Pharmacokinetic Characterization and Comparative Bioavailability of an Innovative Orodispersible Fixed-Dose Combination of Ivermectin and Albendazole: A Single Dose, Open Label, Sequence Randomized, Crossover Clinical Trial in Healthy Volunteers

Abstract

Soil-transmitted helminths are intestinal worm diseases transmitted through the soil. Available treatments are albendazole and/or ivermectin. The co-administration of existing drugs is an appropriate strategy. A fixed-dose combination adds practical advantages mainly considering mass drug administration. The aim is to characterize pharmacokinetics and to evaluate the comparative bioavailability of an innovative fixed-dose combination of ivermectin/albendazole 18/400 mg compared with the marketed references. Seventy-eight healthy volunteers were included in this laboratory-blinded, randomized, three-treatment, three-period crossover study. Each subject received a single dose of ivermectin/albendazole 18/400 mg (1 tablet); ivermectin 3 mg (6 tablets); and albendazole 400 mg (1 tablet). Serial blood samples for the pharmacokinetic analysis were obtained pre-dose and up to 72 h post-dose. Plasma concentrations of ivermectin H2B1a, ivermectin H2B1b, albendazole, and albendazole sulfoxide were analyzed by LC-MS/MS. Pharmacokinetic parameters were estimated by a non-compartmental analysis and bioavailability compared through a bioequivalence analysis. Safety and tolerability were assessed throughout the study. Main pharmacokinetic parameters of the fixed combination were estimated for both, ivermectin [C_max (mean, confidence interval): 86.40 (30.42-39.23) ng/ml; AUC_0-72 (mean, CI): 1,040 (530-1,678) ng·h/mL; t_max (median, min., and max.); 4.50 (2.50-5.50)] and albendazole [C_max (mean, CI): 22.27 (1.89-111.78) ng/ml; AUC_0-72 (mean, CI): 94.65 (11.65-507.78) ng·h/mL; t_max (median, min., and max.): 2.50 (1.00-12.00) h]. The 90% confidence interval of the geometric mean ratios demonstrated the bioequivalence in the case of ivermectin (C_max: 110.68%-120.49%; AUC_0-72: 110.46%-119.60%) but not in the case of albendazole (C_max: 53.10%-70.34%; AUC_0-72: 61.13%-76.54%). The pharmacokinetic profile of a new fixed-dose combination of ivermectin and albendazole was characterized. The bioequivalence versus the reference ivermectin was demonstrated, though bioequivalence versus albendazole was not shown. The three medications analyzed were well tolerated. The results allow the advancement to the next phase of the clinical program to demonstrate efficacy and safety in patients affected by soil-transmitted helminths. Clinical Trial Registration: https://www.clinicaltrialsregister.eu/ctr-search/search/, identifier Nr. 2020-003438-19.

Keywords: albendazole; bioavability; helminitiasis; ivermectin; pharmacokinetics.

FIGURE 1

Subject’s allocation.

FIGURE 2

Concentration/time curves for ivermectin H2B1a following the administration of ivermectin/albendazole 18/400 mg tablets (Test) and Ivermectin 6 × 3 mg tablets (Reference 1). (A) Linear scale; (B) Semi-logarithmic scale.

FIGURE 3

Concentration/time curves for albendazole following the administration of ivermectin/albendazole 18/400 mg tablets (Test) and albendazole tablets (Reference 2). (A) Linear scale; (B) Semi-logarithmic scale.