Population pharmacokinetic analysis of sparsentan in healthy volunteers and patients with focal segmental glomerulosclerosis.
Russell WadaHuub Jan KleijnLu ZhangShang-Chiung ChenPublished in: CPT: pharmacometrics & systems pharmacology (2023)
Sparsentan is a single-molecule dual endothelin angiotensin receptor antagonist (DEARA) currently under investigation as a treatment for focal segmental glomerulosclerosis (FSGS) and IgA nephropathy (IgAN). A population pharmacokinetic (PK) analysis was performed to characterize the PK of sparsentan and to evaluate the impact of FSGS disease characteristics and comedications as covariates on sparsentan PK. Blood samples were collected from 236 healthy volunteers, 16 subjects with hepatic impairment, and 194 primary and genetic FSGS patients enrolled in 9 studies ranging from phase I to phase III. Sparsentan plasma concentrations were determined using validated liquid chromatography-tandem mass spectrometry with a lower limit of quantitation of 2 ng/mL. Modeling was conducted with the first-order conditional estimation with η-ϵ interaction (FOCE-1) method in NONMEM. A total of 20 covariates were tested using a univariate forward addition and stepwise backward elimination analysis with significance level of p < 0.01 and p < 0.001, respectively. A two-compartment model with first-order absorption and an absorption lag time with proportional plus additive residual error (2 ng/mL) described sparsentan PK. A 32% increase of clearance due to CYP3A auto-induction occurred at steady state. Covariates retained in the final model included formulation, cytochrome P450 (CYP) 3A4 inhibitor co-administration, sex, race, creatinine clearance, and serum alkaline phosphatase. Moderate and strong CYP3A4 inhibitors comedications increased AUC by 31.4% and 191.3%, respectively. This population PK model of sparsentan suggests that dose adjustments may be warranted for patients taking moderate and strong CYP3A4 inhibitors concomitantly, but other covariates analyzed may not require dose adjustments.
Keyphrases
- liquid chromatography tandem mass spectrometry
- end stage renal disease
- single molecule
- newly diagnosed
- chronic kidney disease
- ejection fraction
- phase iii
- high intensity
- ms ms
- clinical trial
- drug delivery
- peritoneal dialysis
- living cells
- simultaneous determination
- gene expression
- solid phase extraction
- uric acid
- randomized controlled trial
- genome wide
- high resolution
- metabolic syndrome
- study protocol
- high performance liquid chromatography
- phase ii
- double blind