Ferring Pharmaceuticals Announces Approval for NOCDURNA®, a New Therapeutic Option for the Treatment of Adults Waking Multiple Times to Urinate at Night
Ferring Pharmaceuticals, today announced that NOCDURNA® (desmopressin), has received approval in the EU, for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults.
Nocturia, the need to awaken at night to pass urine, is a complex medical condition with various contributing factors5 . The night-time overproduction of urine, nocturnal polyuria, is responsible for nocturia in up to 88% of cases5,6 .
Specifically developed to reduce the amount of urine the kidneys produce, NOCDURNA® once-daily lyophilisate tablets are administered sublingually (without the need for water) in gender specific low doses, tailored specifically for men (50 mcg) and women (25 mcg).
NOCDURNA® was reviewed via the Decentralised Procedure (DCP) with the Swedish Medical Products Agency (MPA) acting as the Reference Member State (RMS). The majority of the EU countries were involved as concerned member states and they will have 30 days to issue a national approval. Product labelling has been agreed by all countries participating in the procedure who will issue their own local Marketing Authorisations. NOCDURNA® is currently available in Canada for the treatment of nocturia.
Commenting on the authorisation, Pascal Danglas, MD, Chief Medical Officer at Ferring Pharmaceuticals, said, “We are delighted that NOCDURNA® received approval in the EU. The approval is a significant milestone in making this medicine also available to elderly patients diagnosed with nocturia due to nocturnal polyuria, a large patient population who previously had limited treatment options. The long and thorough development process has enabled us to provide gender-specific dosages, enabling a personalised medicine approach for men and women. Ferring Pharmaceuticals remains committed to improving the diagnosis and treatment of nocturia and to ensuring that patients of all ages continue to benefit from these treatment advances.”
The Swedish approval is based on two Phase III studies (CS40 and CS41) with CS40 investigating the efficacy and safety of 25 mcg in adult women and CS41 investigating the efficacy and safety of 50 mcg in adult men. Both trials demonstrated that the treatment significantly reduced the average number of night time urinations compared to the placebo groups7,8 , with nearly doubling the probability of patients reducing the number of night-time urinations by more than 33 percent8,9 .
The drug was well tolerated. The most common adverse events were dry mouth, nausea, fatigue, hyponatraemia and headache which occurred at ≥5%8,9 . No incidences of hyponatraemia occurred in CS408 and only two incidences of hyponatraemia occurred in patients in CS41 who took the 50 mcg dose (≤1%)9 .
“The broken night’s sleep caused by nocturia can have a negative impact on quality of life, daily activity and work productivity9,10,” said Jens Peter Nørgaard MD, Executive Director and Professor Global Medical Affairs Urology at Ferring Pharmaceuticals, “Longer term effects are being studied, but poor quality sleep has been associated with significant health problems including obesity, diabetes, weakened immune systems and even some cancers11,12,13 Therefore we are pleased with the approval of a treatment that can significantly decrease the burden experienced by nocturia patients.”
Oral desmopressin is currently registered and widely available outside the US for the treatment of nocturia associated with nocturnal polyuria in higher doses, but with an upper age limitation of 65 years. Although trials with NOCDURNA® have documented a safety benefit of lower, gender specific doses, sodium monitoring in adults over 65 years of age is warranted.
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About NOCDURNA ®
NOCDURNA® Oral lyophilisate has as an active substance desmopressin, a synthetic analogue of the naturally occurring vasopressin, an antidiuretic hormone that promotes water absorption by the kidneys. Ferring Pharmaceuticals originally developed desmopressin more than 40 years ago. Desmopressin in NOCDURNA® works by mimicking the effect of vasopressin and binds to specific receptors in the kidneys. This action can prevent the kidneys from filtering excessive amounts of water out of the blood as they make urine, reducing the volume of urine and night-time urination. However, desmopressin, unlike vasopressin, does not affect blood pressure.
Desmopressin has been approved in both adults and children and in multiple strengths, dosage forms and routes of administration worldwide for more than 40 years for several medical conditions, such as for central diabetes insipidus and for primary nocturnal enuresis (involuntary discharge of urine at night by children beyond the age of five years). Ferring Pharmaceuticals has already received marketing authorisation in 80 countries for desmopressin orally disintegrating tablets indicated for the symptomatic treatment of nocturia associated with nocturnal polyuria in adults.
Nocturia is the need to awaken at night to void. Many factors can contribute to nocturia, such as an underlying medical condition. However, some people experience nocturia due to nocturnal polyuria, which means a person makes too much urine at night, although their total 24-hour production may remain normal. The broken night’s sleep caused by nocturia also leads to many short and long term health effects12,13,14 . In the short term lack of sleep can have a negative impact on our attention span, memory recall and learning15 . Longer term effects are being studied, but poor quality sleep or sleep deprivation has been associated with significant health problems, such as obesity, diabetes, weakened immune systems and even some cancers12,13,14 . Lack of sleep is also related to many psychological conditions such as depression, anxiety and psychosis14,15 .
Nocturia rates range from 29 to 59 percent in men older than 70 and 28 to 62 percent in women older than 7016 . Between 63 to 75 percent of patients with nocturia believe it is troublesome17 . Nocturia is a serious medical condition that can cause poor sleep quality, which leads to feeling tired, reduced quality of life and decreased productivity, according to the International Consultation on Incontinence Research Society18,19 . Studies have related nocturia to increased rates of death, risks of falls, night sweats and leg cramps and tingling19 .
About Ferring Pharmaceuticals:
Headquartered in Saint-Prex, Switzerland, Ferring Pharmaceuticals is a research-driven, specialty biopharmaceutical group active in global markets. The company identifies, develops and markets innovative products in the areas of reproductive health, urology-oncology, gastroenterology, endocrinology and orthopaedics. Ferring Pharmaceuticals has its own operating subsidiaries in nearly 60 countries and markets its products in 110 countries. To learn more about Ferring Pharmaceuticals or its products please visit www.ferring.com .
1 Bladder and Bowel Foundation website. Bladder. Bladder Conditions and Symptoms. Nocturia page. [Last accessed April 2016] Available from: https://www.bladderandbowelfoundation.org/bladder/bladder-conditions-and-symptoms/nocturia/
2 Benefield LE. Facilitating Aging in Place: Safe, Sound, and Secure, An Issue of Nursing Clinics. 2014
3 Weiss JP, van Kerrebroeck PEV, Klein BM, Nørgaard JP. Excessive nocturnal urine production is a major contributing factor to the etiology of nocturia. J Urol 2011; 186: 1358-63
4 van Kerrebroeck P, Hashim H, Holm-Larsen T, Robinson D, Stanley N. Thinking beyond the bladder: antidiuretic treatment of nocturia. Int J Clin Pract 2010; 64: 807-16
5 Park, H.K. and Kim, H.G., Current Evaluation and Treatment of Nocturia, Korean J Urol. Aug 2013; 54(8): 492–498. page 492. Published online Aug 7, 2013. doi: 10.4111/kju.2013.54.8.492 PMCID: PMC3742899. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742899/
6 Weiss JP, van Kerrebroeck PEV, Klein BM, Nørgaard JP. Excessive nocturnal urine production is a major contributing factor to the etiology of nocturia. J Urol 2011; 186: 1358-63
7 Sand PK, Dmochowski RR, Reddy J, van der Meulen EA. Efficacy and safety of low-dose desmopressin orally disintegrating tablet in women with nocturia: results of a multicenter, randomized, double-blind, placebo-controlled, parallel-group study. J Urol 2013;190(3):958-964. doi: 10.1016/j.juro.2013.02.037.
8 Weiss JP, Herschorn S, Albei CD, van der Meulen EA. Efficacy and safety of low-dose desmopressin orally disintegrating tablet in men with nocturia: results of a multi-center, randomized, double-blind, placebo-controlled, parallel-group study. J Urol 2013;190(3):965-972. doi: 10.1016/j.juro.2012.12.112.
9 Bliwise DL, Holm-Larsen T, Goble S, Nørgaard JP. Short time to first void is associated with lower whole-night sleep quality in nocturia patients. J Clin Sleep Med 2015; 11: 53-5
10 Kobelt G, Borgström F, Mattiasson A. Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia. BJU Int 2003; 91: 190-5
11 Taheri S, Lin L, Austin D et al. Short sleep duration is associated with elevated ghrelin, reduced leptin and increased body mass index. PLoS Med 2004; 1(3): e62
12 Gottlieb DJ, Punjabi NM, Newman AB et al. Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 2005; 165(8): 863-7
13 Meier-Ewert HK et al. Effect of Sleep Loss on C-Reactive Protein, an Inflammatory Marker of Cardiovascular Risk. Journal of the American College of Cardiology. 2004; 43(4). doi:10.1016/j.jacc.2003.07.050
14 Neckelmann D, Mykletun A, Dahl, AA. Chronic Insomnia as a Risk Factor for Developing Anxiety and Depression. Sleep 2007, 30(7): 873-880
15 Petrovsky N et al. Sleep Deprivation Disrupts Prepulse Inhibition and Induces Psychosis-Like Symptoms in Healthy Humans. The Journal of Neuroscience 2014; July, 34(27)-913409140
16 Bosch JL1, Weiss JP. The prevalence and causes of nocturia. J Urol. 2010 Aug;184(2):440-6. doi: 10.1016/j.juro.2010.04.011. Epub 2010 Jun 17. http://www.ncbi.nlm.nih.gov/pubmed/20620395/
17 Laureanno, P., Ellsworth, P., Demystifying Nocturia: Identifying the Cause and Tailoring the Treatment. Urol Nurs. 2010;30(5):276-287. page 2. http://www.medscape.com/viewarticle/731730_5 , page 5
18 Message Grid prepared by 3D, Oct. 7 2014, page 13
19 Bliwise DL , Rosen RC, Baum N. Impact of nocturia on sleep and quality of life: a brief, selected review for the International Consultation on Incontinence Research Society (ICI-RS) nocturia think tank. Neurourol Urodyn. 2014 Apr;33 Suppl 1:S15-8. doi: 10.1002/nau.22585. Abstract.
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