1
|
Yang L, Zhang L, Luo Z. Comparative Pharmacokinetics and Bioequivalence Evaluation of Two Formulations of Pramipexole Dihydrochloride Extended-Release Tablets in Healthy Chinese Subjects Under Fasted and Fed States: A Randomized, Open-Label, Single-Dose, Two-Period Crossover Clinical Trial. Drug Des Devel Ther 2023; 17:2369-2381. [PMID: 37600497 PMCID: PMC10439801 DOI: 10.2147/dddt.s421449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
Background Pramipexole dihydrochloride extended-release tablet is a novel long-acting form of non-ergot dopamine agonist indicated as one of main therapeutic approaches for Parkinson's disease. However, pharmacokinetic properties of extended-release pramipexole in healthy Chinese subjects remain unclear. Methods A single-center, randomized, open-label, two-period crossover, single-dose study was performed to investigate comparative pharmacokinetics and evaluate bioequivalence of 0.375 mg test (Yangtze River Pharmaceutical Group Co., Ltd.) and reference (Trade name: Sifrol®, Boehringer Ingelheim Pharma GmbH & Co. KG) formulations of pramipexole dihydrochloride extended-release tablets in healthy Chinese subjects under fasted and fed states. Results A total of 56 subjects (28 in each dietary trial) were enrolled and randomized. After single dose of 0.375 mg test and reference formulations under fasted condition, main pharmacokinetics of pramipexole were as follows: peak concentration (Cmax) were 409.33±95.93 and 413.77±132.03 pg/mL; plasma area under concentration-time curve from time 0 to last measurable concentration (AUC0-t) were 8801.95±1966.83 and 8646.37±2600.49 h*pg/mL; AUC from time 0 to infinity (AUC0-∞) were 9469.03±1991.61 and 9082.95±2666.26 h*pg/mL; elimination half-life (t1/2) were 11.98±3.91 and 9.85±2.63 h; both time to reach Cmax (Tmax) were about 4.50 h, respectively, for test and reference formulations. The 90% confidence intervals of geometric mean ratios (test/reference) of Cmax, AUC0-t and AUC0-∞ under fasted and fed conditions were all within 80-125%. Following administration under fed condition, Cmax and Tmax for both test and reference formulations slightly increased and prolonged to 5.0 h, respectively, but AUC approximately remained unchanged compared with dosing under fasted condition. Test and reference formulations showed similar bioequivalence and favorable safety under fasted and fed states. Conclusion Test and reference formulations of pramipexole dihydrochloride extended-release tablets (0.375 mg) showed similar bioequivalence and well safety and tolerability in healthy Chinese subjects under fasted and fed states, which supports further investigations of test formulation in patients with Parkinson's disease.
Collapse
Affiliation(s)
- Ling Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Clinical Trial Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Liangliang Zhang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Zhu Luo
- Clinical Trial Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| |
Collapse
|
3
|
Latt MD, Lewis S, Zekry O, Fung VSC. Factors to Consider in the Selection of Dopamine Agonists for Older Persons with Parkinson's Disease. Drugs Aging 2019; 36:189-202. [PMID: 30623310 DOI: 10.1007/s40266-018-0629-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Dopamine agonists (DAs) are frequently used in the management of Parkinson's disease (PD), a complex multisystem disorder influenced substantially by age-related factors. Over 80% of PD patients present after age 60 years and may have clinical features exacerbated by age-related comorbidities or decline in physiological compensatory mechanisms. Pharmacotherapy for motor symptoms in older persons is more likely to involve exclusive use of levodopa combined with a peripheral decarboxylase inhibitor throughout the course of the illness. Non-ergot DAs, such as pramipexole, rotigotine and ropinirole, may be used as de novo monotherapy for the control of motor symptoms in older persons, although they are less efficacious than levodopa therapy. DAs may also be considered as adjunct therapy in older persons when motor symptoms are no longer adequately controlled by levodopa or when motor fluctuations and dyskinesia appear. DAs may be used cautiously in older persons with cognitive impairment and orthostatic hypotension but should be avoided when there is a history or risk of psychosis or impulse control disorders.
Collapse
Affiliation(s)
- Mark Dominic Latt
- Geriatric Medicine Department, University of Sydney, Royal Prince Alfred Hospital, KGV Level 7, Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Simon Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Olfat Zekry
- Department of Pharmacy, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Victor S C Fung
- Department of Neurology, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
4
|
Shen T, Ye R, Zhang B. Efficacy and safety of pramipexole extended-release in Parkinson's disease: a review based on meta-analysis of randomized controlled trials. Eur J Neurol 2017; 24:835-843. [PMID: 28480621 DOI: 10.1111/ene.13303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE We performed a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of pramipexole extended-release (pramipexole ER) versus pramipexole immediate-release (pramipexole IR) or placebo in Parkinson's disease. METHODS We performed a systematic online search for clinical trials for pramipexole ER treatment up to 1 August 2016. We assessed differences in Unified Parkinson's Disease Rating Scale (UPDRS) scores, percentage of 'on' time or 'off' time, withdrawals, adverse events (AEs) and life quality between pramipexole ER and pramipexole IR or placebo. Data analyses were performed by the Cochrane Collaboration's Review Manager 5.3 software. RESULTS Six randomized controlled trials were included. Compared with placebo, pramipexole ER achieved a significant improvement in the UPDRS Part II + III score [weighted mean difference, -4.81; 95% confidence interval (CI), -6.40 to -3.23], whereas no significant difference was found in the UPDRS Part III + III score between pramipexole ER and pramipexole IR groups (weighted mean difference, -0.26; 95% CI, -1.15 to 0.64). No differences were found in total AEs (relative risk, 0.97; 95% CI, 0.92 to 1.03), drug-related AEs (relative risk, 0.97; 95% CI, 0.92 to 1.03) or the commonly reported AEs between pramipexole ER and pramipexole IR. CONCLUSIONS Pramipexole ER is as safe and effective as pramipexole IR in the treatment of Parkinson's disease.
Collapse
Affiliation(s)
- T Shen
- Department of Neurology, Second Affiliated Hospital of Medical School of Zhejiang University, Hangzhou City, Zhejiang, China
| | - R Ye
- Department of Neurology, Second Affiliated Hospital of Medical School of Zhejiang University, Hangzhou City, Zhejiang, China
| | - B Zhang
- Department of Neurology, Second Affiliated Hospital of Medical School of Zhejiang University, Hangzhou City, Zhejiang, China
| |
Collapse
|
8
|
Espay AJ, Pagan FL, Walter BL, Morgan JC, Elmer LW, Waters CH, Agarwal P, Dhall R, Ondo WG, Klos KJ, Silver DE. Optimizing extended-release carbidopa/levodopa in Parkinson disease: Consensus on conversion from standard therapy. Neurol Clin Pract 2016; 7:86-93. [PMID: 28243505 PMCID: PMC5310207 DOI: 10.1212/cpj.0000000000000316] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose of review: To help clinicians optimize the conversion of a patient's Parkinson disease pharmacotherapy from immediate-release carbidopa/levodopa (IR CD/LD) to an extended-release formulation (ER CD/LD). Recent findings: Eleven movement disorders specialists achieved consensus positions on the modification of trial-based conversion guidelines to suit individual patients in clinical practice. Summary: Because the pharmacokinetics of ER CD/LD differ from those of IR CD/LD, modification of dosage and dosing frequency are to be expected. Initial regimens may be based on doubling the patient's preconversion levodopa daily dosage and choosing a division of doses to address the patient's motor complications, e.g., wearing-off (warranting a relatively high ER CD/LD dose, possibly at a lower frequency than for IR CD/LD) or dyskinesia (warranting a relatively low dose, perhaps at an unchanged frequency). Patients should know that the main goal of conversion is a steadier levodopa clinical response, even if dosing frequency is unchanged.
Collapse
Affiliation(s)
- Alberto J Espay
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - Fernando L Pagan
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - Benjamin L Walter
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - John C Morgan
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - Lawrence W Elmer
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - Cheryl H Waters
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - Pinky Agarwal
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - Rohit Dhall
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - William G Ondo
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - Kevin J Klos
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| | - Dee E Silver
- University of Cincinnati (AJE), OH; Georgetown University Hospital (FLP), Washington, DC; Case Western Reserve University (BLW), Cleveland, OH; Medical College of Georgia (JCM), Augusta University; University of Toledo College of Medicine (LWE), OH; Columbia University (CHW), New York, NY; Evergreen Hospital Medical Center (PA), Kirkland, WA; Parkinson's Institute and Clinical Center (RD), Sunnyvale, CA; Methodist Neurological Institute (WGO), Houston, TX; The Movement Disorder Clinic of Oklahoma (KJK), Tulsa; and Coastal Neurological Medical Group, Inc. (DES), La Jolla, CA
| |
Collapse
|