Chemistry:Direclidine

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Direclidine (INN;[1] developmental code names NBI-1117568, HTL-0016878)[2] is an investigational antipsychotic drug for schizophrenia[3] that was out-licensed from Nxera Pharma to Neurocrine Biosciences, a United States-based pharmaceutical company.[4][2][5] It is an oral small molecule.[6][7]

Overview

It is a selective muscarinic acetylcholine M4 receptor agonist that indirectly modulates dopamine as the basis for its putative improvement of schizophrenia.[6] In April 2016, the compound was out-licensed from Nxera Pharma to Allergan, an Irish pharmaceutical company, as part of Nxera's wider muscarinic agonist portfokio. By September 2017, it had advanced to Phase I clinical trial for the indication of "neuropsychiatric symptoms associated with Alzheimer's disease and other dementias"[8] Following Allergan's acquisition by AbbVie, the license was returned to Nxera in January 2021.[9] In November 2021, the compound was newly out-licensed to Neurocrine Biosciences, a U.S. pharmaceutical company.[5] It has been under development as a treatment for schizophrenia, and is currently in Phase III clinical trials.[10][11]

History

  • 2016
    • April: The rights to develop Nxera Pharma's muscarinic agonist portfolio, including NBI-1117568 were transferred to Allergan.[9]
  • 2017
    • September: Allergan initiated Phase I clinical trials for NBI-1117568 to treat "neurobehavioral symptoms related to Alzheimer's disease and other conditions."[8]
  • 2021
    • January: Allergan returned the rights to its muscarinic agonist portfolio, including, NBI-1117568 to Nxera Pharma.[9]
    • November: The rights for the muscarinic agonist portfolio were then transferred to Neurocrine Biosciences, which took over the development of NBI-1117568.[5]
  • 2022
    • October: Phase II clinical trial of NBI-1117568 for the treatment of adults with schizophrenia was initiated.[12]
  • 2024
    • April: Neurocrine Biosciences announced that NBI-1117568 had met the requirements of long-term preclinical toxicity tests.[6]
    • August: Neurocrine Biosciences released the results of the Phase II clinical trial.[13][11]
  • 2025
    • May: Neurocrine Biosciences initiated a Phase III registrational program for NBI-1117568 for the treatment of adults with schizophrenia.[14]

Clinical trials

Phase II clinical trial

The Phase II clinical trial was conducted in 15 sites across the U.S. with 200 adult patients diagnosed with schizophrenia.[15] The primary endpoint was assessed by the change in the total score of the Positive and Negative Syndrome Scale (PANSS) after six weeks of treatment. The 20 mg once-daily group showed a statistically significant improvement of 7.5 points compared to the placebo group (improvement of 18.2 points from baseline, p = 0.011, effect size = 0.61).[16] However, the 40 mg once-daily group, 60 mg once-daily group, and 30 mg twice-daily group did not show statistically significant differences compared to the placebo group (p-values: 40 mg group: 0.282, 60 mg group: 0.189, 30 mg twice-daily group: 0.090).[16]

Market reaction to phase II clinical trial

With a PANSS improvement of 7.5, NBI-111758 lagged behind xanomeline/trospium (KarXT) (Karuna Therapeutics) with 8.4 and emraclidine (Cerevel Therapeutics) with 12.7, both of which were in clinical trials at the same time. Moreover, the lack of dose-dependency led to disappointment in the stock market.[17] Neurocrine Biosciences' share price dropped 19% on the day following the announcement of the Phase II clinical trial results.[18]

See also

References

  1. ↑ https://cdn.who.int/media/docs/default-source/international-nonproprietary-names-(inn)/pl133.pdf [bare URL PDF]
  2. ↑ 2.0 2.1 "Delving into the Latest Updates on Direclidine with Synapse". 30 June 2025. https://synapse.patsnap.com/drug/8a0d752c9c4a4ea092cdc1b28feb42c9. 
  3. ↑ "Current emerging therapeutic targets and clinical investigational agents for schizophrenia: Challenges and opportunities". Medicinal Research Reviews 45 (2): 755–787. March 2025. doi:10.1002/med.22086. PMID 39300769. 
  4. ↑ "HTL 0016878". 2 September 2024. https://adisinsight.springer.com/drugs/800050085. 
  5. ↑ 5.0 5.1 5.2 "ニューロクライン社との統合失調症およびその他の精神神経疾患を対象とした新規ムスカリン受容体作動薬に関するライセンス契約締結のお知らせ" (in ja). PR TIMES. 2021-11-22. https://prtimes.jp/main/html/rd/p/000000065.000036794.html. 
  6. ↑ 6.0 6.1 6.2 "ネクセラファーマ株価6.5%高 薬候補で毒性試験成功 - 日本経済新聞" (in ja). 日本経済新聞社 (Nikkei Inc.). 2024-04-17. https://www.nikkei.com/nkd/company/us/NBIX/news/?DisplayType=1&ng=DGXZQOFL17146017042024000000. 
  7. ↑ "当社提携先のニューロクライン社が、統合失調症を対象にしたNBI-1117568の第II相臨床試験の開始を発表［そーせいグループ］ | NIKKEI COMPASS - 日本経済新聞" (in ja). 日本経済新聞社 (Nikkei Inc.). 2022-10-28. https://www.nikkei.com/compass/content/PRTKDB000000075_000036794/preview. 
  8. ↑ 8.0 8.1 "アルツハイマー病等の主要症状の治療薬として開発中の新薬候補、 選択的ムスカリンM4受容体作動薬の第I相臨床試験で最初の被験者への投与を実施" (in ja). ネクセラファーマ（旧そーせいグループ株式会社）. 2017-09-01. https://ssl4.eir-parts.net/doc/4565/tdnet/1511970/00.pdf. 
  9. ↑ 9.0 9.1 9.2 "ムスカリン作動薬プログラムのグローバルな研究開発権・販売権が返還" (in ja). PR Times. 2021-01-05. https://prtimes.jp/main/html/rd/p/000000055.000036794.html. 
  10. ↑ 日経バイオテクONLINE (2024-09-02). "ネクセラファーマ、統合失調症治療薬候補 NBI-1117568の第II相臨床試験の良好な結果によりニューロクライン社より35百万米ドルのマイルストンを受領" (in ja). 日本経済新聞社. https://bio.nikkeibp.co.jp/atcl/release/24/09/02/21467/. 
  11. ↑ 11.0 11.1 "ネクセラ---大幅反落、ニューロクラインの株価下落に追随売り | 個別株 - 株探ニュース" (in ja). MINKABU THE INFONOID, Inc.. 2024-08-29. https://kabutan.jp/news/marketnews/?&b=n202408290437. 
  12. ↑ "当社提携先のニューロクライン社が、統合失調症を対象にしたNBI-1117568の第Ⅱ相臨床試験の開始を発表" (in ja). PR TIMES. 2022-10-28. https://prtimes.jp/main/html/rd/p/000000075.000036794.html. 
  13. ↑ 日経バイオテク (Nikkei Biotech) ONLINE (2024-09-02). "ネクセラファーマ、統合失調症治療薬候補 NBI-1117568の第II相臨床試験の良好な結果によりニューロクライン社より35百万米ドルのマイルストンを受領" (in ja). 日本経済新聞社. https://bio.nikkeibp.co.jp/atcl/release/24/09/02/21467/. 
  14. ↑ "ネクセラファーマの統合失調症薬、最終治験を開始". 日本経済新聞社. 2025-05-01. https://www.nikkei.com/article/DGXZQOUC012AO0R00C25A5000000/. 
  15. ↑ "Neurocrine Biosciences Initiates Phase 2 Clinical Study Evaluating NBI-1117568 in Adults with Schizophrenia". ニューロクライン. 2022-10-27. https://neurocrine.gcs-web.com/news-releases/news-release-details/neurocrine-biosciences-initiates-phase-2-clinical-study. 
  16. ↑ 16.0 16.1 "ネクセラファーマ[4565：ニューロクライン社との提携プログラムである統合失調症治療薬候補NBI-1117568の第2相臨床試験で良好な結果 2024年8月28日(適時開示) ：日経会社情報DIGITAL：日本経済新聞"] (in ja). 日本経済新聞社. https://www.nikkei.com/nkd/disclosure/tdnr/20240828577868/. 
  17. ↑ "Nxera Pharma Official IR Blog 「ニューロクライン社から35百万米ドルのマイルストン受領」". ネクセラファーマ. 2024-09-02. https://soseiheptares.blogspot.com/?ctry=jp. 
  18. ↑ "Neurocrine Stock Down 19% on Mixed Schizophrenia Study Results" (in en). Zacks Investment. 2024-08-29. https://www.zacks.com/stock/news/2329161/neurocrine-stock-down-19-on-mixed-schizophrenia-study-results?cid=CS-YAHOO-FT-analyst_blog%7Ccompany_news_medical_sector-2329161&t=BMY. 



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