AP511A - The use of granisetron in the manufacture of a medicament for the treatment of post-operative nausea advomiting (PONV). - Google Patents

The use of granisetron in the manufacture of a medicament for the treatment of post-operative nausea advomiting (PONV). Download PDF

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Publication number
AP511A
AP511A APAP/P/1994/000626A AP9400626A AP511A AP 511 A AP511 A AP 511A AP 9400626 A AP9400626 A AP 9400626A AP 511 A AP511 A AP 511A
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AP
ARIPO
Prior art keywords
placebo
granisetron
vomiting
ponv
nausea
Prior art date
Application number
APAP/P/1994/000626A
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AP9400626A0 (en
Inventor
Gareth John Sanger
Phillip Timothy Davey
Christopher Stuart Dott
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Smithkline Beecham Plc
F Foffmann La Roche Ag
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/08—Drugs for disorders of the alimentary tract or the digestive system for nausea, cinetosis or vertigo; Antiemetics

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  • Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Epidemiology (AREA)
  • Hospice & Palliative Care (AREA)
  • Otolaryngology (AREA)
  • Engineering & Computer Science (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • General Chemical & Material Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Organic Chemistry (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Treatment Of Sludge (AREA)
  • Nitrogen Condensed Heterocyclic Rings (AREA)

Abstract

The use of granisetron in the manufacture of a medicament for the treatment of post-operative nausea and vomiting (ponv).

Description

PHARMACEUTICALS
This invention relates to prevention and treatment of post-operative nausea and vomiting (PONV), and pharmaceutical compositions therefor.
PONV is an important patient problem and one that patients rate as the most distressing aspect of operative procedure, even above pain. Consequently, the need, from the patients' perspective, for an effective anti-emetic in this area is important As a clinical problem PONV is troublesome and requires staff around to ensure that vomitus is not regurgitated, which can have very serious clinical sequela. There are certain operative procedures where it is clinically important that patients do not vomit For example, in occular surgery where intra-cranial/occular pressure can increase to the extent that stitches are ruptured and the operative procedure is set back in terms of success to a marked degree.
O Thus from the point of view of patients and clinicians, the control of PONV is essential.
Financially, the control of PONV is also important In regions such as the U.S.A., a lot of surgery is done in the day-care setting and the importance of being able to send patients home without an overnight stay is financially attractive. In other countries the popularity of day-care surgery is increasing and it may reach to over
50% in 5-10 years time.
The number of operations done per year in the Western world and Japan is in the order of 65 million. Many anaesthetists currently use prophylactic anti-emetic such as low dose metoclopramide (lOmg) pre- or peri-operatively and many use no prophylactic anti-emetics at all due to poor efficacy of current agents coupled with troublesome side-effects such as dystonic reactions and somnolence. Thus the need for a safer and efficacious antiemetic in PONV is present
Example 6 of EP-A-200444 (Beecham Group p.l.c.) describes the preparation of the compound, granisetron (or BRL 43694 monohydrochloride) which is available in the United Kingdom as KYTRIL1 a drug for treating cytotoxic agent induced nausea and vomiting.
We have now found that granisetron is of potential use in the prevention and treatment of PONV.
Accordingly, the present invention provides the use of granisetron in the manufacture of a medicament for the treatment (including prophylaxis) of PONV.
AP/P/ 9 4 / 0 06 26
I registered trade mark of SmithKline Beecham p.l.c.
- 1 P30619
The present invention also provides a method of treatment of (including prophylaxis) of PONV in mammals, including man, by administration of granisetron to the mammal in need thereof.
The administration of granisetron may be by way of known methods, such as 5 oral, or parenteral administration.
An amount effective to treat the disorder hereinbefore described depends on the usual factors such as the nature and severity thereof and the weight of the mammal. However, a unit dose will normally contain 0.5 to 10 mg, for example 1 to 3 mg of granistron. A unit dose will normally be administered pre-operatively such as prior to induction of anaesthesia or peri-operatively; and/or post-operatively.
For oral or parenteral administration, it is greatly preferred that granisetron is administered in the form of a unit-dose composition, such as a unit dose oral or parenteral composition.
C Such compositions are prepared by admixture and are suitably adapted for oral or parenteral administration, and as such may be in the form of tablets, capsules, oral liquid preparations, powders, granules, lozenges, reconstitutable powders, injectable and infusable solutions or suspensions or suppositories.
Tablets and capsules for oral administration are usually presented in a unit dose, and contain conventional excipients such as binding agents, fillers, diluents, tabletting agents, lubricants, disintegrants, colourants, flavourings, and wetting agents. The tablets may be coated according to well known methods in the art
Suitable fillers for use include cellulose, mannitol, lactose and other similar agents. Suitable disintegrants include starch, polyvinylpyrrolidone and starch derivatives such as sodium starch glycollate. Suitable lubricants include, for example, magnesium stearate. Suitable pharmaceutically acceptable wetting agents include sodium lauryl sulphate.
These solid oral compositions may be prepared by conventional methods of blending, filling or tabletting. Repeated blending operations may be used to distribute the active agent throughout those compositions employing large quantities of fillers.
Such operations are, of course, conventional in the art
Oral liquid preparations may be in the form of, for example, aqueous or oily suspensions, solutions, emulsions, syrups, or elixirs, or may be presented as a dry product for reconstitution with water or other suitable vehicle before use. Such liquid preparations may contain conventional additives such as suspending agents, for example sorbitol, syrup, methyl cellulose, gelatin, hydroxyethylcellulose, carboxymethyl cellulose, aluminium stearate gel or hydrogenated edible fats, emulsifying agents, for example lecithin, sorbitan monooleate, or acacia; non-aqueous vehicles (which may include edible oils), for example, almond oil, fractionated coconut oil, oily esters such as esters of glycerine, propylene glycol, or ethyl alcohol;
-2P30619 preservatives, for example methyl or propyl p-hydroxybenzoate or sorbic acid, and if desired conventional flavouring or colouring agents.
Oral formulations also include conventional sustained release formulations, such as tablets or granules having an enteric coating.
For parenteral administration, fluid unit dose forms are prepared containing granisetron and a sterile vehicle. The compound, depending on the vehicle and the concentration, can be either suspended or dissolved. Parenteral solutions are normally prepared by dissolving the compound in a vehicle and filter sterilising before filling into a suitable vial or ampoule and sealing. Advantageously, adjuvants such as a local anaesthetic, preservatives and buffering agents are also dissolved in the vehicle. To enhance the stability, the composition can be frozen after filling into the vial and the water removed under vacuum.
Parenteral suspensions are prepared in substantially the same manner except C that the compound is suspended in the vehicle instead of being dissolved and sterilised by exposure to ethylene oxide before suspending in the sterile vehicle. Advantageously, a surfactant or wetting agent is included in the composition to facilitate uniform distribution of the compound of the invention.
As is common practice, the compositions will usually be accompanied by written or printed directions for use in the treatment concerned.
The present invention further provides a pharmaceutical composition for use in the treatment and/(including prophylaxis) of PONV, which comprises granistron and a pharmaceutically acceptable carrier. Such compositions may be prepared in the manner as hereinbefore described.
The following clinical study results illustrate the invention.
Z 9 0 0 ! V 6 IdldV
Clinical Study Outline
30 Title: A double blind parallel group placebo controlled dose ranging study of intravenous granisetron in the prevention of post-operative nausea and vomiting in patients undergoing open surgery.
35 Indication: For the prevention of post-operative nausea and vomiting.
40 Objective: To determine the optimum dose of intravenous granisetron to prevent postoperative nausea and vomiting.
-3P30619
ΑΡ π Ρ Π J 1 ί
Study
Population:
Efficacy
Parameters:
c
Safety
Parameters:
Dosing
Schedule:
c (
Efficacy
Assessments:
480 evaluable patients (120 per group) who are scheduled to undergo general anaesthesia for elective open surgery for gynaecological procedures or cholecystectomy.
Primary efficacy assessment will be the no vomiting rate, over 0-6 hours and 0-24 hours.
Secondary efficacy assessments will include analysis of time to:
i) total control rate (no nausea, no vomit/retching, no rescue antiemetic and not withdrawn) ii) less than total control.
iii) first episode of vomiting.
iv) first episode of nausea.
v) nausea and vomiting rate over day 0-6
Safety will be assessed by recording:
a Vital signs b Laboratory variables c Adverse experiences d Concurrent medication
Patients will be randomised to receive placebo,
0.1 mg, 1.0 mg or 3.0 mg IV granisetron given as a 30 second injection at induction of anaesthesia.
On Day 0 assessments will be made at 1 hour, hours, 6 hours, and 24 hours of nausea (none, mild, moderate or severe) and vomiting (none, 1,2,3,4 or > 4 episodes) in the CRF. On Days 1 - 6 daily assessments of nausea and vomiting will be made on a diary card.
-4P30619
APC 5 1 ’
RESULTS
DOSE RANGING STUDY (PONV)
PLACEBO vs 0.1MG vs 1.0MG vs 3.0MG LV.
NO VOMITING
PLACEBO
Vomiting Status 0-6 hrs n %
Vomiting 67 50.38
No Vomiting 66 49.62
Vomiting Status 0-24 hrs
Vomiting 88 66.17
No Vomiting 45 33.83
TREATMENT GROUP
0.1 MG 1.0 MG 3.0 MG
n % n % n %
55 41.67 29 21.64 30 23.44
77 58.33 105 78.36 98 76.56
73 55.30 49 36.57 49 38.28
59 44.70 85 63.43 79 61.72
Confidence Intervals
Approximate pairwise confidence intervals for the difference in the proportion of 25 vomiting responders, based on a quadratic approximation to the log-likelihood, have been calculated for each treatment group, using the Bonferroni correction (to maintain the two-tailed significance level of 5%)
0-6 hours
30 Pairwise Comparison Confidence Interval p value *sig
BRL 0. IMG IV vs PLACEBO IV [- 4.95%, 22.37%] p=0.155 NS
BRL 1.0MG IV vs PLACEBO IV [16.17%, 41.29%] p<0.001 SIG
35 BRL 3.0MG IV vs PLACEBO IV [14.11%, 39.77%] p<0.001 SIG
0-24 hours Pairwise Comparison Confidence Interval p value ♦sig
BRL 0.1MG IV vs PLACEBO IV [- 2.50%, 24.22%] p=0.07 NS
40 BRL 1.0MG IV vs PLACEBO IV [16.51%, 42.69%] p<0.001 SIG
BRL 3.0MG IV vs PLACEBO IV [14.57%, 41.19%] p<0.001 SIG
♦ Significance using Modified Bonferroni Correction.
9Z900/V6 ,'d/dV
-5P30619
AP Ο 0 3 5 1 1
PLACEBO vs 0.1MG vs 1.0MG vs 3.0MG LV.
NO NAUSEA
Nausea Status 0-6 hrs Nausea
No Nausea
Nausea Status 0-24 hrs
Nausea
No Nausea
TREATMENT GROUP
PLACEBO 0.1 MG 1.0 MG 3.0 MG
n % n % n % n %
87 65.41 81 61.36 49 36.57 55 42.97
46 34.59 51 38.64 85 63.43 73 57.03
104 78.20 95 71.97 67 50.00 74 57.81
29 21.80 37 28.03 67 50.00 54 42.19
Confidence Intervals
Approximate pairwise confidence intervals for the difference in the proportion of 20 vomiting responders, based on a quadratic approximation to the log-likelihood, have been calculated for each treatment group, using the Bonferroni correction (to maintain the two-tailed significance level of 5%)
0-6 hours
25 Pairwise Comparison Confidence Interval p value ♦sig
BRL 0.1MG IV vs PLACEBO IV [-9.20%, 17.30%] p=0.494 NS
BRL 1.0MG IV vs PLACEBO IV [15.73%, 41.97%] p<0.001 SIG
30 BRL 3.0MG IV vs PLACEBO IV [ 8.97%, 35.91%] p<0.001 SIG
0-24 hours Pairwise Comparison Confidence Interval p value ♦sig
BRL 0.1MG IV vs PLACEBO IV [-5.64%, 18.10%] p=0.241 NS
35 BRL 1.0MG IV vs PLACEBO IV [15.63%, 40.77%] p<0.001 SIG
BRL 3.0MG IV vs PLACEBO IV [ 7.73%, 33.03%] p<0.001 SIG
* Significance using Modified Bonferroni Correction.
-6P30619
AP Ο ν ·'· 5 1 1
PLACEBO vs 0.1MG vs 1.0MG vs 3.0MG LV.
TOTAL CONTROL
TREATMENT GROUP
PLACEBO 0.1 MG 1.0 MG 3.0 MG
Total Control Status 0-6 hrs n % n % n % n %
Less than Total Control 91 68.42 83 62.88 49 36.57 58 45.31
Total Control 42 31.58 49 37.12 85 63.43 70 54.69
Total Control Status 0-24 hrs
Less than Total Control 109 81.95 97 73.48 68 50.75 74 57.81
Total Control 24 18.05 35 26.52 66 49.25 54 42.19
Confidence Intervals
Approximate pairwise confidence intervals for the difference in the proportion of 20 vomiting responders, based on a quadratic approximation to the log-likelihood, have been calculated for each treatment group, using the Bonferroni correction (to maintain the two-tailed significance level of 5%)
0-6 hours
25 Pairwise Comparison Confidence Interval p value *sig
BRL 0. IMG IV vs PLACEBO IV [-7.51%, 18.59%] p=0.342 NS
BRL 1.0MG IV vs PLACEBO IV [18.87%, 44.83%] p<0.001 SIG
30 BRL 3.0MG IV vs PLACEBO IV [ 9.74%, 36.48%] p<0.001 SIG
0-24 hours Pairwise Comparison Confidence Interval p value *sig
BRL 0.1MG IV vs PLACEBO IV [ -2.93%, 19.87%] p=0.097 NS
35 BRL 1.0MG IV vs PLACEBO IV [18.99%, 43.43%] p<0.001 SIG
BRL 3.0MG IV vs PLACEBO IV [11.84%, 36.44%] p<0.001 SIG
* Significance using Modified Bonferroni Correction.
AP/P/ 9 4/ 0 06 26
-7P30619
ΑΡπ 0 11 1
Time to first Vomiting (24 hour period)
Forty-five patients (33.83%) in the Placebo group, 59 (44.70%) in the 0.1 MG group, 85 (63.43%) in the 1.0 MG group and 79 (61.72%) in the 3.0 MG group did not experience any vomiting over the 24 hour period. There was evidence to suggest a difference in the survival distributions to times of first vomiting (χ2 = 36.1544, df=3, p < 0.001).
Using the Modified Bonferroni correction for the three pairwise comparisons, there was insufficient evidence to suggest a significant difference between placebo and 0.1 MG (χ2 = 3.0313, df=l, p = 0.082), but there was a significant difference between placebo and 1.0 MG (χ2 = 25.9298, df=l, p < 0.001), and between placebo and 3.0 MG (χ2 = 21.9885, df=l, p < 0.001) in the survival distributions of times to first vomiting.
Time to first Nausea (24 hour period)
Twenty-nine patients (21.80%) in the placebo group, 37 patients (28.03%) in the 0.1 MG group, 67 patients (50.00%) in the 1.0 MG group and 54 patients (42.19%) in the 3.0 MG group did not experience any nausea over the 24 hour period. There was evidence to suggest a difference in the survival distributions of times to first nausea ( χ2 = 30.1666, df=3, p < 0.001).
Using the Modified Bonferroni correction for the three pairwise comparisons, there was insufficient evidence to suggest a significant difference between placebo and 0.1 MG (χ2 = 1.5899, df=l, p = 0.2073),but there was a significant difference between placebo and 1.0 MG (χ2 = 23.3685, df=l, p < 0.001) and between placebo and 3.0 MG (χ2 = 13.9814, df=l, p < 0.001), in the survival distributions of times to first nausea episode.
-8P30619
Time to less than Total Control (24 hour period)
Twenty-four patients (18.05%) in the placebo group, 35 patients (26.52%) in the 0.1 MG group, 66 patients (49.25%) in the 1.0 MG group and 54 patients (42.19%) in the
3.0 MG group maintained total control over the whole 24 hour period. There was evidence to suggest a significant difference in the survival distributions of times to less than total control (χ2 = 37.0051, df=3, p < 0.001).
Using the Modified Bonferroni correction for the three pairwise comparisons there was insufficient evidence to suggest a difference between the placebo and 0.1 MG group (χ2 = 2.7620, df=l, p = 0.097), but there was a significant difference between placebo and 1.0 MG (χ2 = 29.5533, df=l, p < 0.001) and between placebo and 3.0 MG (χ2 = 18.2882, df=l, p < 0.001), in the survival distributions of times to less than total control.
Time to first use of Rescue (24 hour period)
Eighty patients (60.15%) in the placebo group, 89 patients (67.42%) in the
0.1 MG group, 101 patients (75.37%) in the 1.0 MG group and 99 patients (77.34%) in the 3.0 MG group did not require any rescue medication over the 24 hour study period. There was evidence to suggest a significant difference in the survival distributions of times to use of anti-emetic therapy (χ2 = 12.1904, df=3, p = 0.007).
Using the Modified Bonferroni correction for the three pairwise comparisons there was insufficient evidence to suggest a significant difference between placebo and 0.1 MG (χ2 = 1.4836, df=l, p = 0.223), but there was a significant difference between placebo and 1.0 MG (χ2 = 7.3467, df=l, p = 0.007) and between placebo and 3.0 MG (χ2 = 9.0949, df=l, p = 0.003), in the survival distributions of times to first use of rescue therapy.

Claims (4)

1. The use of granisetron in the manufacture of a medicament for the treatment of post-operative nausea and vomiting (PONV).
2. A use according to claim 1 wherein the medicament is adapted for intravenous administration.
3. A use according to claim 1 or 2 wherein granisetron is administered in a 1 mg 10 to 3 mg unit dose.
4. A use according to claim 1,2, or 3 wherein granisetron is administered pre-operatively, peri-operatively; or post-operatively.
15 5. A use according to claim 4 wherein granisetron is administered pre-operatively.
APAP/P/1994/000626A 1993-03-18 1994-03-16 The use of granisetron in the manufacture of a medicament for the treatment of post-operative nausea advomiting (PONV). AP511A (en)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
GB939305593A GB9305593D0 (en) 1993-03-18 1993-03-18 Pharmaceuticals

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AP9400626A0 AP9400626A0 (en) 1994-04-30
AP511A true AP511A (en) 1996-07-26

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APAP/P/1994/000626A AP511A (en) 1993-03-18 1994-03-16 The use of granisetron in the manufacture of a medicament for the treatment of post-operative nausea advomiting (PONV).

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US (1) US5952340A (en)
EP (1) EP0689437B1 (en)
JP (2) JP3792251B2 (en)
KR (1) KR100315606B1 (en)
CN (1) CN1085079C (en)
AP (1) AP511A (en)
AT (1) ATE230596T1 (en)
AU (1) AU676032B2 (en)
CA (1) CA2158354C (en)
CY (1) CY2427B1 (en)
DE (1) DE69431986T2 (en)
DK (1) DK0689437T3 (en)
ES (1) ES2188611T3 (en)
GB (1) GB9305593D0 (en)
HU (1) HU214629B (en)
IL (1) IL109059A (en)
SG (1) SG46724A1 (en)
TW (1) TW312622B (en)
WO (1) WO1994021257A1 (en)
ZA (1) ZA941844B (en)

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GB9412995D0 (en) * 1994-06-28 1994-10-26 Prendergast Kenneth F Safety enhancing pharmaceutical compositions of an active indazole
WO2003100091A1 (en) * 2002-05-24 2003-12-04 Epidauros Biotechnologie Ag Means and methods for improved treatment using 'setrones'
SE0203410D0 (en) * 2002-11-18 2002-11-18 Astrazeneca Ab New use
JO2735B1 (en) * 2003-01-30 2013-09-15 هيلسين هيلث كير أس ايه. Liquid pharmaceutical formulations of palonosetron
TWI355936B (en) 2003-02-18 2012-01-11 Helsinn Healthcare Sa Uses of palonosetron hydrochloride
GB0328186D0 (en) * 2003-12-05 2004-01-07 West Pharm Serv Drug Res Ltd Intranasal compositions
JP6081102B2 (en) * 2012-08-10 2017-02-15 テルモ株式会社 Stable granisetron-containing aqueous formulation
GB201618425D0 (en) * 2016-11-01 2016-12-14 Acacia Pharma Ltd method
JP2017077484A (en) * 2016-11-30 2017-04-27 テルモ株式会社 Package of stable aqueous formulation containing granisetron
GB201702250D0 (en) 2017-02-10 2017-03-29 Acacia Pharma Ltd Method

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DE3650772T2 (en) * 1985-04-27 2003-04-03 F. Hoffmann-La Roche Ag, Basel Derivatives of indazole-3-carboxamide and -3-carboxylic acid
GB8525913D0 (en) * 1985-10-21 1985-11-27 Beecham Group Plc Compounds
GB8928837D0 (en) * 1989-12-21 1990-02-28 Beecham Group Plc Pharmaceuticals
US5225407A (en) * 1990-02-22 1993-07-06 Glaxo Group Limited 5-HT3 receptor antagonists for the treatment of autism
EP0916346A3 (en) * 1991-09-20 2000-12-06 Glaxo Group Limited NK-1 receptor antagonists and 5HT3 receptor antagonists for the treatment of emesis

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Also Published As

Publication number Publication date
AP9400626A0 (en) 1994-04-30
ZA941844B (en) 1995-09-18
JP2006083190A (en) 2006-03-30
HK1012237A1 (en) 1999-07-30
EP0689437B1 (en) 2003-01-08
JPH08507774A (en) 1996-08-20
IL109059A (en) 1996-11-14
HUT73502A (en) 1996-08-28
EP0689437A1 (en) 1996-01-03
ATE230596T1 (en) 2003-01-15
ES2188611T3 (en) 2003-07-01
CA2158354A1 (en) 1994-09-29
DE69431986D1 (en) 2003-02-13
CN1122570A (en) 1996-05-15
AU6377494A (en) 1994-10-11
JP3792251B2 (en) 2006-07-05
HU214629B (en) 1998-04-28
TW312622B (en) 1997-08-11
IL109059A0 (en) 1994-11-28
HU9502692D0 (en) 1995-11-28
CA2158354C (en) 2004-07-13
US5952340A (en) 1999-09-14
SG46724A1 (en) 1998-02-20
CN1085079C (en) 2002-05-22
DK0689437T3 (en) 2003-04-28
DE69431986T2 (en) 2003-11-06
WO1994021257A1 (en) 1994-09-29
GB9305593D0 (en) 1993-05-05
KR100315606B1 (en) 2002-04-24
AU676032B2 (en) 1997-02-27
CY2427B1 (en) 2004-11-12

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