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Rivero MJ, Reddy R, Muthigi A, Reddy R, Han S, Reis IM, Patel M, Ramasamy R. Patient Satisfaction with Oral Testosterone Undecanoate in Men Who Received Prior Testosterone Therapy: An Open-Label, Single-Center Clinical Trial. World J Mens Health 2024; 42:762-771. [PMID: 38164037 PMCID: PMC11439809 DOI: 10.5534/wjmh.230164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE To evaluate patient satisfaction and symptom control in hypogonadal men transitioning from other testosterone therapies to oral testosterone undecanoate (TU). MATERIALS AND METHODS In this open-label clinical trial, men aged 18 to 75 years with hypogonadism were switched to oral TU after a sufficient washout of previous testosterone therapies. Treatment satisfaction and symptom control were primarily measured using the 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9) and quantitative androgen deficiency in aging males (qADAM) questionnaires, respectively. Secondary outcomes included changes in serum testosterone (T), estradiol (E2), hematocrit (HCT), and prostate-specific antigen (PSA) levels. RESULTS Forty-one men participated, with significant improvements in all TSQM-9 scores observed over 6 months. Symptom control as measured by qADAM remained consistent. There was a significant increase in serum T and E2 levels, but HCT and PSA levels remained stable. CONCLUSIONS Switching to oral TU from other testosterone therapies is associated with increased patient satisfaction and stable hypogonadal symptom control.
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Affiliation(s)
- Marco-Jose Rivero
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rohit Reddy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Akhil Muthigi
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Raghuram Reddy
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Sunwoo Han
- Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isildinha M Reis
- Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mehul Patel
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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Goldstein I, Chidambaram N, Dobs A, King S, Miner M, Ramasamy R, Khera FA, Khera M. Newer formulations of oral testosterone undecanoate: development and liver side effects. Sex Med Rev 2024:qeae062. [PMID: 39291780 DOI: 10.1093/sxmrev/qeae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/27/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Testosterone deficiency is a clinical disorder due to either failure of the testes to produce testosterone or failure of the hypothalamus or pituitary to produce sufficient gonadotropins. Previous formulations of oral testosterone therapy, particularly methyltestosterone, have been associated with adverse liver effects. Many different routes of testosterone delivery have been developed, each with their own administrative benefits and challenges. Newer formulations of oral testosterone undecanoate (TU) provide a convenient administration option, although their use has been limited by hepatotoxicity concerns based on older methyltestosterone data, and prescribing physicians may still be concerned about adverse liver effects. OBJECTIVES In this review, we discuss the history of oral testosterone development, clarify the mechanism of action of oral TU, and describe the relevant liver safety findings. METHODS Relevant literature was allocated to present a review on the history of oral TU development and the mechanism of action of oral TU. We pooled data from individual studies of oral TU products to present a safety summary. RESULTS Overall, safety results from studies of the newer formulations of oral TU showed that increased liver function test values are not generally associated with oral TU formulations and that no clinically significant liver toxicities were noted in clinical trials of oral TU. CONCLUSION Continued research into the safety of oral TU will contribute to a better understanding of the potential risks in patients receiving this therapy, an outcome that highlights the importance of providing patient education and reassurance regarding oral TU safety.
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Affiliation(s)
- Irwin Goldstein
- University of California at San Diego, San Diego, CA 92120, United States
| | | | - Adrian Dobs
- The Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Shelby King
- Halozyme, San Diego, CA 92130, United States
| | - Martin Miner
- Men's Health Center, Miriam Hospital, Providence, RI 02906, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Faysal A Khera
- Department of Urology, University of California Irvine, Irvine, CA 92660, United States
| | - Mohit Khera
- Baylor College of Medicine, Houston, TX 77030, United States
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Miller JA, Nguyen TT, Loeb C, Khera M, Yafi FA. Oral testosterone therapy: past, present, and future. Sex Med Rev 2023; 11:124-138. [PMID: 36779549 DOI: 10.1093/sxmrev/qead003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 02/14/2023]
Abstract
INTRODUCTION Testosterone replacement therapy (TRT) remains a commonly utilized treatment for men with testosterone deficiency (TD). Despite the recent FDA approval of new oral TRT medications, concerns remain regarding their efficacy and safety, and prescription rates for these medications have decreased compared to those for TD medications with other routes of administration. OBJECTIVE In this study we sought to investigate the efficacy and safety of oral testosterone undecanoate (oTU), a new oral TRT medication. METHODS A comprehensive review of the literature was performed using the Medline, EMBASE, and Cochrane Library databases; 1269 articles were identified, with 44 articles included in the final review and 12 used to perform meta-analyses to investigate the change in serum total testosterone (TT) and risk of adverse effects following oral testosterone undecanoate (oTU) use. Articles were also reviewed to investigate the reported effects of oTU on body composition, liver function, hematologic assays, lipid profiles, hormone assays, prostate growth, hypertension, and symptoms of TD. RESULTS Across placebo-controlled randomized trials, there was no significant increase in TT for those receiving oTU vs placebo (mean difference, -0.26 [95% CI, -1.26 to 0.73]). On subanalysis, when eugonadal participants received oTU, a significant decrease in TT was demonstrated (mean difference -0.86 [95% CI, -1.28 to 0.43]). When participants who were hypogonadal at baseline received oTU, a significant increase in TT compared to placebo was seen (mean difference 1.25 [95% CI, 0.22-2.29]). There was no significant risk of adverse effects (RR, -0.03 [95% CI, -0.08 to 0.03]) or serious adverse effects (RR, 0.15 [95% CI, -0.66 to 0.96]) in the oTU groups compared to placebo. CONCLUSION oTU was found to be well tolerated in hypogonadal patients, resulting in improved testosterone levels, height velocity, and sexual symptoms, without significant hepatotoxicity, prostatic enlargement, or worsening hypertension. There was no consensus regarding the effect of oTU on lean and fat mass percentages, hematologic assays, lipid profiles, mood, and general well-being.
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Affiliation(s)
- Jake A Miller
- Department of Urology, University of California, Irvine, CA, United States
| | - Tuan T Nguyen
- Department of Urology, University of California, Irvine, CA, United States
| | - Charles Loeb
- Department of Urology, University of California, Irvine, CA, United States
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, CA, United States
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Campbell K, Muthigi A, Ghomeshi A, Schuppe K, Sandler MD, Ramasamy R. Safety Aspects and Rational Use of Testosterone Undecanoate in the Treatment of Testosterone Deficiency: Clinical Insights. Drug Healthc Patient Saf 2023; 15:73-84. [PMID: 37025099 PMCID: PMC10072151 DOI: 10.2147/dhps.s383130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
Testosterone deficiency is diagnosed by a serum total testosterone level below 300 ng/dL in combination with symptoms such as decreased energy and libido. These symptoms can be ameliorated by restoring serum testosterone to the physiologic range with testosterone therapy (TT). There are numerous forms of testosterone therapy, such as injectable, transdermal, nasal, and subcutaneous applications. There are also multiple formulations of injection, such as testosterone cypionate, testosterone enanthate, and testosterone undecanoate. Testosterone undecanoate (TU) is a long-acting ester formulation of testosterone that can be provided in an injectable or oral form. Oral testosterone undecanoate is marketed as Andriol, Jatenzo, Tlando, and Kyzatrex. Oral TU provides a convenient option for many patients, which may increase compliance with TT. Injectable testosterone undecanoate is marketed as Aveed and Nebido. Injectable TT remains the most cost-effective therapeutic option and is appropriate for most patients as an initial therapy. This review describes the pharmacokinetics of these testosterone undecanoate products and provides a guide for prescribers using these medications. While many forms of testosterone are appropriate for TT, a patient-centered discussion focused on goals of care should best guide physician prescription of these medications.
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Affiliation(s)
- Katherine Campbell
- Desai Sethi Urology Institute, University of Miami, Miami, Fl, 33136, USA
| | - Akhil Muthigi
- Desai Sethi Urology Institute, University of Miami, Miami, Fl, 33136, USA
| | - Armin Ghomeshi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - Kyle Schuppe
- Washington State University Elson S. Floyd College of Medicine, Spokane, WA, 99202-2131, USA
| | - Max D Sandler
- University of Miami Miller of Medicine, Miami, Fl, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami, Miami, Fl, 33136, USA
- Correspondence: Ranjith Ramasamy, Desai Sethi Urology Institute, University of Miami, 1120 NW 14th St, Miami, Fl, 33136, USA, Tel +1 305-243-6090, Email
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Figueiredo MG, Gagliano-Jucá T, Basaria S. Testosterone Therapy With Subcutaneous Injections: A Safe, Practical, and Reasonable Option. J Clin Endocrinol Metab 2022; 107:614-626. [PMID: 34698352 PMCID: PMC9006970 DOI: 10.1210/clinem/dgab772] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Injections with intramuscular (IM) testosterone esters have been available for almost 8 decades and not only result in predictable serum testosterone levels but are also the most inexpensive modality. However, they are difficult to self-administer and associated with some discomfort. Recently, subcutaneous (SC) administration of testosterone esters has gained popularity, as self-administration is easier with this route. Available data, though limited, support the feasibility of this route. Here we review the pharmacokinetics and safety of SC testosterone therapy with both long- and ultralong-acting testosterone esters. In addition, we provide guidance for clinicians on how to counsel and manage their patients who opt for the SC route. EVIDENCE ACQUISITION Systematic review of available literature on SC testosterone administration including clinical trials, case series, and case reports. We also review the pharmacology of testosterone absorption after SC administration. EVIDENCE SYNTHESIS Available evidence, though limited, suggests that SC testosterone therapy in doses similar to those given via IM route results in comparable pharmacokinetics and mean serum testosterone levels. With appropriate training, patients should be able to safely self-administer testosterone esters SC with relative ease and less discomfort compared with the IM route. CONCLUSION Although studies directly comparing the safety of SC vs IM administration of testosterone esters are desirable, clinicians should consider discussing the SC route with their patients because it is easier to self-administer and has the potential to improve patient adherence.
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Affiliation(s)
| | | | - Shehzad Basaria
- Correspondence: Shehzad Basaria, MD, Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, BLI 541, Boston, MA 02115, USA.
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Newell-Price J, Huatan H, Quirke J, Porter J, Daniel E, Mumdzic E, Voet B, Keevil B, Whitaker MJ, Ross RJ. An oral lipidic native testosterone formulation that is absorbed independent of food. Eur J Endocrinol 2021; 185:607-615. [PMID: 34379604 PMCID: PMC8558846 DOI: 10.1530/eje-21-0606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
CONTEXT There is no licensed oral native testosterone (NT) because of challenges in the formulation. Licensed oral formulations of the ester, testosterone undecanoate (TU), require a meal for absorption and generate supraphysiological dihydrotestosterone (DHT) levels. OBJECTIVE To develop an oral NT formulation. DESIGN AND METHODS A lipid-based formulation of native testosterone filled into soft-gelatin capsules at 40 mg per capsule was designed with 2 years of stability at ambient temperature. Pharmacokinetic comparison studies of this oral lipidic NT formulation to oral TU were conducted in dogs and hypogonadal men. RESULTS In dogs, 40 mg NT was well absorbed under fasted conditions whereas 40 mg TU required a high-fat meal: for NT, the mean fed/fasted AUC ratio was 1.63 and for TU 7.05. In hypogonadal men, fed and fasted NT had similar pharmacokinetics: Cmax mean 26.5 vs 30.4 nmol/L (769 vs 882 ng/dL), AUC0-10 h 87 vs 88.6 h nmol/L. NT (fed state) showed a testosterone AUC increase of 45% between 120 and 200 mg, and NT 200 mg gave a similar mean AUC0-10 h to TU 80 mg: 87 vs 64.8 h nmol/L. Serum TU levels were variable and on a molar basis were ~ten-fold higher than serum testosterone levels after TU 80 mg fed. The DHT: testosterone AUC0-10 h ratio was more physiological for NT than TU being 0.19 vs 0.36. There were no emerging safety concerns with NT. CONCLUSION This novel oral lipidic native testosterone formulation has potential advantages over oral TU of dosing independently of food and a lower risk of supraphysiological DHT levels. Significance statement There is no licensed oral testosterone because of challenges in formulation, and the oral formulations of the ester, testosterone undecanoate, require a fatty meal for absorption and generate supraphysiological dihydrotestosterone levels. We have overcome the design challenges and formulated an oral native testosterone that can be taken with or without food and provides physiological levels of testosterone and dihydrotestosterone in hypogonadal men. This formulation, DITEST, has the potential advantage of being oral for patients who do not tolerate injections and less risk of adverse events that might theoretically be associated with elevated dihydrotestosterone levels. Future studies will need to define the dosing regimen for replacement in hypogonadal men.
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Affiliation(s)
- John Newell-Price
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | | | | | - Eleni Daniel
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | | | - Brian Keevil
- Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Richard J Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Correspondence should be addressed to R J Ross Email
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Kumar S, Freelander A, Lim E. Type 1 Nuclear Receptor Activity in Breast Cancer: Translating Preclinical Insights to the Clinic. Cancers (Basel) 2021; 13:4972. [PMID: 34638457 PMCID: PMC8507977 DOI: 10.3390/cancers13194972] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
The nuclear receptor (NR) family of transcription factors is intimately associated with the development, progression and treatment of breast cancer. They are used diagnostically and prognostically, and crosstalk between nuclear receptor pathways and growth factor signalling has been demonstrated in all major subtypes of breast cancer. The majority of breast cancers are driven by estrogen receptor α (ER), and anti-estrogenic therapies remain the backbone of treatment, leading to clinically impactful improvements in patient outcomes. This serves as a blueprint for the development of therapies targeting other nuclear receptors. More recently, pivotal findings into modulating the progesterone (PR) and androgen receptors (AR), with accompanying mechanistic insights into NR crosstalk and interactions with other proliferative pathways, have led to clinical trials in all of the major breast cancer subtypes. A growing body of evidence now supports targeting other Type 1 nuclear receptors such as the glucocorticoid receptor (GR), as well as Type 2 NRs such as the vitamin D receptor (VDR). Here, we reviewed the existing preclinical insights into nuclear receptor activity in breast cancer, with a focus on Type 1 NRs. We also discussed the potential to translate these findings into improving patient outcomes.
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Affiliation(s)
- Sanjeev Kumar
- Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, Darlinghurst 2010, Australia; (A.F.); (E.L.)
- Garvan Institute of Medical Research, University of New South Wales, Darlinghurst 2010, Australia
| | - Allegra Freelander
- Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, Darlinghurst 2010, Australia; (A.F.); (E.L.)
- Garvan Institute of Medical Research, University of New South Wales, Darlinghurst 2010, Australia
| | - Elgene Lim
- Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, Darlinghurst 2010, Australia; (A.F.); (E.L.)
- Garvan Institute of Medical Research, University of New South Wales, Darlinghurst 2010, Australia
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8
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Pastuszak AW, Gittelman M, Tursi JP, Jaffe JS, Schofield D, Miner MM. Pharmacokinetics of testosterone therapies in relation to diurnal variation of serum testosterone levels as men age. Andrology 2021; 10:209-222. [PMID: 34510812 PMCID: PMC9293229 DOI: 10.1111/andr.13108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022]
Abstract
Background To improve symptoms associated with testosterone deficiency, many testosterone therapies are available that aim to restore serum testosterone (T) levels to the normal physiologic range. The magnitude, frequency, and duration between peak and trough T concentrations vary with route of administration, and none reflect normal endogenous daily diurnal T variations. Objective To compare pharmacokinetic profiles of serum T from approved T formulations with endogenous diurnal T variations in young and older men, and to consider whether there may be value in mimicking the diurnal T rhythmicity with exogenous testosterone therapies as men age. Materials and methods A literature search of studies examining the diurnal variation of endogenous T in healthy men and men with testosterone deficiency was performed using PubMed in January 2020. Additional searches for serum T pharmacokinetic profiles of various testosterone therapy formulations were also conducted. Prescribing information for various T formulations was also reviewed. Discussion and conclusion Endogenous diurnal T variation is well described and appears to be blunted naturally as men age. Men with testosterone deficiency lack diurnal T variation and exhibit a flatter T profile compared with eugonadal men. Some T replacement options provide intraday T level variations similar to normal circadian secretion, and others provide a flatter exposure profile reflective of depot release. Others provide profiles that exceed the frequency and physiologic range of the natural diurnal variation of T. All exogenous T replacement dosing targets an increase in average T levels to within the normal physiologic range and improves symptoms associated with low T, but no single testosterone therapy can exactly mimic the normal diurnal T patterns seen in younger men and the blunted circadian T secretion of older men.
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Affiliation(s)
| | - Marc Gittelman
- 21st Century Oncology, Uro-Medix/GenesisCare, Aventura, Florida, USA
| | | | | | | | - Martin M Miner
- Men's Health Center, Miriam Hospital, Providence, Rhode Island, USA
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Yuen F, Thirumalai A, Fernando FA, Swerdloff RS, Liu PY, Pak Y, Hull L, Bross R, Blithe DL, Long JE, Page ST, Wang C. Comparison of metabolic effects of the progestational androgens dimethandrolone undecanoate and 11β-MNTDC in healthy men. Andrology 2021; 9:1526-1539. [PMID: 33908182 PMCID: PMC8560544 DOI: 10.1111/andr.13025] [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: 01/21/2021] [Revised: 03/19/2021] [Accepted: 04/19/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dimethandrolone (DMA) and 11β-methyl-19-nortestosterone (11β-MNT) are two novel compounds with both androgenic and progestational activity that are under investigation as potential male hormonal contraceptives. Their metabolic effects have never been compared in men. OBJECTIVE Assess for changes in insulin sensitivity and adiponectin and compare the metabolic effects of these two novel androgens. MATERIALS/METHODS In two clinical trials of DMA undecanoate (DMAU) and 11β-MNT dodecylcarbonate (11β-MNTDC), oral prodrugs of DMA and 11β-MNT, healthy men received drug, or placebo for 28 days. Insulin and adiponectin assays were performed on stored samples. Mixed model analyses were performed to compare the effects of the two drugs. Student's t test, or the non-parametric Kruskal-Wallis test as appropriate, was used to evaluate for an effect of active drug versus placebo. RESULTS Class effects were seen, with decrease in HDL-C and SHBG, and increase in weight and hematocrit, with no statistically significant differences between the two compounds. No changes in fasting glucose, fasting insulin, or HOMA-IR were seen with either compound. There was a slight decrease in adiponectin with DMAU that was not seen with 11β-MNTDC. An increase in LDL-C was seen with 11β-MNTDC but not with DMAU. DISCUSSION There were no significant changes in insulin resistance after 28 days of oral administration of these novel androgens despite a mild increase in weight. There may be subtle differences in their metabolic impacts that should be explored in future studies. CONCLUSION Changes in metabolic parameters should be carefully monitored when investigating androgenic compounds.
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Affiliation(s)
- Fiona Yuen
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, 90502, USA
| | - Arthi Thirumalai
- Department of Medicine, University of Washington, Seattle, Washington, 98195, USA
| | - Frances A. Fernando
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20817, USA
| | - Ronald S. Swerdloff
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, 90502, USA
| | - Peter Y. Liu
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, 90502, USA
| | - Youngju Pak
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, 90502, USA
| | - Laura Hull
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, 90502, USA
| | - Rachelle Bross
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, 90502, USA
| | - Diana L. Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20817, USA
| | - Jill E. Long
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20817, USA
| | - Stephanie T. Page
- Department of Medicine, University of Washington, Seattle, Washington, 98195, USA
| | - Christina Wang
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, 90502, USA
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JATENZO®: Challenges in the development of oral testosterone. Int J Impot Res 2021; 34:721-724. [PMID: 34354245 DOI: 10.1038/s41443-021-00461-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 11/09/2022]
Abstract
Testosterone therapy (TT) for the treatment of testosterone deficiency (TD) can be administered via several routes of administration. Due to a variety of concerns such as hepatotoxicity, an oral formulation has long been absent in the United States. Recently, JATENZO® (testosterone undecanoate) oral capsules was approved by the US FDA as an oral option for men suffering from TD. In this article, we will discuss the history and challenges in the development of a viable oral formulation of exogeneous TT and examine how JATENZO® addresses these concerns.
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11
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Liang X, Hua Y, Liu Q, Li Z, Yu F, Gao J, Zhang H, Zheng A. Solid Self-Emulsifying Drug Delivery System (Solid SEDDS) for Testosterone Undecanoate: In Vitro and In Vivo Evaluation. Curr Drug Deliv 2020; 18:620-633. [PMID: 32887542 DOI: 10.2174/1567201817666200904172626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/01/2020] [Accepted: 08/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The current study aimed to investigate the potential of Solid Self-Emulsifying Drug Delivery Systems (solid SEDDS) loaded with Testosterone Undecanoate (TU) (solid TUSEDDS). The solid TU-SEDDS was composed of TU, Medium-Chain Triglycerides (MCT, oil), 2- Chloro-1-(chloromethyl) ethyl carbamate (EL-35, surfactant) and polyethylene glycol (PEG400, cosurfactant). It was expected to improve the dissolution and oral bioavailability of TU, as a result of investigating the feasibility of the clinical application of SEDDS. METHODS First, a TU-SEDDS was developed by using rational blends of components with the good solubilizing ability for TU. Next, a ternary phase diagram was constructed to determine the self-emulsifying region, and the formulation was optimized. Then, the solid TU-SEDDS formulation was established by screening suitable solid adsorptions. Finally, the prepared SEDDS, TUSEDDS and solid TU-SEDDS formulations were evaluated in vitro and in vivo. RESULTS The size of the solid TU-SEDDS was 189.1 ± 0.23 nm. The Transmission Electron Microscopy (TEM) results showed that the oil droplets were homogenous and spherical with good integrity. The Differential Scanning Calorimetry (DSC) and X-Ray Powder Dffraction (XRD) results indicated that the solid TU-SEDDS formulation almost preserves the amorphous state. Scanning Electron Microscopy (SEM) indicated that neusilin US2 successfully adsorbed the TU-SEDDS. Drug release indicated that the dissolution of the solid TU-SEDDS was faster than that of Andriol Testocaps ®. Furthermore, in vivo pharmacokinetic (PK) studies in Sprague-Dawley (SD) rats showed that the Area Under the Curve (AUC) of the solid TU-SEDDS (487.54±208.80 μg/L×h) was higher than that of Andriol Testocaps® (418.93±273.52 μg/L×h, P < 0.05). In beagles not fed a high-fat diet, the AUC of the solid TU-SEDDS (5.81±4.03 μg/L×h) was higher than that of Andriol Testocaps ® (5.53±3.43 μg/L×h, P > 0.05). In beagles fed a high-fat diet, the AUC of the solid TUSEDDS (38.18±21.90 μg/L×h) was higher than that of Andriol Testocaps® (37.17±13.79 μg/L×h, P > 0.05). CONCLUSION According to the results of this research, oral solid TU-SEDDS is expected to be another alternative delivery system for the late-onset hypogonadism. This is beneficial to the transformation of existing drug delivery systems into preclinical and clinical studies.
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Affiliation(s)
- Xi Liang
- TEAM Academy of Pharmaceutical Sciences Co. Ltd., Beijing 102488, China
| | - Yabing Hua
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Qian Liu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Zhiguo Li
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Fanglin Yu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Jing Gao
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Hui Zhang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Aiping Zheng
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
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Swerdloff RS, Wang C, White WB, Kaminetsky J, Gittelman MC, Longstreth JA, Dudley RE, Danoff TM. A New Oral Testosterone Undecanoate Formulation Restores Testosterone to Normal Concentrations in Hypogonadal Men. J Clin Endocrinol Metab 2020; 105:5834353. [PMID: 32382745 PMCID: PMC7282712 DOI: 10.1210/clinem/dgaa238] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT A novel formulation of oral testosterone (T) undecanoate (TU) was evaluated in a phase 3 clinical trial. OBJECTIVE Determine efficacy, short-term safety, and alignment of new oral TU formulation with current US approval standards for T replacement therapy. DESIGN Randomized, active-controlled, open-label study. SETTING AND PATIENTS Academic and private clinical practice sites; enrolled patients were clinically hypogonadal men 18 to 65 years old. METHODS Patients were randomized 3:1 to oral TU, as prescribed (JATENZO®; n = 166) or a topical T product once daily (Axiron®; n = 56) for 3 to 4 months. Dose titration was based on average T levels (Cavg) calculated from serial pharmacokinetic (PK) samples. T was assayed by liquid chromatography-mass spectrometry/mass spectrometry. Patients had 2 dose adjustment opportunities prior to final PK visit. Safety was assessed by standard clinical measures, including ambulatory blood pressure (BP). RESULTS 87% of patients in both groups achieved mean T Cavg in the eugonadal range. Sodium fluoride-ethylenediamine tetra-acetate plasma T Cavg (mean ± standard deviation) for the oral TU group was 403 ± 128 ng/dL (~14 ± 4 nmol/L); serum T equivalent, ~489 ± 155 ng/dL (17 ± 5 nmol/L); and topical T, 391 ± 140 ng/dL (~14 ± 5 nmol/L). Modeling/simulation of T PK data demonstrated that dose titration based on a single blood sample 4 to 6 h after oral TU dose yielded efficacy (93%) equivalent to Cavg-based titration (87%). Safety profiles were similar in both groups, but oral TU was associated with a mean increase in systolic BP of 3 to 5 mm Hg. CONCLUSION A new oral TU formulation effectively restored T to mid-eugonadal levels in hypogonadal patients.
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Affiliation(s)
- Ronald S Swerdloff
- The Lundquist Institute and Harbor-UCLA Medical Center, Torrance, CA, US
- Correspondence and Reprint Requests: Ronald S. Swerdloff, MD, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502. E-mail:
| | - Christina Wang
- The Lundquist Institute and Harbor-UCLA Medical Center, Torrance, CA, US
| | - William B White
- University of Connecticut School of Medicine, Farmington, CT, US
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13
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Yuen F, Nguyen BT, Swerdloff RS, Wang C. Continuing the search for a hormonal male contraceptive. Best Pract Res Clin Obstet Gynaecol 2020; 66:83-94. [PMID: 32197832 PMCID: PMC7375909 DOI: 10.1016/j.bpobgyn.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Abstract
This chapter discusses the mechanisms of action of hormonal male contraception, which suppresses the hypothalamic-pituitary-testis axis. When the intratesticular concentration of testosterone is subsequently suppressed to adequately low concentrations, spermatogenesis is arrested. Androgens are a necessary hormonal male contraceptive component because they not only suppress the hypothalamic-pituitary-testis axis, but also provide the male hormone necessary to maintain peripheral androgen functions. Past studies using testosterone alone and testosterone combined with progestins demonstrated contraceptive efficacy in the female partner at rates similar to combined hormonal female methods. Newer hormonal male contraceptive formulations and the alternative routes of administration are discussed, along with potential barriers, challenges, and opportunities for hormonal male contraceptive development. Novel methods that are safe, effective, reversible, user-friendly, and coitus-independent are intrinsic to equitably meet the various needs and limitations of an increasingly diverse population.
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Affiliation(s)
- Fiona Yuen
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90007, USA.
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
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Swerdloff RS, Dudley RE. A new oral testosterone undecanoate therapy comes of age for the treatment of hypogonadal men. Ther Adv Urol 2020; 12:1756287220937232. [PMID: 32655691 PMCID: PMC7328356 DOI: 10.1177/1756287220937232] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022] Open
Abstract
Background: A novel formulation of oral testosterone undecanoate (TU) was studied in a
long- and short-term phase III trial to evaluate safety and efficacy. Methods: Hypogonadal men (age 18–65 years; two morning serum testosterone
(T) <300 ng/dl with signs/symptoms) were recruited into a 365 day (trial
I) or 105 day (trial II), randomized, multicenter trial. Patients were
randomized 1:1 to oral TU (n = 161) or T-gel
(n = 160) in trial I, and 3:1 to oral TU, twice daily
(BID) JATENZO® (n = 166) or a topical T product [Axiron®
(n = 56)] in trial II. Dose adjustments were based on
average T concentrations (Cavg). Efficacy was assessed
based on T levels, body composition and bone density. Safety was assessed by
standard clinical measures. Results: Oral TU efficacy (% of patients with eugonadal T Cavg) was
84% (serum Cavg = 628 ± 343 ng/dl) and 87% (serum T
equivalent Cavg ≈ 489 ± 155 ng/dl) in trials I and II,
respectively. Oral TU significantly (p <0.0001) improved
all Psychosexual Daily Questionnaire parameters in trials I and II. In trial
I, lean mass increased 3.2 ± 2.7 kg and fat decreased by 2.4 ± 3.6 kg (both
p <0.0001) and bone density improved in hip
(+0.012 ± 0.0225 g/cm2) and spine
(+0.018 ± 0.0422 g/cm2) after 365 days (both
p <0.0001). Oral TU-associated adverse effects were
consistent with other T-replacement therapies but oral TU patients
experienced a greater number of mild gastrointestinal adverse effects. Oral
TU subjects in both studies exhibited an increase in mean systolic blood
pressure of about 3–5 mmHg. Oral TU was not associated with liver toxicity
nor did it cause an elevation in high-sensitivity C-reactive protein or
lipoprotein-associated phospholipase A2 (cardiovascular safety
biomarkers) after 365 days of therapy. Conclusion: A new oral TU formulation was safe and effective and represents a significant
therapeutic advance for the treatment of appropriate hypogonadal men.
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Affiliation(s)
- Ronald S Swerdloff
- David Geffen School of Medicine at UCLA, Division of Endocrinology, Harbor-UCLA Medical Center, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502, USA
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15
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Yuen F, Thirumalai A, Pham C, Swerdloff RS, Anawalt BD, Liu PY, Amory JK, Bremner WJ, Dart C, Wu H, Hull L, Blithe DL, Long J, Wang C, Page ST. Daily Oral Administration of the Novel Androgen 11β-MNTDC Markedly Suppresses Serum Gonadotropins in Healthy Men. J Clin Endocrinol Metab 2020; 105:5715395. [PMID: 31976519 PMCID: PMC7049261 DOI: 10.1210/clinem/dgaa032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND 11β-methyl-19-nortestosterone (11β-MNT) is a modified testosterone (T) with androgenic and progestational activity. A single oral dose of the prodrug, 11β-MNT dodecylcarbonate (11β-MNTDC), was well tolerated in healthy men. METHODS We conducted a randomized, double-blind study at 2 academic medical centers. 42 healthy men (18-50 years) were randomized to receive oral placebo or 11β-MNTDC, 200 or 400 mg daily, for 28 consecutive days. Primary outcome (safety and tolerability) measures were assessed twice per week. Subjects underwent serial blood sampling over 24 hours on days 1 and 28 to assess secondary outcomes: pharmacokinetics (serum drug concentrations); pharmacodynamics of 11β-MNTDC (serum sex steroids and gonadotropins); and mood and sexual function (via validated questionnaires). RESULTS There were no serious adverse events. No participants discontinued because of an adverse event or laboratory test abnormality. 11β-MNTDC resulted in a dose-related increase in serum 11β-MNTDC and 11β-MNT concentrations sustained over 24 hours. Administration of 11β-MNTDC resulted in a marked suppression of serum gonadotropins, T, calculated free T, estradiol, and SHBG over the treatment period (P < 0.01). Adverse effects that may be related to 11β-MNTDC included weight gain, acne, headaches, fatigue, and mild mood changes, with 5 men reporting decreased libido and 3 decreased erectile/ejaculatory function. Serum low-density lipoprotein cholesterol, weight (~2 kg), hematocrit, and hemoglobin increased and serum high-density lipoprotein cholesterol decreased in both 11β-MNTDC groups. CONCLUSION Daily oral 11β-MNTDC for 28 days in healthy men markedly suppressed serum gonadotropin and T concentrations without serious adverse effects. These results warrant further evaluation of 11β-MNTDC as a potential male oral contraceptive.
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Affiliation(s)
- Fiona Yuen
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Arthi Thirumalai
- Department of Medicine, University of Washington, Seattle, Washington
| | - Cindy Pham
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Ronald S Swerdloff
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Bradley D Anawalt
- Department of Medicine, University of Washington, Seattle, Washington
| | - Peter Y Liu
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - John K Amory
- Department of Medicine, University of Washington, Seattle, Washington
| | - William J Bremner
- Department of Medicine, University of Washington, Seattle, Washington
| | - Clint Dart
- Health Decisions, Durham, North Carolina
| | | | - Laura Hull
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jill Long
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Christina Wang
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
- Correspondence and Reprint Requests: Christina Wang, MD, Clinical and Translational Science Institute, Harbor-UCLA Medical Center and, The Lundquist Research Institute 1124 W. Carson St., Torrance, CA 90509. E-mail:
| | - Stephanie T Page
- Department of Medicine, University of Washington, Seattle, Washington
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16
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Profiling of anabolic androgenic steroids and selective androgen receptor modulators for interference with adrenal steroidogenesis. Biochem Pharmacol 2020; 172:113781. [DOI: 10.1016/j.bcp.2019.113781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022]
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Wu S, Yuen F, Swerdloff RS, Pak Y, Thirumalai A, Liu PY, Amory JK, Bai F, Hull L, Blithe DL, Anawalt BD, Parman T, Kim K, Lee MS, Bremner WJ, Page ST, Wang C. Safety and Pharmacokinetics of Single-Dose Novel Oral Androgen 11β-Methyl-19-Nortestosterone-17β-Dodecylcarbonate in Men. J Clin Endocrinol Metab 2019; 104:629-638. [PMID: 30252057 PMCID: PMC6334268 DOI: 10.1210/jc.2018-01528] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/19/2018] [Indexed: 01/09/2023]
Abstract
Context 11β-Methyl-19-nortestosterone-17β-dodecylcarbonate (11β-MNTDC) is an orally bioavailable prodrug of 11β-methyl-19-nortestosterone (11β-MNT) with androgenic and progestational activity. Objectives (i) Quantify 11β-MNT binding to androgen and progesterone receptors. (ii) Evaluate safety, tolerability, and serum gonadotropin and testosterone suppression by 11β-MNTDC in men. Design and Setting (i) In vitro receptor binding and transactivation studies and (ii) randomized, double-blind, placebo-controlled single-dose, dose-escalating phase I study at two academic medical centers. Participants and Intervention Twelve healthy male volunteers were randomized (five active, one placebo) to escalating single oral doses (100, 200, 400, and 800 mg) of 11β-MNTDC or placebo given with or without food. Main Outcome Measures (i) In vitro 11β-MNT/11β-MNTDC human receptor binding and transactivation and (ii) safety and tolerability, pharmacokinetics, and quantification of serum gonadotropin and testosterone concentrations for 24 hours following dosing. Results 11β-MNT avidly binds and activates human androgen and progesterone receptors, but 11β-MNTDC has minimal activity. Single oral doses of 11β-MNTDC were well tolerated without serious adverse events. Administration of 11β-MNTDC with food markedly increased average 11β-MNTDC and 11β-MNT serum concentrations (P < 0.001 for all doses) compared with fasting with a significant dose-related effect on average serum drug concentrations (P < 0.0001). The 200-, 400-, and 800-mg doses significantly suppressed average serum testosterone concentrations (P < 0.05). Conclusions A single, oral dose of 11β-MNTDC up to 800 mg administered with food is safe and well tolerated in healthy men. The active drug 11β-MNT has androgenic and progestational activity, rapidly suppresses serum testosterone, and is a promising candidate for an effective once-daily oral male hormonal contraceptive.
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Affiliation(s)
- Sherry Wu
- Department of Medicine, University of Washington, Seattle, Washington
| | - Fiona Yuen
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Ronald S Swerdloff
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Youngju Pak
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Arthi Thirumalai
- Department of Medicine, University of Washington, Seattle, Washington
| | - Peter Y Liu
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - John K Amory
- Department of Medicine, University of Washington, Seattle, Washington
| | - Feng Bai
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Laura Hull
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Diana L Blithe
- Contraception Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Bradley D Anawalt
- Department of Medicine, University of Washington, Seattle, Washington
| | - Toufan Parman
- SRI International Biosciences Division, Menlo Park, California
| | - Kyuri Kim
- SRI International Biosciences Division, Menlo Park, California
| | - Min S Lee
- Contraception Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - William J Bremner
- Department of Medicine, University of Washington, Seattle, Washington
| | - Stephanie T Page
- Department of Medicine, University of Washington, Seattle, Washington
| | - Christina Wang
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
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Thirumalai A, Ceponis J, Amory JK, Swerdloff R, Surampudi V, Liu PY, Bremner WJ, Harvey E, Blithe DL, Lee MS, Hull L, Wang C, Page ST. Effects of 28 Days of Oral Dimethandrolone Undecanoate in Healthy Men: A Prototype Male Pill. J Clin Endocrinol Metab 2019; 104:423-432. [PMID: 30252061 PMCID: PMC6306388 DOI: 10.1210/jc.2018-01452] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/16/2018] [Indexed: 12/28/2022]
Abstract
CONTEXT Dimethandrolone (DMA) has androgenic and progestational activity. Single oral doses of DMA undecanoate (DMAU) were well tolerated and reversibly suppressed serum LH and testosterone (T) in men. OBJECTIVE Assess safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of oral DMAU. DESIGN Double-blind, randomized, placebo-controlled study. SETTING Two academic medical centers. PARTICIPANTS Healthy men (18 to 50 years). INTERVENTIONS One hundred men received DMAU [0, 100, 200, or 400 mg, formulated in castor oil/benzyl benzoate (C) or powder (P)] for 28 days. Subjects underwent 24-hour PK sampling on days 1 and 28 and twice weekly ambulatory visits throughout treatment. MAIN OUTCOME MEASURES Primary outcomes were safety and tolerability parameters (vitals, laboratory data, mood, and sexual function scores) and adverse events. Secondary outcomes were drug PK profiles and PD effects (serum LH, FSH, and sex hormones). RESULTS Eighty-two subjects completed the study and were included in the analysis. There were no serious adverse events. No clinically significant changes developed in safety laboratory parameters. A significant dose effect was seen for weight, hematocrit, high-density lipoprotein cholesterol, corrected QT interval, and sexual desire. Serum 24-hour average concentrations of DMAU and DMA showed dose-related increases (P < 0.001). All six subjects in the P400 group and 12 of 13 subjects in the C400 group achieved marked suppression of LH and FSH (<1.0 IU/L) and serum T (<50 ng/dL). CONCLUSIONS Daily oral administration of DMAU for 28 days in healthy men is well tolerated. Doses of ≥200 mg markedly suppress serum T, LH, and FSH. These results support further testing of DMAU as a male contraceptive.
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Affiliation(s)
- Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Correspondence and Reprint Requests: Arthi Thirumalai, MBBS, Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Box 357138, 1959 NE Pacific Street, Seattle, Washington 98195. E-mail:
| | - Jonas Ceponis
- Los Angeles Biomedical Research Institute and Harbor UCLA Medical Center, Torrance, California
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Ronald Swerdloff
- Los Angeles Biomedical Research Institute and Harbor UCLA Medical Center, Torrance, California
| | | | - Peter Y Liu
- Los Angeles Biomedical Research Institute and Harbor UCLA Medical Center, Torrance, California
| | - William J Bremner
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - Diana L Blithe
- National Institutes of Health - National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Min S Lee
- National Institutes of Health - National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Laura Hull
- Los Angeles Biomedical Research Institute and Harbor UCLA Medical Center, Torrance, California
| | - Christina Wang
- Los Angeles Biomedical Research Institute and Harbor UCLA Medical Center, Torrance, California
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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Ceponis J, Swerdloff R, Leung A, Hull L, Bai F, Longstreth J, Dudley R, Danoff T, Wang C. Accurate measurement of androgen after androgen esters: problems created by ex vivo esterase effects and LC-MS/MS interference. Andrology 2019; 7:42-52. [PMID: 30345711 PMCID: PMC6519384 DOI: 10.1111/andr.12554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/16/2018] [Accepted: 09/10/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ex vivo androgen prodrug conversion by blood esterases after oral androgen ester administration may result in an overestimation of the measured blood androgens. OBJECTIVE We investigated whether blood collection tubes with esterase inhibitors decreased the conversion of testosterone undecanoate (TU) and dimethandrolone undecanoate (DMAU) to their active metabolites, testosterone (T), and dimethandrolone (DMA), providing a more accurate assessment of circulating T/DMA levels. METHODS Blood was collected in tubes with/without esterase inhibitors from: (i) four healthy and four hypogonadal men receiving no androgens and spiked ex vivo with TU/DMAU; (ii) four men taking oral TU (Andriol® ); and (iii) eight hypogonadal men dosed with oral 316 mg TU and 15 healthy men with 200 mg DMAU. T/DMA levels were measured by LC-MS/MS. RESULTS Sodium fluoride (NaF, an esterase inhibitor) decreased measured T levels by 14.2% in men not receiving TU. Increasing amounts of TU/DMAU added to blood collected into plain tubes resulted in a concentration-dependent overestimation of T/DMA that was reduced by collecting blood into NaF tubes (by 30-85%), and keeping samples at 4 °C and minimizing time prior to centrifugation. After oral TU/DMAU administration to men, when TU/DMAU levels were >15/10 ng/mL, respectively, blood collected in NaF tubes yielded lower measured T concentrations by 15-30% and DMA by 22% due to an additional inhibitory effect of NaF on blood esterases. CONCLUSION NaF directly lowers plasma T/DMA levels measured by LC-MS/MS and also inhibits blood esterase activity. Overestimation of T/DMA in blood collected in tubes without NaF after oral TU/DMAU administration is important for pharmacokinetics studies in drug development clinical trials but may have limited impact in clinical practice/utilization because the differences between measured and true androgen values are modest and the wide therapeutic androgen efficacy ranges obviate the need for highly accurate androgen measurements during therapy.
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Affiliation(s)
- J. Ceponis
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
- Institute of EndocrinologyLithuanian University of Health SciencesKaunasLithuania
| | - R. Swerdloff
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
| | - A. Leung
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
| | - L. Hull
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
| | - F. Bai
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
| | | | - R. Dudley
- Clarus Therapeutics, Inc.NorthbrookILUSA
| | - T. Danoff
- Clarus Therapeutics, Inc.NorthbrookILUSA
| | - C. Wang
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
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Baldi A, Chaudhary M, Sethi S, Abhiav, Chandra R, Madan J. Armamentarium of nanoscaled lipid drug delivery systems customized for oral administration: In silico docking patronage, absorption phenomenon, preclinical status, clinical status and future prospects. Colloids Surf B Biointerfaces 2018; 170:637-647. [PMID: 29986259 DOI: 10.1016/j.colsurfb.2018.06.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 02/08/2023]
Abstract
Poor drug solubility and bioavailability remain a significant and frequently encountered concern for pharmaceutical scientists. Nanoscaled lipid drug delivery systems (NSLDDS) have exhibited great potentials in oral delivery of poorly water-soluble drugs, primarily for lipophilic drugs, with several successful clinical products. In the past few years, we have find out that optimized composition of drug in lipid, surfactant, or mixture of lipid and surfactant omits the solubility, permeability and bioavailability issues, which are potential limitations for oral absorption of poorly water-soluble drugs. Lipids not only vary in structures and physiochemical properties, but also in their digestibility and absorption pathway; therefore selection of lipid excipients and dosage form has a pronounced effect on biopharmaceutical aspects of drug absorption and distribution both in vitro and in vivo. Therefore, in current critical review, a comprehensive overview of the different lipid based nanostructured drug delivery systems intended for oral administration has been presented. In addition, implication of in silico docking in designing of NSLDDS as well as mechanism of absorption of different lipid based nanoformulations through intestinal absorption window has also been offered. Moreover, attention has also been paid to NSLDDS that are currently undergoing preclinical or clinical analysis.
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Affiliation(s)
- Ashish Baldi
- Department of Pharmaceutical Sciences and Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, Punjab, India
| | - Monika Chaudhary
- Department of Medicinal Chemistry, Hindu College of Pharmacy, Sonepat, Haryana, India
| | - Sheshank Sethi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
| | - Abhiav
- Division of Informatics, Systems and Research Management, Indian Council of Medical Research, New Delhi, India
| | - Ramesh Chandra
- Dr B.R Ambedkar Centre for Biomedical Research, University of Delhi, Delhi, India; Department of Chemistry, University of Delhi, Delhi, India
| | - Jitender Madan
- Department of Pharmaceutics, Chandigarh College of Pharmacy, Mohali, Punjab, India.
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Swerdloff RS, Dudley RE, Page ST, Wang C, Salameh WA. Dihydrotestosterone: Biochemistry, Physiology, and Clinical Implications of Elevated Blood Levels. Endocr Rev 2017; 38:220-254. [PMID: 28472278 PMCID: PMC6459338 DOI: 10.1210/er.2016-1067] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 04/20/2017] [Indexed: 02/07/2023]
Abstract
Benefits associated with lowered serum DHT levels after 5α-reductase inhibitor (5AR-I) therapy in men have contributed to a misconception that circulating DHT levels are an important stimulus for androgenic action in target tissues (e.g., prostate). Yet evidence from clinical studies indicates that intracellular concentrations of androgens (particularly in androgen-sensitive tissues) are essentially independent of circulating levels. To assess the clinical significance of modest elevations in serum DHT and the DHT/testosterone (T) ratio observed in response to common T replacement therapy, a comprehensive review of the published literature was performed to identify relevant data. Although the primary focus of this review is about DHT in men, we also provide a brief overview of DHT in women. The available published data are limited by the lack of large, well-controlled studies of long duration that are sufficiently powered to expose subtle safety signals. Nonetheless, the preponderance of available clinical data indicates that modest elevations in circulating levels of DHT in response to androgen therapy should not be of concern in clinical practice. Elevated DHT has not been associated with increased risk of prostate disease (e.g., cancer or benign hyperplasia) nor does it appear to have any systemic effects on cardiovascular disease safety parameters (including increased risk of polycythemia) beyond those commonly observed with available T preparations. Well-controlled, long-term studies of transdermal DHT preparations have failed to identify safety signals unique to markedly elevated circulating DHT concentrations or signals materially different from T.
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Affiliation(s)
- Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Torrance, California 90502
| | | | - Stephanie T Page
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Seattle, Washington 98195
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Torrance, California 90502
- UCLA Clinical and Translational Science Institute, Harbor-UCLA Medical Center, and Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, California 90509
| | - Wael A Salameh
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Torrance, California 90502
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Iyer R, Mok SF, Savkovic S, Turner L, Fraser G, Desai R, Jayadev V, Conway AJ, Handelsman DJ. Pharmacokinetics of testosterone cream applied to scrotal skin. Andrology 2017; 5:725-731. [DOI: 10.1111/andr.12357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- R. Iyer
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - S. F. Mok
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - S. Savkovic
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - L. Turner
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - G. Fraser
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - R. Desai
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - V. Jayadev
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - A. J. Conway
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - D. J. Handelsman
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
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Abstract
The treatment of hypogonadism in men is of great interest to both patients and providers. There are a number of testosterone formulations currently available and several additional formulations under development. In addition, there are some lesser-used alternative therapies for the management of male hypogonadism, which may have advantages for certain patient groups. The future of hypogonadism therapy may lie in the development of selective androgen receptor modulators that allow the benefits of androgens whilst minimizing unwanted side effects.
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Affiliation(s)
- Arthi Thirumalai
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kathryn E Berkseth
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
| | - John K Amory
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington, Seattle, WA, USA
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Ayoub R, Page ST, Swerdloff RS, Liu PY, Amory JK, Leung A, Hull L, Blithe D, Christy A, Chao JH, Bremner WJ, Wang C. Comparison of the single dose pharmacokinetics, pharmacodynamics, and safety of two novel oral formulations of dimethandrolone undecanoate (DMAU): a potential oral, male contraceptive. Andrology 2016; 5:278-285. [PMID: 27907978 DOI: 10.1111/andr.12303] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/20/2016] [Accepted: 10/20/2016] [Indexed: 11/27/2022]
Abstract
Dimethandrolone (DMA, 7α,11β-dimethyl-19-nortestosterone) has both androgenic and progestational activities, ideal properties for a male hormonal contraceptive. In vivo, dimethandrolone undecanoate (DMAU) is hydrolyzed to DMA. We showed previously that single oral doses of DMAU powder in capsule taken with food are well tolerated and effective at suppressing both LH and testosterone (T), but absorption was low. We compared the pharmacokinetics and pharmacodynamics of two new formulations of DMAU, in castor oil and in self-emulsifying drug delivery systems (SEDDS), with the previously tested powder formulation. DMAU was dosed orally in healthy adult male volunteers at two academic medical centers. For each formulation tested in this double-blind, placebo-controlled study, 10 men received single, escalating, oral doses of DMAU (100, 200, and 400 mg) and two subjects received placebo. All doses were evaluated for both fasting and with a high fat meal. All three formulations were well tolerated without clinically significant changes in vital signs, blood counts, or serum chemistries. For all formulations, DMA and DMAU showed higher maximum (p < 0.007) and average concentrations (p < 0.002) at the 400 mg dose, compared with the 200 mg dose. The powder formulation resulted in a lower conversion of DMAU to DMA (p = 0.027) compared with both castor oil and SEDDS formulations. DMAU in SEDDS given fasting resulted in higher serum DMA and DMAU concentrations compared to the other two formulations. Serum LH and sex hormone concentrations were suppressed by all formulations of 200 and 400 mg DMAU when administered with food, but only the SEDDS formulation was effectively suppressed serum T when given fasting. We conclude that while all three formulations of oral DMAU are effective and well tolerated when administered with food, DMAU in oil and SEDDS increased conversion to DMA, and SEDDS may have some effectiveness when given fasting. These properties might be advantageous for the application of DMAU as a male contraceptive.
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Affiliation(s)
- R Ayoub
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - S T Page
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R S Swerdloff
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - P Y Liu
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - J K Amory
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - A Leung
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - L Hull
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - D Blithe
- Contraception Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - A Christy
- Contraception Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - J H Chao
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - W J Bremner
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - C Wang
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Importance of measuring testosterone in enzyme-inhibited plasma for oral testosterone undecanoate androgen replacement therapy clinical trials. Future Sci OA 2015; 1:FSO55. [PMID: 28031910 PMCID: PMC5137954 DOI: 10.4155/fso.15.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: Testosterone undecanoate (TU) is metabolized by nonspecific esterases in blood to testosterone (T). Typical clinical practice has been to analyze testosterone in human serum. The degradation of TU to testosterone was evaluated in conditions typically used in clinical studies. Methods & Results: Freshly collected whole blood was fortified with TU at known concentration. Serum was prepared and T concentration was determined by LC–MS/MS. It was observed that TU degrades extensively to T in human blood under conditions typical of harvesting serum causing overestimation of T concentration of up to 243%. These results were confirmed in a clinical study in which serum and plasma samples were compared. Conclusion: It was demonstrated that T must be analyzed in enzyme-inhibited plasma when TU is the administered medication. Testosterone undecanoate (TU) is metabolized into testosterone. Its degradation in whole blood into testosterone was studied in conditions typically used in clinical trials. It was observed that TU degrades extensively to testosterone in human blood under conditions typical of harvesting serum, causing overestimation of testosterone concentration. It was demonstrated that testosterone must be analyzed in enzyme-inhibited plasma when TU is the administered medication. Using serum for testosterone quantitation in a clinical trial for androgen replacement therapy would bias the conclusions on formulations adjustment and use.
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Kaminetsky J, Jaffe JS, Swerdloff RS. Pharmacokinetic Profile of Subcutaneous Testosterone Enanthate Delivered via a Novel, Prefilled Single-Use Autoinjector: A Phase II Study. Sex Med 2015; 3:269-79. [PMID: 26797061 PMCID: PMC4721027 DOI: 10.1002/sm2.80] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Hypogonadism is one of the most common male endocrine problems. Although many treatments are currently available, unmet need exists for new testosterone (T) replacement therapies that are simple to administer and use, are safe, and mimic physiologic T levels. AIM The study aim was to determine the pharmacokinetics (PK), safety, and tolerability of T enanthate (TE) administered via a novel single-use autoinjector system, which was designed to eject high-viscosity solutions from a prefilled syringe fitted with a five-eighths-inch 27-gauge needle. METHODS Thirty-nine men with hypogonadism entered this dose-finding, open-label, parallel-group study. Patients were washed out of their topical T regimens and randomized to receive 50 or 100 mg of subcutaneous (SC) TE weekly. The reference group were patients with hypogonadism who were maintained on standard 200-mg intramuscular (IM) TE. MAIN OUTCOME MEASURE The primary outcome measure was the PK profile of SC TE, analyzed in reference to T levels used by the Food and Drug Administration to approve T products. Secondary outcome measures were safety and tolerability assessments. RESULTS Both doses of SC TE achieved normal average concentrations of serum T within a 168-h dosing interval after injection. Concentration ranges were similar at all time points following 50-mg SC TE injections and following the third injection in the 100-mg arm. Mean steady-state T concentration at week 6 was 422.4 and 895.5 ng/dL for the 50- and 100-mg SC TE arms, respectively. SC TE demonstrated PK dose proportionality. SC TE restored normal serum T with low variation relative to 200-mg IM without clinically significant adverse events. CONCLUSIONS Administration of TE via this novel injection system restored T levels to normal range in men with hypogonadism. SC TE dosed weekly demonstrated steady, dose-proportional measures of exposure and was well-tolerated. Kaminetsky J, Jaffe JS, Swerdloff RS. Pharmacokinetic profile of subcutaneous testosterone enanthate delivered via a novel, prefilled single-use autoinjector: A phase II study. Sex Med 2015;3:263-273.
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Affiliation(s)
- Jed Kaminetsky
- Manhattan Medical Research University Urology New York NY USA
| | | | - Ronald S Swerdloff
- Endocrinology Los Angeles Biomedical Research Institute Harbor-University of California Medical Center Torrance CA USA
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Discovery Formulations: Approaches and Practices in Early Preclinical Development. DISCOVERING AND DEVELOPING MOLECULES WITH OPTIMAL DRUG-LIKE PROPERTIES 2015. [DOI: 10.1007/978-1-4939-1399-2_2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Coss CC, Jones A, Hancock ML, Steiner MS, Dalton JT. Selective androgen receptor modulators for the treatment of late onset male hypogonadism. Asian J Androl 2014; 16:256-61. [PMID: 24407183 PMCID: PMC3955335 DOI: 10.4103/1008-682x.122339] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Several testosterone preparations are used in the treatment of hypogonadism in the ageing male. These therapies differ in their convenience, flexibility, regional availability and expense but share their pharmacokinetic basis of approval and dearth of long-term safety data. The brevity and relatively reduced cost of pharmacokinetic based registration trials provides little commercial incentive to develop improved novel therapies for the treatment of late onset male hypogonadism. Selective androgen receptor modulators (SARMs) have been shown to provide anabolic benefit in the absence of androgenic effects on prostate, hair and skin. Current clinical development for SARMs is focused on acute muscle wasting conditions with defined clinical endpoints of physical function and lean body mass. Similar regulatory clarity concerning clinical deficits in men with hypogonadism is required before the beneficial pharmacology and desirable pharmacokinetics of SARMs can be employed in the treatment of late onset male hypogonadism.
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Corona G, Maseroli E, Maggi M. Injectable testosterone undecanoate for the treatment of hypogonadism. Expert Opin Pharmacother 2014; 15:1903-26. [DOI: 10.1517/14656566.2014.944896] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Brayden DJ, Walsh E. Efficacious intestinal permeation enhancement induced by the sodium salt of 10-undecylenic acid, a medium chain fatty acid derivative. AAPS JOURNAL 2014; 16:1064-76. [PMID: 24961919 DOI: 10.1208/s12248-014-9634-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
Abstract
10-undecylenic acid (UA) is an OTC antifungal therapy and a nutritional supplement. It is an unsaturated medium chain fatty acid (MCFA) derivative, so our hypothesis was that its 11-mer sodium salt, uC11, would improve intestinal permeation similar to the established enhancer, sodium caprate (C10), but without the toxicity of the parent saturated MCFA, decylenic acid (C11). MTT assay and high-content screening (HCS) confirmed a cytotoxicity ranking in Caco-2 cells: C11 > C10 = uC11. Five to ten millimolars of the three agents reduced TEER and increased the Papp of [(14)C]-mannitol across Caco-2 monolayers and rat intestinal mucosae, a concentration that matched increases in plasma membrane permeability seen in HCS. Although C11 was the most efficacious enhancer in vitro, it damaged monolayers and tissue mucosae more than the other two agents at similar concentrations and exposure times and was therefore not pursued further. Rat jejunal and colonic in situ intestinal instillations of 100 mM C10 or uC11 with FITC-dextran 4000 (FD4) solutions yielded comparable regional enhancement ratios of ~10 and 30%, respectively, for each agent with acceptable tissue histology. Mini-tablets of uC11 and FD4 however delivered more FD4 compared to C10-FD-4 mini-tablets in both regions, as reflected by a statistically higher AUC, and with no evidence of membrane perturbation. The unsaturated bond in uC11 therefore confers a reduction in lipophilicity and cytotoxicity compared to C11, and the resulting permeation enhancement is on a par with or superior to that of C10, a key component of formulations in current phase II oral peptide clinical trials.
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Affiliation(s)
- David J Brayden
- School of Veterinary Medicine, Veterinary Sciences Centre and Conway Institute, University College Dublin, Room 214 Belfield, Dublin 4, Ireland,
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Surampudi P, Page ST, Swerdloff RS, Nya-Ngatchou JJ, Liu PY, Amory JK, Leung A, Hull L, Blithe DL, Woo J, Bremner WJ, Wang C. Single, escalating dose pharmacokinetics, safety and food effects of a new oral androgen dimethandrolone undecanoate in man: a prototype oral male hormonal contraceptive. Andrology 2014; 2:579-587. [PMID: 24789057 DOI: 10.1111/j.2047-2927.2014.00216.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/10/2014] [Accepted: 03/19/2014] [Indexed: 12/18/2022]
Abstract
The novel androgen, dimethandrolone (DMA) has both androgenic and progestational activities, properties that may maximize gonadotropin suppression. We assessed the pharmacokinetics of dimethandrolone undecanoate (DMAU), an orally bioavailable, longer acting ester of DMA, for male contraceptive development. Our objective was to examine the safety and pharmacokinetics of single, escalating doses of DMAU (powder in capsule formulation) administered orally with or without food in healthy men. We conducted a randomized, double-blind Phase 1 study. For each dose of DMAU (25-800 mg), 10 male volunteers received DMAU and two received placebo at two academic medical centres. DMAU was administered both fasting and after a high-fat meal (200-800 mg doses). Serial serum samples were collected over 24 h following each dose. DMAU was well tolerated without significant effects on vital signs, safety laboratory tests or electrocardiograms. When administered while fasting, serum DMA (active compound) was detectable in only 4/10 participants after the 800 mg dose. When administered with a 50% fat meal, serum DMA was detectable in all participants given 200 mg DMAU and showed a dose-incremental increase up to 800 mg, with peak levels 4-8 h after taking the dose. Serum gonadotropins and sex hormone concentrations were significantly suppressed 12 h after DMAU administration with food at doses above 200 mg. This first-in-man study demonstrated that a single, oral dose of DMAU up to 800 mg is safe. A high-fat meal markedly improved DMAU/DMA pharmacokinetics.
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Affiliation(s)
- Prasanth Surampudi
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Stephanie T Page
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Jean Jacques Nya-Ngatchou
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - John K Amory
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Andrew Leung
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Laura Hull
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Diana L Blithe
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Jason Woo
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - William J Bremner
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
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Abstract
INTRODUCTION Men who have symptoms associated with persistently low serum total testosterone level should be assessed for testosterone replacement therapy. AREAS COVERED Acute and chronic illnesses are associated with low serum testosterone and these should be recognized and treated. Once the diagnosis of male hypogonadism is made, the benefits of testosterone treatment usually outweigh the risks. Without contraindications, the patient should be offered testosterone replacement therapy. The options of testosterone delivery systems (injections, transdermal patches/gels, buccal tablets, capsules and implants) have increased in the last decade. Testosterone improves symptoms and signs of hypogonadism such as sexual function and energy, increases bone density and lean mass and decreases visceral adiposity. In men who desire fertility and who have secondary hypogonadism, testosterone can be withdrawn and the patients can be placed on gonadotropins. New modified designer androgens and selective androgen receptor modulators have been in preclinical and clinical trials for some time. None of these have been assessed for the treatment of male hypogonadism. EXPERT OPINION Despite the lack of prospective long-term data from randomized, controlled clinical trials of testosterone treatment on prostate health and cardiovascular disease risk, the available evidence suggests that testosterone therapy should be offered to symptomatic hypogonadal men.
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Affiliation(s)
- Prasanth Surampudi
- Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Division of Endocrinology, Department of Medicine , Torrance, CA, 90509 , USA
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Yin A, Alfadhli E, Htun M, Dudley R, Faulkner S, Hull L, Leung A, Bross R, Longstreth J, Swerdloff R, Wang C. Dietary fat modulates the testosterone pharmacokinetics of a new self-emulsifying formulation of oral testosterone undecanoate in hypogonadal men. ACTA ACUST UNITED AC 2012; 33:1282-90. [PMID: 22790645 DOI: 10.2164/jandrol.112.017020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigates the effect of dietary fat on the testosterone (T) pharmacokinetics in hypogonadal men following administration of a self-emulsifying capsule formulation of oral T undecanoate (TU). In an open-label, 2-center, 5-way crossover study, a single oral dose of TU containing 300-mg equivalents of T (maximum anticipated human dose per administration) was administered to 16 hypogonadal men with a washout period of at least 5 days between doses. All participants were randomized to receive the TU capsules fasting or 30 minutes after an approximately 800-calorie meal containing 10%, 20%, 30%, or 50% fat. Serial blood samples were collected from 2 hours predose to 25 hours postdose to determine serum T and dihydrotestosterone (DHT) by liquid chromatography tandem mass spectrometry. Administering TU with a meal increased serum T concentrations, with the magnitude of the increase being directly dependent on the amount of fat in the meal. Average and peak serum T concentrations and area under the curve increased as the fat content of the meal was increased. Neither the high-fat meal (50% fat) nor the lower-fat meal (20% fat) showed a significant food effect relative to the normal-fat (Western diet) meal (30% fat). However, administering TU while fasting resulted in 50% or less of the cumulative exposure obtained when administered with 20%- to 50%-fat meals (albeit still substantial). A very-low-fat meal (10% fat) showed a significant food effect relative to the normal meal, but still exceeded the fasting condition by approximately 50%. Serum DHT concentrations showed corresponding increases to the serum T. As expected with the maximum anticipated clinical dose of TU (300 mg T), oral administration of this new formulation with food containing 20% to 50% dietary fat produced T levels at or above the upper range of adult men, and T levels trended higher as dietary fat content increased. Only with a very-low-fat diet (10%) or in a fasted state did a clinically significant food effect occur, but even then sufficient TU was absorbed with the self-emulsifying TU formulation to produce average serum T concentration predicted to be in the normal reference range (10 to 35 nmol/L).
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Affiliation(s)
- Anthony Yin
- Division of Endocrinology, Department of Medicine and the UCLA–Clinical and Translational Science Institute, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90509, USA
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