Duke Early Phase Research Unit, Duke University School of Medicine, Durham, North Carolina, USA.
Argenx BV, Ghent, Belgium.
Clin Pharmacol Ther. 2024 Nov;116(5):1314-1324. doi: 10.1002/cpt.3391. Epub 2024 Jul 25.
(R,S)-Ketamine (ketamine) is a dissociative anesthetic that also possesses analgesic and antidepressant activity. Undesirable dissociative side effects and misuse potential limit expanded use of ketamine in several mental health disorders despite promising clinical activity and intensifying medical need. (2R,6R)-Hydroxynorketamine (RR-HNK) is a metabolite of ketamine that lacks anesthetic and dissociative activity but maintains antidepressant and analgesic activity in multiple preclinical models. To enable future assessments in selected human indications, we report the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of RR-HNK in a Phase 1 study in healthy volunteers (NCT04711005). A six-level single-ascending dose (SAD) (0.1-4 mg/kg) and a two-level multiple ascending dose (MAD) (1 and 2 mg/kg) study was performed using a 40-minute IV administration emulating the common practice for ketamine administration for depression. Safety assessments showed RR-HNK possessed a minimal adverse event profile and no serious adverse events at all doses examined. Evaluations of dissociation and sedation demonstrated that RR-HNK did not possess anesthetic or dissociative characteristics in the doses examined. RR-HNK PK parameters were measured in both the SAD and MAD studies and exhibited dose-proportional increases in exposure. Quantitative electroencephalography (EEG) measurements collected as a PD parameter based on preclinical findings and ketamine's established effect on gamma-power oscillations demonstrated increases of gamma power in some participants at the lower/mid-range doses examined. Cerebrospinal fluid examination confirmed RR-HNK exposure within the central nervous system (CNS). Collectively, these data demonstrate RR-HNK is well tolerated with an acceptable PK profile and promising PD outcomes to support the progression into Phase 2.
(R,S)-氯胺酮(氯胺酮)是一种分离麻醉剂,也具有镇痛和抗抑郁作用。尽管氯胺酮具有有希望的临床活性和加剧的医疗需求,但令人不快的分离副作用和滥用潜力限制了其在几种精神健康障碍中的广泛应用。(2R,6R)-羟基去甲氯胺酮(RR-HNK)是氯胺酮的代谢物,没有麻醉和分离作用,但在多种临床前模型中保持抗抑郁和镇痛作用。为了能够在选定的人类适应症中进行未来的评估,我们报告了健康志愿者中一项 1 期研究(NCT04711005)中 RR-HNK 的安全性、耐受性、药代动力学(PK)和药效学(PD)。使用 40 分钟的静脉内给药进行了六水平单递增剂量(SAD)(0.1-4mg/kg)和两水平递增剂量(MAD)(1 和 2mg/kg)研究,模拟了氯胺酮治疗抑郁症的常见给药方式。安全性评估表明,RR-HNK 在所有检查剂量下均具有最小的不良事件谱,没有严重的不良事件。对分离和镇静的评估表明,RR-HNK 在检查剂量下没有麻醉或分离特性。在 SAD 和 MAD 研究中测量了 RR-HNK 的 PK 参数,并显示出暴露量的剂量比例增加。基于临床前发现和氯胺酮对γ-功率振荡的既定作用而作为 PD 参数收集的定量脑电图(EEG)测量表明,在检查的较低/中剂量范围内,一些参与者的γ功率增加。脑脊液检查证实 RR-HNK 在中枢神经系统(CNS)内的暴露。总的来说,这些数据表明 RR-HNK 具有良好的耐受性,PK 特征可接受,PD 结果有希望支持进入 2 期。