New Low-Volume Regimen With 10 Ounces of Prep Solution
The U.S. Food and Drug Administration (FDA) granted Ferring Pharmaceuticals Inc. approval to market PREPOPIK (sodium picosulfate, magnesium oxide, and anhydrous citric acid) for oral solution indicated for cleansing of the colon as a preparation for colonoscopy in adults. PREPOPIK is a low-volume, orange-flavored, dual-acting, stimulant and osmotic laxative. The FDA approval is based on data from two pivotal Phase III non-inferiority studies in which PREPOPIK was compared to 2L PEG+E plus 2x 5-mg bisacodyl tablets. In both studies, PREPOPIK achieved the primary endpoint (successful colon cleansing based on the Aronchick Scale), demonstrating non-inferiority to the comparator [Study 1: 84.2% v. 74.4%; Study 2: 83.0% v. 79.7%].1 Additionally, PREPOPIK demonstrated statistical superiority in cleansing of the colon versus the comparator.1
The most common (>1%) adverse reactions in Study 1 possibly or probably related to PREPOPIK (n=305) versus the study comparator (n=298) were nausea (2.6% v. 3.7%), headache (1.6% v. 1.7%) and vomiting (1.0% v. 3.4%).1 The most common (>1%) adverse reactions in Study 2 were possibly or probably related to PREPOPIK (n=296) versus the comparator (n=302) were nausea (3.0% v. 4.3%), headache (2.7% v. 1.7%) and vomiting (1.4% v. 2.0%).1
Once commercially available, PREPOPIK will be the lowest volume active ingredient colon preparation available – with 10 ounces of prep solution.
Colon cancer is the third most common cancer and second leading cause of cancer death in the United States.2 Colonoscopies have been shown to help reduce the incidence of colon cancer and deaths associated with the disease.3,4 Complete visualization of the bowel is needed to conduct a thorough colonoscopy to identify precancerous lesions and diagnose other gastrointestinal GI disorders.5 Aversion to bowel prep solutions, including the substantial liquid volume, has been recognized as a key barrier to completion of essential colonoscopy prep regimens.3
“Successful bowel prep is critical for gastroenterologists to clearly see any polyps or abnormalities, yet the sheer volume of prep solutions can prevent patients from adequately completing their prep regimens, leading to suboptimal visualization of the colon,” said Dr. Douglas K. Rex, Director of Endoscopy at Indiana University Hospital; and Professor, Department of Medicine, Division of Gastroenterology and Hepatology, University of Indiana School of Medicine.
PREPOPIK is approved with two dosing options. Preferably, it can be given as the American College of Gastroenterology (ACG)-recommended split-dose taken in the evening before and on the morning of the procedure.1 Recommended by the ACG as the optimal way to prepare for colonoscopy, split-dosing has been shown to improve cleansing quality given its greater proximity to procedure time and appears to have higher compliance due to better tolerability of the liquid volume.6 Day-before dosing is an alternative regimen for patients for whom split-dosing is inappropriate, accounting for colonoscopy scheduling, distance traveled, and other personal circumstances.
“Ferring has a strong global GI presence and with this approval, we are very pleased to introduce PREPOPIK as our first gastroenterology product in the United States,” said Aaron Graff, President & COO, Ferring Pharmaceuticals Inc. “Colonoscopy rates are lower than the target set forth by public health initiatives to detect and prevent colorectal cancer. Adults who have avoided getting screened may benefit from this effective regimen with the lowest active ingredient volume of any FDA-approved bowel prep.”
The FDA approval of PREPOPIK marks Ferring Gastroenterology’s first entry into the gastrointestinal market in the U.S. Approved since 1980 outside of the U.S., PREPOPIK has been used by 28.8 million patients globally based on post-marketing experience.7 The company is committed to growing a U.S. franchise focused on helping people suffering from long-term and debilitating gastrointestinal problems. Ferring has a long history in the international gastroenterology market, where PREPOPIK is available in Canada (marketed under the name PICO-SALAX®), U.K., and other countries (marketed under the names PICOLAX® and PICOPREP® in various other countries).
1. PREPOPIK™ [Prescribing Information]. Parsippany, NJ: Ferring Pharmaceuticals Inc.; July 2012.
2. U.S. Center for Disease Control and Prevention. Basic Information About Colorectal Cancer. Last updated: July 18, 2011.
3. Medina, G.G. and McQueen A. What Would Make Getting Colorectal Cancer Screening Easier? Perspectives from Screeners and Nonscreeners. Gastroenterol Res Pract. 2012;895807:1-8.
4. American Cancer Society. Colorectal Cancer Facts and Figures 2011-2013. Accessed June 25, 2012.
5. Kim, H.N. and Raju, G.S. Bowel Preparation and Colonoscopy Technique to Detect Non-Polypoid Colorectal Neoplasms. Gastrointest Endoscopy Clin N Am. 2010;20:437-448.
6. Rex, D.K. et al. American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008. Am J Gastroenterol.2009; 104:739 – 750; doi: 10.1038/ajg.2009.104; published online 24 February 2009.
7. Ferring Pharmaceuticals, DATA ON FILE.