title: Comparative bioavailability of two oral formulations of mycophenolate mofetil in healthy adult Uruguayan subjects: a case of highly variable rate of drug absorption.
abstract: OBJECTIVE
  To assess the bioequivalence and safety of a new formulation of mycophenolate mofetil (MMF) 500 mg (Suprimun®, Clausen, Montevideo, Uruguay) marketed in Uruguay and other South American countries, and to test Cmax/AUC as a characteristic of its absorption rate.
  
  
  METHODS
  A randomized, open-label, two-way, two-treatment, two-period crossover study in 24 healthy male volunteers was carried out. One tablet (500 mg) of each formulation was administered after an overnight fast. After dosing, serial blood samples were collected for a period of 36 hours. Plasma concentrations of MPA were determined by high-performance liquid chromatography and pharmacokinetic parameters were calculated. Analysis of variance was carried out using log-transformed AUC0-36, Cmax, and Cmax/AUC0-36. 90% confidence intervals and within-subject between-subject variance were calculated. The bioequivalence of the two formulations was established at the 80% - 125% acceptance limits and untransformed tmax medians were compared using Wilcoxon test. Subjects were monitored for adverse events throughout the study.
  
  
  RESULTS
  The means (test and reference) were 21.14 and 20.86 µg × h × ml-1 for AUC0-36, 24.92 and 24.18 µg × h × ml-1 for AUC0-inf, 11.86 and 10.76 µg × ml-1 for Cmax and 0.51 and 0.54 h-1 for Cmax/AUC0-36. The geometric mean ratios (confidence interval 90%) of Test/Reference were 1.00 (0.95 - 1.06) for AUC0-36, 1.09 (0.96 - 1.24) for Cmax and 1.04 (0.99 - 1.09) for Cmax/ AUC0-36. The extra peaks observed are due to enterohepatic recycling of MPA. No serious or unexpected adverse events were observed during the study.
  
  
  CONCLUSIONS
  The test formulation containing mycophenolate mofetil 500 mg met regulatory requirements for bioequivalence. Moreover, Cmax/AUC shows interesting features as a putative metric to evaluate the absorption rate of highly variable drugs like mycophenolate mofetil. Generally, both formulations were well tolerated.
authors.affiliation: Center for Biomedical Sciences, University of Montevideo, Montevideo, Uruguay. Francisco.Estevez@bdbeq.com.uy
authors.forename: F E
authors.initials: FE
authors.lastname: Estevez-Carrizo
authors.forename: S
authors.initials: S
authors.lastname: Parrillo
authors.forename: M
authors.initials: M
authors.lastname: Cedres
authors.forename: F T
authors.initials: FT
authors.lastname: Estevez-Parrillo
authors.forename: P
authors.initials: P
authors.lastname: Rodriguez
mesh_terms: D000042:Absorption; D000284:Administration, Oral; D000328:Adult; D019540:Area Under Curve; D001682:Biological Availability; D018592:Cross-Over Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D014583:Uruguay
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid