Abstract
Background and Objective
Sacubitril/valsartan (LCZ696) is a first-in-class angiotensin receptor neprilysin inhibitor (ARNI) and has been recently approved in several countries for the treatment of patients with heart failure and reduced ejection fraction. This was the first study conducted to characterise the pharmacokinetics of LCZ696 analytes (pro-drug sacubitril, active neprilysin inhibitor LBQ657 and valsartan) after single-dose administration of LCZ696 in healthy Chinese subjects.
Methods
In this open-label, randomised, parallel-group study, following screening and baseline evaluation, eligible healthy subjects received single oral doses of LCZ696 50, 100, 200 or 400 mg. The pharmacokinetics, safety and tolerability of LCZ696 were assessed up to 72 h after dosing. A total of 40 healthy male subjects were enrolled, and all completed the study.
Results
Following oral administration, LCZ696 delivered systemic exposure to sacubitril, LBQ657 and valsartan with a median time to reach maximum plasma concentration (T max) ranging from 0.50 to 1.25, 2.00 to 3.00 and 1.50 to 2.50 h, respectively, over the investigated dose range. The mean terminal elimination half-life (T 1/2) ranged from 0.89 to 1.35, 8.57 to 9.24 and 5.33 to 7.91 h for sacubitril, LBQ657 and valsartan, respectively. The area under the plasma concentration–time curve from time zero to the time of the last quantifiable concentration (AUC0–last), and maximum plasma concentration (C max) for LBQ657 increased dose proportionally over the entire dose range. Dose linear increase in the exposure was observed across the dose range for sacubitril and valsartan. LCZ696 was safe and well tolerated at all doses in this study. Adverse events of only mild intensity, which required no treatment, were reported in 6 (15 %) subjects.
Conclusion
The pharmacokinetic profiles of LCZ696 analytes in Chinese subjects are similar to those reported previously in Caucasian subjects.
Similar content being viewed by others
References
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847. doi:10.1093/eurheartj/ehs104.
Liu L, Eisen HJ. Epidemiology of heart failure and scope of the problem. Cardiol Clin. 2014;32(1):1–8, vii. doi:10.1016/j.ccl.2013.09.009.
Hu SS, Kong LZ, Gao RL, Zhu ML, Wang W, Wang YJ, et al. Outline of the report on cardiovascular disease in China, 2010. Biomed Environ Sci. 2012;25(3):251–6. doi:10.3967/0895-3988.2012.03.001.
Langenickel TH, Dole WP. Angiotensin receptor-neprilysin inhibition with LCZ696: a novel approach for the treatment of heart failure. Drug Discov Today Ther Strateg. 2012;9(4):e131–9. doi:10.1016/j.ddstr.2013.11.002.
Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med. 1998;339(5):321–8. doi:10.1056/NEJM199807303390507.
Bloch MJ, Basile JN. Combination angiotensin receptor blocker-neutral endopeptidase inhibitor provides additive blood pressure reduction over angiotensin receptor blocker alone. J Clin Hypertens (Greenwich). 2010;12(10):809–12. doi:10.1111/j.1751-7176.2010.00358.x.
Vardeny O, Miller R, Solomon SD. Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure. JACC Heart Fail. 2014;2(6):663–70. doi:10.1016/j.jchf.2014.09.001.
McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993–1004. doi:10.1056/NEJMoa1409077.
Packer M, McMurray JJ, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al. Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. Circulation. 2015;131(1):54–61. doi:10.1161/CIRCULATIONAHA.114.013748.
Jhund PS, Claggett B, Packer M, Zile MR, Voors AA, Pieske B, et al. Independence of the blood pressure lowering effect and efficacy of the angiotensin receptor neprilysin inhibitor, LCZ696, in patients with heart failure with preserved ejection fraction: an analysis of the PARAMOUNT trial. Eur J Heart Fail. 2014;16(6):671–7. doi:10.1002/ejhf.76.
Solomon SD, Zile M, Pieske B, Voors A, Shah A, Kraigher-Krainer E, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet. 2012;380(9851):1387–95. doi:10.1016/S0140-6736(12)61227-6.
Gu J, Noe A, Chandra P, Al-Fayoumi S, Ligueros-Saylan M, Sarangapani R, et al. Pharmacokinetics and pharmacodynamics of LCZ696, a novel dual-acting angiotensin receptor-neprilysin inhibitor (ARNi). J Clin Pharmacol. 2010;50(4):401–14. doi:10.1177/0091270009343932.
Shi J, Wang X, Nguyen J, Wu A, Bleske B, Zhu HJ. Sacubitril is selectively activated by carboxylesterase 1 (CES1) in the liver and the activation is affected by CES1 genetic variation. Drug Metab Dispos. 2016;. doi:10.1124/dmd.115.068536.
Gan L, Langenickel T, Petruck J, Kode K, Rajman I, Chandra P, et al. Effects of age and sex on the pharmacokinetics of LCZ696, an angiotensin receptor neprilysin inhibitor. J Clin Pharmacol. 2016;56(1):78–86. doi:10.1002/jcph.571.
Daly AK, Cholerton S, Gregory W, Idle JR. Metabolic polymorphisms. Pharmacol Ther. 1993;57(2–3):129–60.
Ginsberg G, Smolenski S, Neafsey P, Hattis D, Walker K, Guyton KZ, et al. The influence of genetic polymorphisms on population variability in six xenobiotic-metabolizing enzymes. J Toxicol Environ Health Part B. 2009;12(5–6):307–33. doi:10.1080/10937400903158318.
Maekawa M, Sudo K, Dey DC, Ishikawa J, Izumi M, Kotani K, et al. Genetic mutations of butyrylcholine esterase identified from phenotypic abnormalities in Japan. Clin Chem. 1997;43(6 Pt 1):924–9.
Merali Z, Ross S, Pare G. The pharmacogenetics of carboxylesterases: CES1 and CES2 genetic variants and their clinical effect. Drug Metab Drug Interact. 2014;29(3):143–51. doi:10.1515/dmdi-2014-0009.
Kulmatycki K, Langenickel T, Ng D, Pal P, Zhou W, Rajman I, et al. Pharmacokinetics of single-dose LCZ696 in subjects with mild and moderate hepatic impairment. In: American College of Clinical Pharmacology Annual Meeting September 14th–16th, 2014; Atlanta: Clin Pharmacol Drug Dev; 2014. p. 20.
Mendonza A, Akahori M, Langenickel T, Swan T, Pal P, Sunkara G, et al. Assessment of Pharmacokinetic drug interaction between LCZ696 and metformin. Hypertension. 2013;62(3, Suppl. S):456.
Du Y, Chandra P, Alshare Q, Jordaan P, Langenickel T, Pal P, et al. An open-label, single dose study to investigate the absorption, distribution, metabolism, and elimination of [14C]-LCZ696 and its metabolites in healthy male subjects. In: Poster presented at American Association of Pharmaceutical Scientist Conference, Nov 10–14, 2013, San Antonio; 2013.
Waldmeier F, Flesch G, Muller P, Winkler T, Kriemler HP, Buhlmayer P, et al. Pharmacokinetics, disposition and biotransformation of [14C]-radiolabelled valsartan in healthy male volunteers after a single oral dose. Xenobiotica. 1997;27(1):59–71. doi:10.1080/004982597240767.
Bjornsson TD, Wagner JA, Donahue SR, Harper D, Karim A, Khouri MS, et al. A review and assessment of potential sources of ethnic differences in drug responsiveness. J Clin Pharmacol. 2003;43(9):943–67.
Morrissey KM, Stocker SL, Wittwer MB, Xu L, Giacomini KM. Renal transporters in drug development. Annu Rev Pharmacol Toxicol. 2013;53:503–29. doi:10.1146/annurev-pharmtox-011112-140317.
Yamashiro W, Maeda K, Hirouchi M, Adachi Y, Hu Z, Sugiyama Y. Involvement of transporters in the hepatic uptake and biliary excretion of valsartan, a selective antagonist of the angiotensin II AT1-receptor, in humans. Drug Metab Dispos. 2006;34(7):1247–54. doi:10.1124/dmd.105.008938.
Langenickel T, Ayalasomayajula S, Chandra P, Jordaan P, Albrecht D, Pan W, et al. Assessment of steady state pharmacokinetics of LCZ696 in patients with renal impairment. In: American College of Clinical Pharmacology Annual Meeting September 14th–16th, 2014; Atlanta, Georgia: Clin Pharmacol Drug Dev; 2014. p. 22.
Duan J, Chen J, Yin Q, Karan R, Meiser K, Smith HT, et al. Pharmacokinetics of single and multiple oral doses of valsartan/amlodipine (80/5 mg) in healthy Chinese subjects. Int J Clin Pharmacol Ther. 2012;50(1):33–43 (pii:9329).
Sunkara G, Yeh C, Ligueros-Saylan M, Kawashita H, Koseki N, Fukui Y. Assessment of ethnic differences in the pharmacokinetics and pharmacodynamics of valsartan. J Bioequiv Availab. 2010;2:120–4.
Kario K, Sun N, Chiang FT, Supasyndh O, Baek SH, Inubushi-Molessa A, et al. Efficacy and safety of LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor, in Asian patients with hypertension: a randomized, double-blind, placebo-controlled study. Hypertension. 2014;63(4):698–705. doi:10.1161/HYPERTENSIONAHA.113.02002.
Acknowledgments
Medical writing and editorial assistance was provided by Syed Abdul Haseeb (Novartis Healthcare Pvt. Ltd. Hyderabad, India). All the authors had full access to the study data, reviewed and critically revised the manuscript for content and approved the final version of the manuscript for submission.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was supported by Novartis Pharma AG, Basel, Switzerland.
Conflict of interest
YY declare that he has no conflict of interest pertaining to the current work. All the remaining authors were employees of Novartis Pharmaceutical Corporation at the time of the study conduct and may own company stocks.
Ethical approval
The study was conducted according to the ethical principles of the Declaration of Helsinki. The study protocol was reviewed and approved by the Independent Ethics Committee of Shanghai Ruijin Hospital. Written informed consent was obtained from all the subjects before performing any assessment.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Han, Y., Ayalasomayajula, S., Pan, W. et al. Pharmacokinetics, Safety and Tolerability of Sacubitril/Valsartan (LCZ696) After Single-Dose Administration in Healthy Chinese Subjects. Eur J Drug Metab Pharmacokinet 42, 109–116 (2017). https://doi.org/10.1007/s13318-016-0328-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13318-016-0328-3