Grace Therapeutics has announced promising results from its Phase 3 STRIVE-ON safety trial evaluating GTx-104, a novel injectable formulation of nimodipine for patients with aneurysmal Subarachnoid Hemorrhage (aSAH). The trial demonstrated significant improvements in both safety and clinical outcomes compared to traditional oral nimodipine administration.
Key Trial Results and Safety Profile
The prospective, randomized open-label trial enrolled 102 patients, with 50 receiving GTx-104 and 52 receiving oral nimodipine. GTx-104 achieved its primary endpoint, showing a 19% reduction in clinically significant hypotension incidents compared to oral nimodipine (28% versus 35%). This improvement was particularly noteworthy given that the GTx-104 arm included a higher proportion of severe cases (8% Hunt & Hess Grade V compared to 2% in the oral arm).
Drug delivery efficiency marked a substantial advancement, with 54% of GTx-104 patients achieving a relative dose intensity (RDI) of 95% or higher, compared to just 8% in the oral nimodipine group. The trial also revealed favorable outcomes in several key metrics:
- 29% relative increase in patients with positive 90-day outcomes on the modified Rankin scale
- Improved quality of life measurements using EQ-5D-3L
- Reduced ICU readmissions and fewer ventilator days
Clinical Implications and Expert Perspectives
Dr. H Alex Choi, Professor of Neurology and Neurosurgery at UTHealth Houston / McGovern Medical School, emphasized the significance of these findings: "The RDI data show that the IV formulation allows patients to receive more of this powerful medication with fewer hypotensive side effects."
Dr. Loch MacDonald, Chief Medical Officer, noted that while STRIVE-ON wasn't specifically powered for efficacy, the results suggest meaningful improvements in both clinical and patient-reported outcomes. This development represents the first major innovation in aSAH treatment in nearly four decades.
Treatment Innovation for a Critical Condition
aSAH, affecting approximately 42,500 U.S. hospital-treated patients annually, represents about 5% of all strokes. GTx-104's nanoparticle technology enables aqueous formulation of typically insoluble nimodipine for standard peripheral IV infusion, potentially eliminating the need for nasogastric tube administration in unconscious or dysphagic patients.
Path Forward and Market Impact
Prashant Kohli, CEO of Grace Therapeutics, confirmed plans to submit a New Drug Application (NDA) in the first half of 2025. The treatment has received FDA Orphan Drug Designation, which would provide seven years of marketing exclusivity post-launch in the United States.
The development of GTx-104 addresses several critical challenges in current aSAH treatment:
- Eliminates the need for nasogastric tube administration
- Reduces potential dosing errors
- Minimizes food effects and drug-to-drug interactions
- Provides better hypotension management
With over 150 healthy volunteers having already received GTx-104 showing good tolerability and reduced pharmacokinetic variability compared to oral nimodipine, the treatment shows promise in revolutionizing aSAH patient care.
