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| Sponsor: | GlaxoSmithKline |
|---|---|
| Information provided by: | GlaxoSmithKline |
| ClinicalTrials.gov Identifier: | NCT00964106 |
Purpose
The purpose of this study is to identify and validate a probe cocktail for use in future GSK drug-drug interaction studies. Cytochrome P450 enzymes and transport proteins play important roles in the disposition of drugs. Changes in the activity of these pathways can be assessed using probe drugs selected on the basis of their metabolic or transport pathway. This will be a two part study with the same subjects participating in both parts to decrease variability in data. The purpose of Part 1 is to identify a set of probe drugs ('cocktail') which do not interact with one another; groups of healthy volunteers will receive 7 probe drugs individually and as a single combination of the 7 drugs given together as a cocktail. The pathways which mediate clearance of the selected probe drugs are CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP3A4, CYP2D6 and OATP1B1. Between Part 1 and 2, there will be a pharmacokinetic analysis period of approximately 6 weeks when subjects do not have to visit the clinic. If substantial PK interactions are observed, a conditional Part 1B may be performed to evaluate a modified cocktail where probes subject to interaction are removed. Part 2 will assess the performance of the probe cocktail using three known inhibitors (validation). The inhibitors plus probe cocktail will evaluate the ability of the newly established cocktail to accurately quantify metabolizing enzyme or transporter inhibition, representing a fundamental advance in probe cocktail validation and utility for drug development.
| Condition | Intervention | Phase |
|---|---|---|
|
Healthy Volunteer |
Drug: Ketoconazole Drug: Fluconazole Drug: Rifampin Drug: Quinidine Drug: Gemfibrozil Drug: Fluvoxamine Drug: Rosiglitazone Drug: Flurbiprofen Drug: Omeprazole Drug: Caffeine Drug: Dextromethorphan Drug: Midazolam Drug: Rosuvastatin |
Phase I |
| Study Type: | Interventional |
| Study Design: | Basic Science, Randomized, Open Label, Crossover Assignment, Pharmacokinetics Study |
| Official Title: | Validation Study of Simultaneous Administration of Multiple Cytochrome P450/Transporter Probes for Drug Interaction Evaluation in Healthy Adult Subjects |
| Estimated Enrollment: | 60 |
| Study Start Date: | August 2009 |
| Estimated Study Completion Date: | January 2010 |
| Estimated Primary Completion Date: | January 2010 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Probe drugs: Experimental
Caffeine 100 mg CYP1A2 Rosiglitazone 4 mg CYP2C8 Flurbiprofen 40 mg CYP2C9 Omeprazole 20 mg CYP2C19 Dextromethorphan 30 mg CYP2D6 Midazolam 3 mg (Part 1, Part 2 Cohorts B and C) 1 mg (Part 2 Cohort A) CYP3A4/5 Rosuvastatin 10 mg OATP1B1 |
Drug: Rosiglitazone
Dosed at 4 mg as probe for CYP2C8 pathway
Drug: Flurbiprofen
Dosed at 40 mg, probe for CYP2C9 pathway
Drug: Omeprazole
Dosed at 20 mg, probe for CYP2C19 pathway
Drug: Caffeine
Caffeine dosed at 100 mg as probe for CYP1A2 pathway
Drug: Dextromethorphan
Dosed at 30 mg, probe for CYP2D6 pathway
Drug: Midazolam
Dosed at 3 mg for Part 1, Part 2 cohorts B and C and 1 mg for Part 2 Cohort A, probe drug for CYP3A4/5 pathway
Drug: Rosuvastatin
Dosed at 10 mg, probe drug for OATP1B1 pathway
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Contingency Inhibitors: Experimental
A CYP2D6 Quinidine 100 mg x 1 dose on Day 1 and Day 8 B CYP2C8 Gemfibrozil 600 mg twice-daily Day 1 through Day 9 C CYP2C19 Fluvoxamine 50 mg once-daily Day 1 through Day 9 These inhibitors will only be used if midazolam, flurbiprofen, or rosuvastatin are removed from the cocktail due to a PK interaction observed in Part 1 of the study. |
Drug: Quinidine
Dosed at 100 mg x 1 dose on Day 1 and Day 8, inhibitor of CYP2D6 pathway
Drug: Gemfibrozil
Dosed at 600 mg twice daily on Days 1-9, inhibitor of CYP2C8 pathway
Drug: Fluvoxamine
Dosed 50 mg once-daily Days 1-9, inhibitor of CYP2C19 pathway
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Default Inhibitors: Experimental
A Ketoconazole 400 mg once-daily Day 1 through Day 9 CYP3A4 B Fluconazole 400 mg x1 dose on Day 1 200 mg once-daily Day 2 through Day 9 CYP2C9 C Rifampin 600 mg x1 dose on Day 1 and Day 8 OATP1B1
|
Drug: Ketoconazole
Dosed at 400 mg once-daily Day 1 through Day 9, inhibitor of CYP3A4
Drug: Fluconazole
Dosed at 400 mg x 1 dose on day 1, 200 mg once daily on days 2 through 9, inhibitor of CYP2C9 pathway
Drug: Rifampin
Dosed at 600 mg x 1 dose on Day 1 and Day 8, inhibitor of OATP1B1 pathway
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The primary purpose of this study is to establish a validated drug cocktail, containing up to 7 probes, for assessing the activity of six drug metabolizing enzymes (CYP 1A2, 2C8, 2C9, 2C19, 2D6, 3A4/5) and the OATP1B1 transporter. In Part 1, the study will determine if there are pharmacokinetic interactions among the probe drugs by comparing the pharmacokinetics of the probe drugs when administered alone and in combination (i.e., as a cocktail). In Part 2, the study will evaluate the quantitative performance of the cocktail by examining the effect of select inhibitors on the pharmacokinetics of respective probe drugs when the probe drugs are administered alone versus when administered in the cocktail.
The validation step in Part 2 represents a fundamental advance in cocktail studies, as it will provide novel data on whether a DDI study utilizing a cocktail approach yields a quantitatively accurate result compared to a traditional one-probe, one-inhibitor DDI study design. For example, 'is a similar magnitude of increase in the AUC of midazolam observed when midazolam alone is given with ketoconazole compared to when a cocktail (containing midazolam) is given with ketoconazole? ' This study will directly test whether the two results are similar; if they are similar, then the study will provide substantial support to advance cocktail studies from a DDI screening tool to a definitive (quantitatively accurate) study design.
This study aims to establish a standard probe cocktail that can be used for drug-drug interaction studies, with the intention that any subset of the 7-drug cocktail could be selected for study with a drug in development (i.e., the cocktail could be streamlined to contain only the specific pathways affected by the study drug based on in vitro data).
In addition, this study will provide a proof-of-principle evaluation of dried blood spot technology as a method to measure drug concentrations in blood samples collected from clinical studies. Results from the drug blood spot analysis will be reported separately by DMPK. Dried blood spot technology offers advantages in sample volume, preparation, storage, shipment, and analysis which could translate into improved convenience, reduced blood volumes, and cost savings if the technique is shown to be suitable for PK analysis of biological samples.
Eligibility| Ages Eligible for Study: | 20 Years to 50 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
Exclusion Criteria:
Contacts and Locations| Contact: US GSK Clinical Trials Call Center | 877-379-3718 |
| Korea, Republic of | |
| GSK Investigational Site | |
| Seoul, Korea, Republic of, 110-744 | |
| GSK Investigational Site | |
| Busan, Korea, Republic of, 614-735 | |
| Study Director: | GSK Clinical Trials | GlaxoSmithKline |
More Information
| Responsible Party: | GSK ( Study Director ) |
| Study ID Numbers: | 112684 |
| Study First Received: | July 23, 2009 |
| Last Updated: | August 20, 2009 |
| ClinicalTrials.gov Identifier: | NCT00964106 History of Changes |
| Health Authority: | South Korea: Food and Drug Administration |
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probe drug drug interaction CYP cocktail inhibitor inducer caffeine |
dextromethorphan midazolam flurbiprofen omeprazole rosiglitazone rosuvastatin |
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Anti-Inflammatory Agents Anti-Infective Agents Antiprotozoal Agents Neurotransmitter Agents Cholinergic Antagonists Adrenergic Agents Molecular Mechanisms of Pharmacological Action Fluvoxamine Physiological Effects of Drugs Anesthetics Excitatory Amino Acid Agents Cholinergic Agents Antimalarials Antiparasitic Agents Hypoglycemic Agents |
Therapeutic Uses Anti-Ulcer Agents Antidepressive Agents, Second-Generation Antidepressive Agents Caffeine citrate Fluconazole Tranquilizing Agents Antilipemic Agents Cyclooxygenase Inhibitors Adrenergic alpha-Antagonists Hydroxymethylglutaryl-CoA Reductase Inhibitors Ketoconazole Gemfibrozil Dextromethorphan Adrenergic Antagonists |