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PHARMACOKINETICS AND PHARMACODYNAMICS |
From Novartis Pharmaceuticals, Basel, Switzerland and East Hanover, New Jersey (Dr. Kovarik, Dr. Schmouder, Ms. Barilla, Dr. Riviere, Dr. Wang) and PPD Development Clinics, Austin, Texas (Dr. Hunt).
FTY720 is a sphingosine-1-phosphate receptor agonist being developed as an immunomodulator for acute rejection prophylaxis after organ transplantation. This study was performed to characterize the pharmacokinetics of and lymphocyte response to multiple-dose FTY720. In this randomized, double-blind study, three groups of 20 healthy subjects each received either placebo, 1.25 mg/day FTY720, or 5 mg/day FTY720 for 7 consecutive days. FTY720 blood concentrations and lymphocyte counts were assessed over the weeklong treatment phase and over a month-long washout phase. The relationship between FTY720 blood concentrations and lymphocyte counts was explored by an inhibitory Emax model. First-dose exposure was consistent with dose proportionality between the low- and high-dose groups. Blood levels accumulated fivefold over the treatment period. Exposure on day 7 was dose proportional for Cmax (5.0 ± 1.0 vs. 18.2 ± 4.1 ng/mL) and for AUC (109 ± 24 vs. 399 ± 85 ng•h/mL). Washout pharmacokinetics after the last dose indicated an elimination half-life averaging 8 days. Lymphocyte counts decreased by 80% in subjects receiving the lower dose to a nadir of 0.4 ± 0.1 x 109/L and by 88% in subjects receiving the upper dose to a nadir of 0.2 ± 0.1 x 109/L. Descriptive exposure-response modeling estimated that the lymphocyte response at 5 mg/day is near the maximal response achievable. By the end-of-study evaluation on day 35, lymphocyte counts had recovered to within 75% and 50% of baseline in the low- and high-dose groups, respectively. In summary, systemic exposure to FTY720 was consistent with dose-proportionality after both single- and multiple-dose administration. Total lymphocyte counts decreased from baseline by 80% and 88% at regimens of 1.25 and 5 mg/day, respectively. Exposure-response modeling provided evidence that 5 mg/day FTY720 resulted in a near-maximal dynamic effect of this drug on lymphocytes.
Key Words: FTY720 • sphingosine-1-phosphate receptor agonists • pharmacokinetics • lymphocyte response • immunosuppressants • tolerability
Address for reprints: John M. Kovarik, Novartis Pharma AG, Building WSJ 27.4093, 4002 Basel, Switzerland.
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