Setipiprant

Setipiprant (INN; developmental code names ACT-129968, KYTH-105) is an investigational drug developed for the treatment of asthma and scalp hair loss. It was originally developed by Actelion and acts as a selective, orally available antagonist of the prostaglandin D2 receptor 2 (DP2). The drug is being developed as a novel treatment for male pattern baldness by Allergan. Setipiprant (INN; developmental code names ACT-129968, KYTH-105) is an investigational drug developed for the treatment of asthma and scalp hair loss. It was originally developed by Actelion and acts as a selective, orally available antagonist of the prostaglandin D2 receptor 2 (DP2). The drug is being developed as a novel treatment for male pattern baldness by Allergan. Acting through DP2, PGD2 can inhibit hair growth, suggesting that this receptor is a potential target for bald treatment. A phase 2A study to evaluate the safety, tolerability, and efficacy of oral setipiprant relative to a placebo in 18 to 49 year old males with androgenetic alopecia was completed in May 2018 but no results have been published. Setipiprant proved to be well-tolerated and reasonably effective in reducing allergen-induced airway responses in asthmatic patient clinical trials. However, the drug, while supporting the concept that DP2 contributes to asthmatic disease, did not show sufficient advantage over existing drugs and was discontinued from further development for this application. Data from phase II and III clinical trials did not detect any severe adverse effects to setipiprant. The authors were unable to identify any pattern of adverse effects that differ from placebo, including subjective reporting of symptoms and objective laboratory monitoring. While setipiprant mildly induces the drug metabolizing enzyme CYP3A4 in vitro, the interaction appears to not be clinically relevant. Setipiprant binds to the DP2 receptor with a dissociation constant of 6 nM, representing potent antagonism of the receptor. The DP2 receptor, also called the CRTh2 receptor, is a G-protein-coupled receptor (GPCR) that is expressed on certain inflammatory cells, such as eosinophils, basophils, and certain lymphocytes. For its mechanism of action in the treatment of allergic conditions, setipiprant's DP2 antagonism prevents the action of prostaglandin D2 (PGD2) on these receptors. The DP2 receptor mediates the activation of type 2 helper T (Th2) cells, eosinophils, and basophils in the lungs, which are white blood cells implicated in producing the inflammatory response the characterizes allergic conditions. Activation of DP2 on Th2 cells by PGD2 induces the secretion of inflammatory cytokines (interleukin (IL) 4, IL-5, and IL-13), which cause an increase of eosinophils in the blood, remodeling of lung tissue, and hypersensitivity of lung tissue to allergens. Setipiprant does not antagonize the thromboxane receptor (TP). The bronchoconstricting properties of PGD2 are not inhibited by setipiprant, since these are mediated by the TP receptor. As a point of contrast, ramatroban is a selective TP antagonist and DP2 receptor antagonist. Setipiprant does not appreciably inhibit the activity of the enzyme cyclooxygenase 1 (COX-1), which is responsible for the synthesis of prostaglandins (including PGD2). Prostaglandin D2 synthase (PTGDS) is an enzyme that produces PGD2. In men with androgenic alopecia, the enzyme PTGDS is elevated in the bald scalp tissue, as well as its product PGD2. PGD2 inhibits the growth of hair follicles through its activity on the DP2 receptor, but not the DP1 receptor. Theoretically, setipiprant's DP2 receptor antagonism may counteract the activity of PGD2 in hair follicles, thereby stimulating hair growth.