Osilodrostat

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Osilodrostat
Osilodrostat.svg
Names
Trade namesIsturisa
Other namesOsilodrostat phosphate, LCI-699
  • 4-[(5R)-6,7-Dihydro-5H-pyrrolo[1,2-c]imidazol-5-yl]-3-fluorobenzonitrile
Clinical data
Drug classSteroidogenesis inhibitor
Main usesCushing's disease[1]
Side effectsAdrenal insufficiency, headache, vomiting, tiredness, swelling[2]
Routes of
use
By mouth
Typical dose2 to 30 mg BID[2]
External links
AHFS/Drugs.comMonograph
US NLMOsilodrostat
Legal
License data
Legal status
  • US: ℞-only
  • EU: Rx-only
  • In general: ℞ (Prescription only)
Chemical and physical data
FormulaC13H10FN3
Molar mass227.242 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 used to treat Cushing's disease when pituitary surgery is either not possible or not effective.[1] It is taken by mouth.[1]

Common side effects are adrenal insufficiency, headache, vomiting, tiredness, and swelling.[2] QTc prolongation, low potassium, and high blood pressure may also occur.[1] Safety is unclear in pregnancy and use in breastfeeding is not recommended.[3] It works by inhibiting the enzyme 11-beta-hydroxylase which makes cortisol.[2]

Osilodrostat was approved for medical use in Europe and the United States in 2020.[2][1] In the United Kingdom a month of 10 mg twice per day costs about £6700 as of 2021.[4] In the United States this amount costs about 32,200 USD.[5]

Medical uses

Dosage

It is started at 2 mg twice per day.[2] This can be increased up to 30 mg twice per day.[2] The dose is based on cortisol levels.[2]

Mechanism of action

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).[6] It specifically acts as a potent and selective inhibitor of aldosterone synthase (CYP11B2) and at higher dosages of 11β-hydroxylase (CYP11B1).[6]

History

In October 2014, an orphan designation was granted by the European Commission for osilodrostat for the treatment of Cushing's syndrome.[7]

Osilodrostat was approved for medical use in the European Union in January 2020,[2] and for medical use in the United States in March 2020.[8][9]

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.[8] The majority of subjects either had undergone pituitary surgery that did not cure Cushing's disease or were not surgical candidates.[8] 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.[8] At the end of this 24-week period, about half of subjects had cortisol levels within normal limits.[8] 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).[8] 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.[8]

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.[9] 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).[9]

There was one trial of 48 weeks duration that assessed the benefits and side effects of osilodrostat.[9] The trial enrolled subjects with Cushing's disease for whom pituitary gland surgery was not an option or did not work.[9] The trial was divided in four periods.[9] Subjects received osilodrostat two times a day in all four periods.[9] 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.[9]

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.[9] Neither the subjects nor the healthcare providers know which treatment was given during this period.[9] 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.[9]

The FDA granted osilodrostat an orphan drug designation and granted the approval of Isturisa to Novartis.[8][10]

The U.S. Food and Drug Administration (FDA) considers it to be a first-in-class medication.[11]

See also

References

  1. 1.0 1.1 1.2 1.3 1.4 "Osilodrostat Monograph for Professionals". Drugs.com. Retrieved 9 November 2021.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 "Isturisa EPAR". European Medicines Agency (EMA). 18 February 2020. Retrieved 6 March 2020.
  3. "Osilodrostat (Isturisa) Use During Pregnancy". Drugs.com. Retrieved 9 November 2021.
  4. "Osilodrostat". SPS - Specialist Pharmacy Service. 12 January 2016. Retrieved 9 November 2021.
  5. "Isturisa Prices, Coupons & Patient Assistance Programs". Drugs.com. Retrieved 9 November 2021.
  6. 6.0 6.1 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.
  7. "EU/3/14/1345". European Medicines Agency (EMA). Retrieved 23 July 2020.
  8. 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 "FDA Approves New Treatment for Adults with Cushing's Disease". U.S. Food and Drug Administration (FDA) (Press release). 6 March 2020. Retrieved 6 March 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  9. 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 "Drug Trial Snapshot: Isturisa". U.S. Food and Drug Administration (FDA). 6 March 2020. Retrieved 27 March 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  10. "Drug Approval Package: Isturisa". U.S. Food and Drug Administration (FDA). 6 April 2020. Retrieved 17 January 2021.
  11. "New Drug Therapy Approvals 2020". U.S. Food and Drug Administration (FDA). 31 December 2020. Retrieved 17 January 2021.

External links

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