Safety, pharmacodynamics and pharmacokinetics of TPI 1020 in smokers with asthma.
BACKGROUND
TPI 1020 is a novel compound with potential for anti-neutrophil effects. TPI 1020 exerts its effects by a dual mechanism of action involving corticosteroid activity and controlled donation of nitric oxide.


OBJECTIVE
We assessed the safety, pharmacodynamic and pharmacokinetic activity of ascending doses of TPI 1020 compared to budesonide in asthma.


METHODS
Smokers with mild asthma (n=27) were randomized to receive either 600mcg of TPI 1020 (n=13) or 400mcg of budesonide (n=14) bid for 2weeks followed by 1200 and 800mcg bid, respectively, for an additional week.


RESULTS
There was no serious adverse event and all but one adverse event were mild or moderate (severe headache with budesonide). Patients receiving TPI 1020 reported three-fold fewer treatment-emergent AEs (n=13) than those receiving budesonide (n=39). TPI 1020 had similar effects as budesonide on FEV(1), PEF, rescue medication, asthma scoring system, methacholine response, sputum eosinophils and exhaled NO. Sputum neutrophils (%) tended to decrease more with TPI 1020 (32.6% decrease versus 3.7% increase for budesonide); the decrease occurring only in patients with high neutrophils at baseline. A significant difference favoring TPI 1020 was noted for CRP. Budesonide caused a statistically significant decrease in 24h urinary free cortisol over 22days (median of 4.4-2.8mcg/ml, p=0.01) whereas TPI 1020 had no such effect (4.4-5.8mcg/ml), suggesting lower systemic corticosteroid exposure following TPI 1020 treatment.


CONCLUSIONS
TPI 1020 appears safe in asthmatic smokers and warrants further investigation in respiratory conditions.
Boulet
Louis-Philippe
LP
Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Québec, QC G1V 4G5, Canada. lpboulet@med.ulaval.ca
Lemière
Catherine
C
Gauvreau
Gail
G
Olivenstein
Ron
R
Lougheed
Diane
D
Paradis
Bruno
B
O'Byrne
Paul
P
Pageau
René
R
Renzi
Paolo M
PM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics*; D001249:Asthma / Q000188:drug therapy; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation / Q000187:drug effects; D009569:Nitric Oxide / Q000378:metabolism; D013183:Sputum / Q000166:cytology; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; C492926:NCX 1020; D009569:Nitric Oxide; D019819:Budesonide