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A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Phase 2b Trial of P2X3 Receptor Antagonist Sivopixant for Refractory or Unexplained Chronic Cough

McGarvey, Lorcan; Smith, Jaclyn A.; Morice, Alyn; Birring, Surinder S.; Chung, Kian Fan; Dicpinigaitis, Peter V.; Niimi, Akio; Benninger, Michael S.; Sher, Mandel; Matsunaga, Yuko; Miyazaki, Sayaka; Machida, Mitsuaki; Ishihara, Hiroyuki; Mahmood, Adnan; Gomez, Juan Carlos

Authors

Lorcan McGarvey

Jaclyn A. Smith

Surinder S. Birring

Kian Fan Chung

Peter V. Dicpinigaitis

Akio Niimi

Michael S. Benninger

Mandel Sher

Yuko Matsunaga

Sayaka Miyazaki

Mitsuaki Machida

Hiroyuki Ishihara

Adnan Mahmood

Juan Carlos Gomez



Abstract

Introduction: To determine the optimal dose of sivopixant, a highly selective P2X3 receptor antagonist, for refractory or unexplained chronic cough (RCC/UCC). Methods: In this phase 2b, randomized, double-blind, placebo-controlled, parallel-group, multicenter trial, patients received sivopixant 50, 150, or 300 mg or placebo once daily for 4 weeks. The primary endpoint was a change from baseline in 24-h cough frequency (coughs/h) with sivopixant vs placebo. Results: Overall, 390/406 randomized patients completed the study. Placebo-adjusted changes in hourly cough count over 24 h were 13.17% (P = 0.3532), − 1.77% (P = 0.8935), and − 12.47% (P = 0.3241) and in cough severity (visual analog scale) were 1.75 mm (P = 0.5854), − 1.21 mm (P = 0.7056), and − 6.55 mm (P = 0.0433) with sivopixant 50, 150, and 300 mg, respectively. Placebo-adjusted changes from baseline in Leicester Cough Questionnaire total scores were − 0.37 (P = 0.4207), − 0.07 (P = 0.8806), and 0.69 (P = 0.1473) with sivopixant 50, 150, and 300 mg, respectively. Additionally, 61.3%, 78.3%, 86.8%, and 71.4% of patients receiving sivopixant 50, 150, and 300 mg and placebo, respectively, reported any improvements in Patient Global Impression of Change. The incidence of treatment-emergent adverse events (TEAEs) was 25.7%, 32.0%, 49.0%, and 20.6% in sivopixant 50, 150, and 300 mg and placebo groups, respectively; all TEAEs in the sivopixant group were mild-to-moderate. Conclusion: Sivopixant did not demonstrate a statistically significant difference vs placebo in change from baseline in 24-h cough frequency. The dose of 300 mg has potential for RCC/UCC, showing the greatest improvements in cough frequency and patient-reported outcomes and dose-related mild to moderate reversible taste disturbance, although further trials are needed. Clinical Trial Registration: ClinicalTrials.gov identifier NCT04110054; registered September 26, 2019.

Citation

McGarvey, L., Smith, J. A., Morice, A., Birring, S. S., Chung, K. F., Dicpinigaitis, P. V., Niimi, A., Benninger, M. S., Sher, M., Matsunaga, Y., Miyazaki, S., Machida, M., Ishihara, H., Mahmood, A., & Gomez, J. C. (2022). A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Phase 2b Trial of P2X3 Receptor Antagonist Sivopixant for Refractory or Unexplained Chronic Cough. Lung, https://doi.org/10.1007/s00408-022-00592-5

Journal Article Type Article
Acceptance Date Dec 7, 2022
Publication Date Jan 1, 2022
Deposit Date Jul 16, 2023
Publicly Available Date Jul 24, 2023
Journal Lung
Print ISSN 0341-2040
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1007/s00408-022-00592-5
Public URL https://hull-repository.worktribe.com/output/4161285
This output contributes to the following UN Sustainable Development Goals:

SDG 3 - Good Health and Well-Being

Ensure healthy lives and promote well-being for all at all ages

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Copyright Statement
© The Author(s) 2022.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.





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