Effect of a novel prokinetic drug, R093877, on gastrointestinal transit in healthy volunteers

Abstract

Background-Stronger prokinetic agents which specifically enhance transit in different parts of the gut are required. R093877 is a novel 5-HT 4 agonist prokinetic compound which is chemically related to cisapride but believed to have greater eVect on colonic activity. Aims-To evaluate the eVects of R093877 on bowel function, upper and lower gut transit, visceral sensitivity, and sphincter function in healthy volunteers in a double blind, placebo controlled, crossover study. Methods-The study consisted of five consecutive one week periods: no drug treatment; active drug treatment with either 1 or 2 mg daily or placebo; washout; active drug or placebo; no treatment. Seventeen male subjects maintained a detailed diary of bowel function for the entire study. Orocaecal transit (breath hydrogen), whole gut transit (radio-opaque markers), and anorectal function were assessed at the end of each of the two treatment periods. Blood testing was performed to confirm compliance and for safety analysis. Results-One subject withdrew from the study due to side eVects while on placebo. Eight subjects completed the study on 1 mg and a further eight on 2 mg. Blood testing showed non-compliance in one subject on the 2 mg dose, and he was excluded from analysis of all diary and physiological data. Treatment increased the number of stools per week (placebo versus 1 mg, 7.8 versus 13.6, p=0.003; placebo versus 2 mg, 8.9 versus 11.3, p=0.15) and the percentage of loose or watery stools (24.2% versus 61.5%, p<0.04; 9.9% versus 40.0%, p<0.02). Stool frequency and consistency reverted to normal immediately after treatment. Treatment shortened orocaecal and whole gut transit in all subjects on both doses. Treatment accelerated orocaecal (76 versus 51 minutes, p=0.007; 63 versus 47 minutes, p=0.07) and whole gut (38.2 versus 27.0 hours, p=0.05; 44.8 versus 24.0 hours, p<0.04) transit, and decreased the number of retained markers ingested 36 hours previously (4.8 versus 1.8, p=0.016; 7.0 versus 4.3, p=0.033). Gut sensitivity to distension and electrical stimulation, and anal manometry, were unchanged. Transient headache occurred in seven subjects on R093877 and one subject had mild elevation of liver aminotransferases which resolved on drug cessation.Conclusions-R093877 is well tolerated by healthy subjects and has a marked and consistent eVect on stool frequency and consistency, and upper gut and colonic transit. It does not aVect visceral sensitivity or sphincter function. It holds promise for patients with large bowel symptoms or slow gut transit. (Gut 1998;42:511-516)

Opioid-induced constipation: advances and clinical guidance

“…Prucalopride has high selectivity and affinity to 5-HT 4 receptors, which enhance enterokinetic properties in the gastrointestinal tract without risk of cardiovascular toxicity [Emmanuel et al 1998]. Prucalopride primarily acts by releasing 5-hydroxytryptamine (5-HT), which secondarily releases Acetylcholine (Ach) and calcitonin generelated peptide from the intrinsic primary afferent neurons [De Maeyer et al 2008].…”

Clinical and economic profile of prucalopride in the treatment of chronic constipation in women

“…Per entrambi questi end point secondari le differenze tra prucalopride minuisce la consistenza delle feci. Le dosi studiate sono risultate pressoché equi-efficaci nell'accelerare il transito colico [43][44][45][46][47][48]. Nei volontari sani prucalopride riduce il tempo di transito nei segmenti destro e sinistro del colon, senza modificare il transito nel sigma retto e le funzioni anorettali [46,47].…”

“…Le dosi studiate sono risultate pressoché equi-efficaci nell'accelerare il transito colico [43][44][45][46][47][48]. Nei volontari sani prucalopride riduce il tempo di transito nei segmenti destro e sinistro del colon, senza modificare il transito nel sigma retto e le funzioni anorettali [46,47]. Si ritiene che l'effetto di accelerazione del transito sia dovuto alla stimolazione delle contrazioni propagate di grande ampiezza (HAPACs) e all'aumento delle contrazioni segmentali non propagate [48].…”

“…Si ritiene che l'effetto di accelerazione del transito sia dovuto alla stimolazione delle contrazioni propagate di grande ampiezza (HAPACs) e all'aumento delle contrazioni segmentali non propagate [48]. L'effetto sulle abitudini intestinali dei volontari sani è stato evidente fin dal primo giorno di trattamento e alla sospensione non sono stati osservati fenomeni di rebound o effetti residui prolungati [46]. Studi clinici controllati di fase IIa, condotti su gruppi selezionati di pazienti con stipsi funzionale e senza disturbi dell'evacuazione, hanno confermato che prucalopride, alle dosi di 2 e 4 mg, accelera il transito nel colon, aumenta la frequenza delle evacuazioni e riduce la consistenza delle feci [49].…”

Prucalopride: safety, efficacy and potential applications

“…Among patients with constipation, however, the very same authors using the exact same scintigraphic technique found that prucalopride in doses of 2 or 4 mg daily accelerated whole gut, gastric, small bowel and colonic transit in constipated patients [Bouras et al 2001]. Importantly, prucalopride did not appear to adversely affect a number of parameters of anorectal motor function or impair rectal sensation in either healthy volunteers or patients with constipation [Sloots et al 2002;Bouras et al 2001;Poen et al 1999;Emmanuel et al 1998]. In studies of colonic motility, prucalopride has been shown to be stimulatory [De Schryer et al 2002;Emmanule et al 2002].…”