摘要:

Most patients with type 2 (non-insulin-dependent) diabetes mellitus require pharmacotherapy, initially as monotherapy and subsequently in combination, as adjuncts to diet and exercise. Exogenous insulin is ultimately required in a substantial proportion, reflecting the progressive natural history of the disease. Sulphonylureas and biguanides have been employed for over 4 decades as oral antidiabetic agents, but they have a limited capacity to provide long term glycaemic control and can cause serious adverse effects. Thus, more efficacious and tolerable antidiabetic agents are required.Recent years have witnessed the introduction of agents with novel modes of action, that is, the &agr;-glucosidase inhibitors acarbose and miglitol (which reduce postprandial hyperglycaemia) and the first of the thiazolidinedione insulin-sensitising drugs - troglitazone and rosiglitazone. Although the former has been withdrawn in some countries due to adverse effects, another ‘glitazone’ pioglitazone is expected to be approved in the near future. Other recently introduced drugs include glimepiride and the meglitinide insulin secretagogue, repaglinide. Attention is also focusing increasingly on combination therapy using insulin together with sulphonylureas, metformin or troglitazone. Rapid-acting insulin analogues are now being used as alternatives to conventional insulins; their role in the management of type 2 diabetes mellitus is presently uncertain but reports of a reduced frequency of hypoglycaemia are encouraging.The development of new drugs aims to counter the principal metabolic defects of the disorder, respectively, relative insulin deficiency and insulin resistance. Novel classes of rapid-acting secretagogues under evaluation include the morphilinoguanide BTS 67582 and the meglitinides mitiglinide (KAD 1229) and senaglinide (A-4166). Succinate ester derivatives represent a potential novel approach to improving &bgr;-cell function through enhancement of insulin biosynthesis and secretion. Enhancement of nutrient-induced insulin secretion is amechanism with several putative targets within the &bgr;-cell; potentiators of insulin secretion include glucagon-like peptide-1 and its analogues, phosphodiesterase inhibitors and the imidazoline derivative PMS 812 (S 21663). The amylin agonist pramlintide slows gastric emptying and suppression of glucagon secretion. Nonthiazolidinedione insulin-sensitising agents include the &ggr;-receptor agonist G 1262570X (GG 570) and D-chiro-inositol. Insulin analogues with prolonged action and inhaled insulin preparations are also under investigation. Insulin-mimetic agents include organic vanadium compounds.Whether newer agents will offer clinically relevant efficacy and tolerability advantages over existing therapies remains to be determined.

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS

摘要:

All drugs appearing in the Adis Profile Summary table have been selected based on information contained inR&D InsightTM, a proprietary product of Adis International. As the emphasis ofDrugs in R&Dis on the clinical potential of new drugs, selection of agents for full profile is based on the extensiveness of available data. Information on all drugs in clinical development, as identified fromR&D InsightTM, is included in the summary table. Information and/or profiles of agents in preclinical development may be included as appropriate.

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS

摘要:

BTS 67582 is a novel morpholinoguanidine insulinotropic agent being developed by Knoll (BASF) for the treatment of type 2 diabetesmellitus. Phase II trials are underway in the UK, France and the USA. Knoll is currently looking for a collaboration partner for phase III trials.

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS

摘要:

Insulin aspart (Asp-B28) is a biosynthetic insulin analogue which is being developed by Novo Nordisk for the treatment of diabetes mellitus. Insulin aspart (as NovoRapidTM) is currently awaiting registration within the European Union (EU) as an antidiabetic product. The analogue contains an Asp residue substitution at position B28 and consists of a mixture of monomers and dimers. NovoRapidTMhas been recommended for approval within the EU for the treatment of patients with diabetes mellitus. Novo Nordisk is expecting the approval of insulin aspart in Europe over the summer with US Food and Drug Administration (FDA) approval potentially coming in September 1999. The agent can be administered just before a meal compared with the 30 min of time lag needed for conventional insulins. An New Drug Application for FDA approval of insulin aspart for the treatment of patients with diabetes mellitus was submitted in September 1998. AUS brand name for insulin aspart has not been chosen, although Novo Nordisk has applied for Patent and Trademark Office approval of the names of NovomixTMand NovofortTMas possible tradenames for insulin aspart. NovomixTMis the name of a series of premixed formulations containing NovoRapidTMwith intermediate-acting insulin. It is in phase III clinical trials.

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS

摘要:

Insulin glargine (HOE 901, HOE 71GT15, HOE 71GT80), a Gly(A21), Arg(B31, B32) human insulin analogue, is a long-acting biosynthetic insulin which can be administered once daily in patients with type 1 or type 2 diabetes mellitus. It has completed phase III clinical trials with Hoechst Marion Roussel in Germany for the treatment of both type 1 and type 2 diabetes mellitus. Phase III trials have been completed in Europe, the US and Japan. Submissions for regulatory approval were made by Hoechst Marion Roussel in April 1999 to the European Medicinal Evaluations Agency and the US Food and Drug Administration. Regulatory submissions are planned in Japan for 2001.Insulin glargine has an isoelectric point of pH 7, so when administered SC in a solution with a pH of 4, precipitates readily at the neutral tissue pH. This results in delayed absorption and the possibility of once daily administration. Two pharmaceutical formulations of insulin glargine are being investigated, HOE 71GT15 andHOE 71GT80, that differ in their zinc content (15 and 80 &mgr;g/ml, respectively).

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS

摘要:

Aradigm Corporation has developed an inhaled insulin product using its proprietary AERxTMdrug delivery system. The system involves the use of liquid insulin which is converted to an aerosol containing very small particles (1 to 3 microns in diameter), and an electronic device for delivery to the lung. The AERxTMsystem instructs the user on how hard to inhale. Aradigm Corporation and Novo Nordisk have signed an agreement to jointly develop a pulmonary delivery system for insulin by inhalation (NN 1998). The product entered phase II clinical trials in the second half of 1998 in the USAand Australia. Both companies will explore the possibility of using the system to deliver other antidiabetic compounds. In addition, the agreement gives Novo Nordisk an option to develop the technology for delivery of other nondiabetic agents. Novo Nordisk has the exclusive rights for worldwidemarketing of any products resulting fromthe development programmes. Aradigm Corporation will initially manufacture all the products covered by the agreements, and in return will receive a share of the overall gross profits from Novo Nordisk's sales. Novo Nordisk will cover all development costs incurred by Aradigm Corporation while both parties will co-fund final development of the AERxTMdevice. Novo Nordisk agreed to purchase $US10 million of newly-issued Aradigm stock. This is an upfront payment to Aradigm Corporation that could reach up to $US50 million in milestone payments and equity investments.Aradigm Corporation has received a US patent (5 884 620) related to the method of patient breathing technique during pulmonary delivery of insulin. This technique enables a more reproducible pulmonary delivery of insulin, and guides the patient how to breathe.

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS

摘要:

Inhale Therapeutic Systems (ITS) has developed a pulmonary drug delivery system for insulin. The system involves the use of insulin as a dry powder in a hand held inhalation device. The device converts the insulin powder particles into an aerosol cloud for the patient to inhale. No propellants are used. ITS has licensed this system to Pfizer which will lead the clinical development of the insulin inhalation while working with ITS to develop the technology required for packaging the product. Pfizer has initiated phase III clinical trials with inhaled insulin in patients with type 1 and type 2 diabetes mellitus in 117 centres, and will use a fourth prototype inhaler device that is half the size of the first prototype, and has reduced manufacturing costs.Pfizer has filed an application with the US Patent and Trademark Office for the name tradename Exubera® for the inhaled insulin formulation.ITS has initiated a pulmonary controlled-release research programme using its proprietary dry powder delivery technology. Investigations have begun with long-acting insulin, and is funded by Pfizer.Pfizer has entered into the agreement with Hoechst Marion Roussel for manufacturing, developing and promoting inhaled insulin. Hoechst Marion Roussel will supply recombinant insulin to ITS which will process it into a dry powder for incorporation into the inhaler device. ITS will receive royalties on sales of inhaled insulin marketed by Pfizer and Hoechst Marion Roussel, and milestone payments and research support from Pfizer. HoechstMarion Roussel's codename for the product is HMR 4006.

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS

摘要:

&NA;Mitiglinide (KAD 1229) is a potassium channel antagonist and a derivative of benzylsuccinic acid. It has oral hypoglycaemic activity and is structurally different from the sulphonylureas although it appears to act at the suphonylurea receptors on pancreatic &bgr;-cells. Mitiglinide is undergoing phase III clinical trials for diabetes with Kissei in Japan.Because of its short acting effects, the agent is taken before each main meal. Mitiglinide has been licensed to Servier for Europe, where it is undergoing phase II development, and for Russia, the Commonwealth of Independent States, the Baltic Republics, the Middle East and Oceania. Mitiglinide has been licensed to Purdue Frederick for North, South and Central America.

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS

摘要:

PMS 812 (S 21663) is an imidazoline derivative. Preclinical assessments of the drug's antidiabetic activity are underway.

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS

摘要:

Pramlintide (ACO 137, AC 137, Normylin, Tripro-amylin, SymlinTM) is a synthetic human amylin analogue with proline substitutions at positions 25, 28 and 29 which limits the self-aggregation seen with native amylin. Pramlintide improves glycaemic control and appears to reduce postprandial blood glucose peaks and flatten the glucose peaks and troughs observed in patients with diabetes. The reduction of hypoglycaemia would be an immediate advantage, and the reduction of hyperglycaemia could potentially prevent diabetic complications.Amylin is currently conducting 6 phase III clinical trials of pramlintide in North America and Europe for the treatment of patients with type 1 and type 2 diabetes mellitus. The phase III programme is called PARADIGM (Pramlintide for Amylin Replacement: Adjunct for Diabetes in Glycemic Management). All 6 studies have the primary goal of demonstrating that pramlintide can help patients with diabetes who use insulin to improve their glucose control and reduce the risk of complications. Four of the studies involve patients with ‘poor glucose control’ (HbA1c≥ 8%). The PARADIGM programme is expected to enrol around 2800 patients and should be completed in 1999. Unexpectedly in two 6-month phase III combined European and Canadian studies, a clear drug effectwas not observed at the highest dosage which had been designated in advance for regulatory purposes. Therefore, the results from the primary dosage arms do not complete the regulatory requirements. Amylin plans to reassess the regulatory activities for pramlintide after appropriate consultation with regulatory authorities in the USA and Europe. The enrolment for two 1-year studies in theUSAhas been completed, with more than 880 patients at more than 135 sites. The US FDA and European marketing application for either type of diabetes mellitus is planned for mid-2000.In a separate phase II programme, Amylin is investigating the use of pramlintide in patients with type 2 diabetes mellitus who are not achieving satisfactory results with oral hypoglycaemic agents but who have not progressed to using insulin.As an amylin agonist, pramlintide represents a novel approach to treating patients with type 1 and type 2 diabetes mellitus. Pramlintide is the first compound in this class to be developed extensively in clinical trials. The drug requires self-administration of SC injections about 4 times daily which may limit its usefulness in patients with type 2 diabetes mellitus. However, pramlintide may be administered concurrently with insulin in patients with type 1 diabetes mellitus, making this route and frequency of administration less inconvenient in this patient group.

ISSN:1174-5886    

出版商:ADIS    

年代:1999

数据来源: ADIS