thereby preventing PACAP from activating its
receptors.
In 2021, Lundbeck completed a study confirming the
target engagement of Lu AG09222 with PACAP
(NCT04976309). In this study, the preventive effect
of Lu AG09222 on vasodilation induced by PACAP
was investigated and confirmed. Subsequently, in
November 2021, Lundbeck initiated the HOPE-study,
a randomized, double-blind, phase II, proof of
concept study to assess efficacy, safety, and
tolerability of Lu AG09222 as a treatment for the
prevention of migraine (NCT05133323) which is
currently ongoing. A total of 230 patients, recruited
from specialist settings, will be randomly allocated to
one of three treatment groups: high/low dose of Lu
AG09222 or placebo. In parallel with this, in 2021,
Lundbeck initiated a multiple dose safety,
pharmacokinetic (PK) and pharmacodynamic (PD)
trial in subjects with allergic rhinitis (NCT05126316)
to explore effects of Lu AG09222 in patients with
elevated, circulating inflammatory biomarkers.
Participants receive AG09222 high dose, low dose,
or placebo. The study completed enrollment.
Circuitry / neuronal biology:
Brexpiprazole – phase III in Alzheimer’s agitation
In April 2021, Lundbeck and Otsuka Pharmaceutical
announced the decision to continue the recruitment
of patients in a third phase III clinical trial of
brexpiprazole in the treatment of agitation in patients
with dementia of the Alzheimer's type
(NCT03548584). The decision to continue the trial
was based on the results of an independent interim
analysis, supporting to progress the trial to the
planned full enrollment of 330 patients.
Trial 331-14-213 (NCT03548584; Trial 213) was
designed to assess the safety, tolerability and
efficacy of two fixed doses of brexpiprazole (2 mg/day
and 3 mg/day) in the treatment of patients with
agitation in Alzheimer’s dementia. The trial consisted
of a continuous 12-week double-blind treatment
period with a 30-day follow-up. The randomized trial
population included 345 male and female patients,
aged 55–90 years (inclusive), with a diagnosis of
probable Alzheimer’s disease, and meeting criteria of
agitation as defined by the International
Psychogeriatric Association (IPA). The primary
outcome was the change in the Cohen-Mansfield
Agitation Inventory CMAI total score at week 12 for
all patients treated with brexpiprazole versus those
treated with placebo. The key secondary outcome
was the change in the Clinical Global Impression –
Severity of Illness (CGI-S) score, as related to
symptoms of agitation. Participating countries include
Bulgaria, Hungary, Serbia, Slovakia, Spain, Ukraine,
and USA. The study included both patients who were
living at home and those living in institutionalized
settings.
In June 2022, Lundbeck and Otsuka Pharmaceutical
reported positive results showing reduced agitation in
patients with Alzheimer’s dementia treated with
brexpiprazole. In the study, the improvements from
baseline on the primary endpoint of CMAI for patients
receiving brexpiprazole or 2 mg/day or 3 mg/day were
statistically greater than for those receiving placebo
(p=0.0026). This result was supported by a
statistically superior improvement on the key
secondary endpoint of CGI-S, as related to agitation
(p=0.0055).
Brexpiprazole was generally well tolerated, and no
new safety signals were observed. The only
Treatment Emergent Adverse Event (TEAE) with
more than 5% incidence in patients treated with
brexpiprazole was headache (6.6% vs. 6.9% for
placebo). The following TEAEs occurred at an
incidence of at least 2% in brexpiprazole treatment
group and greater than that of placebo: somnolence,
nasopharyngitis, dizziness, diarrhea, urinary tract
infection, and asthenia. There was one death
observed in the 3 mg/day treatment group, assessed
as not related to treatment by the investigator.
Based on this outcome Lundbeck and Otsuka are
planning a regulatory filing to the FDA later in 2022.
The Supplemental New Drug Application will be
comprised of this study as well as two earlier trials. In
February 2016, the FDA granted fast track
designation for brexpiprazole for treatment of
agitation in patients with Alzheimer’s dementia.