Cargando…
Physiologically‐Based Pharmacokinetic‐Led Guidance for Patients With Cystic Fibrosis Taking Elexacaftor‐Tezacaftor‐Ivacaftor With Nirmatrelvir‐Ritonavir for the Treatment of COVID‐19
Cystic fibrosis transmembrane conductance regulator (CFTR) modulating therapies, including elexacaftor‐tezacaftor‐ivacaftor, are primarily eliminated through cytochrome P450 (CYP) 3A–mediated metabolism. This creates a therapeutic challenge to the treatment of coronavirus disease 2019 (COVID‐19) wit...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9087007/ https://www.ncbi.nlm.nih.gov/pubmed/35292968 http://dx.doi.org/10.1002/cpt.2585 |
_version_ | 1784704126415798272 |
---|---|
author | Hong, Eunjin Almond, Lisa M. Chung, Peter S. Rao, Adupa P. Beringer, Paul M. |
author_facet | Hong, Eunjin Almond, Lisa M. Chung, Peter S. Rao, Adupa P. Beringer, Paul M. |
author_sort | Hong, Eunjin |
collection | PubMed |
description | Cystic fibrosis transmembrane conductance regulator (CFTR) modulating therapies, including elexacaftor‐tezacaftor‐ivacaftor, are primarily eliminated through cytochrome P450 (CYP) 3A–mediated metabolism. This creates a therapeutic challenge to the treatment of coronavirus disease 2019 (COVID‐19) with nirmatrelvir‐ritonavir in people with cystic fibrosis (CF) due to the potential for significant drug–drug interactions (DDIs). However, the population with CF is more at risk of serious illness following COVID‐19 infection and hence it is important to manage the DDI risk and provide treatment options. CYP3A‐mediated DDI of elexacaftor‐tezacaftor‐ivacaftor was evaluated using a physiologically‐based pharmacokinetic modeling approach. Modeling was performed incorporating physiological information and drug‐dependent parameters of elexacaftor‐tezacaftor‐ivacaftor to predict the effect of ritonavir (the CYP3A inhibiting component of the combination) on the pharmacokinetics of elexacaftor‐tezacaftor‐ivacaftor. The elexacaftor‐tezacaftor‐ivacaftor models were verified using independent clinical pharmacokinetic and DDI data of elexacaftor‐tezacaftor‐ivacaftor with a range of CYP3A modulators. When ritonavir was administered on Days 1 through 5, the predicted area under the curve (AUC) ratio of ivacaftor (the most sensitive CYP3A substrate) on Day 6 was 9.31, indicating that its metabolism was strongly inhibited. Based on the predicted DDI, the dose of elexacaftor‐tezacaftor‐ivacaftor should be reduced when coadministered with nirmatrelvir‐ritonavir to elexacaftor 200 mg–tezacaftor 100 mg–ivacaftor 150 mg on Days 1 and 5, with delayed resumption of full‐dose elexacaftor‐tezacaftor‐ivacaftor on Day 9, considering the residual inhibitory effect of ritonavir as a mechanism‐based inhibitor. The simulation predicts a regimen of elexacaftor‐tezacaftor‐ivacaftor administered concomitantly with nirmatrelvir‐ritonavir in people with CF that will likely decrease the impact of the drug interaction. |
format | Online Article Text |
id | pubmed-9087007 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90870072022-05-10 Physiologically‐Based Pharmacokinetic‐Led Guidance for Patients With Cystic Fibrosis Taking Elexacaftor‐Tezacaftor‐Ivacaftor With Nirmatrelvir‐Ritonavir for the Treatment of COVID‐19 Hong, Eunjin Almond, Lisa M. Chung, Peter S. Rao, Adupa P. Beringer, Paul M. Clin Pharmacol Ther Research Cystic fibrosis transmembrane conductance regulator (CFTR) modulating therapies, including elexacaftor‐tezacaftor‐ivacaftor, are primarily eliminated through cytochrome P450 (CYP) 3A–mediated metabolism. This creates a therapeutic challenge to the treatment of coronavirus disease 2019 (COVID‐19) with nirmatrelvir‐ritonavir in people with cystic fibrosis (CF) due to the potential for significant drug–drug interactions (DDIs). However, the population with CF is more at risk of serious illness following COVID‐19 infection and hence it is important to manage the DDI risk and provide treatment options. CYP3A‐mediated DDI of elexacaftor‐tezacaftor‐ivacaftor was evaluated using a physiologically‐based pharmacokinetic modeling approach. Modeling was performed incorporating physiological information and drug‐dependent parameters of elexacaftor‐tezacaftor‐ivacaftor to predict the effect of ritonavir (the CYP3A inhibiting component of the combination) on the pharmacokinetics of elexacaftor‐tezacaftor‐ivacaftor. The elexacaftor‐tezacaftor‐ivacaftor models were verified using independent clinical pharmacokinetic and DDI data of elexacaftor‐tezacaftor‐ivacaftor with a range of CYP3A modulators. When ritonavir was administered on Days 1 through 5, the predicted area under the curve (AUC) ratio of ivacaftor (the most sensitive CYP3A substrate) on Day 6 was 9.31, indicating that its metabolism was strongly inhibited. Based on the predicted DDI, the dose of elexacaftor‐tezacaftor‐ivacaftor should be reduced when coadministered with nirmatrelvir‐ritonavir to elexacaftor 200 mg–tezacaftor 100 mg–ivacaftor 150 mg on Days 1 and 5, with delayed resumption of full‐dose elexacaftor‐tezacaftor‐ivacaftor on Day 9, considering the residual inhibitory effect of ritonavir as a mechanism‐based inhibitor. The simulation predicts a regimen of elexacaftor‐tezacaftor‐ivacaftor administered concomitantly with nirmatrelvir‐ritonavir in people with CF that will likely decrease the impact of the drug interaction. John Wiley and Sons Inc. 2022-04-06 2022-06 /pmc/articles/PMC9087007/ /pubmed/35292968 http://dx.doi.org/10.1002/cpt.2585 Text en © 2022 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Research Hong, Eunjin Almond, Lisa M. Chung, Peter S. Rao, Adupa P. Beringer, Paul M. Physiologically‐Based Pharmacokinetic‐Led Guidance for Patients With Cystic Fibrosis Taking Elexacaftor‐Tezacaftor‐Ivacaftor With Nirmatrelvir‐Ritonavir for the Treatment of COVID‐19 |
title | Physiologically‐Based Pharmacokinetic‐Led Guidance for Patients With Cystic Fibrosis Taking Elexacaftor‐Tezacaftor‐Ivacaftor With Nirmatrelvir‐Ritonavir for the Treatment of COVID‐19 |
title_full | Physiologically‐Based Pharmacokinetic‐Led Guidance for Patients With Cystic Fibrosis Taking Elexacaftor‐Tezacaftor‐Ivacaftor With Nirmatrelvir‐Ritonavir for the Treatment of COVID‐19 |
title_fullStr | Physiologically‐Based Pharmacokinetic‐Led Guidance for Patients With Cystic Fibrosis Taking Elexacaftor‐Tezacaftor‐Ivacaftor With Nirmatrelvir‐Ritonavir for the Treatment of COVID‐19 |
title_full_unstemmed | Physiologically‐Based Pharmacokinetic‐Led Guidance for Patients With Cystic Fibrosis Taking Elexacaftor‐Tezacaftor‐Ivacaftor With Nirmatrelvir‐Ritonavir for the Treatment of COVID‐19 |
title_short | Physiologically‐Based Pharmacokinetic‐Led Guidance for Patients With Cystic Fibrosis Taking Elexacaftor‐Tezacaftor‐Ivacaftor With Nirmatrelvir‐Ritonavir for the Treatment of COVID‐19 |
title_sort | physiologically‐based pharmacokinetic‐led guidance for patients with cystic fibrosis taking elexacaftor‐tezacaftor‐ivacaftor with nirmatrelvir‐ritonavir for the treatment of covid‐19 |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9087007/ https://www.ncbi.nlm.nih.gov/pubmed/35292968 http://dx.doi.org/10.1002/cpt.2585 |
work_keys_str_mv | AT hongeunjin physiologicallybasedpharmacokineticledguidanceforpatientswithcysticfibrosistakingelexacaftortezacaftorivacaftorwithnirmatrelvirritonavirforthetreatmentofcovid19 AT almondlisam physiologicallybasedpharmacokineticledguidanceforpatientswithcysticfibrosistakingelexacaftortezacaftorivacaftorwithnirmatrelvirritonavirforthetreatmentofcovid19 AT chungpeters physiologicallybasedpharmacokineticledguidanceforpatientswithcysticfibrosistakingelexacaftortezacaftorivacaftorwithnirmatrelvirritonavirforthetreatmentofcovid19 AT raoadupap physiologicallybasedpharmacokineticledguidanceforpatientswithcysticfibrosistakingelexacaftortezacaftorivacaftorwithnirmatrelvirritonavirforthetreatmentofcovid19 AT beringerpaulm physiologicallybasedpharmacokineticledguidanceforpatientswithcysticfibrosistakingelexacaftortezacaftorivacaftorwithnirmatrelvirritonavirforthetreatmentofcovid19 |