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GLS4 is a first-in-class hepatitis B virus (HBV) capsid assembly modulator (class I) that is co-administered with ritonavir to maintain the anticipated concentration required for the effective antiviral activity of GLS4. In this study, the first physiologically-based pharmacokinetic (PBPK) model for GLS4/ritonavir was successfully developed. The predictive performance of the PBPK model was verified using data from 39 clinical studies, including single-dose, multiple-dose, food effects, and drug-drug interactions (DDI). The PBPK model accurately described the PK profiles of GLS4 and ritonavir, with predicted values closely aligning with observed data. Based on the verified GLS4/ritonavir model, it prospectively predicts the effect of hepatic impairment (HI) and DDI on its pharmacokinetics (PK). Notably, CYP3A4 inducers significantly influenced GLS4 exposure when co-administered with ritonavir; co-administered GLS4 and ritonavir significantly influenced the exposure of CYP3A4 substrates. Additionally, with the severity of HI increased, there was a corresponding increase in the exposure to GLS4 when co-administered with ritonavir. The GLS4/ritonavir PBPK model can potentially be used as an alternative to clinical studies or guide the design of clinical trial protocols.
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http://dx.doi.org/10.1002/psp4.13184 | DOI Listing |
Infect Dis (Lond)
September 2025
Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy.
Background: The combination of antivirals and monoclonal antibodies (mAbs) in the first phase of COVID-19 has demonstrated to reduce time to viral clearance, but the superiority of combination compared to antiviral monotherapy is still debated.
Research Design And Methods: In an observational, prospective study, we enrolled immunocompromised outpatients with mild-to-moderate COVID-19 treated with one antiviral monotherapy within 7 days from symptoms onset, with or without sotrovimab from January 1, 2024 to October 31, 2024, and we compared them to an identical cohort of patients treated with a combination of one antiviral and sotrovimab, from May 1, 2023 to December 30, 2023. 1st of May 2023 and 31st of October 2024.
Infect Drug Resist
August 2025
Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
Purpose: To determine the real-world patterns and extent of potential drug-drug interactions (DDIs) related to nirmatrelvir/ritonavir (NMVr) in China.
Patients And Methods: Data on NMVr-treated patients from over 160 hospitals across 9 Chinese cities from January 2022 to December 2023 were extracted from the Hospital Prescription Analysis (HPA) database, which was established in Beijing in 1997 to promote rational medication use in China. Grade C, D and X DDIs from the Lexicomp database were defined as clinically significant and analyzed in this study.
Front Pharmacol
June 2025
Department of Pharmacy, Virgen del Rocío University Hospital, Seville, Spain.
Voriconazole is a triazole antifungal used for invasive fungal infections, particularly invasive aspergillosis. Its metabolism is primarily mediated by CYP2C19, with CYP3A4 and CYP2C9 also involved. Nirmatrelvir/ritonavir, an oral antiviral for COVID-19, inhibits CYP isoforms potentially altering the metabolism of co-administered drugs.
View Article and Find Full Text PDFPLoS One
May 2025
Department of Kidney Transplantation, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.
Kidney transplantation recipients (KTRs) represent a vulnerable population for COVID-19 infection and severe disease. Nirmatrelvir-ritonavir has demonstrated efficacy in treating COVID-19 among KTRs, and interacts with tacrolimus leading to a precipitous increase in tacrolimus blood levels when co-administered, which may potentially result in toxicity. To explore a safe strategy for the combination of nirmatrelvir-ritonavir and tacrolimus, we established a new administration strategy to restore tacrolimus after the discontinuation of nirmatrelvir-ritonavir and conducted a real-world retrospective observational cohort study to evaluate its clinical efficacy.
View Article and Find Full Text PDFClin Pharmacokinet
June 2025
Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, China.
Background And Objective: Lopinavir/ritonavir (LPV/r) has been widely used in HIV/HBV co-infected pregnant-women. We aim to characterize the maternal-fetal (m-f) pharmacokinetic (PK) of LPV/r and support the dose optimization and potential drug-drug interaction (DDI) evaluation in this population.
Methods: Lopinavir PK characteristics in human immunodeficiency virus/hepatitis B virus (HIV/HBV) co-infected pregnant women (n = 35) and fetus were calculated using non-compartmental analysis followed by quantification of maternal PK characteristics using population PK (PopPK) analysis.