Data and Results: Hemorrhage produced a decrease in hema IRL-1620 prevents beta amyloid (Aβ) induced oxidative stress
tocrit from ~49% to ~27%, which was similar in all the groups.
and cognitive impairment
Sixty minutes following resusctiation with LR, blood lactate level
Seema Briyal, Cortney Shepard, Anil Gulati
was 10.2±0.6 mmol/L, however addition of centhaquin in LR
Midwestern University, Downers Grove, IL, USA
improved lactate level to 4.1±0.3 mmol/L. Similarly, following
resusctiation with SAL, lactate level was 3.4±0.5 mmol/L, and
Statement of Purpose, Innovation or Hypothesis: Alzheimer’s
addtion of centhaquin improved it to 2.0±0.3 mmol/L. Cardiovas
disease (AD) is a progressive brain disorder leading to impair
cular parameters signficantly improved following addition of
ment of learning and memory. Incidence of AD is higher in dia
centhaquin in either LR or SAL. Centhaquin improved the sur
betic patients. Studies indicate that stimulation of ETB receptors
vival following LR treatment from 78±10 mins to 387±38 mins,
may provide neuroprotection. The present study was conducted
and following SAL treatment from 144±22 mins to 326±55 mins.
to investigate the involvement of ETB receptors in Aβinduced
Another experiment showed that centhaquin decreased the
cognitive impairment in nondiabetic and diabetic rats.
requirement of NE by 10 folds in HS. In hemorrhaged rats, a 50%
Description of Methods and Materials: The expression of ETB
decrease in systemic vascular resistance (SVR) was observed in
receptors was studied using Western blotting. Parameters of oxi
spite of infusion of a high dose (50 µg/100g/hour) of NE; whereas,
dative stress assessed were malondialdehyde (MDA), glutathione
only 36% decrease in SVR was observed following a low dose
(GSH) and superoxide dismutase (SOD). Learning and memory
(5 µg/100g/hour) infusion of NE in centhaquin treated rats.
behavior was assessed using the Morris water maze. Rats were
Interpretation, Conclusion or Significance: Centhaquin
treated with Aβ(140) (6.67 µg, icv) was administered on day 1, 7 and
improves the resuscitative effects of LR and SAL and increases
14 and all experiments were performed on day 15. Diabetes was
the vascular responsiveness to NE in hemorrhaged rats.
induced by administering streptozotocin (45 mg/kg, ip) 3 days
prior to Aβ injection. Rats were treated chronically with ETB
receptor agonist (IRL1620) and antagonist (BQ788) for 14 days. Single-dose Plasma PK Parameters of Arbaclofen, R-baclofen Data and Results: Diabetic rats showed sluggish behavior and and S-baclofen
decreased locomotion compared to nondiabetic rats, but there
Glenn Meyer1, Gustavo Fischbein2, David Boyd1
was no difference in cognitive impairment or oxidative stress
parameters following Aβ treatment in nondiabetic and diabetic
1Osmotica Pharmaceutical Corp, Wilmington, NC, USA; 2Osmotica
rats. Aβ treatment produced no change in ETB receptor expres
Pharmaceutical Argentina S.A., Buenos Aires, Argentina
sion in the brain, and ETB receptor expression was not altered by
IRL1620 or BQ788 treatment. A significant increase in levels of
Statement of Purpose, Innovation or Hypothesis: Arbaclofen,
MDA and a concurrent decrease in GSH and SOD levels was
the Renantiomer of the GABAb agonist baclofen, is in develop
observed following Aβ treatment in nondiabetic and diabetic
ment, as the single enantiomer, for the treatment of spasticity due
rats. IRL1620 produced a significant (P<0.001) decrease
to multiple sclerosis. We hypothesized that the PK parameters for
(278.4±8.5 nmol/g wet tissue) in MDA level compared to the
the Renantiomer would be the same when administered alone
vehicle group (516.1±14 nmol/g wet tissue) and reversed the
versus administration as the racemic mixture.
decrease in GSH and SOD levels following Aβ treatment in non
Description of Methods and Materials: A 4arm, double blind,
diabetic and diabetic rats. In Morris water maze task, Aβ treated
parallel group, doseranging PK study of arbaclofen and baclofen
rats showed a significant (P<0.0001) impairment in spatial mem
was conducted in healthy subjects to compare the plasma parame
ory. Administration of IRL1620 to Aβ treated rats produced a
ters. Twelve subjects in each group received either arbaclofen doses
significant improvement in learning and memory compared to the
of 5, 7.5, or 10mg, or baclofen doses of 20mg, initially on Day 1 and
vehicle group in both diabetic and nondiabetic rats. Changes
then every six hours thereafter for four days after an uptitration
induced by IRL1620 were completely blocked by BQ788.
period of nine days. Here we report the initial, singledose results. Interpretation, Conclusion or Significance: Aβ produced an incre Data and Results: On Day 1, initial single, equimolar doses of
ase in oxidative stress parameters and loss of learning and mem
the Renantiomer produced similar PK results for arbaclofen and
ory, which was significantly improved by ETB agonist, IRL1620.
the Renantiomer of baclofen. The pvalues for AUC, Cmax,
Tmax, and t1/2 were, 0.97, 0.43, 0.70, and 0.51 respectively. The
same parameters for the Senantiomer vs. Renantiomer in the
baclofen group were notably different with pvalues less than
Role of centhaquin in the resuscitation of hemorrhagic shock
Anil Gulati1, Manish S. Lavhale2, Suresh Havalad3
Interpretation, Conclusion or Significance: The R and
1Midwestern University, Downers Grove, IL, USA; 2Pharmazz,
Senantiomers of baclofen exhibit different ADME parameters.
Inc., Naperville, IL, USA; 3Advocate Lutheran General Hospital,
Arbaclofen ADME parameters are similar to those of Rbaclofen
when administered as the racemic mixture. Statement of Purpose, Innovation or Hypothesis: Centhaquin
may have a role in resuscitative effect by improving the vascular
Arbaclofen 10 mg Baclofen 20 mg
responsiveness in the resuscitation of hemorrhagic shock (HS). It is
our hypothesis that adding centhaquin to Lactated Ringer’s (LR) or
PK Parameter* Arbaclofen R-baclofen S-baclofen
3% hypertonic saline (SAL) will enhance their resuscitative effect. Description of Methods and Materials: Rats were anaesthe
tized with urethane. The femoral vein was canulated for drug
administration and femoral artery was cannulated for measuing
mean arterial pressure (MAP). A calibrated pressurevolume cath
eter (SPR869) was placed into the left ventricle and data were
analyzed using a LabChart5.00 and PVAN analysis program.
After completion of surgery, induction of HS was initiated by
withdrawing blood from the right femoral artery to maintain the
MAP between 35 and 40 mmHg for 30 minutes.
* all values are arithmetic means of single doses (SD)
ABSTRACTS
for treatment of DPN, PHN and FM was developed. Subsequently,
Population Pharmacokinetics-Pharmacodynamics of the 27 controlled clinical trials with data from >9500 patients, for drugs G-Protein Coupled Receptor 40 (GPR40) Agonist TAK-875 in
evaluated across at least two indications (pregabalin, gabapentin
Subjects with Type 2 Diabetes Mellitus (T2DM)
and duloxetine) and reporting LOCF imputed 010 points Likert or
Majid Vakilynejad, Jingtao Wu, Prabhakar Viswanathan, Vipin
Brief Pain Inventory average pain scores were selected for analysis.
A nonlinear mixedeffects modelbased metaanalysis of change
Takeda Global Research & Development Center, Inc., Deerfield, IL,
from baseline average pain score was conducted using NONMEM 7. Data and Results: The final dose response model was an E
model with indicationdependent placebo and E parameters and
Statement of Purpose, Innovation or Hypothesis:
common E for all drugs within an indication. For DPN only, E
a highly selective and potent GPR40 agonist which causes glu
was found to be dependent on placebo effect (i.e. E E model
cosedependent insulin secretion and is being developed by
was better than E model). There was no statistical evidence that
Takeda for the treatment of T2DM. A sequential population
ED for any of the three drugs differs across tested indications and
pharmacokineticpharmacodynamic (PPKPD) model for TAK875
therefore one ED parameter was used for each drug across indica
was developed to estimate mean population PK and PD parame
tions. The modelestimated placebo effect was 1.5, 0.9 and 1.1
ters using TAK875 concentrations and fasting plasma glucose
points for DPN, PHN and FM, respectively; intertrial standard
(FPG) levels measured in a shortterm 14 day clinical study.
deviation was 0.3 points. The modelestimated maximal effect was
Description of Methods and Materials: Using historical glyce
1.6 points (E E ) for DPN and 2.2 and 1.2 points (E ) for PHN
mic data (13 clinical trials and ~8000 subjects from various Takeda
and FM, respectively. Estimated ED values were 324, 1600 and 28
diabetes programs), an empirical linear mixed effect model was
mg for pregabalin, gabapentin and duloxetine, respectively.
developed to predict longterm effects (changes in HbA1c) from
Interpretation, Conclusion or Significance: Results from this
shortterm changes (FPG levels at day 14). Data from a phase 1,
analysis demonstrate higher placebo effect for DPN compared to
doubleblind, randomized, placebocontrolled, multiple risingdose
PHN and FM and greater maximal drug effect in PHN vs. DPN and
study of TAK875 25, 50, 100, 200 or 400 mg (n=45) or placebo
FM. There was no evidence that the potency of the drugs differed
(n=14) given orally for 14 days to T2DM patients were included. Data and Results: The PK and FPG profiles were best described
using a two compartment model with firstorder absorption and
elimination processes and an Emax stimulatory indirect response
CSF and Plasma PK Parameters of R-baclofen: Arbaclofen Versus
model, respectively. The interpatient variability was included in
the Racemic Mixture
the model as exponential errors for CL, V, and baseline FPG. The
Glenn Meyer1, Gustavo Fischbein2, David Boyd1
model parameters were estimated precisely [CL/F=0.624 (%RSE=10)
L/h, Vc/F=4.11 (%RSE=19), Ka = 0.0750 (%RSE=13) h1, baseline
Osmotica Pharmaceutical Corp, Wilmington, NC, USA; 2Osmotica
FPG=172 (%RSE=3) mg/dL, EC50=1150 (%RSE=38%), ng/mL,
Pharmaceutical Argentina S.A., Buenos Aires, Argentina
Emax=0.349 (%RSE=13)] and the model was stable and predictive. Statement of Purpose, Innovation or Hypothesis: Arbaclofen, Interpretation, Conclusion or Significance: This modeling and
the Renantiomer of the GABAb agonist baclofen, is in development
simulation approach characterized the TAK875 exposureresponse
for the treatment of spasticity due to MS. The PK parameters of oral
relationship and suggested a dose range for Phase 2. Oral adminis
Rbaclofen in the CSF have not been previously reported. Animal
tration of TAK 875 2550 mg once per day is predicted to show an
data suggests competitive transport for the R and Senantiomers
A1c reduction at week 12 that is comparable to sulfonylureas.
across the bloodbrain barrier. We hypothesized this difference in
transport into the CSF would be present in humans. Description of Methods and Materials: A 4arm, doubleblind, Efficacy of Pregabalin, Gabapentin and Duloxetine in Treatment
parallel group, doseranging PK study of arbaclofen and baclofen
of Diabetic Neuropathic Pain, Postherpetic Neuralgia and
was conducted in healthy subjects to compare the plasma and CSF
Fibromyalgia: A Model-Based Meta-Analysis
parameters. Twelve subjects in each group received oral arbaclofen
Ahmed A. Othman1, Sandeep Dutta1, Walid Awni1, Jaap Mandema2
doses of 5, 7.5, or 10mg, or baclofen doses of 20mg every six hours
1Department of Clinical Pharmacology and Pharmacometrics,
for four days after an uptitration period of nine days. Steady state
Abbott Laboratories, Abbott Park, IL, USA; 2Quantitative
PK parameters were calculated from samples taken on Day 14. Data and Results: No difference was observed for AUC, Cmax,
and Cmin in the plasma or CSF for equimolar doses of Rbaclofen
Statement of Purpose, Innovation or Hypothesis: The objec
when administered as the single enantiomer or the racemic mixture.
tive of this work was to characterize the efficacy doseresponse
Interpretation, Conclusion or Significance: Plasma and CSF param
relationship of drugs approved or evaluated for treatment of sev
eters were not dose proportional in the arbaclofen treated groups.
eral neuropathic pain indications: Diabetic Neuropathic Pain
Plasma and CSF PK parameters of Rbaclofen are not different when
(DPN), Postherpetic Neuralgia (PHN), and Fibromyalgia (FM).
administered as the single enantiomer or the racemic mixture. The
Description of Methods and Materials: A database of all pub
competitive blood brain barrier transport of the R and Senantiomers
licly available efficacy information on drugs approved or evaluated
observed in preclinical models was not observed in this study. 1123350: Table 1: R-baclofen PK Results Treatment AUCt ng*h/ml Cmax ng/ml Cmin ng/ml AUCt ng*h/ml Cmax ng/ml Cmin ng/ml ABSTRACTS
patient education is required about drug uses and stricter regula
Many studies showed that information disseminated through the
tory activities will be needful to promote rational drug uses in
advertisement is inconsistent with the code of ethics. Thus this
study aims to evaluate the authenticity and rationality of the
pharmaceutical promotional drug literatures. Description of Methods and Materials: In this prospective
observational study we collected 171 promotional pharmaceuti
A Cross-sectional Study to Assess the Patients’ Satisfaction and
cal drugs literature from various departments such as Cardiology,
Effectiveness of Complementary and Alternative Medicine
Medicine, Nephrology, Oncology Orthopedics, and pediatrics at
(CAM) in four chronic diseases in a tertiary referral centre in
K.E.M. Hospital, Parel, Mumbai. The collected literatures were
analyzed for rationality according to world health organization
Mangesh S. Bhalerao, Pravin M. Bolshete, Balkrishna D. Swar,
criteria (WHO) and authenticity of therapeutic claims made in
Triveni A. Bangera, Vijaykumar R. Kolhe, Swapnil D. Bhowate,
promotional literature were verified by accessing standard litera
Mukund J. Tambe, Umesh B. Sonje, Meenal P. Wade, Nithya J.
Data and Results: In this prospective observational study on
Department of clinical pharmacology, Seth GS Medical College &
pharmaceutical promotional drug literatures showed that 19.30%
KEM hospital Parel, Mumbai, Mumbai, India
(33) were rational, 80.70% (138) were irrational, 49.12% (84) were
authentic and 50.88% (87) were not authentic. Multinational com
Statement of Purpose, Innovation or Hypothesis: The use of
panies showed 9.36% (16) rationale, 24.56% (42) irrational,
Complementary and Alternative Medicine (CAM) is increasing and
19.88% (34) authentic, 14.62% (25) not authentic and non multi
becoming an important treatment option for patients with chronic
national companies showed 9.36% (16) rationale, 56.72% (97)
diseases. The present study was conducted to assess the patients’
irrational, 29.83% (51) authentic and 35.67% (61) not authentic.
satisfaction and extent of CAM use in four chronic diseases; Rheu
Out of 171 promotional literatures 26.90% (46) were from diabetes
matoid arthritis (RA), Diabetes mellitus (DM), Epilepsy and HIV.
blood pressure, 15.79% (27) from analgesics, 15.20% (26) from
Description of Methods and Materials: The study was
antibiotics and 31% (53) from other therapeutic area.
approved by the IRB and conducted over a 16 week period in
Interpretation, Conclusion or Significance: It was concluded
these diseases after written informed consent from participants.
from this study that pharmaceutical companies did not follow the
Key selection criteria were age more than 18 yrs and taking CAM
WHO guidelines while promoting their drugs. They have only the
along with established therapy. The Treatment Satisfaction Ques
commercial motive rather than the ethical educational aspect.
tionnaire for Medication (TSQM)TM was used to assess the satis
Important information about contraindication, precautions, adverse
faction in domains like Effectiveness, no Side Effect, Convenience
drug reaction and drug interactions was usually missing. Non mul
and Global Satisfaction. The domain scores ranged from 0 to 100
tinational pharmaceutical companies showed the more irrationality
with higher scores representing greater satisfaction.
and non authenticity. There will be need of making stringent laws
Data and Results: A total of 4664 patients were screened. Of
for ethical promotion of pharmaceutical drugs material.
these 1619 (34.71%) were found to be using CAM. Of these,
969/1619 (59.85%) declined to consent and thus only 650 were
studied. The extent of use of CAM in DM was 63%, RA 42.73 %,
HIV 26.19 % and Epilepsy 7.67%. Ayurveda was found to be most
Plasma and CSF Levels of Arbaclofen Are Not Associated With
frequently used CAM 57.07 % (95% CI 53.2760.89). Satisfaction
Drowsiness
in terms of effectiveness and global satisfaction was highest in HIV
Glenn Meyer1, Gustavo Fischbein2, David Boyd1
(69.43% and 69.24 % respectively) and least in RA (56.61 % and
1Osmotica Pharmaceutical Corp, Wilmington, NC, USA; 2Osmotica
54.13 % respectively). High scores were reported to “no side effect
Pharmaceutical Argentina S.A., Buenos Aires, Argentina
“domain in all four diseases indicating satisfaction with CAM. Interpretation, Conclusion or Significance: The extent of use of Statement of Purpose, Innovation or Hypothesis: Arbaclofen,
CAM in four chronic diseases in a tertiary referral centre was found
the Renantiomer of baclofen, is in development for spasticity due
to be 34.71% .The users of CAM in DM, HIV and Epilepsy believed
to multiple sclerosis. The primary dose limiting adverse event for
that CAM were safe, effective and convenient with high satisfac
racemic baclofen is drowsiness and sedation. We hypothesized
tion. Given the potential interaction of CAM with conventional
that the Senantiomer was the primary cause of these events.
therapies, patients should be screened at least by history taking for
Description of Methods and Materials: A 4arm, parallel
use of CAM. Studies on the actual effectiveness may help physi
group, doubleblind, doseranging PK study of arbaclofen and
cians and patients in future management of these diseases.
baclofen was conducted in healthy subjects to compare the
plasma and CSF parameters. Twelve subjects in each group
received arbaclofen doses of 5, 7.5, or 10mg, or baclofen doses of
20mg every six hours for four days after an uptitration period of
Evaluation of authenticity and rationality of promotional
nine days. Subjects completed a drowsiness scale every three
pharmaceutical drug literatures
hours while awake on Day 12. Scores ranged from zero “No
Chetan B. Yeola1, Gaurav Zope1, Pravita Yadav1, Sachin Upasani1,
Drowsiness” to 10 “Worst Possible Drowsiness”. PK samples were
Sagar Thakkar1, Manoj Jadhav1, Ashish Nabar2
taken on Day 14. AUC and Cmax values were analyzed by regres
1Department of Infectious Diseases, Maharashtra University of
sion with the mean daily drowsiness scores.
Health Sciences & Seth G S Medical College and KEM Hospital,
Data and Results: No significant correlation was observed
Parel, Mumbai., Parel ( Mumbai), India; 2Department of Cardiology,
between drowsiness scores and arbaclofen or baclofen plasma PK
Seth G S Medical College and KEM Hospital, Parel, Mumbai.,
parameters. No significant correlation was found for arbaclofen
CSF parameters. However, baclofen CSF AUC and Cmax were
significantly correlated to daily drowsiness scores with R2 values
Statement of Purpose, Innovation or Hypothesis: The promo
of 0.78 and 0.88 and pvalues of 0.0016 and 0.0001, respectively.
tional activities of pharmaceutical industry are governed by the
Interpretation, Conclusion or Significance: These results sug
World Health Organization, International Federation of Pharma
gest that drowsiness, the most common dosinglimiting adverse
ceutical Manufacturers and Associations, Organization of Phar
event for baclofen, is associated with CSF exposures of the
maceutical Producers of India, which are self regulatory codes.
Senantiomer and not the Renantiomer. 1354 • J Clin Pharmacol 2011;51:1326-1369
Health Scrutiny Committee – 6 January 2012 Evaluation fol owing the closure of day services provided by South Staffordshire and Shropshire Healthcare NHS Foundation Trust 1. That the Health Scrutiny Commit ee consider and comment on the at ached evaluation fol owing the closure of mental health day services, and transition to other services, in What is the Scrutiny Committee being asked t
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