Boehringer Ingelheim (Taiwan)

Rifapentine (RPT), a critical antituberculosis active pharmaceutical ingredient (API), faces persistent supply shortages compounded by crystallization challenges. Conventional antisolvent crystallization often produces RPT crystals with high aspect ratios (>7) and sizes outside the preferred 5–20 μm range. RPT’s strong adhesion to solid surfaces further increases fouling risk, and makes conventional milling impractical due to equipment damage. To avoid fouling, prior processes have relied on low supersaturation (≤1.5), resulting in long residence times of 4–6 hours. This study introduces a modular, continuous, fouling-free crystallization process that simultaneously addresses these limitations by codesigning precise antisolvent injection, controlled supersaturation, and dynamic noncontact ultrasonication within a tubular slug-flow platform. We establish design criteria enabling reproducible antisolvent (water) injection into flowing RPT solution slugs (in tetrahydrofuran) via continuous droplet formation and merging, minimizing needs for feedback control or complex operation. Guided by simplified semiempirical models and rapid droplet/slug tests, noncontact sonication is strategically applied at three stages─nucleation, growth, and breakage─to suppress fouling and enhance uniformity, without needing milling. Within 0.5 hour of residence time, these steps collectively reduce crystal dimensions while maintaining small variations (e.g., length from 81 μm to 6 μm, coefficient of variation or CVL ∼ 0.20; aspect ratio from 33 to 3.5, CVAR ∼ 0.29) and 100% form purity. This integrated approach offers a scalable pathway toward reliable RPT crystallization and supply resilience.

A seven-step enantioselective route for the synthesis of benzyl (R)-10-oxo-2-oxa-7-azaspiro[4.5]decane-7-carboxylate (1) with >99% ee is reported on a multi-hundred-gram scale in 42% overall yield. The synthesis features an asymmetric allylic alkylation to establish the quaternary stereocenter on a piperidine ring, followed by an oxidation/reduction and Mitsunobu conditions sequence to construct the tetrahydrofuran ring within the chiral oxa-azaspirocycle.

ABSTRACT Background BI 764198 is a selective, oral transient receptor potential cation channel, subfamily C, member 6 inhibitor under investigation for focal segmental glomerulosclerosis. Research design and methods Phase I study in 44 Japanese male volunteers. Single dose part: BI 764198 20 mg (n = 6) vs. placebo (n = 2); multiple dose part: BI 764198 40, 80, or 160 mg (n = 9 each) or placebo (n = 9) as a single dose then multiple daily dosing for 2 weeks. Primary endpoint: participants with drug-related adverse events (DRAEs); secondary endpoints: pharmacokinetic. Results DRAEs were reported in 20.5% (9/44) of participants (total BI 764198 21.2% [7/33]; placebo 18.2% [2/11]), mostly diarrhea (total BI 764198 15.2% [5/33]; placebo 18.2% [2/11]) and headache (BI 764198 80 mg 11.1% [1/9]; BI 764198 160 mg 33.3% [3/9]). BI 764198 exposure increased near dose proportionally to 80 mg and was slightly higher than anticipated with 160 mg. Pharmacokinetics were similar in Asians and non-Asians after accounting for body weight. Limitations include small sample size per dose and short trial duration. Conclusions BI 764198 was well tolerated; exposure increased near dose proportionally to 80 mg, as previously observed in predominantly White volunteers. Clinical trial registration This study was registered on Clinical Trials.gov, identifier NCT04665700.

Generalized pustular psoriasis (GPP) is a chronic inflammatory, potentially life-threatening skin disease. Most patients experience chronic skin symptoms between flares which can lead to significant patient burden. Spesolimab, an anti-interleukin-36 receptor monoclonal antibody, is approved in the United States to treat GPP in adults and pediatric patients 12 years of age and older and weighing at least 40 kg. EFFISAYIL® 2 (NCT04399837) evaluated the efficacy and safety of subcutaneous (SC) spesolimab in GPP. Here, we report the effects on GPP body surface area (BSA) over time in patients treated with the FDA approved spesolimab dosing regimen (600 mg loading dose, then 300 mg maintenance dose every 4 weeks) in EFFISAYIL® 2. Total BSA was determined based on a weighted average of the extent of involvement over 4 main body regions, with head = 10%, upper extremities = 20%, trunk = 30%, and lower extremities = 40%. Total BSA involvement was calculated for each subject at 4 timepoints (baseline, Week 4, Week 16, and Week 48). Data collected closest to the given time points were used by including the effect of potential intravenous spesolimab treatment and subsequent open-label SC spesolimab treatment in patients who experienced a flare. The data were analyzed as observed. Total BSA improved continuously under spesolimab treatment (13.3% at baseline, 10.6% at Week 4, 9.4% at Week 16, ending at 4.5% at Week 48). Continuous treatment with spesolimab SC improved BSA from 13% to 5% at the end of the trial. These findings suggest a role of spesolimab in improving area of involvement as measured by BSA.

ABSTRACTAims/IntroductionWe investigated the utilization of healthcare resources in patients with type 2 diabetes treated with empagliflozin, a sodium‐glucose co‐transporter‐2 (SGLT2) inhibitor, versus dipeptidyl peptidase‐4 (DPP‐4) inhibitors in clinical practice in Japan, South Korea, and Taiwan.Materials and MethodsWe analyzed the Japanese Medical Data Vision database (December 2014–April 2018), the South Korean National Health Information Database, and the Taiwanese National Health Insurance claims database (both May 2016–December 2017). Patients with type 2 diabetes starting empagliflozin, 10 or 25 mg, or a DPP‐4 inhibitor were matched 1:1 via propensity scores (PS). We compared inpatient care needs, emergency room (ER) visits, and outpatient visits between the treatment groups using Poisson regression and Cox proportional hazards models, pooled across countries by random‐effects meta‐analysis.ResultsWe identified 28,712 pairs of PS‐matched patients; the mean follow‐up was 5.7–6.8 months. Empagliflozin‐treated patients had a 27% lower risk of all‐cause hospitalization compared with DPP‐4 inhibitor–treated patients (rate ratio [RR] 0.73, 95% CI 0.67–0.79), and 23% reduced risk for first hospitalization (hazard ratio 0.77, 95% CI 0.73–0.81). The risk for an ER visit was 12% lower with empagliflozin than with DPP‐4 inhibitors (RR 0.88, 95% CI 0.83–0.94) while the risk for outpatient visit was 4% lower (RR 0.96, 95% CI 0.96–0.97). These findings were generally consistent across countries, regardless of baseline cardiovascular disease, and in the subgroup starting empagliflozin with the 10 mg dose.ConclusionsEmpagliflozin treatment was associated with lower inpatient care needs and other healthcare resource utilization than DPP‐4 inhibitors in routine clinical practice in East Asia in this study.

BackgroundIn the INBUILD trial in patients with chronic fibrosing interstitial lung diseases (ILDs) and a progressive phenotype, nintedanib reduced the rate of ILD progression with adverse events that were manageable for most patients. We investigated the potential impact of immunomodulatory therapies on the efficacy and safety of nintedanib.MethodsSubjects with fibrosing ILDs other than idiopathic pulmonary fibrosis, who had shown progression of ILD within the prior 24 months despite management in clinical practice, were randomized to receive nintedanib or placebo. Certain immunomodulatory therapies were restricted for the first 6 months. We analyzed post-hoc the rate of decline in forced vital capacity (FVC) over 52 weeks in subgroups by glucocorticoid use at baseline and in analyses excluding subjects or FVC measurements taken after initiation of restricted immunomodulatory or antifibrotic therapies.ResultsOf 663 subjects, 361 (54.4%) were taking glucocorticoids at baseline (353 at a dose of ≤ 20 mg/day). In the placebo group, the adjusted rate of decline in FVC (mL/year) over 52 weeks was numerically greater in subjects taking than not taking glucocorticoids at baseline (− 206.4 [SE 20.2] vs − 165.8 [21.9]). The difference between the nintedanib and placebo groups was 133.3 (95% CI 76.6, 190.0) mL/year in subjects taking glucocorticoids at baseline and 76.1 (15.0, 137.2) mL/year in subjects who were not (interaction P = 0.18). The effect of nintedanib on reducing the rate of FVC decline in analyses excluding subjects or measurements taken after initiation of restricted immunomodulatory or antifibrotic therapies was similar to the primary analysis. The adverse event profile of nintedanib was similar between subjects who did and did not use prohibited or restricted therapies at baseline or during treatment with trial drug.ConclusionsIn patients with progressive fibrosing ILDs, the effect of nintedanib on reducing FVC decline was not influenced by the use of immunomodulatory therapies. Nintedanib can be used in combination with immunomodulatory therapies in patients with progressive fibrosing ILDs.Trial registration ClinicalTrials.gov, NCT02999178. Registered 21 December 2016, https://clinicaltrials.gov/ct2/show/NCT02999178