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1.
J Mol Recognit ; 34(10): e2900, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33949010

RESUMO

In this study, the rGO-PEI-AgNPs sensor was designed as a new effective platform to sensitive monitoring of deltamethrin in human plasma samples. For this purpose, reduced graphene oxide (rGO)-supported polyethylenimine (PEI) was used as a suitable substrate for dispersion of silver nanoparticles (AgNPs) as amplification and catalytic element. Therefore, a novel interface (rGO-PEI-AgNPs) was prepared by the fully electrochemical method on the surface of glassy carbon electrodes. The engineered nano-sensor showed a wide dynamic range of 10 nM to 1 mM and low limit of quantification (LLOQ) as 10 nM in human plasma sample, which revealed excellent analytical performance for the recognition of deltamethrin with high sensitivity and reproducibility through differential pulse voltammetry and square wave voltammetry techniques. The results confirm that rGO-PEI-AgNPs as a novel biocompatible interface can provide appropriate, reliable, affordable, rapid, and user-friendly diagnostic tools in the detection of deltamethrin in human real samples.


Assuntos
Técnicas Eletroquímicas/métodos , Nanopartículas Metálicas/química , Nitrilas/análise , Praguicidas/análise , Piretrinas/análise , Líquidos Corporais/química , Técnicas Eletroquímicas/instrumentação , Eletrodos , Desenho de Equipamento , Grafite/química , Humanos , Cinética , Limite de Detecção , Microscopia Eletrônica de Varredura , Nitrilas/sangue , Praguicidas/sangue , Polietilenoimina/química , Piretrinas/sangue , Sensibilidade e Especificidade , Prata/química
2.
Med Mycol ; 59(9): 939-942, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34143187

RESUMO

Coccidioidal meningitis (CM) is a life-threatening infection with limited treatment options. Small series have reported success with isavuconazole; however, limited data exist on cerebrospinal fluid (CSF) penetration. Paired plasma and CSF isavuconazole concentrations were measured. Eleven CSF levels were tested, (7 ventricular, 4 lumbar) in three CM patients. Ventricular CSF levels were undetectable despite detectable plasma levels. All lumbar CSF levels were detectable (mean 1.00 µg/ml). Three pairs of lumbar CSF/plasma concentrations taken within 1 h of each other yielded a mean CSF/plasma ratio of 0.31. Isavuconazole was detectable in lumbar but not ventricular CSF in three patients treated for refractory CM. LAY SUMMARY: Isavuconazole is a triazole antifungal that has been used as salvage therapy in the treatment of coccidioidal meningitis (CM). Few data exist characterizing its concentration in the cerebrospinal fluid (CSF). We report tandem plasma and CSF concentrations of isavuconazole in three patients with CM.


Assuntos
Antifúngicos/uso terapêutico , Líquido Cefalorraquidiano/efeitos dos fármacos , Coccidioidomicose/tratamento farmacológico , Meningite Fúngica/tratamento farmacológico , Plasma/efeitos dos fármacos , Piridinas/uso terapêutico , Triazóis/uso terapêutico , Adulto , Idoso , Antifúngicos/farmacocinética , Monitoramento de Medicamentos , Feminino , Humanos , Masculino , Nitrilas/sangue , Nitrilas/líquido cefalorraquidiano , Nitrilas/farmacocinética , Nitrilas/uso terapêutico , Piridinas/sangue , Piridinas/líquido cefalorraquidiano , Resultado do Tratamento , Triazóis/sangue , Triazóis/líquido cefalorraquidiano , Adulto Jovem
3.
J Clin Pharm Ther ; 46(2): 528-531, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33247433

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Invasive fungal infections often occur in patients with comorbidities that complicate oral administration. Serum concentrations of isavuconazole were characterized after enteral tube administration. CASE DESCRIPTION: Thirteen of 14 isavuconazole concentrations were >1 mg/dl (median 1.6 mg/dl) among those receiving enteral tube administration, which was comparable to intravenous (median 1.9 mg/dl). Higher concentrations were observed during oral administration (median 3 mg/dl). WHAT IS NEW AND CONCLUSION: Administration of isavuconazole via tube resulted in concentrations comparable to FDA-approved routes of administration. This route may be feasible and appropriate for select patients.


Assuntos
Antifúngicos/administração & dosagem , Antifúngicos/sangue , Nutrição Enteral/métodos , Infecções Fúngicas Invasivas/tratamento farmacológico , Nitrilas/administração & dosagem , Nitrilas/sangue , Piridinas/administração & dosagem , Piridinas/sangue , Triazóis/administração & dosagem , Triazóis/sangue , Adulto , Antifúngicos/farmacocinética , Vias de Administração de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitrilas/farmacocinética , Piridinas/farmacocinética , Triazóis/farmacocinética
4.
Biomed Chromatogr ; 35(8): e5124, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33772839

RESUMO

Recent studies have shown that therapeutic drug monitoring of tyrosine kinase inhibitors (TKIs) could improve treatment efficacy and safety. A simple analytical method using high-performance LC/electrospray ionization-tandem mass spectrometry has been developed and validated for simultaneous quantification of BCR-ABL and Bruton's TKIs used for chronic leukemia (imatinib, dasatinib, bosutinib, nilotinib, and ibrutinib) in human plasma. Although these structures and physical properties are similar, owing to their different linear ranges, simultaneously determining the plasma levels of these five TKIs by applying optimal MS parameters remains difficult. A quantitative range exceeding 60,000-fold was required, and the linear dynamic ranges of imatinib, bosutinib, and nilotinib were limited because of the presence of a saturated detection signal. In this study, we applied the in-source collision-induced dissociation technique to control the ion amounts in mass spectrometry. This new method allowed rapid determination within 5 min with simple pretreatment. The method was validated according to the US Food and Drug Administration guidelines. Moreover, all samples of patients with chronic leukemia were successfully measured and their values were within the linear range of measurement. Therefore, our high-throughput analytical system is useful to measure the plasma concentrations of imatinib, dasatinib, bosutinib, nilotinib, and ibrutinib in clinical practice.


Assuntos
Cromatografia Líquida/métodos , Monitoramento de Medicamentos/métodos , Inibidores de Proteínas Quinases/sangue , Espectrometria de Massas por Ionização por Electrospray/métodos , Adenina/análogos & derivados , Adenina/sangue , Adenina/uso terapêutico , Compostos de Anilina/sangue , Compostos de Anilina/uso terapêutico , Dasatinibe/sangue , Dasatinibe/uso terapêutico , Feminino , Ensaios de Triagem em Larga Escala , Humanos , Mesilato de Imatinib/sangue , Mesilato de Imatinib/uso terapêutico , Leucemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Nitrilas/sangue , Nitrilas/uso terapêutico , Piperidinas/sangue , Piperidinas/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/sangue , Pirimidinas/uso terapêutico , Quinolinas/sangue , Quinolinas/uso terapêutico , Espectrometria de Massas em Tandem/métodos
5.
Biopharm Drug Dispos ; 42(6): 263-284, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33904202

RESUMO

Renal (RIP) and hepatic (HIP) impairments are prevalent conditions in cancer patients. They can cause changes in gastric emptying time, albumin levels, hematocrit, glomerular filtration rate, hepatic functional volume, blood flow rates, and metabolic activity that can modify drug pharmacokinetics. Performing clinical studies in such populations has ethical and practical issues. Using predictive physiologically-based pharmacokinetic (PBPK) models in the evaluation of the PK of alectinib, ruxolitinib, and panobinostat exposures in the presence of cancer, RIP, and HIP can help in using optimal doses with lower toxicity in these populations. Verified PBPK models were customized under scrutiny to account for the pathophysiological changes induced in these diseases. The PBPK model-predicted plasma exposures in patients with different health conditions within average 2-fold error. The PBPK model predicted an area under the curve ratio (AUCR) of 1, and 1.8, for ruxolitinib and panobinostat, respectively, in the presence of severe RIP. On the other hand, the severe HIP was associated with AUCR of 1.4, 2.9, and 1.8 for alectinib, ruxolitinib, and panobinostat, respectively, in agreement with the observed AUCR. Moreover, the PBPK model predicted that alectinib therapeutic cerebrospinal fluid levels are achieved in patients with non-small cell lung cancer, moderate HIP, and severe HIP at 1-, 1.5-, and 1.8-fold that of healthy subjects. The customized PBPK models showed promising ethical alternatives for simulating clinical studies in patients with cancer, RIP, and HIP. More work is needed to quantify other pathophysiological changes induced by simultaneous affliction by cancer and RIP or HIP.


Assuntos
Antineoplásicos/farmacocinética , Carbazóis/farmacocinética , Hepatopatias/sangue , Modelos Biológicos , Neoplasias/sangue , Nitrilas/farmacocinética , Panobinostat/farmacocinética , Piperidinas/farmacocinética , Inibidores de Proteínas Quinases/farmacocinética , Pirazóis/farmacocinética , Pirimidinas/farmacocinética , Insuficiência Renal/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/sangue , Área Sob a Curva , Carbazóis/sangue , Jejum/metabolismo , Feminino , Humanos , Hepatopatias/metabolismo , Masculino , Pessoa de Meia-Idade , Neoplasias/metabolismo , Nitrilas/sangue , Panobinostat/sangue , Piperidinas/sangue , Inibidores de Proteínas Quinases/sangue , Pirazóis/sangue , Pirimidinas/sangue , Insuficiência Renal/metabolismo
6.
Artigo em Inglês | MEDLINE | ID: mdl-31871077

RESUMO

We analyzed the use of isavuconazole (ISA) as treatment or prophylaxis for invasive fungal disease (IFD) in children with hemato-oncologic diseases. A multicentric retrospective analysis was performed among centers belonging to the Italian Association for Pediatric Hematology and Oncology (AIEOP). Pharmacokinetic (PK) monitoring was applied by a high-performance liquid chromatography-tandem mass spectrometry (HLPC-MS/MS) assay. Twenty-nine patients were studied: 10 during chemotherapy and 19 after allogeneic hematopoietic stem cell transplantation (HSCT). The patients consisted of 20 males and 9 females with a median age of 14.5 years (age range, 3 to 18 years) and a median body weight of 47 kg (body weight range, 15 to 80 kg). ISA was used as prophylaxis in 5 patients and as treatment in 24 cases (20 after therapeutic failure, 4 as first-line therapy). According to European Organization for Research and Treatment of Cancer (EORTC) criteria, we registered 5 patients with proven IFD, 9 patients with probable IFD, and 10 patients with possible IFD. Patients with a body weight of <30 kg received half the ISA dose; the others received ISA on the adult schedule (a 200-mg loading dose every 8 h on days 1 and 2 and a 200-mg/day maintenance dose); for all but 10 patients, the route of administration switched from the intravenous route to the oral route during treatment. ISA was administered for a median of 75.5 days (range, 6 to 523 days). The overall response rate was 70.8%; 12 patients with IFD achieved complete remission, 5 achieved partial remission, 5 achieved progression, and 3 achieved stable IFD. No breakthrough infections were registered. PK monitoring of 17 patients revealed a median ISA steady-state trough concentration of 4.91 mg/liter (range, 2.15 to 8.54 mg/liter) and a concentration/dose (in kilograms) ratio of 1.13 (range, 0.47 to 3.42). Determination of the 12-h PK profile was performed in 6 cases. The median area under the concentration-time curve from 0 to 12 h was 153.16 mg·h/liter (range, 86.31 to 169.45 mg·h/liter). Common Terminology Criteria for Adverse Events grade 1 to 3 toxicity (increased transaminase and/or creatinine levels) was observed in 6 patients, with no drug-drug interactions being seen in patients receiving immunosuppressants. Isavuconazole may be useful and safe in children with hemato-oncologic diseases, even in the HSCT setting. Prospective studies are warranted.


Assuntos
Antifúngicos/farmacocinética , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Infecções Fúngicas Invasivas/tratamento farmacológico , Nitrilas/farmacocinética , Piridinas/farmacocinética , Triazóis/farmacocinética , Administração Intravenosa , Administração Oral , Adolescente , Antifúngicos/sangue , Antifúngicos/farmacologia , Aspergillus/efeitos dos fármacos , Aspergillus/crescimento & desenvolvimento , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Neoplasias Hematológicas/microbiologia , Neoplasias Hematológicas/patologia , Humanos , Infecções Fúngicas Invasivas/microbiologia , Infecções Fúngicas Invasivas/patologia , Masculino , Testes de Sensibilidade Microbiana , Mucor/efeitos dos fármacos , Mucor/crescimento & desenvolvimento , Nitrilas/sangue , Nitrilas/farmacologia , Penicillium/efeitos dos fármacos , Penicillium/crescimento & desenvolvimento , Piridinas/sangue , Piridinas/farmacologia , Estudos Retrospectivos , Transplante Homólogo , Triazóis/sangue , Triazóis/farmacologia
7.
Med Mycol ; 58(7): 996-999, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32396168

RESUMO

We determined isavuconazole serum concentrations for 150 UK patients receiving standard isavuconazole dosing regimens, including serial therapeutic drug monitoring for several patients on prolonged therapy. Mean trough isavuconazole concentrations in these patients were virtually identical to those reported previously from clinical trials, although greater variability was seen in patients below 18 years of age. Serial monitoring in patients receiving prolonged therapy suggested gradual, near-linear accumulation of the drug over many weeks.


Assuntos
Antifúngicos/uso terapêutico , Monitoramento de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Micoses/tratamento farmacológico , Nitrilas/sangue , Nitrilas/uso terapêutico , Piridinas/sangue , Piridinas/uso terapêutico , Soro/química , Triazóis/sangue , Triazóis/uso terapêutico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Reino Unido , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-30962330

RESUMO

This phase 1, open-label, single-dose, parallel-group study evaluated the pharmacokinetics (PK) of isavuconazole after a single oral dose of the prodrug isavuconazonium sulfate in healthy nonelderly (age, 18 to 45 years) and elderly (age, ≥65 years) males and females. Overall, 48 subjects were enrolled in the study (n = 12 each in groups of nonelderly males and females and elderly males and females). All subjects received a single oral dose of 372 mg of isavuconazonium sulfate (equivalent to 200 mg isavuconazole). PK samples were collected for analysis of isavuconazole plasma concentrations from the predose time point up to 336 h postdose. Data were analyzed using population pharmacokinetic (PPK) analysis. The resulting PPK model included two compartments with Weibull absorption function as well as interindividual variability with respect to clearance, intercompartment clearance, volumes of central and peripheral compartments, and two Weibull absorption parameters, RA and KAMAX. The PPK analysis showed that elderly females had the highest exposure versus males (ratio of total area under the time-concentration curve [AUC], 138; 90% confidence interval [CI], 118 to 161) and versus nonelderly females (ratio of AUC, 147; 90% CI, 123 to 176). Higher exposures in elderly females were not associated with significant toxicity or treatment-emergent adverse events, as measured in this study. No dose adjustments appear to be necessary based on either age group or sex even with an increase in exposure for elderly females. (This study has been registered at ClinicalTrials.gov under registration no. NCT01657890.).


Assuntos
Antifúngicos/farmacologia , Nitrilas/farmacologia , Piridinas/farmacologia , Triazóis/farmacologia , Adulto , Antifúngicos/sangue , Intervalos de Confiança , Feminino , Humanos , Masculino , Nitrilas/sangue , Piridinas/sangue , Triazóis/sangue , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-31427296

RESUMO

Isavuconazole plasma concentrations were measured before and after sustained low-efficiency dialysis (SLED) treatment in 22 critically ill adult patients with probable invasive aspergillosis and underlying hematological malignancies. Isavuconazole levels were significantly lower after SLED treatment (5.73 versus 3.36 µg/ml; P < 0.001). However, even after SLED treatment, isavuconazole concentrations exceeded the in vivo MICs for several relevant Aspergillus species.


Assuntos
Antifúngicos/sangue , Antifúngicos/uso terapêutico , Estado Terminal/terapia , Nitrilas/sangue , Nitrilas/uso terapêutico , Piridinas/sangue , Piridinas/uso terapêutico , Triazóis/sangue , Triazóis/uso terapêutico , Adulto , Aspergilose/sangue , Aspergilose/tratamento farmacológico , Aspergillus/efeitos dos fármacos , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade
10.
J Cardiovasc Pharmacol ; 73(4): 215-222, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30747785

RESUMO

BACKGROUND: Activation of the NLRP3 inflammasome is a primary driver of sterile inflammation in response to myocardial ischemia reperfusion. Pharmacologic inhibitors of the NLRP3 inflammasome are being developed. We proposed that OLT1177 (dapansutrile), a novel NLRP3 inflammasome inhibitor, could preserve myocardial function after ischemia reperfusion injury in the mouse. METHODS: We used an experimental murine model of myocardial ischemia reperfusion injury through transient ligation of the left coronary artery and measured the effects of OLT1177 (6, 60, or 600 mg/kg intraperitoneal dose) on infarct size at pathology and on systolic cardiac function at echocardiography. To simulate a clinical scenario, we investigated the time window of therapeutic intervention with OLT1177 (60 mg/kg) administered 60, 120, or 180 minutes after reperfusion. RESULTS: OLT1177 was rapidly detectable in the plasma following intraperitoneal injection and had no effect on cardiac function in healthy mice. OLT1177 treatment at reperfusion showed significant dose-dependent reduction in infarct size (-36%, -67%, and -62% for 6, 60, and 600 mg/kg, respectively; P < 0.001 for linear trend, P = 0.010 vs. vehicle for 6 mg/kg, and P < 0.001 vs. vehicle for 60 and 600 mg/kg) and preserved cardiac systolic function measured as left ventricular fractional shortening at 24 hours and 7 days after injury (P = 0.015 for 6 mg/kg and P < 0.01 for 60 and 600 mg/kg). OLT1177 reduced infarct size also when given after 60 minutes of reperfusion (-71%, P < 0.001 vs. vehicle). CONCLUSION: OLT1177 (dapansutrile) limits infarct size and prevents left ventricular systolic dysfunction when given within 60 minutes following ischemia reperfusion injury in the mouse.


Assuntos
Anti-Inflamatórios/farmacologia , Inflamassomos/antagonistas & inibidores , Contração Miocárdica/efeitos dos fármacos , Infarto do Miocárdio/tratamento farmacológico , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Miocárdio/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/antagonistas & inibidores , Nitrilas/farmacologia , Animais , Anti-Inflamatórios/sangue , Caspase 1/metabolismo , Modelos Animais de Doenças , Inflamassomos/metabolismo , Camundongos , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Traumatismo por Reperfusão Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Miocárdio/patologia , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Nitrilas/sangue , Transdução de Sinais
11.
Ther Drug Monit ; 41(5): 657-664, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568234

RESUMO

BACKGROUND: Under certain circumstances, clinicians treating patients with isavuconazole for invasive aspergillosis or mucormycosis may use therapeutic drug monitoring. However, the accuracy and reproducibility of the various assays used by different laboratories for the quantification of isavuconazole plasma concentrations have yet to be determined. METHODS: Human plasma samples spiked with known concentrations of isavuconazole were provided to 27 European laboratories that took part in a "round-robin" test (an interlaboratory test performed independently at least 2 times; 2 rounds performed in the current study). Assay methods included liquid chromatography-tandem mass spectrometry (LC-MS/MS), LC with ultraviolet detection (LC-UV), LC with fluorescence detection (LC-FL), and bioassay. The accuracy and reproducibility compared with the known concentrations for each sample in each round were compared overall, between assays, and between laboratories. RESULTS: Twenty-seven laboratories participated in the study (LC-MS/MS, n = 15; LC-UV; n = 9; LC-FL, n = 1; bioassay, n = 2). In round 1, for nominal concentrations of 1000, 1700, 2500, and 4000 ng/mL, the mean (SD) determined concentrations were 1007 (183), 1710 (323), 2528 (540), and 3898 (842) ng/mL, respectively. In round 2, for nominal concentrations of 1200, 1800, 2400, and 4000 ng/mL, the mean (SD) determined concentrations were 1411 (303), 2111 (409), 2789 (511), and 4723 (798) ng/mL, respectively. Over both rounds, determined concentrations were consistently within 15% of the nominal concentrations for 10 laboratories (LC-MS/MS, n = 4; LC-UV, n = 5; bioassay, n = 1) and consistently exceeded the upper 15% margin for 7 laboratories (LC-MS/MS and LC-UV, n = 3 each; LC-FL, n = 1). CONCLUSIONS: Alignment of methodologies among laboratories may be warranted to improve the accuracy and reproducibility of therapeutic drug measurements.


Assuntos
Bioensaio/métodos , Nitrilas/sangue , Plasma/química , Piridinas/sangue , Triazóis/sangue , Cromatografia Líquida/métodos , Monitoramento de Medicamentos/métodos , Europa (Continente) , Humanos , Laboratórios , Reprodutibilidade dos Testes , Espectrometria de Massas em Tandem/métodos
12.
Bioorg Med Chem ; 27(10): 1925-1931, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30992201

RESUMO

Folate receptors (FR) are frequently overexpressed in a wide variety of human cancers. The aim of this study was to develop a trivalent 99mTc(CO)3-labeled folate radiotracer containing isonitrile (CN-R) as the coordinating ligand for FR target imaging. [99mTc]Tc-10 was HPLC purified (>98% chemical purity) and evaluated in vitro and in vivo as a potential agent for targeting FR-positive KB cells. [99mTc]Tc-10 is a hydrophilic compound with partition coefficient of -2.90 ±â€¯0.13 that showed high binding affinity (0.04 ±â€¯0.002 nM) in vitro. High accumulation and retention of [99mTc]Tc-10 (5.32 ±â€¯2.99% ID/g) was observed in mice with KB tumors at 4 h after injection through the tail vein, which was significantly inhibited by co-injection of free folic acid (FA). SPECT (single photon emission tomography)/CT results were in accordance with biodistribution data at all time points.


Assuntos
Receptores de Folato com Âncoras de GPI/metabolismo , Nitrilas/química , Compostos Radiofarmacêuticos/química , Animais , Estabilidade de Medicamentos , Receptores de Folato com Âncoras de GPI/química , Humanos , Células KB , Camundongos , Camundongos Nus , Neoplasias/diagnóstico por imagem , Nitrilas/sangue , Nitrilas/metabolismo , Compostos de Organotecnécio/química , Compostos Radiofarmacêuticos/sangue , Compostos Radiofarmacêuticos/metabolismo , Distribuição Tecidual , Tomografia Computadorizada de Emissão de Fóton Único , Transplante Heterólogo
13.
Transpl Infect Dis ; 21(1): e13007, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30295407

RESUMO

INTRODUCTION: Isavuconazole, a triazole antifungal, is an inhibitor of cytochrome P450 3A4, which also metabolizes tacrolimus and sirolimus. In previous studies, isavuconazole administration increased tacrolimus and sirolimus area under the curve values by 2.3-fold and 1.8-fold, respectively, in healthy adults and tacrolimus concentration/dose (C/D) ratio by 1.3-fold in solid organ transplant patients. We aimed to determine the magnitude of effect of isavuconazole administration on tacrolimus and sirolimus C/D ratios in allogeneic hematopoietic stem cell transplant (alloHSCT) patients. METHODS: A retrospective, single-center, single-arm study in adult alloHSCT patients who received at least 10 days of combination therapy with isavuconazole and tacrolimus and/or sirolimus as inpatients or outpatients was conducted. Tacrolimus and sirolimus trough serum concentrations were measured up to twice weekly for up to 4 weeks. RESULTS: Twenty-two patients receiving tacrolimus and twenty patients receiving sirolimus met the inclusion criteria. The mean C/D ratio increased from baseline by 1.42-fold for tacrolimus during week 1 (P = 0.002) and up to 1.56-fold for sirolimus during week 2 (P = 0.02). For the remaining timepoints, tacrolimus and sirolimus C/D ratios were not statistically significantly different from baseline. CONCLUSION: In alloHSCT patients, modest increases in tacrolimus and sirolimus C/D ratios from baseline were observed within the first 2 weeks after initiation of isavuconazole.


Assuntos
Antifúngicos/farmacologia , Inibidores do Citocromo P-450 CYP3A/farmacologia , Doença Enxerto-Hospedeiro/prevenção & controle , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Imunossupressores/farmacologia , Adulto , Idoso , Antifúngicos/uso terapêutico , Citocromo P-450 CYP3A/metabolismo , Inibidores do Citocromo P-450 CYP3A/sangue , Inibidores do Citocromo P-450 CYP3A/uso terapêutico , Interações Medicamentosas , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Nitrilas/sangue , Nitrilas/farmacologia , Nitrilas/uso terapêutico , Piridinas/sangue , Piridinas/farmacologia , Piridinas/uso terapêutico , Estudos Retrospectivos , Sirolimo/sangue , Sirolimo/metabolismo , Sirolimo/farmacologia , Sirolimo/uso terapêutico , Tacrolimo/sangue , Tacrolimo/metabolismo , Tacrolimo/farmacologia , Tacrolimo/uso terapêutico , Transplante Homólogo/efeitos adversos , Triazóis/sangue , Triazóis/farmacologia , Triazóis/uso terapêutico , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-30275091

RESUMO

Isavuconazole may be useful in treating and preventing fungal infections in solid-organ transplant (SOT) recipients due to its safety profile and activity against Aspergillus and some Mucorales Isavuconazole has favorable pharmacokinetics based on clinical trials in various patient populations, but data are limited in SOT recipients. We evaluated the steady-state pharmacokinetics of isavuconazole in 26 SOT recipients receiving the drug intravenously for prophylaxis. There was moderate interpatient variability in isavuconazole pharmacokinetic parameters (coefficients of variation of 51% for the area under the plasma concentration-versus-time curve [AUC] and 59% for the trough plasma concentration [Ctrough]). AUC and steady-state Ctrough were significantly lower in women, patients with a body mass index of ≥18.5 kg/m2, and those receiving hemodialysis. Trough plasma concentrations were highly correlated with AUCs (R2 = 0.94) and can serve as a suitable measure of isavuconazole exposure in patients. In conclusion, moderate interpatient variability in isavuconazole exposure, the identification of factors associated with lower exposure, the recognition that Ctrough is a surrogate marker for AUC, and the availability of a simple analytical method suggest that therapeutic drug monitoring (TDM) may be useful for guiding treatment in at least some SOT recipients. Future studies are needed to correlate isavuconazole exposure with patients' clinical outcomes and to determine the clinical role of TDM.


Assuntos
Antifúngicos/farmacocinética , Aspergilose/prevenção & controle , Imunossupressores/administração & dosagem , Mucormicose/prevenção & controle , Nitrilas/farmacocinética , Transplante de Órgãos/efeitos adversos , Piridinas/farmacocinética , Triazóis/farmacocinética , Adulto , Idoso , Antifúngicos/sangue , Antifúngicos/farmacologia , Área Sob a Curva , Aspergilose/sangue , Aspergilose/etiologia , Aspergilose/microbiologia , Aspergillus/efeitos dos fármacos , Aspergillus/crescimento & desenvolvimento , Aspergillus/patogenicidade , Monitoramento de Medicamentos , Feminino , Humanos , Imunossupressores/efeitos adversos , Injeções Intravenosas , Rim/cirurgia , Fígado/cirurgia , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Mucorales/efeitos dos fármacos , Mucorales/crescimento & desenvolvimento , Mucorales/patogenicidade , Mucormicose/sangue , Mucormicose/etiologia , Mucormicose/microbiologia , Nitrilas/sangue , Nitrilas/farmacologia , Estudos Prospectivos , Piridinas/sangue , Piridinas/farmacologia , Cirurgia Torácica , Transplantados , Triazóis/sangue , Triazóis/farmacologia
15.
Anticancer Drugs ; 29(3): 271-280, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29360661

RESUMO

The aim of this study was to assess the potential effects of palbociclib in combination with letrozole on QTc. PALOMA-2, a phase 3, randomized, double-blind, placebo-controlled trial, compared palbociclib plus letrozole with placebo plus letrozole in postmenopausal women with estrogen receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer. The study included a QTc evaluation substudy carried out as a definitive QT interval prolongation assessment for palbociclib. Time-matched triplicate ECGs were performed at 0, 2, 4, 6, and 8 h at baseline (Day 0) and on Cycle 1 Day 14. Additional ECGs were collected from all patients for safety monitoring. The QT interval was corrected for heart rate using Fridericia's correction (QTcF), Bazett's correction (QTcB), and a study-specific correction factor (QTcS). In total, 666 patients were randomized 2 : 1 to palbociclib plus letrozole or placebo plus letrozole. Of these, 125 patients were enrolled in the QTc evaluation substudy. No patients in the palbociclib plus letrozole arm of the substudy (N=77) had a maximum postbaseline QTcS or QTcF value of ≥ 480 ms, or a maximum increase from clock time-matched baseline for QTcS or QTcF values of ≥ 60 ms. The upper bounds of the one-sided 95% confidence interval for the mean change from time-matched baseline for QTcS, QTcF, and QTcB at all time points and at steady-state Cmax following repeated administration of 125 mg palbociclib were less than 10 ms. Palbociclib, when administered with letrozole at the recommended therapeutic dosing regimen, did not prolong the QT interval to a clinically relevant extent.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Eletrocardiografia/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos , Protocolos de Quimioterapia Combinada Antineoplásica/sangue , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Neoplasias da Mama/sangue , Neoplasias da Mama/fisiopatologia , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Letrozol , Pessoa de Meia-Idade , Nitrilas/administração & dosagem , Nitrilas/sangue , Nitrilas/farmacocinética , Piperazinas/administração & dosagem , Piperazinas/sangue , Piperazinas/farmacocinética , Piridinas/administração & dosagem , Piridinas/sangue , Piridinas/farmacocinética , Triazóis/administração & dosagem , Triazóis/sangue , Triazóis/farmacocinética
16.
Ther Drug Monit ; 40(4): 503-506, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29994987

RESUMO

BACKGROUND: Isavuconazole is a triazole antifungal agent for treatment of invasive aspergillosis and mucormycosis. At present, it is unclear whether a therapeutic drug monitoring (TDM) of isavuconazole would be necessary. The aim of the investigation was to validate a high-performance liquid chromatography (HPLC) assay for routine applications. METHODS: An HPLC assay for routine determination of isavuconazole in plasma has been adapted and validated. The assay used the reagents and HPLC column provided by the ChromSystems HPLC Kit for TDM of itraconazole, posaconazole, and voriconazole. Isocratic flow rate was set at 1.0 mL/min. Detection was performed using a fluorescence detector with excitation wavelength set at 261 nm and emission wavelength set at 366 nm. RESULTS: The assay was linear between 0.15 and 10 mg/L with intraday and interday imprecision and accuracy <10% (<20% at lower limit of quantification). The method was applied to routine TDM of 7 patients after hematopoietic stem cell transplantation (n = 31 samples). In these patients, trough levels ranged from 0.45 to 3.06 mg/L (median 1.44 mg/L). CONCLUSIONS: A robust and simple HPLC assay of isavuconazole in plasma for routine TDM applications is presented.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Monitoramento de Medicamentos/métodos , Nitrilas/sangue , Piridinas/sangue , Triazóis/sangue , Antifúngicos/sangue , Humanos
17.
Chemotherapy ; 63(5): 253-256, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30458443

RESUMO

Invasive fungal disease (IFD) is one of the major causes of morbidity and mortality in immunocompromised patients. Voriconazole (VCZ) and posaconazole (PCZ) remain the most widely used antifungals for the prophylaxis and treatment of IFD. However, VCZ and PCZ are liable for drug-drug interactions and show a pharmacokinetic variability that requires therapeutic drug monitoring (TDM). Isavuconazole (IVZ) is a newest generation triazole antifungal approved for the treatment of invasive aspergillosis (IA) in adult patients and for the treatment of invasive mucormycosis in adult patients for whom treatment with amphotericin B is inappropriate. In clinical trials, IVZ showed linear pharmacokinetics and little or no evidence for interactions with other drugs. There is only modest evidence on IVZ pharmacokinetics and TDM in real-life settings. Here, we report on IVZ pharmacokinetics in a young adult with Ph chromosome-negative acute lymphoblastic leukemia (ALL) who developed a "probable" IA during induction chemotherapy. The patient was initially treated with VCZ, but she developed a severe hepatic toxicity that was associated to the high plasma levels of VCZ. Therefore, VCZ was discontinued and the patient was switched to IVZ. After a loading dose of IVZ, the patient remained on IVZ for 5 months while also receiving standard maintenance chemotherapy for ALL. At day 65 after the start of IVZ, the patient experienced a significant hepatic toxicity; however, no change in IVZ plasma concentrations was observed in the face of a concomitant administration of many other drugs (cancer drugs, antiemetics, other anti-infectives). Hepatic toxicity resolved after discontinuing maintenance chemotherapy but not IVZ. These results show that (i) IVZ plasma concentrations remained stable throughout and were not affected by concomitant ALL therapy, and (ii) there was no relation between IVZ plasma concentration and hepatic toxicity. Thus, in clinical practice IVZ may not require TDM.


Assuntos
Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Nitrilas/uso terapêutico , Piridinas/uso terapêutico , Triazóis/uso terapêutico , Administração Oral , Antifúngicos/farmacocinética , Aspergilose/patologia , Aspergillus flavus/isolamento & purificação , Líquido da Lavagem Broncoalveolar/microbiologia , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Cromatografia Líquida de Alta Pressão , Monitoramento de Medicamentos , Feminino , Meia-Vida , Humanos , Hospedeiro Imunocomprometido , Nitrilas/sangue , Nitrilas/farmacocinética , Piridinas/sangue , Piridinas/farmacocinética , Espectrometria de Massas em Tandem , Triazóis/sangue , Triazóis/farmacocinética , Voriconazol/efeitos adversos , Voriconazol/uso terapêutico , Adulto Jovem
18.
Xenobiotica ; 48(3): 279-284, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28906164

RESUMO

1. There are numerous investigations demonstrating that the cyclooxygenase-2 (COX-2) inhibitors might enhance the efficiency of anastrozole in breast cancer. Hence, this study was conducted to investigate the comparative pharmacokinetics of anastrozole after single administration and combination with celecoxib. 2. A simple protein precipitation procedure was adopted for the sample preparation with satisfactory extraction recovery for both anastrozole and the internal standard, and then anastrozole was separated and analysed on an ACQUITY BEH UPLC C18 column (50 × 2.0 mm, 1.7 µm, Waters) within 2 min. The calibration curves showed good linarites (r = 0.994). Intra- and inter-day precision were within 4.93 and 13.83%, respectively. The mean extraction recoveries across QC levels were within 91.4%, and the matrix effects were within 94.5%. 3. Results showed that the method was reliable to determine anastrozole in rat plasma. Compared with rats in single administration group, no significant difference was found in the combination group. It is workable to use celecoxib combined with anastrozole in clinical therapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Cromatografia Líquida/métodos , Nitrilas/farmacocinética , Espectrometria de Massas em Tandem/métodos , Triazóis/farmacocinética , Anastrozol , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Celecoxib/administração & dosagem , Celecoxib/farmacocinética , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Inibidores de Ciclo-Oxigenase 2/farmacocinética , Feminino , Limite de Detecção , Nitrilas/administração & dosagem , Nitrilas/sangue , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Triazóis/administração & dosagem , Triazóis/sangue
19.
J Clin Lab Anal ; 32(1)2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28374910

RESUMO

BACKGROUND: We propose a simple, sensitive, and fast high-performance liquid chromatography ultraviolet detection (HPLC-UV) method for the quantitative determination of bosutinib in human plasma. METHODS: Plasma samples were processed using an Oasis hydrophilic-lipophilic balance extraction cartridge (1 mL, 30 mg). Bosutinib and the internal standard imatinib were separated using a mobile phase of 0.5% Na2 PO4 H2 O (pH 3.5)-acetonitrile-methanol (55:25:20, v/v/v) on a CAPCELL PAK C18 MG II reversed-phase column 250 nm×4.6 nm i.d., at a flow rate of 1.0 mL/min, with ultraviolet detection at 250 nm. RESULTS: The calibration curve exhibited linearity over the bosutinib concentration range of 25-1500 ng/mL at 250 nm, with coefficient of variation for intraday precision of 2.42%, 6.04%, and 1.11% for 100, 250, and 1500 ng/mL, respectively, of bosutinib. The lower limit of detection was 20 ng/mL. The extraction recovery rates for bosutinib ranged from 84.36% to 85.82%. The intra- and interday precision was below 8.7%, and the accuracy ranged from -5.95% to 5.85% over the linear range. No notable matrix effects or astaticism were observed. CONCLUSION: The proposed HPLC-UV method was successfully applied as an assay to detect bosutinib in human plasma.


Assuntos
Compostos de Anilina/sangue , Nitrilas/sangue , Quinolinas/sangue , Cromatografia Líquida de Alta Pressão/métodos , Humanos , Modelos Lineares , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espectrofotometria Ultravioleta/métodos
20.
Biomed Chromatogr ; 32(11): e4333, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29978912

RESUMO

Isavuconazole is a broad-spectrum triazole antifungal drug recently approved for the therapy of both invasive aspergillosis and mucormycosis. To support a widespread therapeutic drug monitoring of isavuconazole, a simple, sensitive, and precise high-performance liquid chromatography method with UV detection was developed and fully validated for the quantification of this drug in human plasma. The method involved a combined protein precipitation-solid-phase extraction and a chromatographic separation on a Waters XTerra RP18 (150 × 4.6 mm, 3.5 µm) column using an isocratic mobile phase of ammonium acetate buffer (pH 8.0, 10 mm) and acetonitrile (45:55, v/v). The UV detection was performed at 285 nm. This method was linear (correlation coefficients ≥0.998), specific (no interference with plasma components or various potentially co-administrated drugs), sensitive (lower limit of quantification of 0.025 µg/mL), reproducible (coefficients of variation were ≤7.9%) and accurate (deviations ranged from -5.0 to 8.0%) over the range of 0.025-10 µg/mL. The method fulfilled all of the US Food and Drug Administration guidelines validation criteria and performed well in an international proficiency testing program. The assay was also successfully applied to routine therapeutic drug monitoring of patients and to drug stability investigations under various conditions.


Assuntos
Antifúngicos/sangue , Cromatografia Líquida de Alta Pressão/métodos , Nitrilas/sangue , Piridinas/sangue , Espectrofotometria Ultravioleta/métodos , Triazóis/sangue , Antifúngicos/química , Antifúngicos/farmacocinética , Estabilidade de Medicamentos , Humanos , Limite de Detecção , Modelos Lineares , Nitrilas/química , Nitrilas/farmacocinética , Piridinas/química , Piridinas/farmacocinética , Reprodutibilidade dos Testes , Triazóis/química , Triazóis/farmacocinética
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