Management of Drug Interactions with Inducers: Onset and Disappearance of Induction on Cytochrome P450 3A4 and Uridine Diphosphate Glucuronosyltransferase 1A1 Substrates

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Serval ID
serval:BIB_23ECE0BDE9E6
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Article: article from journal or magazin.
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Publications
Institution
Title
Management of Drug Interactions with Inducers: Onset and Disappearance of Induction on Cytochrome P450 3A4 and Uridine Diphosphate Glucuronosyltransferase 1A1 Substrates
Journal
Eur J Drug Metab Pharmacokinet
Author(s)
Bettonte S., Berton M., Stader F., Battegay M., Marzolini C.
ISSN
2107-0180 (Electronic)
0378-7966 (Print)
ISSN-L
0378-7966
Publication state
Published
Issued date
07/2023
Peer-reviewed
Oui
Volume
48
Number
4
Pages
353-362
Language
english
Notes
Bettonte, Sara
Berton, Mattia
Stader, Felix
Battegay, Manuel
Marzolini, Catia
eng
188504/Schweizerischer Nationalfonds zur Forderung der Wissenschaftlichen Forschung/
France
Eur J Drug Metab Pharmacokinet. 2023 Jul;48(4):353-362. doi: 10.1007/s13318-023-00833-9. Epub 2023 Jun 6.
Abstract
BACKGROUND: People living with HIV may present co-morbidities requiring the initiation and subsequently the discontinuation of medications with inducing properties. The time to reach maximal enzyme induction and to return to baseline enzyme levels has not been thoroughly characterized. OBJECTIVE: The aim of this study was to evaluate the onset and disappearance of dolutegravir [uridine diphosphate glucuronosyltransferase (UGT) 1A1 and cytochrome P450 (CYP) 3A4 substrate] and raltegravir (UGT1A1 substrate) induction with strong and moderate inducers using physiologically based pharmacokinetic (PBPK) modeling. METHODS: The predictive performance of the PBPK model to simulate dolutegravir and raltegravir pharmacokinetics and to reproduce the strength of induction was verified using clinical drug-drug interaction studies (steady-state induction) and switch studies (residual induction). The model was considered verified when the predictions were within 2-fold of the observed data. One hundred virtual individuals (50% female) were generated to simulate the unstudied scenarios. The results were used to calculate the fold-change in CYP3A4 and UGT1A1 enzyme levels upon initiation and discontinuation of strong (rifampicin) or moderate (efavirenz or rifabutin) inducers. RESULTS: The time for reaching maximal induction and subsequent disappearance of CYP3A4 induction was 14 days for rifampicin and efavirenz but 7 days for rifabutin. The distinct timelines for the moderate inducers relate to their different half-lives and plasma concentrations. The induction and de-induction processes were more rapid for UGT1A1. CONCLUSIONS: Our simulations support the common practice of maintaining the adjusted dosage of a drug for another 2 weeks after stopping an inducer. Furthermore, our simulations suggest that an inducer should be administered for at least 14 days before conducting interaction studies to reach maximal induction.
Keywords
Humans, Female, Male, *Rifampin, *Cytochrome P-450 CYP3A, Raltegravir Potassium, Drug Interactions, Glucuronosyltransferase, Rifabutin
Pubmed
Funding(s)
Swiss National Science Foundation / 188504
Create date
25/08/2023 6:17
Last modification date
25/01/2024 8:27
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