Napo Pharmaceuticals (LSE:
NAPL/NAPU) announces positive clinical data on the effectiveness of
crofelemer from a study for CRO-ID in treating severely ill cholera
patients in conjunction with an antibiotic and rehydration therapy.
A double-blind placebo-controlled study was conducted in one hundred
(100) patients with confirmed severe cholera. Patients were randomized to
placebo or 125 mg crofelemer every 6 hours or 250 mg crofelemer every 6
hours in a 1:2:2 randomization scheme. This single center trial was
conducted at the International Centre for Diarrhoeal Disease Research
(ICDDR, B) in Dhaka, Bangladesh, popularly known as the “cholera hospital”
for the state-of-the-art treatment of cholera patients.
The purpose of the trial was to obtain a therapeutic proof-of-concept
in the treatment of cholera, by a reduction in the life-threatening fluid
loss characteristic of cholera infection. In addition to receiving
crofelemer, all patients received a single oral dose of azithromycin and
rehydration therapy. These severely ill cholera patients, even when
receiving the antibiotic azithromycin and rehydration therapy (but not
crofelemer), averaged approximately 8.5 liters of stool volume output
during the first 24 hour period. The primary endpoint in this study was the
reduction in stool volume output normalized to the body weight of the
cholera patients.
Following the exclusion of three outlier patients, the data
demonstrates that a crofelemer dose of 125 mg every 6 hours reduced the
amount of stool volume output normalized to body weight by 32% (p=0.028,
Mann-Whitney test) in the first 6 hour period (0-6 hours). A 31% reduction
in normalized stool volume output was also observed during the first 12
hour period (0-12 hours) with crofelemer 125 mg every 6 hours (p=0.072,
Mann-Whitney test). The higher dose of crofelemer (250 mg every 6 hours)
also showed a trend towards significance in the first 12 hour period (0-12
hours, p=0.155, Mann-Whitney test). Crofelemer was well tolerated in
cholera patients. Crofelemer was safely and effectively used in combination
with the antibiotic, azithromycin, and rehydration therapy.
Both Napo and ICDDR, B, upon receipt of additional funding, would like
to continue with studies ranging to lower dosing regimens with crofelemer,
and also include the treatment of children with development of a pediatric
formulation of the product.
Elements of the cholera study in Bangladesh were funded by the National
Institutes of Allergy and Infectious Disease.
Napo is currently conducting a Phase 3 trial for crofelemer for chronic
diarrhea in people living with HIV/AIDS (“CRO-HIV”). This indication has
been fast-tracked by the FDA. Napo expects to file its first NDA around
mid-2009 for this indication, subject to the receipt of further funding.
Dr. Pradip Bardhan, Scientist and Head of Special Care Unit at ICDDR, B
and the principal investigator, commented that “Crofelemer produces an
impressive reduction in stool volume output within the first 12 hour
period. There is a clear need for new agents to produce reduction in stool
volume output in the first 12-18 hours, which is the period where the
patients are at maximum risk for dehydration. Both doses of crofelemer were
well tolerated and no drug related adverse events were observed in the
cholera patients in this study. As a novel antisecretory agent, crofelemer
represents a complementary mechanism to existing standard-of-care treatment
of cholera, which consists of administering rehydration therapy and
antibiotics, with the inherent risk of resistance generation.”
Lisa Conte, Napo’s CEO, commented, “Napo is so pleased to be reporting
this powerful clinical data relating to the treatment of one of the most
extreme cause of secretory/watery diarrhea with crofelemer. These results
extend the recent clinical data relating to the treatment with crofelemer
of acute infectious diarrhea of multiple etiologies in adult patients in
India (see announcement dated April 10, 2008). The mechanistic cause of
these diarrheas is similar to that which effects chronic diarrhea in people
living with HIV/AIDS, an indication for which Napo is in final Phase 3
development with crofelemer in the US (‘CRO-HIV’). Our business strategy
focus on diseases of both lucrative western markets and imperative global
health needs.”
About cholera
Vibrio cholerae is an intestinal infection which results in the abrupt
loss of large volumes of electrolyte rich watery stools and vomiting,
leading to severe and rapidly progressing dehydration and shock. Without
adequate rehydration therapy, the water loss associated with severe cholera
results in death for about half of affected individuals. The cholera toxin
causes the intestine to secrete watery fluid in volumes far exceeding the
intestinal absorptive capacity. Current standard-of-care therapy focuses on
rehydration therapy, either intravenous or oral, and antibiotic therapy to
target the infectious agent. There are no current therapies for cholera
which decrease the secretion of fluid into the small intestine. The
benefits of shorter and less severe duration of diarrhea include reduced
hospitalization time; reduced volume of necessary rehydration therapy; and
reduced V. cholerae infected faecal excretion, thereby reducing the risk of
transmission of infection to other family members and nosocomial infections
at clinic settings. Antibiotic resistance is a growing problem in cholera
infection, with one 2005 study in Bangladesh demonstrating multi-drug
resistance in 79% of the isolates from patients attending the ICDDR, B in
Dhaka.
Cholera, identified and detailed from the beginning of recorded
history, was initially endemic to the Indian sub-continent. The disease
began spreading almost 200 years ago, and is now pandemic and persists
primarily in the developing world. The bacteria spreads through
contaminated water and food. Because outbreaks can become massive
epidemics, it is a reportable disease, and is listed as a category B
bioterrorism agent/disease by the Department of Health and Human Services –
Centers for Disease Control.
About Napo Pharmaceuticals, Inc.
Napo Pharmaceuticals, Inc. focuses on the development and
commercialization of proprietary pharmaceuticals for the global marketplace
in collaboration with local partners. Napo was founded in November 2001,
and is based in California, USA with a subsidiary in Mumbai, India.
Napo’s late-stage proprietary gastro-intestinal compound, crofelemer,
is in various stages of clinical development for four distinct product
indications, including a late-stage Phase 3 program:
— CRO-HIV for chronic diarrhea in people living with HIV/AIDS, Phase 3
— CRO-IBS for irritable bowel syndrome (“D-IBS”), Phase 2
— CRO-ID for acute infectious diarrhea (including cholera), Phase 2
— CRO-PED for pediatric diarrhea, Phase 1
The FDA has granted fast-track status to CRO-IBS and CRO-HIV.
Crofelemer, a proprietary patented agent, is extracted from Croton
lechleri, a medicinal plant which can be sustainably harvested from several
countries in South America. Napo also plans to develop an early clinical
stage product, NP-500, for the treatment of insulin resistant diseases of
Type II diabetes and metabolic syndrome (Syndrome X; pre-diabetic
syndrome). Additionally, Napo has a plant library of approximately 2,300
medicinal plants from tropical regions, and Napo has entered two screening
relationship associated with this collection. Currently, products are based
on the chemical and biological diversity derived from plants with medicinal
properties, but future products may be in-licensed from other sources.
Napo has partnerships with Glenmark Pharmaceuticals Limited of India
and AsiaPharm Group Ltd. of China. The Company has also established an
alliance with Direct Relief International to provide access to and
distribution of crofelemer for pediatric populations in disaster and
resource-constrained geographies, if the product achieves approval and
registration by the FDA. For more information please visit
napopharma.
About Crofelemer
Crofelemer, a proprietary patented agent, is extracted from Croton
lechleri, a medicinal plant which can be sustainably harvested from several
countries in South America. Crofelemer is in various stages of clinical
development for four distinct product indications, one in Phase 3, two in
Phase 2 and one in Phase 1.
Crofelemer has been tested in trials involving approximately 1900
patients in double-blind placebo-controlled, mostly published trials of
AIDS diarrhea, diarrhea-predominant IBS, and acute infectious diarrhea. It
is generally well tolerated and has shown significant anti-diarrheal
activities and improvement in gastrointestinal symptoms. Crofelemer
produces several effects when administered orally providing for activity in
several disease indications. Crofelemer’s first in class anti-secretory
mechanism reduces excess fluid secreted into the gastro-intestinal tract,
while its anti-inflammatory and analgesic activity may provide the
rationale for its significant benefit in abdominal pain. Crofelemer acts
locally in the intestines, with limited systemic exposure.
This announcement contains forward-looking statements relating to Napo
Pharmaceuticals and its products that involve risks and uncertainties,
including statements regarding future products and developments that are
not historical facts. Such statements are only predictions and the
company’s actual results may differ materially from those anticipated in
these forward-looking statements. These statements can be identified by the
use of forward-looking terminology such as “believe,” “expect,” “may,”
“will,” “should,” “could,” “project,” “plan,” “seek,” “intend,” or
“anticipate” or the negative thereof or comparable terminology and
statements about industry trends and Napo’s future performance, operations
and products.
Napo Pharmaceuticals, Inc.
napopharma