1
|
Ford JL, Sabet A, Natarajan J, Stieltjes H, Chao DL, Goyal N, Csonka D. Bioequivalence and the food effect of macitentan/tadalafil 10/20 fixed-dose combination tablets versus the use of single-component tablets in healthy subjects. Pharmacol Res Perspect 2024; 12:e1202. [PMID: 38764241 PMCID: PMC11103125 DOI: 10.1002/prp2.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/21/2024] Open
Abstract
The primary aim was to demonstrate bioequivalence between the 10/20 mg fixed-dose combination (FDC) of macitentan/tadalafil in a single tablet and the free combination of both drugs, and to evaluate the food effect on the 10/20 mg FDC in healthy participants. In this single-center, randomized, open-label, 3-way crossover, single-dose Phase 1 study in healthy adult participants, macitentan/tadalafil was administered as a 10/20 mg FDC formulation and compared with the free combination of macitentan and tadalafil. The food effect on the FDC was also evaluated. Pharmacokinetic sampling (216 h) was conducted. The 90% confidence intervals (CIs) for the geometric mean ratios of maximum observed plasma analyte concentration (Cmax) and area under the plasma analyte concentration-time curves (AUCs) for Treatment A (FDC, fasted) versus C (free combination, fasted) were within bioequivalence limits demonstrating that the FDC formulation can be considered bioequivalent to the free combination. The 90% CIs for the geometric mean ratios of Cmax and AUC for Treatment B (FDC, fed) versus A (FDC, fasted) were contained within bioequivalence limits demonstrating that there was no food effect. The administration of the 10/20 mg FDC was generally safe and well tolerated in healthy participants. This study demonstrated bioequivalence between the FDC of macitentan/tadalafil (10/20 mg) in a single tablet and the free combination of both drugs in healthy participants, and that the FDC can be taken without regard to food, similarly to the individual components. The FDC was generally safe and well tolerated.
Collapse
Affiliation(s)
| | | | | | | | | | - Navin Goyal
- Janssen Research & DevelopmentRaritanNew JerseyUSA
| | - Denes Csonka
- Actelion Pharmaceuticals, A Janssen Pharmaceutical Company of Johnson & JohnsonAllschwilSwitzerland
| |
Collapse
|
2
|
Kodati B, Zhang W, He S, Pham JH, Beall KJ, Swanger ZE, Krishnamoorthy VR, Harris PE, Hall T, Tran AV, Chaphalkar RM, Chavala SH, Stankowska DL, Krishnamoorthy RR. The endothelin receptor antagonist macitentan ameliorates endothelin-mediated vasoconstriction and promotes the survival of retinal ganglion cells in rats. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1185755. [PMID: 38464735 PMCID: PMC10921982 DOI: 10.3389/fopht.2023.1185755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Glaucoma is a chronic and progressive eye disease, commonly associated with elevated intraocular pressure (IOP) and characterized by optic nerve degeneration, cupping of the optic disc, and loss of retinal ganglion cells (RGCs). The pathological changes in glaucoma are triggered by multiple mechanisms and both mechanical effects and vascular factors are thought to contribute to the etiology of glaucoma. Various studies have shown that endothelin-1 (ET-1), a vasoactive peptide, acting through its G protein coupled receptors, ETA and ETB, plays a pathophysiologic role in glaucoma. However, the mechanisms by which ET-1 contribute to neurodegeneration remain to be completely understood. Our laboratory and others demonstrated that macitentan (MAC), a pan endothelin receptor antagonist, has neuroprotective effects in rodent models of IOP elevation. The current study aimed to determine if oral administration of a dual endothelin antagonist, macitentan, could promote neuroprotection in an acute model of intravitreal administration of ET-1. We demonstrate that vasoconstriction following the intravitreal administration of ET-1 was attenuated by dietary administration of the ETA/ETB dual receptor antagonist, macitentan (5 mg/kg body weight) in retired breeder Brown Norway rats. ET-1 intravitreal injection produced a 40% loss of RGCs, which was significantly lower in macitentan-treated rats. We also evaluated the expression levels of glial fibrillary acidic protein (GFAP) at 24 h and 7 days post intravitreal administration of ET-1 in Brown Norway rats as well as following ET-1 treatment in cultured human optic nerve head astrocytes. We observed that at the 24 h time point the expression levels of GFAP was upregulated (indicative of glial activation) following intravitreal ET-1 administration in both retina and optic nerve head regions. However, following macitentan administration for 7 days after intravitreal ET-1 administration, we observed an upregulation of GFAP expression, compared to untreated rats injected intravitreally with ET-1 alone. Macitentan treatment in ET-1 administered rats showed protection of RGC somas but was not able to preserve axonal integrity and functionality. The endothelin receptor antagonist, macitentan, has neuroprotective effects in the retinas of Brown Norway rats acting through different mechanisms, including enhancement of RGC survival and reduction of ET-1 mediated vasoconstriction.
Collapse
Affiliation(s)
- Bindu Kodati
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Wei Zhang
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Shaoqing He
- Department of Pathology, Children’s Health at Dallas, Dallas, TX, United States
| | - Jennifer H. Pham
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Kallen J. Beall
- Department of General Surgery, Honor Health, Phoenix, AZ, United States
| | - Zoe E. Swanger
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States
| | | | - Payton E. Harris
- Department of Graduate Medical Education, Medical City, Fort Worth, TX, United States
| | - Trent Hall
- Williams College, Williamstown, MA, United States
| | - Ashley V. Tran
- School of Natural Sciences and Mathematics, The University of Texas at Dallas, Richardson, TX, United States
| | - Renuka M. Chaphalkar
- Department of Ophthalmology, School of Medicine, University of California, San Francisco, CA, United States
| | - Sai H. Chavala
- Department of Surgery, Burnett School of Medicine at Texas Christian University (TCU), Fort Worth, TX, United States
| | - Dorota L. Stankowska
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Raghu R. Krishnamoorthy
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, United States
| |
Collapse
|
3
|
Dhoble S, Patravale V, Weaver E, Lamprou DA, Patravale T. Comprehensive Review on Novel Targets and Emerging Therapeutic Modalities for Pulmonary Arterial Hypertension. Int J Pharm 2022; 621:121792. [PMID: 35513217 DOI: 10.1016/j.ijpharm.2022.121792] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/17/2022] [Accepted: 04/28/2022] [Indexed: 01/17/2023]
Abstract
Pulmonary Arterial Hypertension (PAH) is the progressive increase in mean pulmonary arterial pressure (mPAP) (≥ 20 mmHg at rest). Current treatment strategies include the drugs targeting at nitric oxide pathway, endothelin receptors, prostaglandin receptors, thromboxane receptors and phosphodiesterase inhibitors, which provides the symptomatic relief. Despite of these treatments, the mortality amongst the PAH patients remains high due to non-reversal of the condition. This review primarily covers the introduction of PAH and the current treatments of the disease. This is followed by the newer disease targets expressed in the pathobiology of the disease like Rho Kinase Pathway, Vasoactive Intestinal Peptide Pathway, Receptor Tyrosine Kinases, Serotonin signalling pathway, Voltage-gated potassium (Kv) channel pathway. Newer formulation strategies for targeting at these specific receptors were covered and includes nano formulations like liposomes, Micelles, Polymeric Nanoparticles, Solid Lipid Nanoparticles (SLN), Bioresorbable stents, NONOates, Cell-Based Therapies, miRNA therapy for PAH. Novel targets were identified for their role in the pathogenesis of the PAH and needs to be targeted with new molecules or existing molecules effectively. Nanosystems have shown their potential as alternative carriers on the virtue of their better performance than traditional drug delivery systems.
Collapse
Affiliation(s)
- Sagar Dhoble
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga (East), Mumbai 400 019, India
| | - Vandana Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga (East), Mumbai 400 019, India.
| | - Edward Weaver
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom.
| | - Tanmay Patravale
- Department of General Surgery, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590 010, India
| |
Collapse
|
4
|
Weathers SP, Rood-Breithaupt J, de Groot J, Thomas G, Manfrini M, Penas-Prado M, Puduvalli VK, Zwingelstein C, Yung WKA. Results of a phase I trial to assess the safety of macitentan in combination with temozolomide for the treatment of recurrent glioblastoma. Neurooncol Adv 2021; 3:vdab141. [PMID: 34693288 PMCID: PMC8528265 DOI: 10.1093/noajnl/vdab141] [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] [Indexed: 11/23/2022] Open
Abstract
Background There is an urgent need for additional therapies to treat recurrent glioblastoma (GBM). Preclinical studies suggest that high dose macitentan, an oral dual endothelin receptor antagonist, enhances the cytotoxic effects of temozolomide (TMZ) in GBM, improving survival. This phase I trial investigated the maximum tolerated dose of macitentan combined with TMZ in patients with recurrent GBM and assessed the safety and tolerability of high dose macitentan in these patients (NCT01499251). Methods Adults with recurrent GBM received ascending doses of macitentan from 30 mg once daily concomitantly with TMZ. Safety and tolerability were assessed in addition to exploratory efficacy and pharmacokinetic endpoints. An ancillary study examined biomarker expression following macitentan treatment prior to surgical resection of recurrent GBM. Results Thirty-eight patients with recurrent GBM were administered macitentan doses up to 300 mg once daily; no dose-limiting toxicities were observed, and a maximum tolerated dose was not determined. All patients experienced at least one treatment-emergent adverse event (TEAE), the majority associated with GBM or TMZ treatment. TEAEs related to macitentan and TMZ were reported for 16 (42.1%) and 26 (68.4%) patients, respectively, with no serious macitentan-related TEAEs. Macitentan concentrations increased with dose, with no plateau in exposure. Substantial heterogeneity was observed in the expression of efficacy biomarkers within tumors. The Kaplan-Meier estimate of median overall survival across all dose groups was 9.4 (95% CI 8.5, 13.4) months. Conclusion High-dose macitentan was well tolerated in recurrent GBM patients concomitantly receiving TMZ. TEAEs were consistent with those seen in patients receiving either drug individually.
Collapse
Affiliation(s)
| | | | - John de Groot
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gail Thomas
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | | | - Vinay K Puduvalli
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | | | - W K Alfred Yung
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
5
|
Csonka D, Fishman V, Natarajan J, Stieltjes H, Armas D, Dishy V, Perez Ruixo JJ. Bioequivalence and food effect of a fixed-dose combination of macitentan and tadalafil: Adaptive design in the COVID-19 pandemic. Pharmacol Res Perspect 2021; 9:e00846. [PMID: 34624174 PMCID: PMC8500343 DOI: 10.1002/prp2.846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/27/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID‐19 pandemic has forced clinical studies to accommodate imposed limitations. In this study, the bioequivalence part could not be conducted as planned. Thus, the aim was to demonstrate bioequivalence, using an adaptive study design, of tadalafil in fixed‐dose combination (FDC) tablets of macitentan/tadalafil with single macitentan and tadalafil (Canadian‐sourced) tablets and assess the effect of food on FDC tablets in healthy subjects. This Phase 1, single‐center, open‐label, single‐dose, two‐part, two‐period, randomized, crossover study enrolled 62 subjects. Tadalafil bioequivalence as part of FDC of macitentan/tadalafil (10/40 mg) with single‐component tablets of macitentan (10 mg) and tadalafil (40 mg) was determined by pharmacokinetic (PK) assessment under fasted conditions. The effect of food on FDC was evaluated under fed and fasted conditions. Fasted 90% confidence intervals (CIs) for geometric mean ratios (GMRs) were within bioequivalence limits for tadalafil and macitentan. Fed and fasted 90% CIs for area under the curve (AUC) GMR were within bioequivalence limits. However, 90% CIs for maximum plasma concentration (Cmax) GMR for macitentan and tadalafil were outside bioequivalence limits. One FDC‐treated subject experienced a serious adverse event of transient ischemic attack (bioequivalence part). To address pandemic‐imposed limitations, an adaptive study design was implemented to demonstrate that the FDC tablet was bioequivalent to the free combination of macitentan and tadalafil (Canadian‐sourced). No clinically significant differences in PK were determined between fed and fasted conditions; the FDC formulation could be taken irrespective of meals. The FDC formulation under fasted and fed conditions was well tolerated with no clinically relevant differences in safety profiles between the treatment groups. NCT Number: NCT04235270.
Collapse
Affiliation(s)
- Dénes Csonka
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - Jaya Natarajan
- Janssen Research and Development, Raritan, New Jersey, USA
| | | | | | - Victor Dishy
- Janssen Research and Development, Raritan, New Jersey, USA
| | | |
Collapse
|
6
|
Bartolucci R, Dosne AG, Csonka D, Pérez-Ruixo JJ, Magni P, Poggesi I. A Population Pharmacokinetic Model of Macitentan and Its Active Metabolite Aprocitentan in Healthy Volunteers and Patients with Pulmonary Arterial Hypertension. Clin Pharmacokinet 2021; 60:1605-1619. [PMID: 34159557 DOI: 10.1007/s40262-021-01049-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Macitentan and its active metabolite, aprocitentan, are non-peptide, potent, dual endothelin receptor antagonists. Macitentan is approved for the treatment of pulmonary arterial hypertension in adults, at a dose of 10 mg/day. OBJECTIVE The objective of this study was to develop a comprehensive population model to describe the pharmacokinetics of macitentan and aprocitentan in healthy adults and adult subjects with pulmonary arterial hypertension. METHODS Pharmacokinetic data of 452 subjects in nine studies, after single and repeated doses (dose range 0.2-600 mg), were pooled for a non-linear mixed-effects analysis and the assessment of covariates, i.e., body weight, age, sex, race, renal and hepatic impairment, health status (healthy volunteers vs patients with pulmonary arterial hypertension), and formulation (capsules vs tablets) on pharmacokinetic parameters. RESULTS The final model was an open one-compartment disposition model, with linear elimination for macitentan and linear formation and elimination for aprocitentan. A semi-mechanistic absorption model described the dose dependency and multiple peaks observed for macitentan. For a female patient with pulmonary arterial hypertension after oral administration at 10 mg, macitentan reached a maximum concentration after 9 h and, following daily dosing, reached steady state after 3 days with a twofold accumulation factor. The apparent volume of distribution was 34 L and clearance was 1.39 L/h. Aprocitentan reached maximum concentration after 51 h and steady state after 9 days, with a 12.5-fold accumulation factor. Body weight, sex, race, renal impairment, health status, and formulation were statistically significant covariates on pharmacokinetic parameters. CONCLUSIONS The comprehensive population pharmacokinetic model adequately described the pharmacokinetics of macitentan and aprocitentan across different dose concentrations, regimens, and formulations. Several covariates significantly influenced the pharmacokinetics of macitentan and aprocitentan, but none was considered clinically relevant.
Collapse
Affiliation(s)
- Roberta Bartolucci
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
- Clinical Pharmacology and Pharmacometrics, Janssen Research and Development, Antwerp, Belgium
| | - Anne-Gaëlle Dosne
- Clinical Pharmacology and Pharmacometrics, Janssen Research and Development, Antwerp, Belgium
| | - Dénes Csonka
- Clinical Pharmacology and Pharmacometrics, Janssen Research and Development, Allschwil, Switzerland
| | - Juan José Pérez-Ruixo
- Clinical Pharmacology and Pharmacometrics, Janssen Research and Development, Antwerp, Belgium
| | - Paolo Magni
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Italo Poggesi
- Clinical Pharmacology and Pharmacometrics, Janssen Research and Development, Antwerp, Belgium.
| |
Collapse
|
7
|
Bhela IP, Serafini M, Del Grosso E, Tron GC, Pirali T. Tritylamine as an Ammonia Surrogate in the Ugi Reaction Provides Access to Unprecedented 5-Sulfamido Oxazoles Using Burgess-type Reagents. Org Lett 2021; 23:3610-3614. [PMID: 33913716 PMCID: PMC8289289 DOI: 10.1021/acs.orglett.1c01002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
![]()
Starting from a wide
range of α-acylamino amide substructures
synthesized using tritylamine as an ammonia surrogate in the Ugi reaction,
Burgess-type reagents enable cyclodehydration and afford unprecedented
oxazole scaffolds with four points of diversity, including a sulfamide
moiety in the 5-position. The synthetic procedure employs readily
available starting materials and proceeds smoothly under mild reaction
conditions with good tolerance for a variety of functional groups,
coming to fill a gap in the field of oxazole compounds.
Collapse
Affiliation(s)
- Irene Preet Bhela
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Largo Donegani 2, Novara 28100, Italy
| | - Marta Serafini
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Largo Donegani 2, Novara 28100, Italy
| | - Erika Del Grosso
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Largo Donegani 2, Novara 28100, Italy
| | - Gian Cesare Tron
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Largo Donegani 2, Novara 28100, Italy
| | - Tracey Pirali
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Largo Donegani 2, Novara 28100, Italy.,ChemICare S.r.l., Enne3, Corso Trieste 15/A, Novara 28100, Italy
| |
Collapse
|
8
|
Stadlbauer C, Golovchenko S, Englert L, Spaeth M, Hoenicka M, Hofmann HS, Ried M. [Organ Bath Experiments on Human Pulmonary Vessels: Assessment of Drug Efficacy for Treatment of Pulmonary Arterial Hypertension]. Pneumologie 2021; 75:369-376. [PMID: 33472251 DOI: 10.1055/a-1332-6892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Various vasodilator medications are used in the treatment of pulmonary arterial hypertension (PAH), such as endothelin receptor antagonists (ERA) or phosphodiesterase-5-(PDE-5-)inhibitors. In a human ex vivo model, we investigated whether the combination of two substance classes could achieve a higher effect or - without loss of vasodilatation - a lower dosage of the individual substances might be sufficient. We established an ex vivo organ bath model to evaluate the dose-dependent effects of ERA and PDE-5-inhibitors on pulmonary vessels harvested from patients who underwent surgery (lung resection/transplantation). We compared the combined use of both substance classes with administration of one class of drugs alone. Due to the limitations of the experimental design, it is not possible to extrapolate our results to the conditions in vivo. Nevertheless, organ bath proved to be helpful in evaluating the dose-dependent effects of ERA and PDE-5 inhibitors, which is not practical in everyday clinical practice. In this setting, the effectiveness of the combination therapy and the potential for dose reduction depended on the concentrations used and on the influence of previous illnesses on blood vessel function. This article describes the most important results of our experimental investigations and suggestions for future projects.
Collapse
Affiliation(s)
- C Stadlbauer
- Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg
| | - S Golovchenko
- Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg
| | - L Englert
- Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg
| | - M Spaeth
- Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg
| | - M Hoenicka
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Ulm, Ulm
| | - H-S Hofmann
- Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg.,Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg
| | - M Ried
- Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg
| |
Collapse
|
9
|
Schweintzger S, Koestenberger M, Schlagenhauf A, Grangl G, Burmas A, Kurath-Koller S, Pocivalnik M, Sallmon H, Baumgartner D, Hansmann G, Gamillscheg A. Safety and efficacy of the endothelin receptor antagonist macitentan in pediatric pulmonary hypertension. Cardiovasc Diagn Ther 2020; 10:1675-1685. [PMID: 33224780 DOI: 10.21037/cdt.2020.04.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Macitentan, a dual endothelin receptor antagonist (ERA), was approved in 2014 for the treatment of adults with idiopathic pulmonary arterial hypertension (PAH). Once-per-day dosing and low potential hepatic toxicity make macitentan an appealing therapeutic option for children with PAH, but reports on its use in pediatric patients are still lacking. Methods Prospective observational study of 18 children [10 male; median age: 8.5, minimum (min.): 0.6, maximum (max.): 16.8 years] with pulmonary hypertension (PH). Four of these 18 patients were treatment-naïve and started on a de novo macitentan therapy. The remaining 14/18 children were already on a PH-targeted pharmacotherapy (sildenafil or bosentan as monotherapy or in combination). Nine children who were on bosentan were switched to macitentan. We analyzed the 6-minute walking distance (6MWD), NYHA functional class (FC)/modified ROSS score, invasive hemodynamics, echocardiographic variables and the biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP). Results The median follow up was 6 months (min.: 0.5, max.: 30). Macitentan treatment was associated with improvement of invasive hemodynamics, e.g., the ratio of mean pulmonary arterial pressure/mean systemic arterial pressure decreased from a median of 62% (min.: 30%, max.: 87%) to 49% (min.: 30%, max.: 69%), P<0.05; pulmonary vascular resistance index (PVRi) decreased from a median of 7.6 (min.: 3.3, max.: 11.5) to 4.8 Wood units × m2 body surface area (min.: 2.5, max.: 10), P<0.05. The tricuspid annular plane systolic excursion (TAPSE) increased from a median of 1.4 (min.: 0.8, max.: 2.8) to 1.9 (min.: 0.8, max.: 2.7) cm, (P<0.05). NT-proBNP values decreased from a median of 272 (min.: 27, max.: 2,010) to 229 (min.: 23, max.: 814) pg/mL under macitentan therapy (P<0.05). The 6MWD and NYHA FC/modified ROSS score did not change significantly. Conclusions This is the first prospective study of macitentan pharmacotherapy in infants and children with PH <12 years of age. Except in one patient, macitentan treatment was well tolerated and was associated with improvements in invasive hemodynamics, longitudinal systolic RV function (TAPSE) and serum NT-proBNP values.
Collapse
Affiliation(s)
- Sabrina Schweintzger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Austria.,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Austria.,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Axel Schlagenhauf
- Division of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gernot Grangl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Austria
| | - Ante Burmas
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Austria
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Austria
| | - Mirjam Pocivalnik
- Pediatric Intensive Care Unit, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Hannes Sallmon
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany.,Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany
| | - Daniela Baumgartner
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Austria
| | - Georg Hansmann
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany.,Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Andreas Gamillscheg
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Austria
| |
Collapse
|
10
|
Treiber A, Delahaye S, Seeland S, Gnerre C. The endothelin receptor antagonist macitentan for the treatment of pulmonary arterial hypertension: A cross-species comparison of its cytochrome P450 induction pattern. Pharmacol Res Perspect 2020; 8:e00619. [PMID: 32613761 PMCID: PMC7330163 DOI: 10.1002/prp2.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/18/2022] Open
Abstract
The dual endothelin receptor antagonist macitentan was approved in 2013 for the treatment of pulmonary arterial hypertension. Macitentan is an inducer of cytochrome P450 expression in vivo in animal species but not in man. In rat and dog, changes in P450 expression manifest as autoinduction upon repeat dosing. The induction pattern, however, significantly differed between both species, and between male and female rats. While macitentan exposure steadily declined with dose in the dog, P450 induction was saturable in the rat reaching levels of 40%-60% and 60%-80% at steady-state in male and female animals, respectively. The nature and number of P450 enzymes involved in macitentan clearance were identified as a major reason for the observed species differences. In the dog, macitentan was metabolized by a single P450 enzyme, that is, Cyp3a12, whereas several members of the Cyp2c and Cyp3a families were involved in the rat. Macitentan selectively upregulated Cyp3a expression in rat, whereas the expression of the Cyp2c enzymes involved in macitentan metabolism remained mostly unchanged, eventually leading to a higher contribution of Cyp3a upon induction. Macitentan also induced CYP3A4 expression in human hepatocytes via initial activation of the human pregnane X receptor. No such induction was evident in humans at the therapeutic macitentan dose of 10 mg as shown in a clinical drug-drug interaction study with the CYP3A4 substrate sildenafil.
Collapse
Affiliation(s)
- Alexander Treiber
- Department of Non‐Clinical Drug Metabolism and PharmacokineticsIdorsia Pharmaceuticals LtdAllschwilSwitzerland
| | - Stephane Delahaye
- Department of Non‐Clinical Drug Metabolism and PharmacokineticsIdorsia Pharmaceuticals LtdAllschwilSwitzerland
| | - Swen Seeland
- Department of Non‐Clinical Drug Metabolism and PharmacokineticsIdorsia Pharmaceuticals LtdAllschwilSwitzerland
| | - Carmela Gnerre
- Department of Non‐Clinical Drug Metabolism and PharmacokineticsIdorsia Pharmaceuticals LtdAllschwilSwitzerland
| |
Collapse
|
11
|
Zebadúa R, Hernández-Pérez AP, García A, Zayas N, Sandoval J, López J, Pulido T. Macitentan in the treatment of pulmonary arterial hypertension. Future Cardiol 2020; 17:49-58. [PMID: 32677463 DOI: 10.2217/fca-2020-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is an uncommon but lethal and progressive disease in which prostacyclin, nitric oxide and endothelin-1 pathways are disturbed and contribute to the pathophysiology of this disease. Endothelin receptor antagonists are a class of drugs that have been approved as PAH therapy. Macitentan is a lipophilic, tissue specific, dual receptor antagonist with a higher potency than bosentan and a reduced risk of hepatic injury. Macitentan has shown a reduction in morbidity and mortality due to PAH at long-term follow-up and improvements in hemodynamics, exercise capacity and functional class at the short term. Its main adverse events are nasopharyngitis, bronchitis and an increased risk of anemia. We review the clinical data of macitentan and its use in PAH.
Collapse
Affiliation(s)
- Rodrigo Zebadúa
- Cardiopulmonary Department, National Heart Institute, Mexico City, Mexico
| | | | - Antonio García
- Cardiopulmonary Department, National Heart Institute, Mexico City, Mexico
| | - Nayeli Zayas
- Cardiopulmonary Department, National Heart Institute, Mexico City, Mexico
| | - Julio Sandoval
- Cardiopulmonary Department, National Heart Institute, Mexico City, Mexico
| | - Julio López
- Cardiopulmonary Department, National Heart Institute, Mexico City, Mexico
| | - Tomás Pulido
- Cardiopulmonary Department, National Heart Institute, Mexico City, Mexico
| |
Collapse
|
12
|
Grill S, Bruderer S, Sidharta PN, Antonova M, Globig S, Carlson J, Schultz A, Csonka D. Bioequivalence of macitentan and tadalafil given as fixed-dose combination or single-component tablets in healthy subjects. Br J Clin Pharmacol 2020; 86:2424-2434. [PMID: 32374030 PMCID: PMC7688529 DOI: 10.1111/bcp.14347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/18/2023] Open
Abstract
Aims To demonstrate the bioequivalence of macitentan/tadalafil fixed‐dose combination (FDC) tablets with single‐component tablets of macitentan and tadalafil in healthy subjects. Methods Studies AC‐077‐101 and AC‐077‐103 were single‐centre, open‐label, single‐dose, 2‐period, randomized, crossover Phase 1 studies conducted in healthy subjects. Two FDCs were investigated: FDC‐1 and FDC‐2 in Study AC‐077‐101 and FDC‐2 in Study AC‐077‐103. Both FDCs contained 10 mg/40 mg of macitentan/tadalafil and differed in excipients and coating materials used. In both studies, pharmacokinetic sampling over 216 hours was conducted, and pharmacokinetic parameters were derived using noncompartmental methods. Results Bioequivalence of macitentan, its active metabolite ACT‐132577, and tadalafil was established for FDC‐2 in both studies AC‐077‐101 and AC‐077‐103 in which tadalafil as a single component was sourced from the USA and EU, respectively, to fulfil regional regulatory requirements. The area under the plasma concentration–time curve and maximum plasma concentration with 90% confidence intervals of all components were entirely within the bioequivalence limits (0.8000–1.2500). No subject died and no serious adverse events were reported in either studies. Conclusion The FDC‐2 tablet containing 10 mg/40 mg of macitentan/tadalafil was bioequivalent to the free combination of 10 mg macitentan and 40 mg tadalafil (both US and EU sourced). Macitentan and tadalafil were well tolerated when administered as FDC or as a free combination.
Collapse
Affiliation(s)
- Simon Grill
- Actelion Pharmaceuticals Ltd., Allschwil, Switzerland
| | | | | | | | | | | | - Armin Schultz
- Clinical Research Services Mannheim GmbH, Mannheim, Germany
| | - Dénes Csonka
- Actelion Pharmaceuticals Ltd., Allschwil, Switzerland
| |
Collapse
|
13
|
Liu HC, Zhou XT, Zheng YS, He H, Liu XQ. PK/PD modeling based on NO-ET homeostasis for improving management of sunitinib-induced hypertension in rats. Acta Pharmacol Sin 2020; 41:719-728. [PMID: 31932646 PMCID: PMC7471499 DOI: 10.1038/s41401-019-0331-8] [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: 07/22/2019] [Accepted: 11/04/2019] [Indexed: 11/09/2022] Open
Abstract
Sunitinib is an oral small molecule multitargeted tyrosine kinase inhibitor, which is currently used to treat severe cancers. Clinical research has shown that patients treated with sunitinib develop hypertension. As soon as sunitinib-induced hypertension appears, it is usual to administer anti-hypertension agent. But this treatment may cause acute blood pressure fluctuation which may lead to additional cardiovascular risk. The aim of this study is to establish a mathematical model for managing sunitinib-induced hypertension and blood pressure fluctuation. A mechanism-based PK/PD model was developed based on animal experiments. Then this model was used to perform simulations, thus to propose an anti-hypertension indication, according to which the anti-hypertension treatment might yield relative low-level AUC and fluctuation of blood pressure. The simulation results suggest that the anti-hypertension agent may yield low-level AUC and fluctuation of blood pressure when relative ET-1 level ranges from −15% to 5% and relative NO level is more than 10% compared to control group. Finally, animal experiments were conducted to verify the simulation results. Macitentan (30 mg/kg) was administered based on the above anti-hypertension indication. Compared with the untreated group, the optimized treatment significantly reduced the AUC of blood pressure; meanwhile the fluctuation of blood pressure in optimized treatment group was 70% less than that in immediate treatment group. This work provides a novel model with potential translational value for managing sunitinib-induced hypertension.
Collapse
|
14
|
Goracci L, Valeri A, Sciabola S, Aleo MD, Moritz W, Lichtenberg J, Cruciani G. A Novel Lipidomics-Based Approach to Evaluating the Risk of Clinical Hepatotoxicity Potential of Drugs in 3D Human Microtissues. Chem Res Toxicol 2019; 33:258-270. [PMID: 31820940 DOI: 10.1021/acs.chemrestox.9b00364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The importance of adsorption, distribution, metabolism, excretion, and toxicity (ADMET) analysis is expected to grow substantially due to recent failures in detecting severe toxicity issues of new chemical entities during preclinical/clinical development. Traditionally, safety risk assessment studies for humans have been conducted in animals during advanced preclinical or clinical phase of drug development. However, potential drug toxicity in humans now needs to be detected in the drug discovery process as soon as possible without reliance on animal studies. The "omics", such as genomics, proteomics, and metabolomics, have recently entered pharmaceutical research in both drug discovery and drug development, but to the best of our knowledge, no applications in high-throughput safety risk assessment have been attempted so far. This paper reports an innovative method to anticipate adverse drug effects in an early discovery phase based on lipid fingerprints using human three-dimensional microtissues. The risk of clinical hepatotoxicity potential was evaluated for a data set of 22 drugs belonging to five different therapeutic chemical classes and with various drug-induced liver injury effect. The treatment of microtissues with repeated doses of each drug allowed collecting lipid fingerprints for five time points (2, 4, 7, 9, and 11 days), and multivariate statistical analysis was applied to search for correlations with the hepatotoxic effect. The method allowed clustering of the drugs based on their hepatotoxic effect, and the observed lipid impairments for a number of drugs was confirmed by literature sources. Compared to traditional screening methods, here multiple interconnected variables (lipids) are measured simultaneously, providing a snapshot of the cellular status from the lipid perspective at a molecular level. Applied here to hepatotoxicity, the proposed workflow can be applied to several tissues, being tridimensional microtissues from various origins.
Collapse
Affiliation(s)
- Laura Goracci
- Department of Chemistry, Biology, and Biotechnology , University of Perugia , Perugia 06123 , Italy
| | | | - Simone Sciabola
- Medicinal Chemistry , Biogen , 115 Broadway Street , Cambridge , Massachusetts 02139 , United States
| | - Michael D Aleo
- Drug Safety R&D , Pfizer Worldwide Research and Development , Groton , Connecticut 06340 , United States
| | | | | | - Gabriele Cruciani
- Department of Chemistry, Biology, and Biotechnology , University of Perugia , Perugia 06123 , Italy
| |
Collapse
|
15
|
Wong AK, Channick RN. Safety and tolerability of macitentan in the management of pulmonary arterial hypertension: an update. DRUG HEALTHCARE AND PATIENT SAFETY 2019; 11:71-85. [PMID: 31564989 PMCID: PMC6731963 DOI: 10.2147/dhps.s173050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/12/2019] [Indexed: 12/20/2022]
Abstract
Macitentan is a medication in the endothelin receptor antagonist class, approved for treatment of pulmonary arterial hypertension in 2013 based on the results of the pivotal SERAPHIN Trial (Study with an Endothelin Receptor Antagonist in Pulmonary arterial Hypertension to Improve cliNical outcome). Macitentan was shown in initial trials to reduce the likelihood of a morbidity/mortality event. Real-world use of this medication additionally reveals a reduced risk of hospitalizations related to pulmonary arterial hypertension, improved health-related quality of life scores, potential clinical utility in other conditions (such as chronic thromboembolic pulmonary hypertension and pulmonary hypertension related to congenital heart disease), and has a similar safety profile as demonstrated in initial trials.
Collapse
Affiliation(s)
- Alexandra K Wong
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Richard N Channick
- Division of Pulmonary and Critical Care, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| |
Collapse
|
16
|
Belge C, Delcroix M. Treatment of pulmonary arterial hypertension with the dual endothelin receptor antagonist macitentan: clinical evidence and experience. Ther Adv Respir Dis 2019; 13:1753466618823440. [PMID: 30736726 PMCID: PMC6376529 DOI: 10.1177/1753466618823440] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Macitentan (10 mg once daily orally), a dual endothelin receptor antagonist (ERA) developed by modifying the structure of bosentan to increase the efficacity and safety, is approved for the treatment of pulmonary arterial hypertension (PAH). The pivotal SERAPHIN trial, (a landmark trial in the history of PAH trials because of the large number of included patients, the long-term follow up and the first trial with morbidity/mortality as the primary endpoint) showed a reduction of the risk of a morbidity or mortality event by 45% over the treatment time compared with placebo. The positive effect on the primary endpoint was observed whether or not the patient was already on PAH therapy. There has been no direct comparison between macitentan and other ERAs, which were approved based on improved exercise capacity, but preclinical and clinical data suggest better pharmacological and safety profiles. Further analyses of the SERAPHIN trial investigated the predictive value of different indices and events on long-term outcome and mortality. The efficacy in children, the long-term effects and safety of macitentan and its place in combination therapy compared with other ERAs are still under investigation. This review presents the preclinical evidence of superiority of macitentan compared with other ERAs, and the available clinical trial data. The place of macitentan in the therapeutic algorithm for PAH treatment, post-marketing experience and future perspectives are discussed.
Collapse
Affiliation(s)
- Catharina Belge
- Department of respiratory diseases, University Hospitals Leuven, Herestraat 49, B3000 Leuven, Leuven, Belgium
| | | |
Collapse
|
17
|
Hoenicka M, Golovchenko S, Englert L, Spaeth M, Shoshiashvili L, Großer C, Hofmann HS, Ried M. Combination Therapy of Pulmonary Arterial Hypertension with Vardenafil and Macitentan Assessed in a Human Ex Vivo Model. Cardiovasc Drugs Ther 2019; 33:287-295. [DOI: 10.1007/s10557-019-06868-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
18
|
Davenport AP, Kuc RE, Southan C, Maguire JJ. New drugs and emerging therapeutic targets in the endothelin signaling pathway and prospects for personalized precision medicine. Physiol Res 2018; 67:S37-S54. [PMID: 29947527 DOI: 10.33549/physiolres.933872] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
During the last thirty years since the discovery of endothelin-1, the therapeutic strategy that has evolved in the clinic, mainly in the treatment of pulmonary arterial hypertension, is to block the action of the peptide either at the ET(A) subtype or both receptors using orally active small molecule antagonists. Recently, there has been a rapid expansion in research targeting ET receptors using chemical entities other than small molecules, particularly monoclonal antibody antagonists and selective peptide agonists and antagonists. While usually sacrificing oral bio-availability, these compounds have other therapeutic advantages with the potential to considerably expand drug targets in the endothelin pathway and extend treatment to other pathophysiological conditions. Where the small molecule approach has been retained, a novel strategy to combine two vasoconstrictor targets, the angiotensin AT(1) receptor as well as the ET(A) receptor in the dual antagonist sparsentan has been developed. A second emerging strategy is to combine drugs that have two different targets, the ET(A) antagonist ambrisentan with the phosphodiesterase inhibitor tadalafil, to improve the treatment of pulmonary arterial hypertension. The solving of the crystal structure of the ET(B) receptor has the potential to identify allosteric binding sites for novel ligands. A further key advance is the experimental validation of a single nucleotide polymorphism that has genome wide significance in five vascular diseases and that significantly increases the amount of big endothelin-1 precursor in the plasma. This observation provides a rationale for testing this single nucleotide polymorphism to stratify patients for allocation to treatment with endothelin agents and highlights the potential to use personalized precision medicine in the endothelin field.
Collapse
Affiliation(s)
- A P Davenport
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
| | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW To review the most recent data on the development of endothelin receptor antagonists (ERAs) for the treatment of hypertension and the management of diabetic nephropathy RECENT FINDINGS: Recent reviews and meta-analyses of experimental and clinical data obtained with ERAs confirmed that endothelin receptor blockade is associated with significant decreases in blood pressure in essential hypertension but also in resistant hypertension. In addition, in patients with diabetic nephropathy, ERAs induce significant 30-40% decreases in albuminuria when administered on top of blockers of the renin-angiotensin system. Yet, the benefits of ERAs have often been limited by their tolerability profile, essentially fluid retention and the development of edema and liver toxicity. Hence, several programs have been interrupted. Today, only one ERA, aprocitentan, is still under development for the treatment of resistant hypertension. Regarding the place of ERAs in the management of diabetic nephropathy, the results of the SONAR trial with atrasentan are eagerly awaited but the recent interruption of this trial because of insufficient events is worrisome, as one might not obtain all the expected information for this major trial. Blockade of endothelin receptor have a high potential in the treatment of hypertension and the prevention of the progression of renal diseases such as diabetic nephropathy. Today, the number of clinical programs investigating the potential benefits of ERAs is limited and more data must be obtained to define the real place of ERAs in these indications.
Collapse
Affiliation(s)
- Michel Burnier
- Department of Medicine, Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 17, 1011, Lausanne, Switzerland.
| |
Collapse
|
20
|
Burbank MG, Sharanek A, Burban A, Mialanne H, Aerts H, Guguen-Guillouzo C, Weaver RJ, Guillouzo A. From the Cover: MechanisticInsights in Cytotoxic and Cholestatic Potential of the Endothelial Receptor Antagonists Using HepaRG Cells. Toxicol Sci 2018; 157:451-464. [PMID: 28369585 DOI: 10.1093/toxsci/kfx062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Several endothelin receptor antagonists (ERAs) have been developed for the treatment of pulmonary arterial hypertension (PAH). Some of them have been related to clinical cases of hepatocellular injury (sitaxentan [SIT]) and/or cholestasis (bosentan [BOS]). We aimed to determine if ambrisentan (AMB) and macitentan (MAC), in addition to BOS and SIT, could potentially cause liver damage in man by use of human HepaRG cells. Our results showed that like BOS, MAC-induced cytotoxicity and cholestatic disorders characterized by bile canaliculi dilatation and impairment of myosin light chain kinase signaling. Macitentan also strongly inhibited taurocholic acid and carboxy-2',7'-dichlorofluorescein efflux while it had a much lower inhibitory effect on influx activity compared to BOS and SIT. Moreover, these three drugs caused decreased intracellular accumulation and parallel increased levels of total bile acids (BAs) in serum-free culture media. In addition, all drugs except AMB variably deregulated gene expression of BA transporters. In contrast, SIT was hepatotoxic without causing cholestatic damage, likely via the formation of reactive metabolites and AMB was not hepatotoxic. Together, our results show that some ERAs can be hepatotoxic and that the recently marketed MAC, structurally similar to BOS, can also cause cholestatic alterations in HepaRG cells. The absence of currently known or suspected cases of cholestasis in patients suffering from PAH treated with MAC is rationalized by the lower therapeutic doses and Cmax, and longer receptor residence time compared to BOS.
Collapse
Affiliation(s)
- Matthew Gibson Burbank
- Inserm UMR 991, Foie, Métabolismes et Cancer, Rennes, France.,Université Rennes 1, Rennes, France.,Biologie Servier, Gidy, France
| | - Ahmad Sharanek
- Inserm UMR 991, Foie, Métabolismes et Cancer, Rennes, France.,Université Rennes 1, Rennes, France
| | - Audrey Burban
- Inserm UMR 991, Foie, Métabolismes et Cancer, Rennes, France.,Université Rennes 1, Rennes, France
| | | | | | | | | | - André Guillouzo
- Inserm UMR 991, Foie, Métabolismes et Cancer, Rennes, France.,Université Rennes 1, Rennes, France
| |
Collapse
|
21
|
Scott KA, Njardarson JT. Analysis of US FDA-Approved Drugs Containing Sulfur Atoms. Top Curr Chem (Cham) 2018; 376:5. [DOI: 10.1007/s41061-018-0184-5] [Citation(s) in RCA: 339] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/05/2018] [Indexed: 12/18/2022]
|
22
|
Rahaghi FF, Alnuaimat HM, Awdish RLA, Balasubramanian VP, Bourge RC, Burger CD, Butler J, Cauthen CG, Chakinala MM, deBoisblanc BP, Eggert MS, Engel P, Feldman J, McConnell JW, Park M, Sager JS, Sood N, Palevsky HI. Recommendations for the clinical management of patients receiving macitentan for pulmonary arterial hypertension (PAH): A Delphi consensus document. Pulm Circ 2017; 7:702-711. [PMID: 28671484 PMCID: PMC5841904 DOI: 10.1177/2045893217721695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In patients treated with macitentan (Opsumit®, Actelion Pharmaceuticals Ltd., Basel, Switzerland) for pulmonary arterial hypertension (PAH), prevention and/or effective management of treatment-related adverse events may improve adherence. However, management of these adverse events can be challenging and the base of evidence and clinical experience for macitentan is limited. In the absence of evidence, consensus recommendations from physicians experienced in using macitentan to treat PAH may benefit patients and physicians who are using macitentan. Consensus recommendations were developed by a panel of physicians experienced with macitentan and PAH using a modified Delphi process. Over three iterations, panelists developed and refined a series of statements on the use of macitentan in PAH and rated their agreement with each statement on a Likert scale. The panel of 18 physicians participated and developed a total of 118 statements on special populations, add-on therapy, drug–drug interactions, warnings and precautions, hospitalization and functional class, and adverse event management. The resulting consensus recommendations are intended to provide practical guidance on real-world issues in using macitentan to treat patients with PAH.
Collapse
Affiliation(s)
| | | | | | | | - Robert C Bourge
- 5 The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | - Peter Engel
- 12 Ohio Heart & Vascular Center; The Christ Hospital, Cincinnati OH, USA
| | | | | | - Myung Park
- 15 Houston Methodist Hospital, Houston, TX, USA
| | - Jeffrey S Sager
- 16 Cottage Pulmonary Hypertension Center, Santa Barbara, CA, USA
| | | | | |
Collapse
|
23
|
Nami M, Sovari SN, Haghighatnia Y, Dabiri M, Salehi P. A Novel Synthesis of Macitentan, an Endothelin Receptor Antagonist. ORG PREP PROCED INT 2017. [DOI: 10.1080/00304948.2017.1320921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Majid Nami
- Faculty of Chemistry, Shahid Beheshti University, G. C., Evin, Tehran 1983963113, Iran
| | - Sara Nasiri Sovari
- Department of Research and Development, Hasti Aria Shimi Co., Tehran 1463745481, Iran
| | - Yaghoub Haghighatnia
- Department of Research and Development, Hasti Aria Shimi Co., Tehran 1463745481, Iran
| | - Minoo Dabiri
- Faculty of Chemistry, Shahid Beheshti University, G. C., Evin, Tehran 1983963113, Iran
| | - Peyman Salehi
- Department of Phytochemistry, Medicinal Plants and Drugs Research Institute, Shahid Beheshti University, G. C., Evin, Tehran 1983963113, Iran
| |
Collapse
|
24
|
Pharmacokinetics of Macitentan in Patients With Pulmonary Arterial Hypertension and Comparison With Healthy Subjects. J Clin Pharmacol 2017; 57:997-1004. [DOI: 10.1002/jcph.888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/14/2017] [Indexed: 11/07/2022]
|
25
|
Sandwich-Cultured Hepatocytes as a Tool to Study Drug Disposition and Drug-Induced Liver Injury. J Pharm Sci 2016; 105:443-459. [PMID: 26869411 DOI: 10.1016/j.xphs.2015.11.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 12/21/2022]
Abstract
Sandwich-cultured hepatocytes (SCH) are metabolically competent and have proper localization of basolateral and canalicular transporters with functional bile networks. Therefore, this cellular model is a unique tool that can be used to estimate biliary excretion of compounds. SCH have been used widely to assess hepatobiliary disposition of endogenous and exogenous compounds and metabolites. Mechanistic modeling based on SCH data enables estimation of metabolic and transporter-mediated clearances, which can be used to construct physiologically based pharmacokinetic models for prediction of drug disposition and drug-drug interactions in humans. In addition to pharmacokinetic studies, SCH also have been used to study cytotoxicity and perturbation of biological processes by drugs and hepatically generated metabolites. Human SCH can provide mechanistic insights underlying clinical drug-induced liver injury (DILI). In addition, data generated in SCH can be integrated into systems pharmacology models to predict potential DILI in humans. In this review, applications of SCH in studying hepatobiliary drug disposition and bile acid-mediated DILI are discussed. An example is presented to show how data generated in the SCH model were used to establish a quantitative relationship between intracellular bile acids and cytotoxicity, and how this information was incorporated into a systems pharmacology model for DILI prediction.
Collapse
|
26
|
Shihoya W, Nishizawa T, Okuta A, Tani K, Dohmae N, Fujiyoshi Y, Nureki O, Doi T. Activation mechanism of endothelin ET B receptor by endothelin-1. Nature 2016; 537:363-368. [PMID: 27595334 DOI: 10.1038/nature19319] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 07/20/2016] [Indexed: 12/14/2022]
Abstract
Endothelin, a 21-amino-acid peptide, participates in various physiological processes, such as regulation of vascular tone, humoral homeostasis, neural crest cell development and neurotransmission. Endothelin and its G-protein-coupled receptor are involved in the development of various diseases, such as pulmonary arterial hypertension, and thus are important therapeutic targets. Here we report crystal structures of human endothelin type B receptor in the ligand-free form and in complex with the endogenous agonist endothelin-1. The structures and mutation analysis reveal the mechanism for the isopeptide selectivity between endothelin-1 and -3. Transmembrane helices 1, 2, 6 and 7 move and envelop the entire endothelin peptide, in a virtually irreversible manner. The agonist-induced conformational changes are propagated to the receptor core and the cytoplasmic G-protein coupling interface, and probably induce conformational flexibility in TM6. A comparison with the M2 muscarinic receptor suggests a shared mechanism for signal transduction in class A G-protein-coupled receptors.
Collapse
Affiliation(s)
- Wataru Shihoya
- Department of Basic Medicinal Sciences, Graduate School of Pharmaceutical Sciences, Nagoya University, Chikusa, Nagoya 464-8601, Japan.,Cellular and Structural Physiology Institute, Nagoya University, Chikusa, Nagoya 464-8601, Japan.,Department of Biophysics and Biochemistry, Graduate School of Science, The University of Tokyo, Bunkyo, Tokyo 113-0032, Japan
| | - Tomohiro Nishizawa
- Department of Biophysics and Biochemistry, Graduate School of Science, The University of Tokyo, Bunkyo, Tokyo 113-0032, Japan.,Precursory Research for Embryonic Science and Technology (PRESTO), Japan Science and Technology Agency, 4-1-8 Honcho, Kawaguchi, Saitama 332-0012, Japan
| | - Akiko Okuta
- Cellular and Structural Physiology Institute, Nagoya University, Chikusa, Nagoya 464-8601, Japan
| | - Kazutoshi Tani
- Cellular and Structural Physiology Institute, Nagoya University, Chikusa, Nagoya 464-8601, Japan
| | - Naoshi Dohmae
- Biomolecular Characterization Unit, RIKEN Center for Sustainable Resource Science, Wako, Saitama 351-0198, Japan
| | - Yoshinori Fujiyoshi
- Department of Basic Medicinal Sciences, Graduate School of Pharmaceutical Sciences, Nagoya University, Chikusa, Nagoya 464-8601, Japan.,Cellular and Structural Physiology Institute, Nagoya University, Chikusa, Nagoya 464-8601, Japan
| | - Osamu Nureki
- Department of Biophysics and Biochemistry, Graduate School of Science, The University of Tokyo, Bunkyo, Tokyo 113-0032, Japan
| | - Tomoko Doi
- Department of Biophysics, Graduate School of Science, Kyoto University, Kyoto 606-8502, Japan
| |
Collapse
|
27
|
Chan EAW, Buckley B, Farraj AK, Thompson LC. The heart as an extravascular target of endothelin-1 in particulate matter-induced cardiac dysfunction. Pharmacol Ther 2016; 165:63-78. [PMID: 27222357 PMCID: PMC6390286 DOI: 10.1016/j.pharmthera.2016.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Exposure to particulate matter air pollution has been causally linked to cardiovascular disease in humans. Several broad and overlapping hypotheses describing the biological mechanisms by which particulate matter exposure leads to cardiovascular disease have been explored, although linkage with specific factors or genes remains limited. These hypotheses may or may not also lead to particulate matter-induced cardiac dysfunction. Evidence pointing to autocrine/paracrine signaling systems as modulators of cardiac dysfunction has increased interest in the emerging role of endothelins as mediators of cardiac function following particulate matter exposure. Endothelin-1, a well-described small peptide expressed in the pulmonary and cardiovascular systems, is best known for its ability to constrict blood vessels, although it can also induce extravascular effects. Research on the role of endothelins in the context of air pollution has largely focused on vascular effects, with limited investigation of responses resulting from the direct effects of endothelins on cardiac tissue. This represents a significant knowledge gap in air pollution health effects research, given the abundance of endothelin receptors found on cardiac tissue and the ability of endothelin-1 to modulate cardiac contractility, heart rate, and rhythm. The plausibility of endothelin-1 as a mediator of particulate matter-induced cardiac dysfunction is further supported by the therapeutic utility of certain endothelin receptor antagonists. The present review examines the possibility that endothelin-1 release caused by exposure to PM directly modulates extravascular effects on the heart, deleteriously altering cardiac function.
Collapse
Affiliation(s)
- Elizabeth A W Chan
- Oak Ridge Institute for Science and Education (ORISE) Fellow at the National Center for Environmental Assessment, U.S. Environmental Protection Agency (EPA), Research Triangle Park, NC, USA
| | - Barbara Buckley
- National Center for Environmental Assessment, U.S. EPA, Research Triangle Park, NC, USA
| | - Aimen K Farraj
- Environmental Public Health Division, U.S. EPA, Research Triangle Park, NC, USA
| | - Leslie C Thompson
- Environmental Public Health Division, U.S. EPA, Research Triangle Park, NC, USA.
| |
Collapse
|
28
|
Avdeev SN. [The new endothelin receptor antagonist macitentan: Prospects for therapy of pulmonary arterial hypertension]. TERAPEVT ARKH 2016; 88:89-97. [PMID: 27459621 DOI: 10.17116/terarkh201688789-97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a clinical group of severe and rare diseases with similar morphological, hemodynamic, and therapeutic characteristics. One of the novel drugs to treat PAH is macitentan, a new double endothelin ETA and ETB receptor antagonist that is characterized by special physicochemical properties, ensuring the penetration of the drug into tissues and its improved receptor-binding properties. The SERAPHIN trial has demonstrated that therapy with macitentan 10 mg versus placebo statistically significantly reduces the risk of poor outcomes and death by 45%. The treatment with macitentan 10 is observed to be highly effective regardless of the presence/absence of basic PAH-specific therapy. The drug considerably improves clinically important outcomes, including 6-minute walk distance and WHO functional class. Macitentan exerts a steady-state therapeutic effect, by improving pulmonary hemodynamics. Macitentan 10 mg statistically significantly reduces the risk of PAH, frequency of its related hospitalizations, and the number of days spent in hospital. The drug has a favorable safety profile; its most common side effects are headache, nasopharyngitis, and anemia. Macitentan is an effective first-line drug to improve long-term outcomes in patients with newly and previously diagnosed PAH.
Collapse
Affiliation(s)
- S N Avdeev
- Research Institute of Pulmonology, Federal Biomedical Agency of Russia, Moscow, Russia
| |
Collapse
|
29
|
Aubert JD, Juillerat-Jeanneret L. Endothelin-Receptor Antagonists beyond Pulmonary Arterial Hypertension: Cancer and Fibrosis. J Med Chem 2016; 59:8168-88. [PMID: 27266371 DOI: 10.1021/acs.jmedchem.5b01781] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The endothelin axis and in particular the two endothelin receptors, ETA and ETB, are targets for therapeutic intervention in human diseases. Endothelin-receptor antagonists are in clinical use to treat pulmonary arterial hypertension and have been under clinical investigation for the treatment of several other diseases, such as systemic hypertension, cancer, vasospasm, and fibrogenic diseases. In this Perspective, we review the molecules that have been evaluated in human clinical trials for the treatment of pulmonary arterial hypertension, as well as other cardiovascular diseases, cancer, and fibrosis. We will also discuss the therapeutic consequences of receptor selectivity with regard to ETA-selective, ETB-selective, or dual ETA/ETB antagonists. We will also consider which chemical characteristics are relevant to clinical use and the properties of molecules necessary for efficacy in treating diseases against which known molecules displayed suboptimal efficacy.
Collapse
Affiliation(s)
- John-David Aubert
- Pneumology Division and Transplantation Center, Centre Hospitalier Universitaire Vaudois (CHUV) , CH1011 Lausanne, Switzerland
| | - Lucienne Juillerat-Jeanneret
- University Institute of Pathology and Transplantation Center, Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne (UNIL), CH1011 Lausanne, Switzerland
| |
Collapse
|
30
|
Tahara N, Dobashi H, Fukuda K, Funauchi M, Hatano M, Ikeda S, Joho S, Kihara Y, Kimura T, Kondo T, Matsushita M, Minamino T, Nakanishi N, Ozaki Y, Saji T, Sakai S, Tanabe N, Watanabe H, Yamada H, Yoshioka K, Sasayama S. Efficacy and Safety of a Novel Endothelin Receptor Antagonist, Macitentan, in Japanese Patients With Pulmonary Arterial Hypertension. Circ J 2016; 80:1478-83. [PMID: 27180890 DOI: 10.1253/circj.cj-15-1305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Macitentan is a novel, dual endothelin receptor antagonist with sustained receptor binding, used for the long-term treatment of pulmonary arterial hypertension (PAH). In the present study, we assessed the efficacy and safety of macitentan in Japanese patients with PAH. METHODS AND RESULTS Macitentan was administered at a once-daily dose of 10 mg in 30 patients. The primary endpoint was change in pulmonary vascular resistance (PVR) from baseline to week 24. Change to week 24 in the other hemodynamic parameters, 6-min walk distance (6MWD), World Health Organization (WHO) functional class, and plasmaN-terminal pro-brain natriuretic peptide (NT-pro-BNP), as well as time to clinical deterioration up to week 52 were also assessed as secondary endpoints. In the 28 patients on per-protocol analysis, PVR decreased from 667±293 to 417±214 dyn·sec·cm(-5)(P<0.0001). 6MWD increased from 427±128 to 494±116 m (P<0.0001). WHO functional class improved in 13 patients (46.4%) and was maintained in 15 patients (53.6%), and NT-pro-BNP was reduced by 18% (P<0.0001). The favorable treatment effect on PVR was apparent regardless of concomitant therapy for PAH. CONCLUSIONS Macitentan was efficacious and well tolerated and improved the hemodynamic parameters, exercise capacity, symptoms, and clinical biomarkers in Japanese PAH patients. Macitentan can be a valuable therapeutic option for Japanese patients with PAH. ( TRIAL REGISTRATION JAPIC Clinical Trials Information [JapicCTI-121986].) (Circ J 2016; 80: 1478-1483).
Collapse
Affiliation(s)
- Nobuhiro Tahara
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Davenport AP, Hyndman KA, Dhaun N, Southan C, Kohan DE, Pollock JS, Pollock DM, Webb DJ, Maguire JJ. Endothelin. Pharmacol Rev 2016; 68:357-418. [PMID: 26956245 PMCID: PMC4815360 DOI: 10.1124/pr.115.011833] [Citation(s) in RCA: 462] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The endothelins comprise three structurally similar 21-amino acid peptides. Endothelin-1 and -2 activate two G-protein coupled receptors, ETA and ETB, with equal affinity, whereas endothelin-3 has a lower affinity for the ETA subtype. Genes encoding the peptides are present only among vertebrates. The ligand-receptor signaling pathway is a vertebrate innovation and may reflect the evolution of endothelin-1 as the most potent vasoconstrictor in the human cardiovascular system with remarkably long lasting action. Highly selective peptide ETA and ETB antagonists and ETB agonists together with radiolabeled analogs have accurately delineated endothelin pharmacology in humans and animal models, although surprisingly no ETA agonist has been discovered. ET antagonists (bosentan, ambrisentan) have revolutionized the treatment of pulmonary arterial hypertension, with the next generation of antagonists exhibiting improved efficacy (macitentan). Clinical trials continue to explore new applications, particularly in renal failure and for reducing proteinuria in diabetic nephropathy. Translational studies suggest a potential benefit of ETB agonists in chemotherapy and neuroprotection. However, demonstrating clinical efficacy of combined inhibitors of the endothelin converting enzyme and neutral endopeptidase has proved elusive. Over 28 genetic modifications have been made to the ET system in mice through global or cell-specific knockouts, knock ins, or alterations in gene expression of endothelin ligands or their target receptors. These studies have identified key roles for the endothelin isoforms and new therapeutic targets in development, fluid-electrolyte homeostasis, and cardiovascular and neuronal function. For the future, novel pharmacological strategies are emerging via small molecule epigenetic modulators, biologicals such as ETB monoclonal antibodies and the potential of signaling pathway biased agonists and antagonists.
Collapse
Affiliation(s)
- Anthony P Davenport
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Kelly A Hyndman
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Neeraj Dhaun
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Christopher Southan
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Donald E Kohan
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Jennifer S Pollock
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - David M Pollock
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - David J Webb
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| | - Janet J Maguire
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (A.P.D., J.J.M.); IUPHAR/BPS Guide to PHARMACOLOGY, Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, Edinburgh, United Kingdom (C.S.); Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah (D.E.K.); Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (K.A.H., J.S.P., D.M.P.); and Department of Renal Medicine, Royal Infirmary of Edinburgh (N.D.) and University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute (D.J.W.N.D.), Edinburgh, Scotland, United Kingdom
| |
Collapse
|
32
|
Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Pulmonary Hypertension. Pediatr Crit Care Med 2016; 17:S89-100. [PMID: 26945333 PMCID: PMC4820013 DOI: 10.1097/pcc.0000000000000622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To review the pharmacologic treatment options for pulmonary arterial hypertension in the cardiac intensive care setting and summarize the most-recent literature supporting these therapies. DATA SOURCES AND STUDY SELECTION Literature search for prospective studies, retrospective analyses, and case reports evaluating the safety and efficacy of pulmonary arterial hypertension therapies. DATA EXTRACTION Mechanisms of action and pharmacokinetics, treatment recommendations, safety considerations, and outcomes for specific medical therapies. DATA SYNTHESIS Specific targeted therapies developed for the treatment of adult patients with pulmonary arterial hypertension have been applied for the benefit of children with pulmonary arterial hypertension. With the exception of inhaled nitric oxide, there are no pulmonary arterial hypertension medications approved for children in the United States by the Food and Drug Administration. Unfortunately, data on treatment strategies in children with pulmonary arterial hypertension are limited by the small number of randomized controlled clinical trials evaluating the safety and efficacy of specific treatments. The treatment options for pulmonary arterial hypertension in children focus on endothelial-based pathways. Calcium channel blockers are recommended for use in a very small, select group of children who are responsive to vasoreactivity testing at cardiac catheterization. Phosphodiesterase type 5 inhibitor therapy is the most-commonly recommended oral treatment option in children with pulmonary arterial hypertension. Prostacyclins provide adjunctive therapy for the treatment of pulmonary arterial hypertension as infusions (IV and subcutaneous) and inhalation agents. Inhaled nitric oxide is the first-line vasodilator therapy in persistent pulmonary hypertension of the newborn and is commonly used in the treatment of pulmonary arterial hypertension in the ICU. Endothelin receptor antagonists have been shown to improve exercise tolerance and survival in adult patients with pulmonary arterial hypertension. Soluble guanylate cyclase stimulators are the first drug class to be Food and Drug Administration approved for the treatment of chronic thromboembolic pulmonary hypertension. CONCLUSIONS Literature and data supporting the safe and effective use of pulmonary arterial hypertension therapies in children in the cardiac intensive care are limited. Extrapolation of adult data has afforded safe medical treatment of pulmonary hypertension in children. Large multicenter trials are needed in the search for safe and effective therapy of pulmonary hypertension in children.
Collapse
|
33
|
Abstract
All three members of the endothelin (ET) family of peptides, ET-1, ET-2, and ET-3, are expressed in the human kidney, with ET-1 being the predominant isoform. ET-1 and ET-2 bind to two G-protein–coupled receptors, ETA and ETB, whereas at physiological concentrations ET-3 has little affinity for the ETA receptor. The human kidney is unusual among the peripheral organs in expressing a high density of ETB. The renal vascular endothelium only expresses the ETB subtype and ET-1 acts in an autocrine or paracrine manner to release vasodilators. Endothelial ETB in kidney, as well as liver and lungs, also has a critical role in scavenging ET-1 from the plasma. The third major function is ET-1 activation of ETB in in the nephron to reduce salt and water re-absorption. In contrast, ETA predominate on smooth muscle, causing vasoconstriction and mediating many of the pathophysiological actions of ET-1. The role of the two receptors has been delineated using highly selective ETA (BQ123, TAK-044) and ETB (BQ788) peptide antagonists. Nonpeptide antagonists, bosentan, macitentan, and ambrisentan, that are either mixed ETA/ETB antagonists or display ETA selectivity, have been approved for clinical use but to date are limited to pulmonary hypertension. Ambrisentan is in clinical trials in patients with type 2 diabetic nephropathy. This review summarizes ET-receptor antagonism in the human kidney, and considers the relative merits of selective versus nonselective antagonism in renal disease.
Collapse
|
34
|
Sidharta PN, Treiber A, Dingemanse J. Clinical pharmacokinetics and pharmacodynamics of the endothelin receptor antagonist macitentan. Clin Pharmacokinet 2016; 54:457-71. [PMID: 25860376 PMCID: PMC4412377 DOI: 10.1007/s40262-015-0255-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease of the lung vascular system, which leads to right-sided heart failure and ultimately death if untreated. Treatments to regulate the pulmonary vascular pressure target the prostacyclin, nitric oxide, and endothelin (ET) pathways. Macitentan, an oral, once-daily, dual ETA and ETB receptor antagonist with high affinity and sustained receptor binding is the first ET receptor antagonist to show significant reduction of the risk of morbidity and mortality in PAH patients in a large-scale phase III study with a long-term outcome. Here we present a review of the available clinical pharmacokinetic, pharmacodynamic, pharmacokinetic/pharmacodynamic relationship, and drug–drug interaction data of macitentan in healthy subjects, patients with PAH, and in special populations.
Collapse
Affiliation(s)
- P N Sidharta
- Department of Clinical Pharmacology, Actelion Pharmaceuticals Ltd, Gewerbestrasse 16, 4123, Allschwil, Switzerland,
| | | | | |
Collapse
|
35
|
Sidharta PN, Lindegger N, Ulč I, Dingemanse J. Pharmacokinetics of the novel dual endothelin receptor antagonist macitentan in subjects with hepatic or renal impairment. J Clin Pharmacol 2015; 54:291-300. [PMID: 24122797 DOI: 10.1002/jcph.193] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Macitentan is under development for the treatment of pulmonary arterial hypertension (PAH). Patients with PAH may suffer from comorbidities such as renal or hepatic impairment. Two prospective, single-center, open-label studies evaluated the pharmacokinetics of macitentan and its metabolites (pharmacologically active ACT-132577 and inactive ACT-373898) in healthy subjects and in subjects with mild, moderate, and severe hepatic impairment or severe renal function impairment (SRFI). After administering a single oral dose of 10 mg macitentan the pharmacokinetic parameters including area under the curve from zero to infinity (AUC∞) were derived from plasma concentration-time profiles. Exposure to macitentan and ACT-132577 was lower in hepatically impaired versus healthy subjects, with no correlation with the degree of hepatic impairment. Exposure to ACT-373898 was lower in subjects with moderate hepatic impairment only. Plasma concentration-time profiles for macitentan and ACT-132577 (active) were similar in healthy subjects and subjects with SRFI. AUC∞ of ACT-373898 (inactive) was 7.3-fold higher in subjects with SRFI versus healthy subjects. No safety concerns were raised in either study. Based on these observations, pharmacokinetic alterations of macitentan due to hepatic or renal function impairment are not considered clinically relevant and no dose adjustment is necessary in these patients.
Collapse
Affiliation(s)
- Patricia N Sidharta
- Department of Clinical Pharmacology, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | | | | |
Collapse
|
36
|
Zhang J, Geng P, Luo X, Zhou G, Lin Y, Zhang L, Wang S, Wen C, Ma J, Ding T. Pharmacokinetic study of ACT-132577 in rat plasma by ultra performance liquid chromatography-tandem mass spectrometry. Int J Clin Exp Med 2015; 8:18420-18426. [PMID: 26770447 PMCID: PMC4694347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
It was reported that macitentan was metabolized predominantly by cytochrome P450 3A4, and ACT-132577, its pharmacologically active metabolite, is fivefold less potent at blocking ET receptors than macitentan. In this work, a sensitive and selective ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for determination of ACT-132577 in rat plasma was developed and validated. After addition of diazepam as an internal standard (IS), protein precipitation by acetonitrile was used to prepare samples. Chromatographic separation was achieved on a UPLC BEH C18 column (2.1 mm × 100 mm, 1.7 μm) with 0.2% formic acid and methanol as the mobile phase with gradient elution. An electrospray ionization source was applied and operated in positive ion mode; multiple reactions monitoring (MRM) mode was used for quantification using target fragment ions m/z 546.9→200.6 for ACT-132577, and m/z 285.1→193.1 for IS. Calibration plots were linear throughout the range 10-4000 ng/mL for ACT-132577 in rat plasma. Mean recovery of ACT-132577 in rat plasma ranged from 82.6% to 90.6%, matrix effect of ACT-132577 in rat plasma ranged from 101.4% to 115.2%. RSD of intra-day and inter-day precision were both less than 11%. The accuracy of the method ranged from 96.1% to 103.5%. The method was successfully applied to pharmacokinetic study of ACT-132577 after oral and intravenous administration of macitentan.
Collapse
Affiliation(s)
- Jin Zhang
- Department of Clinical Lab Medicine, Taizhou Municipal Hospital affiliated with Taizhou UniversityTaizhou 318000, Zhejiang, China
| | - Peiwu Geng
- The Laboratory of Clinical Pharmacy, The People’s Hospital of LishuiLishui 323000, Zhejiang, China
| | - Xinhua Luo
- Department of Clinical Lab Medicine, Taizhou Municipal Hospital affiliated with Taizhou UniversityTaizhou 318000, Zhejiang, China
| | - Genzhi Zhou
- Department of Anesthesiology, Maternity and Child Care of LishuiLishui 323000, Zhejiang, China
| | - Yingying Lin
- Laboratory Animal Centre, Wenzhou Medical UniversityWenzhou 325035, Zhejiang, China
| | - Lijing Zhang
- Laboratory Animal Centre, Wenzhou Medical UniversityWenzhou 325035, Zhejiang, China
| | - Shuanghu Wang
- The Laboratory of Clinical Pharmacy, The People’s Hospital of LishuiLishui 323000, Zhejiang, China
| | - Congcong Wen
- Laboratory Animal Centre, Wenzhou Medical UniversityWenzhou 325035, Zhejiang, China
| | - Jianshe Ma
- Laboratory Animal Centre, Wenzhou Medical UniversityWenzhou 325035, Zhejiang, China
| | - Ting Ding
- The Laboratory of Clinical Pharmacy, The People’s Hospital of LishuiLishui 323000, Zhejiang, China
| |
Collapse
|
37
|
Yu L, Zhou Y, He X, Li H, Chen H, Li W. Simultaneous determination of macitentan and its active metabolite in human plasma by liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 1002:358-63. [PMID: 26363370 DOI: 10.1016/j.jchromb.2015.07.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
Macitentan is a newly approved endothelin receptor antagonist (ERA) for the long-term treatment of PAH with superior receptor-binding properties and a longer duration of action compared to other available ERAs. However, analytical methods for simultaneous determination of macitentan and its active metabolite, ACT-132577, in human plasma have not been fully reported in the literature. In this work, a fast, sensitive, and reliable high-performance liquid chromatography-tandem mass spectrometry method (HPLC-MS/MS) was firstly developed and completely validated for simultaneous determination of macitentan and its active metabolite in human plasma. Plasma samples were processed with a protein precipitation using acetonitrile, followed by chromatographic separation using an Inertsil ODS-SP column (100×2.1mm, 3.5μm) under isocratic elution with a mobile phase consisting of acetonitrile and 0.2% formic acid at a flow rate of 0.3mL/min. Quantification was operated in multiple reaction monitoring (MRM) mode using the transitions m/z 547.1→201.0 for macitentan, m/z 589.0→203.0 for ACT-132577, and m/z 380.5→243.3 for the IS (donepezil). The assay exhibited a linear range of 1-500ng/mL for both macitentan and ACT-132577. The accuracy and the intra- and inter-precisions were within acceptable ranges and no significant matrix effect was observed during the method validation. The developed method was successfully utilized to a human pharmacokinetic study of macitentan as well as ACT-132577 after oral administration of 10mg macitentan tablet in healthy Chinese volunteers.
Collapse
Affiliation(s)
- Lixiu Yu
- Institute of Clinical Pharmacy, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China
| | - Ying Zhou
- Institute of Clinical Pharmacy, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China
| | - Xiaomeng He
- Institute of Clinical Pharmacy, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China
| | - Huqun Li
- Institute of Clinical Pharmacy, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China
| | - Hui Chen
- Department of Infectious Disease, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China.
| | - Weiyong Li
- Institute of Clinical Pharmacy, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China.
| |
Collapse
|
38
|
Selej M, Romero AJ, Channick RN, Clozel M. Development of macitentan for the treatment of pulmonary arterial hypertension. Ann N Y Acad Sci 2015; 1358:68-81. [PMID: 26291180 DOI: 10.1111/nyas.12856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a serious, chronic condition that, without early recognition and treatment, leads to progressive right heart failure and death. The dual endothelin receptor antagonist macitentan was designed through a deliberate discovery process to maximize endothelin-axis blockade while improving adverse-effect profiles compared with previous compounds. Macitentan's efficacy was demonstrated in an event-driven morbidity and mortality study of treatment-naive and background PAH therapy-treated symptomatic patients. Compared to placebo, 10 mg of macitentan significantly reduced the relative risk of morbidity and mortality by 45%, primarily by delaying PAH worsening, most prominently in World Health Organization (WHO) functional class II and III PAH patients. Macitentan reduced the incidence of the composite end point of PAH-related hospitalizations and mortality and improved WHO FC and exercise capacity (6-min walk distance). Furthermore, it significantly improved cardiopulmonary hemodynamics and quality of life, and had a favorable safety and tolerability profile. To date, this was the largest and longest prospective trial for PAH. Macitentan, currently the only approved oral PAH treatment shown to be safe and effective in delaying long-term progression and reducing PAH-related hospitalizations, has changed treatment paradigms from goal-directed to long-term outcome-oriented therapy.
Collapse
Affiliation(s)
- Mona Selej
- Actelion Pharmaceuticals, US, Inc, South San Francisco, California
| | - Alain J Romero
- Actelion Pharmaceuticals, US, Inc, South San Francisco, California
| | - Richard N Channick
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | | |
Collapse
|
39
|
Treiber A, Miraval T, Bolli MH, Funel JA, Segrestaa J, Seeland S. The metabolism of the dual endothelin receptor antagonist macitentan in rat and dog. Xenobiotica 2015; 46:253-67. [DOI: 10.3109/00498254.2015.1070302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
40
|
Perrin S, Chaumais MC, O'Connell C, Amar D, Savale L, Jaïs X, Montani D, Humbert M, Simonneau G, Sitbon O. New pharmacotherapy options for pulmonary arterial hypertension. Expert Opin Pharmacother 2015; 16:2113-31. [PMID: 26290279 DOI: 10.1517/14656566.2015.1074177] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Epoprostenol was the first targeted therapy available for the treatment of pulmonary arterial hypertension (PAH). Since then great advances in our knowledge of the disease have been made and the spectrum of therapeutic options for PAH has expanded. After an overview of current available treatments, this article describes the new pharmacotherapy options and their place in the management of PAH. AREAS COVERED This paper is based on a literature search and the review of studies published on PAH pharmacotherapy using the MEDLINE database. EXPERT OPINION The last decade has been particularly important in PAH management with the emergence of six new molecules, the development of novel routes of administration and improvement of pharmacokinetics. Moreover, pediatric formulations have been developed. However, further research is required to inform clinicians regarding optimal choices of combination therapies (progressive add-on therapy or upfront combination therapy, selection of associated molecules regarding the patient's profile...), to continue to improve the quality of life of patients with new drugs and to reach the ultimate goal of curing the disease.
Collapse
Affiliation(s)
- Swanny Perrin
- a 1 University of Paris-Sud, Faculté de Pharmacie , Chatenay-Malabry, France.,b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France
| | - Marie-Camille Chaumais
- a 1 University of Paris-Sud, Faculté de Pharmacie , Chatenay-Malabry, France.,b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,c 3 APHP, Hôpital Antoine Béclère, Service de Pharmacie , Clamart, France
| | - Caroline O'Connell
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - David Amar
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Laurent Savale
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Xavier Jaïs
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - David Montani
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Marc Humbert
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Gérald Simonneau
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- b 2 INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue , Le Plessis Robinson, France.,d 4 Univ. Paris-Sud, AP-HP, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, INSERM UMR_S999, Hôpital Bicêtre , 78 rue du Général Leclerc, 94275 - Le Kremlin-Bicêtre, France +33 145 217 972 ; +33 145 217 972 ; .,e 5 University Of Paris-Sud, Faculté de Médecine , Le Kremlin-Bicêtre, France
| |
Collapse
|
41
|
Sidharta PN, van Giersbergen PLM, Wolzt M, Dingemanse J. Investigation of mutual pharmacokinetic interactions between macitentan, a novel endothelin receptor antagonist, and sildenafil in healthy subjects. Br J Clin Pharmacol 2015; 78:1035-42. [PMID: 24962473 DOI: 10.1111/bcp.12447] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/16/2014] [Indexed: 12/17/2022] Open
Abstract
AIM To study the mutual pharmacokinetic interactions between macitentan, an endothelin receptor antagonist, and sildenafil in healthy male subjects. METHODS In this open-label, randomized, three way crossover study, 12 healthy male subjects received the following oral treatments: A) a loading dose of 30 mg macitentan on day 1 followed by 10 mg once daily for 3 days, B) sildenafil 20 mg three times a day for 3 days and a single 20 mg dose on day 4 and C) both treatments A and B concomitantly. Plasma concentration-time profiles of macitentan and its active metabolite ACT-132577 (treatments A and C) and sildenafil and its N-desmethyl metabolite (treatments B and C) were determined on day 4 and analyzed non-compartmentally. RESULTS The pharmacokinetics of macitentan were not affected by sildenafil. In the presence of sildenafil Cmax and AUCτ of the metabolite ACT-132577 decreased with geometric mean ratios (90% confidence interval (CI)) of 0.82 (0.76, 0.89) and 0.85 (90% CI 0.80, 0.91), respectively. In the presence of macitentan, plasma concentrations of sildenafil were higher than during treatment with sildenafil alone, resulting in increased Cmax and AUCτ values. The respective geometric mean ratios were 1.26 (90% CI 1.07, 1.48) and 1.15 (90% CI 0.94, 1.41). The pharmacokinetics of N-desmethylsildenafil were not affected by macitentan. All treatments were well tolerated. CONCLUSION A minor, not clinically relevant, pharmacokinetic interaction was observed between macitentan and sildenafil. Based on these results, no dose adjustment of either compound appears necessary during concomitant treatment with macitentan and sildenafil.
Collapse
Affiliation(s)
- Patricia N Sidharta
- Department of Clinical Pharmacology, Actelion Pharmaceuticals Ltd, Gewerbestrasse 16, CH-4123, Allschwil, Switzerland
| | | | | | | |
Collapse
|
42
|
Kim SJ, Lee HJ, Kim MS, Choi HJ, He J, Wu Q, Aldape K, Weinberg JS, Yung WKA, Conrad CA, Langley RR, Lehembre F, Regenass U, Fidler IJ. Macitentan, a Dual Endothelin Receptor Antagonist, in Combination with Temozolomide Leads to Glioblastoma Regression and Long-term Survival in Mice. Clin Cancer Res 2015; 21:4630-41. [PMID: 26106074 DOI: 10.1158/1078-0432.ccr-14-3195] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/30/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE The objective of the study was to determine whether astrocytes and brain endothelial cells protect glioma cells from temozolomide through an endothelin-dependent signaling mechanism and to examine the therapeutic efficacy of the dual endothelin receptor antagonist, macitentan, in orthotopic models of human glioblastoma. EXPERIMENTAL DESIGN We evaluated several endothelin receptor antagonists for their ability to inhibit astrocyte- and brain endothelial cell-induced protection of glioma cells from temozolomide in chemoprotection assays. We compared survival in nude mice bearing orthotopically implanted LN-229 glioblastomas or temozolomide-resistant (LN-229(Res) and D54(Res)) glioblastomas that were treated with macitentan, temozolomide, or both. Tumor burden was monitored weekly with bioluminescence imaging. The effect of therapy on cell division, apoptosis, tumor-associated vasculature, and pathways associated with cell survival was assessed by immunofluorescent microscopy. RESULTS Only dual endothelin receptor antagonism abolished astrocyte- and brain endothelial cell-mediated protection of glioma cells from temozolomide. In five independent survival studies, including temozolomide-resistant glioblastomas, 46 of 48 (96%) mice treated with macitentan plus temozolomide had no evidence of disease (P < 0.0001), whereas all mice in other groups died. In another analysis, macitentan plus temozolomide therapy was stopped in 16 mice after other groups had died. Only 3 of 16 mice eventually developed recurrent disease, 2 of which responded to additional cycles of macitentan plus temozolomide. Macitentan downregulated proteins associated with cell division and survival in glioma cells and associated endothelial cells, which enhanced their sensitivity to temozolomide. CONCLUSIONS Macitentan plus temozolomide are well tolerated, produce durable responses, and warrant clinical evaluation in glioblastoma patients.
Collapse
Affiliation(s)
- Sun-Jin Kim
- Department of Cancer Biology, Metastasis Research Laboratory, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ho Jeong Lee
- Department of Cancer Biology, Metastasis Research Laboratory, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Seungwook Kim
- Department of Cancer Biology, Metastasis Research Laboratory, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hyun Jin Choi
- Department of Cancer Biology, Metastasis Research Laboratory, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Junqin He
- Department of Cancer Biology, Metastasis Research Laboratory, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qiuyu Wu
- Department of Cancer Biology, Metastasis Research Laboratory, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenneth Aldape
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Weinberg
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - W K Alfred Yung
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles A Conrad
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert R Langley
- Department of Cancer Biology, Metastasis Research Laboratory, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Urs Regenass
- Actelion Pharmaceuticals, Ltd., Allschwil, Switzerland
| | - Isaiah J Fidler
- Department of Cancer Biology, Metastasis Research Laboratory, University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
43
|
Dhillon S. Macitentan: a review of its use in patients with pulmonary arterial hypertension. Drugs 2015; 74:1495-507. [PMID: 25060980 DOI: 10.1007/s40265-014-0266-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Macitentan (Opsumit(®)) is an orally active, dual endothelin receptor antagonist (ERA) with tissue targeting properties. Macitentan was approved recently in the EU (as monotherapy or combination therapy) for the long-term treatment of pulmonary arterial hypertension (PAH) in adults of WHO functional class II or III, and in the USA for the treatment of PAH (WHO group I) to delay disease progression and reduce hospitalization for PAH. This article reviews the pharmacological properties, efficacy and tolerability data relevant to the use of macitentan in this indication. Treatment with macitentan 10 mg once daily significantly reduced the risk for the primary composite endpoint of morbidity and mortality in patients with PAH (mostly WHO functional class II or III) in the large, randomized, placebo-controlled SERAPHIN study. Other efficacy outcomes, including exercise capacity, haemodynamic parameters and health-related quality of life also improved significantly with macitentan relative to placebo. Macitentan was generally well tolerated in this study. As with other ERAs, haemoglobin levels decreased with macitentan therapy; however, these were not progressive and stabilized following longer-term treatment. Although comparative studies are needed to definitively position macitentan with respect to other approved agents, current evidence suggests that macitentan is a useful treatment option for initial therapy in patients with WHO functional class II or III PAH, which has the potential advantage of once-daily administration.
Collapse
Affiliation(s)
- Sohita Dhillon
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand,
| |
Collapse
|
44
|
Macitentan: a guide to its use in the treatment of pulmonary arterial hypertension in adults of WHO functional class II or III in the EU. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-014-0180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
45
|
Khadka A, Singh Brashier DB, Tejus A, Sharma AK. Macitentan: An important addition to the treatment of pulmonary arterial hypertension. J Pharmacol Pharmacother 2015; 6:53-7. [PMID: 25709357 PMCID: PMC4319253 DOI: 10.4103/0976-500x.149151] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/08/2014] [Accepted: 10/31/2014] [Indexed: 11/07/2022] Open
Abstract
Macitentan is an orphan drug for the treatment of pulmonary arterial hypertension (PAH). Endothelin-1 (ET-1) plays a critical role of pathophysiology of PAH. Macitentan, a new dual endothelin receptor antagonist, has reportedly improved prognosis of PAH patients by delaying the progression of disease. It prevents the binding of ET-1 to both endothelin A (ETA) and endothelin B (ETB) receptors. Macitentan displays higher efficacy, lesser adverse effects and drug interactions. It has completed phase III trials in 2012 for treatment of PAH and has been tried for ischemic digital ulcers in systemic sclerosis, recurrent glioblastoma and combination with chemotherapeutic agents against various cancers. Safety data for macitentan were obtained primarily from a placebo-controlled clinical study in 742 patients with PAH. The Food and Drug Administration (FDA) approved the drug on 13 October 2013. It is an important addition to long-term treatment of PAH.
Collapse
Affiliation(s)
- Anjan Khadka
- Department of Pharmacology, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
| | - Dick B Singh Brashier
- Department of Pharmacology, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
| | - Anantharamu Tejus
- Department of Pharmacology, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
| | - Ashok Kumar Sharma
- Department of Pharmacology, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
| |
Collapse
|
46
|
Chaumais MC, Guignabert C, Savale L, Jaïs X, Boucly A, Montani D, Simonneau G, Humbert M, Sitbon O. Clinical pharmacology of endothelin receptor antagonists used in the treatment of pulmonary arterial hypertension. Am J Cardiovasc Drugs 2015; 15:13-26. [PMID: 25421754 DOI: 10.1007/s40256-014-0095-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a devastating life-threatening disorder characterized by elevated pulmonary vascular resistance leading to elevated pulmonary arterial pressures, right ventricular failure, and ultimately death. Vascular endothelial cells mainly produce and secrete endothelin (ET-1) in vessels that lead to a potent and long-lasting vasoconstrictive effect in pulmonary arterial smooth muscle cells. Along with its strong vasoconstrictive action, ET-1 can promote smooth muscle cell proliferation. Thus, ET-1 blockers have attracted attention as an antihypertensive drug, and the ET-1 signaling system has paved a new therapeutic avenue for the treatment of PAH. We outline the current understanding of not only the pathogenic role played by ET-1 signaling systems in the pathogenesis of PH but also the clinical pharmacology of endothelin receptor antagonists (ERA) used in the treatment of PAH.
Collapse
MESH Headings
- Animals
- Antihypertensive Agents/adverse effects
- Antihypertensive Agents/pharmacokinetics
- Antihypertensive Agents/therapeutic use
- Drug Interactions
- Drug Therapy, Combination/adverse effects
- Endothelin Receptor Antagonists/adverse effects
- Endothelin Receptor Antagonists/pharmacokinetics
- Endothelin Receptor Antagonists/therapeutic use
- Endothelins/antagonists & inhibitors
- Endothelins/metabolism
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/immunology
- Endothelium, Vascular/metabolism
- Humans
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/immunology
- Hypertension, Pulmonary/metabolism
- Hypertension, Pulmonary/physiopathology
- Models, Biological
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/immunology
- Muscle, Smooth, Vascular/metabolism
- Practice Guidelines as Topic
- Pulmonary Circulation/drug effects
- Signal Transduction/drug effects
- Vasculitis/etiology
- Vasculitis/prevention & control
Collapse
|
47
|
Sidharta PN, Krähenbühl S, Dingemanse J. Pharmacokinetic and pharmacodynamic evaluation of macitentan , a novel endothelin receptor antagonist for the treatment of pulmonary arterial hypertension. Expert Opin Drug Metab Toxicol 2015; 11:437-49. [PMID: 25604973 DOI: 10.1517/17425255.2015.1000859] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a chronic disorder of the pulmonary vasculature characterized by elevated mean pulmonary arterial pressure eventually leading to right-sided heart failure and premature death. Macitentan is an oral, once-daily, dual endothelin (ET)A and ETB receptor antagonist with high affinity and sustained receptor binding that was approved in the USA, Europe, Canada, and Switzerland for the treatment of PAH. AREAS COVERED This review discusses the pharmacokinetics (PK) and pharmacodynamics (PD) of macitentan and its drug interaction potential based on preclinical and clinical data. EXPERT OPINION Up to date, macitentan is the only registered treatment for PAH that significantly reduced morbidity and mortality as a combined endpoint in a long-term event-driven study. The safety profile of macitentan is favorable with respect to hepatic safety and edema/fluid retention and may be better than that of other ET receptor antagonists such as bosentan and ambrisentan. The PK profile supports a once-a-day dosing regimen. Macitentan has limited interactions with other drugs. Based on these characteristics macitentan is an important new addition to the treatment of PAH.
Collapse
Affiliation(s)
- Patricia N Sidharta
- Actelion Pharmaceuticals Ltd., Department of Clinical Pharmacology , Gewerbestrasse 16, CH-4123 Allschwil , Switzerland +41 61 656686 ; +41 61 5656200 ;
| | | | | |
Collapse
|
48
|
Cutolo M, Montagna P, Brizzolara R, Smith V, Alessandri E, Villaggio B, Sulli A, Tavilla PP, Pizzorni C, Soldano S. Effects of macitentan and its active metabolite on cultured human systemic sclerosis and control skin fibroblasts. J Rheumatol 2015; 42:456-63. [PMID: 25593238 DOI: 10.3899/jrheum.141070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effects of the endothelin 1 (ET-1) receptor antagonists (ETRA) macitentan, its active metabolite ACT-132577, and bosentan on myofibroblast activation and extracellular matrix production induced by ET-1 in cultured systemic sclerosis (SSc) and control skin fibroblasts. METHODS Fibroblasts were obtained from skin biopsies of 6 patients with SSc and 5 healthy subjects. Some cultured cells were untreated or treated with macitentan, ACT-132577, or bosentan alone (10 μM). Other cultured cells were treated with ET-1 alone (100 nM) or with ETRA, and after 1 h, also with ET-1. After 48 h of treatment, myofibroblast activation was investigated to evaluate the α-smooth muscle actin (α-SMA) expression by immunofluorescence; type I collagen (COL-1) and fibronectin (FN) were investigated by immunocytochemistry, Western blotting, and quantitative real-time PCR (qRT-PCR). Statistical analysis was performed by the nonparametric Mann-Whitney U test. RESULTS In cultured SSc skin fibroblasts, only the treatment with macitentan significantly reduced the basal level of α-SMA expression (p = 0.03 vs untreated cells). Macitentan also significantly reduced the basal level of COL-1 synthesis, similarly to bosentan (p < 0.05 vs untreated cells). Macitentan or ACT-132577 antagonized the ability of ET-1 to further induce α-SMA expression (p = 0.03), COL-1, and FN synthesis (p = 0.03, p = 0.005); bosentan showed similar effects. These results obtained by immunofluorescence and immunocytochemistry were confirmed by Western blotting and qRT-PCR. The downregulatory effects exerted by ETRA were observed also in cultured human control skin fibroblasts. CONCLUSION Macitentan and ACT-132577 seem to downregulate in vitro the profibrotic myofibroblast phenotype induced by ET-1 in cultured human SSc skin fibroblasts.
Collapse
Affiliation(s)
- Maurizio Cutolo
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital.
| | - Paola Montagna
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital
| | - Renata Brizzolara
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital
| | - Vanessa Smith
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital
| | - Elisa Alessandri
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital
| | - Barbara Villaggio
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital
| | - Alberto Sulli
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital
| | - Pietro Paolo Tavilla
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital
| | - Carmen Pizzorni
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital
| | - Stefano Soldano
- From Research Laboratory and Academic Division of Clinical Rheumatology, Research Laboratory of Nephrology, Department of Internal Medicine, and the Department of Health Science, Unit of Dermatology, University of Genoa, Genoa, Italy; and the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.M. Cutolo, MD, Full Professor, Director; P. Montagna, BS, PhD; R. Brizzolara, BS, PhD; E. Alessandri, MD; A. Sulli, MD, Assistant Professor; C. Pizzorni, MD, Assistant Professor; S. Soldano, BS, PhD, Research Laboratory and Academic Division of Clinical Rheumatology; B. Villaggio, BS, Research Laboratory of Nephrology, Department of Internal Medicine; P.P. Tavilla, MD, Department of Health Science, Unit of Dermatology, University of Genoa; V. Smith, MD, PhD, Department of Rheumatology, Ghent University Hospital
| |
Collapse
|
49
|
Abstract
Macitentan (Opsumit®) is a novel dual endothelin receptor antagonist (ERA) with sustained receptor binding properties developed by Actelion Pharmaceuticals Ltd. In October 2013, oral macitentan 10 mg once daily received its first global approval in the US, followed closely by Canada, for the treatment of pulmonary arterial hypertension (PAH). The drug has also received a positive opinion in the EU from the Committee for Medicinal Products for Human Use for the treatment of PAH, and is under regulatory review in several other countries for the same indication. Endothelin (ET)-1 influences pathological changes via two ET receptor subtypes (ETA and ETB), to which it binds with high affinity. ET-1 is implicated in several forms of vascular disease making it a valid target for the treatment of pulmonary vascular diseases such as PAH. Clinical development is underway for other indications, including Eisenmenger syndrome, ischaemic digital ulcers secondary to systemic sclerosis, and glioblastoma. Macitentan was also evaluated in idiopathic pulmonary fibrosis; however, a phase 2 trial did not meet its primary endpoint and further investigation in this indication was discontinued. Macitentan was developed by modifying the structure of bosentan in the search for an optimal dual ERA with improved efficacy and tolerability compared with other ERAs. This article summarizes the milestones in the development of macitentan leading to this first approval for PAH.
Collapse
Affiliation(s)
- Trina Patel
- Adis R&D Insight, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, 0754, Auckland, New Zealand,
| | | |
Collapse
|
50
|
Kholdani CA, Fares WH, Trow TK. Macitentan for the treatment of pulmonary arterial hypertension. Vasc Health Risk Manag 2014; 10:665-73. [PMID: 25473292 PMCID: PMC4251661 DOI: 10.2147/vhrm.s33904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Macitentan is the most recently approved dual endothelin-receptor antagonist (ERA) for the treatment of symptomatic pulmonary arterial hypertension. Compared to other available ERAs, it demonstrates superior receptor-binding properties, with consequently improved tissue penetration, and a longer duration of action allowing for once-daily dosing. It has a favorable adverse-effect profile, with notably no demonstrable increase in the risk of hepatotoxicity or peripheral edema, but like other ERAs, it is potentially limited by significant anemia. Phase I data have demonstrated a favorable drug-drug interaction profile and no need for dose adjustment with hepatic and renal impairment. In the pivotal SERAPHIN study, treatment of symptomatic pulmonary arterial hypertension patients with macitentan led to statistically significant improvements in functional class, exercise tolerance, and hemodynamic parameters, in addition to a reduction in morbidity in an event-driven long-term trial.
Collapse
Affiliation(s)
- Cyrus A Kholdani
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Wassim H Fares
- Yale Pulmonary Vascular Disease Program, Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Terence K Trow
- Yale Pulmonary Vascular Disease Program, Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|