The metabolic and excretion patterns were highly similar across species with liraglutide being fully metabolised in the body by sequential cleavage of small peptide fragments and amino acids. The in vitro metabolism studies indicate that the initial metabolism involves cleavage of the peptide backbone with no degradation of the glutamate-palmitic acid side-chain. Mice, rats and monkeys displayed similar plasma profiles and showed no significant gender differences. A higher number of metabolites were observed in plasma from the animal species (especially the rat and monkey) as compared to human plasma. This disparity can partly be explained by differences in the sample preparation as human plasma samples were freeze dried prior to analysis causing a removal of volatile metabolites (including tritiated water). All detected metabolites were minor and obtained in low amount (<15%) and therefore no structural identification of these was performed. This is acceptable since the metabolites are only formed in low amounts and since the metabolites are expected to resemble endogenous substances with well-known metabolic pathways
During the initial 24 hours following administration of a single 3(H)-liraglutide dose to healthy subjects, the major component in plasma was intact liraglutide. Liraglutide is endogenously metabolized /SRP: in a manner similar to large proteins/ without a specific organ as a major route of elimination.
In large clinical trials, serum enzyme elevations were no more common with liraglutide therapy than with placebo or comparator agents, and no instances of clinically apparent liver injury were reported. Since licensure, there has been a single case report of autoimmune hepatitis arising in a patient taking liraglutide. She did not improve with stopping liraglutide and ultimately required long term corticosteroid therapy, suggesting that the autoimmune hepatitis was independent of the drug therapy or that liraglutide triggered an underlying condition. Other cases of hepatotoxicity due to liraglutide have not been published and the product label does not list liver injury as an adverse event. Thus, liver injury due to liraglutide must be quite rare.
A single dose of an oral contraceptive combination product containing 0.03 mg ethinylestradiol and 0.15 mg levonorgestrel was administered under fed conditions and 7 hours after the dose of Victoza at steady state. Victoza lowered ethinylestradiol and levonorgestrel Cmax by 12% and 13%, respectively. There was no effect of Victoza on the overall exposure (AUC) of ethinylestradiol. Victoza increased the levonorgestrel AUC0-8 by 18%. Victoza delayed Tmax for both ethinylestradiol and levonorgestrel by 1.5 hr.
A single dose of digoxin 1 mg was administered 7 hours after the dose of Victoza at steady state. The concomitant administration with Victoza resulted in a reduction of digoxin AUC by 16%; Cmax decreased by 31%. Digoxin median time to maximal concentration (Tmax) was delayed from 1 hr to 1.5 hr.
A single dose of lisinopril 20 mg was administered 5 minutes after the dose of Victoza at steady state. The co-administration with Victoza resulted in a reduction of lisinopril AUC by 15%; Cmax decreased by 27%. Lisinopril median Tmax was delayed from 6 hr to 8 hr with Victoza.
Victoza did not change the overall exposure (AUC) of griseofulvin following co-administration of a single dose of griseofulvin 500 mg with Victoza at steady state. Griseofulvin Cmax increased by 37% while median Tmax did not change.
The mean apparent volume of distribution after subcutaneous administration of Victoza 0.6 mg is approximately 13 L. The mean volume of distribution after intravenous administration of Victoza is 0.07 L/kg. Liraglutide is extensively bound to plasma protein (>98%).
Following a 3(H)-liraglutide dose, intact liraglutide was not detected in urine or feces. Only a minor part of the administered radioactivity was excreted as liraglutide-related metabolites in urine or feces (6% and 5%, respectively). The majority of urine and feces radioactivity was excreted during the first 6-8 days. The mean apparent clearance following subcutaneous administration of a single dose of liraglutide is approximately 1.2 L/hr with an elimination half-life of approximately 13 hours, making Victoza suitable for once daily administration.
Following subcutaneous administration, maximum concentrations of liraglutide are achieved at 8-12 hours post dosing. The mean peak (Cmax) and total (AUC) exposures of liraglutide were 35 ng/mL and 960 ng hr/mL, respectively, for a subcutaneous single dose of 0.6 mg. After subcutaneous single dose administrations, Cmax and AUC of liraglutide increased proportionally over the therapeutic dose range of 0.6 mg to 1.8 mg. At 1.8 mg Victoza, the average steady state concentration of liraglutide over 24 hours was approximately 128 ng/mL. AUC0-8 was equivalent between upper arm and abdomen, and between upper arm and thigh. AUC0-8 from thigh was 22% lower than that from abdomen. However, liraglutide exposures were considered comparable among these three subcutaneous injection sites. Absolute bioavailability of liraglutide following subcutaneous administration is approximately 55%.
Liraglutide is a novel once-daily human glucagon-like peptide (GLP)-1 analog in clinical use for the treatment of type 2 diabetes. To study metabolism and excretion of 3(H)-liraglutide, a single subcutaneous dose of 0.75 mg/14.2 MBq was given to healthy males. The recovered radioactivity in blood, urine, and feces was measured, and metabolites were profiled. In addition, 3(H)-liraglutide and [(3)H]GLP-1(7-37) were incubated in vitro with dipeptidyl peptidase-IV (DPP-IV) and neutral endopeptidase (NEP) to compare the metabolite profiles and characterize the degradation products of liraglutide. The exposure of radioactivity in plasma (area under the concentration-time curve from 2 to 24 hr) was represented by liraglutide (> or = 89%) and two minor metabolites (totaling < or =11%). Similarly to GLP-1, liraglutide was cleaved in vitro by DPP-IV in the Ala8-Glu9 position of the N terminus and degraded by NEP into several metabolites. The chromatographic retention time of DPP-IV-truncated liraglutide correlated well with the primary human plasma metabolite [GLP-1(9-37)], and some of the NEP degradation products eluted very close to both plasma metabolites. Three minor metabolites totaling 6 and 5% of the administered radioactivity were excreted in urine and feces, respectively, but no liraglutide was detected. In conclusion, liraglutide is metabolized in vitro by DPP-IV and NEP in a manner similar to that of native GLP-1, although at a much slower rate. The metabolite profiles suggest that both DPP-IV and NEP are also involved in the in vivo degradation of liraglutide. The lack of intact liraglutide excreted in urine and feces and the low levels of metabolites in plasma indicate that liraglutide is completely degraded within the body.
The invention relates to combinations of (2R,4aR,10bR)-6-(2,6-Dimethoxy-pyridin-3-yl)-9-ethoxy-8-methoxy-1,2,3,4,4a,10b-hexahydrophenanthridin-2-ol with other active compounds for the treatment of diabetes mellitus type 2 and/or type 1.
Methods for treating insulin resistance and for sensitizing patients to GLP1 agonist therapy
申请人：Research Development Foundation
公开号：US10258639B2
公开（公告）日：2019-04-16
Methods for treatment of insulin resistance and type II diabetes by administration of inhibitors of the PKI pathway are provided. In some aspects, inhibitors of the PKI pathway, such as inhibitors of PIKB, HIF1 and/or mTOR, can be used to treat subject having insulin resistance who are refractory to GLP1 agonist therapy.
Provided are methods for treating diabetes comprising administering to a patient a GLP-1 agonist and an iron chelator. In various embodiments, methods are provided for culturing pancreatic beta islet cells comprising contacting the beta cells with a GLP-1 agonist and an iron chelator in an amount effective to promote survival of the beta cells.
METHODS FOR TREATING INSULIN RESISTANCE AND FOR SENSITIZING PATIENTS TO GLP1 AGONIST THERAPY
申请人：Research Development Foundation
公开号：US20170189440A1
公开（公告）日：2017-07-06
Methods for treatment of insulin resistance and type II diabetes by administration of inhibitors of the PKI pathway are provided. In some aspects, inhibitors of the PKI pathway, such as inhibitors of PIKB, HIF1 and/or mTOR, can be used to treat subject having insulin resistance who are refractory to GLP1 agonist therapy.
