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Wang M, Men P, Zhang W, Wu J, Gu Y, Wang F, Huang H, Yu X, Duan H. Bedaquiline susceptibility testing of Mycobacterium abscessus complex and Mycobacterium avium complex: A meta-analysis study. J Glob Antimicrob Resist 2024; 37:135-140. [PMID: 38561143 DOI: 10.1016/j.jgar.2024.03.009] [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: 09/17/2023] [Revised: 03/01/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE This study aims to estimate the overall in vitro activity of bedaquiline (BDQ) against clinical isolates of Mycobacterium abscessus complex (MABS) and M. avium complex (MAC), considering BDQ as a repurposed drug for non-tuberculous mycobacteria (NTM) infections. METHODS We conducted a systematic review of publications in PubMed/ MEDLINE, Web of Science, and Embase up to 15 April 2023. Studies were included if they followed the Clinical and Laboratory Standards Institute (CLSI) criteria for drug susceptibility testing (DST). Using a random effects model, we assessed the overall in vitro BDQ resistance rate in clinical isolates of MABS and MAC. Sources of heterogeneity were analysed using Cochran's Q and the I2 statistic. All analyses were performed using CMA V3.0. RESULTS A total of 24 publications (19 reports for MABS and 11 for MAC) were included. Using 1 µg/mL and 2 µg/mL as the breakpoint for BDQ resistance, the pooled rates of in vitro BDQ resistance in clinical isolates of MABS were found to be 1.8% (95% confidence interval [CI], 0.7-4.6%) and 1.7% (95% CI, 0.6-4.4%), respectively. In the case of MAC, the pooled rates were 1.7% (95% CI, 0.4-6.9%) and 1.6% (95% CI, 0.4-6.8%) for 1 µg/mL and 2 µg/mL, respectively. CONCLUSION This study reports the prevalence of BDQ resistance in clinical isolates of MABS and MAC. The findings suggest that BDQ holds potential as a repurposed drug for treating MABS and MAC infections.
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Affiliation(s)
- Ming Wang
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Peixuan Men
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihe Zhang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Jing Wu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yuzhen Gu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Fen Wang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Xia Yu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Hongfei Duan
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China.
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Yu C, Qian H, Wu Q, Zou Y, Ding Q, Cai Y, Liang L, Xu J, Li L, Zan B, Li Y, Liu Y. Safety, pharmacokinetics, and food effect of sudapyridine (WX-081), a novel anti-tuberculosis candidate in healthy Chinese subjects. Clin Transl Sci 2024; 17:e13718. [PMID: 39052984 PMCID: PMC10828974 DOI: 10.1111/cts.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 07/27/2024] Open
Abstract
This study aimed to assess the safety, pharmacokinetics, and food impact on sudapyridine (WX-081), a novel drug designed to inhibit mycobacterium ATP synthase, with clinical applications for drug-resistant tuberculosis (TB) treatment. The research comprised two arms: a single ascending dose (SAD) arm (30 to 600 mg, N = 52) and a multiple ascending dose (MAD) arm (200 to 400 mg, N = 30). The influence of food was evaluated using a 400 mg dose within an SAD cohort. Plasma concentrations of WX-081 and M3 (main metabolite of WX-081) were analyzed using a validated liquid-chromatography tandem mass spectrometry method. In the SAD arm, mean residence time (MRT0-t), terminal half-life, and clearance of WX-081 ranged from 18.87 to 52.8 h, 31.39 to 236.57 h, and 6.4 to 80.34 L/h, respectively. The area under the curve from time zero to the last measurable timepoint (AUC0-t) of WX-081 showed dose-proportional increases in the SAD arm. The disparity between fasted and fed states of WX-081 was significant (p < 0.05), with fed dosing resulting in a 984.07% higher AUC0-t and 961.55% higher maximum plasma concentration. In both the SAD and MAD arms, one case each exhibited a 1 degree atrioventricular block. No QTc elongation was observed, and adverse events were not dose-dependent. Favorable exposure, tolerability, safety, and an extended MRT0-t suggest that WX-081 holds promise as a phase II development candidate for drug-resistant TB treatment.
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Affiliation(s)
- Chengyin Yu
- Shanghai Institute of Materia MedicaChinese Academy of SciencesShanghaiChina
- Central LaboratoryShanghai Xuhui Central Hospital/Zhongshan‐Xuhui Hospital, Fudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Phase I Clinical Research and Quality Consistency Evaluation for DrugsShanghaiChina
| | - Hongjie Qian
- Central LaboratoryShanghai Xuhui Central Hospital/Zhongshan‐Xuhui Hospital, Fudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Phase I Clinical Research and Quality Consistency Evaluation for DrugsShanghaiChina
| | - Qingqing Wu
- Central LaboratoryShanghai Xuhui Central Hospital/Zhongshan‐Xuhui Hospital, Fudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Phase I Clinical Research and Quality Consistency Evaluation for DrugsShanghaiChina
| | - Yang Zou
- Central LaboratoryShanghai Xuhui Central Hospital/Zhongshan‐Xuhui Hospital, Fudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Phase I Clinical Research and Quality Consistency Evaluation for DrugsShanghaiChina
| | - Qicheng Ding
- Central LaboratoryShanghai Xuhui Central Hospital/Zhongshan‐Xuhui Hospital, Fudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Phase I Clinical Research and Quality Consistency Evaluation for DrugsShanghaiChina
| | - Yuting Cai
- Central LaboratoryShanghai Xuhui Central Hospital/Zhongshan‐Xuhui Hospital, Fudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Phase I Clinical Research and Quality Consistency Evaluation for DrugsShanghaiChina
| | - Liyu Liang
- Shanghai Institute of Materia MedicaChinese Academy of SciencesShanghaiChina
- Central LaboratoryShanghai Xuhui Central Hospital/Zhongshan‐Xuhui Hospital, Fudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Phase I Clinical Research and Quality Consistency Evaluation for DrugsShanghaiChina
| | - Juncai Xu
- Shanghai Jiatan Pharmaceutical Technology Co., Ltd, a subsidiary of Guangzhou JOYO PharmaShanghaiChina
| | - Lei Li
- Shanghai Jiatan Pharmaceutical Technology Co., Ltd, a subsidiary of Guangzhou JOYO PharmaShanghaiChina
| | - Bin Zan
- Shanghai Jiatan Pharmaceutical Technology Co., Ltd, a subsidiary of Guangzhou JOYO PharmaShanghaiChina
| | - Yongguo Li
- Shanghai Jiatan Pharmaceutical Technology Co., Ltd, a subsidiary of Guangzhou JOYO PharmaShanghaiChina
| | - Yun Liu
- Central LaboratoryShanghai Xuhui Central Hospital/Zhongshan‐Xuhui Hospital, Fudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Phase I Clinical Research and Quality Consistency Evaluation for DrugsShanghaiChina
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Li B, He S, Tan Z, Li A, Fan J, Zhao L, Zhang Z, Chu H. Impaired ESX-3 Induces Bedaquiline Persistence in Mycobacterium abscessus Growing Under Iron-Limited Conditions. SMALL METHODS 2023; 7:e2300183. [PMID: 37291735 DOI: 10.1002/smtd.202300183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/15/2023] [Indexed: 06/10/2023]
Abstract
ESX-3 is a secretion pathway which is essential for mycobactin-mediated iron acquisition under iron-limited conditions. Although present in all Mycobacterium sp., ESX-3 remains to be elucidated in Mycobacterium abscessus. In the study reported here, impaired ESX-3 seriously restricts the growth of M. abscesses under iron-limited conditions; growth is salvaged by functional ESX-3 or iron supplementation. Notably, impaired ESX-3 does not kill M. abscesses when environmental iron is insufficient but induces persistence to bedaquiline, a diarylquinoline class antibiotic used to treat multidrug-resistant mycobacteria. One potential mechanism contributing to persistence is the iron deficiency due to impaired ESX-3 suppressing succinate dehydrogenase activity, which dysregulates the tricarboxylic acid cycle and inactivates bedaquiline. Experiments conducted here also demonstrate that the regulator, MtrA, can bind ESX-3 and promote the survival of M. abscessus. As such, this study suggests that a novel pathway involving MtrA, ESX-3, iron metabolism, and the TCA cycle contributes to bedaquiline persistence in M. abscesses growing under iron-limited conditions.
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Affiliation(s)
- Bing Li
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Siyuan He
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zhili Tan
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Anqi Li
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Junsheng Fan
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Lan Zhao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zhemin Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
- School of Medicine, Tongji University, Shanghai, 200092, China
| | - Haiqing Chu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
- School of Medicine, Tongji University, Shanghai, 200092, China
- Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
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Li J, Yang G, Cai Q, Wang Y, Xu Y, Zhang R, Lang Y, Cai X. Safety, efficacy, and serum concentration monitoring of bedaquiline in Chinese patients with multidrug-resistant tuberculosis. Int J Infect Dis 2021; 110:179-186. [PMID: 34293490 DOI: 10.1016/j.ijid.2021.07.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To determine the safety and efficacy of bedaquiline for Chinese patients with multidrug-resistant tuberculosis (MDR-TB) based on serum concentration monitoring and to identify factors associated with QTc prolongation occurring during treatment. METHODS Data were collected from 35 patients who received treatment regimens containing bedaquiline for MDR-TB from May 2018 to December 2020. Blood samples were collected, and serum concentrations of bedaquiline were measured using high-performance liquid chromatography-mass spectrometry. RESULTS After completing the 24-week bedaquiline treatment course, 80.0% of the patients' sputum cultures turned negative. The median time to sputum culture conversion was 75.5 days (interquartile range 52-126 days). The mean serum concentration of bedaquiline was 0.586 ± 0.288 µg/ml during treatment and 0.205 ± 0.145 µg/ml at 16 weeks after bedaquiline discontinuation. Bedaquiline remained detectable 52 weeks after discontinuation. Combination with clofazimine during bedaquiline treatment significantly increased cardiac QTc prolongation. When QTc prolongation occurred, serum potassium levels decreased by 10.71% from baseline, while serum sodium levels increased by 1.07% from baseline. CONCLUSIONS Good treatment outcomes were obtained with bedaquiline treatment in Chinese patients with MDR-TB. Combination with clofazimine increased the risk of QTc prolongation. Serum electrolytes (potassium and sodium) should be measured regularly during treatment of MDR-TB with regimens containing bedaquiline.
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Affiliation(s)
- Jinmeng Li
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Gaoyi Yang
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Qingshan Cai
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Yu Wang
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Yingying Xu
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Ruoying Zhang
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
| | - Yazhen Lang
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
| | - Xinjun Cai
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
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Kurosawa K, Rossenu S, Biewenga J, Ouwerkerk-Mahadevan S, Willems W, Ernault E, Kambili C. Population Pharmacokinetic Analysis of Bedaquiline-Clarithromycin for Dose Selection Against Pulmonary Nontuberculous Mycobacteria Based on a Phase 1, Randomized, Pharmacokinetic Study. J Clin Pharmacol 2021; 61:1344-1355. [PMID: 33991350 PMCID: PMC8518967 DOI: 10.1002/jcph.1887] [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: 02/02/2021] [Accepted: 04/23/2021] [Indexed: 11/10/2022]
Abstract
Based on the in vitro profile of bedaquiline against mycobacterial species, it is being investigated for clinical efficacy against pulmonary nontuberculous mycobacteria (PNTM). Being a cytochrome P450 3A substrate, pharmacokinetic interactions of bedaquiline are anticipated with clarithromycin (a cytochrome P450 3A inhibitor), which is routinely used in pulmonary nontuberculous mycobacteria treatment. This phase 1, randomized, crossover study assessed the impact of steady-state clarithromycin (500 mg every 12 hours for 14 days) on the pharmacokinetics of bedaquiline and its metabolite (M2) after single-dose bedaquiline (100 mg; n = 16). Using these data, population pharmacokinetic modeling and simulation analyses were performed to determine the effect of clarithromycin on steady-state bedaquiline exposure. Although no effect was observed on maximum plasma concentration of bedaquiline and time to achieve maximum plasma concentration, its mean plasma exposure increased by 14% after 10 days of clarithromycin coadministration, with slower formation of M2. Simulations showed that bedaquiline plasma trough concentration at steady state was higher (up to 41% until week 48) with clarithromycin coadministration as compared to its monotherapy (400 mg once daily for 2 weeks, followed by 200 mg 3 times a week for 46 weeks; reference regimen). The overall exposure of a simulated bedaquiline regimen (400 mg once dialy for 2 weeks, followed by 200 mg twice a week for 46 weeks) with clarithromycin was comparable (<15% difference) to the monotherapy. Overall, combination of bedaquiline (400 mg once daily for 2 weeks, followed by 200 mg twice a week for 46 weeks) with clarithromycin seems a suitable regimen to be explored for efficacy and safety against pulmonary nontuberculous mycobacteria.
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Affiliation(s)
- Ken Kurosawa
- Department of Clinical Pharmacology, Janssen Pharmaceutical KK, Tokyo, Japan
| | | | | | | | | | | | - Chrispin Kambili
- Johnson and Johnson Services, Inc, New Brunswick, New Jersey, USA
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A Review of Clinical Pharmacokinetic and Pharmacodynamic Relationships and Clinical Implications for Drugs Used to Treat Multi-drug Resistant Tuberculosis. Eur J Drug Metab Pharmacokinet 2021; 45:305-313. [PMID: 31925745 DOI: 10.1007/s13318-019-00604-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is becoming a global health crisis. The World Health Organization has released new guidelines for the use of tuberculosis-active drugs for the treatment of patients with MDR-TB. Despite documented activity against tuberculosis isolates, doses and exposure targets are yet to be optimized. Our objective was therefore to review the clinical pharmacokinetic and pharmacodynamic literature pertaining to drugs recommended to treat MDR-TB and to identify target areas for future research. To date, published research is limited but studies were identified that evaluated the pharmacokinetics and pharmacodynamics of these drugs. Exposure targets were assessed and summarized for each drug. Exposure-based targets (e.g., area under the concentration curve/minimum inhibitory concentration) appear to be most commonly associated with predicting drug efficacy. Dose variation studies based on these targets were largely inconclusive. Future research should focus on determining the risks and benefits of dose optimization to meet exposure targets and improve patient outcomes. The role of therapeutic drug monitoring also remains yet to be confirmed, both from a clinical perspective as well as a resource allocation perspective in regions where MDR-TB is active.
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Okumura M, Yoshiyama T, Ogata H, Kurashima A, Yoshimori K, Ohta K, Kudoh S. Treatment of multidrug-resistant pulmonary tuberculosis with delamanid based on Japanese guideline recommendations. Respir Investig 2020; 58:110-116. [PMID: 31838040 DOI: 10.1016/j.resinv.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/20/2019] [Accepted: 10/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In Japan, a new anti-tuberculous drug, delamanid, was recognized as the drug of choice to treat multi-drug resistant pulmonary tuberculosis in July 2014. METHODS We treated 28 cases of multidrug-resistant tuberculosis (MDR-TB) and three cases of extensively drug-resistant tuberculosis (XDR-TB) with delamanid from July 2014 to June 2018 at our hospital. RESULTS There were 21 men and 10 women, with the mean age of 48 and 37 years, respectively. We used an average of 4.4 sensitive anti-tuberculous drugs for the MDR-TB cases and 4.7 for the XDR-TB cases with delamanid. We used linezolid in 19 of 31 cases, although it has not been recognized as an anti-tuberculous drug in Japan. On electrocardiography, QTc prolongation of more than 450 ms was seen in two cases (6.4%), but they were asymptomatic, thus the treatment with delamanid could be continued. In 10 cases, surgical resection was performed. We completed the treatment in 20 cases and continued the treatment in seven cases; however, the treatment was discontinued in four cases because of side effects. In all cases, the sputum cultures were negative. CONCLUSIONS Delamanid is a relatively safe drug with few side effects. However, some patients could not continue it because of difficulty of use in combination, therefore delamanid should be prescribed considering the side effects of all therapies in the regimen.
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Affiliation(s)
- Masao Okumura
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan.
| | - Takashi Yoshiyama
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Hideo Ogata
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Atsuyuki Kurashima
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Kozo Yoshimori
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Ken Ohta
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
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Kotwal P, Dogra A, Sharma A, Bhatt S, Gour A, Sharma S, Wazir P, Singh PP, Kumar A, Nandi U. Effect of Natural Phenolics on Pharmacokinetic Modulation of Bedaquiline in Rat to Assess the Likelihood of Potential Food-Drug Interaction. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2020; 68:1257-1265. [PMID: 31927919 DOI: 10.1021/acs.jafc.9b06529] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Bedaquiline (TMC-207) is a recently approved drug for the treatment of multidrug-resistant tuberculosis (MDR-TB). Moreover, there is a present and growing concern for natural-product-mediated drug interaction, as these are inadvertently taken by patients as a dietary supplement, food additive, and medicine. In the present study, we investigated the impact of 20 plant-based natural products, typically phenolics, on in vivo oral bedaquiline pharmacokinetics, as previous studies are lacking. Three natural phenolics were identified that can significantly enhance the oral exposure of bedaquiline upon coadministration. We further investigated the possible role of all of the phytochemicals on in vitro P-glycoprotein (P-gp) induction and inhibition and CYP3A4 inhibition in a single platform as bedaquiline is the substrate for both P-gp and CYP3A4. In conclusion, curcumin, CC-I (3',5-dihydroxyflavone-7-O-β-d-galacturonide-4'-O-β-d-glucopyranoside), and 6-gingerol should not be coadministered with bedaquiline to avoid untoward drug interactions and, subsequently, its dose-dependent adverse effects.
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Affiliation(s)
- Pankul Kotwal
- PK-PD, Toxicology and Formulation Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
- Academy of Scientific and Innovative Research (AcSIR) , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
| | - Ashish Dogra
- PK-PD, Toxicology and Formulation Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
- Academy of Scientific and Innovative Research (AcSIR) , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
| | - Ankita Sharma
- PK-PD, Toxicology and Formulation Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
- Academy of Scientific and Innovative Research (AcSIR) , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
| | - Shipra Bhatt
- PK-PD, Toxicology and Formulation Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
- Academy of Scientific and Innovative Research (AcSIR) , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
| | - Abhishek Gour
- PK-PD, Toxicology and Formulation Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
- Academy of Scientific and Innovative Research (AcSIR) , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
| | - Sumit Sharma
- Academy of Scientific and Innovative Research (AcSIR) , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
- Medicinal Chemistry Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
| | - Priya Wazir
- PK-PD, Toxicology and Formulation Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
| | - Parvinder Pal Singh
- Academy of Scientific and Innovative Research (AcSIR) , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
- Medicinal Chemistry Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
| | - Ajay Kumar
- PK-PD, Toxicology and Formulation Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
- Academy of Scientific and Innovative Research (AcSIR) , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
| | - Utpal Nandi
- PK-PD, Toxicology and Formulation Division , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
- Academy of Scientific and Innovative Research (AcSIR) , CSIR-Indian Institute of Integrative Medicine , Jammu 180001 , India
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Tiemersma E, van den Hof S, Dravniece G, Wares F, Molla Y, Permata Y, Lukitosari E, Quelapio M, Aung ST, Aung KM, Thuy HT, Hoa VD, Sulaimanova M, Sagyndikova S, Makhmudova M, Soliev A, Kimerling M. Integration of drug safety monitoring in tuberculosis treatment programmes: country experiences. Eur Respir Rev 2019; 28:28/153/180115. [PMID: 31604816 DOI: 10.1183/16000617.0115-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 09/09/2019] [Indexed: 11/05/2022] Open
Abstract
New drugs and shorter treatments for drug-resistant tuberculosis (DR-TB) have become available in recent years and active pharmacovigilance (PV) is recommended by the World Health Organization (WHO) at least during the early phases of implementation, with active drug safety monitoring and management (aDSM) proposed for this. We conducted a literature review of papers reporting on aDSM. Up to 18 April, 2019, results have only been published from one national aDSM programme. Because aDSM is being introduced in many low- and middle-income countries, we also report experiences in introducing it into DR-TB treatment programmes, targeting the reporting of a restricted set of adverse events (AEs) as per WHO-recommended aDSM principles for the period 2014-2017. Early beneficial effects of active PV for TB patients include increased awareness about the occurrence, detection and management of AEs during TB treatment, and the increase of spontaneous reporting in some countries. However, because PV capacity is low in most countries and collaboration between national TB programmes and national PV centres remains weak, parallel and coordinated co-development of the capacities of both TB programmes and PV centres is needed.
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Affiliation(s)
| | - Susan van den Hof
- KNCV Tuberculosis Foundation, Den Haag, the Netherlands.,Centre for Infectious Disease Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Fraser Wares
- KNCV Tuberculosis Foundation, Den Haag, the Netherlands
| | | | | | - Endang Lukitosari
- National Tuberculosis Program, Ministry of Health, Jakarta, Indonesia
| | | | - Si Thu Aung
- Dept of Public Health, Ministry of Health and Sports, Yangon, Myanmar
| | | | - Hoang Thanh Thuy
- National Tuberculosis Program, Ministry of Health, Hanoi, Vietnam
| | - Vu Dinh Hoa
- National Centre of Drug Information and Adverse Drug Reactions & Hanoi University of Pharmacy, Hanoi, Vietnam
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