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基于生理的药代动力学(PBPK)模型预测非索非那定与CYP1A2抑制剂之间药物相互作用的程度。

Physiologically Based Pharmacokinetic (PBPK) Model to Predict the Magnitude of Drug-Drug Interaction Between Fezolinetant and CYP1A2 Inhibitors.

作者信息

Choules Mary P, Otsuka Yukio, Nielsen Jace C, Iwai Megumi, Bonate Peter L

机构信息

Astellas Pharma, Inc., Northbrook, IL, USA.

Astellas Pharma, Inc., Tokyo, Japan.

出版信息

J Clin Pharmacol. 2025 Apr 8. doi: 10.1002/jcph.70024.

Abstract

Fezolinetant is a non-hormonal, selective neurokinin 3 receptor antagonist approved in multiple countries including the United States, in Europe, and in Asia for the treatment of moderate to severe vasomotor symptoms in menopausal women. Fezolinetant is primarily metabolized by CYP1A2 and was found to be a sensitive substrate for CYP1A2 metabolism based on a clinical DDI study with strong CYP1A2 inhibitor, fluvoxamine. Therefore, coadministration with CYP1A2 inhibitors or inducers (such as smoking) could lead to changes in fezolinetant exposure. A physiological-based pharmacokinetic (PBPK) model was built for fezolinetant using the Simcyp simulator software with in vitro and in vivo data. The final verified model was used to predict fezolinetant exposure following coadministration with mexiletine (moderate CYP1A2 inhibitor), ciprofloxacin (moderate CYP1A2 inhibitor), and cimetidine (weak CYP1A2 inhibitor). Depending on the dosing regimen of the inhibitor and the meal status, coadministration with a weak CYP1A2 inhibitor, such as cimetidine, was predicted to increase fezolinetant C by 1.30 to 1.36 and AUC by 1.61 to 2.01 fold. A moderate CYP1A2 inhibitor, such as mexiletine, was predicted to increase fezolinetant C by 1.36 to 1.59 fold and AUC by 3.38 to 4.61 fold. Another moderate CYP1A2 inhibitor, ciprofloxacin, was predicted to increase fezolinetant C by 1.39 to 1.49 fold and AUC by and 1.99 to 2.33 fold. The results of the PBPK analysis supported global labeling language statements for fezolinetant.

摘要

非索利那新是一种非激素选择性神经激肽3受体拮抗剂,已在美国、欧洲和亚洲等多个国家获批用于治疗绝经后女性的中重度血管舒缩症状。非索利那新主要通过CYP1A2代谢,基于与强效CYP1A2抑制剂氟伏沙明的临床药物相互作用研究,发现其是CYP1A2代谢的敏感底物。因此,与CYP1A2抑制剂或诱导剂(如吸烟)合用可能会导致非索利那新暴露量的变化。使用Simcyp模拟器软件结合体外和体内数据为非索利那新建构了基于生理的药代动力学(PBPK)模型。最终验证的模型用于预测与美西律(中度CYP1A2抑制剂)、环丙沙星(中度CYP1A2抑制剂)和西咪替丁(弱CYP1A2抑制剂)合用时非索利那新的暴露量。根据抑制剂的给药方案和进餐状态,预计与弱CYP1A2抑制剂西咪替丁合用时,非索利那新的Cmax将增加1.30至1.36倍,AUC将增加1.61至2.01倍。预计中度CYP1A2抑制剂美西律会使非索利那新的Cmax增加1.36至1.59倍,AUC增加3.38至4.61倍。另一种中度CYP1A2抑制剂环丙沙星预计会使非索利那新的Cmax增加1.39至1.49倍,AUC增加1.99至2.33倍。PBPK分析结果支持了非索利那新的全球标签声明。

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