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A clinical study investigating the pharmacokinetic interaction between NN703 (tabimorelin), a potential inhibitor of CYP3A4 activity, and midazolam, a CYP3A4 substrate

Abstract

Objective

NN703 (tabimorelin) is an orally active growth hormone (GH) secretagogue intended for use as an alternative to daily injections of GH. In vitro studies in human liver microsomes have indicated that NN703 is a mechanism-based inhibitor of CYP3A4. The aim of the present study was to investigate in man the effects of NN703 on the pharmacokinetics of midazolam, a substrate of CYP3A4.

Methods

Seventeen adult male subjects were enrolled in the study, and each received an oral dose of midazolam (7.5 mg) on four occasions: at baseline (day 1), after one dose of NN703 (day 3), after 7 days once daily NN703 treatment (day 9) and after a 7-day washout period (day 16). The pharmacokinetics of midazolam and its main metabolite, α-hydroxymidazolam, were investigated.

Results

Following a single dose of NN703 (day 3), the AUC of both midazolam and α-hydroxymidazolam increased by 64% and 34%, respectively (P=0.0001 for both). After repeated NN703 dosing (day 9), NN703 levels reached steady state, and midazolam AUC further increased to 93% relative to baseline (P=0.0001), whereas α-hydroxymidazolam AUC decreased slightly and was 11% higher than baseline (n.s.). Following the washout period (day 16), midazolam AUC decreased to values lower than those on day 3 and day 9, but still significantly (45%) higher than baseline levels (P=0.0001). The Cmax values of midazolam and α-hydroxymidazolam demonstrated a pattern similar to the AUC, but the effect following repeated NN703 dosing was more pronounced. The t1/2 of midazolam increased from day 1 to day 3 (P=0.0483) but was essentially unchanged at steady state on day 9.

Conclusion

This study shows that administration of NN703 and midazolam, a CYP3A4 substrate, leads to a significant increase in exposure of midazolam. This is consistent with NN703 inhibition of CYP3A4 activity.

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Acknowledgements

The study performed complies with local laws and was performed in accordance with Good Clinical Practise.

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Correspondence to Milan Zdravkovic.

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Zdravkovic, M., Olsen, A.K., Christiansen, T. et al. A clinical study investigating the pharmacokinetic interaction between NN703 (tabimorelin), a potential inhibitor of CYP3A4 activity, and midazolam, a CYP3A4 substrate. Eur J Clin Pharmacol 58, 683–688 (2003). https://doi.org/10.1007/s00228-002-0539-1

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  • DOI: https://doi.org/10.1007/s00228-002-0539-1

Keywords

  • CYP3A4
  • Interaction
  • Midazolam
  • NN703
  • Clinical study