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Arısoy M, Saydam M, Dolaksız YE, Demirbaş Ö, Talay Ç, Sağlam O, Demiray G, Kurtoğlu ED, Oktay AN. Evaluation of Pharmacokinetics of a BCS Class III Drug with Two Different Study Designs: Tenofovir Alafenamide Monofumarate Film-coated Tablet. AAPS PharmSciTech 2024; 25:123. [PMID: 38816624 DOI: 10.1208/s12249-024-02835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024] Open
Abstract
Tenofovir alafenamide (TAF) is a BCS Class III compound and an oral pro-drug of Tenofovir (TFV) with limited oral bioavailability. The bioavailability of the oral intake increases with food as a result of the low stability of the active substance in the stomach. The reference drug is "Vemlidy® 25 mg Film Tablet", which contains 25 mg of TAF in "hemifumarate" form, is under patent protection until 15.08.2032 by Gilead, and so the "monofumarate" form was used in the present study. At first, a pilot study was conducted involving 12 subjects under fed conditions. The results of the pilot study revealed the test and reference products were not bioequivalent, as a result of insufficient statistical power and high inter-subject variability. Secondly, a physiologically based pharmacokinetic (PBPK) simulation was performed based on the pilot study results and literature data. Finally, the power of the design was increased and the pivotal study design was optimized into a four-period, full-replicated, cross-over study with 34 subjects under fed conditions and it was concluded that the test and reference products were bioequivalent. In conclusion, the present study proved the importance of a correct study design with higher statistical power for a BCS Class III compound with high variability, to present the pharmacokinetics.
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Affiliation(s)
- Mustafa Arısoy
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye
| | - Mehtap Saydam
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye.
| | - Yasemin Ekin Dolaksız
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye
| | - Özge Demirbaş
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye
| | - Çağrı Talay
- Drogsan Pharmaceuticals, 1370 St. No:7, Oğuzlar District, Balgat, Ankara, 06520, Türkiye
| | - Onursal Sağlam
- Novagenix Bioanalytical Drug R&D Centre, Balıkhisar, Özal Av. No:664, Akyurt, Ankara, 06970, Türkiye
| | - Gökçe Demiray
- Novagenix Bioanalytical Drug R&D Centre, Balıkhisar, Özal Av. No:664, Akyurt, Ankara, 06970, Türkiye
| | - Emel Doğan Kurtoğlu
- Novagenix Bioanalytical Drug R&D Centre, Balıkhisar, Özal Av. No:664, Akyurt, Ankara, 06970, Türkiye
| | - Ayşe Nur Oktay
- University of Heath Science, Faculty of Pharmacy, EmrahEtlik, Keçiören, Ankara, 06018, Türkiye
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Maciel AMDA, Ferraz MLCG, Perez RDM, Brandão-Mello CE. Renal dysfunction during treatment of chronic hepatitis B with tenofovir disoproxyl fumarate and associated risk factors. Eur J Gastroenterol Hepatol 2024; 36:482-488. [PMID: 38407882 DOI: 10.1097/meg.0000000000002723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVES To analyze the evolution of glomerular filtration rate (GFR) and the presence of renal tubular dysfunction during the treatment of chronic hepatitis B virus (HBV) infection with tenofovir disoproxil fumarate (TDF) and to determine the risk factors involved. METHODS Retrospective cohort observational study of adults with chronic hepatitis B. Exclusion: hepatitis C virus-HBV coinfection, diabetes, baseline GFR less than 60 ml/min. Measurements of serum and urinary creatinine and phosphate; urinary albumin, retinol-binding protein (RBP) and neutrophil gelatinase-associated lipocalin (NGAL) were performed. Univariate and multivariate analyses tracked factors associated with worsening GFR. RESULTS A total of 120 individuals were included: 35% NAÏVE (G1); 49.2% HBV using TDF (G2); 15.8% HBV-HIV using TDF (G3); 63.3% men; 60.8% white; 30% hypertensive. Average age was 50.5 years (SD ± 12.9 years). Reactive HBeAg predominated in G3 ( P < 0.001) and cirrhosis in G2 ( P < 0.036). NGAL was elevated in 5.3% of cases (G1 = 3.2%; G2 = 8.7%; G3 = 0%; P = 0.582), RBP in 6.7% (G1, G3 = 0%; G2 = 13.6%; P = 0.012), urinary phosphate/creatinine ratio in 16.2% (G1 = 15.2%; G2 = 14.5%; G3 = 23.5%; P = 0.842) and urinary albumin/creatinine ratio in 12.9% (G1 = 12.2%; G2 = 10.7%; G3 = 21.1%; P = 0.494). Worsening of renal function occurred in 22.5% of the population (G1 = 11.9%; G2 = 28.8%; G3 = 26.3%; P = 0.122), independently associated only with systemic arterial hypertension [adjusted odds ratio (AOR) = 4.14; P = 0.008], but not to TDF (AOR = 2.66; P = 0.110) or male sex (AOR = 2.39; P = 0.135). However, the concomitance of these variables generated a high estimated risk for this outcome (51%). CONCLUSIONS Renal tubular dysfunction was uncommon according to NGAL, RBP or urinary phosphate/creatinine ratio. TDF was not an independent factor for worsening renal function, significantly associated only with systemic arterial hypertension. However, in hypertensive men, the use of TDF should be monitored.
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Affiliation(s)
- Alessandra M de A Maciel
- Departamento de Hepatologia e Infectologia da Escola Paulista de Medicina (EPM) - Universidade Federal de São Paulo (UNIFESP)
- Departamento de Hepatologia do Hospital Universitário Gaffrée e Guinle (HUGG) - Universidade Federal do Estado do Rio de Janeiro (HUGG), Rio de Janeiro - RJ, Brazil
| | - Maria Lucia C G Ferraz
- Departamento de Hepatologia e Infectologia da Escola Paulista de Medicina (EPM) - Universidade Federal de São Paulo (UNIFESP)
| | - Renata de M Perez
- Departamento de Hepatologia e Infectologia da Escola Paulista de Medicina (EPM) - Universidade Federal de São Paulo (UNIFESP)
| | - Carlos Eduardo Brandão-Mello
- Departamento de Hepatologia do Hospital Universitário Gaffrée e Guinle (HUGG) - Universidade Federal do Estado do Rio de Janeiro (HUGG), Rio de Janeiro - RJ, Brazil
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Saeki C, Saito M, Tsubota A. Association of chronic liver disease with bone diseases and muscle weakness. J Bone Miner Metab 2024:10.1007/s00774-023-01488-x. [PMID: 38302761 DOI: 10.1007/s00774-023-01488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024]
Abstract
The liver is a vital organ involved in nutrient metabolism, hormone regulation, immunity, cytokine production, and gut homeostasis. Impairment in liver function can result in malnutrition, chronic inflammation, decreased anabolic hormone levels, and dysbiosis. These conditions eventually cause an imbalance in osteoblast and osteoclast activities, resulting in bone loss. Osteoporosis is a frequent complication of chronic liver disease (CLD) that adversely affects quality of life and increases early mortality. Sarcopenia is another common complication of CLD characterized by progressive loss of skeletal muscle mass and function. Assessment criteria for sarcopenia specific to liver disease have been established, and sarcopenia has been reported to be associated with an increase in the risk of liver disease-related events and mortality in patients with CLD. Owing to their similar risk factors and underlying pathophysiological mechanisms, osteoporosis and sarcopenia often coexist (termed osteosarcopenia), progress in parallel, and further exacerbate the conditions mentioned above. Therefore, comprehensive management of these musculoskeletal disorders is imperative. This review summarizes the clinical implications and characteristics of osteoporosis, extending to sarcopenia and osteosarcopenia, in patients with CLD caused by different etiologies.
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Affiliation(s)
- Chisato Saeki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Mitsuru Saito
- Department of Orthopedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Akihito Tsubota
- Project Research Units, Research Center for Medical Science, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
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Wang N, He S, Zheng Y, Wang L. Efficacy and safety of tenofovir disoproxil fumarate versus entecavir in the treatment of acute-on-chronic liver failure with hepatitis B: a systematic review and meta-analysis. BMC Gastroenterol 2023; 23:388. [PMID: 37957546 PMCID: PMC10642028 DOI: 10.1186/s12876-023-03024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Oral nucleoside (acid) analogues (NAs) are recommended for patients with acute-on-chronic liver failure (ACLF) associated with hepatitis B virus (HBV-ACLF). The efficacy and safety of tenofovir (TDF) and entecavir (ETV) in these patients remain unclear. METHODS A comprehensive literature search in PubMed, Web of Science, The Cochrane Library, and Embase database was conducted to select studies published before December 2022 on TDF or ETV for HBV-ACLF. The primary outcomes were survival rates at 4, 12, and 48 weeks. Secondary outcomes were virologic and biochemical responses, serum antigen conversion, liver function score, and safety. RESULTS Four prospective and one retrospective cohort studies were selected. The overall analysis showed comparable survival rates at 4, 12, and 48 weeks for all patients receiving TDF or ETV (4-week: RR = 1.17, 95% CI: 0.90-1.51, p = 0.24; 12-week: RR = 1.00, 95% CI: 0.88-1.13, p = 0.94; 48-week: RR = 0.96, 95% CI: 0.58-1.57, p = 0.86). Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score at 12 weeks were comparable in both groups but lower than baseline (CTP: SMD = -0.75, 95% CI:-2.81-1.30, p = 0.47; MELD: SMD = -1.10, 95% CI:-2.29-0.08, p = 0.07). At 48 weeks, estimated glomerular filtration rate (eGFR) levels were found to decrease to different degrees from baseline in both the TDF and ETV groups, and the decrease was greater in the TDF group than in the ETV group. No significant differences were found in biochemical, virologic response, and serum antigen conversion between the two groups during the observation period. CONCLUSION TDF treatment of HBV-ACLF is similar to ETV in improving survival, liver function, and virologic response but the effects on renal function in two groups in the long term remain unclear. More and larger long-term clinical trials are required to confirm these findings.
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Affiliation(s)
- Neng Wang
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Sike He
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yu Zheng
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lichun Wang
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Woldemedihn GM, Aberra H, Desalegn H, Berhe N, Belay DB, Rueegg CS, Johannessen A. Renal Safety of Long-term Tenofovir Disoproxil Fumarate Treatment in Patients With Chronic Hepatitis B. Open Forum Infect Dis 2023; 10:ofad404. [PMID: 37614515 PMCID: PMC10443609 DOI: 10.1093/ofid/ofad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
Background Data on renal safety of tenofovir disoproxil fumarate (TDF) treatment among individuals with chronic hepatitis B (CHB) are inconsistent. The current study aimed to assess the effect of long-term TDF treatment on renal outcomes in adult patients with CHB. Methods From a CHB cohort in Ethiopia, we included 233 patients treated with TDF and 126 untreated controls. Levels of creatinine and creatinine clearance over time were described in patients with and without TDF treatment. Linear mixed effects models with a treatment × time interaction were used to investigate the effect of TDF on creatinine and creatinine clearance. In treated patients only, change in creatinine and creatinine clearance was estimated separately in the first year as compared with subsequent years via linear mixed effects models. Results Median follow-up in the treated group was 51 months (IQR, 27-72), and 75% of patients were male (median age, 33 years; IQR, 26-40). Median follow-up in the untreated group was 69 months (IQR, 66-72), and 48% of participants were male (median age, 33 years; IQR, 27-41). We found no change in creatinine over time in TDF-treated patients as compared with a slight increase in untreated patients (P interaction = .003). There was a decrease in creatinine clearance over time in both groups, which was stronger in patients without TDF treatment (P interaction = .007). In TDF-treated patients, changes in creatinine and creatinine clearance occurred mainly within the first 12 months after treatment initiation. Conclusions This study showed no evidence of long-term renal toxicity of TDF treatment in patients with CHB.
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Affiliation(s)
- Gezahegn M Woldemedihn
- Department of Statistics, Hawassa University, Hawassa, Ethiopia
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Hanna Aberra
- Medical Department, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Hailemichael Desalegn
- Medical Department, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | - Nega Berhe
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
- Regional Centre for Imported and Tropical Diseases, Oslo University Hospital–Ullevål, Oslo, Norway
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Corina S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Asgeir Johannessen
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
- Regional Centre for Imported and Tropical Diseases, Oslo University Hospital–Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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