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Published in: Journal of Nuclear Cardiology 2/2012

Open Access 01-04-2012 | Original Article

A randomized, double-blind, placebo-controlled study of the safety and tolerance of regadenoson in subjects with stage 3 or 4 chronic kidney disease

Authors: Karthik Ananthasubramaniam, MD, FASNC, Robert Weiss, MD, Bruce McNutt, MD, Barbara Klauke, MS, Kathleen Feaheny, MS, Stan Bukofzer, MBBCh, MMed (Int)

Published in: Journal of Nuclear Cardiology | Issue 2/2012

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Abstract

Background

The safety and tolerability of regadenoson, a pharmacologic stress agent that is excreted primarily by the kidneys, were examined in subjects with chronic kidney disease (CKD).

Methods

This multicenter, double-blind, randomized, placebo-controlled study involved men and women, ≥18 years of age, with stage 3 or 4 [estimated glomerular filtration rate (eGFR) 30-59 mL/minute/1.73 m2 and 15-29 mL/minute/1.73 m2, respectively] CKD and known or suspected coronary artery disease. Subjects were randomized 2:1 to receive one 10-second intravenous injection of regadenoson 0.4 mg or placebo. The primary outcome measure was the frequency of serious adverse events over 24-h post-dose.

Results

The study included 432 subjects with stage 3 (regadenoson n = 287; placebo n = 145) and 72 with stage 4 (regadenoson n = 47; placebo n = 25) CKD. No serious adverse events or deaths were reported over 24-h post-dose. The overall adverse event incidence was higher with regadenoson than placebo (62.6% vs 21.2%; P < .0001). Of the most common adverse events (≥5%) reported by subjects receiving regadenoson, headache (24.9% vs 7.1%), dyspnea (19.2% vs 0.6%), chest discomfort (14.7% vs 0.6%), nausea (14.7% vs 1.2%), flushing (12.0% vs 1.8%), and dizziness (9.6% vs 0.6%) occurred significantly more often (P < .0001) with regadenoson than placebo. There were no trends for clinically meaningful changes in eGFR from baseline to 24-h post-dose in subjects with stage 3 or 4 CKD.

Conclusions

Regadenoson was not associated with any serious or unexpected adverse events in subjects with stage 3 or 4 CKD.
Literature
1.
go back to reference Shryock JC, Belardinelli L. Adenosine and adenosine receptors in the cardiovascular system: Biochemistry, physiology, and pharmacology. Am J Cardiol 1997;79:2-10.PubMedCrossRef Shryock JC, Belardinelli L. Adenosine and adenosine receptors in the cardiovascular system: Biochemistry, physiology, and pharmacology. Am J Cardiol 1997;79:2-10.PubMedCrossRef
2.
go back to reference Fredholm BB, IJzerman AP, Jacobson KA, Klotz KN, Linden J. International Union of Pharmacology. XXV. Nomenclature and classification of adenosine receptors. Pharmacol Rev 2001;53:527-52.PubMed Fredholm BB, IJzerman AP, Jacobson KA, Klotz KN, Linden J. International Union of Pharmacology. XXV. Nomenclature and classification of adenosine receptors. Pharmacol Rev 2001;53:527-52.PubMed
3.
go back to reference Cerqueira MD. The future of pharmacologic stress: Selective A2A adenosine receptor agonists. Am J Cardiol 2004;94:33D-40D.PubMedCrossRef Cerqueira MD. The future of pharmacologic stress: Selective A2A adenosine receptor agonists. Am J Cardiol 2004;94:33D-40D.PubMedCrossRef
4.
go back to reference Zablocki J, Palle V, Blackburn B, Elzein E, Nudelman G, Gothe S, et al. 2-substituted pi system derivatives of adenosine that are coronary vasodilators acting via the A2A adenosine receptor. Nucleosides Nucleotides Nucleic Acids 2001;20:343-60.PubMedCrossRef Zablocki J, Palle V, Blackburn B, Elzein E, Nudelman G, Gothe S, et al. 2-substituted pi system derivatives of adenosine that are coronary vasodilators acting via the A2A adenosine receptor. Nucleosides Nucleotides Nucleic Acids 2001;20:343-60.PubMedCrossRef
5.
go back to reference Gao Z, Li Z, Baker SP, Lasley RD, Meyer S, Elzein E, et al. Novel short-acting A2A adenosine receptor agonists for coronary vasodilation: Inverse relationship between affinity and duration of action of A2A agonists. J Pharmacol Exp Ther 2001;298:209-18.PubMed Gao Z, Li Z, Baker SP, Lasley RD, Meyer S, Elzein E, et al. Novel short-acting A2A adenosine receptor agonists for coronary vasodilation: Inverse relationship between affinity and duration of action of A2A agonists. J Pharmacol Exp Ther 2001;298:209-18.PubMed
6.
go back to reference Lexiscan® (regadenoson injection) [prescribing information]. Deerfield, IL: Astellas Pharma US Inc. April 2011. Lexiscan® (regadenoson injection) [prescribing information]. Deerfield, IL: Astellas Pharma US Inc. April 2011.
7.
go back to reference Buhr C, Gossl M, Erbel R, Eggebrecht H. Regadenoson in the detection of coronary artery disease. J Vasc Health Risk Manag 2008;4:337-40. Buhr C, Gossl M, Erbel R, Eggebrecht H. Regadenoson in the detection of coronary artery disease. J Vasc Health Risk Manag 2008;4:337-40.
8.
go back to reference Hendel RC. Update on myocardial perfusion imaging: Role of regadenoson. Rep Med Imaging 2009;2:13-23. Hendel RC. Update on myocardial perfusion imaging: Role of regadenoson. Rep Med Imaging 2009;2:13-23.
9.
go back to reference Al Jaroudi W, Iskandrian AE. Regadenoson: A new myocardial stress agent. J Am Coll Cardiol 2009;54:1123-30.PubMedCrossRef Al Jaroudi W, Iskandrian AE. Regadenoson: A new myocardial stress agent. J Am Coll Cardiol 2009;54:1123-30.PubMedCrossRef
11.
go back to reference Thompson CA. FDA approves pharmacologic stress agent. Am J Health Syst Pharm 2008;65:890. Thompson CA. FDA approves pharmacologic stress agent. Am J Health Syst Pharm 2008;65:890.
12.
go back to reference Gordi T, Blackburn B, Lieu H. Regadenoson pharmacokinetics and tolerability in subjects with impaired renal function. J Clin Pharmacol 2007;47:825-33.PubMedCrossRef Gordi T, Blackburn B, Lieu H. Regadenoson pharmacokinetics and tolerability in subjects with impaired renal function. J Clin Pharmacol 2007;47:825-33.PubMedCrossRef
13.
go back to reference De Winter O, Van de Veire N, Gemmel F, Goethals I, De Sutter J. Myocardial perfusion imaging in the elderly: A review. Nucl Med Commun 2006;27:529-34.PubMedCrossRef De Winter O, Van de Veire N, Gemmel F, Goethals I, De Sutter J. Myocardial perfusion imaging in the elderly: A review. Nucl Med Commun 2006;27:529-34.PubMedCrossRef
14.
go back to reference Wetzels JF, Kiemeney LA, Swinkels DW, Willems HL, den Heijer M. Age- and gender-specific reference values of estimated GFR in Caucasians: The Nijmegen Biomedical Study. Kidney Int 2007;72:632-7.PubMedCrossRef Wetzels JF, Kiemeney LA, Swinkels DW, Willems HL, den Heijer M. Age- and gender-specific reference values of estimated GFR in Caucasians: The Nijmegen Biomedical Study. Kidney Int 2007;72:632-7.PubMedCrossRef
15.
go back to reference Stevens LA, Li S, Wang C, Huang C, Becker BN, Bomback AS, et al. Prevalence of CKD and comorbid illness in elderly patients in the United States: Results from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2010;55:S23-33.PubMedCrossRef Stevens LA, Li S, Wang C, Huang C, Becker BN, Bomback AS, et al. Prevalence of CKD and comorbid illness in elderly patients in the United States: Results from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2010;55:S23-33.PubMedCrossRef
16.
go back to reference Leoncini G, Viazzi F, Rosei EA, Ambrosioni E, Costa FV, Leonetti G, et al. Chronic kidney disease in hypertension under specialist care: The I-DEMAND study. J Hypertens 2010;28:156-62.PubMedCrossRef Leoncini G, Viazzi F, Rosei EA, Ambrosioni E, Costa FV, Leonetti G, et al. Chronic kidney disease in hypertension under specialist care: The I-DEMAND study. J Hypertens 2010;28:156-62.PubMedCrossRef
17.
go back to reference Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 2007;14:645-58.PubMedCrossRef Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 2007;14:645-58.PubMedCrossRef
18.
go back to reference Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE, on behalf of the ADVANCE-MPI Trial Investigators. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging. J Am Coll Cardiol Imaging 2008;1:307-16. Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE, on behalf of the ADVANCE-MPI Trial Investigators. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging. J Am Coll Cardiol Imaging 2008;1:307-16.
19.
go back to reference Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006;145:247-54.PubMed Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006;145:247-54.PubMed
20.
go back to reference Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-70.PubMed Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-70.PubMed
21.
go back to reference Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med 2003;139:137-47.PubMed Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med 2003;139:137-47.PubMed
22.
go back to reference Gordi T, Frohna P, Sun HL, Wolff A, Belardinelli L, Lieu H. A population pharmacokinetic/pharmacodynamic analysis of regadenoson, an adenosine A2A-receptor agonist, in healthy male volunteers. Clin Pharmacokinet 2006;45:1201-12.PubMedCrossRef Gordi T, Frohna P, Sun HL, Wolff A, Belardinelli L, Lieu H. A population pharmacokinetic/pharmacodynamic analysis of regadenoson, an adenosine A2A-receptor agonist, in healthy male volunteers. Clin Pharmacokinet 2006;45:1201-12.PubMedCrossRef
23.
go back to reference Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:2034-41.PubMedCrossRef Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:2034-41.PubMedCrossRef
24.
go back to reference Hendel RC, Bateman TM, Cerqueira MD, Iskandrian AE, Leppo JA, Blackburn B, et al. Initial clinical experience with regadenoson, a novel selective A2A agonist for pharmacologic stress single-photon emission computed tomography myocardial perfusion imaging. J Am Coll Cardiol 2005;46:2069-75.PubMedCrossRef Hendel RC, Bateman TM, Cerqueira MD, Iskandrian AE, Leppo JA, Blackburn B, et al. Initial clinical experience with regadenoson, a novel selective A2A agonist for pharmacologic stress single-photon emission computed tomography myocardial perfusion imaging. J Am Coll Cardiol 2005;46:2069-75.PubMedCrossRef
25.
go back to reference Lieu HD, Shryock JC, von Mering GO, Gordi T, Blackburn B, Olmsted AW, et al. Regadenoson, a selective A2A adenosine receptor agonist, causes dose-dependent increases in coronary blood flow velocity in humans. J Nucl Cardiol 2007;14:514-20.PubMedCrossRef Lieu HD, Shryock JC, von Mering GO, Gordi T, Blackburn B, Olmsted AW, et al. Regadenoson, a selective A2A adenosine receptor agonist, causes dose-dependent increases in coronary blood flow velocity in humans. J Nucl Cardiol 2007;14:514-20.PubMedCrossRef
26.
go back to reference Dhalla AK, Wong MY, Wang WQ, Biaggioni I, Belardinelli L. Tachycardia caused by A2A adenosine receptor agonists is mediated by direct sympathoexcitation in awake rats. J Pharmacol Exp Ther 2006;316:695-702.PubMedCrossRef Dhalla AK, Wong MY, Wang WQ, Biaggioni I, Belardinelli L. Tachycardia caused by A2A adenosine receptor agonists is mediated by direct sympathoexcitation in awake rats. J Pharmacol Exp Ther 2006;316:695-702.PubMedCrossRef
27.
go back to reference Zhang Y, Zhang L, Abraham S, Apparaju S, Wu TC, Strong JM, et al. Assessment of the impact of renal impairment on systemic exposure of new molecular entities: Evaluation of recent new drug applications. Clin Pharmacol Ther 2009;85:305-11.PubMedCrossRef Zhang Y, Zhang L, Abraham S, Apparaju S, Wu TC, Strong JM, et al. Assessment of the impact of renal impairment on systemic exposure of new molecular entities: Evaluation of recent new drug applications. Clin Pharmacol Ther 2009;85:305-11.PubMedCrossRef
28.
go back to reference Cerqueira MD, Mahmarian JJ, Kinser C, Papatheofanis FJ, Segreti A. Frequency of aminophylline use to attenuate adverse reactions to regadenoson and adenosine. J Nucl Cardiol 2009;16:658. (abstract 10.01). Cerqueira MD, Mahmarian JJ, Kinser C, Papatheofanis FJ, Segreti A. Frequency of aminophylline use to attenuate adverse reactions to regadenoson and adenosine. J Nucl Cardiol 2009;16:658. (abstract 10.01).
29.
go back to reference Johnson SG, Peters S. Advances in pharmacologic stress agents: Focus on regadenoson. J Nucl Med Technol 2010;38:163-71.PubMedCrossRef Johnson SG, Peters S. Advances in pharmacologic stress agents: Focus on regadenoson. J Nucl Med Technol 2010;38:163-71.PubMedCrossRef
Metadata
Title
A randomized, double-blind, placebo-controlled study of the safety and tolerance of regadenoson in subjects with stage 3 or 4 chronic kidney disease
Authors
Karthik Ananthasubramaniam, MD, FASNC
Robert Weiss, MD
Bruce McNutt, MD
Barbara Klauke, MS
Kathleen Feaheny, MS
Stan Bukofzer, MBBCh, MMed (Int)
Publication date
01-04-2012
Publisher
Springer-Verlag
Published in
Journal of Nuclear Cardiology / Issue 2/2012
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI
https://doi.org/10.1007/s12350-011-9508-3

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