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Relacorilant maintained hypertension control versus placebo in adults with endogenous hypercortisolismNew Drug Helps Control High Blood Pressure in Cushing's

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Key Takeaway
Consider relacorilant for hypertension control in endogenous hypercortisolism based on randomised-withdrawal phase 3 data.

This phase 3 randomised-withdrawal study enrolled 152 adults with endogenous hypercortisolism and hypertension, hyperglycaemia, or both across 77 study centres in 11 countries. Participants received relacorilant 400 mg or the highest tolerated dose during the initial phase. The trial design focused on the randomised-withdrawal phase.

During the 12-week randomised-withdrawal phase, significantly more patients with baseline hypertension assigned to placebo lost hypertension control compared with those continuing relacorilant. The proportion difference was 34%, with an odds ratio of 0·17. The 95% CI ranged from 0·04 to 0·77, and the p-value was 0·022. Absolute numbers for this outcome were not reported. This outcome measured the proportion of patients who lost hypertension response.

Adverse events included back pain (5 [17%] vs 6 [19%]), acne (3 [10%] vs 0), arthralgia (3 [10%] vs 3 [9%]), bursitis (3 [10%] vs 0), headache (3 [10%] vs 4 [13%]), and insomnia (0 vs 4 [13%]). Serious adverse events and discontinuations were not reported. No cases of excessive glucocorticoid receptor antagonism, adrenal insufficiency, vaginal bleeding, drug-induced hypokalaemia, or drug-induced QT interval prolongation occurred. Tolerability was assessed for specific safety signals.

Funding was provided by Corcept Therapeutics. Findings support consideration of relacorilant as a therapeutic option to reduce the harmful and debilitating effects of endogenous hypercortisolism. Limitations regarding causality and certainty were not reported. Practice relevance is supported by these findings.

The Big Problem With Too Much Stress Hormone

Imagine your body is stuck in a permanent "fight or flight" mode. This is what happens when someone has Cushing's syndrome. Their body makes too much cortisol, the stress hormone.

Too much cortisol is not just about feeling anxious. It causes real physical damage. It raises blood pressure, spikes blood sugar, and makes you gain weight in the wrong places.

For years, doctors have struggled to fix this. The usual path involves surgery to remove the tumor making the hormone. But what if the tumor cannot be removed? Or what if surgery fails?

Patients are left with high blood pressure and other dangerous symptoms. They need a new way to manage their condition without removing their adrenal glands.

Cushing's syndrome is rare, but it is serious. It affects people of all ages, though it is most common in adults between 30 and 50.

Current treatments are limited. Surgery is the first line of defense, but it does not work for everyone. Radiation and medication options are often weak or come with heavy side effects.

Doctors need a tool that can lower cortisol activity without shutting down the whole system. This new approach offers hope for those who have run out of options.

The Surprising Shift in Treatment

We used to think we had to remove the source of the problem entirely. That meant surgery. If surgery was not possible, patients had very few choices.

But here is the twist. Scientists found a way to block the effects of the hormone instead of stopping its production. They developed a drug called relacorilant.

This drug acts like a decoy. It competes with cortisol for the spots on your cells where cortisol usually binds. Think of it like a fake key that fits the lock but does nothing.

By filling these spots with the fake key, the real cortisol cannot get in. This stops the hormone from causing damage to your blood vessels and muscles.

How It Works Simply

Your cells have special receptors for cortisol. These are like doorways that let the hormone in to tell your body to store fat and raise blood pressure.

Relacorilant blocks these doorways. It sits in the doorway and waits. When cortisol tries to enter, the drug is already there.

This prevents the hormone from sending its harmful signals. Your body can still function normally, but the dangerous effects of excess cortisol are reduced.

It is a targeted approach. It does not stop your body from making the hormone. It just stops the hormone from doing its damage.

Researchers tested this drug in a large study across 11 countries. They looked at adults with Cushing's syndrome who also had high blood pressure or high blood sugar.

The main question was simple. Could the drug keep blood pressure under control when the drug was stopped?

The results were clear. Patients who took the drug kept their blood pressure stable. Those who took a fake pill saw their blood pressure rise quickly.

The difference was significant. About one-third more patients lost control of their blood pressure on the fake pill. The drug group stayed much more stable.

Safety was also checked closely. Common side effects like back pain and headaches happened in both groups. Serious issues like adrenal failure did not occur.

The Catch In Real-World Use

This is where things get interesting. The study showed great promise, but there is a limit.

The drug worked well in the study, but it is not approved for use yet. It is still in the research phase.

Patients cannot buy this medication at a pharmacy today. It is only available in clinical trials.

This does not mean this treatment is available yet.

You must wait for further reviews and official approval from health regulators. This process takes time. It ensures the drug is safe for everyone, not just the people in the study.

If you or a loved one has Cushing's syndrome, talk to your doctor about all options. Ask if you qualify for clinical trials.

This new drug could be a game changer for those who cannot have surgery. It offers a chance to control symptoms without major operations.

Do not lose hope if surgery is not an option. New treatments are coming. Stay informed about the latest research in your field.

The Limitations Of The Study

Every study has limits. This one looked at 152 patients. That is a good number, but it is not everyone.

The study was done in 11 countries. Results might differ in other places. Also, the drug was only tested for a short time.

We do not know yet how it works over many years. Long-term safety data is still missing.

What happens next? The drug needs more testing before it reaches patients.

Regulators will review the data. They will look at the safety and the benefits carefully. If approved, it will be a new option for doctors.

Until then, patients should continue their current treatment plans. Do not stop taking prescribed medicine without talking to your doctor.

Research moves slowly, but it moves forward. This study is a big step toward better care for people with Cushing's syndrome.

Study Details

Study typeRct
Sample sizen = 30
EvidenceLevel 2
Follow-up960.0 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Relacorilant is a selective glucocorticoid receptor modulator designed to reduce excess cortisol activity by competing with cortisol for glucocorticoid receptor binding, mitigating the clinical manifestations of endogenous hypercortisolism (Cushing's syndrome). The aim of this study was to assess the efficacy and safety of relacorilant in adults with endogenous hypercortisolism. METHODS: This multicentre, phase 3, double-blind, placebo-controlled, randomised-withdrawal study enrolled adults with endogenous hypercortisolism and hypertension, hyperglycaemia, or both and was conducted at 77 study centres across 11 countries. Key inclusion criteria included being aged 18-80 years with at least two clinical signs or symptoms of hypercortisolism. In the open-label phase, patients received oral, once-daily relacorilant (escalation from 100 mg up to 400 mg) for 22 weeks. Patients who met response criteria were randomly assigned (1:1) by the interactive web response system to continue relacorilant 400 mg (or highest tolerated dose) or placebo for 12 weeks in the randomised-withdrawal phase. Participants and investigators were masked to treatment assignment. The primary outcome was the proportion of patients who lost hypertension response during the randomised-withdrawal phase compared between relacorilant and placebo at week 12. As per protocol, this outcome was assessed in all participants who received at least one dose of study drug in the study period (intention-to-treat population). Missing randomised-withdrawal week 12 values were considered a loss of response. Safety was assessed in all enrolled patients who received at least one dose of study drug in that period. This study is registered with ClinicalTrials.gov, NCT03697109. FINDINGS: Between Oct 16, 2018, and April 15, 2024, 404 patients were screened, 152 were enrolled, and 95 completed the open-label relacorilant phase. 62 patients met response criteria and were randomly assigned to relacorilant (30 total participants [21 met hypertension response criteria]) or placebo (32 total participants [22 met hypertension response criteria]). In the 30 participants in the relacorilant group, the mean age was 46·6 years (SD 11·0), 22 (73%) were female, and eight (27%) were male. In the 32 participants in the placebo group, the mean age was 48·8 years (SD 14·4), 26 (81%) were female, and six (19%) were male. During the randomised-withdrawal phase, significantly more patients with baseline hypertension who were randomly assigned to placebo lost hypertension control compared with those who continued relacorilant (proportion difference 34%; odds ratio 0·17 [95% CI 0·04-0·77]; p=0·022). In the randomised-withdrawal phase safety population, the most common adverse events in the 30 participants given relacorilant and the 32 participants given placebo were back pain (5 [17%] vs 6 [19%]), acne (3 [10%] vs 0), arthralgia (3 [10%] vs 3 [9%]), bursitis (3 [10%] vs 0), headache (3 [10%] vs 4 [13%]), and insomnia (0 vs 4 [13%]). There were no cases of excessive glucocorticoid receptor antagonism, adrenal insufficiency, vaginal bleeding associated with endometrial hypertrophy, drug-induced hypokalaemia, or drug-induced QT interval prolongation. INTERPRETATION: Patients treated with relacorilant were more likely to maintain hypertension control compared with patients treated with placebo. The findings support consideration of relacorilant as a therapeutic option to reduce the harmful and debilitating effects of endogenous hypercortisolism. FUNDING: Corcept Therapeutics.
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