蒋娟娟
中国医学科学院阜外医院 卫生部心血管药物临床研究重点实验室
Nifekalant hydrochloride is a class III antiarrhythmic agent which could increase the duration of the action potential and the effective refractory period of ventricular and atrial myocytes by blocking the K+ current. Nifekalant is used to prevent ventricular tachycardia/ventricular fibrillation. QT interval prolongation is the main measurable drug effect. However, due to the complicated dosing plan in clinic, the relationship among dosage, time, drug concentration and efficacy is not fully understood. In this study, a single-center, randomized, blind, dose-ascending, placebo-controlled study was conducted to explore the intrinsic characteristics of nifekalant injection in healthy Chinese volunteers by a population pharmacokinetic (PK)-pharmacodynamic (PD) model approach. 42 subjects were enrolled in this study and received one of three dose plans (loading dose on Day 1 (0.15, 0.3 or 0.5 mg/kg), loading dose followed by maintenance dose (0.2, 0.4 or 0.8 mg/kg/h) on Day 4) or vehicle. Blood samples were drawn for PK evaluation, and ECGs were recorded for QTc calculation at the designed timepoints. No Torsades de Pointes occurred during the study. The popPK model of nifekalant injection could be described by a two-compartment model with first-order elimination. The population mean clearance (CL) was 53.8 L/h. The population mean distribution volume of the central (Vc) and peripheral (Vp) compartments was 8.27 L and 45.6 L, respectively. A nonlinear dose-response (Emax) model well described the pharmacodynamic effect (QTc interval prolongation) of nifekalant. The Emax and EC50 from current study were 101 ms and 342 ng/mL, respectively.
Journal of pharmacokinetics and pharmacodynamics 2024
BACKGROUND:The current study was performed to systemically review the efficacy and safety of tranexamic acid (TXA) in patients undergoing cardiac surgery at a single large-volume cardiovascular center.METHODS:A computerized search of electronic databases was performed to identify all relevant studies using search terms till December 31st, 2021. The primary outcomes were postoperative blood loss and the composite incidence of mortality and morbidities during hospitalization. Secondary outcomes included postoperative massive bleeding and transfusion, postoperative recovery profiles, coagulation functions, inflammatory variables, and biomarkers of vital organ injury.RESULTS:Database search yielded 23 qualified studies including 27,729 patients in total. Among them, 14,136 were allocated into TXA group and 13,593 into Control group. The current study indicated that intravenous TXA significantly reduced total volume of postoperative bleeding in both adult and pediatric patients, and that medium- and high-dose TXA were more effective than low-dose TXA in adult patients (P < .05). The current study also demonstrated that intravenous TXA, as compared to Control, remarkably reduced postoperative transfusion incidences and volume of red blood cell and fresh frozen plasma, and reduced postoperative transfusion incidence of platelet concentrates (PC) (P < .05) without obvious dose-effects (P > .05), but TXA did not reduce PC transfusion volume postoperatively in adult patients (P > .05). For pediatrics, TXA did not significantly reduce postoperative transfusion incidence and volume of allogenic red blood cell, fresh frozen plasma and PC (P > .05). Additionally, the current study demonstrated that intravenous TXA did not influence the composite incidence of postoperative mortality and morbidities in either adults or pediatrics during hospitalization (P > .05), and that there was no obvious dose-effect of TXA in adult patients (P > .05).CONCLUSIONS:This current study suggested that intravenous TXA significantly reduced total volume of postoperative bleeding in both adult and pediatric patients undergoing cardiac surgery at the single cardiovascular center without increasing the composite incidence of mortality and morbidities.
Medicine 2023
PURPOSE:The goal of this study was to develop a population pharmacokinetic (PK) and PK/pharmacodynamics (PD) model for ibutilide, to evaluate the time course of its effect on QT interval in Chinese.METHODS:The population PK and PK/PD model were developed using data from 40 Chinese healthy volunteers using nonlinear mixed-effects modeling, and the final population PK/PD model was applied on 100 patients with atrial fibrillation (AF) and/or atrial flutter (AFL).FINDINGS:The PK parameters of ibutilide were best described by a 3-compartment model with first-order elimination. No statistically significant covariate was found for each PK model parameter. Individualized QT interval correction, by heart rate, was performed by a power model, and the circadian rhythm of QT intervals was described by 2 mixed-effect cosine functions. The QT interval data of ibutilide was well characterized by a sigmoid Emax model (E(C)=Emaxγ×Cγ/(EC50γ+Cγ)) with an effect compartment. The final PK/PD model was used to estimate individual parameters of patient data and found good predictions compared with healthy volunteers; AF and/or AFL patients had lower Emax and higher EC50.IMPLICATIONS:A population PK and PK/PD model for ibutilide in healthy volunteers was developed and could well capture ibutilide's PK/PD characteristics. The final PK/PD model was applied on patients with AF and/or AFL successfully.
Clinical therapeutics 2017
A liquid chromatography-tandem mass spectrometry (LC-MS) method to quantify tolvaptan and its two main metabolites and applied to human study was first developed and validated as a measure of compliance in clinical research. Because of the structure similarity of tolvaptan and its multiple metabolites, the method was optimized to obtain a chromatographic and MS separation of the endogenous interference and isotope ions as well as high analysis throughput. Tolvaptan, its two main metabolites and the internal standard were extracted from human serum (0.1mL) using solid-phase extraction, separated on a Waters nova-pak C18 column (150×3.9mm, 5μm) using isocratic elution with a mobile phase composed of acetonitrile, water and formic acid (65:35:0.25, v/v/v). The total run-time was shortened to 3.5min. The mass transition ranges under positive electrospray ionisation that were monitored for quantitation included m/z 449-252 for tolvaptan, m/z 479-252 for metabolite DM-4103, m/z 481-252 for metabolite DM-4107 and m/z 463-266 for the internal standard (IS). The limit of quantification in plasma for all three analytes was 1ng/mL. The method was validated over a linear range from 1 to 500ng/mL for all three analytes with acceptable inter- and intra-assay precision and accuracy. The stability of the analytes was determined to be suitable for routine laboratory practices. The method was successfully applied to samples taken from research volunteers who ingested a 15mg tolvaptan tablet.
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 2016
A liquid chromatography-tandem mass spectrometry method to quantify carvedilol enantiomers in human plasma was developed and validated as a measure of compliance in clinical research. Carvedilol enantiomers were extracted from human serum (0.5 mL) via liquid-liquid extraction with methyl tert-butyl ether (2.5 mL). Carvedilol-related compound C served as the internal standard. The analyte and internal standard were separated on a Sino-Chiral AD column (150 × 4.6mm, 5 μm, amylose tris-3,5-dimethylphenylcarbamate coated on silica-gel) using isocratic elution with mobile phases of methanol, water and diethylamine (94:6:0.01, v/v). The total run-time was 10.5 min. Carvedilol enantiomers were quantified using a triple quadrupole mass spectrometer operated in multiple-reaction-monitoring mode using positive electrospray ionisation. The mass transitions monitored for quantitation were carvedilol (m/z 407→222) and carvedilol-related compound C (m/z 497→222). The limits of quantification for the S- and R-carvedilol enantiomers in plasma were both 0.08 ng/mL. The method was validated in the linear range of 0.08-50 ng/mL with acceptable inter- and intra-assay precision and accuracy and stability suitable for routine laboratory practice. The method was successfully applied to samples taken from research volunteers treated with carvedilol sustained-release tablet 18 mg. Cmax and AUClast were 9.1 ± 5.1 ng/mL and 59.4 ± 39.6 ng h/mL for R-carvedilol, 4.0 ± 2.3 ng/mL and 24.7 ±15.0 ng h/mL for S-carvedilol, respectively. tmax and t1/2 were 4.6 ± 1.9h and 9.6 ± 4.5h for R-carvedilol, and 4.7 ± 1.0 h and 10.7 ± 5.7 h, respectively.
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 2014
A sensitive, rapid assay method for estimating ivabradine in human plasma has been developed and validated using liquid chromatography coupled to tandem mass spectrometry with electrospray ionization in the positive-ion mode. The procedure involved extraction of ivabradine and the internal standard (IS) from human plasma by solid-phase extraction. Chromatographic separation was achieved using an isocratic mobile phase (0.1% formic acid-methanol, 60:40, v/v) at a flow rate of 1.0 mL/min on an Aglient Eclipse XDB C8 column (150 × 4.6 mm, 5 µm; maintained at 35 °C) with a total run time of 4.5 min. Detection was achieved using an Applied Biosystems MDS Sciex (Concord, Ontario, Canada) API 3200 triple-quadrupole mass spectrometer. The MS/MS ion transitions monitored were 469-177 for ivabradine and 453-177 for IS. Method validation was performed according to Food and Drug Administration guidelines, and the results met the acceptance criteria. The calibration curve was linear over a concentration range of 0.1-200 ng/mL. The lower limit of quantitation achieved was 0.1 ng/mL. Intra- and inter-day precisions were in the range of 1.23-14.17% and 5.26-8.96%, respectively. Finally, the method was successfully used in a pharmacokinetic study that measured ivabradine levels in healthy volunteers after a single 5 mg oral dose of ivabradine. Copyright © 2013 John Wiley & Sons, Ltd.
Biomedical chromatography : BMC 2013
BACKGROUND:Ivabradine is a pure heart rate-lowering agent that acts by inhibiting I(f), an important ionic current involved in pacemaker activity in the cells of the sinoatrial node. In the 2012 European Society of Cardiology Guidelines on Heart Failure, it was recommended that patients with a persistently high heart rate, despite treatment with an evidence-based dose of a β-blocker, should be considered for treatment with ivabradine.OBJECTIVE:The aim of this study was to explore the pharmacokinetic/pharmacodynamic properties and safety profile of ivabradine in healthy Chinese men.METHODS:This Phase I, randomized, open-label, parallel-arm, single- and multiple-dose study was conducted at the Clinical Pharmacology Center of the Cardiovascular Institute and Fu Wai Hospital at the Chinese Academy of Medical Sciences & Peking Union Medical College in Beijing, People's Republic of China. Healthy, nonsmoking volunteers were randomly assigned to 1 of 3 treatment groups based on treatment with 5, 10 or 20 mg of ivabradine. After a single dose, the subjects assigned to the 3 dose groups received repeated oral doses of ivabradine BID for 6 days. The plasma concentrations of ivabradine were determined by using a HPLC-MS/MS method. Systolic and diastolic blood pressure and heart rate measurements were taken, and ECG and Holter monitoring was performed. Tolerability was assessed throughout the study by physical and ophthalmologic examinations, vital signs measurement, laboratory analyses, and monitoring of adverse effects.RESULTS:A total of 36 healthy Chinese men were enrolled in the study. After the single dose, plasma ivabradine Cmax and AUC increased approximately linearly with dosage, no statistically significant differences were found in t½ or Tmax between the dose groups. After multiple doses, there was no significant change in Tmax compared with the results after a single dose. After repeated doses, t½, Cmax, and AUC increased significantly (P < 0.001). After a single dose, a significant reduction in heart rate at 2 hours' postdose was observed in the highest dose group, whereas after repeated doses, a significant reduction in heart rate was observed from 2 to 4 hours' postdose for all 3 groups. The mean (SD) heart rate after repeated doses decreased 12.5 (4.8), 12.4 (6.9), and 20.5 (5.8) beats/min for the 5-, 10-, and 20-mg dose groups, respectively. No clear trend in the changes in QTc, systolic and diastolic blood pressures, or respiration rate was observed. Ivabradine was well tolerated in these healthy Chinese men.CONCLUSIONS:The results of the study in a small population of healthy Chinese men suggest that the PK properties of ivabradine are linear with respect to dosing. After single and repeated oral administration of ivabradine, a significant decrease in heart rate was observed. Ivabradine appeared well tolerated in the population studied. Trial identifier: ACTRN1261300027741.
Clinical therapeutics 2013
OBJECTIVE:The aim of this study was to explore the pharmacokinetic (PK) and pharmacodynamic (PD) properties and safety profiles of aranidipine and its active M-1 metabolite in healthy Chinese men.METHODS:This Phase I, randomized, open-label, single- and multiple-dose study included healthy, nons-moking male volunteers aged 18 to 45 years. In the single-dose study, subjects were randomly assigned to receive oral sustained-release, enteric-coated aranidipine tablets 5, 10, or 20 mg. In the multiple-dose study, volunteers who had been assigned to the aranidipine 10-mg group in the single-dose study received this dose for 7 days. In the single-dose study, blood samples for the PK analyses were obtained immediately before dosing and at regular intervals up to 36 hours after dosing. In the multiple-dose study, predose blood samples were collected on days 4 through 7; on the last day of treatment, blood samples were drawn at the same times as in the single-dose study. Plasma concentrations of aranidipine and M-1 were determined using a high-performance liquid chromatography method with tandem mass-spectrometric detection. For the PD analyses, blood pressure (BP) and heart rate were measured before dosing, at regular intervals up to 24 hours after dosing, and after the final dose during repeated administration. Tolerability was assessed throughout the study, based on adverse events, physical examinations, electrocardiography, vital signs, and laboratory tests.RESULTS:The study enrolled 30 healthy Chinese men (mean [SD] age, 23 [2] years; mean body weight, 66 [7] kg; mean height, 174 [6] cm). In the single-dose study, the mean t(1/2) for aranidipine 5, 10, and 20 mg was 3.0 (2.7), 2.7 (1.1), and 3.1 (2.2) hours, respectively; mean T(max) was 4.9 (0.4), 4.4 (1.0), and 4.3 (0.9) hours; mean C(max) was 1.1 (0.6), 2.4 (0.8), and 4.0 (2.0) microg/L; and mean AUC(last) was 4.1 (1.4), 10.3 (2.3), and 20.9 (4.2) microg . h/L. There were no significant differences in any PK parameter between dose groups. For M-1, the corresponding values were 4.6 (1.0), 4.1 (0.5), and 4.1 (0.3) hours for t(1/2); 5.6 (2.0), 5.0 (1.6), and 5.0 (0.8) hours for T(max); 18.4 (0.6), 40.5 (10.0), and 39.2 (11.3) microg/L for C(max); and 143.5 (39.1), 304.5 (108.2), and 403.9 (73.5) microg . h/L for AUC(last). Only dose-normalized Cmax and AUC(last) differed significantly between dose groups (P < 0.001 and P = 0.018, respectively). After multiple doses, the mean values for t(1/2), T(max), C(max), and AUC(0-infinity) for aranidipine 10 mg were 2.3 (0.9) hours, 5.0 (1.2) hours, 3.1 (1.1) microg/L, and 13.8 (3.6) microg . h/L, respectively. Repeated oral administration of aranidipine 10 mg was associated with a significant increase in AUC(last) (P = 0.027). The corresponding values for M-1 were 4.8 (0.9) hours, 5.7 (1.3) hours, 40.0 (11.3) microg/L, and 381.8 (161.2) microg . h/L. There were no significant differences between dose groups in any PK parameter for M-1 after single or multiple doses. In the PD analyses, the mean change from baseline in diastolic BP was statistically significant in all groups (P < 0.01) except the aranidipine 10-mg group in the single-dose study. Three volunteers (10%) reported adverse events after administration of a single dose: headache (10-mg group), palpitations (20-mg group), and dizziness (20-mg group). The headache and palpitations were considered possibly related to study drug.CONCLUSIONS:The results of this small study in healthy Chinese men suggest that the PK properties of aranidipine were linear with respect to dose, whereas the PK properties of the active M-1 metabolite were not fully linear. There was no apparent accumulation of aranidipine or M-1 with administration of single and multiple doses. Aranidipine was generally well tolerated.
Clinical therapeutics 2008
A rapid, selective and sensitive liquid chromatography-tandem mass spectrometry (LC-MS-MS) method with positive electrospray ionization (ESI) was developed for the quantification of ranolazine in human plasma. After liquid-liquid extraction of ranolazine and internal standard (ISTD) phenoprolamine from a 100 microl specimen of plasma, HPLC separation was achieved on a Nova-Pak C(18) column, using acetonitrile-water-formic acid-10% n-butylamine (70:30:0.5:0.08, v/v/v/v) as the mobile phase. The mass spectrometer was operated in multiple reaction monitoring (MRM) mode using the transition m/z 428.5-->m/z 279.1 for ranolazine and m/z 344.3-->m/z 165.1 for the internal standard, respectively. Linear calibration curves were obtained in the concentration range of 5-4000 ng/ml, with a lower limit of quantitation (LLOQ) of 5 ng/ml. The intra- and inter-day precision values were below 3.7% and accuracy was within +/-3.2% at all three quality control (QC) levels. This method was found suitable for the analysis of plasma samples collected during the phase I pharmacokinetic studies of ranolazine performed in 28 healthy volunteers after single oral doses from 200 mg to 800 mg.
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 2007
A simple, sensitive and rapid high-performance liquid chromatography/negative electrospray ionization tandem mass spectrometry method was developed and validated for the assay of aranidipine (AR) and its active metabolite (AR-M) in human plasma. Following a liquid-liquid extraction, the analytes were separated using an isocratic mobile phase on a reversed-phase column and analyzed by mass spectrometry in the multiple reaction monitoring mode using the respective [M-H]- ions, m/z 387.0 --> 164.0 for AR, m/z 389.1 --> 208.1 for AR-M and m/z 359.0 --> 121.8 for the internal standard. The assay exhibited a linear dynamic range of 0.02-10 ng x mL(-1) for AR and 0.2-100 ng x mL(-1) for AR-M in human plasma. The limits of quantitation were 0.02 ng x mL(-1) for AR and 0.2 ng x mL(-1) for AR-M. Acceptable precision and accuracy were obtained for concentrations over the standard curve range. A run time of 2.8 min for each sample exhibited its high-throughout analysis ability. The validated method can be applied to analyze human plasma samples for pharmacokinetic studies.
Rapid communications in mass spectrometry : RCM 2006
