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Foxen B, Neill C, Dunsworth A, Roushan P, Chiaro B, Megrant A, Kelly J, Chen Z, Satzinger K, Barends R, Arute F, Arya K, Babbush R, Bacon D, Bardin JC, Boixo S, Buell D, Burkett B, Chen Y, Collins R, Farhi E, Fowler A, Gidney C, Giustina M, Graff R, Harrigan M, Huang T, Isakov SV, Jeffrey E, Jiang Z, Kafri D, Kechedzhi K, Klimov P, Korotkov A, Kostritsa F, Landhuis D, Lucero E, McClean J, McEwen M, Mi X, Mohseni M, Mutus JY, Naaman O, Neeley M, Niu M, Petukhov A, Quintana C, Rubin N, Sank D, Smelyanskiy V, Vainsencher A, White TC, Yao Z, Yeh P, Zalcman A, Neven H, Martinis JM. Demonstrating a Continuous Set of Two-Qubit Gates for Near-Term Quantum Algorithms. Phys Rev Lett 2020; 125:120504. [PMID: 33016760 DOI: 10.1103/physrevlett.125.120504] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/27/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Quantum algorithms offer a dramatic speedup for computational problems in material science and chemistry. However, any near-term realizations of these algorithms will need to be optimized to fit within the finite resources offered by existing noisy hardware. Here, taking advantage of the adjustable coupling of gmon qubits, we demonstrate a continuous two-qubit gate set that can provide a threefold reduction in circuit depth as compared to a standard decomposition. We implement two gate families: an imaginary swap-like (iSWAP-like) gate to attain an arbitrary swap angle, θ, and a controlled-phase gate that generates an arbitrary conditional phase, ϕ. Using one of each of these gates, we can perform an arbitrary two-qubit gate within the excitation-preserving subspace allowing for a complete implementation of the so-called Fermionic simulation (fSim) gate set. We benchmark the fidelity of the iSWAP-like and controlled-phase gate families as well as 525 other fSim gates spread evenly across the entire fSim(θ,ϕ) parameter space, achieving a purity-limited average two-qubit Pauli error of 3.8×10^{-3} per fSim gate.
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Affiliation(s)
- B Foxen
- Department of Physics, University of California, Santa Barbara, California 93106, USA
- Google Research, Santa Barbara, California 93117, USA
| | - C Neill
- Google Research, Santa Barbara, California 93117, USA
| | - A Dunsworth
- Google Research, Santa Barbara, California 93117, USA
| | - P Roushan
- Google Research, Santa Barbara, California 93117, USA
| | - B Chiaro
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - A Megrant
- Google Research, Santa Barbara, California 93117, USA
| | - J Kelly
- Google Research, Santa Barbara, California 93117, USA
| | - Zijun Chen
- Google Research, Santa Barbara, California 93117, USA
| | - K Satzinger
- Google Research, Santa Barbara, California 93117, USA
| | - R Barends
- Google Research, Santa Barbara, California 93117, USA
| | - F Arute
- Google Research, Santa Barbara, California 93117, USA
| | - K Arya
- Google Research, Santa Barbara, California 93117, USA
| | - R Babbush
- Google Research, Santa Barbara, California 93117, USA
| | - D Bacon
- Google Research, Santa Barbara, California 93117, USA
| | - J C Bardin
- Google Research, Santa Barbara, California 93117, USA
- Department of Electrical and Computer Engineering, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, USA
| | - S Boixo
- Google Research, Santa Barbara, California 93117, USA
| | - D Buell
- Google Research, Santa Barbara, California 93117, USA
| | - B Burkett
- Google Research, Santa Barbara, California 93117, USA
| | - Yu Chen
- Google Research, Santa Barbara, California 93117, USA
| | - R Collins
- Google Research, Santa Barbara, California 93117, USA
| | - E Farhi
- Google Research, Santa Barbara, California 93117, USA
| | - A Fowler
- Google Research, Santa Barbara, California 93117, USA
| | - C Gidney
- Google Research, Santa Barbara, California 93117, USA
| | - M Giustina
- Google Research, Santa Barbara, California 93117, USA
| | - R Graff
- Google Research, Santa Barbara, California 93117, USA
| | - M Harrigan
- Google Research, Santa Barbara, California 93117, USA
| | - T Huang
- Google Research, Santa Barbara, California 93117, USA
| | - S V Isakov
- Google Research, Santa Barbara, California 93117, USA
| | - E Jeffrey
- Google Research, Santa Barbara, California 93117, USA
| | - Z Jiang
- Google Research, Santa Barbara, California 93117, USA
| | - D Kafri
- Google Research, Santa Barbara, California 93117, USA
| | - K Kechedzhi
- Google Research, Santa Barbara, California 93117, USA
| | - P Klimov
- Google Research, Santa Barbara, California 93117, USA
| | - A Korotkov
- Google Research, Santa Barbara, California 93117, USA
| | - F Kostritsa
- Google Research, Santa Barbara, California 93117, USA
| | - D Landhuis
- Google Research, Santa Barbara, California 93117, USA
| | - E Lucero
- Google Research, Santa Barbara, California 93117, USA
| | - J McClean
- Google Research, Santa Barbara, California 93117, USA
| | - M McEwen
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - X Mi
- Google Research, Santa Barbara, California 93117, USA
| | - M Mohseni
- Google Research, Santa Barbara, California 93117, USA
| | - J Y Mutus
- Google Research, Santa Barbara, California 93117, USA
| | - O Naaman
- Google Research, Santa Barbara, California 93117, USA
| | - M Neeley
- Google Research, Santa Barbara, California 93117, USA
| | - M Niu
- Google Research, Santa Barbara, California 93117, USA
| | - A Petukhov
- Google Research, Santa Barbara, California 93117, USA
| | - C Quintana
- Google Research, Santa Barbara, California 93117, USA
| | - N Rubin
- Google Research, Santa Barbara, California 93117, USA
| | - D Sank
- Google Research, Santa Barbara, California 93117, USA
| | - V Smelyanskiy
- Google Research, Santa Barbara, California 93117, USA
| | - A Vainsencher
- Google Research, Santa Barbara, California 93117, USA
| | - T C White
- Google Research, Santa Barbara, California 93117, USA
| | - Z Yao
- Google Research, Santa Barbara, California 93117, USA
| | - P Yeh
- Google Research, Santa Barbara, California 93117, USA
| | - A Zalcman
- Google Research, Santa Barbara, California 93117, USA
| | - H Neven
- Google Research, Santa Barbara, California 93117, USA
| | - J M Martinis
- Department of Physics, University of California, Santa Barbara, California 93106, USA
- Google Research, Santa Barbara, California 93117, USA
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Barends R, Quintana CM, Petukhov AG, Chen Y, Kafri D, Kechedzhi K, Collins R, Naaman O, Boixo S, Arute F, Arya K, Buell D, Burkett B, Chen Z, Chiaro B, Dunsworth A, Foxen B, Fowler A, Gidney C, Giustina M, Graff R, Huang T, Jeffrey E, Kelly J, Klimov PV, Kostritsa F, Landhuis D, Lucero E, McEwen M, Megrant A, Mi X, Mutus J, Neeley M, Neill C, Ostby E, Roushan P, Sank D, Satzinger KJ, Vainsencher A, White T, Yao J, Yeh P, Zalcman A, Neven H, Smelyanskiy VN, Martinis JM. Diabatic Gates for Frequency-Tunable Superconducting Qubits. Phys Rev Lett 2019; 123:210501. [PMID: 31809160 DOI: 10.1103/physrevlett.123.210501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Indexed: 06/10/2023]
Abstract
We demonstrate diabatic two-qubit gates with Pauli error rates down to 4.3(2)×10^{-3} in as fast as 18 ns using frequency-tunable superconducting qubits. This is achieved by synchronizing the entangling parameters with minima in the leakage channel. The synchronization shows a landscape in gate parameter space that agrees with model predictions and facilitates robust tune-up. We test both iswap-like and cphase gates with cross-entropy benchmarking. The presented approach can be extended to multibody operations as well.
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Affiliation(s)
- R Barends
- Google, Santa Barbara, California 93117, USA
| | | | | | - Yu Chen
- Google, Santa Barbara, California 93117, USA
| | - D Kafri
- Google, Venice, California 90291, USA
| | | | - R Collins
- Google, Santa Barbara, California 93117, USA
| | - O Naaman
- Google, Santa Barbara, California 93117, USA
| | - S Boixo
- Google, Venice, California 90291, USA
| | - F Arute
- Google, Santa Barbara, California 93117, USA
| | - K Arya
- Google, Santa Barbara, California 93117, USA
| | - D Buell
- Google, Santa Barbara, California 93117, USA
| | - B Burkett
- Google, Santa Barbara, California 93117, USA
| | - Z Chen
- Google, Santa Barbara, California 93117, USA
| | - B Chiaro
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - A Dunsworth
- Google, Santa Barbara, California 93117, USA
| | - B Foxen
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - A Fowler
- Google, Santa Barbara, California 93117, USA
| | - C Gidney
- Google, Santa Barbara, California 93117, USA
| | - M Giustina
- Google, Santa Barbara, California 93117, USA
| | - R Graff
- Google, Santa Barbara, California 93117, USA
| | - T Huang
- Google, Santa Barbara, California 93117, USA
| | - E Jeffrey
- Google, Santa Barbara, California 93117, USA
| | - J Kelly
- Google, Santa Barbara, California 93117, USA
| | - P V Klimov
- Google, Santa Barbara, California 93117, USA
| | - F Kostritsa
- Google, Santa Barbara, California 93117, USA
| | - D Landhuis
- Google, Santa Barbara, California 93117, USA
| | - E Lucero
- Google, Santa Barbara, California 93117, USA
| | - M McEwen
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - A Megrant
- Google, Santa Barbara, California 93117, USA
| | - X Mi
- Google, Santa Barbara, California 93117, USA
| | - J Mutus
- Google, Santa Barbara, California 93117, USA
| | - M Neeley
- Google, Santa Barbara, California 93117, USA
| | - C Neill
- Google, Santa Barbara, California 93117, USA
| | - E Ostby
- Google, Venice, California 90291, USA
| | - P Roushan
- Google, Santa Barbara, California 93117, USA
| | - D Sank
- Google, Santa Barbara, California 93117, USA
| | | | | | - T White
- Google, Santa Barbara, California 93117, USA
| | - J Yao
- Google, Santa Barbara, California 93117, USA
| | - P Yeh
- Google, Santa Barbara, California 93117, USA
| | - A Zalcman
- Google, Santa Barbara, California 93117, USA
| | - H Neven
- Google, Venice, California 90291, USA
| | | | - John M Martinis
- Google, Santa Barbara, California 93117, USA
- Department of Physics, University of California, Santa Barbara, California 93106, USA
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3
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Appleton E, Buell D, Agnew A, Hunter R. Skeletal Health in Collegiate Club Triathlon Athletes. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.06.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kontoyiannis D, Ratanatharathorn V, Young JA, Raymond J, Laverdière M, Denning D, Patterson T, Facklam D, Kovanda L, Arnold L, Lau W, Buell D, Marr K. Micafungin alone or in combination with other systemic antifungal therapies in hematopoietic stem cell transplant recipients with invasive aspergillosis. Transpl Infect Dis 2009; 11:89-93. [DOI: 10.1111/j.1399-3062.2008.00349.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nucci M, Betts R, Dupont B, Wu C, Buell D, Kovanda L, Lortholary O. Impact of early catheter removal during treatment of invasive candidiasis: analysis from two phase 3 micafungin trials. Crit Care 2009. [PMCID: PMC4084079 DOI: 10.1186/cc7357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ullmann A, De Waele J, Betts R, Rotstein C, Nucci M, Kovanda L, Wu C, Buell D, Diekmann H, Koblinger S, Cornely O. P981 Efficacy of micafungin in patients with deep, invasive Candida infections. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dupont B, De Waele J, Betts R, Rotstein C, Nucci M, Arnold L, Kovanda L, Wu C, Buell D. O140 Micafungin versus caspofungin in patients with invasive candidiasis or candidaemia: a Phase III, randomised, double-blind, parallel group, non-inferiority study. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Keirns J, Sawamoto T, Holum M, Buell D, Wisemandle W, Alak A. Steady-state pharmacokinetics of micafungin and voriconazole after separate and concomitant dosing in healthy adults. Antimicrob Agents Chemother 2006; 51:787-90. [PMID: 17116670 PMCID: PMC1797737 DOI: 10.1128/aac.00673-06] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We assessed the pharmacokinetics and interactions of steady-state micafungin (Mycamine) or placebo with steady-state voriconazole in 35 volunteers. The 90% confidence intervals around the least-squares mean ratios for micafungin pharmacokinetic parameters and placebo-corrected voriconazole pharmacokinetic parameters were within the 80%-to-125% limits, indicating an absence of drug interaction.
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Affiliation(s)
- J Keirns
- Astellas Pharma US, Inc., 3 Parkway North, Deerfield, IL 60015-2548, USA.
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Mita A, Antonia S, Lewis L, Mahany J, Reddy N, Ricart A, Till E, Buell D, Keating A, Tolcher A. 29LB1 Late Breaking ORAL Final safety, pharmacokinetic and antitumor activity results of a phase I study of YM155, a novel survivin inhibitor, when administered by 168 hour continuous infusion. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70035-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Tolcher AW, Antonia S, Lewis LD, Mita A, Mahany J, Reddy NJ, Till E, Buell D, Keating AT. A phase I study of YM155, a novel survivin suppressant, administered by 168 hour continuous infusion to patients with advanced solid tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3014 Background: Survivin is one of the family of inhibitor of apoptosis proteins (IAP) that suppresses apoptosis through inhibition of caspases and procaspases. Survivin is selectively expressed in most solid tumors but not normal tissues. In a PC-3 cell model YM155 inhibited survivin mRNA transcription and survivin protein expression and showed potent (nM) anti-proliferative activity in preclinical models including tumor regressions. Methods: The objectives were to determine the maximum tolerated dose (MTD) of 168 hour continuous infusion of YM155 every 3 weeks, to evaluate toxicity, characterize the pharmacokinetics and observe anti-tumor activity. Standard 3+3 dose escalation scheme was utilized. Additional pts were added to fully characterize toxicities at the MTD. Pharmacokinetic sampling was performed during cycles 1 and 2. Results: 41 pts (M/F: 31/10, median age 61, range 28–78) with performance status of 0–2 were enrolled into 4 dose cohorts [1.8 mg/m2/day (N = 8), 3.6 (6), 6.0 (2) and 4.8 (25)]. Most common tumor types were prostate (9), NHL (5), and colorectal (5). 2/2 pts experienced DLTs at 6.0 (renal tubular necrosis with grade 3 mucositis and increased serum creatinine), thus the MTD was 4.8 mg/m2/day. The most frequent AEs were: pyrexia, arthralgia, nausea, fatigue and diarrhea. The most common grade 3 or 4 drug related AEs were: mucosal inflammation (N = 2, 4.9%) and increased INR (N = 2, 4.9%). At MTD, the median clearance was 47 L/hr with a median steady state concentration of 7.5 ng/mL and a median terminal half-life of 22 hours. Two pts with chemotherapy refractory intermediate grade NHL had marked reduction of lymph nodes including one that was durable (PR reviewed independently). This pt went onto BMT and was in remission at the time of this submission. Two HRPC pts exhibited PSA response (> 50% reduction). Conclusions: YM 155, the first survivin inhibitor, was well tolerated, had a MTD of 4.8 mg/m2/day × 7 days and exhibited provocative anti-tumor activity in 4 pts that warrant broad phase II evaluation. No significant financial relationships to disclose.
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Affiliation(s)
- A. W. Tolcher
- Institute For Drug Development, San Antonio, TX; H. Lee Moffitt Cancer Center, Tampa, FL; Dartmouth-Hitchcock Medical Center, Lebanon, NJ; Astellas Pharma US, Inc., Deerfield, IL
| | - S. Antonia
- Institute For Drug Development, San Antonio, TX; H. Lee Moffitt Cancer Center, Tampa, FL; Dartmouth-Hitchcock Medical Center, Lebanon, NJ; Astellas Pharma US, Inc., Deerfield, IL
| | - L. D. Lewis
- Institute For Drug Development, San Antonio, TX; H. Lee Moffitt Cancer Center, Tampa, FL; Dartmouth-Hitchcock Medical Center, Lebanon, NJ; Astellas Pharma US, Inc., Deerfield, IL
| | - A. Mita
- Institute For Drug Development, San Antonio, TX; H. Lee Moffitt Cancer Center, Tampa, FL; Dartmouth-Hitchcock Medical Center, Lebanon, NJ; Astellas Pharma US, Inc., Deerfield, IL
| | - J. Mahany
- Institute For Drug Development, San Antonio, TX; H. Lee Moffitt Cancer Center, Tampa, FL; Dartmouth-Hitchcock Medical Center, Lebanon, NJ; Astellas Pharma US, Inc., Deerfield, IL
| | - N. J. Reddy
- Institute For Drug Development, San Antonio, TX; H. Lee Moffitt Cancer Center, Tampa, FL; Dartmouth-Hitchcock Medical Center, Lebanon, NJ; Astellas Pharma US, Inc., Deerfield, IL
| | - E. Till
- Institute For Drug Development, San Antonio, TX; H. Lee Moffitt Cancer Center, Tampa, FL; Dartmouth-Hitchcock Medical Center, Lebanon, NJ; Astellas Pharma US, Inc., Deerfield, IL
| | - D. Buell
- Institute For Drug Development, San Antonio, TX; H. Lee Moffitt Cancer Center, Tampa, FL; Dartmouth-Hitchcock Medical Center, Lebanon, NJ; Astellas Pharma US, Inc., Deerfield, IL
| | - A. T. Keating
- Institute For Drug Development, San Antonio, TX; H. Lee Moffitt Cancer Center, Tampa, FL; Dartmouth-Hitchcock Medical Center, Lebanon, NJ; Astellas Pharma US, Inc., Deerfield, IL
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Hiemenz J, Cagnoni P, Simpson D, Devine S, Chao N, Keirns J, Lau W, Facklam D, Buell D. Pharmacokinetic and maximum tolerated dose study of micafungin in combination with fluconazole versus fluconazole alone for prophylaxis of fungal infections in adult patients undergoing a bone marrow or peripheral stem cell transplant. Antimicrob Agents Chemother 2005; 49:1331-6. [PMID: 15793107 PMCID: PMC1068634 DOI: 10.1128/aac.49.4.1331-1336.2005] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this dose escalation study, 74 adult cancer patients undergoing bone marrow or peripheral blood stem cell transplantation received fluconazole (400 mg/day) and either normal saline (control) (12 subjects) or micafungin (12.5 to 200 mg/day) (62 subjects) for up to 4 weeks. The maximum tolerated dose (MTD) of micafungin was not reached, based on the development of Southwest Oncology Group criteria for grade 3 toxicity; drug-related toxicities were rare. Commonly occurring adverse events considered related to micafungin were headache (6.8%), arthralgia (6.8%), hypophosphatemia (4.1%), insomnia (4.1%), maculopapular rash (4.1%), and rash (4.1%). Pharmacokinetic profiles for micafungin on days 1 and 7 were similar. The mean half-life was approximately 13 h, with little variance after repeated or increasing doses. Mean maximum concentrations of the drug in serum and areas under the concentration-time curve from 0 to 24 h were approximately proportional to dose. There was no clinical or kinetic evidence of interaction between micafungin and fluconazole. Five of 12 patients (42%) in the control group and 14 of 62 (23%) in the micafungin-plus-fluconazole groups had a suspected fungal infection during treatment which resulted in empirical treatment with amphotericin B. The combination of micafungin and fluconazole was found to be safe in this high-risk patient population. The MTD of micafungin was not reached even at doses up to 200 mg/day for 4 weeks. The pharmacokinetic profile of micafungin in adult cancer patients with blood or marrow transplants is consistent with the profile in healthy volunteers, and the area under the curve is proportional to dose.
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Affiliation(s)
- J Hiemenz
- Florida Hospital Cancer Institute, Orlando, Florida, USA.
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de Wet NTE, Bester AJ, Viljoen JJ, Filho F, Suleiman JM, Ticona E, Llanos EA, Fisco C, Lau W, Buell D. A randomized, double blind, comparative trial of micafungin (FK463) vs. fluconazole for the treatment of oesophageal candidiasis. Aliment Pharmacol Ther 2005; 21:899-907. [PMID: 15801925 DOI: 10.1111/j.1365-2036.2005.02427.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
AIM To determine efficacy and safety of intravenous micafungin vs. intravenous fluconazole in the treatment of oesophageal candidiasis. METHODS A total of 523 patients > or =16 years with documented oesophageal candidiasis were randomized (1:1) in this controlled, non-inferiority study to receive either micafungin (150 mg/day) or fluconazole (200 mg/day). Response was evaluated clinically and endoscopically. Post-treatment assessments were performed at 2 and 4 weeks after discontinuation of therapy. RESULTS Median duration of therapy was 14 days. For the primary end-point of endoscopic cure, treatment difference was -0.3% (micafungin 87.7%, fluconazole 88.0%). Documented persistent invasive disease at the end of therapy was reported in 2.7% and 3.9% of patients, respectively. Both 84.8% of micafungin and 88.7% of fluconazole patients remained recurrence free at 4-weeks post-treatment. The overall therapeutic response rate was 87.3% for micafungin and 87.2% for fluconazole. The incidence of drug-related adverse events was 27.7% for micafungin and 21.3% for fluconazole. Six (2.3%) micafungin- and two (0.8%) fluconazole-treated patients discontinued therapy; rash was the most common event leading to discontinuation. CONCLUSION Intravenous micafungin (150 mg daily) is well tolerated and as efficacious as intravenous fluconazole (200 mg daily) in the primary treatment of oesophageal candidiasis, achieving high rates of clinical and endoscopic cure.
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Abstract
AIM To determine the minimum effective dose and safety of micafungin in the treatment of HIV-related oesophageal candidiasis. METHOD A total of 120 patients were enrolled in this open label study of the effects of daily 1 h infusions of micafungin on endoscopically proven fungal oesophagitis. Patients were randomly assigned to receive 12.5, 25, 50, 75 and 100 mg of micafungin daily. Response was evaluated clinically and endoscopically. RESULTS The protocol defined minimum effective dose of micafungin was 12.5 mg. The percentage of patients experiencing clearing of physical signs and symptoms showed a dose-response relationship and reached 94.7% in the 100 mg dose group. All patients in the 50, 75 and 100 mg dose groups achieved an endoscopically verified improvement in oesophagitis. Adverse effects of micafungin were generally mild and not dose-related. No serious renal, hepatic or drug-related infusion reactions were encountered. CONCLUSION Micafungin was found to be effective, well-tolerated and safe. The minimum effective dose was found to be 12.5 mg and a significant linear trend in the successful treatment of oesophageal candidiasis was observed across the doses used with 75 and 100 mg dose levels achieving high rates of clinical and endoscopic cure.
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Bekersky I, Boswell GW, Hiles R, Fielding RM, Buell D, Walsh TJ. Safety, toxicokinetics and tissue distribution of long-term intravenous liposomal amphotericin B (AmBisome): a 91-day study in rats. Pharm Res 2000; 17:1494-502. [PMID: 11303959 DOI: 10.1023/a:1007605024942] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Amphotericin B in small, unilamellar liposomes (AmBisome) is safer and produces higher plasma concentrations than other formulations. Because liposomes may increase and prolong tissue exposures, the potential for drug accumulation or delayed toxicity after chronic AmBisome was investigated. METHODS Rats (174/sex) received intravenous AmBisome (1, 4, or 12 mg/kg), dextrose, or empty liposomes for 91 days with a 30-day recovery. Safety (including clinical and microscopic pathology) and toxicokinetics in plasma and tissues were evaluated. RESULTS Chemical and histopathologic changes demonstrated that the kidneys and liver were the target organs for chronic AmBisome toxicity. Nephrotoxicity was moderate (urean nitrogen [BUN] < or = 51 mg/dl; creatinine unchanged). Liposome-related changes (vacuolated macrophages and hypercholesterolemia) were also observed. Although plasma and tissue accumulation was nonlinear and progressive (clearance and volume decreased, half-life increased with dose and time), most toxic changes occurred early, stabilized by the end of dosing, and reversed during recovery. There were no delayed toxicities. Concentrations in liver and spleen greatly exceeded those in plasma: kidney and lung concentrations were similar to those in plasma. Elimination half-lives were 1-4 weeks in all tissues. CONCLUSIONS Despite nonlinear accumulation, AmBisome revealed predictable hepatic and renal toxicities after 91 days, with no new or delayed effects after prolonged treatment at high doses that resulted in plasma levels >200 microg/ml and tissue levels >3000 microg/g.
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Affiliation(s)
- I Bekersky
- Fujisawa Healthcare Inc, Deerfield, IL, USA.
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15
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Nash RA, Antin JH, Karanes C, Fay JW, Avalos BR, Yeager AM, Przepiorka D, Davies S, Petersen FB, Bartels P, Buell D, Fitzsimmons W, Anasetti C, Storb R, Ratanatharathorn V. Phase 3 study comparing methotrexate and tacrolimus with methotrexate and cyclosporine for prophylaxis of acute graft-versus-host disease after marrow transplantation from unrelated donors. Blood 2000; 96:2062-8. [PMID: 10979948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
After the transplantation of unmodified marrow from human leukocyte antigen-matched unrelated donors receiving cyclosporine (CSP) and methotrexate (MTX), the incidence of acute graft-versus-host disease (GVHD) is greater than 75%. Tacrolimus is a macrolide compound that, in previous preclinical and clinical studies, was effective in combination with MTX for the prevention of acute GVHD. Between March 1995 and September 1996, 180 patients were randomized in a phase 3, open-label, multicenter study to determine whether tacrolimus combined with a short course of MTX (n = 90), more than CSP and a short course of MTX (n = 90), would reduce the incidence of acute GVHD after marrow transplantation from unrelated donors. There was a significant trend toward decreased severity of acute GVHD across all grades (P =.005). Based on the Kaplan-Meier estimate, the probability of grade II-IV acute GVHD in the tacrolimus group (56%) was significantly lower than in the CSP group (74%; P =.0002). Use of glucocorticoids for the management of GVHD was significantly lower with tacrolimus than with CSP (65% vs 81%, respectively; P =. 019). The number of patients requiring dialysis in the first 100 days was similar (tacrolimus, 9; CSP, 8). Overall and relapse-free survival rates for the tacrolimus and CSP arms at 2 years was 54% versus 50% (P =.46) and 47% versus 42% (P =.58), respectively. The combination of tacrolimus and MTX after unrelated donor marrow transplantation significantly decreased the risk for acute GVHD than did the combination of CSP and MTX, with no significant increase in toxicity, infections, or leukemia relapse.
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Affiliation(s)
- R A Nash
- Clinical Research Division, Fred Hutchinson Cancer Research Center, and the Department of Medicine, University of Washington, Seattle, WA, USA.
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16
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Bekersky I, Boswell GW, Hiles R, Fielding RM, Buell D, Walsh TJ. Safety and toxicokinetics of intravenous liposomal amphotericin B (AmBisome) in beagle dogs. Pharm Res 1999; 16:1694-701. [PMID: 10571274 DOI: 10.1023/a:1018997730462] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Amphotericin B (AmB) in small, unilamellar liposomes (AmBisome) has an improved therapeutic index, and altered pharmacokinetics. The repeat-dose safety and toxicokinetic profiles of AmBisome were studied at clinically relevant doses. METHODS Beagle dogs (5/sex/group) received intravenous AmBisome (0.25, 1, 4, 8, and 16 mg/kg/day), empty liposomes or vehicle for 30 days. AmB was determined in plasma on days 1, 14, and 30, and in tissues on day 31. Safety parameters included body weight, clinical chemistry, hematology and microscopic pathology. RESULTS Seventeen of twenty animals receiving 8 and 16 mg/kg were sacrificed early due to weight loss caused by reduced food intake. Dose-dependent renal tubular nephrosis, and other effects characteristic of conventional AmB occurred at 1 mg/kg/day or higher. Although empty liposomes and AmBisome increased plasma cholesterol, no toxicities unique to AmBisome were revealed. Plasma ultrafiltrates contained no AmB. AmBisome achieved plasma levels 100-fold higher than other AmB formulations. AmBisome kinetics were non-linear, with clearance and distribution volumes decreasing with increasing dose. This, and nonlinear tissue uptake, suggest AmBisome disposition was saturable. CONCLUSIONS AmBisome has the same toxic effects as conventional AmB, but they appear at much higher plasma exposures. AmBisome's non-linear pharmacokinetics are not associated with increased risk, as toxicity increases linearly with dosage. Dogs tolerated AmBisome with minimal to moderate changes in renal function at doses (4 mg/kg/day) producing peak plasma concentrations of 18-94 microg/mL.
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Affiliation(s)
- I Bekersky
- Fujisawa Healthcare Inc., Deerfield, Illinois 60015-2548, USA.
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17
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Abstract
Amphotericin B has been the mainstay of systemic antifungal therapy for over 30 years, despite its serious side-effects, and, although numerous alternative antifungal agents have been developed, none to date has matched the efficacy of amphotericin B. However, modern drug delivery technology has improved the safety of amphotericin B by incorporating it into lipid-based delivery systems, including liposomes. Three such formulations, based on the natural affinity of amphotericin B for lipids, are currently marketed. All increase the therapeutic index of amphotericin B, thereby allowing more aggressive treatment than is possible with the conventional product. However, they differ in structure, side-effect profiles and evidence of proven efficacy as discussed in this review.
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Affiliation(s)
- I Bekersky
- Fujisawa Healthcare, Inc., Three Parkway North, Deerfield, IL 60015, USA
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18
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Walsh TJ, Yeldandi V, McEvoy M, Gonzalez C, Chanock S, Freifeld A, Seibel NI, Whitcomb PO, Jarosinski P, Boswell G, Bekersky I, Alak A, Buell D, Barret J, Wilson W. Safety, tolerance, and pharmacokinetics of a small unilamellar liposomal formulation of amphotericin B (AmBisome) in neutropenic patients. Antimicrob Agents Chemother 1998; 42:2391-8. [PMID: 9736569 PMCID: PMC105839 DOI: 10.1128/aac.42.9.2391] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/1997] [Accepted: 05/03/1998] [Indexed: 11/20/2022] Open
Abstract
The safety, tolerance, and pharmacokinetics of a small unilamellar liposomal formulation of amphotericin B (AmBisome) administered for empirical antifungal therapy were evaluated for 36 persistently febrile neutropenic adults receiving cancer chemotherapy and bone marrow transplantation. The protocol was an open-label, sequential-dose-escalation, multidose pharmacokinetic study which enrolled a total of 8 to 12 patients in each of the four dosage cohorts. Each cohort received daily doses of either 1.0, 2.5, 5.0, or 7.5 mg of amphotericin B in the form of AmBisome/kg of body weight. The study population consisted of patients between the ages of 13 and 80 years with neutropenia (absolute neutrophil count, <500/mm3) who were eligible to receive empirical antifungal therapy. Patients were monitored for safety and tolerance by frequent laboratory examinations and the monitoring of infusion-related reactions. Efficacy was assessed by monitoring for the development of invasive fungal infection. The pharmacokinetic parameters of AmBisome were measured as those of amphotericin B by high-performance liquid chromatography. Noncompartmental methods were used to calculate pharmacokinetic parameters. AmBisome administered as a 1-h infusion in this population was well tolerated and was seldom associated with infusion-related toxicity. Infusion-related side effects occurred in 15 (5%) of all 331 infusions, and only two patients (5%) required premedication. Serum creatinine, potassium, and magnesium levels were not significantly changed from baseline in any of the dosage cohorts, and there was no net increase in serum transaminase levels. AmBisome followed a nonlinear dosage relationship that was consistent with reticuloendothelial uptake and redistribution. There were no breakthrough fungal infections during empirical therapy with AmBisome. AmBisome administered to febrile neutropenic patients in this study was well tolerated, was seldom associated with infusion-related toxicity, was characterized by nonlinear saturation kinetics, and was effective in preventing breakthrough fungal infections.
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Affiliation(s)
- T J Walsh
- Pediatric Oncology Branch, National Institutes of Health, Bethesda, Maryland, USA.
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19
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Abstract
AmBisome (NeXstarPharmaceuticals, San Dimas, CA) is a unilamellar liposomal formulation of amphotericin B that was recently approved for use as empirical treatment for presumed fungal infections in febrile neutropenic patients and for aspergillosis, candidiasis, and cryptococcosis infections refractory to amphotericin B. It is a small closed microscopic sphere (<100 nm in diameter) with an inner aqueous core (i.e., a true liposome). AmBisome remains as an intact sphere in vitro and for prolonged periods of time in vivo during the processes of systemic transport and pharmacologic action. As a consequence of its size and in vivo stability, AmBisome has physiochemical properties and a pharmacokinetic profile that are considerably different from those of currently available lipid-complexed amphotericin B formulations, with greatly increased area under the plasma concentration-time curve and much lower clearance at equivalent doses. AmBisome liposomes can be seen to accumulate at sites of fungal infection. Disruption of AmBisome liposomes occurs after attachment to the fungal cell wall and results in amphotericin B binding to fungal cell membrane ergosterol with subsequent cell lysis. AmBisome has been shown to penetrate the cell wall of both extracellular and intracellular forms of susceptible fungi.
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Affiliation(s)
- G W Boswell
- Fujisawa USA, Inc., Deerfield, Illinois 60015, USA
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20
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Boswell GW, Bekersky I, Buell D, Hiles R, Walsh TJ. Toxicological profile and pharmacokinetics of a unilamellar liposomal vesicle formulation of amphotericin B in rats. Antimicrob Agents Chemother 1998; 42:263-8. [PMID: 9527770 PMCID: PMC105398 DOI: 10.1128/aac.42.2.263] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AmBisome (ABLP) is a unilamellar liposomal preparation of amphotericin B that has demonstrated an improved safety profile compared to conventional amphotericin B. Single- and multiple-dose pharmacokinetics were determined by using noncompartmental methods for rats administered ABLP at 1, 3, 9, and 20 mg/kg/day. The toxicological profile was evaluated following 30 consecutive days of intravenous ABLP administration. Mean plasma amphotericin B concentrations reached 500 and 380 microg/ml (males and females, respectively) following 30 days of ABLP administration at 20 mg/kg. The overall apparent half-life was 11.2+/-4.5 h (males) or 8.7+/-2.2 h (females), and the overall clearance (CL) was 9.4+/-5.5 ml/h/kg (males) or 10.2+/-4.1 ml/h/kg (females). ABLP appears to undergo saturable disposition, resulting in a non-dose-proportional amphotericin B area under the curve and a lower CL at higher doses. Histopathological examination revealed dose-related transitional-cell hyperplasia in the transitional epithelium of the urinary tract (kidney, ureters, and urinary bladder) and moderate hepatocellular necrosis at the 20 mg/kg/day dose. Administration of ABLP in doses of up to 20 mg/kg/day resulted in 100-fold higher plasma amphotericin B concentrations, with significantly lower toxicity than that reported with conventional amphotericin B therapy.
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Affiliation(s)
- G W Boswell
- Fujisawa USA, Inc., Deerfield, Illinois 60015-2548, USA.
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21
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Schwartz M, Holst B, Facklam D, Buell D. FK 506 in liver transplantation: correlation of whole blood levels with efficacy and toxicity. The US Multicenter FK 506 Dose Optimization. Transplant Proc 1995; 27:1107. [PMID: 7533355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M Schwartz
- U.S. Multicenter Dose Optimization Study Group: Baylor University
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22
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Weinstein HJ, Vance ZB, Jaffe N, Buell D, Cassady JR, Nathan DG. Improved prognosis for patients with mediastinal lymphoblastic lymphoma. Blood 1979; 53:687-94. [PMID: 581853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Patients with diffuse lymphoblastic lymphoma (which includes convoluted lymphocytic lymphoma) with mediastinal involvement have predictable progression of disease to a leukemic phase that is cytologically indistinguishable from acute lymphoblastic leukemia (ALL). Therefore we treated 12 patients with diffuse lymphoblastic lymphoma involving the mediastinum with therapy that is effective in ALL. Treatment consisted of intermittent combination chemotherapy with adriamycin and preventive central nervous system therapy (craniocervical irradiation and intrathecal methotrexate). Mediastinal irradiation was given either for initial respiratory distress or to patients who had incomplete regression of disease following induction chemotherapy. Eleven patients achieve complete remission. With a median follow-up of 41 mo, and using life table analysis, 86% of these patients have remained in continuous complete remission. The results of this study demonstrate the efficacy of treating diffuse lymphoblastic lymphoma with mediastinal presentation as a disseminated lymphoid malignancy.
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Jaffe N, Buell D, Cassady JR, Traggis D, Weinstein H. Role of staging in childhood non-Hodgkin's lymphoma. Cancer Treat Rep 1977; 61:1001-7. [PMID: 902258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Childhood non-Hodgkin's lymphoma is characterized by a high incidence of leukemic transformation. A retrospective analysis of this incidence in 227 children is provided. In an attempt to identify factors associated with this phenomenon, the extent of disease in 30 recently diagnosed patients was determined by means of a modified Ann Arbor staging system. Concurrently, the staging system was utilized for the delivery of a new treatment program: chemotherapy was administered to all patients, and those with stage I and II disease also received radiation therapy to sites of bulk tumor. An overall disease-free survival of 75% was achieved. No patient with stage I disease converted to acute leukemia. The data suggest that the major utility of staging is the delineation of anatomic sites of bulk tumor. The chemotherapeutic program utilized in these patients is outlined.
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Allansmith M, Buell D. Immunoglobulins in the skin of allergic and nonallergic individuals. J Immunol 1965; 95:951-8. [PMID: 4158647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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