title: First Clinical Experience with ONO-4232: A Randomized, Double-blind, Placebo-controlled Healthy Volunteer Study of a Novel Lusitropic Agent for Acutely Decompensated Heart Failure.
abstract: The aim of this study was to evaluate the safety, tolerability, and pharmacokinetic parameters of up to 15 dose levels of ONO-4232, a selective agonist for the EP4 subtype of the prostaglandin E2 receptor, with a dual left ventricular lusitropic and venodilatory action, in healthy, adult, male and female volunteers.
  
  
  
  In this randomized, single-center, double-blind, placebo-controlled, single-dose, sequential-group escalation, first in human study, ONO-4232 (0.001, 0.003, 0.01, 0.02, 0.04, 0.08, 0.12, 0.15, 0.18, or 0.27 ng/kg/min) or placebo was administered as a continuous intravenous infusion over 3 hours. Safety, tolerability, and pharmacokinetic data were collected during dosing and over a period of 3 days (Day -1 to Day 2), and at the follow-up visit (Day 7 [±2 days]).
  
  
  
  Fifty-seven subjects received ONO-4232 and 19 subjects received placebo. Ten of the planned 15 cohorts (dose range, 0.001-0.27 ng/kg/min) were conducted. A total of 34 treatment-emergent adverse events (TEAEs) were reported in 23 subjects. Overall, the majority of TEAEs were mild. No serious TEAEs or deaths were reported and no subjects discontinued due to adverse events. The most frequently reported TEAE was infusion site erythema. A decrease in systolic blood pressure from baseline occurred for ONO-4232 subjects compared with placebo that was statistically significant for the 0.08 ng/kg/min dose, and a dose-dependent increase in heart rate starting at 0.04 ng/kg/min and achieving statistical significance compared with placebo at 0.15 ng/kg/min and above. More orthostatic events occurred in the higher-dose groups and the dose escalation was terminated due to increasing occurrences of orthostatic hypotension/intolerance. Plasma concentrations of ONO-4232 reached steady state approximately 2 hours after the start of infusion and then declined rapidly after the end of infusion, and systemic exposure appeared to increase in a dose-proportional manner. Approximately 30% of the administered dose of ONO-4232 was excreted in the urine.
  
  
  
  In healthy adults ONO-4232 was generally well tolerated in the dose range of 0.001 to 0.27 ng/kg/min. There were dose-related changes in systolic blood pressure and heart rate. Infusion site erythema, which was likely associated with a venodilatory effect and possible evidence for the pharmacologic effects of ONO-4232, occurred increasingly with increasing dose. Pharmacokinetic parameters appeared to be dose-proportional. The study results support further evaluation of the cardiovascular effects of this first-in-class selective left ventricular lusitropic and venodilatory drug in patients with acutely decompensated heart failure.
authors.affiliation: EU/US Drug Development, ONO Pharma UK LTD, London, United Kingdom. Electronic address: t-nabata@ono-uk.co.uk.
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Ward
authors.affiliation: EU/US Drug Development, ONO Pharma UK LTD, London, United Kingdom.
authors.forename: Virginia
authors.initials: V
authors.lastname: Jamieson
authors.affiliation: EU/US Drug Development, ONO Pharma UK LTD, London, United Kingdom.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Nabata
authors.affiliation: EU/US Drug Development, ONO Pharma UK LTD, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Sharpe
authors.affiliation: EU/US Drug Development, ONO Pharma UK LTD, London, United Kingdom.
authors.forename: Koji
authors.initials: K
authors.lastname: Dozono
authors.affiliation: Translational Medicine Center, Ono Pharmaceuticals Co Ltd, Osaka, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Suto
authors.affiliation: EU/US Drug Development, ONO Pharma UK LTD, London, United Kingdom.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Gussak Consulting LLC, Morristown, New Jersey.
authors.forename: Ihor
authors.initials: I
authors.lastname: Gussak
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001794:Blood Pressure / Q000187:drug effects; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D058309:Receptors, Prostaglandin E, EP4 Subtype / Q000819:agonists; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents; D058309:Receptors, Prostaglandin E, EP4 Subtype
keywords: ONO-4232; heart failure; lusitropy; pharmacokinetics; safety and tolerability