Drug-Drug Interaction Study of Colchicine and Clarithromycin

A Pharmacokinetic Study to Evaluate the Effect of Clarithromycin on the Pharmacokinetic Profile of Colchicine in Healthy Adults

Clarithromycin is a potent inhibitor of the activity of cytochrome P450 (CYP) 3A4 and P-glycoprotein (P-gp). CYP 3A4 plays a role in the metabolism of colchicine and P-gp is responsible for the efflux of colchicine across membranes. This study will evaluate the effect of clarithromycin-related inhibition of CYP 3A4 and P-gp on the pharmacokinetics of colchicine. It will also evaluate the safety and tolerability of concurrent administration of clarithromycin and a single dose of colchicine.

Study Overview

• Status: Completed
• Conditions: Pharmacokinetics
• Intervention / Treatment: Drug: colchicine; Drug: colchicine; Drug: clarithromycin

Detailed Description

Clarithromycin is a potent inhibitor of the activity of cytochrome P450 (CYP) 3A4 and P-glycoprotein (P-gp). CYP 3A4 plays a role in the metabolism of colchicine and P-gp is responsible for the efflux of colchicine across membranes. This open-label, one sequence, two-period, drug-drug interaction study will evaluate the effect of clarithromycin-related inhibition of CYP 3A4 and P-gp on colchicine pharmacokinetics in 24 healthy, non-smoking, non-obese (within +/- 15% of ideal body weight), male and female adult volunteers. The safety and tolerability of concurrent administration of clarithromycin and a single dose of colchicine will also be evaluated. During the first period, subjects will be confined to the study unit beginning the afternoon of the day prior to scheduled dosing (Day -1). On the morning of Day 1, after an overnight fast of at least 10 hours, subjects will be administered a single dose of colchicine 0.6 mg tablet with 240 ml of room temperature water. Blood will be drawn at times sufficient to characterize the baseline pharmacokinetics for this group. Following a 20 day washout period on Day 22, all subjects will return to the clinic to receive a supply of clarithromycin 250 mg tablets, which they will take on an outpatient basis twice daily (at 8 a.m. and 8 p.m.) without regard to meals for a total of 14 doses. Clinic staff will make telephone contact daily with subjects during this course to confirm compliance with the clarithromycin dosing regimen, and to monitor for adverse events and use of concomitant medication. On day 28 in the afternoon, subjects will again be confined to the study unit. On the morning of day 29, after an overnight fast of at least 10 hours all subjects will be administered a single dose of colchicine 0.6 mg and the final dose of clarithromycin with 240 ml water. Blood samples will be drawn at times sufficient to determine pharmacokinetic profiles of colchicine in the presence of clarithromycin at steady state. The pharmacokinetic profiles will be compared to determine the extent of drug-drug interaction.

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • North Dakota
    • Fargo, North Dakota, United States, 58104
      • PRACS Institute, Ltd. - Cetero Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Healthy, non-smoking, adult volunteers, male and female, 18 to 45 years of age, weighing at least 55 kg and within 15% of ideal body weight, with hemoglobin >/=12 g/dL.
• Female volunteers must be sexually abstinent for 14 days prior to the first dose and throughout the study or using acceptable birth control methods (prior to and during the study), including being postmenopausal or surgically sterile (or sexual activity restricted to a partner that is surgically sterile), hormonal contraception, an IUD, or barrier methods with spermicide. Additionally, they will be advised to remain sexually inactive or to keep the same birth control method for at least 14 days following the last dose of colchicine.

Exclusion Criteria:

• Subjects who are pregnant or lactating
• Test positive at screening for human immunodeficiency virus (HIV), hepatitis B surface antigen (HbsAg) or hepatitis C virus (HCV)
• Have history or presence of significant cardiovascular, pulmonary, hepatic, renal, hematologic, gastrointestinal, endocrine, immunologic, dermatologic, neurologic, or psychiatric disease; have used any drugs or substances known to inhibit or induce CYP enzymes and/or P-gp within 30 days prior to the first dose and throughout the study
• Recent (2-year) history of evidence of alcoholism or drug abuse
• Subjects who donated 50-499 ml of blood within 30 days and more than 499 ml within 56 days prior to the first dose; subjects who have donated in excess of 500 ml of blood in 14 days, 1500 ml or blood in 180 days, or 2500 ml of blood in 1 year (through completion of the study)
• Have participated in another clinical trial within 30 days prior to dosing
• Known and documented drug allergies to colchicine or macrolide antibiotics.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: colchicine alone; colchicine baseline pharmacokinetics	Drug: colchicine; 0.6mg tablet administered at 9am on Day 1; Drug: colchicine; 0.6 mg tablet administered at 9am on Day 29
Experimental: colchicine with clarithromycin; colchicine pharmacokinetics in presence of clarithromycin	Drug: colchicine; 0.6mg tablet administered at 9am on Day 1; Drug: colchicine; 0.6 mg tablet administered at 9am on Day 29; Drug: clarithromycin; 250 mg clarithromycin tablet taken on an outpatient basis twice daily at 8am and 8pm for 14 doses (starting with 8pm dose on Day 22 and concluding with 8am dose on Day 29)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximum Plasma Concentration (Cmax)	The maximum or peak concentration that colchicine reaches in the plasma.	serial pharmacokinetic blood samples collected immediately prior to dosing on Days 1 and 29, then at 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 16, 24, 36, 48, 72, and 96 hours after dose administration
Area Under the Concentration Versus Time Curve From Time 0 to Time t [AUC(0-t)]	The area under the colchicine plasma concentration versus time curve beginning from the first dose (time 0) to the last measurable colchicine concentration (time t), as calculated by the linear trapezoidal method.	serial pharmacokinetic blood samples collected immediately prior to dosing on Days 1 and 29, then at 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 16, 24, 36, 48, 72, and 96 hours after dose administration
Area Under the Concentration Versus Time Curve From Time 0 Extrapolated to Infinity [AUC(0-∞)]	The area under the colchicine plasma concentration versus time curve from time 0 to infinity. AUC(0-∞) was calculated as the sum of AUC(0-t) plus the ratio of the last measurable colchicine plasma concentration to the elimination rate constant.	serial pharmacokinetic blood samples collected immediately prior to dosing on Days 1 and 29, then at 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 16, 24, 36, 48, 72, and 96 hours after dose administration

Collaborators and Investigators

• Sponsor: Mutual Pharmaceutical Company, Inc.

Publications and helpful links

General Publications

• Terkeltaub RA, Furst DE, Digiacinto JL, Kook KA, Davis MW. Novel evidence-based colchicine dose-reduction algorithm to predict and prevent colchicine toxicity in the presence of cytochrome P450 3A4/P-glycoprotein inhibitors. Arthritis Rheum. 2011 Aug;63(8):2226-37. doi: 10.1002/art.30389. Erratum In: Arthritis Rheum. 2011 Nov;63(11):3521. Dosage error in article text.

Study record dates

Study Major Dates

• Study Start: November 1, 2007
• Primary Completion (Actual): December 1, 2007
• Study Completion (Actual): January 1, 2008

Study Registration Dates

• First Submitted: August 13, 2009
• First Submitted That Met QC Criteria: August 13, 2009
• First Posted (Estimate): September 24, 2009

Study Record Updates

• Last Update Posted (Estimate): October 15, 2009
• Last Update Submitted That Met QC Criteria: October 5, 2009
• Last Verified: October 1, 2009

More Information

Terms related to this study

• Keywords: pharmacokinetics; healthy; drug-drug interaction
• Additional Relevant MeSH Terms: Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Enzyme Inhibitors; Antirheumatic Agents; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Anti-Bacterial Agents; Cytochrome P-450 CYP3A Inhibitors; Cytochrome P-450 Enzyme Inhibitors; Protein Synthesis Inhibitors; Gout Suppressants; Colchicine; Clarithromycin
• Other Study ID Numbers: MPC-004-07-1006