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奥美拉唑给药时间对pH敏感型达沙替尼吸收的严重影响:揭示显著的药物相互作用

Severe Impact of Omeprazole Timing on pH-Sensitive Dasatinib Absorption: Unveiling Substantial Drug-Drug Interaction.

作者信息

Andersson Per, Brisander Magnus, Liljebris Charlotta, Jesson Gérald, Lennernäs Hans

机构信息

Xspray Pharma, Solna, Sweden.

Department of Pharmaceutical Biosciences, Translational Drug Discovery and Development, Uppsala University, Uppsala, Sweden.

出版信息

J Clin Pharmacol. 2025 May;65(5):588-597. doi: 10.1002/jcph.6173. Epub 2024 Dec 26.

Abstract

The absorption and bioavailability of most tyrosine kinase inhibitors are affected by gastrointestinal pH as they are weak basic lipophilic drugs. Hence, concomitant use of acid reducing agents (ARAs) is frequently restricted. Particularly comedication of crystalline dasatinib (Sprycel) and proton-pump inhibitors (PPIs) should be avoided. Drug-drug interaction (DDI) studies with PPIs report approximately 40%-80% bioavailability reduction of dasatinib. Limitations in the design of these studies do not allow for assessing the near maximum DDI as timing of PPI dosing was either not reported or 22 h prior to dasatinib intake. We conducted a DDI study of crystalline dasatinib and omeprazole in healthy, fasted participants, investigating the impact of PPI comedication on dasatinib plasma exposure at a time point when the near maximum DDI effect is expected. Participants were administered omeprazole (day 2-5) to reach steady state. On day 6, a single dose of crystalline dasatinib was given. Crystalline dasatinib dosing alone on day 1 served as control (single dose). The dosing interval between omeprazole administration and crystalline dasatinib was 10 h (median [range: 9-10 h]). Dasatinib C and AUC were reduced by 96% and 89% by omeprazole comedication. C was 224.6 ± 104.7 ng/mL (mean ± SD) and 8.0 ± 4.5 ng/mL (P < .0001) and AUC was 797.6 ± 274.5 and 90.6 ± 38.1 h·ng/mL (P < .0001) without and with omeprazole. T was 5.7 ± 1.5 h (mean ± SD) with crystalline dasatinib dosing alone and could not be reliably calculated with comedication. To ensure optimal patient outcome, it is vital to investigate bioavailability of pH-sensitive drugs at the maximal DDI effect of ARAs to understand the worst-case influence for efficient clinical management.

摘要

大多数酪氨酸激酶抑制剂的吸收和生物利用度会受到胃肠道pH值的影响,因为它们是弱碱性亲脂性药物。因此,酸还原剂(ARAs)的联合使用常常受到限制。特别是应避免将结晶达沙替尼(施达赛)与质子泵抑制剂(PPIs)同时使用。与PPIs的药物相互作用(DDI)研究报告称,达沙替尼的生物利用度降低了约40%-80%。这些研究设计上的局限性使得无法评估接近最大的DDI,因为PPI给药时间要么未报告,要么在服用达沙替尼前22小时。我们在健康的空腹参与者中进行了一项结晶达沙替尼与奥美拉唑的DDI研究,在预期接近最大DDI效应的时间点研究PPI联合用药对达沙替尼血浆暴露的影响。参与者服用奥美拉唑(第2-5天)以达到稳态。在第6天,给予单剂量的结晶达沙替尼。第1天单独服用结晶达沙替尼作为对照(单剂量)。奥美拉唑给药与结晶达沙替尼之间的给药间隔为10小时(中位数[范围:9-10小时])。联合使用奥美拉唑使达沙替尼的C和AUC分别降低了96%和89%。未使用和使用奥美拉唑时,C分别为224.6±104.7 ng/mL(平均值±标准差)和8.0±4.5 ng/mL(P<.0001),AUC分别为797.6±274.5和90.6±38.1 h·ng/mL(P<.0001)。单独服用结晶达沙替尼时T为5.7±1.5小时(平均值±标准差),联合用药时无法可靠计算。为确保患者获得最佳治疗效果,至关重要的是在ARAs的最大DDI效应下研究pH敏感药物的生物利用度,以了解对有效临床管理的最坏情况影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdb4/12034913/c12b7281954f/JCPH-65-588-g001.jpg

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