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HIV整合酶抑制剂卡博特韦的药物相互作用情况:来自体外研究及与咪达唑仑的临床研究评估

Drug interaction profile of the HIV integrase inhibitor cabotegravir: assessment from in vitro studies and a clinical investigation with midazolam.

作者信息

Reese Melinda J, Bowers Gary D, Humphreys Joan E, Gould Elizabeth P, Ford Susan L, Webster Lindsey O, Polli Joseph W

机构信息

a Drug Metabolism and Pharmacokinetics, GlaxoSmithKline , Research Triangle Park , NC , USA and.

b Clinical Platforms and Sciences, GlaxoSmithKline , RTP , NC , USA.

出版信息

Xenobiotica. 2016;46(5):445-56. doi: 10.3109/00498254.2015.1081993. Epub 2015 Sep 4.

Abstract

1. Cabotegravir (CAB; GSK1265744) is a potent HIV integrase inhibitor in clinical development as an oral lead-in tablet and long-acting injectable for the treatment and prevention of HIV infection. 2. This work investigated if CAB was a substrate for efflux transporters, the potential for CAB to interact with drug-metabolizing enzymes and transporters to cause clinical drug interactions, and the effect of CAB on the pharmacokinetics of midazolam, a CYP3A4 probe substrate, in humans. 3. CAB is a substrate for Pgp and BCRP; however, its high intrinsic membrane permeability limits the impact of these transporters on its intestinal absorption. 4. At clinically relevant concentrations, CAB did not inhibit or induce any of the CYP or UGT enzymes evaluated in vitro and had no effect on the clinical pharmacokinetics of midazolam. 5. CAB is an inhibitor of OAT1 (IC50 0.81 µM) and OAT3 (IC50 0.41 µM) but did not or only weakly inhibited Pgp, BCRP, MRP2, MRP4, MATE1, MATE2-K, OATP1B1, OATP1B3, OCT1, OCT2 or BSEP. 6. Based on regulatory guidelines and quantitative extrapolations, CAB has a low propensity to cause clinically significant drug interactions, except for coadministration with OAT1 or OAT3 substrates.

摘要
  1. 卡博特韦(CAB;GSK1265744)是一种强效的HIV整合酶抑制剂,正处于临床开发阶段,有口服导入片和长效注射剂两种剂型,用于治疗和预防HIV感染。2. 本研究调查了CAB是否为外排转运蛋白的底物,CAB与药物代谢酶和转运蛋白相互作用导致临床药物相互作用的可能性,以及CAB对人咪达唑仑(一种CYP3A4探针底物)药代动力学的影响。3. CAB是Pgp和BCRP的底物;然而,其高内在膜通透性限制了这些转运蛋白对其肠道吸收的影响。4. 在临床相关浓度下,CAB在体外未抑制或诱导所评估的任何CYP或UGT酶,对咪达唑仑的临床药代动力学也无影响。5. CAB是OAT1(IC50 0.81 μM)和OAT3(IC50 0.41 μM)的抑制剂,但对Pgp、BCRP、MRP2、MRP4、MATE1、MATE2-K、OATP1B1、OATP1B3、OCT1、OCT2或BSEP未抑制或仅产生微弱抑制作用。6. 根据监管指南和定量推断,除了与OAT1或OAT3底物合用时,CAB引起临床显著药物相互作用的可能性较低。

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