The effects of camicinal, a novel motilin agonist, on gastro‐esophageal function in healthy humans—a randomized placebo controlled trial

Background A proportion of patients with foregut dysmotility fail to respond to standard interventions. Motilin agonists may be beneficial in this group. We aimed to determine the effect of camicinal, a novel motilin agonist, on gastrointestinal physiology in healthy volunteers. Methods Healthy male subjects were randomly assigned to receive a single dose of 125 mg camicinal or placebo in a double‐blind cross‐over design. Esophageal function and reflux indices were assessed using high‐resolution manometry (pre and 1.5‐h post dose) and 24‐h ambulatory multichannel intraluminal impedance/pH. After a standardized meal, subjects ingested a wireless motility capsule from which compartmental transit times and motility indices were derived. Subjects were restudied with the alternate intervention after 7 days. Key Results The study subjects (12 male, mean age 47.4 years, range 22–55) tolerated the drug well, except one who exhibited mild abdominal pain on both placebo and camicinal. In comparison to placebo, gastric emptying time (GET) was accelerated following camicinal (−115.4 min, 95% confidence interval −194.4, −36.4, p = 0.009). No effect was demonstrable on esophageal function, small bowel, colonic, or whole bowel transit times and motility indices. With camicinal, as part of a post hoc analysis, there was a trend association between the percentage reduction in GET and total number of acidic reflux events (r = 0.56, p = 0.09). Conclusions & Inferences Camicinal decreases GET and was generally well‐tolerated. In health, the direct effects of camicinal are on accelerating GET with a potential secondary benefit of reducing reflux events, which warrant further exploration in patient cohorts. Camicinal, a novel motilin agonist, accelerates gastric emptying but has no discernable effect on esophageal function, small bowel, colonic, or whole gut transit times/motility indices in healthy humans. View the podcast on this paper at the following sites:iTunes: https://itunes.apple.com/dk/podcast/neurogastroenterology-motility/id1045893519Youtube: https://youtu.be/DcjApg3j8yU