Original Drug Research Articles

Small-Angle X-ray Scattering for PEGylated Liposomal Doxorubicin Drugs: An Analytical Model Comparison Study.

Liposomal delivery systems are recognized as efficient and safe platforms for chemotherapeutic agents, with doxorubicin-loaded liposomes being the most representative nanopharmaceuticals. Characterizing the structure of liposomal nanomedicines in high spatial and temporal resolution is critical to analyze and evaluate their stability and efficacy. Small-angle X-ray scattering (SAXS) is a powerful tool increasingly used to investigate liposomal delivery systems. In this study, we chose a Doxil-like PEGylated liposomal doxorubicin (PLD) as an example and characterized the liposomal drug structure using synchrotron SAXS. Classical analytical models, including the spherical-shell or flat-slab geometries with Gaussian or uniform electron density profiles, were used to model the internal structure of the liposomal membrane. A cylinder model was applied to fit the scattering from the drug crystal loaded in the liposomes. The high-resolution structures of the original drug, Caelyx, and a similar research drug prepared in our laboratory were characterized using these analytical models. The structural parameters of PLDs, including the thickness of the liposomal membrane and morphology of the drug crystal, were further compared. The results demonstrated that both spherical-shell and flat-slab geometries with Gaussian electron density distribution were suitable to elucidate the structural features of the liposomal membrane under a certain range of scattering vectors, while models with uniform electron density distribution exhibited poor fitting performance. This study highlights the technical features of SAXS, which provides structural information at the nanoscale for liposomal drugs. The demonstrated methods are reliable and easy-to-use for the structural analysis of liposomal drugs, which are helpful for a broader application of SAXS in the production and regulation of nanopharmaceuticals.

Situación actual y evolución de la disponibilidad de medicamentos en la población pediátrica en España

ObjectiveTo analyze the characteristics of the new medicines approved in the pediatric population in the last three years, both those with studies only in the pediatric population and those that extend their indication in this population group, as well as the current situation in relation to their marketing and financing. MethodsDescriptive observational study of all drugs that include an indication in the pediatric population in Spain (by extension of the indications of drugs already authorised or because they are new drugs that already include an indication in this population group), from January 2019 to March 2022. ResultsDuring the study period, 129 drugs included their indication in the pediatric population. 13,9% of them are not marketed, 46,5% are in a situation of non-financing, under study, or without a request for financing, and 4,6% are financed for a specific pediatric subpopulation. 52,7% are original drugs, 4,7% are generic, 38,8% are biological, 3,8% are biosimilar and 17,8% are orphan drugs. 57,36% of these medicines obtain the pediatric indication due to extension of the indication and 42,64% obtain it because they are new medicines that already include their studies in the pediatric population. ConclusionsDrugs with authorised indications are increasingly available in the paediatric population and the trend is to extend the indication of authorised drugs to the adult population. However, barriers in terms of financing and marketing need to be expedited and overcome to facilitate access to them.

Tofacitinib in the treatment of rheumatoid arthritis: real-life practice and randomized clinical trial data

The article justifies the need for a large arsenal of drugs to treat perennial rheumatoid arthritis. The authors present randomized controlled trial data showing high efficacy of tofacitinib at different doses as monotherapy, or in combination with methotrexate, or other conventional synthetic disease-modifying anti-inflammatory drugs in suppressing the activity and progression of the disease in various groups of patients, both non-responders to methotrexate, and non-responders to tumour necrosis factor-alpha inhibitors. Extension-phase data of randomized clinical trials demonstrated sustained efficacy of tofacitinib for up to 9.5 years. The authors presented the real-world evidence confirming high efficiency of the drug and noted the rapidity of onset of the effect and its high analgesic activity. The safety issues of tofacitinib with an emphasis on the cardiovascular safety of the drug, taking into account updates to the latest 2022 EULAR Recommendations on the need to consider risk factors for the development of cardiovascular adverse events when planning therapy with Janus kinase inhibitors are discussed. It is reported that slightly increased risk of such adverse events during use of tofacitinib, as compared with inhibitors of tumour necrosis factor alpha, was observed in elderly patients who have at least one risk factor for the development of cardiovascular events. Tofacitinib safety data were obtained from meta-analyses, systematic reviews, national registries, open observational studies, as well as outcomes of the use of the drug in real clinical practice. The launch of a domestic generic of the original drug was noted in the Russian Federation.

Pharmacokinetic parameters, safety and drug-drug interactions of mirtazapine and tizanidine, combined in the new original drug Dorsumio®

Objective: to study the pharmacokinetic parameters and safety of Dorsumio® (mirtazapine + tizanidine, extended-release tablets, 15 mg + 6 mg, JSC Valenta Pharm, Russia) taken once by healthy volunteers in comparison with Calixta®, a monocomponent drug (INN: Mirtazapine, filmcoated tablets, 30 mg, Belupo, Drugs and Cosmetics d.d., Republic of Croatia) and Sirdalud® MR (INN: Tizanidine, modified-release capsules, 6 mg, Novartis Pharma AG, Switzerland) with an evaluation of their drug interactions when taken concomitantly or separately.Material and methods. A two-stage, randomized, comparative cross-over study of the pharmacokinetics and safety of the complex drug Dorsumio® was conducted. In the first stage, volunteers alternated between taking one or two tablets of the study drug in two administration periods; in the second stage, subjects alternated between taking the reference monodrugs Calixta® and Sirdalud® MR alone and in a joint combination in three administration periods. A total of 38 volunteers were randomized into the study, of which 14 subjects participated in the first and 24 in the second stage of the study. Quantitative levels of mirtazapine and tizanidine were determined by high-performance liquid chromatography with tandem mass spectrometry. Based on the data obtained, the main pharmacokinetic parameters reflecting the bioavailability of each drug were calculated, and the mutual influence of their combination on pharmacokinetics was also studied. During the study, vital signs and laboratory parameters of the subjects were monitored, and the occurrence of adverse events (AEs) and serious AEs was recorded.Results. A two-fold increase in the dose of the combination drug Dorsumio® resulted in a comparable increase in the pharmacokinetics of the individual drugs. There was no significant reciprocal effect of mirtazapine and tizanidine on their pharmacokinetic parameters. In one of the subjects participating in the second stage of the study, two mild side effects were registered after the joint use of Calixta® and Sirdalud® MR that did not require medical intervention and resolved on their own without health consequences.Conclusion. There were no differences in the safety profile of the combined use of mirtazapine and tizanidine in the form of a free or fixed combination. It was shown that the investigated drug combination had no mutual influence on the pharmacokinetics of the individual components.

Development and In Vitro-In Vivo Correlation Evaluation of IMM-H014 Extended-Release Tablets for the Treatment of Fatty Liver Disease.

This study aimed to develop extended-release tablets containing 25 mg IMM-H014, an original drug formulated by a direct powder pressing method based on pharmaceutical-grade hydrophilic matrix polymers such as hydroxypropyl methylcellulose, to establish an in vitro-in vivo correlation (IVIVC) to predict bioavailability. The tablets' mechanical properties and in vitro and in vivo performance were studied. The formulation was optimized using a single-factor experiment and the reproducibility was confirmed. The in vitro dissolution profiles of the tablet were determined in five dissolution media, in which the drug released from the hydrophilic tablets followed the Ritger-Peppas model kinetics in 0.01 N HCl medium for the first 2 h, and in phosphate-buffered saline medium (pH 7.5) for a further 24 h. Accelerated stability studies (40 °C, 75% relative humidity) proved that the optimal formulation was stable for 6 months. The in vivo pharmacokinetics study in beagle dogs showed that compared to the IMM-H014 immediate release preparation, the maximum plasma concentration of the extended-release (ER) preparation was significantly decreased, while the maximum time to peak and mean residence time were significantly prolonged. The relative bioavailability was 97.9% based on the area under curve, indicating that the optimal formulation has an obvious ER profile, and a good IVIVC was established, which could be used to predict in vivo pharmacokinetics based on the formulation composition.

Counterion-induced antibiotic-based small-molecular micelles for methicillin-resistant Staphylococcus aureus infections.

A new counterion-induced small-molecule micelle (SM) with surface charge-switchable activities for methicillin-resistant Staphylococcus aureus (MRSA) infections is proposed. The amphiphilic molecule formed by zwitterionic compound and the antibiotic ciprofloxacin (CIP), via a "mild salifying reaction" of the amino and benzoic acid groups, can spontaneously assemble into counterion-induced SMs in water. Through vinyl groups designed on zwitterionic compound, the counterion-induced SMs could be readily cross-linked using mercapto-3, 6-dioxoheptane by click reaction, to create pH-sensitive cross-linked micelles (CSMs). Mercaptosuccinic acid was also decorated on the CSMs (DCSMs) by the same click reaction to afford charge-switchable activities, resulting in CSMs that were biocompatible with red blood cells and mammalian cells in normal tissues (pH 7.4), while having strong retention to negatively charged bacterial surfaces at infection sites, based on electrostatic interaction (pH 5.5). As a result, the DCSMs could penetrate deep into bacterial biofilms and then release drugs in response to the bacterial microenvironment, effectively killing the bacteria in the deeper biofilm. The new DCSMs have several advantages such as robust stability, a high drug loading content (∼ 30%), easy fabrication, and good structural control. Overall, the concept holds promise for the development of new products for clinical application. STATEMENT OF SIGNIFICANCE: We fabricated a new counterion-induced small-molecule micelle with surface charge-switchable activities (DCSMs) for methicillin-resistant Staphylococcus aureus (MRSA) infections. Compared with reported covalent systems, the DCSMs not only have improved stability, high drug loading content (∼ 30%), and good biosafety, but also have the environmental stimuli response, and antibacterial activity of the original drugs. As a result, the DCSMs exhibited enhanced antibacterial activities against MRSA both in vitro and in vivo. Overall, the concept holds promise for the development of new products for clinical application.

Cancer Drug Prices in the United States: Efficacy, Innovation, Clinical Trial Evidence, and Epidemiology

ObjectivesRising cancer drug prices challenge patients and healthcare systems. Although prices are routinely assigned to original drug indications receiving US Food and Drug Administration (FDA) approval, the pricing of supplemental indication approvals remains uncertain. This study identifies and quantifies factors associated with cancer drug prices, distinctly analyzing original and supplemental indications. MethodsClinical trial evidence and epidemiologic data supporting new indications’ FDA approval (2003-2022) were collected from the Drugs@FDA database, ClinicalTrials.gov, and Global Burden of Disease study. Indication-specific monthly treatment costs were calculated for Medicare patients. The association between log-prices and collected variables were assessed in regression analyses. ResultsWe identified 145 drugs approved across 373 cancer indications. Drugs were priced at $24 444 per month on average (median = $16 013). For original indications, prices weakly correlated to improvements in overall survival (β = 0.28, P = .037) and progression-free survival (β = 0.16, P = .001). Original indications’ prices were as follows: (1) negatively associated with disease incidence (β = −0.21, P < .001) and prevalence; (2) positively correlated with first-in-class drugs (26%, P = .057), gene and cell therapies (176%, P < .001), hematologic cancers (62%, P < .001), and severe diseases with substantial unmet needs (6% per disability-adjusted life-year, P < .001); and (3) negatively correlated to indications with randomized-controlled phase 3 trials. Prices were poorly associated with supplemental indications’ efficacy, clinical evidence, and epidemiology. ConclusionsCancer drug prices are set based on the original indication’s characteristics, thereby omitting the value of supplemental indications. Indication-specific pricing, coverage, and reimbursement policies considering each indication’s safety, efficacy, innovativeness, and unmet needs are necessary to align a drug’s value and price.

Antimicrobial activity and pathogen mutation prevention of originator and generics of cefepime, linezolid and piperacillin/tazobactam against clinical isolates of Staphylococcus aureus

Although generic medicinal products are required to have the same qualitative and quantitative composition of the active substance as their reference originator product, patients and health care professionals express concerns about their interchangeability and safety. Therefore, the present study investigated the antimicrobial activity and pathogen mutation prevention of original and generic cefepime, linezolid and piperacillin/tazobactam against Staphylococcus aureus. Two generic formulations of cefepime, linezolid and piperacillin/tazobactam were tested against their respective originator products. Susceptibility testing was performed with twenty-one clinical isolates of S. aureus and ATCC-29213 using broth microdilution. Time kill curves (TKC) were performed with ATCC-29213 at drug concentrations above and below the respective minimum inhibitory concentrations (MIC). Mutation prevention concentration was determined for each drug formulation against ATCC-29213. All experiments were performed in triplicate. Mutant colonies from mutation prevention concentration (MPC) experiments were genotypically tested by sequence analysis. MIC ratios between contiguous originator and generic drugs were similar for each isolate. No visual differences were observed in TKCs between originator and generic substances. The MPC did not differ between different formulations of the same substance. Although sequence analysis of mutant colonies revealed genomic differences compared with the original ATCC-29213, no differences in mutation frequencies were observed between clinical isolates and ATCC-29213 treated with originator or generic substances. Similar antimicrobial activity and pathogen mutation prevention was observed between contiguous substances. These results support the interchangeability of generic and originator drug formulations with the same active ingredient.

Preparation of caffeic acid grafted chitosan self-assembled micelles to enhance oral bioavailability and antibacterial activity of quercetin.

Quercetin (QR) is a naturally occurring flavonoid organic compound that has poor solubility in water and highly unstable in alkaline conditions, resulting in limited absorption in poultry. Consequently, in our experiment, QR was employed as a model compound, encapsulated within the caffeic acid graft chitosan copolymer (CA-g-CS) self-assembled micelles to enhance its solubility, stability and exhibit a synergistic antibacterial effect. The optimization of the formula was carried out using a combination of single-factor experimentation and the response surface method. The in vitro release rate and stability of CA-g-CS-loaded QR micelles (CA-g-CS/QR) in various pH media were studied and the pharmacokinetics in white feather broiler chickens was evaluated in vivo. Additionally, the antibacterial activity was investigated using Escherichia coliCMCC44102 and Escherichia coli of chicken origin as the test strain. The results showed the optimized formula for the self-assembled micelles were 4 mL water, 0.02 mg/mL graft copolymer, and 1 mg QR, stirring at room temperature. The encapsulation efficiency was 72.09%. The resulting CA-g-CS/QR was uniform in size with an average diameter of 375.6 ± 5.9 nm. The release pattern was consistent with the Ritger-Peppas model. CA-g-CS/QR also significantly improved the stability of QR in alkaline condition. The relative bioavailability of CA-g-CS/QR was found to be 1.67-fold that of the reference drug, indicating a substantial increase in the absorption of QR in the broiler. Compared to the original drug, the antibacterial activity of CA-g-CS/QR was significantly enhanced, as evidenced by a reduction of half in the MIC and MBC values. These results suggest that CA-g-CS/QR improves the bioavailability and antibacterial activity of QR, making it a promising candidate for clinical use.

Hi-plex deep amplicon sequencing for identification, high-resolution genotyping and multidrug resistance prediction of Mycobacterium leprae directly from patient biopsies by using Deeplex Myc-Lep.

Expansion of antimicrobial resistance monitoring and epidemiological surveillance are key components of the WHO strategy towards zero leprosy. The inability to grow Mycobacterium leprae invitro precludes routine phenotypic drug susceptibility testing, and only limited molecular tests are available. We evaluated a culture-free targeted deep sequencing assay, for mycobacterial identification, genotyping based on 18 canonical SNPs and 11 core variable-number tandem-repeat (VNTR) markers, and detection of rifampicin, dapsone and fluoroquinolone resistance-associated mutations in rpoB/ctpC/ctpI, folP1, gyrA/gyrB, respectively, and hypermutation-associated mutations in nth. The limit of detection (LOD) was determined using DNA of M.leprae reference strains and from 246 skin biopsies and 74 slit skin smears of leprosy patients, with genome copies quantified by RLEP qPCR. Sequencing results were evaluated versus whole genome sequencing (WGS) data of 14 strains, and versus VNTR-fragment length analysis (FLA) results of 89 clinical specimens. The LOD for sequencing success ranged between 80 and 3000 genome copies, depending on the sample type. The LOD for minority variants was 10%. All SNPs detected in targets by WGS were identified except in a clinical sample where WGS revealed two dapsone resistance-conferring mutations instead of one by Deeplex Myc-Lep, due to partial duplication of the sulfamide-binding domain in folP1. SNPs detected uniquely by Deeplex Myc-Lep were missed by WGS due to insufficient coverage. Concordance with VNTR-FLA results was 99.4% (926/932 alleles). Deeplex Myc-Lep may help improve the diagnosis and surveillance of leprosy. Gene domain duplication is an original putative drug resistance-related genetic adaptation in M.leprae. EDCTP2 programme supported by the European Union (grant number RIA2017NIM-1847 -PEOPLE). EDCTP, R2Stop: Effect:Hope, The Mission To End Leprosy, the Flemish Fonds Wetenschappelijk Onderzoek.

Hypolipidemic Activity of Sesquiterpene Lactones and their Derivatives

BACKGROUND: Despite the available range of lipid-lowering drugs, mainly of synthetic origin, the problem of atherosclerosis therapy and its manifestations remain unresolved. Bioinformatics methods, in particular molecular docking, are considered as a promising direction in terms of developing effective original lipid-lowering drugs. Today, as a promising source of natural lipid-lowering agents, it is advisable to consider natural terpenoids, namely sesquiterpene lactones, which are distinguished by a wide range of pharmacological activity. This article presents the results of a virtual and biological screening of the lipid-lowering activity of sesquiterpene γ-lactones and their chemically modified derivatives. AIM: The aim is to evaluate the lipid-lowering properties of samples of sesquiterpene γ-lactones and their derivatives by virtual and biological screening methods. METHODS: Molecular modeling of the binding energy of the “ligand-target” complex (docking). Molecular docking of the lipid-lowering activity of sesquiterpene γ-lactones and their derivatives was performed using the Glide program from the developer of the Schrodinger Small-Molecule Drug Discovery package using the Extra Precision algorithm (https://www.schrodinger.com/glide). The effect of sesquiterpene lactones on the expression of genes for key enzymes of lipid metabolism in the liver was studied in an in vivo model of hyperlipidemia caused by an atherogenic diet. CONCLUSION: Virtual screening of the lipid-lowering activity of sesquiterpene γ-lactones and their derivatives by molecular docking revealed a number of promising compounds (matricin, matricarin, grossmisin oxime, austricin oxime, 5β (H)-austricin) receptor interactions on the enzyme system cholesterol 7α-hydroxylase (CYP7A1). New mechanisms of lipid-lowering activity for sesquiterpene γ-lactones were proposed, which were established in the study of gene expression of key enzymes of lipid metabolism in the liver in a model of hyperlipidemia caused by an atherogenic diet in rats under in vivo conditions.

국가건강보장체계에서 의약품 시장 구조와 제네릭 사용추세 분석(2007-2017)

We aimed to analyze the market structure and changes in the market share of new drugs, original drugs, and generic drugs in the pharmaceutical market over the past ten years. We utilized national health insurance claims data, including both national health insurance and medical aid, from 2007 to 2017 to establish pharmaceutical expenditure and usage data. The drugs are categorized into new drugs, original drugs (expired patents), and generic drugs. Furthermore, we classified the original drugs as single-source and multi-source original drugs based on whether generic drugs had entered the market. Market share is calculated based on the volume and value of drugs in each category. The results indicate that the total pharmaceutical expenditure increased by 1.75 times, from 10.4 trillion Korean won (KRW) in 2007 to 18.2 trillion KRW in 2017. The number of claimed ingredients and drug items also increased during the same period. In 2017, the market share of new drugs accounted for 10.3% of the total pharmaceutical expenditure, while original drugs and generic drugs accounted for 45.9% and 43.8%, respectively. The study reveals a slight decline in the market share of generics in the decade. Further sub-analyses based on formulation, medical center types, and the number of generic drugs provide additional insights into the market dynamics. These findings contribute to understanding the trends and implications of pharmaceutical expenditure and the role of generics in achieving sustainable development in national health insurance.

Резолюция Экспертного совета «Необследованная диспепсия: краткосрочная и долгосрочная стратегии ведения пациента»

Purpose. To present the materials of the Expert Council, which was held on April 22, 2023 in Moscow and dedicated to modern approaches to the management of patients with unexplored dyspepsia, as well as the choice of the optimal Helicobacter pylori eradication therapy scheme in the Russian Federation. The main provisions of the resolution. An initial patient with recent dyspeptic symptoms who has not taken drugs that can cause gastric damage should be considered as a patient with undiagnosed dyspepsia. The first diagnosis to be excluded in a patient with unexplored dyspepsia is H. pylori-associated chronic gastritis. In order to alleviate or eliminate the symptoms of dyspepsia in the period before testing for H. pylori, the appointment of the prokinetic itopride hydrochloride is recommended, given the lack of influence on the results of the examination, proven efficacy and high safety profile, as demonstrated in studies on the original drug. The patient's presence of objective signs of gastrointestinal bleeding, unmotivated weight loss, aggravated family history of gastric cancer, as well as age over 50 years are indications for esophagogastroduodenoscopy with biopsy. An initial positive test for H. pylori is an indication for eradication therapy, as infection is a major etiological factor in gastric adenocarcinoma, including proximal gastric cancer and cancer of the gastroesophageal junction. Quadruple therapy with clarithromycin (amoxicillin + clarithromycin + proton pump inhibitor + bismuth tripotassium dicitrate) for 14 days can be defined as first-line therapy in the Russian Federation. In order to increase the effectiveness of eradication, the use of original preparations is recommended

Application of a low copper diet guidance based on food exchange portions in children with hepatolenticular degeneration

To study the efficacy of a low-copper diet guidance based on food exchange portions in children with hepatolenticular degeneration. A self-controlled study was conducted from July 2021 to June 2022, including 30 children under the age of 18 who were diagnosed with hepatolenticular degeneration and poorly controlled with a low-copper diet. During the medical visit, personalized low-copper diet guidance was provided to the children and their parents using a copper-containing food exchange table and a copper food exchange chart. During home care, compliance with the low-copper diet of the children was improved by recording dietary diaries and conducting regular follow-ups. The changes in 24-hour urine copper level, liver function indicators, and the low-copper diet knowledge of the children's parents were observed before and after the intervention, with no change in the original drug treatment. After 8, 16, and 24 weeks of intervention, the 24-hour urine copper level decreased significantly compared to before intervention (P<0.05). When compared to 8-week intervention, the urine copper level decreased significantly after 16 and 24 weeks of intervention. The 24-hour urine copper level after 24 weeks of intervention decreased significantly compared to 16 weeks of intervention (P<0.05).After 24 weeks of intervention, the alanine aminotransferase and aspartate aminotransferase levels decreased significantly compared to before intervention (P<0.05). Additionally, in 16 of the cases (53%), alanine aminotransferase and aspartate aminotransferase returned to normal levels. Following 8 weeks of intervention, the low-copper diet knowledge of the children's parents increased significantly (P<0.05). A low-copper diet guidance based on food exchange portions can effectively decrease the urine copper level and improve liver function in children with hepatolenticular degeneration. Furthermore, it can increase the low-copper diet knowledge of the children's parents.

Results of a Phase I Open-Label Clinical Trial of Direkord in Healthy Volunteers

Direkord is an original drug containing the active substance of dicholine succinate, which enhances neuronal insulin sensitivity. In this work, we study the tolerability, safety, and pharmacokinetic parameters of dicholine succinate when administered intramuscularly in a phase I clinical trial in healthy volunteers. In total, 18 healthy volunteers –11 men and 7 women – with a mean age of 30.4±7.8 years, were recruited into a randomized study. At stage I, 6 volunteers (group 1) received dicholine succinate intramuscularly every other day with a dose escalation from 0.16 mg/kg/day to 600 mg/day. At stage II, 12 volunteers (group 2) received dicholine succinate intramuscularly at a single dose of 200 mg, and then, at stage III, the same 12 volunteers received dicholinesuccinate at a dose of 600 mg/day (3 x 200 mg at an interval of 8 hours) for seven days. The safety population in this study included all randomized volunteers. Data from 12 volunteers (group 2) were included in the calculation of the pharmacokinetic parameters. All volunteers completed all procedures of the three research stages in accordance with the protocol. According to clinical and laboratory monitoring data, no adverse events were registered during the study. The drug was well tolerated, with no signs of hyperemia, edema, and bruising being observed at the injection site. The volunteers did not complain of pain, itching, and burning. After a single injection of dicholine succinate, the concentration of choline in the bloodstream reached its maximum value after an average of 0.375±0.365 hours with the half-life of 1.271±1.071 hours. After repeated administration at a dose of 600 mg per day, no cumulation of the active substance was observed. The data obtained have confirmed a good safety profile of Direkord; therefore, the drug can be recommended for further investigation in a study involving patients.

Investigation of transformation products of selected veterinary drugs generated by electrochemistry, microsomal assays, hydrolysis &amp; photolysis

The knowledge of transformation pathways and transformation products of veterinary drugs is important for health, food and environmental matters. Residues (original veterinary drug and transformation products) are found in food products of animal origin and also in the environment (e.g., soil or surface water). Several transformation processes can alter the original veterinary drug, ranging from biotransformation in living organism to environmental degradation processes like photolysis, hydrolysis, or microbial processes. In this thesis, four veterinary drugs were investigated, three ionophore antibiotics Monensin, Salinomycin and Lasalocid and the macrocyclic lactone Moxidectin. Ionophore antibiotics are mainly used to cure and prevent coccidiosis in poultry especially prophylactic in broiler farming. Moxidectin is an antiparasitic drug and is used for the treatment of internal and external parasites in food‐ producing and companion animals. The main objective of this work was the usage of different laboratory approaches to generate and identify transformation products. The identification was conducted using high‐resolution mass spectrometry (HR‐MS). A major focus was put on the application of electrochemistry for simulation of transformation processes. The electrochemical reactor, equipped with a three‐electrode flow‐through cell, enabled the oxidation or reduction by applying a potential. Derived transformation products were analyzed by online coupling of the electrochemical reactor and a HR‐MS and offline by liquid chromatography (LC) combined with HR‐MS. The main modification reaction of the identified transformation products was different for each investigated veterinary drug. Monensin was showing decarboxylation and demethylation as main modification reactions, for Salinomycin mostly decarbonylation was occurring and for Lasalocid methylation was prevalent. For Moxidectin I observed oxidation (hydroxylation) reaction and adduct formation with solvent. In general, for salinomycin and Lasalocid more transient transformation products (online measurement) than stable transformation products (offline measurements) were detected. In contrast, the number of transformation products using online and offline measurements were identical for monensin and moxidectin. As a complementary approach, metabolism tests with rat or human liver microsomes were made for the ionophore antibiotics. Monensin was investigated by using rat liver microsomes and identified transformation products were based on decarboxylation and demethylation. Salinomycin and Lasalocid were converted by human and rat liver microsomes. For both substances were more transformation products found by using human liver microsomes. The transformation products of the rat liver microsome conversion were redundant, the transformation products were also found at the human liver microsome assay. Oxidation (hydroxylation) was found to be the main modification reaction for both. In addition, a frequent ion‐exchange between sodium and potassium was identified. The last two experiments were performed for one substance each, the hydrolysis of monensin and the photolysis of moxidectin was investigated. The transformation products of the pH‐ dependent hydrolysis were based on ring‐opening and dehydration. Moxidectin formed several transformation products by irradiation with UV‐C light and main modification reactions were isomeric changes, (de‐)hydration and changes of the methoxime moiety. In summary, transformation products of the four investigated veterinary drugs were generated by the different laboratory approaches. Most of the identified transformation products were identified for the first time. The resulting findings provide an understanding for clarifying the transformation behavior.

Biogeochemical behavior and ecological environmental effects of fluoroquinolones.

Synthetic fluoroquinolones (FQs) are the third most commonly used antibiotics in the world and play an extremely important role in antibacterial drugs. The excessive use and discharge will alter ecological environment, with consequence on human health and global sustainable development. It is therefore of great significance for scientific use and management of FQs to systematically understand their biogeochemical behavior and eco-environmental effects. After drug administration in humans and animals, only a small part of FQs are transformed in vivo. The main transformation processes include formylation, acetylation, oxidation and cleavage of piperazine ring, defluorination and decarboxylation of aromatic core ring, etc. About 70% of the original drug and a small amount of transformed products would be migrated to the environment through excretion. After entering the environment, FQs and their transformation products mainly exist in environmental media such as water, soil and sediment, and undergo migration and transformation processes such as adsorption, photolysis and biodegradation. Adsorption facilitates transfer of FQs from medium to another. The photolysis mainly affects the C7-amine substituents of FQs, whereas the core structure of FQs remains intact. Biodegradation mainly refers to the degradation of FQs by microorganisms and microalgae, including piperazine modification of the piperazine ring such as acetylation and formylation, partial or complete ring cleavage, core structure decarboxylation, defluorination and conjugation formation. The migration and transformation processes of FQs cannot completely eliminate them from the environment. Instead, they would become "pseudo-persistent" pollutants, which seriously affect the behavior, growth and reproduction of algae, crustaceans and fish, change biogeochemical cycle, destroy aquatic environment, and stimulate microbial resistance and the generation of resistance genes. In the future, more in-depth studies should be conducted on the environmental behavior of FQs and their impacts on ecological environment, the risk assessment of microbial resistance and resistance genes of FQs, and the mechanism and effect of micro-biodegradation of FQs.

Physicochemical and Functional Characterization of Medicinal Product Rinsulin® R

Introduction. Currently, biosimilars have found quite widespread use in the treatment of a number of chronic and life-threatening diseases. Thanks to them, there is a significant decrease of the economic pressure of biological drugs on the health care system and wide access of patients to effective and safe medicines is ensured. One of the most important stages of proving biosimilarity is the physicochemical and functional characterization of proteins. This set of studies is generally accepted, as sensitive as possible and allows us to give a conclusion about the compliance of the biosimilar with the original drug.Aim. Conducting physicochemical and functional characterization of medicinal product Rinsulin® R (GP40051) in comparison with the original drug Humulin® Regular.Materials and methods. Primary structure was analyzed by high-performance liquid chromatography with mass spectrometry detection and matrix assisted laser desorption/ionization. The identity of the higher protein structures was proved by the methods of circular dichroism, capillary isoelectric focusing, spectrometry and dynamic light scattering. The comparability of the impurity profiles of the preparations was evaluated using the methods of exclusive chromatography and reverse-phase high-performance liquid chromatography. Functional characterization included a metabolic cell test "glucose uptake" and insulin receptor–binding assay (kinetics of binding to type A and B receptors, phosphorylation of insulin receptor).Results and discussion. In the course of this research, the identity of the physicochemical and functional characteristics of GP40051 was shown. A complete overlap of primary sequence, high-order structures and impurity profiles was demonstrated between the comparison drug GP40051 and the reference drug Humulin® Regular. Functional studies have shown that GP40051 and Humulin® Regulars have the same activity.Conclusion. The results of the quality comparability study demonstrated similarity of Rinsulin® R to the reference medicinal product Humulin® Regular, providing the scientific basis for conducting a specifically designed clinical programme, and supported registration in Russian Federation.

An exploratory study on the effect of mechanical stress on particle formation in monoclonal antibody infusions.

Monoclonal antibody infusions (mAb-i) are administered for the treatment of various diseases. They are often transported over long distances from the compounding site to the site of administration. However, transport studies are typically carried out with the original drug product but not with compounded mAb-i. To address this gap, the impact of mechanical stress on the formation of subvisible/nanoparticles in mAb-i was investigated by dynamic light scattering and flow imaging microscopy. Different mAb-i concentrations were subjected to vibrational orbital shaking and stored at 2-8°C up to 35 days. The screening revealed that pembrolizumab and bevacizumab infusions show the highest propensity for particle formation. Especially bevacizumab at low concentrations exhibited an increase in particle formation. Because of the unknown health risks associated with the long-term application of subvisible particles (SVPs)/nanoparticles in infusion bags, stability studies carried out in the frame of licensing application procedures should also focus on SVP formation in mAb-i. In general, pharmacists should minimize the time of storage and mechanical stress during transport, especially in the case of low-concentrated mAb-i. Moreover, if siliconized syringes are used, they should be washed once with saline solution to minimize particle entry.

Cost per responder of biologic drugs used in the treatment of moderate-to-severe plaque psoriasis in France and Germany

Objective The treatment of moderate-to-severe plaque psoriasis has seen significant improvements in recent years with the advent of biologic drugs. The aim of this study was to assess the cost-effectiveness of anti-IL17 drugs and other biologic therapies used to treat moderate-to-severe plaque psoriasis in France and Germany over a one-year time horizon. Methods We developed a cost per responder model for biologic drugs used in psoriasis treatment. The model included anti-IL17s (brodalumab, secukinumab, ixekizumab and bimekizumab), anti-TNFs (adalimumab, etanercept, certolizumab and infliximab), an anti-IL12/23 (ustekinumab), and anti-IL23s (risankizumab, guselkumab and tildrakizumab). Efficacy estimates were collected through a systematic literature review of network meta-analyses on long-term Psoriasis Area and Severity Index (PASI) measures. Dose recommendations and country-specific prices were used to calculate drug costs. Biosimilar drug prices were used when available as a substitute for the originator drugs. Results After one year, brodalumab had the lowest cost per PASI100-responder in both France (€20,220) and Germany (€26,807) across all available biologic treatments. Among the anti-IL17s, brodalumab had a 23% lower cost per PASI100-responder vs. the nearest comparator in France (bimekizumab, €26,369), and 30% lower vs. nearest comparator in Germany (ixekizumab, €38,027). Brodalumab also had the lowest cost per PASI75- and PASI90-responder among the anti-IL17s in both France and Germany after one year. Adalimumab had the lowest cost per PASI100-responder among the anti-TNFs in both France (€23,418) and Germany (€38,264). Among the anti-IL-23s, risankizumab had the lowest cost per PASI100-responder in both France (€20,969) and Germany (€26,994). Conclusion Driven by its lower costs and high response rates, brodalumab was the most cost-effective treatment option for moderate-to-severe plaque psoriasis over a one-year time-horizon within the anti-IL17 class and when compared to all other biologics in France and Germany.