ALISO VIEJO, Calif., March 25, 2019 /PRNewswire/ — Avanir Pharmaceuticals, Inc. announced today the results from the first study of the company’s phase 3 clinical development program investigating the efficacy, safety and tolerability of AVP-786 (deudextromethorphan hydrobromide [d6-DM]/quinidine sulfate [Q]) for the treatment of moderate-to-severe agitation in patients with Alzheimer’s dementia. This study, which used the Sequential Parallel Comparison Design (SPCD), demonstrated a significant improvement on the primary endpoint on the Cohen-Mansfield Agitation Inventory for one of the two doses being evaluated; the other dose demonstrated numerical but not significant improvement on the SPCD analysis. Similar improvements were also observed on the key secondary endpoint. The most common adverse events in patients receiving AVP-786 versus placebo (greater than 5% incidence in either of the two doses of AVP-786) were falls, urinary tract infection, headache and diarrhea. Overall mortality during the study was low and none of the deaths were considered related to treatment.
“These initial data from the first phase 3 study are encouraging and we look forward to continuing to evaluate AVP-786 for the treatment of moderate-to-severe agitation in patients with Alzheimer’s dementia as the clinical program progresses,” said Sanjay Dubé, MD, Vice President, Research & Development, Head of Clinical Development & Scientific Strategy, Avanir Pharmaceuticals, Inc. “Currently there is no FDA-approved treatment for agitation in patients with Alzheimer’s dementia. Any advancement in the treatment and management of agitation in patients with Alzheimer’s dementia would help to bridge the treatment gap in these patients. It is important to note, that there are two additional phase 3 studies ongoing in the clinical development program, which use a conventional parallel-arm design, as opposed to the Sequential Parallel Comparison Design used in this first study. We will continue to analyze the full set of data from this first study and plan to communicate more about the results at the time of publication in a peer-reviewed journal,” said Dr. Dubé.
An estimated 5.8 million people in the U.S. have Alzheimer’s dementiai. Over the course of the disease, many patients with Alzheimer’s dementia will likely experience agitationii, which is characterized by excessive motor activity, verbal aggression and physical aggression, that causes emotional distress to these patientsiii. Symptoms of agitation place a serious burden on the people afflicted with the disease and their caregivers, significantly affecting their health-related quality of life for all concernediv. Agitation has also been associated with increased risk of institutionalization and earlier progression to severe dementiav, vi, vii.
About AVP-786 (deudextromethorphan hydrobromide [d6-DM]/quinidine sulfate [Q])
AVP-786 is a combination of deudextromethorphan hydrobromide (d6-DM) and quinidine sulfate (Q), a CYP2D6 inhibitor. Deuteration was observed to significantly reduce susceptibility to cytochrome P450 (CYP2D6) enzyme metabolism thereby increasing the bioavailability. AVP-786 is being studied in a phase 3 clinical development program as a candidate for moderate-to-severe agitation in patients with Alzheimer’s dementia. AVP-786 is also being investigated in patients with negative symptoms of schizophrenia and neurobehavioral disinhibition in traumatic brain injury.
About the Phase 3 Clinical Development Program
This initial 12-week, phase 3, multicenter, randomized, double-blind, placebo-controlled study employed the Sequential Parallel Comparison Design (SPCD). This study (15-AVP-786-301) enrolled 410 US patients aged 50-90 with moderate-to-severe agitation and probable Alzheimer’s dementia. Patients living in either community or institutional care settings were included in the study. Patients were randomized to one of two doses of drug or placebo in stage 1 of the treatment period (6 weeks); those randomized to drug in stage 1 continued their assigned drug treatment in stage 2 (6 weeks). Patients receiving placebo in Stage 1 were re-randomized to either dose of drug or placebo in stage 2 in a 1:1:1 ratio; however, only placebo non-responders (identified by a priori criteria) were used in the SPCD analysis. An algorithm utilizing data weighted from both stages of the treatment periods was used to analyze the primary endpoint on the CMAI. The SPCD design is being utilized in clinical studies for neuroscience indications to mitigate against placebo response. There are two additional ongoing phase 3 studies (15-AVP-786-302 and 17-AVP-786-305) that use a conventional, parallel-group, placebo-controlled design.
About Avanir Pharmaceuticals, Inc.
Avanir Pharmaceuticals, Inc. is a pharmaceutical company committed to delivering innovative central nervous system (CNS) solutions to improve the lives of patients and their care communities. As part of our commitment, we have extensively invested in our pipeline and are dedicated to advancing CNS treatments in areas of high unmet medical need. For more information about Avanir, please visit http://www.avanir.com.
Avanir is a subsidiary of Otsuka America, Inc. (OAI), a holding company established in the U.S. in 1989. OAI is wholly owned by Otsuka Pharmaceutical Co., Ltd., a global healthcare company with the corporate philosophy, “Otsuka-people creating new products for better health worldwide.”
Otsuka researches, develops, manufactures and markets innovative and original pharmaceutical products for the treatment of diseases and nutraceutical products for the maintenance of everyday health.
In pharmaceuticals, Otsuka is a leader in the challenging area of mental health and also has research programs on several under-addressed diseases including tuberculosis, a significant global public health issue. These commitments illustrate how Otsuka is a “big venture” company at heart, applying a youthful spirit of creativity in everything it does. Otsuka Pharmaceutical and its related companies employ approximately 31,000 people worldwide. You can visit the company’s global website at https://www.otsuka.co.jp/en.
i Alzheimer’s Association. “Facts and Figures.” Last accessed March 13, 2019: www.alz.org/alzheimers-dementia/facts-figures.
ii Alzheimer’s Association. “2017 Alzheimer’s Disease Facts and Figures.” Alzheimer’s & Dementia, 13: 325-373, published April 2017. Last accessed March 15, 2019: www.sciencedirect.com/science/article/pii/S1552526017300511?viewFullText=true.
iii Cummings J, et al. “Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition.” International Psychogeriatrics, 27:1, 7–17, published Jan. 27, 2015. Last accessed on March 15, 2019: www.ncbi.nlm.nih.gov/pubmed/25311499.
iv Laybourne A, et al. “Carer coping and resident agitation as predictors of quality of life in care home residents living with dementia: Managing Agitation and Raising Quality of Life (MARQUE) English national care home prospective cohort study.” International Journal Of Geriatric. Psychiatry, 34:106-113. Published Oct. 1, 2018. Last accessed on March 18, 2019: https://www.ncbi.nlm.nih.gov/pubmed/30276865.
v Knapp M, et al. “Predictors of care home and hospital admissions and their costs for older people with Alzheimer’s disease: findings from a large London case register.” BMJ Open, 6:11, 1-15. Published 2016. Last accessed on March 18, 2019: https://bmjopen.bmj.com/content/bmjopen/6/11/e013591.full.pdf
vi Rabins P, et al. “Neuropsychiatric symptoms at baseline predict shorter time to severe dementia in a population-based sample of incident Alzheimer’s disease: The Cache County dementia progression study.” Alzheimer’s and Dementia, supplement, 8.4: 126-127. Published July 1, 2012. Last accessed on March 18, 2019: https://www.alzheimersanddementia.com/article/S1552-5260(12)00465-7/abstract.
vii Peters M, et al. “Neuropsychiatric symptoms as predictors of progression to severe Alzheimer’s dementia and death: The Cache County Dementia Progression Study.”, 172(5): 460-5. Published May 2015. Last accessed March 18, 2019: https://www.ncbi.nlm.nih.gov/pubmed/25585033.