Evaluating the efficacy and safety of acotiamide in patients with esophagogastric junction outflow obstruction: study protocol for an investigator-initiated, multi-center, randomized, double-blind, placebo-controlled phase II trial

• Published in: Current controlled trials in cardiovascular medicine Vol. 24; no. 1; p. 459
• Main Authors: Esaki, Mitsuru, Ihara, Eikichi, Manabe, Noriaki, Kawami, Noriyuki, Iwakiri, Katsuhiko, Akiyama, Junichi, Kuribayashi, Shiko, Uraoka, Toshio, Ogino, Haruei, Chinen, Takatoshi, Misumi, Akiko, Watanabe, Hiroko, Suzuki, Maya, Kishimoto, Junji, Ogawa, Yoshihiro
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18-07-2023; BioMed Central; BMC
• Subjects: Achalasia; Acotiamide; Cancer; Cholinesterase inhibitors; Clinical outcomes; Clinical trials; Clinical Trials, Phase II as Topic; Double-blind studies; Drugs; Dysphagia; Esophageal diseases; Esophageal motility disorders; Esophageal Motility Disorders - complications; Esophageal Motility Disorders - diagnosis; Esophagogastric Junction; Esophagogastric junction outflow obstruction; Esophagus; Food; Gastroenterology; Hepatology; Humans; Manometry - adverse effects; Manometry - methods; Motility; Multicenter Studies as Topic; Patient safety; Pharmaceuticals; Prospective Studies; Quality of Life; Randomized Controlled Trials as Topic; Stomach Diseases; Study Protocol; Swallowing; Testing; Japan; Achalasia; Esophageal motility disorders; Acotiamide; Esophagogastric junction outflow obstruction
• ISSN: 1745-6215; 1745-6215
• DOI: 10.1186/s13063-023-07468-w

We have determined that the impaired accommodation of the lower esophageal sphincter (LES) underlies the pathogenesis of esophagogastric junction outflow obstruction (EGJOO). We have also found that acotiamide may treat EGJOO by improving impaired LES accommodation. The effects of acotiamide in patients with EGJOO need to be further confirmed in a prospective study.
This trial is a multicenter, randomized, double-blind, placebo-controlled study to compare the efficacy and safety of acotiamide (300 mg/day or 600 mg/day) with those of a placebo in the treatment of patients with EGJOO. The primary endpoint will be the proportion of patients who report an improvement in symptom of food sticking in the chest after 4 weeks of treatment period 1. The secondary endpoints will be the proportion of patients with normalized integrated relaxation pressure (IRP), the value of change from baseline in the distal contractile integral, basal LES pressure, EGJOO-quality of life score, Gastrointestinal Symptom Rating Scale, and the correlation between IRP and each symptom score. During the 2-year trial period, 42 patients from five institutions will be enrolled.
This trial will provide evidence to clarify the efficacy and safety of acotiamide as a treatment for patients with EGJOO. Acotiamide might help improve the quality of life of patients with EGJOO and is expected to prevent the progression of EGJOO to achalasia.
This study was approved by the Institutional Review Board (IRB) of Kyushu University Hospital as well as the local IRBs of the participating sites for clinical trials and registered in the Japan Registry of Clinical Trials (jRCT: 2071210072). The registration date is on October 11, 2021.