What We Do

Our pipeline of gut-restricted therapies is concentrated on providing better medicines in two therapeutic areas: cardiorenal & GI diseases.

PROGRAM
INDICATION
RESEARCH
PHASE 1
PHASE 2
PHASE 3
MARKETED
Cardiorenal Programs
Tenapanor
ESRD Hyperphosphatemia
(NHE3 Inhibitor)
RDX011
Cardiorenal Indications
(NHE3 Inhibitor)
RDX013
Hyperkalemia
(Potassium Secretagogue)
GI Programs
Tenapanor
IBS-C
(NHE3 Inhibitor)
RDX011
GI Indications
(NHE3 Inhibitor)

TENAPANOR FOR HYPERPHOSPHATEMIA

Tenapanor, invented and developed internally by scientists at Ardelyx, is a first-in-class, proprietary, oral, experimental medication that works exclusively in the gut and is in late-stage clinical development. It has a unique mechanism of action that, in hyperphosphatemia, acts by inhibiting, or blocking, the NHE3 transporter in the GI tract to reduce the absorption of dietary sodium, which in turn, increases the number of protons in a cell. These increased protons cause specific tight junction resistance between cells, which then limits the amount of dietary phosphate that can pass from the gut into the blood. Importantly, the effects appear to be selective to phosphate with no apparent impact on other ions, nutrients or macromolecules.

Tenapanor has been specifically designed to work exclusively within the GI tract, thereby significantly reducing the amount of drug that is absorbed into the bloodstream and the potential side effects that could occur.

 

  1. Tenapanor blocks NHE3, increasing sodium in the gut; NHE3 transports sodium in exchange for protons
  2. Elevated proton levels in cells selectively increase tight junction resistance to phosphate transport
  3. Increased tight junction resistance reduces gut phosphate absorption
Tenapanor selectively blocks paracellular transport of phosphate – a major pathway for regulation of phosphate absorption into blood
Tight junctions utilize different combinations of claudin proteins to facilitate paracellular transport of other ions
Clinical and preclinical data suggest no adverse effect on absorption of nutrients or other ions

Elevated levels of phosphorus in the blood, a metabolic disorder known as hyperphosphatemia, is a very common and difficult-to-treat condition in patients with end-stage renal disease (ESRD) who require dialysis.

In February 2018, we initiated the second Phase 3 clinical trial of tenapanor for hyperphosphatemia in patients with ESRD on dialysis. This clinical trial includes a 26-week open-label treatment period, with a 12-week placebo-controlled randomized withdrawal period followed by an additional 14-week open-label safety extension period for a total of up to 52 weeks. An active control group, for safety analysis only and consistent with other Phase 3 registration studies for hyperphosphatemia, will receive sevelamer, open-label, for the entire 52-week study period. We currently expect to report topline data from this clinical trial in 2019.

In February 2017, we reported positive data from the first Phase 3 clinical trial in these patients. The responder population (n=80 out of 164) had a mean reduction in serum phosphorus from baseline to the end of the eight-week treatment period of 2.56 mg/dL, with a reduction of up to 5.7 mg/dL. Notably, in this group, 33 percent of patients had a reduction in serum phosphorus of greater than 3 mg/dL. The study demonstrated a statistically significant difference in change of serum phosphorus levels from the end of the eight-week treatment period to the end of the four-week randomized withdrawal period between the tenapanor-treated group and the placebo-treated group in the responder patient population (mean -1.01 mg/dL, median of -1.3 mg/dL) and met its primary endpoint (95% CI -1.44, -0.21; LSmean -0.82mg/dL; p=0.01). Only 7.8 percent of patients discontinued treatment due to GI side effects.

Learn More About Our Completed Trial in Hyperphosphatemia

Hyperphosphatemia

Hyperphosphatemia is commonly seen in patients with end-stage renal disease (ESRD), the most advanced stage of chronic kidney disease, who are on dialysis. Hyperphosphatemia is characterized by a build-up of excess phosphorus, a vital element that is normally kept in balance by the kidneys, with excess phosphorus removed and excreted in urine. In patients with kidney failure, phosphorus that comes from the food we eat builds up to abnormal levels and leads to bone disease, heart disease and is correlated with a higher risk of death in those patients.

LEARN MORE ABOUT HYPERPHOSPHATEMIA

Eliminating the Pill Burden

Conventional dialysis and dietary restriction of foods and drinks high in phosphorus are the first step in controlling hyperphosphatemia, but this is often not enough in the majority of ESRD patients. Historically, the only other way to manage elevated phosphorus has been to require ESRD patients to take large amounts of oral phosphate binders. This requires patients to take multiple tablets, or single large chewable tablets with every meal and snack. This added pill burden is a significant challenge for dialysis patients as the amount of fluid they are allowed to drink each day is severely restricted. As a result of these challenges, a large proportion of patients have uncontrolled blood phosphorus levels, significantly increasing their risk of poor health outcomes and even death. With tenapanor, which we are evaluating to be a twice-daily dose of a small pill similar to the size of a baby aspirin, we are aiming to significantly reduce that pill burden for these patients.

1. Investigational small molecule currently in phase 3 development-target dose 10-30 mg BID. (10 mg BID shown here)
2. 800mg of Renvela (sevelamer carbonate) up to three times per day with meals per package insert

RDX013 for HYPERKALEMIA

RDX013 is our novel, small molecule program for the potential treatment of hyperkalemia. Our RDX013 approach works by tapping into the GI tract’s natural ability to secrete potassium into the lumen of the gut to reduce serum potassium levels. This mechanism differs significantly from the potassium binders currently on or approaching the market. For a potassium binder to work, it must be present when dietary potassium is ingested so that the agent can bind the potassium and prevent its absorption in the gut. This results in the need for large quantities of binder in order to bind the large amounts of potassium in the diets of most individuals. In contrast, we observed in our preclinical models that a small amount of RDX013 could cause potassium to be secreted into the lumen of the gut. In this way, we believe that RDX013 may have the potential to lower serum potassium whether or not potassium is present in the diet and could result in a very low pill burden, potentially allowing better patient compliance, longer-term use and potentially better efficacy than potassium binders. As described below, certain medications commonly administered to patients with CKD and/or heart failure can also cause hyperkalemia. With the successful development of an effective potassium secretagogue to treat hyperkalemia in a small, convenient pill format, we believe our RDX013 approach may allow nephrologists and cardiologists with an opportunity to treat hyperkalemia chronically without reducing the dose of these medications

Hyperkalemia

Hyperkalemia is a potentially life-threatening condition in which blood levels of potassium are elevated above normal. Potassium is a nutrient that is critical to the normal function of nerve and muscle cells, including those in the heart. Normal potassium blood levels are tightly balanced and maintained primarily by the kidneys. For people with heart failure, chronic kidney disease and diabetes, and particularly those also taking highly beneficial renin-angiotensin-aldosterone system inhibitors (RAASi), there is a greater risk of developing hyperkalemia due to the side effects of those drugs and the kidney’s limited ability to keep potassium in balance.

LEARN MORE ABOUT HYPERKALEMIA

Tenapanor for Irritable Bowel Syndrome with Constipation (IBS-C)

NDA Submitted September 2018

Tenapanor, discovered and developed by Ardelyx, is a first-in-class, oral, experimental medication that works exclusively in the gut and is in late-stage clinical development. It has a unique mechanism of action that, in IBS-C, relieves both constipation and abdominal pain. By inhibiting, or blocking, the NHE3 transporter in the GI tract, tenapanor reduces the absorption of dietary sodium into the blood stream. Blocking NHE3 results in an increase in the amount of sodium in the gut. This increased sodium leads to an increase of fluid in the gut, which loosens stool, helping to relieve constipation. Based upon preclinical findings, we believe that tenapanor works to reduce abdominal pain caused by IBS-C through the inhibition of TRPV-1 dependent signaling. TRPV-1, better known as the “hot chili pepper receptor,” is a well-established pain target known for transmitting painful stimuli from a variety of sources including heat, protons and inflammatory molecules. We presented preclinical findings on this mechanism at the 2017 American Society of Gastroenterology Annual Meeting.

Tenapanor has been specifically designed to work exclusively within the GI tract, thereby significantly reducing the amount of drug that is absorbed into the bloodstream and the potential side effects that could occur.

  1. Tenapanor blocks NHE3, which transports sodium in exchange for protons
  2. Blocking NHE3 increases sodium outside cells/in the gut
  3. Increased sodium increases water in the gut, which loosens stool, alleviating constipation
Data from preclinical studies have shown that tenapanor works to reduce abdominal pain caused by IBS-C through the inhibition of TRPV-1 dependent signaling.

IBS-C is a burdensome GI disorder affecting a significant number of people. It is characterized by significant abdominal pain, constipation, straining during bowel movements, bloating and/or gas.

Tenapanor’s safety and efficacy for the treatment of IBS-C were evaluated in our Phase 3 T3MPO program. This consisted of three studies – T3MPO-1 and T3MPO-2, which we reported positive data from in 2017 – and T3MPO-3, a long-term safety study which is now complete. Based on the findings from this program, we submitted our New Drug Application to the U.S. Food and Drug Administration for tenapanor for IBS-C in September of 2018.

Learn More About Our Completed Trials in IBS-C

 

IBS-C

IBS-C presents a significant burden on patients, the healthcare system and the U.S. economy. While estimates vary, it is projected that approximately 11 million people in the U.S. suffer from IBS-C.

1. Doshi, 20142. Lovell, 2012 LEARN MORE ABOUT IBS-C

PARTNERING

OUR STRATEGIC PARTNERS

In November 2017, we executed a license agreement with Kyowa Hakko Kirin for the development and commercialization of tenapanor for cardiorenal diseases and conditions associated with them, including hyperphosphatemia, in Japan.

Learn more about the collaboration.

In December 2017, we executed a license agreement with Shangai Fosun Pharmaceutical Industrial Development Company Limited for the development and commercialization of tenapanor for IBS-C and hyperphosphatemia related to chronic kidney disease in China.

Learn more about the collaboration.

In March 2018, we executed a license agreement with Knight Therapeutics, Inc. which provides Knight with exclusive rights to commercialize tenapanor in Canada for the treatment of IBS-C and hyperphosphatemia.

PUBLICATIONS

2018. Nephrology Dialysis Transplant. The Effects of Tenapanor on Serum Fibroblast Growth Factor 23 in Patients Receiving Hemodialysis with Hyperphosphatemia.

2017 11. American Society of Nephrology Kidney Week 2017. Gastrointestinal Tolerability of Tenapanor to Treat Hyperphosphatemia in Patients on Hemodialysis.

2017 11. American Society of Nephrology Kidney Week 2017. Efficacy of Tenapanor to Treat Hyperphosphatemia in Patients on Hemodialysis.

2017. Journal of the American Society of Nephrology. Effect of Tenapanor on Serum Phosphate in Patients Receiving Hemodialysis.

2016 09. Clinical Pharmacology in Drug Development. Preclinical and Healthy Volunteer Studies of Potential Drug–Drug Interactions Between Tenapanor and Phosphate Binders.

2015 11. American Society of Nephrology Kidney Week 2015. A Phase 2 Study on the Effect of Tenapanor on Albuminuria in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease.

2015 11. American Society of Nephrology Kidney Week 2015. Tenapanor, a Gastrointestinal NHE3 Inhibitor, Reduces Serum Phosphate in Patients with Chronic Kidney Disease Stage 5D and Hyperphosphatemia.

2014 11. American Society of Nephrology Kidney Week 2014. Tenapanor, a Minimally Absorbed NHE3 Inhibitor, Reduces Dietary Phosphorus Absorption in Healthy Volunteers.

2014 11. American Society of Nephrology Kidney Week 2014. Tenapanor Inhibits Phosphorous Absorption and Protects Against Vascular Calcification in Nephrectomized Rats.

2012 05. 49th ERA-EDTA Congress. RDX5791, a Non-systemic NHE3 Inhibitor for the Treatment of Fluid and Sodium Overload, Shifts Sodium Excretion from Urine to Feces in Healthy Subjects.