addyi tm - flibanserin manufacturer: sprout pharmaceuticals inc. fda approval date: august 18, 2015
TRANSCRIPT
AddyiTM - flibanserin
Manufacturer:
Sprout Pharmaceuticals Inc.
FDA Approval Date: August 18, 2015
AddyiTM - flibanserin
Objectives
• At the end of this presentation participants will be able to:1. Appropriately recommend AddyiTM
(flibanserin)
2. Effectively educate patients on the purpose, proper use and potential adverse effects of AddyiTM (flibanserin)
AddyiTM - flibanserin
Clinical Application
• Indications:• Treatment of generalized, acquired
hypoactive sexual desire disorder (HSDD) in premenopausal women
• Place in therapy:• Treatment of a rare disorder in
premenopausal women (~10%)
AddyiTM [package insert].BEGONIA Trial
AddyiTM - flibanserin
Clinical Application
• Contraindications:• Alcohol intake, hepatic impairment, and concomitant use with
moderate or strong CYP3A4 inhibitors
• Black Box Warning:• Hypotension and syncope in specific situations:
• Contraindicated with alcohol
• Contraindicated with strong or moderate CYP3A4 inhibitors
• Contraindicated in patients with hepatic impairment
• Precautions:• Hypotension and syncope with AddyiTM alone
• CNS depression (i.e. somnolence and sedation)
AddyiTM [package insert].
AddyiTM - flibanserin
Clinical Application
• Pregnancy:• Unknown
• Lactation:• NOT recommended
AddyiTM [package insert].
AddyiTM - flibanserin
Drug Facts
• Pharmacology:• Agonist of 5-HT1A
• Antagonist of 5-HT2A, 5-HT2B, 5-HT2C, and dopamine D4 receptor
• Exact mechanism of action is unknown
AddyiTM [package insert].
AddyiTM - flibanserin
Drug Facts
• Pharmacokinetics:
AF: 33%, Tmax: 0.8 hours, steady state: reached after 3 days
D 98% protein binding
MPrimarily CYP3A4 metabolism (lesser extent CYP2C19) into two inactive metabolites
E T1/2: 11 hours
AddyiTM [package insert].
AddyiTM - flibanserin
Drug Interactions
• Drug Interactions – Object Drugs:
AddyiTM [package insert].
AddyiTM Increases AddyiTM Decreases
• Digoxin 2-fold• Simvastatin 1-3 fold• Oral contraceptives
100%• PGP substrates
• Bupropion (hydroxybupropion) 9%
AddyiTM - flibanserin
Drug Interactions
• Drug Interactions – Precipitant Drugs:
AddyiTM [package insert].
Increases AddyiTM Decreases AddyiTM
• Strong CYP3A4 inhibitors: fluconazole 7-fold, ketoconazole 4.5-fold, itraconazole 2.6-fold,
GFJ 1.4-fold• Strong CYP2C19 inhibitors• Oral contraceptives 1.4-fold
• CYP3A4 inducers: Rifampin 95%
• Paroxetine 4% • Etravirine 21%
AddyiTM - flibanserin
Adverse Effects
AddyiTM [package insert].
Common ADES
•CNS depression (21%) [8%]•Dizziness (11.4%) [2.2%]•Somnolence (11.2%) [2.9%]•Nausea (10.4%) [3.9%]•Fatigue (9.2%) [5.5%]•Insomnia (4.9%) [2.8%]•Dry mouth (2.4%) [1.0%] •Syncope (0.4%) [0.2%]•Hypotension (0.2%) [<0.1%]
AddyiTM - flibanserin
Monitoring Parameters
• Efficacy Monitoring:• Increase in sexual desire
• Toxicity Monitoring:• Hypotension, syncope, and CNS
depression
AddyiTM [package insert].
AddyiTM - flibanserin
Prescription Information
• Dosing:• Initial/Usual: 100mg PO HS
• Maximum: 200mg PO HS
• Renal adjustment: 50mg PO HS
• Cost: $400 for 30 day supply
AddyiTM [package insert].Forbes Accessed 8/18/15
AddyiTM - flibanserin
Literature Review
Efficacy of Flibanserin in Women with Hypoactive Sexual Desire Disorder: Results from the BEGONIA Trial
Purpose: To access the safety and efficacy of flibanserin in premenopausal women with HSDD
Design: multi-center, randomized, double-blind, placebo-controlled
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
• Methods: • 4-week baseline period, followed by a 24-
week treatment period, and a 1-week post-treatment period
• Randomized to receive either flibanserin 100mg QHS (n = 543) or placebo (n = 547)
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
Inclusion Criteria Exclusion Criteria
• > 18 years old • Premenopausal women• Diagnosed with acquired,
generalized HSDD• Heterosexual monogamous
relationship for > 1 year with a sexually functioning partner physically present for > 50% of every month during the trial
• Willing to engage in sexual activity at least once monthly
• Medications that may affect sexual function
• Diagnosed with depression (> 14 score on Beck Depression scale)
• Gynecological issues including endometriosis
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
• General Baseline Characteristics:• Avg. age ~36
• ~74% Caucasian
• Avg. 74.7 kg (164 lbs)
• Avg. length of relationship 11 years
• Avg. duration of HSDD 49 months
• Avg. baseline FSFI total score 19
• Avg. baseline SSE standardized to 28-days 2.6
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
• Intervention: Compare the safety and efficacy of flibanserin to placebo
• Co-primary Endpoints:• Change from baseline to week 24 in FSFI
score
• Number of SSE standardized to 28-days
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
• Secondary Endpoints:• Change from baseline to week 24 in the
FSDS-R Item 13
• FSDS-R total scores
• FSFI total scores
• PGI-I score
• Patient benefit evaluation (PBE) at week 24
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
• Safety Assessment• Evaluation of ADES
• Clinical laboratory parameters
• Vital signs
• Physical exam
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
Coprimary EndpointsResults
Flibanserin PBO P value
Change from baseline to week 24 in FSFI desire domain score
1.0 0.7 <0.001
Number of SSE standardized to 28 days 2.5 1.5 <0.001
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
Secondary EndpointsResults
Flibanserin PBO P value
Change from baseline to week 24 FSDS-R Item 13
-1.0 -0.7 <0.001
Change from baseline to week 24 FSDS-R total score
-9.4 -6.1 <0.001
Change from baseline to week 24 PGI-I score
3.2 3.5 <0.001
PBE at week 24 44.7% 34.8% 0.001
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
• Adverse Events:• Somnolence (14.4%) [3.5%]
• Dizziness (10.3%) [1.1%]
• Nausea (7.6%) [2.2%]
• Fatigue (5.7%) [3.3%]
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Literature Review
• Conclusions: results from this trial, “indicate that flibanserin 100mg QHS has the potential to improve sexual desire and sexual function and reduce distress related to loss of sexual desire in premenopausal women with HSSD.”
Katz et al. BEGONIA trial. J Sex Med. 2013;10(7):1807-15.
AddyiTM - flibanserin
Summary
• First-in-class for HSDD in premenopausal women
• Dosing is 100mg PO daily at bedtime or 50mg for any renal impairment
• Most common ADEs: dizziness, CNS depression, nausea, and sleep issues
• BBW: hypotension, syncope, and CNS depression (REMS program)
AddyiTM - flibanserin
References
1. AddyiTM [package insert]. Raleigh, NC: Sprout Pharmaceuticals Inc.; 2015.
2. Katz M, Derogatis LR, Ackerman R, et al. Efficacy of flibanserin in women with hypoactive sexual desire disorder: results from the BEGONIA trial. J Sex Med. 2013;10(7):1807-15.