VX-509 (Decernotinib)-Mediated CYP3A Time-Dependent Inhibition: An Aldehyde Oxidase Metabolite as a Perpetrator of Drug-Drug Interactions
作者:C. Zetterberg、F. Maltais、L. Laitinen、S. Liao、H. Tsao、A. Chakilam、N. Hariparsad
DOI:10.1124/dmd.116.071100
日期:2016.7.8
(R)-2-((2-(1H-pyrrolo[2,3-b]pyridin-3-yl)pyrimidin-4-yl)amino)-2-methyl- N -(2,2,2-trifluoroethyl)butanamide (VX-509, decernotinib) is an oral Janus kinase 3 inhibitor that has been studied in patients with rheumatoid arthritis. Patients with rheumatoid arthritis often receive multiple medications, such as statins and steroids, to manage the signs and symptoms of comorbidities, which increases the chances of drug-drug interactions (DDIs). Mechanism-based inhibition is a subset of time-dependent inhibition (TDI) and occurs when a molecule forms a reactive metabolite which irreversibly binds and inactivates drug-metabolizing enzymes, potentially increasing the systemic load to toxic concentrations. Traditionally, perpetrating compounds are screened using human liver microsomes (HLMs); however, this system may be inadequate when the precipitant is activated by a non–cytochrome P450 (P450)–mediated pathway. Even though studies assessing competitive inhibition and TDI using HLM suggested a low risk for CYP3A4-mediated DDI in the clinic, VX-509 increased the area under the curve of midazolam, atorvastatin, and methyl-prednisolone by approximately 12.0-, 2.7-, and 4.3-fold, respectively. Metabolite identification studies using human liver cytosol indicated that VX-509 is converted to an oxidative metabolite, which is the perpetrator of the DDIs observed in the clinic. As opposed to HLM, hepatocytes contain the full complement of drug-metabolizing enzymes and transporters and can be used to assess TDI arising from non-P450–mediated metabolic pathways. In the current study, we highlight the role of aldehyde oxidase in the formation of the hydroxyl-metabolite of VX-509, which is involved in clinically significant TDI-based DDIs and represents an additional example in which a system-dependent prediction of TDI would be evident.
(R)-2-((2-(1H-吡咯并[2,3-b]吡啶-3-基)嘧啶-4-基)氨基)-2-甲基-N-(2,2,2-三氟乙基)丁酰胺(VX-509,德卡索地尼)是一种口服的Janus激酶3抑制剂,已在类风湿性关节炎患者中进行了研究。类风湿性关节炎患者通常接受多种药物治疗,如降脂药和皮质类固醇,以管理共病症状,这增加了药物-药物相互作用(DDI)的可能性。基于机制的抑制是时间依赖性抑制(TDI)的一种,当分子形成活性代谢物,不可逆地结合并灭活药物代谢酶时,可能导致全身负荷增加至毒性浓度。传统上,使用人肝微粒体(HLM)筛选产生化合物;然而,当引发物通过非细胞色素P450(P450)介导的途径激活时,这一系统可能不足。尽管使用HLM评估竞争性抑制和TDI的研究表明,临床中由CYP3A4介导的DDI风险较低,但VX-509使咪达唑仑、阿托伐他汀和甲基泼尼松龙的曲线下面积分别增加了约12.0倍、2.7倍和4.3倍。使用人肝细胞质进行的代谢物鉴定研究表明,VX-509被转化为一种氧化代谢物,这是临床观察到的DDI的制造者。与HLM不同,肝细胞含有完整的药物代谢酶和转运蛋白,可用于评估由非P450介导的代谢途径产生的TDI。在本研究中,我们强调了醛氧化酶在形成VX-509的羟基代谢物中的作用,该代谢物涉及临床重要的基于TDI的DDI,并代表了TDI的系统依赖性预测的另一个例子。