Investigation of the impact of urine handling procedures on interpretation of urinalysis findings and product safety in subjects treated with ezogabine

Neil Brickel,¹ Sarah DeRossett,² Mauro Buraglio,³ Christopher Evans,⁴ Siôn Jones<sup>5

1</sup>Neurosciences Therapy Area Unit, GlaxoSmithKline, Uxbridge, Middlesex, UK; ²Neurosciences Therapy Area Unit, GlaxoSmithKline, Research Triangle Park, NC, USA; ³Neurosciences Therapy Area Unit, GlaxoSmithKline, Stevenage, Hertfordshire, UK; ⁴Bioanalytical Science and Toxicokinetics, PTS-DMPK, GlaxoSmithKline, King of Prussia, PA, USA; ⁵Global Clinical Safety and Pharmacovigilance, GlaxoSmithKline, Uxbridge, Middlesex, UK

Background: Ezogabine (also known by the international nonproprietary name of retigabine) is an antiepileptic drug codeveloped and comarketed by Valeant Pharmaceuticals North America and GlaxoSmithKline, which reduces neuronal excitability by enhancing the activity of potassium channels and has the potential to have effects on the urinary system through a pharmacologic action on bladder smooth muscle. In a single post-herpetic neuralgia trial, but not in an extensive epilepsy development program, proteinuria was unexpectedly reported in patients receiving ezogabine. Consequently, investigations were conducted to determine whether the reported proteinuria represented a true or false-positive finding.
Methods: Patients receiving ezogabine 900–1200 mg/day in an open-label extension (Study 303) of a Phase III epilepsy trial voluntarily provided urine samples. Fresh samples were analyzed immediately at the study site, and stabilized aliquots were analyzed 1–3 days after collection at two central laboratories. In an open-label study in healthy volunteers receiving ezogabine 600–900 mg/day (Study RTG114137), urine samples were analyzed fresh (<2 hours after collection) and, using two different stabilizers and storage at room temperature, after 24 and 72 hours. Fluid intake was restricted prior to one sample point. Albumin:creatinine ratios were assessed in both studies.
Results: In Study 303, there was notable variation in clarity, color, and proteinuria between fresh and stored urine samples, and between samples analyzed at different laboratories. In RTG114137, reporting rates of proteinuria were elevated following storage using one stabilizer, and the frequency of color change from fresh to stored samples differed between the stabilizers and between 24 and 72 hours with one stabilizer. Following fluid restriction, proteinuria rates were elevated with both stabilizers. Poor tolerability of ezogabine 750–900 mg/day resulted in limited titration beyond 750 mg/day and early termination of RTG114137.
Conclusion: Hydration status, interval between urine collection and analysis, and the type of stabilizer used are all factors that may lead to false-positive proteinuria findings in patients receiving ezogabine and should be borne in mind if abnormalities are reported.

Keywords: antiepileptic drugs, ezogabine, retigabine, urinary safety, urinalysis