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Umumararungu T, Nkuranga JB, Habarurema G, Nyandwi JB, Mukazayire MJ, Mukiza J, Muganga R, Hahirwa I, Mpenda M, Katembezi AN, Olawode EO, Kayitare E, Kayumba PC. Recent developments in antimalarial drug discovery. Bioorg Med Chem 2023; 88-89:117339. [PMID: 37236020 DOI: 10.1016/j.bmc.2023.117339] [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: 03/01/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
Although malaria remains a big burden to many countries that it threatens their socio-economic stability, particularly in the countries where malaria is endemic, there have been great efforts to eradicate this disease with both successes and failures. For example, there has been a great improvement in malaria prevention and treatment methods with a net reduction in infection and mortality rates. However, the disease remains a global threat in terms of the number of people affected because it is one of the infectious diseases that has the highest prevalence rate, especially in Africa where the deadly Plasmodium falciparum is still widely spread. Methods to fight malaria are being diversified, including the use of mosquito nets, the target candidate profiles (TCPs) and target product profiles (TPPs) of medicine for malarial venture (MMV) strategy, the search for newer and potent drugs that could reverse chloroquine resistance, and the use of adjuvants such as rosiglitazone and sevuparin. Although these adjuvants have no antiplasmodial activity, they can help to alleviate the effects which result from plasmodium invasion such as cytoadherence. The list of new antimalarial drugs under development is long, including the out of ordinary new drugs MMV048, CDRI-97/78 and INE963 from South Africa, India and Novartis, respectively.
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Affiliation(s)
- Théoneste Umumararungu
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda.
| | - Jean Bosco Nkuranga
- Department of Chemistry, School of Science, College of Science and Technology, University of Rwanda, Rwanda
| | - Gratien Habarurema
- Department of Chemistry, School of Science, College of Science and Technology, University of Rwanda, Rwanda
| | - Jean Baptiste Nyandwi
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Marie Jeanne Mukazayire
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Janvier Mukiza
- Department of Mathematical Science and Physical Education, School of Education, College of Education, University of Rwanda, Rwanda; Rwanda Food and Drugs Authority, Nyarutarama Plaza, KG 9 Avenue, Kigali, Rwanda
| | - Raymond Muganga
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda; Rwanda Food and Drugs Authority, Nyarutarama Plaza, KG 9 Avenue, Kigali, Rwanda
| | - Innocent Hahirwa
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Matabishi Mpenda
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Alain Nyirimigabo Katembezi
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda; Rwanda Food and Drugs Authority, Nyarutarama Plaza, KG 9 Avenue, Kigali, Rwanda
| | - Emmanuel Oladayo Olawode
- Department of Pharmaceutical Sciences, College of Pharmacy, Larkin University, 18301 N Miami Ave #1, Miami, FL 33169, USA
| | - Egide Kayitare
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Pierre Claver Kayumba
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
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Martins YA, Gonçalves TM, Lopez RFV. HPLC methods for choloroquine determination in biological samples and pharmaceutical products. Daru 2021; 29:223-239. [PMID: 33738722 PMCID: PMC8149527 DOI: 10.1007/s40199-021-00391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/09/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Review and assess pharmaceutical and clinical characteristics of chloroquine including high-performance liquid chromatography (HPLC)-based methods used to quantify the drug in pharmaceutical products and biological samples. EVIDENCE ACQUISITION A literature review was undertaken on the PubMed, Science Direct, and Scielo databases using the following keywords related to the investigated subject: 'chloroquine', 'analytical methods', and 'HPLC'. RESULTS For more than seven decades, chloroquine has been used to treat malaria and some autoimmune diseases, such as lupus erythematosus and rheumatoid arthritis. There is growing interest in chloroquine as a therapeutic alternative in the treatment of HIV, Q fever, Whipple's disease, fungal, Zika, Chikungunya infections, Sjogren's syndrome, porphyria, chronic ulcerative stomatitis, polymorphic light eruption, and different types of cancer. HPLC coupled to UV detectors is the most employed method to quantify chloroquine in pharmaceutical products and biological samples. The main chromatographic conditions used to identify and quantify chloroquine from tablets and injections, degradation products, and metabolites are presented and discussed. CONCLUSION Research findings reported in this article may facilitate the repositioning, quality control, and biological monitoring of chloroquine in modern pharmaceutical dosage forms and treatments.
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Affiliation(s)
- Yugo Araújo Martins
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo (FCFRP-USP), Avenida do Café, s/n, Ribeirao Preto, São Paulo, 14040-903, Brazil
| | - Talita Mota Gonçalves
- School of Pharmaceutical Sciences, Universidade Federal do Vale do São Francisco, Avenida José de Sá Maniçoba, s/n, Petrolina, Pernambuco, 56304-917, Brazil
| | - Renata F V Lopez
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo (FCFRP-USP), Avenida do Café, s/n, Ribeirao Preto, São Paulo, 14040-903, Brazil.
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Saka C. Analytical Methods on Determination in Pharmaceuticals and Biological Materials of Chloroquine as Available for the Treatment of COVID-19. Crit Rev Anal Chem 2020; 52:19-34. [PMID: 32628049 DOI: 10.1080/10408347.2020.1781592] [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: 12/18/2022]
Abstract
With the outbreak caused by the severe acute respiratory syndrome coronavirus (COVID-19), people's health and existing economies on a global scale are seriously threatened. Currently, most of the countries all over the world are studying extensively to better understand the antimalarial chloroquine (CQ) and hydroxychloroquine (HCQ) for therapeutic purposes due to the COVID-19 outbreak. However, CQ and HCQ can have serious side effects, from psychiatric effects to sudden death. Therefore, a faster and more effective detection method is needed to monitor drug concentrations. In this review, a large study was conducted on the detection techniques and quantitative determination methods of CQ and its related metabolites. In this review, chromatography, electrophoresis, electroanalytical, spectroscopic, and immunological methods for CQ and related metabolites are discussed extensively. It is hoped that a better understanding of the CQ used for therapeutic purposes in the COVID-19 outbreak will be provided.
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Affiliation(s)
- Cafer Saka
- Faculty of Health Sciences, Siirt University, Siirt, Turkey
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Koita OA, Sangaré L, Miller HD, Sissako A, Coulibaly M, Thompson TA, Fongoro S, Diarra Y, Ba M, Maiga A, Diallo B, Mushatt DM, Mather FJ, Shaffer JG, Anwar AH, Krogstad DJ. AQ-13, an investigational antimalarial, versus artemether plus lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria: a randomised, phase 2, non-inferiority clinical trial. THE LANCET. INFECTIOUS DISEASES 2017; 17:1266-1275. [PMID: 28916443 PMCID: PMC5700806 DOI: 10.1016/s1473-3099(17)30365-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 05/16/2017] [Accepted: 06/08/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Chloroquine was used for malaria treatment until resistant Plasmodium falciparum was identified. Because 4-aminoquinolines with modified side chains, such as AQ-13, are active against resistant parasites, we compared AQ-13 against artemether plus lumefantrine for treatment of uncomplicated P falciparum malaria. METHODS We did a randomised, non-inferiority trial. We screened men (≥18 years) with uncomplicated malaria in Missira (northeast Mali) and Bamako (capital of Mali) for eligibility (≥2000 asexual P falciparum parasites per μL of blood). Eligible participants were randomly assigned to either the artemether plus lumefantrine group or AQ-13 group by permuting blocks of four with a random number generator. Physicians and others caring for the participants were masked, except for participants who received treatment and the research pharmacist who implemented the randomisation and provided treatment. Participants received either 80 mg of oral artemether and 480 mg of oral lumefantrine twice daily for 3 days or 638·50 mg of AQ-13 base (two oral capsules) on days 1 and 2, and 319·25 mg base (one oral capsule) on day 3. Participants were monitored for parasite clearance (50 μL blood samples twice daily at 12 h intervals until two consecutive negative samples were obtained) and interviewed for adverse events (once every day) as inpatients during week 1. During the 5-week outpatient follow-up, participants were examined for adverse events and recurrent infection twice per week. All participants were included in the intention-to-treat analysis and per-protocol analysis, except for those who dropped out in the per-protocol analysis. The composite primary outcome was clearance of asexual parasites and fever by day 7, and absence of recrudescent infection by parasites with the same molecular markers from days 8 to 42 (defined as cure). Non-inferiority was considered established if the proportion of patients who were cured was higher for artemether plus lumefantrine than for AQ-13 and the upper limit of the 95% CI was less than the non-inferiority margin of 15%. This trial is registered at ClinicalTrials.gov, number NCT01614964. FINDINGS Between Aug 6 and Nov 18, 2013, and between Sept 18 and Nov 20, 2015, 66 Malian men with uncomplicated malaria were enrolled. 33 participants were randomly assigned to each group. There were no serious adverse events (grade 2-4) and asexual parasites were cleared by day 7 in both groups. 453 less-severe adverse events (≤grade 1) were reported: 214 in the combination group and 239 in the AQ-13 group. Two participants withdrew from the AQ-13 group after parasite clearance and three were lost to follow-up. In the artemether plus lumefantrine group, two participants had late treatment failures (same markers as original isolates). On the basis of the per-protocol analysis, the AQ-13 and artemether plus lumefantrine groups had similar proportions cured (28 [100%] of 28 vs 31 [93·9%] of 33; p=0·50) and AQ-13 was not inferior to artemether plus lumefantrine (difference -6·1%, 95% CI -14·7 to 2·4). Proportions cured were also similar between the groups in the intention-to-treat analysis (28 of 33, 84·8% for AQ-13 vs 31 of 33, 93·9% for artemether and lumefantrine; p=0·43) but the upper bound of the 95% CI exceeded the 15% non-inferiority margin (difference 9·1%, 95% CI -5·6 to 23·8). INTERPRETATION The per-protocol analysis suggested non-inferiority of AQ-13 to artemether plus lumefantrine. By contrast, the intention-to-treat analysis, which included two participants who withdrew and three who were lost to follow-up from the AQ-13 group, did not meet the criterion for non-inferiority of AQ-13, although there were no AQ-13 treatment failures. Studies with more participants (and non-immune participants) are needed to decide whether widespread use of modified 4-aminoquinolones should be recommended. FUNDING US Food and Drug Administration Orphan Product Development, National Institutes of Health, US Centers for Disease Control and Prevention, Burroughs-Wellcome Fund, US State Department, and WHO.
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Affiliation(s)
- Ousmane A Koita
- University of the Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lansana Sangaré
- University of the Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Haiyan D Miller
- Department of Tropical Medicine and the Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Aliou Sissako
- University of the Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Moctar Coulibaly
- University of the Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Trevor A Thompson
- Department of Tropical Medicine and the Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Saharé Fongoro
- University of the Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Youssouf Diarra
- University of the Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mamadou Ba
- University of the Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ababacar Maiga
- University of the Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Boubakar Diallo
- University of the Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - David M Mushatt
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Frances J Mather
- Department of Global Biostatistics and Data Science, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Jeffrey G Shaffer
- Department of Global Biostatistics and Data Science, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Asif H Anwar
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Donald J Krogstad
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA; Department of Tropical Medicine and the Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, LA, USA.
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Development and validation of an HILIC-MS/MS method by one-step precipitation for chloroquine in miniature pig plasma. Bioanalysis 2016; 8:1159-71. [PMID: 27211608 PMCID: PMC7099630 DOI: 10.4155/bio-2015-0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: Quantification of polar compounds such as chloroquine by revered-phase LC is a challenge because of poor retention and silanol interactions with stationary phase. Strong ion-pairing reagents added to mobile phases to improve reversed-phase retention and improve peak shape can be harmful for MS. Results: This new approach provides a rapid and sensitive method for the detection of chloroquine using hydrophilic interaction LC coupled to MS/MS (HILIC–MS/MS). Ammonium formate and formic acid were added to mobile phase to attain good peak shapes and the salified chloroquine as well retained in an HILIC column. Linearity, intra- and inter-day precision, accuracy, recovery, matrix effect and stability were evaluated during the validation process. Conclusion: The validated method has been successfully used in a PK study in miniature pigs, and paves way for future development.
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Van Pham T, Pham Nguyen P, Nguyen Duc Khanh T, Nguyen Thanh Thuy N, Nguyen Thuy Nha C, Pouplin T, Farrar J, Thwaites GE, Tran Tinh H. An HPLC method with diode array detector for the simultaneous quantification of chloroquine and desethylchloroquine in plasma and whole blood samples from Plasmodium vivax patients in Vietnam, using quinine as an internal standard. Biomed Chromatogr 2016; 30:1104-1111. [PMID: 26578224 PMCID: PMC4913743 DOI: 10.1002/bmc.3657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/18/2015] [Accepted: 11/10/2015] [Indexed: 12/02/2022]
Abstract
A sensitive, simple method for quantification of chloroquine (CQ) and desethylchloroquine (MCQ) in whole blood and plasma from Plasmodium vivax patients has been developed using HPLC with diode array detection (DAD). Solid‐phase extraction on Isolute‐96‐CBA was employed to process 100 μL of plasma/whole blood samples. CQ, MCQ and quinine were separated using a mobile phase of phosphate buffer 25 mm, pH 2.60–acetonitrile (88:12, v/v) with 2 mm sodium perchlorate on a Zorbax SB‐CN 150 × 4.6 mm, 5 μm column at a flow rate of 1.2 mL/min, at ambient temperature in 10 min, with the DAD wavelength of 343 nm. The method was linear over the range of 10–5000 ng/mL for both CQ and MCQ in plasma and whole blood. The limit of detection was 4 ng/mL and limit of quantification was 10 ng/mL in both plasma and blood for CQ and MCQ. The intra‐, inter‐ and total assay precision were <10% for CQ and MCQ in plasma and whole blood. In plasma, the accuracies varied between 101 and 103%, whereas in whole blood, the accuracies ranged from 97.0 to 102% for CQ and MCQ. The method is an ideal technique with simple facilities and instruments, bringing about good separation in comparison with previous methods. © 2016 The Authors Biomedical Chromatography Published by John Wiley & Sons Ltd
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Affiliation(s)
- Toi Van Pham
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Phuong Pham Nguyen
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tho Nguyen Duc Khanh
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nhien Nguyen Thanh Thuy
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ca Nguyen Thuy Nha
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Thomas Pouplin
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jeremy Farrar
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Guy E Thwaites
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Hien Tran Tinh
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
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Doddaga S, Peddakonda R. Chloroquine-N-oxide, a major oxidative degradation product of chloroquine: identification, synthesis and characterization. J Pharm Biomed Anal 2013; 81-82:118-25. [PMID: 23644906 DOI: 10.1016/j.jpba.2013.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/30/2013] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
Abstract
Chloroquine (CQ) (1) which has endured as one of the most powerful antimalarial drugs was subjected to oxidative stress conditions and the degradation profile was studied. The oxidative stress condition of CQ furnished one major degradation product along with other minor degradation products. The unknown major degradation product was identified in HPLC and pure impurity was isolated using column chromatography. The structure of this major product was elucidated using UV, FT-IR, (1)H NMR, (13)C NMR, 2D NMR (HSQC) and mass spectral data. Based on the results obtained from the different spectroscopic studies, it was confirmed that the N-oxide was formed at the tertiary amine nitrogen instead of the pyridine nitrogen. Subsequently, an efficient and simple synthetic approach was developed for the synthesis of chloroquine-N-oxide using a work-up procedure that does not require chromatography techniques for further purification. It was observed that the spectral data of the isolated degradation product coincided appropriately with the synthesized product spectral data.
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Affiliation(s)
- Srinivasulu Doddaga
- Department of Chemistry, Sri Venkateswara University, Tirupati 517 502, India.
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Wahajuddin, Raju KSR, Taneja I. Bioanalysis of antimalarials using liquid chromatography. Trends Analyt Chem 2013. [DOI: 10.1016/j.trac.2012.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tang C, Sojinu OS. Simultaneous Determination of Chloroquine and Its Metabolite Desethyl Chloroquine in Human Plasma Using Liquid Chromatography Tandem Mass Spectrometry. ANAL LETT 2012. [DOI: 10.1080/00032719.2012.691588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Clewell RA, Pluta L, Thomas RS, Andersen ME. In utero exposure to chloroquine alters sexual development in the male fetal rat. Toxicol Appl Pharmacol 2009; 237:366-74. [DOI: 10.1016/j.taap.2009.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 04/12/2009] [Accepted: 04/13/2009] [Indexed: 10/20/2022]
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Rivas-Granizo P, Jorge Santos SRC, Ferraz HG. Development of a Stability-Indicating LC Assay Method for Determination of Chloroquine. Chromatographia 2009. [DOI: 10.1365/s10337-009-0985-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mzayek F, Deng H, Mather FJ, Wasilevich EC, Liu H, Hadi CM, Chansolme DH, Murphy HA, Melek BH, Tenaglia AN, Mushatt DM, Dreisbach AW, Lertora JJL, Krogstad DJ. Randomized dose-ranging controlled trial of AQ-13, a candidate antimalarial, and chloroquine in healthy volunteers. PLOS CLINICAL TRIALS 2007; 2:e6. [PMID: 17213921 PMCID: PMC1764434 DOI: 10.1371/journal.pctr.0020006] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 11/03/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine: (1) the pharmacokinetics and safety of an investigational aminoquinoline active against multidrug-resistant malaria parasites (AQ-13), including its effects on the QT interval, and (2) whether it has pharmacokinetic and safety profiles similar to chloroquine (CQ) in humans. DESIGN Phase I double-blind, randomized controlled trials to compare AQ-13 and CQ in healthy volunteers. Randomizations were performed at each step after completion of the previous dose. SETTING Tulane-Louisiana State University-Charity Hospital General Clinical Research Center in New Orleans. PARTICIPANTS 126 healthy adults 21-45 years of age. INTERVENTIONS 10, 100, 300, 600, and 1,500 mg oral doses of CQ base in comparison with equivalent doses of AQ-13. OUTCOME MEASURES Clinical and laboratory adverse events (AEs), pharmacokinetic parameters, and QT prolongation. RESULTS No hematologic, hepatic, renal, or other organ toxicity was observed with AQ-13 or CQ at any dose tested. Headache, lightheadedness/dizziness, and gastrointestinal (GI) tract-related symptoms were the most common AEs. Although symptoms were more frequent with AQ-13, the numbers of volunteers who experienced symptoms with AQ-13 and CQ were similar (for AQ-13 and CQ, respectively: headache, 17/63 and 10/63, p = 0.2; lightheadedness/dizziness, 11/63 and 8/63, p = 0.6; GI symptoms, 14/63 and 13/63; p = 0.9). Both AQ-13 and CQ exhibited linear pharmacokinetics. However, AQ-13 was cleared more rapidly than CQ (respectively, median oral clearance 14.0-14.7 l/h versus 9.5-11.3 l/h; p < or = 0.03). QTc prolongation was greater with CQ than AQ-13 (CQ: mean increase of 28 ms; 95% confidence interval [CI], 18 to 38 ms, versus AQ-13: mean increase of 10 ms; 95% CI, 2 to 17 ms; p = 0.01). There were no arrhythmias or other cardiac AEs with either AQ-13 or CQ. CONCLUSIONS These studies revealed minimal differences in toxicity between AQ-13 and CQ, and similar linear pharmacokinetics.
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Affiliation(s)
- Fawaz Mzayek
- Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Tropical Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Haiyan Deng
- Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Tropical Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Frances J Mather
- Department of Biostatistics, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Elizabeth C Wasilevich
- Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Tropical Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Huayin Liu
- Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Tropical Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Christiane M Hadi
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - David H Chansolme
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Holly A Murphy
- Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Tropical Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Bekir H Melek
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Alan N Tenaglia
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - David M Mushatt
- Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Tropical Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Albert W Dreisbach
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Pharmacology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Tulane–Louisiana State University–Charity Hospital General Clinical Research Center, New Orleans, Louisiana, United States of America
| | - Juan J. L Lertora
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Pharmacology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Tulane–Louisiana State University–Charity Hospital General Clinical Research Center, New Orleans, Louisiana, United States of America
| | - Donald J Krogstad
- Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Tropical Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Tulane–Louisiana State University–Charity Hospital General Clinical Research Center, New Orleans, Louisiana, United States of America
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