Elsevier

Molecular Genetics and Metabolism

Volume 131, Issues 1–2, September–October 2020, Pages 211-218
Molecular Genetics and Metabolism

How a concentration-effect analysis of data from the eliglustat thorough electrocardiographic study was used to support dosing recommendations

https://doi.org/10.1016/j.ymgme.2020.09.003Get rights and content
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Highlights

  • Eliglustat does not prolong ECG intervals when used as recommended in the label.

  • Certain drug-drug interactions may prolong ECG intervals in certain patients.

  • Co-administration of eliglustat is contraindicated in such drug-drug interaction scenarios.

  • No Torsade de pointe has been reported in eliglustat-treated patients to date.

Abstract

Eliglustat is a first-line oral treatment for adults with Gaucher disease type 1 who have cytochrome P450 (CYP) 2D6 extensive, intermediate, or poor metabolizer phenotypes. Per International Conference on Harmonisation (ICH) E14 guidance, a Phase 1 thorough electrocardiographic (ECG) study was done during drug development to assess eliglustat's effects on cardiac repolarization by measuring ECG intervals in healthy adult subjects. Using data from the thorough ECG study, we performed pharmacokinetic/pharmacodynamic-ECG modeling to establish the relationship between eliglustat concentrations and their effects on ECG intervals. We then used that concentration-response relationship to predict the effects of eliglustat on each ECG interval for each CYP2D6 metabolizer phenotype (the main determinant of eliglustat exposure) and in different drug-drug interaction scenarios. These predictions, together with other exposure-related factors, contributed to the CYP2D6 phenotype-based dosing recommendations for eliglustat, including dose adjustments and contraindications when co-administered with drugs metabolized by the CYP2D6 and CYP3A pathways.

Keywords

Eliglustat
Gaucher disease type 1
Thorough ECG study
Cardiac repolarization
QTc
QTcF

Cited by (0)

1

Current affiliation: Vertex Pharmaceuticals, Cambridge, MA USA.

2

Current affiliation: Ultragenyx Pharmaceutical, Cambridge, MA USA.

3

Current affiliation: Gerald Cox Rare Care Consulting, LLC, Needham, MA, USA.