Clinical studies of the DP1 antagonist laropiprant in asthma and allergic rhinitis.
BACKGROUND
Prostaglandin D(2) is a proinflammatory mediator believed to be important in asthma and allergic rhinitis (AR). Allelic variants in the prostaglandin D(2) receptor type 1 (DP1) gene (PTGDR) have been suggested to be associated with asthma susceptibility.


OBJECTIVE
We sought to investigate the efficacy of the DP1 antagonist laropiprant (alone or with montelukast) in asthma and seasonal AR and explore whether sequence variations in PTGDR are associated with asthma severity.


METHODS
For asthma, in a double-blind crossover study, 100 patients with persistent asthma were randomized to placebo or laropiprant, 300 mg/d for 3 weeks, followed by addition of montelukast, 10 mg/d for 2 weeks. PTGDR promoter haplotypes were categorized as high, medium, or low transcriptional efficiency. The primary efficacy end point was FEV(1). For AR, in a double-blind parallel-group study, 767 patients sensitized to a regionally prevalent fall allergen with symptomatic fall rhinitis were allocated to laropiprant, 25 mg/d or 100 mg/d; cetirizine, 10mg/d; or placebo for 2 weeks. The primary end point was the Daytime Nasal Symptoms Score.


RESULTS
For asthma, no significant differences in FEV(1) or asthma symptoms were noted for laropiprant versus placebo or laropiprant plus montelukast vs montelukast (differences between montelukast and placebo: P <or= .001). No clear association was seen between haplotype pair (ie, diplotype) and asthma severity. For AR, although cetirizine (vs placebo) demonstrated an improvement in the Daytime Nasal Symptoms Score (P < .001), laropiprant did not.


CONCLUSIONS
Laropiprant did not demonstrate efficacy in asthmatic patients or patients with AR. Variations in PTGDR did not appear related to baseline asthma severity or treatment response (NCT00533208; NCT00783601).
Philip
George
G
Merck Research Laboratories, Rahway, NJ, USA.
van Adelsberg
Janet
J
Loeys
Thomas
T
Liu
Nancy
N
Wong
Peggy
P
Lai
Eseng
E
Dass
S Balachandra
SB
Reiss
Theodore F
TF
D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000235:genetics; D017332:Cetirizine / Q000008:administration & dosage / Q000627:therapeutic use; D018592:Cross-Over Studies; D003521:Cyclopropanes; D004311:Double-Blind Method; D005260:Female; D020022:Genetic Predisposition to Disease; D006239:Haplotypes / Q000235:genetics; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011401:Promoter Regions, Genetic; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use; D011982:Receptors, Prostaglandin / Q000037:antagonists & inhibitors* / Q000235:genetics; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy* / Q000235:genetics; D013440:Sulfides; D055815:Young Adult
D000085:Acetates; D018926:Anti-Allergic Agents; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D007211:Indoles; C518174:MK-0524; D011804:Quinolines; D011982:Receptors, Prostaglandin; D013440:Sulfides; C501562:prostanoid D receptor 1, human; C093875:montelukast; D017332:Cetirizine