Skip to main content
Top
Published in: Advances in Therapy 8/2018

Open Access 01-08-2018 | Original Research

Pharmacokinetics of a Single Dose of Azilsartan in Pediatric Patients: A Phase 3, Open-Label, Multicenter Study

Authors: Kazuaki Enya, Ben T. Saji, Takuya Kato, Hiroyuki Okamoto, Emiko Koumura

Published in: Advances in Therapy | Issue 8/2018

Login to get access

Abstract

Introduction

Azilsartan is an angiotensin II receptor blocker indicated for the treatment of patients with hypertension. The efficacy and safety of azilsartan are established in adults, but have not been evaluated in pediatric patients, nor has its pharmacokinetic profile been determined in pediatric patients.

Methods

In this phase 3, open-label, multicenter study, we investigated the pharmacokinetics and safety of single doses of azilsartan in six Japanese patients with hypertension, aged 9–14 years. The dose of azilsartan was 5 mg for three patients weighing less than 50 kg, with mean body weight at baseline of 27.5 kg, and 10 mg for three patients weighing at least 50 kg, with mean body weight at baseline of 65.9 kg.

Results

Mean maximum plasma concentration (Cmax) of azilsartan was 888.3 and 831.3 ng/mL and median time to maximum concentration (Tmax) of unchanged azilsartan was 3.0 and 4.0 h, in the 5-mg and 10-mg groups, respectively. Mean areas under the plasma concentration–time curve (AUC) from 0–24 h post-dose (AUC0–24) and 0 h to infinity (AUC0–inf) were 6350.3 and 6635.7 ng h/mL, respectively, in the 5-mg group, and 6871.7 and 7433.3 ng h/mL, respectively, in the 10-mg group. Both doses were well tolerated; no treatment-emergent adverse events considered to be related to azilsartan occurred during the study.

Conclusion

Our data suggest that pediatric patients weighing less than 50 kg may have  approximately 2-fold greater exposure to azilsartan than those weighing at least 50 kg at the same dose. Exposure to azilsartan in children weighing at least 50 kg is comparable to that in healthy adults at the same dose.

Trial Registration

ClinicalTrials.gov identifier, NCT02451150.

Funding

Takeda Pharmaceutical Co. Ltd.
Literature
1.
go back to reference Shimamoto K, Ando K, Fujita T, et al. The Japanese society of hypertension guidelines for the management of hypertension (JSH 2014). Hypertens Res. 2014;37:253–390.CrossRefPubMed Shimamoto K, Ando K, Fujita T, et al. The Japanese society of hypertension guidelines for the management of hypertension (JSH 2014). Hypertens Res. 2014;37:253–390.CrossRefPubMed
2.
go back to reference Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics. 2004;113:475–82.CrossRefPubMed Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics. 2004;113:475–82.CrossRefPubMed
4.
go back to reference Falkner B. Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephrol. 2010;25:1219–24.CrossRefPubMed Falkner B. Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephrol. 2010;25:1219–24.CrossRefPubMed
5.
go back to reference Rakugi H, Enya K, Sugiura K, Ikeda Y. Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I-II essential hypertension: a randomized, double-blind clinical study. Hypertens Res. 2012;35:552–8.CrossRefPubMedPubMedCentral Rakugi H, Enya K, Sugiura K, Ikeda Y. Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I-II essential hypertension: a randomized, double-blind clinical study. Hypertens Res. 2012;35:552–8.CrossRefPubMedPubMedCentral
6.
go back to reference Perez A, Cao C. Azilsartan in patients with mild to moderate hypertension using clinic and ambulatory blood pressure measurements. J Clin Hypertens. 2017;19:82–9.CrossRef Perez A, Cao C. Azilsartan in patients with mild to moderate hypertension using clinic and ambulatory blood pressure measurements. J Clin Hypertens. 2017;19:82–9.CrossRef
7.
go back to reference Trachtman H, Hainer JW, Sugg J, et al. Efficacy, safety, and pharmacokinetics of candesartan cilexetil in hypertensive children aged 6 to 17 years. J Clin Hypertens (Greenwich). 2008;10:743–50.CrossRef Trachtman H, Hainer JW, Sugg J, et al. Efficacy, safety, and pharmacokinetics of candesartan cilexetil in hypertensive children aged 6 to 17 years. J Clin Hypertens (Greenwich). 2008;10:743–50.CrossRef
8.
go back to reference Wells T, Blumer J, Meyers KE, et al. Effectiveness and safety of valsartan in children aged 6 to 16 years with hypertension. J Clin Hypertens (Greenwich). 2011;13:357–65.CrossRef Wells T, Blumer J, Meyers KE, et al. Effectiveness and safety of valsartan in children aged 6 to 16 years with hypertension. J Clin Hypertens (Greenwich). 2011;13:357–65.CrossRef
10.
go back to reference Perry CM. Azilsartan medoxomil: a review of its use in hypertension. Clin Drug Investig. 2012;32:621–39.CrossRefPubMed Perry CM. Azilsartan medoxomil: a review of its use in hypertension. Clin Drug Investig. 2012;32:621–39.CrossRefPubMed
11.
go back to reference Preston RA, Karim A, Dudkowski C, et al. Single-center evaluation of the single-dose pharmacokinetics of the angiotensin II receptor antagonist azilsartan medoxomil in renal impairment. Clin Pharmacokinet. 2013;52:347–58.CrossRefPubMed Preston RA, Karim A, Dudkowski C, et al. Single-center evaluation of the single-dose pharmacokinetics of the angiotensin II receptor antagonist azilsartan medoxomil in renal impairment. Clin Pharmacokinet. 2013;52:347–58.CrossRefPubMed
12.
go back to reference Preston RA, Karim A, Garg D, Zhao C, Dudkowski C. Single-center phase I study of the single- and multiple-dose pharmacokinetics and safety of azilsartan medoxomil (AZL-M) in hepatic impairment (abstract no. PII-99). Clin Pharmacol Ther. 2012;91(Suppl 1):S89. Preston RA, Karim A, Garg D, Zhao C, Dudkowski C. Single-center phase I study of the single- and multiple-dose pharmacokinetics and safety of azilsartan medoxomil (AZL-M) in hepatic impairment (abstract no. PII-99). Clin Pharmacol Ther. 2012;91(Suppl 1):S89.
13.
go back to reference Zaiken K, Cheng JW. Azilsartan medoxomil: a new angiotensin receptor blocker. Clin Ther. 2011;33:1577–89.CrossRefPubMed Zaiken K, Cheng JW. Azilsartan medoxomil: a new angiotensin receptor blocker. Clin Ther. 2011;33:1577–89.CrossRefPubMed
14.
go back to reference Webb NJA, Wells T, Tsai M, Zhao Z, Juhasz A, Dudkowski C. Single-dose pharmacokinetics and safety of azilsartan medoxomil in children and adolescents with hypertension as compared to healthy adults. Eur J Clin Pharmacol. 2016;72:447–57.CrossRefPubMedPubMedCentral Webb NJA, Wells T, Tsai M, Zhao Z, Juhasz A, Dudkowski C. Single-dose pharmacokinetics and safety of azilsartan medoxomil in children and adolescents with hypertension as compared to healthy adults. Eur J Clin Pharmacol. 2016;72:447–57.CrossRefPubMedPubMedCentral
16.
go back to reference Kuze Y, Kogame A, Jinno F, Kondo T, Asahi S. Development, validation and application of the liquid chromatography tandem mass spectrometry method for simultaneous quantification of azilsartan medoxomil (TAK-491), azilsartan (TAK-536), and its 2 metabolites in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci. 2015;1001:174–81.CrossRefPubMed Kuze Y, Kogame A, Jinno F, Kondo T, Asahi S. Development, validation and application of the liquid chromatography tandem mass spectrometry method for simultaneous quantification of azilsartan medoxomil (TAK-491), azilsartan (TAK-536), and its 2 metabolites in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci. 2015;1001:174–81.CrossRefPubMed
18.
go back to reference Anderson BJ, Holford NH. Mechanism-based concepts of size and maturity in pharmacokinetics. Annu Rev Pharmacol Toxicol. 2008;48:303–32.CrossRefPubMed Anderson BJ, Holford NH. Mechanism-based concepts of size and maturity in pharmacokinetics. Annu Rev Pharmacol Toxicol. 2008;48:303–32.CrossRefPubMed
19.
go back to reference Anderson BJ, Holford NH. Understanding dosing: children are small adults, neonates are immature children. Arch Dis Child. 2013;98:737–44.CrossRefPubMed Anderson BJ, Holford NH. Understanding dosing: children are small adults, neonates are immature children. Arch Dis Child. 2013;98:737–44.CrossRefPubMed
20.
go back to reference Anderson BJ, Woollard GA, Holford NH. A model for size and age changes in the pharmacokinetics of paracetamol in neonates, infants and children. Br J Clin Pharmacol. 2000;50:125–34.CrossRefPubMedPubMedCentral Anderson BJ, Woollard GA, Holford NH. A model for size and age changes in the pharmacokinetics of paracetamol in neonates, infants and children. Br J Clin Pharmacol. 2000;50:125–34.CrossRefPubMedPubMedCentral
21.
go back to reference Tod M, Jullien V, Pons G. Facilitation of drug evaluation in children by population methods and modelling. Clin Pharmacokinet. 2008;47:231–43.CrossRefPubMed Tod M, Jullien V, Pons G. Facilitation of drug evaluation in children by population methods and modelling. Clin Pharmacokinet. 2008;47:231–43.CrossRefPubMed
22.
go back to reference Tod M, Lokiec F, Bidault R, De Bony F, Petitjean O, Aujard Y. Pharmacokinetics of oral acyclovir in neonates and in infants: a population analysis. Antimicrob Agents Chemother. 2001;45:150–7.CrossRefPubMedPubMedCentral Tod M, Lokiec F, Bidault R, De Bony F, Petitjean O, Aujard Y. Pharmacokinetics of oral acyclovir in neonates and in infants: a population analysis. Antimicrob Agents Chemother. 2001;45:150–7.CrossRefPubMedPubMedCentral
Metadata
Title
Pharmacokinetics of a Single Dose of Azilsartan in Pediatric Patients: A Phase 3, Open-Label, Multicenter Study
Authors
Kazuaki Enya
Ben T. Saji
Takuya Kato
Hiroyuki Okamoto
Emiko Koumura
Publication date
01-08-2018
Publisher
Springer Healthcare
Published in
Advances in Therapy / Issue 8/2018
Print ISSN: 0741-238X
Electronic ISSN: 1865-8652
DOI
https://doi.org/10.1007/s12325-018-0754-5

Other articles of this Issue 8/2018

Advances in Therapy 8/2018 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.