XYRA LLC, a biopharmaceutical company focused on cardiac rhythm disorders, announced that the FDA has provided guidance on the label for budiodarone, its drug candidate for managing non-permanent atrial fibrillation (AF), including the use of wearable AF monitoring devices. This guidance supports the integration of digital health technology into the treatment paradigm for AF, potentially improving patient outcomes.
Integrating Wearable Monitoring into AF Treatment
The FDA's guidance specifies indications and directions for using budiodarone to control AF symptoms and reduce stroke risk by eliminating long episodes of AF (LEAF) exceeding 5 hours. This approach leverages the increasing use of FDA-approved wearable AF monitoring devices to identify patients at high risk of complications such as stroke, heart failure, and progression to permanent AF.
Peter Milner, M.D., FACC, managing member of XYRA, stated, "Budiodarone, with its dose-proportional pharmacology and intermediate half-life offers an ideal opportunity to integrate state-of-the-art digital AF monitoring technology into routine practice, enabling us to identify the patients with AF who benefit most from the drug."
The FDA indicated that the label could include directions for maintaining patients on the appropriate therapeutic dose of budiodarone, guided by data from AF monitoring systems. This allows for the identification of patients who do not respond to the maximum therapeutic dose, enabling timely discontinuation of the drug and preventing unnecessary exposure.
Clinical Evidence and Potential Benefits of Budiodarone
Phase 2 clinical data suggests that budiodarone significantly reduces symptoms, as well as the frequency and duration of AF episodes, in subjects with non-permanent AF. These results compare favorably to those obtained with AF-ablation in a recent study. Budiodarone's efficacy is attributed to its enhanced late sodium channel blocking properties and shorter half-life compared to amiodarone, with no evidence of accumulation in human or animal studies to date.
The Role of Wearable Devices in AF Management
The currently FDA-approved wearable devices available for use in AF and potentially with budiodarone to determine eligibility and response to therapy include patch devices such as Philips' E-patch® or MCOT®, iRhythm's Zio® Patch, and wrist wearables like the Zio® ZEUS and Apple Watch®. The integration of these devices allows for real-time monitoring of AF episodes, enabling clinicians to tailor treatment strategies and prevent long episodes of AF from recurring.
About Atrial Fibrillation
Atrial fibrillation (AF) is the most common sustained heart arrhythmia in adults, affecting approximately 44 million individuals worldwide. It is associated with thromboembolic risk, impaired cardiac performance, and other morbidities. The management of AF has evolved to prioritize the restoration and maintenance of sinus rhythm, with therapies including anti-arrhythmic drugs (AAD), electrophysiological ablation, or a combination of both.
