Current and evolving approaches for improving the oral permeability of BCS Class III or analogous molecules

The Biopharmaceutics Classification System (BCS) classifies pharmaceutical compounds based on their aqueous solubility and intestinal permeability. The BCS Class III compounds are hydrophilic molecules (high aqueous solubility) with low permeability across the biological membranes. While these compounds are pharmacologically effective, poor absorption due to low permeability becomes the rate-limiting step in achieving adequate bioavailability. Several approaches have been explored and utilized for improving the permeability profiles of these compounds. The approaches include traditional methods such as prodrugs, permeation enhancers, ion-pairing, etc., as well as relatively modern approaches such as nanoencapsulation and nanosizing. The most recent approaches include a combination/hybridization of one or more traditional approaches to improve drug permeability. While some of these approaches have been extremely successful, i.e. drug products utilizing the approach have progressed through the USFDA approval for marketing; others require further investigation to be applicable. This article discusses the commonly studied approaches for improving the permeability of BCS Class III compounds

Pentaerythritol as an excipient/solid-dispersion carrier for improved solubility and permeability of ursodeoxycholic acid

In this study, the feasibility of using pentaerythritol as a novel excipient/solid-dispersion carrier for enhancing the biopharmaceutical properties of ursodeoxycholic acid (UA) is explored. The solid dispersion formulations of UA were prepared using a solvent evaporation technique. The prepared formulations were evaluated for UA content to assess the UA incorporation efficiency. The formulations were further characterized using photomicroscopy, scanning electron microscopy, particle size analysis, zeta potential analysis, infrared spectroscopy, thermal analysis, x-ray diffractometry, and solubility analysis. The performance of the selected formulation was evaluated by dissolution and permeability studies. A preliminary stability study was performed on the selected formulation. Solid dispersions of UA using pentaerythritol as a carrier were successfully prepared with UA incorporation efficiencies ranging from ~97 to 99 %. The formation of dispersions was supported by instrumental analysis. Compared to pure UA, a 22-fold increase in aqueous solubility of UA was observed in the optimized formulation. The biopharmaceutical characteristics of UA, i.e. the rate and extent of dissolution and permeability, were found to be significantly enhanced in the optimized formulation compared to pure UA. The formulation was also found to be functionally stable for six months when stored in controlled conditions of temperature and humidity. This study shows that pentaerythritol can serve as a potential solid dispersion carrier for active pharmaceutical ingredients (API) and contribute to the enhancement of their biopharmaceutical properties

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Chemical and Enzymatic Stability of Amino Acid Prodrugs Containing Methoxy, Ethoxy and Propylene Glycol Linkers

PURPOSE: To evaluate the chemical and enzymatic stabilities of methoxy, ethoxy and propylene glycol linker containing prodrugs in order to find a suitable linker for prodrugs of carboxylic acids with amino acids. METHODS: L-valine and L-phenylalanine prodrugs of model compounds (benzoic acid and phenyl acetic acid) containing methoxy, ethoxy and propylene glycol linkers were synthesized. The hydrolysis rate profile of each compound was studied at physiologically relevant pHs (1.2, 4, 6 and 7.4). Enzymatic hydrolysis of propylene glycol containing compounds was studied using Caco-2 homogenate as well as purified enzymes, valacyclovirase. RESULTS: It was observed that the stability of the prodrugs increases with the linker length (propyl>ethyl>methyl). The model prodrugs were stable at acidic pH as compared to basic pH. It was observed that the prodrug with the aliphatic amino acid promoiety was more stable as compared to its aromatic counterpart. The comparison between benzyl and the phenyl model compounds revealed that the amino acid side chain is significant in determining the stability of the prodrug whereas the benzyl or phenyl carboxylic acid had little or no effect on the stability. The enzymatic activation studies of propylene glycol linker prodrug in presence of valacyclovirase and cell homogenate showed faster generation of the parent drug at pH 7.4. The half life of prodrugs at pH 7.4 was more than 12 hours, whereas in presence of cell homogenate the half lives were less than 1 hour. Hydrolysis by Caco-2 homogenate generated the parent compound in two steps, where the prodrug was first converted to the intermediate, propylene glycol benzoate, which was then converted to the parent compound (benzoic acid). Enzymatic hydrolysis of propylene glycol containing prodrugs by valacyclovirase showed hydrolysis of the amino acid ester part to generate the propylene glycol ester of model compound (propylene glycol benzoate) as the major product. CONCLUSION: The methoxy linker containing amino acid prodrugs were the least stable while propylene glycol linker containing prodrugs were most stable. This work suggests that the propylene glycol linker is an optimal linker for amino acids prodrugs since it has good chemical stability and is enzymatically hydrolyzed to yield the parent drug. This approach can be further extended to other non-amino acid prodrugs and to provide a chemical handle to modify lead molecules containing carboxylic group(s)

Salts of Therapeutic Agents: Chemical, Physicochemical and Biological Considerations

Choice of the salts of therapeutic agents or active pharmaceutical ingredients (API) is based on the physicochemical properties of API and the dosage form considerations. The appropriate salt can have positive effect on overall therapeutic and pharmaceutical effects of API. However, the incorrect salt form can negatively affect the overall pharmaceutical outcomes of the API. This review addresses various criteria for choosing appropriate salt form along with the effect of salt forms on API&amp;rsquo;s pharmaceutical properties. In addition to comprehensive review of the criteria, this review also gives a brief historic perspective of the salt selection process.</jats:p

Salts of Therapeutic Agents: Chemical, Physicochemical, and Biological Considerations

The physicochemical and biological properties of active pharmaceutical ingredients (APIs) are greatly affected by their salt forms. The choice of a particular salt formulation is based on numerous factors such as API chemistry, intended dosage form, pharmacokinetics, and pharmacodynamics. The appropriate salt can improve the overall therapeutic and pharmaceutical effects of an API. However, the incorrect salt form can have the opposite effect, and can be quite detrimental for overall drug development. This review summarizes several criteria for choosing the appropriate salt forms, along with the effects of salt forms on the pharmaceutical properties of APIs. In addition to a comprehensive review of the selection criteria, this review also gives a brief historic perspective of the salt selection processes

Current and evolving approaches for improving the oral permeability of BCS Class III or analogous molecules

The Biopharmaceutics Classification System (BCS) classifies pharmaceutical compounds based on their aqueous solubility and intestinal permeability. The BCS Class III compounds are hydrophilic molecules (high aqueous solubility) with low permeability across the biological membranes. While these compounds are pharmacologically effective, poor absorption due to low permeability becomes the rate-limiting step in achieving adequate bioavailability. Several approaches have been explored and utilized for improving the permeability profiles of these compounds. The approaches include traditional methods such as prodrugs, permeation enhancers, ion-pairing, etc., as well as relatively modern approaches such as nanoencapsulation and nanosizing. The most recent approaches include a combination/hybridization of one or more traditional approaches to improve drug permeability. While some of these approaches have been extremely successful, i.e. drug products utilizing the approach have progressed through the USFDA approval for marketing; others require further investigation to be applicable. This article discusses the commonly studied approaches for improving the permeability of BCS Class III compounds