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多种CYP3A抑制剂对维奈托克药代动力学的影响:一项基于生理药代动力学模型和群体药代动力学的分析。

Impact of Multiple Concomitant CYP3A Inhibitors on Venetoclax Pharmacokinetics: A PBPK and Population PK-Informed Analysis.

作者信息

Mukherjee Dwaipayan, Brackman Deanna J, Suleiman Ahmed A, Zha Jiuhong, Menon Rajeev M, Salem Ahmed Hamed

机构信息

Clinical Pharmacology, AbbVie Inc., North Chicago, Illinois, USA.

Clinical Pharmacy, Ain Shams University, Cairo, Egypt.

出版信息

J Clin Pharmacol. 2023 Jan;63(1):119-125. doi: 10.1002/jcph.2140. Epub 2022 Oct 13.

Abstract

Venetoclax is an approved, orally bioavailable, B-cell lymphoma type 2 (BCL-2) inhibitor that is primarily metabolized by cytochrome P450 3A (CYP3A). Polypharmacy is common in patients undergoing treatment for hematological malignancies such as acute myeloid leukemia or chronic lymphocytic leukemia, and although venetoclax exposure has been well characterized with 1 concomitant CYP3A inhibitor, complex drug-drug interactions (DDIs) involving more than 1 inhibitor have not been systematically evaluated. Here, we aimed to describe the potential impact of multiple concomitant CYP3A inhibitors on venetoclax pharmacokinetics (PK) using physiologically based pharmacokinetic (PBPK) and population PK modeling. The modeling approaches were informed by clinical data in the presence of single or multiple CYP3A inhibitors, and the effects of 1 or more inhibitors were systematically considered within these modeling frameworks. The PBPK modeling approach was independently validated against clinical data involving more than 1 CYP3A inhibitor along with CYP3A substrates other than venetoclax. Both approaches indicated that combining a strong CYP3A inhibitor with another competitive CYP3A inhibitor does not seem to result in any additional increase in venetoclax exposure, beyond what would be expected with a strong inhibitor alone. This suggests that the current dose reductions recommended for venetoclax would be appropriate even when 2 or more CYP3A inhibitors are taken concomitantly. However, the results indicate that the involvement of time-dependent inhibition might lead to additional inhibitory effects over and above the effect of a single strong CYP3A inhibitor. Thus, the clinical management of such interactions must consider the underlying mechanism of the interactions.

摘要

维奈克拉是一种已获批准的、口服生物可利用的B细胞淋巴瘤-2(BCL-2)抑制剂,主要通过细胞色素P450 3A(CYP3A)进行代谢。在接受急性髓系白血病或慢性淋巴细胞白血病等血液系统恶性肿瘤治疗的患者中,联合用药很常见。虽然维奈克拉与1种CYP3A抑制剂同时使用时的暴露情况已得到充分研究,但涉及1种以上抑制剂的复杂药物相互作用(DDI)尚未得到系统评估。在此,我们旨在使用基于生理学的药代动力学(PBPK)和群体药代动力学建模来描述多种CYP3A抑制剂同时使用对维奈克拉药代动力学(PK)的潜在影响。建模方法参考了在存在单一或多种CYP3A抑制剂的情况下的临床数据,并在这些建模框架内系统地考虑了1种或多种抑制剂的影响。PBPK建模方法针对涉及1种以上CYP3A抑制剂以及维奈克拉以外的CYP3A底物的临床数据进行了独立验证。两种方法均表明,将强效CYP3A抑制剂与另一种竞争性CYP3A抑制剂联合使用,似乎不会导致维奈克拉暴露量进一步增加,超出单独使用强效抑制剂时的预期。这表明,即使同时服用2种或更多种CYP3A抑制剂,目前推荐的维奈克拉剂量减少也是合适的。然而,结果表明,时间依赖性抑制的参与可能会导致超出单一强效CYP3A抑制剂作用的额外抑制作用。因此,此类相互作用的临床管理必须考虑相互作用的潜在机制。

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