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Henrich A, Claussen CH, Dingemanse J, Krause A. Pharmacokinetic/pharmacodynamic modeling of drug interactions at the P2Y 12 receptor between selatogrel and oral P2Y 12 antagonists. CPT Pharmacometrics Syst Pharmacol 2021; 10:735-747. [PMID: 33955698 PMCID: PMC8302241 DOI: 10.1002/psp4.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022]
Abstract
Selatogrel is a potent and reversible P2Y12 receptor antagonist developed for subcutaneous self‐administration by patients with suspected acute myocardial infarction. After single‐dose emergency treatment with selatogrel, patients are switched to long‐term treatment with oral P2Y12 receptor antagonists. Selatogrel shows rapid onset and offset of inhibition of platelet aggregation (IPA) to overcome the critical initial time after acute myocardial infarction. Long‐term benefit is provided by oral P2Y12 receptor antagonists such as clopidogrel, prasugrel, and ticagrelor. A population pharmacokinetic (PK)/pharmacodynamic (PD) model based on data from 545 subjects in 4 phase I and 2 phase II studies well described the effect of selatogrel on IPA alone and in combination with clopidogrel, prasugrel, and ticagrelor. The PK of selatogrel were described by a three‐compartment model. The PD model included a receptor‐pool compartment to which all drugs can bind concurrently, reversibly or irreversibly, depending on their mode of action. Furthermore, ticagrelor and its active metabolite can bind to the selatogrel‐receptor complex allosterically, releasing selatogrel from the binding site. The model provided a framework for predicting the effect on IPA of selatogrel followed by reversibly and irreversibly binding oral P2Y12 receptor antagonists for sustained effects. Determining the timepoint for switching from emergency to maintenance treatment is critical to achieve sufficient IPA at all times. Simulations based on the interaction model showed that loading doses of clopidogrel and prasugrel administered 15 h and 4.5 h after selatogrel, respectively, provide sustained IPA with clinically negligible drug interaction. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?
Selatogrel is a potent reversible P2Y12 receptor antagonist developed for subcutaneous self‐administration by patients in case of suspected acute myocardial infarction. Transition to oral P2Y12 receptor antagonists without drug interaction and sufficient inhibition of platelet aggregation must be assured at all times.
WHAT QUESTION DID THIS STUDY ADDRESS?
The pharmacokinetic/pharmacodynamic model semimechanistically describes the effect of selatogrel on platelet inhibition alone and in combination with the oral P2Y12 receptor antagonists clopidogrel, prasugrel, and ticagrelor.
WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?
Model‐based simulations showed that loading doses of clopidogrel and prasugrel can be administered from 15 h and 4.5 h after selatogrel, respectively.
HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?
These results support guiding the clinical transition from selatogrel emergency treatment to oral maintenance therapy in a safe and efficacious way.
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Affiliation(s)
- Andrea Henrich
- Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Christian Hove Claussen
- Cognigen Corporation, A Simulation Plus Company, Pharmacometrics Services, Copenhagen, Denmark
| | - Jasper Dingemanse
- Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Andreas Krause
- Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
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Hubálek F, Refsgaard HHF, Gram-Nielsen S, Madsen P, Nishimura E, Münzel M, Brand CL, Stidsen CE, Claussen CH, Wulff EM, Pridal L, Ribel U, Kildegaard J, Porsgaard T, Johansson E, Steensgaard DB, Hovgaard L, Glendorf T, Hansen BF, Jensen MK, Nielsen PK, Ludvigsen S, Rugh S, Garibay PW, Moore MC, Cherrington AD, Kjeldsen T. Author Correction: Molecular engineering of safe and efficacious
oral basal insulin. Nat Commun 2020; 11:4232. [PMID: 34244486 PMCID: PMC7441397 DOI: 10.1038/s41467-020-18106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hubálek F, Refsgaard HHF, Gram-Nielsen S, Madsen P, Nishimura E, Münzel M, Brand CL, Stidsen CE, Claussen CH, Wulff EM, Pridal L, Ribel U, Kildegaard J, Porsgaard T, Johansson E, Steensgaard DB, Hovgaard L, Glendorf T, Hansen BF, Jensen MK, Nielsen PK, Ludvigsen S, Rugh S, Garibay PW, Moore MC, Cherrington AD, Kjeldsen T. Molecular engineering of safe and efficacious oral basal insulin. Nat Commun 2020; 11:3746. [PMID: 32719315 PMCID: PMC7385171 DOI: 10.1038/s41467-020-17487-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/01/2020] [Indexed: 12/19/2022] Open
Abstract
Recently, the clinical proof of concept for the first ultra-long oral insulin was reported, showing efficacy and safety similar to subcutaneously administered insulin glargine. Here, we report the molecular engineering as well as biological and pharmacological properties of these insulin analogues. Molecules were designed to have ultra-long pharmacokinetic profile to minimize variability in plasma exposure. Elimination plasma half-life of ~20 h in dogs and ~70 h in man is achieved by a strong albumin binding, and by lowering the insulin receptor affinity 500-fold to slow down receptor mediated clearance. These insulin analogues still stimulate efficient glucose disposal in rats, pigs and dogs during constant intravenous infusion and euglycemic clamp conditions. The albumin binding facilitates initial high plasma exposure with a concomitant delay in distribution to peripheral tissues. This slow appearance in the periphery mediates an early transient hepato-centric insulin action and blunts hypoglycaemia in dogs in response to overdosing.
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Affiliation(s)
| | | | | | - Peter Madsen
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | - Erica Nishimura
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | - Martin Münzel
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | | | | | | | - Erik Max Wulff
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | - Lone Pridal
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | - Ulla Ribel
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | | | - Trine Porsgaard
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | - Eva Johansson
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | | | - Lars Hovgaard
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | - Tine Glendorf
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | - Bo Falck Hansen
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | | | | | - Svend Ludvigsen
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | - Susanne Rugh
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | | | | | | | - Thomas Kjeldsen
- Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark.
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