Assess the Influence of Cenobamate on the PK of Cytochrome P450 (CYP) Probe Drugs as a Means of Predicting Drug-drug Interactions



Status:Completed
Conditions:Healthy Studies
Therapuetic Areas:Other
Healthy:No
Age Range:18 - 50
Updated:8/9/2017
Start Date:February 22, 2017
End Date:July 31, 2017

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The Effect of Multiple Doses of Cenobamate (YKP3089) on the Single Dose Pharmacokinetics of Cytochrome P450 Substrates (Midazolam, Warfarin, Omeprazole and Bupropion) Administered Orally in an Open-label, One-sequence Study in Healthy Subjects

This study is aimed to investigate the influence of cenobamate on the activity of CYP3A4/5,
CYP2B6, CYP2C19, and CYP2C9 by using drugs recommended by both the FDA and EMA as in vivo
probes. In order to avoid a potential pharmacokinetic interaction between the probes,
midazolam (CYP3A), warfarin (CYP2C9), and omeprazole (CYP2C19) will be administered together
as a validated cocktail and separately from bupropion (CYP2B6) using an adequate washout time
period between the 2 assessments.

The starting daily dose of cenobamate will be 12.5 mg, which will be administered for 2
weeks. Then, daily cenobamate doses will be increased every 2 weeks to 25 mg, 50 mg, 100 mg,
150 mg, and 200 mg. The CYP probes will be tested before cenobamate administration, at steady
state at 100mg/day of cenobamate for midazolam only and finally at steady state at 200mg/day
of cenobamate for all CYP probes.

The results of this DDI study will provide a basis to make appropriate dose recommendation
for a safe use of concomitant drugs with cenobamate using these isoenzymes in their metabolic
pathway.


Inclusion Criteria:

1. Male or female subjects between 18 to 50 years of age inclusive

2. Subject is willing and able to provide informed consent

3. Body mass index (BMI) within 19.0 kg/m2 and 29.9 kg/m2, inclusive, at screening

4. Subject is a non- or ex-smoker and has not used any nicotine containing products
within 6 months prior to screening

5. Subjects who are considered generally healthy upon completion of medical history,
physical examination, vital signs, screening laboratory results and screening ECG in
the opinion of the Investigator

6. Subjects who are willing and able to comply with the dosing/visit schedule, laboratory
tests, pharmacokinetic sampling schedule, and other study procedures

7. A female study subject must meet one of the following criteria:

If of childbearing potential - agrees to use one of the accepted contraceptive
regimens from screening, during the study and for at least 30 days after the last dose
of the study medication. Hormonal contraceptives alone will not be considered an
adequate method of contraception. An acceptable method of contraception includes one
of the following:

1. Diaphragm and spermicide

2. Condom with spermicide

3. Sponge and spermicide

4. Intrauterine device (with or without hormones; placement at least 3 months prior
to Screening) in combination with a barrier method

5. Oral contraceptives, Depo-Provera, Norplant, Patch or intrauterine progesterone
contraceptive for at least 90 days prior to screening in combination with a
barrier method.

6. Vasectomized partner (6 months minimum since vasectomy)

7. Complete abstinence from heterosexual intercourse. However, if the subject
becomes sexually active, 1 of the above methods must be utilized.

If a female of non-childbearing potential - should be surgically sterile (i.e. has
undergone complete hysterectomy, bilateral oophorectomy, or tubal ligation at least 6
months prior to Screening) or in a menopausal state (at least 1 year without menses),
as confirmed by FSH levels (post menopausal must be confirmed by the subject having a
serum follicle stimulating hormone greater than 40mIU/ml at screening)

8. A female study subject must agree not to donate eggs during the study and for at least
30 days after the last dose of the study medication

9. A male study subject must agree to use one of the accepted contraceptive regimens
during the study and for at least 90 days after the last dose of the study
medications;

1. Abstinence from heterosexual intercourse. However, if the subject becomes
sexually active, 1 of the below methods must be utilized

2. Female partner with hormonal contraceptives (birth control pills,
injectable/implant/insertable hormonal birth control products, transdermal patch)
in combination with a barrier method

3. Female partner with intrauterine device (with or without hormones) in combination
with a barrier method

4. Female partner with condom with spermicide used by male study subject

5. Female partner of non-childbearing potential

6. Female partner with diaphragm with spermicide

7. Female partner with sponge and spermicide

8. Male sterilization with absence of sperm in the post vasectomy ejaculate for ≥ 6
months

10. A male study subject must agree not to donate sperm during the study and for at least
90 days after the last dose of the study medication

Exclusion Criteria:

1. Females who are breastfeeding

2. Inadequate venous access

3. History of any drug related hypersensitivity reactions as well as severe
hypersensitivity reactions (like angioedema), or DRESS syndrome to any drugs in the
opinion of the Investigator

4. History of 1st degree relative having a serious cutaneous adverse reaction

5. Current clinically significant rash

6. Clinically significant history or evidence of gastrointestinal, hepatic, renal,
endocrine, pulmonary, neurological, psychiatric, cardiovascular, hematologic,
dermatologic, immunologic disease or any other condition known to interfere with the
absorption, distribution, metabolism or elimination of drugs that in the opinion of
the Investigator would jeopardize the safety of the subject or impact validity of
study results

7. History of hepatic impairment, cholecystectomy, renal impairment or any other
condition known to interfere with the absorption, distribution, metabolism or
elimination of orally administered drug

8. Presence of observed abnormality (evidenced from physical examination, ECG, vital
signs, or laboratory evaluation) that would be clinically significant in the opinion
of the Investigator

9. Current evidence or history of suicidal tendency, seizures, state of confusion or any
other clinically relevant psychiatric disease.

10. Subject is at imminent risk of suicide (positive response to question 4 or 5 on the
C-SSRS) or had a suicide attempt within 6 months prior to the screening visit

11. History of regular alcohol consumption exceeding 7 drinks per week for females and 14
drinks per week for males within 6 months prior to screening

12. Has current or recent history (within the past year) of alcohol or drug abuse or
dependence

13. Any clinically significant illness in the previous 30 days prior to screening

14. Use of any enzyme-modifying drugs, including strong inhibitors of CYP enzymes (such as
cimetidine, fluoxetine, quinidine, erythromycin, ciprofloxacin, fluconazole,
ketoconazole, diltiazem, and HIV antivirals) and strong inducers of CYP enzymes (such
as barbiturates, carbamazepine, glucocorticoids, phenytoin, rifampin and St John`s
Wort) in the previous 30 days prior to Day 1 of this study

15. Use of all drugs associated with DRESS syndrome such as phenobarbital, carbamazepine,
phenytoin, lamotrigine, minocycline, sulfonamides, allopurinol, modafinil, dapsone,
ziprasidone, vancomycin and olanzapine in the previous 6 months prior to Day 1 of this
study

16. Clinically-relevant, unusual dietary habits (e.g., vegan, Atkins), dietary
restrictions, and/or food allergies

17. Positive urine screen for alcohol and/or drugs of abuse at screening and at each
admission

18. Positive test results for HIV-1/HIV-2 Antibodies, Hepatitis B surface Antigen (HBsAg)
or Hepatitis C Antibody (HCVAb) at screening

19. Has been administered any investigational drug 30 days (or 6 times its terminal
half-live) prior to Day 1 of this study

20. Females with a positive pregnancy test at screening, regardless of child-bearing
potential prior to Day 1 of this study

21. Blood donation (excluding plasma donation) of approximately 500 mL within 56 days
prior to screening

22. Subject is unlikely to comply with the study protocol or, in the opinion of the
Investigator, would not be a suitable candidate for participation in the trial

23. Anyone who has previously been exposed to cenobamate (prior to participation in this
study)
We found this trial at
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Overland Park, Kansas 23112
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Overland Park, KS
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