How a concentration-effect analysis of data from the eliglustat thorough electrocardiographic study was used to support dosing recommendations.

Abstract

Eliglustat is a first-line oral treatment for adults with Gaucher disease type 1 who have cytochrome P450 (CYP) 2D6 extensive, intermediate, or poor metabolizer phenotypes. Per International Conference on Harmonisation (ICH) E14 guidance, a Phase 1 thorough electrocardiographic (ECG) study was done during drug development to assess eliglustat's effects on cardiac repolarization by measuring ECG intervals in healthy adult subjects. Using data from the thorough ECG study, we performed pharmacokinetic/pharmacodynamic-ECG modeling to establish the relationship between eliglustat concentrations and their effects on ECG intervals. We then used that concentration-response relationship to predict the effects of eliglustat on each ECG interval for each CYP2D6 metabolizer phenotype (the main determinant of eliglustat exposure) and in different drug-drug interaction scenarios. These predictions, together with other exposure-related factors, contributed to the CYP2D6 phenotype-based dosing recommendations for eliglustat, including dose adjustments and contraindications when co-administered with drugs metabolized by the CYP2D6 and CYP3A pathways.

• Authors: Jeremy N Ruskin, Catherine Ortemann-Renon, Jerome Msihid, Leorah Ross, Ana Cristina Puga, M Judith Peterschmitt, Gerald F Cox, Pierre Maison-Blanche
• Journal: Molecular genetics and metabolism (Mol Genet Metab) 2020 Sep - Oct Vol. 131 Issue 1-2 Pg. 211-218 ISSN: 1096-7206 [Electronic] United States
• PMID: 33012655 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Pyrrolidines
• eliglustat
• Cytochrome P-450 CYP2D6
• Cytochrome P-450 CYP3A

Topics

• Administration, Oral
• Adult
• Cytochrome P-450 CYP2D6 (genetics)
• Cytochrome P-450 CYP3A (genetics)
• Dose-Response Relationship, Drug
• Drug Interactions (genetics)
• Electrocardiography
• Female
• Gaucher Disease (drug therapy, genetics, pathology)
• Humans
• Inactivation, Metabolic (genetics)
• Liver (drug effects)
• Male
• Pyrrolidines (administration & dosage, pharmacokinetics)