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  1. Article ; Online: DeepARV: ensemble deep learning to predict drug-drug interaction of clinical relevance with antiretroviral therapy.

    Pham, Thao / Ghafoor, Mohamed / Grañana-Castillo, Sandra / Marzolini, Catia / Gibbons, Sara / Khoo, Saye / Chiong, Justin / Wang, Dennis / Siccardi, Marco

    NPJ systems biology and applications

    2024  Volume 10, Issue 1, Page(s) 48

    Abstract: Drug-drug interaction (DDI) may result in clinical toxicity or treatment failure of antiretroviral therapy (ARV) or comedications. Despite the high number of possible drug combinations, only a limited number of clinical DDI studies are conducted. ... ...

    Abstract Drug-drug interaction (DDI) may result in clinical toxicity or treatment failure of antiretroviral therapy (ARV) or comedications. Despite the high number of possible drug combinations, only a limited number of clinical DDI studies are conducted. Computational prediction of DDIs could provide key evidence for the rational management of complex therapies. Our study aimed to assess the potential of deep learning approaches to predict DDIs of clinical relevance between ARVs and comedications. DDI severity grading between 30,142 drug pairs was extracted from the Liverpool HIV Drug Interaction database. Two feature construction techniques were employed: 1) drug similarity profiles by comparing Morgan fingerprints, and 2) embeddings from SMILES of each drug via ChemBERTa, a transformer-based model. We developed DeepARV-Sim and DeepARV-ChemBERTa to predict four categories of DDI: i) Red: drugs should not be co-administered, ii) Amber: interaction of potential clinical relevance manageable by monitoring/dose adjustment, iii) Yellow: interaction of weak relevance and iv) Green: no expected interaction. The imbalance in the distribution of DDI severity grades was addressed by undersampling and applying ensemble learning. DeepARV-Sim and DeepARV-ChemBERTa predicted clinically relevant DDI between ARVs and comedications with a weighted mean balanced accuracy of 0.729 ± 0.012 and 0.776 ± 0.011, respectively. DeepARV-Sim and DeepARV-ChemBERTa have the potential to leverage molecular structures associated with DDI risks and reduce DDI class imbalance, effectively increasing the predictive ability on clinically relevant DDIs. This approach could be developed for identifying high-risk pairing of drugs, enhancing the screening process, and targeting DDIs to study in clinical drug development.
    MeSH term(s) Deep Learning ; Drug Interactions ; Humans ; HIV Infections/drug therapy ; Anti-Retroviral Agents ; Anti-HIV Agents/therapeutic use ; Computational Biology/methods ; Clinical Relevance
    Chemical Substances Anti-Retroviral Agents ; Anti-HIV Agents
    Language English
    Publishing date 2024-05-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2056-7189
    ISSN (online) 2056-7189
    DOI 10.1038/s41540-024-00374-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Physiologically-based pharmacokinetic modelling of long-acting injectable cabotegravir and rilpivirine in pregnancy.

    Atoyebi, Shakir / Bunglawala, Fazila / Cottura, Nicolas / Grañana-Castillo, Sandra / Montanha, Maiara Camotti / Olagunju, Adeniyi / Siccardi, Marco / Waitt, Catriona

    British journal of clinical pharmacology

    2024  

    Abstract: Aims: Long-acting cabotegravir and rilpivirine have been approved to manage HIV in adults, but data regarding safe use in pregnancy are limited. Physiologically-based pharmacokinetic (PBPK) modelling was used to simulate the approved dosing regimens in ... ...

    Abstract Aims: Long-acting cabotegravir and rilpivirine have been approved to manage HIV in adults, but data regarding safe use in pregnancy are limited. Physiologically-based pharmacokinetic (PBPK) modelling was used to simulate the approved dosing regimens in pregnancy and explore if C
    Methods: An adult PBPK model was validated using clinical data of cabotegravir and rilpivirine in nonpregnant adults. This was modified by incorporating pregnancy-induced metabolic and physiological changes. The pregnancy PBPK model was validated with data on oral rilpivirine and raltegravir (UGT1A1 probe substrate) in pregnancy. Twelve weeks' disposition of monthly and bimonthly dosing of long-acting cabotegravir and rilpivirine was simulated at different trimesters and foetal exposure was also estimated.
    Results: Predicted C
    Conclusions: Model predictions suggest that monthly long-acting cabotegravir could maintain antiviral efficacy throughout pregnancy, but that bimonthly administration may require careful clinical evaluation. Both monthly and bimonthly long-acting rilpivirine may not adequately maintain antiviral efficacy in pregnancy.
    Language English
    Publishing date 2024-02-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 188974-6
    ISSN 1365-2125 ; 0306-5251 ; 0264-3774
    ISSN (online) 1365-2125
    ISSN 0306-5251 ; 0264-3774
    DOI 10.1111/bcp.16006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Drug-Drug Interactions in People Living With HIV at Risk of Hepatic and Renal Impairment: Current Status and Future Perspectives.

    Cottura, Nicolas / Kinvig, Hannah / Grañana-Castillo, Sandra / Wood, Adam / Siccardi, Marco

    Journal of clinical pharmacology

    2022  Volume 62, Issue 7, Page(s) 835–846

    Abstract: Despite the advancement of antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV), drug-drug interactions (DDIs) remain a relevant clinical issue for people living with HIV receiving ART. Antiretroviral (ARV) drugs can be ... ...

    Abstract Despite the advancement of antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV), drug-drug interactions (DDIs) remain a relevant clinical issue for people living with HIV receiving ART. Antiretroviral (ARV) drugs can be victims and perpetrators of DDIs, and a detailed investigation during drug discovery and development is required to determine whether dose adjustments are necessary or coadministrations are contraindicated. Maintaining therapeutic ARV plasma concentrations is essential for successful ART, and changes resulting from potential DDIs could lead to toxicity, treatment failure, or the emergence of ARV-resistant HIV. The challenges surrounding DDI management are complex in special populations of people living with HIV, and often lack evidence-based guidance as a result of their underrepresentation in clinical investigations. Specifically, the prevalence of hepatic and renal impairment in people living with HIV are between five and 10 times greater than in people who are HIV-negative, with each condition constituting approximately 15% of non-AIDS-related mortality. Therapeutic strategies tend to revolve around the treatment of risk factors that lead to hepatic and renal impairment, such as hepatitis C, hepatitis B, hypertension, hyperlipidemia, and diabetes. These strategies result in a diverse range of potential DDIs with ART. The purpose of this review was 2-fold. First, to summarize current pharmacokinetic DDIs and their mechanisms between ARVs and co-medications used for the prevention and treatment of hepatic and renal impairment in people living with HIV. Second, to identify existing knowledge gaps surrounding DDIs related to these special populations and suggest areas and techniques to focus upon in future research efforts.
    MeSH term(s) Anti-Retroviral Agents/adverse effects ; Drug Interactions ; HIV Infections/complications ; HIV Infections/drug therapy ; Humans ; Prevalence ; Renal Insufficiency/drug therapy ; Risk Factors
    Chemical Substances Anti-Retroviral Agents
    Language English
    Publishing date 2022-02-08
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 188980-1
    ISSN 1552-4604 ; 0091-2700 ; 0021-9754
    ISSN (online) 1552-4604
    ISSN 0091-2700 ; 0021-9754
    DOI 10.1002/jcph.2025
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: General Framework to Quantitatively Predict Pharmacokinetic Induction Drug-Drug Interactions Using In Vitro Data.

    Grañana-Castillo, Sandra / Williams, Angharad / Pham, Thao / Khoo, Saye / Hodge, Daryl / Akpan, Asangaedem / Bearon, Rachel / Siccardi, Marco

    Clinical pharmacokinetics

    2023  Volume 62, Issue 5, Page(s) 737–748

    Abstract: Introduction: Metabolic inducers can expose people with polypharmacy to adverse health outcomes. A limited fraction of potential drug-drug interactions (DDIs) have been or can ethically be studied in clinical trials, leaving the vast majority unexplored. ...

    Abstract Introduction: Metabolic inducers can expose people with polypharmacy to adverse health outcomes. A limited fraction of potential drug-drug interactions (DDIs) have been or can ethically be studied in clinical trials, leaving the vast majority unexplored. In the present study, an algorithm has been developed to predict the induction DDI magnitude, integrating data related to drug-metabolising enzymes.
    Methods: The area under the curve ratio (AUC
    Results: Two independent variables were deemed significant and included in the algorithm: IVMM and fraction unbound in plasma. The observed and predicted magnitudes of the DDIs were categorised accordingly: no induction, mild, moderate, and strong induction. DDIs were assumed to be well classified if the predictions were in the same category as the observations, or if the ratio between these two was < 1.5-fold. This algorithm correctly classified 70.5% of the DDIs.
    Conclusion: This research presents a rapid screening tool to identify the magnitude of potential DDIs utilising in vitro data which can be highly advantageous in early drug development.
    MeSH term(s) Humans ; Cytochrome P-450 CYP3A/metabolism ; Cytochrome P-450 Enzyme System/metabolism ; Drug Interactions ; Rifampin ; Carbamazepine/pharmacology ; Models, Biological
    Chemical Substances Cytochrome P-450 CYP3A (EC 1.14.14.1) ; Cytochrome P-450 Enzyme System (9035-51-2) ; Rifampin (VJT6J7R4TR) ; Carbamazepine (33CM23913M)
    Language English
    Publishing date 2023-03-29
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 197627-8
    ISSN 1179-1926 ; 0312-5963
    ISSN (online) 1179-1926
    ISSN 0312-5963
    DOI 10.1007/s40262-023-01229-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Prevalence of Potentially Clinically Significant Drug-Drug Interactions With Antiretrovirals Against HIV Over Three Decades: A Systematic Review of the Literature.

    Hodge, Daryl / Hodel, Eva Maria / Hughes, Elen / Hazenberg, Phoebe / Grañana Castillo, Sandra / Gibbons, Sara / Wang, Duolao / Marra, Fiona / Marzolini, Catia / Back, David / Khoo, Saye

    Journal of acquired immune deficiency syndromes (1999)

    2023  Volume 92, Issue 2, Page(s) 97–105

    Abstract: Background: Contemporary first-line antiretrovirals have considerably reduced liability for clinically significant drug-drug interactions (DDI). This systematic review evaluates the prevalence of DDI among people receiving antiretrovirals across 3 ... ...

    Abstract Background: Contemporary first-line antiretrovirals have considerably reduced liability for clinically significant drug-drug interactions (DDI). This systematic review evaluates the prevalence of DDI among people receiving antiretrovirals across 3 decades.
    Methods: We searched 3 databases for studies reporting the prevalence of clinically significant DDIs in patients receiving antiretrovirals published between January 1987 and July 2022. Clinically significant DDIs were graded by severity. All data extractions were undertaken by 2 independent reviewers, adjudicated by a third.
    Results: Of 21,665 records returned, 13,474 were duplicates. After screening the remaining 13,596 abstracts against inclusion criteria, 122 articles were included for full-text analysis, from which a final list of 34 articles were included for data synthesis. The proportion of patients experiencing a clinically significant DDI did not change over time (P = 0.072). The most frequently reported classes of antiretrovirals involved in DDIs were protease inhibitors and non-nucleoside reverse transcriptase inhibitors; of note, integrase use in the most recent studies was highly variable and ranged between 0% and 89%.
    Conclusions: The absolute risk of DDIs has not decreased over the period covered. This is likely related to continued use of older regimens and an ageing cohort of patients. A greater reduction in DDI prevalence can be anticipated with broader uptake of regimens containing unboosted integrase inhibitors or non-nucleoside reverse transcriptase inhibitors.
    MeSH term(s) Humans ; Reverse Transcriptase Inhibitors/therapeutic use ; Prevalence ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Drug Interactions ; Anti-Retroviral Agents/therapeutic use
    Chemical Substances Reverse Transcriptase Inhibitors ; Anti-Retroviral Agents
    Language English
    Publishing date 2023-01-10
    Publishing country United States
    Document type Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 645053-2
    ISSN 1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
    ISSN (online) 1944-7884 ; 1077-9450
    ISSN 0897-5965 ; 0894-9255 ; 1525-4135
    DOI 10.1097/QAI.0000000000003122
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: PBPK Modelling of Dexamethasone in Patients With COVID-19 and Liver Disease.

    Montanha, Maiara Camotti / Cottura, Nicolas / Booth, Michael / Hodge, Daryl / Bunglawala, Fazila / Kinvig, Hannah / Grañana-Castillo, Sandra / Lloyd, Andrew / Khoo, Saye / Siccardi, Marco

    Frontiers in pharmacology

    2022  Volume 13, Page(s) 814134

    Abstract: The aim of the study was to apply Physiologically-Based Pharmacokinetic (PBPK) modelling to predict the effect of liver disease (LD) on the pharmacokinetics (PK) of dexamethasone (DEX) in the treatment of COVID-19. A whole-body PBPK model was created to ... ...

    Abstract The aim of the study was to apply Physiologically-Based Pharmacokinetic (PBPK) modelling to predict the effect of liver disease (LD) on the pharmacokinetics (PK) of dexamethasone (DEX) in the treatment of COVID-19. A whole-body PBPK model was created to simulate 100 adult individuals aged 18-60 years. Physiological changes (e.g., plasma protein concentration, liver size, CP450 expression, hepatic blood flow) and portal vein shunt were incorporated into the LD model. The changes were implemented by using the Child-Pugh (CP) classification system. DEX was qualified using clinical data in healthy adults for both oral (PO) and intravenous (IV) administrations and similarly propranolol (PRO) and midazolam (MDZ) were qualified with PO and IV clinical data in healthy and LD adults. The qualified model was subsequently used to simulate a 6 mg PO and 20 mg IV dose of DEX in patients with varying degrees of LD, with and without shunting. The PBPK model was successfully qualified across DEX, MDZ and PRO. In contrast to healthy adults, the simulated systemic clearance of DEX decreased (35%-60%) and the plasma concentrations increased (170%-400%) in patients with LD. Moreover, at higher doses of DEX, the AUC ratio between healthy/LD individuals remained comparable to lower doses. The exposure of DEX in different stages of LD was predicted through PBPK modelling, providing a rational framework to predict PK in complex clinical scenarios related to COVID-19. Model simulations suggest dose adjustments of DEX in LD patients are not necessary considering the low dose administered in the COVID-19 protocol.
    Language English
    Publishing date 2022-01-28
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2587355-6
    ISSN 1663-9812
    ISSN 1663-9812
    DOI 10.3389/fphar.2022.814134
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: PBPK modelling of dexamethasone in patients with COVID-19 and liver disease

    Montanha, Maiara Camotti / Cottura, Nicolas / Booth, Michael / Hodge, Daryl / Bunglawala, Fazila / Kinvig, Hannah / Grañana-Castillo, Sandra / Lloyd, Andrew / Khoo, Saye / Siccardi, Marco

    medRxiv

    Abstract: The aim of the study was to apply Physiologically-Based Pharmacokinetic (PBPK) modelling to predict the effect of liver disease (LD) on the pharmacokinetics (PK) of dexamethasone (DEX) in the treatment of COVID-19. A whole-body PBPK model was created to ... ...

    Abstract The aim of the study was to apply Physiologically-Based Pharmacokinetic (PBPK) modelling to predict the effect of liver disease (LD) on the pharmacokinetics (PK) of dexamethasone (DEX) in the treatment of COVID-19. A whole-body PBPK model was created to simulate 100 adult individuals aged 18-60 years. Physiological changes (e.g., plasma protein concentration, liver size, CP450 expression, hepatic blood flow) and portal vein shunt were incorporated into the LD model. The changes were implemented by using the Child-Pugh (CP) classification system. DEX was qualified using clinical data in healthy adults for both oral (PO) and intravenous (IV) administrations and similarly propranolol (PRO) and midazolam (MDZ) were qualified with PO and IV clinical data in healthy and LD adults. The qualified model was subsequently used to simulate a 6 mg PO and 20 mg IV dose of DEX in patients with varying degrees of LD, with and without shunting. The PBPK model was successfully qualified across DEX, MDZ and PRO. In contrast to healthy adults, the simulated systemic clearance of DEX decreased (35% - 60%) and the plasma concentrations increased (170% - 400%) in patients with LD. Moreover, at higher doses of DEX, the AUC ratio between healthy/LD individuals remained comparable to lower doses. The exposure of DEX in different stages of LD was predicted through PBPK modelling, providing a rational framework to predict PK in complex clinical scenarios related to COVID-19. Model simulations suggest dose adjustments of DEX in LD patients are not necessary considering the low dose administered in the COVID-19 protocol.
    Keywords covid19
    Language English
    Publishing date 2021-11-10
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2021.11.10.21266141
    Database COVID19

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