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EVALUATION OF A PEDIATRIC LIQUID FORMULATION TO IMPROVE 6-MERCAPTOPURINE THERAPY IN CHILDREN
  1. Tiphanie Adam de Beaumanis1,
  2. Lisa Lynqsie Hjalgrim2,
  3. Jacob Nersting2,
  4. Jörg Breitkreutz3,
  5. Yves Bertrand4,
  6. Martin Stanulla5,
  7. Guy Leverger1,
  8. André Baruchel1,
  9. Kjeld Schmiegelow6,
  10. Evelyne Jacqz-Aigrain1
  1. 1Robert Debré hospital, Paris
  2. 2Copenhagen University hospital
  3. 3Institute of Pharmaceutics and Biopharmaceutics, Düsseldorf
  4. 4Hospices Civils de Lyon, Lyon
  5. 5Department of Pediatric Hematology and Oncology, Hannover
  6. 6Institute of Clinical Medicine, Denmark

Abstract

Background 6-mercaptopurine (6-MP), a key drug for treatment of acute lymphoblastic leukemia (ALL), has until recently had no adequate formulation for pediatric patients. Several approaches have been taken but the only oral paraben-free 6-MP liquid formulation named Loulla was developed and evaluated in the target population. Preclinical and clinical evaluation was performed according to a Pediatric Investigation Plan, in order to apply for a Pediatric Use Marketing Authorization.

Methods The pre-clinical study assessed the maximum tolerated dosage-volume and evaluated local mucosal toxicity of 28 daily administrations in treated compared to controls gold hamsters. The multi-centre clinical study was single-dose, open-label, crossover trial, conducted in 15 ALL children during maintenance therapy. The bioavailability and palatability of a single 50 mg fixed dose of Loulla compared to 50 mg registered tablets were evaluated in a random order on two consecutive days. Seven blood samples over 9 hours were obtained each day at to determine 6-MP pharmacokinetic parameters, including Tmax, Cmax, AUC0–9 and AUC0–∞. A questionnaire adapted to children testing Loulla palatability and preference for either Loulla or the usual 6-MP tablet was completed. Occurrence of adverse events was determined at study visits by vital sign measurements, patient's spontaneous reporting, investigator's questioning and clinical examination.

Results The preclinical study in gold hamsters showed that dosage-volume of 75 mg/kg/day was well tolerated. The relative bioavailability of liquid Loulla formulation compared to the reference presentation is 76% for AUC0-9 and AUC0-∞ and 80% for Cmax. The taste of Loulla and the mouth feeling after ingestion compare favorably to the tablet. No adverse event occurred.

Conclusion Pharmacokinetic, palatability and safety data support the use of Loulla in children.

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