Effects of ketoconazole and valproic acid on the pharmacokinetics of the next generation NNRTI, lersivirine (UK‐453,061), in healthy adult subjects

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Lersivirine (UK‐453,061) is predominantly cleared by glucuronidation (UGT2B7) and oxidation via cytochrome P450 (CYP) 3A4. • Lersivirine metabolism, and thus pharmacokinetics, may be affected by concomitant administration of drugs affecting CYP3A4 and UGT2B...

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Published in:British journal of clinical pharmacology Vol. 73; no. 5; pp. 768 - 775
Main Authors: Langdon, Grant, Davis, John, Layton, Gary, Chong, Chew‐Lan, Weissgerber, Georges, Vourvahis, Manoli
Format: Journal Article
Language:English
Published: Oxford, UK Blackwell Publishing Ltd 01.05.2012
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ISSN:0306-5251, 1365-2125, 1365-2125
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Abstract WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Lersivirine (UK‐453,061) is predominantly cleared by glucuronidation (UGT2B7) and oxidation via cytochrome P450 (CYP) 3A4. • Lersivirine metabolism, and thus pharmacokinetics, may be affected by concomitant administration of drugs affecting CYP3A4 and UGT2B7. • Ketoconazole is a potent inhibitor of CYP3A4 and an inhibitor of UGT2B7. Valproic acid is a potent inhibitor of UGT2B7. WHAT THIS STUDY ADDS • Combined inhibition of CYP3A4 and UGT2B7 with ketoconazole increases the exposure of lersivirine, and may warrant lersivirine dose adjustment to compensate for this interaction. • Inhibition of UGT2B7 with valproic acid does not have a substantial effect on lersivirine pharmacokinetics. AIMS To investigate the effect of inhibitors of cytochrome P450 (CYP) 3A4 and glucuronidation (UGT2B7) on the pharmacokinetics of lersivirine (UK‐453,061), a next generation non‐nucleoside reverse transcriptase inhibitor with a unique resistance profile, and to investigate the safety and tolerability of co‐administration of lersivirine with these inhibitors. METHODS Two open‐label, randomized, placebo‐controlled, crossover studies were conducted in healthy subjects. Study 1 investigated the effect of ketoconazole (400 mg once daily) on the pharmacokinetics of lersivirine (250 mg once daily). Subjects received ketoconazole 400 mg once daily or placebo on days 1–2 and received lersivirine 250 mg once daily and ketoconazole 400 mg once daily or placebo on days 3–9. Study 2 investigated the effect of valproic acid (VPA, sodium valproate, 1000 mg once daily) on the PK of lersivirine (500 mg once daily). On days 1–7, subjects received lersivirine 500 mg once daily plus either VPA 1000 mg or placebo. RESULTS Compared with lersivirine alone, co‐administration with ketoconazole increased the lersivirine mean area under the curve (AUC(0,24 h)) and maximum plasma concentration (Cmax) by 82% (90% CI 74%, 91%) and 61% (90% CI 41%, 83%), respectively. VPA increased the mean lersivirine AUC(0,24 h) by 25% (90% CI 16%, 35%), with little effect on Cmax (2.5%, 90% CI −9%, 16%). There were no serious adverse events and no treatment‐related discontinuations from either study. CONCLUSIONS Inhibition of CYP3A4 and UGT2B7 by ketoconazole increased lersivirine exposure. Inhibition of UGT2B7‐mediated glucuronidation by VPA had a modest effect on lersivirine exposure. Co‐administration of lersivirine with either ketoconazole or VPA appeared to be well tolerated.
AbstractList WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Lersivirine (UK‐453,061) is predominantly cleared by glucuronidation (UGT2B7) and oxidation via cytochrome P450 (CYP) 3A4. • Lersivirine metabolism, and thus pharmacokinetics, may be affected by concomitant administration of drugs affecting CYP3A4 and UGT2B7. • Ketoconazole is a potent inhibitor of CYP3A4 and an inhibitor of UGT2B7. Valproic acid is a potent inhibitor of UGT2B7. WHAT THIS STUDY ADDS • Combined inhibition of CYP3A4 and UGT2B7 with ketoconazole increases the exposure of lersivirine, and may warrant lersivirine dose adjustment to compensate for this interaction. • Inhibition of UGT2B7 with valproic acid does not have a substantial effect on lersivirine pharmacokinetics. AIMS To investigate the effect of inhibitors of cytochrome P450 (CYP) 3A4 and glucuronidation (UGT2B7) on the pharmacokinetics of lersivirine (UK‐453,061), a next generation non‐nucleoside reverse transcriptase inhibitor with a unique resistance profile, and to investigate the safety and tolerability of co‐administration of lersivirine with these inhibitors. METHODS Two open‐label, randomized, placebo‐controlled, crossover studies were conducted in healthy subjects. Study 1 investigated the effect of ketoconazole (400 mg once daily) on the pharmacokinetics of lersivirine (250 mg once daily). Subjects received ketoconazole 400 mg once daily or placebo on days 1–2 and received lersivirine 250 mg once daily and ketoconazole 400 mg once daily or placebo on days 3–9. Study 2 investigated the effect of valproic acid (VPA, sodium valproate, 1000 mg once daily) on the PK of lersivirine (500 mg once daily). On days 1–7, subjects received lersivirine 500 mg once daily plus either VPA 1000 mg or placebo. RESULTS Compared with lersivirine alone, co‐administration with ketoconazole increased the lersivirine mean area under the curve (AUC(0,24 h)) and maximum plasma concentration (Cmax) by 82% (90% CI 74%, 91%) and 61% (90% CI 41%, 83%), respectively. VPA increased the mean lersivirine AUC(0,24 h) by 25% (90% CI 16%, 35%), with little effect on Cmax (2.5%, 90% CI −9%, 16%). There were no serious adverse events and no treatment‐related discontinuations from either study. CONCLUSIONS Inhibition of CYP3A4 and UGT2B7 by ketoconazole increased lersivirine exposure. Inhibition of UGT2B7‐mediated glucuronidation by VPA had a modest effect on lersivirine exposure. Co‐administration of lersivirine with either ketoconazole or VPA appeared to be well tolerated.
To investigate the effect of inhibitors of cytochrome P450 (CYP) 3A4 and glucuronidation (UGT2B7) on the pharmacokinetics of lersivirine (UK-453,061), a next generation non-nucleoside reverse transcriptase inhibitor with a unique resistance profile, and to investigate the safety and tolerability of co-administration of lersivirine with these inhibitors.AIMSTo investigate the effect of inhibitors of cytochrome P450 (CYP) 3A4 and glucuronidation (UGT2B7) on the pharmacokinetics of lersivirine (UK-453,061), a next generation non-nucleoside reverse transcriptase inhibitor with a unique resistance profile, and to investigate the safety and tolerability of co-administration of lersivirine with these inhibitors.Two open-label, randomized, placebo-controlled, crossover studies were conducted in healthy subjects. Study 1 investigated the effect of ketoconazole (400 mg once daily) on the pharmacokinetics of lersivirine (250 mg once daily). Subjects received ketoconazole 400 mg once daily or placebo on days 1-2 and received lersivirine 250 mg once daily and ketoconazole 400 mg once daily or placebo on days 3-9. Study 2 investigated the effect of valproic acid (VPA, sodium valproate, 1000 mg once daily) on the PK of lersivirine (500 mg once daily). On days 1-7, subjects received lersivirine 500 mg once daily plus either VPA 1000 mg or placebo.METHODSTwo open-label, randomized, placebo-controlled, crossover studies were conducted in healthy subjects. Study 1 investigated the effect of ketoconazole (400 mg once daily) on the pharmacokinetics of lersivirine (250 mg once daily). Subjects received ketoconazole 400 mg once daily or placebo on days 1-2 and received lersivirine 250 mg once daily and ketoconazole 400 mg once daily or placebo on days 3-9. Study 2 investigated the effect of valproic acid (VPA, sodium valproate, 1000 mg once daily) on the PK of lersivirine (500 mg once daily). On days 1-7, subjects received lersivirine 500 mg once daily plus either VPA 1000 mg or placebo.Compared with lersivirine alone, co-administration with ketoconazole increased the lersivirine mean area under the curve (AUC(0,24 h)) and maximum plasma concentration (C(max) ) by 82% (90% CI 74%, 91%) and 61% (90% CI 41%, 83%), respectively. VPA increased the mean lersivirine AUC(0,24 h) by 25% (90% CI 16%, 35%), with little effect on C(max) (2.5%, 90% CI -9%, 16%). There were no serious adverse events and no treatment-related discontinuations from either study.RESULTSCompared with lersivirine alone, co-administration with ketoconazole increased the lersivirine mean area under the curve (AUC(0,24 h)) and maximum plasma concentration (C(max) ) by 82% (90% CI 74%, 91%) and 61% (90% CI 41%, 83%), respectively. VPA increased the mean lersivirine AUC(0,24 h) by 25% (90% CI 16%, 35%), with little effect on C(max) (2.5%, 90% CI -9%, 16%). There were no serious adverse events and no treatment-related discontinuations from either study.Inhibition of CYP3A4 and UGT2B7 by ketoconazole increased lersivirine exposure. Inhibition of UGT2B7-mediated glucuronidation by VPA had a modest effect on lersivirine exposure. Co-administration of lersivirine with either ketoconazole or VPA appeared to be well tolerated.CONCLUSIONSInhibition of CYP3A4 and UGT2B7 by ketoconazole increased lersivirine exposure. Inhibition of UGT2B7-mediated glucuronidation by VPA had a modest effect on lersivirine exposure. Co-administration of lersivirine with either ketoconazole or VPA appeared to be well tolerated.
To investigate the effect of inhibitors of cytochrome P450 (CYP) 3A4 and glucuronidation (UGT2B7) on the pharmacokinetics of lersivirine (UK-453,061), a next generation non-nucleoside reverse transcriptase inhibitor with a unique resistance profile, and to investigate the safety and tolerability of co-administration of lersivirine with these inhibitors. Two open-label, randomized, placebo-controlled, crossover studies were conducted in healthy subjects. Study 1 investigated the effect of ketoconazole (400 mg once daily) on the pharmacokinetics of lersivirine (250 mg once daily). Subjects received ketoconazole 400 mg once daily or placebo on days 1-2 and received lersivirine 250 mg once daily and ketoconazole 400 mg once daily or placebo on days 3-9. Study 2 investigated the effect of valproic acid (VPA, sodium valproate, 1000 mg once daily) on the PK of lersivirine (500 mg once daily). On days 1-7, subjects received lersivirine 500 mg once daily plus either VPA 1000 mg or placebo. Compared with lersivirine alone, co-administration with ketoconazole increased the lersivirine mean area under the curve (AUC(0,24 h)) and maximum plasma concentration (C(max) ) by 82% (90% CI 74%, 91%) and 61% (90% CI 41%, 83%), respectively. VPA increased the mean lersivirine AUC(0,24 h) by 25% (90% CI 16%, 35%), with little effect on C(max) (2.5%, 90% CI -9%, 16%). There were no serious adverse events and no treatment-related discontinuations from either study. Inhibition of CYP3A4 and UGT2B7 by ketoconazole increased lersivirine exposure. Inhibition of UGT2B7-mediated glucuronidation by VPA had a modest effect on lersivirine exposure. Co-administration of lersivirine with either ketoconazole or VPA appeared to be well tolerated.
Author Davis, John
Chong, Chew‐Lan
Weissgerber, Georges
Layton, Gary
Langdon, Grant
Vourvahis, Manoli
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Issue 5
Keywords Human
Imidazole derivatives
4-Aminobutyrate transaminase
Healthy subject
Ketoconazole
Enzyme
Transferases
Non nucleoside compound
UK-453,061
Enzyme inhibitor
Anticonvulsant
Valproic acid
Histone deacetylase inhibitor
Antifungal agent
Mood stabilizer
Transaminases
Reverse transcriptase inhibitor
Lersivirine
Antiviral
Pharmacokinetics
Language English
License http://onlinelibrary.wiley.com/termsAndConditions#vor
CC BY 4.0
2011 Pfizer Inc. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.
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Notes Current address: ESBATech, an Alcon Biomedical Research Unit, Wagistrasse 21, 8952 Zurich‐Schlieren, Switzerland.
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Snippet WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Lersivirine (UK‐453,061) is predominantly cleared by glucuronidation (UGT2B7) and oxidation via cytochrome P450...
To investigate the effect of inhibitors of cytochrome P450 (CYP) 3A4 and glucuronidation (UGT2B7) on the pharmacokinetics of lersivirine (UK-453,061), a next...
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StartPage 768
SubjectTerms Adult
Antifungal Agents - pharmacology
Area Under Curve
Asian People
Biological and medical sciences
Cross-Over Studies
Cytochrome P-450 CYP3A - metabolism
Drug Interactions
Enzyme Inhibitors - pharmacology
Glucuronosyltransferase - metabolism
Humans
ketoconazole
Ketoconazole - pharmacology
lersivirine
Male
Medical sciences
Middle Aged
Nitriles - administration & dosage
Nitriles - pharmacokinetics
pharmacokinetics
Pharmacology. Drug treatments
Pyrazoles - administration & dosage
Pyrazoles - pharmacokinetics
Reverse Transcriptase Inhibitors - administration & dosage
Reverse Transcriptase Inhibitors - pharmacokinetics
UK‐453,061
valproic acid
Valproic Acid - pharmacology
Young Adult
Title Effects of ketoconazole and valproic acid on the pharmacokinetics of the next generation NNRTI, lersivirine (UK‐453,061), in healthy adult subjects
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fj.1365-2125.2011.04136.x
https://www.ncbi.nlm.nih.gov/pubmed/22040521
https://www.proquest.com/docview/993316214
https://pubmed.ncbi.nlm.nih.gov/PMC3403204
Volume 73
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