Effect of the anti-inflammatory agent tenidap on the pharmacokinetics and pharmacodynamics of prednisolone

Quantification of unbound prednisolone, prednisone, cortisol and cortisone in human plasma by ultrafiltration and direct injection into liquid chromatrography tandem mass spectrometry

BACKGROUND

The existing methods for quantitative analysis of free corticosteroids require high volume of plasma and laborious extraction processes. Development of ultrafiltration followed by the liquid chromatrography tandem mass spectrometry (LC-MS/MS) method that requires 300 microL of plasma, does not entail any offline extraction and achieves good sensitivity was described.

METHODS

Unbound corticosteroids were separated by the ultrafiltration of plasma using Microcon centrifugal filter devices (10,000 Dal nominal molecular weight limit). A 30 microL aliquot of the ultrafiltrate was directly injected into a two-dimensional high-performance liquid chromatography clean-up and separation system coupled with API-4000 mass spectrometer. The clean-up was performed on a Strata-X on-line extraction cartridge. A Zorbax-SB Phenyl, Rapid Resolution HT (2.1 x 100 mm) column was employed to chromatographically resolve cortisol and prednisolone from each other, from cortisone and prednisone as well as from interferences found in plasma from stable kidney transplant recipients.

RESULTS

Intra- and inter-run imprecision and inaccuracy within +/-15% were achieved during a three-batch validation for quality control samples at six concentrations in ultrafiltrate from charcoal-stripped plasma and three concentrations from normal plasma, over a 2000-fold dynamic range. The lower limit of quantification was 0.100 ng/mL for all four corticosteroids.

CONCLUSIONS

A highly selective, sensitive, simple and robust LC-MS/MS method was developed for the simultaneous quantification of free cortisol, cortisone, prednisolone and prednisone. The performance of the Strata-X on-line extraction cartridge was maintained for over 700 injections. The assay was successfully applied for the analysis of the analytes in over 500 plasma samples from stable kidney transplant recipients.

Assessment of the impact of dosing time on the pharmacokinetics/pharmacodynamics of prednisolone

Prednisolone is widely used for the treatment of inflammation and auto-immune diseases. It exhibits nonlinear pharmacokinetics (PK); and its induced systemic effects (pharmacodynamics (PD)) are commonly evaluated with two biomarkers, cortisol and blood lymphocytes in plasma. Circadian patterns are observed in both biomarkers. Furthermore, the disease itself may show a circadian pattern. For example, in rheumatoid arthritis patients, better therapeutic outcomes have been reported when prednisolone was administered in the very early morning. The aim of this study is to evaluate the impact of dosing time on the PK/PD of prednisolone with a simulation approach using an interactive algorithm. A series of simulations were performed with either intravenous or oral administration of prednisolone or prednisone. The results showed that the initial or maximum concentration and trough concentration of total prednisolone were lower when the drug was administered in the early morning around 6 AM: . Oscillation patterns were observed in cumulative cortisol suppression (CCS) and alteration of total lymphocyte trafficking in blood. When the drug was given in the morning within the therapeutic dose range, or around 6 PM: for a small dose amount (<1 mg), the minimum CCS and maximum effect on lymphocytes were observed. These results indicated that the PK/PD of prednisolone are time- and dose-dependent, and suggested that it is necessary to consider the application of chronotherapy to achieve better clinical outcomes with fewer side effects of prednisolone, and a PK/PD simulation approach could provide a valuable tool to evaluate and predict time-dependency in the system.

Pharmacokinetic and adrenal interactions of IL-10 and prednisone in healthy volunteers

The pharmacokinetic and adrenal interactions of recombinant human interleukin-10 and prednisolone were examined in this open-label, randomized, four-way crossover study in 12 healthy adult male volunteers. Single doses of IL-10 (8 micrograms/kg s.c.), IL-10 with prednisone (15 mg p.o.), placebo with prednisone, or placebo were administered on four separate occasions with at least 3-week interceding washout periods. Measurements included plasma prednisone, prednisolone and cortisol, unbound prednisolone, and serum IL-10 concentrations. Pharmacokinetic parameters were determined using noncompartmental and model-fitting analysis, while area analysis and an indirect response model were used to assess cortisol dynamics. IL-10 exhibited prolonged serum concentrations owing to dual-absorption processes that were largely unaffected by prednisone. The Cmax values were about 3 ng/mL, while the tmax occurred at 7 to 9 hours. Prednisolone exhibited rapid systemic kinetics with a Cmax of 235 ng/mL, tmax at 1.11 hours, and t1/2 of 2.54 hours with no significant alterations owing to IL-10. Both prednisolone and prednisolone/IL-10 caused marked suppression of cortisol concentrations with similar magnitude and IC50 values; however, IL-10 alone significantly increased the 24-hour AUC of cortisol by 20%. Thus, IL-10 and prednisolone do not interact in disposition or adrenal suppression to a clinically significant degree.

Pharmacokinetic and pharmacodynamic evaluation of triamcinolone acetonide after intravenous, oral, and inhaled administration

Triamcinolone acetonide (TCA) is a corticosteroid that is frequently used in the treatment of asthma. After inhalation, TCA can become systemically available when the inhaled formulation is swallowed, causing undesirable systemic effects. A clinical study was conducted to determine the systemic side effects of TCA after intravenous (2 mg as phosphate ester), oral (5 mg), and inhaled (2 mg) administration. Blood samples were collected at appropriate times over 24 hours, and TCA concentrations in plasma were measured by high-performance liquid chromatography and radioimmunoassay. Free drug concentrations were determined by ultrafiltration for correlating pharmacokinetics and pharmacodynamics. The free fraction of TCA (+/- standard deviation) was 29.0 +/- 1.3% and was independent of the investigated concentration range up to 1,000 ng/mL. Pharmacodynamic parameters were determined by monitoring lymphocytes, granulocytes, and cortisol. Pharmacokinetic/pharmacodynamic modeling was performed using a modified Emax model for lymphocytes and granulocytes. A novel linear release rate model was used to characterize the cortisol data. The E50 values determined from all three pharmacodynamic endpoints were not significantly different for the three treatments, indicating that these effects can be explained based on systemic steroid concentrations.

Pharmacokinetics and receptor-mediated pharmacodynamics of corticosteroids

The corticosteroids, such as prednisolone and methylprednisolone, provide diverse antiinflammatory and immunosuppressive effects which typically show responses with slow onset and prolonged duration. This report summarizes modeling efforts which are successful in describing such steroid effects. Clinical effects with such a pattern, including adrenal suppression and altered trafficking of basophils and helper T-cells, can be related to plasma drug concentrations by models containing an inhibition function and differential equations for controlling input and disposition of the response variable. Some responses have circadian-controlled inputs which add time-dependent complexities to the models. Kinetic/dynamic data for several corticosteroid effects yield IC50 values which agree well with receptor KD values. A relationship of linear AUC of effect versus log AUC of steroid in plasma is found with these models over a large range of doses. Gene-mediated effects of corticosteroids are initiated by receptor-binding which causes a cascade effect altering DNA transcription, RNA, mRNA and proteins or enzymes accounting for drug effects. Models for such behavior have been developed in animals for hepatic tyrosine aminotransferase (TAT) enzyme activity. Studies with methylprednisolone formulated in liposomes show tissue sequestration of steroid, prolonged receptor-binding and extended inhibition of splenocyte proliferation. The data and models usually show good correspondence of the AUC of receptor occupancy with the AUC of pharmacologic response.

Fifteen years of operation of a high-performance liquid chromatographic assay for prednisolone, cortisol and prednisone in plasma

A high-performance liquid chromatographic (HPLC) assay first described in 1979 has been modified and revalidated for the simultaneous determination of prednisone, cortisol and prednisolone in human plasma using betamethasone as an internal standard. Revisions include: mobile phase composition; use of a precolumn, automated injector, integrator, and computer software; improved sensitivity and quantitation; thorough investigation of stability, variation, and specimen type; and inclusion of suggested quality control criteria. Plasma-based drug standards are extracted with methylene chloride and washed with sodium hydroxide followed by a water wash. After evaporation of solvent and reconstitution with mobile phase, the extracts are then injected onto a silica gel column (Zorbax SIL) for chromatography with UV absorbance at 254 nm. Calculated limits of quantitation are 10 ng/ml and limits of detection are less than 5 ng/ml. Intra- and inter-day coefficients of variation for quality control samples for all three corticosteroids are less than 11.2%. Recovery and stability data are also provided. Several drugs that may be coadministered do not interfere with the analysis.

Effects of indomethacin on the pharmacokinetics and pharmacodynamics of prednisolone in rats

The effect of indomethacin on the disposition of prednisolone and the induction of tyrosine aminotransferase (TAT) was examined in male Sprague-Dawley rats. Rats were pretreated with either indomethacin (5 mg/kg, intraperitoneally) or phosphate buffered saline (control) twice daily for 6 days followed by a single dose of prednisolone. Blood samples were collected after prednisolone administration. In separate animals, hepatic TAT activity (pharmacologic effect) was measured 4 h after the prednisolone dose. In addition, the effect of indomethacin on the in vitro protein binding of prednisolone was examined in pooled rat and human plasma. The clearance and apparent volume of distribution of prednisolone in the control and indomethacin-treated animals were similar, averaging 4.71 versus 4.05 L/h/kg and 1.37 versus 1.33 L/kg, respectively. The elimination half-life was 0.48 h in both groups. Indomethacin also did not affect the protein binding of prednisolone in rat or human plasma. However, indomethacin pretreatment increased the hepatic TAT activity induced by prednisolone. These studies indicate that indomethacin may affect the pharmacological effects of prednisolone without influencing its pharmacokinetics.