Prolonged-release Formulation Research Articles

Clinical effectiveness and safety of prolonged release form of alimemazine in patients with generalized anxiety disorder

The prolonged release tablets form of alimemazine is seen as a promising agent for the long-term treatment of generalized anxiety disorder (GAD).Objective: to investigate the efficacy and safety of therapy with alimemazine (Teraligen® retard, prolonged release film-coated tablets) in patients with GAD.Material and methods. The study design was a multicentre, open-label, non-comparative clinical trial (CT) with two doses of alimemazine 20 and 40 mg (Teraligen® retard, prolonged-release film-coated tablets). 129 patients diagnosed with GAD (criteria according to the ICD-10 classification), 86 women and 43 men were included, mean age 38.0±11.1 years. The level of anxiety, assessed by the Hamilton HARS scale, at Week 0 (Visit 1) was 24.8±7.3 points.Results. By Week 6, the level of anxiety statistically significantly decreased to a mean score of 10.8±6.6, while the dynamics of the mean score relative to baseline was -14.0±6.27 (p<0.0001). The proportion of patients with a decrease in the total score on the HARS scale by 50% or more compared with the initial value was: after 1 week of therapy – 10.3% (n=13); after 3 weeks of therapy – 60.5% (n=75; compared to baseline, p<0.0001); after 6 weeks of therapy – 69.4% (n=86; compared to baseline, p<0.0001). The therapy was well tolerated, among the adverse events (AEs) patients noted: morning sleepiness (7.8%; n=10); dry mouth (7.8%; n=10); general weakness (4.7%; n=6). Other AEs (dizziness, headache, impaired concentration, muscle weakness, memory impairment, tinnitus, tachycardia) were much less common. From the side of the liver, no AEs were detected, including changes in the activity of liver enzymes.Conclusion. Prolonged release alimemazine tablets 20 mg and 40 mg for six weeks resulted in a statistically significant reduction in anxiety levels, with at least two-thirds of patients experiencing more than half their anxiety. The effect increases with each week as you continue to take the drug. The prolonged release form of alimemazine is well tolerated, the treatment of GAD with the drug is effective and safe and may represent a rational alternative to antidepressant therapy.

The cytisine-enriched poly(3-hydroxybutyrate) fibers for sustained-release dosage form

The polymeric cytisine-enriched fibers based on poly(3-hydroxybutyrate) were obtained using electrospinning method. The biocompatibility study, advanced thermal analysis and release of cytisine from the poly(3-hydroxybutyrate) fibers were carried out. The nanofibers' morphology was evaluated by scanning electron microscopy. The formation and description of phases during the thermal processes of fibers by the advanced thermal analysis were examined. The new quantitative thermal analysis of polymeric fibers with cytisine phases based on vibrational, solid and liquid heat capacities was presented. The apparent heat capacity of fibers was measured using the standard differential scanning calorimetry. The quantitative analysis allowed for the study of the glass transition and melting/crystallization process. The mobile amorphous fraction, degree of crystallinity and rigid amorphous fraction were determined depending on the thermal history of semicrystalline polymeric fibers. Furthermore, the cytisine dissolution behaviour was studied. It was observed that the kinetic of the release from polymeric nanofiber is delayed than for the marketed product. The immunosafety of the tested polymeric nanofibers with cytisine was confirmed by the Food and Drug Agency Guidance as well as the European Medicines Agency. The polymeric matrix with cytisine seems to be a promising candidate for the prolonged release formulation.

Bioavailability of Cariban® Capsules: A Modified-Release Fixed-Dose Combination of Doxylamine and Pyridoxine to Relieve Nausea and Vomiting During Pregnancy.

Nausea and vomiting is a very prevalent condition during pregnancy. Combination of doxylamine and pyridoxine is placed as first-line pharmacological option for its treatment in most clinical guidelines. Among different release forms available, Cariban® is a fixed-dose combination of doxylamine/pyridoxine 10/10 mg, formulated as modified-release capsules. In the present study, we aimed to characterize the bioavailability performance of Cariban® invitro and invivo. An invitro dissolution test was performed to evaluate the release profile of Cariban®, together with immediate- and delayed-release formulations available on the market. A single-center, single-dose, open-label bioavailability study following Cariban® administration in 12 healthy adult female patients was carried out to explore the drug behavior invivo (protocol NBR-002-13; EUDRA-CT 2013-005422-35). These data were additionally used to perform a computational pharmacokinetic simulation of the posology approved for this drug. Cariban® capsules demonstrate a prolonged-release performance, with an early, gradual, and progressive release of both actives until reaching a complete dissolution after 4-5h in solution. The pharmacokinetic features of these capsules show that doxylamine and pyridoxine metabolites are early absorbed, being all detectable in plasma within 1h following oral administration. Computational pharmacokinetic simulation predicts that different posology provides distinct profiles of metabolites in plasma, with 1-1-2 (morning-midafternoon-night) being the one that concentrates higher plasma levels but lower dose dumping for 24h. Cariban® behaves as a prolonged-release formulation, which correlates with rapid absorption and arising of the actives in the plasma, but also long-lasting and sustained bioavailability, especially when administered following the complete posology. These results would underlie its demonstrated efficacy to relieve nausea and vomiting of pregnancy (NVP) under clinical settings.

Safety and Efficacy of Conversion to Once-Daily Tacrolimus from Twice-Daily Tacrolimus in Pediatric Liver Transplant Recipients

BackgroundNonadherence to immunosuppression is the most common cause of late acute rejection in pediatric liver transplant (LT) recipients. A prolonged-release once-daily tacrolimus formulation was developed to improve adherence and long-term allograft survival. MethodsWe screened 179 pediatric LT recipients who converted from twice-daily tacrolimus (TD-TAC) to once-daily tacrolimus (OD-TAC) between February 2011 and September 2019. ResultsOne hundred seventy-nine recipients converted to OD-TAC and were followed for 18 months. 152 OD-TAC-converted recipients (84.9%) experienced uneventful follow-up, while 21 recipients showed LFT elevation. Four recipients had biopsy-proven acute rejection within six months of conversion, all of which were successfully treated with steroid pulse. 166 recipients (92.7%) remain on OD-TAC and 13 (7.3%) were switched back to TD-TAC. The mean tacrolimus trough level significantly decreased three months following conversion (3.14 ± 1.9 ng/mL) compared with pre-conversion levels (3.69 ± 1.98 ng/mL). Mean tacrolimus trough levels remained unchanged from 3 months to 12 months following conversion. Percent coefficient of variation of tacrolimus trough levels decreased significantly from 32.5 ± 16.4 ng/mL to 27.5 ± 15.6 ng/mL after conversion to OD-TAC, reflecting a decrease in variation of tacrolimus trough levels following conversion. ConclusionsConversion to OD-TAC in pediatric LT recipients with stable graft function is safe and effective. Level of evidenceLevel IV.

EnGraft: a multicentre, open-label, randomised, two-arm, superiority study protocol to assess bioavailability and practicability of Envarsus® versus Advagraf™ in liver transplant recipients

BackgroundGraft rejection and chronic CNI toxicity remain obstacles to organ transplant success. Current formulations of tacrolimus, such as Prograf® and Advagraf™, exhibit limitations in terms of pharmacokinetics and tolerability, related in part to suboptimal bioavailability. As dosing non-compliance can result in graft rejection, the once daily formulation of tacrolimus, Advagraf™, was developed (vs 2x/day Prograf®). Benefits of Advagraf™ are counterbalanced by delayed achievement of therapeutic trough levels and need for up to 50% higher doses to maintain Prograf®-equivalent troughs. Envarsus® is also a prolonged-release once-daily tacrolimus formulation, developed using MeltDose™ drug-delivery technology to increase drug bioavailability; improved bioavailability results in low patient drug absorption variability and less pronounced peak-to-trough fluctuations. In phase III de novo kidney transplant studies, Envarsus® proved non-inferior to twice-daily tacrolimus; however, no phase IV studies show superiority of Envarsus® vs Advagraf™ in de novo liver transplant (LTx) recipients.MethodsThe EnGraft compares bioavailability and tests superiority of Envarsus® (test arm) versus Advagraf™ (comparator arm) in de novo LTx recipients. A total of 268 patients from 15 German transplant centres will be randomised 1:1 within 14 days post-LTx. The primary endpoint is dose-normalised trough level (C/D ratio) measured 12 weeks after randomisation. Secondary endpoints include the number of dose adjustments, time to reach first defined trough level and incidence of graft rejections. Additionally, clinical and laboratory parameters will be assessed over a 3-year period.DiscussionC/D ratio is an estimate for tacrolimus bioavailability. Improving bioavailability and increasing C/D ratio using Envarsus could reduce renal dysfunction and other tacrolimus-related toxicities; previous trials have shown that a higher C/D ratio (i.e. slower tacrolimus metabolism) is not only associated with improved renal function but also linked to reduced neurotoxic side effects. A higher C/D ratio could improve clinical outcomes for LTx recipients; EnGraft has begun, with one third of patients recruited by January 2022.Trial registrationThis trial has been registered (4 May 2020) in the EU Clinical Trials Register, EudraCT-Nummer: 2020–000796-20. Additionally, this trial has been registered (22 January 2021) at ClinicalTrials.gov: NCT04720326. The trial received a favourable opinion from the concerned lead ethics committee at the University of Regensburg, under the reference 20–1842-112.

Features of using prolonged-release melatonin in patients with type 2 diabetes

Diabetes mellitus (DM) and its complications are one of the leading causes of death worldwide, with approximately 700 million people expected to suffer from DM by 2045, according to the International Diabetes Federation. DM is a progressive, chronic disease that affects various body systems and can lead to serious physical health complications. Type 2 diabetes mellitus (T2DM) has been shown to be associated with a higher incidence of sleep disturbances, which may be due to the disease itself or secondary complications or comorbidities associated with DM. However, epidemiological evidence suggests a higher risk of obesity, metabolic syndrome, and T2DM in individuals with shorter sleep duration and poor quality of sleep. Therefore, an assessment of the quality of sleep, its disorders and their pharmacological correction is recommended as a comprehensive medical examination for existing T2DM and for groups at risk of its development. Among pharmacotherapeutic agents for the treatment of sleep disorders, melatonin (N-acetyl-5-methoxytryptamine) attracts special attention. It is indoleamine, a pineal hormone synthesized in the human body, which name is related to the ability to aggregate melanin pigment granules. It has been found that melatonin directly participates in many biological processes and limits oxidative stress both extracellularly and intracellularly. Endogenous melatonin has linear kinetics, the half-life of the usual form of melatonin with rapid release ranges from 45 to 65 minutes, it is quickly metabolized and is completely excreted after 3–4 hours. Currently, 1 and 2 mg prolonged-release forms of melatonin are available, which provide slower and longer absorption, a delayed and lower peak dose, and levels maintained for 8 to 10 hours— similar to the physiological secretion curve of endogenous melatonin. Since the dose of melatonin in prolonged-release forms is much lower than in immediate release forms, this will help reduce the risk of possible side effects, including in patients with T2DM and in groups at risk of its development.

Development of Doxazosin mesylate liquisolid system for improved manufacturing processability and bioavailability: in vitro and in vivo evaluation for tailored hypertension treatment approach with modified dissolution rates

In the present research, an attempt was made to optimize the blends of different carriers Neusiln US2, Avicel PH101, and Fujicalin SG by individually blending with each of coating materials Aerosil 200 and Syloid 244 FP that were proposed to contribute to a modified drug dissolution rates of Doxazosin mesylate (DX) through a liquisolid polymer matrix system. The liquisolid formulations were prepared using selected solvent, carriers, and coats by varying drug to polymer ratios. Further formulations were investigated for pre-compression processability by Heckel plot analysis, elastic recovery studies, and post-compression characteristics. In case of carriers, compared to Avicel PH101 highest flowable values (ф) were observed for Neusilin US2 and Fujicalin SG whereas, for coat these values were highest for Aerosil 200 than Sylloid 244 FP. Liquisolid compact with Fujicalin SG and Aerosil 200 exhibited fast release (FR) of 78% in 20 minutes. The liquisolid compact with Neusilin US2 and Syloid 244 FP exhibited prolonged release (PR) of 60% in 240 minutes. DSC and XRD analysis showed loss of DX crystallinity which was confirmed by SEM analysis indicating DX detention within the liquisolid system, in a molecularly dispersed solubilized form. The in vivo studies of DX liquisolid FR formulation exhibited 1.89 fold increase in the oral bioavailability which was 1.69 fold for DX PR formulation compared to pure DX which demonstrated a promising tailored hypertension treatment approach.

Use of paliperidone palmitate half-yearly release in patients diagnosed with psychotic disorder: profile and satisfaction of use

IntroductionThe lack of insight can be present among patients with a diagnosis of schizophrenia, which often results in lack of adherence to pharmacological treatments1 and, subsequently, in treatment discontinuation and relapses2. This vicious pattern leads to further clinical deterioration, impaired functioning, and reduced quality of life 3. There is a plethora of evidence supporting the fact that long-acting injectable and depot antipsychotics can increase adherence to treatment, reduce the risk of discontinuation and hospital admissions4. It is also known that low fluctuations between peaks and lows in plasma drug levels could be related to a better tolerability profiles5. A new paliperidone palmitate prolonged release formulation, which is administered twice annually, has been approved as maintenance treatment for patients with schizophrenia who are already stable on the monthly or quarterly prolonged release paliperidone palmitate6.ObjectivesWe aimed to evaluate the transition of monthly and quarterly paliperidone palmitate to the new six-monthly formulation and patients’ satisfaction with it in a real-world clinical setting.MethodsWe collected a basic epidemiologic questionnaire, responses to a query about local pain after administration, and the Drugs Attitude Inventory (DAI).ResultsA total of 21 patients from an outpatient clinic for severe mental disorders with a long evolution of their disease in Salamanca, Spain, were included. All of them had a DSM5-TR diagnosis of Schizophrenia. Sixteen were male and 5 female. The mean age was 42.6 years. 14 were receiving quartlery paliperidone palmitate (10 with high doses (525 mg) and 4 with moderate doses (350 mg)) and 7 were on monthly injections (6 with high doses (150 mg) and 1 with a moderate dose (100 mg)). Those receiving moderate doses of quarterly or monthly paliperidone palmitate were administered 700 mg of six-monthly paliperidone palmitate; 1000 mg were injected to those with higher doses. The mean score on the DAI scale was 8. Only one patient reported an increase in local pain after the injection, and another reported dissatisfaction with the administration in the gluteus instead of the deltoid muscle. The first administration of the new formulation in our site was on June 26th; to date none of these patients have required hospital admission due to relapse.ConclusionsSix-monthly prolonged release paliperidone palmitate seems to be an effective maintenance treatment for schizophrenia. In addition, this new formulation is well received and tolerated by patients previously on monthly or quarterly formulations of the same drug.Disclosure of InterestNone Declared

Dental Drug Delivery System used in Periodontitis

Periodontitis, a condition affecting the teeth’s supporting structures, affects people of all ages, ethnicities, races, and genders. There is a well-established link involving microbial infection and the progression of gum diseases and tooth cavities. There are different types of periodontal diseases caused by microbial infection. Aggressive periodontitis can be localized or generalized. Periodontal infection has been successfully treated with antibacterial medicines. The effectiveness of mechanical plaque debridement and regular use of topical and systemic medicines is limited due to a lack of access to infecting organisms into the periodontal tissues. Systemically administered drugs achieve effective concentration at the infected area, but only for a small period, necessitating multiple doses over extensive periods of time. Antimicrobials delivered locally have being studied to see if they can overcome the limits of conventional therapy. Anti-bacterial is delivered using prolonged release formulations. Anti-bacterial is increasingly being delivered at the infection site (periodontal pocket) through sustained release formulations. This review discusses the main drug delivery system used in periodontal disease, their advantages and evaluations. The usage of collagen dental cones after an infected tooth has been extracted is also discussed in this review. Periodontal regeneration, soft-tissue restoration, and wound healing are all aided by dental cones containing antibacterial and biodegradable polymers.

Renal Function, Adherence and Quality of Life Improvement After Conversion From Immediate to Prolonged-Release Tacrolimus in Liver Transplantation: Prospective Ten-Year Follow-Up Study.

Immunosuppression non-adherence is a major cause of graft failure after liver transplantation. The aim of this study was to evaluate practice surrounding conversion from immediate-release to prolonged-release Tacrolimus formulation and to assess patient adherence and quality of life (QoL). One hundred and seven adult liver transplant recipients, receiving immediate-release Tacrolimus for a minimum of 6months, were converted to prolonged-release formulation, based on a dose ratio of one (1:1). The median follow-up was 120 [IQR, 120-123] months. Tacrolimus dosage and blood level, liver and renal function, lipid and glucose profiles were recorded. In addition, questionnaires were submitted to evaluate adherence and QoL following conversion. No rejection was recorded. The median serum Tacrolimus blood level decreased over 1month (5.80, [IQR, 2.0-10.8] vs. 3.8 [IQR, 1.4-8.7]; p < 0.0005). Significant improvement in renal function was noted (median GFR was 81.7 [IQR, 43.4-128.6] vs. 73.9 [IQR, 27.1-130.2]; p = 0.0002). At the end of the follow-up, conversion resulted in an overall decrease in non-adherence of 53.3% (p = 0.0001) and an improvement in QoL was reported by 76.2% of patients. Thus, 1:1 conversion from immediate to prolonged-release Tacrolimus is safe, feasible and efficient, avoiding under-therapeutic and toxic peak concentrations, improving renal function, adherence to immunosuppression and overall patient QoL.

Quality Control Dissolution Data Is Biopredictive for a Modified Release Ropinirole Formulation: Virtual Experiment with the Use of Re-Developed and Verified PBPK Model.

Physiologically based pharmacokinetic and absorption modeling are being used by industry and regulatory bodies to address various scientifically challenging questions. While there is high confidence in the prediction of exposure for the BCS class I drugs administered as immediate-release formulations, in the case of prolonged-release formulations, special attention should be given to the input dissolution data. Our goal was to develop and verify a PBPK model for a BCS class I compound, ropinirole, and check the biopredictiveness of the dissolution data for the prolonged-release formulation administered by Parkinson’s patients. The model was built based on quality control dissolution data reported in the certificates of analysis and verified with the use of data derived from five clinical trial reports. The simulated pharmacokinetic parameters being within a two-fold range of the observed values confirmed acceptable model performance, in vivo relevance of the in vitro dissolution profiles, and indirectly indicated ropinirole stable release from the formulation in the patients’ gastro-intestinal tract. Ropinirole PBPK model will be used for exploring potential clinical scenarios while developing a new formulation.

MO1004: Non-Antibiotic Prophylaxis with D-MANOSE for Uti in DE-NOVO Kidney Transplant Recipients: The Manotras Study

Abstract BACKGROUND AND AIMS Urinary tract infections (UTIs) are one of the most frequent complications in the first 6 months after kidney transplantation. (1) D-Mannose, a simple sugar, could play a very important role in the prevention of urinary infections, inhibiting the attachment of bacterial type one fimbriae to the urothelium, reducing their ability to infect de host. Proanthocyanides (PAC) have also been shown in vitro activity to inhibit the adherence of Escherichia coli by a similar mechanism. Both have shown promising results in reducing the risk of UTI in healthy women, but its efficacy has not been evaluated in kidney transplant population yet. (2) In this single-cantre, double-blind, prospective, randomized clinical trial, we aimed to evaluate the impact and security of a 24-h prolonged release formulation of D-Mannose in de-novo kidney transplantation UTI's. METHOD Between April 2019 and September 2020, 60 patients were recruited and randomized in 1:1 ratio according to treatment arm. Control group was treated with PAC, while the study group received PAC plus Mannose. Treatments were given as a prophylaxis strategy immediate after renal transplantation and during the first 3 months. All patients were followed for 6 months. RESULTS No statistically differences were observed in the baseline characteristics among study groups (Table 1). During the follow up; 61% of patients had at least one UTI episode (asymptomatic bacteriuria 56%, cystitis 6% and acute graft pyelonephritis 17%). Escherichia coli accounted for 28% of all UTI episodes, followed by Enterococcus faecalis (15%), Enterobacter cloacae (13%) and Klebsiella pneumoniae (13%). The main renal outcomes (eGFR at 6 months, acute rejection and DGF) did not differ among study groups. We found no statistically differences recording in the incidence of UTI between groups (Fig. 1). At univariate analysis the surgical complications, and female gender were independently associated with UTI. {OR 5.92, [95% confidence interval (95% CI) 1.021–34.36]; P = .041 and OR 3.59 95% CI 1.051–12.27; P = .047} with no effect of treatment with D-mannose. CONCLUSION In this study, a prophylaxis strategy based on Mannose + PAC did not show a significant impact compared with PAC alone on UTI in the de-novo kidney transplant population.

Nap judgment: why parties involved in parallel EPO proceedings should inform the Patents Court about scheduling issues

Abstract In the latest chapter of the litigation involving Neurim’s second medical use patent relating to ‘Circadin’ (a prolonged-release formulation of melatonin), the Patents Court has held that Mylan—who had allegedly infringed Neurim’s European patent (‘EP702’) and had counterclaimed for revocation of EP702 on grounds of invalidity unsuccessfully before the UK court but successfully in opposition proceedings before the European Patent Office—was not issue-estopped from challenging the validity in the UK court of Neurim’s divisional patent (‘EP443’) with claims amended into a form ‘patentably indistinct’ from those of EP702.

Lived experiences of patients with distal renal tubular acidosis treated with ADV7103 and of their caregivers: a qualitative study

BackgroundConsequences of distal renal tubular acidosis (dRTA) on growth, bone and kidney, sometimes associated with hearing loss, may significantly affect quality of life (QoL). This descriptive qualitative study explores QoL linked to dRTA and gathers the impressions of patients with this rare disease (and caregivers) 5 years after enrolment in a clinical study, during which patients were treated with ADV7103, a prolonged-release granule formulation combining potassium citrate and potassium bicarbonate. Semi-structured, one-hour interviews with 6 adult and 13 paediatric patients with a confirmed diagnosis of dRTA and with parents of paediatric patients were performed using an interview guide. Qualitative analysis of anonymized interview transcripts based on grounded theory was conducted.ResultsThe main QoL domains impacted by dRTA and its treatment were education/work, social/family life, and emotional and physical well-being. ADV7103 (administered twice daily) was compared with the standard of care (SoC) taken before study entry (more than twice daily). Patients/parents reported that switching from previous SoC to ADV7103 had changed their lives:Difficulties at school due to burdensome administrative issues and need to explain disease and treatment affecting all families of paediatric patients (n = 13) disappeared, facilitating parents who had stopped working (to deal with their child’s treatment) to return to work,Family functioning was improved (n = 18), as travel and holidays became easier to organise and patients/parents stopped thinking about managing treatment daily/nightly, reducing tension in the family or couple,The emotional burden of disease perceived was relieved (n = 12) in the absence of treatment-related invasive questions from others,Gastro-intestinal adverse events and taste problems improved with ADV7103 (n = 18) and better compliance led to milder physical impacts and less need to be hospitalised.The mean satisfaction score with ADV7103 compared to SoC was 9 out of 10 (10 = very satisfied). ADV7103 exceeded or met the expectations of 14 out of 17 patients that commented on that.ConclusionsQualitative interviews show that dRTA and its treatment have a significant impact on QoL of patients and parents and that ADV7103 helps improve daily-life and reduces treatment burden, resulting in greater overall satisfaction of the patients and their families.Trial registration EU Clinical Trials Register, EudraCT 2013-003828-36 on the 3rd of September 2013.

Clinical evaluation of switching from immediate-release to prolonged-release lithium in bipolar patients, poorly tolerant tolithium immediate-release treatment: A randomized clinicaltrial.

AimThe effect of switching from lithium immediate release (Li‐IR) to lithium prolonged release (Li‐PR) on lithium‐induced tremor after 1 and 12 weeks of treatment was evaluated in a randomized, multicenter, open trial, in bipolar patients from the participating sites with a tremor severity ≥2 (Udvalg for Kliniske Undersøgelser [UKU] rating scale) despite optimal lithium titration.MethodsThe primary endpoint was the evaluation of tremor by means of the UKU scale after 1 week of treatment. Secondary endpoints included manic Young Mania Rating Scale (YMRS) and depressive symptoms (Montgomery–Asberg Depression Rating Scale), a global assessment of the patient's status (Clinical Global Impression), polyuria/polydipsia (UKU item 3.8) and patient‐reported outcomes.ResultsOwing to difficulties in including suitable patients the enrollment phase was closed when 73 patients were randomized. Notwithstanding the lower number of patients, in the modified intention‐to‐treat population (n = 70) the primary endpoint was statistically significant: tremor improved after 1 week in 62.9% in Li‐PR group against 20.0% of patients in Li‐IR group (p = .0006; two‐tailed Fisher's exact test). The difference remained statistically significant after 4 (p = .0031) and 12 weeks (p = .0128). The same analysis performed in the PP population confirmed these results. Among the secondary endpoints, only the factor convenience of the treatment satisfaction questionnaire showed a statistically significant difference between groups. There were no apparent differences in the safety profile of the two formulations.ConclusionsThis study is the first comparative documentation of a potential benefit of the prolonged‐release formulation in reducing the symptom tremor, a well‐known adverse effect of lithium therapy. Indeed, the study results should be interpreted taking into account the sample size lower than planned.

Assessment of the impact of partial area under the curve in a bioavailability/bioequivalence study on generic prolonged-release formulations

The requirement for multiple-dose bioequivalence studies for the approval of generic prolonged-release (PR) formulations is not agreed upon by the EMA and FDA. While the EMA requests these studies, the FDA has no specific requirement, nor does ANVISA.Additional metrics are suggested for the assessment of prolonged-release products, and the partial Area Under the Curve (pAUC) metric has received increasing regulatory recognition.The objective of this work was to investigate whether the evaluation of the partial AUC in studies assessed by ANVISA can detect differences between 2 prolonged-release formulations that have demonstrated bioequivalence by the usual metrics.Twenty-four studies in a total of 117, which were already approved by ANVISA considering the usual metrics in the last 14 years, failed to demonstrate bioequivalence for partial AUC, which is related to 33.9% of evaluated PR products.For 76.92% of the studies, there was no significant increase in the intrasubject variability observed in the partial AUC analysis compared to the usual metrics, with a CV < 30% for both cases, calculated individually for each study, indicating that there is no need to increase the sample size to perform such analysis.The results of this paper demonstrate that the current criteria for assessing the bioequivalence of some prolonged-release formulations are insufficient and that the evaluation of partial AUC could be useful to assure the therapeutic parity of two products.

Pharmacological and safety profile of a prolonged-release lanreotide formulation in acromegaly

ABSTRACT Background Patients with acromegaly require lifelong medication; a longer dosing interval would reduce treatment burden. This study investigated the pharmacokinetics, pharmacodynamics and safety profile of a new prolonged-release formulation (PRF) of lanreotide every 12 weeks. Research design and methods In this multicenter, open-label, dose-ascending study, cohorts of nine patients with acromegaly received single doses of lanreotide PRF according to a 3 + 3 + 3 scheme in order to determine the maximum tolerated dose (MTD). Following a 12-week treatment period, patients were followed up for a further 12 weeks. Serum lanreotide, insulin-like growth factor-1 and growth hormone concentrations were analyzed. Adverse events were monitored throughout the study. Results The MTD was not reached. Peak lanreotide serum concentration values were similar in all cohorts, whereas area under the curve values from time zero to 85 days increased but were not dose-proportional. The apparent elimination half-life of lanreotide PRF was approximately 54–63 days, in line with the expected prolonged-release characteristics. Growth hormone and insulin-like growth factor-1 levels were generally stable. Conclusions The safety and tolerability profile was in-line with the known safety profile of lanreotide autogel. Lanreotide PRF was well tolerated and the pharmacokinetic profile suggests that a dosing interval of 12 weeks could be achievable. Clinical trial registration www.clinicaltrials.gov identifier is NCT02396953; EudraCT 2014–002389-62.

FORMULATION AND EVALUATION OF SUSTAINED RELEASE MATRIX TABLET OF LORNOXICAM BY DIRECT COMPRESSION METHOD

The aim of the present work was to develop sustained release Lornoxicam matrix tablets with polymers like HPMC K15M, Ethyl cellulose, and Crospovidone as carriers in varying quantities. Direct compression was used to make matrix tablets. Various assessment parameters, such as hardness, friability, thickness, percent drug content, weight variation, and so on, were applied to the prepared formulations. In vitro dissolution studies were carried out for 24 hrs. The tablets were subjected to in-vitro drug release in (pH 1.2) for first 2 hrs. Then followed by (pH 6.8) phosphate buffer for next 22 hrs. And the results showed that among the six formulations FL3 showed good dissolution profile to control the drug release respectively. The drug and polymer compatibility were tested using FT-IR spectroscopy, which revealed that the drug was compatible with all polymers. It is also required to design an appropriate prolonged release formulation for Lornoxicam in order to maintain the drug's release. Hence by using the compatible polymers sustained release tablets were formulated and subjected for various types of evaluation parameters like friability, hardness, drug content and dissolution behaviour. Finally, the findings reveal that the prepared sustained release matrix tablets of lornoxicam have improved efficacy and patient compliance.

A single‐center, open‐label, randomized cross‐over study to evaluate the pharmacokinetics and bioavailability of once‐daily prolonged‐release formulations of tacrolimus in de novo liver transplant recipients

BackgroundThe narrow therapeutic window of tacrolimus (Tac) requires intense drug monitoring to achieve adequate efficacy while minimizing dose‐related toxicities. Once‐daily formulations of Tac (LCP‐Tac and PR‐Tac) have been recently designed for higher bioavailability and a more consistent exposure over time, as opposed to the twice‐daily, administered immediate‐release formulation of Tac (IR‐Tac).MethodsThis single‐center, open‐label, randomized cross‐over pharmacokinetic (PK) study compares extended‐release LCP‐Tac with the prolonged‐release formulation of tacrolimus (PR‐Tac) in adult de novo liver transplant recipients. Eligible patients were screened and randomized 1:1 to the two treatment arms up to 30 days after liver transplantation. Patients were administered either LCP‐Tac or PR‐Tac for 14 days followed by another 14‐day time interval of the other once‐daily Tac medication. A 24hr‐PK profile was obtained at the end of each time interval.ResultsNine patients (45%) completed the study resulting in a total of 18 Tac PK profiles. Overall, the profile of the mean concentrations indicated a flattened kinetic of LCP‐Tac compared to PR‐Tac, especially in the first 3 h after drug intake. The average cumulative dose per day to achieve equivalent trough levels was approximately 25% lower for LCP‐Tac (8.7 mg) than for PR‐Tac (11.7 mg). LCP‐Tac resulted in a longer tmax and fewer peak‐to‐trough fluctuations compared to PR‐Tac.ConclusionDespite methodological weaknesses that limit the conclusions, we have found a more consistent drug exposure for LCP‐Tac in de novo LT recipients. LCP‐Tac demonstrated a greater bioavailability compared to PR‐Tac.

Tacrolimus Trough Intravariability in Patients Treated With the Prolonged-Release Formulation Is a Risk Factor for Acute Graft Rejection.

Tacrolimus has a narrow therapeutic window, and lack of adherence to the therapeutic regimen is a main risk factor for acute graft rejection; hence, the prolonged-release formulation was created. A high intrapatient variability for tacrolimus trough levels has been associated with worse graft outcomes; therefore, we investigated the correlation between the tacrolimus variation coefficient and the development of biopsy-proven acute graft rejection in kidney transplant patients with typical maintenance immunosuppression versus the prolonged-release formulation. This was a single-center observational retrospective study that included all adult kidney transplants from deceased donors between January 2011 and December 2014 for which the transplant recipients were given maintenance therapy with tacrolimus prolonged-release formulation (Advagraf). The overall tacrolimus variation coefficient was calculated for the follow-up period from transplant until December 2019. Biopsy-proven acute graft rejection results were collected throughout follow-up. Statistical analysis was performed with SPSS software. The study was composed of 147 patients with a mean follow-up time of 60.4 ± 15 months. The mean age of the patients was 47.5 ± 11.9 years and 67.3% were men. Of these 147 patients, 29 had at least 1 episode of acute graft rejection during follow-up. There was a significant correlation between patients with a higher tacrolimus variation coefficient and the presence of biopsy-proven acute graft rejection. Receiver operating characteristic curves were used to determine an intrapatient variability cutoff point of 28.3% for tacrolimus. Younger patients were also more likely than older patients to develop acute graft rejection in our sample. High intrapatient variability of tacrolimus trough levels is a risk factor for acute graft rejection in kidney transplant patients.