title: Pharmacokinetics of oral sitamaquine taken with or without food and safety and efficacy for treatment of visceral leishmaniais: a randomized study in Bihar, India.
abstract: This randomized, open-label study of patients in India with visceral leishmaniasis (VL) investigated the effect of food on sitamaquine and desethyl-sitamaquine pharmacokinetics. Patients were randomized to receive oral sitamaquine, 2 mg/kg/day, once a day for 21 days across four cohorts (n = 41) (fasted/fed, fed/fasted, fed/fed, and fasted/fasted) over two periods (days 1-10 and 11-21), or intravenous amphotericin B (AmB), 1 mg/kg every other day for 30 days (n = 20). Mean day 21 pharmacokinetics across the four cohorts were sitamaquine, area under curve (AUC)((0-τ)) = 6,627-8,903 ng.hr/mL, AUC((0-16)) = 4,859-6,633 ng.hr/mL, maximum plasma concentration (C(max)) = 401-570 ng/mL, apparent terminal half-life (t(1/2)) = 18.3-22.8 hr, time to reach C(max) (t(max)) = 3.5-6 hr; and desethyl-sitamaquine, AUC((0-τ)) = 2,307-3,163 ng.hr/mL, C(max) = 109-154 ng/mL, t(1/2) = 23.0-27.9 hr, t(max) = 2-10 hr, with no significant food effect. On-therapy adverse events were observed for sitamaquine in 4 (10%) of 41 patients and for AmB in 17 (85%) of 20 patients. The final clinical cure (day 180) was 85% (95% confidence interval = 70.8-94.4%) for sitamaquine and 95% (95% confidence interval = 75.1-99.9) for AmB. Sitamaquine can be taken regardless of food intake, was generally well tolerated, and showed potential efficacy in patients with visceral leishmaniasis.
authors.affiliation: Kala-azar Medical Research Centre, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. drshyamsundar@hotmail.com
authors.forename: Shyam
authors.initials: S
authors.lastname: Sundar
authors.forename: Prabhat K
authors.initials: PK
authors.lastname: Sinha
authors.forename: Susan A
authors.initials: SA
authors.lastname: Dixon
authors.forename: Renata
authors.initials: R
authors.lastname: Buckley
authors.forename: Ann K
authors.initials: AK
authors.lastname: Miller
authors.forename: Khadeeja
authors.initials: K
authors.lastname: Mohamed
authors.forename: Mahir
authors.initials: M
authors.lastname: Al-Banna
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000634:Aminoquinolines / Q000493:pharmacokinetics*; D000666:Amphotericin B / Q000493:pharmacokinetics*; D000981:Antiprotozoal Agents / Q000493:pharmacokinetics*; D019540:Area Under Curve; D015331:Cohort Studies; D018592:Cross-Over Studies; D005215:Fasting; D005260:Female; D005502:Food; D018565:Food-Drug Interactions; D006207:Half-Life; D006801:Humans; D007194:India; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000634:Aminoquinolines; D000981:Antiprotozoal Agents; D000666:Amphotericin B; C080436:8-aminoquinoline