Single-dose FTY720 pharmacokinetics, food effect, and pharmacological responses in healthy subjects.
OBJECTIVE
FTY720 is a sphingosine-1-phosphate receptor agonist that redirects lymphocytes from the circulation to lymph nodes without impairing lymphocyte function. It is being developed as an immunomodulator for the prevention of acute rejection after organ transplantation. This study was performed to provide guidance on administration with respect to meals and to measure pharmacologic responses in healthy subjects.


METHODS
In this randomized, two-period, crossover study, 14 healthy subjects received placebo on day -1 of each period with baseline circadian measurements of lymphocyte count and heart rate. Subjects subsequently received a single 1 mg oral dose of FTY720 on day 1 under fasting conditions and after a high fat meal. Blood FTY720 concentrations, lymphocyte count, and supine heart rate were assessed over an 8 day period after each FTY720 dose. The effect of food on FTY720 pharmacokinetics was assessed by standard bioequivalence testing.


RESULTS
Both the peak concentration (0.65 +/- 0.17 vs 0.64 +/- 0.18 ng ml(-1)) and total exposure (AUC 149 +/- 65 vs 139 +/- 43 ng ml(-1) h) did not differ significantly between fasting and fed states, respectively. The corresponding fed/fasting ratios and 90% confidence intervals were 1.00 (0.86, 1.17) for Cmax and 0.98 (0.86, 1.11) for AUC. Under both treatment conditions peripheral blood lymphocyte count decreased from baseline by 38 +/- 9% over the first 2 days postdose and then increased towards predose values over the subsequent week. Whereas a circadian rhythm in supine heart rate was preserved in the presence of FTY720, the heart rate vs time curve was shifted downwards by 10% over the first day postdose and then recovered to prestudy values by days 3-5 postdose. These changes were asymptomatic.


CONCLUSIONS
Single 1 mg doses of FTY720 were well tolerated in healthy subjects and elicited a moderate decrease in peripheral blood lymphocyte count and a transient decrease in heart rate consistent with its pharmacological mode of action. FTY720 may be administered without regard to the timing of meals or their fat content.
Kovarik
John M
JM
Novartis Pharmaceuticals, Basel, Switzerland. john.kovarik@pharma.novartis.com
Schmouder
Robert
R
Barilla
Denise
D
Wang
Yibin
Y
Kraus
Gerolf
G
D000284:Administration, Oral; D000328:Adult; D019540:Area Under Curve; D002940:Circadian Rhythm; D018592:Cross-Over Studies; D004041:Dietary Fats / Q000494:pharmacology; D005215:Fasting / Q000097:blood; D000068876:Fingolimod Hydrochloride; D005502:Food; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D007408:Intestinal Absorption; D018655:Lymphocyte Count; D008297:Male; D011409:Propylene Glycols / Q000008:administration & dosage / Q000493:pharmacokinetics*; D013110:Sphingosine / Q000031:analogs & derivatives
D004041:Dietary Fats; D007166:Immunosuppressive Agents; D011409:Propylene Glycols; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine