Bioequivalence and food effect of a fixed‐dose combination of macitentan and tadalafil: Adaptive design in the COVID‐19 pandemic. Issue 5 (8th October 2021)

• Record Type: Journal Article
• Authors: Csonka, Dénes; Fishman, Vladislav; Natarajan, Jaya; Stieltjes, Hans; Armas, Danielle; Dishy, Victor; Perez Ruixo, Juan Jose
• Is Part Of: Pharmacology research & perspectives. Volume 9:Issue 5(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-10-08
• Subjects: bioequivalence -- fasted -- fed -- fixed‐dose combination -- food effect -- macitentan -- pulmonary arterial hypertension -- tadalafil; Pharmacology -- Periodicals; Drug development -- Periodicals; 615.105
• DOI: 10.1002/prp2.846
• Languages: English
• ISSNs: 2052-1707

Abstract

Abstract: The COVID‐19 pandemic has forced clinical studies to accommodate imposed limitations. In this study, the bioequivalence part could not be conducted as planned. Thus, the aim was to demonstrate bioequivalence, using an adaptive study design, of tadalafil in fixed‐dose combination (FDC) tablets of macitentan/tadalafil with single macitentan and tadalafil (Canadian‐sourced) tablets and assess the effect of food on FDC tablets in healthy subjects. This Phase 1, single‐center, open‐label, single‐dose, two‐part, two‐period, randomized, crossover study enrolled 62 subjects. Tadalafil bioequivalence as part of FDC of macitentan/tadalafil (10/40 mg) with single‐component tablets of macitentan (10 mg) and tadalafil (40 mg) was determined by pharmacokinetic (PK) assessment under fasted conditions. The effect of food on FDC was evaluated under fed and fasted conditions. Fasted 90% confidence intervals (CIs) for geometric mean ratios (GMRs) were within bioequivalence limits for tadalafil and macitentan. Fed and fasted 90% CIs for area under the curve (AUC) GMR were within bioequivalence limits. However, 90% CIs for maximum plasma concentration ( C max ) GMR for macitentan and tadalafil were outside bioequivalence limits. One FDC‐treated subject experienced a serious adverse event of transient ischemic attack (bioequivalence part). To address pandemic‐imposed limitations, an adaptive study design was implemented to demonstrate that the FDC tablet was bioequivalent to the free combination of macitentan and tadalafil (Canadian‐sourced). No clinically significant differences in PK were determined between fed and fasted conditions; the FDC formulation could be taken irrespective of meals. The FDC formulation under fasted and fed conditions was well tolerated with no clinically relevant differences in safety profiles between the treatment groups. NCT Number: NCT04235270. Abstract : The macitentan 10 mg/tadalafil 40 mg Fixed Dose Combination is bioequivalent to the free combination. No clinically significant differences in PK were determined between fed and fasted conditions of the FDC formulation.