1. Disease–Drug Interaction of Sarilumab and Simvastatin in Patients with Rheumatoid Arthritis
- Author
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Anne Paccaly, Barry Miller, Roy Fleischmann, Inga Bodrug, Eun Bong Lee, Nikki Daskalakis, Christine Xu, and Alan Kivitz
- Subjects
Adult ,Male ,Simvastatin ,medicine.medical_specialty ,Arthritis ,Sirukumab ,Pharmacology ,Antibodies, Monoclonal, Humanized ,030226 pharmacology & pharmacy ,Arthritis, Rheumatoid ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Tocilizumab ,Pharmacokinetics ,Internal medicine ,polycyclic compounds ,medicine ,Cytochrome P-450 CYP3A ,Humans ,Drug Interactions ,Pharmacology (medical) ,Original Research Article ,cardiovascular diseases ,Aged ,Interleukin-6 ,business.industry ,organic chemicals ,nutritional and metabolic diseases ,Middle Aged ,Drug interaction ,medicine.disease ,Receptors, Interleukin-6 ,Sarilumab ,Endocrinology ,chemistry ,Antirheumatic Agents ,030220 oncology & carcinogenesis ,Rheumatoid arthritis ,Female ,lipids (amino acids, peptides, and proteins) ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,medicine.drug - Abstract
Introduction Elevated interleukin (IL)-6 occurs in patients with active rheumatoid arthritis (RA), which has been shown to lead to a decrease in cytochrome P450 (CYP) enzyme activity and alterations in drug concentrations metabolized by CYP. IL-6 signaling blockade by IL-6 receptor (IL-6R) antagonists may reverse this effect of IL-6 and restore CYP activity. This study evaluated the pharmacokinetic profile of simvastatin (a CYP3A4 substrate) before and 1 week after a single dose of sarilumab (a human monoclonal antibody [mAb] blocking the IL-6Rα) in patients with RA, to assess potential interaction. Methods Nineteen patients with active RA received oral simvastatin 40 mg 1 day before and 7 days after subcutaneous injection of sarilumab 200 mg. The pharmacokinetic parameters of simvastatin and its primary metabolite, β-hydroxy-simvastatin acid, were calculated using noncompartmental analysis. Results Compared with simvastatin alone, single-dose simvastatin administration 7 days after single-dose sarilumab administration in patients with RA resulted in reduced simvastatin and β-hydroxy-simvastatin acid exposure in plasma. Mean effect ratios (90 % confidence interval) for simvastatin peak plasma concentration (C max) and area under the concentration–time curve extrapolated to infinity (AUC∞) were 54.1 % (42.2–69.4 %) and 54.7 % (47.2–63.3 %), respectively. No changes occurred in time to C max or half-life for either simvastatin or β-hydroxy-simvastatin acid after sarilumab administration. Conclusions Sarilumab treatment resulted in a reduction in exposure of simvastatin, consistent with reversal of IL-6-mediated CYP3A4 suppression in patients with active RA, as was reported for tocilizumab with simvastatin and for sirukumab with midazolam. Clinical trial registration number NCT02017639. Electronic supplementary material The online version of this article (doi:10.1007/s40262-016-0462-8) contains supplementary material, which is available to authorized users.
- Published
- 2016