Osilodrostat, a potent oral 11β-hydroxylase inhibitor: 22-week, prospective, Phase II study in Cushing’s disease

Maria Fleseriu, Rosario Pivonello, Jacques Young, Amir H. Hamrahian, Mark E. Molitch, Chikara Shimizu, Tomoaki Tanaka, Akira Shimatsu, Tracy White, Annie Hilliard, Chuan Tian, Nicholas Sauter, Beverly M K Biller, Xavier Bertagna

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Purpose: In a 10-week proof-of-concept study (LINC 1), the potent oral 11β-hydroxylase inhibitor osilodrostat (LCI699) normalized urinary free cortisol (UFC) in 11/12 patients with Cushing’s disease. The current 22-week study (LINC 2; NCT01331239) further evaluated osilodrostat in patients with Cushing’s disease. Methods: Phase II, open-label, prospective study of two patient cohorts. Follow-up cohort: 4/12 patients previously enrolled in LINC 1, offered re-enrollment if baseline mean UFC was above ULN. Expansion cohort: 15 newly enrolled patients with baseline UFC > 1.5 × ULN. In the follow-up cohort, patients initiated osilodrostat twice daily at the penultimate efficacious/tolerable dose in LINC 1; dose was adjusted as needed. In the expansion cohort, osilodrostat was initiated at 4 mg/day (10 mg/day if baseline UFC > 3 × ULN), with dose escalated every 2 weeks to 10, 20, 40, and 60 mg/day until UFC ≤ ULN. Main efficacy endpoint was the proportion of responders (UFC ≤ ULN or ≥50 % decrease from baseline) at weeks 10 and 22. Results: Overall response rate was 89.5 % (n/N = 17/19) at 10 weeks and 78.9 % (n/N = 15/19) at 22 weeks; at week 22, all responding patients had UFC ≤ ULN. The most common AEs observed during osilodrostat treatment were nausea, diarrhea, asthenia, and adrenal insufficiency (n = 6 for each). New or worsening hirsutism (n = 2) and/or acne (n = 3) were reported among four female patients, all of whom had increased testosterone levels. Conclusions: Osilodrostat treatment reduced UFC in all patients; 78.9 % (n/N = 15/19) had normal UFC at week 22. Treatment with osilodrostat was generally well tolerated.

Original languageEnglish (US)
JournalPituitary
DOIs
StateAccepted/In press - Nov 5 2015

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Pituitary ACTH Hypersecretion
Mixed Function Oxygenases
Hydrocortisone
Asthenia
Hirsutism
Adrenal Insufficiency
Acne Vulgaris
Nausea
Testosterone
Diarrhea
Therapeutics
Prospective Studies

Keywords

  • 11β-hydroxylase
  • Cortisol
  • Cushing’s
  • LCI699
  • Osilodrostat

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Osilodrostat, a potent oral 11β-hydroxylase inhibitor : 22-week, prospective, Phase II study in Cushing’s disease. / Fleseriu, Maria; Pivonello, Rosario; Young, Jacques; Hamrahian, Amir H.; Molitch, Mark E.; Shimizu, Chikara; Tanaka, Tomoaki; Shimatsu, Akira; White, Tracy; Hilliard, Annie; Tian, Chuan; Sauter, Nicholas; Biller, Beverly M K; Bertagna, Xavier.

In: Pituitary, 05.11.2015.

Research output: Contribution to journalArticle

Fleseriu, M, Pivonello, R, Young, J, Hamrahian, AH, Molitch, ME, Shimizu, C, Tanaka, T, Shimatsu, A, White, T, Hilliard, A, Tian, C, Sauter, N, Biller, BMK & Bertagna, X 2015, 'Osilodrostat, a potent oral 11β-hydroxylase inhibitor: 22-week, prospective, Phase II study in Cushing’s disease', Pituitary. https://doi.org/10.1007/s11102-015-0692-z
Fleseriu, Maria ; Pivonello, Rosario ; Young, Jacques ; Hamrahian, Amir H. ; Molitch, Mark E. ; Shimizu, Chikara ; Tanaka, Tomoaki ; Shimatsu, Akira ; White, Tracy ; Hilliard, Annie ; Tian, Chuan ; Sauter, Nicholas ; Biller, Beverly M K ; Bertagna, Xavier. / Osilodrostat, a potent oral 11β-hydroxylase inhibitor : 22-week, prospective, Phase II study in Cushing’s disease. In: Pituitary. 2015.
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abstract = "Purpose: In a 10-week proof-of-concept study (LINC 1), the potent oral 11β-hydroxylase inhibitor osilodrostat (LCI699) normalized urinary free cortisol (UFC) in 11/12 patients with Cushing’s disease. The current 22-week study (LINC 2; NCT01331239) further evaluated osilodrostat in patients with Cushing’s disease. Methods: Phase II, open-label, prospective study of two patient cohorts. Follow-up cohort: 4/12 patients previously enrolled in LINC 1, offered re-enrollment if baseline mean UFC was above ULN. Expansion cohort: 15 newly enrolled patients with baseline UFC > 1.5 × ULN. In the follow-up cohort, patients initiated osilodrostat twice daily at the penultimate efficacious/tolerable dose in LINC 1; dose was adjusted as needed. In the expansion cohort, osilodrostat was initiated at 4 mg/day (10 mg/day if baseline UFC > 3 × ULN), with dose escalated every 2 weeks to 10, 20, 40, and 60 mg/day until UFC ≤ ULN. Main efficacy endpoint was the proportion of responders (UFC ≤ ULN or ≥50 {\%} decrease from baseline) at weeks 10 and 22. Results: Overall response rate was 89.5 {\%} (n/N = 17/19) at 10 weeks and 78.9 {\%} (n/N = 15/19) at 22 weeks; at week 22, all responding patients had UFC ≤ ULN. The most common AEs observed during osilodrostat treatment were nausea, diarrhea, asthenia, and adrenal insufficiency (n = 6 for each). New or worsening hirsutism (n = 2) and/or acne (n = 3) were reported among four female patients, all of whom had increased testosterone levels. Conclusions: Osilodrostat treatment reduced UFC in all patients; 78.9 {\%} (n/N = 15/19) had normal UFC at week 22. Treatment with osilodrostat was generally well tolerated.",
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AU - Hamrahian, Amir H.

AU - Molitch, Mark E.

AU - Shimizu, Chikara

AU - Tanaka, Tomoaki

AU - Shimatsu, Akira

AU - White, Tracy

AU - Hilliard, Annie

AU - Tian, Chuan

AU - Sauter, Nicholas

AU - Biller, Beverly M K

AU - Bertagna, Xavier

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N2 - Purpose: In a 10-week proof-of-concept study (LINC 1), the potent oral 11β-hydroxylase inhibitor osilodrostat (LCI699) normalized urinary free cortisol (UFC) in 11/12 patients with Cushing’s disease. The current 22-week study (LINC 2; NCT01331239) further evaluated osilodrostat in patients with Cushing’s disease. Methods: Phase II, open-label, prospective study of two patient cohorts. Follow-up cohort: 4/12 patients previously enrolled in LINC 1, offered re-enrollment if baseline mean UFC was above ULN. Expansion cohort: 15 newly enrolled patients with baseline UFC > 1.5 × ULN. In the follow-up cohort, patients initiated osilodrostat twice daily at the penultimate efficacious/tolerable dose in LINC 1; dose was adjusted as needed. In the expansion cohort, osilodrostat was initiated at 4 mg/day (10 mg/day if baseline UFC > 3 × ULN), with dose escalated every 2 weeks to 10, 20, 40, and 60 mg/day until UFC ≤ ULN. Main efficacy endpoint was the proportion of responders (UFC ≤ ULN or ≥50 % decrease from baseline) at weeks 10 and 22. Results: Overall response rate was 89.5 % (n/N = 17/19) at 10 weeks and 78.9 % (n/N = 15/19) at 22 weeks; at week 22, all responding patients had UFC ≤ ULN. The most common AEs observed during osilodrostat treatment were nausea, diarrhea, asthenia, and adrenal insufficiency (n = 6 for each). New or worsening hirsutism (n = 2) and/or acne (n = 3) were reported among four female patients, all of whom had increased testosterone levels. Conclusions: Osilodrostat treatment reduced UFC in all patients; 78.9 % (n/N = 15/19) had normal UFC at week 22. Treatment with osilodrostat was generally well tolerated.

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