KONCENTRACIJE ITRAKONAZOLA I HIDROKSI-ITRAKONAZOLA NAKON ORALNE PRIMENE LEKA KOD ZDRAVIH LJUDI: UTICAJ POLA

  • Tijana Stanojković
  • Milijana Miljković
  • Nemanja Rančić Centre for Clinical Pharmacology; Medical Faculty Military Medical Academy, University of Defence, Belgrade, Serbia https://orcid.org/0000-0002-5122-8094
  • Aleksandra Kovačević
  • Viktorija Dragojević Simić
Ključne reči: itrakonazol, hidroksi-hidroksiitrakonazol, koncentracije leka, zdravi ispitanici, pol

Sažetak


Cilj rada je bio da se ispita uticaj pola na koncentracije itrakonazola i hidroksi-itrakonazola u plazmi zdravih odraslih osoba nakon peroralne primene leka. Sprovedena je klinička farmakokinetska studija u kojoj je učestvovalo 22 odraslih zdravih muških ispitanika i 16 ženskih kod kojih je peroralno primenjen itrakonazol u jednoj dozi od 100mg. Uzorci krvi su uzeti pre primene leka, kao i u odgovarajućim vremenskim intervalima do 72 sata nakon toga. Koncentracije leka i metabolita su određivane primenom validirane metode tečne hromatografije sa masenom spektrometrijskom detekcijom, a njihovi farmakokinetski parametri korišćenjem Kinetica programa, verzija 5.0: Cmax,Tmax,PIK(0-72),PIK(0-∞),T1/2  i Ke.   
Kod ispitanica vrednosti medijane koncentracija i itrakonazola i hidroksi-itrakonazola su bile manje u odnosu na muškarce u toku celog posmatranog perioda. Takođe, izračunete vrednosti medijana parametara resorpcije – Cmax, PIK(0-72) i PIK(0-∞) su bile statistički značajno manje i za lek (p=0,005, 0,036 i 0,036) i za metabolit (p=0,004, 0,010 i 0,044) kod žena. Parametri eliminacije - T1/2  i  Ke se nisu razlikovali među polovima.
Žene su nakon peroralne primene leka u manjem stepenu izložene itrakonazolu i njegovom aktivnom metabolitu u odnosu na muškarce, kao rezultat manje bioraspoloživosti ovog leka, uključujući i intenzivniji presistemski metabolizam usled veće ekspresije i/ili aktivnosti izoforme enzima koji ga metaboliše, a što bi bilo neophodno potvrditi farmakogenomskim analizama.

Reference

1. Hamburg MA, Collins FS. The path to personalized medicine. New England Journal of Medicine 2010; 363(4): 301-304.
2. Soldin OP, Chung SH, Mattison DR. Sex differences in drug disposition. J Biomed Biotechnol 2011; 2011: 187103.
3. Chu T. Gender Differences in Pharmacokinetics. US Pharm 2014; 39(9): 40-43.
4. Rademaker M. Do women have more adverse drug reactions? Am J Clin Dermatol 2001; 2(6): 349-351.
5. Center for Drug Evaluation and Research. Food and Drug Administration. Guidance for Industry—Bioavailability and Bioequivalence Studies for Orally Administered Drug Products —General Considerations. U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research (CDER) 2002.
6. Fletcher CV, Acosta EP, Strykowski JM. Gender differences in human pharmacokinetics and pharmacodynamics. J Adolesc Health 1994; 15(8): 619-629.
7. Hutson WR, Roehrkasse RL, Wald A. Influence of gender and menopause on gastric emptying and motility. Gastroenterology 1989; 96(1): 11-17.
8. Tuo B, Wen G, Wei J, Liu X, Wang X, Zhang Y, et al. Estrogen regulation of duodenal bicarbonate secretion and sex-specific protection of human duodenum. Gastroenterology 2011; 141(3): 854-863.
9. Kim WY, Benet LZ. P-glycoprotein (P-gp/MDR1) - mediated efflux of sex-steroid hormones and modulation of P-gp expression in vitro. Pharm Res 2004; 21(7): 1284-1293.
10. Paine MF, Ludington SS, Chen ML, Stewart PW, Huang SM, Watkins PB. Do men and women differ in proximal small intestinal CYP3A or P-glycoprotein expression? Drug Metab Dispos 2005; 33(3): 426-433.
11. Baraona E, Abittan CS, Dohmen K, Moretti M, Pozzato G, Chayes ZW, et al. Gender differences in pharmacokinetics of alcohol. Alcohol Clin Exp Res 2001; 25(4): 502-507.
12. Brinkman-Van der Linden CM, Havenaar EC, Van Ommen CR, Van Kamp GJ, Gooren LJ, Van Dijk W. Oral estrogen treatment induces a decrease in expression of sialyl Lewis x on alpha 1-acid glycoprotein in females and male-to-female transsexuals. Glycobiology 1996; 6(4): 407-412.
13. Wiegratz I, Kutschera E, Lee JH, Moore C, Mellinger U, Winkler UH, et al. Effect of four different oral contraceptives on various sex hormones and serum-binding globulins. Contraception 2003; 67(1): 25-32.
14. Wolbold R, Klein K, Burk O, Nüssler AK, Neuhaus P, Eichelbaum M, et al. Sex is a Major Determinant of CYP3A4 Expression in Human Liver. Hepatology 2003; 38(4): 978-988.
15. Jaffe CA, Turgeon DK, Lown K, Demott-Friberg R, Watkins PB. Growth Hormone Secretion Pattern Is an Independent Regulator of Growth Hormone Actions in Humans. Am J Physiol Endocrinol Metab 2002; 283(5): E1008-E1015.
16. Handschin C, Meyer UA. Induction of drug metabolism: the role of nuclear receptors. Pharmacol Rev 2003; 55(4): 649-673.
17. Schwartz JB. The influence of sex on pharmacokinetic. Clin Pharmacokinet 2003; 42(2): 107-121.
18. Gross JL, Friedman R, Azevedo MJ, Silveiro SP, Pecis M. Effects of age and sex on glomerular filtration rate measured by 51Cr-EDTA. Braz J Med Biol Res 1992; 25(2): 129-134.
19. Cleary JD, Taylor JW, Chapman SW. Itraconazole in antifungal therapy. Ann Pharmacother 1992; 26(4): 502-509.
20. Zhou H, Goldman M, Wu J, Woestenborghs R, Hassell AE, Lee P, et al. A pharmacokinetic study of intravenous itraconazole followed by oral administration of itraconazole capsules in patients with advanced human immunodeficiency virus infection. J Clin Pharmacol 1998; 38(7): 593-602.
21. Tricot G, Joosten E, Boogaerts MA, Vande-Pitte J, Cauwenbergh G. Ketoconazole vs itraconazole for antifungal prophylaxis in patients with severe granulocytopenia: preliminary results of two nonrandomized studies. Rev Infect Dis 1987; 9(1): 94-99.
22. Jaruratanasirikul S, Kleepkaew A. Influence of an acidic beverage (Coca-Cola) on the absorption of itraconazole. Eur J Clin Pharmacol 1997; 52(3): 235-237.
23. Van Peer A, Woestenborghs R, Heykants J, Gasparini R, Gauwenbergh G. The effects of food and dose on the oral systemic availability of itraconazole in healthy subjects. Eur J Clin Pharmacol 1989; 36(4): 423-426.
24. De Beule K, Van Gestel J. Pharmacology of Itraconazole. Drugs 2001; 61(l): 27-37.
25. Poirier JM, Cheymol G. Optimisation of Itraconazole Therapy Using Target Drug Concentrations. Clin Pharmacokinet 1998; 35(6): 461-473.
26. Blume HH, Midha KK. Bio-International 92, conference on bioavailability, bioequivalence, and pharmacokinetic studies. J Pharm Sci 1993; 82(11): 1186-1189.
27. Guideline on the investigation of bioequivalence. European Medicines Agency (EMA). Available from: http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2010/01/ WC500070039.pdf.
28. Patni AK, Monif T, Khuroo AH, Iyer SS, Tiwary AK. A comparative bioavailability study of two formulations of itraconazole 100 mg capsule in healthy human Indian subjects under fasting conditions. Clinic Res Regul Aff 2010; 27: 128-132.
29. Patni AK, Monif T, Khuroo AH, Iyer SS, Jain R, Kumar S, et al. Determination of pharmacokinetics of itraconazole in healthy Indian subjects under fed condition and incurred sample analysis using a validated liquid chromatography tandem mass spectrometric method. Clinic Res Regul Aff 2012; 29: 35-40.
30. Dragojević-Simić V, Kovačević A, Jaćević V, Rančić N, Đordjević S, Kilibarda V, et al. Bioequivalence study of two formulations of itraconazole 100 mg capsules in healthy volunteers under fed conditions: a randomized, three-period, reference-replicated, crossover study. Expert Opin Drug Metab Toxicol 2018; 14(9): 979-988.
31. Guideline Clinical Safety Data Management: Definitions AND Standards FOR Expedited Reporting E2A. International Conference on Harmonization of Technical Requirement for Registration of Pharmaceuticals for Human use (ICH). Available from: https://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E2A/Step4/E2A_Guideline.pdf
32. The use of the WHO-UMC system for standardized case causality assessment. The Uppsala Monitoring Centre. Available from: https://www.whoumc.org/media/2768/standardised-case-causality-assessment.pdf
33. Maertens JA. History of the development of azole derivatives. Clin Microbiol Infect 2004; 10(1): 1-10.
34. Davit BM, Conner DP, Fabian-Fritsch B, Haidar SH, Jiang X, Patel DT, et al. Highly Variable Drugs: Observations from Bioequivalence Data Submitted to the FDA for New Generic Drug Applications. The AAPS Journal 2008; 10(1): 148-156.
35. Hope WW, Billaud EM, Lestner J, Denning DW. Therapeutic drug monitoring for triazoles. Curr Opin Infect Dis 2008; 21(6): 580-586.
36. John J, Loo A, Mazur S, Walsh TJ. Therapeutic drug monitoring of systemic antifungal agents: a pragmatic approach for adult and pediatric patients. Expert Opin Drug Metab Toxicol 2019; 15(11): 881-895.
37. Soldin OP, Mattison DR. Sex differences in Pharmacokinetics and Pharmacodynamics. Clin Pharmacokinet 2009; 48(3): 143-157.
38. Fagiolino P, González N, Vázquez M, Eiraldi R. Itraconazole Bioequivalence Revisited: Influence of Gender on Highly Variable Drugs. The Open Drug Metabolism Journal 2007; 1(1): 7-13.
39. Yasuda K, Lan LB, Sanglard D, Furuya K, Schuetz JD, Schuetz EG. Interaction of cytochrome P450 3A inhibitors with P-glycoprotein. J Pharmacol Exp Ther 2002; 303(1): 323-332.
40. Schuetz EG, Furuya KN, Schuetz JD. Interindividual variation in expression of P-glycoprotein in normal human liver and secondary hepatic neoplasms. J Pharmacol Exp Ther 1995; 275(2): 1011-1018.
41. Hunt CM, Westerkam WR, Stave GM. Effect of age and gender on the activity of human hepatic CYP3A. Biochem Pharmacol 1992; 44(2): 275-283.
42. 42 George J, Byth K, Farrell GC. Age but not gender selectively affects expression of individual cytochrome P450 proteins in human liver. Biochem Pharmacol 1995; 50(5): 727-730.
43. Meffin PJ, Brooks PM, Sallustio BC. Alterations in prednisolone disposition as a result of time of administration, gender and dose. Br J Clin Pharmacol 1984; 17(4): 395-404.
44. Sakuma T, Kawasaki Y, Jarukamjorn K, Nemoto N. Sex differences of drug-metabolizing enzyme: Female Predominant Expression of Human and Mouse Cytochrome P450 3A Isoforms. Journal of Health Science 2009; 55(3): 325-337.
45. Sansone-Parsons A, Krishna G, Simon J, Soni P, Kantesaria B, Herron J, et al. Effects of Age, Gender, and Race/Ethnicity on the Pharmacokinetics of Posaconazole in Healthy Volunteers. Antimicrobial agents and chemotherapy. Antimicrob Agents Chemother 2007; 51(2): 495-502.
46. Allegra S, Fatiguso G, De Francia S, Favata F, Pirro E, Carcieri C, et al. Evaluation of Posaconazole Pharmacokinetics in Adult Patients with Invasive Fungal Infection. Biomedicines 2017; 5(4): 66.
47. Carrasco-Portugal MC, Flores-Murrieta FJ. Gender Differences in the Oral Pharmacokinetics of Fluconazole. Clin Drug Invest 2007; 27(12): 851-855.
48. Tothfalusi L, Endrenyi L, Arieta AG. Evaluation of bioequivalence for highly variable drugs with scaled average bioequivalence. Clin Pharmacokinet 2009; 48(11): 725-743.
49. Guidance for industry bioequivalence studies with pharmacokinetic endpoints for drugs submitted under an ANDA. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER). Available from: https://www.fda.gov/downloads/drugs/guidances/ucm377465.pdf.
50. Davit BM, Chen ML, Conner DP, Haidar SH, Kim S, Lee CH, et al. Implementation of a reference-scaled average bioequivalence approach for highly variable generic drug products by the US Food and Drug Administration. AAPS J 2012; 14(4): 915-924.
51. Midha K, Rawson M, Hubbard J. The bioequivalence of highly variable drugs and drug products. Int J Clin Pharmacol Ther 2005; 43(10): 485-498.
52. Public Assessment Report. Decentralised Procedure Itraconazole 100 mg Capsules. Available from: http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con046562.pdf.
53. Tucker R, Haq Y, Denning D, Stevens D. Adverse events associated with itraconazole in 189 patients on chronic therapy. J Antimicrob Chemother 1990; 26(4): 561-566.
54. Sharkey P, Rinaldi M, Dunn J, Hardin T, Fetchick R, Graybill J. High dose itraconazole in the treatment of severe mycoses . Antimicrobial agents and chemotherapy 1991; 35(4): 707-713.
55. Haneke E, Abeck D, Ring J. Safety and efficacy of intermittent therapy with itraconazole in finger- and toe nail onychomycosis: a multicentre trial. Mycoses 1998; 41(11-12): 521-527.
56. Cartledge J, Midgely J, Gazzard B. Itraconazole solution: higher serum drug concentrations and better clinical response rates than the capsule formulation in acquired immunodeficiency syndrome patients with candidosis. J Clin Pathol 1997; 50(6): 477-480.
57. Lestner J, Roberts S, Moore C, Howard S, Denning D, Hope W. Toxicodynamics of Itraconazole: Implications for Therapeutic Drug Monitoring. Clinical Infectious Diseases 2009; 49(6): 928-930.
Objavljeno
2021/04/27
Rubrika
Članci