The purpose of this study was to investigate how vamorolone affects the CYP3A4 enzyme in humans by measuring the pharmacokinetics of midazolam and its metabolite, 1'-hydroxymidazolam, in healthy subjects. The pharmacokinetics of midazolam were measured on Day 1 and then on Day 14 to investigate the potential interaction between the two compounds. The safety and the tolerability was also investigated.
This was a non-randomized, single-center, open-label, single-sequence, single-arm Phase I study. * Day 1: Participants received a single dose of 2.5 mg midazolam in fasted state in the morning. * Day 2: Wash-out period. * Days 3 to 13: Participants received daily doses of 6 mg/kg vamorolone in the morning within 30 minutes after start of a standard breakfast. * Day 14: Participants received single doses of 2.5 mg midazolam and 6 mg/kg vamorolone in fasted state in the morning. * Safety and tolerability parameters were collected during the entire study phase from screening to follow-up. * Blood samples for PK assessment of midazolam and 1'-hydroxymidazolam were collected from predose through 10 hours following the midazolam doses on Days 1 and 14. * Blood samples for PK assessment of vamorolone were collected throughout the vamorolone dosing period. * Blood and urine biomarkers samples for CYP3A4 induction assessment were collected throughout the treatment period. * On Day 28, a follow-up safety phone call was done
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
18
Days 3 to 14: 6 mg/kg vamorolone once daily.
Day 1 and 14: Single oral doses of 2.5 mg midazolam
Nuvisan GmbH
Neu-Ulm, Germany
AUC0-tlast of Midazolam
Area under the plasma concentration-time curve from 0 to the time of the last observed concentration (h\*pg/mL) on day 1 and day 14. The timepoints at which the data were collected to create the curve are as follows: predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8 and 10 hours postdose.
Time frame: Day 1 and Day 14
AUC0-inf of Midazolam
Area under the plasma concentration-time curve from zero to infinite time on day 1 and day 14. The timepoints at which the data were collected to create the curve are as follows: predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8 and 10 hours postdose and extrapolation to infinity.
Time frame: Day 1 and Day 14
Cmax of Midazolam
maximum measured concentration of midazolam after administration of midazolam until the last collection time, i.e., 10 hours after dosing on day 1 and day 14
Time frame: Day 1 and Day 14
AUC0-tlast of 1'-Hydroxymidazolam
Area under the plasma concentration-time curve from 0 to the time of the last observed concentration (h\*pg/mL) on day 1 and day 14. The timepoints at which the data were collected to create the curve are as follows: predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8 and 10 hours postdose.
Time frame: Day 1 and Day 14
AUC-inf of 1'-Hydroxymidazolam
Area under the plasma concentration-time curve from 0 to the infinite time (h\*pg/mL) on day 1 and Day 14. The timepoints at which the data were collected to create the curve are as follows: predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8 and 10 hours postdose and extrapolation to infinity.
Time frame: Day 1 and Day 14
Cmax of 1'-Hydroxymidazolam
maximum measured concentration of 1'-Hydroxymidazolam after administration of midazolam until the last collection time, i.e., 10 hours after dosing
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Time frame: Day 1 and Day 14
Tmax of Midazolam
Time to reach observed maximal concentration of midazolam after administration of midazolam until the last collection time, i.e., 10 hours after administration on day 1 and day 14
Time frame: Day 1 and Day 14
CL/F of Midazolam
The apparent clearance measures how quickly a drug leaves the body, considering how much reaches it after being taken orally. It was calculated using the formula: Dose/AUCinf on day 1 and day 14. The timepoints used were as follows: predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10 hours on day 1 and day 14
Time frame: Day 1 and Day 14
Vz/F of Midazolam
Vz/F is the ratio of the volume of distribution of a drug to its bioavailability. It describes how widely the drug is distributed in the body after oral administration. It was calculated based on the terminal phase (ℷz)using the formula: Dose /ℷz.AUCinf on day 1 and day 14. The timepoints were as follows: predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10 hours.
Time frame: Day 1 and Day 14
t1/2 of Midazolam
Elimination half-life is the amount of time it takes for the concentration of the drug (midazolam) in the body to decrease by half after administration on day 1 and day 14. The collection times were predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10 hours.
Time frame: Day 1 and Day 14
Tmax of 1'-Hydroxymidazolam
Time to reach observed maximal concentration of 1'-Hydroxymidazolam after administration of midazolam until the last collection time, i.e., 10 hours after dosing on day 1 and day 14
Time frame: Day 1 and Day 14
t1/2 of 1'-Hydroxymidazolam
Elimination half-life is the amount of time it takes for the concentration of the drug (1'-Hydroxymidazolam) in the body to decrease by half on day 1 and day 14. The collection times were predose, 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10 hours.
Time frame: Day 1 and Day 14
Predose Concentration (Ctrough) of Vamorolone
Concentration measurements taken just before the first administration of vamorolone on day 3, and at the end of each vamorolone dosing interval before the next dose on days 4, 7, 11, 13, and 14.
Time frame: Day 3, Day 4, Day 7, Day 11, Day 13, Day 14
Urinary 6β-hydroxycortisol to Cortisol Ratio
Urinary 6β-hydroxycortisol to cortisol ratio is used as in vivo biomarkers for CYP3A4 activity. The impact of vamorlone on adrenal suppression could result in alterations in urinary cortisol and 6-β-hydroxycortisol levels.. Thus, the 6-β-hydroxycortisol to cortisol ratio is an unreliable measure of vamorolone's CYP3A4 induction potential.
Time frame: Day 1, Day 3, Day 4, Day 7, Day 11, Day 14, Day 15
Plasma 4β-hydroxycholesterol Level
The plasma concentration of 4-β-hydroxycholesterol is used as an in vivo marker to assess CYP3A4 induction activity
Time frame: Day 1, Day 3, Day 4, Day 7, Day 11, Day 14, Day 15