1
|
Overview of Side-Effects of Antibacterial Fluoroquinolones: New Drugs versus Old Drugs, a Step Forward in the Safety Profile? Pharmaceutics 2023; 15:pharmaceutics15030804. [PMID: 36986665 PMCID: PMC10056716 DOI: 10.3390/pharmaceutics15030804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023] Open
Abstract
Antibacterial fluoroquinolones (FQs) are frequently used in treating infections. However, the value of FQs is debatable due to their association with severe adverse effects (AEs). The Food and Drug Administration (FDA) issued safety warnings concerning their side-effects in 2008, followed by the European Medicine Agency (EMA) and regulatory authorities from other countries. Severe AEs associated with some FQs have been reported, leading to their withdrawal from the market. New systemic FQs have been recently approved. The FDA and EMA approved delafloxacin. Additionally, lascufloxacin, levonadifloxacin, nemonoxacin, sitafloxacin, and zabofloxacin were approved in their origin countries. The relevant AEs of FQs and their mechanisms of occurrence have been approached. New systemic FQs present potent antibacterial activity against many resistant bacteria (including resistance to FQs). Generally, in clinical studies, the new FQs were well-tolerated with mild or moderate AEs. All the new FQs approved in the origin countries require more clinical studies to meet FDA or EMA requirements. Post-marketing surveillance will confirm or infirm the known safety profile of these new antibacterial drugs. The main AEs of the FQs class were addressed, highlighting the existing data for the recently approved ones. In addition, the general management of AEs when they occur and the rational use and caution of modern FQs were outlined.
Collapse
|
2
|
Chen Y, Wu X, Tsai C, Chang L, Yu J, Cao G, Guo B, Shi Y, Zhu D, Hu F, Yuan J, Liu Y, Zhao X, Zhang Y, Wu J, Zhang J. Integrative population pharmacokinetic/pharmacodynamic analysis of nemonoxacin capsule in Chinese patients with community-acquired pneumonia. Front Pharmacol 2023; 14:912962. [PMID: 36923351 PMCID: PMC10010492 DOI: 10.3389/fphar.2023.912962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 02/06/2023] [Indexed: 02/28/2023] Open
Abstract
Introduction: Nemonoxacin is an innovative quinolone antibiotic for treatment of community-acquired pneumonia (CAP). As more data are available from clinical studies, it is necessary to perform an integrative pharmacokinetic/pharmacodynamic (PK/PD) analysis to support and justify the optimal dosing regimen of nemonoxacin in clinical practice. Methods and Results: We developed a population PK model using non-linear mixed effect model based on the data of 195 Chinese subjects receiving nemonoxacin in phase I to III clinical trials. The base model was a standard two-compartment PK model defined by clearance (12 L/h) and central volume of distribution (86 L). Covariates included creatinine clearance (CLcr), body weight (BW), sex, disease status and food. Compared to the subject with BW 60 kg, Cmax and A U C 0 - 24 , ss reduced by 24% and 19% in the subject with BW 80 kg, respectively. Compared to the subject with CLcr 150 ml/min, A U C 0 - 24 , ss and T1/2 increased by 28% and 24%, respectively in the subject with CLcr 30 ml/min. Compared to the fasted status, Tmax of nemonoxacin increased by 1.2 h in the subject with fed status. Effects of sex and disease status on PK parameters were small (change of PK parameters ≤19%). AUC0-24/MIC and %T > MIC were identified as the optimal PK/PD indices for predicting clinical efficacy. The AUC0-24/MIC target was 63.3, 97.8, and 115.7 against Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae, respectively. The %T > MIC target was 7.96% against Klebsiella pneumoniae. Monte Carlo simulation showed that treatment with nemonoxacin 500 mg q24 h could attain a PK/PD cutoff value higher than the MIC90 against S. pneumoniae and S. aureus. The corresponding cumulative fraction of response (CFR) was greater than 93%, while nemonoxacin 750 mg q24 h would provide higher PK/PD cutoff value against Haemophilus parainfluenzae, and higher CFR (83%) than 500 mg q24 h. Conclusion: Integrative PK/PD analysis justifies the reliable clinical and microbiological efficacy of nemonoxacin 500 mg q24 h in treating CAP caused by S. pneumoniae, S. aureus, and K. pneumoniae, irrespective of patient sex, mild renal impairment, empty stomach or not. However, nemonoxacin 750 mg q24 h would provide better efficacy than 500 mg q24 h for the CAP caused by H. parainfluenzae in terms of CFR.
Collapse
Affiliation(s)
- Yuancheng Chen
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaojie Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengyuan Tsai
- TaiGen Biopharmaceuticals Beijing Co., Ltd., Beijing, China
| | - Liwen Chang
- TaiGen Biopharmaceuticals Beijing Co., Ltd., Beijing, China
| | - Jicheng Yu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Guoying Cao
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaoguo Shi
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Demei Zhu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinyi Yuan
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Zhao
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yingyuan Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jufang Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
3
|
Zhao M, Chen Y, Yang D, Lyu C, Bian X, Li X, Qiu W, Huang Z, Hu Z, Zhang J. Regulatory utility of pharmacometrics in the development and evaluation of antimicrobial agents and its recent progress in China. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:1466-1478. [PMID: 34651458 PMCID: PMC8674004 DOI: 10.1002/psp4.12716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/24/2021] [Accepted: 09/20/2021] [Indexed: 11/08/2022]
Abstract
Pharmacometrics is an emerging science that interprets drug, disease, and trial information in a mathematical fashion to inform and facilitate efficient drug development and/or regulatory decisions. Pharmacometrics study is increasingly adopted in the regulatory review of new antimicrobial agents. We summarized the 31 antimicrobial agents approved by the US Food and Drug Administration (FDA) and the 26 antimicrobial agents approved by European Medicines Agency (EMA) from January 2001 to May 2019. We also reviewed recent examples of utilizing pharmacometrics to support antimicrobial agent's registration in China, including modeling and simulation methods, effects of internal/external factors on pharmacokinetic (PK) parameters, safety and efficacy evaluation in terms of exposure-response analysis, refinement of the wording of product labeling and package leaflet, and possible postmarketing clinical trial. Ongoing communication among regulator, academia, and industry regarding pharmacometrics is encouraged to streamline and facilitate the development of new antimicrobial agents. The industry can maximize its benefit in drug development through continued pharmacometrics education/training.
Collapse
Affiliation(s)
- Ming Zhao
- Office of Clinical Evaluation II, Center for Drug Evaluation, National Medical Products Administration, Beijing, China
| | - Yuancheng Chen
- Phase I Unit, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Dong Yang
- Covance Pharmaceutical Research and Development (Beijing) Co., Ltd., Beijing, China
| | - Cheng Lyu
- Department of Translational Medicine, Clinical Development Business Unit, CSPC Zhongqi Pharmaceutical Technology (Shijiazhuang) Co., Ltd., Shanghai, China.,Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Xingchen Bian
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Xin Li
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Weiyi Qiu
- Beijing Institute of Biotechnology, Beijing, China
| | - Zhiwei Huang
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Zijian Hu
- Department of Translational Medicine, Clinical Development Business Unit, CSPC Zhongqi Pharmaceutical Technology (Shijiazhuang) Co., Ltd., Shanghai, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| |
Collapse
|
4
|
Li Y, Lu J, Kang Y, Xu X, Li X, Chen Y, Wang K, Liu X, Fan Y, Wu H, Wang Y, Hu J, Yu J, Wu J, Guo B, Zhang Y, Zeng X, Zhao M, Xue J, Zhang J. Nemonoxacin dosage adjustment in patients with severe renal impairment based on population pharmacokinetic and pharmacodynamic analysis. Br J Clin Pharmacol 2021; 87:4636-4647. [PMID: 33928669 DOI: 10.1111/bcp.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022] Open
Abstract
AIMS To optimize the dosing regimen in patients with severe renal impairment based on population pharmacokinetic (PPK)/pharmacodynamic analysis. METHODS The pharmacokinetics and safety of nemonoxacin was evaluated in a single-dose, open-label, nonrandomized, parallel-group study after single oral dose of a 0.5-g nemonoxacin capsule in 10 patients with severe renal impairment and 10 healthy controls. Both blood and urine samples were collected within 72 hours after admission and determined the concentrations. A PPK model was built using nonlinear mixed effects modelling. The probability of target attainment and the cumulative fraction of response against Streptococcus pneumoniae and Staphylococcus aureus was calculated by Monte Carlo simulation. RESULTS The data best fitted a 2-compartment model, from which the PPK parameters were estimated, including clearance (8.55 L/h), central compartment volume (80.8 L) and peripheral compartment volume (50.6 L). The accumulative urinary excretion was 23.4 ± 6.5% in severe renal impairment patients and 66.1 ± 16.8% in healthy controls. PPK/pharmacodynamic modelling and simulation of 4 dosage regimens found that nemonoxacin 0.5 g every 48 hours (q48h) was the optimal dosing regimen in severe renal impairment patients, evidenced by higher probability of target attainment (92.7%) and cumulative fraction of response (>99%) at nemonoxacin minimum inhibitory concentration ≤ 1 mg/L against S. pneumoniae and S. aureus. The alternative regimens (0.25 g q24h; loading dose 0.5 g on Day 1 followed by 0.25 g q24h) were insufficient to cover the pathogens even if minimum inhibitory concentration = 1 mg/L. CONCLUSION An extended dosing interval (0.5 g q48h) may be appropriate for optimal efficacy of nemonoxacin in case of severe renal impairment.
Collapse
Affiliation(s)
- Yi Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianda Lu
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yue Kang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyong Xu
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuancheng Chen
- China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Kun Wang
- Shanghai Qiangshi Information Technology Co., Ltd, Shanghai, China
| | - Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaxin Fan
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Hailan Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiali Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jicheng Yu
- China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Jufang Wu
- China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yingyuan Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Zeng
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China.,Center for Drug Evaluation, National Medical Products Administration, Beijing, China
| | - Ming Zhao
- Center for Drug Evaluation, National Medical Products Administration, Beijing, China
| | - Jun Xue
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.,National Clinical Research Center for Geriatric Diseases, Huashan Hospital, Fudan University, Shanghai, China.,Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|