A systematic strategy for estimating hERG block potency and its implications in a new cardiac safety paradigm.
Toxicol Appl Pharmacol 2020;
394:114961. [PMID:
32209365 PMCID:
PMC7166077 DOI:
10.1016/j.taap.2020.114961]
[Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/14/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022]
Abstract
Introduction
hERG block potency is widely used to calculate a drug's safety margin against its torsadogenic potential. Previous studies are confounded by use of different patch clamp electrophysiology protocols and a lack of statistical quantification of experimental variability. Since the new cardiac safety paradigm being discussed by the International Council for Harmonisation promotes a tighter integration of nonclinical and clinical data for torsadogenic risk assessment, a more systematic approach to estimate the hERG block potency and safety margin is needed.
Methods
A cross-industry study was performed to collect hERG data on 28 drugs with known torsadogenic risk using a standardized experimental protocol. A Bayesian hierarchical modeling (BHM) approach was used to assess the hERG block potency of these drugs by quantifying both the inter-site and intra-site variability. A modeling and simulation study was also done to evaluate protocol-dependent changes in hERG potency estimates.
Results
A systematic approach to estimate hERG block potency is established. The impact of choosing a safety margin threshold on torsadogenic risk evaluation is explored based on the posterior distributions of hERG potency estimated by this method. The modeling and simulation results suggest any potency estimate is specific to the protocol used.
Discussion
This methodology can estimate hERG block potency specific to a given voltage protocol. The relationship between safety margin thresholds and torsadogenic risk predictivity suggests the threshold should be tailored to each specific context of use, and safety margin evaluation may need to be integrated with other information to form a more comprehensive risk assessment.
hERG potency/safety margin is a widely used nonclinical cardiac safety strategy.
A new regulatory paradigm promotes the integration of nonclinical and clinical data.
Lack of uncertainty quantification hindered using hERG potency in the new paradigm.
A systematic method was established to address this limitation.
Analysis supports using different safety margin thresholds in different context.
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