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Nguyen Ngoc Pouplin J, Kaendiao T, Rahimi BA, Soni M, Basopia H, Shah D, Patil J, Dholakia V, Suthar Y, Tarning J, Mukaka M, Taylor WR. Bioequivalence of a new coated 15 mg primaquine formulation for malaria elimination. Malar J 2024; 23:176. [PMID: 38840151 PMCID: PMC11155120 DOI: 10.1186/s12936-024-04947-6] [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: 12/14/2023] [Accepted: 04/12/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND With only one 15 mg primaquine tablet registered by a stringent regulatory authority and marketed, more quality-assured primaquine is needed to meet the demands of malaria elimination. METHODS A classic, two sequence, crossover study, with a 10-day wash out period, of 15 mg of IPCA-produced test primaquine tablets and 15 mg of Sanofi reference primaquine tablets was conducted. Healthy volunteers, aged 18-45 years, without glucose-6-phosphate dehydrogenase deficiency, a baseline haemoglobin ≥ 11 g/dL, creatinine clearance ≥ 70 mL/min/1.73 ms, and body mass index of 18.5-30 kg/m2 were randomized to either test or reference primaquine, administered on an empty stomach with 240 mL of water. Plasma primaquine and carboxyprimaquine concentrations were measured at baseline, then 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.333, 2.667, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 8.0, 10.0, 12.0, 16.0, 24.0, 36.0, 48.0 and 72.0 h by liquid chromatography coupled to tandem mass spectrometry. Primaquine pharmacokinetic profiles were evaluated by non-compartmental analysis and bioequivalence concluded if the 90% confidence intervals (CI) of geometric mean (GM) ratios of test vs. reference formulation for the peak concentrations (Cmax) and area under the drug concentration-time (AUC0-t) were within 80.00 to 125.00%. RESULTS 47 of 50 volunteers, median age 33 years, completed both dosing rounds and were included in the bioequivalence analysis. For primaquine, GM Cmax values for test and reference formulations were 62.12 vs. 59.63 ng/mL, resulting in a GM ratio (90% CI) of 104.17% (96.92-111.96%); the corresponding GM AUC0-t values were 596.56 vs. 564.09 ngxh/mL, for a GM ratio of 105.76% (99.76-112.08%). Intra-subject coefficient of variation was 20.99% for Cmax and 16.83% for AUC0-t. Median clearances and volumes of distribution were similar between the test and reference products: 24.6 vs. 25.2 L/h, 189.4 vs. 191.0 L, whilst the median half-lives were the same, 5.2 h. CONCLUSION IPCA primaquine was bioequivalent to the Sanofi primaquine. This opens the door to prequalification, registration in malaria endemic countries, and programmatic use for malaria elimination. Trial registration The trial registration reference is ISRCTN 54640699.
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Affiliation(s)
- Julie Nguyen Ngoc Pouplin
- Réseau Médicaments et Développement, 21Bis Avenue du Commandant l'Herminier, 44600, Saint-Nazaire, France.
| | - Thoopmanee Kaendiao
- Mahidol Oxford Tropical Medicine Clinical Research Unit, Mahidol University, Bangkok, Thailand
| | - Bilal Ahmad Rahimi
- Department of Paediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mayur Soni
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Hensi Basopia
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Darshana Shah
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Jitendra Patil
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Vyom Dholakia
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Yash Suthar
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Clinical Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Clinical Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Walter R Taylor
- Mahidol Oxford Tropical Medicine Clinical Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Gomes F, Ribeiro AC, Sanches GS, Borges HS, Takahashi LAU, Daniel-Ribeiro CT, Tedesco AC, Nascimento JWL, Carvalho LJM. A nanochitosan-D-galactose formulation increases the accumulation of primaquine in the liver. Antimicrob Agents Chemother 2024; 68:e0091523. [PMID: 38517190 PMCID: PMC11064505 DOI: 10.1128/aac.00915-23] [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: 07/11/2023] [Accepted: 02/25/2024] [Indexed: 03/23/2024] Open
Abstract
Primaquine is the mainstream antimalarial drug to prevent Plasmodium vivax relapses. However, this drug can induce hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency. Nanostructure formulations of primaquine loaded with D-galactose were used as a strategy to target the drug to the liver and decrease the hemolytic risks. Nanoemulsion (NE-Pq) and nanochitosan (NQ-Pq) formulations of primaquine diphosphate containing D-galactose were prepared and characterized by their physicochemistry properties. Pharmacokinetic and biodistribution studies were conducted using Swiss Webster mice. A single dose of 10 mg/kg of each nanoformulation or free primaquine solution was administered by gavage to the animals, which were killed at 0.5, 1, 2, 4, 8, and 24 hours. Blood samples and tissues were collected, processed, and analyzed by high-performance liquid chromatography. The nanoformulation showed sizes around 200 nm (NE-Pq) and 400 nm (NQ-Pq) and physicochemical stability for over 30 days. Free primaquine solution achieved higher primaquine Cmax in the liver than NE-Pq or NQ-Pq at 0.5 hours. However, the half-life and mean residence time (MRT) of primaquine in the liver were three times higher with the NQ-Pq formulation than with free primaquine, and the volume distribution was four times higher. Conversely, primaquine's half-life, MRT, and volume distribution in the plasma were lower for NQ-Pq than for free primaquine. NE-Pq, on the other hand, accumulated more in the lungs but not in the liver. Galactose-coated primaquine nanochitosan formulation showed increased drug targeting to the liver compared to free primaquine and may represent a promising strategy for a more efficient and safer radical cure for vivax malaria.
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Affiliation(s)
- F. Gomes
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
| | - A. C. Ribeiro
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
- Department of Pharmacology (LaFaCE) - ICB, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - G. S. Sanches
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
| | - H. S. Borges
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering - Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L. A. U. Takahashi
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering - Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - C. T. Daniel-Ribeiro
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
| | - A. C. Tedesco
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering - Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - J. W. L. Nascimento
- Department of Pharmacology (LaFaCE) - ICB, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - L. J. M. Carvalho
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
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Khan W, Wang YH, Chaurasiya ND, Nanayakkara NPD, Bandara Herath HM, Harrison KA, Dale G, Stanford DA, Dahl EP, McChesney JD, Gul W, ElSohly MA, Jollow D, Tekwani BL, Walker LA. Comparative metabolism and tolerability of racemic primaquine and its enantiomers in human volunteers during 7-day administration. Front Pharmacol 2023; 13:1104735. [PMID: 36726785 PMCID: PMC9885159 DOI: 10.3389/fphar.2022.1104735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
Primaquine (PQ) is an 8-aminoquinoline antimalarial, active against dormant Plasmodium vivax hypnozoites and P. falciparum mature gametocytes. PQ is currently used for P. vivax radical cure and prevention of malaria transmission. PQ is a racemic drug and since the metabolism and pharmacology of PQ's enantiomers have been shown to be divergent, the objectives of this study were to evaluate the comparative tolerability and metabolism of PQ with respect to its two enantiomers in human volunteers in a 7 days' treatment schedule. Fifteen subjects with normal glucose-6-phosphate dehydrogenase (G6PDn) completed four arms, receiving each of the treatments, once daily for 7 days, in a crossover fashion, with a 7-14 days washout period in between: R-(-) enantiomer (RPQ) 22.5 mg; S-(+) enantiomer (SPQ) 22.5 mg; racemic PQ (RSPQ) 45 mg, and placebo. Volunteers were monitored for any adverse events (AEs) during the study period. PQ and metabolites were quantified in plasma and red blood cells (RBCs) by UHPLC-UV-MS/MS. Plasma PQ was significantly higher in SPQ treatment group than for RPQ. Carboxy-primaquine, a major plasma metabolite, was much higher in the RPQ treated group than SPQ; primaquine carbamoyl glucuronide, another major plasma metabolite, was derived only from SPQ. The ortho-quinone metabolites were also detected and showed differences for the two enantiomers in a similar pattern to the parent drugs. Both enantiomers and racemic PQ were well tolerated in G6PDn subjects with the 7 days regimen; three subjects showed mild AEs which did not require any intervention or discontinuation of the drug. The most consistent changes in G6PDn subjects were a gradual increase in methemoglobin and bilirubin, but these were not clinically important. However, the bilirubin increase suggests mild progressive damage to a small fraction of red cells. PQ enantiomers were also individually administered to two G6PD deficient (G6PDd) subjects, one heterozygous female and one hemizygous male. These G6PDd subjects showed similar results with the two enantiomers, but the responses in the hemizygous male were more pronounced. These studies suggest that although the metabolism profiles of individual PQ enantiomers are markedly different, they did not show significant differences in the safety and tolerability in G6PDn subjects.
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Affiliation(s)
- Washim Khan
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States
| | - Yan-Hong Wang
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States
| | - Narayan D. Chaurasiya
- Department of Infectious Diseases, Division of Drug Discovery, Southern Research Institute, Birmingham, AL, United States
| | - N. P. Dhammika Nanayakkara
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States
| | - H. M. Bandara Herath
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States
| | - Kerri A. Harrison
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States
| | - Gray Dale
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States
| | - Donald A. Stanford
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States
| | - Eric P. Dahl
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States
| | | | - Waseem Gul
- ElSohly Laboratories Inc., Oxford, MS, United States
| | - Mahmoud A. ElSohly
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States,ElSohly Laboratories Inc., Oxford, MS, United States,Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, United States
| | - David Jollow
- Professor Emeritus, Department Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, United States
| | - Babu L. Tekwani
- Department of Infectious Diseases, Division of Drug Discovery, Southern Research Institute, Birmingham, AL, United States,*Correspondence: Babu L. Tekwani, ; Larry A. Walker,
| | - Larry A. Walker
- National Center for Natural Products Research, The University of Mississippi, University, MS, United States,*Correspondence: Babu L. Tekwani, ; Larry A. Walker,
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Khan W, Wang YH, Dhammika Nanayakkara N, Bandara Herath H, Chaurasiya ND, Tekwani BL, ElSohly MA, McChesney JD, Khan IA, Walker LA. Quantitative analysis of primaquine and its metabolites in human urine using liquid chromatography coupled with tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1213:123517. [DOI: 10.1016/j.jchromb.2022.123517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
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