Multiple-dose tolerability, pharmacokinetics, and pharmacodynamics of ponesimod, an S1P1 receptor modulator: favorable impact of dose up-titration.

Abstract

This multiple-ascending-dose study investigated the safety, tolerability, pharmacokinetics, and pharmacodynamics of ponesimod, an S1P1 receptor modulator and a potential new treatment for autoimmune diseases. In part A, 10 healthy male and female subjects received once daily oral doses of ponesimod (5, 10, or 20 mg) or placebo for 7 days. Sinus bradycardia and, in some subjects, atrioventricular (AV) block occurred primarily on the first day of dosing, as desensitization developed to ponesimod-induced heart rate (HR) reduction and PR-prolongation. This elicited the design of an up-titration schedule in 17 subjects to a dose of 40 mg in part B. The up-titration regimen reduced HR and PQ/PR effects. Reported adverse events were mainly related to the cardiac and respiratory systems. Respiratory effects increased with higher doses. Ponesimod multiple-dose pharmacokinetics were slightly more than dose-proportional and characterized by a time to maximum concentration and an elimination half-life varying from 2.5 to 4.0 hours and 30.9 to 33.5 hours, respectively, and an accumulation of about 2.3-fold. Ponesimod caused a dose-dependent sustained decrease in total lymphocyte count, reversible within 7 days of discontinuation. A pharmacokinetic-pharmacodynamic model enabled comparing day 1 and steady-state conditions. These results warrant further investigation of ponesimod in patients.

• Authors: P Brossard, M Scherz, A Halabi, H Maatouk, A Krause, J Dingemanse
• Journal: Journal of clinical pharmacology (J Clin Pharmacol) Vol. 54 Issue 2 Pg. 179-88 (Feb 2014) ISSN: 1552-4604 [Electronic] England
• PMID: 24408162 (Publication Type: Controlled Clinical Trial, Journal Article, Randomized Controlled Trial)
• Copyright: © 2013, The American College of Clinical Pharmacology.

Chemical References

• Receptors, Lysosphingolipid
• Thiazoles
• ponesimod

Topics

• Adolescent
• Adult
• Dose-Response Relationship, Drug
• Double-Blind Method
• Drug Administration Schedule
• Female
• Humans
• Lymphocyte Count
• Male
• Middle Aged
• Models, Biological
• Receptors, Lysosphingolipid (antagonists & inhibitors)
• Thiazoles (administration & dosage, adverse effects, pharmacokinetics, pharmacology)
• Young Adult