Population Pharmacokinetic Analysis of Ixazomib, an Oral Proteasome Inhibitor, Including Data from the Phase III TOURMALINE-MM1 Study to Inform Labelling.

Abstract

Ixazomib is an oral proteasome inhibitor, approved in USA, Canada, Australia and Europe in combination with lenalidomide and dexamethasone, for the treatment of patients with multiple myeloma who have received at least one prior therapy. We report a population pharmacokinetic model-based analysis for ixazomib that was pivotal in describing the clinical pharmacokinetics of ixazomib, to inform product labelling. Plasma concentration-time data were collected from 755 patients who received oral or intravenous ixazomib in once- or twice-weekly schedules in ten trials, including the global phase III TOURMALINE-MM1 study. Data were analysed using nonlinear mixed-effects modelling (NONMEM software version 7.2, ICON Development Solutions, Hanover, MD, USA). Ixazomib plasma concentrations from intravenous and oral studies were described by a three-compartment model with linear distribution and elimination kinetics, including first-order linear absorption with a lag time describing the oral dose data. Body surface area on the volume of the second peripheral compartment was the only covariate included in the final model. None of the additional covariates tested including body surface area (1.2-2.7 m2), sex, age (23-91 years), race, mild/moderate renal impairment and mild hepatic impairment were found to impact systemic clearance, suggesting that no dose adjustment is required based on these covariates. The geometric mean terminal disposition phase half-life was 9.5 days, steady-state volume of distribution was 543 L and systemic clearance was 1.86 L/h. The absolute bioavailability of an oral dose was estimated to be 58%.

• Authors: Neeraj Gupta, Paul M Diderichsen, Michael J Hanley, Deborah Berg, Helgi van de Velde, R Donald Harvey, Karthik Venkatakrishnan
• Journal: Clinical pharmacokinetics (Clin Pharmacokinet) Vol. 56 Issue 11 Pg. 1355-1368 (11 2017) ISSN: 1179-1926 [Electronic] Switzerland
• PMID: 28290121 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Boron Compounds
• Proteasome Inhibitors
• ixazomib
• Glycine

Topics

• Administration, Intravenous
• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Boron Compounds (administration & dosage, blood, pharmacokinetics)
• Clinical Trials as Topic
• Clinical Trials, Phase III as Topic
• Drug Labeling
• Female
• Glycine (administration & dosage, analogs & derivatives, blood, pharmacokinetics)
• Humans
• Male
• Middle Aged
• Models, Biological
• Proteasome Inhibitors (administration & dosage, blood, pharmacokinetics)
• Young Adult