Simultaneous quantitation of favipiravir and its hydroxide metabolite in human plasma and hamster matrices using a UPLC-MS/MS method

Favipiravir, a broad-spectrum RNA-dependent RNA polymerase inhibitor, is currently being evaluated in preclinical and clinical studies for the treatment of various infectious diseases including COVID-19. We developed an ultra-performance liquid chromatography tandem mass spectrometry (UPLC–MS/MS) assay for the quantification of favipiravir and its hydroxide metabolite (M1), in human and hamster biological matrices. Analytes were separated on an Acquity UPLC HSS T3 column (2.1 × 100 mm, 1.8 μm) after a simple protein precipitation with acetonitrile. The mobile phase consisted of water and methanol, each containing 0.05% formic acid. Experiments were performed using electrospray ionization in the positive and negative ion mode, with protonated molecules used as the precursor ion and a total run time of 6 min. The MS/MS response was linear over the concentration ranges from 0.5–100 μg/ml for favipiravir and 0.25–30 μg/ml for M1. Intra- and inter-day accuracy and precision were within the recommended limits of the European Medicines Agency guidelines. No significant matrix effect was observed, and the method was successfully applied to inform favipiravir dose adjustments in six immunocompromised children with severe RNA viral infections. In conclusion, the UPLC–MS/MS assay is suitable for quantification of favipiravir over a wide range of dosing regimens, and can easily be adapted to other matrices and species

Preclinical evaluation of Imatinib does not support its use as an antiviral drug against SARS-CoV-2

Following the emergence of SARS-CoV-2, the search for an effective and rapidly available treatment was initiated worldwide based on repurposing of available drugs. Previous reports described the antiviral activity of certain tyrosine kinase inhibitors (TKIs) targeting the Abelson kinase 2 against pathogenic coronaviruses. Imatinib, one of them, has more than twenty years of safe utilization for the treatment of hematological malignancies. In this context, Imatinib was rapidly evaluated in clinical trials against Covid-19. Here, we present the pre-clinical evaluation of imatinib in multiple models. Our results indicated that imatinib and another TKI, the masitinib, exhibit an antiviral activity in VeroE6 cells. However, imatinib was inactive in a reconstructed bronchial human airway epithelium model. In vivo, imatinib therapy failed to impair SARS-CoV-2 replication in a golden Syrian hamster model despite high concentrations in plasma and in the lung. Overall, these results do not support the use of imatinib and similar TKIs as antivirals in the treatment of Covid-19

Registered replication report: a large multilab cross-cultural conceptual replication of Turri, Buckwalter, & Blouw (2015)

According to the Justified True Belief account of knowledge (JTB), a person can only truly know something if they have a belief that is both justified and true (i.e., knowledge is justified true belief). This account was challenged by Gettier (1963), who argued that JTB does not explain knowledge attributions in certain situations, later called Gettier-type cases, wherein a protagonist is justified in believing something to be true, but their belief was only correct due to luck. Lay people may not attribute knowledge to protagonists with justified but only luckily true beliefs. While some research has found evidence for these so-called Gettier intuitions (e.g., Machery et al., 2017a), Turri et al. (2015) found no evidence that participants attributed knowledge in a counterfeit-object Gettier-type case differently than in a matched case of justified true belief. In a large-scale, cross-cultural conceptual replication of Turri and colleagues’ (2015) Experiment 1 (N = 4,724) using a within-participants design and three vignettes across 19 geopolitical regions, we did find evidence for Gettier intuitions; participants were 1.86 times more likely to attribute knowledge to protagonists in standard cases of justified true belief than to protagonists in Gettier-type cases. These results suggest that Gettier intuitions may be detectable across different scenarios and cultural contexts. However, the size of the Gettier intuition effect did vary by vignette, and the Turri et al. (2015) vignette produced the smallest effect, which was similar in size to that observed in the original study. Differences across vignettes suggest epistemic intuitions may also depend on contextual factors unrelated to the criteria of knowledge, such as the characteristics of the protagonist being evaluated

[Evidence-based Therapeutic Drug Monitoring for Saquinavir].

International audienceThe human immunodeficiency virus (HIV) protease inhibitor saquinavir displays a large inter-individual variability in its pharmacokinetic parameters, related to a low absorption rate and an important hepatic metabolism. Based on literature, is the saquinavir therapeutic drug monitoring relevant? In naïve HIV-infected patients, the probability of achieving an undetectable HIV viral load at W48 was significantly associated with a saquinavir plasma trough concentration >100 ng/mL. Two studies in HIV-infected pre-treated patients reported that the genotypic inhibitory quotient was a predictive factor of virologic response with a threshold value around 40 ng/mL/mutation. Concerning the exposure-toxicity relationship, the risk of occurrence of grade 3-4 abdominal pains was more frequently associated with high concentrations of saquinavir, but without threshold value determination. Several studies, one of which was randomized, have reported the interest of saquinavir therapeutic drug monitoring to optimize the virologic response. Therefore, the level of evidence of the interest of saquinavir therapeutic drug monitoring is "recommended"

Drug-Drug Interactions Potential of Direct-Acting Antivirals for the treatment of Chronic Hepatitis C Virus infection

International audienceThe advent of direct-acting antiviral agents (DAAs) has transformed the hepatitis C virus (HCV) therapeutic landscape in terms of efficacy and safety, with a cure rate of more than 90%. However, an important potential for drug-drug interactions (DDIs) is expected with these combinations, particularly in patients with other comorbidities (e.g. HIV co-infection, cardiovascular diseases). Each DAA can be a substrate, an inhibitor and/or an inducer of metabolic enzymes and drug efflux transporters. DAAs can act as both victims and perpetrators of DDIs and can sometimes increase the risk and/or intensity of side effects or limit the efficacy of treatment. Therefore, knowledge and management of DDIs with DAAs should be considered a key issue of HCV therapy. This review describes the pharmacokinetic profile of currently used and recommended DAA regimens and summarizes available data regarding DDIs to optimize HCV treatment in clinical practice

Place du suivi thérapeutique pharmacologique du maraviroc (Celsentri®) dans la prise en charge des patients infectes par le VIH

AIX-MARSEILLE2-BU Pharmacie (130552105) / SudocSudocFranceF

Grossesse et VIH

AIX-MARSEILLE2-BU Pharmacie (130552105) / SudocSudocFranceF

Pharmacocinétique, pharmacogénétique et neurotoxicité de la vincristine dans une population pédiatrique

La vincristine est un vinca-alcaloïde très largement utilisé et reste incontournable dans la prise en chargethérapeutique de nombreux cancers, notamment en pédiatrie. Ce médicament présente une neurotoxicitédose-limitant, très variable d un individu à l autre, difficilement prévisible, ayant ainsi des conséquencescliniques directes sur l efficacité thérapeutique. Cette variabilité pourraient avoir une originepharmacocinétique et pharmacogénétique, en partie liée au métabolisme hépatique intense de la vincristinepar les enzymes CYP3A4 et CYP3A5 et à son transport par la P-glycoprotéine (codée par le gène ABCB1).En effet, de nombreux polymorphismes génétiques des gènes CYP3A4, CYP3A5 et ABCB1 ont été décritsdont certains sont associés à d importantes différences d expression et/ou de fonctionnalité de la protéine.Nous avons donc développé une méthode de dosage sensible et hautement spécifique de la vincristine parLC-MSMS, adaptée à la réalisation d une étude de pharmacocinétique-pharmacogénétique dans unepopulation pédiatrique atteinte de tumeurs solides.Nous avons montré que les différents facteurs démographiques, thérapeutiques et génétiques étudiés(allèles CYP3A5*3, CYP3A4*1B ; mutations ABCB1 C1236T, G2677T(A) et C3435T) ne sont pasprédictifs de la variabilité de la pharmacocinétique de la vincristine observée dans notre populationpédiatrique. Ces résultats sont renforcés par l observation d une large variabilité pharmacocinétique entreles cures pour un même patient, qui ne peut être expliquée par des facteurs génétiques. Nous avons pu chezcertains patients, évaluer l accumulation intracellulaire de la vincristine. Une importante variabilité estégalement retrouvée au niveau cellulaire et nos résultats montrent deux profils d accumulationintracellulaire de vincristine très distincts qui pourraient avoir une origine génétique. En effet, les patientsporteurs du génotype hétérozygote d ABCB1 présentaient une tendance à une plus forte accumulation surles temps précoces.Néanmoins, l incidence de survenue d une neurotoxicité n a pas non plus été associée à des différencesd exposition plasmatique ou d accumulation intracellulaire de vincristine ou encore aux polymorphismesgénétiques étudiés du CYP3A4, CYP3A5 et d ABCB1 dans notre population. La pertinence clinique d unedifférence d accumulation intracellulaire de la vincristine reste à être évaluée sur un effectif beaucoup plusimportant. La variabilité de la neurotoxicité de la vincristine ne semble donc pas être prédite par desfacteurs génétiques affectant la pharmacocinétique et pourrait donc avoir notamment une originepharmacodynamique, liée à une modification de sa sensibilité chez certains patients.Vincristine is a natural vinca-alkaloid widely used in many chemotherapy regimens for paediatric tumourdiseases. The most frequent and clinically relevant side-effect of vincristine is a dose-limitingneurotoxicity which is unpredictable and characterized by a great variability between patients. Thisvariability could have a pharmacokinetic and pharmacogenetic origin, partly due to the intense hepaticmetabolism of vincristine through both CYP3A4 and CYP3A5 and a transport by P-glycoprotein (encodedby the ABCB1 gene). Indeed, several genetic polymorphisms have been described for CYP3A4, CYP3A5and ABCB1 which could affect the expression and/or the functionality of the protein. We have firstdeveloped a sensitive and highly specific LC-MS/MS method for vincristine quantification, suitable for apharmacokinetics-pharmacogenetics study in paediatric patients treated for solid tumours diseases.Our results showed that demographic, therapeutic and genetic factors assessed (CYP3A5*3, CYP3A4*1Balleles and ABCB1 C1236T, G2677T (A) and C3435T mutations) are not predictive of vincristinepharmacokinetics variability observed in our paediatric population. These results are enhanced by theobservation of a wide inter-course variability which cannot be explained by genetic factors. In somepatients, we were able to evaluate the vincristine intracellular concentration and we observed similarly alarge inter-patient variability. Two populations emerge according with the intracellular vincristineaccumulation and this dichotomic distribution could have a genetic origin. Indeed, a tendency to a greateraccumulation of intracellular vincristine was observed in patients with ABCB1 CGC-TTT diplotype in theearly post-dose period.Nevertheless, the incidence of neurotoxicity in our population has not been associated to differences inplasma exposure and intracellular accumulation of vincristine and to the assessed genetic polymorphismsof CYP3A4, CYP3A5 and ABCB1. The clinical relevance of differences in the intracellular accumulation ofvincristine remains to be evaluated on a larger cohort of patients. The variability of vincristineneurotoxicity does not seem to be explained by genetic factors affecting its pharmacokinetics and thereforecould have a pharmacodynamic origin, probably linked to a modification of vincristine sensitivity inpatients.AIX-MARSEILLE2-Bib.electronique (130559901) / SudocSudocFranceF