Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
AbbVie Inc., North Chicago, Illinois, USA.
Clin Transl Sci. 2024 May;17(5):e13807. doi: 10.1111/cts.13807.
Venetoclax, a highly potent BCL-2 inhibitor, is indicated for treatment of some hematologic malignancies as monotherapy, and/or in combination with other agents. Venetoclax pharmacokinetics has been extensively characterized in patients and healthy participants. After oral dosing, the median time to reach maximum plasma concentration ranged from 5 to 8 h and harmonic mean half-life ranged from 14 to 18 h. Food increases venetoclax bioavailability by 3-5-fold and venetoclax should be administered with food to ensure adequate and consistent bioavailability. Venetoclax is eliminated via cytochrome P450 (CYP)3A metabolism, and a negligible amount of unchanged drug is excreted in urine. Strong CYP3A/P-glycoprotein inhibitors increased venetoclax exposures (AUC) by 1.44- to 6.90-fold while a significant decrease (71%) has been observed when dosed with strong CYP3 inducers. Venetoclax does not inhibit or induce CYP enzymes or transporters. Venetoclax pharmacokinetics is not appreciably altered by age, weight, sex, but the exposure is up to twofold higher in participants from Asian countries. Mild-to-severe renal impairment or end-stage renal disease do not alter venetoclax exposures, and venetoclax is not cleared by dialysis. Although mild-to-moderate hepatic impairment does not affect venetoclax exposures, twofold higher exposure was observed in subjects with severe hepatic impairment. Venetoclax exposure is comparable across patients with different hematologic malignancies and healthy participants. Overall, venetoclax exposure is only affected by food and CYP3A modulators and is only higher in Asian subjects and subjects with severe hepatic impairment. Venetoclax exposure-response relationships are malignancy-dependent and can be different between monotherapy and combination therapy.
维奈托克是一种高效的 BCL-2 抑制剂,被批准用于治疗某些血液系统恶性肿瘤的单药治疗和/或联合其他药物治疗。维奈托克的药代动力学在患者和健康受试者中得到了广泛的研究。口服给药后,达到血浆峰浓度的中位数时间范围为 5 至 8 小时,调和平均半衰期范围为 14 至 18 小时。食物可使维奈托克的生物利用度增加 3 至 5 倍,为确保充分和一致的生物利用度,维奈托克应随食物服用。维奈托克通过细胞色素 P450(CYP)3A 代谢消除,几乎没有未改变的药物经尿液排泄。强效 CYP3A/P-糖蛋白抑制剂使维奈托克的暴露量(AUC)增加了 1.44 至 6.90 倍,而当与强效 CYP3 诱导剂合用时,暴露量显著下降(71%)。维奈托克不抑制或诱导 CYP 酶或转运体。维奈托克的药代动力学不受年龄、体重、性别影响,但在来自亚洲国家的参与者中,暴露量增加了 2 倍。轻至中度肾功能损害或终末期肾病不会改变维奈托克的暴露量,且维奈托克不能通过透析清除。尽管轻度至中度肝损伤不影响维奈托克的暴露量,但在严重肝损伤的患者中观察到暴露量增加了 2 倍。不同血液系统恶性肿瘤患者和健康受试者的维奈托克暴露量相似。总体而言,维奈托克的暴露量仅受食物和 CYP3A 调节剂的影响,且仅在亚洲患者和严重肝损伤患者中较高。维奈托克的暴露-反应关系与恶性肿瘤相关,且在单药治疗和联合治疗之间可能不同。