Skip to main content
Top
Published in: Inflammopharmacology 3/2018

01-06-2018 | Original Article

A phase I/II randomized, controlled, clinical trial for assessment of the efficacy and safety of β-d-mannuronic acid in rheumatoid arthritis patients

Authors: Hossein Ahmadi, Ahmad Reza Jamshidi, Farhad Gharibdoost, Mahdi Mahmoudi, Noushin Rastkari, Shayan Mostafaei, Mohammad Javad Fattahi, Mahdi Vojdanian, Salvatore Cuzzocrea, Bernd H. A. Rehm, Hidenori Matsuo, Mostafa Hosseini, Zahra Aghazadeh, Seyed Shahabeddin Mortazavi-Jahromi, Abbas Mirshafiey

Published in: Inflammopharmacology | Issue 3/2018

Login to get access

Abstract

Background

Following the potent efficacy of β-d-mannuronic acid (M2000) in phase I/II trial in ankylosing spondylitis patients, the present clinical trial was conducted to evaluate the efficacy, safety, and tolerability of this novel drug in rheumatoid arthritis (RA) patients who had inadequate response to conventional therapy.

Method

The study was a 12-week randomized, controlled, phase I/II clinical trial with two treatment arms: M2000 and conventional treatment. Patients who had RA according to the modified American College of Rheumatology (ACR) criteria, with active disease at baseline also inadequate response to conventional therapy, were enrolled in this study. M2000 was administrated at a dose of two capsules (500 mg) per day orally during a period of 12 weeks. The primary endpoint was the proportion of patients fulfilling the ACR 20% improvement criteria after 12 weeks of M2000 therapy. Moreover, the patients were also followed up for safety.

Results

There were no statistically significant differences between treatment and conventional groups at baseline characteristics. The ACR20 response rate was significantly higher among M2000-treated patients than conventional-treated control, so that 74% of patients in treatment group showed an ACR20 response after 12 weeks of M2000 therapy (74 versus 16%; P = 0.011). 10% of M2000-treated patients and 57.1% of conventional-treated patient’s adverse events occurred during this study.

Conclusion

Treatment with M2000 in combination with conventional therapy showed a significantly superior efficacy along with a high safety profile compared to conventional-treated patients. Thereby, M2000 might be suggested as a suitable option in the treatment of RA.
Literature
go back to reference Aletaha D et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 62:2569–2581CrossRef Aletaha D et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 62:2569–2581CrossRef
go back to reference Aletaha S, Haddad L, Roozbehkia M, Bigdeli R, Asgary V, Mahmoudi M, Mirshafiey A (2017) M2000 (β-d-mannuronic acid) as a novel antagonist for blocking the TLR2 and TLR4 downstream signalling pathway. Scand J Immunol 85:122–129CrossRefPubMed Aletaha S, Haddad L, Roozbehkia M, Bigdeli R, Asgary V, Mahmoudi M, Mirshafiey A (2017) M2000 (β-d-mannuronic acid) as a novel antagonist for blocking the TLR2 and TLR4 downstream signalling pathway. Scand J Immunol 85:122–129CrossRefPubMed
go back to reference Blumenthal KG, Lai KH, Huang M, Wallace ZS, Wickner PG, Zhou L (2017) Adverse and hypersensitivity reactions to prescription nonsteroidal anti-inflammatory agents in a large health care system. J Allergy Clin Immunol Pract 5(737–743):e733 Blumenthal KG, Lai KH, Huang M, Wallace ZS, Wickner PG, Zhou L (2017) Adverse and hypersensitivity reactions to prescription nonsteroidal anti-inflammatory agents in a large health care system. J Allergy Clin Immunol Pract 5(737–743):e733
go back to reference Fattahi MJ et al (2015) Preclinical assessment of β-d-mannuronic acid (M2000) as a non-steroidal anti-inflammatory drug. Immunopharmacol Immunotoxicol 37:535–540CrossRefPubMed Fattahi MJ et al (2015) Preclinical assessment of β-d-mannuronic acid (M2000) as a non-steroidal anti-inflammatory drug. Immunopharmacol Immunotoxicol 37:535–540CrossRefPubMed
go back to reference Felson DT et al (1993) The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arthritis Rheumatol 36:729–740CrossRef Felson DT et al (1993) The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arthritis Rheumatol 36:729–740CrossRef
go back to reference Felson DT et al (1995) American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheumatol 38:727–735CrossRef Felson DT et al (1995) American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheumatol 38:727–735CrossRef
go back to reference Furst DE, Emery P (2014) Rheumatoid arthritis pathophysiology: update on emerging cytokine and cytokine-associated cell targets. Rheumatology 53:1560–1569CrossRefPubMedPubMedCentral Furst DE, Emery P (2014) Rheumatoid arthritis pathophysiology: update on emerging cytokine and cytokine-associated cell targets. Rheumatology 53:1560–1569CrossRefPubMedPubMedCentral
go back to reference Grosser T, Ricciotti E, FitzGerald GA (2017) The cardiovascular pharmacology of nonsteroidal anti-inflammatory drugs. Trends Pharmacol Sci 38:733–748CrossRefPubMedPubMedCentral Grosser T, Ricciotti E, FitzGerald GA (2017) The cardiovascular pharmacology of nonsteroidal anti-inflammatory drugs. Trends Pharmacol Sci 38:733–748CrossRefPubMedPubMedCentral
go back to reference Harirforoosh S, Asghar W, Jamali F (2014) Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. J Pharm Pharm Sci 16:821–847CrossRef Harirforoosh S, Asghar W, Jamali F (2014) Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. J Pharm Pharm Sci 16:821–847CrossRef
go back to reference Hosseini F et al (2017a) Targeting of crosstalk between tumor and tumor microenvironment by β-d mannuronic acid (M2000) in murine breast cancer model. Cancer Med 6:640–650CrossRefPubMedPubMedCentral Hosseini F et al (2017a) Targeting of crosstalk between tumor and tumor microenvironment by β-d mannuronic acid (M2000) in murine breast cancer model. Cancer Med 6:640–650CrossRefPubMedPubMedCentral
go back to reference Hosseini S et al (2017b) Anti-aging effects of M2000 (β-d-mannuronic acid) as a novel immunosuppressive drug on the enzymatic and non-enzymatic oxidative stress parameters in an experimental model. J Basic Clin Physiol Pharmacol 28:249–255CrossRefPubMed Hosseini S et al (2017b) Anti-aging effects of M2000 (β-d-mannuronic acid) as a novel immunosuppressive drug on the enzymatic and non-enzymatic oxidative stress parameters in an experimental model. J Basic Clin Physiol Pharmacol 28:249–255CrossRefPubMed
go back to reference Lee S-H, Han C-D, Yang I-H, Ha C-W (2011) Prescription pattern of NSAIDs and the prevalence of NSAID-induced gastrointestinal risk factors of orthopaedic patients in clinical practice in Korea. J Korean Med Sci 26:561–567CrossRefPubMedPubMedCentral Lee S-H, Han C-D, Yang I-H, Ha C-W (2011) Prescription pattern of NSAIDs and the prevalence of NSAID-induced gastrointestinal risk factors of orthopaedic patients in clinical practice in Korea. J Korean Med Sci 26:561–567CrossRefPubMedPubMedCentral
go back to reference Mirshafiey A, Cuzzocrea S, Rehm B, Matsuo H (2005a) M2000: a revolution in pharmacology. Med Sci Monit 11:PI53–PI63PubMed Mirshafiey A, Cuzzocrea S, Rehm B, Matsuo H (2005a) M2000: a revolution in pharmacology. Med Sci Monit 11:PI53–PI63PubMed
go back to reference Mirshafiey A, Cuzzocrea S, Rehm B, Mazzon E, Saadat F, Sotoude M (2005b) Treatment of experimental arthritis with M2000, a novel designed non-steroidal anti-inflammatory drug. Scand J Immunol 61:435–441CrossRefPubMed Mirshafiey A, Cuzzocrea S, Rehm B, Mazzon E, Saadat F, Sotoude M (2005b) Treatment of experimental arthritis with M2000, a novel designed non-steroidal anti-inflammatory drug. Scand J Immunol 61:435–441CrossRefPubMed
go back to reference Mirshafiey A, Matsuo H, Nakane S, Rehm BH, Koh C-S, Miyoshi S (2005c) Novel immunosuppressive therapy by M2000 in experimental multiple sclerosis. Immunopharmacol Immunotoxicol 27:255–265CrossRefPubMed Mirshafiey A, Matsuo H, Nakane S, Rehm BH, Koh C-S, Miyoshi S (2005c) Novel immunosuppressive therapy by M2000 in experimental multiple sclerosis. Immunopharmacol Immunotoxicol 27:255–265CrossRefPubMed
go back to reference Mirshafiey A, Rehm B, Abhari RS, Borzooy Z, Sotoude M, Razavi A (2007a) Production of M2000 (β-d-mannuronic acid) and its therapeutic effect on experimental nephritis. Environ Toxicol Pharmacol 24:60–66CrossRefPubMed Mirshafiey A, Rehm B, Abhari RS, Borzooy Z, Sotoude M, Razavi A (2007a) Production of M2000 (β-d-mannuronic acid) and its therapeutic effect on experimental nephritis. Environ Toxicol Pharmacol 24:60–66CrossRefPubMed
go back to reference Mirshafiey A, Rehm B, Sotoude M, Razavi A, Abhari RS, Borzooy Z (2007b) Therapeutic approach by a novel designed anti-inflammatory drug, M2000, in experimental immune complex glomerulonephritis. Immunopharmacol Immunotoxicol 29:49–61CrossRefPubMed Mirshafiey A, Rehm B, Sotoude M, Razavi A, Abhari RS, Borzooy Z (2007b) Therapeutic approach by a novel designed anti-inflammatory drug, M2000, in experimental immune complex glomerulonephritis. Immunopharmacol Immunotoxicol 29:49–61CrossRefPubMed
go back to reference Mirshafiey A et al (2017) Introduction of β-d-mannuronic acid (M2000) as a novel NSAID with immunosuppressive property based on COX-1/COX-2 activity and gene expression. Pharmacol Rep 69:1067–1072CrossRefPubMed Mirshafiey A et al (2017) Introduction of β-d-mannuronic acid (M2000) as a novel NSAID with immunosuppressive property based on COX-1/COX-2 activity and gene expression. Pharmacol Rep 69:1067–1072CrossRefPubMed
go back to reference Movahedi M, Beauchamp ME, Abrahamowicz M, Ray DW, Michaud K, Pedro S, Dixon WG (2016) Risk of incident diabetes mellitus associated with the dosage and duration of oral glucocorticoid therapy in patients with rheumatoid arthritis. Arthritis Rheumatol 68:1089–1098CrossRefPubMedPubMedCentral Movahedi M, Beauchamp ME, Abrahamowicz M, Ray DW, Michaud K, Pedro S, Dixon WG (2016) Risk of incident diabetes mellitus associated with the dosage and duration of oral glucocorticoid therapy in patients with rheumatoid arthritis. Arthritis Rheumatol 68:1089–1098CrossRefPubMedPubMedCentral
go back to reference Pincus T, Summey JA, Soraci SA, Wallston KA, Hummon NP (1983) Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheumatol 26:1346–1353CrossRef Pincus T, Summey JA, Soraci SA, Wallston KA, Hummon NP (1983) Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheumatol 26:1346–1353CrossRef
go back to reference Prevoo M, Van’T Hof MA, Kuper H, Van Leeuwen M, Van De Putte L, Van Riel P (1995) Modified disease activity scores that include twenty-eight-joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheumatol 38:44–48CrossRef Prevoo M, Van’T Hof MA, Kuper H, Van Leeuwen M, Van De Putte L, Van Riel P (1995) Modified disease activity scores that include twenty-eight-joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheumatol 38:44–48CrossRef
go back to reference Sostres C, Gargallo CJ, Arroyo MT, Lanas A (2010) Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Gastroenterol 24:121–132CrossRefPubMed Sostres C, Gargallo CJ, Arroyo MT, Lanas A (2010) Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Gastroenterol 24:121–132CrossRefPubMed
go back to reference Sung Y-K et al (2017) Comparative effectiveness of treatment options after conventional DMARDs failure in rheumatoid arthritis. Rheumatol Int 37:975–982CrossRefPubMed Sung Y-K et al (2017) Comparative effectiveness of treatment options after conventional DMARDs failure in rheumatoid arthritis. Rheumatol Int 37:975–982CrossRefPubMed
go back to reference Youssouf L et al (2017) Ultrasound-assisted extraction and structural characterization by NMR of alginates and carrageenans from seaweeds. Carbohydr Polym 166:55–63CrossRefPubMed Youssouf L et al (2017) Ultrasound-assisted extraction and structural characterization by NMR of alginates and carrageenans from seaweeds. Carbohydr Polym 166:55–63CrossRefPubMed
Metadata
Title
A phase I/II randomized, controlled, clinical trial for assessment of the efficacy and safety of β-d-mannuronic acid in rheumatoid arthritis patients
Authors
Hossein Ahmadi
Ahmad Reza Jamshidi
Farhad Gharibdoost
Mahdi Mahmoudi
Noushin Rastkari
Shayan Mostafaei
Mohammad Javad Fattahi
Mahdi Vojdanian
Salvatore Cuzzocrea
Bernd H. A. Rehm
Hidenori Matsuo
Mostafa Hosseini
Zahra Aghazadeh
Seyed Shahabeddin Mortazavi-Jahromi
Abbas Mirshafiey
Publication date
01-06-2018
Publisher
Springer International Publishing
Published in
Inflammopharmacology / Issue 3/2018
Print ISSN: 0925-4692
Electronic ISSN: 1568-5608
DOI
https://doi.org/10.1007/s10787-018-0475-z

Other articles of this Issue 3/2018

Inflammopharmacology 3/2018 Go to the issue