Mellado Lagarde Marcia M, Wilbraham Darren, Martins Ricardo Fonseca, Zhao Heather Shi, Jackson Kimberley, Johnson Kirk W, Knopp Kelly L, DiBenedetto David, Broad Lisa M
Eli Lilly and Company, Indianapolis, IN, United States.
Eli Lilly and Company, Bracknell, United Kingdom.
Pain. 2024 Dec 13;166(7):1497-1518. doi: 10.1097/j.pain.0000000000003487.
Transient receptor potential ankyrin 1 (TRPA1) is implicated in physiological and pathological nociceptive signaling, but the clinical benefit of TRPA1 antagonists in chronic pain is not clearly demonstrated. LY3526318 is an oral, potent, and selective novel TRPA1 antagonist. The Chronic Pain Master Protocol was used to evaluate the safety and efficacy of LY3526318 in 3 randomized, placebo-controlled, proof-of-concept studies in knee osteoarthritis pain (OA), chronic low back pain (CLBP), and diabetic peripheral neuropathic pain (DPNP). Participants were randomized (1:2, placebo:LY3526318, 250 mg daily) into an 8-week double-blinded period. At 4 weeks, participants treated with LY3526318 transitioned to a placebo. The primary endpoint was the self-reported daily pain intensity measured using a Numerical Rating Scale (NRS) at 4 weeks. All endpoints were collected for up to 8 weeks. Change from baseline in average weekly NRS was analyzed using Bayesian mixed model repeated measures in the OA (N = 160), CLBP (N = 159), and DPNP (N = 154) studies. Baseline characteristics were balanced between treatment arms. Mean NRS change from baseline to week 4 did not differ significantly between placebo and LY3526318; however, a numerical improvement was observed in the CLBP, not in the OA or DPNP populations. Safety analysis integrated across studies enhanced understanding of the safety profile of LY3526318. LY3526318 showed a potential drug-induced hepatotoxic effect posing a risk for clinical development. No other safety signals were identified. LY3526318 showed potential for different responses among chronic pain indications and patient subpopulations, highlighting challenges in developing TRPA1 antagonists but supporting their value as a target in managing chronic pain.
瞬时受体电位锚蛋白1(TRPA1)参与生理和病理伤害性信号传导,但TRPA1拮抗剂在慢性疼痛中的临床益处尚未得到明确证实。LY3526318是一种口服、强效且选择性的新型TRPA1拮抗剂。慢性疼痛主方案被用于在3项针对膝骨关节炎疼痛(OA)、慢性下腰痛(CLBP)和糖尿病性周围神经病变性疼痛(DPNP)的随机、安慰剂对照、概念验证研究中评估LY3526318的安全性和有效性。参与者被随机分组(1:2,安慰剂:LY3526318,每日250毫克)进入为期8周的双盲期。在4周时,接受LY3526318治疗的参与者转为服用安慰剂。主要终点是在4周时使用数字评分量表(NRS)自我报告的每日疼痛强度。所有终点数据收集长达8周。在OA(N = 160)、CLBP(N = 159)和DPNP(N = 154)研究中,使用贝叶斯混合模型重复测量分析平均每周NRS相对于基线的变化。各治疗组之间的基线特征均衡。安慰剂组和LY3526318组从基线到第4周的平均NRS变化无显著差异;然而,在CLBP组中观察到数值上的改善,而在OA或DPNP人群中未观察到。跨研究的安全性分析增强了对LY3526318安全性概况的了解。LY3526318显示出潜在的药物性肝毒性作用,对临床开发构成风险。未发现其他安全信号。LY3526318在不同慢性疼痛适应症和患者亚组中显示出不同反应的可能性,突出了开发TRPA1拮抗剂的挑战,但也支持了其作为管理慢性疼痛靶点的价值。