Abstract

The primary objective of this single- and multiple-dose pharmacokinetic study was the investigation of rifamycin SV’s pharmacokinetic profile in plasma and urine. All the 18 enrolled healthy men and post-menopausal women received modified release tablets containing 600 mg of the oral non-absorbable antibiotic, rifamycin SV, according to a multiple dose regimen: one tablet three times a day (daily intake: 1800 mg) for 14 consecutive days. Blood sampling and urine collection were performed up to 24 h post-dose after the first dose on Days 1 and 7. On average, on Day 1, Cmax,0–24 was 5.79 ± 4.24 ng/mL and was attained in a median time of 9 h. On Day 7, all the subjects had quantifiable levels of rifamycin SV in plasma at each sampling time. After a peak concentration attained 2 h post-dose (mean ± SD concentration: 10.94 ± 16.41 ng/mL), rifamycin SV decreased in plasma to levels similar to those of Day 1. The amounts of rifamycin SV excreted in urine paralleled the plasma concentration at the corresponding times. On Day 1, the total amount excreted in urine was 0.0013%, and was 0.0029% on Day 7. The study results confirmed those of the previous Phase I study: the systemic absorption of rifamycin SV was also proved negligible after 7 days of the 600 mg t.i.d. dose regimen of the newly formulated tablets, currently under development for the treatment of several small and large intestinal pathologies, including diarrhea-predominant irritable bowel syndrome, hepatic encephalopathy, and others. Registered at ClinicalTrials.gov with the identifier NCT02969252, last updated on 26JAN18.

Highlights

  • Rifamycin SV, used as sodium salt, is a semisynthetic antibiotic belonging to the class of ansamycins obtained from rifamycin B, which is produced in the fermentation broth of Streptomyces mediterranei [1,2]

  • The new dosage form of rifamycin SV was administered for 14 consecutive days for the first time in the present study, which took advantage of a more sensitive LC–MS/MS analytical method for the assay of the antibiotic in plasma and urine

  • The plasma concentrations of rifamycin SV observed in the present study were consistent with the results of the previous Phase I study [8] with a different formulation, published in 2011, and confirmed that the systemic absorption after oral administration of rifamycin SV is negligible after 7 days of a t.i.d. treatment with the new rifamycin SV tablets for a daily dose of 1800 mg

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Summary

Introduction

Rifamycin SV, used as sodium salt, is a semisynthetic antibiotic belonging to the class of ansamycins obtained from rifamycin B, which is produced in the fermentation broth of Streptomyces mediterranei (or Amycolatopsis Mediterranei or Nocardia Mediterranea n. sp.) [1,2]. Thanks to a multi-matricial core composition, surrounded by a pH-sensitive coating, MMX tablets arrive unaltered to the terminal part of the ileum, where they start to gradually release rifamycin SV, which continues during the tablet’s transit from the terminal ileum onward This specific formulation, designed to deliver the non-absorbable antibiotic directly into the lumen of the large intestine districts, as previously demonstrated by pharmaco-scintigraphic studies of other active substances [5,6], offers consistent advantages over other formulations, and minimizing the side effects closely related to unwanted activity against the saprophytic flora living in the upper intestinal tract, and improving the drug’s efficacy through an intestine-targeted topical delivery. The possibility to administer rifamycin SV in a new oral formulation designed to deliver the non-absorbable antibiotic directly into more intestinal districts, including the terminal part of the small intestine, is expected to offer consistent advantages over the formulations currently used to treat IBS, and to improve the drug efficacy due to direct topical delivery, without exposing the patients to unwanted systemic effects thanks to the negligible drug absorption

Study Design
Study Population and Criteria for Inclusion
Investigational Treatments and Dose Regimen
Ethical Procedures
Pharmacokinetics Variables and Data Analysis
Disposition of Subjects
Rifamycin SV Plasma Kinetic Profile
Safety
Discussion
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