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Pharmacokinetic Study to Evaluate Dabigatran Etexilate in Elderly Subjects

Primary Purpose

Nonvalvular Atrial Fibrillation, Health, Subjective

Status
Recruiting
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Dabigatran etexilate capsule
Sponsored by
Dongyang Liu
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Nonvalvular Atrial Fibrillation focused on measuring dabigatran pharmacokinetics, P-glycoprotein, older adult

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: With full capacity for civil conduct, the age of adult healthy subjects is ≥18 years old and ≤30 years old; elderly healthy subjects ≥ 75 years old; elderly patients with atrial fibrillation are ≥75 years old. Male weight ≥ 50 kg, female weight ≥ 45 kg; body mass index (BMI) within the range of 19.0~27.0 (including upper and lower limits), body mass index (BMI) = weight (kg) / height 2 (m2). Creatinine clearance rate (CRCL): calculated by Cock Croft-Gault equation, adult healthy subjects should have CRCL≥90mL/min; elderly healthy subjects should have CRCL≥60mL/min; elderly patients with atrial fibrillation should have CRCL≥30mL/min. Elderly patients with atrial fibrillation should have meet the diagnostic criteria for non-valvular atrial fibrillation. Elderly patients with atrial fibrillation are taking Dabigatran etexilate for routine treatment. Exclusion Criteria: History of fainting of needles and blood. Diseases affecting intestinal P-glycoprotein: severe diarrhea (excretion more than 3 times a day with watery stool characteristics), Crohn's disease, ulcerative colitis, irritable bowel syndrome, diverticulitis, difficult Identify Clostridium infection (recurrent) or Helicobacter pylori infection. Diseases affecting the activity of CYP3A in the liver: acute kidney injury, liver cirrhosis, liver abscess, liver cancer, intrahepatic bile duct stones, etc. Diseases affecting changes in intestinal flora: non-alcoholic fatty liver disease, diabetes, chronic constipation. History of major diseases or newly discovered diseases: prostate cancer, leukemia, liver cancer, breast cancer, colorectal cancer, leukemia and other tumor diseases. Diseases or conditions with significant risk of major bleeding, such as current or recent peptic ulcer, malignant neoplasms with high bleeding risk, recent brain or spinal cord injury, recent brain, spinal cord, or eye surgery, recent intracranial hemorrhage, known or suspected Esophageal varices, arteriovenous malformations, vascular aneurysms, or major intraspinal or intracranial vascular abnormalities. Clinically significant active bleeding. Are using anticoagulant drugs such as unfractionated heparin (UFH), low molecular weight heparin (LMWH) and heparin derivatives (fondaparinux sodium), vitamin K antagonists, rivaroxaban or other direct thrombin Inhibitors (recombinant hirudin, bivalirudin); thrombolytic drugs; or current use of antiplatelet aggregation drugs such as GPIIb/IIIa receptor antagonists, ticlopidine, prasugrel, dextran, sulfinpyrazone, aspirin, etc. Use of drugs that may affect the intestinal flora within 1 week before the trial: Continuous use of antibiotics, Bifidobacterium triple viable bacteria powder, lactobacillus tablets, compound Lactobacillus acidophilus tablets, Bacillus subtilis dual viable bacteria enteric-coated capsules, containing bismuth subsalicylate, etc. Use of drugs that may affect the activity of intestinal P-glycoprotein/CYP3A within 1 week before the trial: ① Potent P-glycoprotein/CYP3A inhibitors: amiodarone, verapamil, diltiazem, quinidine, dronedarone, tacrolimus, cyclosporine, protease inhibitors indinavir, nelfinavir, saquinavir, lopinavir), macrolide antibiotics (erythromycin, clarithromycin, telithromycin), chloramphenicol, azole Antifungal drugs (ketoconazole, itraconazole, Posaconazole, voriconazole, fluconazole, miconazole), nefazodone, cobicistat, cimetidine, ciprofloxacin, Imatinib, St. John's Wort, Ranolazine; ② Potent P-glycoprotein/CYP3A inducers: rifampicin, carbamazepine, phenytoin, phenobarbital, dexamethasone, antiandrogens (enzalutamide, apalutamide). Those who have a history of smoking and drinking in the past, and who do not agree with the prohibition of smoking and drinking during the trial period: smokers (the average daily cigarettes smoked more than 5 cigarettes within one month before the test); alcoholism (the average daily drinking within one month before the test) ≥100mL high-quality liquor (ethanol content ≥40%)). History of gastrointestinal surgery such as gallbladder or appendectomy, bariatric surgery, etc. within the past 6 months. Positive virological test (human immunodeficiency virus antibody (HIV-Ab), syphilis serological test, hepatitis B virus surface antigen (HBsAg) or hepatitis C virus antibody (HCV-Ab)) within 3 months before screening. Those who have participated in clinical trials of any drug or medical device within 1 month before screening (in the case of drug clinical trials, those who participated in the previous clinical trial before screening have more than 5 half-lives). Subjects who are considered by the investigator to have any factors that are not suitable for participating in this trial. Adult healthy subjects, with the following additional exclusion criteria: Pregnant and lactating women. Suffering from atrial fibrillation, hypertension, heart failure, coronary heart disease, heart valve disease and other diseases.

Sites / Locations

  • Peking University Third HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Evaluating the pharmacokinetics of dabigatran etexilate in elderly healthy subjects

Arm Description

Adult healthy subjects and elderly healthy subjects only took one 110mg dabigatran etexilate capsule orally, and elderly patients with atrial fibrillation took dabigatran etexilate according to routine medical care.

Outcomes

Primary Outcome Measures

Concentration in plasma of dabigatran on the first day before administration
Plasma concentration of dabigatran will be measured by LC-MS/MS or HPLC
Concentration in plasma of dabigatran on the 2, 6, 10, and 24 hours after administration
Plasma concentration of dabigatran will be measured by LC-MS/MS or HPLC
Species of intestinal flora
Bacterial composition will be measured by 16s or Metagenome

Secondary Outcome Measures

Gene polymorphsim
Gene polymorphisms of CES1, CES2, P-glycolprotein will be measured

Full Information

First Posted
July 4, 2022
Last Updated
February 6, 2023
Sponsor
Dongyang Liu
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1. Study Identification

Unique Protocol Identification Number
NCT05715658
Brief Title
Pharmacokinetic Study to Evaluate Dabigatran Etexilate in Elderly Subjects
Official Title
A Study Evaluating the Pharmacokinetics of Dabigatran Etexilate in Adult Healthy Subjects, Elderly Healthy Subjects, and Elderly Patients With Atrial Fibrillation
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 15, 2022 (Actual)
Primary Completion Date
June 30, 2023 (Anticipated)
Study Completion Date
July 30, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Dongyang Liu

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study intends to collect blood samples of adult healthy subjects, elderly healthy subjects and elderly patients with atrial fibrillation after taking dabigatran etexilate for pharmacokinetics and other studies, aiming to reveal the effect of dabigatran etexilate in Chinese elderly population. Pharmacokinetic profile and biomarker concentration levels; fecal samples were collected for gut microbiota studies to further explore potential mechanisms. The results of the study may provide reference for the precision medicine of dabigatran etexilate and other drugs in the elderly population or the development of new clinical drugs.
Detailed Description
This study is a single-center, open-label clinical study, with adult healthy subjects, elderly healthy subjects and elderly patients with atrial fibrillation as the research subjects. Adult healthy subjects and elderly healthy subjects only take one 110 mg dabigatran etexilate capsule (low-dose specification in the instruction manual) orally. Elderly patients with atrial fibrillation take dabigatran etexilate according to routine medical treatment. Blood samples at 0 h(before dosing), 2 h, 6 h, 10 h and 24 h after dosing, and additional stool samples were collected.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Nonvalvular Atrial Fibrillation, Health, Subjective
Keywords
dabigatran pharmacokinetics, P-glycoprotein, older adult

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Control group: 12 healthy adults (18-30 years old); Test group A: 12 elderly healthy people (≥75 years old); Test group B: 12 elderly patients with atrial fibrillation (≥75 years old).
Masking
None (Open Label)
Allocation
N/A
Enrollment
36 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Evaluating the pharmacokinetics of dabigatran etexilate in elderly healthy subjects
Arm Type
Experimental
Arm Description
Adult healthy subjects and elderly healthy subjects only took one 110mg dabigatran etexilate capsule orally, and elderly patients with atrial fibrillation took dabigatran etexilate according to routine medical care.
Intervention Type
Drug
Intervention Name(s)
Dabigatran etexilate capsule
Intervention Description
Adult healthy subjects and elderly healthy subjects only take one 110 mg dabigatran etexilate capsule (low-dose specification in the instruction manual) orally. Elderly patients with atrial fibrillation take dabigatran etexilate according to routine medical treatment.
Primary Outcome Measure Information:
Title
Concentration in plasma of dabigatran on the first day before administration
Description
Plasma concentration of dabigatran will be measured by LC-MS/MS or HPLC
Time Frame
on the first 1 day before administration
Title
Concentration in plasma of dabigatran on the 2, 6, 10, and 24 hours after administration
Description
Plasma concentration of dabigatran will be measured by LC-MS/MS or HPLC
Time Frame
on the 2, 6, 10, and 24 hours after administration
Title
Species of intestinal flora
Description
Bacterial composition will be measured by 16s or Metagenome
Time Frame
on the first 1 day before administration
Secondary Outcome Measure Information:
Title
Gene polymorphsim
Description
Gene polymorphisms of CES1, CES2, P-glycolprotein will be measured
Time Frame
on the first 1 day before administration

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: With full capacity for civil conduct, the age of adult healthy subjects is ≥18 years old and ≤30 years old; elderly healthy subjects ≥ 75 years old; elderly patients with atrial fibrillation are ≥75 years old. Male weight ≥ 50 kg, female weight ≥ 45 kg; body mass index (BMI) within the range of 19.0~27.0 (including upper and lower limits), body mass index (BMI) = weight (kg) / height 2 (m2). Creatinine clearance rate (CRCL): calculated by Cock Croft-Gault equation, adult healthy subjects should have CRCL≥90mL/min; elderly healthy subjects should have CRCL≥60mL/min; elderly patients with atrial fibrillation should have CRCL≥30mL/min. Elderly patients with atrial fibrillation should have meet the diagnostic criteria for non-valvular atrial fibrillation. Elderly patients with atrial fibrillation are taking Dabigatran etexilate for routine treatment. Exclusion Criteria: History of fainting of needles and blood. Diseases affecting intestinal P-glycoprotein: severe diarrhea (excretion more than 3 times a day with watery stool characteristics), Crohn's disease, ulcerative colitis, irritable bowel syndrome, diverticulitis, difficult Identify Clostridium infection (recurrent) or Helicobacter pylori infection. Diseases affecting the activity of CYP3A in the liver: acute kidney injury, liver cirrhosis, liver abscess, liver cancer, intrahepatic bile duct stones, etc. Diseases affecting changes in intestinal flora: non-alcoholic fatty liver disease, diabetes, chronic constipation. History of major diseases or newly discovered diseases: prostate cancer, leukemia, liver cancer, breast cancer, colorectal cancer, leukemia and other tumor diseases. Diseases or conditions with significant risk of major bleeding, such as current or recent peptic ulcer, malignant neoplasms with high bleeding risk, recent brain or spinal cord injury, recent brain, spinal cord, or eye surgery, recent intracranial hemorrhage, known or suspected Esophageal varices, arteriovenous malformations, vascular aneurysms, or major intraspinal or intracranial vascular abnormalities. Clinically significant active bleeding. Are using anticoagulant drugs such as unfractionated heparin (UFH), low molecular weight heparin (LMWH) and heparin derivatives (fondaparinux sodium), vitamin K antagonists, rivaroxaban or other direct thrombin Inhibitors (recombinant hirudin, bivalirudin); thrombolytic drugs; or current use of antiplatelet aggregation drugs such as GPIIb/IIIa receptor antagonists, ticlopidine, prasugrel, dextran, sulfinpyrazone, aspirin, etc. Use of drugs that may affect the intestinal flora within 1 week before the trial: Continuous use of antibiotics, Bifidobacterium triple viable bacteria powder, lactobacillus tablets, compound Lactobacillus acidophilus tablets, Bacillus subtilis dual viable bacteria enteric-coated capsules, containing bismuth subsalicylate, etc. Use of drugs that may affect the activity of intestinal P-glycoprotein/CYP3A within 1 week before the trial: ① Potent P-glycoprotein/CYP3A inhibitors: amiodarone, verapamil, diltiazem, quinidine, dronedarone, tacrolimus, cyclosporine, protease inhibitors indinavir, nelfinavir, saquinavir, lopinavir), macrolide antibiotics (erythromycin, clarithromycin, telithromycin), chloramphenicol, azole Antifungal drugs (ketoconazole, itraconazole, Posaconazole, voriconazole, fluconazole, miconazole), nefazodone, cobicistat, cimetidine, ciprofloxacin, Imatinib, St. John's Wort, Ranolazine; ② Potent P-glycoprotein/CYP3A inducers: rifampicin, carbamazepine, phenytoin, phenobarbital, dexamethasone, antiandrogens (enzalutamide, apalutamide). Those who have a history of smoking and drinking in the past, and who do not agree with the prohibition of smoking and drinking during the trial period: smokers (the average daily cigarettes smoked more than 5 cigarettes within one month before the test); alcoholism (the average daily drinking within one month before the test) ≥100mL high-quality liquor (ethanol content ≥40%)). History of gastrointestinal surgery such as gallbladder or appendectomy, bariatric surgery, etc. within the past 6 months. Positive virological test (human immunodeficiency virus antibody (HIV-Ab), syphilis serological test, hepatitis B virus surface antigen (HBsAg) or hepatitis C virus antibody (HCV-Ab)) within 3 months before screening. Those who have participated in clinical trials of any drug or medical device within 1 month before screening (in the case of drug clinical trials, those who participated in the previous clinical trial before screening have more than 5 half-lives). Subjects who are considered by the investigator to have any factors that are not suitable for participating in this trial. Adult healthy subjects, with the following additional exclusion criteria: Pregnant and lactating women. Suffering from atrial fibrillation, hypertension, heart failure, coronary heart disease, heart valve disease and other diseases.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Dongyang Liu
Phone
(86)010-82266658
Email
liudongyang@vip.sina.com
First Name & Middle Initial & Last Name or Official Title & Degree
Cheng Cui
Phone
13011825605
Email
cuicheng1226@163.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dongyang Liu
Organizational Affiliation
Drug Clinical Trial Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Peking University Third Hospital
City
Beijing
ZIP/Postal Code
100191
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dongyang Liu
Email
liudongyang@vip.sina.com

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
22078863
Citation
Hines LE, Murphy JE. Potentially harmful drug-drug interactions in the elderly: a review. Am J Geriatr Pharmacother. 2011 Dec;9(6):364-77. doi: 10.1016/j.amjopharm.2011.10.004. Epub 2011 Nov 11.
Results Reference
result
PubMed Identifier
4749689
Citation
Zorab PA. Proceedings: Prognosis for life in childhood scoliosis. Arch Dis Child. 1973 Oct;48(10):824-5. doi: 10.1136/adc.48.10.824-c. No abstract available.
Results Reference
result
PubMed Identifier
32052379
Citation
Elmeliegy M, Vourvahis M, Guo C, Wang DD. Effect of P-glycoprotein (P-gp) Inducers on Exposure of P-gp Substrates: Review of Clinical Drug-Drug Interaction Studies. Clin Pharmacokinet. 2020 Jun;59(6):699-714. doi: 10.1007/s40262-020-00867-1.
Results Reference
result

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Pharmacokinetic Study to Evaluate Dabigatran Etexilate in Elderly Subjects

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