Key result
In silico simulations show combining high- or intermediate-risk with low-risk drugs nonlinearly alters TdP risk.
Why the study?
While CiPA assesses single-drug TdP risk, multiple medication therapies are common, necessitating expansion of TdP risk assessment to drug combinations.
Does the combination of various CiPA drugs alter the in silico Torsade de pointes (TdP) risk compared to single drug effects?
Does the combination of various CiPA drugs alter the in silico Torsade de pointes (TdP) risk compared to single drug effects?
In silico modeling of drug-drug interactions reveals that combining drugs with different proarrhythmic risk profiles alters Torsade de pointes risk in a highly nonlinear, concentration-dependent manner.
Highlights potential TdP risk variability with combined CiPA drugs; leaves open clinical translation of nonlinear interactions.
Researchers have recently proposed the Comprehensive In-vitro Proarrhythmia Assay (CiPA) to analyze medicines' TdP risks. Using the TdP metric known as qNet, numerous single-drug effects have been studied to classify the medications as low, intermediate, and high-risk. Furthermore, multiple medication therapies are recognized as a potential method for curing patients, mainly when limited drugs are available. This work expands the TdP risk assessment of drugs by introducing a CiPA-based in silico analysis of the TdP risk of combined drugs. The cardiac cell model was simulated using the population of models approach incorporating drug-drug interactions (DDIs) models on several ion channels for various drug pairs. Action potential duration (APD90), qNet, and calcium duration (CaD90) were computed and analyzed as biomarker features. The drug combination maps were also used to illustrate combined medicines' TdP risk. We found that the combined drugs alter cell responses in terms of biomarkers such as APD90, qNet, and CaD90 in a highly nonlinear manner. The results also revealed that combinations of high-risk with low-risk and intermediate-risk with low-risk drugs could result in compounds with varying TdP risks depending on the drug concentrations.
No takes yet. Share an insight, caveat, or question.
Qauli et al. (2023) studied Torsade de pointes (TdP) risk. Drug combinations (12 CiPA drugs) vs. Single drug effects was evaluated on TdP risk metrics (qNet, APD90, CaD90). In silico simulations demonstrated that combinations of high-risk with low-risk and intermediate-risk with low-risk drugs alter cardiac biomarkers nonlinearly, resulting in varying TdP risks.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: