Integrated Use of In Vitro and In Vivo Information for Comprehensive Prediction of Drug Interactions Due to Inhibition of Multiple CYP Isoenzymes

• Published in: Clinical pharmacokinetics 2023-06, Vol.62 (6), p.849-860
• Main Authors: Hozuki, Shizuka, Yoshioka, Hideki, Asano, Satoshi, Nakamura, Mikiko, Koh, Saori, Shibata, Yukihiro, Tamemoto, Yuta, Sato, Hiromi, Hisaka, Akihiro
• Format: Article
• Language: English
• Subjects: Clinical trials; Cytochrome P-450 CYP2D6 - metabolism; Cytochrome P-450 CYP3A - metabolism; Cytochrome P-450 Enzyme System - metabolism; Drug dosages; Drug Interactions; Enzymes; Humans; Internal Medicine; Isoenzymes; Liver; Markov analysis; Medicine; Medicine & Public Health; Metabolism; Original Research Article; Pharmacokinetics; Pharmacology/Toxicology; Pharmacotherapy
• ISSN: 0312-5963; 1179-1926
• DOI: 10.1007/s40262-023-01234-6

Background Mechanistic static pharmacokinetic (MSPK) models are simple, have fewer data requirements, and have broader applicability; however, they cannot use in vitro information and cannot distinguish the contributions of multiple cytochrome P450 (CYP) isoenzymes and the hepatic and intestinal first-pass effects appropriately. We aimed to establish a new MSPK analysis framework for the comprehensive prediction of drug interactions (DIs) to overcome these disadvantages. Methods Drug interactions that occurred by inhibiting CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A in the liver and CYP3A in the intestine were simultaneously analyzed for 59 substrates and 35 inhibitors. As in vivo information, the observed changes in the area under the concentration-time curve (AUC) and elimination half-life ( t 1/2 ), hepatic availability, and urinary excretion ratio were used. As in vitro information, the fraction metabolized (fm) and the inhibition constant (Ki) were used. The contribution ratio (CR) and inhibition ratio (IR) for multiple clearance pathways and hypothetical volume (V Hyp ) were inferred using the Markov Chain Monte Carlo (MCMC) method. Result Using in vivo information from 239 combinations and in vitro 172 fm and 344 Ki values, changes in AUC, and t 1/2 were estimated for all 2065 combinations, wherein the AUC was estimated to be more than doubled for 602 combinations. Intake-dependent selective intestinal CYP3A inhibition by grapefruit juice has been suggested. By separating the intestinal contributions, DIs after intravenous dosing were also appropriately inferred. Conclusion This framework would be a powerful tool for the reasonable management of various DIs based on all available in vitro and in vivo information.