1. The Pharmacokinetic Profile of Palovarotene: An Open-Label Phase I Trial Investigating the Effect of Food and Potential for Drug–Drug Interaction in Healthy Participants.
- Author
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Marino, Rose, Dube, Louise, Ogier, Julien, and Le Quan Sang, Kim-Hanh
- Abstract
Background and Objectives: Palovarotene is under development for the treatment of fibrodysplasia ossificans progressiva (FOP). The objectives of this study were to evaluate palovarotene pharmacokinetics under fed versus fasted conditions and its induction potential towards cytochrome P450 3A4 (CYP3A4) substrate, midazolam. Methods: In this phase I, open-label trial (NCT04829773), palovarotene pharmacokinetics were characterized after repeated once-daily dosing. In one cohort, healthy participants received three doses of palovarotene 20 mg on Days 1, 6, and 11, as whole capsules under fasted or fed conditions, or sprinkled on food under fed conditions. In another cohort, individuals received midazolam 2 mg on Days 1 and 15 and a daily dose of palovarotene 20 mg on Days 2–15. Palovarotene and midazolam pharmacokinetics, including area under the concentration-time curve from time zero to infinity (AUC
(0–∞) ) and maximum observed plasma drug concentration (Cmax ), were assessed. Adverse events (AEs) were recorded. Results: Overall, 23 participants completed each part. Palovarotene Cmax and AUC(0–∞) increased by 16.5% and 39.7% under fed versus fasted conditions. Pharmacokinetics were comparable between the whole capsule and sprinkled on food, under fed conditions. Midazolam AUC(0–∞) and Cmax decreased by 13.3% and 9.7% upon palovarotene co-administration over 14 days, less than that required to be considered a weak CYP3A4 inducer. Plasma palovarotene exposures were comparable after single and multiple doses. No serious AEs were reported. Conclusions: These data support palovarotene administration after a meal, as a whole capsule or sprinkled on food. Palovarotene at 20 mg/day is a not a clinical inducer of CYP3A4. These results provide insights into palovarotene pharmacokinetics, aiding optimization of administration for patients with FOP. Clinical Trials Registration Number: NCT04829773. Plain Language Summary: Fibrodysplasia ossificans progressiva, also known as FOP, is a very rare genetic condition where bone forms in places it is not usually found, such as in the muscles, tendons, and ligaments. Retinoids are molecules that the body produces from vitamin A to aid normal bone development. Palovarotene is a therapeutic retinoid that has been developed for the treatment of FOP. This article describes a clinical trial where people without FOP received oral palovarotene to determine how it is absorbed and broken down (metabolized) by the body when taken after a meal or after fasting (a period of not eating) as a whole capsule or when sprinkled on food. The trial also examined how palovarotene might interact with other treatments that are broken down by the body in the same way as palovarotene. The trial found that the amount of palovarotene that circulates in the blood increased more when taken after a meal compared with after fasting. Palovarotene was metabolized by the body in a similar way when taken as a whole capsule or when sprinkled on food. This finding is important as some people with FOP have difficulty swallowing. At a 20 mg dose, palovarotene was unlikely to interact with other treatments that are metabolized in the same way. No serious side effects were reported. These results show that palovarotene should be taken after a meal, either as a whole capsule or sprinkled on food. [ABSTRACT FROM AUTHOR]- Published
- 2023
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