title: A single-center, open-label, one-sequence study of dalcetrapib coadministered with ketoconazole, and an in vitro study of the S-methyl metabolite of dalcetrapib.
abstract: BACKGROUND
  Dalcetrapib (RO4607381/JTT-705) is currently under clinical investigation for the prevention of cardiovascular events. It inhibits the activity of cholesteryl ester transfer protein and has been reported to increase levels of high-density lipoprotein cholesterol.
  
  
  OBJECTIVE
  Because dalcetrapib is likely to be coadministered with agents that inhibit the cytochrome P450 (CYP) 3A4 isozyme, this study aimed to determine the effect of ketoconazole, a strong CYP3A4 inhibitor, on the pharmacokinetics of dalcetrapib.
  
  
  METHODS
  An open-label, 1-sequence study was conducted in 2 cohorts of healthy, nonsmoking male volunteers aged 18 through 65 years, with a body mass index of 18 to 32 kg/m(2). The first cohort received dalcetrapib 600 mg on days 1 and 7 and ketoconazole 400 mg on days 2 through 7, and, based on the results of a planned interim analysis, the second cohort received dalcetrapib 900 mg alone on days 1 and 7 and ketoconazole on days 2 through 7. Pharmacokinetic and safety parameters were assessed at specific times throughout the study. To confirm CYP involvement in the metabolism of the inactive metabolite dalcetrapib-S-methyl, in vitro studies were performed using human liver microsomes and recombinantly expressed CYP isoforms.
  
  
  RESULTS
  Of the 26 participants, 96% were white, with a mean age of 38.1 years and a mean weight of 78.6 kg. In the in vivo portion of the study, coadministration of ketoconazole with dalcetrapib 600 mg had no significant effect on any pharmacokinetic parameter of dalcetrapib. Coadministration of ketoconazole with dalcetrapib 900 mg was associated with significant decreases in the dalcetrapib C(max) (-23%; P = 0.002) and AUC(0-infinity) (-18%; P = 0.001) and a significant increase in oral clearance (22%; P = 0.001). Significant increases in the C(max) (P = 0.001) and AUC(0-infinity) (P < 0.001) of dalcetrapib-S-methyl were observed with coadministration of ketoconazole. The combination was generally well tolerated, with 32 of 35 adverse events (91.4%) being mild in intensity. The most frequent adverse events were headache (6/26 [23.1%] in the ketoconazole group; 4/18 [22.2%] in the group receiving dalcetrapib 900 mg plus ketoconazole) and diarrhea (4/26 [15.4%] in the ketoconazole group; 2/18 [11.1%] in the group receiving dalcetrapib 900 mg plus ketoconazole). The in vitro studies confirmed the involvement of CYP3A in the metabolism of dalcetrapib-S-methyl.
  
  
  CONCLUSIONS
  In this clinical study in healthy male volunteers, coadministration of dalcetrapib 600 mg with the CYP3A4 inhibitor ketoconazole was not associated with any significant changes in the pharmacokinetic parameters of the parent compound. Coadministration of dalcetrapib 900 mg with ketoconazole was associated with significant decreases in the dalcetrapib C(max) and AUC, contrary to the increases that would be expected if dalcetrapib were a substrate for CYP3A4. The combination of dalcetrapib and ketoconazole was generally well tolerated.
authors.affiliation: F. Hoffmann-La Roche Ltd., Basel, Switzerland. michael.derks@roche.com
authors.forename: Michael
authors.initials: M
authors.lastname: Derks
authors.forename: Stephen
authors.initials: S
authors.lastname: Fowler
authors.forename: Olaf
authors.initials: O
authors.lastname: Kuhlmann
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000577:Amides; D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001711:Biotransformation; D015331:Cohort Studies; D051544:Cytochrome P-450 CYP3A / Q000378:metabolism; D065692:Cytochrome P-450 CYP3A Inhibitors; D004334:Drug Administration Schedule; D004347:Drug Interactions; D004952:Esters; D006801:Humans; D066298:In Vitro Techniques; D007654:Ketoconazole / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008745:Methylation; D008862:Microsomes, Liver / Q000201:enzymology; D008875:Middle Aged; D011994:Recombinant Proteins / Q000037:antagonists & inhibitors / Q000378:metabolism; D013438:Sulfhydryl Compounds / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D055815:Young Adult
chemical_list: D000577:Amides; D000924:Anticholesteremic Agents; D000935:Antifungal Agents; D065692:Cytochrome P-450 CYP3A Inhibitors; D004952:Esters; D011994:Recombinant Proteins; D013438:Sulfhydryl Compounds; C411602:dalcetrapib; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; D007654:Ketoconazole