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Bhardwaj R, Morris B, Matschke K, Bertz R, Croop R, Liu J. A Drug-Drug Interaction Study to Evaluate the Impact of Rimegepant on OCT2- and MATE1-Mediated Transport of Metformin in Healthy Participants. Clin Pharmacol Drug Dev 2024; 13:465-473. [PMID: 38174905 DOI: 10.1002/cpdd.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
Rimegepant is a calcitonin gene-related peptide receptor antagonist approved for migraine treatment. This phase 1, open-label, single-center, fixed-sequence study evaluated the effect of rimegepant on the pharmacokinetics (PK) of metformin. Twenty-eight healthy participants received metformin 500 mg twice daily from Days 1 to 4 and Days 7 to 10, and once daily on Days 5 and 11. Rimegepant, 75 mg tablet, was administered once daily from Days 9 to 12. At pre-specified time points, plasma metformin concentration, serum glucose levels, and safety and tolerability were evaluated. A 16% increase in the area under the plasma metformin concentration-time curve (AUC) for 1 dosing interval (AUC0-τ,ss), a statistically insignificant increase in maximum and minimum steady-state metformin concentration (Cmax,ss and Cmin,ss), and a decrease in metformin renal clearance were observed on Day 11 following metformin-rimegepant coadministration compared with metformin alone; however, the changes were not clinically relevant. Additionally, coadministration of rimegepant with metformin did not induce clinically meaningful change in the maximum observed glucose concentration (Gmax) or AUCgluc compared with metformin alone. Overall, rimegepant and metformin coadministration did not result in clinically relevant changes in metformin PK, renal clearance, or the antihyperglycemic effects of metformin. Rimegepant is considered safe for use with metformin.
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Piscitelli J, Reddy MB, Wollenberg L, Del Frari L, Gong J, Wood L, Zhang Y, Matschke K, Williams JH. Clinical Evaluation of the Effect of Encorafenib on Bupropion, Rosuvastatin, and Coproporphyrin I and Considerations for Statin Coadministration. Clin Pharmacokinet 2024; 63:483-496. [PMID: 38424308 PMCID: PMC11052825 DOI: 10.1007/s40262-024-01352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Encorafenib is a kinase inhibitor indicated for the treatment of patients with unresectable or metastatic melanoma or metastatic colorectal cancer, respectively, with selected BRAF V600 mutations. A clinical drug-drug interaction (DDI) study was designed to evaluate the effect of encorafenib on rosuvastatin, a sensitive substrate of OATP1B1/3 and breast cancer resistance protein (BCRP), and bupropion, a sensitive CYP2B6 substrate. Coproporphyrin I (CP-I), an endogenous substrate for OATP1B1, was measured in a separate study to deconvolute the mechanism of transporter DDI. METHODS DDI study participants received a single oral dose of rosuvastatin (10 mg) and bupropion (75 mg) on days - 7, 1, and 14 and continuous doses of encorafenib (450 mg QD) and binimetinib (45 mg BID) starting on day 1. The CP-I data were collected from participants in a phase 3 study who received encorafenib (300 mg QD) and cetuximab (400 mg/m2 initial dose, then 250 mg/m2 QW). Pharmacokinetic and pharmacodynamic analysis was performed using noncompartmental and compartmental methods. RESULTS Bupropion exposure was not increased, whereas rosuvastatin Cmax and area under the receiver operating characteristic curve (AUC) increased approximately 2.7 and 1.6-fold, respectively, following repeated doses of encorafenib and binimetinib. Increase in CP-I was minimal, suggesting that the primary effect of encorafenib on rosuvastatin is through BCRP. Categorization of statins on the basis of their metabolic and transporter profile suggests pravastatin would have the least potential for interaction when coadministered with encorafenib. CONCLUSION The results from these clinical studies suggest that encorafenib does not cause clinically relevant CYP2B6 induction or inhibition but is an inhibitor of BCRP and may also inhibit OATP1B1/3 to a lesser extent. Based on these results, it may be necessary to consider switching statins or reducing statin dosage accordingly for coadministration with encorafenib. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT03864042, registered 6 March 2019.
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Wilbring M, Arzt S, Alexiou K, Charitos E, Matschke K, Kappert U. Clinical Safety and Efficacy of the Transaxillary Access Route for Minimally Invasive Aortic Valve Replacement. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Baehring S, Dittfeld C, Alexiou K, Welzel C, Jannasch A, Matschke K, Tugtekin SM. Autologous or bovine pericardium for aortic cusp replacement? Histomorphological and biomechanical properties as decision making tools. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Aortic valve cusp replacement using autologous pericardium is a promising technique. Expected advantages are reduced immune response, proper biomechanics and lower treatment expenses. During surgery decision for preferred pericardium segment is based on visual criteria. Autologous pericardium can be affected by patient's condition and age. Bovine pericardium, also the basic material for aortic valve prostheses, is easy available and carefully pre-examined. In this study, the homogeneity of tissue thickness, elastic modulus, vessel density and ECM components of GA-treated residual pericardia after surgery is compared with bovine pericardia equivalently treated.
Purpose
Aim of the study is the comparison of homogeneity of remaining autologous pericardium after surgical aortic valve replacement with bovine pericardia to evaluate and classify the individual applicability.
Methods
Up to 12 samples of human (n=7) or bovine (n=3) pericardia were analysed. Tissues were treated with 0.6% glutaraldehyde according to surgical protocol. Picrosiriusred- and HE-staining were performed (three edges per separated leaflet). Vessel or collagen content was determined with Zen Blue resp. Fiji software (colour deconvolution plugin, user threshold values). Sample thickness was measured via thickness gauge FD50 before uniaxial tensile testing. Hydroxyproline content was determined and related to dry weight. T-Test or ANOVA were used to test inter-species or intra-individual differences, respectively.
Results
Human pericardia contain with 64.66±3.85% less collagenous fibres compared to bovine pericardia (86.01±1.713%); their vessel density is with 29.46±3.73 mm–2 significantly higher than in bovine samples (12.34±1.636 mm–2). In addition, human pericardia are with 367.7±59.2 μm significantly thinner than bovine (524.4±96.8 μm). Tensile testing (human: 36.00±15.17 MPa; bovine: 41.30±7.767 MPa) also revealed significant differences. With 77.80±11.76 mg/g merely a trend was observed for a lower hydroxyproline content in human samples (bovine 93.16±5.130 mg/g). ANOVA analyses of human pericardia illustrate significant differences for all properties, thus thickness, elastic modulus and hydroxyproline and collagen content between the individual human pericardium samples. In contrast, bovine pericardia showed an intra-individual difference only for the parameter of tissue thickness.
Conclusion
Human and bovine pericardia differ in histological and biomechanical parameters. In contrast to bovine pericardia, individual human pericardia were significantly different in most parameters investigated, leading to the conclusion that autologous materials are critically more heterogeneous than xenogeneic tissues. Vessel density in human pericardium was twofold higher than in bovine pericardia and can result in a higher risk for calcification.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): TU Dresden
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Diab AH, Moussa ME, Matschke K, Allham O. Mechanical Circulatory Support with the Transaortic Impella LD for Postcardiotomy Cardiogenic Shock at Heart Center Dresden (the Early, the Better Concept). Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weber C, Luehr M, Petrov G, Misfeld M, Akhyari P, Tugtekin SM, Diab M, Saha S, Elderia A, Lichtenberg A, Hagl C, Doenst T, Matschke K, Borger MA, Wahlers T. Increased Incidence of Mitral Valve and Streptococcus-Related Infective Endocarditis after the 2009 ESC Prophylaxis Guideline Modifications. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lühr M, Weber C, Misfeld M, Akhyari P, Tugtekin SM, Diab M, Saha S, Matschke K, Doenst T, Borger M, Wahlers T, Lichtenberg A, Hagl C. Incidence and Surgical Outcomes of Staphylococcus endocarditis: A Contemporary Analysis from the CAMPAIGN Registry. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Xu H, O'Gorman M, Matschke K, Boutros T, Brega N, Tan W, Bello A. Evaluation of Proton Pump Inhibitor Esomeprazole on Crizotinib Pharmacokinetics in Healthy Participants. Clin Pharmacol Drug Dev 2021; 11:34-42. [PMID: 34825782 PMCID: PMC9299459 DOI: 10.1002/cpdd.1032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
Crizotinib is a small‐molecule, multitargeted tyrosine kinase inhibitor that exhibits decreased aqueous solubility at a higher pH. This open‐label, randomized, phase 1 study (NCT01549574) evaluated the effect of multiple doses of the proton pump inhibitor esomeprazole on the pharmacokinetics (PK) of crizotinib and the safety of crizotinib with or without esomeprazole in healthy adults. Participants received a single 250‐mg crizotinib dose after overnight fast or a single 250‐mg crizotinib dose following esomeprazole 40 mg/day for 5 days. After a washout of ≥14 days, participants crossed over to the alternate treatment. Blood samples for plasma analysis were taken up to 144 hours after crizotinib dosing and relevant PK parameters estimated. Safety was assessed in all participants receiving ≥1 dose of study medication. Fifteen participants were evaluable for PK and safety for each treatment. Coadministration with esomeprazole resulted in a slight decrease (≈10%) in the crizotinib geometric mean area under the plasma concentration–time profile from time 0 to infinity (adjusted geometric mean ratio, 89.81% [90% confidence interval, 79.05‐102.03]). Coadministration of esomeprazole did not affect peak crizotinib exposure. Adverse events (AEs) occurred in similar numbers between treatments; no serious or severe AEs occurred. The most common AE was diarrhea. Although esomeprazole decreased total exposure of crizotinib, it is not considered clinically meaningful, and dose modification is not required when crizotinib is coadministered with agents that affect gastric pH.
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Dittfeld C, Koenig U, Welzel C, Jannasch A, Matschke K, Sperling C, Tugtekin SM, Maitz M. Haemocompatibility testing allows selective adaption of GA-free SULEEI-preparation strategy for bovine pericardium. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Bovine pericardium is the main natural source for patches or valve substitutes in cardiac surgery, but still, long-term durability is limited. An alternative, glutaraldehyde (GA)-free preparation combining decellularization, riboflavin/UVA crosslinking, and low-energy electron irradiation (SULEEI) procedure was established to avoid this. Protocol optimization is ongoing to further improve the final material. Haemocompatibility in vitro testing with fresh, human whole blood has advantages for material analysis, as it provides essential information on the activation of the complement system and immune cells therefore substantiating and possibly reducing the amount of animal testing.
Purpose
The haemocompatibility testing system was applied to reveal advantageous protocol adaptation of GA-free SULEEI preparation of pericardia.
Methods
Decellularized bovine pericardia were UVA-crosslinked in riboflavin/dextran solution. Protocol SULEEI B adaption includes the addition of trypsin in decellularization buffer and a 10x reduced riboflavin/dextran concentration during prolonged UVA irradiation with reduced intensity. Electron irradiation with 36 kGy was retained. Pericardia were incubated in blood chambers with heparinized human blood (2h, 37°C, GA-fixed/native controls). Inflammation (granulocyte loss and activation [CD11b]), complement activation (C5a) and haemostasis parameters (F1+2, PF4, granulocyte/platelet conjugates, platelet loss) were analyzed via flow cytometry or ELISA. Surface cell adhesion was investigated immunohistologically and via REM-analyses. Nuclear fragments were quantified in HE-stained sections.
Results
Haemostasis parameters F1+2 and PF4 were significantly higher in SULEEI A-pericardium (133±25 nmol/l and 1507±677 U/ml) vs. GA-fixation (2.9±2.9 nmol/l and 320±160 U/ml). Also, granulocyte/platelet conjugates (76.3±18.8%) and platelet loss (40.4±29.7%) were significantly higher after SULEEI A preparation in comparison to GA-fixation (39.3±9.9% and 20.5±6.4%). SULEEI B treated pericardia did not differ significantly. C5a complement activation was significantly lower in SULEEI A samples but comparable in SULEEI B to GA-fixed material. This is in contrast to a higher rate of nuclear fragments in SULEEI A tissue HE stained sections. Granulocyte activation of SULEEI pericardium (A: 89.8±29.7%; B: 106.2±18.8%) was significantly higher compared to native (46.1±22.6%) and for SULEEI B higher than in GA-fixed samples (67.2±9%). Granulocyte loss was comparable to GA-fixed pericardium after SULEEI B protocol. REM-analyses and histological evaluation visualized a dense blood cell and fibrin covering particular of SULEEI A-pericardium.
Conclusions
Haemocompatibility testing reveals advantageous properties of SULEEI B-pericardium. The impact of treatment substances such as dextran on high inflammatory response and dense surface covering in SULEEI A protocol is focus in ongoing experiments.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU/EFRE
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Dittfeld C, Winkelkotte M, Behrens S, Schmieder F, Jannasch A, Matschke K, Sonntag F, Tugtekin SM. Establishment of a resazurin-based aortic valve tissue viability assay for dynamic culture in a microphysiological system. Clin Hemorheol Microcirc 2021; 79:167-178. [PMID: 34487029 DOI: 10.3233/ch-219112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIM Tissue pathogenesis of aortic valve (AV) stenosis is research focus in cardiac surgery. Model limitations of conventional 2D culture of human or porcine valvular interstitial/endothelial cells (VIC/VECs) isolated from aortic valve tissues but also limited ability of (small) animal models to reflect human (patho)physiological situation in AV position raise the need to establish an in vitro setup using AV tissues. Resulting aim is to approximate (patho)physiological conditions in a dynamic pulsatile Microphysiological System (MPS) to culture human and porcine AV tissue with preservation of tissue viability but also defined ECM composition. MATERIALS/METHODS A tissue incubation chamber (TIC) was designed to implement human or porcine tissues (3×5 mm2) in a dynamic pulsatile culture in conventional cell culture ambience in a MPS. Cell viability assays based on lactate dehydrogenase (LDH)-release or resazurin-conversion were tested for applicability in the system and applied for a culture period of 14 days with interval evaluation of tissue viability on every other day. Resazurin-assay setup was compared in static vs. dynamic culture using varying substance saturation settings (50-300μM), incubation times and tissue masses and was consequently adapted. RESULTS Sterile dynamic culture of human and porcine AV tissue segments was established at a pulsatile flow rate range of 0.9-13.4μl/s. Implementation of tissues was realized by stitching the material in a thermoplastic polyurethane (TPU)-ring and insertion in the TIC-MPS-system. Culture volume of 2 ml caused LDH dilution not detectable in standard membrane integrity assay setup. Therefore, detection of resazurin-conversion of viable tissue was investigated. Optimal incubation time for viability conversion was determined at two hours at a saturated concentration of 300μM resazurin. Measurement in static conditions was shown to offer comparable results as dynamic condition but allowing optimal handling and TIC sterilization protocols for long term culture. Preliminary results revealed favourable porcine AV tissue viability over a 14 day period confirmed via resazurin-assay comparing statically cultured tissue counterparts. CONCLUSIONS Human and porcine AV tissue can be dynamically cultured in a TIC-MPS with monitoring of tissue viability using an adapted resazurin-assay setup. Preliminary results reveal advantageous viability of porcine AV tissues after dynamic TIC-MPS culture compared to static control.
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Knaut M, Sindt M, Grimm S, Matschke K, Madej T. Baroreflex Activation Therapy for Resistant Hypertension: Results from Midterm Prospective Ambulatory Blood Pressure Registry. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Madej T, Matschke K, Knaut M. Laser Lead Extraction: Predictors of Success and Complications. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Welzel C, Dittfeld C, Jannasch A, König U, Sperling C, Maitz M, Matschke K, Tugtekin SM. Hemocompatibility Assays Offer a New Option for Evaluation of Decellularized Bovine Pericardium for Application in Cardiac Surgery. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alexiou K, Tugtekin SM, Matschke K, Kappert U, Wilbring M, Arzt S. Does Clinical Outcome Still Justify the Application of Transcatheter Mitral Valve in Valve or Valve in Ring Procedures? Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zayat R, Allham O, Rotaru A, Diab AH, Huenges K, Panholzer B, Schnoering H, Matschke K, Cremer J, Autschbach R, Haneya A. Hemocompatibility-Related Adverse Events in a Real-World Cohort Comparing Three Different LVADs, the HeartWare, HeartMate II, and HeartMate 3: A Multicenter Observational Study. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dawra VK, Pelletier K, Matschke K, Shi H, Hickman A, Zhou S, Krishna R, Sahasrabudhe V. Bioequivalence of Metformin in Ertugliflozin/Metformin Fixed-Dose Combination Tablets to Canadian-Sourced Metformin Coadministered With Ertugliflozin Under Fasted and Fed States. Clin Pharmacol Drug Dev 2020; 10:510-520. [PMID: 33135865 PMCID: PMC8246554 DOI: 10.1002/cpdd.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
A fixed‐dose combination (FDC) product of a selective sodium‐glucose cotransporter 2 inhibitor ertugliflozin and immediate‐release metformin is approved for type 2 diabetes mellitus in the United States, European Union countries, Canada, and other countries. Two studies were conducted to assess the bioequivalence of metformin in the ertugliflozin/metformin FDC tablets to the corresponding doses of Canadian‐sourced metformin (Glucophage) coadministered with ertugliflozin. Both studies were phase 1 randomized, open‐label, 2‐period, single‐dose crossover studies (n = 32) in which healthy subjects received an ertugliflozin/metformin FDC tablet (2.5/500 mg or 7.5/850 mg) and the respective doses of the individual components (ertugliflozin coadministered with Canadian‐sourced metformin) under fasted (n = 18) or fed (n = 14) conditions. Blood samples were collected 72 hours postdose to determine metformin concentrations. The 90% confidence intervals were within the bioequivalence acceptance criteria for the adjusted geometric mean ratios (FDC:coadministered) for metformin area under the plasma concentration‐time curve from time zero to time t, where t is the last point with a measurable concentration and peak observed plasma concentration for both dose strengths under fasted and fed conditions. All study medications were well tolerated. Bioequivalence was demonstrated for the metformin component of the ertugliflozin/metformin FDC tablets and the corresponding doses of the Canadian‐sourced metformin coadministered with ertugliflozin.
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Tarabar S, Kelsh D, Vince B, Leyva R, Song D, Matschke K, Kellstein DE, Meeves S, Cruz-Rivera M. Phase I Pharmacokinetic Study of Fixed-Dose Combinations of Ibuprofen and Acetaminophen in Healthy Adult and Adolescent Populations. Drugs R D 2020; 20:23-37. [PMID: 32130679 PMCID: PMC7067710 DOI: 10.1007/s40268-020-00293-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction A fixed-dose combination (FDC) of ibuprofen and acetaminophen has been developed that provides greater analgesic efficacy than either agent alone at the same doses without increasing the risk for adverse events. Methods We report three clinical phase I studies designed to assess the pharmacokinetics (PK) of the FDC of ibuprofen/acetaminophen 250/500 mg (administered as two tablets of ibuprofen 125 mg/acetaminophen 250 mg) in comparison with its individual components administered alone or together, and to determine the effect of food on the PK of the FDC. Two studies in healthy adults aged 18–55 years used a crossover design in which subjects received a single dose of each treatment with a 2-day washout period between each. In the third study, the bioavailability of ibuprofen and acetaminophen from a single oral dose of the FDC was assessed in healthy adolescents aged 12–17 years, inclusive. Results A total of 35 and 46 subjects were enrolled in the two adult studies, respectively, and 21 were enrolled in the adolescent study. Ibuprofen and acetaminophen in the FDC were bioequivalent to the monocomponents administered alone or together. With food, the maximum concentration (Cmax) for ibuprofen and acetaminophen from the FDC was reduced by 36% and 37%, respectively, and time to Cmax (i.e. tmax) was delayed. Overall drug exposure to ibuprofen or acetaminophen in the fed versus fasted states was similar. In adolescents, overall exposure to acetaminophen and ibuprofen was comparable with that in adults, with a slightly higher overall exposure to ibuprofen. Exposure to acetaminophen and ibuprofen in adolescents aged 12–14 years was slightly higher versus those aged 15–17 years. Adverse events were similar across all treatment groups. Conclusions The FDC of ibuprofen/acetaminophen 250/500 mg has a PK profile similar to its monocomponent constituents when administered separately or coadministered, indicating no drug–drug interactions and no formulation effects. Similar to previous findings for the individual components, the rates of absorption of ibuprofen and acetaminophen from the FDC were slightly delayed in the presence of food. Overall, adolescents had similar exposures to acetaminophen and ibuprofen as adults, while younger adolescents had slightly greater exposure than older adolescents, probably due to their smaller body size. The FDC was generally well tolerated.
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Park JW, Matschke K, Mrowietz C, Krüger-Genge A, Jung F. HELP-(Heparin-induced Extracorporeal LDL Precipitation)-apheresis in heart recipients with cardiac allograft vasculopathy and concomitant hypercholesterolemia: Influence of long-term treatment on the microcirculation. Clin Hemorheol Microcirc 2020; 73:19-27. [PMID: 31561344 DOI: 10.3233/ch-199216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hyperlipidemic heart transplant patients who develop cardiac allograft vasculopathy (CAV) benefit from HELP-apheresis (Heparin-induced Extracorporeal LDL Precipitation) which enables drastic lowering of plasma low-density lipoprotein, lipoprotein (a), and fibrinogen. There is evidence that HELP-apheresis also improves microcirculation by an immediate improvement of impaired endothelial-dependent vasodilatation and additive hemorheological effects.Therefore, cutaneous microcirculation was examined before, during, and after the first HELP-apheresis in eight hyperlipidemic cardiac transplant recipients with CAV. To study the long-term effect the intravital microscopy was repeated after three and 12 months of weekly apheresis treatment.In CAV patients the baseline mean erythrocyte velocity was pathologically reduced with 0.13±0.07 mm/s. During the first HELP-apheresis the erythrocyte velocity increased significantly (p = 0.0001) and remained increased until the end of the HELP procedure (p < 0.05). After three months of weekly apheresis treatment a decrease of temporary flow stops in the capillaries with a progressive homogenization (concordance) of the cutaneous microcirculation was observed. After one year of weekly treatment a markedly increase in mean erythrocyte velocity under resting conditions occurred. In addition, a reactive post-ischemic hyperemia could be established for the first time.Even the first single HELP-apheresis resulted in a significant improvement of the cutaneous microcirculation. The long-term treatment of these patients resulted in a marked improvement of the cutaneous microcirculation with the tendency to a normalization of the regulation of the capillary perfusion.
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Wilbring M, Petrov A, Kappert U, Arzt S, Alexiou K, Matschke K. What TAVI Has Done with Us—Impact of Catheter-based Procedures on a Surgical Aortic Valve Program. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wilbring M, Matschke K, Kappert U. No Visible Scars LVAD Implantation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wilbring M, Alexiou K, Arzt S, Matschke K, Kappert U. One-Access Concept for Minimally Invasive Valve Surgery. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wilbring M, Alexiou K, Matschke K, Kappert U. Surgical Aortic Valve Replacement without Visible Scars: The Right Lateral Access. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fediuk DJ, Matschke K, Liang Y, Pelletier KB, Wei H, Shi H, Bass A, Hickman A, Terra SG, Zhou S, Krishna R, Sahasrabudhe V. Bioequivalence of Ertugliflozin/Sitagliptin Fixed-Dose Combination Tablets and Coadministration of Respective Strengths of Individual Components. Clin Pharmacol Drug Dev 2019; 8:884-894. [PMID: 31219248 PMCID: PMC6851892 DOI: 10.1002/cpdd.722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 06/03/2019] [Indexed: 12/12/2022]
Abstract
A fixed-dose combination (FDC) tablet of ertugliflozin, a selective inhibitor of sodium-glucose cotransporter 2, and sitagliptin, a dipeptidyl peptidase-4 inhibitor, was developed for the treatment of patients with type 2 diabetes mellitus. Four studies were conducted under fasted conditions to demonstrate bioequivalence of ertugliflozin/sitagliptin FDC tablets and individual components at respective strengths when coadministered in healthy subjects. All studies had open-label, randomized, 2-period, 2-sequence, single-dose crossover designs. In each study 18 or 19 subjects were enrolled and received an ertugliflozin/sitagliptin FDC tablet (5 mg/50 mg, 5 mg/100 mg, 15 mg/50 mg, or 15 mg/100 mg) and corresponding strengths of ertugliflozin and sitagliptin coadministered as individual components. For both ertugliflozin and sitagliptin, the 90%CIs for the ratio (FDC:coadministration) of geometric means for area under the plasma concentration-time profile from time 0 extrapolated to infinite time, and maximum observed plasma concentration, were within acceptance criteria for bioequivalence (80% to 125%). All adverse events were mild in intensity. The 4 studies demonstrated that each strength of FDC tablet is bioequivalent to the respective dose of coadministered individual components. This indicates that the known efficacy and tolerability of ertugliflozin and sitagliptin when coadministered can be translated to the use of a FDC formulation.
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Li Y, Mu Y, Shi H, Liang Y, Liu Z, Matschke K, Hickman A, Krishna R, Sahasrabudhe V. Pharmacokinetic Properties of Single and Multiple Doses of Ertugliflozin, a Selective Inhibitor of SGLT2, in Healthy Chinese Subjects. Clin Pharmacol Drug Dev 2019; 9:97-106. [PMID: 30934166 PMCID: PMC7003779 DOI: 10.1002/cpdd.686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/11/2019] [Indexed: 12/22/2022]
Abstract
Ertugliflozin, a sodium-glucose cotransporter 2 inhibitor for the treatment of type 2 diabetes mellitus, prevents renal glucose reabsorption resulting in urinary glucose excretion. This open-label, parallel cohort, randomized study conducted in healthy Chinese adults residing in China assessed the pharmacokinetics, tolerability, and safety of 5 mg and 15 mg of ertugliflozin following single (fasted condition) and multiple-dose (fed condition) administration. Sixteen subjects were randomized and completed the study. Ertugliflozin absorption was rapid, with maximum plasma concentrations observed 1 hour after dosing under fasted conditions and 2 to 4 hours after dosing under fed conditions. Following single- and multiple-dose administration, ertugliflozin exhibited dose-proportional exposures with an apparent mean terminal half-life of approximately 9.5 to 11.9 hours. Steady state was reached after 4 once-daily doses. The accumulation ratio based on the area under the plasma concentration-time curve after multiple-dose administration was approximately 1.3 and 1.2 for ertugliflozin 5 mg and 15 mg, respectively. Ertugliflozin was generally well tolerated following administration of single and multiple oral doses of 5 mg and 15 mg in healthy Chinese subjects. Pharmacokinetic comparison with non-Asian subjects indicated that there are no clinically meaningful racial differences and no dose modification of ertugliflozin is required based on race or body weight.
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Wilbring M, Matschke K. Rekonstruktion bei Trikuspidalklappenerkrankungen in jedem Fall? ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-018-0252-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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