Edaravone

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Edaravone
Edaravone Structural Formula V1.svg
Edaravone ball-and-stick model.png
Clinical data
Trade names Radicava, others
Other namesMCI-186
AHFS/Drugs.com Monograph
MedlinePlus a617027
License data
Pregnancy
category
Routes of
administration
Intravenous, by mouth
ATC code
Legal status
Legal status
Identifiers
  • 5-methyl-2-phenyl-4H-pyrazol-3-one
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
PDB ligand
CompTox Dashboard (EPA)
ECHA InfoCard 100.001.719 OOjs UI icon edit-ltr-progressive.svg
Chemical and physical data
Formula C10H10N2O
Molar mass 174.203 g·mol−1
3D model (JSmol)
  • O=C1N(/N=C(\C1)C)c2ccccc2
  • InChI=1S/C10H10N2O/c1-8-7-10(13)12(11-8)9-5-3-2-4-6-9/h2-6H,7H2,1H3 Yes check.svgY
  • Key:QELUYTUMUWHWMC-UHFFFAOYSA-N Yes check.svgY
   (verify)

Edaravone, sold under the brand name Radicava among others, is a medication used to treat stroke and amyotrophic lateral sclerosis (ALS). [4] [5] It is given by intravenous infusion [4] and by mouth. [4] [6]

Contents

The mechanism by which edaravone might be effective is unknown. [4] The medication is known to be an antioxidant, and oxidative stress has been hypothesized to be part of the process that kills neurons in people with ALS and in stroke victims. [7]

The most common side effects include bruising (contusions), problems walking (gait disturbances), and headaches. [6]

The U.S. Food and Drug Administration (FDA) considers it to be a first-in-class medication. [8]

Medical uses

Edaravone is used to help people recover from stroke in Japan, [9] and is used to treat ALS in the US and Japan. [4] [7]

Adverse effects

The label carries a warning about the potential for hypersensitivity reactions to edaravone, and adverse effects include bruising, gait disturbances, headache, skin inflammation, eczema, problems breathing, excess sugar in urine, and fungal skin infections. [4]

The following adverse effects in at least 2% more people given the medication than were given placebo: bruising, gait disturbances, headache, skin inflammation, eczema, problems breathing, excess sugar in urine, and fungal skin infections. [4]

There is no data on whether it is safe for pregnant women to take, and it is unknown if edaravone is secreted in breast milk. [4]

Pharmacology

The mechanism by which edaravone might be effective is unknown. [4] The medication is known to be an antioxidant, and oxidative stress has been hypothesized to be part of the process of neurodegeneration. [7]

The half-life of edaravone is 4.5 to 6 hours and the half-lives of its metabolites are 2 to 3 hours. It is metabolized to a sulfate conjugate and a glucuronide conjugate, neither of which are active. It is primarily excreted in urine as the glucuronide conjugate form. [4]

It suppresses reperfusion injury in animal models of stroke and improves stroke recovery after reperfusion therapy in humans. [10]

History

Researchers first developed the free radical scavenger edaravone in the late 1980s as a treatment for stroke. The approach, introduced by Koji Abe, at Okayama University Hospital ("University Hospital" in the late 1980s) [11] in Japan, aimed to prevent the brain swelling that sometimes follows stroke. [12] It has been marketed in Japan by Mitsubishi Pharma for stroke since 2001 and is now generic. [9] [13]

Mitsubishi Pharma started a phase III clinical trial in ALS in 2011, in Japan, and by June 2015, it had been approved for that use in Japan. The company had received orphan drug designation for edaravone from the FDA and the EU by 2016. [14]

It was approved for ALS in the US in 2017, based on a small randomized-controlled trial with people who had early-stage ALS in Japan, who were administered the medication for 6 months; it had failed two earlier trials in people with all stages of ALS. [4] [7]

In May 2017, I.V. edaravone was approved by the FDA to treat people with amyotrophic lateral sclerosis (ALS) in the United States. [15] The FDA approval was conditioned on Mitsubishi Tanabe completing several additional studies to clarify the risks of cancer and liver disease, among other effects of the medication. [16] [17]

Re-analyses of efficacy

The efficacy of edaravone for the treatment of ALS was previously demonstrated in a six-month clinical trial that served as the basis for approval in 2017. [6] In that trial, 137 participants were randomized to receive edaravone or placebo. At week 24, individuals receiving edaravone declined less on a clinical assessment of daily functioning than those receiving placebo. [6] An analysis of real-world data from 194 patients from 12 ALS clinics of the intravenous formulation failed to reproduce the effect. [18]

Efficacy of edaravone for stroke as an adjunct to regular reperfusion therapy has been reproduced in two retrospective studies of Japanese medical records. [10] [9]

New formulations

A formulation of edaravone by mouth, which is a mixture of edaravone and hydroxypropyl-sulfobutyl ether β-cyclodextrin (SBE-HP-βCD), [19] has been under development by Ferrer (called FAB122) and licensed by Treeway (called TW001) for ALS. As of 2015, the drug had successfully completed a phase I trial and received orphan status in the US and the European Union. [20] Ferrer reported on 10 January 2024 that the phase III ADORE clinical trial (EudraCT 2020-003376-40/NCT05178810) of FAB122/TW001 fo4 ALS did not meet the primary or key secondary study endpoints. [21]

A different oral formulation of edaravone from Mitsubishi Tanabe Pharma America (MT1186/MT-1186) was approved for medical use in the United States in May 2022. [4] [6] [22] The estimated effectiveness of oral edaravone is based on a study that showed comparable levels of oral edaravone in the bloodstream to the levels from the IV formulation of edaravone. [6] A global phase 3b study of MT1186 was halted in 2023 due to failure. [23]

Combination formulations

Edaravone is combined with dextro-borneol (dexborneol) in edaravone/dexborneol, a drug approved in China for stroke. It is approved in intravenous (2021) and sublingual (2025) forms. The intravenous combination was approved on the basis of trials showing it to be superior to edavarone alone. [24] [25]

Society and culture

Economics

The price for the medication when it launched in Japan for stroke in 2001, was set by the Japanese government at 9,931 yen/ampule. [26]

When the medication launched in Japan for ALS in 2001, the price was $35,000; the price in Japan in 2017 was $5,000, the US price at launch was around $145,000. [13] In the US the medication was approved for all people with ALS but it was unclear at approval whether insurers would agree to pay for the medication for all people with ALS, or only people in the early stages of the disease. [13] [27]

Brand names

Brand names include Radicut, Radicava, Xavron. [28]

References

  1. 1 2 "Radicava". Therapeutic Goods Administration (TGA). 24 February 2023. Archived from the original on 24 February 2023. Retrieved 7 April 2023.
  2. "Radicava edaravone 30 mg/20 mL concentrated injection ampoule (375455)". Therapeutic Goods Administration (TGA). 16 February 2023. Archived from the original on 8 April 2023. Retrieved 7 April 2023.
  3. "Regulatory Decision Summary for Radicava". 23 October 2014. Archived from the original on 7 June 2022. Retrieved 7 June 2022.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 "Radicava- edaravone injection Radicava ORS- edaravone kit". DailyMed. 12 May 2022. Archived from the original on 27 January 2022. Retrieved 27 May 2022.
  5. Bailly C, Hecquet PE, Kouach M, Thuru X, Goossens JF (May 2020). "Chemical reactivity and uses of 1-phenyl-3-methyl-5-pyrazolone (PMP), also known as edaravone". Bioorganic & Medicinal Chemistry. 28 (10) 115463: 115463. doi:10.1016/j.bmc.2020.115463. PMID   32241621. S2CID   214766793.
  6. 1 2 3 4 5 6 "FDA Approves Oral Form of ALS Treatment". U.S. Food and Drug Administration (FDA). 12 May 2022. Archived from the original on 12 May 2022. Retrieved 12 May 2022.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  7. 1 2 3 4 Petrov D, Mansfield C, Moussy A, Hermine O (2017). "ALS Clinical Trials Review: 20 Years of Failure. Are We Any Closer to Registering a New Treatment?". Frontiers in Aging Neuroscience. 9: 68. doi: 10.3389/fnagi.2017.00068 . PMC   5360725 . PMID   28382000.
  8. New Drug Therapy Approvals 2017. U.S. Food and Drug Administration (FDA) (Report). January 2018. Archived from the original (PDF) on 23 October 2020. Retrieved 16 September 2020.
  9. 1 2 3 Miyaji Y, Yoshimura S, Sakai N, Yamagami H, Egashira Y, Shirakawa M, et al. (2015). "Effect of edaravone on favorable outcome in patients with acute cerebral large vessel occlusion: subanalysis of RESCUE-Japan Registry". Neurologia Medico-chirurgica. 55 (3). Tokyo: 241–247. doi:10.2176/nmc.ra.2014-0219. PMC   4533339 . PMID   25739433.
  10. 1 2 Enomoto M, Endo A, Yatsushige H, Fushimi K, Otomo Y (March 2019). "Clinical Effects of Early Edaravone Use in Acute Ischemic Stroke Patients Treated by Endovascular Reperfusion Therapy". Stroke. 50 (3): 652–658. doi:10.1161/STROKEAHA.118.023815. PMID   30741623.
  11. "History of Okayama University Hospital". OKAYAMA UNIV. HOSPITAL (in Japanese).
  12. "FDA Approves Edaravone as a Treatment for ALS". Research ALS. Archived from the original on 12 February 2019. Retrieved 10 May 2017.
  13. 1 2 3 Herper M. "The First ALS Drug In 22 Years Is Approved -- And It Costs 4 Times What It Does In Japan". Forbes. Archived from the original on 6 May 2017. Retrieved 10 May 2017.
  14. Lane EJ (20 April 2016). "Mitsubishi Tanabe says ALS drug meets PhIII endpoint". FiercePharma. Archived from the original on 13 February 2019. Retrieved 13 May 2017.
  15. "FDA approves drug to treat ALS". U.S. Food and Drug Administration (FDA) (Press release). Archived from the original on 8 May 2017. Retrieved 7 May 2017.
  16. "NDA 209176 Approval letter" (PDF). U.S. Food and Drug Administration (FDA). 5 May 2017. Archived from the original (PDF) on 10 May 2018. Retrieved 13 May 2017.
  17. "Radicava (edaravone) Injection". U.S. Food and Drug Administration (FDA). 20 June 2017. Archived from the original on 13 May 2022. Retrieved 12 May 2022.
  18. Witzel S, Maier A, Steinbach R, et al. Safety and Effectiveness of Long-term Intravenous Administration of Edaravone for Treatment of Patients With Amyotrophic Lateral Sclerosis. JAMA Neurol. 2022;79(2):121–130. doi:10.1001/jamaneurol.2021.4893
  19. Rong WT, Lu YP, Tao Q, Guo M, Lu Y, Ren Y, et al. (February 2014). "Hydroxypropyl-sulfobutyl-β-cyclodextrin improves the oral bioavailability of edaravone by modulating drug efflux pump of enterocytes". Journal of Pharmaceutical Sciences. 103 (2): 730–742. Bibcode:2014JPhmS.103..730R. doi:10.1002/jps.23807. PMID   24311389.
  20. "Edaravone oral". AdisInsight. Archived from the original on 7 July 2017. Retrieved 13 May 2017.
  21. "Ferrer reports top-line results from Phase III ADORE study in ALS | Ferrer". www.ferrer.com. Archived from the original on 8 March 2024. Retrieved 8 March 2024.
  22. NDA Approval [ dead link ] fda.gov "NDA APPROVAL" (PDF). Archived from the original on 13 May 2022. Retrieved 13 May 2022.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  23. Media_MTPA@mt-pharma-us.com (1 August 2023). "Press Releases". Mitsubishi Tanabe Pharma America. Archived from the original on 8 March 2024. Retrieved 8 March 2024.
  24. Xu J, Wang A, Meng X, Yalkun G, Xu A, Gao Z, et al. (March 2021). "Edaravone Dexborneol Versus Edaravone Alone for the Treatment of Acute Ischemic Stroke: A Phase III, Randomized, Double-Blind, Comparative Trial". Stroke. 52 (3): 772–780. doi:10.1161/STROKEAHA.120.031197. PMID   33588596.
  25. Fu Y, Wang A, Tang R, Li S, Tian X, Xia X, et al. (1 April 2024). "Sublingual Edaravone Dexborneol for the Treatment of Acute Ischemic Stroke: The TASTE-SL Randomized Clinical Trial". JAMA Neurology. 81 (4): 319–326. doi:10.1001/jamaneurol.2023.5716. PMC   10877503 . PMID   38372981.
  26. "Launching of Radicut Injection. 30 mg" (Press release). Mitsubishi-Tokyo Pharmaceuticals via Evaluate. 23 May 2001. Archived from the original on 3 July 2022. Retrieved 9 May 2017.
  27. Grady D (5 May 2017). "A Second Drug Is Approved to Treat A.L.S." The New York Times . Archived from the original on 4 April 2018. Retrieved 8 May 2017.
  28. Makam AN, Suh K, Nikitin D, Carlson J, Richardson M, Mohammed R, et al. (4 August 2022). "AMX0035 and Oral Edaravone for Amyotrophic Lateral Sclerosis: Evidence Report" (PDF). Institute for Clinical and Economic Review: D6.

Further reading