Comparison of in vitro, in vivo, and in silico bioavailability results of different prednisone tablet formulations to assess the feasibility of possible biowaiver / Comparación de los resultados de biodisponibilidad in vitro, in vivo e in silico de diferentes formulaciones de comprimidos de prednisona para evaluar la viabilidad de una posible bioexención

Introducción: Los productos orales sólidos de liberación inmediata que contienen fármacos muy solubles y perme-ables son candidatos para el proceso de bioexención. Este trabajo tiene como objetivo comparar datos in vitro, in silico e in vivo para establecer si las formulaciones de comprimidos orales de prednisona publicadas anteriormente son candidatas a la bioexención. Método: Para lograr este objetivo se realizaron estudios de permeación en células Caco-2. Se aplicó un estudio de bioequivalencia previo entre la formulación de prueba y el medicamento de referencia en una evaluación in silicoutilizando Gastroplus® para evaluar la bioequivalencia de otras dos formulaciones propuestas anteriormente. Resultados: El coeficiente de permeabilidad aparente para prednisona presentó un valor de 3,69 x 10-5 cm/s en 180 minutos. El estudio de bioequivalencia muestra que el producto probado y de referencia era equivalente. Las simulaciones in silicopredijeron con éxito la farmacocinética de las formulaciones probadas y las otras dos, ya que fueron validadas con el estudioin vivo. Ambos exhiben los mismos perfiles de concentración plasmática frente a tiempo. Conclusiones: A través de los resultadosin silico, es posible inferir que las otras dos formulaciones ensayadas pueden ser bioequivalentes respecto al producto de referencia. Este resultado puede ser útil en la solicitud de bio-exenciones. Para reducir los costos y el uso de seres humanos en los estudios de bioequivalencia, este enfoque podría ser una forma esencial de trabajar en la industria farmacéutica. (AU)

Introduction: The immediate-release solid oral products containing very soluble and permeable drugs are candidates for the biowaiver process. This work aims to compare in vitro, in silico, and in vivo data to establish if previously published prednisone oral tablet formulations are biowaiver candidates. Method: To achieve this goal, permeation studies were conducted on Caco-2 cells. A previous bioequivalence study between the test and the reference drug product was applied on an in silico evaluation using Gastroplus® to assess the bioequivalence of two other previously proposed formulations. Results: The apparent permeability coefficient for prednisone presented a value of 3.69 x 10-5 cm/s in 180 minutes. The bioequivalence study shows that the tested and reference product was equivalent. The in silico simulations successfully predicted the pharmacokinetics of the tested and the other two formulations since they were validated with the in vivo study. Both exhibit the same plasma concentration vs. time profiles. Conclusions: Through the in silico results, it is possible to infer that the other two formulations tested may be bioequivalent concerning the reference product. This result may be helpful in biowaiver requesting. Toward to reduce costs and the use of human beings in bioequivalence studies, this approach could be an essential way to work in the pharmaceutical industry. (AU)

Asma como causa de atendimentos de emergência na cidade do Rio de Janeiro / Asthma as a reason for emergency visits in Rio de Janeiro city

Objetivo: Estimar a proporção de consultas motivadas pela asma na Rede de Atenção às Urgências e Emergências (RUE) da cidade do Rio de Janeiro/RJ, Brasil. A RUE é composta por Unidades de Pronto Atendimento (UPA), Coordenações de Emergência Regional (CER) e hospitais de Pronto-Socorro. Método: Foram coletados dados referentes aos atendimentos de 35 unidades (UPAs e CERs) abrangendo desde a data de início de funcionamento de cada uma até 31 de dezembro de 2015 (UPA) e 31 de dezembro de 2016 (CER), compreendendo cerca de 12 milhões de atendimentos. Os hospitais de Pronto- Socorro não foram incluídos já que, neles, o atendimento não é informatizado, ao contrário das UPAs e CERs. Resultados: Cerca de 9% das consultas não puderam ser analisadas por falhas no registro. Do total de atendimentos analisados (11 milhões), 5% (562 mil) foram registrados como causados por asma. Vinte por cento dos atendimentos por asma envolveram a faixa etária de 0-4 anos, não tendo sido evidenciadas diferenças significativas entre os sexos nas diferentes faixas etárias.

Objective: To estimate the number of consultations due to asthma in the urgent and emergency care network of the city of Rio de Janeiro/RJ, Brazil. This network consists of emergency care units (ECUs), regional emergency centers (RECs) and hospital emergency rooms. Method: Data from 35 units (ECUs and RECs) were collected from the day each one started operating until December 31, 2015 (ECUs) or December 31, 2016 (RECs), comprising about 12 million consultations. Hospital emergency rooms were not included because, unlike ECUs and RECs, consultations are not recorded electronically. Results: Approximately 9% of consultations could not be analyzed because of missing data. Of all consultations analyzed (11 million), 5% (562 thousand) had asthma as reported cause. Twenty percent of the visits for asthma involved the age group of 0-4 years, and there were no significant differences between male and female patients in different age groups.

Efavirenz dissolution enhancement III: Colloid milling, pharmacokinetics and electronic tongue evaluation.

Efavirenz (EFV), a non-nucleoside reverse transcriptase inhibitor (NNRTI), is part of first-line therapy for the treatment of human immunodeficiency virus type 1 infection (HIV-1/AIDS). This drug shows relatively low oral absorption and bioavailability, as well as high intra- and inter-subject variability. Several studies have shown that treatment failure and adverse effects are associated with low and high EFV plasma concentrations, respectively. Some studies suggest different EFV formulations to minimize inter-patient variability and improve its solubility and dissolution; however, all of these formulations are complex, using for instance, cyclodextrins, dendrimers and polymeric nanoparticles, rendering them inviable industrially. The aim of this work was to prepare simple and low-cost suspensions of EFV for improvement of solubility and dissolution rate by using colloid mill, spray or freeze-drying, and characterization of the powders obtained. The results demonstrated an increase in the dissolution rate of EFV, using 0.2% of sodium lauryl sulfate (SLS) and 0.2% of hydroxypropylcellulose (HPC) or hydroxypropylmetilcellulose (HPMC) in both freeze and spray dried powders. The pharmacokinetic studies demonstrated improved pharmacokinetic parameters for the formulation containing SLS and HPC. The powders obtained, which present enhanced dissolution properties, can be incorporated in a solid dosage form for treatment of AIDS in paediatric patients with promising results.

Safety, efficacy and pharmacokinetic evaluations of a new coated chloroquine tablet in a single-arm open-label non-comparative trial in Brazil: a step towards a user-friendly malaria vivax treatment.

BACKGROUND: Malaria remains a major public health problem, with half the world population at risk of contracting malaria. The effects of Plasmodium vivax on prosperity and longevity have been highlighted in several recent clinical case reports. The first line of vivax treatment drugs has seen no radical innovation for more than 60 years. This study introduces a subtle incremental innovation to vivax treatment: a chloroquine and primaquine co-blister. The co-blister includes a new chloroquine formulation incorporating coated tablets to mask the drug's bitter taste and user-friendly packaging containing tablets of each drug, which may improve patient adherence and facilitate the appropriate use of the drugs. This new formulation will replace the non-coated chloroquine distributed in Brazil. METHODS: Patients were orally treated with 150 mg coated chloroquine tablets for 3 days: an initial 450 mg dose, followed by two 300 mg doses. The patients were treated concomitantly with two 15 mg primaquine tablets for 7-9 days, according to their weight. The primary objective of this study was to prove parasitological and clinical cure rates above 90 % by day 28. RESULTS: This single-arm open-label non-comparative trial was conducted according to the WHO recommended methodology for the surveillance of anti-malarial drug efficacy in the Brazilian Amazon. On day 28, the parasitological and clinical response was adequate in 98.8 % of patients (CI 95 % 93.4-100 %). The success rate on day 3 was 100 %, and the cumulative success rate by day 28 was 98.8 % (CI 95 % 91.7-99.8 %). There were no serious adverse events, with most adverse events classified as mild. The pharmacokinetic parameters of chloroquine analysed in whole blood dry spot samples showed mean (coefficient of variation) Cmax and AUC0-t values of 374.44 (0.35) and 3700.43 (0.36) ng/mL, respectively. DISCUSSION: This study reports an appropriate safety and efficacy profile of a new formulation of coated chloroquine tablets for vivax malaria treatment in the Brazilian Amazon. The cure rates meet the WHO efficacy criteria, supporting current Brazilian guidelines and the use of the formulation for vivax malaria treatment. Nevertheless, further studies should be conducted to address adherence and the effectiveness of the formulation. Trial registration RBR-77q7t3-UTN: U1111-1121-2982. Registered 10th May 2011.

Using a single tablet daily to treat latent tuberculosis infection in Brazil: bioequivalence of two different isoniazid formulations (300 mg and 100 mg) demonstrated by a sensitive and rapid high-performance liquid chromatography-tandem mass spectrometry method in a randomised, crossover study.

The recommended treatment for latent tuberculosis (TB) infection in adults is a daily dose of isoniazid (INH) 300 mg for six months. In Brazil, INH was formulated as 100 mg tablets. The treatment duration and the high pill burden compromised patient adherence to the treatment. The Brazilian National Programme for Tuberculosis requested a new 300 mg INH formulation. The aim of our study was to compare the bioavailability of the new INH 300 mg formulation and three 100 mg tablets of the reference formulation. We conducted a randomised, single dose, open label, two-phase crossover bioequivalence study in 28 healthy human volunteers. The 90% confidence interval for the INH maximum concentration of drug observed in plasma and area under the plasma concentration vs. time curve from time zero to the last measurable concentration "time t" was 89.61-115.92 and 94.82-119.44, respectively. The main limitation of our study was that neither adherence nor the safety profile of multiple doses was evaluated. To determine the level of INH in human plasma, we developed and validated a sensitive, simple and rapid high-performance liquid chromatography-tandem mass spectrometry method. Our results showed that the new formulation was bioequivalent to the 100 mg reference product. This finding supports the use of a single 300 mg tablet daily strategy to treat latent TB. This new formulation may increase patients' adherence to the treatment and quality of life.

Using a single tablet daily to treat latent tuberculosis infection in Brazil: bioequivalence of two different isoniazid formulations (300 mg and 100 mg) demonstrated by a sensitive and rapid high-performance liquid chromatography-tandem mass spectrometry method in a randomised, crossover study

The recommended treatment for latent tuberculosis (TB) infection in adults is a daily dose of isoniazid (INH) 300 mg for six months. In Brazil, INH was formulated as 100 mg tablets. The treatment duration and the high pill burden compromised patient adherence to the treatment. The Brazilian National Programme for Tuberculosis requested a new 300 mg INH formulation. The aim of our study was to compare the bioavailability of the new INH 300 mg formulation and three 100 mg tablets of the reference formulation. We conducted a randomised, single dose, open label, two-phase crossover bioequivalence study in 28 healthy human volunteers. The 90% confidence interval for the INH maximum concentration of drug observed in plasma and area under the plasma concentration vs. time curve from time zero to the last measurable concentration “time t” was 89.61-115.92 and 94.82-119.44, respectively. The main limitation of our study was that neither adherence nor the safety profile of multiple doses was evaluated. To determine the level of INH in human plasma, we developed and validated a sensitive, simple and rapid high-performance liquid chromatography-tandem mass spectrometry method. Our results showed that the new formulation was bioequivalent to the 100 mg reference product. This finding supports the use of a single 300 mg tablet daily strategy to treat latent TB. This new formulation may increase patients’ adherence to the treatment and quality of life.

Estudo dos métodos estatísticos na análise da biodisponibilidade relativa/bioequivalência para o registro de medicamentos no Brasil / I study of the statistical methods in the analysis of the biodisponibilidade relativa/bioequivalência for the registration of medications in Brazil

A ANVISA, órgão que regulamenta e controla a liberação dos medicamentos no Brasil, não indica um método estatístico específico para ser utilizado nos estudos de BDrelativa/BE. Tendo em vista que existem vários métodos estatísticos possíveis, hipotetizamos aqui que, em determinados casos, poderíamos obter um resultado não bioequivalente com um determinado modelo estatístico e bioequivalente utilizando um outro modelo. Em nosso trabalho, comparamos os resultados dos seguintes métodos estatísticos: Filler, Anderson e Hauck, Shortest, Lehmann (NP), T-test, Westlake, Baseado ANOVA, Hauschke. Trabalhamos com 49 estudos de bioequivalência e constatamos que 28 (57 por cento) destes foram bioequivalentes, enquanto 9 (18,4 por cento) se apresentaram bioinequivalentes em todos os métodos utilizados. Nos 12 (24,5 por cento) restantes, obtivemos resultados contraditórios. Analisando o resultado de um determinado método em relação ao da maioria, demonstramos que o Teste t na diferença, Lehmann, Hauschke e o Anderson e Hauck foram os que concluíram mais resultados diferentes da maioria dos métodos em questão. Já o Teste t e o teste baseado na ANOVA, ambos utilizando a razão das médias, e o método de Westlake, foram os que obtiveram apenas um resultado diferente da maioria dos métodos estatísticos utilizados. Podemos ressaltar que a maior parte dos resultados em bioinequivalência foi em função do parâmetro Cmax com 67,36 por cento. Já em relação ao parâmetro ASC, concluímos bioinequivalência em apenas 1,04 por cento dos métodos. Além disso, obtivemos 31,61 por cento dos resultados acusando não bioequivalência em ambos os parâmetros.