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Jain P, Thota A, Saini PK, Raghuvanshi RS. Comprehensive Review on Different Analytical Techniques for HIV 1- Integrase Inhibitors: Raltegravir, Dolutegravir, Elvitegravir and Bictegravir. Crit Rev Anal Chem 2022; 54:401-415. [PMID: 35617468 DOI: 10.1080/10408347.2022.2080493] [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] [Indexed: 10/18/2022]
Abstract
The advent of HIV-Integrase inhibitors (IN) has marked a significant impact on the lives of HIV patients. Since the launch of the first anti retro-viral drug "Azidothymidine" to the recent advances of IN inhibitors, about 27.4 million people benefit by antiretroviral therapy (ART). The path had been challenging due to many crossroads, leading to the discovery of newer targets. One such recent ART target is Integrase. Use of Integrase inhibitors has surpassed the usage of all other ART owing to a strong barrier to resistance and have been reported to be the first-line therapy. Raltegravir, Elvitegravir, Dolutegravir and Bictegravir are US FDA approved IN inhibitors. The high usage of ART created an opportunity to study various analytical techniques for IN inhibitors. Hitherto, no review encompassing all IN inhibitors is presented. Herein, this review describes the analytical techniques employed for IN inhibitors estimation and quantification reported in the literature and official compendia. Literature suggests that most studies focus on LC-MS/MS and HPLC methods for drug estimation, and few reports suggest spectrophotometric, spectrofluorimetric and electrochemical methods. Furthermore, the review presents the techniques that describe the quantification of integrase drugs in various matrices. Although, antiretroviral drugs are extensively used but data suggests that limited studies have been conducted for determination of impurity profile and stability. This therefore, presents a scope to detect and validate impurities in order to meet ICH guidelines for their limits and further to improve the quality and safety of antiretroviral drugs.
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Affiliation(s)
- Priti Jain
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Anusha Thota
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Pawan K Saini
- Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Ghaziabad, UP, India
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Zheng Y, Aboura R, Boujaafar S, Lui G, Hirt D, Bouazza N, Foissac F, Treluyer JM, Benaboud S, Gana I. HPLC-MS/MS method for the simultaneous quantification of dolutegravir, elvitegravir, rilpivirine, darunavir, ritonavir, raltegravir and raltegravir-β-d-glucuronide in human plasma. J Pharm Biomed Anal 2020; 182:113119. [PMID: 32004775 DOI: 10.1016/j.jpba.2020.113119] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/26/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022]
Abstract
Therapeutic drug monitoring (TDM) is essential in the optimization of antiretroviral (ARV) treatments. In this work, we describe a new method for the simultaneous quantification of six molecules: the three novel ARV agents dolutegravir (DTG), elvitegravir (ELV) and rilpivirine (RPV), the first integrase inhibitor raltegravir (RAL) and its major metabolite the raltegravir-β-d-glucuronide (RAL-GLU), an protease inhibitor darunavir (DRV) and its booster ritonavir (RTV) in human plasma. The drugs were extracted from 100 μL of plasma by a simple method of protein precipitation using acetonitrile. The separation was carried out on a Kinetex phehyl-hexyl column using a phase mobile composed of 55 % of water (0.05 % formic acid,v/v) and 45 % of methanol (0.05 % formic acid,v/v). The flow rate was set at 0.5 mL/min. The calibration ranged from 60 to 15000 ng/mL for DRV, from 20 to 5000 ng/mL for DTG and ELV, from 10 to 2500 ng/mL for RAL, RAL-GLU, RTV and RPV. The proposed method was validated with a good precision (inter- and intra-day CV% inferior to 12.3 %) and a good accuracy (inter- and intra-day bias between -9.9 % and 10 %) for all the analytes. The proposed method is simple, reliable and suitable for therapeutic drug monitoring (TDM) and for pharmacokinetics studies.
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Affiliation(s)
- Yi Zheng
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Paris Centre, Paris, France; EA 7323, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France; Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France.
| | - Radia Aboura
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Paris Centre, Paris, France
| | - Sana Boujaafar
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Paris Centre, Paris, France
| | - Gabrielle Lui
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Paris Centre, Paris, France; EA 7323, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France; Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Déborah Hirt
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Paris Centre, Paris, France; EA 7323, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France; Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Naïm Bouazza
- EA 7323, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France; Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Frantz Foissac
- EA 7323, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France; Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jean-Marc Treluyer
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Paris Centre, Paris, France; EA 7323, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France; Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Sihem Benaboud
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Paris Centre, Paris, France; EA 7323, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France; Unité de Recherche Clinique Paris Descartes Necker Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Inès Gana
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Paris Centre, Paris, France
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Moreira FDL, Marques MP, Duarte G, Lanchote VL. Determination of raltegravir and raltegravir glucuronide in human plasma and urine by LC-MS/MS with application in a maternal-fetal pharmacokinetic study. J Pharm Biomed Anal 2019; 177:112838. [PMID: 31525573 DOI: 10.1016/j.jpba.2019.112838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 12/01/2022]
Abstract
Raltegravir (RAL) is a HIV-integrase inhibitor recommended for treatment of HIV type 1 infection during pregnancy. The elimination of RAL to RAL glucuronide (RAL GLU) is mediated primarily by UDP glucuronosyltransferase 1A1 (UGT1A1). The present study shows the development and validation of 4 different methods for the analysis of RAL and RAL GLU in plasma and in urine samples. The methods were applied to evaluate the maternal-fetal pharmacokinetics of RAL and RAL GLU in a HIV-infected pregnant woman receiving RAL 400 mg twice daily. The sample preparation for RAL and RAL GLU analysis in 25 μL plasma and 100 μL diluted urine (10-fold with water containing 0.1% formic acid) were carried out by protein precipitation procedure. RAL and RAL GLU generate similar product mass fragments and require separation in the chromatographic system, so a suitable resolution was achieved for unchanged RAL and RAL GLU employing Ascentis Express C18 (75 × 4.6 mm, 2.7 μm) for both plasma and urine samples. The methods showed linearities at the ranges of 0.1-13.5 μg/mL RAL and 0.15-19.5 μg/mL RAL GLU in urine and 10-2000 ng/mL RAL and 2.5-800 RAL GLU in plasma. Precise and accurate evaluation showed coefficients of variation and relative errors ≤ 15%. The methods have been successfully applied in a maternal-fetal pharmacokinetic study.
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Affiliation(s)
- Fernanda de Lima Moreira
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria Paula Marques
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Geraldo Duarte
- Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Vera Lucia Lanchote
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
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4
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Lee LSU, Seng KY, Wang LZ, Yong WP, Hee KH, Soh TI, Wong A, Cheong PF, Soong R, Sapari NS, Soo R, Fan L, Lee SC, Goh BC. Phenotyping of UGT1A1 Activity Using Raltegravir Predicts Pharmacokinetics and Toxicity of Irinotecan in FOLFIRI. PLoS One 2016; 11:e0147681. [PMID: 26808671 PMCID: PMC4726617 DOI: 10.1371/journal.pone.0147681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/06/2016] [Indexed: 02/04/2023] Open
Abstract
Background Irinotecan toxicity correlates with UGT1A1 activity. We explored whether phenotyping UGT1A1 using a probe approach works better than current genotyping methods. Methods Twenty-four Asian cancer patients received irinotecan as part of the FOLFIRI regimen. Subjects took raltegravir 400 mg orally and intravenous midazolam 1 mg. Pharmacokinetic analyses were performed using WinNonLin and NONMEM. Genomic DNA was isolated and screened for the known genetic variants in UGT1A1 and CYP3A4/5. Results SN-38G/SN-38 AUC ratio correlated well with Raltegravir glucuronide/ Raltegravir AUC ratio (r = 0.784 p<0.01). Midazolam clearance correlated well with irinotecan clearance (r = 0.563 p<0.01). SN-38 AUC correlated well with Log10Nadir Absolute Neutrophil Count (ANC) (r = -0.397 p<0.05). Significant correlation was found between nadir ANC and formation rate constant of raltegravir glucuronide (r = 0.598, P<0.005), but not UGT1A1 genotype. Conclusion Raltegravir glucuronide formation is a good predictor of nadir ANC, and can predict neutropenia in East Asian patients. Prospective studies with dose adjustments should be done to develop raltegravir as a probe to optimize irinotecan therapy. Trial Registration Clinicaltrials.gov NCT00808184
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Affiliation(s)
- Lawrence Soon-U Lee
- Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Kok-Yong Seng
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Ling-Zhi Wang
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Cancer Science Institute, National University of Singapore, Singapore, Singapore
| | - Wei-Peng Yong
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
| | - Kim-Hor Hee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Thomas I. Soh
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
| | - Andrea Wong
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
| | - Pei F. Cheong
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
| | - Richie Soong
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Nur S. Sapari
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Ross Soo
- Department of Medicine, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Lu Fan
- Cancer Science Institute, National University of Singapore, Singapore, Singapore
| | - Soo-Chin Lee
- Cancer Science Institute, National University of Singapore, Singapore, Singapore
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
| | - Boon C. Goh
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Cancer Science Institute, National University of Singapore, Singapore, Singapore
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
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Gupta A, Guttikar S, Shah PA, Solanki G, Shrivastav PS, Sanyal M. Selective and rapid determination of raltegravir in human plasma by liquid chromatography-tandem mass spectrometry in the negative ionization mode. J Pharm Anal 2015; 5:101-109. [PMID: 29403921 PMCID: PMC5761471 DOI: 10.1016/j.jpha.2014.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/28/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022] Open
Abstract
A selective and rapid high-performance liquid chromatography-tandem mass spectrometry method was developed and validated for the quantification of raltegravir using raltegravir-d3 as an internal standard (IS). The analyte and IS were extracted with methylene chloride and n-hexane solvent mixture from 100 µL human plasma. The chromatographic separation was achieved on a Chromolith RP-18e endcapped C18 (100 mm×4.6 mm) column in a run time of 2.0 min. Quantitation was performed in the negative ionization mode using the transitions of m/z 443.1→316.1 for raltegravir and m/z 446.1→319.0 for IS. The linearity of the method was established in the concentration range of 2.0-6000 ng/mL. The mean extraction recovery for raltegravir and IS was 92.6% and 91.8%, respectively, and the IS-normalized matrix factors for raltegravir ranged from 0.992 to 0.999. The application of this method was demonstrated by a bioequivalence study on 18 healthy subjects.
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Affiliation(s)
- Ajay Gupta
- Chemistry Department, Kadi Sarva Vishwavidyalaya, Sarva Vidyalaya Campus, Sector 15/23, Gandhinagar 382015, Gujarat, India
| | - Swati Guttikar
- Bioanalytical Research Department, Veeda Clinical Research, Ambawadi, Ahmedabad 380015, Gujarat, India
| | - Priyanka A Shah
- Department of Chemistry, School of Sciences, Gujarat University, Ahmedabad 380009, Gujarat, India
| | - Gajendra Solanki
- Bioanalytical Research Department, Veeda Clinical Research, Ambawadi, Ahmedabad 380015, Gujarat, India
| | - Pranav S Shrivastav
- Department of Chemistry, School of Sciences, Gujarat University, Ahmedabad 380009, Gujarat, India
| | - Mallika Sanyal
- Chemistry Department, Kadi Sarva Vishwavidyalaya, Sarva Vidyalaya Campus, Sector 15/23, Gandhinagar 382015, Gujarat, India.,Department of Chemistry, St. Xavier׳s College, Navrangpura, Ahmedabad 380009, Gujarat, India
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6
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Simultaneous determination of probe drugs, metabolites, inhibitors and inducer in human plasma by liquid chromatography/tandem mass spectrometry and its application to pharmacokinetic study. J Pharm Biomed Anal 2014; 88:584-93. [DOI: 10.1016/j.jpba.2013.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/03/2013] [Accepted: 09/04/2013] [Indexed: 12/20/2022]
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7
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Seng KY, Hee KH, Soon GH, Sapari NS, Soong R, Goh BC, Lee LSU. CYP3A5*3 and bilirubin predict midazolam population pharmacokinetics in Asian cancer patients. J Clin Pharmacol 2013; 54:215-24. [DOI: 10.1002/jcph.230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 11/05/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Kok-Yong Seng
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
- Defence Medical & Environmental Research Institute; DSO National Laboratories; Singapore Singapore
| | - Kim-Hor Hee
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Gaik Hong Soon
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Nur Sabrina Sapari
- Cancer Science Institute of Singapore; National University of Singapore; Singapore Singapore
| | - Richie Soong
- Cancer Science Institute of Singapore; National University of Singapore; Singapore Singapore
- Department of Pathology; National University Health System; Singapore Singapore
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore; National University of Singapore; Singapore Singapore
- National University Health System; Singapore Singapore
- Haematology Oncology Research Group; National University Cancer Institute of Singapore, National University Health System; Singapore Singapore
| | - Lawrence Soon-U Lee
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
- National University Health System; Singapore Singapore
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8
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Wang LZ, Thuya WL, Toh DSL, Lie MGL, Lau JYA, Kong LR, Wan SC, Chua KN, Lee EJD, Goh BC. Quantification of L-ergothioneine in human plasma and erythrocytes by liquid chromatography-tandem mass spectrometry. JOURNAL OF MASS SPECTROMETRY : JMS 2013; 48:406-412. [PMID: 23494799 DOI: 10.1002/jms.3150] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/24/2012] [Accepted: 11/27/2012] [Indexed: 06/01/2023]
Abstract
A sensitive analytical method has been developed and validated for the quantification of L-ergothioneine in human plasma and erythrocytes by liquid chromatography-tandem mass spectrometry. A commercially available isotope-labeled L-ergothioneine-d9 is used as the internal standard. A simple protein precipitation with acetonitrile is utilized for bio-sample preparation prior to analysis. Chromatographic separation of L-ergothioneine is conducted using gradient elution on Alltime C18 (150 mm × 2.1 mm, 5 µ). The run time is 6 min at a constant flow rate of 0.45 ml/min. The mass spectrometer is operated under a positive electrospray ionization condition with multiple reaction monitoring mode. The mass transitions of L-ergothioneine and L-ergothioneine-d9 are m/z 230 > 127 and m/z 239 > 127, respectively. Excellent linearity [coefficient of determination (r(2)) ≥ 0.9998] can be achieved for L-ergothioneine quantification at the ranges of 10 to 10,000 ng/ml, with the intra-day and inter-day precisions at 0.9-3.9% and 1.3-5.7%, respectively, and the accuracies for all quality control samples between 94.5 and 101.0%. This validated analytical method is suitable for pharmacokinetic monitoring of L-ergothioneine in human and erythrocytes. Based on the determination of bio-samples from five healthy subjects, the mean concentrations of L-ergothioneine in plasma and erythrocytes are 107.4 ± 20.5 ng/ml and 1285.0 ± 1363.0 ng/ml, respectively.
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Affiliation(s)
- Ling-Zhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore, 117599, Singapore.
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Jourdil JF, Tonini J, Stanke-Labesque F. Simultaneous quantitation of azole antifungals, antibiotics, imatinib, and raltegravir in human plasma by two-dimensional high-performance liquid chromatography–tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2013; 919-920:1-9. [DOI: 10.1016/j.jchromb.2012.12.028] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 12/18/2012] [Accepted: 12/20/2012] [Indexed: 11/26/2022]
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10
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Stachulski AV, Meng X. Glucuronides from metabolites to medicines: a survey of the in vivo generation, chemical synthesis and properties of glucuronides. Nat Prod Rep 2013; 30:806-48. [DOI: 10.1039/c3np70003h] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Lee LSU, Pham P, Flexner C. Unexpected Drug-Drug Interactions in Human Immunodeficiency Virus (HIV) Therapy: Induction of UGT1A1 and Bile Efflux Transporters by Efavirenz. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n12p559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Efavirenz is an inducer of drug metabolism enzymes. We studied the effect of efavirenz and ritonavir-boosted darunavir on serum unconjugated and conjugated bilirubin, as probes for UGT1A1 and bile transporters. Materials and Methods: Healthy volunteers were enrolled in a clinical trial. There were 3 periods: Period 1, 10 days of darunavir 900 mg with ritonavir 100 mg once daily; Period 2, 14 days of efavirenz 600 mg with darunavir/ritonavir once daily; and Period 3, 14 days of efavirenz 600 mg once daily. Serum bilirubin (conjugated and unconjugated) concentrations were obtained at baseline, at the end of each phase and at exit. Results: We recruited 7 males and 5 females. One subject developed grade 3 hepatitis on efavirenz and was excluded. Mean serum unconjugated bilirubin concentrations were 6.09 μmol/L (95% confidence interval [CI], 4.99 to 7.19) at baseline, 5.82 (95% CI, 4.88 to 6.76) after darunavir/ritonavir, 4.00 (95% CI, 2.92 to 5.08) after darunavir/ritonavir with efavirenz, 3.55 (95% CI, 2.58 to 4.51) after efavirenz alone and 5.27 (95% CI, 3.10 to 7.44) at exit (P <0.01 for the efavirenz phases). Mean serum conjugated bilirubin concentrations were 3.55 μmol/L (95% CI, 2.73 to 4.36) at baseline, 3.73 (95% CI, 2.77 to 4.68) after darunavir/ritonavir, 2.91 (95% CI, 2.04 to 3.78) after darunavir/ritonavir with efavirenz, 2.64 (95% CI, 1.95 to 3.33) after efavirenz alone and 3.55 (95% CI, 2.19 to 4.90) at exit (P <0.05 for the efavirenz phases). Conclusion: Efavirenz decreased unconjugated bilirubin by 42%, suggesting UGT1A1 induction. Efavirenz also decreased conjugated bilirubin by 26%, suggesting induction of bile efflux transporters. Ritonavir-boosted darunavir had no effect on bilirubin concentrations. These results indicate that efavirenz may reduce concentrations of drugs or endogenous substances metabolized by UGT1A1 or excreted by bile efflux transporters.
Key words: Drug-drug interactions, Drug transporters, Efavirenz, HIV Therapy, UGT1A1
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Affiliation(s)
- Lawrence SU Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Pham
- Johns Hopkins University, Baltimore USA
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12
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Sun L, Li H, Willson K, Breidinger S, Rizk ML, Wenning L, Woolf EJ. Ultrasensitive Liquid Chromatography–Tandem Mass Spectrometric Methodologies for Quantification of Five HIV-1 Integrase Inhibitors in Plasma for a Microdose Clinical Trial. Anal Chem 2012; 84:8614-21. [PMID: 23030780 DOI: 10.1021/ac301581h] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Li Sun
- Merck Research Laboratories,
West Point, Pennsylvania, 19486, United States
| | - Hankun Li
- Merck Research Laboratories,
West Point, Pennsylvania, 19486, United States
| | - Kenneth Willson
- Merck Research Laboratories,
West Point, Pennsylvania, 19486, United States
| | - Sheila Breidinger
- Merck Research Laboratories,
West Point, Pennsylvania, 19486, United States
| | - Matthew L. Rizk
- Merck Research Laboratories,
West Point, Pennsylvania, 19486, United States
| | - Larissa Wenning
- Merck Research Laboratories,
West Point, Pennsylvania, 19486, United States
| | - Eric J. Woolf
- Merck Research Laboratories,
West Point, Pennsylvania, 19486, United States
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13
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Pharmacokinetic modeling of plasma and intracellular concentrations of raltegravir in healthy volunteers. Antimicrob Agents Chemother 2011; 55:4090-5. [PMID: 21746959 DOI: 10.1128/aac.00593-11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Raltegravir is a potent inhibitor of HIV integrase. Persistently high intracellular concentrations of raltegravir may explain sustained efficacy despite high pharmacokinetic variability. We performed a pharmacokinetic study of healthy volunteers. Paired blood samples for plasma and peripheral blood mononuclear cells (PBMCs) were collected predose and 4, 8, 12, 24, and 48 h after a single 400-mg dose of raltegravir. Samples of plasma only were collected more frequently. Raltegravir concentrations were determined using liquid chromatography-mass spectrometry. The lower limits of quantitation for plasma and PBMC lysate raltegravir were 2 nmol/liter and 0.225 nmol/liter, respectively. Noncompartmental analyses were performed using WinNonLin. Population pharmacokinetic analysis was performed using NONMEM. Six male subjects were included in the study; their median weight was 67.4 kg, and their median age was 33.5 years. The geometric mean (GM) (95% confidence interval shown in parentheses) maximum concentration of drug (C(max)), area under the concentration-time curve from 0 to 12 h (AUC(0-12)), and area under the concentration-time curve from 0 h to infinity (AUC(0-∞)) for raltegravir in plasma were 2,246 (1,175 to 4,294) nM, 10,776 (5,770 to 20,126) nM · h, and 13,119 (7,235 to 23,788) nM · h, respectively. The apparent plasma raltegravir half-life was 7.8 (5.5 to 11.3) h. GM intracellular raltegravir C(max), AUC(0-12), and AUC(0-∞) were 383 (114 to 1,281) nM, 2,073 (683 to 6,290) nM · h, and 2,435 (808 to 7,337) nM · h (95% confidence interval shown in parentheses). The apparent intracellular raltegravir half-life was 4.5 (3.3 to 6.0) h. Intracellular/plasma ratios were stable for each patient without significant time-related trends over 48 h. Population pharmacokinetic modeling yielded an intracellular-to-plasma partitioning ratio of 11.2% with a relative standard error of 35%. The results suggest that there is no intracellular accumulation or persistence of raltegravir in PBMCs.
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