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Kavanagh ON. An analysis of multidrug multicomponent crystals as tools for drug development. J Control Release 2024; 369:1-11. [PMID: 38513727 DOI: 10.1016/j.jconrel.2024.03.034] [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: 12/19/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
In a typical tablet or capsule formulation, the active drug is often present as a crystalline solid. This solid emerges from the relationships between the individual atoms within the crystal, which confer a distinct set of physical properties. Then, it follows that if we modify the packing arrangement of the individual molecules within these crystals, we can modulate their properties. This can be achieved by crystal engineering. Crystal engineering has also seen teams arrange multiple drug molecules within the same crystal, resulting in dramatic improvements to drug properties in the lab. The success of drugs like SEGLENTIS® and Entresto® have revitalised interest in these forms, but controversy surrounding their translation has prompted this reconsideration of their clinical utility. I reflect on the current academic, clinical, and commercial interest in multidrug multicomponent crystals, drawing parallels with developments pre-Bragg, contributing to a nuanced understanding of the potential and limitations of crystal engineering in pharmaceutical applications.
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Affiliation(s)
- Oisín N Kavanagh
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.
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2
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Sun J, Xiao Y, Xu W, Xing W, Du F, Tian M, Xu D, Ren Y, Fang X. Anti-hypertensive effect of a novel angiotensin II receptor neprilysin inhibitor (ARNi) -S086 in DSS rat model. Front Cardiovasc Med 2024; 11:1348897. [PMID: 38420263 PMCID: PMC10899683 DOI: 10.3389/fcvm.2024.1348897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Angiotensin receptor-neprilysin inhibitor (ARNi), comprised of an angiotensin receptor blocker (ARB) and a neprilysin inhibitor (NEPi), has established itself as a safe and effective intervention for hypertension. S086 is a novel ARNi cocrystal developed by Salubris for the treatment of heart failure and hypertension. Methods Dahl Salt Sensitive (DSS) hypertensive rat model and telemetry system were employed in this study to investigate the anti-hypertensive efficacy of S086 and compare it with the first ARNi-LCZ696. Results and discussion The study showed that oral administration of S086 dose-dependently lowered blood pressure (P < 0.001). The middle dosage of S086 (23 mg/kg) exhibited efficacy comparable to LCZ696 (68 mg/kg), while also demonstrating superiority at specific time points (P < 0.05). Notably, water consumption slightly decreased post-treatment compared to the vehicle group. Furthermore, there were significant increases in natriuresis and diuresis observed on the first day of treatment with 23 mg/kg and 68 mg/kg S086 (P < 0.001). However, over the course of treatment, the effects in all treatment groups gradually diminished. This study demonstrates the anti-hypertensive efficacy of S086 in DSS hypertensive rat model, offering promising avenues for the clinical development of S086 as a hypertension treatment.
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Affiliation(s)
- Jingchao Sun
- R&D Center, Shenzhen Salubris Pharmaceutical Co., Ltd., Shenzhen, Guangdong, China
- iBHE, Tsinghua Shenzhen International Graduate School, Shenzhen, Guangdong, China
| | - Ying Xiao
- R&D Center, Shenzhen Salubris Pharmaceutical Co., Ltd., Shenzhen, Guangdong, China
| | - Wenjie Xu
- R&D Center, Shenzhen Salubris Pharmaceutical Co., Ltd., Shenzhen, Guangdong, China
| | - Wei Xing
- R&D Center, Shenzhen Salubris Pharmaceutical Co., Ltd., Shenzhen, Guangdong, China
| | - Frank Du
- Pharmacology Department, WuXi AppTec (Shanghai) Co., Ltd., Shanghai, China
| | - Maozhi Tian
- Pharmacology Department, WuXi AppTec (Shanghai) Co., Ltd., Shanghai, China
| | - Danqi Xu
- Pharmacology Department, WuXi AppTec (Shanghai) Co., Ltd., Shanghai, China
| | - Yihua Ren
- Pharmacology Department, WuXi AppTec (Shanghai) Co., Ltd., Shanghai, China
| | - Xin Fang
- Pharmacology Department, WuXi AppTec (Shanghai) Co., Ltd., Shanghai, China
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Kanellopoulos P, Nock BA, Rouchota M, Loudos G, Krenning EP, Maina T. Side-Chain Modified [ 99mTc]Tc-DT1 Mimics: A Comparative Study in NTS 1R-Positive Models. Int J Mol Sci 2023; 24:15541. [PMID: 37958525 PMCID: PMC10647616 DOI: 10.3390/ijms242115541] [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: 10/07/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Radiolabeled neurotensin analogs have been developed as candidates for theranostic use against neurotensin subtype 1 receptor (NTS1R)-expressing cancer. However, their fast degradation by two major peptidases, neprilysin (NEP) and angiotensin-converting enzyme (ACE), has hitherto limited clinical success. We have recently shown that palmitoylation at the ε-amine of Lys7 in [99mTc]Tc-[Lys7]DT1 (DT1, N4-Gly-Arg-Arg-Pro-Tyr-Ile-Leu-OH, N4 = 6-(carboxy)-1,4,8,11-tetraazaundecane) led to the fully stabilized [99mTc]Tc-DT9 analog, displaying high uptake in human pancreatic cancer AsPC-1 xenografts but unfavorable pharmacokinetics in mice. Aiming to improve the in vivo stability of [99mTc]Tc-DT1 without compromising pharmacokinetics, we now introduce three new [99mTc]Tc-DT1 mimics, carrying different pendant groups at the ε-amine of Lys7: MPBA (4-(4-methylphenyl)butyric acid)-[99mTc]Tc-DT10; MPBA via a PEG4-linker-[99mTc]Tc-DT11; or a hydrophilic PEG6 chain-[99mTc]Tc-DT12. The impact of these modifications on receptor affinity and internalization was studied in NTS1R-positive cells. The effects on stability and AsPC-1 tumor uptake were assessed in mice without or during NEP/ACE inhibition. Unlike [99mTc]Tc-DT10, the longer-chain modified [99mTc]Tc-DT11 and [99mTc]Tc-DT12 were significantly stabilized in vivo, resulting in markedly improved tumor uptake compared to [99mTc]Tc-DT1. [99mTc]Tc-DT11 was found to achieve the highest AsPC-1 tumor values and good pharmacokinetics, either without or during NEP inhibition, qualifying for further validation in patients with NTS1R-positive tumors using SPECT/CT.
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Affiliation(s)
| | - Berthold A. Nock
- Molecular Radiopharmacy, INRaSTES, NCSR “Demokritos”, 15341 Athens, Greece; (P.K.); (B.A.N.)
| | - Maritina Rouchota
- BIOEMTECH, Lefkippos Attica Technology Park NCSR “Demokritos”, 15310 Athens, Greece; (M.R.); (G.L.)
| | - George Loudos
- BIOEMTECH, Lefkippos Attica Technology Park NCSR “Demokritos”, 15310 Athens, Greece; (M.R.); (G.L.)
| | - Eric P. Krenning
- Cyclotron Rotterdam BV, Erasmus MC, 3015 CE Rotterdam, The Netherlands;
| | - Theodosia Maina
- Molecular Radiopharmacy, INRaSTES, NCSR “Demokritos”, 15341 Athens, Greece; (P.K.); (B.A.N.)
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Kanellopoulos P, Nock BA, Krenning EP, Maina T. Toward Stability Enhancement of NTS 1R-Targeted Radioligands: Structural Interventions on [ 99mTc]Tc-DT1. Pharmaceutics 2023; 15:2092. [PMID: 37631306 PMCID: PMC10459693 DOI: 10.3390/pharmaceutics15082092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
The neurotensin subtype 1 receptor (NTS1R) is overexpressed in a number of human tumors, thereby representing a valid target for cancer theranostics with radiolabeled neurotensin (NT) analogs like [99mTc]Tc-DT1 (DT1, N4-Gly7-NT(8-13)). Thus far, the fast degradation of intravenously injected NT-radioligands by neprilysin (NEP) and angiotensin-converting enzyme (ACE) has compromised their clinical applicability. Aiming at metabolic stability enhancements, we herein introduce (i) DT7 ([DAsn14]DT1) and (ii) DT8 ([β-Homoleucine13]DT1), modified at the C-terminus, along with (iii) DT9 ([(palmitoyl)Lys7]DT1), carrying an albumin-binding domain (ABD) at Lys7. The biological profiles of the new [99mTc]Tc-radioligands were compared with [99mTc]Tc-DT1, using NTS1R-expressing AsPC-1 cells and mice models without or during NEP/ACE inhibition. The radioligands showed enhanced in vivo stability vs. [99mTc]Tc-DT1, with [99mTc]Tc-DT9 displaying full resistance to both peptidases. Furthermore, [99mTc]Tc-DT9 achieved the highest cell internalization and tumor uptake even without NEP/ACE-inhibition but with unfavorably high background radioactivity levels. Hence, unlike C-terminal modification, the introduction of a pendant ABD group in the linker turned out to be the most promising strategy toward metabolic stability, cell uptake, and tumor accumulation of [99mTc]Tc-DT1 mimics. To improve the observed suboptimal pharmacokinetics of [99mTc]Tc-DT9, the replacement of palmitoyl on Lys7 by other ABD groups is currently being pursued.
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Affiliation(s)
| | - Berthold A. Nock
- Molecular Radiopharmacy, INRaSTES, NCSR “Demokritos”, 15341 Athens, Greece; (P.K.); (B.A.N.)
| | - Eric P. Krenning
- Cyclotron Rotterdam BV, Erasmus MC, 3015 CE Rotterdam, The Netherlands;
| | - Theodosia Maina
- Cyclotron Rotterdam BV, Erasmus MC, 3015 CE Rotterdam, The Netherlands;
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Hu Y, Zhang H, Li X, Mai J, Yang L, Yan J, Li Y, Sun J, Xu W, He S, Li J, Wu M. A randomized, double-blind, placebo-controlled, single, and multiple dose-escalation Phase I clinical trial to investigate the safety, pharmacokinetic, and pharmacodynamic profiles of oral S086, a novel angiotensin receptor-neprilysin inhibitor, in healthy Chinese volunteers. Expert Opin Investig Drugs 2021; 31:977-985. [PMID: 34633260 DOI: 10.1080/13543784.2021.1985464] [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: 10/20/2022]
Abstract
BACKGROUND This study evaluated the safety, pharmacokinetic (PK), and pharmacodynamic (PD) profiles of single ascending doses (SAD) and multiple ascending doses (MAD) of S086 in healthy Chinese volunteers. RESEARCH DESIGN AND METHODS This randomized, double-blind, placebo-controlled, Phase I clinical trial enrolled 113 subjects, including 65 subjects in the SAD (60-1080 mg) study and 48 subjects in the MAD study (180-720 mg). The safety, PK (sacubitril, LBQ657, and EXP3174) and PD (MAD study: blood pressure, pulse) of S086 were assessed. RESULTS There were no deaths, serious adverse events, or discontinuations due to TEAEs, and there were no significant safety concerns associated with S086. PK parameters for sacubitril, LBQ657, and EXP3174 increased in a dose-dependent manner after single oral doses of S086. Plasma concentrations of sacubitril, LBQ657, and EXP3174 were maintained at steady state within 5 days of once-daily oral administration of S086. In the MAD study, S086 administration was associated with a dose-dependent decrease in mean diastolic and systolic blood pressure compared to baseline. CONCLUSIONS The safety and PK profile profiles of S086 support the use of S086 240 mg once daily in a future Phase II study in patients with heart failure. TRIAL REGISTRATION The trial is registered at chinadrugtrials.org.cn (CT.gov identifier: CTR20182350 and CTR20182351).
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Affiliation(s)
- Yue Hu
- Department of Phase I Clinical Trial Unit, First Hospital of Jilin University, Changchun, Jilin, China
| | - Hong Zhang
- Department of Phase I Clinical Trial Unit, First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaojiao Li
- Department of Phase I Clinical Trial Unit, First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiajia Mai
- Department of Phase I Clinical Trial Unit, First Hospital of Jilin University, Changchun, Jilin, China
| | - Lizhi Yang
- Nanguan District Maternal and Child Health and Family Planning Service Center of Changchun, Changchun, Jilin, China
| | - Jie Yan
- Shenzhen Salubris Pharmaceuticals Co., Ltd, Shenzhen, Guangdong, China
| | - Ying Li
- Shenzhen Salubris Pharmaceuticals Co., Ltd, Shenzhen, Guangdong, China
| | - Jingchao Sun
- Shenzhen Salubris Pharmaceuticals Co., Ltd, Shenzhen, Guangdong, China
| | - Wenjie Xu
- Shenzhen Salubris Pharmaceuticals Co., Ltd, Shenzhen, Guangdong, China
| | - Shiying He
- Shenzhen Salubris Pharmaceuticals Co., Ltd, Shenzhen, Guangdong, China
| | - Jinfeng Li
- Shenzhen Salubris Pharmaceuticals Co., Ltd, Shenzhen, Guangdong, China
| | - Min Wu
- Department of Phase I Clinical Trial Unit, First Hospital of Jilin University, Changchun, Jilin, China
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Moussa BA, Hashem HMA, Mahrouse MA, Mahmoud ST. Synchronized determination of sacubitril and valsartan with some co-administered drugs in human plasma via UPLC-MS/MS method using solid-phase extraction. Biomed Chromatogr 2021; 35:e5203. [PMID: 34145610 DOI: 10.1002/bmc.5203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 11/07/2022]
Abstract
An accurate and sensitive UPLC-MS/MS method was developed and validated for the simultaneous estimation of the newly developed combination of sacubitril and valsartan and the co-administered drugs nebivolol, chlorthalidone and esomeprazole in human plasma. Solid-phase extraction was conducted for the purification and extraction of the drugs from human plasma. Chromatographic separation was carried out on an Agilent SB-C18 (1.8 μm, 2.1 × 50 mm) column using losartan as internal standard. Isocratic elution was applied using acetonitrile-0.1% formic acid in water (85: 15, v/v) as mobile phase. Detection was carried out using a triple-quadrupole tandem mass spectrometer using multiple reaction monitoring, at positive mode at m/z 412.23 → 266.19 for sacubitril, m/z 436.29 → 235.19 for valsartan, m/z 405.8 → 150.98 for nebivolol, m/z 346.09 → 198 for esomeprazole and a selected combination of two fragments m/z 423.19 → 207.14 and 423.19 → 192.2 for losartan (internal standard), and in negative ionization mode at m/z 337.02 → 190.12 for chlorthalidone. The method was linear over the concentration ranges 30-2,000 ng/ml for sacubitril, 70-2,000 ng/ml for valsartan, esomeprazole and chlorthalidone and 70-5,000 pg/ml for nebivolol. The developed method is sensitive and selective and could be applied for dose adjustment, bioavailability and drug-drug interaction studies.
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Affiliation(s)
- Bahia Abbas Moussa
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Hanaa M A Hashem
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | | | - Sally Tarek Mahmoud
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Moussa BA, Hashem HMA, Alphonse Mahrouse M, Mahmoud ST. Synchronized determination of the novel heart failure combination therapy containing sacubitril calcium and valsartan by a validated spectrofluorimetric method. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2021; 253:119613. [PMID: 33667887 DOI: 10.1016/j.saa.2021.119613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
A sensitive and accurate spectrofluorimetric method was proposed for the determination of Sacubitril calcium and Valsartan simultaneously in binary mixture. The method was established on measuring the native fluorescence of Sacubitril calcium and Valsartan upon excitation at 240 nm in acetonitrile. The emission of Sacubitril calcium was measured at 615 nm. For the determination Valsartan a first derivative ratio method was employed to eliminate any spectral interference. The ratio emission spectra were achieved by dividing the emission spectra of various concentrations of Valsartan by the emission spectrum of Sacubitril calcium (100 ng/ml) then the first derivative of the obtained ratio emission spectra was recorded using the proper smoothing factor. The amplitude at 354.9 nm on the first derivative ratio emission spectrum was used to calculate the concentrations of Valsartan in presence of Sacubitril calcium. The method was linear over the concentration range 100-1000 ng/ml for both Sacubitril calcium and Valsartan. The mean accuracy values were found to be 99.32 ± 0.62 and 99.30 ± 0.70 for Sacubitril calcium and Valsartan, respectively. Statistical comparison between results obtained by the proposed method and a reported method for this drugs showed no significant difference. This developed method was used for the quantitative determination of Sacubitril calcium and Valsartan in both pure and pharmaceutical dosage form.
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Affiliation(s)
- Bahia Abbas Moussa
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo 11562, Egypt
| | - Hanaa M A Hashem
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo 11562, Egypt
| | - Marianne Alphonse Mahrouse
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo 11562, Egypt
| | - Sally Tarek Mahmoud
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo 11562, Egypt.
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Hu C, Zhang F, Fan H. Evaluation of Drug Dissolution Rate in Co-amorphous and Co-crystal Binary Drug Delivery Systems by Thermodynamic and Kinetic Methods. AAPS PharmSciTech 2021; 22:21. [PMID: 33389277 DOI: 10.1208/s12249-020-01864-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022] Open
Abstract
In order to better explain and predict the dissolution characteristics of binary drug delivery systems (BDDSs), the dissolution behaviors of co-crystal (CC) and co-amorphous (CA) systems of sacubitril (SCB) and valsartan (VST) were evaluated in vitro and in vivo by thermodynamic and kinetic methods. The CCs of SCB and VST were prepared into a CA state through rotary evaporation. Solid-state properties were systematically evaluated. Herein, based on the results from previous studies of single-phase systems, we used thermodynamic methods to evaluate the increase in drug dissolution rate after BDDSs change from the crystalline to the amorphous state. After comparing the predicted and measured dissolution rate enhancement of the CC and CA systems, this paper attempts to explain the dissolution rate characteristics of the BDDSs. We then evaluated the bioavailability of two BDDSs in beagle dogs to confirm that there was no discrepancy in vivo with the results obtained in vitro. The results exhibited that there is strong intermolecular interaction between SCB and VST and good physical stability for the CA system. Compared with the CC, the bioavailability of SCB and VST in the CA system increased by 313.9% and 130.5%, respectively. The predicted dissolution rate ratio between CC and CA systems and their actual intrinsic dissolution rates differed by only a factor of 2.5, demonstrating the good correlation between the predicted and measured values. In the future, this method could be expanded to a variety of new samples and exciting drug prospects.
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Abumayyaleh M, El-Battrawy I, Behnes M, Borggrefe M, Akin I. Current evidence of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction. Future Cardiol 2020; 16:227-236. [DOI: 10.2217/fca-2020-0002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) is one of the most common reasons for hospital admission in western countries. The measurement of the left ventricular ejection fraction is essential for the classification of HF and deciding on HF treatment. The treatment of HF has been improved in both diagnostic and therapeutic fields over the past two decades. The angiotensin receptor-neprilysin inhibitor decreased the cardiovascular mortality in patients with chronic HF with reduced ejection fraction. Sacubitril/valsartan (LCZ696) improves the imbalance between the renin-angiotensin-aldosterone and natriuretic peptide systems. We present the clinical efficacy, real-world experience, safety and tolerability, the relevance of etiology of cardiomyopathy, and gender differences and regulatory affairs of LCZ696 in the treatment of patients with HF with reduced ejection fraction.
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Affiliation(s)
- Mohammad Abumayyaleh
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, 68167, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg–Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, 68167, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg–Mannheim, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, 68167, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg–Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, 68167, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg–Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, 68167, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg–Mannheim, Mannheim, Germany
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Wehland M, Simonsen U, Buus NH, Krüger M, Grimm D. An evaluation of the fixed-dose combination sacubitril/valsartan for the treatment of arterial hypertension. Expert Opin Pharmacother 2020; 21:1133-1143. [PMID: 32133873 DOI: 10.1080/14656566.2020.1735356] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Essential hypertension is a significant risk factor for cardiovascular disease, renal disease, and mortality with increasing prevalence. Despite the availability of various antihypertensive agents, hypertension is still poorly controlled. Therefore, new chemical compounds with antihypertensive efficacy need to be developed. The dual angiotensin II receptor-neprilysin inhibitor LCZ696 is a single molecule synthesized by co-crystallization of valsartan and the neprilysin inhibitor prodrug sacubitril (1:1 molar ratio). AREAS COVERED This review includes an overview of hypertension and the current pharmacotherapy. The authors summarize the LCZ696 drug chemistry, pharmacodynamics, pharmacokinetics, metabolism, randomized control trials (RCTs), and safety concerns. Databases searched included PubMed, Google Scholar, Embase, and ClinicalTrials.gov. EXPERT OPINION LCZ696 is effective in hypertension treatment. Short-term RCTs have shown that the highest doses of LCZ696 (200 and 400 mg [q.d.]) were more effective at lowering office and ambulatory blood pressure than angiotensin II receptor blockers (ARB) alone while having a similar tolerability profile. The effects of LCZ696 on hypertensive organ damage are only sparsely investigated and so far no studies have established the impact of LCZ696 on cardiovascular event rates. Future studies should focus on the comparison of LCZ696 and combination therapies already in use such as ARB and calcium channel blockers.
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Affiliation(s)
- Markus Wehland
- Department of Biomedicine, Aarhus University , Aarhus C, Denmark.,Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University Magdeburg , Magdeburg, Germany
| | - Ulf Simonsen
- Department of Biomedicine, Aarhus University , Aarhus C, Denmark
| | - Niels Henrik Buus
- Department of Biomedicine, Aarhus University , Aarhus C, Denmark.,Department of Renal Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - Marcus Krüger
- Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University Magdeburg , Magdeburg, Germany
| | - Daniela Grimm
- Department of Biomedicine, Aarhus University , Aarhus C, Denmark.,Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University Magdeburg , Magdeburg, Germany.,Department of Microgravity and Translational Regenerative Medicine, Faculty of Medicine and Mechanical Engineering, Otto von Guericke University , Magdeburg, Germany
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11
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Prediction of pharmacokinetic drug-drug interactions causing atorvastatin-induced rhabdomyolysis using physiologically based pharmacokinetic modelling. Biomed Pharmacother 2019; 119:109416. [PMID: 31518878 DOI: 10.1016/j.biopha.2019.109416] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022] Open
Abstract
Atorvastatin and its lactone form metabolite are reported to be associated with statin-induced myopathy (SIM) such as myalgia and life-threatening rhabdomyolysis. Though the statin-induced rhabdomyolysis is not common during statin therapy, its incidence will significantly increase due to pharmacokinetic drug-drug interactions (DDIs) with inhibitor drugs which inhibit atorvastatin's and its lactone's metabolism and hepatic uptake. Thus, the quantitative analysis of DDIs of atorvastatin and its lactone with cytochrome P450 3A4 (CYP3A4) and organic anion-transporting polypeptide (OATP) inhibitors is of great importance. This study aimed to predict pharmacokinetic DDIs possibly causing atorvastatin-induced rhabdomyolysis using Physiologically Based Pharmacokinetic (PBPK) Modelling. Firstly, we refined the PBPK models of atorvastatin and atorvastatin lactone for predicting the DDIs with CYP3A4 and OATP inhibitors. Thereafter, we predicted the exposure changes of atorvastatin and atorvastatin lactone originating from the case reports of atorvastatin-induced rhabdomyolysis using the refined models. The simulation results show that pharmacokinetic DDIs of atorvastatin and its lactone with fluconazole, palbociclib diltiazem and cyclosporine are significant. Consequently, clinicians should be aware of necessary dose adjustment of atorvastatin being used with these four inhibitor drugs.
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12
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Nielsen PM, Grimm D, Wehland M, Simonsen U, Krüger M. The Combination of Valsartan and Sacubitril in the Treatment of Hypertension and Heart Failure - an Update. Basic Clin Pharmacol Toxicol 2017; 122:9-18. [DOI: 10.1111/bcpt.12912] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/15/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Peter Munch Nielsen
- Department of Biomedicine, Pharmacology; Aarhus University; Aarhus C Denmark
| | - Daniela Grimm
- Department of Biomedicine, Pharmacology; Aarhus University; Aarhus C Denmark
- Clinic for Plastic, Aesthetic and Hand Surgery; Otto-von-Guericke-University Magdeburg; Magdeburg Germany
| | - Markus Wehland
- Clinic for Plastic, Aesthetic and Hand Surgery; Otto-von-Guericke-University Magdeburg; Magdeburg Germany
| | - Ulf Simonsen
- Department of Biomedicine, Pharmacology; Aarhus University; Aarhus C Denmark
| | - Marcus Krüger
- Clinic for Plastic, Aesthetic and Hand Surgery; Otto-von-Guericke-University Magdeburg; Magdeburg Germany
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Ayalasomayajula S, Pan W, Han Y, Yang F, Langenickel T, Pal P, Zhou W, Yuan Y, Rajman I, Sunkara G. Assessment of Drug-Drug Interaction Potential Between Atorvastatin and LCZ696, A Novel Angiotensin Receptor Neprilysin Inhibitor, in Healthy Chinese Male Subjects. Eur J Drug Metab Pharmacokinet 2017; 42:309-318. [PMID: 27245340 DOI: 10.1007/s13318-016-0349-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE LCZ696 (sacubitril/valsartan), a novel angiotensin receptor neprilysin inhibitor has been recently approved for the treatment of patients with heart failure (HF) and reduced ejection fraction. As several HF patients are likely to use statins as co-medications, the potential for a pharmacokinetic drug-drug interaction between atorvastatin and LCZ696 was evaluated. METHODS This was an open-label, three-period, single-sequence study in 28 healthy Chinese male subjects wherein LCZ696 200 mg was administered twice daily for 5 days in period 1. Following a washout period, atorvastatin 80 mg was administered once daily for 4 days (period 2) and subsequently co-administered with LCZ696 200 mg for 5 days (period 3). Serial plasma samples were collected to determine pharmacokinetic parameters of LCZ696 analytes (sacubitril, LBQ657, and valsartan) and atorvastatin and its metabolites. RESULTS Atorvastatin co-administration had no effect on the pharmacokinetics of LBQ657, while the AUCτ,ss and C max,ss of sacubitril increased by 30 and 19 %, respectively, and the corresponding values for valsartan decreased by 19 and 9 %, respectively. Co-administration with LCZ696 increased C max,ss of atorvastatin, o-hydroxyatorvastatin, and p-hydroxyatorvastatin by 74, 68, and 108 %, respectively, and the AUCτ,ss of corresponding analytes increased by 34, 22, and 26 %, respectively. CONCLUSIONS While atorvastatin had no significant impact on the pharmacokinetics of LCZ696 analytes upon co-administration, the C max of atorvastatin and its metabolites increased twofold, with a marginal increase in AUC (<1.3-fold). Multiple-dose administration of LCZ696 200 mg twice daily and atorvastatin 80 mg once daily either alone or in combination was generally safe and well tolerated in healthy subjects.
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Affiliation(s)
- Surya Ayalasomayajula
- Drug Metabolism and Pharmacokinetics, Novartis Institutes for BioMedical Research, East Hanover, NJ, USA.
| | - Wei Pan
- Drug Metabolism and Pharmacokinetics, Novartis Institutes for BioMedical Research, Shanghai, China
| | - Yi Han
- Drug Metabolism and Pharmacokinetics, Novartis Institutes for BioMedical Research, Shanghai, China
| | - Fan Yang
- Clinical Sciences and Innovation, Novartis Institutes for Biomedical Research, Shanghai, China
| | - Thomas Langenickel
- Translational Medicine, Clinical Pharmacology and Profiling, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Parasar Pal
- Biostatistical Sciences, Novartis Healthcare Private Limited, Hyderabad, India
| | - Wei Zhou
- Drug Metabolism and Pharmacokinetics, Novartis Institutes for BioMedical Research, East Hanover, NJ, USA
| | - Yaozong Yuan
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Iris Rajman
- Translational Medicine, Clinical Pharmacology and Profiling, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Gangadhar Sunkara
- Drug Metabolism and Pharmacokinetics, Novartis Institutes for BioMedical Research, East Hanover, NJ, USA
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Li B, Zhao Y, Yin B, Helian M, Wang X, Chen F, Zhang H, Sun H, Meng B, An F. Safety of the neprilysin/renin-angiotensin system inhibitor LCZ696. Oncotarget 2017; 8:83323-83333. [PMID: 29137346 PMCID: PMC5669972 DOI: 10.18632/oncotarget.18312] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/23/2017] [Indexed: 12/11/2022] Open
Abstract
Objectives The combined neprilysin/rennin-angiotensin system inhibitor sacubitril/valsartan (LCZ696) has shown its superiority over ACEI/ARB therapy. In view of the existing concern of its adverse effects, we aimed to provide evidence of the safety of the new drug. Results A total of 6 randomized trials with 11,821 subjects were included in this analysis. No significant differences were found in any adverse effects between LCZ696 and ACEI/ARB or placebo groups. LCZ696 significantly decreased the risks of serious adverse events and death compared with ACEI/ARB. LCZ696 also significantly decrease the risk of discontinuation of treatment for any adverse event no matter compared with ACEI/ARB or a placebo. LCZ696 significantly increased the risk of angioedema and dizziness, while it decreased the risk of renal dysfunction and bronchitis. There was no difference for hypotension, hyperkalemia, cough, upper respiratory tract inflammation, diarrhoea, back pain, nasopharyngitis, headache and influenza between the LCZ696 group and the ACEI/ARB group. Materials and Methods A meta-analysis of eligible studies that used LCZ696 in heart failure and hypertension was performed. Embase, PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) with data on any adverse effects, serious adverse events, discontinuation of treatment for any adverse event, death, angioedema, hypotension, hyperkalemia, and other adverse effects to perform this meta-analysis. Conclusions In addition to the beneficial effect of LCZ696 on end point events, the available evidences showed that LCZ696 was associated with less drug-risks than a placebo and ACEI/ARB.
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Affiliation(s)
- Bo Li
- Department of Cardiology, Central Hospital of Zibo, Zibo, 255036, PR China
| | - Yunhe Zhao
- Department of Cardiology, Central Hospital of Zibo, Zibo, 255036, PR China
| | - Bo Yin
- Department of Cardiology, Central Hospital of Zibo, Zibo, 255036, PR China
| | - Mengfei Helian
- Department of Pathology, Central Hospital of Zibo, Zibo, 255036, PR China
| | - Xinmei Wang
- Department of Pathology, Central Hospital of Zibo, Zibo, 255036, PR China
| | - Feng Chen
- Department of Cardiology, Central Hospital of Zibo, Zibo, 255036, PR China
| | - Hongxia Zhang
- Department of Cardiology, Central Hospital of Zibo, Zibo, 255036, PR China
| | - Hui Sun
- Department of Cardiology, Central Hospital of Zibo, Zibo, 255036, PR China
| | - Bin Meng
- Department of Cardiology, Central Hospital of Zibo, Zibo, 255036, PR China
| | - Fengshuang An
- Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, 250012, PR China
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Ayalasomayajula S, Langenickel T, Pal P, Boggarapu S, Sunkara G. Erratum to: Clinical Pharmacokinetics of Sacubitril/Valsartan (LCZ696): A Novel Angiotensin Receptor-Neprilysin Inhibitor. Clin Pharmacokinet 2017; 57:105-123. [PMID: 28527109 DOI: 10.1007/s40262-017-0558-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sacubitril/valsartan (LCZ696) is indicated for the treatment of heart failure with reduced ejection fraction. Absorption of sacubitril/valsartan and conversion of sacubitril (prodrug) to sacubitrilat (neprilysin inhibitor) was rapid with maximum plasma concentrations of sacubitril, sacubitrilat, and valsartan (angiotensin receptor blocker) reaching within 0.5, 1.5-2.0, and 2.0-3.0 h, respectively. With a twofold increase in dose, an increase in the area under the plasma concentration-time curve was proportional for sacubitril, ~1.9-fold for sacubitrilat, and ~1.7-fold for valsartan in healthy subjects. Following multiple twice-daily administration, steady-state maximum plasma concentration was reached within 3 days, showing no accumulation for sacubitril and valsartan, while ~1.6-fold accumulation for sacubitrilat. Sacubitril is eliminated predominantly as sacubitrilat through the kidney; valsartan is eliminated mainly by biliary route. Drug-drug interactions of sacubitril/valsartan were evaluated with medications commonly used in patients with heart failure including furosemide, warfarin, digoxin, carvedilol, levonorgestrel/ethinyl estradiol combination, amlodipine, omeprazole, hydrochlorothiazide, intravenous nitrates, metformin, statins, and sildenafil. Co-administration with sacubitril/valsartan increased the maximum plasma concentration (~2.0-fold) and area under the plasma concentration-time curve (1.3-fold) of atorvastatin; however, it did not affect the pharmacokinetics of simvastatin. Age, sex, or ethnicity did not affect the pharmacokinetics of sacubitril/valsartan. In patients with heart failure vs. healthy subjects, area under the plasma concentration-time curves of sacubitril, sacubitrilat, and valsartan were higher by approximately 1.6-, 2.1-, and 2.3-fold, respectively. Renal impairment had no significant impact on sacubitril and valsartan area under the plasma concentration-time curves, while the area under the plasma concentration-time curve of sacubitrilat correlated with degree of renal function (1.3-, 2.3-, 2.9-, and 3.3-fold with mild, moderate, and severe renal impairment, and end-stage renal disease, respectively). Moderate hepatic impairment increased the area under the plasma concentration-time curves of valsartan and sacubitrilat ~2.1-fold.
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Affiliation(s)
| | - Thomas Langenickel
- Novartis Institutes for Biomedical Research, Translational Medicine, Novartis Pharma AG, Basel, Switzerland
| | - Parasar Pal
- Novartis Healthcare Private Limited, Hyderabad, India
| | | | - Gangadhar Sunkara
- Novartis Institutes for Biomedical Research, Clinical PKPD, East Hanover, NJ, USA
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16
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Gervasini G, Robles NR. Potential beneficial effects of sacubitril-valsartan in renal disease: a new field for a new drug. Expert Opin Investig Drugs 2017; 26:651-659. [DOI: 10.1080/13543784.2017.1317345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Guillermo Gervasini
- Department of Medical and Surgical Therapeutics, Division of Pharmacology, Medical School, University of Extremadura, Badajoz, Spain
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Abstract
LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is comprised of the angiotensin receptor blocker valsartan and the neprilysin inhibitor pro-drug sacubitril (AHU377). After oral administration, AHU377 is rapidly metabolized to the active neprilysin inhibitor LBQ657. LCZ696 exerts its effects of diuresis, natriuresis, vasodilation and aldosterone secretion inhibition through simultaneous renin-angiotensin-aldosterone system (RAAS) blockade and natriuretic peptides system (NPS) enhancement. Powerful evidence including PARAMETER and PRARDIGM-HF trials have shown that LCZ696 outperforms RAAS inhibition in treating patients with hypertension and heart failure with reduced ejection fraction (HFrEF), and is well tolerated. In addition, accumulating evidence also suggests its potential use in heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), post-myocardium infarction (post-MI) and stroke. Both the FDA and CHMP have approved LCZ696 for treatment of HFrEF. Despite all this, some special issues (e.g. use in specific subgroups, adverse events, contraindications and cost-effectiveness analysis) should be considered before its implementation in clinical practice.
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18
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Khder Y, Shi V, McMurray JJV, Lefkowitz MP. Sacubitril/Valsartan (LCZ696) in Heart Failure. Handb Exp Pharmacol 2017; 243:133-165. [PMID: 28004291 DOI: 10.1007/164_2016_77] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
It has been known since the 1990s that long-term morbidity and mortality is improved in patients with heart failure with reduced ejection fraction (HFrEF) by treatments that target the renin-angiotensin-aldosterone system (RAAS). It has also long been thought that enhancement of the activity of natriuretic peptides (NPs) could potentially benefit patients with HFrEF, but multiple attempts to realize this benefit had failed over the years - until 2014, when a large, phase III, randomized, controlled clinical trial (PARADIGM-HF) was completed comparing sacubitril/valsartan with enalapril, a well-established treatment for HFrEF. Sacubitril/valsartan (formerly known as LCZ696) is a first-in-class angiotensin receptor neprilysin inhibitor (ARNI) that simultaneously suppresses RAAS activation through blockade of angiotensin II type 1 receptors and enhances vasoactive peptides including NPs through inhibition of neprilysin, the enzyme responsible for their degradation. In PARADIGM-HF, patients with HFrEF treated with sacubitril/valsartan had 20% less risk for cardiovascular death or hospitalization for heart failure (the primary endpoint), 20% less risk for cardiovascular death, 21% less risk for first hospitalization for heart failure, and 16% less risk for death from any cause, compared with enalapril (all p < 0.001). Concerning tolerability, the sacubitril/valsartan group had higher proportions of patients with hypotension and nonserious angioedema but lower proportions with renal impairment, hyperkalemia, and cough, compared with the enalapril group. The use of sacubitril/valsartan has been endorsed by the latest heart failure treatment guidelines in Europe and the USA. This chapter reviews the discoveries, scientific reasoning, and clinical evidence that led to the development of sacubitril/valsartan, the first novel therapy in a new drug class to improve survival in HFrEF in the last 15 years.
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Affiliation(s)
- Yasser Khder
- Novartis Institutes for Biomedical Research, Postfach, 4002, Basel, Switzerland.
| | - Victor Shi
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Martin P Lefkowitz
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA
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Akahori M, Ayalasomayajula S, Langenickel T, Pal P, Zhou W, Sunkara G. Pharmacokinetics After Single Ascending Dose, Food Effect, and Safety of Sacubitril/Valsartan (LCZ696), an Angiotensin Receptor and Neprilysin Inhibitor, in Healthy Japanese Subjects. Eur J Drug Metab Pharmacokinet 2016; 42:407-416. [DOI: 10.1007/s13318-016-0354-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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