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Gooderham MJ, de Bruin-Weller M, Weidinger S, Cork MJ, Eichenfield LF, Simpson EL, Tsianakas A, Kerkmann U, Feeney C, Romero W. Practical Management of the JAK1 Inhibitor Abrocitinib for Atopic Dermatitis in Clinical Practice: Special Safety Considerations. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01200-5. [PMID: 38954384 DOI: 10.1007/s13555-024-01200-5] [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: 03/06/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024] Open
Abstract
Abrocitinib, an oral, once-daily, Janus kinase (JAK) 1-selective inhibitor, is approved for the treatment of adults and adolescents with moderate-to-severe atopic dermatitis (AD). Abrocitinib has shown rapid and sustained efficacy in phase 3 trials and a consistent, manageable safety profile in long-term studies. Rapid itch relief and skin clearance are more likely to be achieved with a 200-mg daily dose of abrocitinib than with dupilumab. All oral JAK inhibitors are associated with adverse events of special interest and laboratory changes, and initial risk assessment and follow-up monitoring are important. Appropriate selection of patients and adequate monitoring are key for the safe use of JAK inhibitors. Here, we review the practical use of abrocitinib and discuss characteristics of patients who are candidates for abrocitinib therapy. In general, abrocitinib may be used in all appropriate patients with moderate-to-severe AD in need of systemic therapy, provided there are no contraindications, e.g., in patients with active serious systemic infections and those with severe hepatic impairment, as well as pregnant or breastfeeding women. For patients aged ≥ 65 years, current long-time or past long-time smokers, and those with risk factors for venous thromboembolism, major adverse cardiovascular events, or malignancies, a meticulous benefit-risk assessment is recommended, and it is advised to start with the 100-mg dose, when abrocitinib is the selected treatment option.
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Affiliation(s)
- Melinda J Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Queen's University, Kingston, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | | | | | - Michael J Cork
- Sheffield Dermatology Research, University of Sheffield, Sheffield, UK
- Sheffield Children's Hospital, Sheffield, UK
| | - Lawrence F Eichenfield
- University of California San Diego and Rady Children's Hospital San Diego, San Diego, CA, USA
| | | | | | | | - Claire Feeney
- Pfizer Ltd, Walton Oaks, Dorking Road, Tadworth, Surrey, KT20 7NS, UK.
| | - William Romero
- Pfizer Ltd, Walton Oaks, Dorking Road, Tadworth, Surrey, KT20 7NS, UK
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Kim RW, Lam M, Abuabara K, Simpson EL, Drucker AM. Targeted Systemic Therapies for Adults with Atopic Dermatitis: Selecting from Biologics and JAK Inhibitors. Am J Clin Dermatol 2024; 25:179-193. [PMID: 38216802 DOI: 10.1007/s40257-023-00837-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Abstract
Therapeutic options for people with moderate or severe atopic dermatitis refractory to topical therapy have rapidly expanded in recent years. These new targeted immunomodulatory agents-biologics and Janus kinase (JAK) inhibitors-have each demonstrated high levels of efficacy and acceptable safety in mostly placebo-controlled clinical trials for atopic dermatitis, but there is no universally applicable algorithm to help choose between them for a given patient. Hence, patients and physicians should utilize shared decision making, discussing efficacy, safety, mode of delivery, monitoring, costs, speed of onset, and other factors to reach individualized treatment decisions. In this review, we try to aid shared decision making by summarizing the efficacy, safety, and monitoring of biologics and oral JAK inhibitors for adults with atopic dermatitis. Network meta-analyses suggest that higher doses of abrocitinib and upadacitinib are more effective than biologics. They also show that, among biologics, dupilumab is likely more effective than tralokinumab and lebrikizumab. Biologics are generally considered safer than JAK inhibitors, although concerns about JAK inhibitors are mainly extrapolated from older generation JAK inhibitors used in higher-risk populations. We also outline evidence and considerations for choosing and using systemic immunomodulatory treatments for special populations including pregnant individuals, those with human immunodeficiency virus (HIV), hepatitis B and C, end stage kidney disease, and older adults.
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Affiliation(s)
- Richard W Kim
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Megan Lam
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Division of Epidemiology and Biostatistics, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Medicine and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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Samynathan A, Silverberg JI. Navigating the atopic dermatitis toolbox: Challenging scenarios and shared decision-making. Ann Allergy Asthma Immunol 2024; 132:337-343. [PMID: 38145707 DOI: 10.1016/j.anai.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease with a complex pathogenesis and heterogeneous clinical presentation. Recently, multiple advanced therapies were approved for the treatment of moderate-severe AD, including the biologics dupilumab, tralokinumab, and lebrikizumab and oral Janus kinase inhibitors abrocitinib, upadacitinib, and baricitinib. These treatments have different efficacy, safety, and tolerability profiles and monitoring requirements. The availability of multiple recently approved therapies poses a clinical challenge for health care providers and patients on how to select the best treatment for patients. This article aims to highlight clinical considerations and patient perspectives to guide shared decision-making for biologic and oral systemic therapy, particularly Janus kinase inhibitors, in AD. Important aspects to consider include treatment goals, medical history, symptom severity, physician assessments, safety profile of drugs, and the risk predispositions in patients.
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Affiliation(s)
- Archana Samynathan
- Department of Dermatology, George Washington University, Washington, District of Columbia
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University, Washington, District of Columbia.
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Tachet J, Versace F, Mercier T, Buclin T, Decosterd LA, Choong E, Girardin FR. Development and validation of a multiplex HPLC-MS/MS assay for the monitoring of JAK inhibitors in patient plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1230:123917. [PMID: 37956468 DOI: 10.1016/j.jchromb.2023.123917] [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: 08/30/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
Janus kinase inhibitors (JAKi) are oral small molecules used in the treatment of a broad spectrum of autoimmune and myeloproliferative diseases. JAKi exhibit significant intra- and inter-individual pharmacokinetic variabilities, due to fluctuations in compliance with oral treatments and their metabolism essentially driven by cytochrome P450 enzymes. Intrinsically, JAKi have dose-response relationship and narrow therapeutic index: therapeutic drug monitoring (TDM) is expected to optimize and adapt their dosage regimen in order to resolve problems of efficacy and tolerance linked to dose and safety. A sensitive analytical method using multiplex high-performance liquid-chromatography coupled to tandem mass spectrometry (HPLC-MS/MS) was developed and validated for the simultaneous quantification in plasma of the 6 major currently used JAKi, namely abrocitinib, baricitinib, fedratinib, ruxolitinib, tofacitinib, and upadacitinib. Plasma samples are subjected to protein precipitation with MeOH, using stable isotopically labelled internal standards. The separation of JAKi in supernatants diluted 1:1 with ultrapure H2O was performed using a C18 column Xselect HSS T3 2.5 µm, 2.1x150 mm using a mobile phase composed of formic acid (FA) 0.2% and acetonitrile (+FA 0.1%) in gradient mode. The analytical run time for the multiplex assay was 7 min. JAKi drugs were monitored by electrospray ionization in the positive mode followed by triple-stage quadrupole MS/MS analysis. The method was validated according to SFSTP and ICH guidelines over the clinically relevant concentration ranges (0.5-200 ng/mL for abrocitinib, baricitinib and upadacitinib; 1-400 ng/mL for tofacitinib; 0.5-400 ng/mL for ruxolitinib, and 10-800 ng/mL for fedratinib). This multiplex HPLC-MS/MS assay achieved good performances in term of trueness (91.1-113.5%), repeatability (3.0-9.9%), and intermediate precision (4.5-11.3%). We developed and validated a highly sensitive method for the multiplex quantification of the JAKi abrocitinib, baricitinib, fedratinib, ruxolitinib, tofacitinib, and upadacitinib in human plasma. The method will be applied for prospective clinical pharmacokinetic studies to determine whether TDM programs for JAKi based on residual drug concentrations can be recommended using disease-specific therapeutic ranges.
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Affiliation(s)
- Jérémie Tachet
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - François Versace
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Mercier
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Buclin
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurent A Decosterd
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eva Choong
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - François R Girardin
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland.
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Liu J, Li W, Zhang K, Huang J, Zhang X, Lei Y, Liu J, Sun J, Yang G, Zhang H. Low-dose apatinib in subjects with renal impairment: A pharmacokinetics study. Eur J Pharm Sci 2023; 190:106536. [PMID: 37490973 DOI: 10.1016/j.ejps.2023.106536] [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: 04/22/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE In patients with renal impairment, we studied apatinib and its major metabolites (M1-1, M1-2, M1-6, and M9-2) for pharmacokinetics. METHODS Subjects with different renal functions were given a single oral dose of apatinib mesylate tablets of 250 mg. Pharmacokinetic samples were collected at 1 hour before dosing,0.25, 0.5, 1, 2, 3, 4, 6, 8, 24, 48, 72, and 96 h after dosing. The pharmacokinetic parameters of apatinib and its major metabolites were calculated by noncompartmental analysis. RESULTS Comparing PK parameters of the mild or moderate renal impairment group with the healthy group: the geometric mean ratios of maximum observed drug concentration (Cmax), the area under the plasma drug concentration-time curve from time 0 to the final quantifiable time (AUC0-t), and the area under the plasma concentration-time curve from time 0 extrapolated to infinity (AUC0-inf) were all about one. No significant effect of mild and moderate renal impairment on apatinib pharmacokinetics was observed. Mild and moderate renal impairment was also not observed to have a significant effect on the pharmacokinetics of metabolites M1-1, M1-2, and M1-6. However, mild and moderate renal impairment had a certain increase in exposure to the metabolite M9-2. Considering that M9-2 has no inhibitory effect on protein tyrosine kinase, it has no clinical significance. In addition, the proportion of cumulative excretion of apatinib and its major metabolites was small and almost negligible in all three groups of subjects. CONCLUSION Patients with mild and moderate renal impairment do not need to adjust the dose of apatinib when using low dose (250 mg) apatinib.
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Affiliation(s)
- Jishi Liu
- Department of Nephrology, The Third Xiangya Hospital, Central South University No. 138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Wei Li
- Department of Nephrology, The Third Xiangya Hospital, Central South University No. 138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Kaiqian Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University No. 138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Jie Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, PR China
| | - Xingfei Zhang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, PR China
| | - Yumeng Lei
- Department of Nephrology, The Third Xiangya Hospital, Central South University No. 138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Jun Liu
- Department of Nephrology, The Third Xiangya Hospital, Central South University No. 138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Jian Sun
- Department of Nephrology, The Third Xiangya Hospital, Central South University No. 138, Tongzipo Road, Changsha, 410013, Hunan Province, China
| | - Guoping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, PR China; Research Center of Drug Clinical Evaluation of Central South University, Changsha, 410013, Hunan, China; Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410013, Hunan, China.
| | - Hao Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University No. 138, Tongzipo Road, Changsha, 410013, Hunan Province, China.
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Miot HA, Criado PR, de Castro CCS, Ianhez M, Talhari C, Ramos PM. JAK-STAT pathway inhibitors in dermatology. An Bras Dermatol 2023; 98:656-677. [PMID: 37230920 PMCID: PMC10404561 DOI: 10.1016/j.abd.2023.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 05/27/2023] Open
Abstract
The JAK-STAT signaling pathway mediates important cellular processes such as immune response, carcinogenesis, cell differentiation, division and death. Therefore, drugs that interfere with different JAK-STAT signaling patterns have potential indications for various medical conditions. The main dermatological targets of JAK-STAT pathway inhibitors are inflammatory or autoimmune diseases such as psoriasis, vitiligo, atopic dermatitis and alopecia areata; however, several dermatoses are under investigation to expand this list of indications. As JAK-STAT pathway inhibitors should gradually occupy a relevant space in dermatological prescriptions, this review presents the main available drugs, their immunological effects, and their pharmacological characteristics, related to clinical efficacy and safety, aiming to validate the best dermatological practice.
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Affiliation(s)
- Hélio Amante Miot
- Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Paulo Ricardo Criado
- Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brazil; Faculdade de Ciências Médicas de Santos, Santos, SP, Brazil
| | - Caio César Silva de Castro
- Hospital de Dermatologia Sanitária do Paraná, Curitiba, PR, Brazil; Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Mayra Ianhez
- Department of Tropical Medicine and Dermatology, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Carolina Talhari
- Department of Dermatology, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Paulo Müller Ramos
- Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Samuel C, Cornman H, Kambala A, Kwatra SG. A Review on the Safety of Using JAK Inhibitors in Dermatology: Clinical and Laboratory Monitoring. Dermatol Ther (Heidelb) 2023; 13:729-749. [PMID: 36790724 PMCID: PMC9930707 DOI: 10.1007/s13555-023-00892-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023] Open
Abstract
Janus kinase (JAK) inhibitors are disease-modifying agents with efficacy in treating a spectrum of burdensome dermatologic conditions. The US Food and Drug Administration (FDA) recently placed a black box warning on this class of medications due to safety concerns based on data from studies investigating tofacitinib in patients with rheumatoid arthritis. Here we provide an overview of the timeline of FDA approval of JAK inhibitors in dermatology. We also discuss the available safety profiles of approved oral JAK1 inhibitors, namely abrocitinib and upadacitinib, oral baricitinib, a JAK1/2 inhibitor, deucravacitinib, a Tyk2 inhibitor, and the topical JAK1/2 inhibitor ruxolitinib in dermatology patients. Additionally, we offer suggestions for initial screening and laboratory monitoring for patients receiving JAK inhibitors. We found that the rates of venous thromboembolism reported in trials ranged from no events to 0.1-0.5% in dermatology-specific phase 3 clinical trials compared with no events in the placebo. The rates of cardiovascular events ranged from no events to 0.4-1.2% compared with no events to 0.5-1.2% in the placebo. The rates of serious infections were 0.4-4.8% compared with no events to 0.5-1.3% in the placebo. The rates of nonmelanoma skin cancer (NMSC) ranged from no event to 0.6-0.9% compared with no events in the placebo. The rates of non-NMSC ranged from no event to 0.2-0.7% compared with no event to 0.6% in the placebo. Most patients who developed these adverse events had risk factors for the specific event. The most common adverse events of oral JAK inhibitors included upper respiratory infections, nasopharyngitis, nausea, headache, and acne. Dermatologists should consider patients' baseline risk factors for developing serious complications when prescribing oral JAK inhibitors.
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Affiliation(s)
- Christeen Samuel
- Department of Dermatology, Johns Hopkins School of Medicine, Cancer Research Building II, Suite 206, 1550 Orleans Street, Baltimore, MD 21231 USA
| | - Hannah Cornman
- Department of Dermatology, Johns Hopkins School of Medicine, Cancer Research Building II, Suite 206, 1550 Orleans Street, Baltimore, MD 21231 USA
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins School of Medicine, Cancer Research Building II, Suite 206, 1550 Orleans Street, Baltimore, MD 21231 USA
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins School of Medicine, Cancer Research Building II, Suite 206, 1550 Orleans Street, Baltimore, MD 21231 USA
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Efficacy and Safety of JAK1 Inhibitor Abrocitinib in Atopic Dermatitis. Pharmaceutics 2023; 15:pharmaceutics15020385. [PMID: 36839707 PMCID: PMC9960033 DOI: 10.3390/pharmaceutics15020385] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Abrocitinib is a JAK1 selective inhibitor recently approved for the treatment of moderate-to-severe atopic dermatitis in adults. It has demonstrated efficacy and safety in several clinical trials, both in children and adults, in monotherapy, and compared with dupilumab. The expected EASI-75 response rate estimates at week 12 are 62.9% (95% CrI 42.5-79.9%) for abrocitinib 200 mg and 43.0% (95% CrI 24.8-64.0%) for abrocitinib 100 mg. Abrocitinib has shown a faster effect than dupilumab as regards early alleviation of itch. Because of the incomplete target selectivity of JAK inhibitors, when abrocitinib treatment is considered, laboratory screening is necessary, latent tuberculosis must be screened for, active infections are a contraindication, and special caution must be exerted in treating elderly patients and those predisposed to thromboembolic events. Even though recent meta-analyses of clinical trials have not shown that atopic dermatitis, or its treatment with JAK inhibitors or dupilumab, modify the risk of deep venous thrombosis or pulmonary embolism, long-term follow-up studies will better define the safety profile of abrocitinib.
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Eichner A, Wohlrab J. Pharmacology of inhibitors of Janus kinases – Part 1: Pharmacokinetics. J Dtsch Dermatol Ges 2022; 20:1485-1499. [DOI: 10.1111/ddg.14921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Adina Eichner
- An‐Institute of Applied Dermatopharmacy Martin Luther University Halle‐Wittenberg Halle (Saale) Germany
| | - Johannes Wohlrab
- An‐Institute of Applied Dermatopharmacy Martin Luther University Halle‐Wittenberg Halle (Saale) Germany
- Department of Dermatology and Venereology Martin Luther University Halle‐Wittenberg Halle (Saale) Germany
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Eichner A, Wohlrab J. Pharmakologie der Januskinase‐Inhibitoren – Teil 1: Pharmakokinetik. J Dtsch Dermatol Ges 2022; 20:1485-1500. [DOI: 10.1111/ddg.14921_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Adina Eichner
- An‐Institut für angewandte Dermatopharmazie Martin‐Luther‐Universität Halle‐Wittenberg Halle (Saale)
| | - Johannes Wohlrab
- An‐Institut für angewandte Dermatopharmazie Martin‐Luther‐Universität Halle‐Wittenberg Halle (Saale)
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie Martin‐ Luther‐Universität Halle‐Wittenberg Halle (Saale)
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Wang X, Gupta P, Malhotra BK, Farooqui SA, Le VH, Wojciechowski J, Mukherjee A, Nicholas T. Population Pharmacokinetic/Pharmacodynamic Modeling of the Effect of Abrocitinib on QT Intervals in Healthy Volunteers. Clin Pharmacol Drug Dev 2022; 11:1036-1045. [PMID: 35532896 PMCID: PMC9835371 DOI: 10.1002/cpdd.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/11/2022] [Indexed: 01/26/2023]
Abstract
Abrocitinib is a selective Janus kinase 1 inhibitor for the treatment of moderate to severe atopic dermatitis (AD). To assess the relationship between abrocitinib plasma concentrations and heart rate (HR)-corrected QT (QTc) and HR and calculate the effect of abrocitinib on these parameters at supratherapeutic concentrations, 36 healthy volunteers received single doses of abrocitinib 600 mg, placebo, and moxifloxacin 400 mg in a 3-period crossover study. The relationship between change from baseline in Fridericia-corrected QTc (∆QTcF) values and abrocitinib plasma concentrations was modeled using a prespecified linear mixed-effects model. The 90%CIs for time-matched placebo-corrected ∆QTcF (∆∆QTcF) were calculated from model parameter estimates and assessed against the regulatory threshold (10 millisecond) at the predicted supratherapeutic concentration in patients with atopic dermatitis (2156 ng/mL). Mean (90%CI) time-matched placebo-corrected change from baseline in HR (∆∆HR) was calculated similarly. At the supratherapeutic concentration, mean (90%CI) estimates for ∆∆QTcF and ∆∆HR were 6.00 (4.52-7.49) milliseconds and 6.51 (5.23-7.80) bpm, respectively. Despite a concentration-dependent effect on ∆QTcF and ∆HR, with statistically significant slopes (90%CI) of 0.0026 (0.0018-0.0035) milliseconds/(ng/mL) and 0.0031 (0.0024-0.0038) bpm/(ng/mL), respectively, abrocitinib does not have a clinically significant effect on QTc interval or HR at supratherapeutic exposures.
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Bauman JN, Doran AC, King-Ahmad A, Sharma R, Walker GS, Lin J, Lin TH, Telliez JB, Tripathy S, Goosen TC, Banfield C, Malhotra BK, Dowty ME. The Pharmacokinetics, Metabolism, and Clearance Mechanisms of Abrocitinib, a Selective Janus Kinase Inhibitor, in Humans. Drug Metab Dispos 2022; 50:1106-1118. [PMID: 35701182 DOI: 10.1124/dmd.122.000829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Abstract
Abrocitinib is an oral once-daily Janus kinase 1 selective inhibitor being developed for the treatment of moderate-to-severe atopic dermatitis. This study examined the disposition of abrocitinib in male participants following oral and intravenous administration using accelerator mass spectroscopy methodology to estimate pharmacokinetic parameters and characterize metabolite profiles. The results indicated abrocitinib had a systemic clearance of 64.2 L/h, a steady state volume of distribution of 100 L, extent of absorption >90%, time to maximum plasma concentration of ≈0.5 hour, and absolute oral bioavailability of 60%. The half-life of both abrocitinib and total radioactivity was similar with no indication of metabolite accumulation. Abrocitinib was the main circulating drug species in plasma (≈26%) with 3 major mono-hydroxylated metabolites (M1, M2, and M4) at >10%. Oxidative metabolism was the primary route of elimination for abrocitinib with the greatest disposition of radioactivity shown in the urine (≈85%). In vitro phenotyping indicated abrocitinib cytochrome P450 fraction of metabolism assignments of 0.53 for CYP2C19, 0.30 for CYP2C9, 0.11 for CYP3A4, and ≈0.06 for CYP2B6. The principal systemic metabolites M1, M2, and M4 were primarily cleared renally. Abrocitinib, M1, and M2 showed pharmacology with similar Janus kinase 1 selectivity, whereas M4 was inactive. Significance Statement This study provides a detailed understanding of the disposition and metabolism of abrocitinib, a JAK inhibitor for atopic dermatitis, in humans, as well as characterization of clearance pathways and pharmacokinetics of abrocitinib and its metabolites.
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Affiliation(s)
| | | | | | | | | | | | - Tsung H Lin
- Inflammation and Immunology, Pfizer Inc, United States
| | | | | | - Theunis C Goosen
- Pharmacokinetics, Dynamics & Metabolism, Pfizer, Inc, United States
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