The efficacy and side-effects of drugs do not just reflect the biochemical and pharmacodynamic properties of the parent compound, but often comprise of cooperative effects between the properties of the parent and active metabolites. Metabolites of imatinib, nilotinib and midostaurin
have been synthesised and evaluated in assays to compare their properties as protein kinase inhibitors with the parent drugs. The N-desmethyl-metabolite of imatinib is substantially less active than imatinib as a BCR-ABL1 kinase inhibitor, thus providing an explanation as to why patients
producing high levels of this metabolite show a relatively low response rate in chronic myeloid leukaemia (CML) treatment. The hydroxymethylphenyl and N-oxide metabolites of imatinib and nilotinib are only weakly active as BCR-ABL1 inhibitors and are unlikely to play a role in the efficacy
of either drug in CML. The 3-(R)-HO-metabolite of midostaurin shows appreciable accumulation following chronic drug administration and, in addition to mutant forms of FLT3, potently inhibits the PDPK1 and VEGFR2 kinases (IC50 values
药物的功效和副作用不仅仅反映了母化合物的生化和药效特性,而且通常包括母化合物和活性代谢物之间的协同效应。已经合成和评估了伊马替尼、尼洛替尼和米多斯他林的代谢物,以比较它们作为蛋白激酶抑制剂的特性与母药的区别。伊马替尼的N-去甲基代谢物作为BCR-ABL1激酶抑制剂的活性明显低于伊马替尼,这解释了为什么产生高水平该代谢物的患者在慢性髓细胞白血病(CML)治疗中显示相对较低的反应率。伊马替尼和尼洛替尼的羟甲基苯和N-氧代谢物作为BCR-ABL1抑制剂的活性很弱,不太可能在CML中发挥作用。米多斯他林的3-(R)-HO-代谢物在长期用药后显示出明显的积累,并且除了FLT3的突变形式外,还强力抑制PDPK1和VEGFR2激酶(IC50值