Abstract
Momelotinib-approved for treatment of myelofibrosis in adults with anemia-and its major active metabolite, M21, were assessed as drug-drug interaction (DDI) victims with a strong cytochrome P450 (CYP) 3A4 inhibitor (multiple-dose ritonavir), an organic anion transporting polypeptide (OATP) 1B1/1B3 inhibitor (single-dose rifampin), and a strong CYP3A4 inducer (multiple-dose rifampin). Momelotinib DDI perpetrator potential (multiple-dose) was evaluated with CYP3A4 and breast cancer resistance protein (BCRP) substrates (midazolam and rosuvastatin, respectively). DDI was assessed from changes in maximum plasma concentration (C(max)), area under the concentration-time curve (AUC), time to reach C(max), and half-life. The increase in momelotinib (23% C(max), 14% AUC) or M21 (30% C(max), 24% AUC) exposure with ritonavir coadministration was not clinically relevant. A moderate increase in momelotinib (40% C(max), 57% AUC) and minimal change in M21 was observed with single-dose rifampin. A moderate decrease in momelotinib (29% C(max), 46% AUC) and increase in M21 (31% C(max), 15% AUC) were observed with multiple-dose rifampin compared with single-dose rifampin. Due to potentially counteracting effects of OATP1B1/1B3 inhibition and CYP3A4 induction, multiple-dose rifampin did not significantly change momelotinib pharmacokinetics compared with momelotinib alone (C(max) no change, 15% AUC decrease). Momelotinib did not alter the pharmacokinetics of midazolam (8% C(max), 16% AUC decreases) or 1'-hydroxymidazolam (14% C(max), 16% AUC decreases) but increased rosuvastatin C(max) by 220% and AUC by 170%. Safety findings were mild in this short-term study in healthy volunteers. This analysis suggests that momelotinib interactions with OATP1B1/1B3 inhibitors and BCRP substrates may warrant monitoring for adverse reactions or dose adjustments.