HPLC determination of glucocorticoid alcohols, their phosphates and hydrocortisone in aqueous solutions and biological fluids

High-performance liquid chromatographic (HPLC) assays are described for the determination of dexamethasone phosphate, dexamethasone and hydrocortisone and for the determination of triamcinolone, triamcinolone acetonide, triamcinolone acetonide phosphate and hydrocortisone in aqueous solutions and biological fluids. These assays allow quantification of the glucocorticoids in plasma down to a concentration of 100 ng ml(-1) (dexamethasone phosphate 300 ng ml(-1), hydrocortisone 40 ng ml(-1)). During the development of optimum extraction procedures the pK(a) values of the esters were determined by extractions performed at different pH values. The stability in vitro of the phosphate esters in ampoules, plasma and blood was studied. The esters are stable in their formulated ampoules after long-term storage, whereas the half-life in vitro of dexamethasone phosphate in plasma at 37 degrees C is 5 h and that of triamcinolone acetonide phosphate is 3.5 h. Determination by HPLC of endogenous hydrocortisone in samples from patients who received either dexamethasone phosphate or triamcinolone acetonide phosphate gave results identical with those obtained by radio-immunoassay (RIA).     

Development of a placebo effect model combined with a dropout model for bipolar disorder

The aim of this study was to develop a placebo model for bipolar disorder to help optimize clinical trial designs for studies targeting manic episodes in bipolar disorder. A bipolar disease database was built based on individual longitudinal data collected from over 3,000 patients in 11 clinical trials for 5 approved bipolar drugs. An empirical placebo effect model with an exponential decay process plus a linear progression process was developed to quantify the time course of the Young Mania Rating Scale total score based on only placebo data from the database. In order to describe the dropout pattern during the trials, a parametric survival model was developed and the Weibull distribution was identified to be the best distribution to describe the data. Based on the likelihood ratio test, it was found that patients with higher baseline score, slower disease improvement and more rapid disease progression tended to dropout earlier, and the trial features such as trial starting year and trial site were also significant covariates for dropout. A combination of the placebo effect model and the dropout model was applied to simulate new clinical trials through Monte-Carlo simulation. Both the placebo effect model and dropout model described the observed data reasonably well based on various diagnostic plots. The joint placebo response and dropout models can serve as a tool to simulate the most likely level of placebo response with the expected dropout pattern to help design a new clinical trial.     

A clinical phase II study with sorafenib in patients with progressive hormone-refractory prostate cancer: a study of the CESAR Central European Society for Anticancer Drug Research-EWIV

Sorafenib is a multi-kinase inhibitor with antiangiogenic and antiproliferative activity. The activity of sorafenib in progressive hormone-refractory prostate cancer (HRPC) patients was investigated in a phase II clinical study. Progressive HRPC patients received sorafenib 400 mg bid p.o. continuously. Only patients with no prior chemotherapy, and either one-unidimensional measurable lesion according to RECIST-criteria or increasing prostate-specific antigen (PSA) values reflecting a hormone-refractory situation, were eligible for study entry. The primary study objective was the rate of progression-free survival of >/=12 weeks (PFS12). Secondary end points were overall response, overall survival, and toxicity. Fifty-seven patients with PC were enrolled. Two patients had to be withdrawn from the set of eligible patients. According to RECIST criteria, 4 patients out of 55 evaluable patients showed stable disease (SD). According to PSA-response, we saw 11 patients with SD PSA and 2 patients were responders at 12 weeks (PFS12=17/55=31%). Among the 257 adverse events, 15 were considered drug related of maximum CTC-grade 3. Twenty-four serious adverse events occurred in 14 patients (14/55=26%). Seven of them were determined to be drug related. No treatment-related death was observed. Sorafenib has antitumour activity in HRPCP when evaluated for RECIST- and PSA-based response. Further investigation as a component of combination regimens is necessary to evaluate its definite or overall clinical benefit for HRPCP.     

Ueber familiäre spastische Spinalparalyse

Ohne Zusammenfassung     

Pharmacokinetic characterization and tissue distribution of the new glucocorticoid soft drug loteprednol etabonate in rats and dogs.

Loteprednol etabonate, a new glucocorticoid soft drug with a characteristic chloromethyl ester function in the 17 beta-position, is currently in the early phases of clinical development. As the basis for human trials, this study describes a new reversed-phase high-performance liquid chromatographic method for the determination of levels of drug in plasma and urine samples and assesses the pharmacokinetic properties of loteprednol etabonate in dogs and rats. Intravenous administration of loteprednol etabonate (5 mg/kg) to dogs revealed a terminal half-life of 2.8 h, a volume of distribution of 3.7 L/kg, and a total body clearance of 0.9 L/h/kg. Intact loteprednol etabonate was not detectable in the urine. After oral administration of the drug (5 mg/kg) to dogs, only metabolites, but no intact drug, were found in the plasma, an indication for a high first-pass effect. A pronounced binding of the drug to plasma protein (> 90%) and a high erythrocyte-buffer partition coefficient of 7.8 were determined in vitro. Preliminary information about tissue distribution and possible metabolic pathways were obtained in rats after oral administration of a 14C-labeled loteprednol etabonate suspension (5 mg/kg). pH-selective extraction into ethyl acetate revealed three distinguishable fractions: (1) a neutral lipophilic fraction, presumably intact drug, (2) an acidic, lipophilic fraction, and (3) a hydrophilic nonextractable fraction. Levels of intact drug and metabolites were highest in liver and kidney, whereas significantly lower levels were found in other investigated organs (lung, brain, heart).(ABSTRACT TRUNCATED AT 250 WORDS)     

Simultaneous determination of glucocorticoid alcohols, their succinates and hydrocortisone in plasma

A reversed-phase high-performance liquid chromatographic (HPLC) assay is described for the simultaneous determination of methylprednisolone, methylprednisolone-21-hemisuccinate and endogenous hydrocortisone in biological fluids. This assay is also applicable to the determination of prednisolone-21-hemisuccinate in the presence of prednisolone and hydrocortisone in biological fluids. Prednisolone and hydrocortisone are determined by normal-phase HPLC. The stability of hemisuccinate esters in ampoules, in saline and in plasma has been studied. Whereas the esters were stable in saline at 37°C, they were considerably hydrolysed in plasma at the same temperature. Comparison of hydrocortisone levels obtained by HPLC and radioimmunoassay (RIA) showed the large influence of the cross-reactivity of methylprednisolone and hydrocortisone in the presence of high serum concentrations of methylprednisolone.     

Oral Bioavailability of Triamcinolone Tablets and a Triamcinolone Diacetate Suspension

Pharmaceutical Research -