April 14, 1998
United States Patent
H.P.O. Wolf

April 14, 1998

Medicaments for the treatment of cardiac insufficiency

The use of oxirane carboxylic acids having the formula I: ##STR1## in which R1 and R2 are independently selected from hydrogen, halogen, straight-chain or branched 1-4C alkyl groups, straight-chain or branched 1-4C alkoxy groups, nitro or trifluoromethyl; R3 is hydrogen or straight-chain or branched 1-4C alkyl; Y is --O--(CH.sub.2).sub.m --, where m is zero or a whole number from 1 to 4, and n is a whole number from 2 to 8, or a pharmaceutically acceptable salt thereof, is disclosed for treating heart insufficiency.


July 18, 1998
Dr. J. Benz, patent attorney of Dr. H.P.O. Wolf,  offered a correction of inventorship naming Dr. H. Rupp as co-inventor (excerpt of letter of Dr. J. Benz to Dr. H. Rupp, dated July 18, 1998).

October 11, 1999
MediGene AG, "a biopharmaceutical company dedicated to the discovery, development and commercialization of efficient and innovative therapeutics especially in the area of cancer and cardiac disease",  has in-licensed the drug etomoxir to treat heart failure.

December 12, 2000
Medigene announced the start of a multi-center phase 2 clinical trial named ERGO-1 (Etomoxir for the Recovery of Glucose Oxidation) for MediGene’s lead product in cardiology, Etomoxir, to treat Congestive Heart Failure (CHF).

Clin Sci (Lond). 2000 Jul;99(1):27-35.

First clinical trial with etomoxir in patients with chronic congestive heart failure.

Schmidt-Schweda S, Holubarsch C.

Medizinische Universitätsklinik, University of Freiburg, Department of Cardiology & Angiology, Hugstetter Strasse 55, 79106 Freiburg, Germany.

In the failing human myocardium, both impaired calcium homoeostasis and alterations in the levels of contractile proteins have been observed, which may be responsible for reduced contractility as well as diastolic dysfunction. In addition, levels of a key protein in calcium cycling, i.e. the sarcoplasmic reticulum Ca(2+)-ATPase, and of the alpha-myosin heavy chain have been shown to be enhanced by treatment with etomoxir, a carnitine palmitoyltransferase inhibitor, in normal and pressure-overloaded rat myocardium. We therefore studied, for the first time, the influence of long-term oral application of etomoxir on cardiac function in patients with chronic heart failure. A dose of 80 mg of etomoxir was given once daily to 10 patients suffering from heart failure (NYHA functional class II-III; mean age 55+/-4 years; one patient with ischaemic heart disease and nine patients with dilated idiopathic cardiomyopathy; all male), in addition to standard therapy. The left ventricular ejection fraction was measured echocardiographically before and after a 3-month period of treatment. Central haemodynamics at rest and exercise (supine position bicycle) were defined by means of a pulmonary artery catheter and thermodilution. All 10 patients improved clinically; no patient had to stop taking the study medication because of side effects; and no patient died during the 3-month period. Maximum cardiac output during exercise increased from 9.72+/-1.25 l/min before to 13.44+/-1.50 l/min after treatment (P<0.01); this increase was mainly due to an increased stroke volume [84+/-7 ml before and 109+/-9 ml after treatment (P<0.01)]. Resting heart rate was slightly reduced (not statistically significant). During exercise, for any given heart rate, stroke volume was significantly enhanced (P<0.05). The left ventricular ejection fraction increased significantly from 21.5+/-2.6% to 27.0+/-2.3% (P<0.01). In acute studies, etomoxir showed neither a positive inotropic effect nor vasodilatory properties. Thus, although the results of this small pilot study are not placebo-controlled, all patients seem to have benefitted from etomoxir treatment. Etomoxir, which has no acute inotropic or vasodilatory properties and is thought to increase gene expression of the sarcoplasmic reticulum Ca(2+)-ATPase and the alpha-myosin heavy chain, improved clinical status, central haemodynamics at rest and during exercise, and left ventricular ejection fraction.

Clin Sci (Lond). 2007 Aug;113(4):205-12.

A double-blind randomized multicentre clinical trial to evaluate the efficacy and safety of two doses of etomoxir in comparison with placebo in patients with moderate congestive heart failure: the ERGO (etomoxir for the recovery of glucose oxidation) study.

Holubarsch CJ, Rohrbach M, Karrasch M, Boehm E, Polonski L, Ponikowski P, Rhein S.

Department of Cardiology, Hospital Lazariterhof and Baden, Median-Clinics Bad Krozingen, Bad Krozigen, Germany. c.holubarsch@median-bk.de

Etomoxir is an inhibitor of mitochondrial CPT1 (carnitine palmitoyltransferase 1) and thereby switches energy metabolism from fatty acids to glucose oxidation. Such a metabolic change may be beneficial in CHF (congestive heart failure). The ERGO (etomoxir for the recovery of glucose oxidation) study was designed in which etomoxir was tested at a dose of 80 and 40 mg compared with placebo for a period of 6 months in patients with CHF. As the principle measure of efficacy, a maximal exercise tolerance test and a submaximal 6-min corridor walk test were used. Secondary end points were echocardiographical dimensions and quality-of-life assessment scores. A total of 350 patients were planned to be screened, with the expectation that end point data would be available from approx. 260 patients. However, the study had to be stopped prematurely, because unacceptably high liver transaminase levels were detected in four patients taking etomoxir. At the termination of the study, 121 patients were randomized to placebo, 118 to 40 mg of etomoxir and 108 to 80 mg of etomoxir. At that time, 21 patients in the placebo group, 16 in the 40 mg of etomoxir group and 14 patients in the 80 mg of etomoxir group had completed the study. The mean increases in exercise time were 3.3, 10.2 and 19.4 s for the placebo, 40 mg of etomoxir and 80 mg of etomoxir groups respectively (P value was not significant). No changes were obvious in the 6-min corridor walk test or in echocardiographical parameters from baseline. The number of patients that completed the study was too small to demonstrate significant effects on exercise time, although there was a tendency towards an increase in exercise time. Therefore, before rejecting the hypothesis that inhibition of fatty acid oxidation might be beneficial in CHF, similar studies have to be performed using different inhibitors of fatty acid oxidation targeting CPT1 and other enzymes in this metabolic pathway.

June 25, 2008
Etomoxir in-licensed by MetrioPharm AG:

MetrioPharm AG erwirbt Lizenzrechte für Etomoxir und Nachfolgesubstanzen

January 16, 2001

updated December 17, 2009