Data reinforcing efficacy and safety of gadopiclenol in contrast-enhanced MRI published in Radiology



Bracco Imaging has announced the publication of the PROMISE trial in Radiology. The PROMISE study was a prospective, multinational, crossover (within-patient), double-blind comparison of the safety and efficacy of 0.05 mmol/kg gadopiclenol (Vueway) with 0.1 mmol/kg gadobutrol (Gadavist) in adult patients referred for contrast-enhanced magnetic resonance imaging (MRI) of head and neck, thorax (including breast), abdomen (including liver, pancreas, and kidneys), pelvis (including ovaries, uterus, and prostate), and musculoskeletal (including extremities).

Despite being administered at half the dose of gadobutrol, gadopiclenol provided a comparable degree of contrast enhancement and quality of morphologic assessment of lesions. The type and severity of adverse events (AEs) were similar with the two gadolinium-based contrast agents, with Vueway (4.2%) having a slightly lower rate to that of Gadavist (5.5%).

The publication of the results of the PROMISE study comes on the heels of those of the PICTURE clinical trial, which were published in Investigative Radiology and showed
non-inferior quality of morphologic assessment of lesions of the brain and spine with 0.05 mmol/kg Vueway compared with 0.1 mmol/kg gadobutrol (Gadavist). The combined results of the PROMISE and PICTURE trials, and additional clinical evidence, supported the regulatory application for gadopiclenol submitted to the US Food and Drug Administration (FDA), resulting in priority review and subsequent approval in 2022.

The PROMISE trial included 273 adult patients suspected of having an enhancing abnormality in one of three different body regions (head/neck, breast/thorax/abdomen/pelvis, or musculoskeletal). Off-site blinded readers with expertise in the respective body regions rated border delineation, internal morphology, and visual contrast enhancement. All primary and secondary endpoints of the study were achieved. For all blinded readers, 0.05 mmol/kg gadopiclenol was non-inferior to 0.1 mmol/kg gadobutrol for all visualisation parameters and all readers (P<.001), and superior to unenhanced images (P<.001). Two of three readers yielded higher percentage enhancement for gadopiclenol (P<.001). Lesion-to-background ratio did not differ. For most participants (75%–83%), readers reported no preference between 0.05 mmol/kg gadopiclenol and 0.1 mmol/kg gadobutrol images.

“The results of the PROMISE Study led to the approval of the use of gadopiclenol with MRI of the head and neck, thorax, abdomen, pelvis, and the musculoskeletal system,” said Alberto Spinazzi, chief medical and regulatory officer at Bracco. “Of note, gadopiclenol was approved for both MRI of the central nervous system and of the body at the dose of 0.05 mmol/kg, which showed to provide similar contrast enhancement efficacy compared with a dose of 0.1 mmol/kg of Gadavist. This is thanks to the high relaxivity of gadopiclenol.”

Vueway injection is a Group II agent within the American College of Radiology’s classification of gadolinium-based agents relative to the risk of nephrogenic systemic fibrosis (NSF), indicating association with few if any, unconfounded cases. It is approved for use in adult and paediatric patients aged two years and older with MRI of the brain, spine, and surrounding tissues, and the body (head and neck, thorax, abdomen, pelvis, and musculoskeletal system).


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