe Chronic Constipation. N Engl J Med.2008;358:2344-2354.
3 Miner, PB, Camilleri, M., Burton, D., et. al. Prucalopride Induces High-Amplitude PropagatingContractions in the Colon Of Patients With Chronic Constipation: A Randomized Study.
Neurogastroenterol. Motil. 2016;28:(9):1341-1348.
4 DeSchryver, et. al. The effects of the specific 5HT4 receptor agonist, prucalopride, on colonic motility in healthy volunteers. Aliment Pharmacol Ther. 2002; 16: 603-612.
5 Tack J, van Outryve M, Beyens G, Kerstens R, Vandeplassche L. Prucalopride (Resolor) in the treatment of severe chronic constipation in patients dissatisfied with laxatives. Gut. 2009;58 (3):357-65
6 Camilleri M, et al. Efficacy and Safety of Prucalopride in Chronic Constipation: An Integrated Analysis of Six Randomized, Controlled Clinical Trials. Digestive Diseases and Sciences. 2016.61:2357-2372.
7 Non-Interventional Cohort Study of the Relative Incidence of Major Cardiovascular Events Among Patients Initiating Prucalopride versus a Matched Comparator Cohort Initiating Polyethylene Glycol 3350 (PEG) Gilsenan, Alicia et al. Gastroenterology, Volume 154, Issue 6, S-92 – S-93. Abs #386.
8 Shire Errata to Shire’s FDA Briefing Document. October 18, 2018.
9 U.S. Census Data. Available at: https://www.census.gov/quickfacts/fact/table/US/PST045216. 2017.
10 Suares NC, Ford AC. Prevalence of, and Risk Factors for, Chronic Idiopathic Constipation in the Community: Systematic Review and Meta-analysis. The American Journal of Gastroenterology 2011;106:1582-1591.
11 Lacy BE, Mearin F, Chang L, et al. Bowel Disorders. Gastroenterology 2016;150:1393–407.
12 Ford AC, Moayyedi P, Lacy BE, et. al. American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation. Am J Gastroenterol 2014;109:S2 – S26.
13 Resolor® (prucalopride), EU Summary of Product Characteristics, December 2015.
(Source: Shire plc)
Filed Under: Drug Discovery and Development
