Pharmaceutical Department, First Hospital of Nanjing Medical University, Nanjing, China.
Clin Ther. 2010 Jan;32(1):171-8. doi: 10.1016/j.clinthera.2010.01.013.
BACKGROUND: Mycophenolate mofetil (MMF) is an ester prodrug of mycophenolic acid (MPA), so clinical studies measure the circulating plasma MPA concentration instead of MMF. MPA is extensively glucuronidated by several uridine diphosphate glycosyltransferases into an inactive 7-O-glucuronide and a pharmacologically active acylglucuronide. Considering the effect of racial differences and genetic factors on the pharmacokinetic (PK) properties of drugs, it is necessary to study them in Chinese populations. OBJECTIVES: The aim of this study was to compare the clinical bioequivalence and PK properties of a test (dispersible tablets) and reference (capsules) formulation of MMF 1.0 g in healthy Chinese volunteers. We also established a validated HPLC method for the determination and quantification of MPA in human plasma. The study was required to obtain Chinese regulatory approval for the test formulation. METHODS: This open-label, randomized-sequence, single-dose, 2-way crossover study was conducted at the First Hospital of Nanjing Medical University, Nanjing, China. Eligible subjects were healthy male volunteers who were randomly assigned at a 1:1 ratio to receive a single 1.0-g dose of the test or reference formulation, followed by a 1-week washout period and administration of the alternate formulation. The plasma concentration of MPA, which is the active metabolite of MMF, was determined using a validated HPLC method. For analysis of PK properties, blood samples were collected at 0, 10, 20, 30, and 45 minutes, and 1, 1.5, 3, 5, 8, 11, 18, 36, and 48 hour(s). The PK parameters, including C(max), T(max), t((1/2)), AUC(0-48), and AUC(0-infinity), were determined from the plasma concentrations of the 2 formulations by noncompartmental analysis. Tolerability was assessed at baseline (be- fore administration) and at 30 minutes and 1, 5, 18, and 48 hours after administration by monitoring vital signs. Laboratory tests (hematology, blood biochemistry, hepatic function, and urinalysis) were performed for the identification of adverse events (AEs) (eg, leukopenia, thrombocytopenia, anemia). Patient interviews were conducted to assess the occurrence of AEs such as diarrhea, abdominal pain, nausea, vomiting, and secondary infections. The formulations were considered to meet the regulatory requirements of bioequivalence if the log-transformed ratios of C(max) and AUC were within the predetermined equivalence range (80%-125%) as established by the US Food and Drug Administration (FDA). RESULTS: Eighteen healthy Chinese male volunteers (mean [range] age, 23.5 [22-30] years; weight, 63.3 [56-68] kg; height, 171 [165-184] cm) were enrolled and completed the study. The main PK parameters of the MMF test and reference formulations were as follows: mean (SD) T(max), 0.68 (0.21) and 0.81 (0.18) hour, respectively; C(max), 25.58 (4.79) and 26.47 (3.67) mg/L; AUC(0-48), 59.19 (9.23) and 58.32 (9.28) mg/L/h; t((1/2)), 15.12 (3.17) and 16.04 (4.22) hours; AUC(0-infinity)), 63.28 (10.23) and 62.41 (10.28) mg/L/h. The mean (SD) relative bioavailability was 101.5% (10.3%). No statistically significant differences were found based on ANOVA. The ratios of C(max) (0.97) and AUC (1.01) for the test and reference formulations were within the FDA bioequivalence definition intervals of 80% to 125%. No AEs were reported by subjects or found on analysis of vital signs or laboratory tests. CONCLUSIONS: In this study in healthy Chinese male volunteers, results from the PK analysis suggested that a single dose of the test and reference formulations of MMF 1.0 g met the regulatory requirements of bioequivalence, based on the FDA regulatory definition (rate and extent of absorption). Both formulations were well tolerated.
背景:霉酚酸酯(MMF)是霉酚酸(MPA)的酯前体药物,因此临床研究测量的是循环血浆 MPA 浓度,而不是 MMF。MPA 被几种尿苷二磷酸葡萄糖醛酸基转移酶广泛葡萄糖醛酸化,形成无活性的 7-O-葡萄糖醛酸和具有药理活性的酰基葡萄糖醛酸。鉴于种族差异和遗传因素对药物药代动力学(PK)特性的影响,有必要在中国人中进行研究。
目的:本研究旨在比较健康中国志愿者中试验(分散片)和参比(胶囊)制剂的 MMF1.0g 的临床生物等效性和 PK 特性。我们还建立了一种用于测定人血浆中 MPA 的高效液相色谱法(HPLC)。该研究需要获得中国监管机构对试验制剂的批准。
方法:这是一项在南京医科大学第一附属医院进行的开放标签、随机序列、单剂量、2 向交叉研究。合格的受试者为健康男性志愿者,他们按照 1:1 的比例随机分配,接受单次 1.0g 试验或参比制剂,然后进行 1 周的洗脱期和交替制剂给药。采用已验证的 HPLC 法测定 MPA(MMF 的活性代谢物)的血浆浓度。进行 PK 特性分析时,在 0、10、20、30 和 45 分钟,以及 1、1.5、3、5、8、11、18、36 和 48 小时采集血样。通过非房室分析从两种制剂的血浆浓度中确定 PK 参数,包括 Cmax、Tmax、t(1/2)、AUC(0-48)和 AUC(0-∞)。在给药前(基线)和给药后 30 分钟以及 1、5、18 和 48 小时通过监测生命体征评估耐受性。通过血液学、血液生化学、肝功能和尿液分析等实验室检测识别不良事件(AE)(例如白细胞减少症、血小板减少症、贫血)。对腹泻、腹痛、恶心、呕吐和继发感染等 AE 的发生情况进行患者访谈。如果美国食品和药物管理局(FDA)确定的 80%-125%等效范围(Log 转化比值)内包含 Cmax 和 AUC 的比值,则认为制剂符合生物等效性的监管要求。
结果:共纳入 18 名健康的中国男性志愿者(平均[范围]年龄,23.5[22-30]岁;体重,63.3[56-68]kg;身高,171[165-184]cm),并完成了研究。MMF 试验和参比制剂的主要 PK 参数如下:Tmax 的平均值(SD),分别为 0.68(0.21)和 0.81(0.18)小时;Cmax 的平均值(SD),分别为 25.58(4.79)和 26.47(3.67)mg/L;AUC(0-48)的平均值(SD),分别为 59.19(9.23)和 58.32(9.28)mg/L/h;t(1/2)的平均值(SD),分别为 15.12(3.17)和 16.04(4.22)小时;AUC(0-∞)的平均值(SD),分别为 63.28(10.23)和 62.41(10.28)mg/L/h。试验和参比制剂的平均(SD)相对生物利用度为 101.5%(10.3%)。基于方差分析,无统计学差异。试验和参比制剂的 Cmax(0.97)和 AUC(1.01)比值均在 FDA 生物等效性定义区间 80%-125%内。受试者未报告任何不良事件,生命体征或实验室检查也未发现任何异常。
结论:在这项在中国健康男性志愿者中进行的研究中,PK 分析结果表明,MMF1.0g 的试验和参比制剂单次给药符合 FDA 监管定义(吸收的速率和程度)的生物等效性要求。两种制剂均具有良好的耐受性。