Indivior Announces Publication Demonstrating that OPVEE® (nalmefene) Nasal Spray Rapidly Reverses Effects of Opioid-Induced Respiratory Depression in Head-to-Head Study Against Intranasal Naloxone
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Insights
The results of the pharmacodynamic study comparing OPVEE and intranasal naloxone for the reversal of opioid-induced respiratory depression have significant implications for the treatment of opioid overdoses. The rapid efficacy of OPVEE, reaching 95% of pre-opioid baseline in 5 minutes, suggests a potential for improved clinical outcomes in emergency scenarios. The study's design and its FDA review as part of the approval process lend credibility to these findings.
From a medical research perspective, the superiority of OPVEE over naloxone in terms of speed could influence emergency protocols. Given the rise in opioid-related deaths, particularly from synthetic opioids like fentanyl, a faster-acting reversal agent could be critical in reducing mortality rates. The minute ventilation metric used in the study is a standard measure of respiratory function and the robust reversal maintained by OPVEE indicates a strong pharmacological profile.
The announcement by Indivior PLC regarding OPVEE's performance in reversing opioid-induced respiratory depression is likely to be of considerable interest to investors. As the opioid crisis persists, the demand for effective treatment options escalates, potentially expanding the market for products like OPVEE. The study's outcome, indicating non-inferiority and superiority to a current standard treatment, could position OPVEE favorably within this niche market.
For stakeholders, the short-term implications may include an increase in Indivior PLC's stock value as investors anticipate market approval and potential sales growth. In the long term, if OPVEE gains market share, it could contribute significantly to the company's revenue stream. However, investors should also consider the regulatory hurdles and competition in the space, which might influence the product's commercial success.
The pharmacodynamics of OPVEE, as presented, indicate a promising profile for emergency treatment of opioid overdose. The mechanism by which OPVEE reverses respiratory depression more rapidly than naloxone could be attributed to differences in drug-receptor affinity, onset of action, or pharmacokinetic properties. Understanding these factors is crucial for determining the clinical applicability of OPVEE.
For healthcare providers, the potential benefits of OPVEE include faster patient stabilization and reduced risk of complications from prolonged hypoxia. However, the long-term safety profile and the possibility of adverse effects will need thorough investigation. The study's reference to remifentanil, a potent opioid, as the agent for induced respiratory depression is relevant, as it simulates the high-risk scenarios where rapid reversal is most needed.
- This head-to-head pharmacodynamic study in healthy volunteers examined the ability of both OPVEE and intranasal naloxone to reverse opioid-induced respiratory depression, which is the shallow and slow breathing associated with an opioid overdose
- In this model, OPVEE 2.7mg reversed respiratory depression to
95% of pre-opioid baseline within 5 minutes; a similar reversal following a 4 mg dose of intranasal naloxone required 20 minutes
This study met the primary endpoint by demonstrating that OPVEE reversed the respiratory depression produced by remifentanil, a potent synthetic opioid related to fentanyl, within the first 5 minutes following administration. Both OPVEE and IN naloxone produced a time-dependent reversal of the opioid-induced respiratory depression 2.5 to 20 minutes post administration. Point estimates favored OPVEE, demonstrating non-inferiority and superiority to naloxone. After OPVEE administration, subjects' minute ventilation (a measure of the amount of air that enters the lungs per minute) reached approximately
"This study provides the first head-to-head comparison of IN OPVEE and IN naloxone in a clinical model of opioid-induced respiratory depression. While both reverse the effects of remifentanil induced respiratory depression, this pharmacodynamic study provides important insights about the time course of reversal for both drugs," said Christian Heidbreder, Ph.D. and Chief Scientific Officer of Indivior. "The first few minutes following an overdose – particularly with very potent and fast acting synthetic opioids like fentanyl – are critical for a successful rescue. OPVEE reverses the respiratory depression rapidly in this model, making it a valuable tool for combating the synthetic opioid overdose crisis we're facing as a nation."
Following administration of OPVEE, subjects' minute ventilation (MV), a measure of how much a person is breathing, increased by an average of 5.75 L/min at 5 minutes, the study's primary endpoint. Intranasal naloxone produced a mean increase of 3.01 L/min at 5 minutes post-administration, and 20 minutes was required to produce an increase in MV similar to that observed 5 minutes after OPVEE.
Adverse events (AEs) occurred in
In
About the Study
This study was an open-label, head-to-head, randomized, 2-period, 2-treatment crossover noninferiority study designed to model the pharmacodynamic effects of intranasal OPVEE® (nalmefene) and intranasal naloxone. A total of 69 opioid-experienced, non -dependent healthy male and female volunteers were randomized to receive study drugs. Subjects breathed a hypercapnic gas mixture containing
About OPVEE®
OPVEE (nalmefene) nasal spray
INDICATION
OPVEE nasal spray is an opioid antagonist indicated for the emergency treatment of known or suspected overdose induced by natural or synthetic opioids in adults and pediatric patients aged 12 years and older, as manifested by respiratory and/or central nervous system depression.
OPVEE nasal spray is intended for immediate administration as emergency therapy in settings where opioids may be present.
OPVEE nasal spray is not a substitute for emergency medical care.
HIGHLIGHTED SAFETY INFORMATION
CONTRAINDICATIONS
Hypersensitivity to nalmefene or to any of the other ingredients.
WARNINGS AND PRECAUTIONS
Risk of Recurrent Respiratory and Central Nervous System Depression: While the duration of action of nalmefene is as long as most opioids, a recurrence of respiratory depression is possible, therefore, keep patient under continued surveillance and administer repeat doses of OPVEE using a new nasal spray with each dose, as necessary, while awaiting emergency medical assistance.
Limited Efficacy with Partial Agonists or Mixed Agonist/Antagonists: Reversal of respiratory depression caused by partial agonists or mixed agonists/antagonists, such as buprenorphine and pentazocine, may be incomplete. Larger or repeat doses may be required.
Precipitation of Severe Opioid Withdrawal: Use in patients who are opioid dependent may precipitate opioid withdrawal. In neonates, opioid withdrawal may be life-threatening if not recognized and properly treated. Monitor for the development of opioid withdrawal.
Risk of Cardiovascular (CV) Effects: Abrupt postoperative reversal of opioid depression may result in adverse CV effects. These events have primarily occurred in patients who had preexisting CV disorders or received other drugs that may have similar adverse CV effects. Monitor these patients closely in an appropriate healthcare setting after use of nalmefene hydrochloride.
Risk of Opioid Overdose from Attempts to Overcome the Blockade: Attempts to overcome opioid withdrawal symptoms caused by opioid antagonists with high or repeated doses of exogenous opioids may lead to opioid intoxication and death.
ADVERSE REACTIONS
Most common adverse reactions (incidence at least
For more information about OPVEE and the full Prescribing Information visit www.opvee.com.
About Indivior
Indivior is a global pharmaceutical company working to help change patients' lives by developing medicines to treat substance use disorders (SUD) and serious mental illnesses. Our vision is that all patients around the world will have access to evidence-based treatment for the chronic conditions and co-occurring disorders of SUD. Indivior is dedicated to transforming SUD from a global human crisis to a recognized and treated chronic disease. Building on its global portfolio of opioid use disorder treatments, Indivior has a pipeline of product candidates designed to both expand on its heritage in this category and potentially address other chronic conditions and co-occurring disorders of SUD, including alcohol use disorder and cannabis use disorder. Headquartered in
References
- Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. July 2023. Accessed February 8, 2024, from https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
- Palkovic B, Marchenko V, Stuth EA, Stucke AG. Multi-level regulation of opioid-induced respiratory depression. Physiology. 2020; 35(6):391-404.
- Rawat, D., Modi, P., & Sharma, S. (2023). Hypercapnea. In StatPearls. StatPearls Publishing. Accessed February 15, 2024, from https://pubmed.ncbi.nlm.nih.gov/29763188/
- Gelberg J, Jonmarker C, Stenqvist O, Werner O. Intravenous boluses of fentanyl, 1 μg kg-1, and remifentanil, 0.5 μg kg-1, give maximum ventilatory depression in awake volunteers. Brit. J. Anaes. 2012; 108(6):1028-34.
- Webster L, Hansen E, Stoddard G, Rynders A, Ostler D, Lennon H. Ventilatory response to hypercapnia as experimental model to study effects of oxycodone on respiratory depression. Curr. Rev. Clin. Exper. Pharmacol. 2021; 16:1-9.
- Glass PS, Iselin-Chaves IA, Goodman D, Delong E, Hermann DJ. Determination of the potency of remifentanil compared with alfentail using ventilatory depression as the measure of opioid effect. Anesthesiol. 1999; 90(6):1556-1563.
- Dahan A, Aarts L, Smith T. Incidence, reversal and prevention of opioid-induced respiratory depression. Anesthes. 2010; 112(1):226-238.
- Glass, P, Jhaveri, R, Smith, L. Comparison of potency and duration of action of nalmefene and naloxone. Anesth. Analg., 1994; 78(3):536-541.
- Konieczko K, Jones J, Barrowcliffe M, Jordan C, Altman, D. Antagonism of morphine-induced respiratory depression with nalmefene. Br. J. Anaesth. 1988; 61(3):318-323.
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SOURCE Indivior PLC
FAQ
How does OPVEE compare to intranasal naloxone in reversing opioid-induced respiratory depression?
What were the key findings of the pharmacodynamic study conducted by Indivior PLC?