Also, in 2022, Lundbeck has initiated a phase IV
study investigating the add-on efficacy of
eptinezumab treatment to brief educational
intervention, for the preventive treatment of migraine
in patients with a dual diagnosis of migraine and
medication overuse headache (RESOLUTION). The
study (NCT05452239) is planned to recruit around
570 patients that will be randomly assigned to receive
either eptinezumab or placebo given by IV infusion.
The total study duration is approximately 36 weeks
including screening period and safety follow-up.
Lu AG09222 – phase II
Lu AG09222 represents a potential new therapeutic
option for the treatment of migraine, which unlike the
recently available calcitonin gene-related peptide
(CGRP) migraine treatment drug class, targets
pituitary adenylate cyclase-activating polypeptide
(PACAP). PACAP and its receptors are broadly
expressed in the nervous system, including at sites
implicated in migraine pathophysiology. In pre-clinical
and clinical studies in healthy subjects, Lu AG09222
has shown to bind with high affinity to PACAP,
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 Lu AG09222 high dose, low
dose, or placebo. The study has completed
enrollment.
Circuitry / neuronal biology:
Brexpiprazole – phase III in Alzheimer’s agitation
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
by the investigator as not related to treatment.
Based on this outcome, Lundbeck and Otsuka are
planning a regulatory filing to the FDA in the fourth
quarter of 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 the
treatment of agitation in patients with Alzheimer’s
dementia.
Brexpiprazole – phase III in Post-Traumatic
Stress Disorder (PTSD)
PTSD is a psychiatric disorder that can develop as a
response to traumatic events, such as interpersonal
violence, combat, life-threatening accidents or
natural disasters. Core features of PTSD include a
variety of symptoms, such as re-experiencing
phenomena (i.e., flashbacks and nightmares),
avoidance behavior, numbing (i.e., amnesia,
anhedonia, withdrawal, negativism) and increased
arousal (i.e., insomnia, irritability, poor concentration,