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Zhao H, Zhao Z, He K, Mi N, Lou K, Dong X, Zhang W, Sun J, Hu X, Pang S, Cheng H, Wen Q. Pharmacokinetics, Pharmacodynamics and Safety of Janagliflozin in Chinese Type 2 Diabetes Mellitus Patients with Renal Impairment. Clin Pharmacokinet 2023; 62:1093-1103. [PMID: 37284974 DOI: 10.1007/s40262-023-01256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Janagliflozin is a novel sodium-glucose cotransport-2 inhibitor. Despite its remarkable effect in glycemic control, no systematic research has evaluated the effect of renal impairment (RI) on its pharmacokinetics and pharmacodynamics. METHODS Here, patients with T2DM (n = 30) were divided into normal renal function (eGFR ≥ 90 mL/min/1.73 m2), mild RI (eGFR between 60 and 89 mL/min/1.73 m2), moderate RI-I (eGFR between 45 and 59 mL/min/1.73 m2), and moderate RI-II (eGFR between 30 and 44 mL/min/1.73 m2) groups. They were administered 50 mg janagliflozin orally, and plasma and urine samples were collected for the determination of janagliflozin concentration. RESULTS Following oral administration, janagliflozin was rapidly absorbed, with the time to Cmax of 2-6 h for janagliflozin and 3-6 h for its metabolite XZP-5185. Plasma exposure levels were similar for janagliflozin in T2DM patients with or without RI but decreased for the metabolite XZP-5185 in T2DM patients with eGFR between 45 and 89 mL/min/1.73 m2. Janagliflozin significantly promoted the excretion of urinary glucose, even in patients with reduced eGFR. Janagliflozin was well tolerated in patients with T2DM with or without RI, and no serious adverse events (SAEs) occurred during this trial. CONCLUSIONS The exposure levels of janagliflozin in T2DM patients were slightly increased with worsening of RI (i.e., 11% increase in the AUC in patients with moderate RI compared with the normal renal function group). Despite worsening of renal function, janagliflozin exerted a significant pharmacologic effect and was well tolerated, even in patients with moderate RI, implying a promising role in the treatment of patients with in T2DM. REGISTRATION China Drug Trial register ( http://www.chinadrugtrials.org.cn/I ) identifier no.: CTR20192721.
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Affiliation(s)
- Hengli Zhao
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Li Xia District, Jinan, 250013, People's Republic of China
| | - Zhirui Zhao
- Department of Renal Division, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Street, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Kun He
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Li Xia District, Jinan, 250013, People's Republic of China
| | - Nianrong Mi
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Li Xia District, Jinan, 250013, People's Republic of China
| | - Kai Lou
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Li Xia District, Jinan, 250013, People's Republic of China
| | - Xiaolin Dong
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Li Xia District, Jinan, 250013, People's Republic of China
| | - Wenyu Zhang
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Li Xia District, Jinan, 250013, People's Republic of China
| | - Jingfang Sun
- Jilin Huisheng Biopharmaceutical Co., Ltd., Jilin, 135000, People's Republic of China
| | - Xinyu Hu
- Jilin Huisheng Biopharmaceutical Co., Ltd., Jilin, 135000, People's Republic of China
| | - Shuguang Pang
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Li Xia District, Jinan, 250013, People's Republic of China.
| | - Hong Cheng
- Department of Renal Division, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Street, Chaoyang District, Beijing, 100029, People's Republic of China.
| | - Qing Wen
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Li Xia District, Jinan, 250013, People's Republic of China.
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Song L, Wang X, Sun J, Hu X, Li H, Hu P, Liu D. A Model-Informed Approach to Accelerate the Clinical Development of Janagliflozin, an Innovative SGLT2 Inhibitor. Clin Pharmacokinet 2023; 62:505-518. [PMID: 36802026 DOI: 10.1007/s40262-022-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 02/21/2023]
Abstract
AIM To apply model-informed drug development (MIDD) approach to support the decision making in drug development and accelerate the clinical development of janagliflozin, an orally selective SGLT2 inhibitor. METHOD We previously developed a mechanistic pharmacokinetic/pharmacodynamic (PK/PD) model of janagliflozin based on preclinical data to optimize dose design in the first-in-human (FIH) study. In the current study, we used clinical PK/PD data of the FIH study to validate the model and then simulate the PK/PD profiles of multiple ascending dosing (MAD) study in healthy subjects. Besides, we developed a population PK/PD model of janagliflozin to predict steady-state urinary glucose excretion (UGE [UGE,ss]) in healthy subjects in the Phase 1 stage. This model was subsequently used to simulate the UGE, ss in patients with type 2 diabetes mellitus (T2DM) based on a unified PD target (ΔUGEc) across healthy subjects and patients with T2DM. This unified PD target was estimated from our previous work of model-based meta-analysis (MBMA) for the same class of drugs. The model-simulated UGE,ss in patients with T2DM was validated by data from the clinical Phase 1e study. Finally, at the end of the Phase 1 study, we simulated the 24-week hemoglobin A1c (HbA1c) level in patients with T2DM of janagliflozin based on the quantitative UGE/FPG/HbA1c relationship informed by our previous MBMA study for the same class of drugs. RESULTS The pharmacologically active dose (PAD) levels of multiple ascending dosing (MAD) study were estimated to be 25, 50,100 mg once daily (QD) for 14 days based on the effective PD target of approximately 50 g daily UGE in healthy subjects. Besides, our previous MBMA analysis for the same class of drugs has provided a unified effective PD target of ΔUGEc approximately 0.5-0.6 g/(mg/dL) in both healthy subjects and patients with T2DM. In this study, the model-simulated steady-state ΔUGEc (ΔUGEc,ss) of janagliflozin in patients with T2DM were 0.52, 0.61 and 0.66 g/(mg/dL) for 25, 50, 100 mg QD dose levels. Finally, we estimated that HbA1c at 24 weeks would decrease 0.78 and 0.93 from baseline for the 25 and 50 mg QD dose groups. CONCLUSIONS The application of MIDD strategy adequately supported the decision making at each stage of janagliflozin development process. A waiver of Phase 2 study was successfully approved for janagliflozin based on these model-informed results and suggestions. This MIDD strategy of janagliflozin could be further utilized to support the clinical development of other SGLT2 inhibitors.
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Affiliation(s)
- Ling Song
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, China.,Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.,Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, 100191, China
| | - Xiaoxu Wang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, China.,Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Jingfang Sun
- Huisheng Bio-pharmaceutical Co., Ltd, Jilin, 135099, China
| | - Xinyu Hu
- Huisheng Bio-pharmaceutical Co., Ltd, Jilin, 135099, China
| | - Haiyan Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, China.,Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, 100191, China
| | - Pei Hu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences, Beijing, 100032, China.
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, China. .,Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, 100191, China. .,Clinical Pharmacology Research Center, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences, Beijing, 100032, China.
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Zhao H, Wei Y, He K, Zhao X, Mu H, Wen Q. Prediction of Janagliflozin Pharmacokinetics in Type 2 Diabetes Mellitus Patients with Liver Cirrhosis or Renal Impairment Using a Physiologically Based Pharmacokinetic Model. Eur J Pharm Sci 2022; 179:106298. [PMID: 36162752 DOI: 10.1016/j.ejps.2022.106298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/18/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
Janagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor for type 2 diabetes mellitus (T2DM). The janagliflozin pharmacokinetics (PK) in T2DM patients with cirrhosis or renal impairment (RI) are unknown. To predict the janagliflozin PK in these patients, we constructed a physiologically based PK (PBPK) model that predicted the janagliflozin PK in normal animals. The model was extrapolated to healthy humans and optimized with the measured data. A PBPK model for T2DM patients was developed and optimized with the measured data. Based on the physiological alterations in cirrhosis or RI patients, the T2DM model was applied to predict the janagliflozin PK in these patients. Results were validated using fold error values. The predicted AUC values were 21880, 24881, 26996, and 28419 ng/ml·h in T2DM patients with no cirrhosis, Child-Pugh-A, B, and C, respectively, and those in T2DM patients with RI-mild, RI-moderate, and RI-severe were 21810, 21840, and 22845 ng/ml·h, respectively. Janagliflozin exposure increased with increasing cirrhosis severity, whereas it remained stable regardless of the RI severity. The PBPK model predicted the janagliflozin PK in patients with T2DM and liver cirrhosis or RI. Dose adjustment is less critical for these patients. Risk benefit assessment in janagliflozin dosing for T2DM patients with liver disease is recommended.
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Affiliation(s)
- Hengli Zhao
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 China
| | - Yilin Wei
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 China
| | - Kun He
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 China
| | - Xiaoyu Zhao
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 China
| | - Hongli Mu
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 China
| | - Qing Wen
- Department of Clinical Research Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 China.
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