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通过 CYP3A 代谢和转运体对莫洛替尼药物相互作用的临床评估。

Clinical assessment of momelotinib drug-drug interactions via CYP3A metabolism and transporters.

机构信息

GSK, Collegeville, Pennsylvania, USA.

出版信息

Clin Transl Sci. 2024 Apr;17(4):e13799. doi: 10.1111/cts.13799.

Abstract

Momelotinib-approved for treatment of myelofibrosis in adults with anemia-and its major active metabolite, M21, were assessed as drug-drug interaction (DDI) victims with a strong cytochrome P450 (CYP) 3A4 inhibitor (multiple-dose ritonavir), an organic anion transporting polypeptide (OATP) 1B1/1B3 inhibitor (single-dose rifampin), and a strong CYP3A4 inducer (multiple-dose rifampin). Momelotinib DDI perpetrator potential (multiple-dose) was evaluated with CYP3A4 and breast cancer resistance protein (BCRP) substrates (midazolam and rosuvastatin, respectively). DDI was assessed from changes in maximum plasma concentration (C), area under the concentration-time curve (AUC), time to reach C, and half-life. The increase in momelotinib (23% C, 14% AUC) or M21 (30% C, 24% AUC) exposure with ritonavir coadministration was not clinically relevant. A moderate increase in momelotinib (40% C, 57% AUC) and minimal change in M21 was observed with single-dose rifampin. A moderate decrease in momelotinib (29% C, 46% AUC) and increase in M21 (31% C, 15% AUC) were observed with multiple-dose rifampin compared with single-dose rifampin. Due to potentially counteracting effects of OATP1B1/1B3 inhibition and CYP3A4 induction, multiple-dose rifampin did not significantly change momelotinib pharmacokinetics compared with momelotinib alone (C no change, 15% AUC decrease). Momelotinib did not alter the pharmacokinetics of midazolam (8% C, 16% AUC decreases) or 1'-hydroxymidazolam (14% C, 16% AUC decreases) but increased rosuvastatin C by 220% and AUC by 170%. Safety findings were mild in this short-term study in healthy volunteers. This analysis suggests that momelotinib interactions with OATP1B1/1B3 inhibitors and BCRP substrates may warrant monitoring for adverse reactions or dose adjustments.

摘要

莫米松替尼获批用于治疗伴贫血的成人骨髓纤维化,其主要活性代谢物 M21 被评估为与强效细胞色素 P450(CYP)3A4 抑制剂(利托那韦多剂量)、有机阴离子转运多肽 1B1/1B3 抑制剂(利福平单剂量)和强 CYP3A4 诱导剂(利福平多剂量)发生药物-药物相互作用(DDI)。莫米松替尼的 DDI 潜在性(多剂量)通过 CYP3A4 和乳腺癌耐药蛋白(BCRP)底物(咪达唑仑和瑞舒伐他汀)进行评估。DDI 通过最大血浆浓度(C)、浓度-时间曲线下面积(AUC)、达到 C 的时间和半衰期的变化进行评估。与利托那韦合用,莫米松替尼(23% C,14% AUC)或 M21(30% C,24% AUC)的暴露量增加无临床意义。与单剂量利福平相比,莫米松替尼(40% C,57% AUC)适度增加,M21 变化最小。与单剂量利福平相比,多剂量利福平(29% C,46% AUC)使莫米松替尼减少,M21(31% C,15% AUC)增加。由于 OATP1B1/1B3 抑制和 CYP3A4 诱导的潜在拮抗作用,与单独使用莫米松替尼相比,多剂量利福平并未显著改变莫米松替尼的药代动力学(C 无变化,AUC 减少 15%)。莫米松替尼不改变咪达唑仑(8% C,16% AUC 减少)或 1'-羟基咪达唑仑(14% C,16% AUC 减少)的药代动力学,但使瑞舒伐他汀 C 增加 220%,AUC 增加 170%。在这项健康志愿者的短期研究中,安全性发现为轻度。该分析表明,莫米松替尼与 OATP1B1/1B3 抑制剂和 BCRP 底物的相互作用可能需要监测不良反应或剂量调整。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b385/11024956/78ee279d7df9/CTS-17-e13799-g001.jpg

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