Atogepant Is Not Associated With Clinically Meaningful Alanine Aminotransferase Elevations in Healthy Adults

Abstract

Atogepant is a potent, selective, oral calcitonin gene-related peptide (CGRP) receptor antagonist in development for migraine prevention. The chemical structure of atogepant is distinct from previous CGRP receptor antagonists, which were associated with elevated serum alanine aminotransferase (ALT) in clinical trials. Here, we report the safety, tolerability, and pharmacokinetics (PKs) of a once-daily supratherapeutic dose (170 mg) of atogepant for 28 days from a randomized, double-blind, placebo-controlled phase I trial in healthy participants. Overall safety, hepatic safety, and plasma PK parameters were evaluated. Thirty-four participants aged 23-55 years enrolled; 28 (82.4%) completed the study in accordance with the protocol. Multiple doses of 170 mg atogepant for 28 consecutive days were generally well-tolerated. All adverse events (AEs; reported in 87.0% of the atogepant group; 72.7%, placebo) were mild in severity except one serious AE of subarachnoid hemorrhage due to a bicycle accident and not considered related to treatment. There were two discontinuations due to AEs, both with atogepant, one considered possibly related to treatment. Over 28 days of treatment, no participant receiving atogepant had an ALT elevation above 1.5 × upper limit of normal. Change from baseline in serum ALT levels was not different between atogepant and placebo. Atogepant is rapidly absorbed (median time to maximum plasma concentration, ~ 2 hours) with an apparent terminal half-life of ~ 11 hours, and no evidence of accumulation after once-daily dosing. Overall, atogepant at a high oral dose is safe and well-tolerated in healthy participants with no clinically meaningful elevations in ALT.

Trial registration: ClinicalTrials.gov NCT03700320 NCT03777059 NCT03855137 NCT03939312.

Conflict of interest statement

K.C.M., J.X., and L.M. were employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, with stock in Merck & Co., Inc., Kenilworth, NJ, USA, at the time of this study. W.K.K. served as a consultant to Merck in 2019 for a topic unrelated to atogepant. P.B., F.C.‐G., W.L., D.P., M.F.D., and C.Z.M. are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, with stock in Merck & Co., Inc., Kenilworth, NJ, USA. R.B. is an employee of AbbVie, and may hold AbbVie stock.

© 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of the American Society for Clinical Pharmacology and Therapeutics.

Figures

Figure 1

Participant disposition.

Figure 2

Atogepant concentrations in plasma over time. Arithmetic mean values for atogepant plasma concentration over time following administration of 170 mg q.d. for 28 days in fasted healthy participants are shown on (a) linear scale and (b) log‐linear scale. Error bars represent SDs.

Figure 3

Serum ALT concentrations over time. Arithmetic mean values for ALT serum concentration at baseline and following administration of atogepant 170 mg q.d. (black line) or placebo q.d. (gray line) for 28 days in healthy participants. Dotted and dashed lines indicate ALT ULN for men (45 IU/L) and women (30 IU/L), respectively. ALT, alanine aminotransferase; ULN, upper limit of normal.