In vitro evaluations for pharmacokinetic drug-drug interactions of a novel serotonin-dopamine activity modulator, brexpiprazole

Abstract

1. Brexpiprazole, a serotonin-dopamine activity modulator, is indicated for the treatment of schizophrenia and also adjunctive therapy to antidepressants for the treatment of Major Depressive Disorder. To determine the drug–drug interaction risk for cytochrome P450, and SLC and ABC transporters, brexpiprazole and its metabolite, DM-3411 were assessed in this in vitro investigation.

2. Brexpiprazole exhibited weak inhibitory effects (IC₅₀ >13 μmol/L) on CYP2C9, CYP2C19, CYP2D6 and CYP3A4 activities, but had moderate inhibitor activity on CYP2B6 (IC₅₀ 8.19 μmol/L). The ratio of systemic unbound concentration (3.8 nmol/L) to the K_i value was sufficiently low. DM-3411 had comparable inhibitory potentials with brexpiprazole only for CYP2D6 and CYP3A4. The mRNA expressions of CYP1A2, CYP2B6 and CYP3A4 were not changed by the exposure of brexpiprazole to human hepatocytes.

3. Brexpiprazole and DM-3411 exhibited weak or no inhibitory effects for hepatic and renal transporters (OATPs, OATs, OCTs, MATE1, and BSEP), except for MATE-2K (0.156 μmol/L of DM-3411), even for which the ratio to systemic unbound concentration (5.3 nmol/L) was sufficiently low.

4. Brexpiprazole effected the functions of P-gp and BCRP with IC₅₀ values of 6.31 and 1.16 μmol/L, respectively, however, the pharmacokinetic alteration was not observed in the clinical concomitant study on P-gp and BCRP substrates.

5. These in vitro data suggest that brexpiprazole is unlikely to cause clinically relevant drug interactions resulting from the effects on CYPs or transporters mediating the absorption, metabolism, and/or disposition of co-administered drugs.

Keywords:

• Brexpiprazole
• OPC-34712
• REXULTI
• CYPs
• ABC transporter
• SLC transporter
• drug–drug interaction

Disclosure statement

The authors report no declarations of interest.

Acknowledgments

We are grateful to Kenji Maeda Ph.D. and Mikio Suzuki Ph.D. and the many members at REXULTI Project of Otsuka Pharmaceutical Co., Ltd. for their advices with the scientific discussion. The authors thank Takuya Kuno Ph.D. in our division for his help in statistical analyses. And, we are grateful to the many members at the ADME & Toxicology Research Institute of Sekisui Medical Co., Ltd. and XenoTech, LLC, and at the Kashima Laboratory of LSIM Safety Institute Corporation for their help and advices with the scientific discussion.