EP42675, a synthetic parenteral dual-action anticoagulant: pharmacokinetics, pharmacodynamics, and absence of interactions with antiplatelet drugs

Pharmacokinetic-Pharmacodynamic Analysis' Role in Design of Phase ⅠClinical Trials of Anticoagulant Agents: A Systematic Review

INTRODUCTION

There remains an unmet need for better anticoagulants. The phase I clinical trial is of great significance in the development of anticoagulants, and the design is special. This system review aims to provide insights for the design of future phase I clinical trials of anticoagulants.

AREAS COVERED

We searched the database PubMed and ClinicalTrail.gov website, to collate the phase I clinical trial of anticoagulants in healthy people. The study protocol, inclusion-exclusion criteria, safety, and pharmacodynamic indexes were reviewed.

EXPERT OPINION

New anticoagulants under development focused on inhibiting one or more than one serine proteases within the coagulation cascade. Agents targeting intrinsic factors are in the pipeline of the drug development. The enrollment eligibility criteria have more restrictions on laboratory tests, medical history, or medication history related to bleeding and coagulation; more precautions were taken to assess and minimize the risk of hemorrhagic events. Pharmacodynamics markers were evaluated as a surrogate marker of anticoagulation potency to guide further dose selection in drug's development. In future, the positive control study can be applied in phase I studies of new anticoagulants with appropriate pharmacodynamics markers, which can provide more favorable information on making 'go/no' decision in drug development.

EP217609, a neutralisable dual-action FIIa/FXa anticoagulant, with antithrombotic effects in arterial thrombosis

EP217609 is a new synthetic parenteral dual-action anticoagulant combining a direct thrombin inhibitor (α-NAPAP analog), an indirect factor Xa inhibitor (fondaparinux analog) and a biotin moiety allowing its neutralisation. EP217609 exhibited similar in vitro anticoagulant properties as its parent compounds. On the basis of dose-response curves, we identified low and moderate doses of EP217609 resulting in similar ex vivo prolongation of the APTT as α-NAPAP analog and comparable ex vivo anti-FXa activity as fondaparinux. The effects of EP217609 were compared to those of its parent compounds used alone or in combination in two models of experimental thrombosis induced by FeCl3 injury of the carotid artery or mechanical injury of atherosclerotic plaques in ApoE-deficient mice. When administered at low doses increasing the APTT by only 1.1 fold, EP217609 significantly reduced the thrombus area in both models as compared to α-NAPAP analog or fondaparinux alone, but not to the combination of these drugs. In contrast, at higher doses increasing the APTT 1.5 times, EP217609 was not superior to either parent compound. Low doses of EP217609 did not prolong the tail bleeding time or increase the volume of blood loss, although a tendency towards an increased blood loss was observed in five out of 12 mice. Finally, the effects of EP217609 could be neutralised in vivo by injection of avidin. The pharmacological profile of EP217609, its performance in arterial thrombosis models and its possible neutralisation make it an interesting molecule and a potential candidate as an antithrombotic drug.