re notsensitive for distinct, single-target anticoagulants such asthe FXa inhibitors. As shown in Fig. 5, apixaban onlyprolonged ex vivo aPTT and PT modestly, even at thehighest dose that created 80% antithrombotic efficacy inrabbits. As expected from its mechanism of action,apixaban Cell Signaling inhibitor did not prolong thrombin Cell Signaling inhibitor time. Among theclotting time tests, mPT was essentially the most sensitive for apixabanand tracked well using the antithrombotic activity ofapixaban. Similar mPT outcomes were also observed with.other FXa inhibitors for example rivaroxaban. Data from aphase II study with apixaban show that the anti-FXa assayis far more accurate and precise than the mPT test.Indeed, we also observed that the anti-FXa assay trackedwell with antithrombotic activity in rabbits with arterialthrombosis. As shown in Fig.
6, apixaban created adose-dependent inhibition of FXa and did not inhibitthrombin activity ex vivo. The ex vivo fgf inhibitor anti-FXaactivity of apixaban correlated well with both its antithromboticactivity and plasma concentration.Hence, the anti-FXa activity assay could be suitable formonitoring the anticoagulant and plasma levels of apixabanif required in particular situations for example an overdose, acutebleeding or urgent surgery.Drug metabolism and pharmacokineticsThe metabolism and pharmacokinetics of apixaban havebeen studied extensively in animals and humans. In thesestudies, absorption of apixaban soon after oral administrationwas rapid, with a time to peak plasma concentrationof 1–2 h. Absolute oral bioavailability of apixaban wasgood in rats, dogs and humans.
Following IVadministration, apixaban was slowly eliminated in rats,dogs and humans, with an apparent terminal eliminationhalf-lifeof 2–11 h, and also a total plasma clearance ofless than 5% hepatic blood flow. The steady-state volumeof distribution for apixaban was low in rats, dogs andhumans. Such steadystatevolume of distribution values are indicative of a largeportion HSP on the drug remaining within the target compartment. Apixaban had a greater clearance and also a lowerbioavailability in rabbits compared with rats, dogs, chimpanzeesor humans. In humans, apixaban features a lowpeak-to-trough ratio of roughly 4 or less followingoral administration. Serum protein binding did notappear to be concentration dependent within the range of 0.5–5.Table 4 summarizes the pharmacokinetic properties ofapixaban in animal species and humans.
In animals and humans receivingapixaban, theparent compound was the predominant component inplasma and excreta, althoughnumerous metabolites were detected at comparatively lowconcentrations. fgf inhibitor Metabolic pathways of apixabanin animals and humans are presented in Figs. 7 and 8.In humans, O-demethyl apixaban, O-demethylapixaban sulfate, 3-hydroxy apixabanandhydroxylated O-demethyl apixabanwere the mostabundant in vivo metabolites. Of these, O-demethyl apixabansulfate was the predominant circulating humanmetabolite, with levels of exposure to this metaboliteequivalent to roughly 25% of those of apixaban;exposure to other metabolites did not exceed 5% of parent. General, roughly 25% on the dose was recoveredas metabolites in humans, primarily within the feces.
O-Demethylapixaban followed by O-demethyl apixaban Cell Signaling inhibitor sulfate,3-hydroxy apixaban and hydroxylated O-demethyl apixaban,were essentially the most abundant metabolites in human excreta.These metabolites were also formed in animal speciesduring non-clinical safety assessments. Soon after administrationofapixaban in mice, rats and dogs, no metaboliteexceeded 5% on the total plasma radioactivity at any timepoint. Even though O-demethylapixaban sulfate will be the significant human circulating metabolite,it doesn't have meaningful pharmacological activity. In thein vitro enzyme assay, this metabolite did not significantlyinhibit purified human FXa at concentrations below 20 lM,and did not inhibit thrombin or trypsin at concentrations upto 30 lM. Moreover, O-demethyl apixaban sulfate doesnot possess structural alerts and is of no toxicologicalconcern.
Primary biotransformation reactions of apixaban includeO-demethylation and mono-oxidation; fgf inhibitor in some species,opening on the keto-lactam ring and hydrolysis on the amidemoiety are extra minor pathways. Combinationsof these reactions were also observed as sulfation ofO-demethyl apixaban, sulfation of hydroxylated O-demethylapixaban and glucuronidation of O-demethyl apixaban. Apixaban was metabolized incredibly slowly inliver microsomes and hepatocytes, although O-demethylapixaban was formed in hepatocytes from all species, whileO-demethyl apixaban sulfate was detected in rat, monkeyand human hepatocytes only. No metabolites were formedby human kidney microsomes or human intestinal S9fraction. Similarly, no glutathione adduct of apixaban wasdetected in microsomes or hepatocytes, indicating that theformation of reactive metabolites with apixaban is unlikely.The in vitro metabolism of apixaban was primarily mediatedby CYP3A4/5, with comparatively minor contributionsfrom CYP1A2 and CYP2J2 towards the formation ofO-demethyl apixaban. In ad
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