Cardiac risk assessment based on early Phase I data and PK-QTc analysis is concordant with the outcome of thorough QTc trials: an assessment based on eleven drug candidates

• Published in: Journal of pharmacokinetics and pharmacodynamics 2019-12, Vol.46 (6), p.617-626
• Main Authors: Gaitonde, Puneet, Huh, Yeamin, Darpo, Borje, Ferber, Georg, Heimann, Günter, Li, James, Lu, Kaifeng, Sebastien, Bernard, Tsai, Kuenhi, Riley, Steve
• Format: Article
• Language: English
• Subjects: Biochemistry; Biomedical and Life Sciences; Biomedical Engineering and Bioengineering; Biomedicine; Clinical Trials, Phase I as Topic; Confidence intervals; Cross-Over Studies; Dose-Response Relationship, Drug; Drug development; Drug-Related Side Effects and Adverse Reactions - etiology; Electrocardiography - drug effects; Heart; Heart - drug effects; Heart Rate - drug effects; Humans; Liability; Original Paper; Pharmaceutical Preparations - administration & dosage; Pharmacology/Toxicology; Pharmacy; Prospective Studies; Retrospective Studies; Risk assessment; Risk Assessment - methods; Veterinary Medicine/Veterinary Science
• ISSN: 1567-567X; 1573-8744
• DOI: 10.1007/s10928-019-09662-3

Cardiac safety assessment is a key regulatory requirement for almost all new drugs. Until recently, one evaluation aspect was via a specifically designated, expensive, and resource intensive thorough QTc study, and a by-time-point analysis using an intersection–union test (IUT). ICH E14 Q&A (R3) ( http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E14/E14_Q_As_R3__Step4.pdf ) allows for analysis of the PK-QTc relationship using early Phase I data to assess QTc liability. In this paper, we compared the cardiac risk assessment based on the early Phase I analysis with that from a thorough QTc study across eleven drug candidate programs, and demonstrate that the conclusions are largely the same. The early Phase I analysis is based upon a linear mixed effect model with known covariance structure (Dosne et al. in Stat Med 36(24):3844–3857, 2017). The treatment effect was evaluated at the supratherapeutic C max as observed in the thorough QTc study using a non-parametric bootstrap analysis to generate 90% confidence intervals for the treatment effect, and implementation of the standardized methodology in R and SAS software yielded consistent results. The risk assessment based on the concentration–response analysis on the early Phase I data was concordant with that based on the standard analysis of the thorough QTc study for nine out of the eleven drug candidates. This retrospective analysis is consistent with and supportive of the conclusion of a previous prospective analysis by Darpo et al. (Clin Pharmacol Ther 97(4):326–335, 2015) to evaluate whether C-QTc analysis can detect QTc effects in a small study with healthy subjects.