Ospemifene is the first oral and non-hormonal treatment for moderate or severe vulvo-vaginal atrophy (VVA) in postmenopausal women who are not candidates to treatment with local oestrogens. Its effects are mediated though the regeneration of the proportion of superficial and intermediate cells of the vagina, improving menopausal symptomatology such as dryness and dyspareunia.
Only two studies to date have directly compared brain activation patterns in women with normal sexual function with women complaining with hypoactive sexual desire disorder. Arnow et al. demonstrated that women with normal sexual function showed brain activations in multiple regions different from women with FSIAD. When comparing the two groups, women with normal sexual function showed greater activation of the bilateral entorhinal cortex while women with FSIAD exhibited greater activation of the medial frontal gyrus, right inferior frontal gyrus, and bilateral putamen. The medial frontal gyrus activation has been associated with self-monitoring; thus, it is possible that women with FSIAD allocate more attention to monitoring their response, which may be inhibitory to sexual functioning. The other study was done by Woodard and colleges showing that women with normal sexual function showed significantly differences on cerebral activation in comparison with women with FSIAD.
These differences observed in women with FSIAD could suggest that they may have alterations in activation of limbic and cortical structures responsible for acquiring, encoding, and retrieving memory, the processing and memory of emotional reactions, and areas responsible for heightened attention to one's own physical state.
For this reason the authors believe that it is essential to determine if the effect of ospemifene on the improvement on sexual function is due to the improvement on the vagina tract or due to its effect on brain function.

Start Date01 Nov 2021

Sponsor / Collaborator

Hospital Clínic de Barcelona

NCT03018106

/ TerminatedPhase 4IIT

Ospemifene Versus Conjugated Estrogens in the Treatment of Postmenopausal Sexual Dysfunction

Vulvovaginal atrophy (VVA) is a condition that impacts up to 60% of the growing postmenopausal female population, and the most common symptom is dyspareunia. Vaginal estrogen is the most common treatment for VVA, but it only marginally improves overall sexual function, and many women and clinicians avoid using it because of the risks of exogenous estrogen use during menopause. Ospemifene is a non-estrogen selective estrogen receptor modulator (SERM) that is FDA-approved for treating dyspareunia related to VVA, and has shown superb improvements in overall sexual health. 104 women will be randomized to receive 12 weeks of 60mg oral ospemifene, taken daily, or 12 weeks of 0.5mg vaginal conjugated estrogens, which is placed vaginally twice per week. The improvements in sexual health and VVA symptom severity will be compared in each group. This study will help determine if ospemifene is a better treatment medication than conjugated estrogens.

Start Date30 Jun 2017

Sponsor / Collaborator

Emory University

NCT02638337

/ CompletedPhase 3

A Phase 3, Randomized, Double-blind, Placebo-controlled Multicenter Study to Evaluate the Efficacy and Safety of Ospemifene in Patients With Moderate to Severe Vaginal Dryness, a Symptom of Vulvo-vaginal Atrophy (VVA) Due to Menopause

The objective of this study is to evaluate the efficacy and safety of ospemifene 60 mg once daily (QD) compared with placebo in treatment of vulvo-vaginal atrophy (VVA) due to menopause in women with moderate to severe vaginal dryness as the most bothersome symptom (MBS) of VVA.

Start Date26 Jan 2016

Sponsor / Collaborator

Shionogi, Inc.

100 Clinical Results associated with Ospemifene

100 Translational Medicine associated with Ospemifene

100 Patents (Medical) associated with Ospemifene

271

Literatures (Medical) associated with Ospemifene

01 Nov 2024·The French Journal of Urology

Midurethral sling in the treatment of mixed urinary incontinence: A literature review of functional outcomes and associated factors

Review

Author: Herforth, Christine ; Guérin, Sonia ; Carmel, Maude

PURPOSETo review the functional results of the midurethral sling (MUS) in the management of mixed urinary incontinence (MUI) and provide guidance on patient selection and the potential benefits of concomitant treatments.METHODSA literature review from the past 20years was conducted from the PubMed database using the terms "mixed urinary incontinence," associated to "sling," "midurethral sling," "suburethral sling," "mid-urethral sling," "sub-urethral sling," and "tension-free vaginal tape".RESULTSThe efficacy of the MUS varies considerably depending on the definition of success used. Stress urinary incontinence resolved in 78 to 100% of patients while urge urinary incontinence (UUI) resolved in 57.4 to 82% of patients at short-term follow up. Overall urinary incontinence (UI) resolved in 58% to 85% during this time. A significant proportion of women report a high degree of satisfaction with this treatment. Long-term studies with follow-up period greater than 36months revealed a deterioration of the functional outcomes, especially for UUI. Older women with predominant UUI or detrusor overactivity on urodynamics may be at risk for poorer outcomes. Among concomitant treatments studied, OnabotulinumtoxinA injection, ospemifene, physiotherapy, percutaneous tibial nerve stimulation and surgical bladder denervation appears to offer benefits in improving UI. However, the evidence is currently insufficient to recommend their routine concomitant use.CONCLUSIONMUS is an effective treatment for MUI. Further research is needed to better understand the potential benefits of concurrent treatments and to develop models that can predict outcomes and assist physicians in shared decision making about how to approach the management of MUI.LEVEL OF EVIDENCE: 4

01 Oct 2024·Annals of Internal Medicine

A Systematic Review

Review

Author: Zerzan, Nicholas ; Anthony, Maylen ; Abdi, Hamdi I. ; Greer, Nancy ; Dahm, Philipp ; Forte, Mary L. ; Diem, Susan ; Kalinowski, Caleb ; Sowerby, Catherine ; Landsteiner, Adrienne ; Fok, Cynthia ; Danan, Elisheva R. ; Nardos, Rahel ; Ullman, Kristen E. ; Friedman, Jessica K. ; Butler, Mary ; Ensrud, Kristine ; Wilt, Timothy J.

BACKGROUNDPostmenopausal women commonly experience vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM).PURPOSETo evaluate effectiveness and harms of vaginal estrogen, nonestrogen hormone therapies, and vaginal moisturizers for treatment of GSM symptoms.DATA SOURCESMedline, Embase, and CINAHL through 11 December 2023.STUDY SELECTIONRandomized controlled trials (RCTs) of at least 8 weeks' duration enrolling postmenopausal women with at least 1 GSM symptom and reporting effectiveness or harms of hormonal interventions or vaginal moisturizers.DATA EXTRACTIONRisk of bias and data extraction were performed by one reviewer and verified by a second reviewer. Certainty of evidence (COE) was assessed by one reviewer and verified by consensus.DATA SYNTHESISFrom 11 993 citations, 46 RCTs evaluating vaginal estrogen (k = 22), nonestrogen hormones (k = 16), vaginal moisturizers (k = 4), or multiple interventions (k = 4) were identified. Variation in populations, interventions, comparators, and outcomes precluded meta-analysis. Compared with placebo or no treatment, vaginal estrogen may improve vulvovaginal dryness, dyspareunia, most bothersome symptom, and treatment satisfaction. Compared with placebo, vaginal dehydroepiandrosterone (DHEA) may improve dryness, dyspareunia, and distress, bother, or interference from genitourinary symptoms; oral ospemifene may improve dryness, dyspareunia, and treatment satisfaction; and vaginal moisturizers may improve dryness (all low COE). Vaginal testosterone, systemic DHEA, vaginal oxytocin, and oral raloxifene or bazedoxifene may provide no benefit (low COE) or had uncertain effects (very low COE). Although studies did not report frequent serious harms, reporting was limited by short-duration studies that were insufficiently powered to evaluate infrequent serious harms.LIMITATIONSMost studies were 12 weeks or less in duration and used heterogeneous GSM diagnostic criteria and outcome measures. Few studies enrolled women with a history of cancer.CONCLUSIONVaginal estrogen, vaginal DHEA, oral ospemifene, and vaginal moisturizers may improve some GSM symptoms in the short term. Few long-term data exist on efficacy, comparative effectiveness, tolerability, and safety of GSM treatments.PRIMARY FUNDING SOURCEAgency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684).

23 Jul 2024·Expert Opinion on Pharmacotherapy

Ospemifene and vulvovaginal atrophy: an update of the clinical profile for post-menopausal women

Review

Author: Maffei, Silvia ; Cagnacci, Angelo ; Di Carlo, Costantino ; Murina, Filippo ; Becorpi, Angelamaria ; Lello, Stefano

INTRODUCTIONThe demand for effective and safe treatments of genitourinary syndrome (GSM) in post-menopausal women (PMW) is growing. Published data on the efficacy and safety of ospemifene (OSP) prompt an updated literature review to enlighten possible improvements in the GSM treatment.AREA COVEREDWe searched articles published in English from 2010 to 2023 through Medline (PubMed) and Embase databases with Boolean terms: OSP, PMW, GSM, endometrium, breast cancer, cardiometabolic syndrome, bone metabolism, adherence to treatment, and patient satisfaction. We selected randomized controlled trials (RCTs) and observational and cross-sectional studies and completed the search manually.EXPERT OPINIONOf the 157 retrieved records, 25 primary studies met the inclusion criteria (15 regarding efficacy and safety, two for additional effects, and four for adherence and satisfaction with the OSP treatment). Seven RCTs involved nearly 5,000 patients, 10 out of 18 prospective observational studies 563, and six retrospective analyses 356,439. Evidence of OSP treatment in PMW with GSM relies on RCTs and remarkable real-world data. The 25 primary studies showcased the high clinical response to symptoms, the favorable safety profile of OSP with very few adverse events, a neutral impact on the endometrium, breast, bone, and thrombosis, and the possible improvement of cardiovascular risk factors.

News (Medical) associated with Ospemifene

10 Sep 2024

·www.drugs.com

Review Weighs Treatments for Genitourinary Symptoms of Menopause

TUESDAY, Sept. 10, 2024 -- Vaginal estrogen, vaginal dehydroepiandrosterone (DHEA), oral ospemifene, and vaginal moisturizers may be beneficial for some genitourinary symptoms of menopause (GSM), according to a review published online Sept. 10 in the Annals of Internal Medicine . Elisheva R. Danan, M.D., M.P.H., from the University of Minnesota in Minneapolis, and colleagues examined the effectiveness and harms of vaginal estrogen, nonestrogen hormone therapies, and vaginal moisturizers for treatment of GSM in a systematic review of randomized controlled trials (RCTs). A total of 46 RCTs assessing vaginal estrogen, nonestrogen hormones, vaginal moisturizers, or multiple interventions were identified from 11,993 citations. The researchers found that vaginal estrogen may improve vulvovaginal dryness, dyspareunia , the most bothersome symptom, and treatment satisfaction compared with placebo or no treatment. Vaginal DHEA may improve dryness, dyspareunia, and distress, bother, or interference from genitourinary symptoms compared with placebo; oral ospemifene may improve dryness, dyspareunia, and treatment satisfaction; and dryness may also be improved by vaginal moisturizers (all low certainty of evidence [COE]). No benefit or uncertain effects (low and very low COE, respectively) may be provided by vaginal testosterone, systemic DHEA, vaginal oxytocin, and oral raloxifene or bazedoxifene. Reporting was limited by studies of short duration that were insufficiently powered to assess infrequent serious harms. "Future studies would be strengthened by standard definitions of symptoms and uniform diagnostic criteria for GSM, a common set of validated outcome measures and reporting standards, and attention to clinically relevant patient populations and intervention comparisons," the authors write.

Clinical Result

21 Jun 2022

·www.biospace.com

Duchesnay announces the launch of Vablys® (dequalinium chloride vaginal tablets), an antiseptic and anti-infective treatment for bacterial vaginosis

BLAINVILLE, Quebec, June 21, 2022 (GLOBE NEWSWIRE) -- Duchesnay Inc., a pharmaceutical company specializing in women’s health and part of Duchesnay Pharmaceutical Group headquartered in Blainville, Quebec, is pleased to announce that it has launched its newest treatment, Vablys® (dequalinium chloride vaginal tablets). Vablys® is the first prescription antiseptic and anti-infective treatment for bacterial vaginosis in women under 55 years of age. With its multiple modes of action and anti-infective properties against a wide range of pathogens, a treatment course of Vablys® consists of one tablet inserted in the vagina at bedtime for six consecutive days. “Vablys® offers Canadian physicians and their patients the first gynecological anti infective and antiseptic prescription treatment option,” said Gino Henry, Senior Manager, Commercial Affairs, at Duchesnay. “We’re convinced that our product provides a new and effective way to treat this condition.” 1 Vablys® is the third new prescription treatment for Canadian women launched by Duchesnay in 2022, achieving an aggressive target set by the company’s new management team. The other two new treatments are the contraceptive Slynd® (drospirenone), a progestin-only pill (POP) which offers a 24-hour safe window for a missed pill, during which no other contraception is needed to prevent pregnancy, and Osphena® (ospemifene tablets), a selective estrogen receptor modulator (SERM) approved by Health Canada as a once-daily prescription treatment for postmenopausal women to treat vaginal dryness and painful intercourse. “Duchesnay is very proud to have achieved its ambitious target of bringing three new innovative prescription treatments to Canadian women in the first six months of 2022, a key element of our growth plans under our new management team,” said Dany Hallé, Vice-President, Commercial Affairs at Duchesnay. “All three new treatments address important needs for women at different stages of their lives and demonstrate concretely the commitment of Duchesnay to providing women’s health solutions. We look forward to continuing to do so.” The Health Canada-approved product monographs for Vablys®, Slynd® and Osphena® are available on the Duchesnay website at . They give contraindications, warnings, precautions, adverse reactions, interactions, dosing and conditions of clinical use. The product monographs are also available through the Duchesnay Medical Information Department, 1-888-666-0611 or medicalinfo@duchesnay.com. About bacterial vaginosis Bacterial vaginosis (BV) is an imbalance of the naturally-occurring, healthy bacteria found in the vagina or internal genitals. This imbalance can cause symptoms that may include more vaginal discharge than usual, a fish-like smell or irritation in the vaginal area2, though often symptoms are not noticed. According to the Public Health Agency of Canada, bacterial vaginosis is the most common cause of vaginal discharge in people of reproductive age. Bacterial vaginosis is not usually considered sexually transmitted, but it is associated with increased acquisition of human immunodeficiency virus (HIV), human papilloma virus (HPV) and Chlamydia trachomatis (CT).3 About Duchesnay Pharmaceutical Group Duchesnay Pharmaceutical Group, with its affiliated companies, is headquartered in Blainville, Quebec. The group consists of five pharmaceutical companies to meet the needs of patients in Canada, the U.S. and abroad. The companies are Duchesnay and Duchesnay USA, both dedicated to women's health; Médunik Canada and Medunik USA, which provide treatments for rare diseases; and Analog Pharma, an American generic drugs company, specializing in authorized generics and orphan drugs. From its state-of-the-art manufacturing plant, Duchesnay can export its innovative treatments to more than 50 countries. Duchesnay and Medunik, through their proprietary research and development, and through partnerships, offer innovative treatments for a variety of medical conditions in women's health, urology, oncology as well as for rare diseases. The group of companies recognizes the dedication and professionalism of its employees and promotes a positive culture and flexible work environment. It is deeply committed to environmental responsibility and giving back to the community through the support of various charitable organizations. For more information, please visit duchesnay.com, medunik.com and analogpharma.com. References Duchesnay Inc., Vablys® Product Monograph, September 2021. British Columbia Centre for Disease Control, Bacterial Vaginosis, Health Canada, STI-associated syndromes guide: Vaginitis, Public Health Importance, September 2021, Media contact: Email: info@duchesnay.com Telephone: (877) 833-7734 A photo accompanying this announcement is available at Vablys Vablys

Orphan DrugGeneric DrugAcquisition

31 Oct 2017

·www.bioportfolio.com

Shionogi Inc 4507 Pharmaceuticals Healthcare Deals and Alliances Profile [Report Updated: 26102017] Prices from USD $250

Summary Shionogi Inc Shionogi, formerly Sciele Pharma, Inc., is a pharmaceutical company. It undertakes the development and commercialization of pharmaceutical products to address the unmet medical needs. The company offers a wide range of branded prescription products to treat chronic diseases. It markets products for various therapeutic areas such as pain, antiinfectives, women's health, pediatrics, cardiovascular, diabetes and others. Shionogi offers its products in various formulations such as tablets, oral suspensions solutions, lotions, capsules, chewable tablets and injections. Some of the company's key branded products include Doribax, Fortamet, Triglide, Altoprev, Fexmid, Methylin, Osphena and Furadantin, among others. The company is a subsidiary of Shionogi Co Ltd Shionogi is headquartered in Florham Park, New Jersey, the US. Shionogi Inc 4507 Pharmaceuticals Healthcare Deals and Alliances Profile provides you comprehensive data and trend analysis of the company's Mergers and Acquisitions MAs, partnerships and financings. The report provides detailed information on Mergers and Acquisitions, Equity/Debt Offerings, Private Equity, Venture Financing and Partnership transactions recorded by the company over a five year period. The report offers detailed comparative data on the number of deals and their value categorized into deal types, subsector and regions. GlobalData derived the data presented in this report from proprietary inhouse Pharma eTrack deals database, and primary and secondary research. Scope Financial Deals Analysis of the company's financial deals including Mergers and Acquisitions, Equity/Debt Offerings, Private Equity, Venture Financing and Partnerships. Deals by Year Chart and table displaying information encompassing the number of deals and value reported by the company by year, for a five year period. Deals by Type Chart and table depicting information including the number of deals and value reported by the company by type such as Mergers and Acquisitions, Equity/Debt Offering etc. Deals by Region Chart and table presenting information on the number of deals and value reported by the company by region, which includes North America, Europe, Asia Pacific, the Middle East and Africa and South and Central America. Deals by Subsector Chart and table showing information on the number of deals and value reported by the company, by subsector. Major Deals Information on the company's major financial deals. Each such deal has a brief summary, deal type, deal rationale; and deal financials and target Company's major public companies key financial metrics and ratios. Business Description A brief description of the company's operations. Key Employees A list of the key executives of the company. Important Locations and Subsidiaries A list and contact details of key centers of operation and subsidiaries of the company. Key Competitors A list of the key competitors of the company. Key Recent Developments A brief on recent news about the company. Reasons to Buy Get detailed information on the company's financial deals that enable you to understand the company's expansion/divestiture and fund requirements The profile enables you to analyze the company's financial deals by region, by year, by business segments and by type, for a five year period. Understand the company's business segments' expansion / divestiture strategy The profile presents deals from the company's core business segments' perspective to help you understand its corporate strategy. Access elaborate information on the company's recent financial deals that enable you to understand the key deals which have shaped the company Detailed information on major recent deals includes a summary of each deal, deal type, deal rationale, deal financials and Target Company's key financial metrics and ratios. Equip yourself with detailed information about the company's operations to identify potential customers and suppliers. The profile analyzes the company's business structure, locations and subsidiaries, key executives and key competitors. Stay uptodate on the major developments affecting the company Recent developments concerning the company presented in the profile help you track important events. Gain key insights into the company for academic or business research Key elements such as break up of deals into categories and information on detailed major deals are incorporated into the profile to assist your academic or business research needs. Note*: Some sections may be missing if data is unavailable for the company.

Acquisition

100 Deals associated with Ospemifene

External Link

KEGG	Wiki	ATC	Drug Bank
D08958	Ospemifene	G03XC05	DB04938

R&D Status

Approved

10 top approved records.

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Indication	Country/Location	Organization	Date
vaginal mucosa dry	US	Duchesnay, Inc.	25 Jan 2019
Dyspareunia	US	Duchesnay, Inc.	26 Feb 2013
Vulvovaginal atrophy	CA	Duchesnay, Inc.	-

Developing

10 top R&D records.

to view more data

Indication	Highest Phase	Country/Location	Organization	Date
vaginal mucosa dry	Preclinical	-	QuatRx Pharmaceuticals Co.	01 Jul 2008
vaginal mucosa dry	Preclinical	-	Shionogi, Inc.	01 Jul 2008
Atrophy	Preclinical	-	Shionogi, Inc.	01 Jan 2006
Atrophy	Preclinical	-	QuatRx Pharmaceuticals Co.	01 Jan 2006
Vulvovaginal atrophy	Preclinical	-	QuatRx Pharmaceuticals Co.	01 Jan 2006
Vulvovaginal atrophy	Preclinical	-	Shionogi, Inc.	01 Jan 2006

Clinical Result

Indication

Phase

Evaluation

View All Results

Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT02638337 (CTgov)	Phase 3	Vulvovaginal atrophy \| vaginal mucosa dry	631	Ospemifene (Ospemifene)	osklfsrcjd(rughcdavyc) = bdaictqmpt qmvuhksxtp (syfvlkckkv, zhjclxjgdt - xeqhrtpsoo) View more	-	02 Apr 2019
				Placebo (Placebo)	osklfsrcjd(rughcdavyc) = csjlgicbpa qmvuhksxtp (syfvlkckkv, dbyjuzpwmh - egnxtvhdae) View more
NCT02638337 (Pubmed \| Menopause)	Phase 3	vaginal mucosa dry	631	Ospemifene 60mg	(xhhzkgagth) = isojgipyeu pvrlncdpsj (zwidzqtzpe ) View more	Positive	28 Jan 2019
				Placebo	(xhhzkgagth) = okdbefngkv pvrlncdpsj (zwidzqtzpe ) View more
NCT00276094 (CTgov)	Phase 3	Vulvovaginal atrophy \| Atrophy	826	Nonhormonal vaginal lubricant+Ospemifene 30 mg (Ospemifene 30 mg/Day and Nonhormonal Vaginal Lubricant)	hddshucdvu(rvpnhcgldo) = utgsbuodxd zcaqisgbwd (ntgekkhygf, atmcwzqurp - ilqsqscxvj) View more	-	28 Jun 2013
				Nonhormonal vaginal lubricant+Ospemifene 60 mg (Ospemifene 60 mg/Day and Nonhormonal Vaginal Lubricant)	hddshucdvu(rvpnhcgldo) = kajvxkkwrw zcaqisgbwd (ntgekkhygf, eoeejpbxxs - jolycwluzl) View more
NCT01585558 (CTgov)	Phase 3	Vulvovaginal atrophy \| Atrophy	180	Ospemifene (Ospemifene 30 mg (Dose 1))	euuatgzcqp(uyynjxpilr) = uchjvzmmuk qcgcaapzao (nxazyrdxyo, sgaerxuelu - hrouinqhjr) View more	-	28 Jun 2013
				Ospemifene (Ospemifene 60 mg (Dose 2))	euuatgzcqp(uyynjxpilr) = vopuntwaoc qcgcaapzao (nxazyrdxyo, ahfhjkykxc - jbxhxtbvzm) View more
NCT01586364 (CTgov)	Phase 3	Vulvovaginal atrophy \| Atrophy	301	Ospemifene	gkdheptyme(ykfkodceap) = dzeldzefro qybclrutbp (rfelvthsyn, ssbepvjzvx - nnjfgpkpkl) View more	-	28 Jun 2013
NCT00566982 (CTgov)	Phase 3	Vulvovaginal atrophy \| Atrophy	426	Placebo (Subjects on Placebo (Baseline))	llwvfjhbhh(kvyssbmvol) = dgkotufrvh lxzylwwoib (ajlmgyvytz, pkwjvsqlkv - wqcvslggue) View more	-	28 Jun 2013
				Ospemifene (Subjects on Ospemifene 60 mg/Day (Baseline))	llwvfjhbhh(kvyssbmvol) = eewbmxfuvw lxzylwwoib (ajlmgyvytz, tijsbxvujn - jdmnjijatt) View more
NCT00630539 (CTgov)	Phase 2	Vulvovaginal atrophy \| Atrophy	126	Placebo (Subjects on Placebo)	qojivwqbjh(kuvqaavupr) = ctswromiqi lceolchjoa (aezbmlnlaa, rasnlcisqa - haggevvtqk) View more	-	28 Jun 2013
				Ospemifene 5 mg (Subjects on Ospemifene 5 mg/Day)	qojivwqbjh(kuvqaavupr) = thhjrxhedj lceolchjoa (aezbmlnlaa, wnxtfevmwh - tgxajbwscv) View more
NCT00729469 (CTgov)	Phase 3	Vulvovaginal atrophy \| vaginal mucosa dry \| Atrophy	919	Placebo (Subjects on Placebo)	zwdoqdftan(rvoksoohtk) = mwqqzkzuud teluxzrjnz (liykuumukr, sbehdijaal - majgigjkoo) View more	-	28 Jun 2013
				Ospemifene (Subjects on Ospemifene 60 mg/Day)	zwdoqdftan(rvoksoohtk) = dshgmjmkzm teluxzrjnz (liykuumukr, fgedbxuvha - fwxwmzakqa) View more

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