title: Bioequivalence of a new cyclosporine a formulation to Neoral.
abstract: New cyclosporine A (CsA) formulations must prove their bioequivalence to Neoral, the reference CsA formulation, to allow free prescription for the patients. The aim of this study was to compare the pharmacokinetics (PK) of a new CsA formulation (Zinograf-ME), produced by Strides-Arcolab, to Neoral and to demonstrate their interchangeability in stable renal transplant recipients. Twelve-hour PK studies were obtained from 18 (13 M/5 F) adult patients (mean age 44.7 +/- 12 years). They received their renal allografts from 13 cadaver and 5 living donors. Before enrollment, all patients were receiving a third generic CsA for a mean of 48 months. Nine patients were also under azathioprine and 9 under mycophenolate mofetil; 17 received prednisone. A single oral dose of either Zinograf or Neoral was administered. The first PK study was performed with one formulation, and 1 week later, a second PK was done with the other formulation. During the washout period, patients continued taking the third CsA formulation. The drug substitution was done milligram-for-milligram. The CsA whole-blood level was measured by TDx immunoassay. Mean +/- SD of area under the curve (AUC), maximum concentration (C(max)), and concentration at the second hour (C2) of Zinograf were not statistically different from those with Neoral (4019 +/- 1466 vs 3971 +/- 1325 ng x h/mL, 998 +/- 376 vs 1021 +/- 356 ng/mL, and 707 +/- 254 vs 734 +/- 229 ng/mL, respectively). In the same way, the Zinograf 90% confidence interval for either C(max) (-123, +77 ng/mL) or AUC (-214, +311 ng.mL/h) were within the Neoral bioequivalence interval for the same parameters (+/-204 ng/mL and +/-794 ng x mL/h, respectively). These data demonstrate that the ZinografME CsA formulation is bioequivalent to Neoral.
authors.affiliation: Unidade de Transplante Renal, Divisão de Clínica Urológica das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. elias.david.neto@attglobal.net
authors.forename: Elias
authors.initials: E
authors.lastname: David-Neto
authors.forename: Erica
authors.initials: E
authors.lastname: Kakehashi
authors.forename: Cristiane Feres
authors.initials: CF
authors.lastname: Alves
authors.forename: Lilian M
authors.initials: LM
authors.lastname: Pereira
authors.forename: Maria Cristina R
authors.initials: MC
authors.lastname: de Castro
authors.forename: Renata Maciel
authors.initials: RM
authors.lastname: de Mattos
authors.forename: Nairo Massakazu
authors.initials: NM
authors.lastname: Sumita
authors.forename: Paschoalina
authors.initials: P
authors.lastname: Romano
authors.forename: Maria Elizabete
authors.initials: ME
authors.lastname: Mendes
authors.forename: William Carlos
authors.initials: WC
authors.lastname: Nahas
authors.forename: Luiz Estevam
authors.initials: LE
authors.lastname: Ianhez
mesh_terms: D000284:Administration, Oral; D019540:Area Under Curve; D016572:Cyclosporine / Q000097:blood / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000493:pharmacokinetics*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013810:Therapeutic Equivalency
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine