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Zeng Z, Wang L, Hua L, Jiang J, Pang H, Huang Y, Li Y, Tian L. Population Pharmacokinetic/Pharmacodynamics Modeling of Ibutilide in Chinese Healthy Volunteers and Patients With Atrial Fibrillation (AF) and/or Atrial Flutter (AFL). Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dubois VFS, Danhof M, Della Pasqua O. Characterizing QT interval prolongation in early clinical development: a case study with methadone. Pharmacol Res Perspect 2017; 5:e00284. [PMID: 28596836 PMCID: PMC5461648 DOI: 10.1002/prp2.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/18/2016] [Indexed: 11/09/2022] Open
Abstract
Recently, we have shown how pharmacokinetic–pharmacodynamic (PKPD) modeling can be used to assess the probability of QT interval prolongation both in dogs and humans. A correlation between species has been identified for a drug‐specific parameter, making it possible to prospectively evaluate nonclinical signals. Here, we illustrate how nonclinical data on methadone can be used to support the evaluation of dromotropic drug effects in humans. ECG and drug concentration data from a safety pharmacology study in dogs were analyzed using nonlinear mixed effects modeling. The slope of the PKPD model describing the probability of QT interval prolongation was extrapolated from dogs to humans and subsequently combined with methadone pharmacokinetic data as input for clinical trial simulations. Concentration versus time profiles were simulated for doses between 5 and 500 mg. Predicted peak concentrations in humans were then used as reference value to assess the probability of an increase in QT interval of ≥5 and ≥10 ms. Point estimates for the slope in dogs suggested low probability of ≥10 ms prolongation in humans, whereas an effect of approximately 5 ms increase is predicted when accounting for the 90% credible intervals of the drug‐specific parameter in dogs. Interspecies differences in drug disposition appear to explain the discrepancies between predicted and observed QT prolonging effects in humans. Extrapolation of the effects of racemic compound may not be sufficient to describe the increase in QT interval observed after administration of methadone to patients. Assessment of the contribution of enantioselective metabolism and active metabolites is critical.
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Affiliation(s)
- Vincent F S Dubois
- Division of Pharmacology Leiden Academic Centre for Drug Research Leiden University Leidenthe Netherlands
| | - Meindert Danhof
- Division of Pharmacology Leiden Academic Centre for Drug Research Leiden University Leidenthe Netherlands
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline Stockley Park Uxbridge United Kingdom.,Clinical Pharmacology & Therapeutics University College London London United Kingdom
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Dubois VFS, Smania G, Yu H, Graf R, Chain ASY, Danhof M, Della Pasqua O. Translating QT interval prolongation from conscious dogs to humans. Br J Clin Pharmacol 2017; 83:349-362. [PMID: 27614058 PMCID: PMC5237692 DOI: 10.1111/bcp.13123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 08/08/2016] [Accepted: 08/19/2016] [Indexed: 12/16/2022] Open
Abstract
AIM In spite of screening procedures in early drug development, uncertainty remains about the propensity of new chemical entities (NCEs) to prolong the QT/QTc interval. The evaluation of proarrhythmic activity using a comprehensive in vitro proarrhythmia assay does not fully account for pharmacokinetic-pharmacodynamic (PKPD) differences in vivo. In the present study, we evaluated the correlation between drug-specific parameters describing QT interval prolongation in dogs and in humans. METHODS Using estimates of the drug-specific parameter, data on the slopes of the PKPD relationships of nine compounds with varying QT-prolonging effects (cisapride, sotalol, moxifloxacin, carabersat, GSK945237, SB237376 and GSK618334, and two anonymized NCEs) were analysed. Mean slope estimates varied between -0.98 ms μM-1 and 6.1 ms μM-1 in dogs and -10 ms μM-1 and 90 ms μM-1 in humans, indicating a wide range of effects on the QT interval. Linear regression techniques were then applied to characterize the correlation between the parameter estimates across species. RESULTS For compounds without a mixed ion channel block, a correlation was observed between the drug-specific parameter in dogs and humans (y = -1.709 + 11.6x; R2 = 0.989). These results show that per unit concentration, the drug effect on the QT interval in humans is 11.6-fold larger than in dogs. CONCLUSIONS Together with information about the expected therapeutic exposure, the evidence of a correlation between the compound-specific parameter in dogs and in humans represents an opportunity for translating preclinical safety data before progression into the clinic. Whereas further investigation is required to establish the generalizability of our findings, this approach can be used with clinical trial simulations to predict the probability of QT prolongation in humans.
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Affiliation(s)
- Vincent F. S. Dubois
- Leiden Academic Centre for Drug Research, Division of PharmacologyLeiden UniversityLeidenThe Netherlands
- PharmacometricsGrunenthal GmbHAachenGermany
| | - Giovanni Smania
- Clinical Pharmacology Modelling & SimulationGlaxoSmithKline, Stockley ParkUxbridgeUK
| | - Huixin Yu
- Leiden Academic Centre for Drug Research, Division of PharmacologyLeiden UniversityLeidenThe Netherlands
| | - Ramona Graf
- Clinical Pharmacology Modelling & SimulationGlaxoSmithKline, Stockley ParkUxbridgeUK
| | - Anne S. Y. Chain
- Leiden Academic Centre for Drug Research, Division of PharmacologyLeiden UniversityLeidenThe Netherlands
| | - Meindert Danhof
- Leiden Academic Centre for Drug Research, Division of PharmacologyLeiden UniversityLeidenThe Netherlands
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling & SimulationGlaxoSmithKline, Stockley ParkUxbridgeUK
- Clinical Pharmacology & TherapeuticsUCLLondonUK
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Marostica E, Van Ammel K, Teisman A, Gallacher D, Van Bocxlaer J, De Ridder F, Boussery K, Vermeulen A. PK/PD Modelling of the QT Interval: a Step Towards Defining the Translational Relationship Between In Vitro, Awake Beagle Dogs, and Humans. AAPS JOURNAL 2016; 18:1000-12. [PMID: 27116025 DOI: 10.1208/s12248-016-9920-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Abstract
Inhibiting the human ether-a-go-go-related gene (hERG)-encoded potassium ion channel is positively correlated with QT-interval prolongation in vivo, which is considered a risk factor for the occurrence of Torsades de Pointes (TdP). A pharmacokinetic/pharmacodynamic model was developed for four compounds that reached the clinic, to relate drug-induced QT-interval change in awake dogs and humans and to derive a translational scaling factor a 1. Overall, dogs were more sensitive than humans to QT-interval change, an a 1 of 1.5 was found, and a 10% current inhibition in vitro produced a higher percent QT-interval change in dogs as compared to humans. The QT-interval changes in dogs were predictive for humans. In vitro and in vivo information could reliably describe the effects in humans. Robust translational knowledge is likely to reduce the need for expensive thorough QT studies; therefore, expanding this work to more compounds is recommended.
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Affiliation(s)
- Eleonora Marostica
- Laboratory of Medical Biochemistry and Clinical Analysis, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium. .,LAP&P Consultants B.V., Leiden, The Netherlands.
| | - Karel Van Ammel
- Global Safety Pharmacology, Janssen R&D, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Ard Teisman
- Global Safety Pharmacology, Janssen R&D, Janssen Pharmaceutica NV, Beerse, Belgium
| | - David Gallacher
- Global Safety Pharmacology, Janssen R&D, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jan Van Bocxlaer
- Laboratory of Medical Biochemistry and Clinical Analysis, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Filip De Ridder
- Statistics & Decision Sciences, Janssen R&D, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Koen Boussery
- Laboratory of Medical Biochemistry and Clinical Analysis, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - An Vermeulen
- Laboratory of Medical Biochemistry and Clinical Analysis, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.,Clinical Pharmacology & Pharmacometrics, Janssen R&D, Janssen Pharmaceutica NV, Beerse, Belgium
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Accardi MV, Troncy E, Abtout S, Ascah A, Maghezzi S, Authier S. Rat cardiovascular telemetry: Marginal distribution applied to positive control drugs. J Pharmacol Toxicol Methods 2016; 81:120-7. [PMID: 27039258 DOI: 10.1016/j.vascn.2016.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/25/2016] [Accepted: 03/27/2016] [Indexed: 11/26/2022]
Abstract
Cardiovascular effects are considered frequent during drug safety testing. This investigation aimed to characterize the pharmacological response of the conscious telemetered rat in vivo model to known cardiovascular active agents. These effects were analyzed using statistical analysis and cloud representation with marginal distribution curves for the contractility index and heart rate as to assess the effect relationship between cardiac variables. Arterial blood pressure, left ventricular pressure, electrocardiogram and body temperature were monitored. The application of data cloud with marginal distribution curves to heart rate and contractility index provided an interesting tactic during the interpretation of drug-induced changes particularly during selective time resolution (i.e. marginal distribution curves restricted to Tmax). Taken together, the present data suggests that marginal distribution curves can be a valuable interpretation strategy when using the rat cardiovascular telemetry model to detect drug-induced cardiovascular effects. Marginal distribution curves could also be considered during the interpretation of other inter-dependent parameters in safety pharmacology studies.
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Affiliation(s)
- M V Accardi
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | - E Troncy
- Faculty of Veterinary Medicine, University of Montreal, P.O. box 5000, St-Hyacinthe, QC J2S 7C6, Canada
| | - S Abtout
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | - A Ascah
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | - S Maghezzi
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | - S Authier
- CiToxLAB North America, 445 Armand Frappier, Laval, QC H7V 4B3, Canada; Faculty of Veterinary Medicine, University of Montreal, P.O. box 5000, St-Hyacinthe, QC J2S 7C6, Canada.
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Sahota T, Danhof M, Della Pasqua O. Pharmacology-based toxicity assessment: towards quantitative risk prediction in humans. Mutagenesis 2016; 31:359-74. [PMID: 26970519 DOI: 10.1093/mutage/gev081] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Despite ongoing efforts to better understand the mechanisms underlying safety and toxicity, ~30% of the attrition in drug discovery and development is still due to safety concerns. Changes in current practice regarding the assessment of safety and toxicity are required to reduce late stage attrition and enable effective development of novel medicines. This review focuses on the implications of empirical evidence generation for the evaluation of safety and toxicity during drug development. A shift in paradigm is needed to (i) ensure that pharmacological concepts are incorporated into the evaluation of safety and toxicity; (ii) facilitate the integration of historical evidence and thereby the translation of findings across species as well as between in vitro and in vivo experiments and (iii) promote the use of experimental protocols tailored to address specific safety and toxicity questions. Based on historical examples, we highlight the challenges for the early characterisation of the safety profile of a new molecule and discuss how model-based methodologies can be applied for the design and analysis of experimental protocols. Issues relative to the scientific rationale are categorised and presented as a hierarchical tree describing the decision-making process. Focus is given to four different areas, namely, optimisation, translation, analytical construct and decision criteria. From a methodological perspective, the relevance of quantitative methods for estimation and extrapolation of risk from toxicology and safety pharmacology experimental protocols, such as points of departure and potency, is discussed in light of advancements in population and Bayesian modelling techniques (e.g. non-linear mixed effects modelling). Their use in the evaluation of pharmacokinetics (PK) and pharmacokinetic-pharmacodynamic relationships (PKPD) has enabled great insight into the dose rationale for medicines in humans, both in terms of efficacy and adverse events. Comparable benefits can be anticipated for the assessment of safety and toxicity profile of novel molecules.
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Affiliation(s)
- Tarjinder Sahota
- Division of Pharmacology, Leiden Academic Centre for Drug Research, University of Leiden, Leiden, The Netherlands
| | - Meindert Danhof
- Division of Pharmacology, Leiden Academic Centre for Drug Research, University of Leiden, Leiden, The Netherlands
| | - Oscar Della Pasqua
- Division of Pharmacology, Leiden Academic Centre for Drug Research, University of Leiden, Leiden, The Netherlands, Clinical Pharmacology, Modelling and Simulation, GlaxoSmithKline, Stockley Park West, Uxbridge, UK, Clinical Pharmacology and Therapeutics, University College London, London, UK
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Dubois VFS, de Witte WEA, Visser SAG, Danhof M, Della Pasqua O. Assessment of Interspecies Differences in Drug-Induced QTc Interval Prolongation in Cynomolgus Monkeys, Dogs and Humans. Pharm Res 2015; 33:40-51. [PMID: 26553352 PMCID: PMC4689776 DOI: 10.1007/s11095-015-1760-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 07/16/2015] [Indexed: 11/30/2022]
Abstract
Background and Purpose The selection of the most suitable animal species and subsequent translation of the concentration-effect relationship to humans are critical steps for accurate assessment of the pro-arrhythmic risk of candidate molecules. The objective of this investigation was to assess quantitatively the differences in the QTc prolonging effects of moxifloxacin between cynomolgus monkeys, dogs and humans. The impact of interspecies differences is also illustrated for a new candidate molecule. Experimental Approach Pharmacokinetic data and ECG recordings from pre-clinical protocols in monkeys and dogs and from a phase I trial in healthy subjects were identified for the purpose of this analysis. A previously established Bayesian model describing the combined effect of heart rate, circadian variation and drug effect on the QT interval was used to describe the pharmacokinetic-pharmacodynamic relationships. The probability of a ≥10 ms increase in QT was derived as measure of the pro-arrhythmic effect. Key Results For moxifloxacin, the concentrations associated with a 50% probability of QT prolongation ≥10 ms (Cp50) varied from 20.3 to 6.4 and 2.6 μM in dogs, monkeys and humans, respectively. For NCE05, these values were 0.4 μM vs 2.0 μM for monkeys and humans, respectively. Conclusions and Implications Our findings reveal significant interspecies differences in the QT-prolonging effect of moxifloxacin. In addition to the dissimilarity in pharmacokinetics across species, it is likely that differences in pharmacodynamics also play an important role. It appears that, regardless of the animal model used, a translation function is needed to predict concentration-effect relationships in humans.
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Affiliation(s)
- V F S Dubois
- Leiden Academic Centre for Drug Research, Division of Pharmacology, Leiden University, Leiden, The Netherlands
| | - W E A de Witte
- Leiden Academic Centre for Drug Research, Division of Pharmacology, Leiden University, Leiden, The Netherlands
| | - S A G Visser
- Global DMPK, AstraZeneca R&D, Sodertalje, Sweden
| | - M Danhof
- Leiden Academic Centre for Drug Research, Division of Pharmacology, Leiden University, Leiden, The Netherlands
| | - O Della Pasqua
- Leiden Academic Centre for Drug Research, Division of Pharmacology, Leiden University, Leiden, The Netherlands. .,Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline, Stockley Park, Uxbridge, UK. .,Clinical Pharmacology & Therapeutics, University College London, London, UK.
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Marostica E, Van Ammel K, Teisman A, Boussery K, Van Bocxlaer J, De Ridder F, Gallacher D, Vermeulen A. Modelling of drug-induced QT-interval prolongation: estimation approaches and translational opportunities. J Pharmacokinet Pharmacodyn 2015; 42:659-79. [DOI: 10.1007/s10928-015-9434-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/06/2015] [Indexed: 01/08/2023]
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Collins TA, Bergenholm L, Abdulla T, Yates J, Evans N, Chappell MJ, Mettetal JT. Modeling and Simulation Approaches for Cardiovascular Function and Their Role in Safety Assessment. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2015. [PMID: 26225237 PMCID: PMC4394617 DOI: 10.1002/psp4.18] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Systems pharmacology modeling and pharmacokinetic-pharmacodynamic (PK/PD) analysis of drug-induced effects on cardiovascular (CV) function plays a crucial role in understanding the safety risk of new drugs. The aim of this review is to outline the current modeling and simulation (M&S) approaches to describe and translate drug-induced CV effects, with an emphasis on how this impacts drug safety assessment. Current limitations are highlighted and recommendations are made for future effort in this vital area of drug research.
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Affiliation(s)
- T A Collins
- Drug Safety and Metabolism, AstraZeneca Alderley Park, Macclesfield, UK
| | | | - T Abdulla
- School of Engineering, University of Warwick UK
| | - Jwt Yates
- Oncology, AstraZeneca Alderley Park, Macclesfield, UK
| | - N Evans
- School of Engineering, University of Warwick UK
| | | | - J T Mettetal
- Drug Safety and Metabolism, AstraZeneca Waltham, Massachusetts, USA
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