Oliceridine fumarate

在阿片类镇痛新药开发中，偏向性μ-阿片受体激动剂近期已经取得监管新突破： 恩华药业从Trevena公司引进的富马酸奥赛利定注射液（简称：TRV130，商品名名：欧立罗)和恒瑞医药自主开发的富马酸泰吉利定注射液（商品名：艾苏特）分别于2023年5月和2024年1月在国内获批上市。 偏向性μ-阿片受体激动剂选择性激活G蛋白偶联通路，该通路介导中枢强效镇痛作用，仅弱激活与呼吸抑制和胃肠道功能障碍等不良事件有关的β-arrestin-2通路，充分镇痛的同时副作用更少。如TRV130与吗啡相比，镇痛效果相当，起效更快，且恶心呕吐等不良反应发生率更低。而富马酸泰吉利定控制疼痛起效迅速，且恶心呕吐、呼吸系统等不良反应发生率与安慰剂组相当。 不过，偏向性μ-阿片受体激动剂风头正劲，现在follow似乎已为时已晚。 阿片μ/NOP双重激动剂有望成为下一个阿片类镇痛新药风口。 近日，北京君科华元医药开发的1类新药HY-1608注射液获CDE批准用于术后疼痛的治疗临床试验，从而开启了阿片μ-受体和NOP受体双重激动剂国产新药开发大门。 作为阿片μ/NOP双重激动剂领头羊，Tris Pharma于9月初公布了其开发的cebranopadol临床试验的数据，该药物可产生有效且持久的镇痛效果，且呼吸抑制比羟考酮减少25%。 Tris Pharma已于8月启动了cebranopadol两项Ⅲ期临床试验（ALLEVIATE 1/2）. 虽然μ受体是吗啡类化合物的主要靶点，但镇痛可以通过激活阿片受体家族四个成员中的任何一个来介导，如κ-阿片受体、δ-阿片受体 和痛敏肽/孤啡肽 FQ 肽受体（NOP）。 然而，选择性δ或κ受体激动剂镇痛效力有限，尽管缺乏典型的 μ 受体介导的副作用，例如呼吸抑制和便秘，但它们具有自己独特的副作用，包括 κ 受体激动剂的烦躁、镇静、利尿和便秘，因而临床开发中屡遭失败。 NOP 受体介导的镇痛作用是阿片受体家族最复杂的。根据外源性阿片受体激动剂的暴露情况，要么阻断阿片类药物的镇痛作用，要么通过减少阿片类药物戒断期间的痛觉过敏来介导镇痛作用。总之，NOP 受体似乎在中枢神经系统中充当“功能性阿片拮抗剂”。 而针对多靶点阿片类配体药物开发中，主要集中在同时针对μ/NOP受体或μ/δ受体，而其中前者已率先取得临床研究突破。 μ 和 NOP 受体共享共同的信号传导通路，并且都在疼痛通路（例如脊髓、PAG 和 RVM）中功能性表达。对于药物开发来说最重要的可能是发现 NOP 受体激动剂比经典阿片类药物显示出更好的治疗神经性疼痛的潜力。在恒河猴研究中，NOP 受体已被证明是治疗疼痛的有效靶点。这些效应似乎是在脊髓水平和外周伤害性感觉神经元介导的。此外，早期研究表明混合μ/NOP受体激动剂有可能减轻纯μ受体激动剂的一些副作用，包括耐受性和依赖性。基于这些发现，为双重 μ/NOP 受体激动剂的设计提供了明确的基础。 新型阿片类镇痛药开发的目标始终保持不变：创造一种“更好的吗啡”，其镇痛效果与吗啡相同，但不会产生非常严重的副作用，例如依赖性或致命过量的可能性。 μ/NOP受体双功能激动剂的开发已取得了极大进展，目前其科学基础可能是最有力的，其治疗慢性炎症和神经性疼痛的潜力，在很大程度上将会满足临床未得到满足的治疗需求。 本文由「新药前沿」微信公众号根据公开资料整理编辑，欢迎个人转发至朋友圈。媒体或机构转载授权请在「新药前沿」微信公众号留言公众号名称，审核通过后开通白名单获取转载授权，转载请标识来源。 免责声明：本文仅作信息交流之目的，非投资建议或者治疗方案推荐，「新药前沿」微信公众号不对任何主体因使用本文内容而导致的任何损失承担责任。 限于作者水平和专业知识所限，如有谬误，欢迎指正！

CHESTERBROOK, Pa., Nov. 07, 2024 (GLOBE NEWSWIRE) -- Trevena, Inc. (Nasdaq: TRVN), a biopharmaceutical company focused on the development and commercialization of novel medicines for patients with central nervous system (CNS) disorders, today reported its financial results for the third quarter ended September 30, 2024 and provided an overview of its recent operational updates. Third Quarter 2024 and Recent Corporate Updates $2 million Non-Dilutive Financing Tranche. In July 2024, the Company announced receipt of a non-dilutive, $2 million tranche in connection with an amendment (the “Amendment”) to its existing ex-US royalty financing with R-Bridge Healthcare Fund (“R-Bridge”). The Company is further eligible to receive up to an additional $8 million based on future milestones. As part of the Amendment, (i) certain OLINVYK Chinese IP that had been previously pledged to R-Bridge under the Royalty Financing was transferred to R-Bridge, (ii) warrants previously issued to R-Bridge as part of the Royalty Financing were amended to reduce the exercise price to a 15% premium to the then-current stock price and to extend the exercise period to five years from the effective date of the Amendment, (iii) the existing cap on the US royalty payable to R-Bridge was increased from $10 million to $12 million (with no minimum or fixed payments), and (iv) R-Bridge agreed to forgive $10.0 million of the amount that was outstanding to them prior to the Amendment. This $10.0 million forgiveness was determined to be a troubled debt restructuring and therefore no gain will be recognized by the Company for accounting purposes.Reverse Stock Split. In August 2024 the Company effected a 1-for-25 reverse stock of the Company’s common stock (the “Reverse Stock Split”). As a result of the Reverse Stock Split, each 25 shares of the Company’s issued and outstanding common stock were automatically combined into one validly issued, fully paid and non-assessable share of common stock. In addition, proportional adjustments were made to the number of shares of the Company’s common stock issuable under the Company’s equity incentive plans and all outstanding securities and other rights convertible or exercisable into shares of the Company’s common stock, including all stock options and warrants outstanding immediately prior to the effectiveness of the Reverse Stock Split. The Reverse Stock Split did not have any effect on the stated par value of the Company’s common stock.Nasdaq Delisting and Subsequent Initiation of Trading on OTC Pink Sheets. On October 4, 2024, the Company announced that it had received notice that the Nasdaq Hearings Panel (the “Panel”) had determined to delist the Company’s common stock from The Nasdaq Stock Market LLC (“Nasdaq”) due to the Company’s failure to comply with the minimum stockholder’s equity requirement under Nasdaq Listing Rule 5550(b)(1) (the “Equity Standard Rule”). As previously disclosed, the Panel had provided the Company until October 2, 2024, to regain compliance with the Equity Standard Rule. Trading in the Company’s common stock was suspended on Nasdaq effective with the open of business on October 8, 2024, and the Company’s common stock began trading on the Pink Open Market operated by the OTC Markets Group, Inc. (commonly referred to as the “pink sheets”) on October 8, 2024 under the trading symbol “TRVN.”Additional Cost-Cutting Measures. On October 5, 2024, in connection with certain cost-cutting measures, the Board of Directors (“the Board”) approved the termination of employment, without cause, of three senior executives: Carrie Bourdow (President & CEO), Mark Demitrack (SVP & CMO), and Barry Shin (EVP & COO/CFO). The terminations did not involve any disagreement concerning the Company’s operations, policies or practices, and the Board thanked these executives for their service to the Company. Following the effectiveness of these terminations, Ms. Bourdow continues to serve as Chairman of the Board and Acting CEO; Mr. Demitrack continues to serve as Acting CMO; Mr. Shin continues to serve as Acting COO/CFO; and all entered into consulting agreements with the Company. Following these cost-cutting measures, the Company has four employees. Resignation of Certain Directors. On November 5, 2024, in connection with the ongoing cost-cutting measures, Mark Corrigan, M.D.; Marvin H. Johnson, Jr.; Jake R. Nunn; and Anne M. Phillips each informed the Company of his or her intent to resign from the Board and the committees thereof, effective as of November 5, 2024. None of these resignations was related to any disagreement with the Company over any of its operations, policies or practices. Carrie Bourdow continues to serve as Chairman of the Board and Scott Braunstein, M.D. and Barbara Yanni continue to serve as directors of the Company. Continued Strategic Review. The Company continues its review of strategic alternatives, including for OLINVYK, TRV045 and its other pipeline assets. There can be no assurance regarding the schedule for completion of the strategic review process, that this strategic review process will result in the Company pursuing any transaction or that any transaction, if pursued, will be completed. Potential strategic alternatives that may be explored or evaluated include, but are not limited to, a sale, license, divestiture or discontinuation of US commercial sales of OLINVYK; a sale, license or divestiture of our pipeline assets; or a sale, merger or wind down of the Company. Financial Results and Other Updates for Third Quarter 2024For the third quarter of 2024, the Company reported a net loss attributable to common stockholders of $4.9 million, or $5.79 per share, compared to $7.9 million, or $14.20 per share in the third quarter of 2023. Cash and cash equivalents were $13.5 million as of September 30, 2024. About Trevena Trevena, Inc. is a biopharmaceutical company focused on the development and commercialization of innovative medicines for patients with CNS disorders. The Company has one approved product in the United States, OLINVYK® (oliceridine) injection, indicated in adults for the management of acute pain severe enough to require an intravenous opioid analgesic and for whom alternative treatments are inadequate. The Company’s novel pipeline is based on Nobel Prize winning research and includes three differentiated investigational drug candidates: TRV045 for diabetic neuropathic pain and epilepsy, TRV250 for the acute treatment of migraine and TRV734 for maintenance treatment of opioid use disorder. For more information, please visit www.Trevena.com About TRV045 TRV045 is a novel, highly selective sphingosine-1-phosphate subtype 1 (S1P1) receptor modulator being developed as a potential treatment for acute and chronic neuropathic pain secondary to diabetic peripheral neuropathy. Through a collaboration with the National Institutes of Health, Trevena is also exploring TRV045 as a potential treatment for epilepsy. S1P receptors are located throughout the body, including the central nervous system, where they are believed to play a role in modulating neurotransmission and membrane excitability. Trevena's discovery efforts have identified a family of compounds that are highly selective for the S1P1 receptor. TRV045 reversed thermal hyperalgesia, a measure of neuropathic pain, in nonclinical models of diabetic peripheral neuropathy and chemotherapy-induced peripheral neuropathy. TRV045 was not associated with lymphopenia and produced no changes in blood pressure, heart rate, or respiratory function at or above pharmacologically active doses in nonclinical studies. TRV045 is an investigational product and is not yet approved by the FDA. Subjects in both studies referenced in this press release were enrolled outside of the United States, and the studies were not conducted under the Investigational New Drug Application for TRV045. About OLINVYK® (oliceridine) injection OLINVYK is a new chemical entity approved by the FDA in August 2020. OLINVYK contains oliceridine, an opioid, which is a Schedule II controlled substance with a high potential for abuse similar to other opioids. It is indicated in adults for the management of acute pain severe enough to require an intravenous opioid analgesic and for whom alternative treatments are inadequate. OLINVYK is available in 1 mg/1 mL and 2 mg/2 mL single-dose vials, and a 30 mg/30 mL single-patient-use vial for patient-controlled analgesia (PCA). Approved PCA doses are 0.35 mg and 0.5 mg and doses greater than 3 mg should not be administered. The cumulative daily dose should not exceed 27 mg. Please see Important Safety Information, including the BOXED WARNING, and full prescribing information at www.OLINVYK.com. IMPORTANT SAFETY INFORMATION WARNING: SERIOUS AND LIFE-THREATENING RISKS FROM USE OF OLINVYK Addiction, Abuse, and Misuse Because the use of OLINVYK exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of these behaviors and conditions. Life-Threatening Respiratory Depression Serious, life-threatening, or fatal respiratory depression may occur with use of OLINVYK, especially during initiation or following a dosage increase. To reduce the risk of respiratory depression, proper dosing and titration of OLINVYK are essential. Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of OLINVYK and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate. Neonatal Opioid Withdrawal Syndrome If opioid use is required for an extended period of time in a pregnant woman, advise the patient of the risk of NOWS, which may be life-threatening if not recognized and treated. Ensure that management by neonatology experts will be available at delivery. INDICATIONS AND USAGE OLINVYK is an opioid agonist indicated in adults for the management of acute pain severe enough to require an intravenous opioid analgesic and for whom alternative treatments are inadequate. Limitations of Use Because of the risks of addiction, abuse, and misuse with opioids, which can occur at any dosage or duration, reserve OLINVYK for use in patients for whom alternative treatment options [e.g., non-opioid analgesics or opioid combination products]: Have not been tolerated or are not expected to be tolerated.Have not provided adequate analgesia or are not expected to provide adequate analgesia. The cumulative total daily dose should not exceed 27 mg. CONTRAINDICATIONS OLINVYK is contraindicated in patients with: Significant respiratory depressionAcute or severe bronchial asthma in an unmonitored setting or in absence of resuscitative equipmentKnown or suspected gastrointestinal obstruction, including paralytic ileusKnown hypersensitivity to oliceridine (e.g. anaphylaxis) WARNINGS AND PRECAUTIONS OLINVYK contains oliceridine, a Schedule II controlled substance, that exposes users to the risks of addiction, abuse, and misuse. Although the risk of addiction in any individual is unknown, it can occur in patients appropriately prescribed OLINVYK. Assess risk, counsel, and monitor all patients receiving opioids.Serious, life-threatening respiratory depression has been reported with the use of opioids, even when used as recommended, especially in patients with chronic pulmonary disease, or in elderly, cachectic and debilitated patients. The risk is greatest during initiation of OLINVYK therapy, following a dose increase, or when used with other drugs that depress respiration. Proper dosing of OLINVYK is essential, especially when converting patients from another opioid product to avoid overdose. Management of respiratory depression may include close observation, supportive measures, and use of opioid antagonists, depending on the patient’s clinical status.Opioids can cause sleep-related breathing disorders including central sleep apnea (CSA) and sleep-related hypoxemia with risk increasing in a dose-dependent fashion. In patients who present with CSA, consider decreasing the dose of opioid using best practices for opioid taper.Profound sedation, respiratory depression, coma, and death may result from the concomitant use of OLINVYK with benzodiazepines and/or other CNS depressants (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, or alcohol). Because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate, prescribe the lowest effective dose, and minimize the duration.Use of OLINVYK for an extended period of time during pregnancy can result in withdrawal in the neonate that may be life-threatening. Observe newborns for signs of neonatal opioid withdrawal syndrome and manage accordingly. Advise pregnant women using opioids for a prolonged period of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.OLINVYK was shown to have mild QTc interval prolongation in thorough QT studies where patients were dosed up to 27 mg. Total cumulative daily doses exceeding 27 mg per day were not studied and may increase the risk for QTc interval prolongation. Therefore, the cumulative total daily dose of OLINVYK should not exceed 27 mg.Increased plasma concentrations of OLINVYK may occur in patients with decreased Cytochrome P450 (CYP) 2D6 function or normal metabolizers taking moderate or strong CYP2D6 inhibitors; also in patients taking a moderate or strong CYP3A4 inhibitor, in patients with decreased CYP2D6 function who are also receiving a moderate or strong CYP3A4 inhibitor, or with discontinuation of a CYP3A4 inducer. These patients may require less frequent dosing and should be closely monitored for respiratory depression and sedation at frequent intervals. Concomitant use of OLINVYK with CYP3A4 inducers or discontinuation of a moderate or strong CYP3A4 inhibitor can lower the expected concentration, which may decrease efficacy, and may require supplemental doses.Opioid-Induced Hyperalgesia (OIH) occurs when an opioid analgesic paradoxically causes an increase in pain, or an increase in sensitivity to pain. This differs from tolerance where increasing doses are required to maintain the desired effect. Symptoms of OIH include, but may not be limited to, increased levels of pain upon dose increase, decreased levels of pain upon dose decrease, or pain from ordinarily non-painful stimuli (allodynia). These symptoms may suggest OIH only if there is no evidence of disease progression, opioid tolerance, withdrawal, or addictive behavior. If OIH is suspected, carefully consider appropriately decreasing the dose of the current opioid analgesic or opioid rotation.Cases of adrenal insufficiency have been reported with opioid use (usually greater than one month). Presentation and symptoms may be nonspecific and include nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure. If confirmed, treat with physiologic replacement doses of corticosteroids and wean patient from the opioid.OLINVYK may cause severe hypotension, including orthostatic hypotension and syncope in ambulatory patients. There is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics). Monitor these patients for signs of hypotension. In patients with circulatory shock, avoid the use of OLINVYK as it may cause vasodilation that can further reduce cardiac output and blood pressure. Avoid the use of OLINVYK in patients with impaired consciousness or coma. OLINVYK should be used with caution in patients who may be susceptible to the intracranial effects of CO2 retention, such as those with evidence of increased intracranial pressure or brain tumors, as a reduction in respiratory drive and the resultant CO2 retention can further increase intracranial pressure. Monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy.As with all opioids, OLINVYK may cause spasm of the sphincter of Oddi, and may cause increases in serum amylase. Monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms.OLINVYK may increase the frequency of seizures in patients with seizure disorders and may increase the risk of seizures in vulnerable patients. Monitor patients with a history of seizure disorders for worsened seizure control.Do not abruptly discontinue OLINVYK in a patient physically dependent on opioids. Gradually taper the dosage to avoid a withdrawal syndrome and return of pain. Avoid the use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving OLINVYK, as they may reduce the analgesic effect and/or precipitate withdrawal symptoms.OLINVYK may impair the mental or physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery.Although self-administration of opioids by patient-controlled analgesia (PCA) may allow each patient to individually titrate to an acceptable level of analgesia, PCA administration has resulted in adverse outcomes and episodes of respiratory depression. Health care providers and family members monitoring patients receiving PCA analgesia should be instructed in the need for appropriate monitoring for excessive sedation, respiratory depression, or other adverse effects of opioid medications. ADVERSE REACTIONS Adverse reactions are described in greater detail in the Prescribing Information. The most common (incidence ≥10%) adverse reactions in Phase 3 controlled clinical trials were nausea, vomiting, dizziness, headache, constipation, pruritus, and hypoxia. MEDICAL INFORMATION For medical inquiries or to report an adverse event, other safety-related information or product complaints for a company product, please contact the Trevena Medical Information Contact Center at 1-844-465-4686 or email MedInfo@Trevena.com. You are encouraged to report suspected adverse events of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. PLEASE see www.OLINVYK.com for full prescribing information including BOXED warning and important safety information Forward-Looking Statements Any statements in this press release about future expectations, plans and prospects for the Company, including statements about the Company’s strategy, future operations, clinical development and trials of its therapeutic candidates, plans for potential future product candidates and other statements containing the words “anticipate,” “believe,” “estimate,” “expect,” “intend,” “may,” “plan,” “predict,” “project,” “suggest,” “target,” “potential,” “will,” “would,” “could,” “should,” “continue,” and similar expressions, constitute forward-looking statements within the meaning of The Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by such forward-looking statements as a result of various important factors, including: the expectations surrounding the continued advancement of the Company’s product pipeline; the potential safety and efficacy of the Company’s product candidates and their regulatory and clinical development; the Company’s intention to pursue strategic alternatives for OLINVYK and the ability of any such strategic alternative to provide shareholder value; the expected financial and operational impacts of the Company’s decision to reduce commercial support for OLINVYK; the status, timing, costs, results and interpretation of the Company’s clinical trials or any future trials of any of the Company’s investigational drug candidates; the uncertainties inherent in conducting clinical trials; expectations for regulatory interactions, submissions and approvals, including the Company’s assessment of discussions with FDA; available funding; uncertainties related to continued listing on NASDAQ; uncertainties related to the Company’s intellectual property; uncertainties related to other matters that could affect the availability or commercial potential of the Company’s therapeutic candidates and approved product; and other factors discussed in the Risk Factors set forth in the Company’s Annual Report on Form 10-K and Quarterly Reports on Form 10-Q filed with the Securities and Exchange Commission (SEC) and in other filings the Company makes with the SEC from time to time. In addition, the forward-looking statements included in this press release represent the Company’s views only as of the date hereof. The Company anticipates that subsequent events and developments may cause the Company’s views to change. However, while the Company may elect to update these forward-looking statements at some point in the future, it specifically disclaims any obligation to do so, except as may be required by law. For more information, please contact: Company Contact: Bob YoderSVP, Chief Business Officer & Head of Commercial OperationsTrevena, Inc.(610) 354-8840 TREVENA, INC. Condensed Statements of Operations (Unaudited, in thousands except share and per share data) Three Months Ended Sept 30, Nine Months Ended Sept 30, 2024 2023 2024 2023 Product revenue $(21) $1 $13 $28 License revenue 304 179 615 3,179 Total revenue 283 180 628 3,207 Operating expenses: Cost of goods sold 114 175 305 389 Selling, general and administrative 3,880 4,572 13,323 15,799 Research and development 1,866 4,260 8,958 12,160 Total operating expenses 5,860 9,007 22,586 28,348 Loss from operations (5,577) (8,827) (21,958) (25,141) Other income 638 897 4,450 1,380 Net loss $(4,939) $(7,930) $(17,508) $(23,761) Per share information: Net loss per share of common stock, basic and diluted ($5.79) ($14.20) ($20.54) ($50.65) Weighted average shares outstanding, basic and diluted 852,801 558,564 852,253 469,149 TREVENA, INC.Condensed Balance Sheets(Unaudited, in thousands) September 30, 2024December 31, 2023Assets Current assets: Cash and cash equivalents $13,462 $32,975 Restricted cash 282 - Prepaid expenses and other current assets 991 2,230 Total current assets 14,735 35,205 Restricted cash, net of current portion 340 540 Property and equipment, net 923 1,195 Right-of-use lease assets 3,190 3,665 Total assets $19,188 $40,605 Liabilities and stockholders’ (deficit) equity Current liabilities: Accounts payable, net $918 $2,303 Accrued expenses and other current liabilities 3,164 4,239 Current portion of loans payable, net 902 - Lease liabilities 1,102 1,012 Total current liabilities 6,086 7,554 Loans payable, net 31,972 30,809 Leases, net of current portion 3,588 4,424 Warrant liability 851 5,475 Total liabilities 42,497 48,262 Common stock 1 1 Additional paid-in capital 582,259 580,403 Accumulated deficit (605,569) (588,061)Total stockholders’ (deficit) equity (23,309) (7,657)Total liabilities and stockholders’ (deficit) equity $19,188 $40,605