Osilodrostat

Last updated

Osilodrostat
Osilodrostat.svg
Clinical data
Trade names Isturisa
Other namesLCI-699
AHFS/Drugs.com Monograph
License data
Pregnancy
category
Routes of
administration 		By mouth
Drug class Steroidogenesis inhibitor
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only) [1]
  • US: ℞-only
  • EU:Rx-only
  • In general: ℞ (Prescription only)
Identifiers
  • 4-[(5R)-6,7-Dihydro-5H-pyrrolo[1,2-c]imidazol-5-yl]-3-fluorobenzonitrile
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
Formula C13H10FN3
Molar mass 227.242 g·mol−1
3D model (JSmol)
  • C1CC2=CN=CN2C1C3=C(C=C(C=C3)C#N)F
  • InChI=1S/C13H10FN3/c14-12-5-9(6-15)1-3-11(12)13-4-2-10-7-16-8-17(10)13/h1,3,5,7-8,13H,2,4H2/t13-/m1/s1
  • Key:USUZGMWDZDXMDG-CYBMUJFWSA-N

Osilodrostat, sold under the brand name Isturisa, is a medication for the treatment of adults with Cushing's disease who either cannot undergo pituitary gland surgery or have undergone the surgery but still have the disease. [3] It is taken by mouth. [3]

Contents

The most common side effects are adrenal insufficiency, headache, vomiting, nausea, fatigue, and edema (swelling caused by fluid retention). [3] [4]

Hypocortisolism (low cortisol levels), QTc prolongation (a heart rhythm condition) and elevations in adrenal hormone precursors (inactive substance converted into a hormone) and androgens (hormone that regulates male characteristics) may also occur in people taking osilodrostat. [3]

Osilodrostat was approved for medical use in the European Union in January 2020, [4] and for medical use in the United States in March 2020. [3] [5] [6] The U.S. Food and Drug Administration (FDA) considers it to be a first-in-class medication. [7]

Osilodrostat is an orally active, nonsteroidal corticosteroid biosynthesis inhibitor which was developed by Novartis for the treatment of Cushing's syndrome and pituitary ACTH hypersecretion (a specific subtype of Cushing's syndrome). [8] It specifically acts as a potent and selective inhibitor of aldosterone synthase (CYP11B2) and at higher dosages of 11β-hydroxylase (CYP11B1). [8]

History

In October 2014, an orphan designation was granted by the European Commission for osilodrostat for the treatment of Cushing's syndrome. [9]

Osilodrostat was approved for medical use in the European Union in January 2020, [4] and for medical use in the United States in March 2020. [3] [5]

Osilodrostat's safety and effectiveness for treating Cushing's disease among adults was evaluated in a study of 137 adult subjects (about three-quarters women) with a mean age of 41 years. [3] The majority of subjects either had undergone pituitary surgery that did not cure Cushing's disease or were not surgical candidates. [3] In the 24-week, single-arm, open-label period, all subjects received a starting dose of 2 milligrams (mg) of osilodrostat twice a day that could be increased every two weeks up to 30 mg twice a day. [3] At the end of this 24-week period, about half of subjects had cortisol levels within normal limits. [3] After this point, 71 subjects who did not need further dose increases and tolerated the drug for the last 12 weeks entered an eight-week, double-blind, randomized withdrawal study where they either received osilodrostat or a placebo (inactive treatment). [3] At the end of this withdrawal period, 86% of subjects receiving osilodrostat maintained cortisol levels within normal limits compared to 30% of subjects taking the placebo. [3]

The U.S. Food and Drug Administration (FDA) approved osilodrostat based on the evidence from one clinical trial (NCT02180217) of 137 subjects with Cushing's disease. [5] The trial was conducted at 66 sites across 19 countries (United States, Argentina, Austria, Bulgaria, Canada, China, Columbia, Germany, Spain, France, Great Britain, India, Italy, Japan, Korea, Netherlands, Russia, Thailand, and Turkey). [5]

There was one trial of 48 weeks duration that assessed the benefits and side effects of osilodrostat. [5] The trial enrolled subjects with Cushing's disease for whom pituitary gland surgery was not an option or did not work. [5] The trial was divided in four periods. [5] Subjects received osilodrostat two times a day in all four periods. [5] After the first two periods (24 weeks), the benefit of osilodrostat was assessed by the percentage of subjects who had 24-hour urinary free cortisol levels within normal limits. [5]

In the third period (which lasted eight weeks), half of the subjects who had normal urinary free cortisol levels after 24 weeks of treatment continued taking osilodrostat and the other half was switched to placebo. [5] Neither the subjects nor the healthcare providers know which treatment was given during this period. [5] The benefit of osilodrostat was assessed on the percentage of subjects who had normal cortisol levels at the end of this period versus the subjects who received placebo. [5]

The FDA granted osilodrostat an orphan drug designation and granted the approval of Isturisa to Novartis. [3] [6]

Cost

At the recommended starting dose of 2 mg, a year's supply would cost $172,800 at 2021 prices in the United States. [10]

See also

Related Research Articles

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Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face due to facial plethora, a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly. Women may have more hair and irregular menstruation. Occasionally there may be changes in mood, headaches, and a chronic feeling of tiredness.

Cushing's disease is one cause of Cushing's syndrome characterised by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary. This is most often as a result of a pituitary adenoma or due to excess production of hypothalamus CRH that stimulates the synthesis of cortisol by the adrenal glands. Pituitary adenomas are responsible for 80% of endogenous Cushing's syndrome, when excluding Cushing's syndrome from exogenously administered corticosteroids. The equine version of this disease is Pituitary pars intermedia dysfunction.

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<span class="mw-page-title-main">Adrenal insufficiency</span> Medical condition

Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones. The adrenal glands—also referred to as the adrenal cortex—normally secrete glucocorticoids, mineralocorticoids, and androgens. These hormones are important in regulating blood pressure, electrolytes, and metabolism as a whole. Deficiency of these hormones leads to symptoms ranging from abdominal pain, vomiting, muscle weakness and fatigue, low blood pressure, depression, mood and personality changes to organ failure and shock. Adrenal crisis may occur if a person having adrenal insufficiency experiences stresses, such as an accident, injury, surgery, or severe infection; this is a life-threatening medical condition resulting from severe deficiency of cortisol in the body. Death may quickly follow.

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<span class="mw-page-title-main">Hyperandrogenism</span> Medical condition

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References

  1. 1 2 "Isturisa". Therapeutic Goods Administration (TGA). 29 August 2022. Retrieved 29 April 2023.
  2. ↑ "Updates to the Prescribing Medicines in Pregnancy database". Therapeutic Goods Administration (TGA). 21 December 2022. Archived from the original on 3 April 2022. Retrieved 2 January 2023.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 "FDA Approves New Treatment for Adults with Cushing's Disease". U.S. Food and Drug Administration (FDA) (Press release). 6 March 2020. Archived from the original on 26 July 2020. Retrieved 6 March 2020.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  4. 1 2 3 "Isturisa EPAR". European Medicines Agency (EMA). 18 February 2020. Archived from the original on 7 March 2020. Retrieved 6 March 2020.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 "Drug Trial Snapshot: Isturisa". U.S. Food and Drug Administration (FDA). 6 March 2020. Archived from the original on 21 September 2020. Retrieved 27 March 2020.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  6. 1 2 "Drug Approval Package: Isturisa". U.S. Food and Drug Administration (FDA). 6 April 2020. Archived from the original on 21 January 2021. Retrieved 17 January 2021.
  7. ↑ "New Drug Therapy Approvals 2020". U.S. Food and Drug Administration (FDA). 31 December 2020. Archived from the original on 18 January 2021. Retrieved 17 January 2021.
  8. 1 2 Fleseriu M, Castinetti F (2016). "Updates on the role of adrenal steroidogenesis inhibitors in Cushing's syndrome: a focus on novel therapies". Pituitary. 19 (6): 643–653. doi:10.1007/s11102-016-0742-1. PMC   5080363 . PMID   27600150.
  9. ↑ "EU/3/14/1345". European Medicines Agency (EMA). 17 September 2018. Archived from the original on 24 July 2020. Retrieved 23 July 2020.
  10. ↑ Yuen, Kevin C.J. (September 2021). "Osilodrostat: A Review of Recent Clinical Studies and Practical Recommendations for its Use in the Treatment of Cushing Disease". Endocrine Practice. 27 (9): 956–965. doi:10.1016/j.eprac.2021.06.012.

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