PMID- 16750468 OWN - NLM STAT- MEDLINE DCOM- 20060622 LR - 20141120 IS - 0149-2918 (Print) IS - 0149-2918 (Linking) VI - 28 IP - 4 DP - 2006 Apr TI - Effects of cilomilast, a selective phosphodiesterase 4 inhibitor, on esophageal motility and pH, and orocecal and colonic transit: two single-center, randomized, double-blind, placebo-controlled, two-part crossover studies in healthy volunteers. PG - 569-81 AB - BACKGROUND: Phase IIb studies have reported that cilomilast, a selective phosphodiesterase 4 inhibitor being developed for the treatment of chronic obstructive pulmonary disease, is associated with gastrointestinal (GI) adverse effects (AEs) in a small proportion (approximately 5%) of individuals. OBJECTIVES: The aims of these 2 studies were to investigate the effects of cilomilast 15 mg BID on: (1) lower esophageal sphincter pressure (LESP) and esophageal body motility and pH (study 1); and (2) orocecal and whole-gut transit times (OCTT and WGTT, respectively) (study 2) in healthy volunteers. METHODS: These 2 randomized, double-blind, placebo-controlled, 2-part crossover studies were conducted at the Neurogastroenterology Unit, Wythenshawe Hospital, Manchester, United Kingdom (study 1) and GlaxoSmithKline, Harlow, United Kingdom (study 2). In study 1, subjects were randomly assigned to receive either cilomilast (15 mg BID) or matched placebo (control) for 7 days (13 doses; subjects were not given the evening dose on day 7), and in study 2, cilomilast (15 mg BID) or matched placebo (control) for 9 days (18 doses) in each of 2 treatment periods. After study drug administration, combined esophageal motility and pH were recorded for 2 hours before and 4 hours after the administration of a standardized meal (2400 kJ [573 kcal]). Sequences of 6 consecutive 5-mL water swallows (separated by 20 seconds) were carried out 60 and 90 minutes (fasting) and 150, 180, 210, 240, 300, and 360 minutes (fed) after study drug administration. OCTT was determined from the increase in breath hydrogen after the meal. WGTT was determined from the time taken to excrete at least 16 of 20 ingested radiopaque markers, ingested as 2 capsules, each containing 10 radiopaque markers, with 240 mL of water. AEs were elicited at specified times throughout each session using nonleading questions, spontaneously reported AEs, and diary cards. RESULTS: Study 1 enrolled 20 subjects (11 men, 9 women; age range, 20-52 years). Study 2 enrolled 16 subjects (10 men, 6 women; age range, 19-48 years). No clinically significant differences in the amplitude (mean difference in postprandial-preprandial AUC0-t/t, 6.09 mm Hg; 95% CI, -10.66 to 22.84), duration (difference, -0.08 second; 95% CI, -0.54 to 0.37), or velocity of propagation (difference, 0.90 cm/s; 95% CI, -0.66 to 2.46) of esophageal contractions, LESP (difference, -0.39 mm Hg; 95% CI, -5.23 to 4.45), or preprandial or postprandial percentage time pH<4 (median differences: preprandial, 0.47% [95% CI, -0.45 to 1.27]; postprandial, -0.005% [95% CI, -1.30 to 6.27]) were found with cilomilast compared with placebo. No significant differences in OCTT (difference, -0.37 hour; 95% CI, -1.59 to 0.84) or WGTT (difference, -2.96 hours; 95% CI, -20.76 to 14.84) were found with cilomilast compared with controls. In both studies, the most frequently reported AEs with cilomilast use were nausea (8/18 in study 1 and 3/16 in study 2) and headache (8/18 in study 1 and 6/16 in study 2); however, these were generally of mild to moderate intensity. Overall, GI AEs did not correlate with changes in GI motility. CONCLUSION: The results of these 2 studies suggest that cilomilast was not associated with significant changes in esophageal motility and pH or GI transit in these healthy volunteers. FAU - Houghton, Lesley A AU - Houghton LA AD - Neurogastroenterology Unit, Wythenshawe Hospital, Manchester, United Kingdom. Lesley.Houghton@manchester.ac.uk FAU - Atkinson, Wendy AU - Atkinson W FAU - Whorwell, Peter J AU - Whorwell PJ FAU - Morris, Julie AU - Morris J FAU - Murdoch, Robert D AU - Murdoch RD FAU - Cooper, Stephen M AU - Cooper SM FAU - Webber, Dawn M AU - Webber DM FAU - Walls, Christine M AU - Walls CM LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - Clin Ther JT - Clinical therapeutics JID - 7706726 RN - 0 (Carboxylic Acids) RN - 0 (Cyclohexanecarboxylic Acids) RN - 0 (Nitriles) RN - 0 (Phosphodiesterase Inhibitors) RN - 8ATB1C1R6X (Cilomilast) RN - EC 3.1.4.17 (3',5'-Cyclic-AMP Phosphodiesterases) RN - EC 3.1.4.17 (Cyclic Nucleotide Phosphodiesterases, Type 4) SB - IM MH - 3',5'-Cyclic-AMP Phosphodiesterases/*antagonists & inhibitors MH - Adult MH - Area Under Curve MH - Carboxylic Acids/adverse effects/pharmacology MH - Cecum/drug effects MH - Cross-Over Studies MH - Cyclic Nucleotide Phosphodiesterases, Type 4 MH - Cyclohexanecarboxylic Acids MH - Double-Blind Method MH - Esophageal Sphincter, Lower/drug effects MH - Esophagus/*drug effects MH - Female MH - Gastrointestinal Motility/*drug effects MH - Gastrointestinal Transit/*drug effects MH - Humans MH - Hydrogen-Ion Concentration MH - Male MH - Manometry MH - Middle Aged MH - Nitriles/adverse effects/*pharmacology MH - Phosphodiesterase Inhibitors/adverse effects/*pharmacology EDAT- 2006/06/06 09:00 MHDA- 2006/06/23 09:00 CRDT- 2006/06/06 09:00 PHST- 2006/02/09 00:00 [accepted] PHST- 2006/06/06 09:00 [pubmed] PHST- 2006/06/23 09:00 [medline] PHST- 2006/06/06 09:00 [entrez] AID - S0149-2918(06)00091-9 [pii] AID - 10.1016/j.clinthera.2006.04.003 [doi] PST - ppublish SO - Clin Ther. 2006 Apr;28(4):569-81. doi: 10.1016/j.clinthera.2006.04.003.