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Department of Neurology
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Friday

 

Therapeutic protein–drug interaction assessment for Zenapax (daclizumab) high-yield process in patients with MS using a cocktail approach: STUDY









































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Abstract

Aims:
To characterize the potential effect of daclizumab high-yield process (DAC HYP), a monoclonal antibody that blocks the high-affinity interleukin-2 receptors for treatment of multiple sclerosis, on activity of cytochrome P450 (CYP) enzymes.

Methods:
Twenty patients with multiple sclerosis received an oral cocktail of probe substrates of CYP1A2 (caffeine 200 mg), CYP2C9 (warfarin 10 mg/vitamin K 10 mg), CYP2C19 (omeprazole 40 mg), CYP2D6 (dextromethorphan 30 mg) and CYP3A (midazolam 5 mg) on two sequential occasions: 7 days before and 7 days after subcutaneous administration of DAC HYP 150 mg every 4 weeks for three doses. Serial pharmacokinetic blood samples up to 96 h post dose and 12-h urine samples were collected on both occasions. Area under the curve (AUC) for caffeine, S-warfarin, omeprazole and midazolam, and urine dextromethorphan to dextrorphan ratio were calculated. Statistical analyses were conducted on log-transformed parameters using a linear mixed-effects model.

Results:
The 90% confidence intervals (CIs) for the geometric mean ratio (probe substrate with DAC HYP/probe substrate alone) for caffeine AUC from 0–12 h (0.93–1.15), S-warfarin AUC from 0 to infinity (AUC[0–inf]) (0.95–1.06), omeprazole AUC(0–inf) (0.88–1.13) and midazolam AUC(0–inf) (0.89–1.15) were within the no-effect boundary of 0.80–1.25. The geometric mean ratio for urine dextromethorphan to dextrorphan ratio was 1.01, with the 90% CI (0.76–1.34) extending slightly outside the no-effect boundary, likely due to high variability with urine collections and CYP2D6 activity.

Conclusions:
DAC HYP treatment in patients with multiple sclerosis had no effect on CYP 1A2, 2C9, 2C19, 2D6 and 3A activity.

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