The purpose of this study is to determine whether the pharmacokinetics (PK) of stiripentol and of its relevant metabolites would be altered in subjects with renal impairment compared with normal controls in order to assess the need of dose adjustment in the renal impaired population. This study will include subjects with mild, moderate and severe renal impairment.
The pharmacokinetic studies conducted with stiripentol in humans evidenced that at steady state after multiple administration, up to 54.1%. of the stiripentol dose was excreted unchanged in hydrolyzed urine over the 24 h interval. Stiripentol is extensively metabolized by the liver; around 20 metabolites have been detected in urine, but the fraction of dose excreted as unchanged stiripentol is much less than one percent. At steady state, stiripentol and its metabolites in urine accounted collectively for 90% of the oral dose. The risk of a clinically relevant increase in exposure in renal impairment is expected to be largest for drugs that are primarily renally eliminated, according to the European Medicines Agency (EMA) guideline on the evaluation of the pharmacokinetics of medicinal products in patients with decreased renal function and the draft Food and Drug Administration's (FDA) guidance for industry "Pharmacokinetics in Patients with Impaired Renal Function - Study Design, Data Analysis, and Impact on Dosing and Labeling". But since the literature shows that impaired renal function can alter some drug metabolism and transport pathways in the liver and gut a dedicated renal impairment study with a full pharmacokinetics (PK) design is recommended. Therefore, the purpose of this study is to determine whether the pharmacokinetics (PK) of stiripentol and of its relevant metabolites would be altered in subjects with renal impairment compared with normal controls in order to assess the need of dose adjustment in the renal impaired population. This study will include subjects with mild, moderate and severe renal impairment. Data from subjects with renal impairment will be compared to matched controls with normal renal function. Both groups should be similar with respect to sex, age, BMI and ethnicity. This approach is consistent with recommendations of the EMA guideline and FDA guidance for pharmacokinetics (PK) in patients with renal function as the control group in this study should be representative of the typical patient population for the drug under study, considering the patients' renal function and other factors known to affect the drug's pharmacokinetics (PK). Plasma protein binding is often altered in patients with impaired renal function. Stiripentol is strongly bound (\>99%) to plasma proteins. Therefore, the EMA guideline and FDA guidance recommend the measurement of unbound drug concentrations. Therefore, the fraction of unbound stiripentol will be determined using two samples taken pre-dose and 3 h post-dose on Day 15 from each subject on-study.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
39
Oral administration of: * Days 1 and 2: 1000 mg of stiripentol (single dose at the end of breakfast), * Day 3 to Day 14: 1000 mg of stiripentol bis in die (BID) (approximately 12 hours apart, at the end of breakfast and at the end of dinner), * Day 15: 1000 mg of stiripentol (single dose at the end of breakfast).
Mc Comac Medical
Sofia, Bulgaria
Area under the plasma concentration versus time curve
Area under the plasma concentration versus time curve: AUC0-12 (corresponding to AUC0-tau), in order to assess the need of dose adjustment in the renal impaired population.
Time frame: Steady state at Day15
Peak Plasma Concentration
Peak Plasma Concentration: Cmax in order to assess the need of dose adjustment in the renal impaired population.
Time frame: Steady state at Day15
Peak Plasma Concentration, for stiripentol in plasma
Peak Plasma Concentration : Cmax on Day 1
Time frame: Day 1 and Day 15 when applicable
The area under the concentration-time curve from time zero (pre-dose) to 12 h post-dose, for stiripentol in plasma
The area under the concentration-time curve from time zero (pre-dose) to 12 h post-dose: AUC0-12 corresponds to AUC0-tau on Day 15): AUC0-12 on Day 1
Time frame: Day 1 and Day 15 when applicable
The time at which Cmax is apparent, for stiripentol in plasma
The time at which Cmax is apparent: tmax
Time frame: Day 1 and Day 15 when applicable
The area under the concentration-time curve from time zero (pre-dose) to 24 h post-dose, for stiripentol in plasma
The area under the concentration-time curve from time zero (pre-dose) to 24 h post-dose: AUC0-24,
Time frame: Day 1 and Day 15 when applicable
The area under the concentration-time from time zero (pre-dose) to the time of last quantifiable concentration, for stiripentol in plasma
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The area under the concentration-time from time zero (pre-dose) to the time of last quantifiable concentration: AUC0-t
Time frame: Day 1 and Day 15 when applicable
The apparent terminal elimination half-life, for stiripentol in plasma
The apparent terminal elimination half-life t1/2
Time frame: Day 1 and Day 15 when applicable
Apparent total clearance at steady-state, for stiripentol in plasma
Apparent total clearance at steady-state: CLss/F
Time frame: Day 1 and Day 15 when applicable
Fraction unbound (stiripentol) in plasma defined as unbound concentration/total concentration (on Day 15 only), for stiripentol in plasma
Fraction unbound (stiripentol) in plasma defined as unbound concentration/total concentration (on Day 15 only) : Fu
Time frame: Day 1 and Day 15 when applicable
Pre-morning dose concentration, for stiripentol in plasma
Pre-morning dose concentration : Cmin
Time frame: Day 1 and Day 15 when applicable
Accumulation ratio evaluated, for stiripentol in plasma
Accumulation ratio evaluated: Racc
Time frame: Day 1 and Day 15 when applicable
Total amount excreted over the time interval between 0 and 12 h, for stiripentol in urine
Total amount excreted over the time interval between 0 and 12 h : Ae0-12
Time frame: Day 1 and Day 15 when applicable
Total amount excreted over the total time interval of urine collection i.e. ]0 - 24] h, for stiripentol in urine
Total amount excreted over the total time interval of urine collection i.e. \]0 - 24\] h : Ae0-24
Time frame: Day 1 and Day 15 when applicable
The fraction of the dose excreted in urine over the total time interval of urine collection i.e. ]0 - 24] h, for stiripentol in urine
The fraction of the dose excreted in urine over the total time interval of urine collection i.e. \]0 - 24\] h : fe0-24
Time frame: Day 1 and Day 15 when applicable
The renal clearance, for stiripentol in urine
The renal clearance : CLr
Time frame: Day 1 and Day 15 when applicable
Peak Plasma Concentration, for stiripentol relevant metabolites in plasma
Peak Plasma Concentration : Cmax
Time frame: Day 1 and Day 15 when applicable
The time at which Cmax is apparent, for stiripentol relevant metabolites in plasma
Peak Plasma Concentration : Cmax
Time frame: Day 1 and Day 15 when applicable
The area under the concentration-time curve from time zero (pre-dose) to 12 h post-dose: AUC0-12 corresponds to AUC0-tau on Day 15), for stiripentol relevant metabolites in plasma
The area under the concentration-time curve from time zero (pre-dose) to 12 h post-dose: AUC0-12 corresponds to AUC0-tau on Day 15) : AUC0-12,
Time frame: Day 1 and Day 15 when applicable
The area under the concentration-time curve from time zero (pre-dose) to 24 h post-dose, for stiripentol relevant metabolites in plasma
The area under the concentration-time curve from time zero (pre-dose) to 24 h post-dose: AUC0-24,
Time frame: Day 1 and Day 15 when applicable
The area under the concentration-time from time zero (pre-dose) to the time of last quantifiable concentration, for stiripentol relevant metabolites in plasma
The area under the concentration-time from time zero (pre-dose) to the time of last quantifiable concentration: AUC0-t,
Time frame: Day 1 and Day 15 when applicable
The apparent terminal elimination half-life, for stiripentol relevant metabolites in plasma
The apparent terminal elimination half-life : t1/2,
Time frame: Day 1 and Day 15 when applicable
Pre-morning dose concentration, for stiripentol relevant metabolites in plasma
Pre-morning dose concentration : Cmin.
Time frame: Day 1 and Day 15 when applicable
Total amount excreted over the time interval between 0 and 12 h, for stiripentol relevant metabolites in urine
Total amount excreted over the time interval between 0 and 12 h : Ae0-12
Time frame: Day 1 and Day 15 when applicable
Total amount excreted over the total time interval of urine collection i.e. ]0 - 24] h, for stiripentol relevant metabolites in urine
Total amount excreted over the total time interval of urine collection i.e. \]0 - 24\] h : Ae0-24
Time frame: Day 1 and Day 15 when applicable
The fraction of the dose excreted in urine over the total time interval of urine collection i.e. ]0 - 24] h, for stiripentol relevant metabolites in urine
The fraction of the dose excreted in urine over the total time interval of urine collection i.e. \]0 - 24\] h : fe0-24
Time frame: Day 1 and Day 15 when applicable
The renal clearance, for stiripentol relevant metabolites in urine
The renal clearance : CLr
Time frame: Day 1 and Day 15 when applicable